WorldWideScience
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Antenatal care and perinatal outcomes in Kwale district, Kenya  

OpenAIRE

Abstract Background The importance of antenatal care (ANC) for improving perinatal outcomes is well established. However access to ANC in Kenya has hardly changed in the past 20 years. This study aims to identify the determinants of attending ANC and the association between attendance and behavioural and perinatal outcomes (live births and healthy birthweight) for women in the Kwale region of Kenya. Method A Cohort survey of 1,562 perinatal outcomes (response ra...

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

2008-01-01

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

Scientific Electronic Library Online (English)

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

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

2012-07-01

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Midwifery care: a perinatal mental health case scenario.  

Science.gov (United States)

The establishment of the National Perinatal Depression Initiative (NPDI, 2008-2013) has brought a focus across Australia for the need to identify women at risk of perinatal mental health disorders, suggesting that routine screening by relevant health professionals may aid earlier detection, better care and improved outcomes. Midwives are frequently the primary point of contact in the perinatal period and thus ideally placed to identify, interpret and manage complex situations, including screening for perinatal mental health disorders. This paper offers strategies that could be implemented into daily midwifery practice in order to achieve the goals consistent with the National Perinatal Depression Initiative. A case study (Jen) and discussion, guided by recommendations from the Australian Nursing and Midwifery Competency standards and beyondblue Clinical Practice Guidelines, are used to demonstrate how midwifery care can be provided. In accordance with her legal obligations, the midwife should act within her scope of practice to undertake a series of psychosocial and medical assessments in order to best determine how midwifery care and support can be of benefit to Jen, her infant and her family. Suggestions described include administration of validated screening questionnaires, clinical interview, physical assessment, discussion with partner, awareness of the mother-infant interactions and questioning around baby's sleep and feeding. Based on evaluation of the information gained from a bio-psycho-social assessment, suggestions are made as to the midwifery care options that could be applied. PMID:24080179

Marnes, Joanne; Hall, Pauline

2013-12-01

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Care of the newborn in perinatal units in New Brunswick.  

OpenAIRE

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

Stephen, David L.

1986-01-01

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

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

Valéria Saraceni

2005-08-01

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Allocation of health care resources in the neonatal and perinatal area –CPS Symposium 1996  

OpenAIRE

There have been publically expressed concerns about the costs and allocation of neonatal and perinatal health care resources in Canada and elsewhere for the past 15 years. This paper reports information from a symposium held during the 1996 Canadian Paediatric Society (CPS) annual meeting sponsored by the CPS Section on Perinatal Medicine. Experts in perinatal epidemiology, health care economics, public policy and finance, and consumer perspectives on the outcomes of neonatal and perinatal in...

Mcmillan, Dd; Lee, Sk; Serediak, M.; Finn, Jg; Saigal, S.; Walker, Cr

1999-01-01

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Perinatal staff perceptions of safety and quality in their service.  

Science.gov (United States)

BackgroundEnsuring 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 service and to explore potential influences on service safety.MethodsThe study was undertaken within a new low risk metropolitan maternity service in Victoria, Australia with a staffing profile comprising midwives (including students), neonatal nurses, specialist obstetricians, junior medical staff and clerical staff. In depth open-ended interviews using a semi-structured questionnaire were conducted with 23 staff involved in the delivery of perinatal care, including doctors, midwives, nurses, nursing and midwifery students, and clerical staff. Data were analyzed using naturalistic interpretive inquiry to identify emergent themes.ResultsStaff unanimously reported that there were robust systems and processes in place to maintain safety and quality. Three major themes were apparent: (1) clinical governance, (2) dominance of midwives, (3) inter-professional relationships. Overall, there was a strong sense that, at least in this midwifery-led service, midwives had the greatest opportunity to be an influence, both positively and negatively, on the safe delivery of perinatal care. The importance of understanding team dynamics, particularly mutual respect, trust and staff cohesion, were identified as key issues for potential future service improvement.ConclusionsSenior staff, particularly midwives and neonatal nurses, play central roles in shaping team behaviors and attitudes that may affect the safety and quality of service delivery. We suggest that strategies targeting senior staff to enhance their performance in their roles, particularly in the training and teamwork role-modeling of the transitory junior workforce, are important for the development and maintenance of a high quality and safe maternity service. PMID:25430702

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

2014-11-28

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Pregnancy care in two adolescents perinatally infected with HIV.  

OpenAIRE

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...

2009-01-01

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

Scientific Electronic Library Online (English)

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

Laura, Lorén Guerrero; Edyta, Barna& #347; ; Karolina, Kochma& #324; ska; Dominika, Pasierb; Renata, Ra& #347; ; Elzbieta, Porada.

2014-06-01

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

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

Manandhar Dharma

2005-03-01

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Perinatal health care in a conflict-affected setting: evaluation of health-care services and newborn outcomes at a regional medical centre in Iraq.  

Science.gov (United States)

A field-based assessment was conducted to assess maternal and newborn health-care services, perinatal and newborn outcomes and associated risk factors at Bint Al-Huda Maternal and Newborn Teaching Hospital, a large referral hospital in southern Iraq. The multi-method approach used interviews, discussions, observation and review of perinatal and newborn outcome data. There is limited assessment of maternal vital signs, labour pattern, fetal response, and complications during pregnancy and labour. Perinatal and neonatal mortality rates are 27.4/1000 births and 30.9/1000 live births respectively. Associated neonatal mortality factors were gestational age 35 years, rural maternal residence and vaginal delivery. Improving birth outcomes in southern Iraq requires evidence-based clinical guidelines, additional supplies and equipment, quality improvement initiatives and in-service training. PMID:25664517

Ahamadani, F A B; Louis, H; Ugwi, P; Hines, R; Pomerleau, M; Ahn, R; Burke, T F; Nelson, B D

2015-01-01

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Quality of care: assessment  

OpenAIRE

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

Sridhar Gumpeny; Rao Allam

2007-01-01

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Perinatal palliative care: Parent perceptions of caring in interactions surrounding counseling for risk of delivering an extremely premature infant.  

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Objective: When infants are at risk of being born at a very premature gestation (22-25 weeks), parents face important life-support decisions because of the high mortality for such infants. Concurrently, providers are challenged with providing parents a supportive environment within which to make these decisions. Practice guidelines for medical care of these infants and the principles of perinatal palliative care for families can be resources for providers, but there is limited research to bridge these medical and humanistic approaches to infant and family care. The purpose of this article is to describe how parents at risk of delivering their infant prior to 26 weeks gestation interpreted the quality of their interpersonal interactions with healthcare providers. Methods: Directed content analysis was employed to perform secondary analysis of data from 54 parents (40 mothers and 14 fathers) from the previously coded theme "Quality of Interactions." These categorized data described parents' encounters, expectations, and experiences of interactions that occurred prenatally with care providers. For this analysis, Swanson's theory of caring was selected to guide analysis and to delineate parents' descriptions of caring and uncaring interactions. Results: Parents' expectations for caring included: (a) respecting parents and believing in their capacity to make the best decisions for their family (maintaining belief); (b) understanding parents' experiences and their continued need to protect their infant (knowing); (c) physically and emotionally engaging with the parents (being with); (d) providing unbiased information describing all possibilities (enabling); and (e) helping parents navigate the system and creating a therapeutic environment for them in which to make decisions (doing for). Significance of Results: Understanding parents' prenatal caring expectations through Swanson's theory gives deeper insights, aligning their expectations with the palliative care movement. PMID:24183005

Kavanaugh, Karen; Roscigno, Cecelia I; Swanson, Kristen M; Savage, Teresa A; Kimura, Robert E; Kilpatrick, Sarah J

2013-11-01

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

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Full Text Available Abstract Background Antenatal Care (ANC during pregnancy can play an important role in the uptake of evidence-based services vital to the health of women and their infants. Studies report positive effects of ANC on use of facility-based delivery and perinatal mortality. However, most existing studies are limited to cross-sectional surveys with long recall periods, and generally do not include population-based samples. Methods This study was conducted within the Health and Demographic Surveillance System (HDSS of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b in Matlab, Bangladesh. The HDSS area is divided into an icddr,b service area (SA where women and children receive care from icddr,b health facilities, and a government SA where people receive care from government facilities. In 2007, a new Maternal, Neonatal, and Child Health (MNCH program was initiated in the icddr,b SA that strengthened the ongoing maternal and child health services including ANC. We estimated the association of ANC with facility delivery and perinatal mortality using prospectively collected data from 2005 to 2009. Using a before-after study design, we also determined the role of ANC services on reduction of perinatal mortality between the periods before (2005 – 2006 and after (2008–2009 implementation of the MNCH program. Results Antenatal care visits were associated with increased facility-based delivery in the icddr,b and government SAs. In the icddr,b SA, the adjusted odds of perinatal mortality was about 2-times higher (odds ratio (OR 1.91; 95% confidence intervals (CI: 1.50, 2.42 among women who received ?1 ANC compared to women who received ?3 ANC visits. No such association was observed in the government SA. Controlling for ANC visits substantially reduced the observed effect of the intervention on perinatal mortality (OR 0.64; 95% CI: 0.52, 0.78 to non-significance (OR 0.81; 95% CI: 0.65, 1.01, when comparing cohorts before and after the MNCH program initiation (Sobel test of mediation P Conclusions ANC visits are associated with increased uptake of facility-based delivery and improved perinatal survival in the icddr,b SA. Further testing of the icddr,b approach to simultaneously improving quality of ANC and facility delivery care is needed in the existing health system in Bangladesh and in other low-income countries to maximize health benefits to mothers and newborns.

Pervin Jesmin

2012-10-01

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

OpenAIRE

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

Neto, Mt

2011-01-01

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How an extended perinatal audit may improve perinatal policy.  

Science.gov (United States)

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

Dehaene, Isabelle; Roelens, Kristien; Page, Geert

2014-09-29

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

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

Khan Zulfia

2009-01-01

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[Vaccine prevention in perinatal health care: parents, children and professionals].  

Science.gov (United States)

Recent legislative texts have changed vaccinal policy and reinforced the role of midwives in vaccine prevention in perinatal healthcare. Quite as paediatricians and obstetricians-gynecologists, midwives can now prescribe and carry out, for the mothers, vaccines against rubella, tetanus, poliomyelitis, diphtheria, hepatitis B, influenza and whooping-cough and for the newborns vaccines against hepatitis B and tuberculosis. Concerning vaccinations, practitioners have to respect the vaccination calendar and a collaborative action is useful and necessary. These national guidelines are regularly updated when new vaccines and new recommendations come to light, for example for children (papillomavirus, tuberculosis, pneumococcus...), young adults (varicella, whooping-cough) and health professions in contact with very young children (varicella, measles, influenza and whooping-cough). The recent changes in tuberculosis prevention from routine vaccination of all newborn infants to selective vaccination lead to reinforce measures to detect the infants at higher risk, for them to be vaccinated before discharge at home. Midwives and nurses occupy a central place in family policy and become, with obstetricians-gynecologists and pediatricians, key actors for the effectiveness and the success of vaccine strategies in perinatal health. PMID:18417409

Pinquier, D; Gagneur, A; Guen, C Gras-Le; Blandin, S; Stephan, J-L; Régnier, F; Picherot, G; Brissaud, O; Marpeau, L; Marret, S; Reinert, P

2008-04-01

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

OpenAIRE

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

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

2012-01-01

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Quality of Cancer Care  

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

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Providing Perinatal Mental Health Services in Pediatric Primary Care  

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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…

Talmi, Ayelet; Stafford, Brian; Buchholz, Melissa

2009-01-01

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

OpenAIRE

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...

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

1997-01-01

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

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

Parrotta C

2012-11-01

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

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

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

2014-12-01

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Newborn Care Training and Perinatal Mortality in Communities in Developing Countries  

Science.gov (United States)

Background Ninety-eight percent of the 3.7 million neonatal deaths and 3.3 million stillbirths per year occur in developing countries, and evaluation of community-based interventions is needed. Methods Using a train-the-trainer model, local instructors trained birth attendants from rural communities in six countries (Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan, and Zambia) in the World Health Organization Essential Newborn Care course (routine neonatal care, resuscitation, thermoregulation, breastfeeding, kangaroo care, care of the small baby, and common illnesses), and in a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (in depth basic resuscitation), except in Argentina. The Essential Newborn Care intervention was assessed with a before and after design (N=57, 643). The Neonatal Resuscitation Program intervention was assessed as a cluster randomized controlled trial (N=62,366). The primary outcome was 7-day neonatal mortality. Results The 7-day follow-up rate was 99.2%. Following Essential Newborn Care training, there was no significant reduction from baseline in all-cause 7-day neonatal (RR 0.99; CI 0.81, 1.22) or perinatal mortality; there was a significant reduction in the stillbirth rate (RR 0.69; CI 0.54, 0.88; p<0.01). Seven-day neonatal mortality, stillbirth, and perinatal mortality were not reduced in clusters randomized to Neonatal Resuscitation Program training as compared with control clusters. Conclusions Seven-day neonatal mortality did not decrease following the introduction of Essential Newborn Care training of community-based birth attendants, although the rate of stillbirths was reduced following this intervention. Subsequent training in the Neonatal Resuscitation Program did not significantly reduce the mortality rates. (clinicaltrials.gov number, NCT00136708). PMID:20164485

Carlo, Waldemar A.; Goudar, Shivaprasad S.; Jehan, Imtiaz; Chomba, Elwyn; Tshefu, Antoinette; Garces, Ana; Parida, Sailajanandan; Althabe, Fernando; McClure, Elizabeth M.; Derman, Richard J.; Goldenberg, Robert L.; Bose, Carl; Krebs, Nancy F.; Panigrahi, Pinaki; Buekens, Pierre; Chakraborty, Hrishikesh; Hartwell, Tyler D.; Wright, Linda L.

2013-01-01

26

[Quality management in palliative care].  

Science.gov (United States)

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

Cottier, Christoph

2012-02-01

27

Measuring quality of care nationwide.  

Science.gov (United States)

This brief summarizes a study conducted by researchers at the RAND Corporation that measured the quality of health care for randomly selected adults from 12 communities across the United States. Because the researchers used 439 quality indicators to evaluate health care performance in 30 clinical areas, including diabetes mellitus, hypertension, heart disease, and related preventive care, the size and comprehensiveness of this study is particularly noteworthy. The findings reveal comparable deficits in adherence to standard care processes by both inpatient and outpatient providers within the 12 chosen communities. Overall, study participants received only half of the care consistent with evidence-based knowledge. Thus, study results provide systematic evidence detailing the gaps between the science and the practice of health care delivery throughout the country. PMID:15875428

Clark, Amy

2005-03-01

28

The quality of caring relationships  

Directory of Open Access Journals (Sweden)

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

Tineke A Abma

2009-03-01

29

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

OpenAIRE

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

Ban, Lu

2012-01-01

30

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

Directory of Open Access Journals (Sweden)

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

Manandhar Madan

2003-08-01

31

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

OpenAIRE

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...

Berger, T. M.; Bernet, V.; El Alama, S.; Fauche?re, J. C.; Ho?sli, I.; Irion, O.; Kind, C.; Latal, B.; Nelle, M.; Pfister, R. E.; Surbek, D.; Truttmann, A. C.; Wisser, J.; Zimmermann, R.

2011-01-01

32

From public health to population health: epidemiological yardsticks for perinatal care.  

Science.gov (United States)

Perinatal epidemiology and health services research have focused on specific health outcomes or disease states ("key" indicators and/or sentinel events), clients of public programs, and clinical service populations. In this paper, the concept of "population health" is defined and operationalized for the broad perinatal healthcare context within the framework of population health informatics. Traditional indicators and outcome measures for perinatal health are compared with some newer measures and assessed for their relevance to population health. A hypothetical model for the implementation of population health informatics for maternal and child health is described; in addition, and some obstacles to the practice of population health are identified, with strategies to overcome these obstacles. PMID:10685290

Kirby, R S

1999-09-01

33

Perinatal mortality in a rural district of south India.  

Science.gov (United States)

Perinatal mortality is one of the most sensitive indices of maternal and child health. The perinatal mortality rate is an indicator of the extent of pregnancy wastage as well as of the quality and quantity of health care available to the mother and the newborn. A community based prospective study carried out on 13,214 births in South Kanara district between Oct. 1991-Sept. 1992 revealed a perinatal mortality rate (PNMR) of 44.65/1000 births. Among the various factors influencing perinatal mortality, breech deliveries and babies of multiple pregnancies had a very high perinatal mortality rate of 180.81/1000 births (adjusted odd's ratio: 4.90) and 128/1000 births (adjusted odd's ratio: 2.64). The previous bad obstetric history of the mother, parity and sex of the newborn were among the other important factors influencing the PNMR. PMID:10773926

Chandrashekar, S; Rao, R S; Chakladar, B K; Krishnan, L; Nair, N S

1998-01-01

34

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

Directory of Open Access Journals (Sweden)

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

Ruy Laurenti

1985-06-01

35

[Recommendations to improve quality of obstetrics care].  

Science.gov (United States)

The maternal care represents 50 percent of surgical and medical interventions in México. Around 80% of the maternal deaths are foreseeable with actions as risk-managed prenatal care. Prevention of these complications are difficult and require of a competent obstetrician to handle them appropriate. Some assays calculate about 46.4% of maternal deaths, as related to professional responsibility, and 9.7% with hospital responsibility. In México, obstetric malpractice complaints are the most frequent, and reached 14.5% of total matters received by the National Commission of Medical Arbitration (CONAMED) between 1996 and 2001. We analyzed 121 cases concluded, specifically obstetrics-related, requested to the Commission between 1996 and 2001, to identify moments and factors of the medical attention, linked to obstetric claims. Most prominent finds were: high risk pregnancies in 57%, prior cesarean section 22%, hospital income by labor in 28%. Complications were fetal death 25%, obstetric trauma and perinatal asphyxia 12% each one. Births ocurred by cesarean in 37%. Perinatal mortality was 39% and maternal mortality in 33%. The principal deviation was deficient care of labor. They were observed medical patient communication deficiencies in 76%, incomplete expedients in 45%, ethics deviations in 30%, and malpractice in 55%. Whole this information was presented to gynaecologist leaders of opinion: speciality Council, medical associations, public and private hospitals representatives. The conclusion were Nine recommendations to improve the patients care during the pregnancy, labor and postpartum: 1) Pregnancy, labor and postpartum should be attended by personnel qualified and properly authorized; 2) Value integrally each case during the prenatal care and identify high risk patients; 3) Tighten the prenatal care during the third quarter of the gestation; 4) Provide the best obstetric care; 5) Establish best way for each birth; 6) Reduce unnecessary risks; 7) Watch narrowly all patients during the immediate postpartum; 8) Document all the process of attention; 9) Promote and facilitate health education to pregnant patients and their relatives on the gestation inherent risks. PMID:14619695

Tena-Tamayo, Carlos; Ahued-Ahued, José Roberto

2003-08-01

36

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

Scientific Electronic Library Online (English)

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

Maria da Consolação, Magalhães; Marilia Sá, Carvalho.

2003-09-01

37

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

Directory of Open Access Journals (Sweden)

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

Maria da Consolação Magalhães

2003-09-01

38

Quality of Child Care and Children's Quality of Life.  

Science.gov (United States)

This paper examines child care quality and the effects of in-home and out-of-home child care on children's quality of life, focusing on the results of a 1992 study of child care in northern and central Italy. The study surveyed the parents of 2,158 toddlers cared for exclusively in the home and 2,346 toddlers attending public day care centers. It…

Musatti, Tullia

39

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

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

Thomas Angela N

2009-09-01

40

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

OpenAIRE

Background: Despite Malawi government’s policy to support women to deliver in health facilities with the assistance of skilled attendants, some women do not access this care. Objective: The study explores the reasons why women delivered at home without skilled attendance despite receiving antenatal care at a health centre and their perceptions of perinatal care. Methods: A descriptive study design with qualitative data collection and analysis methods. Data were collected through face-to-fac...

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

2013-01-01

41

Leadership and the quality of care  

OpenAIRE

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

Firth-cozens, J.; Mowbray, D.

2001-01-01

42

Eliminating Perinatal HIV Transmission  

Centers for Disease Control (CDC) Podcasts

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

2012-11-26

43

Organisational culture and quality of health care  

OpenAIRE

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

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

2000-01-01

44

Quality of Cancer Care - Applied Research  

Science.gov (United States)

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

45

Leadership and the quality of care  

Science.gov (United States)

The importance of good leadership is becoming increasingly apparent within health care. This paper reviews evidence which shows that it has effects, not only on financial management, but on the quality of care provided. Some theories of leadership are discussed, primarily in terms of how different types of leaders might affect quality in different ways, including the effects that they might have on the stress or wellbeing of their staff which, in turn, is related to the quality of care produced. Finally, the conflicts shown in terms of leadership within the context of health care are discussed, leading to the conclusion that development programmes must be specially tailored to address the complexities of this arena. Key Words: leadership; quality of care; stress; personality PMID:11700372

Firth-Cozens, J; Mowbray, D

2001-01-01

46

Standards for perinatal education Part 1  

OpenAIRE

Quality control in perinatal education is imperative, with the purpose to deliver a high quality and appropriate healthcare service to the family in the perinatal period. The purpose of this study was to develop valid standards for perinatal education in South Africa.

Richter, M. S.

2002-01-01

47

Quality Matters in Early Childhood Education and Care  

SCPinfonet

Title: Quality Matters in Early Childhood Education and Care ...Quality Matters in Early Childhood Education and Care UNITED KINGDOM (ENGLAND) ...Quality Matters in Early Childhood Education and Care: United Kingdom (England)2012

48

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

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

49

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

OpenAIRE

Carmen Parrotta,1 William Riley,1 Les Meredith21School of Public Health, University of Minnesota, Minneapolis, MN, 2Premier Insurance Management Services Inc, Charlotte, NC, USAAbstract: Highly reliable care requires standardization of clinical practices and is a prerequisite for patient safety. However, standardization in complex hospital settings is extremely difficult to attain and health care leaders are challenged to create care delivery processes that ensure patient safety. Moreover, on...

Parrotta C; Riley W; Meredith L

2012-01-01

50

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

Directory of Open Access Journals (Sweden)

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

Karuga Robinson N

2010-10-01

51

Living with diabetes: quality of care and quality of life  

Directory of Open Access Journals (Sweden)

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

Pilar Isla Pera

2011-01-01

52

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

OpenAIRE

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

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

2000-01-01

53

Does Audit Improve the Quality of Care?  

Directory of Open Access Journals (Sweden)

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

Areti Tsaloglidou

2009-01-01

54

Quality of care in Crohn's disease.  

Science.gov (United States)

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. PMID:25400990

Makharia, Govind K

2014-11-15

55

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

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

Kumbani Lily

2013-02-01

56

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

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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

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

57

Dengue perinatal / Perinatal dengue  

Scientific Electronic Library Online (English)

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

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

2013-09-01

58

[Mechanical ventilation near large centers. The experience of a perinatal care unit].  

Science.gov (United States)

A retrospective study of the newborns who were submitted to mechanical ventilation at the Neonatal Intermediate Care Unit was made between July 1991 and June 1994. Mechanical ventilation in such a unit should be transitory and not exceed 24 hours. Information concerning pregnancy, labour, neonates, type of ventilation and its problems was gathered. Forty seven neonates were ventilated. The average ventilation time was six hours (1-20 hours). The main cause of ventilation was hyaline membrane disease which occurred in 24% of all cases. Mortality observed was 16.6% and some sequellae were registered which were related not only to ventilation but also to the basic pathology in 26% of cases. PMID:9235851

Vale, P; Guerreiro, R; Luiz, P; Gonçalves, G; Areias, F; Nunes, A; Mocho, A; Garcia, P; Berdeja, A; Avelar, C

1997-01-01

59

Prospective study on quality of newborn care  

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

N Khanam

2013-12-01

60

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

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Exposure to endocrine disruptors (EDs) during early development might lead to adverse health outcomes later in life. Tributyltin (TBT), a proven ED, is widely used in consumer goods and industrial products. Herein we demonstrate the effects of low doses of tributyltin chloride (TBTCl) on reproduction of male KM mice. Pregnant mice were administered by gavage with 0, 1, 10, or 100 ?g TBTCl/kg body weight/day from day 6 of pregnancy through the period of lactation. TBTCl dramatically decreased sperm counts and motility on postnatal days (PNDs) 49 and 152. Meanwhile, a significant increase in sperm abnormality was observed in exposed mice on PND 49, but comparable to that in the control on PND 152. The histopathological analysis of testes of treated animals showed a dose-dependent increase in sloughing of germ cells in seminiferous tubules. Mice treated with 10 ?g TBTCl/kg exhibited decreased intratesticular 17?-estradiol (E2) levels on PND 49, and then followed by an obvious recovery on PND 152. While, no significant differences in serum E2, testosterone (T) levels and intratesticular T levels were detectable between control and TBTCl-exposed offspring at the sacrifice. These results suggest that perinatal TBTCl exposure is implicated in causing long lasting alterations in male reproductive system and these changes may persist far into adulthood. © 2013 Wiley Periodicals, Inc. Environ Toxicol 30: 44-52, 2015. PMID:23913619

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

2015-01-01

61

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

Science.gov (United States)

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

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

2010-06-01

62

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

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

Adair Timothy

2011-03-01

63

The NC Quality Center: empowering excellence in health care.  

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The NC Quality Center is transforming health care quality and patient safety in North Carolina by providing leadership, direction, and a vision to ensure that North Carolina delivers the best health care possible. PMID:23802472

Koeble, Carol; Campione, Joanne

2013-01-01

64

Comportamiento del embarazo prolongado en el servicio de cuidados perinatales Behavior of prolonged pregnancy at the perinatal care service  

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Full Text Available El embarazo prolongado es todavía un tema lleno de controversias. Se realizó un estudio retrospectivo longitudinal y descriptivo de todas las pacientes con diagnóstico de embarazo prolongado que ingresaron en el servicio de cuidados perinatales del hospital docente ginecoobstétrico de Guanabacoa durante el año 2002. Se seleccionó un grupo control de los 4 primeros nacimientos de cada mes con una edad gestacional entre 37 y 41 semanas. El 60,4 % del total de pacientes fueron nulíparas y el 49,4 % comenzó el trabajo de parto espontáneamente; prevaleció el parto inducido, 67,4 % en las pacientes del grupo estudio. Hubo un total de 30 mujeres a las que se les realizó cesárea y de ellas el mayor porcentaje, 46,5 %, correspondió también al grupo estudio. En este grupo se apreció líquido amniótico meconial en un mayor número de mujeres con relación al grupo control, no hubo recién nacidos severamente deprimidos y en el 16,2 % de estas pacientes el peso de sus productos fue mayor o igual a 4 000 g. Se concluyó que el comportamiento del embarazo prolongado en el hospital ginecoobstétrico de Guanabacoa fue similar en lo fundamental en lo descrito a la literatura médica revisada.Prolonged pregnancy is still a controversial topic. A retrospective, longitudinal and descriptive study of all patients with prolonged pregnancy that were admitted at the perinatal care service of the Gynecoobstetric Teaching Hospital of Guanabacoa during 2002, was conducted. A control group of the first four births of every month with a gestational age between 37 and 41 weeks was selected. 60.4 % of the total of patients were nulliparas and 49.4 % began the labor spontaneously. Induced delivery prevailed (67.4 % in patients from the study group. A total of 30 women underwent cesarean section and of them, the highest percentage, 46.5 %, corresponded to the study group. The meconial amniotic fluid predominated in the study group, 46.6 %. There were no severely depressed newborn infants in the study. Only 5.4 % of the newborn infants had low Apgar score at the minute of extrauterine life. In 16.2 % of the study group, birth weight was ³ 4 000 grams.

Vivian Asunción Álvarez Ponce

2004-08-01

65

Deficiencies in the quality of diabetes care: comparing specialist with generalist care misses the point.  

Science.gov (United States)

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 into improving quality of care, as the difference between specialists and generalists in these studies is small compared to the overall deficiency in quality. Therefore, future research should instead focus on ways to implement high quality care, regardless of specialty. To date, few methodologically rigorous studies have uncovered interventions that can improve quality of care. The development of such interventions to help all physicians implement better quality care could greatly benefit people with diabetes. PMID:17357000

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

2007-02-01

66

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

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

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

2015-01-01

67

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

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

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

2011-02-01

68

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

Scientific Electronic Library Online (English)

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

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

2010-04-01

69

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  

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

Eduardo Malvino

2005-03-01

70

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

Scientific Electronic Library Online (English)

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

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

2005-03-01

71

Evaluating the Quality of the Child Care in Finland  

Science.gov (United States)

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

Hujala, Eeva; Fonsen, Elina; Elo, Janniina

2012-01-01

72

System Change: Quality Assessment and Improvement for Medicaid Managed Care  

OpenAIRE

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...

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

1996-01-01

73

Is Health Care Ready for Six Sigma Quality?  

OpenAIRE

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,...

Chassin, Mark R.

1998-01-01

74

Deficiencies in the Quality of Diabetes Care: Comparing Specialist with Generalist Care Misses the Point  

OpenAIRE

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...

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

2007-01-01

75

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

Science.gov (United States)

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

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

2014-09-01

76

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

Scientific Electronic Library Online (English)

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

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

2010-04-01

77

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

Scientific Electronic Library Online (English)

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

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

2010-04-01

78

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

Directory of Open Access Journals (Sweden)

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

Isabel Río

2010-04-01

79

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

OpenAIRE

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

Abrahamsen Grøndahl, Vigdis

2012-01-01

80

Quality end-of-life care: A global perspective  

Directory of Open Access Journals (Sweden)

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

Singer Peter A

2002-07-01

81

Child Outcome Measures in the Study of Child Care Quality  

Science.gov (United States)

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

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

2006-01-01

82

42 CFR 483.25 - Quality of care.  

Science.gov (United States)

...Facilities § 483.25 Quality of care. Each resident must receive...facility must provide the necessary care and services to attain or...comprehensive assessment and plan of care. (a) Activities of daily...grooming, and personal and oral hygiene. (b) Vision...

2010-10-01

83

Improving quality of cancer care through surgical audit  

OpenAIRE

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

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

2010-01-01

84

Systems and processes that ensure high quality care.  

Science.gov (United States)

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

Bassett, Sally; Westmore, Kathryn

2012-10-01

85

The legal framework for health care quality assurance in Germany.  

Science.gov (United States)

Like most industrialized countries, Germany's health care system is facing two major challenges. The first is to find a sustainable financing system for increasing health care expenditures. The second is to ensure - and improve - the quality of care provided. This article describes the status quo in quality assurance in Germany and analyses the changes introduced into the SHI (Statutory Health Insurance) system with the Modernization Act of 2004. First, a theoretical framework for quality assurance that is consistent with the logic of the German social market economy is outlined. The analysis then describes new actors and their duties in the field of quality assurance, highlighting improvements in regulation and the regulatory instruments applied. Although the strategy for quality assurance is still dominated by regulation and corporatist bodies, the latest reform acts of 2004 and 2007 focus on more and better information about the quality of services provided - an important prerequisite for more competitive elements in the German health care system. PMID:19099618

Sauerland, Dirk

2009-01-01

86

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

Directory of Open Access Journals (Sweden)

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

Sônia Lansky

2002-12-01

87

Correlates of Perinatal Depression in HIV-Infected Women  

OpenAIRE

Maternal perinatal depression (PND) may interfere with effective perinatal HIV care. In order to begin examining the prevalence and characteristics of PND in HIV-infected women, we analyzed data from the medical records of all HIV-infected women who had received perinatal care in the Maternal-Child and Adolescent Center for Infectious Diseases and Virology at LAC/USC Medical Center from 1997 through 2006. Data from 273 individual women (328 live births) were analyzed. Demographic, medical his...

Kapetanovic, Suad; Christensen, Shawna; Karim, Roksana; Lin, Florence; Mack, Wendy J.; Operskalski, Eva; Frederick, Toni; Spencer, Lashonda; Stek, Alice; Kramer, Francoise; Kovacs, Andrea

2009-01-01

88

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

Directory of Open Access Journals (Sweden)

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

Sword Wendy

2012-04-01

89

Benchmarking and audit of breast units improves quality of care  

OpenAIRE

?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 ?...

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

2013-01-01

90

Measuring quality in social care services: theory and practice  

OpenAIRE

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

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

2010-01-01

91

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

Science.gov (United States)

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

Albright, Jamie N; Fair, Cynthia D

2014-11-01

92

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

OpenAIRE

Background: Pediatric subspecialists can participate in the care of obese children. Objective: To describe steps to help subspecialty providers initiate quality improvement efforts in obesity care. Methods: An anonymous patient data download, provider surveys and interviews assessed subspecialty providers’ identification and perspectives of childhood obesity and gathered information on perceived roles and care strategies. Participating divisions received summary analyses of quantitative and...

Chang, Sheila Z.; Beacher, Daniel R.; Soyang Kwon; Mccarville, Megan A.; Binns, Helen J.; Ariza, Adolfo J.

2014-01-01

93

Delivering High-Quality Cancer Care: The Critical Role of Quality Measurement.  

Science.gov (United States)

In 1999, the Institute of Medicine (IOM) published Ensuring Quality Cancer Care, an influential report that described an ideal cancer care system and issued ten recommendations to address pervasive gaps in the understanding and delivery of quality cancer care. Despite generating much fervor, the report's recommendations-including two recommendations related to quality measurement-remain largely unfulfilled. Amidst continuing concerns regarding increasing costs and questionable quality of care, the IOM charged a new committee with revisiting the 1999 report and with reassessing national cancer care, with a focus on the aging US population. The committee identified high-quality patient-clinician relationships and interactions as central drivers of quality and attributed existing quality gaps, in part, to the nation's inability to measure and improve cancer care delivery in a systematic way. In 2013, the committee published its findings in Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, which included two recommendations that emphasize coordinated, patient-centered quality measurement and information technology enhancements: Develop a national quality reporting program for cancer care as part of a learning health care system; and,Develop an ethically sound learning health care information technology system for cancer that enables real-time analysis of data from cancer patients in a variety of care settings. These recommendations underscore the need for independent national oversight, public-private collaboration, and substantial funding to create robust, patient-centered quality measurement and learning enterprises to improve the quality, accessibility, and affordability of cancer care in America. PMID:24839592

Spinks, Tracy; Ganz, Patricia A; Sledge, George W; Levit, Laura; Hayman, James A; Eberlein, Timothy J; Feeley, Thomas W

2014-03-01

94

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

OpenAIRE

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

Brouwer W; Jh, Stubbe; Dmj, Delnoij

2007-01-01

95

Leadership, staffing and quality of care in nursing homes  

Directory of Open Access Journals (Sweden)

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

Havig Anders

2011-11-01

96

Leadership, staffing and quality of care in nursing homes  

Science.gov (United States)

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

2011-01-01

97

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

Science.gov (United States)

...Activities to improve the quality of child care. 98.51...HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT...Activities to improve the quality...Activities to improve the quality of child care services may...

2010-10-01

98

42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.  

Science.gov (United States)

...interpretations on the quality of health care. 480.141 Section 480.141...interpretations on the quality of health care. Subject to the procedures...generalizations on the quality of health care that identify a particular...

2010-10-01

99

Is there an association between female circumcision and perinatal death?  

Directory of Open Access Journals (Sweden)

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

Essén Birgitta

2002-01-01

100

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

Directory of Open Access Journals (Sweden)

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

Zhang Li

2006-12-01

101

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

OpenAIRE

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

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

2006-01-01

102

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

OpenAIRE

Objective: To evaluate the relationship between presence and nature of co-morbidity and quality of care for diabetes patients enrolled in diabetes disease management programmes provided by care groups.Methods: We performed an observational study within eight Dutch diabetes care groups. Data from patient record systems of care groups and patient questionnaires were used to determine quality of care. Quality of care was measured as provision of the re...

Bruin, Simone R.; Oostrom, Sandra H.; Drewes, Hanneke W.; Jong-van Til, Janneke T.; Baan, Caroline A.; Struijs, Jeroen N.

2013-01-01

103

The European initiative for quality management in lung cancer care  

DEFF Research Database (Denmark)

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

Blum, Torsten G; Rich, Anna

2014-01-01

104

Standards of access and quality in primary care.  

OpenAIRE

This paper reviews recent changes in the provision and organization of primary care in the UK. Access and availability are of prime importance to patients, particularly when medical care is sought urgently, and are therefore important elements of quality. The paper also discusses the possible impact of further changes in the delivery of primary care, including overlapping responsibilities of general practice and accident and emergency (A&E) departments and the role of NHS Direct, a telephone ...

Murfin, D.

2001-01-01

105

Improving regional variation using quality of care measures  

OpenAIRE

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

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

2009-01-01

106

Quality of care in Crohn's disease  

OpenAIRE

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 gastroente...

Makharia, Govind K.

2014-01-01

107

Agents for Change: Nonphysician Medical Providers and Health Care Quality  

Science.gov (United States)

Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization’s quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts.

Boucher, Nathan A; McMillen, Marvin A; Gould, James S

2015-01-01

108

Recurrent perinatal loss: a case study.  

Science.gov (United States)

To date, investigators have not demonstrated a clear relationship between a parent's history of prior perinatal losses and intensity of grief response following a subsequent perinatal loss. Examining this relationship for low-income, African-American parents is important because they are a vulnerable population due to the high incidence of perinatal mortality in Blacks and their other life stressors that can impact on grief response and caring needs. The purpose of this case study was to examine the impact of recurrent perinatal loss on a low-income African-American parent. The research design for this study was case report, using interview data collected from a mother who had recently experienced her fourth perinatal loss, which occurred at twenty-five weeks of gestation. Transcripts from two open-ended interviews were analyzed. The theoretical framework used to guide analysis of this case study was Lazarus and Folkman's stress and coping theory. Results demonstrated that the prior perinatal losses did not appear as critical components of the way the mother responded to her most recent loss. Instead, perception of the care she received from healthcare providers and how that care related to her experiences with her one living child who was born at the same gestational age was an important determinant in how she responded to her loss. The results of this case study demonstrate the importance assessing a person's perception of their experience and those factors which contribute to the way they respond. PMID:16871322

Kavanaugh, K; Robertson, P A

1999-01-01

109

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

Directory of Open Access Journals (Sweden)

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

Cormick Gabriela

2012-08-01

110

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

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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…

Gilbert, Jaesook Lee; Harte, Helene Arbouet

2013-01-01

111

Reflections on total quality management and health care supervisors.  

Science.gov (United States)

Total quality management (TQM) has become an integral process in service delivery for many health care organizations. This article reviews the fundamental concepts underlying TQM and how TQM is relevant to health care supervisors. In many respects TQM represents a contemporary approach to supervising innovation and change, to analytically solving customer problems, and to implementing continuous quality improvement. Several strategies are examined that health care supervisors can adopt for improving service quality, including cultivating a climate for innovation, motivating by example, leading staff to do what is right and to tolerate no service delivery errors, retraining staff, developing control systems, and creating barrier-free organizations. These strategies are examined from the perspective of achieving continuous improvement in health care settings. PMID:10130077

Smith, H L; Discenza, R; Piland, N F

1993-12-01

112

Quality of care delivered to hospitalized inflammatory bowel disease patients  

Directory of Open Access Journals (Sweden)

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

Geoffrey C Nguyen

2013-01-01

113

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

Science.gov (United States)

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

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

2014-10-01

114

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

DEFF Research Database (Denmark)

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

Peters, Michele; Jenkinson, Crispin

2012-01-01

115

Providing high-quality care in North Carolina nursing homes.  

Science.gov (United States)

Quality in North Carolina's nursing facilities is intertwined in multiple dimensions of person-centered care, evidence-based practice, innovation, pursuit of continued excellence, meaningful relationships, and recognition of choice and autonomy. By striving to excel in their role of providing skilled nursing care for medically related acuity, North Carolina's nursing facilities have been a contributor to the growth of the long-term care continuum, enabling North Carolina to have an extensive and well-developed system of skilled care and home- and community-based service models. PMID:25237874

Welsh, Polly Godwin; Kivisto, Eric

2014-01-01

116

Nurse care manager contribution to quality of care in a dual-eligible special needs plan.  

Science.gov (United States)

We evaluated the quality of care provided to older patients with complex needs in a dual-eligible, community-based Medicare Special Needs Plan that used a nurse care manager model. Care provided by physicians was substantially supplemented by nurse care managers, as measured by Assessing Care of Vulnerable Elders quality indicators. We describe selected nurse care manager activities for six geriatric conditions (falls, dementia, depression, nutrition, urinary incontinence, and end-of-life care) during provision of patient care coordination and management for patients in the highest decile of clinical complexity. We identify areas of high nurse performance (i.e., falls screening, functional assessment, behavioral interventions for dementia problems, advance care planning) and areas of potential missed opportunities (i.e., follow up for new memory problems, targeted dementia counseling, nutrition, and behavioral approaches to urinary incontinence). Increasing the collaborative interaction between nurses providing care in this model and physicians has the potential to enhance nurses' contributions to primary care for vulnerable older adults. PMID:22833891

Roth, Carol P; Ganz, David A; Nickles, Lorraine; Martin, David; Beckman, Robin; Wenger, Neil S

2012-07-01

117

[Diabetes, psychosocial distress and quality of care].  

Science.gov (United States)

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

Fatati, Giuseppe

2014-10-01

118

Quality of care for hypertension in the United States  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Despite heavy recent emphasis on blood pressure (BP control, many patients fail to meet widely accepted goals. While access and adherence to therapy certainly play a role, another potential explanation is poor quality of essential care processes (QC. Yet little is known about the relationship between QC and BP control. Methods We assessed QC in 12 U.S. communities by reviewing the medical records of a randomly selected group of patients for the two years preceding our study. We included patients with either a diagnosis of hypertension or two visits with BPs of ?140/90 in their medical records. We used 28 process indicators based on explicit evidence to assess QC. The indicators covered a broad spectrum of care and were developed through a modified Delphi method. We considered patients who received all indicated care to have optimal QC. We defined control of hypertension as BP Results Of 1,953 hypertensive patients, only 57% received optimal care and 42% had controlled hypertension. Patients who had received optimal care were more likely to have their BP under control at the end of the study (45% vs. 35%, p = .0006. Patients were more likely to receive optimal care if they were over age 50 (76% vs. 63%, p Conclusions Higher QC for hypertensive patients is associated with better BP control. Younger patients without cardiac risk factors are at greatest risk for poor care. Quality measurement systems like the one presented in this study can guide future quality improvement efforts.

LaPuerta Pablo

2005-01-01

119

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

Directory of Open Access Journals (Sweden)

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

Isabel Río Sánchez

2009-10-01

120

MRI of perinatal brain injury  

Energy Technology Data Exchange (ETDEWEB)

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

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

2010-06-15

121

Board oversight of patient care quality in community health systems.  

Science.gov (United States)

In hospitals and health systems, ensuring that standards for the quality of patient care are established and continuous improvement processes are in place are among the board's most fundamental responsibilities. A recent survey has examined governance oversight of patient care quality at 123 nonprofit community health systems and compared their practices with current benchmarks of good governance. The findings show that 88% of the boards have established standing committees on patient quality and safety, nearly all chief executive officers' performance expectations now include targets related to patient quality and safety, and 96% of the boards regularly receive formal written reports regarding their organizations' performance in relation to quality measures and standards. However, there continue to be gaps between present reality and current benchmarks of good governance in several areas. These gaps are somewhat greater for independent systems than for those affiliated with a larger parent organization. PMID:20042764

Prybil, Lawrence D; Peterson, Richard; Brezinski, Paul; Zamba, Gideon; Roach, William; Fillmore, Ammon

2010-01-01

122

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

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

123

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

Science.gov (United States)

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

Hsieh, Chang-Ming

2009-01-01

124

Helping You Choose Quality Behavioral Health Care  

Science.gov (United States)

... like a printed copy, please call the Customer Service Center at (630) 792-5800. To report information or concerns about accredited organizations: ? Call or e-mail our Office of Quality Monitoring (800) 994-6610 or complaint@jointcommission.org .

125

Measuring the quality of inpatient health care.  

Science.gov (United States)

A validated case mix and severity adjusted performance measurement system and methodology are presented. Using this methodology in a user-friendly interactive interface, those who are interested in the performance of a hospital or providers within a hospital can easily identify areas for quality improvement. PMID:10176409

Grana, J R; Diamond, C C; Kobylinski, R W; McDermott, P D; Hanchak, N A

1997-01-01

126

The military health care system: providing quality care at a low per capita cost.  

Science.gov (United States)

Orthopaedic trauma constitutes a significant portion of injuries in the military. By focusing on the "Quadruple Aim" of readiness, population health, experience of care, and per capita costs, the Military Health System delivers high-quality care with low costs. We examine the components of military health policy to find avenues of improvement for civilian orthopaedics. Greater emphasis on preventive medicine, alternative clinic structures, and interchangeability will help civilian orthopaedists lower costs and deliver quality patient-centered care similar to current military structure. PMID:25229677

Stinner, Daniel J; Sathiyakumar, Vasanth; Ficke, James R

2014-10-01

127

Labour complications remain the most important risk factors for perinatal mortality in rural Kenya / Les complications du travail restent les facteurs de risque les plus importants de mortalité périnatale dans les zones rurales du Kenya / Las complicaciones del parto siguen siendo el factor de riesgo de mortalidad perinatal más importante en la Kenya rural  

Scientific Electronic Library Online (English)

Full Text Available SciELO Public Health | Language: English Abstract in spanish OBJETIVO: Identificar y cuantificar los factores de riesgo de mortalidad perinatal en un hospital de distrito de Kenya y evaluar la proporción de defunciones perinatales atribuibles a complicaciones del parto, desnutrición materna, malaria, anemia y virus de la inmunodeficiencia humana (VIH). MÉTODO [...] S: Entre enero de 1996 y julio de 1997 se realizó un estudio transversal de 910 nacimientos para analizar los factores de riesgo de defunción perinatal. RESULTADOS: La tasa de mortalidad perinatal fue de 118 por 1000 nacimientos. Las complicaciones del parto consistentes en hemorragias, ruptura prematura de membranas/parto prematuro, y parto obstruido/presentación defectuosa multiplicaban el riesgo de defunción por un factor de entre 8 y 62, y el 53% de todas las defunciones perinatales se atribuyeron a complicaciones del parto. La malaria placentaria y el VIH materno, en cambio, no se asociaron a mortalidad perinatal. CONCLUSIÓN: Es necesario prestar más atención a la calidad de la atención obstétrica dispensada en el entorno de los hospitales de distrito rurales. Abstract in english OBJECTIVES: To identify and quantify risk factors for perinatal mortality in a Kenyan district hospital and to assess the proportion of perinatal deaths attributable to labour complications, maternal undernutrition, malaria, anaemia and human immunodeficiency virus (HIV). METHODS: A cross-sectional [...] study of 910 births was conducted between January 1996 and July 1997 and risk factors for perinatal mortality were analysed. FINDINGS: The perinatal mortality rate was 118 per 1000 births. Complications of labour such as haemorrhage, premature rupture of membranes/premature labour, and obstructed labour/ malpresentation increased the risk of death between 8- and 62-fold, and 53% of all perinatal deaths were attributable to labour complications. Placental malaria and maternal HIV, on the other hand, were not associated with perinatal mortality. CONCLUSIONS: Greater attention needs to be given to the quality of obstetric care provided in the rural district-hospital setting.

Renay, Weiner; Carine, Ronsmans; Ed, Dorman; Hilton, Jilo; Anne, Muhoro; Caroline, Shulman.

128

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

Science.gov (United States)

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

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

2013-01-01

129

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

Scientific Electronic Library Online (English)

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

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

2009-10-01

130

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

Scientific Electronic Library Online (English)

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

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

2009-10-01

131

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

OpenAIRE

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

Donaldson, L.

2001-01-01

132

Quality of end-of-life care for cancer patients: does home hospice care matter?  

Science.gov (United States)

Objectives Since metastasized cancer patients receive many treatments and services, it is important to ascertain whether home hospice (HH) care makes a meaningful contribution to end-of-life quality for terminal patients. This study examines whether people who had died from metastasized cancer-both recipients of HH care and nonrecipients-were cared for according to palliative indicators and whether HH care made a difference. Study Design Three to 6 months after the deaths of 193 metastatic cancer patients, members of their families were interviewed face-to-face. Information on their loved ones' utilization of healthcare services in the last 2 months of life was retrieved from computerized administrative files. Results The patients' average age was 69.5 years (SD = 13.9), 56% were men, and 21% received HH care. More patients with HH care than without received opiate medication (92% vs 68%, respectively; P patients were treated with curative care in the last 2 month of life, compared with 40% of those without HH (P care, more of them died at home (56% vs 26%, respectively; P care. Clinicians should consider referring cancer patients to palliative care services and establishing working relationships with HH and palliative care providers. PMID:25526387

Bentur, Netta; Resnizky, Shirli; Balicer, Ran; Eilat-Tsanani, Tsofia

2014-12-01

133

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  

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Methods: The Cama and Albless hospital is a tertiary care center located in South Mumbai, which cares for over 3000 deliveries per year. In the present retrospective analytical study, all cases of caesarean delivery from August 2013 to January 2014 were analyzed regarding the indication, associated risks factors, and all NICU admissions were studied. The decision to perform a caesarean section in each of these patients was made by a consultant on duty in consultation with the unit head telephonically. The primary objective of the study was to do LSCS audit with the secondary objective to analyse relationship of early peri-natal morbidity with indication of LSCS and risk factors associated. Results: In the present study we found that the overall incidence of LSCS is 25.7%, incidence of primary LSCS is 23.1 %, incidence of LSCS in Referred cases is 61.7 %. So overall high incidence of LSCS is justified as our's is a tertiary care referral unit. 3.5% of total LSCS cases were elderly gravidas and teenage pregnancies each. In our study, 11.8% and 3.5% patients were less than 37 weeks and 34 weeks respectively. However 30.6 % of NICU admissions were due to low birth weight. So IUGR in near term patients is an important morbid factor. Previous LSCS was the leading indication in 35.2% of cases followed by foetal distress in 14.9% of cases and Previous 2 LSCS 10.5%. Two important relative indications we found were Previous 1 LSCS and PIH contributing for nearly half of the total cases. Average duration of surgery was 86 minutes in our study and average stay in hospital was 9 days. In our study early perinatal mortality was 1.6% and morbidity in the form of NICU admissions was 20.8%. Most common cause for NICU admission was LBW followed by Respiratory distress. After comparing high risks factors and indications with NICU admissions we found highest morbidity in neonates who underwent LSCS for fetal distress, multiple pregnancy and premature rupture of membranes. Conclusions: Individualization of the indication and careful evaluation can help us limiting early peri-natal morbidity and mortality. Obstetric audits in the institution, following standardized guidelines and practice of evidenced-based medicine will help us a lot in reducing the peri-natal morbidity and mortality. [Int J Reprod Contracept Obstet Gynecol 2014; 3(4.000: 963-968

Rajshree Dayanand Katke

2014-08-01

134

Quality health care for children and the Affordable Care Act: a voltage drop checklist.  

Science.gov (United States)

The Affordable Care Act (ACA) introduces enormous policy changes to the health care system with several anticipated benefits and a growing number of unanticipated challenges for child and adolescent health. Because the ACA gives each state and their payers substantial autonomy and discretion on implementation, understanding potential effects will require state-by-state monitoring of policies and their impact on children. The "voltage drop" framework is a useful interpretive guide for assessing the impact of insurance market change on the quality of care received. Using this framework we suggest a state-level checklist to examine ACA statewide implementation, assess its impact on health care delivery, and frame policy correctives to improve child health system performance. Although children's health care is a small part of US health care spending, child health provides the foundation for adult health and must be protected in ACA implementation. PMID:25225140

Cheng, Tina L; Wise, Paul H; Halfon, Neal

2014-10-01

135

Taking a systemwide approach to improving quality care.  

Science.gov (United States)

For the past decade, health insurer Anthem has been working with more than 300 hospitals in Ohio, Kentucky, and Indiana in a quality program designed to help them better use clinical data, monitoring, outcomes, and best practices to improve care in their facilities and promote patient safety. The results have been stimulation of new quality programs at the hospital level and a sense of partnership. PMID:11759467

Simmons, J C

2001-11-01

136

Quality of Life and Supportive Care in Multiple Myeloma  

OpenAIRE

Multiple myeloma is the second most common haematological malignancy. Novel therapies have led to improvement in survival. Current myeloma management is matching the progress made in improved survival through disease control while optimising quality of life with effective supportive care. Supportive treatment is an essential part of the therapeutic management of myeloma patients because it is directed towards improving the patient’s quality of life and also can improve survival. The aim of ...

Co?mert, Melda; Gu?nes?, Ajda Ersoy; S?ahin, Fahri; Saydam, Gu?ray

2013-01-01

137

Palliative care and quality of life in neuro-oncology  

OpenAIRE

Health-related quality of life has become an important end point in modern day clinical practice in patients with primary or secondary brain tumors. Patients have unique symptoms and problems from diagnosis till death, which require interventions that are multidisciplinary in nature. Here, we review and summarize the various key issues in palliative care, quality of life and end of life in patients with brain tumors, with the focus on primary gliomas.

Mummudi, Naveen; Jalali, Rakesh

2014-01-01

138

Quality of antenatal care in Zambia: a national assessment  

OpenAIRE

Abstract Background Antenatal care (ANC) is one of the recommended interventions to reduce maternal and neonatal mortality. Yet in most Sub-Saharan African countries, high rates of ANC coverage coexist with high maternal and neonatal mortality. This disconnect has fueled calls to focus on the quality of ANC services. However, little conceptual or empirical work exists on the measurement of ANC quality at health facilities in low-income countries. We developed a classification...

Kyei Nicholas N A; Chansa Collins; Gabrysch Sabine

2012-01-01

139

Effects of quality improvement in health facilities and community mobilization through women's groups on maternal, neonatal and perinatal mortality in three districts of Malawi: MaiKhanda, a cluster randomized controlled effectiveness trial  

OpenAIRE

Background: Maternal, perinatal and neonatal mortality remains high in low-income countries. We evaluated community and facility-based interventions to reduce deaths in three districts of Malawi. Methods: We evaluated a rural participatory women's group community intervention (CI) and a quality improvement intervention at health centres (FI) via a two-by-two factorial cluster randomized controlled trial. Consenting pregnant women were followed-up to 2 months after birth using key informant...

Colbourn, T.; Nambiar, B.; Bondo, A.; Makwenda, C.; Tsetekani, E.; Makonda-ridley, A.; Msukwa, M.; Barker, P.; Kotagal, U.; Williams, C; Davies, R.; Webb, D.; Flatman, D.; Lewycka, S.; Rosato, M.

2013-01-01

140

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

Scientific Electronic Library Online (English)

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

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

2012-06-01

141

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

Directory of Open Access Journals (Sweden)

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

Ricardo Silva

2012-06-01

142

Adolescent Substance Abuse Treatment: Organizational Change and Quality of Care  

Science.gov (United States)

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

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

2011-01-01

143

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

Science.gov (United States)

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

Chassin, Mark R

2013-10-01

144

Improving the quality of cancer care in America.  

Science.gov (United States)

Thomas Feeley is the Helen Shafer Fly Distinguished Professor of Anesthesiology, and the Head of the Institute for Cancer Care Innovation at the University of Texas MD Anderson Cancer Center (TX, USA), which he has led since its formation in 2008. He received his undergraduate degree and M.D. from Boston University (MA, USA) and trained in anesthesiology and critical care medicine at Harvard’s Beth Israel Hospital in Boston. He was a faculty member at Stanford University (CA, USA) for 19 years prior to moving to The University of Texas MD Anderson Cancer Center in 1997 to lead the then newly created Division of Anesthesiology and Critical Care. Dr Feeley served on the Institute of Medicine’s Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population that published its report in September of 2013. He was recently appointed by Texas Governor Rick Perry to the board of directors of the Texas Institute for Health Care Quality and Efficiency. In addition to his research and administrative roles, Dr Feeley provides patient care services in the delivery of anesthesia. PMID:24947254

Feeley, Thomas W; Lake, Francesca

2014-05-01

145

Improving regional variation using quality of care measures  

Directory of Open Access Journals (Sweden)

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

Scott A Berkowitz

2009-11-01

146

The impact of technology on the quality of health care.  

Science.gov (United States)

Laser technology, developments in three-dimensional imaging, genetic engineering, and biosynthetic materials, and other technologies can promote quality care if they are used appropriately and correctly, are accessible to physicians and patients, and are shown to lead to successful outcomes. Formal organizational linkages and networks will enable providers to specialize in different technology and equipment yet still assure access for their patients to a full continuum of health care services. Advances in technology should have a significant, positive impact on the quality of care, yet with continued escalations in cost. Technology-based cost increases can be minimized with a renewed focus on early detection of diseases and on preventive strategies, efforts to ensure appropriate and cost-effective use of technology, greater selectivity in the use of "halfway" technologies, and increased incentives for healthy life-styles. PMID:2120656

Misener, J H

1990-06-01

147

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

OpenAIRE

Recently, moral deliberation within care institutions is gaining more attention in medical ethics. Ongoing dialogues about ethical issues are considered as a vehicle for quality improvement of health care practices. The rise of ethical conversation methods can be understood against the broader development within medical ethics in which interaction and dialogue are seen as alternatives for both theoretical or individual reflection on ethical questions. In other disciplines, intersubjectivity i...

Abma, T. A.; Molewijk, A. C.; Widdershoven, G. A. M.

2009-01-01

148

Measuring technical efficiency of output quality in intensive care units.  

Science.gov (United States)

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

Junoy, J P

1997-01-01

149

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

Science.gov (United States)

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

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

2012-01-01

150

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

Directory of Open Access Journals (Sweden)

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

Sh. Salarilak

1999-08-01

151

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

Science.gov (United States)

Health care and today's medical and technical achievements and approved standards of treatment provide comprehensive quality, safety and traceability of medical procedures respecting the principles of health protection. Continuous education improves the quality of nursing health care and increases the effectiveness of patient care, consequently maintaining and enhancing patient safety. Patient health problems impose the need of appropriate, planned and timely nursing care and treatment. In providing quality nursing care, attention is focused on the patient and his/her needs in order to maintain and increase their safety, satisfaction, independence and recovery or peaceful death, so the health and nursing practices must be systematized, planned and based on knowledge and experience. Health and nursing care of patients at risk of developing acute and chronic wounds or already suffering from some form of this imply preventive measures that are provided through patient education, motivation, monitoring, early recognition of risk factors and causes, and reducing or removing them through the prescribed necessary medical treatment which is safe depending on the patient health status. Except for preventive measures, nursing care of patients who already suffer from some form of acute or chronic wounds is focused on the care and treatment of damaged tissue by providing appropriate and timely diagnosis, timely and proper evaluation of the wound and patient general status, knowledge and understanding of the wide range of local, oral and parenteral therapy and treatment, aiming to increase patient safety by preventing progression of the patient general condition and local wound status and reducing the possibility of developing infection or other complications of the underlying disease. In the overall patient management, through nursing process, medical interventions are implemented and aimed to maintain and optimize health status, prevent complications of existing diseases and conditions, provide appropriate wound treatment, increase satisfaction, reduce pain, increase mobility, reduce and eliminate aggravating factors, and achieve a satisfactory functional and aesthetic outcome. Many scientific researches and knowledge about the pathophysiological processes of wound formation and healing are currently available. Modern achievements can accelerate independence, reduce pain and encourage faster wound healing, thus it is important to continuously develop awareness, knowledge and experience, along with the treatment to achieve, maintain and enhance the quality of health care and patient safety. PMID:25326985

Fumi?, Nera; Marinovi?, Marin; Brajan, Dolores

2014-10-01

152

The invisible homebound: setting quality-of-care standards for home-based primary and palliative care.  

Science.gov (United States)

Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care. Home-based medical care can improve outcomes and reduce health care costs, but this care operates in a quality measurement desert, having been largely left out of the national conversation on care quality. To address this shortcoming, two of the authors created the National Home-Based Primary and Palliative Care Network, an organization whose members include exemplary home-based medical practices, professional societies, and patient advocacy groups. This article describes the current status of home-based medical care in the United States and offers a brief narrative of a fictional homebound patient and the health events and fragmented care she faces. The article then describes the network's quality-of-care framework, which includes ten quality-of-care domains, thirty-two standards, and twenty quality indicators that are being tested in the field. The same two authors also developed a practice-based registry that will be used for quality-of-care benchmarking, practice-based quality improvement, performance reporting, and comparative effectiveness research. Together, these steps should help bring home-based medical care further into the mainstream of US health care. PMID:25561640

Leff, Bruce; Carlson, Charlotte M; Saliba, Debra; Ritchie, Christine

2015-01-01

153

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

Science.gov (United States)

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

Conrad, Douglas A; Perry, Lisa

2009-01-01

154

Perinatal considerations in the hospital disaster management process.  

Science.gov (United States)

Nurses play a vital role in providing care to mothers and infants during a disaster, yet few are fully prepared for the challenges they will encounter under extreme conditions. The ability to provide the best possible care for families begins with understanding the perinatal issues in relation to each phase of the disaster management process. This article reviews the hospital and perinatal nursing role in the mitigation, preparedness, response, and recovery phases of disaster management. PMID:20629934

Orlando, Susan; Danna, Denise; Giarratano, Gloria; Prepas, Robbie; Johnson, Cheri Barker

2010-01-01

155

Improving quality and safety in the hospital: The link between organisational culture,burnout and quality of care  

OpenAIRE

The need to improve quality of care represents a major goal of all health care systems. The objective of this series is to illuminate how the contextual factors of hospitals from eight European countries, and the well-being of their healthcare professionals, contribute to either construct or degrade quality of care. The studies reported here provide an important bottom-up perspective on quality of care, and the way that burnout and organizational cultur...

Montgomery Anthony; Todorova Irina; Baban Adriana; Panagopoulou Efharis

2013-01-01

156

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

Directory of Open Access Journals (Sweden)

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

Rashmi

2010-01-01

157

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

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

Sônia Lansky

2002-10-01

158

A new set of quality indicators for palliative care: process and results of the development trajectory  

OpenAIRE

CONTEXT: In some countries (the United States in particular), quality indicators for palliative care have already been developed. However, these quality indicators often cover one specific setting or target group, for example, palliative cancer care or palliative home care. OBJECTIVES: This article describes the development and initial testing of a set of quality indicators for palliative care, applicable for all settings in which palliative care is being provided for adult patients in the Ne...

Claessen, S. J. J.; Francke, A. L.; Belarbi, H. E.; Pasman, H. R. W.; Putten, M. J. A.; Deliens, L.

2011-01-01

159

Quality of plasma cholesterol measurements in primary care.  

OpenAIRE

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

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

1989-01-01

160

Quality and utilisation of antenatal care services in Lao PDR  

OpenAIRE

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

Manithip, Chanthanom

2012-01-01

161

Enabling and empowering certified nursing assistants for quality dementia care.  

Science.gov (United States)

Currently, 1.2 million full-time equivalent employees (FTEs) care for more than 1.5 million residents in nursing homes where 75% of residents have dementia. By the year 2010, the number of residents in these institutions may double. Registered nurses (RNs) make up less than 7% of a home's total FTEs. In contrast, certified nursing assistants (CNAs) account for more than 40% of total FTEs. Thus, CNAs serve as the primary caregivers in nursing homes. Typically, CNAs have a high school education or less, and receive little more than minimum wage. Their extensive contact with residents has a tremendous impact on quality of life, but significant barriers limit their caregiving effectiveness. These barriers include poor pay, minimal long-term benefits, and insufficient training, recognition and support for their physically and emotionally labor-intensive care. This paper addresses the issues of training CNAs for dementia care by suggesting an organizational framework within which to view dementia training; providing an overview of barriers to empowering CNAs to provide quality care to dementia residents; reviewing research that has addressed a specific barrier; making recommendations for future research; and suggesting research approaches to address these recommendations. PMID:10202662

Beck, C; Ortigara, A; Mercer, S; Shue, V

1999-03-01

162

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

Scientific Electronic Library Online (English)

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

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

2008-06-01

163

Barriers to quality patient care in rural district hospitals  

Directory of Open Access Journals (Sweden)

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

Ethelwynn L. Stellenberg

2012-05-01

164

Maternal and perinatal guideline development in hospitals in South East Asia: the experience of the SEA-ORCHID project  

OpenAIRE

Abstract Background Clinical practice guidelines (CPGs) are commonly used to support practitioners to improve practice. However many studies have raised concerns about guideline quality. The reasons why guidelines are not developed following the established development methods are not clear. The SEA-ORCHID project aims to increase the generation and use of locally relevant research and improve clinical practice in maternal and perinatal care in four countries in South ...

Short Jacki; Turner Tari J

2009-01-01

165

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

OpenAIRE

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

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

2014-01-01

166

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

Science.gov (United States)

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

Molenat, Françoise

2015-01-01

167

‘TOP HEAVY’ SYSTEMS AND QUALITY OF HEALTH CARE  

Directory of Open Access Journals (Sweden)

Full Text Available The paper is based on a primary survey of 1095 patients from the Medicine, General Surgery and Cardiac departments in R.G. Kar Medical College and Hospital (a major public sector health care institution in the metropolitan city of Kolkata, India. The results show that public health care institutions remain a vital life support system of the poorer sections of the population. However, this is not a matter of choice, but necessity. The breakdown of the three tiered referral system in the region has resulted in the Hospital, originally conceived as a super specialty hospital and referral health care institution for patients from the adjacent district of North 24 Parganas, functioning as a diagnosis unit. The resultant pressure has exceeded the carrying capacity of the institution and led to poor quality of health care in the Hospital. Revitalizing lower level institutions is therefore essential not only to increase accessibility of health services, but also to ensure efficiency in higher level health care institutions.

Bijoya Roy

2009-06-01

168

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

OpenAIRE

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

Oscanoa, Mery; Bergdahl, Roger

2008-01-01

169

The quality of COPD care in general practice  

DEFF Research Database (Denmark)

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

Rasmussen, F.V.; Borgeskov, H.

2008-01-01

170

Quality of patient record keeping: an indicator of the quality of care?  

OpenAIRE

Background: Patient record review of hospitalised patients is by far the most applied method to assess adverse events (AEs) in hospitals. The diligence with which information is recorded may influence the visibility of AEs. On the other hand, poor quality of the information in patient records may be a cause or a consequence of poor quality of care and may thus be associated with higher rates of AEs. The objective of this study was to assess the relation between the ...

Zegers, M.; Bruijne, M. C.; Spreeuwenberg, P.; Wagner, C.; Groenewegen, P. P.; Wal, G.

2011-01-01

171

Quality of asthma care: Western Cape Province, South Africa  

Scientific Electronic Library Online (English)

Full Text Available SciELO South Africa | Language: English Abstract in english BACKGROUND: Asthma is the eighth leading contributor to the burden of disease in South Africa, but has received less attention than other chronic diseases. The Asthma Guidelines Implementation Project (AGIP) was established to improve the impact of the South African guidelines for chronic asthma in [...] adults and adolescents in the Western Cape. One strategy was an audit tool to assist with assessing and improving the quality of care. METHODS: The audit of asthma care targeted all primary care facilities that managed adult patients with chronic asthma within all six districts of the Western Cape province. The usual steps in the quality improvement cycle were followed. RESULTS: Data were obtained from 957 patients from 46 primary care facilities. Only 80% of patients had a consistent diagnosis of asthma, 11.5% of visits assessed control and 23.2% recorded a peak expiratory flow (PEF), 14% of patients had their inhaler technique assessed and 11.2% were given a self-management plan; 81% of medication was in stock, and the controller/reliever dispensing ratio was 0.6. Only 31.5% of patients were well controlled, 16.3% of all visits were for exacerbations, and 17.6% of all patients had been hospitalised in the previous year. CONCLUSION: The availability of medication and prescription of inhaled steroids is reasonable, yet control is poor. Health workers do not adequately distinguish asthma from chronic obstructive pulmonary disease, do not assess control by questions or PEF, do not adequately demonstrate or assess the inhaler technique, and have no systematic approach to or resources for patient education. Ten recommendations are made to improve asthma care.

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

2009-12-01

172

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

Directory of Open Access Journals (Sweden)

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

Simone R de Bruin

2013-12-01

173

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

Scientific Electronic Library Online (English)

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

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

2010-07-01

174

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

Science.gov (United States)

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

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

2006-01-01

175

Caregivers in older peoples' care: perception of quality of care, working conditions, competence and personal health.  

Science.gov (United States)

The aim was to describe and compare nursing assistants', enrolled nurses' and registered nurses' perceptions of quality of care, working conditions, competence and personal health in older peoples' care. Altogether 70 nursing assistants, 163 enrolled nurses and 198 registered nurses completed a questionnaire comprising Quality from the Patient's Perspective modified for caregivers, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items on education and competence and Health Index. The caregivers reported higher perceived reality of quality of care in medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere. In subjective importance, the highest rating was assessed in one of the physical-technical items. The organisational climate was for three of the dimensions rather close/reached the value for a creative climate, for seven dimensions close to a stagnant climate. In perceived stress of conscience, there were low values. Nursing assistants had lower values than enrolled nurses and registered nurses. The caregivers reported highest values regarding previous education making them feel safe at work and lowest value on the item about education increasing the ability for a scientific attitude. Registered nurses could use knowledge in practice and to a higher degree than nursing assistants/enrolled nurses reported a need to gain knowledge, but the latter more often received education during working hours. The health index among caregivers was high, but registered nurses scored lower on emotional well-being than nursing assistants/enrolled nurses. The caregivers' different perceptions of quality of care and work climate need further attention. Although stress of conscience was low, it is important to acknowledge what affected the caregivers work in a negative way. Attention should be paid to the greater need for competence development among registered nurses during working hours. PMID:23088213

From, Ingrid; Nordström, Gun; Wilde-Larsson, Bodil; Johansson, Inger

2013-09-01

176

Enfermedad hemolítica perinatal Perinatal hemolytic disease  

OpenAIRE

La enfermedad hemolítica perinatal (EHPN) es una afección inmunológica aloinmune contra antígenos de origen paterno presentes en los hematíes fetales y del recién nacido. Se han reportado numerosos aloanticuerpos dirigidos contra antígenos eritrocitarios como causa de la EHPN, más frecuentemente los del sistema ABO y Rh. La EHPN por el sistema Rh (EHPN-Rh) suele ser severa, en particular por el antígeno D. Es muy común encontrar el anti-D asociado con otros anticuerpos Rh (C, E, de ...

María del Rosario López De Roux; Lázaro Cortina Rosales

2000-01-01

177

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

OpenAIRE

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

From, Ingrid

2011-01-01

178

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

OpenAIRE

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

Busari, Jamiu O.

2012-01-01

179

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

Directory of Open Access Journals (Sweden)

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

Coltart Cordelia EM

2011-10-01

180

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

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

Pérez-Cuevas Ricardo

2010-02-01

181

Intensive-care unit lungs - possibilities to improve the quality  

International Nuclear Information System (INIS)

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

182

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

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

Adhikari S

2014-09-01

183

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

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Full Text Available Abstract In Japan, attention has increasingly focused on ensuring the quality of care, particularly in the area of cancer care. The 2006 Basic Cancer Control Act reinforced efforts to ensure the quality of cancer care in a number of sectors, including the role of government in ensuring quality. We initiated a government-funded research project to develop quality indicators to measure the quality of care for five major cancers (breast, lung, stomach, colorectal, and liver cancer in Japan, and palliative care for cancers in general. While we successfully developed a total of 206 quality indicators, a number of issues have been raised regarding the concepts and methodologies used to measure quality. Examples include the choice between measuring the process of care versus the outcome of care; the degree to which the process-outcome link should be confirmed in real-world measurement; handling of exceptional cases; interpretation of measurement results between quality of care versus quality of documentation; creation of summary scores; and the optimal number of quality indicators for measurement considering the trade-off between the measurement validity versus resource limitations. These and other issues must be carefully considered when attempting to measure quality of care, and although many appear to have no correct answer, continuation of the project requires that a decision nevertheless be made. Future activities in this project, which is still ongoing, should focus on the further exploration of these problems.

Higashi Takahiro

2010-11-01

184

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

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

Green Michael E

2012-07-01

185

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

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

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

2013-01-01

186

Quality improvement of patient care - forensic pathologists' perspective.  

Science.gov (United States)

In the U.S. today, the pathologists, both hospital-based and forensic, are regularly involved in quality assurance (QA) programs, the evaluation of patient safety at all levels of medical care, including treatments in walk-in clinics and medical offices. In the United States, official death investigations are conducted by the Medical Examiner's Office. The Medical Examiner's Office is aided in its work by a network of coordinating agencies to provide complete, comprehensive reporting and investigation of deaths placed under its jurisdiction. Those agencies are the Health Department, the Registrar of Vital Statistics on Births and Deaths, Division of Health Facilities, the Hospital Office of Decedent Affairs and the State medical licensing agencies, as well as the various law enforcement and regulatory agencies and the prosecuting attorney's office. Forensic pathologists are witnesses to the fatal results of often avoidable untoward events. They need to use their experiences to address and emphasize overall prevention programs to improve the quality of life in the community, to publicize the avoidable actions which can lead to untoward results. In the current growing atmosphere of threatening chemical, biological and radiation terrorist attacks, the health care system, especially hospitals, including emergency services, are mobilizing to develop plans to meet possible anticipated need for disaster preparedness. PMID:17275382

Noguchi, Thomas T; Rogers, Christopher; Sathyavagiswaran, Lakshmanan

2007-03-01

187

Quality improvement in radiography in a neonatal intensive care unit  

International Nuclear Information System (INIS)

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

188

Quality improvement in radiography in a neonatal intensive care unit  

Energy Technology Data Exchange (ETDEWEB)

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)

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

189

Management of perinatal lung malformations.  

Science.gov (United States)

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

Macardle, C A; Kunisaki, S M

2014-10-13

190

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

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

Klomp Helena

2010-08-01

191

Quality of life in cancer patients receiving palliative care  

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

Singh Divya

2010-01-01

192

Quality of Life and Quality of Care for patients with Gout  

OpenAIRE

Acute and chronic gouty arthritis lead to significant pain, activity limitation and disability and impact patient’s health-related quality of life (HRQoL). Many effective therapies are available for treatment of gouty arthritis, yet medication errors in treatment of gout are common. One of the main goals of therapy is to lower serum uric acid, which in turn leads to a reduction in frequency of gout flares. Evidence suggests that the quality of care provided to patients with gout may impact ...

Singh, Jasvinder A.

2009-01-01

193

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

OpenAIRE

To determine the coverage rate, timeliness and quality of ante-natal care in rural areas under the coverage of Health Houses in West Azerbaijan province, 30 Health Houses (HH) were randomly selected out of 731 HH in the province. In each HH, using the method of Lot Quality Assurance Sampling (LQAS) 28 women having recently born babies was selected. Data were collected using check-list for facilities, and questionnaires and forms to be completed from the files by interview. The study showed th...

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

1999-01-01

194

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

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

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

2004-01-01

195

HCFA's Health Care Quality Improvement Program and the Cooperative Cardiovascular Project.  

Science.gov (United States)

The Health Care Financing Administration (HCFA) is changing the direction of its quality assessment and improvement program from one that tries to identify and cull "bad apples" to one that tries to improve the mainstream of care. This strategy change is known as the "Health Care Quality Improvement Program." An important aspect of this strategy change is to develop a partnership with providers that will ensure the provision of quality improvement information that is valid and useful to them. The Health Care Quality Improvement Program consists of both quality improvement projects and a series of quality indicators. The Medicare Quality Indicator System will develop a small number of indicators or appropriateness criteria for each major medical condition that affects Medicare beneficiaries. This national monitoring system has three primary goals: (1) to track trends in the quality of care over time and in variations in the quality of care across regions; (2) to provide the basis for making decisions on where it would be appropriate to carry out quality-of-care improvement projects; and (3) to support the execution of these projects. Quality improvement projects are cooperative efforts designed to improve a specific aspect of care. The Cooperative Cardiovascular Project is an early quality improvement project focusing initially on acute myocardial infarction; it will later focus on coronary artery bypass grafting and percutaneous coronary artery angioplasty. PMID:7979782

Jencks, S F

1994-12-01

196

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

Science.gov (United States)

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

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

2014-12-01

197

Developing a Total Quality Management Model for Health Care Systems  

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

AM Mosadegh Rad

2005-10-01

198

Hospital competition, resource allocation and quality of care  

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

Zwanziger Jack

2002-05-01

199

Assessment of quality of care in acute postoperative pain management  

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

Milutinovi? Dragana

2009-01-01

200

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

OpenAIRE

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

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

2014-01-01

201

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

OpenAIRE

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

Muntlin, A?sa

2009-01-01

202

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

OpenAIRE

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

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

2001-01-01

203

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

OpenAIRE

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

Sugiharto, J.

2012-01-01

204

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

OpenAIRE

For the success of health care organizations, accurate measurement of health care service quality is as important as understanding the nature of the service delivery system. Without a valid measure, it would be difficult to establish and implement appropriate tactics or strategies for service quality management. Experts have struggled for decades to formulate a concise, meaningful and generally applicable definition of the quality of health care. However, the complexity and variability of man...

Nakkeeran, Senthil Kumar; G, Thiagarajan

2010-01-01

205

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

OpenAIRE

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

Whitfield, Jonathan; Charsha, Dianne; Sprague, Pam

2001-01-01

206

Quality of care for patients with sexually transmitted diseases in Zambia  

OpenAIRE

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...

Faxelid, Elisabeth

1997-01-01

207

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

Science.gov (United States)

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

Hickox, Benjamin C

2015-01-01

208

PERINATAL LEUKODYSTROPHY CLINICAL CASE  

OpenAIRE

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

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

2004-01-01

209

PERINATAL LEUKODYSTROPHY CLINICAL CASE  

Directory of Open Access Journals (Sweden)

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

Dana Mihut

2004-01-01

210

38 CFR 52.120 - Quality of care.  

Science.gov (United States)

...assessment and plan of care. (a) Reporting of...Geriatrics and Extended Care Strategic Healthcare...in an adult day health care program is to prevent...appropriate treatment and services to maintain or improve his or her...

2010-07-01

211

Quality of Care is Similar for Safety-Net and Non-Safety-Net Hospitals  

Science.gov (United States)

... Newsroom Publication # 13-RA007 Go to Online Store Quality of care is similar for safety-net and non-safety-net hospitals Patient Safety and Quality Safety-net hospitals are institutions typically located in ...

212

Development and testing of a measure designed to assess the quality of care transitions  

OpenAIRE

Background: To improve the quality of care delivered to older persons receiving care across multiple settings, interventions are needed. However, the absence of a patient-centred measure specifically designed to assess this care has constrained innovation. Objective: To develop a rigorously designed and tested measure, the Care Transition Measure (CTM). Setting: A large, integrated managed care organisation in Colorado with approximately 55,000 members ove...

Coleman, Eric A.; Smith, Jodi D.; Frank, Janet C.; Eilertsen, Theresa B.; Thiare, Jill N.; Kramer, Andrew M.

2002-01-01

213

National BTS bronchiectasis audit 2012: is the quality standard being adhered to in adult secondary care?  

Science.gov (United States)

A significant step towards improving care of patients with non-cystic fibrosis bronchiectasis was the creation of the British Thoracic Society (BTS) national guidelines and the quality standard. A BTS bronchiectasis audit was conducted between 1 October and 30 November 2012, in adult patients with bronchiectasis attending secondary care, against the BTS quality standard. Ninety-eight institutions took part, submitting a total of 3147 patient records. The audit highlighted the variable adoption of the quality standard. It will allow the host institutions to benchmark against UK figures and drive quality improvement programmes to promote the quality standard and improve patient care. PMID:23878159

Hill, Adam T; Routh, Chris; Welham, Sally

2014-03-01

214

Nursing and threats to patient and nurse safety and quality of patient care.  

Science.gov (United States)

A major effect of today's emphasis on cost-cutting in health care has been reductions in the numbers and mix of registered nurses (RNs). RNs have increased concerns over patient and practitioner safety and patient care quality. The American Nurses Association (ANA) has a major, multi-phase project addressing these concerns, called Nursing's Safety and Quality Initiative. This initiative encompasses: nursing-sensitive quality indicators, educating staff nurses, researching the impact of skill mix on patient outcomes, political activities, a national database of nursing quality indicators, and liaisons and coalitions. These activities reflects ANA's commitment to patient and nurse safety and the quality of patient care. PMID:9529792

Rowell, P A; Milholland, D K

1998-04-01

215

Eclampsia: Repercusión materna y perinatal  

Directory of Open Access Journals (Sweden)

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

Marianela Rivas

2012-03-01

216

Survey using incognito standardized patients shows poor quality care in China's rural clinics.  

Science.gov (United States)

Over the past decade, China has implemented reforms designed to expand access to health care in rural areas. Little objective evidence exists, however, on the quality of that care. This study reports results from a standardized patient study designed to assess the quality of care delivered by village clinicians in rural China. To measure quality, we recruited individuals from the local community to serve as undercover patients and trained them to present consistent symptoms of two common illnesses (dysentery and angina). Based on 82 covert interactions between the standardized patients and local clinicians, we find that the quality of care is low as measured by adherence to clinical checklists and the rates of correct diagnoses and treatments. Further analysis suggests that quality is most strongly correlated with provider qualifications. Our results highlight the need for policy action to address the low quality of care delivered by grassroots providers. PMID:24653216

Sylvia, Sean; Shi, Yaojiang; Xue, Hao; Tian, Xin; Wang, Huan; Liu, Qingmei; Medina, Alexis; Rozelle, Scott

2014-03-20

217

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

Science.gov (United States)

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

Bai, Ge; Krishnan, Ranjani

2015-01-01

218

Ensuring Quality Cancer Care: A Follow-Up Review of the Institute of Medicine’s Ten Recommendations for Improving the Quality of Cancer Care in America  

OpenAIRE

Responding to growing concerns regarding the safety, quality, and efficacy of cancer care in the United States, the Institute of Medicine (IOM) of the National Academy of Sciences commissioned a comprehensive review of cancer care delivery in the US healthcare system in the late 1990s. The National Cancer Policy Board (NCPB), a twenty-member board with broad representation, performed this review. In its review, the NCPB focused on the state of cancer care delivery at that time, its shortcomin...

Spinks, Tracy; Albright, Heidi W.; Feeley, Thomas W.; Walters, Ron; Burke, Thomas W.; Aloia, Thomas; Bruera, Eduardo; Buzdar, Aman; Foxhall, Lewis; Hui, David; Summers, Barbara; Rodriguez, Alma; Dubois, Raymond; Shine, Kenneth I.

2012-01-01

219

Current efforts in chiropractic quality assurance and standards of care  

OpenAIRE

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

Hansen, Daniel T.

1991-01-01

220

Age and gender as predictors of allied health quality stroke care  

Directory of Open Access Journals (Sweden)

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

Luker JA

2011-07-01

221

An Exploratory Study: Reducing Nursing Students Stress Levels Facilitate Perceived Quality of Patient Care  

OpenAIRE

The aim of this project was to examine if stress levels in Associate Degree (AD) nursing students can affect their perceived quality of care provided to patients. Nursing students experience tremendous amounts of stress especially during their clinical experience. High levels of stress may affect the quality of patient care provided. This project implemented a stress reducing workshop and an i...

Williams, Kristiann T.

2014-01-01

222

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

LENUS (Irish Health Repository)

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

Walsh, T

2012-01-31

223

[Telemedicine: Improving the quality of care for critical patients from the pre-hospital phase to the intensive care unit].  

Science.gov (United States)

The Health System is in crisis and critical care (from transport systems to the ICU) cannot escape from that. Lack of integration between ambulances and reference Hospitals, a deep shortage of critical care specialists and assigned economical resources that increase less than critical care demand are the cornerstones of the problem. Moreover, the analysis of the situation anticipated that the problem will be worse in the future. "Closed" ICUs in which critical care specialists direct patient care outperform "open" ones in which primary admitting physicians direct patient care in consultation with critical care specialists. However, the current paradigm in which a critical care specialist is close to the patient is in the edge of the trouble so, only a new paradigm could help to increase the number of patients under intensivist care. Current information technology and networking capabilities should be fully exploited to improve both the extent and quality of intensivist coverage. Far to be a replacement of the existing model Telemedicine might be a complimentary tool. In fact, to centralize medical data into servers has many additional advantages that could even improve the way in which critical care physicians take care of their patients under the traditional system. PMID:19811855

Murias, G; Sales, B; García-Esquirol, O; Blanch, L

2010-01-01

224

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

Science.gov (United States)

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

Adams, Kelly L; Iseler, Jackeline I

2014-01-01

225

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

OpenAIRE

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

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

2008-01-01

226

Perspectives of elderly people receiving home help on health, care and quality of life  

OpenAIRE

From a nursing perspective it is important to have information about the type of care needed, the reasons care is needed and quality of life among the most elderly people living in their own homes, in order to support their independence and maximise their quality of life. Thus a study was performed to investigate people aged 75 years and older dependent on care from professionals and/or a next of kin, their functional health, diseases, and complaints in relation to qua...

Hellstro?m, Ylva; Hallberg, Ingalill

2001-01-01

227

eHealth, care and quality of life  

CERN Document Server

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

Capello, Fabio; Manca, Marco

2014-01-01

228

Perinatal tuberculosis: a diagnostic challenge  

Directory of Open Access Journals (Sweden)

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.

Edna Lúcia S. de Souza

2006-06-01

229

[Congenital and perinatal infections  

Science.gov (United States)

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

Mussi-Pinhata, M M; Yamamoto, A Y

1999-07-01

230

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

Directory of Open Access Journals (Sweden)

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

Busari JO

2012-12-01

231

38 CFR 51.120 - Quality of care.  

Science.gov (United States)

...Any resident death, paralysis, coma or other major...given the appropriate treatment and services to maintain...receives the appropriate treatment and services to prevent...residents receive proper treatment and care for the following...Respiratory care; (7) Foot care; and (8)...

2010-07-01

232

38 CFR 51.120 - Quality of care.  

Science.gov (United States)

...management must provide the necessary care and services to attain or...comprehensive assessment and plan of care. (a) Reporting of Sentinel...Office of Geriatrics and Extended Care (114) within 24 hours of notification...hydration, grooming, personal and oral hygiene, mobility, and...

2010-07-01

233

38 CFR 52.120 - Quality of care.  

Science.gov (United States)

...comprehensive assessment and plan of care. (a) Reporting of sentinel...Consultant, Geriatrics and Extended Care Strategic Healthcare Group...event in an adult day health care program is to prevent future...hydration, grooming, personal and oral hygiene, mobility, and...

2010-07-01

234

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

OpenAIRE

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

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

2009-01-01

235

Technical Quality of Maternity Care: the Pregnant Women’s Perspective  

OpenAIRE

Background: Improving adherence to care standards is one way to im¬prove quality of delivered care. This study aimed to determine the degree of provid¬ers' adherence to maternity care standards from the perspective of pregnant women.Methods: This cross-sectional study was conducted on 185 pregnant women in their ninth month of pregnancy who received maternity care from health centres in Tabriz, Iran. Participants were selected randomly from 40 health centres. Data collection used a research...

Mostafa Farahbakhsh; Kamal Gholipour; Jafar Sadegh Tabrizi; Andrew Wilson

2013-01-01

236

Quality of life measures in health care. I: Applications and issues in assessment.  

OpenAIRE

Many clinicians remain unsure of the relevance of measuring quality of life to their clinical practice. In health economics quality of life measures have become the standard means of assessing the results of health care interventions and, more controversially, the means of prioritising funding; but they have many other applications. This article--the first of three on measuring quality of life--reviews the instruments available and their application in screening programmes, audit, health care...

Fitzpatrick, R.; Fletcher, A.; Gore, S.; Jones, D.; Spiegelhalter, D.; Cox, D.

1992-01-01

237

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

OpenAIRE

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

Nguyen, Geoffrey C.; Weizman, Adam V.

2013-01-01

238

Palliative care hits a triple win: access, quality, and cost.  

Science.gov (United States)

Like the generation before them, an ever-increasing proportion of baby boomers in the United States have a chronic illness and often multiple chronic illnesses, using ever-increasing national healthcare resources. With the Triple Aim, Don Berwick's overarching goals to help guide positive transformation to the healthcare system, palliative care can be seen as a valuable ally in the growing arsenal of models of care aimed at addressing the nation's needs. The SPARK Program, the palliative care management program of a large home care agency in a metropolitan area, was created to address the needs of patients with chronic serious illness and palliative care needs. PMID:24584316

DiBello, Karol; Coyne, Noreen

2014-03-01

239

Association Between Perinatal Medical Expenses and a Waiver to Increase Florida Healthy Start Services Within Florida Medicaid Programs: 1998 to 2006  

OpenAIRE

To assess the association between perinatal care expenditures and a Medicaid waiver to increase Florida Healthy Start services among Florida Medicaid non-managed care organization (non-MCO) program enrollees. We assessed perinatal care expenditures from Medicaid claims and encounter data among non-MCO enrollees with increased risk pregnancies who gave birth in Florida during 1998–2006. We used a pre-post design to compare adjusted perinatal medical expenditures among women who received Heal...

Staras, Stephanie A. S.; Kairalla, John A.; Hou, Wei; Sappenfield, William M.; Thompson, Daniel R.; Ranka, Deepa; Shenkman, Elizabeth A.

2011-01-01

240

Corioamnionitis: Repercusión perinatal  

Directory of Open Access Journals (Sweden)

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

Pedro Faneite

2010-12-01

241

Multimorbidity and Quality of Preventive Care in Swiss University Primary Care Cohorts  

OpenAIRE

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 compo...

Streit, Sven; Da Costa, Bruno R.; Bauer, Douglas C.; Collet, Tinh-hai; Weiler, Stefan; Zimmerli, Lukas; Frey, Peter; Cornuz, Jacques; Gaspoz, Jean-michel; Battegay, Edouard; Kerr, Eve; Aujesky, Drahomir; Rodondi, Nicolas

2014-01-01

242

Quality choice in a health care market: a mixed duopoly approach.  

Science.gov (United States)

We investigate a health care market with uncertainty in a mixed duopoly, where a partially privatized public hospital competes against a private hospital in terms of quality choice. We use a simple Hotelling-type spatial competition model by incorporating mean-variance analysis and the framework of partial privatization. We show how the variance in the quality perceived by patients affects the true quality of medical care provided by hospitals. In addition, we show that a case exists in which the quality of the partially privatized hospital becomes higher than that of the private hospital when the patient's preference for quality is relatively high. PMID:18712422

Sanjo, Yasuo

2009-05-01

243

Nursing home care for people with dementia and residents quality of life, quality of care and staff well-being: Design of the Living Arrengements for people with Dementia (LAD)-study.  

OpenAIRE

Abstract Background There is limited information available on how characteristics of the organization of nursing home care and especially group living home care and staff ratio contribute to care staff well being, quality of care and residents' quality of life. Furthermore, it is unknown what the consequences of the increasingly small scale organization of care are for the amount of care staff required in 2030 when there will be much more older people with dementia. Me...

de Lange Jacomine; Smit Dieneke; Willemse Bernadette M; Pot Anne

2011-01-01

244

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

Directory of Open Access Journals (Sweden)

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

Hirdes John P

2005-01-01

245

Coverage and Quality of Antenatal Care Provided at Primary Health Care Facilities in the ‘Punjab’ Province of ‘Pakistan’  

Science.gov (United States)

Background Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In ‘Pakistan’ antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to ‘Divisions’ and ‘Districts’. By population ‘Punjab’ is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in ‘Punjab’ province of ‘Pakistan’. Methods Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers. Results The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage. Conclusion The coverage and quality of the antenatal care services in ‘Punjab’ are extremely compromised. Only half of the expected pregnancies are enrolled and out of those 1/3 drop out in follow-up visits. PMID:25409502

Majrooh, Muhammad Ashraf; Hasnain, Seema; Akram, Javaid; Siddiqui, Arif; Memon, Zahid Ali

2014-01-01

246

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

OpenAIRE

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

Barber, Sarah L.; Gertler, Paul J.

2008-01-01

247

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

Science.gov (United States)

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

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

2005-01-01

248

Incarceration, maternal hardship, and perinatal health behaviors.  

Science.gov (United States)

Parental incarceration is associated with mental and physical health problems in children, yet little research directly tests mechanisms through which parental incarceration could imperil child health. We hypothesized that the incarceration of a woman or her romantic partner in the year before birth constituted an additional hardship for already-disadvantaged women, and that these additionally vulnerable women were less likely to engage in positive perinatal health behaviors important to infant and early childhood development. We analyzed 2006-2010 data from the Pregnancy Risk Assessment and Monitoring System to assess the association between incarceration in the year prior to the birth of a child and perinatal maternal hardships and behaviors. Women reporting incarceration of themselves or their partners in the year before birth of a child had .86 the odds (95 % CI .78-.95) of beginning prenatal care in the first trimester compared to women not reporting incarceration. They were nearly twice as likely to report partner abuse and were significantly more likely to rely on WIC and/or Medicaid for assistance during pregnancy. These associations persist after controlling for socioeconomic measures and other stressors, including homelessness and job loss. Incarceration of a woman or her partner in the year before birth is associated with higher odds of maternal hardship and poorer perinatal health behaviors. The unprecedented scale of incarceration in the US simultaneously presents an underutilized public health opportunity and constitutes a social determinant of health that may contribute to disparities in early childhood development. PMID:24615355

Dumont, Dora M; Wildeman, Christopher; Lee, Hedwig; Gjelsvik, Annie; Valera, Pamela; Clarke, Jennifer G

2014-11-01

249

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

Science.gov (United States)

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

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

2013-02-01

250

A question of quality: do children from disadvantaged backgrounds receive lower quality early years education and care in England?  

OpenAIRE

This paper examines how the quality of formal early childhood education and care is associated with children’s background. By using different indicators of quality, the research also explored how the relationship varies depending on the way quality is measured. The analysis combines information from three administrative datasets – the Early Years Census, the Schools Census and the Office for Standards in Education, Children’s Services and Skills (Ofsted) dataset on inspections (2010-...

Gambaro, Ludovica; Stewart, Kitty; Waldfogel, Jane

2013-01-01

251

Perinatal Risk Factors for Strabismus  

OpenAIRE

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

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

2010-01-01

252

Impact of an interdisciplinary health care team on elderly patients' health-related quality of life, patient satisfaction, and health care utilization  

OpenAIRE

The purpose of this project was to develop and implement a mechanism for integrating and coordinating health care services for older patients' through the use of an interdisciplinary health care team. There were four main objectives: (1) To determine if elderly patients' perceived health-related quality of life is higher when an interdisciplinary health care team administers care, (2) To determine if care administered by an interdisciplinary health care team affects patients' perceived satisf...

Plake, Kimberly Sue

1999-01-01

253

Enfermedad hemolítica perinatal Perinatal hemolytic disease  

Directory of Open Access Journals (Sweden)

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

María del Rosario López de Roux

2000-12-01

254

Enfermedad hemolítica perinatal / Perinatal hemolytic disease  

Scientific Electronic Library Online (English)

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

María del Rosario, López de Roux; Lázaro, Cortina Rosales.

2000-12-01

255

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

Science.gov (United States)

...Provide Quality of Care to Children AGENCY...Medicare & Medicaid Services (CMS), HHS...legislative changes to improve the quality of care provided to children...Health and Human Services to provide to...legislative changes to improve the quality of care provided to...

2010-07-30

256

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

Directory of Open Access Journals (Sweden)

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

Hammouche Salah

2011-11-01

257

Quality of care in reproductive health programmes: concepts, assessments, barriers and improvements--an overview.  

Science.gov (United States)

At the end of the first decade of the Safe Motherhood Initiative there are still, at a minimum, 1600 women dying every day from complications of pregnancy and childbirth: this is an intolerable human tragedy. The fact that there are almost 100,000 more maternal deaths annually now compared to 10 years ago, 585,000, must present a challenge to every citizen in society. Policy makers, health professionals, social workers, religious leaders, human-rights advocates and the media all have a responsibility to ask themselves: 'What can I do?' All have a role in affecting quality reproductive-health services, which are essential for the reduction of maternal mortality and morbidity, and are an intrinsic human right. The midwife is the obvious catalyst and linch-pin for this effort in the fabric of society. Three papers will address the issues of quality of care in reproductive-health programmes with particular emphasis on safe motherhood. This, the first, article describes the concepts of quality of care in reproductive-health programmes, the determinants of quality improvement, assessment tools for service quality, barriers to quality of care and quality improvement together with examples from relevant countries. The second article will address education issues relative to quality of care, and the third will describe the monitoring and evaluation of quality of care with relevant indicators and project results. PMID:10382474

Kwast, B E

1998-06-01

258

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

International Nuclear Information System (INIS)

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

259

Assessing the knowledge of perinatal mental illness among student midwives.  

Science.gov (United States)

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

Phillips, Louise

2014-09-28

260

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

Science.gov (United States)

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

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

2014-06-01

261

The arduous and challenging journey of improving patient safety and quality of care.  

Science.gov (United States)

The 20th century has seen dramatic improvements in quality, efficiency, and productivity of the industrial, manufacturing, and selected service sectors through the redesign of the management and production processes. Moreover, the health care sector, plagued by overuse, underuse, and misuse of care remained a laggard in adopting needed changes to improve quality, effectiveness, and delivery. The change agent may have been the 2001 report by the Institute of Medicine, which shocked the collective conscience of the industry with the revelation of the alarming statistics of death owing to preventable medical errors. A variety of methodologies have since been adopted by the health care sector with mixed successes. However, scant attention has been given to the historical significance of Florence Nightingale pioneering quality management in nursing care over a century ago with her use of statistics to influence health care decisions, to enhance quality care delivery, and to improve facility design. This article addresses the abstract concept of quality, its illusive nature, and multidimensionality from different perspectives in health utilization and delivery. It presents a survey of the various quality management theories and models and their variance, which have attracted the attention of the health sectors as potential saviors of the beleaguered health industry afflicted by the quality crisis. PMID:24267627

Lee, Esther

2013-12-01

262

Examining the role of patient experience surveys in measuring health care quality.  

Science.gov (United States)

Patient care experience surveys evaluate the degree to which care is patient-centered. This article reviews the literature on the association between patient experiences and other measures of health care quality. Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety within hospitals, and less health care utilization. Patient experience measures that are collected using psychometrically sound instruments, employing recommended sample sizes and adjustment procedures, and implemented according to standard protocols are intrinsically meaningful and are appropriate complements for clinical process and outcome measures in public reporting and pay-for-performance programs. PMID:25027409

Anhang Price, Rebecca; Elliott, Marc N; Zaslavsky, Alan M; Hays, Ron D; Lehrman, William G; Rybowski, Lise; Edgman-Levitan, Susan; Cleary, Paul D

2014-10-01

263

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

Directory of Open Access Journals (Sweden)

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

Martin Rejler

2012-01-01

264

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

OpenAIRE

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

Blenkiron, P.; Hammill, C.

2003-01-01

265

Improving the quality of STI care by private general practitioners: a South African case study  

OpenAIRE

Objectives: Evaluation of an intervention to improve quality of sexually transmitted infections (STI) care among 64 private general practitioners (GPs) working in two urban districts in Gauteng Province, South Africa.

Schneider, H.; Chabikuli, N.; Blaauw, D.; Funani, I.; Brugha, R.

2005-01-01

266

Quality improvement programme for cardiovascular disease risk factor recording in primary care  

OpenAIRE

Objectives—Evaluation of the effect of a quality improvement programme on cardiovascular disease (CVD) risk factor recording and risk factor levels in a controlled study at two primary health care centres serving 26 000 inhabitants in Northern Helsinki.

Ketola, E.; Sipila, R.; Makela, M.; Klockars, M.

2000-01-01

267

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

Directory of Open Access Journals (Sweden)

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

Sadigeh Fayazi

2012-04-01

268

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

OpenAIRE

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

Armstrong David; Ashworth Mark

2006-01-01

269

Perinatal urinary and fecal incontinence: suffering in silence.  

Science.gov (United States)

This article focuses on the prevention, identification, and management of urinary and fecal incontinence in the perinatal period. Both urinary and fecal incontinence are common concerns affecting women throughout pregnancy, intrapartum, and postpartum. These are the problems that are not approached by healthcare providers during the initial antepartal assessment, nor are they fully investigated after delivery. Many women hesitate to disclose this information. Women tend to consider this to be a minor discomfort of pregnancy and a consequence resulting from childbirth in the postpartum period. Intervention strategies and nursing care components in the perinatal period will be presented. PMID:21045612

Marecki, Marsha; Seo, Jin Young

2010-01-01

270

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

OpenAIRE

Background & Objective: sickle cell anemia, a chronic disease, which has many complication affects patient’s. This quality of life’s. Therefor, they need caring to maintain their life. The goal of this study was investigating the effect of self care plan on the quality of life’s sickle cell anemia. Subjects and Methods: This study was a clinical trial research Carried out on 70 sickle cell anemics and allocated in two groups randomly. The instruments of data collection were demographic,...

Gholam Reza Mahmodi; Sadigeh Fayazi; Simin Jahani; Bizhan Kaykhaei; Seyed Mahmod Latifi

2012-01-01

271

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

OpenAIRE

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

Kebriaei, A.; Akbari, F.

2006-01-01

272

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

OpenAIRE

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

Forder, Julien; Allan, Stephen

2014-01-01

273

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

OpenAIRE

ackground & Aim: Performance appraisal is one of the most important duties for nursing managers. This will improve the quality of nursing care, and it needs suitable approaches and effective strategies in nursing services. The aim of this study is to determine the impact of performance appraisal using management by objective approach on nursing care quality. Methods & Materials: This was a quasi-experimental and single-blind study that was carried out in two surgical units of ...

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

2007-01-01

274

The Impact of Continuing Education on the Quality of Patient Care  

OpenAIRE

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

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

1983-01-01

275

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

OpenAIRE

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

Sundby Johanne; Cham Mamady; Vangen Siri

2009-01-01

276

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

Directory of Open Access Journals (Sweden)

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

Emamzadeh Ghasemi

2007-10-01

277

Measuring the contribution of nursing to quality, patient safety, and health care outcomes.  

Science.gov (United States)

In 2004, the National Quality Forum (NQF) endorsed a set of voluntary consensus standards for nursing-sensitive care that quantifies nursing's contribution to patient safety, health care outcomes, and a professional work environment. Since endorsement, these consensus standards have been the basis for research, quality improvement, and policy setting. This article provides a summary of NQF's consensus development process and various efforts that have cascaded from the endorsement of these consensus standards. PMID:17470769

Kurtzman, Ellen T; Corrigan, Janet M

2007-02-01

278

38 CFR 51.120 - Quality of care.  

Science.gov (United States)

...of care. (a) Reporting of Sentinel Events —(1) Definition. A sentinel event is an adverse event that results in the loss of life or limb...with a medication error; or (ii) Any suicide of a resident, including suicides...

2010-07-01

279

38 CFR 52.120 - Quality of care.  

Science.gov (United States)

...of care. (a) Reporting of sentinel events. (1) Definition. A sentinel event is an adverse event that results in the loss of life or limb...with a medication error; or (ii) Any suicide or attempted suicide of a...

2010-07-01

280

Disparities in Health Care Quality among Minority Women  

Science.gov (United States)

... Care System (Advice from Dr. Clancy) Consejos de salud para tà Newsletters AHRQ Web M&M Health ... statistically unreliable. — = data not available. Return to Contents Mental Health and Substance Abuse Mental disorders are common ...

281

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

OpenAIRE

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

Ahmet Kara

2006-01-01

282

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

OpenAIRE

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

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

1999-01-01

283

Joining the Quality Circle: Developmentally Appropriate Practice in School-Age Care.  

Science.gov (United States)

Describes characteristics of a high-quality school-age care program: resourceful, caring staff; recognition of the importance of peers; opportunities for mixed- and same-age grouping; children's selection of activities and experiences; guidance for children's social and emotional development; and environments that encourage a wide variety of…

Albrecht, Kay

1993-01-01

284

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

Science.gov (United States)

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

Viney, Linda L.; And Others

1994-01-01

285

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

Science.gov (United States)

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

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

2014-01-01

286

Quality care at the end of life in Africa  

OpenAIRE

Each year about 0.5% of the total population in Botswana, Ethiopia, Tanzania, Uganda, and Zimbabwe die from HIV/AIDS or cancer. The members of a WHO project to improve palliative care in these countries discuss their work. The greatest needs of terminally ill patients were for adequate pain relief, accessible and affordable drugs, and financial support to counter the loss of income of both patient and family caregiver. Special emphasis should be given to home based palliative care provi...

Sepulveda, Cecilia; Habiyambere, Vincent; Amandua, Jacinto; Borok, Margaret; Kikule, Ekie; Mudanga, Barbara; Ngoma, Twalib; Solomon, Bogale

2003-01-01

287

Caregiver Evaluation of the Quality of End-Of-Life Care (CEQUEL) Scale: The Caregiver's Perception of Patient Care Near Death  

OpenAIRE

Purpose End-of-life (EOL) measures are limited in capturing caregiver assessment of the quality of EOL care. Because none include caregiver perception of patient suffering or prolongation of death, we sought to develop and validate the Caregiver Evaluation of Quality of End-of-Life Care (CEQUEL) scale to include these dimensions of caregiver-perceived quality of EOL care. Patients and Methods Data were derived from Coping with Cancer (CwC), a multisite, prospective, longitudinal study of adva...

Higgins, Philip C.; Prigerson, Holly G.

2013-01-01

288

Voluntary peer review as innovative tool for quality improvement in the intensive care unit – a retrospective descriptive cohort study in German intensive care units  

OpenAIRE

Introduction: Quality improvement and safety in intensive care are rapidly evolving topics. However, there is no gold standard for assessing quality improvement in intensive care medicine yet. In 2007 a pilot project in German intensive care units (ICUs) started using voluntary peer reviews as an innovative tool for quality assessment and improvement. We describe the method of voluntary peer review and assessed its feasibility by evaluating anonymized peer review reports and analysed the them...

Kumpf, Oliver; Bloos, Frank; Bause, Hanswerner; Brinkmann, Alexander; Deja, Maria; Marx, Gernot; Kaltwasser, Arnold; Dubb, Rolf; Muhl, Elke; Greim, Clemens-a; Weiler, Norbert; Chop, Ines; Jonitz, Gu?nther; Schaefer, Henning; Felsenstein, Matthias

2014-01-01

289

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

Directory of Open Access Journals (Sweden)

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

von dem Knesebeck Olaf

2011-05-01

290

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

Science.gov (United States)

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

Clarke, Nicholas

2013-01-01

291

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

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Structured care is proposed as a lever for improving care for patients with chronic conditions. The purpose of this study was to explore the associations of structured care characteristics, derived from the Chronic Care Model, with health-related quality of life (HRQOL and optimal clinical management in chronic heart failure (CHF patients in primary care, as well as the association between optimal management and HRQOL. Methods Cross-sectional observational study using multi-level random-coefficient analyses of a representative sample of 357 patients diagnosed with CHF from 42 primary care practices in the Netherlands. We combined individual medical record data with patient and physician questionnaires. Results There was large variation in the levels and presence of structured care elements. A 91% of physicians indicated that next appointments for CHF patients were made immediately after visits, while 11% indicated that reminders on CHF management were periodically received in their practice. Few associations were found between the organizational characteristics and optimal treatment or HRQOL. Optimal pharmacological treatment related to better quality of life (? = -11.5, P P = .04. Conclusion HRQOL and treatment quality in CHF patients were not consistently associated with characteristics of structured care in primary care practices.

Schers Henk

2009-06-01

292

Corioamnionitis: Repercusión perinatal  

Scientific Electronic Library Online (English)

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

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

2010-12-01

293

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

Directory of Open Access Journals (Sweden)

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

Jenssen Jon A

2008-09-01

294

Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan.  

Science.gov (United States)

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. PMID:25120917

Alyeshmerni, Daniel; Froehlich, James B; Lewin, Jack; Eagle, Kim A

2014-07-01

295

Combining QOF data with the care bundle approach may provide a more meaningful measure of quality in general practice  

OpenAIRE

Abstract Background A significant minority of patients do not receive all the evidence-based care recommended for their conditions. Health care quality may be improved by reducing this observed variation. Composite measures offer a different patient-centred perspective on quality and are utilized in acute hospitals via the ‘care bundle’ concept as indicators of the reliability of specific (evidence-based) care delivery tasks and improved outcomes. A care bundle consists o...

de Wet Carl; McKay John; Bowie Paul

2012-01-01

296

Development and application of an electronic health record information extraction tool to assess quality of pain management in primary care  

OpenAIRE

Chronic pain is one of the most common presenting problems in primary care. Standards and guidelines have been developed for managing chronic pain, but it is unclear whether primary care providers routinely engage in guideline-concordant care. The purpose of this study is to develop a tool for extracting information about the quality of pain care in the primary care setting. Quality indicators were developed through review of the literature, input from an interdisciplinary panel of pain exper...

Dorflinger, Lindsey M.; Gilliam, Wesley P.; Lee, Allison W.; Kerns, Robert D.

2014-01-01

297

Tel-eNurse Practice. Quality of care and patient outcomes.  

Science.gov (United States)

As a growing specialty, telephone nursing practice requires definition, standardization, and identification of quality indicators and nursing-sensitive outcomes. An informal study was conducted to explore the relationship between telephone nursing quality indicators-assessment, critical thinking, use of protocols, and continuity of care-found in documentation and nursing-sensitive patient outcomes. Findings provide insight into the telephone process of care and application of critical thinking reflected in documentation and greater understanding of the complexity of telephone nursing practice and integration of care and outcomes. PMID:11263064

Larson-Dahn, M L

2001-03-01

298

Will changes in primary care improve health outcomes? Modelling the impact of financial incentives introduced to improve quality of care in the UK  

OpenAIRE

Objectives: To estimate the total health gain from improving the quality of care among patients with cardiovascular disease in line with the quality indicator targets in the new contract for general practitioners (GPs) in the UK.

Mcelduff, P.; Lyratzopoulos, G.; Edwards, R.; Heller, R.; Shekelle, P.; Roland, M.

2004-01-01

299

Identifying resident care areas for a quality improvement intervention in long-term care: a collaborative approach  

Directory of Open Access Journals (Sweden)

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.

Cranley Lisa A

2012-09-01

300

Effect of a Quality-Improvement Intervention on End-of-Life Care in the Intensive Care Unit  

Science.gov (United States)

Rationale: Because of high mortality, end-of-life care is an important component of intensive care. Objectives: We evaluated the effectiveness of a quality-improvement intervention to improve intensive care unit (ICU) end-of-life care. Methods: We conducted a cluster-randomized trial randomizing 12 hospitals. The intervention targeted clinicians with five components: clinician education, local champions, academic detailing, clinician feedback of quality data, and system supports. Outcomes were assessed for patients dying in the ICU or within 30 hours of ICU discharge using surveys and medical record review. Families completed Quality of Dying and Death (QODD) and satisfaction surveys. Nurses completed the QODD. Data were collected during baseline and follow-up at each hospital (May 2004 to February 2008). We used robust regression models to test for intervention effects, controlling for site, patient, family, and nurse characteristics. Measurements and Main Results: All hospitals completed the trial with 2,318 eligible patients and target sample sizes obtained for family and nurse surveys. The primary outcome, family-QODD, showed no change with the intervention (P = 0.33). There was no change in family satisfaction (P = 0.66) or nurse-QODD (P = 0.81). There was a nonsignificant increase in ICU days before death after the intervention (hazard ratio = 0.9; P = 0.07). Among patients undergoing withdrawal of mechanical ventilation, there was no change in time from admission to withdrawal (hazard ratio = 1.0; P = 0.81). Conclusions: We found this intervention was associated with no improvement in quality of dying and no change in ICU length of stay before death or time from ICU admission to withdrawal of life-sustaining measures. Improving ICU end-of-life care will require interventions with more direct contact with patients and families. Clinical trial registered with www.clinicaltrials.gov (NCT00685893). PMID:20833820

Curtis, J. Randall; Nielsen, Elizabeth L.; Treece, Patsy D.; Downey, Lois; Dotolo, Danae; Shannon, Sarah E.; Back, Anthony L.; Rubenfeld, Gordon D.; Engelberg, Ruth A.

2011-01-01

301

Hearing Parents' and Carers' Voices: Experiences of Accessing Quality Long Day Care in Northern Regional Australia  

Science.gov (United States)

This article explores parents' and carers' experiences of accessing quality long day care in northern regional Australia. The data was gathered in 2009, after the collapse of ABC Developmental Learning Centres (herein referred to as ABC Learning) and before the implementation of the "National Quality Framework," and provides a snapshot of…

Harris, Nonie; Tinning, Beth

2012-01-01

302

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

Science.gov (United States)

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

McNamara, P

2006-06-01

303

‘TOP HEAVY’ SYSTEMS AND QUALITY OF HEALTH CARE  

OpenAIRE

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

Bijoya Roy; Saswata Ghosh; Zakir Husain

2009-01-01

304

Will Choosing Wisely® improve quality and lower costs of care for patients with critical illness?  

Science.gov (United States)

In 2009, a group of experts convened by the Institute of Medicine estimated that 30% of health care costs amounted to waste, including a substantial share from nonbeneficial and often harmful services. Professional organizations and medical ethicists subsequently called on specialty groups to generate "top five" lists of expensive tests or treatments without known benefits. Responding to this call, the American Board of Internal Medicine launched its Choosing Wisely campaign, with the top-five Choosing Wisely lists for pulmonary medicine and critical care released in 2014. In order for the critical care list to have an impact on costs and quality, two things must occur: providers whose practice is discordant with the list must adhere to the list when making decisions, and those decisions must lead to improvements in the quality of care at lower costs. Although the campaign addresses some limitations of past efforts to improve quality and reduce waste, we believe it will do little to change provider behavior. Even if the top-five list for critical care were to change the behavior of providers, its ultimate impact on costs and quality will be lower than anticipated. Here we suggest several strategies for stakeholders to increase the impact of the critical care top-five list, and further discuss that despite limitations of the campaign it is still imperative for advancing best practice in critical care. PMID:24762102

Admon, Andrew J; Cooke, Colin R

2014-06-01

305

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

Scientific Electronic Library Online (English)

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

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

2012-12-01

306

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

Directory of Open Access Journals (Sweden)

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

Marianne Storm

2014-05-01

307

Perinatal oxygen in the developing lung.  

Science.gov (United States)

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

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

2015-02-01

308

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

Directory of Open Access Journals (Sweden)

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

Heidari Gorji Ali

2011-12-01

309

Paths to partnership: Veterans Health Administration's Journey in pilot testing breast cancer care quality measures.  

Science.gov (United States)

Prioritizing personalized, proactive, patient-driven health care is among the Veterans Health Administration's (VHA's) transformational initiatives. As one of the largest integrated healthcare systems, the VHA sets standards for performance measures and outcomes achieved in quality of care. Evidence-based practice (EBP) is a hallmark in oncology nursing care. EBP can be linked to positive outcomes and improving quality that can be influenced directly by nursing interventions. VHA oncology nurses had the opportunity to partner with the Oncology Nursing Society (ONS), ONS Foundation, and the Joint Commission in the multiyear development of a comprehensive approach to quality cancer care. Building on a platform of existing measures and refining measurement sets culminated in testing evidence-based, nursing-sensitive quality measures for reliability through the ONS Foundation-supported Breast Cancer Care (BCC) Quality Measures Set. The BCC Measures afforded the VHA to have its many sites collectively assess documentation of the symptoms of patients with breast cancer, the use of colony-stimulating factors, and education about neutropenia precautions provided. Parallel paths of the groups, seeking evidence-based measures, led to the perfect partnership in the VHA's journey in pilot testing the BCC Measures in veterans with breast cancer. This generated further quality assessments and continuous improvement projects for spread and sustainability throughout the VHA. PMID:25252994

Hogg, Lori Hoffman

2014-10-01

310

42 CFR 483.25 - Quality of care.  

Science.gov (United States)

...receives appropriate treatment and services to correct...receives the appropriate treatment and services to prevent...Receives a therapeutic diet when there is a nutritional...residents receive proper treatment and care for the following...In excessive dose (including duplicate drug...

2010-10-01

311

38 CFR 51.120 - Quality of care.  

Science.gov (United States)

...receives appropriate treatment and services to correct...receives the appropriate treatment and services to prevent...Receives a therapeutic diet when a nutritional deficiency...residents receive proper treatment and care for the following...In excessive dose (including duplicate drug...

2010-07-01

312

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

Science.gov (United States)

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

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

2014-12-01

313

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

OpenAIRE

AIM: To create and apply a framework for quality assessment and improvement in care for inflammatory bowel disease (IBD) patients. less thanbrgreater than less thanbrgreater thanMETHODS 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 pe...

Martin Rejler; Xf Rgen Tholstrup, J.; Mattias Elg; Anna Spångéus; Xe Re, Boel Andersson G.

2012-01-01

314

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

Directory of Open Access Journals (Sweden)

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

Gholam Reza Mahmodi

2012-05-01

315

Assessment of health care quality in the tertiary level pediatric hospitals in Serbia  

OpenAIRE

Background/Aim. It is necessary to improve the quality of health care for children. Assessment data would provide new insights into better treatment outcomes. The aim of this descriptive study was to estimate and to compare applied quality indicators in five pediatric inpatient tertiary level institutions in Serbia during the period from January 1st to December 31st 2008. Methods. Quality data and indicators were collected in the Institute for Public Health of Serbia “Dr. Milan Jovano...

Kuburovi? Nina; ?uri?i? Slaviša M.; Neškovi? An?elija; Dedi? Velimir; Kuburovi? Vladimir

2011-01-01

316

Quality of provided care in vascular surgery : outcome assessment & improvement strategies  

OpenAIRE

The aim of this thesis was to evaluate the quality of care in vascular surgery in end-stage renal disease (ESRD) and peripheral arterial occlusive disease (PAOD): intermittent claudication (IC) and critical lower limb ischaemia (CLI) patients. Therefore firstly it focused on the improvement of the quality of perioperative patient management concerning: (1) a systematic review concerning all quality initiatives in vascular surgery was conducted, (2) an assessed of the implementation of establi...

Flu, Hans Christiaan

2010-01-01

317

[Acceptance of dental care guidelines by quality circles].  

Science.gov (United States)

The discussion about the advantages of evidence-based guidelines in daily dental practice is a matter of current interest. In this report three high-quality S3 level pilot guidelines which have been developed in dental medicine were evaluated under practice conditions. Quality circles in the city of Hamburg readily accepted to join this survey. By means of a questionnaire before and after a 4-month field test in dental practices the participants of quality circles were interviewed about their attitude towards guidelines and to the application of the guidelines. In addition, the experience gained with the application of the guidelines was incorporated into a group discussion with moderators of quality circles. The inclusion of quantitative and qualitative methods enabled a recording of the complete range of differentiated opinions concerning the application of guidelines. The results show that the concerns expressed by participants can be reduced by integrating guidelines in their everyday clinical practice. A strength and weakness analysis demonstrates that the quality circle moderators' attitudes towards approved guidelines range from rather positive to ambivalent. Field testing by quality circles proves to be a sound method for evaluating the acceptance of guidelines in daily practice. PMID:21095616

Bergmann-Krauss, Barbara; Micheelis, Wolfgang; Szecsenyi, Joachim

2010-01-01

318

Perinatal Mortality In Employed Women  

OpenAIRE

Research questions: Is employment during pregnancy a risk factor for perinatal mortality? Objective: To study the occurrence of perinatal mortality in working women and compare the results with those of non-working women taken as controls and also between the experience of working women before and after joining service. Study design: Retrospective cohort study. Setting: Jute mills in Hooghly district of West Bengal. Participants: 100 women workers of the mills under study as study population ...

Banerjee Bratati; Chatterjee Pronab; Kanti Dey Tushar

2003-01-01

319

Morale and quality of life among frail older users of community care: key issues for the success of community care  

OpenAIRE

Many Social Services Departments have successfully developed services which meet older people’s physical survival needs so that they can continue living in their own homes despite serious disabilities. An emerging priority is to support the morale and quality of life of the same individuals. Assisted by SPRU, a team of Social Services managers conducted a programme of interviews, designed to obtain the views of very old, frail home care clients about their services and their lives in genera...

Patmore, C.

2002-01-01

320

Quality of care for patients with multiple chronic conditions: the role of comorbidity interrelatedness.  

Science.gov (United States)

Multimorbidity--the presence of multiple chronic conditions in a patient--has a profound impact on health, health care utilization, and associated costs. Definitions of multimorbidity in clinical care and research have evolved over time, initially focusing on a patient's number of comorbidities and the associated magnitude of required care processes, and later recognizing the potential influence of comorbidity characteristics on patient care and outcomes. In this article, we review the relationship between multimorbidity and quality of care, and discuss how this relationship may be mediated by the degree to which conditions interact with one another to generate clinical complexity (comorbidity interrelatedness). Drawing on established theoretical frameworks from cognitive engineering and biomedical informatics, we describe how interactions among conditions result in clinical complexity and may affect quality of care. We discuss how this comorbidity interrelatedness influences the value of existing quality guidelines and performance metrics, and describe opportunities to quantify this construct using data widely available through electronic health records. Incorporating comorbidity interrelatedness into conceptualizations of multimorbidity has the potential to enhance clinical and research efforts that aim to improve care for patients with multiple chronic conditions. PMID:24081443

Zulman, Donna M; Asch, Steven M; Martins, Susana B; Kerr, Eve A; Hoffman, Brian B; Goldstein, Mary K

2014-03-01

321

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

Science.gov (United States)

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

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

2014-12-01

322

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

Directory of Open Access Journals (Sweden)

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

Jaakko Matomäki

2013-03-01

323

Baby Care 101  

Medline Plus

Full Text Available ... body Prenatal care Eating and nutrition Physical activity Emotional and life changes Staying safe Smoking, alcohol and ... Professionals Info for your patients Medical resources Professional education Perinatal Statistics Scholarships and grants Advocacy Federal advocacy ...

324

The quality in psychiatric care-forensic in-patient instrument: psychometric properties and patient views of the quality of forensic psychiatric services in Sweden.  

Science.gov (United States)

The aim of this study was to evaluate the psychometric properties and dimensionality of the instrument Quality in Psychiatric Care-Forensic In-Patient and to describe the quality of psychiatric care among forensic in-patients. The study group consisted of patients all receiving care during 2 weeks in September 2009 and meeting the inclusion criteria. A sample of 134 in-patients from 34 forensic wards in Sweden participated. Confirmatory factor analysis revealed a seven-factor structure, and 69% of the patients reported the quality of care as high. The highest rating was for the secluded environment dimension, and the lowest was for the participation dimension. The Quality in Psychiatric Care-Forensic In-Patient is a reliable and valid measurement instrument recommended for use in evaluating quality in forensic in-patient care. PMID:24256985

Schröder, Agneta; Agrim, Joakim; Lundqvist, Lars-Olov

2013-01-01

325

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

Directory of Open Access Journals (Sweden)

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

Goh Teik T

2009-10-01

326

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

DEFF Research Database (Denmark)

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

Rostgaard, Tine

2012-01-01

327

Enhancing home-based child care quality through video-feedback intervention: a randomized controlled trial.  

Science.gov (United States)

In the present randomized controlled trial, the effectiveness of video-feedback intervention to promote positive parenting-child care (VIPP-CC) was tested in home-based child care. Forty-eight caregivers were randomly assigned either to the intervention group or to the control group. Global child care quality improved in the intervention group but not in the control group. The program did not change observed caregiver sensitivity. After the intervention however, caregivers in the intervention group reported a more positive attitude toward sensitive caregiving than caregivers in the control group. The study shows that the family-based intervention can be applied with some minor modifications in a professional group setting as well. The brief VIPP-CC program is an important tool for enhancing quality of home-based child care. PMID:21355649

Groeneveld, Marleen G; Vermeer, Harriet J; van Ijzendoorn, Marinus H; Linting, Mariëlle

2011-02-01

328

Evaluation of an intervention to improve quality of care in family planning programme in the Philippines.  

Science.gov (United States)

This paper presents the results of a longitudinal intervention study carried out in the Davao del Norte province of the Philippines. The intervention, tested through a quasi-experimental design, consisted of training of family planning service providers in information exchange and training of their supervisors in facilitative supervision. The training intervention significantly improved providers' knowledge and quality of care received by clients. Moreover, good quality care received by clients at the time of initiating contraception use increased the likelihood of contraceptive continuation and decreased the likelihood of both having an unintended pregnancy and an unwanted birth. However, comparison of women in the experimental group with those in the control group did not show any significant effect of provider-level training intervention on these client-level outcomes. The reasons for this conundrum and the implications for quality of care are discussed. PMID:21933467

Jain, Anrudh K; Ramarao, Saumya; Kim, Jacqueline; Costello, Marilou

2012-01-01

329

C-A2-04: The Geisinger Transitions of Care Initiative: Overview of an Interdisciplinary Quality Improvement Process  

OpenAIRE

Background: Care transitions between inpatient and outpatient providers are quickly becoming a surrogate marker of quality for care of the hospitalized patient. Almost one in six (17.6%) Medicare patients are readmitted within 30 days of hospital discharge. As a result the Centers for Medicare and Medicaid Services (CMS) is targeting readmissions as a probable marker for both poor quality of care and money going down the drain. The Geisinger Transitions of Care Initiative (TOCI) focuses on cr...

Bulger, John B.; Maynor, Kenric A.; Frazier, Seth

2010-01-01

330

Developing a Total Quality Management Model for Health Care Systems  

OpenAIRE

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

Am, Mosadegh Rad; Ansarian, M.

2005-01-01

331

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

DEFF Research Database (Denmark)

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

Ingeman, A.; Pedersen, Lars

2008-01-01

332

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

OpenAIRE

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

Kebalepile, Tapiwa Mavis

2001-01-01

333

HIV in Kenya: Sexual behaviour and quality of care of sexually transmitted diseases  

OpenAIRE

This thesis describes three important determinants of HIV spread in Kenya: 1. Sexual behaviour of female sex workers, their clients, and young adults 2. Health care seeking behaviour for sexually transmitted diseases (STD) 3. Quality of STD care in the public and private health sector The first determinant was studied in urban and rural areas of Nyanza, the province in the west of Kenya which has the highest HIV prevalence. The latter two determinants were studie...

Voeten, H. A. C. M.

2006-01-01

334

The effects of the implementation of snoezelen on the quality of working life in psychogeriatric care  

OpenAIRE

BACKGROUND: Dementia among nursing home residents is often accompanied by high care dependency and behavioral disturbances, resulting in an increased workload for the caregivers. Snoezelen, integrated into 24-hour dementia care, is an approach that might improve the quality of working life of dementia caregivers. This study aims to investigate the effectiveness of integrated snoezelen on work-related outcomes (workload and psychological outcomes) of caregivers in psychogeriatric nursing homes...

Weert, J. C. M.; Dulmen, A. M.; Spreeuwenberg, P.; Bensing, J. M.; Ribbe, M. W.

2005-01-01

335

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

OpenAIRE

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

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

2011-01-01

336

Quality improvement in the care of patients with inflammatory bowel disease  

OpenAIRE

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

Rejler, Martin

2012-01-01

337

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

OpenAIRE

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...

Jo, Busari

2012-01-01

338

Improving the quality of morbidity indicators in electronic health records in Swiss primary care  

OpenAIRE

QUESTIONS UNDER STUDY: The FIRE Project established a standardised data collection to facilitate research and quality improvement projects in Swiss primary care. The project is based on the concept of merging clinical and administrative data. Since chronic conditions and multimorbidity are major challenges in primary care, in this study we investigated the agreement between different approaches to identify patients with chronic and multimorbid conditions in electronic medical records (EMRs). ...

Busato, A.; Bhend, H.; Chmiel, C.; Tandjung, R.; Senn, O.; Zoller, M.; Rosemann, T.

2012-01-01

339

With or Without: Empirical Analyses of Disparities in Health Care Access and Quality  

OpenAIRE

The existence of unfair differences or disparities in access to and quality of health care is well known. However, the nature of disparities at different stages of the health seeking pathway and interventions to reduce them are less clear. Applying the tools of statistics and quasi experimental design-- interrupted time series, propensity score matching, hierarchical models---we can analyze how care is accessed in low, middle and high income countries and assess for disparities. The results a...

Pande, Aakanksha

2012-01-01

340

EuroCareCF Quality Assessment of Diagnostic Microbiology of Cystic Fibrosis Isolates?  

OpenAIRE

The identification of microbial species from respiratory specimens and their susceptibility to antimicrobial agents are among the most important diagnostic measures of care for patients with cystic fibrosis (CF). Under the umbrella of EuroCareCF, two quality assurance trials of CF microbiology were performed in 2007 and 2008. Nine formulations with CF bacterial isolates were dispatched. A total of 31/37 laboratories from 18/21 European countries participated in the 2007 and 2008 trials. The c...

Hogardt, Michael; Ulrich, Jutta; Riehn-kopp, Helga; Tu?mmler, Burkhard

2009-01-01

341

How palliative care can reduce healthcare costs & improve quality of care  

Directory of Open Access Journals (Sweden)

Full Text Available The sustainability of the healthcare system has been in question for several years. With rising healthcare costs, limited resources and an aging population, society needs to come up with innovative ideas to reduce healthcare spending. This paper attempts to illustrate how addressing goals of care can have a significant impact on healthcare costs.  

Kwadwo Kyeremanteng

2013-12-01

342

Moving the Goal Posts: The Shift from Child Care Supply to Child Care Quality  

Science.gov (United States)

As policymakers in Madison redesign the state's child care subsidy program--known as Wisconsin Shares--it is important to understand the original vision for the program. This report investigates the development and implementation of Wisconsin Shares and its linkages to the state's landmark W-2 welfare reform initiative. In particular, the authors…

Dickman, Anneliese; Kovach, Melissa; Smith, Annemarie; Henken, Rob

2010-01-01

343

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

OpenAIRE

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

Fournier Pierre; Dogba Maman

2009-01-01

344

"Assessing The Quality Of Care In Patients With Acute Coronary Syndrome In A TUMS-Affiliated Hospital (2003-2004) "  

OpenAIRE

Background and Aim: Quality of care and its concordance with scientific evidence has a significant role in improvement of prognosis in patients with acute coronary syndrome (ACS). The present study was performed to evaluate the quality of care in a TUMS-affiliated hospital. Materials and Methods: The quality indicators of the process and outcome of care according to guidelines of the MONICA project was used in this study. 320 cases with primary impression of ACS (including 80 cases from each ...

Fakhrzadeh, H.; Moradi, M.; Mj, Mahmoudi; Naderpoor, N.; Bagheri Rad, M.; Mj, Mahmoodi; Arefi, M. Ahmadzad-asl H.

2006-01-01

345

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

Science.gov (United States)

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

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

346

Trends in perinatal mortality and cerebral palsy in Western Australia, 1967 to 1985.  

OpenAIRE

OBJECTIVE--To analyse the trends in stillbirths, neonatal deaths, and cerebral palsy in all infants born in Western Australia from 1967 to 1985. To relate these trends to changes in perinatal care, particularly in relation to avoidance of intrapartum asphyxia in term infants and the increased survival of low birthweight infants. DESIGN--Descriptive epidemiological study calculating population rates for perinatal deaths and cerebral palsy according to year of birth and birth weight. SETTING--W...

Stanley, F. J.; Watson, L.

1992-01-01

347

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

OpenAIRE

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

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

2012-01-01

348

Emergency Care and the National Quality Strategy: Highlights From the Centers for Medicare & Medicaid Services.  

Science.gov (United States)

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

Venkatesh, Arjun K; Goodrich, Kate

2014-08-13

349

[The role of motivation of medical personnel in system of medical care quality support].  

Science.gov (United States)

The article considers causes of insufficient quality of medical care. The low motivation of paramedical personnel during medical services rendering is examined. The sociological survey data made it possible to analyze opinion of students of medical college as future paramedical personnel concerning attractiveness of this profession. Their social and material status was established. The notions concerning possibility of carrier and professional progress were established too. The factors hampering involvement of this category of professionals into public health system and negatively impacting medical care quality were analyzed. PMID:25373296

Pogosian, S G; Sidorenkov, D A; Balokhina, S A; Orlov, A E

2014-01-01

350

The experience of quality of care in patients with diabetes type 2   

OpenAIRE

ABSTRACT In Sweden diabetes is one of the largest illnesses and today there’s about 300 000 people who’s affected with the illness. Out of the people who’s affected by diabetes 90 % of them suffer from diabetes type 2. The illness is expected to increase greatly in the future. The aim of this literature review was to describe how patients with diabetes type 2 experienced their quality of care. It’s important that the quality of care for people who suffers from diabetes type 2 is at a ...

Pramborn, Anders

2008-01-01

351

Markers of Access to and Quality of Primary Care for Aboriginal People in Ontario, Canada  

Science.gov (United States)

Objectives. We evaluated primary care accessibility and quality for Ontario’s aboriginal population. Methods. We compared a defined aboriginal cohort with nonaboriginal populations with analogous geographic isolation and low socioeconomic status. We determined rates of hospitalization for the following indicators of adequacy of primary care: ambulatory care–sensitive (ACS) conditions and utilization of referral care–sensitive (RCS) procedures from administrative databases. Results. ACS hospitalization rates, relative to the general population, were 2.54, 1.50, and 1.14 for the aboriginal population, the geographic control populations, and the socioeconomic control populations, respectively. The relative RCS procedure utilization rates were 0.64, 0.91, and 1.00, respectively. Conclusions. The increased ACS hospitalization rate and reduced RCS procedure utilization rate suggest that northern Ontario’s aboriginal residents have insufficient or ineffective primary care. PMID:12721147

Shah, Baiju R.; Gunraj, Nadia; Hux, Janet E.

2003-01-01

352

Care Burden and Quality of Life Among the Caregivers of Patients with COPD  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: An individual with COPD needs the assistance and support of the caregiver in many areas, such as his daily life, medicines and medical controls. The difficulties undergone during the disease course affect not only patients but also their caregivers. The aim of the research was to determine the care burden and quality of life of caregivers.Materials and Methods: Two hundred and eighteen caregivers of COPD patients who lived within the responsibility area of a district clinic were included in the research. The Informational Form, Burden Interview and WHOQOL BREF were used to collect the data. Results: It was found that the quality of life of caregivers decreased as the care burden increased. The caregivers whowere aged 45 and literate was lower. The social domain of the quality of life of those who were widowed and had an insufficient economic income was lower. All domains of the quality of life among those who lived in separated families were low. Scores of psychological and social domains of the caregivers of female patients were lower, whereas scores of the social domain of caregivers who had dependent patients, had completed primary education and used aids to daily living were lower.Conclusion: The quality of life of the caregivers decreases while they perform care of the COPD patient. The burden of caregivers who experience difficulties in the care increases.

Hatice Tel

2012-08-01

353

[Steps to improve the quality of urinary incontinence care].  

Science.gov (United States)

Urinary incontinence is a frequent symptom rarely spontaneously reported. This emphasizes the need to address it in every patient. Once disclosed, its origin needs to be specified so that therapeutic issues may be reached. These being often efficient, patient quality of life will improve significantly. In order to improve urinary incontinence management, a multidisciplinary group of healthcare professionals of our institution have proposed to spread basic knowledge, screening tools and evaluation scales of this bothersome worldwide symptom. This team enables healthcare providers to unite themselves in a network which will help to orientate patients in order to fulfill their needs. PMID:24416886

Kassouha, Ammar; Gogniat, Véronique; Vuagnat, Hubert; Meriat, Habib; Iselin, Christophe

2013-12-01

354

Modern cosmetic products for skin care: Formulations and quality requirements  

Directory of Open Access Journals (Sweden)

Full Text Available The efficiency of modern cosmetic products mostly involves multifunctionality. The denoted requirements impose on producers of cosmetic raw materials and preparations the continuous improvement of formulations of existing emulsion supports for cosmetically active substancs, the use of new raw materials and technologies for manufacturing preparations, as well as the development of completely new supports for active components and a large number of various sources and concepts for obtaining cosmetically active substances. Special requirements for the quality of cosmetic raw materials and products are analyzed, as well as the corresponding legislation.

Vuleta Gordana

2003-01-01

355

Racial and ethnic disparities in access to and quality of health care.  

Science.gov (United States)

Racial and ethnic disparities in access to care and quality of care are pervasive but not universal. This Synthesis reviews the evidence on racial and ethnic disparities. Key findings include: disparities exist in many indicators of access, such as having a usual source of care, number of ambulatory visits, and receiving recommended preventive care, but some disparities are reduced or nearly eliminated after adjusting for factors such as income and insurance coverage. Hispanics have a large gap relative to Whites in many access factors. Spanish-speaking Hispanics have the greatest disparities relative to non-Hispanic whites, suggesting language is a barrier. Both Blacks and Hispanics are less likely than Whites to identify a doctor's office as their usual source of care, which can point to problems with continuity of care and less favorable outcomes. The most significant disparities in quality of care involve newer therapies and invasive procedures. Adjusting the data for insurance coverage demonstrates that expanding coverage will reduce but not eliminate disparities. PMID:22051771

Escarce, Jose J; Goodell, Sarah

2007-09-01

356

Chief Complaint-Based Performance Measures: A New Focus for Acute Care Quality Measurement.  

Science.gov (United States)

Performance measures are increasingly important to guide meaningful quality improvement efforts and value-based reimbursement. Populations included in most current hospital performance measures are defined by recorded diagnoses using International Classification of Diseases, Ninth Revision codes in administrative claims data. Although the diagnosis-centric approach allows the assessment of disease-specific quality, it fails to measure one of the primary functions of emergency department (ED) care, which involves diagnosing, risk stratifying, and treating patients' potentially life-threatening conditions according to symptoms (ie, chief complaints). In this article, we propose chief complaint-based quality measures as a means to enhance the evaluation of quality and value in emergency care. We discuss the potential benefits of chief complaint-based measures, describe opportunities to mitigate challenges, propose an example measure set, and present several recommendations to advance this paradigm in ED-based performance measurement. PMID:25443989

Griffey, Richard T; Pines, Jesse M; Farley, Heather L; Phelan, Michael P; Beach, Christopher; Schuur, Jeremiah D; Venkatesh, Arjun K

2014-10-16

357

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

Science.gov (United States)

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

Waßmuth, Ralf

2015-01-01

358

Resultados maternos e perinatais de dez anos de assistência obstétrica a portadoras do vírus da imunodeficiência humana Maternal and perinatal results in ten years of obstetrical care to human immunodeficiency virus-infected women  

Directory of Open Access Journals (Sweden)

Full Text Available OBJETIVOS: avaliar a transmissão vertical do vírus da imunodeficiência humana (HIV e os fatores de risco associados à infecção perinatal. MÉTODOS: estudo descritivo de 170 gestantes infectadas pelo HIV e seus 188 recém-nascidos, admitidas na Maternidade do Hospital das Clínicas da UFMG, no período de junho de 1994 a setembro de 2004. Foram analisados as características demográficas, o perfil sorológico e a via de parto das gestantes, assim como os resultados perinatais. As crianças foram acompanhadas por período de 18 meses após o nascimento. Os dados foram armazenados e analisados no Epi-Info, Versão 6.0. Estabeleceu-se intervalo de confiança a 95% (pPURPOSE: to evaluate human immunodeficiency virus (HIV vertical transmission and risk factors related to perinatal infection. METHODS: descriptive study of 170 HIV-infected pregnant women and their 188 neonates, admitted from June 1994 to September 2004 at the "Maternidade do Hospital das Clínicas da UFMG". Demographic characteristics, mother's serologic state, mode of delivery and perinatal results were analyzed. Children were followed for 18 months after birth. Data were stored and analyzed by Epi-Info, version 6.0. Confidence interval was established at 95% (p<0.05. RESULTS: HIV infection was confirmed in 84 (45.4% patients during gestation. Viral load was below 1,000 copies/mL in 60.4% patients. Highly active antiretroviral therapy was the predominant antiretroviral regimen (65.5%. C-section rate was high: 79.5%. Prematurity rate was 18.2%. There were 184 (97.8% live births and four (2.2% perinatal deaths among 188 neonates. Among live neonates 97.8% received zidovudine after birth. Global mother-to-child transmission rate was 3.8%. Virus vertical transmission rates for each period were: 60%, until 1996; 28% between 1996 and 1998; 0.68%, between 1999 and 2004. Significant risk factors were not found related to perinatal HIV-infection because there was a small number of infected neonates (n=6. CONCLUSION: there was a great reduction of HIV vertical transmission during the analyzed period. Current transmission rate is zero. This confirms that by adopting adequate measures perinatal virus transmission can be prevented.

Victor Hugo Melo

2005-11-01

359

Quality and effectiveness of different approaches to primary care delivery in Brazil  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Since 1994, Brazil has developed a primary care system based on multidisciplinary teams which include not only a physician and a nurse, but also 4–6 lay community health workers. This system now consists of 26,650 teams, covering 46% of the Brazilian population. Yet relatively few investigations have examined its effectiveness, especially in contrast with that of the traditional multi-specialty physician team approach it is replacing, or that of other existing family medicine approaches placing less emphasis on lay community health workers. Primary health care can be defined through its domains of access to first contact, continuity, coordination, comprehensiveness, community orientation and family orientation. These attributes can be ascertained via instruments such as the Primary Care Assessment Tool (PCATool, and correlated with the effectiveness of care. The objectives of our study are to validate the adult version of this instrument in Portuguese, identify the extent (quality of primary care present in different models of primary care services, and correlate this extent with measures of process and outcomes in patients with diabetes, hypertension and coronary heart disease (CHD. Methods/Design We are conducting a population-based cross-sectional study of primary care in the municipality of Porto Alegre. We will interview a random sample totaling 3000 adults residing in geographic areas covered by four distinct models of primary care of the Brazilian national health system or, alternatively, by one nationally prominent complementary health care service, as well as the physicians and nurses of the health teams of these services. Interviews query perceived quality of care (PCATool-Adult Version, patient satisfaction, and process indicators of management of diabetes, hypertension and known CHD. We are measuring blood pressure, anthropometrics and, in adults with known diabetes, glycated hemoglobin. Discussion We hope to contribute not only by validating the PCATool-Adult Version for use in Brazil, but also by furnishing ample data concerning the appropriate mix of health care professionals in the primary care team, a question of international import. Once validated, future use of this instrument should help direct advances aiming at improving the quality of primary care in Brazil.

Trindade Thiago G

2006-12-01

360

The transport on newborns in the perinatal and neonatal period  

Directory of Open Access Journals (Sweden)

Full Text Available The rapid advances in neonatal care of the past two decades have been accompanied by a decrease in neonatal mortality. Neonatal mortality and morbidity rates depend not only on technological advances, but also on the way in which perinatal care is organized. The transport of mother and her baby from a referring hospital to a tertiary care center may become necessary. Ideally the mother would be transferred to the tertiary center before delivery of a high-risk infant, but this is not always possible.

M. Adnan Öztürk

2007-06-01

361

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

OpenAIRE

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

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

2006-01-01

362

Can health insurance improve access to quality care for the Indian poor?  

OpenAIRE

PURPOSE: Recently, the Indian government launched health insurance schemes for the poor both to protect them from high health spending and to improve access to high-quality health services. This article aims to review the potentials of health insurance interventions in order to improve access to quality care in India based on experiences of community health insurance schemes. DATA SOURCES: PubMed, Ovid MEDLINE (R), All EBM Reviews, CSA Sociological Abstracts, CSA Social Service Abstracts, Eco...

Michielsen, J.; Criel, B.; Devadasan, N.; Soors, W.; Wouters, E.; Meulemans, H.

2011-01-01

363

The 'off-hour' effect in trauma care: a possible quality indicator with appealing characteristics  

OpenAIRE

Abstract A recent paper has drawn attention to the paucity of widely accepted quality indicators for trauma care. At the same time, several studies have measured whether mortality of trauma patients changes between normal working time and other parts of the day/week, i.e. the so-called 'off-hour' or 'weekend' effect. This measure has the characteristics to become an accepted quality indicator because it combines the advantages of both outcome and process indicators. As an outcome in...

Di Bartolomeo Stefano

2011-01-01

364

The Dorset Seedcorn Project: interprofessional learning and continuous quality improvement in primary care.  

OpenAIRE

There is a need to develop models of practice-based learning that are effective in bringing about improvement in the quality of care that patients receive. This paper describes a facilitated practice-based project where five general practices in Dorset formed interprofessional teams that worked over a six-month period using a continuous quality improvement (CQI) approach to make a change in areas of importance to them. All the teams completed the project and planned and implemented demonstrab...

Wilcock, Peter M.; Campion-smith, Charles; Head, Michael

2002-01-01

365

Comprehension of Quality Care Indicators: Differences Among Privately Insured, Publicly Insured, and Uninsured  

OpenAIRE

This study explores consumers' comprehension of quality indicators appearing in health care report cards. Content analyses of focus group transcripts show differences in understanding individual quality indicators and among three populations: privately insured; Medicaid; and uninsured. Several rounds of coding and analysis assess: the degree of comprehension; what important ideas are not understood; and what exactly is not understood about the indicator (inter-rater reliability exceeded 94 pe...

Jewett, Jacquelyn J.; Hibbard, Judith H.

1996-01-01

366

The role of performance measures for improving quality in managed care organizations.  

OpenAIRE

OBJECTIVES: To understand how managed care plans use performance measures for quality improvement and to identify the strengths and weaknesses of currently used standardized performance measures such as the Health Plan Employer Data and Information Set (HEDIS) and the Consumer Assessment of Health Plans (CAHPS) survey. DATA SOURCES/STUDY SETTING: Representatives (chief executive officers, medical directors, and quality-improvement directors) from 24 health plans in four states were surveyed. ...

Scanlon, D. P.; Darby, C.; Rolph, E.; Doty, H. E.

2001-01-01

367

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

OpenAIRE

Background & Objective: Poor physical and psychological health status in chemical warfare victims could result in decreasing quality of sleep. This study was conducted in order to evaluate the effect of using Continuous Care Model on sleep quality in chemical warfare victims with bronchiolitis obliterans. Methods & Materials: A total of 62 chemical warfare victims with bronchiolitis obliterans were recruited to the study. The participants were randomly allocated to experimenta...

Mehdizadeh, S.; Mm, Salaree; Ebadi, A.; Aslani, J.; Naderi, Z.; Jafari Varjoshani, N.

2010-01-01

368

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

OpenAIRE

Objective: investigate the quality of life of three health care workers in a philanthropic Hospital in Minas Gerais. Method: this is about a descriptive study, from transversal design (n=27) with nurses, doctors and physiotherapists whom work in a philanthropic Hospital in Minas Gerais. The valid and reliable Portuguese WHOQOL-bref version was used as a tool to measure quality of life. The study was approved by the Research Ethics Committee of the Pontifícia Universidade Católica de Minas G...

Josiane Costa Sales, Carolina Marques Borges

2010-01-01

369

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

Scientific Electronic Library Online (English)

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

Linda, Gask.

2007-03-01

370

How much time is available for antenatal care consultations? Assessment of the quality of care in rural Tanzania  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Many women in Sub-Saharan African countries do not receive key recommended interventions during routine antenatal care (ANC including information on pregnancy, related complications, and importance of skilled delivery attendance. We undertook a process evaluation of a successful cluster randomized trial testing the effectiveness of birth plans in increasing utilization of skilled delivery and postnatal care in Ngorongoro district, rural Tanzania, to document the time spent by health care providers on providing the recommended components of ANC. Methods The study was conducted in 16 health units (eight units in each arm of the trial. We observed, timed, and audio-recorded ANC consultations to assess the total time providers spent with each woman and the time spent for the delivery of each component of care. T-test statistics were used to compare the total time and time spent for the various components of ANC in the two arms of the trial. We also identified the topics discussed during the counselling and health education sessions, and examined the quality of the provider-woman interaction. Results The mean total duration for initial ANC consultations was 40.1 minutes (range 33-47 in the intervention arm versus 19.9 (range 12-32 in the control arm p Conclusion Although the implementation of birth plans in the intervention health units improved provider-women dialogue on skilled delivery attendance, most recommended topics critical to improving maternal and newborn survival were rarely covered.

Cousens Simon

2011-09-01

371

Psychosocial impact of perinatal loss among Muslim women  

Directory of Open Access Journals (Sweden)

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

Sutan Rosnah

2012-06-01

372

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

DEFF Research Database (Denmark)

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

TØttenborg, Sandra SØgaard; Thomsen, Reimar W.

2012-01-01

373

Ventilation, indoor air quality, and human health and comfort in dwellings and day-care centers  

Energy Technology Data Exchange (ETDEWEB)

The objective of the study was to assess the actual ventilation and indoor air quality in the Finnish building stock (dwellings and day-care centers) with special reference to the existing guideline values. Furthermore, the objective was to evaluate the occurrence of symptoms and perceptions among occupants (adult residents, children, workers) in relation to ventilation system, ventilation rate and dampness. The measurements of ventilation and indoor air quality in the dwellings and day-care centers included ventilation rate, CO{sub 2} concentration, and temperature and humidity. Self- and parent-administered questionnaires were distributed to the occupants inquiring their personal characteristics, occurrence of symptoms of interest, perceived indoor air quality and details of their home and work environments. Airflows and air change rates varied remarkably both in the dwellings and day-care centers. In the majority of the dwellings and day-care centers, the Finnish guideline values of ventilation rates were not achieved. No consistent associations were observed between the magnitude of mechanical ventilation rates and the occurrence of eye, respiratory, skin and general symptoms, that is, symptoms of sick building syndrome (SBS) among the day-care workers. The results indicate that there is much room for improvement in the ventilation and indoor air quality of Finnish dwellings and day-care centers. The control of ventilation, temperature and humidity and the prevention of water damage are important issues on which to concentrate in the future. There is need to improve the quality in all phases of construction: design, installation, adjustment, operation, and maintenance

Ruotsalainen, R.

1995-12-31

374

Perinatal mortality in diabetic pregnancy.  

Science.gov (United States)

Perinatal mortality rate (PMR) is one of the most important perinatal health indicators. PMR in diabetic pregnancies varies throughout the world and is higher than the background PMR. The prevalence of pregestational diabetes is increasing and is associated with an elevated risk of congenital malformations, macrosomia, preeclampsia, and preterm delivery. The incidence of PMR in preexisting diabetes mellitus ranges considerably, with congenital abnormalities and preterm labor the main factors contributing to the higher PMR. Women with gestational diabetes mellitus or impaired glucose tolerance are a mixed group that may have low to a high PMR, especially if they require insulin in their pregnancy. All the known diabetic women should plan their pregnancies and optimize glycemic control periconceptually and throughout pregnancy, as this reduces the frequency of congenital abnormalities, obstetric complications, and perinatal mortality. PMID:20840259

Vitoratos, N; Vrachnis, N; Valsamakis, G; Panoulis, K; Creatsas, G

2010-09-01

375

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

Science.gov (United States)

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

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

2006-01-01

376

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

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

S Mehdizadeh

2010-11-01

377

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

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Full Text Available This study aims to identify quality gap by assessing users` perceptions and expectations of primary health care quality at Kashan district health centers in Iran. This cross sectional study was carried out during the first three months of 2002. A total of 324 regular female users of primary health care services at Kashan district health centers have been approached. Random sampling of the households covered by each health center was undertaken. The survey instrument was designed around the validated SERVQUAL instrument. Service quality gap was measured by computing the difference between the rating respondents assign to expectations and perceptions statements. Internal consistency of different items of expectations and perceptions were 0.80 and 0.85, respectively using Cronbach`s alpha coefficient. The Wilcoxon signed rank test to compare the distributions of the expectations and perceptions. Results show that there were mean differences between clients` expectations and perceptions in all dimensions of service. The largest and smallest mean quality gaps were in the responsiveness and tangibility dimensions, respectively. There were significant differences between clients` expectations and perceptions. The clients` choices clearly show that responsiveness, reliability and assurance are the three most critical dimensions of health care services, respectively. Negative quality gap in all dimensions indicate that there is room for service quality improvement in all five dimensions. These findings suggest that primary health care managers should be looking carefully at each of the dimensions where customers perceive that they are receiving a different service than expected and consider the extent to which they should work on influencing expectations or perceptions, or both.

A. Kebriaei

2006-01-01

378

Communication and access to information in assessing the quality of multiprofessional care of patients  

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Full Text Available Objective: To assess the quality of a multiprofessional healthcare model for in-hospital patients by means of two performance indicators (communication and knowledge about the case. Methods: A cross-sectional study assessed the knowledge that professionals had about the clinical information of patients and the use of communication strategies by the team. Healthcare professionals were interviewed during their work period. Seven occupational categories were interviewed. A total of 199 medical charts were randomly selected for interviews, and 312 professionals of different categories were interviewed. The sample comprised mostly nurses and physical therapists in the charts that were interviewed. Results: There were no statistically significant differences between the expected performing model group and the under-performing model group for sex, location and job. In the under-performing model group, a larger number of professionals correlated with less knowledge. Communication was improved when nurses had the relevant information about interdisciplinary care (97.4%, appropriate use of the Plan of Care form (97.0%, and formalized discussions with physicians (88.2%. In the expected performing model group, it was observed that the higher the number of healthcare professionals involved, the higher the communication levels. Conclusions: This model of care based on case knowledge and multiprofessional team communication performance indices allowed to assess quality of care. This assessment is measurable and there is the possibility of establishing the quality of care delivered.

Leny Vieira Cavalheiro

2010-09-01

379

Resultados maternos e perinatais de dez anos de assistência obstétrica a portadoras do vírus da imunodeficiência humana Maternal and perinatal results in ten years of obstetrical care to human immunodeficiency virus-infected women  

OpenAIRE

OBJETIVOS: avaliar a transmissão vertical do vírus da imunodeficiência humana (HIV) e os fatores de risco associados à infecção perinatal. MÉTODOS: estudo descritivo de 170 gestantes infectadas pelo HIV e seus 188 recém-nascidos, admitidas na Maternidade do Hospital das Clínicas da UFMG, no período de junho de 1994 a setembro de 2004. Foram analisados as características demográficas, o perfil sorológico e a via de parto das gestantes, assim como os resultados perinatais. As crian...

Victor Hugo Melo; Regina Amélia Lopes Pessoa de Aguiar; Ana Christina de Lacerda Lobato; Ines Katerina Damasceno Cavallo; Fabiana Maria Kakehasi; Roberta Maia de Castro Romanelli; Jorge Andrade Pinto

2005-01-01

380

The effects of gestational anemia on perinatal outcomes  

OpenAIRE

Untreated anemia during pregnancy is reported to be associated with fetal complications. The aim of present study was to investigate perinatal outcomes associated with maternal anemia during pregnancy. Twenty-nine pregnant women with second trimester hemoglobin (Hb) levels under 8 g/dL (Group 1) and 30 over 10 g/dL (Group 2) were included. The ratios of preterm birth, intrauterine growth restriction (IUGR) and admission to neonatal intensive care unit (NICU) were recorded. Preterm...

Erdal Sak, M.; Özgür Özkul; Mehmet S?dd?k Evsen; Sibel Sak; Osman Evliyao?lu

2009-01-01

381

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

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Full Text Available 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 primary care systems have on the performance of health care systems. QUALICOPC is funded by the European Commission under the "Seventh Framework Programme". In this article the background and design of the QUALICOPC study is described. Methods/design QUALICOPC started in 2010 and will run until 2013. Data will be collected in 31 European countries (27 EU countries, Iceland, Norway, Switzerland and Turkey and in Australia, Israel and New Zealand. This study uses a three level approach of data collection: the system, practice and patient. Surveys will be held among general practitioners (GPs and their patients, providing evidence at the process and outcome level of primary care. These surveys aim to gain insight in the professional behaviour of GPs and the expectations and actions of their patients. An important aspect of this study is that each patient's questionnaire can be linked to their own GP's questionnaire. To gather data at the structure or national level, the study will use existing data sources such as the System of Health Accounts and the Primary Health Care Activity Monitor Europe (PHAMEU database. Analyses of the data will be performed using multilevel models. Discussion By its design, in which different data sources are combined for comprehensive analyses, QUALICOPC will advance the state of the art in primary care research and contribute to the discussion on the merit of strengthening primary care systems and to evidence based health policy development.

Van den Berg Michael J

2011-10-01

382

The Minimum Data Set Depression Quality Indicator: Does It Reflect Differences in Care Processes?  

Science.gov (United States)

Purpose. The objective of this work was to determine if nursing homes that score differently on prevalence of depression, according to the Minimum Data Set (MDS) quality indicator, also provide different processes of care related to depression. Design and Methods. A cross-sectional study with 396 long-term residents in 14 skilled nursing…

Simmons, S.F.; Cadogan, M.P.; Cabrera, G.R.; Al-Samarrai, N.R.; Jorge, J.S.; Levy-Storms, L.; Osterweil, D.; Schnelle, J.F.

2004-01-01

383

An evaluation of generic screens for poor quality of hospital care on a general medicine service.  

Science.gov (United States)

In this study, 675 general medicine admissions at a university teaching hospital were reviewed to evaluate six potential generic quality screens: 1) in-hospital death; 2) 28-day early readmission; 3) low patient satisfaction; 4) worsening severity of illness (as determined by an increase in Laboratory Acute Physiology and Chronic Health Evaluation APACHE-L); and 5) deviations from expected hospital length of stay; and 6) expected ancillary resource use. The quality of care for a stratified random sample of admissions were evaluated using structured implicit review (inter-rate reliability, Kappa = 0.5). Patients who died in-hospital were substantially more likely than those who were discharged alive to be rated as having had substandard care (30% vs. 10%; P < 0.001). In contrast, cases who had subsequent early readmissions did not have poorer quality ratings. Similarly, lower patient satisfaction was not associated with poorer ratings of technical process of care. Cases with lower-than-expected ancillary resource use (case-mix adjusted for diagnosis-related group) were more likely to be rated as having received substandard care than those with higher-than-expected resource use (16% vs. 6%; P < 0.05), and there was a similar trend for cases with shorter than expected length of stays. Associations between worsening severity of illness, as determined by APACHE-L scores, and quality were confounded because such patients were more likely to have died in-hospital.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8501988

Hayward, R A; Bernard, A M; Rosevear, J S; Anderson, J E; McMahon, L F

1993-05-01

384

Investing in Young Children: A Fact Sheet on Early Care and Education Participation, Access, and Quality  

Science.gov (United States)

Across the U.S., large numbers of young children are affected by one or more risk factors that have been linked to academic failure and poor health. High quality early care and education can play a critical role in promoting young children's early learning and success in life, while also supporting families' economic security. Young…

Schmit, Stephanie; Matthews, Hannah; Smith, Sheila; Robbins, Taylor

2013-01-01

385

Quality of sick child care delivered by Health Surveillance Assistants in Malawi  

OpenAIRE

Objective To assess the quality of care provided by Health Surveillance Assistants (HSAs)—a cadre of community-based health workers—as part of a national scale-up of community case management of childhood illness (CCM) in Malawi.

Gilroy, Kate E.; Callaghan-koru, Jennifer A.; Cardemil, Cristina V.; Nsona, Humphreys; Amouzou, Agbessi; Mtimuni, Angella; Daelmans, Bernadette; Mgalula, Leslie; Bryce, Jennifer

2012-01-01

386

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

Science.gov (United States)

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

Khan, Arshia A.

2012-01-01

387

The quality of critical care service management in South African hospitals  

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Full Text Available The purpose of this study is to determine the quality of critical care service management in South African hospitals.

Opsomming
Die doel met hierdie studie is om die gehalte van die bestuur van kritiekesorgdienste in Suid-Afrikaanse hospitale te bepaal. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

Marie Muller

1999-02-01

388

Cortisol Levels of Caregivers in Child Care Centers as Related to the Quality of their Caregiving  

Science.gov (United States)

The present study examined whether stress in professional caregivers--as reflected in salivary cortisol levels--is related to the quality of their caregiving behavior. The 221 professional female caregivers in 64 child care centers were observed in three different situations and saliva samples were taken three times during the morning. Results…

de Schipper, Elles J.; Riksen-Walraven, J. Marianne; Geurts, Sabine A. E.; de Weerth, Carolina

2009-01-01

389

Technical Limitations of Electronic Health Records in Community Health Centers: Implications on Ambulatory Care Quality  

Science.gov (United States)

Research objectives: This dissertation examines the state of development of each of the eight core electronic health record (EHR) functionalities as described by the IOM and describes how the current state of these functionalities limit quality improvement efforts in ambulatory care settings. There is a great deal of literature describing both the…

West, Christopher E.

2010-01-01

390

Resultados maternos e perinatais de dez anos de assistência obstétrica a portadoras do vírus da imunodeficiência humana / Maternal and perinatal results in ten years of obstetrical care to human immunodeficiency virus-infected women  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVOS: avaliar a transmissão vertical do vírus da imunodeficiência humana (HIV) e os fatores de risco associados à infecção perinatal. MÉTODOS: estudo descritivo de 170 gestantes infectadas pelo HIV e seus 188 recém-nascidos, admitidas na Maternidade do Hospital das Clínicas da UFMG, no período [...] de junho de 1994 a setembro de 2004. Foram analisados as características demográficas, o perfil sorológico e a via de parto das gestantes, assim como os resultados perinatais. As crianças foram acompanhadas por período de 18 meses após o nascimento. Os dados foram armazenados e analisados no Epi-Info, Versão 6.0. Estabeleceu-se intervalo de confiança a 95% (p Abstract in english PURPOSE: to evaluate human immunodeficiency virus (HIV) vertical transmission and risk factors related to perinatal infection. METHODS: descriptive study of 170 HIV-infected pregnant women and their 188 neonates, admitted from June 1994 to September 2004 at the "Maternidade do Hospital das Clínicas [...] da UFMG". Demographic characteristics, mother's serologic state, mode of delivery and perinatal results were analyzed. Children were followed for 18 months after birth. Data were stored and analyzed by Epi-Info, version 6.0. Confidence interval was established at 95% (p

Victor Hugo, Melo; Regina Amélia Lopes Pessoa, Aguiar; Ana Christina de Lacerda, Lobato; Ines Katerina Damasceno, Cavallo; Fabiana Maria, Kakehasi; Roberta Maia de Castro, Romanelli; Jorge Andrade, Pinto.

2005-11-01

391

Psychological and social consequences among mothers suffering from perinatal loss: perspective from a low income country  

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Full Text Available Abstract Background In developed countries, perinatal death is known to cause major emotional and social effects on mothers. However, little is known about these effects in low income countries which bear the brunt of perinatal mortality burden. This paper reports the impact of perinatal death on psychological status and social consequences among mothers in a rural area of Bangladesh. Methods A total of 476 women including 122 women with perinatal deaths were assessed with the Edinburgh Postnatal Depression Scale (EPDS-B at 6 weeks and 6 months postpartum, and followed up for negative social consequences at 6 months postpartum. Trained female interviewers carried out structured interviews at women's home. Results Overall 43% (95% CI: 33.7-51.8% of women with a perinatal loss at 6 weeks postpartum were depressed compared to 17% (95% CI: 13.7-21.9% with healthy babies (p = Conclusions This study highlights the greatly increased vulnerability of women with perinatal death to experience negative psychological and social consequences. There is an urgent need to develop appropriate mental health care services for mothers with perinatal deaths in Bangladesh, including interventions to develop positive family support.

Ali Mohammed

2011-06-01

392

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

Science.gov (United States)

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

Mayer, Deborah K

2014-08-01

393

[Perceived quality of care in a nursing home in Piedmont (Italy)].  

Science.gov (United States)

A cross-sectional study was conducted in the years 2003, 2005 and 2006, to assess client satisfaction in a nursing home in Piedmont (Italy). A structured questionnaire was used to evaluate three dimensions of care: interpersonal relationships, clinical care received and room comfort. Six-hundred eighty-four patients participated in the study. Of these, 33.6% were surgical patients, 33.6% were rehabilitation patients and 32.8% were medical patients. Overall, quality of care was reported as being "excellent" by 85% of patients in 2003, 85.3% of patients in 2005 and 66.1% in 2006. The study has made it possible to give a general description of client satisfaction regarding quality of services provided in a nursing home, and to identify the major critical areas. These should be analyzed in more detail, in order to identify which factors are most relevant to the patient and to implement corrective actions. PMID:23369995

Fidanza, Katia; Salerno, Christian; Barbieri, Antonietta; Leigheb, Fabrizio; Panella, Massimiliano

2012-01-01

394

The Effect of Advanced Access Implementation on Quality of Diabetes Care  

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Full Text Available IntroductionThe study analyzes the effect of an advanced access program on quality of diabetes care.MethodsWe conducted this study in a medical group of 240,000 members served by 17 primary care clinics. Seven thousand adult patients older than 18 years of age with diabetes were identified from administrative databases. Two aspects of advanced access — wait time for appointments and continuity of care — were calculated yearly for each patient during 1999 through 2001. We developed three composite measures of glucose and lipid control — process (proportion of patients with appropriate testing rates of hemoglobin A1c [HbA1c] and low-density lipoprotein [LDL], good control (proportion with HbA1c < 8% and LDL < 130 mg/dL and excellent control (proportion with HbA1c < 7% and LDL < 100 mg/dL — and assessed them each year for each patient. We used multilevel logistic regression to predict the measures in 2000 and 2001 (years during and after advanced access implementation relative to 1999 (year pre-advanced access.ResultsAfter implementation of advanced access, wait time decreased from 21.6 days to 4.2 days, and continuity improved by 6.5% (both P < .01. The percentage of patients with HbA1c < 7% increased from 44.4% to 52.3% and with LDL < 100 mg/dL from 29.8% to 38.7%. Increased continuity predicted improved process (P = .01, good control (P = .033, and excellent control (P < .001. However, wait time did not significantly predict process (P = .62 or quality measures (P = .95.ConclusionMeasures of the quality of diabetes control improved in the year after implementation of advanced access, but better care did not correlate with decreased wait time to see a provider. However, improved continuity of care predicted improvements in both process and quality of diabetes care.

JoAnn M. Sperl-Hillen, MD

2008-01-01

395

Perinatal and neonatal mortality in Fallujah General Hospital, Fallujah City, Anbar Province, west of Iraq  

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Full Text Available Objective: Perinatal and neonatal mortality reflects the quality of health services provided at any obstetrical/neonatal center. After eight years of being occupied, what became of the quality of the services we provide? Methods: A cross sectional study of 290 neonatal deaths at the neonatal intensive care unit (NICU of Fallujah General Hospital during the period from the 1st of january to the 31st of December of the year 2010, utilizing multiple obstetrical and neonatal variables: Results: The results showed that although there was a high PMR & NMR during the last decade, being 50.3/1000 live births & 41.5/1000 live births respectively in the year 2010 at the same hospital, and in comparison to most of Arab & Eastern Meditaranean countries our PMR and NMR are much higher. Conclusion: It is concluded that we have very high death rates, which necessitates providing better care at obstetrical/neonatal centers, plus establishing a collaborative network of neonatologists for eva- luating and improving neonatal care.

Samira T. Abdulghani

2012-09-01

396

Determinants of quality of life in elderly patients of a psychosocial care center in Brazil.  

Science.gov (United States)

The purpose of the present study was to identify the sociodemographic, clinical, and functional determinants of quality of life in elderly (older than 60 years) patients from a Psychosocial Care Center. The sample was randomly selected patients undergoing treatment at the center during the study period. Quality of life was assessed using the brief version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF) and the World Health Organization Quality of Life Assessment for older adults (WHOQOL-OLD). A total of 50 elderly individuals with a mean age of 67.5 (SD = 5.72) years were included in the study. A hierarchical linear regression showed that clinical characteristics, such as severe symptoms of depression and a higher number of comorbidities, were related to lower quality of life. Better functional capacity and more frequent visits to the center were determinants of higher quality of life. These findings underscore the importance of assessing quality of life and of taking this variable into account when planning health interventions for elderly patients at a Psychosocial Care Center. PMID:24597583

Bottan, Gabriela; Morais, Eliane Pinheiro de; Schneider, Jacó Fernando; Trentini, Clarissa; Heldt, Elizeth

2014-03-01

397

Opportunities for quality measurement to improve the value of care for patients with multiple chronic conditions.  

Science.gov (United States)

Quality measurement efforts have not historically focused on patients with multiple chronic conditions (MCCs), despite them comprising one quarter of the population and two thirds of health care spending. The Patient Protection and Affordable Care Act (ACA) creates several mechanisms for the Centers for Medicare & Medicaid Services (CMS) to transform quality measurement into an organized enterprise designed to support clinicians caring for this vulnerable population. This article highlights 3 emerging policy opportunities for CMS to guide public and private quality measurement efforts for patients with MCCs. First, it discusses infusing an MCC framework into measure development to promote patient-centered, as opposed to single-disease-specific, performance measurement. Second, it describes the importance of using common performance measures for individual clinicians, hospitals, and communities to accelerate meaningful improvement in the prevention and management of chronic conditions across local populations. Finally, the need for longitudinal measurement as a foundation for sustained quality improvement is presented. The ACA's expansion of insurance access and portability necessitates collaborative alignment of chronic condition quality measurement efforts between public and private programs to develop a high-value lifelong health system. PMID:25402407

Venkatesh, Arjun; Goodrich, Kate; Conway, Patrick H

2014-11-18

398

[Strategies for the development of the quality of integrated home care].  

Science.gov (United States)

Home Health Care (HHC) is a strategy to provide holistic care for elderly, chronic and terminal patients and for patients early discharged from hospitals. The aim of this article is to give some advice to ensure social and health integration, coordination of procedures and family participation in HCC. Moreover a framework to ensure organization of a HHC service is required and a guideline to define functions and responsibilities, human and physical resources and procedures to deliver health care is provided. The first stage of a HHC project must be an educational programme for the multidisciplinary team involved in home care. The common education is the strategy to improve Quality of a HHC service, involving medical and social workers in the definition of their own "criteria and standards" for organization, resources and procedures. PMID:10189903

Becchi, M A; Tavasanis, G; Turci, G

1998-10-01

399

PELAYANAN KESEHATAN PERINATAL DI DAERAH PEDESAAN UJUNG BERUNG  

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Full Text Available A survey on perinatal care in a rural area at Ujung Berung district, located 15—20 km outside Bandung, West Java was conducted. Three villages with a population of 40,787 were selected. Health services were provided by one health post and several family planning posts. In this study 1303 pregnant women were followed throughout the 28 weeks of pregnancy until the infant is 28 days of age. Among the 1303 pregnant women 5.7% had received tetanus toxoid immunization. Perinatal mortality rate (PMR was 43.6 per thousand and incidence of low birth weight was 14.3 percent. Only 12.8% pregnant women were using some kind of contraception before the last pregnancy. The PMR decreased in spite of the low percentage users. The main causes of death during perinatal period vece asphyxia neonatorum and infections. The incidence of tetanus neonatorum during neonatal period was 17 per thousand live births. An evaluation of health service activities showed 47.5% of these pregnant women had antenatal care. Care during delivery and early postnatal period was carried out by TBAs. No significant difference was found between the PMR of trained and untrained TBAs. Another aspect of health service activities is referral to the health centre or hospital. A total of 3.8 percent infants were referred because of neo­natal problems; among these, refusal was 12.5% due to the totalistic attitude of the parents in the village. The results showed that coverage of pregnant women and their infants by safe health care services is very low. This may be due to lack of facilities and health personnel, and probably also due to the confidence of village people for traditional health care providers. Thus, education and training as well as supervision of traditional health care providers and their integration into the formal health care structure is of extreme importance.  

Anna Alisjahbana

2012-09-01

400

Development and testing of a measure designed to assess the quality of care transitions  

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Full Text Available Background: To improve the quality of care delivered to older persons receiving care across multiple settings, interventions are needed. However, the absence of a patient-centred measure specifically designed to assess this care has constrained innovation. Objective: To develop a rigorously designed and tested measure, the Care Transition Measure (CTM. Setting: A large, integrated managed care organisation in Colorado with approximately 55,000 members over the age of 65 years. Participants: Patients 65 years and older who were recently discharged from hospital and received subsequent skilled nursing care in a facility or in the home. Methods: Six focus groups of older persons and their caregivers (n=49 were established. Standard qualitative analytic techniques were applied to written transcripts and four key domains were identified: (1 information transfer; (2 patient and caregiver preparation; (3 self-management support; and (4 empowerment to assert preferences. Specific CTM items were developed, pilot tested, and refined. Psychometric testing, conducted in a different population but selected using the same entry criteria (n=60, included content and construct validity, intra-item variation, and floor/ceiling properties. Results: Older patients and clinicians found the measure to be highly relevant and comprehensive (i.e. content validity. Construct validity was assessed by comparing items from the CTM to selected items from a measure developed by Hendriks and colleagues (Medical Care 2001; 39(3: 270–283. Inter-item Spearman correlations ranged 0.388–0.594. No significant floor or ceiling effects were detected. Conclusions: The CTM was developed with substantial input from older patients and their caregivers. Psychometric testing suggested that the measure was valid. The CTM may serve to fill an important gap in health system performance evaluation by measuring the quality of care delivered across settings.

Eric A. Coleman

2002-06-01

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