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Sample records for assessing patient-centered care

  1. Patient-centered Care.

    Science.gov (United States)

    Reynolds, April

    2009-01-01

    Patient-centered care focuses on the patient and the individual's particular health care needs. The goal of patient-centered health care is to empower patients to become active participants in their care. This requires that physicians, radiologic technologists and other health care providers develop good communication skills and address patient needs effectively. Patient-centered care also requires that the health care provider become a patient advocate and strive to provide care that not only is effective but also safe. For radiologic technologists, patient-centered care encompasses principles such as the as low as reasonably achievable (ALARA) concept and contrast media safety. Patient-centered care is associated with a higher rate of patient satisfaction, adherence to suggested lifestyle changes and prescribed treatment, better outcomes and more cost-effective care. This article is a Directed Reading. Your access to Directed Reading quizzes for continuing education credit is determined by your area of interest. For access to other quizzes, go to www.asrt.org/store. According to one theory, most patients judge the quality of their healthcare much like they rate an airplane flight. They assume that the airplane is technically viable and is being piloted by competent people. Criteria for judging a particular airline are personal and include aspects like comfort, friendly service and on-time schedules. Similarly, patients judge the standard of their healthcare on nontechnical aspects, such as a healthcare practitioner's communication and "soft skills." Most are unable to evaluate a practitioner's level of technical skill or training, so the qualities they can assess become of the utmost importance in satisfying patients and providing patient-centered care.(1). PMID:19901351

  2. Assessing Patient-Centered Communication in Cancer Care: Stakeholder Perspectives

    OpenAIRE

    Mazor, Kathleen M.; Gaglio, Bridget; Nekhlyudov, Larissa; Alexander, Gwen L.; Stark, Azadeh; Hornbrook, Mark C.; Walsh, Kathleen; Boggs, Jennifer; Lemay, Celeste A.; Firneno, Cassandra; Biggins, Colleen; Blosky, Mary Ann; Arora, Neeraj K.

    2013-01-01

    Patient reports of their communication experiences during cancer care could increase understanding of the communication process, stimulate improvements, inform interventions, and provide a basis for evaluating changes in communication practices.

  3. The Patient Centered Assessment Method (PCAM: integrating the social dimensions of health into primary care

    Directory of Open Access Journals (Sweden)

    Rebekah Pratt

    2015-07-01

    Full Text Available Background: Social dimensions of health are known to contribute to what is often termed “patient complexity”, which is particularly common among patients with multimorbidity. Health-care professionals require tools to help them identify and manage these aspects of patient needs. Objectives: To examine: (i the Patient Centered Assessment Method (PCAM, a tool for assessing patient complexity in ways that are sensitive to the biopsychosocial dimensions of health, in primary care settings in Scotland; (ii the impact of the PCAM on referral patterns and its perceived value; and (iii the PCAM’s perceived applicability for use in a complex patient population. Design: Two studies are described: (i a mixed-methods prospective cohort study of the implementation of the PCAM in primary care clinics; and (ii a qualitative exploratory study that evaluated the value of the PCAM in a complex patient population. Results: Use of the PCAM did not impact patient satisfaction or perception of practitioners’ empathy, but it did increase both the number of onward referrals per referred patient (9–12% and the proportion of referrals to non-medical services addressing psychological, social, and lifestyle needs. Nurses valued the PCAM, particularly its ability to help them address psychological and social domains of patients’ lives, and found it to be highly relevant for use in populations with known high complexity. Conclusions: The PCAM represents a feasible approach for assessing patient needs with consideration to the social dimensions of health, and allows practitioners to refer patients to a broader range of services to address patient complexity.

  4. Measuring the quality of patient-centered care: why patient-reported measures are critical to reliable assessment

    Directory of Open Access Journals (Sweden)

    Tzelepis F

    2015-06-01

    Full Text Available Flora Tzelepis, Robert W Sanson-Fisher, Alison C Zucca, Elizabeth A FradgleyPriority Research Centre for Health Behaviour, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, AustraliaPurpose: The Institute of Medicine (IOM identified patient-centeredness as crucial to quality health care. The IOM endorsed six patient-centeredness dimensions that stipulated that care must be: respectful to patients’ values, preferences, and expressed needs; coordinated and integrated; provide information, communication, and education; ensure physical comfort; provide emotional support; and involve family and friends. Patient-reported measures examine the patient’s perspective and are essential to the accurate assessment of patient-centered care. This article’s objectives are to: 1 use the six IOM-endorsed patient-centeredness dimensions as a framework to outline why patient-reported measures are crucial to the reliable measurement of patient-centered care; and 2 to identify existing patient-reported measures that assess each patient-centered care dimension.Methods: For each IOM-endorsed patient-centeredness dimension, the published literature was searched to highlight the essential role of patients in assessing patient-centered care and informing quality improvement efforts. Existing literature was also searched to identify examples of patient-reported measures that assess each patient-centeredness dimension.Conclusion: Patient-reported measures are arguably the best way to measure patient-centeredness. For instance, patients are best positioned to determine whether care aligns with patient values, preferences, and needs and the Measure of Patient Preferences is an example of a patient-reported measure that does so. Furthermore, only the patient knows whether they received the level of information desired, and if information was understood and can be recalled. Patient-reported measures that examine information provision include

  5. Caregiver Objective Burden and Assessments of Patient-Centered, Family-Focused Care for Frail Elderly Veterans

    Science.gov (United States)

    Rose, Julia Hannum; Bowman, Karen F.; O'Toole, Elizabeth E.; Abbott, Katherine; Love, Thomas E.; Thomas, Charles; Dawson, Neal V.

    2007-01-01

    Purpose: There is a growing consensus that quality of care for frail elders should include family and be evaluated in terms of patient-centered, family-focused care (PCFFC). Family caregivers are in a unique and sometimes sole position to evaluate such care. In the context of caring for physically frail elders, this study examined the extent to…

  6. Assessing patient-centered care in patients with chronic health conditions attending chiropractic practice: protocol for a mixed-methods study

    OpenAIRE

    Stuber, Kent Jason; Langweiler, Mark; Mior, Silvano; McCarthy, Peter William

    2016-01-01

    Background The management of chronic health conditions increasingly requires an organized, coordinated, and patient-centered approach to care. The Chronic Care Model (CCM) has been adopted in primary care to improve care delivery for those with chronic health conditions. Chiropractors manage chronic health conditions; however, little is known if such care is patient-centered. The primary aim of this study is to determine to what extent chiropractic patients with chronic health conditions perc...

  7. Scoping review of patient-centered care approaches in healthcare

    OpenAIRE

    Constand, Marissa K; MacDermid, Joy C; Dal Bello-Haas, Vanina; Law, Mary

    2014-01-01

    Background The purpose of this scoping review was to describe how three tenants of patient-centered care provision: communication, partnership, and health promotion are addressed in patient-centered care models/frameworks across the literature. Methods A scoping review of literature published in English since 1990 was conducted using Medline, CINAHL, and EMBASE. A key term search strategy was employed using “patient-centered care”, “client-centered care”, “framework” and “model” to identify r...

  8. A Patient-Centered Primary Care Practice Approach Using Evidence-Based Quality Improvement: Rationale, Methods, and Early Assessment of Implementation

    OpenAIRE

    Rubenstein, Lisa V.; Stockdale, Susan E.; Sapir, Negar; Altman, Lisa; Dresselhaus, Timothy; Salem-Schatz, Susanne; Vivell, Susan; Ovretveit, John; Hamilton, Alison B.; Yano, Elizabeth M

    2014-01-01

    ABSTRACT BACKGROUND Healthcare systems and their primary care practices are redesigning to achieve goals identified in Patient-Centered Medical Home (PCMH) models such as Veterans Affairs (VA)’s Patient Aligned Care Teams (PACT). Implementation of these models, however, requires major transformation. Evidence-Based Quality Improvement (EBQI) is a multi-level approach for supporting organizational change and innovation spread. OBJECTIVE To describe EBQI as an approach for promoting VA’s PACT a...

  9. Healthcare professionals’ views on patient-centered care in hospitals

    OpenAIRE

    Berghout, Mathilde; van Exel, Job; Leensvaart, Laszlo; Cramm, Jane M

    2015-01-01

    Background Patient-centered care (PCC) is a main determinant of care quality. Research has shown that PCC is a multi-dimensional concept, and organizations that provide PCC well report better patient and organizational outcomes. However, little is known about the relative importance of PCC dimensions. The aim of this study was therefore to investigate the relative importance of the eight dimensions of PCC according to hospital-based healthcare professionals, and examine whether their viewpoin...

  10. Journey toward a Patient-Centered Medical Home: Readiness for Change in Primary Care Practices

    OpenAIRE

    Wise, Christopher G; Alexander, Jeffrey A.; Green, Lee A.; Cohen, Genna R.; Koster, Christina R

    2011-01-01

    Context: Information is limited regarding the readiness of primary care practices to make the transformational changes necessary to implement the patient-centered medical home (PCMH) model. Using comparative, qualitative data, we provide practical guidelines for assessing and increasing readiness for PCMH implementation.

  11. Why Patient Centered Care Coordination Is Important in Developing Countries?

    Science.gov (United States)

    Luna, D.; Marcelo, A.; Househ, M.; Mandirola, H.; Curioso, W.; Pazos, P.; Villalba, C.

    2015-01-01

    Summary Patient Centered Care Coordination (PCCC) focuses on the patient health care needs. PCCC involves the organization, the patients and their families, that must coordinate resources in order to accomplish the goals of PCCC. In developing countries, where disparities are frequent, PCCC could improve clinical outcomes, costs and patients satisfaction. Objective the IMIA working group Health Informatics for Development analyzes the benefits, identifies the barriers and proposes strategies to reach PCCC. Methods Discussions about PCCC emerged from a brief guide that posed questions about what is PCCC, why consider PCCC important, barriers to grow in this direction and ask about resources considered relevant in the topic. Results PCCC encompasses a broad definition, includes physical, mental, socio-environmental and self care. Even benefits are proved, in developing countries the lack of a comprehensive and integrated healthcare network is one of the main barriers to reach this objective. Working hard to reach strong health policies, focus on patients, and optimizing the use of resources could improve the performance in the devolvement of PCCC programs. International collaboration could bring benefits. We believe information IT, and education in this field will play an important role in PCCC. Conclusion PCCC in developing countries has the potential to improve quality of care. Education, IT, policies and cultural issues must be addressed in an international collaborative context in order to reach this goal. PMID:26123907

  12. Patient-centered care: the key to cultural competence.

    Science.gov (United States)

    Epner, D E; Baile, W F

    2012-04-01

    Much of the early literature on 'cultural competence' focuses on the 'categorical' or 'multicultural' approach, in which providers learn relevant attitudes, values, beliefs, and behaviors of certain cultural groups. In essence, this involves learning key 'dos and don'ts' for each group. Literature and educational materials of this kind focus on broad ethnic, racial, religious, or national groups, such as 'African American', 'Hispanic', or 'Asian'. The problem with this categorical or 'list of traits' approach to clinical cultural competence is that culture is multidimensional and dynamic. Culture comprises multiple variables, affecting all aspects of experience. Cultural processes frequently differ within the same ethnic or social group because of differences in age cohort, gender, political association, class, religion, ethnicity, and even personality. Culture is therefore a very elusive and nebulous concept, like art. The multicultural approach to cultural competence results in stereotypical thinking rather than clinical competence. A newer, cross cultural approach to culturally competent clinical practice focuses on foundational communication skills, awareness of cross-cutting cultural and social issues, and health beliefs that are present in all cultures. We can think of these as universal human beliefs, needs, and traits. This patient centered approach relies on identifying and negotiating different styles of communication, decision-making preferences, roles of family, sexual and gender issues, and issues of mistrust, prejudice, and racism, among other factors. In the current paper, we describe 'cultural' challenges that arise in the care of four patients from disparate cultures, each of whom has advanced colon cancer that is no longer responding to chemotherapy. We then illustrate how to apply principles of patient centered care to these challenges. PMID:22628414

  13. Transformation of Care: Integrating the Registered Nurse Care Coordinator into the Patient-Centered Medical Home.

    Science.gov (United States)

    Biernacki, Pamela J; Champagne, Mary T; Peng, Shane; Maizel, David R; Turner, Barbara S

    2015-10-01

    The purpose of this quality improvement project was to implement and evaluate a care delivery model integrating the registered nurse care coordinator (RNCC) into a family practice that is certified as a patient-centered medical home (PCMH) by the National Committee for Quality Assurance. The initial target population was the 937 patients with diabetes in the family practice. A pre-post design was used to assess changes in patients' diabetic quality indicators after integrating the role of RNCC using existing staff. This 6-month project compared the following diabetic quality indicators: blood pressure post scores for A1c (P = .001, n = 790), foot exam (P = .001, n = 850), and microalbumin (P = .01, n = 850). Post intervention, patient and health care team satisfaction with the RNCC role was high (mean scores ≥3 on a 5-point Likert scale). Integrating the RNCC within a multidisciplinary team in the PCMH had a significant positive impact on diabetic quality indicators. Patient and health care team satisfaction with the RNCC role was high. PMID:25632926

  14. Cancer patient-centered home care: a new model for health care in oncology

    Science.gov (United States)

    Tralongo, Paolo; Ferraù, Francesco; Borsellino, Nicolò; Verderame, Francesco; Caruso, Michele; Giuffrida, Dario; Butera, Alfredo; Gebbia, Vittorio

    2011-01-01

    Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients’ needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients’ needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective. PMID:21941445

  15. Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home

    OpenAIRE

    O’Donnell, Alison J.; Bogner, Hillary R.; Cronholm, Peter F.; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F. de Vries; Kaye, Elise M.; Gabbay, Robert

    2016-01-01

    Introduction: Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in ...

  16. Elements of the patient-centered medical home associated with health outcomes among veterans: the role of primary care continuity, expanded access, and care coordination.

    Science.gov (United States)

    Nelson, Karin; Sun, Haili; Dolan, Emily; Maynard, Charles; Beste, Laruen; Bryson, Christopher; Schectman, Gordon; Fihn, Stephan D

    2014-01-01

    Care continuity, access, and coordination are important features of the patient-centered medical home model and have been emphasized in the Veterans Health Administration patient-centered medical home implementation, called the Patient Aligned Care Team. Data from more than 4.3 million Veterans were used to assess the relationship between these attributes of Patient Aligned Care Team and Veterans Health Administration hospitalization and mortality. Controlling for demographics and comorbidity, we found that continuity with a primary care provider was associated with a lower likelihood of hospitalization and mortality among a large population of Veterans receiving VA primary care. PMID:25180648

  17. Communication About Sexuality in Advanced Illness Aligns With a Palliative Care Approach to Patient-Centered Care.

    Science.gov (United States)

    Leung, Margaret W; Goldfarb, Shari; Dizon, Don S

    2016-02-01

    Treatment-related sexual complications are common in cancer patients although rarely discussed in the palliative care setting. Sexuality is an important survivorship issue and remains relevant even in the terminal setting. There are multiple barriers in dialoguing about intimacy and sexual functioning from the patient and provider perspectives. Palliative care providers, while not expected to be sexual health experts, can provide comprehensive patient-centered care by including sexual health as part of their evaluation. They can explore how sexual dysfunction can impair functioning and utilize an interdisciplinary approach to manage symptoms. Palliative care providers can help patients identify their goals of care and explore what anticipated sexual changes and treat-related side effects are tolerable and intolerable to the patient's quality of life. Principles on addressing sexuality in the palliative setting and practical ways of incorporating sexual history into the palliative care assessment are provided. PMID:26769116

  18. Cancer patient-centered home care: a new model for health care in oncology

    Directory of Open Access Journals (Sweden)

    Tralongo P

    2011-09-01

    Full Text Available Paolo Tralongo1, Francesco Ferraù2, Nicolò Borsellino3, Francesco Verderame4, Michele Caruso5, Dario Giuffrida6, Alfredo Butera7, Vittorio Gebbia81Medical Oncology Unit, Azienda Sanitaria Provinciale, Siracusa; 2Medical Oncology Unit, Ospedale San Vincenzo, Taormina; 3Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo; 4Medical Oncology Unit, Ospedale Giovanni Paolo II, Sciacca; 5Medical Oncology Unit, Istituto Humanitas, Catania; 6Medical Oncology Unit, Istituto Oncologico del Mediterraneo, Catania; 7Medical Oncology Unit, Ospedale San Giovanni di Dio, Agrigento; 8Medical Oncology Unit, Dipartimento Oncologico, La Maddalena, Università degli Studi, Palermo, ItalyAbstract: Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients' needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients' needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective.Keywords: cancer, home care

  19. Designing a patient-centered personal health record to promote preventive care

    Directory of Open Access Journals (Sweden)

    Krist Alex H

    2011-11-01

    Full Text Available Abstract Background Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential. Methods Using a previously described model to make information technology more patient-centered, we developed an interactive preventive health record (IPHR designed to more deeply engage patients in preventive care and health promotion. We recruited 14 primary care practices to promote the IPHR to all adult patients and sought practice and patient input in designing the IPHR to ensure its usability, salience, and generalizability. The input involved patient usability tests, practice workflow observations, learning collaboratives, and patient feedback. Use of the IPHR was measured using practice appointment and IPHR databases. Results The IPHR that emerged from this process generates tailored patient recommendations based on guidelines from the U.S. Preventive Services Task Force and other organizations. It extracts clinical data from the practices' electronic medical record and obtains health risk assessment information from patients. Clinical content is translated and explained in lay language. Recommendations review the benefits and uncertainties of services and possible actions for patients and clinicians. Embedded in recommendations are self management tools, risk calculators, decision aids, and community resources - selected to match patient's clinical circumstances. Within six months, practices had encouraged 14.4% of patients to use the IPHR (ranging from 1.5% to 28.3% across the 14 practices. Practices successfully incorporated the IPHR into workflow, using it to prepare patients for visits, augment health behavior counseling, explain test results

  20. Shared Decision Making and Effective Physician-Patient Communication: The Quintessence of Patient-Centered Care

    Directory of Open Access Journals (Sweden)

    Huy Ming Lim

    2015-03-01

    Full Text Available The Institute of Medicine’s (IOM 2001 landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century, identified patient-centeredness as one of the fundamental attributes of quality health care, alongside safety, effectiveness, timeliness, efficiency, and equity. The IOM defined patient-centeredness as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” This concept of patient-centered care represents a paradigm shift from the traditional disease-oriented and physician-centered care, grounding health care in the subjective experience of illness and the needs and preferences of individual patients rather than the evaluation and treatment of diseases which emphasizes on leveraging clinical expertise and evidence derived from population-based studies. Regrettably, despite the ubiquitous talk about patient-centered care in modern health care, shared decision-making and effective physician-patient communication—the two cruxes of patient-centered care—are yet to become the norms. Strategies to promote and enhance shared decision-making and effective communication between clinicians and patients should be rigorously implemented to establish a health care system that truly values patients as individuals and turn the rhetoric of patient-centered care into reality.

  1. Preventing intensive care unit delirium: a patient-centered approach to reducing sleep disruption.

    Science.gov (United States)

    Stuck, Amy; Clark, Mary Jo; Connelly, Cynthia D

    2011-01-01

    Delirium in the intensive care unit is a disorder with multifactorial causes and is associated with poor outcomes. Sleep-wake disturbance is a common experience for patients with delirium. Care processes that disrupt sleep can lead to sleep deprivation, contributing to delirium. Patient-centered care is a concept that considers what is best for each individual. How can clinicians use a patient-centered approach to alter processes to decrease patient disruptions and improve sleep and rest? Could timing of blood draws and soothing music work to promote sleep? PMID:21983504

  2. Diabetes Stories: Use of Patient Narratives of Diabetes to Teach Patient-Centered Care

    Science.gov (United States)

    Kumagai, Arno K.; Murphy, Elizabeth A.; Ross, Paula T.

    2009-01-01

    A critical component to instituting compassionate, patient-centered diabetes care is the training of health care providers. Our institution developed the Family Centered Experience (FCE), a comprehensive 2-year preclinical program based on longitudinal conversations with patients about living with chronic illness. The goal of the FCE is to explore…

  3. Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington State

    Directory of Open Access Journals (Sweden)

    Reed Peter

    2012-12-01

    Full Text Available Abstract Background Growing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for patient-centered innovations. We sought to understand the process of patient-centered care innovation undertaken by innovative health care organizations – from strategic planning to goal selection to implementation to maintenance. Methods We conducted key-informant interviews with executives at five health plans, five provider organizations, and ten primary care clinics in Washington State. At least two readers of each interview transcript identified themes inductively; final themes were determined by consensus. Results Innovation in patient-centered care was a strategic objective chosen by nearly every organization in this study. However, other goals were paramount: cost containment, quality improvement, and organization survival. Organizations commonly perceived effective chronic disease management and integrated health information technology as key elements for successful patient-centered care innovation. Inertia, resource deficits, fee-for-service payment, and regulatory limits on scope of practice were cited as barriers to innovation, while organization leadership, human capital, and adaptive culture facilitated innovation. Conclusions Patient-centered care innovations reflected organizational perspectives: health plans emphasized cost-effectiveness while providers emphasized health care delivery processes. Health plans and providers shared many objectives, yet the two rarely collaborated to achieve them. The process of innovation is heavily dependent on organizational culture and leadership. Policymakers can improve the pace and quality of patient-centered innovation by setting targets

  4. Advancing patient-centered care through transformative educational leadership: a critical review of health care professional preparation for patient-centered care

    Directory of Open Access Journals (Sweden)

    Lévesque MC

    2013-07-01

    Full Text Available Martine C Lévesque,1,2 Richard Bruce Hovey,2,3 Christophe Bedos2,4 1Faculté de médecine, Université de Montréal, Montréal, QC, Canada; 2Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada; 3Faculty of Medicine, University of Calgary, Calgary, AB, Canada; 4Département de médecine sociale et préventive, Faculté de médicine, Université de Montréal, Montréal, QC, Canada Abstract: Following a historical brief on the development of patient-centered care (PCC, we discuss PCC's value and role in counterbalancing the evidence-based movement in health care. We in turn make a case for a philosophical shift in thinking about the PCC concept, one based on a consideration for how knowledge is produced, used, and valued within care provision processes. A “shared epistemology” foundation is presented, defined, and promoted as essential to the authentic and ethical realization of “shared decision making” between patient and health care provider, and, more generally, of PCC. In accordance with these views, this article critically reviews the literature on health care professional education for the development of PCC. We uncover the disturbing ways in which education frequently undermines the development of patient centeredness, despite curricular emphasis on professionalism and ethical PCC. We also establish the need to raise awareness of how dominant approaches to evaluating student or practitioner performance often fail to reinforce or promote patient centeredness. Finally, we identify successful and inspiring cases of teaching and learning experiences that have achieved perspective transformation on PCC and on new ways of providing care. The pertinence of adopting the theoretical foundations of adult transformative learning is argued, and a call to action is proposed to the leadership of health professional educators across all disciplines. Keywords: patient-centered care, health professional

  5. Patient-centered care in lung cancer: exploring the next milestones

    OpenAIRE

    Ben-Arye, Eran; Samuels, Noah

    2015-01-01

    In this editorial, the authors comment on a recently published review paper by Molassiotis et al. on the developments made over the past 40 years in supportive care for patients with lung cancer. During this period, a paradigm shift promoting patient-centered care (PCC) has led to an important change in the approach of supportive cancer care, from a purely disease-centered approach, measuring survival-related outcomes, to recognizing the importance of quality of life outcomes as well. This ch...

  6. Patient-Centered Care and Population Health: Establishing Their Role in the Orthopaedic Practice.

    Science.gov (United States)

    Harwood, Jared L; Butler, Craig A; Page, Alexandra E

    2016-05-18

    As health care increasingly emphasizes high value, the terms "population health" and "patient-centered care" have become common, but their application is less clear. Patient-centered care encourages using data to optimize care for an individual. Population health offers a framework to consider how to efficiently and effectively manage a condition for a population, how prevention affects large groups, and the specific distribution of a given disorder. Integrating both concepts into practice can facilitate required outcome-measure reporting and potentially improve patient outcomes. Clinical practice guidelines and appropriate use criteria are examples of reconciliation of these topics. By embracing attempts to decrease variation in treating musculoskeletal disorders while personalizing delivery to individual patients, surgeons may benefit from the improvement of both efficiency and patient experience. PMID:27194502

  7. Professional Quality of Life of Veterans Affairs Staff and Providers in a Patient-Centered Care Environment.

    Science.gov (United States)

    Locatelli, Sara M; LaVela, Sherri L

    2015-01-01

    Changes to the work environment prompted by the movement toward patient-centered care have the potential to improve occupational stress among health care workers by improving team-based work activities, collaboration, and employee-driven quality improvement. This study was conducted to examine professional quality of life among providers at patient-centered care pilot facilities. Surveys were conducted with 76 Veterans Affairs employees/providers at facilities piloting patient-centered care interventions, to assess demographics, workplace practices and views (team-based environment, employee voice, quality of communication, and turnover intention), and professional quality of life (compassion satisfaction, burnout, and secondary traumatic stress).Professional quality-of-life subscales were not related to employee position type, age, or gender. Employee voice measures were related to lower burnout and higher compassion satisfaction. In addition, employees who were considering leaving their position showed higher burnout and lower compassion satisfaction scores. None of the work practices showed relationships with secondary traumatic stress. PMID:26218000

  8. Patient-centered care requires a patient-oriented workflow model

    OpenAIRE

    Ozkaynak, Mustafa; Flatley Brennan, Patricia; Hanauer, David A.; Johnson, Sharon; Aarts, Jos; Zheng, Kai; Haque, Saira N.

    2013-01-01

    Effective design of health information technology (HIT) for patient-centered care requires consideration of workflow from the patient's perspective, termed ‘patient-oriented workflow.’ This approach organizes the building blocks of work around the patients who are moving through the care system. Patient-oriented workflow complements the more familiar clinician-oriented workflow approaches, and offers several advantages, including the ability to capture simultaneous, cooperative work, which is...

  9. Designing a patient-centered personal health record to promote preventive care

    OpenAIRE

    Krist Alex H; Peele Eric; Woolf Steven H; Rothemich Stephen F; Loomis John F; Longo Daniel R; Kuzel Anton J

    2011-01-01

    Abstract Background Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential. Methods Using a previously described model to make information technology more patient-centered, we dev...

  10. Market-Based Health Care in Specialty Surgery: Finding Patient-Centered Shared Value.

    Science.gov (United States)

    Smith, Timothy R; Rambachan, Aksharananda; Cote, David; Cybulski, George; Laws, Edward R

    2015-10-01

    : The US health care system is struggling with rising costs, poor outcomes, waste, and inefficiency. The Patient Protection and Affordable Care Act represents a substantial effort to improve access and emphasizes value-based care. Value in health care has been defined as health outcomes for the patient per dollar spent. However, given the opacity of health outcomes and cost, the identification and quantification of patient-centered value is problematic. These problems are magnified by highly technical, specialized care (eg, neurosurgery). This is further complicated by potentially competing interests of the 5 major stakeholders in health care: patients, doctors, payers, hospitals, and manufacturers. These stakeholders are watching with great interest as health care in the United States moves toward a value-based system. Market principles can be harnessed to drive costs down, improve outcomes, and improve overall value to patients. However, there are many caveats to a market-based, value-driven system that must be identified and addressed. Many excellent neurosurgical efforts are already underway to nudge health care toward increased efficiency, decreased costs, and improved quality. Patient-centered shared value can provide a philosophical mooring for the development of health care policies that utilize market principles without losing sight of the ultimate goals of health care, to care for patients. PMID:26308640

  11. The internet as a tool for patient-centered care in transplantation.

    Science.gov (United States)

    Hanif, Faisal; Read, Janet C; Gibbs, Paul

    2009-12-01

    The Internet is a popular communication tool that plays a significant role in patient-centered care. It is argued that a driving force for the demand for online health information is the paucity of information easily obtained from traditional channels. As the quality of medical information available on the Internet is variable, and the quantity is constantly increasing and changing, there is a need for rigorous assessment of quality and effectiveness of health Web sites, and the Internet-based health care support services for different fields of medicine. On one hand, Internet-based patient support tools and Web sites have been used successfully in managing patients with different illnesses like lung transplant, vascular surgery, and treating diabetes mellitus - but on the other hand, other studies have shown that a majority of Web sites providing information on kidney and liver transplant are of poor quality and need overhauling. In the modern world, where e-technology has become common place, patients deserve e-services that are informative, trustworthy, and useful. It is not only a challenge, but also the responsibility of clinicians to make this happen. PMID:20353371

  12. Patient Navigators: Agents of Creating Community-Nested Patient-Centered Medical Homes for Cancer Care.

    Science.gov (United States)

    Simon, Melissa A; Samaras, Athena T; Nonzee, Narissa J; Hajjar, Nadia; Frankovich, Carmi; Bularzik, Charito; Murphy, Kara; Endress, Richard; Tom, Laura S; Dong, XinQi

    2016-01-01

    Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients' interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus-community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented. PMID:27594792

  13. Does the Planetree patient-centered approach to care pay off?: a cost-benefit analysis.

    Science.gov (United States)

    Coulmont, Michel; Roy, Chantale; Dumas, Lucie

    2013-01-01

    Although the Planetree patient-centered approach to care is being implemented in many institutions around the world, its impact is still the subject of some debate. On the one hand, it is viewed as the most cost-effective way to provide care and create a positive work environment that reduces staff burnout. On the other hand, it is argued that it requires higher staffing ratios and a substantial infusion of financial resources and is time consuming, which in turn results in more work. The present study addresses the economic agenda of the Planetree patient-centered approach to care and has been designed to answer the following question: do the advantages of the Planetree patient-centered approach outweigh its costs? This question is of considerable interest for health care administrators and managers because the relevant authorities the world over have limited resources to allocate to health care organizations. Using a trend analysis approach to cost-benefit in a rehabilitation center, this study shows that the revenues the model generates are greater than the costs of implementing it. Fewer grievances and vacant positions, an improved employee retention rate, a better working atmosphere, and a high level of employee satisfaction (higher than in similar establishments) were also noted. PMID:23364422

  14. What Is Known About the Benefits of Patient-Centered Care in Patients with Heart Failure.

    Science.gov (United States)

    Ulin, Kerstin; Malm, Dan; Nygårdh, Annette

    2015-12-01

    Treatment for chronic heart failure (CHF) has improved, and symptom burden has been identified as an important treatment goal. Because patient-centered care may ease the burden, we need to know its benefits for patients with CHF, hence this systematic literature review. We found that one benefit of person-centered care is an increase in quality of life in patients with CHF. Improvements were found in self-care, physical and mental status, health care costs, general uncertainty regarding illness and recovery, patient dignity, treatment, and systems of care. Improvements also were observed in symptom burden, self-efficacy, and quality of life. These findings indicate that person-centered care is a powerful approach to current and future health care. However, because an appropriate tool to measure person-centered care does not yet exist, it will be a challenge to determine whether the goal has been reached from a long-term and patient perspective. PMID:26497193

  15. The Phoenix Physician: defining a pathway toward leadership in patient-centered care.

    Science.gov (United States)

    Good, Robert G; Bulger, John B; Hasty, Robert T; Hubbard, Kevin P; Schwartz, Elliott R; Sutton, John R; Troutman, Monte E; Nelinson, Donald S

    2012-08-01

    Health care delivery has evolved in reaction to scientific and technological discoveries, emergent patient needs, and market forces. A current focus on patient-centered care has pointed to the need for the reallocation of resources to improve access to and delivery of efficient, cost-effective, quality care. In response to this need, primary care physicians will find themselves in a new role as team leader. The American College of Osteopathic Internists has developed the Phoenix Physician, a training program that will prepare primary care residents and practicing physicians for the changes in health care delivery and provide them with skills such as understanding the contributions of all team members (including an empowered and educated patient), evaluating and treating patients, and applying performance metrics and information technology to measure and improve patient care and satisfaction. Through the program, physicians will also develop personal leadership and communication skills. PMID:22904250

  16. Creative group performances to assess core competencies in a first-year patient-centered medicine course

    OpenAIRE

    Carol A. Terregino; Norma S. Saks

    2010-01-01

    Introduction:A novel assessment of systems-based practice and practice-based learning and improvement learning objectives, implemented in a first-year patient-centered medicine course, is qualitatively described. Methods: Student learning communities were asked to creatively demonstrate a problem and solution for health care delivery. Skits, filmed performances, plays, and documentaries were chosen by the students. Video recordings were reviewed for themes and the presence of course competenc...

  17. Care team identification in the electronic health record: A critical first step for patient-centered communication.

    Science.gov (United States)

    Dalal, Anuj K; Schnipper, Jeffrey L

    2016-05-01

    Patient-centered communication is essential to coordinate care and safely progress patients from admission through discharge. Hospitals struggle with improving the complex and increasingly electronic conversation patterns among care team members, patients, and caregivers to achieve effective patient-centered communication across settings. Accurate and reliable identification of all care team members is a precursor to effective patient-centered communication and ideally should be facilitated by the electronic health record. However, the process of identifying care team members is challenging, and team lists in the electronic health record are typically neither accurate nor reliable. Based on the literature and on experience from 2 initiatives at our institution, we outline strategies to improve care team identification in the electronic health record and discuss potential implications for patient-centered communication. Journal of Hospital Medicine 2016;11:381-385. © 2016 Society of Hospital Medicine. PMID:26762584

  18. Developing patient-centered teams: The role of sharing stories about patients and patient care.

    Science.gov (United States)

    Bennett, Ariana H; Hassinger, Jane A; Martin, Lisa A; Harris, Lisa H; Gold, Marji

    2015-09-01

    Research indicates that health care teams are good for staff, patients, and organizations. The characteristics that make teams effective include shared objectives, mutual respect, clarity of roles, communication, trust, and collaboration. We were interested in examining how teams develop these positive characteristics. This paper explores the role of sharing stories about patients in developing patient-centered teams. Data for this paper came from 1 primary care clinic as part of a larger Providers Share Workshop study conducted by the University of Michigan. Each workshop included 5 facilitated group sessions in which staff met to talk about their work. This paper analyzes qualitative data from the workshops. Through an iterative process, research team members identified major themes, developed a coding scheme, and coded transcripts for qualitative data analysis. One of the most powerful ways group members connected was through sharing stories about their patients. Sharing clinical cases and stories helped participants bond around their shared mission of patient-centered care, build supportive relationships, enhance compassion for patients, communicate and resolve conflict, better understand workflows and job roles, develop trust, and increase morale. These attributes highlighted by participants correspond to those documented in the literature as important elements of teambuilding and key indicators of team effectiveness. The sharing of stories about patients seems to be a promising tool for positive team development in a primary care clinical setting and should be investigated further. PMID:26348238

  19. Identifying elements of patient-centered care in underserved populations: a qualitative study of patient perspectives.

    Directory of Open Access Journals (Sweden)

    Sheela Raja

    Full Text Available Patient-centered care is an important goal in the delivery of healthcare. However, many patients do not engage in preventive medical care. In this pilot study, we conducted twenty in depth, semi-structured qualitative interviews at the University of Illinois at Chicago Health Sciences campus in a four month time frame. Many patients were underserved and underinsured, and we wanted to understand their experiences in the healthcare system. Using content analysis, several themes emerged from the interview data. Participants discussed the need for empathy and rapport with their providers. They identified provider behaviors that fostered a positive clinical relationship, including step-by step explanations of procedures, attention to body language and clinic atmosphere, and appropriate time management. Participants identified cost as the most common barrier to engaging in preventive care and discussed children and social support as motivating factors. A long-term relationship with a provider was an important motivator for preventive care, suggesting that the therapeutic alliance was essential to many patients. Conversely, many participants discussed a sense of dehumanization in the healthcare system, reporting that their life circumstances were overlooked, or that they were judged based on insurance status or ethnicity. We discuss implications for provider training and healthcare delivery, including the importance of patient-centered medical homes.

  20. What is patient-centered care really? Voices of Hispanic prenatal patients.

    Science.gov (United States)

    Bergman, Alicia A; Connaughton, Stacey L

    2013-01-01

    Variations in patient-centered care (PCC) models and approaches contribute to ambiguity in how PCC is understood and defined, especially with regard to meeting the needs of diverse patient populations. One of the biggest challenges of putting PCC into practice is knowing what elements are the most important to patients. This qualitative study privileges patients' voices and adds a cultural dimension to existing health communication research on PCC through an empirical investigation of 48 Hispanic prenatal care patients' understandings and expectations of PCC. Semistructured interviews with 48 patients revealed five key themes in order of frequency: (a) una relación amable (a friendly relationship), (b) la atencion médica efectiva (effective medical care), (c) Español hablado (the Spanish language spoken), (d) comprensión de la información (understanding of information), and (e) eliminación del racismo (elimination of racism). The themes reflected several different assumptions and expectations with regard to PCC as compared to those espoused in many of the existing models and frameworks, such as the extent to which friendly interpersonal behaviors (e.g., smiling, making eye contact, displaying patience, and engaging in formal greetings, introductions, and farewells) were critical to patient satisfaction with the health care experience. Not only did patients feel better understood, but accompanied by friendly behaviors, information was viewed as more believable and accurate, and thus more patient-centered. The findings suggest that implementing culturally sensitive PCC approaches to caring for Hispanic prenatal care patients can include training health care staff on the importance of displaying friendly communicative behaviors such as smiling. PMID:23421385

  1. Implementation of Patient-Centered Medical Homes in Adult Primary Care Practices.

    Science.gov (United States)

    Alexander, Jeffrey A; Markovitz, Amanda R; Paustian, Michael L; Wise, Christopher G; El Reda, Darline K; Green, Lee A; Fetters, Michael D

    2015-08-01

    There has been relatively little empirical evidence about the effects of patient-centered medical home (PCMH) implementation on patient-related outcomes and costs. Using a longitudinal design and a large study group of 2,218 Michigan adult primary care practices, our study examined the following research questions: Is the level of, and change in, implementation of PCMH associated with medical surgical cost, preventive services utilization, and quality of care in the following year? Results indicated that both level and amount of change in practice implementation of PCMH are independently and positively associated with measures of quality of care and use of preventive services, after controlling for a variety of practice, patient cohort, and practice environmental characteristics. Results also indicate that lower overall medical and surgical costs are associated with higher levels of PCMH implementation, although change in PCMH implementation did not achieve statistical significance. PMID:25861803

  2. Patient-centered care in lung cancer: exploring the next milestones.

    Science.gov (United States)

    Ben-Arye, Eran; Samuels, Noah

    2015-10-01

    In this editorial, the authors comment on a recently published review paper by Molassiotis et al. on the developments made over the past 40 years in supportive care for patients with lung cancer. During this period, a paradigm shift promoting patient-centered care (PCC) has led to an important change in the approach of supportive cancer care, from a purely disease-centered approach, measuring survival-related outcomes, to recognizing the importance of quality of life outcomes as well. This change of understanding in supportive and palliative care for patients with lung cancer can be further advanced through the understanding that there is a need to address bio-psycho-spiritual concerns and health belief models, within the context of the family socio-cultural environment, for both patients and their caregivers. There is also a need to address the psycho-spiritual effects of cancer on those health care professionals treating patients with lung cancer, in order to reduce compassion fatigue and increase resilience. Future directions for supportive care for patients with lung cancer may include the development of a patient-tailored treatment approach, assisted by the integration of a multidisciplinary team of health care providers and evidence-based complementary medicine practices, within conventional supportive care practice. PMID:26629435

  3. A patient-centered research agenda for the care of the acutely ill older patient

    Science.gov (United States)

    Wald, Heidi L.; Leykum, Luci K.; Mattison, Melissa L. P.; Vasilevskis, Eduard E.; Meltzer, David O.

    2015-01-01

    Hospitalists and others acute care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine (SHM) sponsored the Acute Care of Older Patients (ACOP) Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through four steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a Partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of ten research questions in the following areas: advanced care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision-making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training. PMID:25877486

  4. Facilitators and Barriers to Care Coordination in Patient-centered Medical Homes (PCMHs) from Coordinators’ Perspectives

    Science.gov (United States)

    Friedman, Asia; Howard, Jenna; Shaw, Eric K.; Cohen, Deborah J.; Shahidi, Laleh; Ferrante, Jeanne M.

    2016-01-01

    Background Care coordinators are increasingly featured in patient-centered medical home (PCMH) projects, yet little research examines how coordinators themselves define and experience their role. This is the first study describing experiences of care coordinators across the US from their own perspectives. Methods This qualitative study used a 5-month private, online discussion forum to gather data from 25 care coordinators from PCMH practices representing diversity in practice size, setting, and type. Participants answered questions and interacted with one another, creating an online social learning collaborative while allowing for data collection for research. Results Coordinators identified barriers and facilitators in their work at the organization/system level, the interpersonal level, and the individual level. Some factors emerged as both barriers and facilitators, including the functionality of clinical information technology; the availability of community resources; interactions with clinicians and other health care facilities; interactions with patients; and self-care practices for mental health and wellness. Colocation and full integration into practices were other key facilitators, whereas excessive case loads and data management responsibilities were felt to be important barriers. Conclusions While all the barriers and facilitators were important to performing coordinators’ roles, relationship building materialized as key to effective care coordination, whether with clinicians, patients, or outside organizations. We discuss implications for practice and provide suggestions for further research. PMID:26769881

  5. Educating Patients about CKD: The Path to Self-Management and Patient-Centered Care.

    Science.gov (United States)

    Narva, Andrew S; Norton, Jenna M; Boulware, L Ebony

    2016-04-01

    Patient education is associated with better patient outcomes and supported by international guidelines and organizations, but a range of barriers prevent widespread implementation of comprehensive education for people with progressive kidney disease, especially in the United States. Among United States patients, obstacles to education include the complex nature of kidney disease information, low baseline awareness, limited health literacy and numeracy, limited availability of CKD information, and lack of readiness to learn. For providers, lack of time and clinical confidence combine with competing education priorities and confusion about diagnosing CKD to limit educational efforts. At the system level, lack of provider incentives, limited availability of practical decision support tools, and lack of established interdisciplinary care models inhibit patient education. Despite these barriers, innovative education approaches for people with CKD exist, including self-management support, shared decision making, use of digital media, and engaging families and communities. Education efficiency may be increased by focusing on people with progressive disease, establishing interdisciplinary care management including community health workers, and providing education in group settings. New educational approaches are being developed through research and quality improvement efforts, but challenges to evaluating public awareness and patient education programs inhibit identification of successful strategies for broader implementation. However, growing interest in improving patient-centered outcomes may provide new approaches to effective education of people with CKD. PMID:26536899

  6. A Comparison of Patient-Centered Care in Pharmacy Curricula in the United States and Europe

    Science.gov (United States)

    Nunes-da-Cunha, Ines; Arguello, Blanca; Martinez, Fernando Martinez

    2016-01-01

    Objective. To compare United States and European Higher Education Area (EHEA) undergraduate pharmacy curricula in terms of patient-centered care courses. Methods. Websites from all pharmacy colleges or schools in the United States and the 41 countries in the EHEA were retrieved from the FIP Official World List of Pharmacy Schools and investigated. A random sample of schools was selected and, based on analyses of course descriptions from syllabi, each course was classified into the following categories: social/behavioral/administrative pharmacy sciences, clinical sciences, experiential, or other/basic sciences. Results. Of 147 schools of pharmacy, 59 were included (23 in US and 36 in the EHEA). Differences existed in the percentages of credits/hours in all of the four subject area categories. Conclusion. Institutions in EHEA countries maintain a greater focus on basic sciences and a lower load of clinical sciences in pharmacy curricula compared to the United States. These differences may not be in accordance with international recommendations to educate future pharmacists focused on patient care. PMID:27402986

  7. Patient-Centered Medical Home Features and Health Care Expenditures of Medicare Beneficiaries with Chronic Disease Dyads.

    Science.gov (United States)

    Philpot, Lindsey M; Stockbridge, Erica L; Padrón, Norma A; Pagán, José A

    2016-06-01

    Three out of 4 Medicare beneficiaries have multiple chronic conditions, and managing the care of this growing population can be complex and costly because of care coordination challenges. This study assesses how different elements of the patient-centered medical home (PCMH) model may impact the health care expenditures of Medicare beneficiaries with the most prevalent chronic disease dyads (ie, co-occurring high cholesterol and high blood pressure, high cholesterol and heart disease, high cholesterol and diabetes, high cholesterol and arthritis, heart disease and high blood pressure). Data from the 2007-2011 Medical Expenditure Panel Survey suggest that increased access to PCMH features may differentially impact the distribution of health care expenditures across health care service categories depending on the combination of chronic conditions experienced by each beneficiary. For example, having no difficulty contacting a provider after regular hours was associated with significantly lower outpatient expenditures for beneficiaries with high cholesterol and diabetes (n = 635; P = 0.038), but it was associated with significantly higher inpatient expenditures for beneficiaries with high blood pressure and high cholesterol (n = 1599; P = 0.015), and no significant differences in expenditures in any category for beneficiaries with high blood pressure and heart disease (n = 1018; P > 0.05 for all categories). However, average total health care expenditures are largely unaffected by implementing the PCMH features considered. Understanding how the needs of Medicare beneficiaries with multiple chronic conditions can be met through the adoption of the PCMH model is important not only to be able to provide high-quality care but also to control costs. (Population Health Management 2016;19:206-211). PMID:26440215

  8. Internet Use Frequency and Patient-Centered Care: Measuring Patient Preferences for Participation Using the Health Information Wants Questionnaire

    OpenAIRE

    Xie, Bo; Wang, Mo; Feldman, Robert; Zhou, Le

    2013-01-01

    Background The Internet is bringing fundamental changes to medical practice through improved access to health information and participation in decision making. However, patient preferences for participation in health care vary greatly. Promoting patient-centered health care requires an understanding of the relationship between Internet use and a broader range of preferences for participation than previously measured. Objective To explore (1) whether there is a significant relationship between...

  9. Practicing Patient-Centered Care: The Questions Clinically Excellent Physicians Use to Get to Know their Patients as Individuals

    OpenAIRE

    Hanyok, Laura A.; Hellmann, David B.; Cynthia Rand; Ziegelstein, Roy C

    2012-01-01

    Background and Objective:Background and Objective: Patient-centered care, which is dependent on knowing each patient as an individual, has been identified as a critical aspect of healthcare. The most effective and efficient methods to get to know patients as individuals have not been defined. Our aim was to identify questions and phrases that can be used by physicians to get to know their patients. Abstract: Methods:Methods: We surveyed 15 physicians who have been formally recognized for thei...

  10. Teaching About Culture and Health in Ontario Medical Schools: Learning about culture and health through patient-centered care

    OpenAIRE

    Hennen, B K; Blackman, N.

    1992-01-01

    Questionnaire surveys and on-site visits determined that culture and health are not a formal part of a curriculum for all students in any undergraduate or family medicine residency program in Ontario medical schools. Electives and other opportunities exist, but only some students benefit. Suggestions from the programs on how to improve such learning and make it universally available are noted. Patient-centered care is endorsed as a suitable model for learning about culture and health in the c...

  11. The Treatment Effectiveness Assessment (TEA: an efficient, patient-centered instrument for evaluating progress in recovery from addiction

    Directory of Open Access Journals (Sweden)

    Ling W

    2012-12-01

    Full Text Available Walter Ling,1 David Farabee,1 Dagmar Liepa,2 Li-Tzy Wu31Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA; 2Valley Care Medical Center, Panorama City, CA, USA; 3Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USAAbstract: The fields of addiction medicine and addiction research have long sought an efficient yet comprehensive instrument to assess patient progress in treatment and recovery. Traditional tools are expensive, time consuming, complex, and based on topics that clinicians or researchers think are important. Thus, they typically do not provide patient-centered information that is meaningful and relevant to the lives of patients with substance use disorders. To improve our ability to understand patients’ progress in treatment from their perspectives, the authors and colleagues developed a patient-oriented assessment instrument that has considerable advantages over existing instruments: brevity, simplicity, ease of administration, orientation to the patient, and cost (none. The resulting Treatment Effectiveness Assessment (TEA elicits patient responses that help the patient and the clinician quickly gauge patient progress in treatment and in recovery, according to the patients’ sense of what is important within four domains established by prior research. Patients provide both numerical responses and representative details on their substance use, health, lifestyle, and community. No software is required for data entry or scoring, and no formal training is required to administer the TEA. This article describes the development of the TEA and the initial phases of its application in clinical practice and in research.Keywords: substance use disorders, global treatment progress, brief instrument, patient-centered

  12. An online module series to prepare pharmacists to facilitate student engagement in patient-centered care delivery: development and evaluation

    Directory of Open Access Journals (Sweden)

    Kassam R

    2012-06-01

    Full Text Available Rosemin Kassam,1 Mona Kwong,1 John B Collins21Faculty of Pharmaceutical Sciences, 2Department of Educational Studies, University of British Columbia, Vancouver, CanadaIntroduction: Accreditation bodies across North America have adopted revised standards that place increased emphasis on experiential education and preceptors to promote and demonstrate patient-centered, pharmaceutical care practices to students. Since such practices are still evolving, challenges exist in recruiting skilled preceptors who are prepared to provide such opportunities. An online educational module series titled "A Guide to Pharmaceutical Care" (The Guide was developed and evaluated to facilitate this transition. The objectives of this paper are: (1 to describe the development of the modules; and (2 to present the evaluation results from its pilot testing.Methods: The Guide was developed as an online, self-directed training program. It begins by providing an overview of patient care (PC philosophy and practice, and then discusses the tools that facilitate PC. It also provides a range of tips to support students as they provide PC during their experiential learning. Pharmacists participating in the pilot study were recruited using purposive and snowball sampling techniques. A pre–post quantitative survey with additional open-ended questions was used to evaluate the modules.Results: The modules incorporated a variety of teaching strategies: self-reflection exercises, quizzes to review important concepts, quick tips, flash cards, and video clips to illustrate more in-depth learning. Thirty-two pharmacists completed the pre–post assessment and reported significant increases in their confidence because of this training. The most influenced outcome was "Application of techniques to facilitate learning opportunities that enable pharmacy students to practice pharmaceutical care competencies." They also indicated that the training clarified necessary changes in their

  13. Patient-centered cancer treatment planning: improving the quality of oncology care. Summary of an Institute of Medicine workshop.

    Science.gov (United States)

    Balogh, Erin P; Ganz, Patricia A; Murphy, Sharon B; Nass, Sharyl J; Ferrell, Betty R; Stovall, Ellen

    2011-01-01

    The Institute of Medicine's National Cancer Policy Forum recently convened a workshop on patient-centered cancer treatment planning, with the aim of raising awareness about this important but often overlooked aspect of cancer treatment. A primary goal of patient-centered treatment planning is to engage patients and their families in meaningful, thorough interactions with their health care providers to develop an accurate, well-conceived treatment plan, using all available medical information appropriately while also considering the medical, social, and cultural needs and desires of the patient and family. A cancer treatment plan can be shared among the patient, family, and care team in order to facilitate care coordination and provide a roadmap to help patients navigate the path of cancer treatment. There are numerous obstacles to achieving patient-centered cancer treatment planning in practice. Some of these challenges stem from the patient and include patients' lack of assertiveness, health literacy, and numeracy, and their emotional state and concurrent illnesses. Others are a result of physician limitations, such as a lack of time to explain complex information and a lack of tools to facilitate treatment planning, as well as insensitivity to patients' informational, cultural, and emotional needs. Potential solutions to address these obstacles include better training of health care providers and patients in optimal communication and shared decision making, and greater use of support services and tools such as patient navigation and electronic health records. Other options include greater use of quality metrics and reimbursement for the time it takes to develop, discuss, and document a treatment plan. PMID:22128118

  14. 患者中心疗法疗效评估%Patient-centered Therapy Efficacy Assessment

    Institute of Scientific and Technical Information of China (English)

    卢雅; 王欢; 苗银宁

    2014-01-01

    Patient-centered therapy (CCT) was created by the famous American Humanism psychologist Carl o Rogers. This therapy is based on the characteristics of the patient as the center, the entire treatment process of creating a suitable environ-ment for the atmosphere and the patient to alleviate the patient's anxiety. This article will be based on collecting and collating documents, to assess the efficacy of CCT.%患者中心疗法(CCT)由美国著名人本主义心理学家卡尔·罗杰斯倡导创立。这种疗法的特点是以患者为中心,在整个治疗过程中为患者创造适宜的气氛和环境,以减轻患者的焦虑。本文将在文献搜集和整理的基础上,对CCT的疗效进行评估。

  15. Are patient-centered care values as reflected in teaching scenarios really being taught when implemented by teaching faculty? A discourse analysis on an Indonesian medical school's curriculum

    Directory of Open Access Journals (Sweden)

    Claramita Mora

    2011-04-01

    Full Text Available Abstract Background According to The Indonesian Medical Council, 2006, Indonesian competence-based medical curriculum should be oriented towards family medicine. We aimed to find out if the educational goal of patient-centered care within family medicine (comprehensive care and continuous care were adequately transferred from the expected curriculum to implemented curriculum and teaching process. Methods Discourse analysis was done by 3 general practitioners of scenarios and learning objectives of an Indonesian undergraduate medical curriculum. The coders categorized those sentences into two groups: met or unmet the educational goal of patient-centered care. Results Text analysis showed gaps in patient-centered care training between the scenarios and the learning objectives which were developed by both curriculum committee and the block planning groups and the way in which the material was taught. Most sentences in the scenarios were more relevant to patient-centered care while most sentences in the learning objectives were more inclined towards disease-perspectives. Conclusions There is currently a discrepancy between expected patient-centered care values in the scenario and instructional materials that are being used.

  16. Patient-Centered Medical Home Adoption: Lessons Learned and Implications for Health Care System Reform.

    Science.gov (United States)

    Gurewich, Deborah; Cabral, Linda; Sefton, Laura

    2016-01-01

    Case studies of 8 primary care medical homes participating in a Massachusetts-based initiative were conducted to understand the approaches they used to operationalize medical home standards and associated barriers. All sites received their National Committee on Quality Assurance recognition as medical homes, yet varied considerably in how components were implemented. Despite this variation, they faced similar challenges to implementing and sustaining medical home standards. Variations and challenges strongly emerged in 4 areas: team-based care, scheduling and online access, identifying and managing high-risk patients, and organizing follow-up care. Our study offers insight into various pathways to medical home success, and notes areas for further study. PMID:27232687

  17. An interprofessional service-learning course: uniting students across educational levels and promoting patient-centered care.

    Science.gov (United States)

    Dacey, Marie; Murphy, Judy I; Anderson, Delia Castro; McCloskey, William W

    2010-12-01

    Recognizing the importance of interprofessional education, we developed a pilot interprofessional education course at our institution that included a total of 10 nursing, BS health psychology, premedical, and pharmacy students. Course goals were for students to: 1) learn about, practice, and enhance their skills as members of an interprofessional team, and 2) create and deliver a community-based service-learning program to help prevent or slow the progression of cardiovascular disease in older adults. Teaching methods included lecture, role-play, case studies, peer editing, oral and poster presentation, and discussion. Interprofessional student teams created and delivered two different health promotion programs at an older adult care facility. Despite barriers such as scheduling conflicts and various educational experiences, this course enabled students to gain greater respect for the contributions of other professions and made them more patient centered. In addition, inter-professional student teams positively influenced the health attitudes and behaviors of the older adults whom they encountered. PMID:20795606

  18. Police officer, deal-maker, or health care provider? Moving to a patient-centered framework for chronic opioid management.

    Science.gov (United States)

    Nicolaidis, Christina

    2011-06-01

    How we frame our thoughts about chronic opioid therapy greatly influences our ability to practice patient-centered care. Even providers who strive to be nonjudgmental may approach clinical decision-making about opioids by considering if the pain is real or they can trust the patient. Not only does this framework potentially lead to poor or unshared decision-making, it likely adds to provider and patient discomfort by placing the provider in the position of a police officer or a judge. Similarly, providers often find themselves making deals with patients using a positional bargaining approach. Even if a compromise is reached, this framework can potentially inadvertently weaken the therapeutic relationship by encouraging the idea that the patient and provider have opposing goals. Reframing the issue can allow the provider to be in a more therapeutic role. As recommended in the American Pain Society/American Academy of Pain Medicine guidelines, providers should decide whether the benefits of opioid therapy are likely to outweigh the harms for a specific patient (or sometimes, for society) at a specific time. This article discusses how providers can use a benefit-to-harm framework to make and communicate decisions about the initiation, continuation, and discontinuation of opioids for managing chronic nonmalignant pain. Such an approach focuses decisions and discussions on judging the treatment, not the patient. It allows the provider and the patient to ally together and make shared decisions regarding a common goal. Moving to a risk-benefit framework may allow providers to provide more patient-centered care, while also increasing provider and patient comfort with adequately monitoring for harm. PMID:21539703

  19. Hourly rounding is key contributor to patient-centered care at high-performing hospitals.

    Science.gov (United States)

    2015-10-01

    According to new findings, hospitals with the highest HCAHPS scores suggest that hourly rounding on patients is one of the best ways to elevate the patient experience. In a survey of top-performing hospitals, 83% reported they employed the practice of regular nurse rounding on patients, and 62% employed leadership rounding. When rounding on patients, experts suggest nurses should always consider pain, the plan of care, and duration, or "PPD". PMID:26447259

  20. Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women.

    Directory of Open Access Journals (Sweden)

    Elysia Larson

    Full Text Available In order to develop patient-centered care we need to know what patients want and how changing socio-demographic factors shape their preferences.We fielded a structured questionnaire that included a discrete choice experiment to investigate women's preferences for place of delivery care in four rural districts of Pwani Region, Tanzania. The discrete choice experiment consisted of six attributes: kind treatment by the health worker, health worker medical knowledge, modern equipment and medicines, facility privacy, facility cleanliness, and cost of visit. Each woman received eight choice questions. The influence of potential supply- and demand- side factors on patient preferences was evaluated using mixed logit models.3,003 women participated in the discrete choice experiment (93% response rate completing 23,947 choice tasks. The greatest predictor of health facility preference was kind treatment by doctor (β = 1.13, p<0.001, followed by having a doctor with excellent medical knowledge (β = 0.89 p<0.001 and modern medical equipment and drugs (β = 0.66 p<0.001. Preferences for all attributes except kindness and cost were changed with changes to education, primiparity, media exposure and distance to nearest hospital.Care quality, both technical and interpersonal, was more important than clinic inputs such as equipment and cleanliness. These results suggest that while basic clinic infrastructure is necessary, it is not sufficient for provision of high quality, patient-centered care. There is an urgent need to build an adequate, competent, and kind health workforce to raise facility delivery and promote patient-centered care.

  1. [Requirements of optimal working conditions and patient-centered care in hospital nursing].

    Science.gov (United States)

    Walter, A; Merboth, H; Böger, S

    1997-12-01

    Nursing--a human service increasing in size and significance--is facing deep changes. The organization of hospital wards is also influenced by these profound changes. The aim of this psychological research project sponsored by the German Federal Ministry for Education and Science, Research and Technology (BMBF) and part of the Saxonian Public Health Association was to determine the external and individual working conditions that put the personnel's health at risk, particularly in regard to burnout syndromes. Investigations should show possibilities in work organization that minimize such risks. Organizational designs have to ensure high quality levels of nursing care, as well as high quality of working conditions in nursing for the individual employee. This empirical study presents the results of an investigation of 53 medical, surgical and intensive care units of 7 Saxonian hospitals with 336 employees of the nursing departments. The size of the hospital, the service profile, the nursing standards and the organizational conditions of the nursing service influence work pressure and working attitude. PMID:9456781

  2. Patient-Centered Cancer Care Programs in Italy: Benchmarking Global Patient Education Initiatives.

    Science.gov (United States)

    Truccolo, Ivana; Cipolat Mis, Chiara; Cervo, Silvia; Dal Maso, Luigino; Bongiovanni, Marilena; Bearz, Alessandra; Sartor, Ivana; Baldo, Paolo; Ferrarin, Emanuela; Fratino, Lucia; Mascarin, Maurizio; Roncadin, Mario; Annunziata, Maria Antonietta; Muzzatti, Barbara; De Paoli, Paolo

    2016-06-01

    In Italy, educational programs for cancer patients are currently provided by the national government, scientific societies, and patient advocate organizations. Several gaps limit their effectiveness, including the lack of coordinated efforts, poor involvement of patient feedback in the planning of programs, as well as a lack of resources on innovative cancer-related topics. This process is parallel to a strong shift in the attitude of patients towards health in general and taking charge of their own health conditions in particular. The National Cancer Institute in the USA and the Organization of European Cancer Institutes encourage comprehensive cancer centers in providing educational programs conceived to overcome these gaps. The goal of this paper is to identify and describe the key elements necessary to develop a global patient education program and provide recommendations for strategies with practical examples for implementation in the daily activities of cancer institutes. A multidisciplinary committee was established for patient education, including patient representatives as equal partners, to define, implement, verify, and evaluate the fundamental steps for establishing a comprehensive education program. Six essential topics were identified for the program: appropriate communication of cancer epidemiology, clinical trial information, new therapeutic technologies, support in the use of medicines, psycho-oncological interventions, age-personalized approaches, and training programs for healthcare providers. Integration of these topics along with patient feedback is the key to a successful model for educational programs. An integrated educational program can transform a comprehensive cancer center to an institution that provides research and care for and with patients. PMID:25773134

  3. Do Patient-Centered Medical Home Access and Care Coordination Measures Reflect the Contribution of All Team Members? A Systematic Review.

    Science.gov (United States)

    Annis, Ann M; Harris, Marcelline; Robinson, Claire H; Krein, Sarah L

    2016-01-01

    Patient-Centered Medical Home (PCMH) evaluations have primarily focused on primary care providers and not on the primary care team. This systematic literature review examined the extent to which access and care coordination measures in PCMH reflect the involvement of associate care providers (ACPs), which include registered and licensed practical nurses, nursing and medical assistants, clerks, pharmacists, social workers, and dietitians. Among 42 studies, few measures specified ACP roles or linked ACP care to outcomes. Increasing attention on team-based care emphasizes a vital need to reframe measures within a team context. PMID:27219827

  4. Patient-centered Radiology.

    Science.gov (United States)

    Itri, Jason N

    2015-10-01

    Patient-centered care (ie, care organized around the patient) is a model in which health care providers partner with patients and families to identify and satisfy patients' needs and preferences. In this model, providers respect patients' values and preferences, address their emotional and social needs, and involve them and their families in decision making. Radiologists have traditionally been characterized as "doctor-to-doctor" consultants who are distanced from patients and work within a culture that does not value patient centeredness. As medicine becomes more patient driven and the trajectory of health care is toward increasing patient self-reliance, radiologists must change the perception that they are merely consultants and become more active participants in patient care by embracing greater patient interaction. The traditional business model for radiology practices, which devalues interaction between patients and radiologists, must be transformed into a patient-centered model in which radiologists are reintegrated into direct patient care and imaging processes are reorganized around patients' needs and preferences. Expanding radiology's core assets to include direct patient care may be the most effective deterrent to the threat of commoditization. As the assault on the growth of Medicare spending continues, with medical imaging as a highly visible target, radiologists must adapt to the changing landscape by focusing on their most important consumer: the patient. This may yield substantial benefits in the form of improved quality and patient safety, reduced costs, higher-value care, improved patient outcomes, and greater patient and provider satisfaction. PMID:26466190

  5. The impact of a regional patient-centered medical home initiative on cost of care among commercially insured population in the US

    OpenAIRE

    Maeng DD; Sciandra JP; Tomcavage JF

    2016-01-01

    Daniel Dukjae Maeng, Joann P Sciandra, Janet F Tomcavage Geisinger Health System, Danville, PA, USAAbstract: The impact of a patient-centered medical home (PCMH) in reducing total cost of care remains a subject of debate, particularly among the non-elderly adult population. This study examines a 6-year experience of a large integrated regional health care delivery system in the US implementing PCMH among its commercially insured population. A regional health plan's claims data from 2008 t...

  6. The impact of a regional patient-centered medical home initiative on cost of care among commercially insured population in the US

    OpenAIRE

    Maeng, Daniel

    2016-01-01

    Daniel Dukjae Maeng, Joann P Sciandra, Janet F Tomcavage Geisinger Health System, Danville, PA, USAAbstract: The impact of a patient-centered medical home (PCMH) in reducing total cost of care remains a subject of debate, particularly among the non-elderly adult population. This study examines a 6-year experience of a large integrated regional health care delivery system in the US implementing PCMH among its commercially insured population. A regional health plan's claims data from 20...

  7. Adaptive practices in heart failure care teams: implications for patient-centered care in the context of complexity

    Directory of Open Access Journals (Sweden)

    Tait GR

    2015-08-01

    Full Text Available Glendon R Tait,1 Joanna Bates,2 Kori A LaDonna,3 Valerie N Schulz,4 Patricia H Strachan,5 Allan McDougall,3 Lorelei Lingard3 1Department of Psychiatry and Division of Medical Education, Dalhousie University, Halifax, NS, 2Centre for Health Education Scholarship, Vancouver General Hospital, Vancouver, BC, 3Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, 4Palliative Care, London Health Sciences Centre, University Hospital, London; 5School of Nursing, McMaster University, Hamilton, ON, Canada Background: Heart failure (HF, one of the three leading causes of death, is a chronic, progressive, incurable disease. There is growing support for integration of palliative care’s holistic approach to suffering, but insufficient understanding of how this would happen in the complex team context of HF care. This study examined how HF care teams, as defined by patients, work together to provide care to patients with advanced disease. Methods: Team members were identified by each participating patient, generating team sampling units (TSUs for each patient. Drawn from five study sites in three Canadian provinces, our dataset consists of 209 interviews from 50 TSUs. Drawing on a theoretical framing of HF teams as complex adaptive systems (CAS, interviews were analyzed using the constant comparative method associated with constructivist grounded theory. Results: This paper centers on the dominant theme of system practices, how HF care delivery is reported to work organizationally, socially, and practically, and describes two subthemes: “the way things work around here”, which were commonplace, routine ways of doing things, and “the way we make things work around here”, which were more conscious, effortful adaptations to usual practice in response to emergent needs. An adaptive practice, often a small alteration to routine, could have amplified effects beyond those intended by the innovating team

  8. Internet Use Frequency and Patient-Centered Care: Measuring Patient Preferences for Participation Using the Health Information Wants Questionnaire

    Science.gov (United States)

    Wang, Mo; Feldman, Robert; Zhou, Le

    2013-01-01

    Background The Internet is bringing fundamental changes to medical practice through improved access to health information and participation in decision making. However, patient preferences for participation in health care vary greatly. Promoting patient-centered health care requires an understanding of the relationship between Internet use and a broader range of preferences for participation than previously measured. Objective To explore (1) whether there is a significant relationship between Internet use frequency and patients’ overall preferences for obtaining health information and decision-making autonomy, and (2) whether the relationships between Internet use frequency and information and decision-making preferences differ with respect to different aspects of health conditions. Methods The Health Information Wants Questionnaire (HIWQ) was administered to gather data about patients’ preferences for the (1) amount of information desired about different aspects of a health condition, and (2) level of decision-making autonomy desired across those same aspects. Results The study sample included 438 individuals: 226 undergraduates (mean age 20; SD 2.15) and 212 community-dwelling older adults (mean age 72; SD 9.00). A significant difference was found between the younger and older age groups’ Internet use frequencies, with the younger age group having significantly more frequent Internet use than the older age group (younger age group mean 5.98, SD 0.33; older age group mean 3.50, SD 2.00; t 436=17.42, P<.01). Internet use frequency was positively related to the overall preference rating (γ=.15, P<.05), suggesting that frequent Internet users preferred significantly more information and decision making than infrequent Internet users. The relationships between Internet use frequency and different types of preferences varied: compared with infrequent Internet users, frequent Internet users preferred more information but less decision making for diagnosis (γ=.57

  9. The Power to drive change: Working together for excellence. Creating a continuously improving consumer engagement framework for excellence in patient-centered care.

    Science.gov (United States)

    Ryan, Catherine

    2016-01-01

    The World Health Organization has acknowledged Patient Safety while receiving hospital care as a serious global public health issue, with patient empowerment and community engagement key to continuously improving safety and quality of care for the best possible clinical and patient outcomes. In Australia, the introduction of ten mandatory National Safety and Quality Health Service Standards in 2011 provided the catalyst for all Australian health facilities to review their systems. Standard 2: Partnering with Consumers required health facilities across Australia to assess commitment to, and capacity for consumer and community engagement and participation. At this time, the Royal Brisbane and Women's Hospital did not have a strategic perspective and understanding, or an organizational structure for engaging with consumers (patients, families, care givers and community members). The concept required a new model to replace the clinician-led model of healthcare historically featured in Australia, with a change in culture and core business. processes to partner with consumers at all levels of the system, from individual patient care through to participating in policy development, health service planning and delivery, and evaluation and measurement processes. The challenge for the hospital was to build a sustainable framework of engagement for a genuine patient-centered model of care informed by best practice, and provide leadership and commitment to developing as an area of excellence in patient engagement and experience. A successful and sustainable framework for consumer and community engagement has been embedded in the hospital, with resultant culture change, achieving accreditation across all core and developmental criteria for the partnering with consumer standards including several Met with Merit ratings. PMID:27180474

  10. Mindfulness-based interventions with social workers and the potential for enhanced patient-centered care: A systematic review of the literature.

    Science.gov (United States)

    Trowbridge, Kelly; Mische Lawson, Lisa

    2016-01-01

    The use of mindfulness-based interventions (MBIs) is well documented in the mental health, medical, and education literature. There is minimal research on the use of mindfulness with social workers. As demonstrated in other professional and helping fields, mindfulness may enhance clinical skills, reduce burnout, and increase job satisfaction among social workers. In the health care field mindfulness appears integral to patient and family relationships and personal resilience. The evolving and expanding role of hospital social workers may lead to increased work stress and greater demands from both the medical system and patients and families. Research with medical providers, such as physicians and nurses, suggests mindfulness may help in reducing stress, enhancing relationships, and fostering the self-reflection required to provide patient-centered care. We systematically reviewed the existing literature to begin understanding both mindfulness qualities and practices and the effectiveness of MBIs among social workers as well as the relationship of mindfulness to patient-centered care. PMID:26745592

  11. Patient-Centered Homes and Integrated Behavioral Health Care: Reclaiming the Role of "Consultant" for Psychiatric-Mental Health Nurse Practitioner.

    Science.gov (United States)

    Soltis-Jarrett, Victoria

    2016-06-01

    The notion of patient-centered care has long been linked with nursing practice since Florence Nightingale. The discipline of nursing is focused on the holistic care of individuals, families, and communities in times of sickness and/or health. However, in psychiatric-mental health nursing, the concepts of mental health and psychiatric illness still remain marginalized in our health care delivery systems, as well as in nursing education, knowledge development, and practice. Even with the concept of patient-centered homes, acute and primary care providers are reluctant to embrace care of those with psychiatric illness in their respective settings. Psychiatric illness was and continues to be in the shadows, hidden and often ignored by the larger community as well as by health care providers. This paper describes a Health Resources Services Administration (HRSA) Advanced Nursing Education (ANE) training grant's objective of reintegrating psychiatric-mental health practice into ALL health care delivery systems using the concept of patient-centered nursing care as a foundation for, and promotion of, the Psychiatric-Mental Health Nurse Practitioner (PMH-NP) as the "navigator" for not only the patients and their families, but also for their acute and primary care colleagues using an Interprofessional Education Model. The major barriers and lessons learned from this project as well as the need for psychiatric-mental health nurses to reclaim their role as a consultant/liaison in acute, primary, and long-term care settings will be discussed. The PMHNP as a consultant/liaison is being revitalized as an innovative advanced practice nursing health care model in North Carolina. PMID:27144999

  12. Attributes of patient-centered primary care associated with the public perception of good healthcare quality in Brazil, Colombia, Mexico and El Salvador.

    Science.gov (United States)

    Doubova, Svetlana V; Guanais, Frederico C; Pérez-Cuevas, Ricardo; Canning, David; Macinko, James; Reich, Michael R

    2016-09-01

    This study evaluated primary care attributes of patient-centered care associated with the public perception of good quality in Brazil, Colombia, Mexico and El Salvador. We conducted a secondary data analysis of a Latin American survey on public perceptions and experiences with healthcare systems. The primary care attributes examined were access, coordination, provider-patient communication, provision of health-related information and emotional support. A double-weighted multiple Poisson regression with robust variance model was performed. The study included between 1500 and 1503 adults in each country. The results identified four significant gaps in the provision of primary care: not all respondents had a regular place of care or a regular primary care doctor (Brazil 35.7%, Colombia 28.4%, Mexico 22% and El Salvador 45.4%). The communication with the primary care clinic was difficult (Brazil 44.2%, Colombia 41.3%, Mexico 45.1% and El Salvador 56.7%). There was a lack of coordination of care (Brazil 78.4%, Colombia 52.3%, Mexico 48% and El Salvador 55.9%). Also, there was a lack of information about healthy diet (Brazil 21.7%, Colombia 32.9%, Mexico 16.9% and El Salvador 20.8%). The public's perception of good quality was variable (Brazil 67%, Colombia 71.1%, Mexico 79.6% and El Salvador 79.5%). The primary care attributes associated with the perception of good quality were a primary care provider 'who knows relevant information about a patient's medical history', 'solves most of the health problems', 'spends enough time with the patient', 'coordinates healthcare' and a 'primary care clinic that is easy to communicate with'. In conclusion, the public has a positive perception of the quality of primary care, although it has unfulfilled expectations; further efforts are necessary to improve the provision of patient-centered primary care services in these four Latin American countries. PMID:26874326

  13. Psychosocial risk factors, interventions and comorbidity in patients with non-specific low back pain in primary care: need for comprehensive and patient-centered care.

    Directory of Open Access Journals (Sweden)

    Aline eRamond-Roquin

    2015-10-01

    psychosocial conditions, this suggests taking into account any potential comorbidity in patients with chronic LBP, as in other patients. All these results support the adoption of a more comprehensive and patient-centered approach when dealing with patients with LBP in primary care. As this condition is illustrative of many situations encountered in primary care, the strategies proposed here may benefit most patients consulting in this setting.

  14. A web-based, patient-centered toolkit to engage patients and caregivers in the acute care setting: a preliminary evaluation.

    Science.gov (United States)

    Dalal, Anuj K; Dykes, Patricia C; Collins, Sarah; Lehmann, Lisa Soleymani; Ohashi, Kumiko; Rozenblum, Ronen; Stade, Diana; McNally, Kelly; Morrison, Constance Rc; Ravindran, Sucheta; Mlaver, Eli; Hanna, John; Chang, Frank; Kandala, Ravali; Getty, George; Bates, David W

    2016-01-01

    We implemented a web-based, patient-centered toolkit that engages patients/caregivers in the hospital plan of care by facilitating education and patient-provider communication. Of the 585 eligible patients approached on medical intensive care and oncology units, 239 were enrolled (119 patients, 120 caregivers). The most common reason for not approaching the patient was our inability to identify a health care proxy when a patient was incapacitated. Significantly more caregivers were enrolled in medical intensive care units compared with oncology units (75% vs 32%; P usability scores and satisfaction ratings of a sample of surveyed enrollees were favorable. From analysis of feedback, we identified barriers to adoption and outlined strategies to promote use. PMID:26239859

  15. Protocol for the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) Million Persons Project pilot

    Science.gov (United States)

    Lu, Jiapeng; Xuan, Si; Downing, Nicholas S; Wu, Chaoqun; Li, Li; Krumholz, Harlan M; Jiang, Lixin

    2016-01-01

    Introduction Collection of high-quality data from large populations is considered essential to generate knowledge that is critical to an era of precision medicine. Cardiovascular disease (CVD) is a leading cause of mortality in China and is a suitable focus of an initiative to discover factors that would improve our ability to assess and modify individual risk. Methods and analysis The pilot phase of China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) Million Persons Project is being conducted during 2014–2015 in four provinces across China to demonstrate the feasibility of a population-based assessment. It is designed to screen 0.4 million community-dwelling residents aged 40–75 years with measurements of blood pressure, height and weight, a lipid blood test, and a questionnaire on cardiovascular-related health status. Participants identified at high risk of CVD receive further health assessments, including ECG, ultrasound scan, blood and urine analysis, and a questionnaire on lifestyle and medical history. Collection of blood and urine samples is used to establish a biobank. High-risk subjects are also counselled with suggestions regarding potential lifestyle changes. In addition, high-risk subjects are followed-up either in a return clinic visit or by telephone interview, with measurement of blood pressure, weight, ECG, and a questionnaire on survival status, hospitalisations and lifestyle. The first 0.1 million participants screened were used to conduct a preliminary analysis, with information on baseline characteristics, health-related behaviours, anthropometric variables, medical history, and prevalence of high-risk subjects. Ethics and dissemination The central ethics committee at the China National Center for Cardiovascular Disease (NCCD) approved the pilot. Written informed consent is obtained from all participants on entry into the project. Findings will be disseminated in future peer-reviewed papers and will inform strategies

  16. China Patient-centered Evaluative Assessment of Cardiac Events Prospective Study of Acute Myocardial Infarction:Study Design

    Institute of Scientific and Technical Information of China (English)

    Jing Li; Rachel P Dreyer; Xi Li; Xue Du; Nicholas S Downing; Li Li; Hai-Bo Zhang

    2016-01-01

    Background: Despite the rapid growth in the incidence of acute myocardial infarction (AMI) in China, there is limited information about patients' experiences after AMI hospitalization, especially on long-term adverse events and patient-reported outcomes (PROs).Methods: The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE)-Prospective AMI Study will enroll 4000 consecutive AMI patients from 53 diverse hospitals across China and follow them longitudinally for 12 months to document their treatment, recovery, and outcomes.Details of patients' medical history, treatment, and in-hospital outcomes are abstracted from medical charts.Comprehensive baseline interviews are being conducted to characterize patient demographics, risk factors, presentation, and healthcare utilization.As part of these interviews, validated instruments are administered to measure PROs, including quality of life, symptoms, mood, cognition, and sexual activity.Follow-up interviews, measuring PROs, medication adherence, risk factor control, and collecting hospitalization events are conducted at 1, 6, and 12 months after discharge.Supporting documents for potential outcomes are collected for adjudication by clinicians at the National Coordinating Center.Blood and urine samples are also obtained at baseline, 1-and 12-month follow-up.In addition, we are conducting a survey of participating hospitals to characterize their organizational characteristics.Conclusion: The China PEACE-Prospective AMI study will be uniquely positioned to generate new information regarding patient's experiences and outcomes after AMI in China and serve as a foundation for quality improvement activities.

  17. A cluster randomized trial of standard quality improvement versus patient-centered interventions to enhance depression care for African Americans in the primary care setting: study protocol NCT00243425

    Directory of Open Access Journals (Sweden)

    Ghods Bri K

    2010-02-01

    Full Text Available Abstract Background Several studies document disparities in access to care and quality of care for depression for African Americans. Research suggests that patient attitudes and clinician communication behaviors may contribute to these disparities. Evidence links patient-centered care to improvements in mental health outcomes; therefore, quality improvement interventions that enhance this dimension of care are promising strategies to improve treatment and outcomes of depression among African Americans. This paper describes the design of the BRIDGE (Blacks Receiving Interventions for Depression and Gaining Empowerment Study. The goal of the study is to compare the effectiveness of two interventions for African-American patients with depression--a standard quality improvement program and a patient-centered quality improvement program. The main hypothesis is that patients in the patient-centered group will have a greater reduction in their depression symptoms, higher rates of depression remission, and greater improvements in mental health functioning at six, twelve, and eighteen months than patients in the standard group. The study also examines patient ratings of care and receipt of guideline-concordant treatment for depression. Methods/Design A total of 36 primary care clinicians and 132 of their African-American patients with major depressive disorder were recruited into a cluster randomized trial. The study uses intent-to-treat analyses to compare the effectiveness of standard quality improvement interventions (academic detailing about depression guidelines for clinicians and disease-oriented care management for their patients and patient-centered quality improvement interventions (communication skills training to enhance participatory decision-making for clinicians and care management focused on explanatory models, socio-cultural barriers, and treatment preferences for their patients for improving outcomes over 12 months of follow

  18. "It's Not Like You Need to Live 10 or 20 Years": Challenges to Patient-Centered Care in Gynecologic Oncologist-Patient Interactions.

    Science.gov (United States)

    Hsieh, Elaine; Bruscella, Jacqueline; Zanin, Alaina; Kramer, Eric M

    2016-07-01

    The literature suggests that the patient-perspective approach (i.e., eliciting and responding to patients' perspectives, including beliefs, preferences, values, and attitudes) to patient-centered care (PCC) is not a reliable predictor of positive outcomes; however, little is known about why the patient-perspective approach does not necessarily lead to positive outcomes. By using discourse analysis to examine 44 segments of oncologist-patient interactions, we found that providers' use of patient-perspective contextualization can affect the quality of care through (a) constructing the meanings of patient conditions, (b) controlling interpreting frames for patient conditions, and (c) manipulating patient preferences through strategic information sharing. We concluded that providers' use of patient-perspective contextualization is an insufficient indicator of PCC because these discursive strategies can be used to control and manipulate patient preferences and perspectives. At times, providers' patient-perspective contextualization can silence patients' voice and appear discriminatory. PMID:26078327

  19. Academic-Community Partnership to Develop a Patient-Centered Breast Cancer Risk Reduction Program for Latina Primary Care Patients.

    Science.gov (United States)

    Castañeda, Sheila F; Giacinto, Rebeca E; Medeiros, Elizabeth A; Brongiel, Ilana; Cardona, Olga; Perez, Patricia; Talavera, Gregory A

    2016-06-01

    This collaborative study sought to address Latina breast cancer (BC) disparities by increasing health literacy (HL) in a community health center situated on the US-Mexico border region of San Diego County. An academic-community partnership conducted formative research to develop a culturally tailored promotora-based intervention with 109 individuals. The Spanish language program, entitled Nuestra Cocina: Mesa Buena, Vida Sana (Our Kitchen: Good Table, Healthy Life), included six sessions targeting HL, women's health, BC risk reduction, and patient-provider communication; sessions include cooking demonstrations of recipes with cancer-risk-reducing ingredients. A pilot study with 47 community health center Latina patients was conducted to examine the program's acceptability, feasibility, and ability to impact knowledge and skills. Pre- and post-analyses demonstrated that participants improved their self-reported cancer screening, BC knowledge, daily fruit and vegetable intake, and ability to read a nutrition label (p < 0.05). Results of the pilot study demonstrate the importance of utilizing patient-centered culturally appropriate noninvasive means to educate and empower Latina patients. PMID:27271058

  20. Patient-Centered Medical Homes in 2016.

    Science.gov (United States)

    Tayloe, David T

    2016-01-01

    There is much information in the medical literature concerning the medical home concept. Each medical practice must utilize that literature to devise a system of care-a patient-centered medical home-that best meets the needs of patients, families, and practice staff. This article is Goldsboro Pediatrics' attempt to describe its system of care, its patient-centered medical home. PMID:27422953

  1. Quality, Safety and Patient Centered Care--A Dream Come True in the Mountains of Northern Pakistan. An Award winning project of "2015 Quality, Safety & Patient Centered Care Award" at, Chicago USA.

    Science.gov (United States)

    Jassani, Kashif; Essani, Rozina Roshan; Abbas, Syed Nadeem Husain

    2016-01-01

    Northern Pakistan remains very challenging terrain due to harsh weather all year round presenting an infrastructura, human resource and supply chain challenge of its own. Many times the facility had to move to different locations on emergency and ad hoc basis due to landslides, earthquakes affecting continuity of care. Providing quality healthcare to often resource constraint hard-to-reach areas has always been AKHS,P's unique forte. Breaking barriers for catchment population to access quality healthcare, AKHS,P embarked on an initiative of implementing, achieving and sustaining ISO 9001:2008 Quality Management System international standards certification. This article shares the unique experience of AKHS,P in achieving and sustaining ISO 9001:2008 International Quality Management System Certification. After untiring efforts and the hard work of ground staff; AKHS,P achieved ISO 9001:2008 International Quality Management System Certification as well as 1st Surveillance Audit which itself proved that AKHS,P sustained quality systems and ensured continuous quality improvement in the Mountains of Northern Pakistan. PMID:27180469

  2. Full body photography in the massive weight loss population: an inquiry to optimize patient-centered care.

    Science.gov (United States)

    Wasicek, Philip; Kaswan, Sumesh; Messing, Susan; Gusenoff, Jeffrey A

    2013-11-01

    Medical photography of body contouring patients often requires complete nudity, placing patients in a vulnerable situation. We investigated patient perspectives on full body photography in an effort to better protect the patients and enhance comfort with the photography process. Sixty-five massive weight loss patients were identified who underwent body contouring surgery with full body photography. Photographs were taken at the time of initial consult, time of marking, and postoperatively. A retrospective chart review was performed to assess body mass indices and comorbidities, and a telephone survey inquired about several aspects of the photographic process. Fifty-six (86%) patients participated. Patients were more comfortable at the time of markings (P = 0.0004) and at the postoperative session (P = 0.0009). Patients' perception of positive body image increased after body contouring surgery (P < 0.0001). Patients who reported being comfortable at their initial session had a higher body mass index (P = 0.0027). Professionalism of the staff was rated as the most important aspect of the photographic process. Patients preferring a chaperone of the same sex tended to be less comfortable with the process (P = 0.015). Most patients preferred the surgeon as the photographer (P = 0.03). Patient comfort with full body photography improves quickly as they move through the surgical process. Maintaining professionalism is the most important factor in achieving patient trust and comfort. Limiting the number of observers in the room, providing explicit details of the photography process, and having at least 1 person of the same sex in the room can optimize patient safety and comfort. PMID:23542830

  3. The University of California at Los Angeles Alzheimer's and Dementia Care program for comprehensive, coordinated, patient-centered care: Preliminary data

    OpenAIRE

    Reuben, DB; Evertson, LC; Wenger, NS; Serrano, K; Chodosh, J; Ercoli, L.; Tan, ZS

    2013-01-01

    Dementia is a chronic disease that requires medical and social services to provide high-quality care and prevent complications. As a result of time constraints in practice, lack of systems-based approaches, and poor integration of community-based organizations (CBOs), the quality of care for dementia is poorer than that for other diseases that affect older persons. The University of California at Los Angeles (UCLA) Alzheimer's and Dementia Care (UCLA ADC) program partners with CBOs to provide...

  4. Teaching in a Patient-Centered Medical Home

    OpenAIRE

    Hotelling, Barbara A.

    2011-01-01

    Teaching Lamaze International classes in a patient-centered medical home allows the childbirth educator the best environment for giving evidence-based information and empowering parents to give birth their way. Patient-centered medical home facilities and providers practice evidence-based care and adhere to the principles of family-centered maternity care. In patient-centered medical homes, women can expect to give birth using the Lamaze Healthy Birth Practices and to fully participate in the...

  5. Psychosocial Risk Factors, Interventions, and Comorbidity in Patients with Non-Specific Low Back Pain in Primary Care: Need for Comprehensive and Patient-Centered Care

    OpenAIRE

    Ramond-Roquin, Aline; Bouton, Céline; Bègue, Cyril; Petit, Audrey; Roquelaure, Yves; Huez, Jean-François

    2015-01-01

    Non-specific low back pain (LBP) affects many people and has major socio-economic consequences. Traditional therapeutic strategies, mainly focused on biomechanical factors, have had moderate and short-term impact. Certain psychosocial factors have been linked to poor prognosis of LBP and they are increasingly considered as promising targets for management of LBP. Primary health care providers (HCPs) are involved in most of the management of people with LBP and they are skilled in providing co...

  6. Psychosocial risk factors, interventions and comorbidity in patients with non-specific low back pain in primary care: need for comprehensive and patient-centered care.

    OpenAIRE

    Aline eRamond-Roquin; Céline eBouton; Cyril eBègue; Audrey ePetit; Yves eRoquelaure; Jean-François eHuez

    2015-01-01

    Non-specific low back pain (LBP) affects many people and has major socio-economic consequences. Traditional therapeutic strategies, mainly focused on biomechanical factors, have had moderate and short-term impact. Certain psychosocial factors have been linked to poor prognosis of LBP and they are increasingly considered as promising targets for management of LBP. Primary health care providers (HCPs) are involved in most of the management of people with LBP and they are skilled in providing co...

  7. Health care technology assessment

    Science.gov (United States)

    Goodman, Clifford

    1994-12-01

    The role of technology in the cost of health care is a primary issue in current debates concerning national health care reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in health care technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of health care technologies, including: technical performance; clinical safety and efficacy/effectiveness; cost-effectiveness and other economic attributes; appropriate circumstances/indications for use; and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in health care. Among the important trends in HCTA are: (1) proliferation of HCTA groups in the public and private sectors; (2) higher standards for scientific evidence concerning technologies; (3) methodological development in cost analyses, health-related quality of life measurement, and consolidation of available scientific evidence (e.g., meta-analysis); (4) emphasis on improved data on how well technologies work in routine practice and for traditionally under-represented patient groups; (5) development of priority-setting methods; (6) greater reliance on medical informatics to support and disseminate HCTA findings.

  8. Home Improvement in HIV Primary Care: Investigating the Patient-Centered Medical Home Model for People Living with HIV/AIDS.

    Science.gov (United States)

    Friedman, Erin Gael; Crowley, Megan; Howard, Kim Ammann; Pavel, M Paoloma

    2015-10-01

    This article details the processes and findings of a 3-year demonstration project implementing population health management and the Patient-Centered Medical Home (PCMH) model in 3 community health centers in Alameda County, California. The article provides a first look at the PCMH Continuum, a tool for aiding staff in conceptualizing and implementing complex organizational change. Findings of the project evaluation also are shared, comprising a road map for other organizations looking to implement population health management, panel management, and PCMH. The article reflects on lessons learned and best practices from the demonstration project. PMID:25867483

  9. Patient-Reported Outcome Measures and Risk Factors in a Quality Registry: A Basis for More Patient-Centered Diabetes Care in Sweden

    Directory of Open Access Journals (Sweden)

    Sixten Borg

    2014-11-01

    Full Text Available Diabetes is one of the chronic diseases that constitute the greatest disease burden in the world. The Swedish National Diabetes Register is an essential part of the diabetes care system. Currently it mainly records clinical outcomes, but here we describe how it has started to collect patient-reported outcome measures, complementing the standard registry data on clinical outcomes as a basis for evaluating diabetes care. Our aims were to develop a questionnaire to measure patient abilities and judgments of their experience of diabetes care, to describe a Swedish diabetes patient sample in terms of their abilities, judgments, and risk factors, and to characterize groups of patients with a need for improvement. Patient abilities and judgments were estimated using item response theory. Analyzing them together with standard risk factors for diabetes comorbidities showed that the different types of data describe different aspects of a patient’s situation. These aspects occasionally overlap, but not in any particularly useful way. They both provide important information to decision makers, and neither is necessarily more relevant than the other. Both should therefore be considered, to achieve a more complete evaluation of diabetes care and to promote person-centered care.

  10. Development and evaluation of a patient-centered cardiovascular health education program among insured primary care patients with hypertension in rural Nigeria: The QUICK-II study

    NARCIS (Netherlands)

    A.O. Odusola

    2015-01-01

    Background: Cardiovascular diseases (CVD) are increasingly common in Nigeria and sub Saharan Africa (SSA). Poverty is rampant and quality of primary care substandard. Moreover adherence capacity for prescribed anti-hypertensive treatment is limited and blood pressure (BP) control consequently poor.

  11. Social media: opportunities for quality improvement and lessons for providers-a networked model for patient-centered care through digital engagement.

    Science.gov (United States)

    Bornkessel, Alexandra; Furberg, Robert; Lefebvre, R Craig

    2014-07-01

    Social media brings a new dimension to health care for patients, providers, and their support networks. Increasing evidence demonstrates that patients who are more actively involved in their healthcare experience have better health outcomes and incur lower costs. In the field of cardiology, social media are proposed as innovative tools for the education and update of clinicians, physicians, nurses, and medical students. This article reviews the use of social media by healthcare providers and patients and proposes a model of "networked care" that integrates the use of digital social networks and platforms by both patients and providers and offers recommendations for providers to optimize their use and understanding of social media for quality improvement. PMID:24947833

  12. Effectively implementing FDA medication alerts utilizing patient centered medical home clinical pharmacists.

    Science.gov (United States)

    Arenz, Barbara J; Diez, Heidi L; Bostwick, Jolene R; Kales, Helen C; Zivin, Kara; Dalack, Gregory W; Fluent, Tom E; Standiford, Connie J; Stano, Claire; Mi Choe, Hae

    2016-03-01

    FDA medication alerts can be successfully implemented within patient centered medical home (PCMH) clinics utilizing clinical pharmacists. Targeted selection of high-risk patients from an electronic database allows PCMH pharmacists to prioritize assessments. Trusting relationships between PCMH clinical pharmacists and primary care providers facilitates high response rates to pharmacist recommendations. This health system approach led by PCMH pharmacists provides a framework for proactive responses to FDA safety alerts and medication related quality measure improvement. PMID:27001101

  13. Instruments to assess integrated care

    DEFF Research Database (Denmark)

    Lyngsø, Anne Marie; Godtfredsen, Nina Skavlan; Høst, Dorte;

    2014-01-01

    measure the level of integration across health-care sectors and to assess and evaluate the organisational elements within the instruments identified. METHODS: An extensive, systematic literature review in PubMed, CINAHL, PsycINFO, Cochrane Library, Web of Science for the years 1980-2011. Selected...... and six include cultural aspects; 14 explicitly stated using a theoretical framework. CONCLUSION AND DISCUSSION: This review did not identify any measurement instrument covering all aspects of integrated care. Further, a lack of uniform use of the eight organisational elements across the studies was...

  14. Patients' preferences for patient-centered communication

    DEFF Research Database (Denmark)

    Lau, Sofie Rosenlund; Christensen, Søren Troels; Andreasen T., Jesper

    2013-01-01

    To investigate patients' preferences for patient-centered communication (PCC) in the encounter with healthcare professionals in an outpatient department in rural Sierra Leone.......To investigate patients' preferences for patient-centered communication (PCC) in the encounter with healthcare professionals in an outpatient department in rural Sierra Leone....

  15. The Patient-Centered Medical Home: Preparation of the Workforce, More Questions than Answers.

    Science.gov (United States)

    Reynolds, P Preston; Klink, Kathleen; Gilman, Stuart; Green, Larry A; Phillips, Russell S; Shipman, Scott; Keahey, David; Rugen, Kathryn; Davis, Molly

    2015-07-01

    As American medicine continues to undergo significant transformation, the patient-centered medical home (PCMH) is emerging as an interprofessional primary care model designed to deliver the right care for patients, by the right professional, at the right time, in the right setting, for the right cost. A review of local, state, regional and national initiatives to train professionals in delivering care within the PCMH model reveals some successes, but substantial challenges. Workforce policy recommendations designed to improve PCMH effectiveness and efficiency include 1) adoption of an expanded definition of primary care, 2) fundamental redesign of health professions education, 3) payment reform, 4) responsiveness to local needs assessments, and 5) systems improvement to emphasize quality, population health, and health disparities. PMID:25707941

  16. It can't hurt to ask; a patient-centered quality of service assessment of health canada's medical cannabis policy and program

    Directory of Open Access Journals (Sweden)

    Lucas Philippe

    2012-01-01

    Full Text Available Abstract Background In 2001 Health Canada responded to a series of Ontario court decisions by creating the Marihuana Medical Access Division (MMAD and the Marihuana Medical Access Regulations (MMAR. Although Health Canada has conducted a small number of stakeholder consultations, the federal government has never polled federally authorized cannabis patients. This study is an attempt to learn more about patient needs, challenges and experiences with the MMAD. Methods Launched in the spring of 2007, Quality of Service Assessment of Health Canada's Medical Cannabis Policy and Program pairs a 50 question online survey addressing the personal experiences of patients in the federal cannabis program with 25 semi-guided interviews. Data gathering for this study took place from April 2007 to Jan. 2008, eventually garnering survey responses from 100 federally-authorized users, which at the time represented about 5% of the patients enrolled in Health Canada's program. This paper presents the results of the survey portion of the study. Results 8% of respondents report getting their cannabis from Health Canada, while 66% grow it for themselves. >50% report that they frequent compassion clubs or dispensaries, which remain illegal and unregulated in Canada. 81% of patients would chose certified organic methods of cultivation; >90% state that not all strains are equally effective at relieving symptoms, and 97% would prefer to obtain cannabis from a source where multiple strains are available. Of the 48 patients polled that had tried the Health Canada cannabis supply, >75% rank it as either "1" or "2" on a scale of 1-10 (with "1" being "very poor", and 10 being "excellent". Discussion 72% of respondents report they are either "somewhat" or "totally unsatisfied" with Canada's medical cannabis program. These survey results and relevant court decisions suggest that the MMAR are not meeting the needs of most of the nation's medical cannabis patient community. It is

  17. Patient-Centered Medical Home in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Ortiz G

    2011-10-01

    Full Text Available Gabriel Ortiz1, Len Fromer21Pediatric Pulmonary Services, El Paso, TX; 2Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USAAbstract: Chronic obstructive pulmonary disease (COPD is a progressive and debilitating but preventable and treatable disease characterized by cough, phlegm, dyspnea, and fixed or incompletely reversible airway obstruction. Most patients with COPD rely on primary care practices for COPD management. Unfortunately, only about 55% of US outpatients with COPD receive all guideline-recommended care. Proactive and consistent primary care for COPD, as for many other chronic diseases, can reduce hospitalizations. Optimal chronic disease management requires focusing on maintenance rather than merely acute rescue. The Patient-Centered Medical Home (PCMH, which implements the chronic care model, is a promising framework for primary care transformation. This review presents core PCMH concepts and proposes multidisciplinary team-based PCMH care strategies for COPD.Keywords: Patient-Centered Medical Home, chronic care model, chronic obstructive pulmonary disease, patient education, physician assistants, nurse practitioners

  18. Developing and implementing a patient-centered IT strategy.

    Science.gov (United States)

    Malone, Eileen B; Kirchbdoerfer, Richard G; Wolford-Connors, Ann

    2005-01-01

    The Army Medical Department (AMEDD), a comprehensive worldwide integrated healthcare system with an annual budget of more than $6 billion, more than 50,000 employees, and 2.4 million beneficiaries, developed and implemented a comprehensive patient-centered enterprise-wide information management and information technology strategy to facilitate information management systems and infrastructure decisions by leaders. This article describes a patient-centered model used to organize and link healthcare activities and activity leaders to portray patient care, administrative, business, financial, supply, and strategic support information systems. Activity and IT leaders applied a refined strategic alignment model to identify specific clinical, business, and IT goals and to detail the necessary infrastructure investments using a systems view. The use of patient and process outcome measures tied to the AMEDD's Balanced Score Card' helped leaders to manage IT strategy execution. Now, two years into the effort, a sample activity strategy--outpatient care--is used to illustrate the application of these tools to the development and implementation of a patient-centered IT strategy. PMID:16045084

  19. Quality Assessment in the Primary care

    OpenAIRE

    Muharrem Ak

    2013-01-01

    -Quality Assessment in the Primary care Dear Editor; I have read the article titled as “Implementation of Rogi Kalyan Samiti (RKS) at Primary Health Centre Durvesh” with great interest. Shrivastava et all concluded that assessment mechanism for the achievement of objectives for the suggested RKS model was not successful (1). Hereby I would like to emphasize the importance of quality assessment (QA) especially in the era of newly established primary care implementations in our coun...

  20. Patient-centered appointment scheduling using agent-based simulation.

    Science.gov (United States)

    Turkcan, Ayten; Toscos, Tammy; Doebbeling, Brad N

    2014-01-01

    Enhanced access and continuity are key components of patient-centered care. Existing studies show that several interventions such as providing same day appointments, walk-in services, after-hours care, and group appointments, have been used to redesign the healthcare systems for improved access to primary care. However, an intervention focusing on a single component of care delivery (i.e. improving access to acute care) might have a negative impact other components of the system (i.e. reduced continuity of care for chronic patients). Therefore, primary care clinics should consider implementing multiple interventions tailored for their patient population needs. We collected rapid ethnography and observations to better understand clinic workflow and key constraints. We then developed an agent-based simulation model that includes all access modalities (appointments, walk-ins, and after-hours access), incorporate resources and key constraints and determine the best appointment scheduling method that improves access and continuity of care. This paper demonstrates the value of simulation models to test a variety of alternative strategies to improve access to care through scheduling. PMID:25954423

  1. Incorporating the principles of the patient- centered medical home into a student-run free clinic

    Directory of Open Access Journals (Sweden)

    Riddle MC

    2014-09-01

    Full Text Available Megan C Riddle,1,* Jiahui Lin,3,* Jonathan B Steinman,2 Joshua D Salvi,2 Margaret M Reynolds,3 Anne S Kastor,3,† Christina Harris,4 Carla Boutin-Foster3 1Department of Psychiatry and Behavioral Sciences, University of Washington, 2Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD–PhD Program, 3Department of Internal Medicine, Weill Cornell Medical College, New York, NY, 4Department of Medicine, Division of General Internal Medicine, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, LA, USA *These authors contributed equally to this work †Anne S Kastor passed away on July 5, 2013. Abstract: As the health care delivery landscape changes, medical schools must develop creative strategies for preparing future physicians to provide quality care in this new environment. Despite the growing prominence of the patient-centered medical home (PCMH as an effective model for health care delivery, few medical schools have integrated formal education on the PCMH into their curricula. Incorporating the PCMH model into medical school curricula is important to ensure that students have a comprehensive understanding of the different models of health care delivery and can operate effectively as physicians. The authors provide a detailed description of the process by which the Weill Cornell Community Clinic (WCCC, a student-run free clinic, has integrated PCMH principles into a service-learning initiative. The authors assessed patient demographics, diagnoses, and satisfaction along with student satisfaction. During the year after a PCMH model was adopted, 112 students and 19 licensed physicians volunteered their time. A review of the 174 patients seen from July 2011 to June 2012 found that the most common medical reasons for visits included management of hypertension, hyperlipidemia, diabetes, gastrointestinal conditions, arthritis, anxiety, and depression. During the year after the adoption of the PCMH model, 87

  2. Health-Care Technology Assessment in Radiology

    Directory of Open Access Journals (Sweden)

    Arash Deljou

    2010-05-01

    Full Text Available Health-care service provision and procurement is increasingly subject to policy decisions, managed more than ever before. Becoming more international, collaboration is increasing as the health professions, research and industry all work across borders. Differing health-care systems across the countries result from national and regional policy developments and priorities."nIn health-care, all interventions and procedures are basically technologies-including radiology and sur-gery, and technology assessment is mandatory to meet the national and professional goals in this sec-tor. "nHealth-care technology assessment (HTA is a systematic, broad-ranging evaluation of the implications of using technologies within a particular health-care system. Structured and evidence-based input are its aim for policymaking in order to inform the formulation of safe and effective health policies that are patient-focused and seek to achieve the best value in all health-care sectors, more specifically in the radiology department. The following headlines are the topics in our study:"n•Decisions Related to Health Technologies"n•Appraisal Entities and Corresponding As-sessment Units"n•Assessment, Appraisal and Decision-Making Institutions"n•HTA Agencies and Units in Radiology"n•Model of a Policy Process in Radiology"n•Factors that Influence Radiology Policy-Making"n•HTA Process"n•Different Levels of Health-Care Technolo-gies/Intervention

  3. Quality Assessment in the Primary care

    Directory of Open Access Journals (Sweden)

    Muharrem Ak

    2013-04-01

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

  4. Scheduled telephone visits in the veterans health administration patient-centered medical home

    OpenAIRE

    Sperber, Nina R; King, Heather A.; Steinhauser, Karen; Ammarell, Natalie; Danus, Susanne; Powers, Benjamin J

    2014-01-01

    Background The Veterans Health Administration (VHA) patient-centered medical home model, Patient Aligned Care Teams (PACT), includes telephone visits to improve care access and efficiency. Scheduled telephone visits can replace in-person care for some focused issues, and more information is needed to understand how this mode can best work for primary care. We conducted a study at the beginning of PACT implementation to elicit stakeholder views on this mode of healthcare delivery, including po...

  5. Driving Care Quality: Aligning Trainee Assessment and Supervision Through Practical Application of Entrustable Professional Activities, Competencies, and Milestones.

    Science.gov (United States)

    Carraccio, Carol; Englander, Robert; Holmboe, Eric S; Kogan, Jennifer R

    2016-02-01

    To address the long-standing challenge of meaningful trainee assessment, the authors reviewed and expanded on the Accountable Assessment for Quality Care and Supervision (AAQCS) equation. The equation proposes that care quality is the product of the interaction between trainee performance (measured by workplace assessment) and supervision (required level of intervention to ensure care quality) in the context of the environment where the care occurs: Trainee performance × Appropriate supervision = Safe, effective patient-centered care. Assessing trainee performance and matching that performance to "appropriate" supervision, however, is fraught with challenges. The authors suggest a unifying framework that integrates entrustable professional activities (EPAs), competencies, and milestones to inform trainee assessment and supervision, thereby enabling the practical application of the AAQCS equation in the workplace. Because the unit of measure for an EPA is the outcome of whether the trainee can safely and effectively perform the professional activity without supervision, the proposed unifying framework directly aligns with the dependent variable in the AAQCS equation: care quality.The value of applying a unifying framework that integrates EPAs, competencies, and milestones to the AAQCS equation in the clinical learning environment lies in its ability to provide supervisors with a shared mental model of performance expectations for trainees, reducing unwanted variability and improving assessment accuracy; guidance for aligning performance milestones of trainees with the needed level of supervisor intervention to ensure care quality; and substrate for specific feedback to improve the trainee's professional development as a way to ensure future care quality. PMID:26509601

  6. Validation of the Spanish Translation of the Patient Assessment of Chronic Illness Care (PACIC Survey

    Directory of Open Access Journals (Sweden)

    Abraham Aragones, MD, MSCI

    2008-10-01

    Full Text Available IntroductionThe Patient Assessment of Chronic Illness Care (PACIC survey is a patient-centered instrument for evaluating the quality and patient-centeredness of chronic illness care received according to the Chronic Care Model paradigm. This study validates the Spanish translation of the PACIC in an urban, Spanish-speaking population.MethodsOne hundred Spanish-speaking patients with diabetes completed the translated PACIC and sociodemographic and cultural questionnaires. Test-retest reliability was assessed in a subset of 20 patients who completed the questionnaire 2 to 4 months later. Internal consistency was evaluated with Cronbach α. PACIC score and subscale associations with sociodemographic characteristics were examined.ResultsTest-retest reliability for the overall translated PACIC scale was 0.77. Scores were not associated with patient sociodemographic characteristics, including age, country of birth, years living in the United States, or education level (P >.05.ConclusionThe Spanish translation of the PACIC survey demonstrated high reliability, internal consistency, and test-retest reliability. Scores showed no association with sociodemographic or cultural characteristics. The Spanish version can reliably be used to assess care delivered according to the Chronic Care Model in a heterogeneous Spanish-speaking population.

  7. The millennium bug: a patient-centered approach to diagnosis and treatment.

    Science.gov (United States)

    Meador, C L; Freeman, L G; Zimmermann, E C; Safran, C

    1998-01-01

    Economic, regulatory, and competitive pressures compete for institutional resources, increasing the likelihood that critical delivery systems will be missed. Setting patient-centered priorities should now be the primary focus of the solution process. Risk assessment should work from the patient out, recognizing that the highest risk lies with components that most directly influence the care and health of patients. Any successful plan must include enough awareness and commitment to ensure the availability of funding and resources in a highly competitive environment. The remediation process involves both internal expertise and external entities, such as companies selling equipment, software, or hardware [8], with outside consultants if experts on year 2000 problems are not available internally. Aggressive pursuit of solutions to the year 2000 problem is essential to preventing severe difficulties at the turn of the century. PMID:9540320

  8. Health Technology Assessment of Integrated Home Care

    DEFF Research Database (Denmark)

    Larsen, Torben

    2012-01-01

    Background: The fragmented delivery of healthcare and social services as advanced by WHO 2002. Objectives: This project of international collaboration assesses integrated home care (IHC) for frail elder somatic patients as compared to usual hospital care. Methods: The HTA follows the special......-up: Stroke: A meta-analysis including 14 randomized trials (N=2139) demonstrate a significant reduction (p< 0.001) in the risk being dead or dependent compared with conventional care with OR=0.75 (CI95%: 0.61-0.92). HF: 3 RCT (N=568) demonstrate each a significant reduction of all-cause readmissions. A meta...

  9. Patients’ needs for care in public mental health: unity and diversity of self-assessed needs for care

    Directory of Open Access Journals (Sweden)

    Tanja eBellier-Teichmann

    2016-02-01

    Full Text Available Purpose. Needs assessment is recognized to be a key element of mental health care. Patients tend to present heterogeneous profiles of needs. However, there is no consensus in previous research about how patients’ needs are organized. This study investigates both general and specific dimensions of patients’ needs for care. Methods. Patients’ needs were assessed with ELADEB, an 18-domain self-report scale. The use of a self-assessment scale represents a unique way of obtaining patients’ perceptions. A patient-centered psychiatric practice facilitates empowerment as it is based on the patients’ personal motivations, needs and wants. 471 patients’ profiles were analyzed through exploratory factor analysis. Results. A four-factor bi-factor model, including one general factor and three specific factors of needs was most adequate. Specific factors were: (a ‘finances’ and ‘administrative tasks’; (b ‘transports’, ‘public places’, ‘self-care’, ‘housework’ and ‘food’; (c ‘family’, ‘children’, ‘intimate relationships’ and ‘friendship’.Conclusions. As revealed by the general factor, patients expressing urgent needs in some domains are also more susceptible to report urgent needs in several other domains. This general factor relates to high versus low utilizers of public mental healthcare. Patients also present specific needs in life domains, which are organized in three dimensions: management; functional disabilities; familial and interpersonal relationships. These dimensions relate to the different types of existing social support described in the literature.

  10. The role of the pharmacist in patient-centered medical home practices: current perspectives

    Directory of Open Access Journals (Sweden)

    Lewis NJW

    2014-06-01

    Full Text Available Nancy JW Lewis,1 Leslie A Shimp,2 Stuart Rockafellow,2 Jeffrey M Tingen,2 Hae Mi Choe,3 Marie A Marcelino21Private consultancy practice, Rochester Hills, MI, USA; 2Clinical, Social and Administrative Department, University of Michigan College of Pharmacy, Ann Arbor, MI, USA; 3Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USAAbstract: Patient-centered medical homes (PCMHs are the centerpiece of primary care transformation in the US. They are intended to improve care coordination and communication, enhance health care quality and patient experiences, and lower health care costs by linking patients to a physician-led interdisciplinary health care team. PCMHs are widely supported by health care associations, payers, and employers. Health care accreditation organizations have created performance measures that promote the adoption of PCMH core attributes. Public and private payers are increasingly providing incentives and bonuses related to performance measure status. Evidence-based prescription, medication adherence, medication use coordination, and systems to support medication safety are all necessary components of PCMHs. Pharmacists have unique knowledge and skills that can complement the care provided by other PCMH team members. Their experience in drug therapy assessments, medication therapy management, and population health has documented benefits, both in terms of patient health outcomes and health care costs. Through collaborative care, pharmacists can assist physicians and other prescribers in medication management and thus improve prescriber productivity and patient access to care. Pharmacists are engaged in PCMHs through both employment and contractual arrangements. While some pharmacists serve a unique PCMH, others work within practice networks that serve practices within a geographical area. Financial support for pharmacist-provided services includes university funding, external grant funding

  11. Health Literacy and Communication Quality in Health Care Organizations

    OpenAIRE

    Wynia, Matthew K; Osborn, Chandra Y.

    2010-01-01

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

  12. Assessing the Quality of Diabetic Patients Care

    Directory of Open Access Journals (Sweden)

    Belkis Vicente Sánchez

    2012-12-01

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

  13. A special issue on the patient-centered medical home.

    Science.gov (United States)

    Blount, Alexander

    2010-12-01

    This special issue on the Patient-Centered Medical Home (PCMH) reflects its times. At the present time, the PCMH is an aspirational model with a few pilots functioning well around the country. How long the current period of idealism, fueled by the energy of early adopters, the consensus of diverse stakeholders, and the dollars of the Affordable Care Act will continue is anybody's guess. Representing the thinking of some of the best minds in the field, the articles in this issue have an aspirational and idealistic tone as much as a descriptive and analytic one. A year ago the balance would have been tipped more toward idealism and model building and a year from now it would, in all likelihood, tip more toward model description and analysis. The authors in this volume have been personally responsible for helping to move behavioral health to a more central position in the PCMH model. PMID:21299276

  14. Pediatrics Education in an AHEC Setting: Preparing Students to Provide Patient Centered Medicine

    Science.gov (United States)

    Evans, Steven Owens

    2012-01-01

    Patient centered medicine is a paradigm of health care that seeks to treat the whole person, rather than only the illness. The physician must understand the patient as a whole by considering the patient's individual needs, social structure, socioeconomic status, and educational background. Medical education includes ways to train students in this…

  15. Examining Health Information Technology Implementations: Case of the Patient-Centered Medical Home

    Science.gov (United States)

    Behkami, Nima A.

    2012-01-01

    It has been shown that the use of Health Information Technology (HIT) is associated with reduced cost and increased quality of care. This dissertation examined the use of registries in Patient Centered Medical Home (PCMH) practices. A survey questionnaire was sent to a nationwide group of clinics certified for being a PCMH. They were asked to…

  16. Defining a standard set of patient-centered outcomes for men with localized prostate cancer

    NARCIS (Netherlands)

    N.E. Martin (Neil E.); L. Massey (Laura); C. Stowell (Caleb); C.H. Bangma (Chris); A. Briganti (Alberto); A. Bill-Axelson (Anna); M. Blute (Michael); J.W.F. Catto (James); R.C. Chen (Ronald C.); A.V. D'Amico (Anthony V.); G. Feick (Günter); J.M. Fitzpatrick (John); S.J. Frank (Steven J.); M. Froehner (Michael); M. Frydenberg (Mark); A. Glaser (Adam); M. Graefen (Markus); D. Hamstra (Daniel); A. Kibel (Adam); N. Mendenhall (Nancy); K. Moretti (Kim); J. Ramon (Jacob); I. Roos (Ian); H. Sandler (Howard); F.J. Sullivan (Francis J.); D. Swanson (David); A. Tewari (Ashutosh); A.J. Vickers (Andrew); T. Wiegel (Thomas); H. Huland (Hartwig)

    2015-01-01

    textabstractBackground Value-based health care has been proposed as a unifying force to drive improved outcomes and cost containment. Objective To develop a standard set of multidimensional patient-centered health outcomes for tracking, comparing, and improving localized prostate cancer (PCa) treatm

  17. An International Standard Set of Patient-Centered Outcome Measures After Stroke

    Science.gov (United States)

    Salinas, Joel; Sprinkhuizen, Sara M.; Ackerson, Teri; Bernhardt, Julie; Davie, Charlie; George, Mary G.; Gething, Stephanie; Kelly, Adam G.; Lindsay, Patrice; Liu, Liping; Martins, Sheila C.O.; Morgan, Louise; Norrving, Bo; Ribbers, Gerard M.; Silver, Frank L.; Smith, Eric E.; Williams, Linda S.

    2016-01-01

    Background and Purpose— Value-based health care aims to bring together patients and health systems to maximize the ratio of quality over cost. To enable assessment of healthcare value in stroke management, an international standard set of patient-centered stroke outcome measures was defined for use in a variety of healthcare settings. Methods— A modified Delphi process was implemented with an international expert panel representing patients, advocates, and clinical specialists in stroke outcomes, stroke registers, global health, epidemiology, and rehabilitation to reach consensus on the preferred outcome measures, included populations, and baseline risk adjustment variables. Results— Patients presenting to a hospital with ischemic stroke or intracerebral hemorrhage were selected as the target population for these recommendations, with the inclusion of transient ischemic attacks optional. Outcome categories recommended for assessment were survival and disease control, acute complications, and patient-reported outcomes. Patient-reported outcomes proposed for assessment at 90 days were pain, mood, feeding, selfcare, mobility, communication, cognitive functioning, social participation, ability to return to usual activities, and health-related quality of life, with mobility, feeding, selfcare, and communication also collected at discharge. One instrument was able to collect most patient-reported subdomains (9/16, 56%). Minimum data collection for risk adjustment included patient demographics, premorbid functioning, stroke type and severity, vascular and systemic risk factors, and specific treatment/care-related factors. Conclusions— A consensus stroke measure Standard Set was developed as a simple, pragmatic method to increase the value of stroke care. The set should be validated in practice when used for monitoring and comparisons across different care settings. PMID:26604251

  18. Assessing the prognoses on Health care in the information society 2013--thirteen years after.

    Science.gov (United States)

    Knaup, Petra; Ammenwerth, Elske; Dujat, Carl; Grant, Andrew; Hasman, Arie; Hein, Andreas; Hochlehnert, Achim; Kulikowski, Casimir; Mantas, John; Maojo, Victor; Marschollek, Michael; Moura, Lincoln; Plischke, Maik; Röhrig, Rainer; Stausberg, Jürgen; Takabayashi, Katsuhiko; Uckert, Frank; Winter, Alfred; Wolf, Klaus-Hendrik; Haux, Reinhold

    2014-07-01

    Health care and information technology in health care is advancing at tremendous speed. We analysed whether the prognoses by Haux et al. - first presented in 2000 and published in 2002 - have been fulfilled in 2013 and which might be the reasons for match or mismatch. Twenty international experts in biomedical and health informatics met in May 2013 in a workshop to discuss match or mismatch of each of the 71 prognoses. After this meeting a web-based survey among workshop participants took place. Thirty-three prognoses were assessed matching; they reflect e.g. that there is good progress in storing patient data electronically in health care institutions. Twenty-three prognoses were assessed mismatching; they reflect e.g. that telemedicine and home monitoring as well as electronic exchange of patient data between institutions is not established as widespread as expected. Fifteen prognoses were assessed neither matching nor mismatching. ICT tools have considerably influenced health care in the last decade, but in many cases not as far as it was expected by Haux et al. in 2002. In most cases this is not a matter of the availability of technical solutions but of organizational and ethical issues. We need innovative and modern information system architectures which support multiple use of data for patient care as well as for research and reporting and which are able to integrate data from home monitoring into a patient centered health record. Since innovative technology is available the efficient and wide-spread use in health care has to be enabled by systematic information management. PMID:24952606

  19. Clinical risk assessment in intensive care unit

    Directory of Open Access Journals (Sweden)

    Saeed Asefzadeh

    2013-01-01

    Full Text Available Background: Clinical risk management focuses on improving the quality and safety of health care services by identifying the circumstances and opportunities that put patients at risk of harm and acting to prevent or control those risks. The goal of this study is to identify and assess the failure modes in the ICU of Qazvin′s Social Security Hospital (Razi Hospital through Failure Mode and Effect Analysis (FMEA. Methods: This was a qualitative-quantitative research by Focus Discussion Group (FDG performed in Qazvin Province, Iran during 2011. The study population included all individuals and owners who are familiar with the process in ICU. Sampling method was purposeful and the FDG group members were selected by the researcher. The research instrument was standard worksheet that has been used by several researchers. Data was analyzed by FMEA technique. Results: Forty eight clinical errors and failure modes identified, results showed that the highest risk probability number (RPN was in respiratory care "Ventilator′s alarm malfunction (no alarm" with the score 288, and the lowest was in gastrointestinal "not washing the NG-Tube" with the score 8. Conclusions: Many of the identified errors can be prevented by group members. Clinical risk assessment and management is the key to delivery of effective health care.

  20. Novel Diagnostic and Monitoring Tools in Stroke: an Individualized Patient-Centered Precision Medicine Approach.

    Science.gov (United States)

    de Villiers, Sulette; Swanepoel, Albe; Bester, Janette; Pretorius, Etheresia

    2016-05-01

    Central to the pathogenesis of ischaemic stroke are the normally protective processes of platelet adhesion and activation. Experimental evidence has shown that the ligand-receptor interactions in ischaemic stroke represent a thrombo-inflammatory cascade, which presents research opportunities into new treatment. However, as anti-platelet drugs have the potential to cause severe side effects in ischaemic stroke patients (as well as other vascular disease patients), it is important to carefully monitor the risk of bleeding and risk of thrombus in patients receiving treatment. Because thrombo-embolic ischaemic stroke is a major health issue, we suggest that the answer to adequate treatment is based on an individualized patient-centered approach, inline with the latest NIH precision medicine approach. A combination of viscoelastic methodologies may be used in a personalized patient-centered regime, including thromboelastography (TEG®) and the lesser used scanning electron microscopy approach (SEM). Thromboelastography provides a dynamic measure of clot formation, strength, and lysis, whereas SEM is a visual structural tool to study patient fibrin structure in great detail. Therefore, we consider the evidence for TEG® and SEM as unique means to confirm stroke diagnosis, screen at-risk patients, and monitor treatment efficacy. Here we argue that the current approach to stroke treatment needs to be restructured and new innovative thought patterns need to be applied, as even approved therapies require close patient monitoring to determine efficacy, match treatment regimens to each patient's individual needs, and assess the risk of dangerous adverse effects. TEG® and SEM have the potential to be a useful tool and could potentially alter the clinical approach to managing ischaemic stroke. As envisaged in the NIH precision medicine approach, this will involve a number of role players and innovative new research ideas, with benefits that will ultimately only be realized in a

  1. Implementing Geriatric Resources for Assessment and Care of Elders Team Care in a Veterans Affairs Medical Center: Lessons Learned and Effects Observed.

    Science.gov (United States)

    Schubert, Cathy C; Myers, Laura J; Allen, Katie; Counsell, Steven R

    2016-07-01

    In a randomized clinical trial, Geriatric Resources for Assessment and Care of Elders (GRACE), a model of care that works in collaboration with primary care providers (PCPs) and patient-centered medical homes to provide home-based geriatric care management focusing on geriatric syndromes and psychosocial problems commonly found in older adults, improved care quality and reduced acute care use for high-risk, low-income older adults. To assess the effect of GRACE at a Veterans Affairs (VA) Medical Center (VAMC), veterans aged 65 and older from Marion County, Indiana, with PCPs from four of five VAMC clinics who were not on hospice or dialysis were enrolled in GRACE after discharge home from an acute hospitalization. After an initial home-based transition visit to GRACE enrollees, the GRACE team returned to conduct a geriatric assessment. Guided by 12 protocols and input from an interdisciplinary panel and the PCP, the GRACE team developed and implemented a veteran-centric care plan. Hospitalized veterans from the fifth clinic, who otherwise met enrollment criteria, served as a usual-care comparison group. Demographic, comorbidity, and usage data were drawn from VA databases. The GRACE and comparison groups were similar in age, sex, and burden of comorbidity, although predicted risk of 1-year mortality in GRACE veterans was higher. Even so, GRACE enrollment was associated with 7.1% fewer emergency department visits, 14.8% fewer 30-day readmissions, 37.9% fewer hospital admissions, and 28.5% fewer total bed days of care, saving the VAMC an estimated $200,000 per year after program costs during the study for the 179 veterans enrolled in GRACE. Having engaged, enthusiastic VA leadership and GRACE staff; aligning closely with the medical home; and accommodating patient acuity were among the important lessons learned during implementation. PMID:27305428

  2. The German version of the Individualized Care Scale – assessing validity and reliability

    Science.gov (United States)

    Köberich, Stefan; Suhonen, Riitta; Feuchtinger, Johanna; Farin, Erik

    2015-01-01

    Aim To assess validity and reliability of the German version of the Individualized Care Scale (ICS). Background Individualized nursing care plays a pivotal role in establishing patient-centered care. To assess individualized nursing care and to compare it in different settings and countries, valid and reliable instruments are needed. No psychometric-tested instrument for comparing individualized nursing care with other countries is available in Germany. Design Cross-sectional study. Methods Data were collected between September 2013 and June 2014 from 606 patients in 20 wards in five hospitals across Germany. Unidimensionality of the ICS scales ICSA (patients’ views on how individuality is supported through nursing interventions) and ICSB (patients’ perceptions of individualized nursing care) was analyzed by confirmatory factor analysis. Internal consistency was assessed by calculating Cronbach’s alpha. The Smoliner Scale (patients’ perceptions of the decision-making process in nursing care) and results from participating hospitals’ assessment of the nursing care delivery systems were used to assess known-groups validity and concurrent validity. Results Fit indices of confirmatory factor analysis indicate unidimensionality of the ICSA (Comparative Fit Index: 0.92; Tucker-Lewis Index: 0.902; root mean square error of approximation: 0.09; standardized root mean square residual: 0.05) and the ICSB (Comparative Fit Index: 0.91; Tucker-Lewis Index: 0.89; root mean square error of approximation: 0.09; standardized root mean square residual: 0.05). Internal consistency using Cronbach’s alpha was 0.95 (95% confidence interval: 0.94–0.95) for ICSA and 0.93 (95% confidence interval: 0.92–0.94) for the ICSB. Concurrent validity was established by a significant relationship between the Smoliner Scale and ICSA (r=0.66; P<0.01) and ICSB (r=0.72; P<0.01). Known-groups validity was approved by ICSA/ICSB score differences related to nursing care delivery systems and

  3. Multidisciplinary Teams and Obesity: Role of the Modern Patient-Centered Medical Home.

    Science.gov (United States)

    Bernstein, Kevin M; Manning, Debra A; Julian, Regina M

    2016-03-01

    With the growing obesity epidemic, it is difficult for individual primary care providers to devote the time and effort necessary to achieve meaningful weight loss for significant numbers of patients. A variety of health care professionals provide value and evidence-based care that is effective in treating obesity and other preventable diseases. Multidisciplinary collaboration between primary care physicians and other trained health professionals within patient-centered medical homes offers an effective approach to sustainable behavioral treatment options for individuals who are obese or overweight. PMID:26896199

  4. Spreading a patient-centered medical home redesign: a case study.

    Science.gov (United States)

    Hsu, Clarissa; Coleman, Katie; Ross, Tyler R; Johnson, Eric; Fishman, Paul A; Larson, Eric B; Liss, David; Trescott, Claire; Reid, Robert J

    2012-01-01

    Health care leaders and policymakers are turning to the patient-centered medical home (PCMH) model to contain costs, improve the quality of care, and create a more positive primary care work environment. We describe how Group Health, an integrated delivery system, developed and implemented a PCMH intervention that included standardized structural and practice level changes. This intervention was spread to a diverse set of 26 primary care practices in 14 months using Lean Management principles. Group Health's experience provides valuable insights that can be used to improve the design and implementation of future PCMH models. PMID:22415283

  5. Genomic sequencing: assessing the health care system, policy, and big-data implications.

    Science.gov (United States)

    Phillips, Kathryn A; Trosman, Julia R; Kelley, Robin K; Pletcher, Mark J; Douglas, Michael P; Weldon, Christine B

    2014-07-01

    New genomic sequencing technologies enable the high-speed analysis of multiple genes simultaneously, including all of those in a person's genome. Sequencing is a prominent example of a "big data" technology because of the massive amount of information it produces and its complexity, diversity, and timeliness. Our objective in this article is to provide a policy primer on sequencing and illustrate how it can affect health care system and policy issues. Toward this end, we developed an easily applied classification of sequencing based on inputs, methods, and outputs. We used it to examine the implications of sequencing for three health care system and policy issues: making care more patient-centered, developing coverage and reimbursement policies, and assessing economic value. We conclude that sequencing has great promise but that policy challenges include how to optimize patient engagement as well as privacy, develop coverage policies that distinguish research from clinical uses and account for bioinformatics costs, and determine the economic value of sequencing through complex economic models that take into account multiple findings and downstream costs. PMID:25006153

  6. From Translational Research to Translational Effectiveness: The “Patient-Centered Dental Home” Model

    Directory of Open Access Journals (Sweden)

    Francesco Chiappelli

    2011-06-01

    Full Text Available Toward revitalizing the Nation’s primary medical care system, the Agency for Health Research & Quality (AHRQ stated that new foundational measures must be crafted for achieving high-quality, accessible, efficient health care for all Americans. The efficiency of medical care is viewed along two dimensions: first, we must continue to pursue translational research; and second, we must translate research to optimize effectiveness in specific clinical settings. It is increasingly evident that the efficiency of both translational processes is critical to the revitalization of health care, and that it rests on the practical functionality of the nexus among three cardinal entities: the researcher, the clinician, and the patient. A novel model has evolved that encapsulates this notion, and that proposes the advanced pri-mary care “medical home”, more commonly referred to as the “patient-centered medical home” (PCMH. It is a promising model for transforming the organization and delivery of primary medical care, because it is not simply a place per se, but it is a function-ing unit that delivers medical care along the fundamental principles of being patient-centered, comprehensive, coordinated, and accessible. It is energized by translational research, and its principal aim and ultimate goal is translational effectiveness. The PCMH is a model that works well within the priorities set by the American Recovery and Reinvestment Act of 2009, and the Health Care Reform Act of 2010. However, while dentistry has a clearly defined place in both Acts, the PCMH is designed for medical and nursing care. A parallel model of the “patient-centered dental home” (PCDH must be realized.

  7. Landscape of Medication Management in the Minnesota Patient-Centered Medical Home (PCMH)

    OpenAIRE

    Donald L. Uden, PharmD, FCCP; Jody L. Lounsbery, PharmD, BCPS; Jean Moon, PharmD, BCACP; Margaret L. Wallace, PharmD, BCACP

    2013-01-01

    Purpose: To describe the landscape of medication management within the patient-centered medical homes (PCMH) in the state of Minnesota. Methods: An electronic survey of care coordinators within PCMHs certified with the Department of Health in state of Minnesota was conducted. The survey and follow up were distributed by the Minnesota Department of Health. At the time the survey was distributed, there were 161 certified PCMHs in the state. Results: The final analysis included 21 respondents. S...

  8. Development and evaluation of a patient centered cardiovascular health education program for insured patients in rural Nigeria (QUICK - II

    Directory of Open Access Journals (Sweden)

    Osibogun Akin

    2011-03-01

    Full Text Available Abstract Background In Sub Saharan Africa, the incidence of hypertension and other modifiable cardiovascular risk factors is growing rapidly. Poor adherence to prescribed prevention and treatment regimens by patients can compromise treatment outcomes. Patient-centered cardiovascular health education is likely to improve shortcomings in adherence. This paper describes a study that aims to develop a cardiovascular health education program for patients participating in a subsidized insurance plan in Nigeria and to evaluate the applicability and effectiveness in patients at increased risk for cardiovascular disease. Methods/Design Design: The study has two parts. Part 1 will develop a cardiovascular health education program, using qualitative interviews with stakeholders. Part 2 will evaluate the effectiveness of the program in patients, using a prospective (pre-post observational design. Setting: A rural primary health center in Kwara State, Nigeria. Population: For part 1: 40 patients, 10 healthcare professionals, and 5 insurance managers. For part 2: 150 patients with uncontrolled hypertension or other cardiovascular risk factors after one year of treatment. Intervention: Part 2: patient-centered cardiovascular health education program. Measurements: Part 1: Semi-structured interviews to identify stakeholder perspectives. Part 2: Pre- and post-intervention assessments including patients' demographic and socioeconomic data, blood pressure, body mass index and self-reporting measures on medication adherence and perception of care. Feasibility of the intervention will be measured using process data. Outcomes: For program development (part 1: overview of healthcare professionals' perceptions on barriers and facilitators to care, protocol for patient education, and protocol implementation plan. For program evaluation (part 2: changes in patients' scores on adherence to medication and life style changes, blood pressure, and other physiological and self

  9. Obstetrics Patients' Assessment of Medical Students' Role in Their Care.

    Science.gov (United States)

    Magrane, Diane

    1988-01-01

    Obstetric patients rated the skills and assessed the roles of students caring for them during a clinical clerkship. They rated skills and attitudes high, generally, with lower ratings for their ability to answer questions and preparation to participate in care. Most felt students improved their care, primarily in supportive ways. (Author/MSE)

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

    OpenAIRE

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

    1996-01-01

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

  11. Health-Care Technology Assessment in Radiology

    OpenAIRE

    Arash Deljou

    2010-01-01

    Health-care service provision and procurement is increasingly subject to policy decisions, managed more than ever before. Becoming more international, collaboration is increasing as the health professions, research and industry all work across borders. Differing health-care systems across the countries result from national and regional policy developments and priorities."nIn health-care, all interventions and procedures are basically technologies-including radiology and sur-gery, and tec...

  12. Advancing Patient-centered Outcomes in Emergency Diagnostic Imaging: A Research Agenda.

    Science.gov (United States)

    Kanzaria, Hemal K; McCabe, Aileen M; Meisel, Zachary M; LeBlanc, Annie; Schaffer, Jason T; Bellolio, M Fernanda; Vaughan, William; Merck, Lisa H; Applegate, Kimberly E; Hollander, Judd E; Grudzen, Corita R; Mills, Angela M; Carpenter, Christopher R; Hess, Erik P

    2015-12-01

    Diagnostic imaging is integral to the evaluation of many emergency department (ED) patients. However, relatively little effort has been devoted to patient-centered outcomes research (PCOR) in emergency diagnostic imaging. This article provides background on this topic and the conclusions of the 2015 Academic Emergency Medicine consensus conference PCOR work group regarding "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The goal was to determine a prioritized research agenda to establish which outcomes related to emergency diagnostic imaging are most important to patients, caregivers, and other key stakeholders and which methods will most optimally engage patients in the decision to undergo imaging. Case vignettes are used to emphasize these concepts as they relate to a patient's decision to seek care at an ED and the care received there. The authors discuss applicable research methods and approaches such as shared decision-making that could facilitate better integration of patient-centered outcomes and patient-reported outcomes into decisions regarding emergency diagnostic imaging. Finally, based on a modified Delphi process involving members of the PCOR work group, prioritized research questions are proposed to advance the science of patient-centered outcomes in ED diagnostic imaging. PMID:26574729

  13. Physician Satisfaction in Practices That Transformed Into Patient-Centered Medical Homes: A Statewide Study in New York.

    Science.gov (United States)

    Richardson, Joshua E; Kern, Lisa M; Silver, Michael; Jung, Hye-Young; Kaushal, Rainu

    2016-07-01

    Patient-centered medical home (PCMH) transformation can significantly affect physicians' job satisfaction, which in turn can affect the quality of patient care. Between November 2012 and March 2013, the study team surveyed 159 community-based physicians in 159 practice sites that had experienced PCMH practice transformations in New York State. Of the 159 physicians, 121 responded (77% response rate) to the online survey. Nearly two thirds (60%) of physicians reported being somewhat or very satisfied overall with their practice after PCMH transformation. Overall satisfaction was lower than satisfaction with specific domains of practice: patient-centered care (82%), coordination of care (81%), access to care (79%), efficiency (76%), organizational culture (69%), and quality (69%). Although the physicians were moderately satisfied with care quality in their practices after PCMH transformation, their overall satisfaction was notably lower. The findings reveal a need to identify factors beyond quality for measuring physician satisfaction in PCMH transformed practices. PMID:25877964

  14. Assessment of oral self-care in patients with periodontitis: a pilot study in a dental school clinic in Japan

    Directory of Open Access Journals (Sweden)

    Masuda Hitomi

    2009-10-01

    Full Text Available Abstract Background Oral hygiene education is central to every stage of periodontal treatment. Successful management of periodontal disease depends on the patient's capacity for oral self-care. In the present study, the oral self-care and perceptions of patients attending a dental school clinic in Japan were assessed using a short questionnaire referring to existing oral health models. Methods A cross-sectional study design was used. The study population consisted of sixty-five patients (age range 23-77 with chronic periodontitis. The pre-tested 19-item questionnaire comprised 3 domains; 1 oral hygiene, 2 dietary habits and 3 perception of oral condition. The questionnaire was used as a part of the comprehensive assessment. Results Analyses of the assessment data revealed no major problems with the respondents' perceived oral hygiene habits, although their actual plaque control levels were not entirely adequate. Most of the respondents acknowledged the importance of prevention of dental caries and periodontal diseases, but less than one third of them were regular users of the dental care system. Twenty-five percent of the respondents were considered to be reluctant to change their daily routines, and 29% had doubts about the impact of their own actions on oral health. Analyzing the relationships between patient responses and oral hygiene status, factors like 'frequency of tooth brushing', 'approximal cleaning', 'dental check-up' and 'compliance with self-care advice' showed statistically significant associations (P Conclusion The clinical utilization of the present questionnaire facilitates the inclusion of multiple aspects of patient information, before initiation of periodontal treatment. The significant associations that were found between some of the self-care behaviors and oral hygiene levels document the important role of patient-centered oral health assessment in periodontal care.

  15. The Critical Role of Clerks in the Patient-Centered Medical Home.

    Science.gov (United States)

    Solimeo, Samantha L; Stewart, Greg L; Rosenthal, Gary E

    2016-07-01

    Research evaluating the effectiveness, function, and implementation of patient-centered medical homes (PCMHs) has found major socioprofessional transformations and contributions of primary care physicians and, to a lesser degree, nurses. Our longitudinal ethnographic research with teams implementing PCMH in Veterans Health Administration (VHA) primary care identifies the important but largely underutilized contributions of clerks to PCMH outcomes. Although the relationship of high-performing clerical staff to patient satisfaction is widely acknowledged, PCMH can be further enhanced by enabling clerks to use administrative tasks as conduits for investing in long-term personalized relationships with patients that foster trust in the PCMH and the broader health care organization. Such relationships are engendered through the care-coordination activities clerks perform, which may be bolstered by organizational investment in clerks as skilled health care team members. PMID:27401428

  16. Patient Experience Assessment is a Requisite for Quality Evaluation: A Discussion of the In-Center Hemodialysis Consumer Assessment of Health Care Providers and Systems (ICH CAHPS) Survey.

    Science.gov (United States)

    Cavanaugh, Kerri L

    2016-03-01

    Patient experience surveys provide a critical and unique perspective on the quality of patient-centered healthcare delivery. These surveys provide a mechanism to systematically express patients' voice on topics valued by patients to make decisions about choices in care. They also provide an assessment to healthcare organizations about their service that cannot be obtained from any other source. Regulatory agencies have mandated the assessment of patients' experience as part of healthcare value based purchasing programs and weighted the results to account for up to 30% of the total scoring. This is a testimony to the accepted importance of this metric as a fundamental assessment of quality. After more than a decade of rigorous research, there is a significant body of growing evidence supporting specifically the validity and use of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, including a version specific to in-center hemodialysis (ICH CAHPS). This review will focus on the ICH CAHPS survey including a review of its development, content, administration, and also a discussion of common criticisms. Although it is suggested that the survey assesses activities and experiences that are not modifiable by the healthcare organization (or the dialysis facility in our case) emerging evidence suggests otherwise. Dialysis providers have an exclusive opportunity to lead the advancement of understanding the implications and serviceability of the evaluation of the patient experience in health care. PMID:26858008

  17. Pre-operative fasting - a patient centered approach.

    Science.gov (United States)

    Hamid, Sana

    2014-01-01

    Prolonged pre-operative fasting can be an unpleasant experience and result in serious medical complications. The Royal College of Nursing guidelines state a minimum fasting period of six hours for food and two hours for clear fluids, prior to elective anaesthesia or sedation in healthy patients. We audited the Moorfields South Pre-operative Assessment Unit fasting instruction policy to ensure it is clear and in accordance with national guidelines. A questionnaire assessing the clarity and accuracy of fasting instructions and patient hydration was employed to survey patients undergoing elective anaesthesia or sedation in July 2013 (first cycle) and September 2013 (second cycle). The fasting instruction policy and patient information leaflet were reviewed; they state "nothing to eat or drink from midnight" for morning surgery and "nothing to eat or drink from 7AM" for afternoon surgery. The 10 patients surveyed in the first cycle reported that the instructions they were given were clear. 70% expressed subjective dehydration and 40% showed clinical evidence of dehydration. The patients had not been encouraged to drink clear fluids up till two hours before surgery. Patients fasted for unnecessarily prolonged periods, the longest of which was 17 hours. Our interventions were: delivering a teaching session to update staff of current pre-operative fasting guidelines, producing a patient information leaflet that was correct, reader-friendly and comprehensive and displaying posters as a reminder of the updated fasting instruction policy. The 12 patients surveyed in the second cycle had been encouraged to drink clear fluids up till two hours before surgery. A dramatically reduced 25% expressed subjective dehydration and 25% showed clinical evidence of dehydration. The longest fasting period was reduced to eight hours. We encourage all hospitals to adopt a patient centered approach to pre-operative fasting, dispelling the "nil my mouth for eight hours" policy, to improve

  18. Instruments to assess integrated care:a systematic review

    OpenAIRE

    Lyngsø, Anne Marie; Skavlan, Nina; Høst, Dorte; Frølich, Anne

    2014-01-01

    INTRODUCTION: Although several measurement instruments have been developed to measure the level of integrated health care delivery, no standardised, validated instrument exists covering all aspects of integrated care. The purpose of this review is to identify the instruments concerning how to measure the level of integration across health-care sectors and to assess and evaluate the organisational elements within the instruments identified.METHODS: An extensive, systematic literature review in...

  19. Palliative care in India: Situation assessment and future scope

    OpenAIRE

    S S Kar; Subitha, L.; S Iswarya

    2015-01-01

    Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems – physical, psychosocial, and spiritual. It is estimated that in India the total number of people who need palliative care is likely to be 5.4 million people a year. Though palliative care services have been i...

  20. Developing and implementing an oral care policy and assessment tool.

    LENUS (Irish Health Repository)

    Stout, Michelle

    2012-01-09

    Oral hygiene is an essential aspect of nursing care. Poor oral care results in patients experiencing pain and discomfort, puts individuals at risk of nutritional deficiency and infection, and has an adverse effect on quality of life. This article describes how an oral care policy and assessment tool were updated to ensure the implementation of evidence-based practice at one hospital in the Republic of Ireland.

  1. Racial and ethnic differences in parents' assessments of pediatric care in Medicaid managed care.

    OpenAIRE

    Weech-Maldonado, R; Morales, L. S.; Spritzer, K; Elliott, M.; Hays, R D

    2001-01-01

    OBJECTIVE: This study examines whether parents' reports and ratings of pediatric health care vary by race/ethnicity and language in Medicaid managed care. DATA SOURCES: The data analyzed are from the National Consumer Assessment of Health Plans (CAHPS) Benchmarking Database 1.0 and consist of 9,540 children enrolled in Medicaid managed care plans in Arkansas, Kansas, Minnesota, Oklahoma, Vermont, and Washington state from 1997 to 1998. DATA COLLECTION: The data were collected by telephone and...

  2. Genetic Assessment of Breast Cancer Risk in Primary Care Practice

    OpenAIRE

    Burke, Wylie; Culver, Julie; Pinsky, Linda; Hall, Sarah; Reynolds, Susan E; Yasui, Yutaka; Press, Nancy

    2009-01-01

    Family history is increasingly important in primary care as a means to detect candidates for genetic testing or tailored prevention programs. We evaluated primary care physicians’ skills in assessing family history for breast cancer risk, using unannounced standardized patient visits to 86 general internists and family medicine practitioners in King County, WA. Transcripts of clinical encounters were coded to determine ascertainment of family history, risk assessment, and clinical follow-up. ...

  3. Palliative care in India: Situation assessment and future scope

    Directory of Open Access Journals (Sweden)

    S S Kar

    2015-01-01

    Full Text Available Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems – physical, psychosocial, and spiritual. It is estimated that in India the total number of people who need palliative care is likely to be 5.4 million people a year. Though palliative care services have been in existence for many years, India ranks at the bottom of the Quality of Death index in overall score. However there has been steady progress in the past few years through community-owned palliative care services. One of the key objectives of the National Programme for prevention and control of cancer, diabetes, cardiovascular diseases, and stroke is to establish and develop capacity for palliative and rehabilitative care. Community models for the provision of home-based palliative care is possible by involving community caregivers and volunteers supervised by nurses trained in palliative care. Training of medical officers and health care professionals, and sensitization of the public through awareness campaigns are vital to improve the scope and coverage of palliative care. Process of translating palliative care plan into action requires strong leadership, competent management, political support and integration across all levels of care.

  4. Finding Common Ground: Interprofessional Collaborative Practice Competencies in Patient-Centered Medical Homes.

    Science.gov (United States)

    Swihart, Diana

    2016-01-01

    The patient-centered medical home model is predicated on interprofessional collaborative practice and team-based care. While information on the roles of various providers is increasingly woven into the literature, the competencies of those providers have been generally profession-specific. In 2011, the Interprofessional Education Collaborative comprising the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Dental Education Association, the Association of American Medical Colleges, and the Association of Schools of Public Health sponsored an expert panel of their members to identify and develop 4 domains of core competencies needed for a successful interprofessional collaborative practice: (1) Values/Ethics for Interprofessional Practice; (2) Roles/Responsibilities; (3) Interprofessional Communication; and (4) Teams and Teamwork. Their findings and recommendations were recorded in their Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. This article explores these 4 domains and how they provide common ground for team-based care within the context of the medical home model approach to patient-centered primary care. PMID:26938181

  5. Beyond satisfaction: Using the Dynamics of Care assessment to better understand patients' experiences in care

    Directory of Open Access Journals (Sweden)

    Kahalas Wendy

    2008-03-01

    Full Text Available Abstract Background Patient perceptions of and satisfaction with care have become important indicators of the quality of services and the relationship of services to treatment outcomes. However, assessment of these indicators continues to be plagued by measurement problems, particularly the lack of variance in satisfaction data. In this article, we present a new approach to better capture patient perceptions of experiences in care, the Dynamics of Care (DoC assessment. It is an in-depth approach to defining and assessing patients' perspectives at different junctures in care, including their decisions about whether and where to seek care, the barriers encountered, and the treatments and services received. Methods The purpose of this article is to describe, validate, and discuss the benefits and limitations of the DoC, which was administered as part of a longitudinal study to evaluate the New York State HIV Special Needs Plan (SNP, a Medicaid managed care model for people living with HIV/AIDS. Data are from 426 study respondents across two time points. Results The results demonstrate the validity and value of the DoC. Help seeking decisions and satisfaction with care appear to be situation-specific, rather than person-specific. However, barriers to care appear to be more cross-situational for respondents, and may be associated with clients' living situations or care arrangements. Inventories in this assessment that were designed to identify potential deterrents to help seeking and difficulties encountered in care demonstrated clear principal component structures, and helped to explain satisfaction with care. The problem resolution index was found to be independent from satisfaction with care and the data were more normally distributed. DoC data were also associated with subsequent utilization and change in quality of life. Conclusion The DoC was designed to be a flexible, integrated measure to determine individuals' salient service needs, help

  6. Assessing Quality in Mental Health Care

    OpenAIRE

    Ian Shaw

    1997-01-01

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

  7. A Model for Risk Assessment in Health Care.

    Science.gov (United States)

    Prijatelj, Vesna; Rajkovič, Vladislav; Šušteršič, Olga

    2016-01-01

    The purpose of our research is to reduce risks and hence prevent errors in the health care process. The aim is to design an organizational information model using error prevention methods for risk assessment in a clinical setting. The model is based on selected indicators of quality nursing care, resulting from the world-known theoretical and practical models combined with experience in the Slovenian health care. The proposed organizational information model and software solution has a significant impact on the professional attention, communication and information, critical thinking, experience and knowledge. PMID:27332383

  8. Measurement Properties and Implementation of a Checklist to Assess Leadership Skills during Interdisciplinary Rounds in the Intensive Care Unit

    OpenAIRE

    Ten Have, Elsbeth C. M.; Nap, Raoul E; Tulleken, Jaap E.

    2015-01-01

    The implementation of interdisciplinary teams in the intensive care unit (ICU) has focused attention on leadership behavior. A daily recurrent situation in ICUs in which both leadership behavior and interdisciplinary teamwork are integrated concerns the interdisciplinary rounds (IDRs). Although IDRs are recommended to provide optimal interdisciplinary and patient-centered care, there are no checklists available for leading physicians. We tested the measurement properties and implementation of...

  9. Challenges of Assessing Maltreated Children Coming into Foster Care.

    Science.gov (United States)

    Pritchett, Rachel; Hockaday, Harriet; Anderson, Beatrice; Davidson, Claire; Gillberg, Christopher; Minnis, Helen

    2016-01-01

    Children who have experienced early adversity have been known to be at risk of developing cognitive, attachment, and mental health problems; therefore, it is crucial that children entering foster care can be properly assessed as early as possible. There are known difficulties in assessing children in foster care, for example, in finding a reliable informant. An ongoing randomised controlled trial in Glasgow, Scotland, recruiting infants entering foster care, provides a unique opportunity to explore some of the issues which need to be considered when assessing these children. The assessment data of 70 infants entering care is described while exploring the reliability of foster carers as informants and the importance of infant engagement with tasks. This group of infants was shown to be having more problems than children from the general population. While correlations were found between a carer's level of concern about a child and the severity of a child's problem, there were still a number of children displaying worrying problem scores whom foster carers did not report concern. The child's engagement in the cognitive task showed associations with the child's attainment on the task. Findings emphasise the importance of a holistic assessment for these children and all should be considered as potential cases with Maltreatment-Associated Psychiatric Problems (MAPP). PMID:26881270

  10. Challenges of Assessing Maltreated Children Coming into Foster Care

    Directory of Open Access Journals (Sweden)

    Rachel Pritchett

    2016-01-01

    Full Text Available Children who have experienced early adversity have been known to be at risk of developing cognitive, attachment, and mental health problems; therefore, it is crucial that children entering foster care can be properly assessed as early as possible. There are known difficulties in assessing children in foster care, for example, in finding a reliable informant. An ongoing randomised controlled trial in Glasgow, Scotland, recruiting infants entering foster care, provides a unique opportunity to explore some of the issues which need to be considered when assessing these children. The assessment data of 70 infants entering care is described while exploring the reliability of foster carers as informants and the importance of infant engagement with tasks. This group of infants was shown to be having more problems than children from the general population. While correlations were found between a carer’s level of concern about a child and the severity of a child’s problem, there were still a number of children displaying worrying problem scores whom foster carers did not report concern. The child’s engagement in the cognitive task showed associations with the child’s attainment on the task. Findings emphasise the importance of a holistic assessment for these children and all should be considered as potential cases with Maltreatment-Associated Psychiatric Problems (MAPP.

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

    Directory of Open Access Journals (Sweden)

    Rashmi

    2010-01-01

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

  12. Uncovering paradoxes from physicians' experiences of patient-centered ward-round.

    Science.gov (United States)

    Bååthe, Fredrik; Ahlborg, Gunnar; Edgren, Lars; Lagström, Annica; Nilsson, Kerstin

    2016-05-01

    Purpose The purpose of this paper is to uncover paradoxes emerging from physicians' experiences of a patient-centered and team-based ward round, in an internal medicine department. Design/methodology/approach Abductive reasoning relates empirical material to complex responsive processes theory in a dialectical process to further understandings. Findings This paper found the response from physicians, to a patient-centered and team-based ward round, related to whether the new demands challenged or confirmed individual physician's professional identity. Two empirically divergent perspectives on enacting the role of physician during ward round emerged: We-perspective and I-perspective, based on where the physician's professional identity was centered. Physicians with more of a We-perspective experienced challenges with the new round, while physicians with more of an I-perspective experienced alignment with their professional identity and embraced the new round. When identity is challenged, anxiety is aroused, and if anxiety is not catered to, then resistance is likely to follow and changes are likely to be hampered. Practical implications For change processes affecting physicians' professional identity, it is important for managers and change leaders to acknowledge paradox and find a balance between new knowledge that needs to be learnt and who the physician is becoming in this new procedure. Originality/value This paper provides increased understanding about how physicians' professional identity is interacting with a patient-centered ward round. It adds to the knowledge about developing health care in line with recent societal requests and with sustainable physician engagement. PMID:27198705

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

    Directory of Open Access Journals (Sweden)

    Camacho Luiz Antonio Bastos

    1996-01-01

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

  14. Workplace-based assessment in a primary-care setting.

    Science.gov (United States)

    Hecker, Kent G; Norris, Jill; Coe, Jason B

    2012-01-01

    Workplace-based assessment (WBA) is the process of directly observing students' work within a clinical setting, assessing their performance, and providing specific, goal oriented feedback. Assessment methods used for workplace-based assessment include tools developed for clinical interaction (e.g., the mini clinical evaluation exercise [mini-CEX]), for procedural or technical skills (e.g., the direct observation of procedural skills [DOPS]), and multi-source feedback tools to assess interpersonal and technical skills. While several of these assessment methods are being adopted by veterinary schools to evaluate students' progress through their clinical rotations, there is little reported at this time about their utility and effectiveness within the veterinary context. This article provides an introduction to the use of these tools and offers guidance in selecting appropriate methods for assessment in the primary health care setting. PMID:22951458

  15. Self-assessment in cancer patients referred to palliative care

    DEFF Research Database (Denmark)

    Strömgren, Annette S; Goldschmidt, Dorthe; Groenvold, Mogens;

    2002-01-01

    -based study using the European Organization for Research and Treatment of Cancer quality-of-life instrument EORTC QLQ-C30, the Edmonton Symptom Assessment System (ESAS), and the Hospital Anxiety and Depression Scale (HADS) in cancer patients who were receiving palliative care. This report describes the......-based study of symptomatology in consecutive cancer patients in palliative care, achieving rather complete data from the participants. The symptomatology in these patients was very pronounced. The questionnaires were able to detect clinically important differences between places of service.......BACKGROUND: Research in palliative care is considered difficult due to the poor health of patients. However, patient-provided data are essential for a thorough description of patient symptomatology and for the evaluation of care. METHODS: The authors examined the feasibility of a questionnaire...

  16. Evaluating the Child Care Director: The Collaborative Professional Assessment Process.

    Science.gov (United States)

    Freeman, Nancy K.; Brown, Mac H.

    2000-01-01

    Describes the Collaborative Professional Assessment Process (CPAP) to guide the evaluation of the director of early childhood programs. Examines the assumptions upon which the CPAP is based. Lists the management skills and leadership abilities of successful child care directors. Includes the Director Self-Evaluation form and a program evaluation…

  17. Measurement Properties and Implementation of a Checklist to Assess Leadership Skills during Interdisciplinary Rounds in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Elsbeth C. M. Ten Have

    2015-01-01

    Full Text Available The implementation of interdisciplinary teams in the intensive care unit (ICU has focused attention on leadership behavior. A daily recurrent situation in ICUs in which both leadership behavior and interdisciplinary teamwork are integrated concerns the interdisciplinary rounds (IDRs. Although IDRs are recommended to provide optimal interdisciplinary and patient-centered care, there are no checklists available for leading physicians. We tested the measurement properties and implementation of a checklist to assess the quality of leadership skills in interdisciplinary rounds. The measurement properties of the checklist, which included 10 essential quality indicators, were tested for interrater reliability and internal consistency and by factor analysis. The interrater reliability among 3 raters was good (κ, 0.85 and the internal consistency was acceptable (α, 0.74. Factor analysis showed all factor loadings on 1 domain (>0.65. The checklist was further implemented during videotaped IDRs which were led by senior physicians and in which 99 patients were discussed. Implementation of the checklist showed a wide range of “no” and “yes” scores among the senior physicians. These results may underline the need for such a checklist to ensure tasks are synchronized within the team.

  18. An instrument assessing patient satisfaction with day care in hospitals

    Directory of Open Access Journals (Sweden)

    Kleefstra SM

    2012-05-01

    Full Text Available Abstract Background Patient satisfaction is an important indicator of quality of care in hospitals. Reliable and valid instruments to measure clinical and outpatient satisfaction already exist. Recently hospitals have increasingly provided day care, i.e., admitting patients for one day without an overnight stay. This article describes the adaption of the ‘Core questionnaire for the assessment of Patient Satisfaction’ (COPS for general Day care (COPS-D, and the subsequent validation of the COPS-D. Methods The clinical COPS was supplemented with items to cover two new dimensions: Pre-admission visit and Operation Room. It was sent to a sample of day care patients of five general Dutch hospitals to investigate dimensionality, acceptability, reliability, construct and external validity. Construct validity was established by correlating the dimensions of the COPS-D with patients’ overall satisfaction. Results The COPS-D was returned by 3802 patients (response 46%. Factor analysis confirmed its’ structure: Pre-intake visit, Admission, Operation room, Nursing care, Medical care, Information, Autonomy and Discharge and aftercare (extraction communality 0.63-0.90. The internal consistency of the eight dimensions was good (α = 0.82-0.90; the item internal consistency corrected for overlap was satisfactory (>0.40; all inter-item correlations were higher than 0.45 but not too high (Information dimension had the strongest correlation with overall day care satisfaction. Conclusions The COPS-D is a reliable and valid instrument for measuring satisfaction with day care. It complements the model of measuring patient satisfaction with clinical and outpatient care given in hospitals. It also fulfils the conditions made while developing the clinical and outpatient COPS: a short, core instrument to screen patient satisfaction.

  19. Health-care technology assessment: a clinical perspective.

    Science.gov (United States)

    Chantler, Cyril

    2004-01-01

    Health technology assessment needs to relate to contemporary questions which concern public health-care systems: how to keep people healthy, how to focus on the needs of those with chronic disabilities and integrate care between the hospital and the community, how to encourage and audit effective teamwork, and how to establish a consensus about what is effective and affordable. Clinicians have an ethical responsibility to practice efficiently and economically, for profligacy in the care of one patient may mean that another is treated inadequately. For similar reasons, clinicians need to play a full role in the management of services. Advice from health technology assessment is vital and needs to be accurate, relevant, timely, clear, and accessible. As well as being concerned about what works, we need also to eliminate from practice what does not. Regular audit and appraisal of practice against the evidence base should be useful in this respect. Alternative approaches to management, such as the provision of care as opposed to aggressive treatments, need to be evaluated, and health technology assessment needs to consider how services are delivered, not just specific treatments. PMID:15176183

  20. Advancing patient-centered care through transformative educational leadership: a critical review of health care professional preparation for patient-centered care

    OpenAIRE

    Lévesque MC; Hovey RB; Bedos C

    2013-01-01

    Martine C Lévesque,1,2 Richard Bruce Hovey,2,3 Christophe Bedos2,4 1Faculté de médecine, Université de Montréal, Montréal, QC, Canada; 2Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada; 3Faculty of Medicine, University of Calgary, Calgary, AB, Canada; 4Département de médecine sociale et préventive, Faculté de médicine, Université de Montréal, Montr&eacut...

  1. Advancing patient-centered care through transformative educational leadership: a critical review of health care professional preparation for patient-centered care

    OpenAIRE

    Lévesque, Martine

    2013-01-01

    Martine C Lévesque,1,2 Richard Bruce Hovey,2,3 Christophe Bedos2,4 1Faculté de médecine, Université de Montréal, Montréal, QC, Canada; 2Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada; 3Faculty of Medicine, University of Calgary, Calgary, AB, Canada; 4Département de médecine sociale et préventive, Faculté de médicine, Unive...

  2. Creation of complexity assessment tool for patients receiving home care

    Directory of Open Access Journals (Sweden)

    Maria Leopoldina de Castro Villas Bôas

    2016-06-01

    Full Text Available Abstract OBJECTIVE To create and validate a complexity assessment tool for patients receiving home care from a public health service. METHOD A diagnostic accuracy study, with estimates for the tool's validity and reliability. Measurements of sensitivity and specificity were considered when producing validity estimates. The resulting tool was used for testing. Assessment by a specialized team of home care professionals was used as the gold standard. In the tool's reliability study, the authors used the Kappa statistic. The tool's sensitivity and specificity were analyzed using various cut-off points. RESULTS On the best cut-off point-21-with the gold standard, a sensitivity of 75.5% was obtained, with the limits of confidence interval (95% at 68.3% and 82.8% and specificity of 53.2%, with the limits of confidence interval (95% at 43.8% and 62.7%. CONCLUSION The tool presented evidence of validity and reliability, possibly helping in service organization at patient admission, care type change, or support during the creation of care plans.

  3. Rapid assessment methods in eye care: An overview

    Directory of Open Access Journals (Sweden)

    Srinivas Marmamula

    2012-01-01

    Full Text Available Reliable information is required for the planning and management of eye care services. While classical research methods provide reliable estimates, they are prohibitively expensive and resource intensive. Rapid assessment (RA methods are indispensable tools in situations where data are needed quickly and where time- or cost-related factors prohibit the use of classical epidemiological surveys. These methods have been developed and field tested, and can be applied across almost the entire gamut of health care. The 1990s witnessed the emergence of RA methods in eye care for cataract, onchocerciasis, and trachoma and, more recently, the main causes of avoidable blindness and visual impairment. The important features of RA methods include the use of local resources, simplified sampling methodology, and a simple examination protocol/data collection method that can be performed by locally available personnel. The analysis is quick and easy to interpret. The entire process is inexpensive, so the survey may be repeated once every 5-10 years to assess the changing trends in disease burden. RA survey methods are typically linked with an intervention. This article provides an overview of the RA methods commonly used in eye care, and emphasizes the selection of appropriate methods based on the local need and context.

  4. Palau assessment for a continuing health care professional development program.

    Science.gov (United States)

    Chen, Tai-Ho; Dever, Gregory; Kuartei, Stevenson; Maskarinec, Gregory G

    2007-03-01

    In 2003, the University of Hawai'i Department of Family Medicine and Community Health entered a 4-year cooperative agreement with the U.S. Health Resources and Services Administration to establish the "Pacific Association for Clinical Training" (PACT). PACT's goal is to develop effective distance education methods to improve the education and skills of health care professionals in the U.S.-Affiliated Pacific Island nations. To determine the situation existing in 2004, one of PACT's first projects was to perform site visits to each jurisdiction, conducting needs assessments through interviews with key health care professionals, hospital administrators and government officials. This article highlights findings of PACT's Palau assessment. Meant to establish a baseline for future reference, all data were collected in 2004-2005 and have not been updated. PMID:19772140

  5. Age, gender, socioeconomic, and ethnic differences in patients' assessments of primary health care

    OpenAIRE

    Campbell, J.; Ramsay, J.; Green, J.

    2001-01-01

    Background—Patients' evaluations are an important means of measuring aspects of primary care quality such as communication and interpersonal care. This study aims to examine variations in assessments of primary care according to age, gender, socioeconomic, and ethnicity variables.

  6. Psychometrics of shared decision making and communication as patient centered measures for two language groups.

    Science.gov (United States)

    Alvarez, Kiara; Wang, Ye; Alegria, Margarita; Ault-Brutus, Andrea; Ramanayake, Natasha; Yeh, Yi-Hui; Jeffries, Julia R; Shrout, Patrick E

    2016-09-01

    Shared decision making (SDM) and effective patient-provider communication are key and interrelated elements of patient-centered care that impact health and behavioral health outcomes. Measurement of SDM and communication from the patient's perspective is necessary in order to ensure that health care systems and individual providers are responsive to patient views. However, there is a void of research addressing the psychometric properties of these measures with diverse patients, including non-English speakers, and in the context of behavioral health encounters. This study evaluated the psychometric properties of 2 patient-centered outcome measures, the Shared Decision-Making Questionnaire-9 (SDM-Q) and the Kim Alliance Scale-Communication subscale (KAS-CM), in a sample of 239 English and Spanish-speaking behavioral health patients. One dominant factor was found for each scale and this structure was used to examine whether there was measurement invariance across the 2 language groups. One SDM-Q item was inconsistent with the configural invariance comparison and was removed. The remaining SDM-Q items exhibited strong invariance, meaning that item loadings and item means were similar across the 2 groups. The KAS-CM items had limited variability, with most respondents indicating high communication levels, and the invariance analysis was done on binary versions of the items. These had metric invariance (loadings the same over groups) but several items violated the strong invariance test. In both groups, the SDM-Q had high internal consistency, whereas the KAS-CM was only adequate. These findings help interpret results for individual patients, taking into account cultural and linguistic differences in how patients perceive SDM and patient-provider communication. (PsycINFO Database Record PMID:27537002

  7. Cancer patient-centered home care: a new model for health care in oncology

    OpenAIRE

    Tralongo P; Ferraù F; Borsellino N; Verderame F; Caruso M.; Giuffrida D; Butera A; Gebbia V

    2011-01-01

    Paolo Tralongo1, Francesco Ferraù2, Nicolò Borsellino3, Francesco Verderame4, Michele Caruso5, Dario Giuffrida6, Alfredo Butera7, Vittorio Gebbia81Medical Oncology Unit, Azienda Sanitaria Provinciale, Siracusa; 2Medical Oncology Unit, Ospedale San Vincenzo, Taormina; 3Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo; 4Medical Oncology Unit, Ospedale Giovanni Paolo II, Sciacca; 5Medical Oncology Unit, Istituto Humanitas, Catania; 6Medical Oncology Unit, Istituto...

  8. Exploring valid and reliable assessment methods for care management education.

    Science.gov (United States)

    Gennissen, Lokke; Stammen, Lorette; Bueno-de-Mesquita, Jolien; Wieringa, Sietse; Busari, Jamiu

    2016-07-01

    Purpose It is assumed that the use of valid and reliable assessment methods can facilitate the development of medical residents' management and leadership competencies. To justify this assertion, the perceptions of an expert panel of health care leaders were explored on assessment methods used for evaluating care management (CM) development in Dutch residency programs. This paper aims to investigate how assessors and trainees value these methods and examine for any inherent benefits or shortcomings when they are applied in practice. Design/methodology/approach A Delphi survey was conducted among members of the platform for medical leadership in The Netherlands. This panel of experts was made up of clinical educators, practitioners and residents interested in CM education. Findings Of the respondents, 40 (55.6 per cent) and 31 (43 per cent) participated in the first and second rounds of the Delphi survey, respectively. The respondents agreed that assessment methods currently being used to measure residents' CM competencies were weak, though feasible for use in many residency programs. Multi-source feedback (MSF, 92.1 per cent), portfolio/e-portfolio (86.8 per cent) and knowledge testing (76.3 per cent) were identified as the most commonly known assessment methods with familiarity rates exceeding 75 per cent. Practical implications The findings suggested that an "assessment framework" comprising MSF, portfolios, individual process improvement projects or self-reflections and observations in clinical practice should be used to measure CM competencies in residents. Originality/value This study reaffirms the need for objective methods to assess CM skills in post-graduate medical education, as there was not a single assessment method that stood out as the best instrument. PMID:27397747

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

    Directory of Open Access Journals (Sweden)

    Green Michael E

    2012-07-01

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

  10. Assessment of nursing care using indicators generated by software

    Directory of Open Access Journals (Sweden)

    Ana Paula Souza Lima

    2015-04-01

    Full Text Available OBJECTIVE: to analyze the efficacy of the Nursing Process in an Intensive Care Unit using indicators generated by software. METHOD: cross-sectional study using data collected for four months. RNs and students daily registered patients, took history (at admission, performed physical assessments, and established nursing diagnoses, nursing plans/prescriptions, and assessed care delivered to 17 patients using software. Indicators concerning the incidence and prevalence of nursing diagnoses, rate of effectiveness, risk diagnoses, and rate of effective prevention of complications were computed. RESULTS: the Risk for imbalanced body temperature was the most frequent diagnosis (23.53%, while the least frequent was Risk for constipation (0%. The Risk for Impaired skin integrity was prevalent in 100% of the patients, while Risk for acute confusion was the least prevalent (11.76%. Risk for constipation and Risk for impaired skin integrity obtained a rate of risk diagnostic effectiveness of 100%. The rate of effective prevention of acute confusion and falls was 100%. CONCLUSION: the efficacy of the Nursing Process using indicators was analyzed because these indicators reveal how nurses have identified patients' risks and conditions, and planned care in a systematized manner.

  11. Use of CAHPS® patient experience survey data as part of a patient-centered medical home quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Quigley DD

    2015-07-01

    Full Text Available Denise D Quigley,1 Peter J Mendel,1 Zachary S Predmore,2 Alex Y Chen,3 Ron D Hays41RAND Corporation, Santa Monica, CA, 2RAND Corporation, Boston, MA, 3AltaMed Health Services Corporation, 4Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USAObjective: To describe how practice leaders used Consumer Assessment of Healthcare Providers and Systems (CAHPS® Clinician and Group (CG-CAHPS data in transitioning toward a patient-centered medical home (PCMH.Study design: Interviews conducted at 14 primary care practices within a large urban Federally Qualified Health Center in California.Participants: Thirty-eight interviews were conducted with lead physicians (n=13, site clinic administrators (n=13, nurse supervisors (n=10, and executive leadership (n=2.Results: Seven themes were identified on how practice leaders used CG-CAHPS data for PCMH transformation. CAHPS® was used: 1 for quality improvement (QI and focusing changes for PCMH transformation; 2 to maintain focus on patient experience; 3 alongside other data; 4 for monitoring site-level trends and changes; 5 to identify, analyze, and monitor areas for improvement; 6 for provider-level performance monitoring and individual coaching within a transparent environment of accountability; and 7 for PCMH transformation, but changes to instrument length, reading level, and the wording of specific items were suggested.Conclusion: Practice leaders used CG-CAHPS data to implement QI, develop a shared vision, and coach providers and staff on performance. They described how CAHPS® helped to improve the patient experience in the PCMH model, including access to routine and urgent care, wait times, provider spending enough time and listening carefully, and courteousness of staff. Regular reporting, reviewing, and discussing of patient-experience data alongside other clinical quality and productivity measures at multilevels of the organization was critical in maximizing the

  12. Ethics and Regulatory Challenges and Opportunities in Patient-Centered Comparative Effectiveness Research.

    Science.gov (United States)

    Sugarman, Jeremy

    2016-04-01

    The Affordable Care Act includes provisions for the conduct of large-scale, patient-centered comparative effectiveness research. Such efforts aim toward the laudable moral goal of having evidence to improve health care decision making. Nevertheless, these pragmatic clinical research efforts that typically pose minimal incremental risk and are enmeshed in routine care settings perhaps surprisingly encounter an array of ethics and regulatory challenges and opportunities for academic health centers. An emphasis on patient-centeredness forces an examination of the appropriateness of traditional methods used to protect the rights, interests, and welfare of participants. At the same time, meaningful collaboration with patients throughout the research process also necessitates ensuring that novel approaches to research (including recruitment and consent) entail necessary protections regarding such issues as privacy. As the scientific and logistical aspects of this research are being developed, substantial attention is being focused on the accompanying ethics and regulatory issues that have emerged, which should help to facilitate ethically appropriate research in a variety of contexts. PMID:26826074

  13. Nurses and Psychologists Advancing the Patient-Centered Medical Home Model.

    Science.gov (United States)

    Corso, Kent A; Gage, Donna

    2016-01-01

    As America experiences the largest health care revolution of the past 50 years, clinicians and administrators are refocusing their attention on the goals of the Quadruple Aim. Motivation and capabilities among stakeholders vary as practical tools and an adequate workforce remain elusive. At the same time, the patient-centered medical home (PCMH) model is spreading rapidly but demonstrating variable results. Positive PCMH outcomes seem to reflect high-quality teamwork. A primary care physician shortage is looming, and increasing numbers of health professionals are being pushed into the PCMH, mandated to provide "integrated" care. Even now, the majority of our Graduate Medical Education programs do not train clinicians in team-based workflow models and interaction skills. Consequently, PCMH teams will only optimize and realize the model's true potential if they learn to coordinate, communicate, and collaborate effectively. This means all PCMH staff members achieve solid teamwork skills and work at the top of their license. The authors discuss resources for improving coordination, communication, and collaboration among members of PCMH teams, and strategies for including other professionals. PMID:27259123

  14. Assessing effective care in normal labor: the Bologna score.

    Science.gov (United States)

    Chalmers, B; Porter, R

    2001-06-01

    The intention of the "Bologna score" is to quantify, both in an individual labor and in a wider population, the extent to which labors have been managed as if they are normal as opposed to complicated. In this way it may be possible to assess both attitudes and practices within a maternity service toward the effective care of normal labor. A scoring system for normal labor was proposed at the World Health Organization (Regional Office for Europe) Task Force Meeting on Monitoring and Evaluation of Perinatal Care, held in Bologna in January 2000. This paper describes conceptual development of the scale. Recommendations for future evaluation of the Bologna score's validity and potential include field testing globally, comparison with the Apgar score, and evaluation of the relative weight contributed by each of the five measures comprising the Bologna score. PMID:11380378

  15. The emerging role of patient-centered outcomes research in shaping the future of healthcare delivery in India: A brief review

    Directory of Open Access Journals (Sweden)

    Amit Dang

    2015-04-01

    Full Text Available With the Indian patient becoming more empowered with regards to his disease and its treatment options, many Indian physicians still depend only on disease-related outcome measures to take health-care related decisions, and give minimal importance to patient-centered outcomes pertaining to the effect of the healthcare interventions on the patient's well-being. Thus, objective lab values and physician intuition are given more importance than the subjective feeling of well-being that the patient is experiencing following the introduction of the intervention. This review presents a concept of integrating patient-centered and patient-reported data with the existing disease-centered and doctor-reported data for making healthcare-related decisions. This concept, termed patient-centered outcomes research, has already become popular in the Western World.

  16. Assessment in health psychology: Introduction to the special issue.

    Science.gov (United States)

    Butt, Zeeshan

    2016-09-01

    For the past 27 years, has been committed to publishing empirical research relevant to clinical assessment of basic and applied cognition, personality, interpersonal behavior, psychopathology, forensics, and biological psychology. There is growing interest in the use of patient-centered outcomes in medical/surgical care and for measuring health care performance. Patient-centered outcome measures complement traditional clinical outcomes of morbidity and mortality, capturing the patient's perspective regarding their health and its treatment. In this issue, we highlight 11 articles that address different aspects of such work. The articles in this special issue represent both the depth and breadth of the opportunities that exist for psychological assessment in the health setting. While there are countless patient-centered measures currently in use to measure health and health outcomes, the evidence base for their use can be quite variable (Butt, 2016). The hope is that future issues of will highlight more work in this area. (PsycINFO Database Record PMID:27536998

  17. Patient-Centered e-Health Record over the Cloud.

    Science.gov (United States)

    Koumaditis, Konstantinos; Themistocleous, Marinos; Vassilacopoulos, George; Prentza, Andrianna; Kyriazis, Dimosthenis; Malamateniou, Flora; Maglaveras, Nicos; Chouvarda, Ioanna; Mourouzis, Alexandros

    2014-01-01

    The purpose of this paper is to introduce the Patient-Centered e-Health (PCEH) conceptual aspects alongside a multidisciplinary project that combines state-of-the-art technologies like cloud computing. The project, by combining several aspects of PCEH, such as: (a) electronic Personal Healthcare Record (e-PHR), (b) homecare telemedicine technologies, (c) e-prescribing, e-referral, e-learning, with advanced technologies like cloud computing and Service Oriented Architecture (SOA), will lead to an innovative integrated e-health platform of many benefits to the society, the economy, the industry, and the research community. To achieve this, a consortium of experts, both from industry (two companies, one hospital and one healthcare organization) and academia (three universities), was set to investigate, analyse, design, build and test the new platform. This paper provides insights to the PCEH concept and to the current stage of the project. In doing so, we aim at increasing the awareness of this important endeavor and sharing the lessons learned so far throughout our work. PMID:25000049

  18. Medical Center Farmers Markets: A Strategic Partner in the Patient-Centered Medical Home

    Directory of Open Access Journals (Sweden)

    Daniel R. George, PhD, MSc

    2013-08-01

    Full Text Available Background The number of medical center���based farmers markets has increased in the past decade, but little is known about how such organizations contribute to the preventive health goals of the patient-centered medical home. Community Context In 2010, we started a seasonal farmers market at Penn State Hershey Medical Center to help support the institution’s commitment to the medical home. Methods We obtained descriptive data on the farmers market from hospital and market records and tracking information on the market’s Facebook and Twitter sites. We computed summary measures to characterize how the market has begun to meet the 6 standards of the 2011 National Committee for Quality Assurance’s report on the medical home. Outcome During the 2010 and 2011 seasons, 146 medical center volunteers from 40 departments formed 23 interprofessional teams that spent an average of 551 volunteer hours per season at the market, providing health screenings (n = 695 and speaking to customers (n = 636 about preventive health. Fifty-five nonmedical community health partners provided 208 hours of service at the market alongside medical center staff. Market programming contributed to 5 regional preventive health partnerships and created opportunities for interprofessional mentoring, student leadership, data management, development of social media skills, and grant-writing experience. The market contributed to all 6 medical home standards outlined by the National Committee for Quality Assurance. Interpretation Medical center markets can support medical home standards. With systematic tracking of the health effects and integration with electronic medical health records, markets hold potential to contribute to comprehensive patient-centered care.

  19. PS1-38: Building a Patient-centered Medical Home: Patient Perspectives from a Survey in an Integrated Healthcare System

    Science.gov (United States)

    Forjuoh, Samuel; Miller, Sarah; Reis, Michael

    2014-01-01

    Background/Aims As healthcare evolves to meet growing demand, it is crucial to maintain quality patient-centered care. In our quest to build a viable Patient-Centered Medical Home (PCMH) in our ambulatory care setting, we conducted this study to assess our patients’ perspectives on patient-centeredness in our integrated healthcare system. Methods Surveys were administered to all consenting English-speaking patients and accompanying relatives ages = 18 at 4 Family Medicine clinics. The questionnaire consisted primarily of Likert-type items with 5 choices ranging from strongly agree to strongly disagree on relationships within healthcare, communication with providers, access to providers, and coordination of care, along with basic demographics. Results Of 316 patients approached, 204 (64.6%) returned completed surveys. Mean age was 47.4 (SD = 16.0; range 18–89); 67% were female, 84.4% white, 11.8% black, and 12.8% Hispanic. Majority were married (57.0%), employed (60.2%), had college education (69.4%), and reported an annual income of <$60,000 (68.7%). The vast majority expressed believe that their healthcare team treats them with courtesy and respect (96.1%), trust their healthcare team with their medical care (93.6%), feel their healthcare provider communicates with them clearly using understandable language (95.6%) and listens to their questions, answering them directly (96%). Also the vast majority believe they play an active role in their healthcare (95.5%) and think it is important to be proactive in their healthcare (97%). Comparatively lower percentages of positive responses were noted when asked if the patient would like to use the Internet for filling prescriptions, making appointments, or communicating with their healthcare team (52%), if their provider inquires about their health goals (61.9%), and if their provider takes their health goals into account when developing a treatment plan (69.4%). Conclusions In order to move towards a more PCMH

  20. Patients’ Needs for Care in Public Mental Health: Unity and Diversity of Self-Assessed Needs for Care

    OpenAIRE

    Bellier-Teichmann, Tanja; Golay, Philippe; Bonsack, Charles; Pomini, Valentino

    2016-01-01

    Purpose Needs assessment is recognized to be a key element of mental health care. Patients tend to present heterogeneous profiles of needs. However, there is no consensus in previous research about how patients’ needs are organized. This study investigates both general and specific dimensions of patients’ needs for care. Methods Patients’ needs were assessed with ELADEB, an 18-domain self-report scale. The use of a self-assessment scale represents a unique way of obtaining patients...

  1. Exploratory trials, confirmatory observations: A new reasoning model in the era of patient-centered medicine

    Directory of Open Access Journals (Sweden)

    Sacristán José A

    2011-04-01

    Full Text Available Abstract Background The prevailing view in therapeutic clinical research today is that observational studies are useful for generating new hypotheses and that controlled experiments (i.e., randomized clinical trials, RCTs are the most appropriate method for assessing and confirming the efficacy of interventions. Discussion The current trend towards patient-centered medicine calls for alternative ways of reasoning, and in particular for a shift towards hypothetico-deductive logic, in which theory is adjusted in light of individual facts. A new model of this kind should change our approach to drug research and development, and regulation. The assessment of new therapeutic agents would be viewed as a continuous process, and regulatory approval would no longer be regarded as the final step in the testing of a hypothesis, but rather, as the hypothesis-generating step. The main role of RCTs in this patient-centered research paradigm would be to generate hypotheses, while observations would serve primarily to test their validity for different types of patients. Under hypothetico-deductive logic, RCTs are considered "exploratory" and observations, "confirmatory". Summary In this era of tailored therapeutics, the answers to therapeutic questions cannot come exclusively from methods that rely on data aggregation, the analysis of similarities, controlled experiments, and a search for the best outcome for the average patient; they must also come from methods based on data disaggregation, analysis of subgroups and individuals, an integration of research and clinical practice, systematic observations, and a search for the best outcome for the individual patient. We must look not only to evidence-based medicine, but also to medicine-based evidence, in seeking the knowledge that we need.

  2. Police Officer, Deal-Maker, or Healthcare Provider? Moving to a Patient-Centered Framework for Chronic Opioid Management

    OpenAIRE

    Nicolaidis, Christina

    2011-01-01

    How we frame our thoughts about chronic opioid therapy greatly influences our ability to practice patient-centered care. Even providers who strive to be non-judgmental may approach clinical decision-making about opioids by considering if the pain is real or they can trust the patient. Not only does this framework potentially lead to poor or unshared decision-making, it likely adds to provider and patient discomfort by placing the provider in the position of a police officer or judge. Similarl...

  3. Invite, listen, and summarize: a patient-centered communication technique.

    Science.gov (United States)

    Boyle, Dennis; Dwinnell, Brian; Platt, Frederic

    2005-01-01

    The need for physicians to have patient-centered communication skills is reflected in the educational objectives of numerous medical schools' curricula and in the competencies required by groups such as the Accreditation Council for Graduate Medical Education. An innovative method for teaching communications skills has been developed at the University of Colorado School of Medicine as part of its three-year, longitudinal course focusing on basic clinical skills required of all physicians. The method emphasizes techniques of open-ended inquiry, empathy, and engagement to gather data. Students refer to the method as ILS, or Invite, Listen, and Summarize. ILS was developed to combat the high-physician-control interview techniques, characterized by a series of "yes" or "no" questions. The authors began teaching the ILS approach in 2001 as one basic exercise and have since developed a two-year longitudinal communications curriculum. ILS is easy to use and remember, and it emphasizes techniques that have been shown in other studies to achieve the three basic functions of the medical interview: creating rapport, collecting good data, and improving compliance. The skills are taught using standardized patients in a series of four small-group exercises. Videotaped standardized patient encounters are used to evaluate the students. Tutors come from a variety of disciplines and receive standardized training. The curriculum has been well received. Despite the fact that the formal curriculum only occurs in the first two years, there is some evidence that it is improving students' interviewing skills at the end of their third year. PMID:15618088

  4. Implementing health information technology in a patient-centered manner: patient experiences with an online evidence-based lifestyle intervention.

    Science.gov (United States)

    Lyden, Jennifer R; Zickmund, Susan L; Bhargava, Tina D; Bryce, Cindy L; Conroy, Molly B; Fischer, Gary S; Hess, Rachel; Simkin-Silverman, Laurey R; McTigue, Kathleen M

    2013-01-01

    The patient-centered care (PCC) model and the use of health information technology (HIT) are major initiatives for improving U.S. healthcare quality and delivery. A lack of published data on patient perceptions of Internet-based care makes patient-centered implementation of HIT challenging. To help ascertain patients' perceptions of an online intervention, patients completing a 1-year web-based lifestyle intervention were asked to complete a semistructured interview. We used qualitative methodology to determine frequency and types of interview responses. Overall satisfaction with program features was coded on a Likert-type scale. High levels of satisfaction were seen with the online lifestyle coaching (80%), self-monitoring tools (57%), and structured lesson features (54%). Moderated chat sessions and online resources were rarely used. Frequently identified helpful aspects were those that allowed for customized care and shared decision-making consistent with the tenets of PCC. Unhelpful program aspects were reported less often. Findings suggest that despite challenges for communicating effectively in an online forum, the personalized support, high-tech data management capabilities, and easily followed evidence-based curricula afforded by HIT may be a means of providing PCC and improving healthcare delivery and quality. PMID:24004039

  5. Validity Assessment of Referral Decisions at a VA Health Care System Polytrauma System of Care.

    Science.gov (United States)

    Chung, Joyce; Aguila, Fatima; Harris, Odette

    2015-01-01

    There has been intensive interest to ensure equitable and appropriate access to the specialized rehabilitative services of the VA Polytrauma System of Care (PSC) for patients sustaining polytrauma and traumatic brain injuries (TBI). A retrospective cohort study with prospective data acquisition was conducted to assess validity and objectivity of the acceptance decision algorithm to the VA Palo Alto Health Care System (VAPAHCS) PSC. Our hypotheses are (1) VAPAHCS PSC referral decisions were appropriate and without bias and (2) the identified needs of redirected referrals were addressed. This analysis included 1,025 referrals (906 patients); 813 patients (89.7%) were accepted, and 93 (10.3%) were redirected. Redirected cases were older, were more often active duty service members, and were not from the West Coast. There were more females redirected due to concomitant spinal cord injury. These are rationale differences. In redirected patients, the most commonly identified rehabilitation needs were psychological support, mobility/physical therapy, and communication/speech services; >75% of patients had these services offered elsewhere outside of the PSC resources. While balancing financial stewardship and meeting our mission to provide outstanding rehabilitative care to veterans and service members, we demonstrated that acceptance decisions were valid and without bias, and redirected patients received appropriate alternate resources. PMID:26180664

  6. The Global Mental Health Assessment Tool - Primary Care Version (GMHAT/PC). Development, reliability and validity

    OpenAIRE

    Sharma, Vimal K; Lepping, Peter; Cummins, Anthony GP; Copeland, John RM; Parhee, Rashmi; Mottram, Patricia

    2004-01-01

    The Global Mental Health Assessment Tool – Primary Care Version (GMHAT/PC) is a computerised clinical assessment tool developed to assess and identify a wide range of mental health problems in primary care. It generates a computer diagnosis, a symptom rating, a self-harm risk assessment, and a referral letter. Patients from primary care and community psychiatric outpatient clinics and a small sample of inpatients were interviewed for a period of two months using the GMHAT/PC...

  7. 75 FR 59720 - Methodology Committee of the Patient-Centered Outcomes Research Institute (PCORI)

    Science.gov (United States)

    2010-09-28

    ... OFFICE Methodology Committee of the Patient-Centered Outcomes Research Institute (PCORI) AGENCY... appointing not more than 15 members to a Methodology Committee of the Patient- Centered Outcomes Research Institute. In addition, the Directors of the Agency for Healthcare Research and Quality and the...

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

    Directory of Open Access Journals (Sweden)

    Milutinović Dragana

    2009-01-01

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

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

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

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

  10. Primary Care Fall Risk Assessment for Elderly West Virginians.

    Science.gov (United States)

    Minkemeyer, Vivian M; Meriweather, Matt; Shuler, Franklin D; Mehta, Saurabh P; Qazi, Zain N

    2015-01-01

    West Virginia is ranked second nationally for the percent of its population 65 years of age. The elderly are especially susceptible to falls with fall risk increasing as age increases. Because falls are the number one cause of injury-related morbidity and mortality in the West Virginia elderly, evaluation of fall risk is a critical component of the patient evaluation in the primary care setting. We therefore highlight fall risk assessments that require no specialized equipment or training and can easily be completed at an established office visit. High quality clinical practice guidelines supported by the American Geriatric Society recommend yearly fall risk evaluation in the elderly. Those seniors at greatest risk of falls will benefit from the standardized therapy protocols outlined and referral to a balance treatment center. Patients with low-to-moderate fall risk attributed to muscle weakness or fatigue should be prescribed lower extremity strengthening exercises, such as kitchen counter exercises, to improve strength and balance. PMID:26665892

  11. A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP

    Directory of Open Access Journals (Sweden)

    Francis Rebecca

    2010-01-01

    Full Text Available Abstract Background Cardiac rehabilitation programs offer effective means to prevent recurrence of a cardiac event, but poor uptake of current programs have been reported globally. Home based models are considered as a feasible alternative to avoid various barriers related to care centre based programs. This paper sets out the study design for a clinical trial seeking to test the hypothesis that these programs can be better and more efficiently supported with novel Information and Communication Technologies (ICT. Methods/Design We have integrated mobile phones and web services into a comprehensive home- based care model for outpatient cardiac rehabilitation. Mobile phones with a built-in accelerometer sensor are used to measure physical exercise and WellnessDiary software is used to collect information on patients' physiological risk factors and other health information. Video and teleconferencing are used for mentoring sessions aiming at behavioural modifications through goal setting. The mentors use web-portal to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content are stored or transferred via messaging systems to the patients phone to be viewed on demand. We have designed a randomised controlled trial to compare the health outcomes and cost efficiency of the proposed model with a traditional community based rehabilitation program. The main outcome measure is adherence to physical exercise guidelines. Discussion The study will provide evidence on using mobile phones and web services for mentoring and self management in a home-based care model targeting sustainable behavioural modifications in cardiac rehabilitation patients. Trial registration The trial has been registered in the Australian New Zealand Clinical Trials Registry (ANZCTR with number ACTRN12609000251224.

  12. Physical Therapy Observation and Assessment in the Neonatal Intensive Care Unit

    Science.gov (United States)

    Byrne, Eilish; Campbell, Suzann K.

    2013-01-01

    This article presents the elements of the Observation and Assessment section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy assessments presented in this path are evidence-based and the suggested timing of these assessments is primarily based on practice knowledge from expert…

  13. Assessment of Environmental Sustainability in Health Care Organizations

    Directory of Open Access Journals (Sweden)

    María Carmen Carnero

    2015-06-01

    Full Text Available Healthcare organizations should set a standard in corporate social responsibility and encourage environmental sustainability, since protection of the environment implies the development of preventive measures in healthcare. Environmental concern has traditionally focused on manufacturing plants. However, a Health Care Organization (HCO is the only type of company which generates all existing classes of waste, and 20% is dangerous, being infectious, toxic or radioactive in nature. Despite the extensive literature analysing environmental matters, there is no objective model for assessing the environmental sustainability of HCOs in such a way that the results may be compared over time for an organization, and between different organizations, to give a comparison or benchmarking tool for HCOs. This paper presents a Multi-Criteria Decision Analysis model integrating a Fuzzy Analytic Hierarchy Process and utility theory, to evaluate environmental sustainability in HCOs. The model uses criteria assessed as a function of the number of annual treatments undertaken. The model has been tested in two HCOs of very different sizes.

  14. Training Residents to Work in a Patient-Centered Medical Home: What Are the Outcomes?

    Science.gov (United States)

    Hasley, Peggy B; Simak, Deborah; Cohen, Elan; Buranosky, Raquel

    2016-05-01

    Background The patient-centered medical home (PCMH) provides a setting to enhance resident training in systems-based practice. Few studies have addressed the impact of PCMHs on resident knowledge and confidence. Objective The goal of this study was to evaluate resident knowledge, confidence, behavior, and patient outcomes in a PCMH. Methods Our curriculum emphasized patient panel report card interpretation, a telephone medicine curriculum, and interdisciplinary team-based care of chronic medical conditions. We measured resident satisfaction, knowledge, and confidence. Patient outcomes included hemoglobin A1c (HbA1c) and blood pressures. Prescores and postscores were compared using paired t tests for continuous measures and McNemar's test for binary measures. Results A total of 154 residents were eligible for the curriculum. All residents participated in the curriculum, though not all residents completed the evaluation. Completion rates for paired pre-post knowledge and confidence surveys were 38% and 37%, respectively. Nearly 80% (69 of 87) of residents indicated that the curriculum was above average or outstanding. Our evaluation revealed very small immediate improvements in knowledge and confidence. No significant improvement in patients' HbA1cs or blood pressures occurred after the curriculum. Conclusions Explicit training to work in a PCMH was feasible and resulted in high levels of resident satisfaction and immediate small improvements in knowledge and confidence. PMID:27168892

  15. The impact of patient centered communication in managing Gardner′s syndrome

    Directory of Open Access Journals (Sweden)

    Gayathri Subramanian

    2015-01-01

    Full Text Available Effective patient communication and comprehension are fundamental toward empowering the patient to make optimal health decisions. Barriers in patient health literacy extend beyond cultural and language differences and can significantly impede this process. This case report illustrates a major communication gap that resulted in contradictory perceptions between a treating oncologist and a patient. The patient′s dentist was able to resolve this miscommunication and facilitate the patient′s acceptance of the recommended intravenous chemotherapy for management of malignant desmoid tumors occurring secondary to Gardner′s syndrome (GS. This report also documents classic craniofacial manifestations of GS including multiple unerupted supernumerary teeth, compound odontomas associated with a dentigerous cyst, as well as multiple osteomas in both arches and in the ethmoid and irregularly shaped radioopacities in both arches. In summary, effective patient-centered communication is a prerequisite for the optimal delivery of healthcare. Both interdisciplinary care and one-on-one patient-provider relationship center on coherent bidirectional communication.

  16. Barriers and Facilitators of Healthcare for People with Mental Illness: Why Integrated Patient Centered Healthcare Is Necessary.

    Science.gov (United States)

    Bellamy, Chyrell D; H Flanagan, Elizabeth; Costa, Mark; O'Connell-Bonarrigo, Maria; Tana Le, Thanh; Guy, Kimberly; Antunes, Kimberly; Steiner, Jeanne L

    2016-06-01

    Understanding barriers and facilitators of healthcare for people with mental illness is essential for healthcare and mental healthcare organizations moving towards patient centered care. This paper presents findings of a measure on barriers and facilitators of healthcare completed by 204 patients being served at a co-located wellness center (primary healthcare clinic) located in an urban mental health center. The top 10 results show important findings for planning healthcare services that are responsive to the needs of people with mental illness. Basic structural issues as a result of poverty are extremely important (transportation, housing, payment) as well as difficulty with public healthcare that often involves long wait-times for appointments and at the doctor's office and hours that might not be convenient. Healthcare services that want to meet the needs of people with mental illness need to address these issues. What facilitates healthcare is not just removing the barriers to receiving healthcare services but instead involves more interpersonal aspects of healthcare such as liking your provider, being able to talk with your provider, feeling your provider cares about you and listens to you. Structural supports such as also being in mental health services, having systems for remembering appointments, and/or having appointment times that are convenient also facilitate seeking healthcare. Facilitating healthcare seeking also seems to involve a sense of agency-looking forward to taking charge of your health and feeling capable of following healthcare provider instructions. Healthcare systems for people with mental illness need to support these facilitators to give care-seekers the support they need. Key points are provided on how organizations and staff can work more effectively in implementing patient centered care. PMID:27104370

  17. Comparison of two pain assessment tools in nonverbal critical care patients.

    Science.gov (United States)

    Paulson-Conger, Melissa; Leske, Jane; Maidl, Carolyn; Hanson, Andrew; Dziadulewicz, Laurel

    2011-12-01

    It is recommended that patient's self-report of pain should be obtained as often as possible as the "gold standard." Unfortunately in critical care, many factors can alter verbal communication with patients, making pain assessment more difficult. Scientific advances in understanding pain mechanisms, multidimensional methods of pain assessment, and analgesic pharmacology have improved pain management strategies. However, pain assessment for nonverbal patients in critical care continues to present a challenge for clinicians and researchers. The purpose of this study was to compare the Pain Assessment in Advanced Dementia (PAINAD) and the Critical-Care Pain Observation Tool (CPOT) scores for assessment in nonverbal critical care patients. A descriptive, comparative, prospective design was used in this study. A convenience sample of 100 critical care, nonverbal, adult patients of varying medical diagnoses who required pain evaluation were assessed with the PAINAD and CPOT scales. Data were collected over a 6-month period in all critical care areas. Observations of pain assessments for nonverbal patients who required pain evaluation were recorded on the PAINAD and the CPOT successively. Internal consistency reliability for the PAINAD was 0.80 and for the CPOT 0.72. Limits of agreement indicated that there was no difference in PAINAD and CPOT scores for assessing pain in nonverbal patients in critical care. Further research in the area of pain assessment for nonverbal patients in critical care is needed. PMID:22117753

  18. Evaluating complementary and alternative medicine interventions: in search of appropriate patient-centered outcome measures

    Directory of Open Access Journals (Sweden)

    Mallory Devon

    2006-11-01

    Full Text Available Abstract Background Central to the development of a sound evidence base for Complementary and Alternative Medicine (CAM interventions is the need for valid, reliable and relevant outcome measures to assess whether the interventions work. We assessed the specific needs for a database that would cover a wide range of outcomes measures for CAM research and considered a framework for such a database. Methods The study was a survey of CAM researchers, practitioners and students. An online questionnaire was emailed to the members of the Canadian Interdisciplinary Network for CAM Research (IN-CAM and the CAM Education and Research Network of Alberta (CAMera. The majority of survey questions were open-ended and asked about outcome measures currently used, outcome measures' assessment criteria, sources of information, perceived barriers to finding outcome measures and outcome domains of importance. Descriptive quantitative analysis and qualitative content analysis were used. Results One hundred and sixty-four completed surveys were received. Of these, 62 respondents reported using outcome measures in their CAM research and identified 92 different specific outcomes. The most important barriers were the fact that, for many health concepts, outcome measures do not yet exist, as well as issues related to accessibility of instruments. Important outcome domains identified included physical, psychological, social, spiritual, quality of life and holistic measures. Participants also mentioned the importance of individualized measures that assess unique patient-centered outcomes for each research participant, and measures to assess the context of healing and the process of healing. Conclusion We have developed a preliminary framework that includes all components of health-related outcomes. The framework provides a foundation for a larger, comprehensive collection of CAM outcomes. It fits very well in a whole systems perspective, which requires an expanded set of

  19. Assessment of a pharmacist-driven point-of-care spirometry clinic within a primary care physicians office

    OpenAIRE

    Cawley MJ; Pacitti R; Warning W

    2011-01-01

    Objective: To assess value-added service of a pharmacist-driven point-of-care spirometry clinic to quantify respiratory disease abnormalities within a primary care physicians officeMethods: This retrospective, cohort study was an analysis of physician referred patients who attended our spirometry clinic during 2008-2010 due to pulmonary symptoms or disease. After spirometry testing, data was collected retrospectively to include patient demographics, spirometry results, and pulmonary pharmaceu...

  20. Developmentally supportive neonatal care : A study of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) in a Swedish environment

    OpenAIRE

    Westrup, Björn

    2003-01-01

    A family-centred, developmentally supportive approach to newborn intensive care, referred to as the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has attracted considerable interest in recent years. Studies performed in North America have reported that NIDCAP improves short-term growth, decreases the need for respiratory support, decreases the length and cost of hospitalisation, and improves neurodevelopment. The aim of the present study was to ch...

  1. Development of a trauma care assessment instrument for emergency nurses in West Africa

    OpenAIRE

    Sue Anne Bell, MSN FNP-BC; Victoria Bam, RN PhD; Sarah Rominski, MPH; Nee-Kofi Mould-Millman, MD; Petra Brysiewicz, PhD RN

    2014-01-01

    Background: Strengthening the provision of emergency health services, including the nursing workforce, is progress towards decreasing the burden of injury in sub-Saharan Africa. The WHO Essential Trauma Care Guidelines provide minimum knowledge and skills to ensure quality in-hospital trauma care. Our aim was to develop an emergency nursing trauma care knowledge, attitudes, and skills minimum competency assessment instrument with WHO guidelines for African emergency care settings. Methods:...

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

    OpenAIRE

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

    2014-01-01

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

  3. Training needs assessment of health care professionals in a developing country: the example of Saint Lucia

    OpenAIRE

    Gaspard, Janice; Yang, Che-Ming

    2016-01-01

    Background Continuing education (CE) is crucial for quality improvement in health care. The needs assessment of CE helps ensure effectiveness. However, such an assessment necessitates certain techniques that are unfamiliar to health care communities in developing countries. This study identifies the needs of providing CE to health care personnel in Saint Lucia. Methods This study was designed as a questionnaire survey to investigate the demographics, training needs, and preferred approaches t...

  4. Assessment of patient satisfaction with acute pain management service: Monitoring quality of care in clinical setting

    OpenAIRE

    Farooq, Fizzah; Khan, Robyna; Ahmed, Aliya

    2016-01-01

    Background and Aims: Assessment of patient satisfaction is an important tool for monitoring the quality of care in hospitals. The aim of this survey was to develop a reliable tool to assess patient satisfaction with acute pain management service (APMS) and identify variables affecting this so that care can be improved. Methods: A questionnaire was developed and administered to patients after being discharged from APMS care by an unbiased person. Data collected from record included patient dem...

  5. Assessment of patient satisfaction with acute pain management service: Monitoring quality of care in clinical setting

    OpenAIRE

    Fizzah Farooq; Robyna Khan; Aliya Ahmed

    2016-01-01

    Background and Aims: Assessment of patient satisfaction is an important tool for monitoring the quality of care in hospitals. The aim of this survey was to develop a reliable tool to assess patient satisfaction with acute pain management service (APMS) and identify variables affecting this so that care can be improved. Methods: A questionnaire was developed and administered to  patients after being discharged from APMS care by an unbiased person. Data collected from record included patient de...

  6. An assessment of antenatal care among Syrian refugees in Lebanon

    OpenAIRE

    Benage, Matthew; Greenough, P Gregg; Vinck, Patrick; Omeira, Nada; Pham, Phuong

    2015-01-01

    Background After more than three years of violence in Syria, Lebanon hosts over one million Syrian refugees creating significant public health concerns. Antenatal care delivery to tens of thousands of pregnant Syrian refugee women is critical to preventing maternal and fetal mortality but is not well characterized given the multiple factors obtaining health data in a displaced population. This study describes antenatal care access, the scope of existing antenatal care, and antenatal and famil...

  7. An assessment of antenatal care among Syrian refugees in Lebanon

    OpenAIRE

    Benage, Matthew; Greenough, P Gregg; Vinck, Patrick; Omeira, Nada; Pham, Phuong

    2015-01-01

    Background: After more than three years of violence in Syria, Lebanon hosts over one million Syrian refugees creating significant public health concerns. Antenatal care delivery to tens of thousands of pregnant Syrian refugee women is critical to preventing maternal and fetal mortality but is not well characterized given the multiple factors obtaining health data in a displaced population. This study describes antenatal care access, the scope of existing antenatal care, and antenatal and fami...

  8. Patient and Other Stakeholder Engagement in Patient-Centered Outcomes Research Institute Funded Studies of Patients with Kidney Diseases.

    Science.gov (United States)

    Cukor, Daniel; Cohen, Lewis M; Cope, Elizabeth L; Ghahramani, Nasrollah; Hedayati, S Susan; Hynes, Denise M; Shah, Vallabh O; Tentori, Francesca; Unruh, Mark; Bobelu, Jeanette; Cohen, Scott; Dember, Laura M; Faber, Thomas; Fischer, Michael J; Gallardo, Rani; Germain, Michael J; Ghahate, Donica; Grote, Nancy; Hartwell, Lori; Heagerty, Patrick; Kimmel, Paul L; Kutner, Nancy; Lawson, Susan; Marr, Lisa; Nelson, Robert G; Porter, Anna C; Sandy, Phillip; Struminger, Bruce B; Subramanian, Lalita; Weisbord, Steve; Young, Bessie; Mehrotra, Rajnish

    2016-09-01

    Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is "Patient Centered-Research", in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications. As of March 2015, PCORI funded seven clinically-focused studies of patients with kidney disease. The goal of this paper is to synthesize the experiences of these studies to gain an understanding of how meaningful patient and stakeholder engagement can occur in clinical research of kidney diseases, and what the key barriers are to its implementation. Our collective experience suggests that successful implementation of a patient- and stakeholder-engaged research paradigm involves: (1) defining the roles and process for the incorporation of input; (2) identifying the particular patients and other stakeholders; (3) engaging patients and other stakeholders so they appreciate the value of their own participation and have personal investment in the research process; and (4) overcoming barriers and challenges that arise and threaten the productivity of the collaboration. It is our hope that the experiences of these studies will further interest and capacity for incorporating patient and stakeholder perspectives in research of kidney diseases. PMID:27197911

  9. Current Issues in Assessment in Early Childhood Care and Education in Japan

    Science.gov (United States)

    Kitano, Sachiko

    2011-01-01

    This paper introduces the characteristics of early childhood care and education (ECCE) assessment and identifies current challenges and changes in the assessment of ECCE in Japan. There are differences in assessment between ECCE and elementary school education. Assessment in ECCE is used to focus on making better plans, improving the understanding…

  10. Needs Assessment for Health Care Management Education in Russia

    Science.gov (United States)

    Rekhter, Natalia; Togunov, Igor A.

    2006-01-01

    Introduction: For more than 70 years, health care management in the Soviet Union reflected a centralized directive style familiar to the Soviet political system. Market-oriented reform in post-Soviet Russia is pushing practicing physicians and physician-executives to acquire new information and skills regarding health care management. To assist…

  11. Telemedicine: The Assessment of an Evolving Health Care Technology.

    Science.gov (United States)

    Reich, Joel J.

    Telemedicine, the use of bidirectional telecommunications systems for the delivery of health care at a distance, could create a more equitable distribution of medical care. Many medical tasks can be performed at a distance although some require the presence of a physician's assistant. Cost-benefit analysis of this service is difficult and requires…

  12. Assessment of Anxiety in Older Home Care Recipients

    Science.gov (United States)

    Diefenbach, Gretchen J.; Tolin, David F.; Meunier, Suzanne A.; Gilliam, Christina M.

    2009-01-01

    Purpose: This study determined the psychometric properties of a variety of anxiety measures administered to older adults receiving home care services. Design and Methods: Data were collected from 66 adults aged 65 years and older who were receiving home care services. Participants completed self-report and clinician-rated measures of anxiety and…

  13. Assessing Health Literacy in Diverse Primary Care Settings

    Science.gov (United States)

    McCune, Renee L.

    2010-01-01

    Patient health literacy skills are critical to effective healthcare communication and safe care delivery in primary care settings. Methods and strategies to identify patient health literacy (HL) capabilities and provider/staff knowledge, attitudes and beliefs (KAB) regarding HL must be known before addressing provider/staff communication skills.…

  14. The Dutch health care performance report: seven years of health care performance assessment in the Netherlands

    OpenAIRE

    van den Berg, Michael J.; Kringos, Dionne S; Marks, Lisanne K; Klazinga, Niek S

    2014-01-01

    In 2006, the first edition of a monitoring tool for the performance of the Dutch health care system was released: the Dutch Health Care Performance Report (DHCPR). The Netherlands was among the first countries in the world developing such a comprehensive tool for reporting performance on quality, access, and affordability of health care. The tool contains 125 performance indicators; the choice for specific indicators resulted from a dialogue between researchers and policy makers. In the ‘poli...

  15. The Homeless Child Health Care Inventory: assessing the efficacy of linkages to primary care.

    OpenAIRE

    Redlener, I.; Karich, K. M.

    1994-01-01

    Each year, the New York City homeless family shelter system provides transitional housing for nearly 20,000 homeless children. While the health care needs of these children are substantial, there is currently no system-wide mechanism for ensuring that they have access to appropriate medical care. This report analyzes information from the Homeless Child Health Care Inventory, a survey conducted by Montefiore Medical Center's Division of Community Pediatrics, to examine the adequacy of health c...

  16. Bridging the Gap: The Role of the Patient-Centered Medical Home in Reducing Time to Follow-Up After Hospital Discharge.

    Science.gov (United States)

    Hearld, Larry R; Hearld, Kristine R; Budhwani, Henna

    2016-01-01

    Poor transitions in care represent opportunities for improvement. The purpose of this study was to examine whether early follow-up by patients discharged from a hospital varied as a function of patient-centered medical home (PCMH) capacity. The PCMH capacity was not significantly associated with early follow-up; however, higher levels of capacity were associated with early follow-up among patients with more chronic conditions. Policy makers and practitioners should consider how the PCMH may be targeted to maximize its potential to improve transitions in care for these patients and ways it may be modified to improve transitions for other types of patients. PMID:27232682

  17. Psychiatric Issues in Palliative Care: Assessing Mental Capacity

    OpenAIRE

    Itoro Udo; Zeid Mohammed; Amanda Gash

    2013-01-01

    Issues surrounding capacity to consent to or refuse treatment are increasingly receiving clinical and legal attention. Through the use of 3 case vignettes that involve different aspects of mental health care in palliative care settings, mental capacity issues are discussed. The vignettes tackle capacity in a patient with newly developed mental illness consequent to physical illness, capacity in a patient with mental illness but without delirium and capacity in a patient with known impairment ...

  18. Patient-Centered Cancer Care Programs in Italy: Benchmarking Global Patient Education Initiatives

    OpenAIRE

    Truccolo, Ivana; Cipolat Mis, Chiara; Cervo, Silvia; Dal Maso, Luigino; Bongiovanni, Marilena; Bearz, Alessandra; Sartor, Ivana; Baldo, Paolo; Ferrarin, Emanuela; Fratino, Lucia; Mascarin, Maurizio; Roncadin, Mario; Annunziata, Maria Antonietta; Muzzatti, Barbara; De Paoli, Paolo

    2015-01-01

    In Italy, educational programs for cancer patients are currently provided by the national government, scientific societies, and patient advocate organizations. Several gaps limit their effectiveness, including the lack of coordinated efforts, poor involvement of patient feedback in the planning of programs, as well as a lack of resources on innovative cancer-related topics. This process is parallel to a strong shift in the attitude of patients towards health in general and taking charge of th...

  19. Sharing clinical information across care settings: the birth of an integrated assessment system

    Directory of Open Access Journals (Sweden)

    Henrard Jean-Claude

    2009-04-01

    Full Text Available Abstract Background Population ageing, the emergence of chronic illness, and the shift away from institutional care challenge conventional approaches to assessment systems which traditionally are problem and setting specific. Methods From 2002, the interRAI research collaborative undertook development of a suite of assessment tools to support assessment and care planning of persons with chronic illness, frailty, disability, or mental health problems across care settings. The suite constitutes an early example of a "third generation" assessment system. Results The rationale and development strategy for the suite is described, together with a description of potential applications. To date, ten instruments comprise the suite, each comprising "core" items shared among the majority of instruments and "optional" items that are specific to particular care settings or situations. Conclusion This comprehensive suite offers the opportunity for integrated multi-domain assessment, enabling electronic clinical records, data transfer, ease of interpretation and streamlined training.

  20. Health needs assessment in primary care: the evolution of a practical public health approach.

    Science.gov (United States)

    Kilduff, A; McKeown, K; Crowther, A

    1998-05-01

    The purpose of the paper is to place health needs assessment in its primary care context. This is a dynamic context where changes in policies, staff roles and patient expectations have all to be considered. Given this complexity and the variations between practices, it is necessary to help primary health care teams (PHCTs) to understand their stage of development and how this will directly affect any health needs assessment. The technical and methodological aspects of health needs assessment have been explored and described by others, and that work will not be duplicated here. This paper reviews the health needs assessment (HNA) work of the Ribblesdale Total Purchasing Project (RTPP) and then sets this review against the political, organisational, professional and practical pressures that currently confront primary care. Out of this analysis emerges a diagnostic and development tool which links together, and emphasises the intimate relationships between, five stages of development needed for effective primary care-oriented health needs assessment work. The emphasis is on understanding the place of health needs assessment within the general processes and systems of the primary health care team. The paper concludes by suggesting ways in which public health practitioners and specialists might approach the task of supporting and influencing the evolution of the recently proposed Primary Care Groups and Primary Care Trusts. The overall intention of the article is to stimulate debate and action. PMID:9629025

  1. Assessing the skills of home care workers in helping older people take their prescribed medications.

    Science.gov (United States)

    Smyth, Elizabeth E J

    2015-08-01

    The Southern Health and Social Care Trust in Northern Ireland applied a modified version of the Objective Structured Clinical Examination (OSCE) to assess the skills of home care workers in assisting older people taking prescribed medications. In Northern Ireland, home care workers are care workers employed by health and social care trusts or private agencies. The application of the model has developed the skills of this staff group, improved the relationship between the commissioner and provider, significantly reduced the time spent by community nurses in individual training and assessment, and enhanced the patient experience for those taking medication. Overall, the application of this model has provided assurances to the Trust board, the executive director of nursing, and operational directors that home care workers are competent in assisting older people in this high-risk activity. PMID:26252238

  2. A tool for assessing continuity of care across care levels: an extended psychometric validation of the CCAENA questionnaire

    Directory of Open Access Journals (Sweden)

    Marta Beatriz Aller

    2013-12-01

    Full Text Available Background: The CCAENA questionnaire was developed to assess care continuity across levels from the patients’ perspective. The aim is to provide additional evidence on the psychometric properties of the scales of this questionnaire. Methods: Cross-sectional study by means of a survey of a random sample of 1500 patients attended in primary and secondary care in three healthcare areas of the Catalan healthcare system. Data were collected in 2010 using the CCAENA questionnaire. To assess psychometric properties, an exploratory factor analysis was performed (construct validity and the item-rest correlations and Cronbach’s alpha were calculated (internal consistency. Spearman correlation coefficients were calculated (multidimensionality and the ability to discriminate between groups was tested. Results: The factor analysis resulted in 21 items grouped into three factors: patient-primary care provider relationship, patient-secondary care provider relationship and continuity across care levels. Cronbach’s alpha indicated good internal consistency (0.97, 0.93, 0.80 and the correlation coefficients indicated that dimensions can be interpreted as separated scales. Scales discriminated patients according to healthcare area, age and educational level. Conclusion: The CCAENA questionnaire has proved to be a valid and reliable tool for measuring patients’ perceptions of continuity. Providers and researchers could apply the questionnaire to identify areas for healthcare improvement. 

  3. Pinellas Plant: Child Care/Partnership School safety assessment

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1989-11-01

    The Albuquerque Operations Office through the Pinellas Plant Area Office is involved in a joint venture to establish a Partnership School and a Day Care Facility at the Plant. The venture is unique in that it is based on a partnership with the local county school system. The county school system will provide the teachers, supplies and classroom furnishings for the operation of the school for pre-kindergarten, kindergarten, first and second grade during regular school hours. The Government will provide the facility and its normal operating and maintenance costs. A Day Care Facility will also be available for children from infancy through the second grade for outside school hours. The day care will be operated as a non-profit corporation. Fees paid by parents with children in the day care center will cove the cost of staff, food, supplies and liability insurance. Again, the government will provide the facility and its normal operating and maintenance costs. Between 75 and 90 children are expected in the first year of operation. The Partnership School will consist of one class each for pre-kindergarten, kindergarten and first grade. Second grade will be added in 1990. The total estimated number of children for both the Child Care and Partnership School should not exceed 200 children. Expected benefits include reduced absenteeism, tardiness and turnover and thus increased productivity. The program will be an asset in recruiting and retaining the best workforce. Other benefits include improved education for the children.

  4. Validation of the Danish version of the Patient Assessment of Care for Chronic Conditions questionnaire (PACIC)

    DEFF Research Database (Denmark)

    Sokolowski, Ineta; Maindal, Helle Terkildsen; Vedsted, Peter

    Objective: To evaluate the level of chronic care patients must be involved. The Danish version of the 20-item Patient Assessment of Care for Chronic Conditions PACIC questionnaire consisting of 5 scales and an overall summary score measuring patient reported assessment of structured chronic care...... has not been evaluated with regard to psychometric properties. This study aims to assess data quality and internal consistency and to validate the proposed factorial structure. Materials and methods: Setting: Diabetes population receiving chronic care in Denmark. Subjects: A total of 624 patients aged...... same questionnaire is constructed and applied to different countries with diverse cultural backgrounds and health care systems. It is decisive, that translated questionnaires are validated in country they are used....

  5. Hemodynamic Assessment and Monitoring in the Intensive Care Unit: an Overview

    OpenAIRE

    Adler, Adam C.; Ramakant Sharma; Thomas Higgins; McGee, William T

    2014-01-01

    The goal of hemodynamic monitoring in intensive care is to assess the adequacy of perfusion, specifically with regard to maintaining sufficient perfusion pressures and oxygen delivery. Precise volume management of peri-operative and critical care patients is crucial as under or over resuscitation is associated with adverse outcomes. Hemodynamic monitoring allows care to be individualized based on specific patient response to therapy and can provide early warning of impending perfusion deficit...

  6. Assessment of distress with physical and psychological symptoms of patients in german palliative care services.

    OpenAIRE

    Neuwöhner, Karl; Lindena, Gabriele

    2011-01-01

    BACKGROUND: Within the framework of the nationwide Hospice and Palliative Care Evaluation (HOPE), the German Basic Documentation for Psycho-oncology (PO-Bado) was used from 2004 to 2006 as an optional module in most participating palliative care services to investigate how patient distress due to symptom burdens in different palliative care settings should be assessed and how professional interventions could be derived. PATIENTS AND METHODS: The distress scores of 3,317 PO-Bado records o...

  7. Assessment of patient safety culture in primary care setting, Al-Mukala, Yemen

    OpenAIRE

    Webair, Hana H; Al-assani, Salwa S.; Al-haddad, Reema H.; Al-Shaeeb, Wafa H.; Bin Selm, Manal A.; Alyamani, Abdulla S.

    2015-01-01

    Background Patient safety culture in primary care is the first step to achieve high quality health care. This study aims to provide a baseline assessment of patient safety culture in primary care settings in Al-Mukala, Yemen as a first published study from a least developed country. Methods A survey was conducted in primary healthcare centres and units in Al-Mukala District, Yemen. A comprehensive sample from the available 16 centres was included. An Arabic version of the Medical Office Surve...

  8. The validity and reliability of an instrument to assess nursing competencies in spiritual care

    NARCIS (Netherlands)

    van Leeuwen, Rene; Tiesinga, Lucas J.; Middel, Berrie; Post, Doeke; Jochemsen, Henk

    2009-01-01

    Aim. This study contributes to the development of a valid and reliable instrument, the spiritual care competence scale, as an instrument to assess nurses' competencies in providing spiritual care. Background. Measuring these competencies and their development is important and the construction of a r

  9. The validity and reliability of an instrument to assess nursing competencies in spiritual care

    NARCIS (Netherlands)

    Leeuwen, R.R.; Tiesinga, L.J.; Middel, L.J.; Post, D.; Jochemsen, H.

    2009-01-01

    Aim. This study contributes to the development of a valid and reliable instrument, the spiritual care competence scale, as an instrument to assess nurses’ competencies in providing spiritual care. Background. Measuring these competencies and their development is important and the construction of a r

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

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

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

  11. Patient-centered Bedside Education and Traditional Jewish Law and Ethics

    Directory of Open Access Journals (Sweden)

    Yigal Shafran

    2012-01-01

    Full Text Available Background Bedside rounds have long been a time-honored component of medical education. Recently, there have been various recommendations that residency-training programs further incorporate bedside teaching into clinical curricula. Objectives To compare these current attitudes regarding bedside education with the position of traditional Jewish law and ethics. Methods Relevant medical journal articles and traditional Jewish sources were reviewed. Results Halacha (the corpus of traditional Jewish law and ethics gives greater focus to a patient-centered rather than student-centered bedside education experience. Conclusion Residency training programs should give greater consideration to the importance of a patient-centered bedside education experience.

  12. Assessment of Systems for Paying Health Care Providers in Mongolia

    OpenAIRE

    Joint Learning Network; Mongolia Ministry of Health; World Bank; World Health Organization,

    2015-01-01

    Achieving access to basic health services for the entire population without risk of financial hardship or impoverishment from out-of-pocket expenditures (‘universal health coverage’ or UHC) is a challenge that continues to confront most low- and middle-income countries. As coverage expands in these countries, issues of financial sustainability, efficiency, and quality of care quickly rise ...

  13. Proposals for enhanced health risk assessment and stratification in an integrated care scenario

    OpenAIRE

    Dueñas-Espín, Ivan; Vela, Emili; Pauws, Steffen; Bescos, Cristina; Cano, Isaac; Cleries, Montserrat; Contel, Joan Carles; de Manuel Keenoy, Esteban; Garcia-Aymerich, Judith; Gomez-Cabrero, David; Kaye, Rachelle; Lahr, Maarten M H; Lluch-Ariet, Magí; Moharra, Montserrat; Monterde, David

    2016-01-01

    Objectives Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies and health indicators used in the five regions participating in the Advancing Care Coordination and Telehealth Deployment (ACT) programme (http://www.act-programme.eu). The second purpose was to ela...

  14. Assessment of linkages from HIV testing to enrolment and retention in HIV care in Central Mozambique

    OpenAIRE

    Celso Azarias Inguane; Stephen Gloyd; João Luis Manuel; Charlene Brown; Vincent Wong; Orvalho Augusto; Wisal Mustafa Hassan; Lúcia Vieira; Pires Afonso; Mehol Jamnadás; Jama Joy Bernard; James Cowan; Samuel Kalibala; James Pfeiffer

    2016-01-01

    Introduction: Effectiveness of the rapid expansion of antiretroviral therapy (ART) throughout sub-Saharan Africa is highly dependent on adequate enrolment and retention in HIV care. However, the measurement of both has been challenging in these settings. This study aimed to assess enrolment and retention in HIV care (pre-ART and ART) among HIV-positive adults in Central Mozambique, including identification of barriers and facilitators. Methods: We assessed linkages to and retention in HIV car...

  15. Undergoing Transformation to the Patient Centered Medical Home in Safety Net Health Centers: Perspectives from the Front Lines

    Science.gov (United States)

    Quinn, Michael T.; Gunter, Kathryn E.; Nocon, Robert S.; Lewis, Sarah E.; Vable, Anusha M.; Tang, Hui; Park, Seo-Young; Casalino, Lawrence P.; Huang, Elbert S.; Birnberg, Jonathan; Burnet, Deborah L.; Summerfelt, W. Thomas; Chin, Marshall H.

    2013-01-01

    Objectives Safety Net Health Centers (SNHCs), which include Federally Qualified Health Centers (FQHCs) provide primary care for underserved, minority and low income patients. SNHCs across the country are in the process of adopting the Patient Centered Medical Home (PCMH) model, based on promising early implementation data from demonstration projects. However, previous demonstration projects have not focused on the safety net and we know little about PCMH transformation in SNHCs. Design This qualitative study characterizes early PCMH adoption experiences at SNHCs. Setting and Participants We interviewed 98 staff,(administrators, providers, and clinical staff) at 20 of 65 SNHCs, from five states, who were participating in the first of a five-year PCMH collaborative, the Safety Net Medical Home Initiative. Main Measures We conducted 30-45 minute, semi-structured telephone interviews. Interview questions addressed benefits anticipated, obstacles encountered, and lessons learned in transition to PCMH. Results Anticipated benefits for participating in the PCMH included improved staff satisfaction and patient care and outcomes. Obstacles included staff resistance and lack of financial support for PCMH functions. Lessons learned included involving a range of staff, anticipating resistance, and using data as frequent feedback. Conclusions SNHCs encounter unique challenges to PCMH implementation, including staff turnover and providing care for patients with complex needs. Staff resistance and turnover may be ameliorated through improved healthcare delivery strategies associated with the PCMH. Creating predictable and continuous funding streams may be more fundamental challenges to PCMH transformation. PMID:23914423

  16. Cancer Risk Assessment for the Primary Care Physician

    OpenAIRE

    Korde, Larissa A; Gadalla, Shahinaz M.

    2009-01-01

    Cancer is the second leading cause of death in the United States. Cancer risk assessment can be divided into two major categories: assessment of familial or genetic risk and assessment of environmental factors that may be causally related to cancer. Identification of individuals with a suspected heritable cancer syndrome can lead to additional evaluation and to interventions that can substantially decrease cancer risk. Special attention should also be paid to potentially modifiable cancer ris...

  17. Symptom severity of patients with advanced cancer in palliative care unit: longitudinal assessments of symptoms improvement

    OpenAIRE

    Tai, Shu-Yu; Lee, Chung-Yin; Wu, Chien-Yi; Hsieh, Hui-ya; Huang, Joh-Jong; Huang, Chia-Tsuan; Chien, Chen-Yu

    2016-01-01

    Background This study assessed the symptom severity of patients with advanced cancer in a palliative care unit and explored the factors associated with symptom improvement. Methods This study was conducted in a palliative care unit in Taiwan between October 2004 and December 2009. Symptom intensity was measured by the “Symptom Reporting Form”, and graded on a scale of 0 to 4 (0 = none, and 4 = extreme). These measures were assessed on the 1st, 3rd, 5th, and 7th Day in the palliative care unit...

  18. CLINICAL PSYCHOLOGICAL ASSESSMENT IN LITHUANIAN HEALTH CARE INSTITUTIONS: OPINION ANALYSIS OF PROFESSIONALS

    OpenAIRE

    Augustinas Rotomskis

    2015-01-01

    Purpose – to investigate the state of clinical psychological assessment in the Lithuanian health care system: 1) what kind of tests are used in clinical practice and what are clinicians opinions about them; 2) what kind of psychological functions are assessed in clinical practice and what is the opinion of clinicians about the assessment of these psychological functions; 3) what kind of issues are the most pressing in clinical assessment. Design/methodology/approach – 101 clinical psychol...

  19. The Development and Evaluation of Delirium Assessment and Nursing Care Decision-Making Assistant Mobile Application for Intensive Care Unit.

    Science.gov (United States)

    Yang, Fangyu; Ji, Meihua; Ding, Shu; Wu, Ying; Chang, Polun; Lin, Chiawei; Yang, Xin

    2016-01-01

    Delirium is a common complication among patients in ICU settings. Although it has been repeatedly confirmed that Confusion Assessment Model for Intensive Care Unit (CAM-ICU), one of the most commonly used ICU delirium assessment tool, is highly accurate in validation studies, it's sensitivity and specificity is relatively low during routine practice among bedside nurses. The aim of this study is to develop a mobile application (app) to detect delirium and to test its reliability and validity both by research nurses and among ICU bedside nurses. The app was programmed with Java and installed on a mobile device with Android system. After completion of reliability and validity testing, the app will be integrated into the existing Hospital Information System in order to automatically retrieve essential information for risk factor identification and formulation of care plan accordingly to prevent or manage ICU delirium. PMID:27332299

  20. Assessment of Environmental Sustainability in Health Care Organizations

    OpenAIRE

    María Carmen Carnero

    2015-01-01

    Healthcare organizations should set a standard in corporate social responsibility and encourage environmental sustainability, since protection of the environment implies the development of preventive measures in healthcare. Environmental concern has traditionally focused on manufacturing plants. However, a Health Care Organization (HCO) is the only type of company which generates all existing classes of waste, and 20% is dangerous, being infectious, toxic or radioactive in nature. Despite th...

  1. CLINICAL PSYCHOLOGICAL ASSESSMENT IN LITHUANIAN HEALTH CARE INSTITUTIONS: OPINION ANALYSIS OF PROFESSIONALS

    Directory of Open Access Journals (Sweden)

    Augustinas Rotomskis

    2015-07-01

    Full Text Available Purpose – to investigate the state of clinical psychological assessment in the Lithuanian health care system: 1 what kind of tests are used in clinical practice and what are clinicians opinions about them; 2 what kind of psychological functions are assessed in clinical practice and what is the opinion of clinicians about the assessment of these psychological functions; 3 what kind of issues are the most pressing in clinical assessment. Design/methodology/approach – 101 clinical psychologists, who work in Lithuanian health care institutions, completed a questionnaire about their opinion on clinical psychological assessment. Findings – Attention, memory, executive functions, intelligence and emotions are the most important and frequently assessed psychological functions in clinical practice. Neuropsychogical assessment of attention, memory, executive functions, are viewed as the most problematic fields of assessment. The adaptation, standartization and revision of the various neuropsychological tests is suggested. The most pressing issues in clinical practice are: 1 the assessment of specific psychological functions (neuropsychological and psychosocial functioning; 2 the assessment of specific disorders (schizophrenia spectrum disorders and autism spectrum disorders; 3 the asessment of specific stages of development (children and teenagers. Research limitations/implications – 32 percent of health care institutions (30 out of 95 identified institutions, which provide mental health care, did not participate in the study. The majority of these institutions are from the provinces. Practical implications – psychological assessment plays a key role in the practice of a clinical psychologist. This study investigated and pinpointed the most pressing issues and needs of psychologists in clinical practice. According to the study results, recommendations ascertaining to the adaptation and revision of tests and preparation of clinical psychologists

  2. Long-term mortality after critical care: what is the starting point?

    OpenAIRE

    Ranzani, Otavio T.; Zampieri, Fernando G.; Park, Marcelo; Salluh, Jorge IF

    2013-01-01

    Mortality is still the most assessed outcome in the critically ill patient and is routinely used as the primary end-point in intervention trials, cohort studies, and benchmarking analysis. Despite this, interest in patient-centered prognosis after ICU discharge is increasing, and several studies report quality of life and long-term outcomes after critical illness. In a recent issue of Critical Care, Cuthbertson and colleagues reported interesting results from a cohort of 439 patients with sep...

  3. The psychosocial oncology learning assessment: a province-wide survey of cancer care providers' learning needs.

    Science.gov (United States)

    Rennie, Heather; Mackenzie, Gina

    2010-06-01

    A psychosocial oncology learning needs assessment was developed and offered online to cancer care providers in a variety of settings across all health regions in British Columbia. The purpose was to better understand the psychosocial learning needs of cancer care providers and to use this knowledge to shape continuing education priorities. Respondents' preferred learning formats, access to technology and barriers to accessing psychosocial learning opportunities were also assessed. Cancer care providers including radiation therapists, social workers, dieticians, pharmacists, physicians and nurses in both community and agency settings were surveyed. Two hundred and sixty-seven people completed the survey. Key learning needs identified included cultural aspects of care, symptom management, treating the anxious patient, self-care for the professional, care of elderly patients, basic cancer-related medical issues surrounding care and ethics. Community respondents indicated more needs than agency respondents. On-site training was the most preferred learning format, and time constraints were the biggest barrier to accessing learning opportunities. Participants had access to technology. Next steps include conducting key informant and focus group interviews to determine if interest in a learning need is the same as a relevant knowledge and practice gap. This research suggests that cancer care providers are interested in learning more about the psychosocial issues related to cancer care. PMID:20361284

  4. Conceptual and practical foundations of patient engagement in research at the patient-centered outcomes research institute

    OpenAIRE

    Frank, Lori; Forsythe, Laura.; Ellis, Lauren; Schrandt, Suzanne; Sheridan, Sue; Gerson, Jason; Konopka, Kristen; Daugherty, Sarah

    2015-01-01

    Purpose To provide an overview of PCORI’s approach to engagement in research. Methods The Patient-Centered Outcomes Research Institute (PCORI) was established in 2010 to fund patient-centered comparative effectiveness research. Requirements for research funding from PCORI include meaningful engagement of patients and other stakeholders in the research. PCORI’s approach to engagement in research is guided by a conceptual model of patient-centered outcomes research (PCOR), that provides a struc...

  5. Developing Patient-Centered Communication Skills Training for Oncologists: Describing the Content and Efficacy of Training

    Science.gov (United States)

    Brown, Richard F.; Bylund, Carma L.; Gueguen, Jennifer A.; Diamond, Catherine; Eddington, Julia; Kissane, David

    2010-01-01

    Communication Skills Training (CST) is a proven aid to help oncologists achieve high quality patient-centered communication. No research studies have provided clear guidelines for developing the content of CST. The aim of this work is to describe a method of developing such content and evaluation of effectiveness of CST training workshops (based…

  6. Shock as a determinant of poor patient-centered outcomes in implantable cardioverter defibrillator patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Van Den Broek, Krista C; Van Den Berg, Martha;

    2010-01-01

    The medical benefits of the implantable cardioverter defibrillator (ICD) are well established, but ICD shocks are known to influence patient-centered outcomes. In this viewpoint, we examine the strength of the evidence as found in primary and secondary prevention trials that used quality of life ...

  7. Assessing the acceptability of community pharmacy based pharmaceutical care services in Karachi

    Directory of Open Access Journals (Sweden)

    Muhammad Amir, B.Pharmacy, MSc. MBA, Assistant Professor/Clinical Pharmacist

    2011-01-01

    Full Text Available Provision of pharmaceutical care services in community pharmacies is a new trend in pharmacy practice worldwide. Published literature from developed countries is available showing benefits of pharmaceutical care services provided in community pharmacies. However, relatively little published literature is available from developing countries in which unique market environments are encountered. This study was conducted to assess the acceptability of community pharmacy based pharmaceutical care services in Karachi. Pharmaceutical care services were developed and offered to pharmacy customers for a period of two months. Acceptability was evaluated with respect to enrollment of participants in the program, discontinuation, and complaints registered. The findings provide a better understanding of pharmaceutical care marketing strategies and are discussed within the context of the health care environment in Karachi.

  8. Wholistic Health Care: Evolutionary Conceptual Analysis.

    Science.gov (United States)

    Ziebarth, Deborah Jean

    2016-10-01

    While performing a data search to define "wholistic health care", it was evident that a definite gap existed in published literature. In addition, there are different definitions and several similar terms (whole person care, wholistic health, whole person health, wholism, etc.), which may cause confusion. The purpose of this paper was to present the analysis of "wholistic health care" using Rodgers' Evolutionary Method. The method allows for the historical and social nature of "wholistic health care" and how it changes over time. Attributes, antecedents, and consequences of wholistic health care were reduced using a descriptive matrix. In addition, attributes that consistently occurred in wholistic health care were presented as essential attributes. Definitions of Wholistic Health Care Provider(s), Wholistic Health, Wholistic Illness, Wholistic Healing, and Patient were created from the analysis of the literature review of attributes, antecedents, and consequences of wholistic health care. Wholistic Health Care is defined as the assessment, diagnosis, treatment and prevention of wholistic illness in human beings to maintain wholistic health or enhance wholistic healing. Identified wholistic health needs are addressed simultaneously by one or a team of allied health professionals in the provision of primary care, secondary care, and tertiary care. Wholistic health care is patient centered and considers the totality of the person (e.g., human development at a given age, genetic endowments, disease processes, environment, culture, experiences, relationships, communication, assets, attitudes, beliefs, and lifestyle behaviors). Patient centered refers to the patient as active participant in deciding the course of care. Essential attributes of wholistic health care are faith (spiritual) integrating, health promoting, disease managing, coordinating, empowering, and accessing health care. Wholistic health care may occur in collaboration with a faith-based organization to

  9. CO2CARE - Site Closure Assessment Research - Recent Results

    Science.gov (United States)

    Wipki, Mario; Liebscher, Axel; Kühn, Michael; Lüth, Stefan; Durucan, Sevket; Deflandre, Jean-Pierre; Wollenweber, Jens; Chadwick, Andy; Böhm, Gualtiero

    2013-04-01

    The EU project CO2CARE, which started in January 2011, supports the large scale demonstration of CCS technology by addressing requirements of operators and regulators face in terms of CO2 storage site abandonment. The CO2CARE consortium, consisting of 24 project partners from universities, research institutes, and the industry, investigate technologies and procedures for abandonment and post-closure safety, satisfying the regulatory requirements for the transfer of responsibility. Nine key injections sites in Europe, USA, Japan, and Australia, each with a specific (hydro) geological and environmental character, were selected for investigations. These sites can be divided into the CO2 storage types on-shore, off-shore, natural CO2 reservoir, depleted gas reservoirs, and saline aquifers. The project mainly focuses on three key areas: - well abandonment and long-term integrity; - reservoir management and prediction from closure to the long-term; - risk management methodologies for long-term safety. These key areas are in turn closely linked to the three high-level requirements of the EU Directive 2009/31/EC, Article 18 for CO2 storage which are: (i) absence of any detectable leakage, (ii) conformity of actual behaviour of the injected CO2 with the modeled behaviour, and (iii) the storage site is evolving towards a situation of long-term stability. The identification of criteria and the development of site abandonment procedures and technologies, which guarantee the fulfillment of the high-level requirements, are the major objectives in CO2CARE. These criteria have to be fulfilled prior to subsequent transfer of responsibility to the competent authorities, typically 20 or 30 years after site closure. Finally, the essential results of the different working groups in CO2CARE will feed into overall guidelines for regulatory compliance and "Best Practice" for site abandonment. Dissemination of the results will show policy makers and the general public how site abandonment

  10. Assessment of brain death in the neurocritical care unit.

    Science.gov (United States)

    Hwang, David Y; Gilmore, Emily J; Greer, David M

    2013-07-01

    This article reviews current guidelines for death by neurologic criteria and addresses topics relevant to the determination of brain death in the intensive care unit. The history of brain death as a concept leads into a discussion of the evolution of practice parameters, focusing on the most recent 2010 update from the American Academy of Neurology and the practice variability that exists worldwide. Proper transition from brain death determination to possible organ donation is reviewed. This review concludes with a discussion regarding ethical and religious concerns and suggestions on how families of patients who may be brain dead might be optimally approached. PMID:23809039

  11. Improving end-of-life care for ESRD patients: an initiative for professionals.

    Science.gov (United States)

    Moss, Alvin H; Armistead, Nancy C

    2013-09-01

    The Coalition for Supportive Care of Kidney Patients convened subject matter experts (SMEs) to assess the current state of palliative care for pre-dialysis (chronic kidney disease) and end-stage renal disease patients (stages 3-5). The SMEs noted that in the final month of life, dialysis patients have the higher percentage of hospitalizations, longer length of stay, greater intensive care admissions, and higher number of deaths in hospitals than cancer or heart failure patients, but use hospice only half as much as these two groups. The group identified a strategic approach and framework for achieving specific aims to improve palliative care education of health care providers, raise awareness of supportive care resources, define palliative care skills for nephrologists, and continue the implementation of shared decision-making for individualized patient-centered care. PMID:24266270

  12. Sequential organ failure assessment score as prognostic marker in critically ill patients in a tertiary care intensive care unit

    Directory of Open Access Journals (Sweden)

    Charan Bale

    2013-07-01

    Full Text Available Introduction: Sepsis is one of the most important causes of mortality in the intensive care setting. An effective predictor of prognosis of sepsis is required to assess morbidity and mortality of this condition. In this study, sepsis in the intensive care unit (ICU of a tertiary care hospital was evaluated, with specific reference to clinical features and causative organisms. The sequential organ failure assessment (SOFA score was calculated to assess the severity of sepsis and multi-organ failure at presentation and after 48 h. The correlation of SOFA and mean SOFA scores with outcome was studied. Materials and Methods: This was a prospective, observational, cohort study carried out in a tertiary care teaching hospital. Forty consecutive cases of septicemia were studied. Detailed history, clinical features, and SOFA score was recorded to assess the disease severity at the time of presentation and after 48 h. Inclusion of patients in the study was performed using the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM definition of sepsis. Two sample t-test and 95% confidence interval (CI for difference of mean was applied. Results: When the SOFA score was <7, the mortality was 56%. It increased to 70% when the score was 8-15 (P = 0.0989, t value: 1.69, Mean difference: 2.12, 95% CI: 0.41-4.665. Patients with SOFA score <7 after 48 h had 52% mortality and it increased to 88% when the score was 8-15. The mean SOFA score at 48 h was 6.96 in patients who died and 2.5 in those who improved (P < 0.001, t value: 4.332, mean difference: 4.39, 95% CI: 2.34-6.44. Hence, the predictive value for mortality of SOFA score was better at 48 h than at presentation. Conclusions: Sequential assessment of organ dysfunction in ICU at presentation and at 48 h is a good indicator of prognosis. Both mean and highest SOFA scores are particularly useful predictors of outcome, independent of the initial score. A high SOFA score at 48 h of

  13. CHoosing Options for Insomnia in Cancer Effectively (CHOICE): Design of a patient centered comparative effectiveness trial of acupuncture and cognitive behavior therapy for insomnia.

    Science.gov (United States)

    Garland, Sheila N; Gehrman, Philip; Barg, Frances K; Xie, Sharon X; Mao, Jun J

    2016-03-01

    Insomnia is a prevalent and persistent side effect of cancer, which if left unaddressed, can be unremitting and negatively influence physical and mental well-being. Acupuncture and Cognitive Behavioral Therapy (CBT) are commonly used non-pharmacological treatments that are efficacious for treating insomnia in cancer patients; however, little is known about the comparative effectiveness of these options. The goal of personalized medicine is to determine which treatments are most effective for which individuals, and patient preference for treatment is a particularly important contributor to adherence and outcomes. Here we describe the design of a clinical trial that begins to determine how best to personalize the treatment of insomnia for cancer survivors. This project is a randomized controlled comparative effectiveness trial with a nested qualitative study comparing acupuncture and CBT for insomnia and co-morbid symptoms in a heterogeneous sample of 160 cancer survivors. The primary aim is to determine which treatment is associated with the largest reduction in insomnia severity. The secondary aim is to examine the demographic, clinical, and psychological characteristics that predict and/or moderate treatment effect. Patients will receive ten treatments of acupuncture or 7 sessions of CBT over eight weeks and complete validated patient-reported outcome measures of sleep and co-morbid symptoms at baseline, mid-treatment, post-treatment, and at three-months to assess durability of effect. The results of the proposed study have the potential to improve healthcare outcomes by helping cancer survivors and their caregivers make informed and evidence-based decisions, leading to patient-centered and personalized care for cancer survivors with insomnia. PMID:26956541

  14. Assessing emergency medical care in low income countries: A pilot study from Pakistan

    Directory of Open Access Journals (Sweden)

    Akhtar Tasleem

    2008-07-01

    Full Text Available Abstract Background Emergency Medical Care is an important component of health care system. Unfortunately it is however, ignored in many low income countries. We assessed the availability and quality of facility-based emergency medical care in the government health care system at district level in a low income country – Pakistan. Methods We did a quantitative pilot study of a convenience sample of 22 rural and 20 urban health facilities in 2 districts – Faisalabad and Peshawar – in Pakistan. The study consisted of three separate cross-sectional assessments of selected community leaders, health care providers, and health care facilities. Three data collection instruments were created with input from existing models for facility assessment such as those used by the Joint Commission of Accreditation of Hospitals and the National Center for Health Statistics in USA and the Medical Research Council in Pakistan. Results The majority of respondents 43/44(98%, in community survey were not satisfied with the emergency care provided. Most participants 36/44(82% mentioned that they will not call an ambulance in health related emergency because it does not function properly in the government system. The expenses on emergency care for the last experience were reported to be less than 5,000 Pakistani Rupees (equivalent to US$ 83 for 19/29(66% respondents. Most health care providers 43/44(98% were of the opinion that their facilities were inadequately equipped to treat emergencies. The majority of facilities 31/42(74% had no budget allocated for emergency care. A review of medications and equipment available showed that many critical supplies needed in an emergency were not found in these facilities. Conclusion Assessment of emergency care should be part of health systems analysis in Pakistan. Multiple deficiencies in emergency care at the district level in Pakistan were noted in our study. Priority should be given to make emergency care responsive to

  15. The health-care system: an assessment and reform agenda.

    Science.gov (United States)

    Mataria, Awad; Khatib, Rana; Donaldson, Cam; Bossert, Thomas; Hunter, David J; Alsayed, Fahed; Moatti, Jean-Paul

    2009-04-01

    Attempts to establish a health plan for the occupied Palestinian territory were made before the 1993 Oslo Accords. However, the first official national health plan was published in 1994 and aimed to regulate the health sector and integrate the activities of the four main health-care providers: the Palestinian Ministry of Health, Palestinian non-governmental organisations, the UN Relief and Works Agency, and a cautiously developing private sector. However, a decade and a half later, attempts to create an effective, efficient, and equitable system remain unsuccessful. This failure results from arrangements for health care established by the Israeli military government between 1967 and 1994, the nature of the Palestinian National Authority, which has little authority in practice and has been burdened by inefficiency, cronyism, corruption, and the inappropriate priorities repeatedly set to satisfy the preferences of foreign aid donors. Although similar problems exist elsewhere, in the occupied Palestinian territory they are exacerbated and perpetuated under conditions of military occupation. Developmental approaches integrated with responses to emergencies should be advanced to create a more effective, efficient, and equitable health system, but this process would be difficult under military occupation. PMID:19268349

  16. An assessment of burn care professionals' attitudes to major burn.

    LENUS (Irish Health Repository)

    Murphy, A D

    2008-06-01

    The resuscitation of severe burn remains a controversial area within the burn care profession. There is ongoing debate as to what percentage burn is associated with a sufficient quality of life to support initial resuscitation efforts. We conducted a survey of delegates at the 39th Annual Meeting of the British Burns Association (2005), regarding attitudes towards resuscitation following major burns. Respondents were asked the maximum percentage total body surface area (TBSA) burn beyond which they would not wish to be resuscitated. They were also asked what maximum TBSA they perceived to be commensurate with an acceptable quality of life (QOL). One hundred and forty three of 300 delegates responded to the questionnaire. Thirty three percent of respondents would not wish to be resuscitated with 50-75% TBSA burns or greater. A further 35% would not wish to have life-sustaining intervention with 75-95% TBSA burns or greater. The remaining 32% indicated that they would not want resuscitation with TBSA burns>95%. Regardless of TBSA affected, 16% would not wish resuscitation if they had full thickness facial burns, a further 10% did not want resuscitation if both their hands and faces were affected. Our survey demonstrates the diversity of personal preference amongst burn care professionals. This would suggest that a unifying philosophy regarding the resuscitation of extensive burns will remain elusive.

  17. Assessing and Enhancing Health Care Providers’ Response to Domestic Violence

    Directory of Open Access Journals (Sweden)

    Tuija Leppäkoski

    2014-01-01

    Full Text Available This study aimed to examine possible changes from 2008 to 2012 in the skills of health care staff in identifying and intervening in domestic violence (DV. A longitudinal descriptive study design with volunteer samples (baseline; n=68, follow-up; n=100 was used to acquire information regarding the present state and needs of the staff in practices related to DV. The results of the baseline survey were used as a basis for planning two interventions: staff training and drafting practical guidelines. Information was collected by questionnaires from nurses, physicians, and social workers and supplemented by responses from the interviews. The data were analysed using both quantitative and qualitative methods. A chi-square test was used to test the statistical significance of the data sets. In addition, participants’ quotes are used to describe specific phenomena or issues. The comparison showed that overall a small positive change had taken place between the study periods. However, the participants were aware of their own shortcomings in identifying and intervening in DV. Changes happen slowly, and administrative support is needed to sustain such changes. Therefore, this paper offers recommendations to improve health care providers’ response to DV. Moreover, there is a great need for evaluating the training programme used.

  18. Clinical undergraduate training and assessment in primary health care: Experiences gained from Crete, Greece

    Directory of Open Access Journals (Sweden)

    Fioretos Michael

    2005-05-01

    Full Text Available Abstract Background Primary Health Care (PHC is increasingly being introduced into undergraduate medical education. In Greece, the Faculty of Medicine of the University of Crete was the first to introduce a 4-week long training in primary health care. This paper presents the experiences gained from the initial implementation of the teaching of practice-based primary care in rural Crete and reports on the assessment scale that was developed. Methods 284 students' case write-ups from the 6 primary care units (PCUs where they were allocated for the period 1990 to 1994 were analysed. The demographic data of the students and patients and the number of home visits were studied. Content analysis of the students' write-ups was carried out, using an assessment scale consisting of 10 dichotomous variables, in order to quantify eight (8 primary qualitative criteria. Results Internal reliability was estimated by the index KR20 = 0.67. Face and content validity was found to conform to the standards set for the course, while logistic linear regression analysis showed that the quality criteria could be used as an assessment scale. The number of home visits carried out varied between the various different PCUs (p Conclusion The primary health care course achieved the objectives of introducing students to comprehensive, community oriented care, although there was variation between the PCUs. The assessment scale that was developed to analyse the case-write ups of the students provided data that can be used to evaluate the course.

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

    Directory of Open Access Journals (Sweden)

    Cousens Simon

    2011-09-01

    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.

  20. Reliable and Valid Assessment of Point-of-care Ultrasonography

    DEFF Research Database (Denmark)

    Todsen, Tobias; Tolsgaard, Martin Grønnebæk; Olsen, Beth Härstedt;

    2015-01-01

    surgical patient cases in a controlled set-up. All ultrasound examinations were video-recorded and assessed by 2 blinded radiologists using OSAUS. Reliability was examined using generalizability theory. Construct validity was examined by comparing performance scores between the groups and by correlating...

  1. Developing a pressure ulcer risk assessment scale for patients in long-term care.

    Science.gov (United States)

    Lepisto, Mervi; Eriksson, Elina; Hietanen, Helvi; Lepisto, Jyri; Lauri, Sirkka

    2006-02-01

    Previous pressure ulcer risk assessment scales appear to have relied on opinions about risk factors and are based on care setting rather than research evidence. Utilizing 21 existing risk assessment scales and relevant risk factor literature, an instrument was developed by Finnish researchers that takes into account individual patient risk factors, devices and methods applied in nursing care, and organizational characteristics. The instrument underwent two pilot tests to assess the relevance and clarity of the instrument: the first involved 43 nurses and six patients; the second involved 50 nurses with expertise in wound care. Changes to questionnaire items deemed necessary as a result of descriptive analysis and agreement percentages were completed. After pilot testing, the final instrument addressed the following issues: 1) patient risks: activity, mobility in bed, mental status, nutrition, urinary incontinence, fecal incontinence, sensory perception, and skin condition; 2) devices and methods used in patient care: technical devices, bed type, mattress, overlay, seat cushions, and care methods; and 3) staff number and structure, maximum number of beds, and beds in use (the last group of questions were included to ensure participants understood the items; results were not analyzed). The phases of the study provided an expeditious means of data collection and a suitable opportunity to assess how the instrument would function in practice. Instrument reliability and validity were improved as a result of the pilot testing and can be enhanced further with continued use and assessment. PMID:16464993

  2. Nurses' Knowledge and Responsibility toward Nutritional Assessment for Patients in Intensive Care Units

    OpenAIRE

    Mahmoud Al Kalaldeh; Mahmoud Shahein

    2014-01-01

    Introduction: Nutritional assessment is a prerequisite for nutritional delivery. Patients in intensive care suffer from under-nutrition and nutritional failure due to poor assessment. Nursing ability to early detect nutritional failure is the key for minimizing imparities in practice and attaining nutritional goals. Aim of this article is to examine the ability of Jordanian ICU nurses to assess the nutritional status of critically ill patients, considering biophysical and biochemical measures...

  3. There is no "i" in teamwork in the patient-centered medical home: defining teamwork competencies for academic practice.

    Science.gov (United States)

    Leasure, Emily L; Jones, Ronald R; Meade, Lauren B; Sanger, Marla I; Thomas, Kris G; Tilden, Virginia P; Bowen, Judith L; Warm, Eric J

    2013-05-01

    Evidence suggests that teamwork is essential for safe, reliable practice. Creating health care teams able to function effectively in patient-centered medical homes (PCMHs), practices that organize care around the patient and demonstrate achievement of defined quality care standards, remains challenging. Preparing trainees for practice in interprofessional teams is particularly challenging in academic health centers where health professions curricula are largely siloed. Here, the authors review a well-delineated set of teamwork competencies that are important for high-functioning teams and suggest how these competencies might be useful for interprofessional team training and achievement of PCMH standards. The five competencies are (1) team leadership, the ability to coordinate team members' activities, ensure appropriate task distribution, evaluate effectiveness, and inspire high-level performance, (2) mutual performance monitoring, the ability to develop a shared understanding among team members regarding intentions, roles, and responsibilities so as to accurately monitor one another's performance for collective success, (3) backup behavior, the ability to anticipate the needs of other team members and shift responsibilities during times of variable workload, (4) adaptability, the capability of team members to adjust their strategy for completing tasks on the basis of feedback from the work environment, and (5) team orientation, the tendency to prioritize team goals over individual goals, encourage alternative perspectives, and show respect and regard for each team member. Relating each competency to a vignette from an academic primary care clinic, the authors describe potential strategies for improving teamwork learning and applying the teamwork competences to academic PCMH practices. PMID:23524923

  4. Instrument for assessing the quality of mobile emergency pre-hospital care: content validation.

    Science.gov (United States)

    Dantas, Rodrigo Assis Neves; Torres, Gilson de Vasconcelos; Salvetti, Marina de Góes; Dantas, Daniele Vieira; Mendonça, Ana Elza Oliveira de

    2015-01-01

    OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K) and Content Validity Index (CVI), considering K> 0.80 and CVI ≥ 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services. PMID:26107697

  5. Assessing Patient Attitudes to Computerized Screening in Primary Care: Psychometric Properties of the Computerized Lifestyle Assessment Scale

    OpenAIRE

    Ahmad, Farah; Hogg-Johnson, Sheilah; Skinner, Harvey A

    2008-01-01

    Background Computer-based health-risk assessments are electronic surveys which can be completed by patients privately, for example during their waiting time in a clinic, generating a risk report for the clinician and a recommendation sheet for the patient at the point of care. Despite increasing popularity of such computer-based health-risk assessments, patient attitudes toward such tools are rarely evaluated by reliable and valid scales. The lack of psychometric appraisal of appropriate scal...

  6. A primary care-based health needs assessment in inner city Dublin.

    LENUS (Irish Health Repository)

    O'Kelly, C M

    2012-02-01

    BACKGROUND: In 2001, a primary care-based health needs assessment (HNA) in South Inner City of Dublin identified high levels of morbidity and widespread and frequent use of primary care and specialist hospital services as particular concerns. AIMS: This study aims to determine the primary care health needs of a local community, from the perspective of service users and service providers. METHODS: A similar methodology to our 2001 HNA was adopted, involving semi-structured interviews with a convenience sample of patients attending two general practices and key informants regarding local health issues and health service utilisation. RESULTS: High levels of morbidity and chronic illness were found. A correlation between the local environment and ill-health was identified, as well as high utilisation of primary care services in the area. CONCLUSION: The establishment of a Primary Care Team would begin to address the health needs of the community.

  7. How to systematically assess serious games applied to health care.

    Science.gov (United States)

    Graafland, Maurits; Dankbaar, Mary; Mert, Agali; Lagro, Joep; De Wit-Zuurendonk, Laura; Schuit, Stephanie; Schaafstal, Alma; Schijven, Marlies

    2014-01-01

    The usefulness and effectiveness of specific serious games in the medical domain is often unclear. This is caused by a lack of supporting evidence on validity of individual games, as well as a lack of publicly available information. Moreover, insufficient understanding of design principles among the individuals and institutions that develop or apply a medical serious game compromises their use. This article provides the first consensus-based framework for the assessment of specific medical serious games. The framework provides 62 items in 5 main themes, aimed at assessing a serious game's rationale, functionality, validity, and data safety. This will allow caregivers and educators to make balanced choices when applying a serious game for healthcare purposes. Furthermore, the framework provides game manufacturers with standards for the development of new, valid serious games. PMID:25654163

  8. Computerised Genetic Risk Assessment and Decision Support in Primary Care

    OpenAIRE

    Andrew Coulson; David Glasspool; John Fox; Jon Emery

    2000-01-01

    Public awareness of the availability of genetic testing threatens to put severe strain upon genetics clinics in the near future. General practitioners (GPs) could help avert this problem by making an initial genetic risk assessment and acting as gatekeepers to specialist services. However, studies in the United Kingdom suggest that few GPs feel they have the requisite skills for taking family history details and making an appropriate referral decision. They are also poorly served by compute...

  9. Ventilator assessment of respiratory mechanics in paediatric intensive care

    OpenAIRE

    Harikumar, Gopinathannair; Greenough, Anne; Rafferty, Gerrard F.

    2007-01-01

    Many modern “paediatric” mechanical ventilators have in-built features for estimation of respiratory mechanics which could be useful in the management of ventilated infants and children. The aim of this study was to determine if such measurements were reproducible and accurate. Ventilator (Draeger Evita 4) displayed compliance (Cvent) and resistance (Rvent) values were assessed and compared to the results of respiratory system mechanics (respiratory system compliance (Crs) and resistance (Rrs...

  10. Surplus Appropriation from R&D and Health Care Technology Assessment Procedures

    OpenAIRE

    Philipson, Tomas J.; Jena, Anupam B.

    2006-01-01

    Given the rapid growth in health care spending that is often attributed to technological change, many private and public institutions are grappling with how to best assess and adopt new health care technologies. The leading technology adoption criteria proposed in theory and used in practice involve so called "cost-effectiveness" measures. However, little is known about the dynamic efficiency implications of such criteria, in particular how they influence the R&D investments that make technol...

  11. The validity and reliability of an instrument to assess nursing competencies in spiritual care

    OpenAIRE

    van Leeuwen, Rene; Tiesinga, Lucas J.; Middel, Berrie; Post, Doeke; Jochemsen, Henk

    2009-01-01

    Aim. This study contributes to the development of a valid and reliable instrument, the spiritual care competence scale, as an instrument to assess nurses' competencies in providing spiritual care. Background. Measuring these competencies and their development is important and the construction of a reliable and valid instrument is recommended in the literature. Design. Survey. Method. The participants were students from Bachelor-level nursing schools in the Netherlands (n = 197) participating ...

  12. Assessment of health care quality among penitentiary employees with hypertension in the Saratov region

    OpenAIRE

    Balashov S.V.; Balashova M.E.; Popova Yu.V.

    2015-01-01

    The aim of the study is to assess the quality of health care among penitentiary employees with hypertension in the Saratov region from 2003 to 2013. Material and Methods. The data from 62 employees with hypertension (43 men and 19 women) who followed up in the dispensary of Branch of Center of Medical and Social Rehabilitation of Medical Unit no.64 of Russian Federal Penitentiary Service in 2013 were evaluated. We analyzed retrospectively the quality of health care in every calendar year from...

  13. Quality along the continuum: a health facility assessment of intrapartum and postnatal care in Ghana.

    Directory of Open Access Journals (Sweden)

    Robin C Nesbitt

    Full Text Available To evaluate quality of routine and emergency intrapartum and postnatal care using a health facility assessment, and to estimate "effective coverage" of skilled attendance in Brong Ahafo, Ghana.We conducted an assessment of all 86 health facilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC, emergency newborn care (EmNC and non-medical quality. Linking the health facility assessment to surveillance data we estimated "effective coverage" of skilled attendance as the proportion of births in facilities of high quality.Delivery care was offered in 64/86 facilities; only 3-13% fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63% and 58% of facilities categorized as "low" or "substandard" for EmOC and EmNC, respectively. This implies performing less than four EmOC or three EmNC signal functions, and/or employing less than two skilled health professionals, and/or that no health professionals were present during our visit. Routine delivery care was "low" or "substandard" in 39% of facilities, meaning 25/64 facilities performed less than six routine signal functions and/or had less than two skilled health professionals and/or less than one midwife. While 68% of births were in health facilities, only 18% were in facilities with "high" or "highest" quality in all dimensions.Our comprehensive facility assessment showed that quality of routine and emergency intrapartum and postnatal care was generally low in the study region. While coverage with facility delivery was 68%, we estimated "effective coverage" of skilled attendance at 18%, thus revealing a large "quality gap." Effective coverage could be a meaningful indicator of progress towards

  14. [Assessment of the spiritual needs of patients in palliative care].

    Science.gov (United States)

    Hajnová Fukasová, E; Bužgová, R; Feltl, D

    2015-01-01

    The appraisal and the right diagnostics of all needs and problems of patients, including the spiritual needs, are unavoidable for increase of the quality of the all-embracing nursing care. In the case of satisfying of the needs of the patients, it is important to have view the person as a unity of thebody and the soul. Identification and satisfying of the spiritual needs are not uncomplicated; moreover, spirituality does not have a target--ed and clear definition. In the palliative care, the solution and saturation of spiritual needs have a great priority, and it can be the key aspect of psychological activity. Also, medical experts are becoming aware of the meaning of spirituality as the part of psychological contentment more and more. Smaller importance is attached to measurement of spiritual needs, and in many medical institutions ends at the case history with the questions: "Are you a believer?", "Do you have any spiritual needs?". Spirituality and religion are very personal matters of every human. Many patients turn to religion to find answers to difficult questions while others find support through the spiritual beliefs outside the scope of organized religion. Mistaking of meanings of the spirituality and religionism can lead to many misunderstandings. The basic condition for the right diagnostics and satisfaction of spiritual needs are the definition of the used terms and using of standardized measurement devices in the clinical praxis. The target of summarizing study was to define the term of spirituality, to describe a lot of measurement devices these are suitable for the evaluation of human spiritual needs. For methodology for acquiring of the results of research works that are concerned with the questions of spiritual needs in case of the incurable patients, the following databases were used (2005-2013): EBSCO, Bibliographia Medica Čechoslovaca, Google Scholar, Solen - www.solen.cz, Profese on-line as the source of the data. The choice of studies were

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

    Institute of Scientific and Technical Information of China (English)

    Martin Rejler; J(o)rgen Tholstrup; Mattias Elg; Anna Sp(a)ngéus; Boel Andersson G(a)re

    2012-01-01

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

  16. The perception of midwives regarding psychosocial risk assessment during antenatal care

    Directory of Open Access Journals (Sweden)

    Johanna M. Mathibe-Neke

    2014-05-01

    Full Text Available Background: The physiological and psychological changes caused by pregnancy may increase a woman’s vulnerability to depression, which may in turn have adverse effects on both maternal and foetal wellbeing. Inadequate psychosocial risk assessment of women by midwives may lead to lack of psychosocial support during pregnancy and childbirth. Pregnant women who lack psychosocial support may experience stress, anxiety and depression that could possibly affect foetal wellbeing. Objective:The objective of this study was toexplore and describe the perception of psychosocial risk assessment and psychosocial care by midwives providing antenatal care to pregnant women. Method: An interpretive and descriptive qualitative approach was adopted. Three focus group interviews were conducted with midwives working in three Maternal Obstetric Units in Gauteng Province, using a semi-structured interview guide. The constant comparison data analysis approach was used. Results:Findings revealed that midwives are aware of and have encountered a high prevalence of psychosocial problems in pregnant women. Furthermore, they acknowledged the importance of psychosocial care for pregnant women although they stated that they were not equipped adequately to offer psychosocial assessment and psychosocial care. Conclusion:The findings provided a basis for incorporation of psychosocial care into routine antenatal care.

  17. Effect of Organizational Culture on Patient Access, Care Continuity, and Experience of Primary Care.

    Science.gov (United States)

    Hung, Dorothy; Chung, Sukyung; Martinez, Meghan; Tai-Seale, Ming

    2016-01-01

    This study examined relationships between organizational culture and patient-centered outcomes in primary care. Generalized least squares regression was used to analyze patient access, care continuity, and reported experiences of care among 357 physicians in 41 primary care departments. Compared with a "Group-oriented" culture, a "Rational" culture type was associated with longer appointment wait times, and both "Hierarchical" and "Developmental" culture types were associated with less care continuity, but better patient experiences with care. Understanding the unique effects of organizational culture can enhance the delivery of more patient-centered care. PMID:27232685

  18. Primary care assessment of capillaroscopy abnormalities in patients with Raynaud's phenomenon.

    Science.gov (United States)

    Overbury, Rebecca; Murtaugh, Maureen A; Fischer, Aryeh; Frech, Tracy M

    2015-12-01

    Raynaud's phenomenon is a clinical symptom that can commonly present to a primary care provider or generalist. Proper identification of an underlying connective tissue disease in a patient with Raynaud's could allow for the prevention of possible critical digital ischemia. Capillaroscopy is a tool which can identify abnormalities associated with connective tissue disease. Patients presenting with a complaint of Raynaud's phenomenon were assessed with capillaroscopy. In twenty consecutive Raynaud patients, 8 digits were assessed by a ×200 magnification dermatoscope and an image was obtained. Each image was assessed for the following abnormalities: drop-out (skill that could assist primary care providers and generalists in identifying and qualifying changes associated with the common presentation of Raynaud's disease. However, formal training is needed to ensure accuracy and reproducibility. Furthermore, training and scoring systems should address time constraints of busy primary care practitioners. PMID:26400642

  19. Hemophilia and von Willebrand's disease: 1. Diagnosis, comprehensive care and assessment. Association of Hemophilia Clinic Directors of Canada.

    OpenAIRE

    1995-01-01

    OBJECTIVE: To present current strategies for the assessment and comprehensive care of patients with hemophilia and von Willebrand's disease. OPTIONS: Hospital care, home care, single-provider care and multidisciplinary care. OUTCOMES: Morbidity and quality of life associated with bleeding and treatment. EVIDENCE: Relevant clinical studies and reports published from 1974 to 1994 were examined. A search was conducted of own reprint files, MEDLINE, citations in the articles reviewed and referenc...

  20. Patient satisfaction is biased by renovations to the interior of a primary care office: a pretest-posttest assessment

    OpenAIRE

    Tièche, Raphaël; da Costa, Bruno R; Streit, Sven

    2016-01-01

    Abstract Background Measuring quality of care is essential to improve primary care. Quality of primary care for patients is usually assessed by patient satisfaction questionnaires. However, patients may not be able to judge quality of care without also reflecting their perception of the environment. We determined the effect that redesigning a primary care office had on patient satisfaction. We hypothesized that renovating the interior would make patients more satisfied with the qualit...

  1. Anticipated Ethics and Regulatory Challenges in PCORnet: The National Patient-Centered Clinical Research Network.

    Science.gov (United States)

    Ali, Joseph; Califf, Robert; Sugarman, Jeremy

    2016-01-01

    PCORnet, the National Patient-Centered Clinical Research Network, seeks to establish a robust national health data network for patient-centered comparative effectiveness research. This article reports the results of a PCORnet survey designed to identify the ethics and regulatory challenges anticipated in network implementation. A 12-item online survey was developed by leadership of the PCORnet Ethics and Regulatory Task Force; responses were collected from the 29 PCORnet networks. The most pressing ethics issues identified related to informed consent, patient engagement, privacy and confidentiality, and data sharing. High priority regulatory issues included IRB coordination, privacy and confidentiality, informed consent, and data sharing. Over 150 IRBs and five different approaches to managing multisite IRB review were identified within PCORnet. Further empirical and scholarly work, as well as practical and policy guidance, is essential if important initiatives that rely on comparative effectiveness research are to move forward. PMID:26192996

  2. Effects of a Late Life Suicide Risk Assessment Training on Multidisciplinary Health Care Providers

    Science.gov (United States)

    Huh, J.W. Terri; Weaver, Christopher M.; Martin, Jennifer L.; Caskey, Nicholas H.; O’Riley, Alisa; Kramer, B. Josea

    2016-01-01

    Older adults are among the highest at risk group for completing suicide, and they are more likely to seek mental health services from providers outside of traditional mental healthcare. However, providers across the spectrum of care have limited training in suicide risk assessment and management and particularly lack training in suicide prevention for older adults. An educational program was developed to increase awareness and improve suicide risk assessment and management training for a range of health care providers who may see older adults in their care settings. One hundred and thirty two participants from two VA Medical Centers participated in a 6.5 hour long workshop in the assessment and management of suicide risk among older adults. Participants were asked to complete pre- and- post workshop case notes and report on subjective changes in knowledge, attitude, and confidence in assessment and managing suicide risk in older adults. Participants included social workers, nurses, physicians, psychologists, and occupational therapists coming from a variety of care settings including outpatient and inpatient medical, outpatient and inpatient mental health, specialty clinics, and home and community. Following the workshop, participants demonstrated improvement in the overall quality of case notes (p<.01), increased ability to recognize important conceptual suicide risk categories (p<.05), and reported heightened awareness of the importance of late life suicide. Results suggested that educational training may have beneficial impact on multidisciplinary care providers’ ability to identify and manage suicide risk in the elderly. PMID:22288717

  3. Evaluating medical residents as managers of care: a critical appraisal of assessment methods

    Directory of Open Access Journals (Sweden)

    Busari JO

    2014-02-01

    Full Text Available Jamiu O Busari,1,2 Lorette A Stammen,2 Lokke M Gennissen,2 Rob M Moonen1 1Department of Pediatrics, Atrium Medical Center, Henri Dunantstraat 5, 6401 CX Heerlen, the Netherlands; 2Faculty of Health, Medicine and Life Sciences, University of Maastricht, the Netherlands Introduction: The increasing demands for effective and efficient health care delivery systems worldwide have resulted in an expansion of the desired competencies that physicians need to possess upon graduation. Presently, medical residents require additional professional competencies that can prepare them to practice adequately in a continuously changing health care environment. Recent studies show that despite the importance of competency-based training, the development and evaluation of management competencies in residents during residency training is inadequate. The aim of this literature review was to find out which assessment methods are currently being used to evaluate trainees' management competencies and which, if any, of these methods make use of valid and reliable instruments. Methods: In September 2012, a thorough search of the literature was performed using the PubMed, Cochrane, Embase®, MEDLINE®, and ERIC databases. Additional searches included scanning the references of relevant articles and sifting through the “related topics” displayed by the databases. Results: A total of 25 out of 178 articles were selected for final review. Four broad categories emerged after analysis that best reflected their content: 1 measurement tools used to evaluate the effect of implemented curricular interventions; 2 measurement tools based on recommendations from consensus surveys or conventions; 3 measurement tools for assessing general competencies, which included care-management; and 4 measurement tools focusing exclusively on care-management competencies. Conclusion: Little information was found about (validated assessment tools being used to measure care-management competence

  4. Music therapy for the Assessment of Parental Competencies for Children in need of Care

    DEFF Research Database (Denmark)

    Jacobsen, Stine; Wigram, Tony

    2007-01-01

    The assessment for parenting competencies for parents of children potentially in need of care involves an evaluation of their relationship with their child, and the interaction that underpins that relationship. The "Assessment of Parenting Competences" (APC) music therapy assessment provides a...... structured series of interactional exercises that allow the therapist to explore the nature of the relationship both as a tool in every day clinical work and as a research method. The method of the assessment involves free improvisation, turn-taking exercises, and following leading exercises and is evaluated...

  5. Helicobacter pylori infection in children: should it be carefully assessed?

    Science.gov (United States)

    Ortiz-Princz, D; Daoud, G; Salgado-Sabel, A; Cavazza, M E

    2016-05-01

    The prevalence of H. pylori infection, mainly acquired during childhood and may be persisting throughout life, has been found high in developing countries; this high prevalence is related to low socioeconomic status. The persistence of bacterium exposure is related to gastritis and other severe complications including peptic ulcer, lymphoma MALT and gastric cancer, which are rarely present in the pediatric age due to a lower inflammatory and immunological response. Virulence factors, host gastric mucosal factors, and the natural environment of patients are associated with the clinical outcome of H. pylori infection. The main bacterial virulence factors include adhesins (BabA, SabA), vacuolating cytotoxin VacA, and the products of the cag pathogenicity island (cag PAI). There are geographic differences between cagA, vacA status and H. pylori related diseases. The main criteria to evaluate H. pylori infection in children are gastrointestinal and extra gastrointestinal manifestations related to H. pylori infection, familial history of gastric cancer, peptic ulcer, lymphoma MALT, symptomatic children living in high prevalence regions, and immigrant or adopted children in developed countries. Early detection of H. pylori and its virulence factors, in addition to effective methods of eradication associated with prevention programs, may lead to the decrease of H. pylori incidence and gastritis, especially in endemic high-risk regions. The early assessment in children may prevent further severe complications in adulthood. PMID:27212173

  6. Development and Validation of a Questionnaire to Assess Multimorbidity in Primary Care: An Indian Experience

    Directory of Open Access Journals (Sweden)

    Sanghamitra Pati

    2016-01-01

    Full Text Available Multimorbidity remains an underexplored domain in Indian primary care. We undertook a study to assess the prevalence, correlates, and outcomes of multimorbidity in primary care settings in India. This paper describes the process of development and validation of our data collection tool “Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC.” An iterative process comprising desk review, chart review, and expert consultations was undertaken to generate the questionnaire. The MAQ-PC contained items on chronic conditions, health care utilization, health related quality of life, disease severity, and sociodemographics. It was first tested with twelve adults for comprehensibility followed by test-retest reliability with 103 patients from four primary care practices. For interrater reliability, two interviewers separately administered the questionnaire to sixteen patients. MAQ-PC displayed strong internal consistency (Cronbach’s alpha: 0.69, interrater reliability (Cohen’s Kappa: 0.78–1, and test-retest reliability (ICC: 0.970–0.741. Substantial concordance between self-report and physician diagnosis (Scott Kappa: 0.59–1.0 was observed for listed chronic conditions indicating strong concurrent validity. Nearly 54% had one chronic condition and 23.3% had multimorbidity. Our findings demonstrate MAQ-PC to be a valid and reliable measure of multimorbidity in primary care practice and suggest its potential utility in multimorbidity research in India.

  7. Knowledge, Skills, and Attitudes in Caring for Older Adults With Advanced Illness Among Staff Members of Long-Term Care and Assisted Living Facilities: An Educational Needs Assessment.

    Science.gov (United States)

    Cimino, Nina M; Lockman, Kashelle; Grant, Marian; McPherson, Mary Lynn

    2016-05-01

    In long-term care and assisted living facilities, many groups of health care professionals contribute to the work of the health care team. These staff members perform essential, direct patient care activities. An educational needs assessment was conducted to determine the learning needs and preferences of staff members related to providing care for patients with life-limiting illnesses. Staff members placed importance on understanding topics such as principles of palliative care, pain assessment, pain management, and nonpain symptom management. The majority of survey respondents were also interested in learning more about these topics. The results of this educational needs analysis suggest staff members would benefit from a course tailored to these identified educational needs and designed to overcome previously identified educational barriers. PMID:25473091

  8. Cold plasma treatment in wound care: efficacy and risk assessment

    Science.gov (United States)

    Stoffels, Eva

    2007-10-01

    Cold atmospheric plasma is an ideal medium for non-destructive modification of vulnerable surfaces. One of the most promising medical applications of cold plasma treatment is wound healing. Potential advantages in wound healing have been demonstrated in vitro: the plasma does not necrotize the cells and does not affect the extracellular matrix [1], has clear bactericidal or bacteriostatic effects [2], and stimulates fibroblast cells towards faster attachment and proliferation [3]. However, safety issues, such as the potential cytotoxicity of the plasma must be clarified prior to clinical implementation. This work comprises the recent facts on sub-lethal plasma effects on mammalian cells, as well as studies on apoptosis induction and quantitative assessment of DNA damage. Fibroblast, smooth muscle and endothelial cells were treated using the standard cold plasma needle [1,2]; intra- and extracellular oxidant levels as well as the influence of the plasma on intracellular antioxidant balance were monitored using appropriate fluorescent markers [1]. We have studied long-term cellular damage was monitored using flow cytometry to determine the DNA profiles in treated cells. Dose-response curves were obtained: increased proliferation as well as apoptosis were visualized under different treatment conditions. The results from the in vitro studies are satisfying. [1] I.E. Kieft, ``Plasma needle: exploring biomedical applications of non-thermal plasmas'', PhD Thesis, Eindhoven University of Technology (2005). [2] R.E.J. Sladek, ``Plasma needle: non-thermal atmospheric plasmas in dentistry'' PhD Thesis, Eindhoven University of Technology (2006). [3] I.E. Kieft, D. Darios, A.J.M. Roks, E. Stoffels, IEEE Trans. Plasma Sci. 34(4), 2006, pp. 1331-1336.

  9. Mining care trajectories using health administrative information systems: the use of state sequence analysis to assess disparities in prenatal care consumption

    OpenAIRE

    Meur, Nolwenn Le; Gao, Fei; Bayat, Sahar

    2015-01-01

    Background Pregnant women are a vulnerable population. Although regular follow-ups are recommended during pregnancy, not all pregnant women seek care. This pilot study wanted to assess whether the integration of data from administrative health information systems and socio-economic features allows identifying disparities in prenatal care trajectories. Methods Prenatal care trajectories were extracted from the permanent sample of the French health insurance information system linked to the hos...

  10. Relationship between adductor pollicis muscle thickness and subjective global assessment in a cardiac intensive care unit

    OpenAIRE

    Karst, Fernanda Pickrodt; Vieira, Renata Monteiro; Barbiero, Sandra

    2015-01-01

    Objective To verify the relationship between the adductor pollicis muscle thickness test and the subjective global assessment and to correlate it with other anthropometric methods. Methods This observational cross-sectional study was conducted in the intensive care unit of a cardiology hospital in the state of Rio Grande do Sul, Brazil. The hospitalized patients underwent subjective global assessment and adductor pollicis muscle thickness tests on both hands, along with measurement of the rig...

  11. Primary care physicians' use of family history for cancer risk assessment

    OpenAIRE

    Stockdale Alan; Ashikaga Takamaru; Wood Marie E; Flynn Brian S; Dana Greg S; Naud Shelly

    2010-01-01

    Abstract Background Family history (FH) assessment is useful in identifying and managing patients at increased risk for cancer. This study assessed reported FH quality and associations with physician perceptions. Methods Primary care physicians practicing in two northeastern U.S. states were surveyed (n = 880; 70% response rate). Outcome measures of FH quality were extent of FH taken and ascertaining age at cancer diagnosis for affected family members. Predictors of quality measured in this s...

  12. Standardizing Assessment of Competences and Competencies of Oncology Nurses Working in Ambulatory Care.

    Science.gov (United States)

    Beaver, Clara; Magnan, Morris A; Henderson, Denise; DeRose, Patricia; Carolin, Kathleen; Bepler, Gerold

    2016-01-01

    A nursing quality consortium standardized nursing practice across 17 independently functioning ambulatory oncology sites. Programs were developed to validate both competences and competencies. One program assessed nine competences needed to develop systems of care to detect and treat treatment-related side effects. A second program was developed to assess competencies needed to prevent harm to oncology patients. This manuscript describes a successful approach to standardizing nursing practice across geographically distant academic and community sites. PMID:26985750

  13. Assessment of COPD wellness tools for use in primary care: an IPCRG initiative

    Directory of Open Access Journals (Sweden)

    Cave AJ

    2012-07-01

    Full Text Available Andrew J Cave,1 Lana Atkinson,1 Ioanna G Tsiligianni,2,3 Alan G Kaplan41Department of Family Medicine, University of Alberta, Edmonton, Canada; 2Department of General Practice, University Medical Centre of Groningen, Groningen, Netherlands; 3Agia Barbara Health Care Centre, Heraklion, Greece; 4Family Physician Airways Group of Canada, North York, CanadaAbstract: COPD is considered a complex disease and global problem that is predicted to be the third most common cause of death by 2030. While managing this chronic condition, primary health care practitioners are faced with the ongoing challenge of achieving good quality of life and overall "wellness" for those affected. As such, a practical tool for monitoring quality of life in a clinical setting is required. However, due to the wide variety of general and disease-specific tools from which to choose, primary health care practitioners are given minimal guidance as to which tool may be most appropriate. To address these challenges, the International Primary Care Respiratory Group (IPCRG proposed the creation of a user's guide for primary health care practitioners to assess "wellness" in COPD patients in an everyday clinical setting. This short report outlines the process by which the IPCRG Users' Guide to COPD "Wellness" Tools was developed. It also describes why this guide has the potential to be of great value in guiding primary health care practitioners to improve patient wellness.Keywords: wellness, quality of life, primary care, instrument

  14. Assessment of a primary and tertiary care integrated management model for chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Peiro Meritxell

    2009-02-01

    Full Text Available Abstract Background The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1 improvement in the rational utilization of health-care services and 2 benefits reflected in improved health status and quality of life for patients. Methods/Design A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients and the other the control group (n = 32,114 patients. The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts. Discussion The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of

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

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

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

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

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

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

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

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

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

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

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

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

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

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

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

  20. Developing a new assessment procedure of social information processing in adolescents within secure residential care

    NARCIS (Netherlands)

    van Rest, Maaike M.; van Bokhoven, Irene; van Nieuwenhuijzen, Maroesjka; Embregts, Petri J. C. M.; Vriens, Aart; Matthys, Walter

    2014-01-01

    The purpose of the present study was to develop a new assessment procedure of social information processing (SIP) for adolescents, to explore its validity and to examine whether it differentiated between IQ groups. Ninety-four adolescents within secure residential care were administered the SIP inst

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

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

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

  2. Food Sanitation and Safety Self-assessment Instrument for Family Day-Care Homes.

    Science.gov (United States)

    1990

    This self-assessment instrument for family day care providers is designed to help caregivers provide safe food to children. The eight sections of the instrument, presented in checklist format, concern: (1) personal hygiene; (2) purchasing and inspecting of food; (3) food storage; (4) kitchen equipment; (5) food preparation; (6) infant food…

  3. Food Sanitation and Safety Self-assessment Instrument for Child Care Centers.

    Science.gov (United States)

    1990

    This self-assessment instrument for day care center staff is designed to help caregivers provide safe food to children. The nine sections of the instrument, presented in checklist format, concern: (1) personal hygiene; (2) purchasing, receiving, and inspecting of food; (3) food storage; (4) food service equipment; (5) food preparation; (6) infant…

  4. Applicability of the assessment of chronic illness care (ACIC instrument in Germany resulting in a new questionnaire: questionnaire of chronic illness care in primary care

    Directory of Open Access Journals (Sweden)

    Campbell Stephen

    2011-07-01

    Full Text Available Abstract Background The Chronic Care Model (CCM is an evidence based, population based approach to improve care for people with chronic conditions. The Assessment of Chronic Illness Care (ACIC instrument is widely used to measure to what extent within a healthcare system the CCM is implemented. The aim of this study was to translate and culturally adapt the ACIC Instrument for the German healthcare system. Methods For translating the ACIC instrument, principles of Good Practice for the Translation and Cultural Adaptation Process by the ISPOR Task Force were followed. Focus groups were additionally conducted with general practitioners to adapt the items culturally. Results The ACIC instrument can not be used in the German healthcare system easily due to a multifaceted understanding of words, different levels of knowledge of the CCM and fundamental differences between health systems. Conclusions As following the CCM leads to benefits for patients with chronic illnesses, measuring to which extent it is implemented is of major interest. A new questionnaire using the CCM as its theoretical basis, sensitive to the healthcare systems of the host country has to be created. Knowledge transfer between countries by using an instrument from a different healthcare system can lead to a completely new questionnaire.

  5. Development of a Self-Assessment Tool to Facilitate Decision-Making in Choosing a Long Term Care Administration Major

    Science.gov (United States)

    Johs-Artisensi, Jennifer L.; Olson, Douglas M.; Nahm, Abraham Y.

    2016-01-01

    Long term care administrators need a broad base of knowledge, skills, and interests to provide leadership and be successful in managing a fiscally responsible, quality long term care organization. Researchers developed a tool to help students assess whether a long term care administration major is a compatible fit. With input from professionals in…

  6. Examination of Patient Centered Medical Home Components and Disparities in Mental Health Services Use Among Non-Latino White, Non-Latino Black, and Latino Adults in the U.S.

    OpenAIRE

    Jones, Audrey Lynn

    2013-01-01

    Mental health disorders are common but often remain untreated, resulting in a considerable burden of illness in the population. This burden falls most heavily on racial/ethnic minority populations who, compared to Non-Latino Whites, experience significant disparities in mental health services (MHS). Under the Affordable Care Act adults with a mental health disorder will experience new access to the Patient Centered Medical Home (PCMH). However, it is not yet known if core features of the P...

  7. 75 FR 9913 - Request for Measures of Patient Experiences of Cancer Care

    Science.gov (United States)

    2010-03-04

    ... tool being developed to measure Patient Centered Communication (PCC) in cancer care. While both... of the communication between patients and clinicians throughout the spectrum of cancer care (i.e...) as cited in Epstein & Street (Epstein RM, Street RL Jr. Patient Centered Communication in Cancer...

  8. Primary care physicians’ perspectives on computer-based health risk assessment tools for chronic diseases: a mixed methods study

    OpenAIRE

    Teja Voruganti; Mary Ann O'Brien; Straus, Sharon E; McLaughlin, John R.; Eva Grunfeld

    2015-01-01

    Background Health risk assessment tools compute an individual’s risk of developing a disease. Routine use of such tools by primary care physicians (PCPs) is potentially useful in chronic disease prevention. We sought physicians’ awareness and perceptions of the usefulness, usability and feasibility of performing assessments with computer-based risk assessment tools in primary care settings.Methods Focus groups and usability testing with a computer-based risk assessment tool were conducted wit...

  9. Assessment of a prototype for the Systemization of Nursing Care on a mobile device

    Directory of Open Access Journals (Sweden)

    Laura Cristhiane Mendonça Rezende

    2016-01-01

    Full Text Available Abstract Objectives: assess a prototype for use on mobile devices that permits registering data for the Systemization of Nursing Care at a Neonatal Intensive Care Unit. Method: an exploratory and descriptive study was undertaken, characterized as an applied methodological research, developed at a teaching hospital. Results: the mobile technology the nurses at the Neonatal Intensive Care Unit use was positive, although some reported they faced difficulties to manage it, while others with experience in using mobile devices did not face problems to use it. The application has the functions needed for the Systematization of Nursing Care at the unit, but changes were suggested in the interface of the screens, some data collection terms and parameters the application offers. The main contributions of the software were: agility in the development and documentation of the systemization, freedom to move, standardization of infant assessment, optimization of time to develop bureaucratic activities, possibilities to recover information and reduction of physical space the registers occupy. Conclusion: prototype software for the Systemization of Nursing Care with mobile technology permits flexibility for the nurses to register their activities, as the data can be collected at the bedside.

  10. Assessment in Kinship Foster Care: A New Tool to Evaluate the Strengths and Weaknesses

    Directory of Open Access Journals (Sweden)

    Nuria Fuentes-Peláez

    2014-12-01

    Full Text Available Placement in kinship family has existed informally throughout time. There are many countries in which kinship family care is the most common measure used for child protection. However, it is a subject of continuous debate. One of the major issues is that kinship foster care is relied upon without carrying out an evaluation study of the family; often the child is placed directly with grandparents and uncles simply because they are direct family. This article presents an assessment tool to evaluate extended families in order to ensure the welfare of the child. The tool was created as a result of the cooperative research of 126 professionals from seven regions of Spain. The tool can identify the strengths and weaknesses of families by considering six factors: personal characteristics, the coverage of basic needs, collaboration with professionals, the family structure and dynamics, the relationship between family, child, and biological family, and, finally, the attitude towards the placement. The assessment tool is innovative and introduces the opportunity to consider the skills of the kinship foster care family, the needs of support, and which families are unfit to take care of the child. To conclude, the tool tries to overcome one of the principal disadvantages of kinship foster care: the lack of knowledge about the kinship family.

  11. Patient-Assessed Chronic Illness Care (PACIC) scenario in an Indian homeopathic hospital.

    Science.gov (United States)

    Koley, Munmun; Saha, Subhranil; Ghosh, Shubhamoy; Nag, Goutam; Kundu, Monojit; Mondal, Ramkumar; Purkait, Rajib; Patra, Supratim; Ali, Seikh Swaif

    2016-01-01

    Homeopathy research has focused on chronic conditions; however, the extent to which current homeopathic care is compliant with the Chronic Care Model (CCM) has been sparsely shown. As the Bengali Patient-Assessed Chronic Illness Care (PACIC)-20 was not available, the English questionnaire was translated and evaluated in a government homeopathic hospital in West Bengal, India. The translation was done in six steps, and approved by an expert committee. Face validity was tested by 15 people for comprehension. Test/retest reliability (reproducibility) was tested on 30 patients with chronic conditions. Internal consistency was tested in 377 patients suffering from various chronic conditions. The questionnaire showed acceptable test/retest reliability [intraclass correlation coefficient (ICC) 0.57-0.75; positive to strong positive correlations; p  0.05); however, monthly household income had a significant influence (p < 0.05) on the subscales except for "delivery system or practice design." Overall, chronic illness care appeared to be quite promising and CCM-compliant. The psychometric properties of the Bengali PACIC-20 were satisfactory, rendering it a valid and reliable instrument for assessing chronic illness care among the patients attending a homeopathic hospital. PMID:26933640

  12. Perspectives and strategies of alternative methods used in the risk assessment of personal care products.

    Science.gov (United States)

    Quantin, P; Thélu, A; Catoire, S; Ficheux, H

    2015-11-01

    Risk assessment for personal care products requires the use of alternative methods since animal testing is now totally banned. Some of these methods are effective and have been validated by the "European Union Reference Laboratory for alternatives to animal testing"; but there is still a need for development and implementation of methods for specific endpoints. In this review, we have focused on dermal risk assessment because it is the prime route of absorption and main target organ for personal care products. Within this field, various areas must be assessed: irritation, sensitisation and toxicokinetic. Personal care product behaviour after use by the consumer and potential effects on the environment are also discussed. The purpose of this review is to show evolution and the prospects of alternative methods for safety dermal assessment. Assessment strategies must be adapted to the different chemical classes of substances studied but also to the way in which they are used. Finally, experimental and theoretical technical parameters that may impact on measured effects have been identified and discussed. PMID:26184446

  13. Goal Setting and Treatment Adherence among Patients with Chronic Illness and Depressive Symptoms: Applying a Patient-Centered Approach

    Science.gov (United States)

    Houston, Eric; Tatum, Alexander K.; Guy, Arryn; Mikrut, Cassandra; Yoder, Wren

    2016-01-01

    Objective: Poor treatment adherence is a major problem among individuals with chronic illness. Research indicates that adherence is worsened when accompanied by depressive symptoms. In this preliminary study, we aimed to describe how a patient-centered approach could be employed to aid patients with depressive symptoms in following their treatment regimens. Methods: The sample consisted of 14 patients undergoing antiretroviral therapy (ART) for HIV who reported clinically-significant depressive symptoms. Participant ratings of 23 treatment-related statements were examined using two assessment and analytic techniques. Interviews were conducted with participants to determine their views of information based on the technique. Results: Results indicate that while participants with optimal adherence focused on views of treatment associated with side effects to a greater extent than participants with poor adherence, they tended to relate these side effects to sources of intrinsic motivation. Conclusion: The study provides examples of how practitioners could employ the assessment techniques outlined to better understand how patients think about treatment and aid them in effectively framing their health-related goals. PMID:26755463

  14. Personality Assessment Screener, Childhood Abuse, and Adult Partner Violence in African American Women Using Primary Care.

    Science.gov (United States)

    Porcerelli, John H; Hurrell, Kristen; Cogan, Rosemary; Jeffries, Keturah; Markova, Tsveti

    2015-12-01

    This study assessed the relationship between psychopathology with the Personality Assessment Screener (PAS) and childhood physical and sexual abuse and adult physical and sexual partner violence in a primary care sample of 98 urban-dwelling African American women. Patients completed the PAS, the Childhood Trauma Questionnaire, and the Conflict Tactics Scale. The PAS total score significantly correlated with all measures of childhood and adult abuse. Stepwise regression analyses revealed that PAS element scores of Suicidal Thinking and Hostile Control significantly predicted a history of childhood physical abuse; Suicidal Thinking, Hostile Control, and Acting Out significantly predicted a history of childhood sexual abuse; Suicidal Thinking, Negative Affect, and Alienation significantly predicted current adult partner physical violence; and Psychotic Features, Alcohol Problems, and Anger Control significantly predicted current adult sexual partner violence. The PAS appears to be a useful measure for fast-paced primary care settings for identifying patients who need a more thorough assessment for abuse. PMID:26374084

  15. Hemodynamic Assessment and Monitoring in the Intensive Care Unit: an Overview

    Directory of Open Access Journals (Sweden)

    Adam C. Adler

    2014-08-01

    Full Text Available The goal of hemodynamic monitoring in intensive care is to assess the adequacy of perfusion, specifically with regard to maintaining sufficient perfusion pressures and oxygen delivery. Precise volume management of peri-operative and critical care patients is crucial as under or over resuscitation is associated with adverse outcomes. Hemodynamic monitoring allows care to be individualized based on specific patient response to therapy and can provide early warning of impending perfusion deficits or instability. Physiologic monitoring aids determination of appropriate therapy. Methods for obtaining accurate and continuous measurements in the critically ill patient have evolved from surgical and anesthetic techniques dating back more than a century. These techniques transitioned from the operating room to early intensive care units as necessitated by the polio epidemics of the 1950s. The advantages of cohorting critically ill patients led to specialized intensive care and later cardiac care units. Telemetry developed to monitor astronauts and miniaturization of electronics made possible by substituting transistors for vacuum tubes helped create the first generation of intensive care monitors in the 1960s. Transcutaneous oxygen sensors, end-tidal measurement of carbon dioxide, and pulse oximetry took monitoring to a new level by the 1980s. Monitors became more sophisticated and capable of calculating derived variables such as oxygen delivery and consumption as computer processing became routine. These data sets were useful to clinicians using fluids and vasoactive agents primarily to manipulate oxygen delivery in hemodynamically unstable patients. Recently, simply monitoring vascular pressures has given way to dynamic monitoring where physiologic changes with respiration can be used to derive additional parameters such as pulse pressure variation (PPV and stroke volume variation (SVV. Today’s clinician has a wealth of information available at the

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

    OpenAIRE

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

    2006-01-01

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

  17. Personal Care Product Use in Pregnancy and the Postpartum Period: Implications for Exposure Assessment

    Science.gov (United States)

    Lang, Carly; Fisher, Mandy; Neisa, Angelica; MacKinnon, Leona; Kuchta, Sandra; MacPherson, Susan; Probert, Adam; Arbuckle, Tye E.

    2016-01-01

    Concern regarding the potential for developmental health risks associated with certain chemicals (e.g., phthalates, antibacterials) used in personal care products is well documented; however, current exposure data for pregnant women are limited. The objective of this study was to describe the pattern of personal care product use in pregnancy and the post-partum period. Usage patterns of personal care products were collected at six different time points during pregnancy and once in the postpartum period for a cohort of 80 pregnant women in Ottawa, Canada. The pattern of use was then described and groups of personal care product groups commonly used together were identified using hierarchical cluster analysis. The results showed that product use varied by income and country of birth. General hygiene products were the most commonly used products and were consistently used over time while cosmetic product use declined with advancing pregnancy and post-delivery. Hand soaps and baby products were reported as used more frequently after birth. This study is the first to track personal care product use across pregnancy and into the postpartum period, and suggests that pregnant populations may be a unique group of personal care product users. This information will be useful for exposure assessments. PMID:26751460

  18. Unraveling care integration: Assessing its dimensions and antecedents in the Italian Health System.

    Science.gov (United States)

    Calciolari, Stefano; Ilinca, Stefania

    2016-01-01

    In recent decades, consensus has grown on the need to organize health systems around the concept of care integration to better confront the challenges associated with demographic trends and financial sustainability. However, care integration remains an imprecise umbrella term in both the academic and policy arenas. In addition, little substantive knowledge exists on the success factors for integration initiatives. We propose a composite measure of care integration and a conceptual framework suggesting its relationships with three types of antecedents: contextual, cultural, and organizational factors. Our framework was tested using data from the Italian National Health System (NHS). We administered an ad-hoc questionnaire to all Italian local health units (LHUs), with a 60.4% response rate, and used structural equation modeling to assess the relationships between the relevant latent constructs. The results validated our measure of care integration and supported the hypothesized relationships. In particular, integration was found to be fostered by results-oriented institutional settings, a professional culture conducive to inclusiveness and shared goals, and organizational arrangements promoting clear expectations among providers. Thus, integration improves care and mediates the effects of specific operating means on care enhancement. PMID:26725643

  19. Personal Care Product Use in Pregnancy and the Postpartum Period: Implications for Exposure Assessment

    Directory of Open Access Journals (Sweden)

    Carly Lang

    2016-01-01

    Full Text Available Concern regarding the potential for developmental health risks associated with certain chemicals (e.g., phthalates, antibacterials used in personal care products is well documented; however, current exposure data for pregnant women are limited. The objective of this study was to describe the pattern of personal care product use in pregnancy and the post-partum period. Usage patterns of personal care products were collected at six different time points during pregnancy and once in the postpartum period for a cohort of 80 pregnant women in Ottawa, Canada. The pattern of use was then described and groups of personal care product groups commonly used together were identified using hierarchical cluster analysis. The results showed that product use varied by income and country of birth. General hygiene products were the most commonly used products and were consistently used over time while cosmetic product use declined with advancing pregnancy and post-delivery. Hand soaps and baby products were reported as used more frequently after birth. This study is the first to track personal care product use across pregnancy and into the postpartum period, and suggests that pregnant populations may be a unique group of personal care product users. This information will be useful for exposure assessments.

  20. Getting on with your computer is associated with job satisfaction in primary care: entrants to primary care should be assessed for their competency with electronic patient record systems

    Directory of Open Access Journals (Sweden)

    Simon de Lusignan

    2014-02-01

    Full Text Available Job satisfaction in primary care is associated with getting on with your computer. Many primary care professionals spend longer interacting with their computer than anything else in their day. However, the computer often makes demands rather than be an aid or supporter that has learned its user’s preferences. The use of electronic patient record (EPR systems is underrepresented in the assessment of entrants to primary care, and in definitions of the core competencies of a family physician/general practitioner. We call for this to be put right: for the use of the EPR to support direct patient care and clinical governance to be given greater prominence in training and assessment. In parallel, policy makers should ensure that the EPR system use is orientated to ensuring patients receive evidence-based care, and EPR system suppliers should explore how their systems might better support their clinician users, in particular learning their preferences.

  1. Getting on with your computer is associated with job satisfaction in primary care: entrants to primary care should be assessed for their competency with electronic patient record systems.

    Science.gov (United States)

    de Lusignan, Simon; Pearce, Christopher; Munro, Neil

    2013-01-01

    Job satisfaction in primary care is associated with getting on with your computer. Many primary care professionals spend longer interacting with their computer than anything else in their day. However, the computer often makes demands rather than be an aid or supporter that has learned its user's preferences. The use of electronic patient record (EPR) systems is underrepresented in the assessment of entrants to primary care, and in definitions of the core competencies of a family physician/general practitioner. We call for this to be put right: for the use of the EPR to support direct patient care and clinical governance to be given greater prominence in training and assessment. In parallel, policy makers should ensure that the EPR system use is orientated to ensuring patients receive evidence-based care, and EPR system suppliers should explore how their systems might better support their clinician users, in particular learning their preferences. PMID:24629650

  2. Assessment of linkages from HIV testing to enrolment and retention in HIV care in Central Mozambique

    Science.gov (United States)

    Inguane, Celso Azarias; Gloyd, Stephen; Manuel, João Luis; Brown, Charlene; Wong, Vincent; Augusto, Orvalho; Hassan, Wisal Mustafa; Vieira, Lúcia; Afonso, Pires; Jamnadás, Mehol; Bernard, Jama Joy; Cowan, James; Kalibala, Samuel; Pfeiffer, James

    2016-01-01

    Introduction Effectiveness of the rapid expansion of antiretroviral therapy (ART) throughout sub-Saharan Africa is highly dependent on adequate enrolment and retention in HIV care. However, the measurement of both has been challenging in these settings. This study aimed to assess enrolment and retention in HIV care (pre-ART and ART) among HIV-positive adults in Central Mozambique, including identification of barriers and facilitators. Methods We assessed linkages to and retention in HIV care using a mixed quantitative and qualitative approach in six districts of Manica and Sofala provinces. We analyzed routine district and health facility monthly reports and HIV care registries from April 2012 to March 2013 and used single imputation and trimmed means to adjust for missing values. In eight health facilities in the same districts and period, we assessed retention in HIV care among 795 randomly selected adult patient charts (15 years and older). We also conducted 25 focus group discussions and 53 in-depth interviews with HIV-positive adults, healthcare providers and community members to identify facilitators and barriers to enrolment and retention in HIV care. Results Overall, 46% of the monthly HIV testing reports expected at the district level were missing, compared to 6.4% of the pre-ART registry reports. After adjustment for missing values, we estimated that the aggregate numbers of adults registered in pre-ART was 75% of the number of persons tested HIV-positive in the six districts. In the eight health facilities, 40% of the patient charts for adults enrolled in pre-ART and 44% in ART were missing. Of those on ART for whom charts were found, retention in treatment within 90 and 60 days prior to the study team visit was 34 and 25%, respectively. Combining these multiple data sources, the overall estimated retention was 18% in our sample. Individual-level factors were perceived to be key influences to enrolment in HIV care, while health facility and structural

  3. Improving adjustments for older age in pre-hospital assessment and care

    Directory of Open Access Journals (Sweden)

    Rehn Marius

    2013-01-01

    Full Text Available Abstract Population estimates projects a significant increase in the geriatric population making elderly trauma patients more common. The geriatric trauma patients experience higher incidence of pre-existing medical conditions, impaired age-dependent physiologic reserve, use potent drugs and suffer from trauma system related shortcomings that influence outcomes. To improve adjustments for older age in pre-hospital assessment and care, several initiatives should be implemented. Decision-makers should make system revisions and introduce advanced point-of-care initiatives to improve outcome after trauma for the elderly.

  4. Assessment and Availability of Trauma Care Services in a District Hospital of South India; A Field Observational Study

    OpenAIRE

    Pallavi Sarji Uthkarsh; Gopalkrishna Gururaj; Sai Sabharish Reddy; Mandya Siddalingaiah Rajanna

    2016-01-01

    Objective: To assess the availability of trauma care services in a district referral hospital of Southern India. Methods: This was a cross-sectional study being performed during 2013 in a tertiary healthcare centre in Southern Indian. A detailed assessment of trauma care services was done in a 400 bed speciality hospital which is an apex referral hospital in the public health system using a check list based on WHO guidelines for evaluation of essential trauma care services, along with in-d...

  5. Model documentation of assessment and nursing diagnosis in the practice of nursing care management for nursing students

    OpenAIRE

    A. Aziz Alimul Hidayat; M. Kes

    2015-01-01

    Model documentation of assessment and nursing diagnosis in the practice of nursing care management is an integration model in nursing care records, especially records nursing assessment and diagnosis in one format. This model can reduce the duration of the recording in nursing care, and make it easier for students to understand the nursing diagnosis, so that nursing interventions more effective. The purpose of this paper was to describes the form integration documentation of nursing assessmen...

  6. Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition

    OpenAIRE

    Latour Judith; Leduc Nicole; Leclerc Bernard-Simon; Kergoat Marie-Jeanne; Berg Katherine; Bolduc Aline

    2009-01-01

    Abstract Background The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs). Methods The methodology involved a reliability and feasibility study of a retrospective chart review on 934 o...

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

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    Cuembelo Fatima

    2011-05-01

    Full Text Available Abstract Background Primary health care is recognized as a main driver of equitable health service delivery. For it to function optimally, routine health information systems (HIS are necessary to ensure adequate provision of health care and the development of appropriate health policies. Concerns about the quality of routine administrative data have undermined their use in resource-limited settings. This evaluation was designed to describe the availability, reliability, and validity of a sample of primary health care HIS data from nine health facilities across three districts in Sofala Province, Mozambique. HIS data were also compared with results from large community-based surveys. Methodology We used a methodology similar to the Global Fund to Fight AIDS, Tuberculosis and Malaria data verification bottom-up audit to assess primary health care HIS data availability and reliability. The quality of HIS data was validated by comparing three key indicators (antenatal care, institutional birth, and third diptheria, pertussis, and tetanus [DPT] immunization with population-level surveys over time. Results and discussion The data concordance from facility clinical registries to monthly facility reports on five key indicators--the number of first antenatal care visits, institutional births, third DPT immunization, HIV testing, and outpatient consults--was good (80%. When two sites were excluded from the analysis, the concordance was markedly better (92%. Of monthly facility reports for immunization and maternity services, 98% were available in paper form at district health departments and 98% of immunization and maternity services monthly facility reports matched the Ministry of Health electronic database. Population-level health survey and HIS data were strongly correlated (R = 0.73, for institutional birth, first antenatal care visit, and third DPT immunization. Conclusions Our results suggest that in this setting, HIS data are both reliable and

  8. Application of Donabedian quality-of-care framework to assess the outcomes of preconception care in urban health centers, Mashhad, Iran in 2012

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    Fatemeh Ghaffari

    2013-12-01

    Full Text Available Background and aim: Improving patient health status is the primary goal of healthcare system. and planning to improve the health care services without taking into account the views of care receivers is not possible .In this regard, Donabedian Model as an appropriate framework in assessing the quality of health care, has particular attention to the issue of "outcomes", which are sometimes seen as the most important indicators of quality. This study therefore aimed to assess the outcomes of preconception care including changes to health knowledge as well as patient satisfaction in urban health centers, Mashhad, Iran in 2012. Methods: In this descriptive study, 350 women of reproductive age who received preconception care in urban health centers of Mashhad, Iran, were selected using a two stage sampling design. Demographic and obstetric data were collected through a self-structured questionnaire.  Outcomes of preconception care including health knowledge as well as patient satisfaction were measured using a questionnaire adopted from Donabedian Model. Data were analyzed with SPSS Software version 16 and statistical tests such as ANOVA, Chi-square and Pearson correlation coefficient. Findings: The mean age of women was 22.5 ± 26.93 and the mean score of their marriage years was 6.32±4.77.  67.4% of subjects experienced between one and six pregnancies. The mean score of health knowledge of preconception care was 53.4 ± 8.14 and the highest score of its subdomains was related to the personal hygiene. The mean score of patients' satisfaction of preconception care was 84.11 ± 56.75 and its highest score was in relation to counseling and provided care. Conclusion: According to the results, planning to provide better education services for clients, raising public awareness regarding preconception care and more emphasis on preconception care importance in continuous education of health care providers are recommended.  

  9. Stakeholders' Perceptions About a Newly Established Dental School with a Problem-Based, Student-Led, Patient-Centered Curriculum: A Qualitative Study.

    Science.gov (United States)

    Ali, Kamran; Tredwin, Christopher; Kay, Elizabeth; Slade, Anita

    2016-03-01

    The aim of this study was to explore the perceptions of stakeholders regarding a newly established dental school with a problem-based, student-led, patient-centered curriculum in a community setting. Qualitative methods using 16 semistructured interviews and two focus groups were used to engage a range of stakeholders from students to faculty members to practitioners. Purposive sampling was employed with participants contacted through professional channels. Interview and focus group transcripts were transcribed verbatim. The data were analyzed thematically using an inductive approach. Themes related to preparedness of dental graduates were identified during data analyses. Early clinical exposure with patients in the first year of the course, holistic care using a patient-centered approach, and the acquisition of communication skills, professionalism, team-working skills, reflective practice, and evidence-informed clinical practice were perceived to be key strengths of the curriculum. The participants also expressed the need to strengthen teaching of life sciences and provide additional clinical experience in simulated general dental practice clinics. This study provides insight into the perceptions of a wide range of stakeholders and provides a deeper understanding of the merits and challenges of an innovative undergraduate dental curriculum. PMID:26933104

  10. Harnessing person-generated health data to accelerate patient-centered outcomes research: the Crohn's and Colitis Foundation of America PCORnet Patient Powered Research Network (CCFA Partners).

    Science.gov (United States)

    Chung, Arlene E; Sandler, Robert S; Long, Millie D; Ahrens, Sean; Burris, Jessica L; Martin, Christopher F; Anton, Kristen; Robb, Amber; Caruso, Thomas P; Jaeger, Elizabeth L; Chen, Wenli; Clark, Marshall; Myers, Kelly; Dobes, Angela; Kappelman, Michael D

    2016-05-01

    The Crohn's and Colitis Foundation of America Partners Patient-Powered Research Network (PPRN) seeks to advance and accelerate comparative effectiveness and translational research in inflammatory bowel diseases (IBDs). Our IBD-focused PCORnet PPRN has been designed to overcome the major obstacles that have limited patient-centered outcomes research in IBD by providing the technical infrastructure, patient governance, and patient-driven functionality needed to: 1) identify, prioritize, and undertake a patient-centered research agenda through sharing person-generated health data; 2) develop and test patient and provider-focused tools that utilize individual patient data to improve health behaviors and inform health care decisions and, ultimately, outcomes; and 3) rapidly disseminate new knowledge to patients, enabling them to improve their health. The Crohn's and Colitis Foundation of America Partners PPRN has fostered the development of a community of citizen scientists in IBD; created a portal that will recruit, retain, and engage members and encourage partnerships with external scientists; and produced an efficient infrastructure for identifying, screening, and contacting network members for participation in research. PMID:26911821

  11. Patient Assessment of Chronic Illness Care (PACIC) in Type 2 Diabetes: A Longitudinal Study.

    Science.gov (United States)

    Aung, Eindra; Ostini, Remo; Dower, Jo; Donald, Maria; Coll, Joseph R; Williams, Gail M; Doi, Suhail A R

    2016-06-01

    The Patient Assessment of Chronic Illness Care (PACIC) was designed to measure care congruent with several elements of the chronic care model (CCM), including self-management support and delivery system design. However, support for the a priori 5-subscale structure of the PACIC in previous research has been conflicting. Thus, we aim to investigate psychometric characteristics of the PACIC including the content and stability of its construct over time. A population-based prospective cohort study of patients with type 2 diabetes was conducted in Queensland, Australia, from 2008 (N = 3,761) to 2010 (N = 3,040). Participants completed annually the 20-item PACIC as well as measures of providers' adherence to guideline-recommended self-management support activities. We used exploratory factor analysis to determine its factor structure and examined internal consistency as well as agreement between the PACIC at baseline with repeated measurements at follow-up after 1 and 2 years. We also determined a criterion-related validity using multinomial logistic regression to explore PACIC's association with providers' self-management support. A one-factor structure was deemed optimal according to our findings. High internal consistency and moderate agreement within the scales over time were observed. Higher PACIC scores predicted better providers' self-management support. In conclusion, the PACIC is a reliable, valid, and reproducible instrument for assessment of diabetes care, and we recommend its promotion and use as a single scale rather than subscales as originally proposed. PMID:25380699

  12. Assessment of primary care nursing in relation to adolescent health behaviour by means of trigger films.

    Science.gov (United States)

    Eshed, H; Epstein, L

    1991-01-01

    The patterns of adolescents' behaviour place them at a risk from developing health and social pathology. In order to assess whether primary care nursing meets adolescents' health needs, the reported performance of 306 registered nurses working in different primary health care settings was studied. The research tool developed especially for the study was a video-taped trigger film. Demographic, education and work-related variables were studied by means of a questionnaire. The behaviour patterns studied were smoking, sexual activity, alcohol and drug consumption, and eating habits. The clinical issues were hypertension, obesity and anorexia nervosa. Reported performance was low--35% of the total possible score--with the lowest scores in the areas of preventive care, data gathering and recording, and somewhat higher in the areas of curative care and follow-up. The video-taped trigger films were considered to have face validity; they were found to be reliable, with an ability to assess the nurses' reported performance and to differentiate between the nurses in the three different work settings. This is the first study of its kind in Israel. The results show that primary health nursing of adolescents is insufficient, and that teenagers should get higher priority as a target population from the nursing profession in order to achieve WHO's aims of 'health for all by the year 2000'. PMID:2005286

  13. Instrument for assessing the quality of mobile emergency pre-hospital care: content validation

    Directory of Open Access Journals (Sweden)

    Rodrigo Assis Neves Dantas

    2015-06-01

    Full Text Available OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K and Content Validity Index (CVI, considering K> 0.80 and CVI ≥ 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services.

  14. Assessing the context of health care utilization in Ecuador: A spatial and multilevel analysis

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    Chi Chunhuei

    2010-03-01

    Full Text Available Abstract Background There are few studies that have analyzed the context of health care utilization, particularly in Latin America. This study examines the context of utilization of health services in Ecuador; focusing on the relationship between provision of services and use of both preventive and curative services. Methods This study is cross-sectional and analyzes data from the 2004 National Demographic and Maternal & Child Health dataset. Provider variables come from the Ecuadorian System of Social Indicators (SIISE. Global Moran's I statistic is used to assess spatial autocorrelation of the provider variables. Multilevel modeling is used for the simultaneous analysis of provision of services at the province-level with use of services at the individual level. Results Spatial analysis indicates no significant differences in the density of health care providers among Ecuadorian provinces. After adjusting for various predisposing, enabling, need factors and interaction terms, density of public practice health personnel was positively associated with use of preventive care, particularly among rural households. On the other hand, density of private practice physicians was positively associated with use of curative care, particularly among urban households. Conclusions There are significant public/private, urban/rural gaps in provision of services in Ecuador; which in turn affect people's use of services. It is necessary to strengthen the public health care delivery system (which includes addressing distribution of health workers and national health information systems. These efforts could improve access to health care, and inform the civil society and policymakers on the advances of health care reform.

  15. Stress assessment by anaesthesiologists and nurses working in paediatric intensive care units

    OpenAIRE

    Grzeskowiak, Malgorzata; Bartkowska-Sniatkowska, Alicja; Rosada-Kurasinska, Jowita; Kielbasiewicz-Drozdowska, Iwona; Janicki, Piotr K

    2013-01-01

      Abstract. Paediatric intensive care units (PICU) play a special role in the therapy of critically ill children. The physicians (anaesthesiologists) and nurses are at a particular risk of job-related stress because continuous work stress can lead to psychological and physical disturbances. The aim of the study was to assess the stress level among the anaesthesiologists and nurses in the PICU. The anaesthesiologists and nurses (104), recruited from five university hospital centres in Poland, ...

  16. Practical aspects of conducting a pragmatic randomised trial in primary care: patient recruitment and outcome assessment.

    OpenAIRE

    2000-01-01

    BACKGROUND: Conducting a pragmatic randomised trial in primary care is often accompanied by practical problems. Such problems are seldom reported and may constitute useful lessons for researchers planning future trials. AIM: To address the difficulties involved in patient recruitment and to present measures to minimise bias during outcome assessment. METHOD: A recently conducted trial comparing the effects of corticosteroid injections and physiotherapy for painful stiff shoulder was used to i...

  17. Using Diffusion of Innovations Theory to implement the confusion assessment method for the intensive care unit.

    Science.gov (United States)

    Bowen, Constance Mary; Stanton, Marietta; Manno, Martin

    2012-01-01

    Routine screening of mechanically ventilated patients for delirium is essential for prompt recognition and management; however, this represents a change in practice. Rogers' Diffusion of Innovations Theory can be useful as a strategy to facilitate adoption of a practice change. This case study describes the effectiveness of identifying barriers to a change in practice and developing strategies, specific to Rogers' innovation decision process, for implementing the Confusion Assessment Method for the intensive care unit. PMID:22367153

  18. Antenatal Care Strengthening in Jimma, Ethiopia: A Mixed-Method Needs Assessment

    OpenAIRE

    Sarah Fredsted Villadsen; Britt Pinkowski Tersbøl; Dereje Negussie; Abebe GebreMariam; Abebech Tilahun; Henrik Friis; Vibeke Rasch

    2014-01-01

    Objective. We assessed how health system priorities matched user expectations and what the needs for antenatal care (ANC) strengthening were for improved maternal health in Jimma, Ethiopia. Methods. A questionnaire survey among all recent mothers in the study area was conducted to study the content of ANC and to identify the predictors of low ANC satisfaction. Further, a qualitative approach was applied to understand perceptions, practices, and policies of ANC. Results. There were no national...

  19. Improving adjustments for older age in pre-hospital assessment and care

    OpenAIRE

    Rehn Marius

    2013-01-01

    Abstract Population estimates projects a significant increase in the geriatric population making elderly trauma patients more common. The geriatric trauma patients experience higher incidence of pre-existing medical conditions, impaired age-dependent physiologic reserve, use potent drugs and suffer from trauma system related shortcomings that influence outcomes. To improve adjustments for older age in pre-hospital assessment and care, several initiatives should be implemented. Decision-makers...

  20. Pulmonary Edema Assessed by Ultrasound: Impact in Cardiology and Intensive Care Practice.

    Science.gov (United States)

    Blanco, Pablo A; Cianciulli, Tomás F

    2016-05-01

    Pulmonary edema is a frequent condition found in adult patients hospitalized in cardiology wards and intensive care units. Ultrasonography is a diagnostic modality with a high sensitivity for the detection of extravascular lung water, visualized as B lines, and usually caused by cardiogenic or noncardiogenic pulmonary edema. This paper highlights a simple method for the assessment of patients with pulmonary edema, which allows for a differential diagnosis of its possible mechanism and contributes to therapeutic intervention guiding and monitoring. PMID:26841270

  1. Instrument for assessing the quality of mobile emergency pre-hospital care: content validation

    OpenAIRE

    2015-01-01

    OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K) and Content Validity Index (CVI), considering K> 0.80 and CVI ≥ 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes a...

  2. Assessment of the breath alcohol concentration in emergency care patients with different level of consciousness

    OpenAIRE

    Kaisdotter Andersson, Annika; Kron, Josefin; Castren, Maaret; Muntlin Athlin, Åsa; Hök, Bertil; Wiklund, Lars

    2015-01-01

    Background Many patients seeking emergency care are under the influence of alcohol, which in many cases implies a differential diagnostic problem. For this reason early objective alcohol screening is of importance not to falsely assign the medical condition to intake of alcohol and thus secure a correct medical assessment. Objective At two emergency departments, demonstrate the feasibility of accurate breath alcohol testing in emergency patients with different levels of cooperation. Method As...

  3. An approach to sexuality from primary care nursing, what to assess?

    Directory of Open Access Journals (Sweden)

    Laura Figueroa-Martín

    2015-08-01

    Full Text Available This study analyzes the content validity and criterion of different parts of the interview relationed with the sexuality pattern and studies the clinimetric and psychometric characteristics of the selected instruments in the review of literature -scoping review-.. By the inclusions criteria, 28 items have been selected; of which seven questionnaires assess sexuality in women and men. The contribution of this study to nursing care is to provide suitable tools for valuation of sexuality, raising awareness on the need to conclude in important areas of exploration and develop effective tools for the assessment of this pattern in children, adolescents and elderly.

  4. Assessment of the structural and process aspects of pharmaceutical care at a university hospital in Ethiopia

    Directory of Open Access Journals (Sweden)

    Abdrrahman Shemsu Surur

    2015-01-01

    Full Text Available Objective: To assess the structural and process components of the pharmaceutical care at Gondar University Referral Hospital (GURH. Materials and Methods: An institution-based cross-sectional study was conducted on all the four pharmacies at GURH from October 1 to December 31, 2013. By adopting data collection instruments from a previously done study, the structural aspects of the pharmacies were assessed using an observation checklist and the process of pharmaceutical care delivery using a self-administered questionnaire. The data collected was entered to and analyzed using Statistical Packages for Social Sciences (SPSS version 16.0. Results: none of the pharmacies had a private counseling room, fire extinguisher and meeting area. None of the pharmacy stores were equipped with fan and air ventilation system and had no cross aisles. The mean values for documentation, patient assessment and implementation of therapeutic objective were 12.14, 14.03 and 5.64 respectively. Many pharmacists (64.29% did not participate in ward rotation with physicians. The overall pharmacy professionals′ level of job satisfaction was found to be 2.77. Conclusion: There were gaps in the structure and the process of the provision of pharmaceutical care in GURH.

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

    Science.gov (United States)

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

    2011-04-01

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

  6. An opportunity for coordinated cancer care: intersection of health care reform, primary care providers, and cancer patients.

    Science.gov (United States)

    Collins, Lauren G; Wender, Richard; Altshuler, Marc

    2010-01-01

    The US health care system has become increasingly unsustainable, threatened by poor quality and spiraling costs. Many Americans are not receiving recommended preventive care, including cancer screening tests. Passage of the Affordable Care Act in March 2010 has the potential to reverse this course by increasing access to primary care providers, extending coverage and affordability of health insurance, and instituting proven quality measures. In order for health care reform to succeed, it will require a stronger primary care workforce, a new emphasis on patient-centered care, and payment incentives that reward quality over quantity. Innovations such as patient-centered medical homes, accountable care organizations, and improved quality reporting methods are central features of a redesigned health care delivery system and will ultimately change the face of cancer care in the United States. PMID:21131791

  7. Patient-Centered Communication: Exploring the Dentist's Role in the Era of e-Patients and Health 2.0.

    Science.gov (United States)

    Seymour, Brittany; Yang, Helen; Getman, Rebekah; Barrow, Jane; Kalenderian, Elsbeth

    2016-06-01

    In today's digital era, people are increasingly relying on the Internet-including social media-to access health information and inform their health decisions. This article describes an exploratory initiative to better understand and define the role of dentists in patient education in the context of e-patients and Health 2.0. This initiative consisted of four phases. In Phase I, an interdisciplinary expert advisory committee was assembled for a roundtable discussion about patients' health information-seeking behaviors online. In Phase II, a pilot case study was conducted, with methods and analysis informed by Phase I recommendations. Phase III consisted of a debriefing conference to outline future areas of research on modernizing health communication strategies. In Phase IV, the findings and working theories were presented to 75 dental students, who then took a survey regarding their perspectives with the objective of guiding potential curriculum design for predoctoral courses. The results of the survey showed that the validity of online content was often secondary to the strength of the network sharing it and that advocacy online could be more effective if it allowed for emotional connections with peers rather than preserving accuracy of the information. Students expressed high interest in learning how to harness modern health communications in their clinical care since the role of the dentist is evolving from giving information to giving personalized guidance against the backdrop of an often contradictory modern information environment. The authors recommend that the dental profession develop patient-centered health communication training for predoctoral students and professional development and continuing education for practicing professionals. PMID:27251352

  8. Quality of life assessment in advanced cancer patients treated at home, an inpatient unit, and a day care center

    OpenAIRE

    Leppert, Wojciech; Majkowicz, Mikolaj; Forycka, Maria; Mess, Eleonora; Zdun-Ryzewska, Agata

    2014-01-01

    Aim of the study To assess quality of life (QoL) in cancer patients treated at home, at an in-patient palliative care unit (PCU), and at a day care center (DCC). Patients and methods QoL was assessed in advanced cancer patients at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL), the Edmonton Symptom Assessment System (ESAS), and the Karnofsky Perfor...

  9. Certification of health care organisations, assessment of professional practices and external radiotherapy

    International Nuclear Information System (INIS)

    In France, accreditation of health care organisations (HCOs) is mandatory every 4 years. It is based on a systemic approach and, since 2004, includes professional practice appraisal (EPP) against good practice guidelines. However, following an incident in Epinal, a new quality assurance criterion was introduced in 2007 for external radiotherapy (ERT) on top of the annual inspection of patient radiation protection by the Nuclear Safety Authority. In the accreditation procedure starting January 2010, ERT work organisation will come under 'high-risk activity' (criterion 26b) and radio-vigilance will be included in the adverse events reporting system (8i). In addition, ERT will have to comply with many generic criteria on quality and safety improvement. For example, practice appraisal of all clinical activities will become routine. Thus, besides self-assessment against criteria 26b and 8i, ERT professionals will have report the impact of their quality improvement actions on patient care. They will be able to freely choose the area for improvement, as long as it is in line with the HCO's overall quality and safety plan. In oncology, multidisciplinary team meetings for deciding on the treatment plan, as well as mortality and morbidity meetings providing feedback, are compulsory (28a). Appraisal of appropriateness of care (28b) and indicator-based practice appraisal (28c) complete the process. In conclusion, the generic practice appraisal approach that is part of the French HCO accreditation procedure can contribute toward improving health care and education, but it has not been designed for in-depth assessment of complex, multidisciplinary clinical practice such as ERT. Such assessment requires a specific clinical audit and specialized auditors. (authors)

  10. Balanced Scorecards As a Tool for Developing Patient-Centered Pharmacy Services

    Science.gov (United States)

    Enwere, Emmanuel N.; Keating, Ellen A.; Weber, Robert J.

    2014-01-01

    Having accurate data is essential for the pharmacy director to manage the department and develop patient-centered pharmacy services. A balanced scorecard (BSC) of essential department data, which is a broad view of a department’s function beyond its financial performance, is an important part of any department’s strategic plan. This column describes how the pharmacy director builds and promotes a department’s BSC. Specifically, this article reviews how the BSC supports the department’s mission and vision, describes the metrics of the BSC and how they are collected, and recommends how the pharmacy director can effectively use the scorecard results in promoting the pharmacy. If designed properly and updated consistently, a BSC can present a broad view of the pharmacy’s performance, serve as a guide for strategic decision making, and improve on the quality of its services. PMID:24958976

  11. Putting patients first: a novel patient-centered model for medical enterprise success.

    Science.gov (United States)

    Dhawan, Naveen

    2014-01-01

    This article introduces a new way of viewing patient-customers. It encourages a greater emphasis on patients' needs and the importance of considering dimensions of the patient experience to better serve them. It also draws from examples in the general business world as they can be applied to medical enterprises. The author introduces a model that directs all business activities toward the end consumer with an underlying guidance by patient needs. A business is advised to understand its customer, design a patient-directed vision, and focus on creating a unique customer experience. The article delineates key action items for physicians and administrators that will allow them to better meet their patient-customers' needs and develop loyalty. By practicing a patient-centered approach and following these guidelines, one may ensure greater success of the medical enterprise. PMID:25108980

  12. Design and Implementation Content Validity Study: Development of an instrument for measuring Patient-Centered Communication

    Directory of Open Access Journals (Sweden)

    Vahid Zamanzadeh

    2015-06-01

    Full Text Available ABSTRACT Introduction: The importance of content validity in the instrument psychometric and its relevance with reliability, have made it an essential step in the instrument development. This article attempts to give an overview of the content validity process and to explain the complexity of this process by introducing an example. Methods: We carried out a methodological study conducted to examine the content validity of the patient-centered communication instrument through a two-step process (development and judgment. At the first step, domain determination, sampling (item generation and instrument formation and at the second step, content validity ratio, content validity index and modified kappa statistic was performed. Suggestions of expert panel and item impact scores are used to examine the instrument face validity. Results: From a set of 188 items, content validity process identified seven dimensions includes trust building (eight items, informational support (seven items, emotional support (five items, problem solving (seven items, patient activation (10 items, intimacy/friendship (six items and spirituality strengthening (14 items. Content validity study revealed that this instrument enjoys an appropriate level of content validity. The overall content validity index of the instrument using universal agreement approach was low; however, it can be advocated with respect to the high number of content experts that makes consensus difficult and high value of the S-CVI with the average approach, which was equal to 0.93. Conclusion: This article illustrates acceptable quantities indices for content validity a new instrument and outlines them during design and psychometrics of patient-centered communication measuring instrument.

  13. Foster care assessment: A study of the placement decision process in Flanders.

    Science.gov (United States)

    Vanderfaeillie, Johan; Pijnenburg, Huub; Damen, Harm; Van Holen, Frank

    2015-11-01

    Family foster care placement decision-making has a weak scientific underpinning. Mostly a 'variable-oriented approach' is taken, which requires a lot of information that is not always available. The identification of clusters of foster children with similar characteristics may be a more viable decision strategy. In this study we investigated if foster children could indeed be clustered, which problems were identified at the time of placement, and the influence of placement history. It proved possible to group foster children into two clusters: (1) young children with familial problems and few behavioral problems, and (2) older children with prominent child problems and behavioral problems. For foster children with and without placement history, problems associated with placement proved identical. Considering that a foster care placement did not result in fundamental change in the problems present at time of placement, the importance is stressed of approaching foster care assessment as part of a decision making process which looks back as well as forward. Placement decisions should be based on an appraisal of the appropriateness of foster placement as a solution for the child. In conjunction with this appraisal a decision is required on how parents can be supported toward reunification. Or--if this is not an option--whether long term foster care is the best option for the child and if so, what conditions need to be met. PMID:25913381

  14. Report to Congress: Summary Report of the Assessment of Current State Practices in Title XX Funded Day Care Programs.

    Science.gov (United States)

    Administration for Children, Youth, and Families (DHHS), Washington, DC.

    In 1980 the federal government mandated that assistance be given states to conduct systematic assessment of current practices in Title XX funded day care programs and that a summary report of this assessment be provided to Congress. Assessment findings are given in this document. Overall, provider practices exceeded state licensing standards and…

  15. A study assessing patient satisfaction in a tertiary care hospital in India: the changing healthcare scenario.

    Science.gov (United States)

    Agarwal, Aashima; Garg, Shalini; Pareek, Udai

    2009-06-01

    The healthcare service scenario in India is expected to evolve into a more developed stage. More emphasis has been given on patient satisfaction as this is an important consideration for the assessment of the hospital services. The concept of patient satisfaction is also rapidly changing and the hospitals are using variety of techniques to improve patient care and organizational efficiency. Patient satisfaction questionnaire is a validated instrument to assess the level of the satisfaction of adult patients. The questionnaire was administered on those patients who were admitted in hospital for at least three days. In our study 88% patients were satisfied with treatment and medical care they had received. About 86% patients found that the hospital services were excellent. However, it is felt that patient values and culture should be explored for further improving patient doctor communication. There is hence a scope for improvement in meeting patient's needs and preferences and rendering hospital services. This can be achieved by some feedback system which could be available to the patients and later worked upon by the management, to improve the patient care by bridging the gap between senior management and patients. PMID:22010498

  16. The PERS(2) ON score for systemic assessment of symptomatology in palliative care: a pilot study.

    Science.gov (United States)

    Masel, E K; Berghoff, A S; Schur, S; Maehr, B; Schrank, B; Simanek, R; Preusser, M; Marosi, C; Watzke, H H

    2016-07-01

    The comprehensive assessment of symptoms is the basis for effective, individualised palliative treatment. Established scoring systems provide in-depth information but are often lengthy and hence unsuitable. We introduce the PERS(2) ON score as a short and practically feasible score to evaluate symptom burden. Fifty patients admitted to a Palliative Care Unit rated seven items, i.e. pain, eating (loss of appetite/weight loss), rehabilitation (physical impairment), social situation (possibility for home care), suffering (anxiety/burden of disease/depression), O2 (dyspnoea) and nausea/emesis, on a scale ranging from 0 (absence) to 10 (worst imaginable), resulting in a score ranging from 0 to 70. Assessments were performed at admission, 7 days after admission and at the day of discharge. Symptom intensity scores were calculated, and change over time was evaluated. A significant improvement was observed from the PERS²ON score between admission and 7 days (P evaluation to evaluation on the day of discharge was observed (P = 0.001; paired t-test). This study provides initial evidence that the PERS²ON score is both feasible and sensitive to changes of the most prominent symptoms in palliative care. It may be useful in clinical practice to direct palliative treatment strategies and provide targeted symptom management. PMID:26564404

  17. Quality of life assessment in advanced cancer patients treated at home, an inpatient unit, and a day care center

    OpenAIRE

    Leppert, Wojciech

    2014-01-01

    Wojciech Leppert,1 Mikolaj Majkowicz,2 Maria Forycka,1 Eleonora Mess,3 Agata Zdun-Ryzewska2 1Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland; 2Department of Quality of Life Research, Gdansk Medical University, Gdansk, Poland; 3Palliative Care Nursing Department, Wroclaw Medical University, Wroclaw, Poland Aim of the study: To assess quality of life (QoL) in cancer patients treated at home, at an in-patient palliative care unit (PCU), and at a day care...

  18. Complex health care interventions: Characteristics relevant for ethical analysis in health technology assessment

    Directory of Open Access Journals (Sweden)

    Lysdahl, Kristin Bakke

    2016-03-01

    Full Text Available Complexity entails methodological challenges in assessing health care interventions. In order to address these challenges, a series of characteristics of complexity have been identified in the Health Technology Assessment (HTA literature. These characteristics are primarily identified and developed to facilitate effectiveness, safety, and cost-effectiveness analysis. However, ethics is also a constitutive part of HTA, and it is not given that the conceptions of complexity that appears relevant for effectiveness, safety, and cost-effectiveness analysis are also relevant and directly applicable for ethical analysis in HTA. The objective of this article is therefore to identify and elaborate a set of key characteristics of complex health care interventions relevant for addressing ethical aspects in HTA. We start by investigating the relevance of the characteristics of complex interventions, as defined in the HTA literature. Most aspects of complexity found to be important when assessing effectiveness, safety, and efficiency turn out also to be relevant when assessing ethical issues of a given health technology. However, the importance and relevance of the complexity characteristics may differ when addressing ethical issues rather than effectiveness. Moreover, the moral challenges of a health care intervention may themselves contribute to the complexity. After identifying and analysing existing conceptions of complexity, we synthesise a set of five key characteristics of complexity for addressing ethical aspects in HTA: 1 multiple and changing perspectives, 2 indeterminate phenomena, 3 uncertain causality, 4 unpredictable outcome, and 5 ethical complexity. This may serve as an analytic tool in addressing ethical issues in HTA of complex interventions.

  19. Integrating Biopsychosocial Intervention Research in a Changing Health Care Landscape

    Science.gov (United States)

    Ell, Kathleen; Oh, Hyunsung; Wu, Shinyi

    2016-01-01

    Objective: Safety net care systems are experiencing unprecedented change from the "Affordable Care Act," Patient-Centered Medical Home (PCMH) uptake, health information technology application, and growing of mental health care integration within primary care. This article provides a review of previous and current efforts in which social…

  20. Weight Care Project: Health professionals' attitudes and ability to assess body weight status - Study protocol

    Directory of Open Access Journals (Sweden)

    Murphy Kathy

    2011-03-01

    Full Text Available Abstract Background Health professionals working in primary care and public health have opportunities to address body weight status issues with their patients through face-to-face contact. The objectives of this all-Ireland project are: 1. to assess the attitudes, current practices/behaviours and knowledge of key health professional groups on body weight status; 2. to assess the health professional groups' ability to identify body weight status in both adults and children. The health professional groups are: (a community related public health nurses; (b school public health nurses; (c GPs and practice nurses (primary care; and (d occupational health nurses (workplace from both Northern Ireland and the Republic of Ireland. Methods/Design This all-Ireland multi-disciplinary project follows a mixed methods approach using both quantitative and qualitative methodologies, and consists of four components: 1. Literature review - to explore the role of health professionals in managing obesity through spontaneous intervention in a variety of health promotion settings. 2. Telephone interviews and focus groups - to gain an in-depth insight into the views of health professionals in assessing body weight status. 3. Survey (primarily online but also paper-based - to determine the attitudes, current practices/behaviours and knowledge of health professionals in assessing body weight status. 4. Online evaluation study - an online interactive programme will be developed to assess health professionals' ability to identify the body weight status of adults and children. Discussion This project will assess and report the attitudes, current practices/behaviours and knowledge of key health professional groups within Northern Ireland and the Republic of Ireland on body weight status, and their ability to identify body weight status in both adults and children. The results of this project will generate recommendations for clinical practice in managing obesity, which may

  1. Proposals for enhanced health risk assessment and stratification in an integrated care scenario

    Science.gov (United States)

    Dueñas-Espín, Ivan; Vela, Emili; Pauws, Steffen; Bescos, Cristina; Cano, Isaac; Cleries, Montserrat; Contel, Joan Carles; de Manuel Keenoy, Esteban; Garcia-Aymerich, Judith; Gomez-Cabrero, David; Kaye, Rachelle; Lahr, Maarten M H; Lluch-Ariet, Magí; Moharra, Montserrat; Monterde, David; Mora, Joana; Nalin, Marco; Pavlickova, Andrea; Piera, Jordi; Ponce, Sara; Santaeugenia, Sebastià; Schonenberg, Helen; Störk, Stefan; Tegner, Jesper; Velickovski, Filip; Westerteicher, Christoph; Roca, Josep

    2016-01-01

    Objectives Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies and health indicators used in the five regions participating in the Advancing Care Coordination and Telehealth Deployment (ACT) programme (http://www.act-programme.eu). The second purpose was to elaborate on strategies toward enhanced health risk predictive modelling in the clinical scenario. Settings The five ACT regions: Scotland (UK), Basque Country (ES), Catalonia (ES), Lombardy (I) and Groningen (NL). Participants Responsible teams for regional data management in the five ACT regions. Primary and secondary outcome measures We characterised and compared risk assessment strategies among ACT regions by analysing operational health risk predictive modelling tools for population-based stratification, as well as available health indicators at regional level. The analysis of the risk assessment tool deployed in Catalonia in 2015 (GMAs, Adjusted Morbidity Groups) was used as a basis to propose how population-based analytics could contribute to clinical risk prediction. Results There was consensus on the need for a population health approach to generate health risk predictive modelling. However, this strategy was fully in place only in two ACT regions: Basque Country and Catalonia. We found marked differences among regions in health risk predictive modelling tools and health indicators, and identified key factors constraining their comparability. The research proposes means to overcome current limitations and the use of population-based health risk prediction for enhanced clinical risk assessment. Conclusions The results indicate the need for further efforts to improve both comparability and flexibility of current population-based health risk predictive modelling approaches

  2. Weight Care Project: Health professionals' attitudes and ability to assess body weight status - Study protocol

    LENUS (Irish Health Repository)

    Moorhead, Anne

    2011-03-31

    Abstract Background Health professionals working in primary care and public health have opportunities to address body weight status issues with their patients through face-to-face contact. The objectives of this all-Ireland project are: 1. to assess the attitudes, current practices\\/behaviours and knowledge of key health professional groups on body weight status; 2. to assess the health professional groups\\' ability to identify body weight status in both adults and children. The health professional groups are: (a) community related public health nurses; (b) school public health nurses; (c) GPs and practice nurses (primary care); and (d) occupational health nurses (workplace) from both Northern Ireland and the Republic of Ireland. Methods\\/Design This all-Ireland multi-disciplinary project follows a mixed methods approach using both quantitative and qualitative methodologies, and consists of four components: 1. Literature review - to explore the role of health professionals in managing obesity through spontaneous intervention in a variety of health promotion settings. 2. Telephone interviews and focus groups - to gain an in-depth insight into the views of health professionals in assessing body weight status. 3. Survey (primarily online but also paper-based) - to determine the attitudes, current practices\\/behaviours and knowledge of health professionals in assessing body weight status. 4. Online evaluation study - an online interactive programme will be developed to assess health professionals\\' ability to identify the body weight status of adults and children. Discussion This project will assess and report the attitudes, current practices\\/behaviours and knowledge of key health professional groups within Northern Ireland and the Republic of Ireland on body weight status, and their ability to identify body weight status in both adults and children. The results of this project will generate recommendations for clinical practice in managing obesity, which may

  3. Parental Stress and Child Behavior and Temperament in the First Year after the Newborn Individualized Developmental Care and Assessment Program

    Science.gov (United States)

    van der Pal, Sylvia; Maguire, Celeste M.; Le Cessie, Saskia; Veen, Sylvia; Wit, Jan M.; Walther, Frans J.; Bruil, Jeanet

    2008-01-01

    A randomized controlled trial involving 128 infants born prematurely compared basic developmental care (nests and incubator covers) and the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) intervention (behavior observations and guidance by a trained developmental specialist) in relation to effects on parental stress and…

  4. Primary care units in Emilia-Romagna, Italy: an assessment of organizational culture.

    Science.gov (United States)

    Pracilio, Valerie P; Keith, Scott W; McAna, John; Rossi, Giuseppina; Brianti, Ettore; Fabi, Massimo; Maio, Vittorio

    2014-01-01

    This study investigates the organizational culture and associated characteristics of the newly established primary care units (PCUs)-collaborative teams of general practitioners (GPs) who provide patients with integrated health care services-in the Emilia-Romagna Region (RER), Italy. A survey instrument covering 6 cultural dimensions was administered to all 301 GPs in 21 PCUs in the Local Health Authority (LHA) of Parma, RER; the response rate was 79.1%. Management style, organizational trust, and collegiality proved to be more important aspects of PCU organizational culture than information sharing, quality, and cohesiveness. Cultural dimension scores were positively associated with certain characteristics of the PCUs including larger PCU size and greater proportion of older GPs. The presence of female GPs in the PCUs had a negative impact on collegiality, organizational trust, and quality. Feedback collected through this assessment will be useful to the RER and LHAs for evaluating and guiding improvements in the PCUs. PMID:24006025

  5. Environmental and ventilation assessment in Child Day Care Centers in Porto: the ENVIRH Project.

    Science.gov (United States)

    Mendes, Ana; Aelenei, Daniel; Papoila, Ana Luísa; Carreiro-Martins, Pedro; Aguiar, Lívia; Pereira, Cristiana; Neves, Paula; Azevedo, Susana; Cano, Manuela; Proença, Carmo; Viegas, João; Silva, Susana; Mendes, Diana; Neuparth, Nuno; Teixeira, João Paulo

    2014-01-01

    Children attending day care centers (CDCC) have been reported to be more prone to infectious diseases when compared with those cared for at home, and are exposed to conditions that may increase the risk of allergies and asthma. Several studies revealed that consequences of poor ventilation conditions include high levels of carbon dioxide (CO2) and many other indoor pollutants commonly detected in schools. Nine child day care centers were selected randomly to participate in this study. Fifty-two classrooms were assessed for chemical, biological, physical, and allergen parameters in spring and winter seasons in these nine CDCC located in Porto, Portugal. Outdoor measurements were also conducted for comparison. Our results indicated that (i) particulate matter (PM10) median levels were above the national reference levels, both by classroom type and by season; (ii) TVOC kindergarten peak values may raise some concern; (iii) CO2 was present at high median and maximum levels during spring and winter assessment in both nurseries and kindergartens classrooms; (iv) total bacteria concentrations were 57- and 52-fold higher in the nursery and kindergarten than outdoors, respectively, for the spring season; (v) winter and spring median predicted mean vote (PMV) indices were between "neutral" (0) and "slightly cool" (≤ -1) in the thermal sensation scale for comfort situations (-2 to 2) for both types of classrooms; (vi) there were significant differences for both PMV and predicted percentage of dissatisfied (PPD) indices by season; and (vii) CO2, total bacteria, and gram-negative bacteria were associated with low airflow rates. These data will help to evaluate the effectiveness of current building operation practices in child day care centers regarding indoor air quality and respiratory health. PMID:25072725

  6. A rapid assessment of the availability and use of obstetric care in Nigerian healthcare facilities.

    Directory of Open Access Journals (Sweden)

    Daniel O Erim

    Full Text Available BACKGROUND: As part of efforts to reduce maternal deaths in Nigeria, pregnant women are being encouraged to give birth in healthcare facilities. However, little is known about whether or not available healthcare facilities can cope with an increasing demand for obstetric care. We thus carried out this survey as a rapid and tactical assessment of facility quality. We visited 121 healthcare facilities, and used the opportunity to interview over 700 women seeking care at these facilities. FINDINGS: Most of the primary healthcare facilities we visited were unable to provide all basic Emergency Obstetric Care (bEmOC services. In general, they lack clinical staff needed to dispense maternal and neonatal care services, ambulances and uninterrupted electricity supply whenever there were obstetric emergencies. Secondary healthcare facilities fared better, but, like their primary counterparts, lack neonatal care infrastructure. Among patients, most lived within 30 minutes of the visited facilities and still reported some difficulty getting there. Of those who had had two or more childbirths, the conditional probability of a delivery occurring in a healthcare facility was 0.91 if the previous delivery occurred in a healthcare facility, and 0.24 if it occurred at home. The crude risk of an adverse neonatal outcome did not significantly vary by delivery site or birth attendant, and the occurrence of such an outcome during an in-facility delivery may influence the mother to have her next delivery outside. Such an outcome during a home delivery may not prompt a subsequent in-facility delivery. CONCLUSIONS: In conclusion, reducing maternal deaths in Nigeria will require attention to both increasing the number of facilities with high-quality EmOC capability and also assuring Nigerian women have access to these facilities regardless of where they live.

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

    Directory of Open Access Journals (Sweden)

    Saeed Karimi

    2015-12-01

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

  8. Nurses' Knowledge and Responsibility toward Nutritional Assessment for Patients in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mahmoud Al Kalaldeh

    2014-09-01

    Full Text Available Introduction: Nutritional assessment is a prerequisite for nutritional delivery. Patients in intensive care suffer from under-nutrition and nutritional failure due to poor assessment. Nursing ability to early detect nutritional failure is the key for minimizing imparities in practice and attaining nutritional goals. Aim of this article is to examine the ability of Jordanian ICU nurses to assess the nutritional status of critically ill patients, considering biophysical and biochemical measures.Methods: This cross sectional study recruited nurses from different health sectors in Jordan. ICU nurses from the governmental sector (two hospitals and private sectors (two hospitals were surveyed using a self-administered questionnaire. Nurses' knowledge and responsibility towards nutritional assessment were examined.Results: A total of 220 nurses from both sectors have completed the questionnaire. Nurses were consistent in regard to knowledge, responsibility, and documentation of nutritional assessment. Nurses in the governmental hospitals inappropriately perceived the application of aspiration reduction measures. However, they scored higher in applying physical examination and anthropometric assessment.  Although both nurses claimed higher use of biochemical measurements, biophysical measurements were less frequently used. Older nurses with longer clinical experience exhibited better adherence to biophysical measurement than younger nurses.Conclusion: Nursing nutritional assessment is still suboptimal to attain nutritional goals. Assessment of body weight, history of nutrition intake, severity of illness, and function of gastrointestinal tract should be considered over measuring albumin and pre-albumin levels.  A well-defined evidence-based protocol as well as a multidisciplinary nutritional team for nutritional assessment is the best to minimize episodes of under-nutrition.

  9. Patient and referring health care provider satisfaction with a physiotherapy spinal triage assessment service

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    Bath B

    2011-12-01

    Full Text Available Brenna Bath1, Bonnie Janzen21School of Physical Therapy, College of Medicine, University of Saskatchewan, 2Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaPurpose: To evaluate participant and referring care provider satisfaction associated with a spinal triage assessment service delivered by physiotherapists in collaboration with orthopedic surgeons.Methods: People with low back-related complaints were recruited from those referred to a spinal triage assessment program delivered by physiotherapists. Measures of patient and provider satisfaction were completed at approximately 4 weeks after the assessment. The satisfaction surveys were analyzed quantitatively with descriptive statistics and qualitatively with an inductive thematic approach of open and axial coding.Results: A total of 108/115 participants completed the posttest satisfaction survey. Sixty-six percent of participants were “very satisfied” with the service and 55% were “very satisfied” with the recommendations that were made. Only 18% of referring care providers completed the satisfaction survey and 90.5% of those were “very satisfied” with the recommendations. Sixty-one participants and 14 care providers provided comments which revealed a diverse range of themes which were coded into positive (ie, understanding the problem, communication, customer service, efficiency, and management direction, negative (ie, lack of detail, time to follow-up, cost and neutral related to the triage service, and an “other” category unrelated to the service (ie, chronic symptoms, comorbidities, and limited access to health care.Conclusion: The quantitative results of the participant survey demonstrated very high levels of satisfaction with the service and slightly less satisfaction with the recommendations that were made. Satisfaction of referring care providers with the recommendations and report was also high, but given

  10. The Seamless Transfer-of-Care Protocol: a randomized controlled trial assessing the efficacy of an electronic transfer-of-care communication tool

    Directory of Open Access Journals (Sweden)

    Okoniewska Barbara M

    2012-11-01

    evaluation will assess the cost per life saved, cost per readmission avoided and cost per QALY gained with the TOC communication tool compared to traditional dictation summaries. Discussion This paper outlines the study protocol for a randomized controlled trial evaluating an electronic transfer-of-care communication tool, with sufficient statistical power to assess the impact of the tool on the significant outcomes of post-discharge death or readmission. The study findings will inform health systems around the world on the potential benefits of such tools, and the value for money associated with their widespread implementation. Trial registration ClinicalTrials.gov NCT01402609.

  11. Development of scales to assess patients' perception of physicians' cultural competence in health care interactions.

    Science.gov (United States)

    Ahmed, Rukhsana; Bates, Benjamin R

    2012-07-01

    This study describes the development of scales to measure patients' perception of physicians' cultural competence in health care interactions and thus contributes to promoting awareness of physician-patient intercultural interaction processes. Surveys were administrated to a total of 682 participants. Exploratory factor analyses were employed to assess emergent scales and subscales to develop reliable instruments. The first two phases were devoted to formative research and pilot study. The third phase was devoted to scale development, which resulted in a five-factor solution to measure patient perception of physicians' cultural competence for patient satisfaction. PMID:22477717

  12. Assessing the relative health care spending needs of the UK’s devolved territories: a Scottish perspective

    OpenAIRE

    Rob Ball; David King; David Eiser

    2012-01-01

    This paper applies Scotland’s health allocation formula to Primary Care Trusts (PCTs) in England, Health Boards in Wales, and Health and Social Care Trusts in Northern Ireland in order to assess the relative health care expenditure needs of the countries. According to the Scottish formula, England’s per capita health care expenditure need is around 10% lower than Scotland’s, while Wales’ per capita expenditure need is around 2% lower than Scotland’s, and Northern Ireland’s is around 7% lower ...

  13. Assessing pediatric patient's risk of distress during health-care encounters: The psychometric properties of the Psychosocial Risk Assessment in Pediatrics.

    Science.gov (United States)

    Staab, Jennifer H; Klayman, Gail Jean; Lin, Li

    2014-12-01

    The aim of this study was to examine the psychometric properties of the Psychosocial Risk Assessment in Pediatrics (PRAP). PRAP is a screening tool designed to assess pediatric patients who are at risk of experiencing elevated distress during health-care encounters. A cross-sectional observational study was conducted with 200 pediatric patients. Patient's distress levels were observed during their health-care encounter using the Children's Emotional Manifestation Scale (CEMS). Health-care staff and parents were asked to rate the patient's level of cooperation and stress. Exploratory factor analysis supported a single latent factor structure of the PRAP tool. Cronbach's α for internal reliability was .83. PRAP score was strongly correlated with CEMS score with r = .82 (p < .0001). The PRAP is a standardized, reliable, and valid method for health-care providers to assess a patient's risk of experiencing significant distress during treatment or testing. PMID:23939720

  14. Geriatric assessment with management in cancer care: Current evidence and potential mechanisms for future research

    Science.gov (United States)

    Magnuson, Allison; Allore, Heather; Cohen, Harvey Jay; Mohile, Supriya G.; Williams, Grant R.; Chapman, Andrew; Extermann, Martine; Olin, Rebecca L.; Targia, Valerie; Mackenzie, Amy; Holmes, Holly M.; Hurria, Arti

    2016-01-01

    Older adults with cancer represent a complex patient population. Geriatric assessment (GA) is recommended to evaluate the medical and supportive care needs of this group. “GA with management” is a term encompassing the resultant medical decisions and interventions implemented in response to vulnerabilities identified on GA. In older, non-cancer patients, GA with management has been shown to improve a variety of outcomes, such as reducing functional decline and health care utilization. However, the role of GA with management in the older adult with cancer is less well established. Rigorous clinical trials of GA with management are necessary to develop an evidence base and support its use in the routine oncology care of older adults. At the recent U-13 conference, “Design and Implementation of Intervention Studies to Improve or Maintain Quality of Survivorship in Older and/or Frail Adults with Cancer,” a session was dedicated to developing research priorities in GA with management. Here we summarize identified knowledge gaps in GA with management studies for older patients with cancer and propose areas for future research. PMID:27197915

  15. Antenatal Care Strengthening in Jimma, Ethiopia: A Mixed-Method Needs Assessment

    Directory of Open Access Journals (Sweden)

    Sarah Fredsted Villadsen

    2014-01-01

    Full Text Available Objective. We assessed how health system priorities matched user expectations and what the needs for antenatal care (ANC strengthening were for improved maternal health in Jimma, Ethiopia. Methods. A questionnaire survey among all recent mothers in the study area was conducted to study the content of ANC and to identify the predictors of low ANC satisfaction. Further, a qualitative approach was applied to understand perceptions, practices, and policies of ANC. Results. There were no national guidelines for ANC in Ethiopia. Within the health system, the teaching of health professional students was given high priority, and that contributed to a lack of continuity and privacy. To the women, poor user-provider interaction was a serious concern hindering the trust in the health care providers. Further, the care provision was compromised by the inadequate laboratory facilities, unstructured health education, and lack of training of health professionals. Conclusions. Health system trials are needed to study the feasibility of ANC strengthening in the study area. Nationally and internationally, the leadership needs to be strengthened with supportive supervision geared towards building trust and mutual respect to protect maternal and infant health.

  16. Geriatric assessment with management in cancer care: Current evidence and potential mechanisms for future research.

    Science.gov (United States)

    Magnuson, Allison; Allore, Heather; Cohen, Harvey Jay; Mohile, Supriya G; Williams, Grant R; Chapman, Andrew; Extermann, Martine; Olin, Rebecca L; Targia, Valerie; Mackenzie, Amy; Holmes, Holly M; Hurria, Arti

    2016-07-01

    Older adults with cancer represent a complex patient population. Geriatric assessment (GA) is recommended to evaluate the medical and supportive care needs of this group. "GA with management" is a term encompassing the resultant medical decisions and interventions implemented in response to vulnerabilities identified on GA. In older, non-cancer patients, GA with management has been shown to improve a variety of outcomes, such as reducing functional decline and health care utilization. However, the role of GA with management in the older adult with cancer is less well established. Rigorous clinical trials of GA with management are necessary to develop an evidence base and support its use in the routine oncology care of older adults. At the recent U-13 conference, "Design and Implementation of Intervention Studies to Improve or Maintain Quality of Survivorship in Older and/or Frail Adults with Cancer," a session was dedicated to developing research priorities in GA with management. Here we summarize identified knowledge gaps in GA with management studies for older patients with cancer and propose areas for future research. PMID:27197915

  17. Choosing a primary care provider

    Science.gov (United States)

    ... et al. Improving patient care. The patient centered medical home. A systematic review. Ann Intern Med . 2013;158(3):169-178. PMID: 24779044 www.ncbi.nlm.nih.gov/pubmed/24779044 . Rohrer JE, Angstman ... Population Health Management . 2013;16(4):242-5. PMID: 23537159 ...

  18. Needs assessment for home-based care and the strengthening of social support networks: the role of community care workers in rural South Africa

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    Mosa Moshabela

    2015-12-01

    Full Text Available Background: Community care workers (CCWs in rural South Africa provide medical, personal, household, educational, and social care services to their clients. However, little understanding exists on how provision of services is approached within a household, taking into account available social support networks. Objective: The aim of this study was to generate an understanding of the processes that underpin the provision of care by CCWs in rural households and their engagement with clients, primary caregivers (PCGs, and other members of the social support network. Design: We analysed in-depth interviews conducted in a triad of participants involved in a home-based care (HBC encounter – 32 clients, 32 PCGs, and 17 CCWs. For each triad, a purposefully selected CCW was linked with a purposefully selected client and the corresponding PCG using maximum variation sampling. Three coders used an inductive content analysis method to describe participants’ references to the nuances of processes followed by CCWs in servicing HBC clients. Written informed consent was obtained from all participants. Findings: The results suggest that, by intuition and prior knowledge, CCWs treated each household uniquely, depending on the clients’ care needs, cooperation, availability of a social network, and the reliability and resilience of the social support system for the client. Four distinct processes took place in rural households: needs assessment for care, rationing of care, appraisal of care, and reinforcement of a social support system. However, there was no particular order or sequence established for these processes, and caregivers followed no prescribed or shared standards. Conclusions: CCWs bring a basket of services to a household, but engage in a constant, dynamic, and cyclical process of weighing needs against services provided. The service package is uniquely crafted and tailored for each household, depending on the absorptive capacity of the social

  19. Using big data for quality assessment in oncology.

    Science.gov (United States)

    Broughman, James R; Chen, Ronald C

    2016-05-01

    There is increasing attention in the US healthcare system on the delivery of high-quality care, an issue central to oncology. In the report 'Crossing the Quality Chasm', the Institute of Medicine identified six aims for improving healthcare quality: safe, effective, patient-centered, timely, efficient and equitable. This article describes how current big data resources can be used to assess these six dimensions, and provides examples of published studies in oncology. Strengths and limitations of current big data resources for the evaluation of quality of care are also discussed. Finally, this article outlines a vision where big data can be used not only to retrospectively assess the quality of oncologic care, but help physicians deliver high-quality care in real time. PMID:27090300

  20. From Practice Culture to Patient Outcomes: Improving Primary Care Through Interdisciplinary Health Care Teams

    OpenAIRE

    Grace, Sherry M.

    2013-01-01

    Background: In 2011, a large integrated healthcare organization implemented a primary care team redesign in five pilot practices to improve the delivery of patient-centered chronic illness care and augment the physician-medical assistant dyads by adding two new primary care team roles for each practice - a nurse care manager (NCM) and a patient health coach (PHC). This work examines three aspects of implementing the care team redesign: 1) The facilitators and barriers of implementation, 2) Th...

  1. ASSESSING THE IMPORTANCE OF BREAST SELF EXAMINATION AND BREAST CANCER AWARENESS AMONG HEALTH CARE PROFESSIONALS

    Directory of Open Access Journals (Sweden)

    Tejaswi Vittal

    2015-07-01

    Full Text Available INTRODUCTION: Breast cancer appears to be a disease of both developing and developed country. Breast cancer is now the most common cancer in most cities in India, and 2nd most common in the rural areas. OBJECTIVES: 1. To assess the knowledge, attitude and practice of self breast examination am ong health care professionals. 2. To assess breast cancer awareness among health care professionals. METHODOLOGY : A questionnaire based cross sectional study in which 133 women belonging to various medical and allied specialties were included. RESULTS: It was found that most (91% respondents were aware of BSE. The electronic media were the major sources of information followed by information from co - health workers. The attitude of health professionals on BSE was positive, with a fairly high degree of accep tability of the idea. Despite the positive attitude to BSE, its practice was low (73.7%. CONCLUSION: BSE is a cost effective screening modality. In view of worldwide rising trends in the incidence of breast cancer rates, importance of BSE should be popula rised through mass media.

  2. Primary care physicians' use of family history for cancer risk assessment

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    Stockdale Alan

    2010-06-01

    Full Text Available Abstract Background Family history (FH assessment is useful in identifying and managing patients at increased risk for cancer. This study assessed reported FH quality and associations with physician perceptions. Methods Primary care physicians practicing in two northeastern U.S. states were surveyed (n = 880; 70% response rate. Outcome measures of FH quality were extent of FH taken and ascertaining age at cancer diagnosis for affected family members. Predictors of quality measured in this survey included: perceived advantages and disadvantages of collecting FH information, knowledge of management options, access to supportive resources, and confidence in ability to interpret FH. Results Reported collection of information regarding second degree blood relatives and age of diagnosis among affected relatives was low. All hypothesized predictors were associated with measures of FH quality, but not all were consistent independent predictors. Perceived advantages of taking a family history, access to supportive resources, and confidence in ability to identify and manage higher risk patients were independent predictors of both FH quality measures. Perceived disadvantages of taking a family history was independently associated one measure of FH quality. Knowledge of management options was not independently associated with either quality measure. Conclusions Modifiable perception and resource factors were independently associated with quality of FH taking in a large and diverse sample of primary care physicians. Improving FH quality for identification of high risk individuals will require multi-faceted interventions.

  3. Comprehensive Care Plan Development Using Resident Assessment Instrument Framework: Past, Present, and Future Practices

    Directory of Open Access Journals (Sweden)

    Mary Ellen Dellefield

    2015-10-01

    Full Text Available Development of the comprehensive care plan (CCP is a requirement for nursing homes participating in the federal Medicare and Medicaid programs, referred to as skilled nursing facilities. The plan must be developed within the context of the comprehensive interdisciplinary assessment framework—the Resident Assessment Instrument (RAI. Consistent compliance with this requirement has been difficult to achieve. To improve the quality of CCP development within this framework, an increased understanding of complex factors contributing to inconsistent compliance is required. In this commentary, we examine the history of the comprehensive care plan; its development within the RAI framework; linkages between the RAI and registered nurse staffing; empirical evidence of the CCP’s efficacy; and the limitations of extant standards of practices in CCP development. Because of the registered nurse’s educational preparation, professional practice standards, and licensure obligations, the essential contributions of professional nurses in CCP development are emphasized. Recommendations for evidence-based micro and macro level practice changes with the potential to improve the quality of CCP development and regulatory compliance are presented. Suggestions for future research are given.

  4. 77 FR 72721 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

    Science.gov (United States)

    2012-12-06

    ... the IRS issued proposed regulations under sections 4375 through 4377 on April 17, 2012 (77 FR 22,691... considered all comments in issuing proposed regulations under sections 4375, 4376, and 4377 (77 FR 22,691... private, nonprofit corporation, the Patient-Centered Outcomes Research Institute (the...

  5. A five-year assessment of the affordable care act: market forces still trump the common good in U.S. Health care.

    Science.gov (United States)

    Geyman, John P

    2015-01-01

    The Affordable Care Act (ACA) was enacted in 2010 as the signature domestic achievement of the Obama presidency. It was intended to contain costs and achieve near-universal access to affordable health care of improved quality. Now, five years later, it is time to assess its track record. This article compares the goals and claims of the ACA with its actual experience in the areas of access, costs, affordability, and quality of care. Based on the evidence, one has to conclude that containment of health care costs is nowhere in sight, that more than 37 million Americans will still be uninsured when the ACA is fully implemented in 2019, that many more millions will be underinsured, and that profiteering will still dominate the culture of U.S. health care. More fundamental reform will be needed. The country still needs to confront the challenge that our for-profit health insurance industry, together with enormous bureaucratic waste and widespread investor ownership throughout our market-based system, are themselves barriers to health care reform. Here we consider the lessons we can take away from the ACA's first five years and lay out the economic, social/political, and moral arguments for replacing it with single-payer national health insurance. PMID:25674797

  6. From Translational Research to Translational Effectiveness: The “Patient-Centered Dental Home” Model

    OpenAIRE

    Francesco Chiappelli

    2011-01-01

    Toward revitalizing the Nation’s primary medical care system, the Agency for Health Research & Quality (AHRQ) stated that new foundational measures must be crafted for achieving high-quality, accessible, efficient health care for all Americans. The efficiency of medical care is viewed along two dimensions: first, we must continue to pursue translational research; and second, we must translate research to optimize effectiveness in specific clinical settings. It is increasingly evident that th...

  7. Focus group reflections on the current and future state of cognitive assessment tools in geriatric health care

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    Whitehead JC

    2015-06-01

    Full Text Available Jocelyne C Whitehead,1 Sara A Gambino,1 Jeffrey D Richter,2 Jennifer D Ryan1,3,41Rotman Research Institute, Baycrest, 2Independent Human Factors Consultant, Toronto, ON, Canada; 3Department of Psychology, 4Department of Psychiatry, University of Toronto, Toronto, ON, CanadaObjective: This study provides insight into the thoughts and opinions of geriatric health-care professionals toward cognitive assessments and the use of emerging technologies, such as eye-tracking, to supplement current tools.Methods: Two focus group sessions were conducted with nurses and physicians who routinely administer neurocognitive assessments to geriatric populations. Video recordings of the focus group sessions were transcribed and a thematic analysis was performed.Results: Participants reported the need for assessment and diagnostic tools that are accessible and efficient, and that are capable of accommodating the rapid growth in the aging population. The prevalence of more complex ailments experienced by older adults has had repercussions in the quality of care that the clients receive, and has contributed to lengthy wait times and resource shortages. Health-care professionals stated that they are hampered by the disjointed structure of the health-care system and that they would benefit from a more efficient allocation of responsibilities made possible through tools that did not require extensive training or certification. Eyetracking-based cognitive assessments were thought to strongly complement this system, yet it was thought that difficulty would be faced in gaining the support and increased uptake by health-care professionals due to the nonintuitive relationship between eyetracking and cognition.Conclusion: The findings suggest that health-care professionals are receptive to the use of eyetracking technology to assess for cognitive health as it would conserve resources by allowing frontline staff to administer assessments with minimal training

  8. Spiritual Assessment within Clinical Interventions Focused on Quality of Life Assessment in Palliative Care: A Secondary Analysis of a Systematic Review

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    Gianluca Catania

    2016-03-01

    Full Text Available One of the most crucial palliative care challenges is in determining how patients’ needs are defined and assessed. Although physical and psychological needs are commonly documented in patient’s charts, spiritual needs are less frequently reported. The aim of this review was to determine which explicit, longitudinal documentation of spiritual concerns would sufficiently affect clinical care to alleviate spiritual distress or promote spiritual wellbeing. A secondary analysis of a systematic review originally aimed at appraising the effectiveness of complex interventions focused on quality of life in palliative care was conducted. Five databases were searched for articles reporting interventions focused on QoL including at least two or more QoL dimensions. A narrative synthesis was performed to synthesize findings. In total, 10 studies were included. Only three studies included spiritual wellbeing assessment. Spirituality tools used to assess spiritual wellbeing were different between studies: Hospital QoL Index 14; Spiritual Needs Inventory; Missoula-Vitas QoL Index; and the Needs Assessment Tool: Progressive Disease-Cancer. Only one study reported a healthcare professional’s session training in the use of the QoL tool. Two out of three studies showed in participants an improvement in spiritual wellbeing, but changes in spiritual wellbeing scores were not significant. Overall patients receiving interventions focused on QoL assessment experienced both improvements in their QoL and in their spiritual needs. Although spiritual changes were not significant, the results provide evidence that a spiritual need exists and that spiritual care should be appropriately planned and delivered. Spiritual needs assessment precedes spiritual caring. It is essential that interventions focused on QoL assessment in palliative care include training on how to conduct a spiritual assessment and appropriate interventions to be offered to patients to address their

  9. Academic-Community Partnership to Develop a Patient-Centered Breast Cancer Risk Reduction Program for Latina Primary Care Patients

    OpenAIRE

    Castañeda, Sheila F.; Rebeca E. Giacinto; Medeiros, Elizabeth A.; Brongiel, Ilana; Cardona, Olga; Perez, Patricia; Talavera, Gregory A.

    2015-01-01

    This collaborative study sought to address Latina breast cancer (BC) disparities by increasing health literacy (HL) in a community health center situated on the US-Mexico border region of San Diego County. An academic-community partnership conducted formative research to develop a culturally tailored promotora-based intervention with 109 individuals. The Spanish language program, entitled Nuestra Cocina: Mesa Buena, Vida Sana (Our Kitchen: Good Table, Healthy Life), included six sessions targ...

  10. Developing a visualized patient-centered, flow-based and objective-oriented care path of cardiac catheterization examination.

    Science.gov (United States)

    Kuo, Ming Chuan; Chang, Polun

    2009-01-01

    It has been known that visualization is a user-preferred and more meaningful interface of information systems. To reduce the anxiety and uncertainty of patients, we transformed the sophisticated process of cardiac catheterization into visualized information. The Microsoft Visio 2003 and Excel 2003 with the VBA automation tool were used to design a process flow of Cardiac Catheterization. The results show the technical feasibility and potentials helpful for patient to realize the nursing process of cardiac catheterization. PMID:19593031

  11. Mind-body skills groups for medical students: reducing stress, enhancing commitment, and promoting patient-centered care

    OpenAIRE

    Gordon, James S.

    2014-01-01

    Background For several decades, psychological stress has been observed to be a significant challenge for medical students. The techniques and approach of mind-body medicine and group support have repeatedly demonstrated their effectiveness at reducing stress and improving the quality of the education experience. Discussion Mind-Body Skills Groups provide medical students with practical instruction in and scientific evidence for a variety of techniques that reduce stress, promote self-awarenes...

  12. Translation and validation of the Korean confusion assessment method for the intensive care unit

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    Han Sung

    2011-05-01

    Full Text Available Abstract Background Delirium is a common problem and associated with poor outcomes in intensive care unit (ICU patients. Diagnosis of delirium in ICU patients is limited and usually underdiagnosed by physicians. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU is one of the most widely used screening methods for detection of ICU delirium. Our goal was to translate and validate the CAM-ICU for use in the Korean ICU setting. Methods Translation of the CAM-ICU was done according to the guidelines suggested by the Translation and Cultural Adaptation Group. For validation and interrater reliability assessment of the Korean CAM-ICU, two nurses independently assessed delirium in ICU patients and the results were compared with the reference evaluation, which was done by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV. Results Twenty-two patients were evaluated by two nurses and one psychiatrist expert independently. During the study period, we have continuously educated study nurses. Based on DSM-IV criteria, 16 out of 22 (72.7% patients developed delirium. The sensitivities of the two nurses' evaluations using the Korean CAM-ICU were 89.80% for nurse 1 and 77.40% for nurse 2. Their specificities were 72.40% and 75.80% and their overall accuracy was 83.33% and 88.37% respectively. The Korean CAM-ICU was done with reasonable interrater reliability between nurse 1 and nurse 2 (κ = 0.81, p Conclusions The Korean CAM-ICU showed good validity and could be incorporated into clinical practice in Korean ICUs. Trial registration ISRCTN: ISRCTN50265663

  13. Applications of life cycle assessment and cost analysis in health care waste management

    Energy Technology Data Exchange (ETDEWEB)

    Soares, Sebastiao Roberto, E-mail: soares@ens.ufsc.br [Department of Sanitary Engineering, Federal University of Santa Catarina, UFSC, Campus Universitario, Centro Tecnologico, Trindade, PO Box 476, Florianopolis, SC 88040-970 (Brazil); Finotti, Alexandra Rodrigues, E-mail: finotti@ens.ufsc.br [Department of Sanitary Engineering, Federal University of Santa Catarina, UFSC, Campus Universitario, Centro Tecnologico, Trindade, PO Box 476, Florianopolis, SC 88040-970 (Brazil); Prudencio da Silva, Vamilson, E-mail: vamilson@epagri.sc.gov.br [Department of Sanitary Engineering, Federal University of Santa Catarina, UFSC, Campus Universitario, Centro Tecnologico, Trindade, PO Box 476, Florianopolis, SC 88040-970 (Brazil); EPAGRI, Rod. Admar Gonzaga 1347, Itacorubi, Florianopolis, Santa Catarina 88034-901 (Brazil); Alvarenga, Rodrigo A.F., E-mail: alvarenga.raf@gmail.com [Department of Sanitary Engineering, Federal University of Santa Catarina, UFSC, Campus Universitario, Centro Tecnologico, Trindade, PO Box 476, Florianopolis, SC 88040-970 (Brazil); Ghent University, Department of Sustainable Organic Chemistry and Technology, Coupure Links 653/9000 Gent (Belgium)

    2013-01-15

    Highlights: Black-Right-Pointing-Pointer Three Health Care Waste (HCW) scenarios were assessed through environmental and cost analysis. Black-Right-Pointing-Pointer HCW treatment using microwave oven had the lowest environmental impacts and costs in comparison with autoclave and lime. Black-Right-Pointing-Pointer Lime had the worst environmental and economic results for HCW treatment, in comparison with autoclave and microwave. - Abstract: The establishment of rules to manage Health Care Waste (HCW) is a challenge for the public sector. Regulatory agencies must ensure the safety of waste management alternatives for two very different profiles of generators: (1) hospitals, which concentrate the production of HCW and (2) small establishments, such as clinics, pharmacies and other sources, that generate dispersed quantities of HCW and are scattered throughout the city. To assist in developing sector regulations for the small generators, we evaluated three management scenarios using decision-making tools. They consisted of a disinfection technique (microwave, autoclave and lime) followed by landfilling, where transportation was also included. The microwave, autoclave and lime techniques were tested at the laboratory to establish the operating parameters to ensure their efficiency in disinfection. Using a life cycle assessment (LCA) and cost analysis, the decision-making tools aimed to determine the technique with the best environmental performance. This consisted of evaluating the eco-efficiency of each scenario. Based on the life cycle assessment, microwaving had the lowest environmental impact (12.64 Pt) followed by autoclaving (48.46 Pt). The cost analyses indicated values of US$ 0.12 kg{sup -1} for the waste treated with microwaves, US$ 1.10 kg{sup -1} for the waste treated by the autoclave and US$ 1.53 kg{sup -1} for the waste treated with lime. The microwave disinfection presented the best eco-efficiency performance among those studied and provided a feasible

  14. Applications of life cycle assessment and cost analysis in health care waste management

    International Nuclear Information System (INIS)

    Highlights: ► Three Health Care Waste (HCW) scenarios were assessed through environmental and cost analysis. ► HCW treatment using microwave oven had the lowest environmental impacts and costs in comparison with autoclave and lime. ► Lime had the worst environmental and economic results for HCW treatment, in comparison with autoclave and microwave. - Abstract: The establishment of rules to manage Health Care Waste (HCW) is a challenge for the public sector. Regulatory agencies must ensure the safety of waste management alternatives for two very different profiles of generators: (1) hospitals, which concentrate the production of HCW and (2) small establishments, such as clinics, pharmacies and other sources, that generate dispersed quantities of HCW and are scattered throughout the city. To assist in developing sector regulations for the small generators, we evaluated three management scenarios using decision-making tools. They consisted of a disinfection technique (microwave, autoclave and lime) followed by landfilling, where transportation was also included. The microwave, autoclave and lime techniques were tested at the laboratory to establish the operating parameters to ensure their efficiency in disinfection. Using a life cycle assessment (LCA) and cost analysis, the decision-making tools aimed to determine the technique with the best environmental performance. This consisted of evaluating the eco-efficiency of each scenario. Based on the life cycle assessment, microwaving had the lowest environmental impact (12.64 Pt) followed by autoclaving (48.46 Pt). The cost analyses indicated values of US$ 0.12 kg−1 for the waste treated with microwaves, US$ 1.10 kg−1 for the waste treated by the autoclave and US$ 1.53 kg−1 for the waste treated with lime. The microwave disinfection presented the best eco-efficiency performance among those studied and provided a feasible alternative to subsidize the formulation of the policy for small generators of HCW.

  15. Assessing the Extent of Adherence to the Recommended Antenatal Care Content in Malaysia: Room for Improvement.

    Directory of Open Access Journals (Sweden)

    Ping Ling Yeoh

    Full Text Available Recent papers on monitoring of health services affirmed that while antenatal care (ANC is an effective measure, quality is still a problem. Quality in maternal services "…involves providing a minimum level of care to all pregnant women…" Yet adherence to a minimum level of recommended ANC content appears to be unmet. Comprehensive review of ANC content rendered in environments with rapid changes in demographic, socio-economic, lifestyle and morbidity was sparse. Malaysia is such a country that has undergone these transitions with tremendous progress in health. However, recent progress in pregnancy outcomes is stagnating. This study aims to analyse adherence to recommended ANC; specifically, to examine the extent of adherence to recommended ANC content and to determine the factors influencing ANC content score.A retrospective cohort study of 522 randomly selected women who used ANC was conducted. Data were extracted from individual records. The study examined adherence to essential ANC guidelines using weighted scoring for physical examination, health screening, case management, and health education. GLM Univariate analysis procedure was used to determine the factors associated with ANC content score. Binary logistic regression was used to assess ANC content level and pregnancy outcomes, controlled for ANC utilisation.Around half of the women had <80% of recommended ANC content documented. Health education had the lowest mean score, at around 35%. The low-risk pregnancies had a higher ANC content score than the high-risk pregnancies (78% vs. 75%; P = 0.002. The smallest clinics had a higher ANC content score than the bigger clinics (78% vs. 74-76%; P<0.001. ANC content score among the women with "adequate" ANC utilisation, as defined by the modified Adequacy of Prenatal Care Utilisation Index, was lower than the women with "adequate-plus" ANC utilisation (75% vs. 78%, P<0.001. Assessment of symphysis-fundal height, foetal presentation and

  16. Orthopaedic surgeries - assessment of ionising radiations exposure in health care workers

    International Nuclear Information System (INIS)

    Full text of publication follows: 1. Objectives: The health care workers are exposed to ionizing radiations during their activities. In the operating rooms, the ionizing radiations are used in orthopaedic surgery and the dose depends on some factors, like the characteristics of the equipment. This study aims to: Estimate the occupational dose of ionizing radiations exposure of the orthopaedic doctors and nurses during the orthopaedic surgeries, in a Portuguese operating room; Sensitize the health care workers to use the individual dosimeter and to adopt radiation preventive measures. 2. Population and methods The study was conducted on nine Orthopaedic doctors and two nurses of an operating room of a hospital in Lisbon neighborhoods. We made a risk evaluating concerning: the radiations dose in different points, corresponding to gonads, hands and crystalline lens levels of all the professionals, during the surgeries; the average period of radiation in the orthopaedic surgeries; the number of annual orthopaedic surgeries, looking for that in the surgeries registers, to estimate the annual ionizing radiations dose of each orthopaedic doctor and nurse. 3. Results The annual doses estimated at different levels for orthopaedic doctors were the following: gonads: between 20,63 and 68,75 mGy; hands: 4,95 16,50 mGy; crystalline lens: 8,25 27,50 mGy). For the orthopaedic nurses: gonads: 130,63 151,25 mGy; hands: 31,35 36,30 mGy; crystalline lens 52,25 60,25 mGy. 4. Conclusions Although the location and positions of health care workers are not the same during the different surgeries and the equipment has an automatic control of the X ray emission, the annual ionizing radiations dose exposure for health care workers is an important one. The risk rating justifies the use of individual dosimeters for better individual dose assessment as part of an ionizing radiations prevention program. As a matter of fact preventive measures begin with a good quantitative risk assessment of

  17. Orthopaedic surgeries - assessment of ionising radiations exposure in health care workers

    Energy Technology Data Exchange (ETDEWEB)

    Leite, E.S.; Uva, A.S. [Lisbon Univ., National School of Public Health/New (Portugal)

    2006-07-01

    Full text of publication follows: 1. Objectives: The health care workers are exposed to ionizing radiations during their activities. In the operating rooms, the ionizing radiations are used in orthopaedic surgery and the dose depends on some factors, like the characteristics of the equipment. This study aims to: Estimate the occupational dose of ionizing radiations exposure of the orthopaedic doctors and nurses during the orthopaedic surgeries, in a Portuguese operating room; Sensitize the health care workers to use the individual dosimeter and to adopt radiation preventive measures. 2. Population and methods The study was conducted on nine Orthopaedic doctors and two nurses of an operating room of a hospital in Lisbon neighborhoods. We made a risk evaluating concerning: the radiations dose in different points, corresponding to gonads, hands and crystalline lens levels of all the professionals, during the surgeries; the average period of radiation in the orthopaedic surgeries; the number of annual orthopaedic surgeries, looking for that in the surgeries registers, to estimate the annual ionizing radiations dose of each orthopaedic doctor and nurse. 3. Results The annual doses estimated at different levels for orthopaedic doctors were the following: gonads: between 20,63 and 68,75 mGy; hands: 4,95 16,50 mGy; crystalline lens: 8,25 27,50 mGy). For the orthopaedic nurses: gonads: 130,63 151,25 mGy; hands: 31,35 36,30 mGy; crystalline lens 52,25 60,25 mGy. 4. Conclusions Although the location and positions of health care workers are not the same during the different surgeries and the equipment has an automatic control of the X ray emission, the annual ionizing radiations dose exposure for health care workers is an important one. The risk rating justifies the use of individual dosimeters for better individual dose assessment as part of an ionizing radiations prevention program. As a matter of fact preventive measures begin with a good quantitative risk assessment of

  18. Assessing screening practices among health care workers at a tertiary-care hospital in Sao Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Ana Claudia Gonçalves-Silva

    2010-01-01

    Full Text Available OBJECTIVE: To ascertain the extent to which screening procedures (with and without evidence of effectiveness are practiced among health care workers at a tertiary-care hospital in Sao Paulo, Brazil. METHODS: From February 2001 to September 2003, a cross-sectional study involving physicians, nurses and nursing assistants (aged 40 to 69 years was carried out at a tertiary-care hospital in the city of Sao Paulo, Brazil. Subjects were interviewed using a questionnaire that addresses 17 procedures with grades of recommendation of A, B, C, D or E, in accordance with the 1996 United States Preventive Services Task Force guidelines for routine screening. RESULTS: Of the 333 health care workers included, 228 (68.5% were female. The mean age was 48.8 (SD 6.6 years. Most subjects had undergone screening for hypertension (blood pressure measurement and lipid abnormalities (cholesterol testing. Screening for breast and cervical cancer was common among females. Resting electrocardiography, serum glucose testing, urine tests, chest X-rays and serum prostate-specific antigen testing were also quite common. However, only 6 (1.8% of the subjects had undergone screening for colorectal cancer (fecal occult blood test or sigmoidoscopy. CONCLUSIONS: A sizeable proportion of health care workers underwent screening procedures that are not recommended or for which there was insufficient evidence of a benefit. Conversely, certain recommended procedures were performed on a small proportion of such workers. These results indicate that the Brazilian National Ministry of Health must develop nationwide evidence-based screening recommendations and disseminate such recommendations among health care professionals in Brazil.

  19. Assessing coverage, equity and quality gaps in maternal and neonatal care in sub-saharan Africa: an integrated approach.

    Directory of Open Access Journals (Sweden)

    Calistus Wilunda

    Full Text Available Gaps in coverage, equity and quality of health services hinder the achievement of the Millennium Development Goals 4 and 5 in most countries of sub-Saharan Africa as well as in other high-burden countries, yet few studies attempt to assess all these dimensions as part of the situation analysis. We present the base-line data of a project aimed at simultaneously addressing coverage, equity and quality issues in maternal and neonatal health care in five districts belonging to three African countries.Data were collected in cross-sectional studies with three types of tools. Coverage was assessed in three hospitals and 19 health centres (HCs utilising emergency obstetric and newborn care needs assessment tools developed by the Averting Maternal Death and Disability program. Emergency obstetrics care (EmOC indicators were calculated. Equity was assessed in three hospitals and 13 HCs by means of proxy wealth indices and women delivering in health facilities were compared with those in the general population to identify inequities. Quality was assessed in three hospitals using the World Health Organization's maternal and neonatal quality of hospital care assessment tool which evaluates the whole range of aspects of obstetric and neonatal care and produces an average score for each main area of care.All the three hospitals qualified as comprehensive EmOC facilities but none of the HCs qualified for basic EmOC. None of the districts met the minimum requisites for EmOC indicators. In two out of three hospitals, there were major quality gaps which were generally greater in neonatal care, management of emergency and complicated cases and monitoring. Higher access to care was coupled by low quality and good quality by very low access. Stark inequities in utilisation of institutional delivery care were present in all districts and across all health facilities, especially at hospital level.Our findings confirm the existence of serious issues regarding coverage

  20. The Professional Nurse Self-Assessment Scale: Psychometric testing in Norwegian long term and home care contexts

    OpenAIRE

    Finnbakk, Elisabeth; Wangensteen, Sigrid; Skovdahl, Kirsti; Fagerström, Lisbeth

    2015-01-01

    Background Nurses’ clinical competence is vital to ensure safe and high quality care, and the continuous assessment of nurses’ clinical competence is of major concern. A validated instrument for the self-assessment of nurses’ clinical competence at different educational levels across specialties and countries is lacking. The aim of this study was to test the reliability and construct validity of the new Professional Nurse Self-Assessment Scale (ProffNurse SAS) questionnaire in long term and h...

  1. Relationship between cognitive impairment and nutritional assessment on functional status in Calabrian long-term-care

    Directory of Open Access Journals (Sweden)

    Malara A

    2014-01-01

    Full Text Available Alba Malara, Giovanni Sgrò, Chiara Caruso, Francesco Ceravolo, Giuseppe Curinga, Grazia Francesca Renda, Fausto Spadea, Michele Garo, Vincenzo RispoliScientific Committee of the National Association of Third Age Structures (ANASTE Calabria, ItalyObjective: The interaction between dementia and nutritional state is very complex and not yet fully understood. The aim of the present study was to assess the interaction between cognitive impairment and nutritional state in a cohort of residential elderly in relationship with functional condition of patients and their load of assistance in long-term-care facilities of the National Association of Third Age Structures (ANASTE Calabria.Methods: One hundred seventy-four subjects (122 female and 52 male were admitted to the long-term-care ANASTE Calabria study. All patients underwent multidimensional geriatric assessment. Nutritional state was assessed with the Mini Nutritional Assessment (MNA, whereas cognitive performance was evaluated by the Mini-Mental State Examination (MMSE. The functional state was assessed by Barthel Index (BI and Activity Daily Living (ADL. The following nutritional biochemical parameters were also evaluated: albumin, cholesterol, iron, and hemoglobin. All patients were reassessed 180 days later.Results: A severe cognitive impairment in MMSE performance was displayed in 49.7% patients, while 39.8% showed a moderate deficit; 6.9% had a slight deficit; and 3.4% evidenced no cognitive impairment. In MNA, 30% of patients exhibited an impairment of nutritional state; 56% were at risk of malnutrition; and 14% showed no nutritional problems. Malnutrition was present in 42% of patients with severe cognitive impairment, but only 4% of malnourished patients showed moderate cognitive deficit. The statistical analysis displayed a significant correlation between MNA and MMSE (P<0.001, as did MMSE correlated with Activity Daily Living (P<0.001 and BI (P<0.05. MNA correlated with BI (P<0.001 and

  2. Yoga Therapy Research: A Whole-Systems Perspective on Comparative Effectiveness and Patient-Centered Outcomes.

    Science.gov (United States)

    Rioux, Jennifer G

    2015-01-01

    For the yoga research community to capitalize on its current momentum, it is critical to consider certain developments in research theory and innovative methodologies. The concept of model validity must be incorporated in yoga therapy research so that explanatory constructs employed and outcome measures chosen reflect the principles of traditional yogic science. Focusing on effectiveness research will ensure maximum generalizability of study results and reflect real-world therapy delivery settings, thereby increasing the relevance of outcomes. Whole systems of healing require research methodologies that address complex relationships between multi-target therapies with multiple potential treatment results. Complex, dynamic systems theory provides the theoretical and methodological innovations necessary to design studies, choose outcomes, and analyze data in a way that can account for charting complex, cyclical, therapeutic trajectories across time. Emphasizing patient-centered outcomes is aligned with the patent-oriented and tailored natured of yoga therapy delivery. Increasing the quality and quantity of comparative effectiveness research to analyze the harms and benefits of contrasting therapies can provide an infrastructure for designing studies that can have significant practical impact. The creation of practice-based research networks within the yoga research community will incentivize links between mainstream clinical researchers and yoga therapy delivery settings, ultimately developing collaborative networks. Yoga therapy centers can facilitate patient recruitment for studies and inform standards for yoga researchers. Collaborative efforts between the yoga and ayurvedic research communities will streamline efforts, solidify expertise, cross-pollinate theoretical and methodological innovation, and consolidate efforts to secure research funding and increase publication and dissemination of study findings. PMID:26667283

  3. Construction of a Questionnaire to Assess Parental Stress in Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    haydeh heidari

    2015-09-01

    Full Text Available Background: Once an infant is hospitalized in the Neonatal Intensive Care Unit (NICU, the entire family dynamics is disrupted due to stressors such as interruption in maternal-infant bonding, abandonment of other siblings and financial burdens. Combination of multiple stressors often ends in divorce or other devastating results. In this study, a novel survey questionnaire has been developed to assess the level of parental stress in NICU and identify the warning signs, in order to provide assistance to young couples in need of help. Methods: Qualitative content analysis was performed to survey 13couplesrecruited from various teaching hospitals in Isfahan, Iran. Results: The initial part of the questionnaire was designed to assess parents’ stress level with an expected content validity index of 0.78 or above and to measure face validity of the questionnaire, all the items received a mean impact score of 1.5 or above, and the Cronbach’s alpha reliability of the 12-item questionnaire equaled to 0.904.Based on the factor analysis, the items with a correlation coefficient of less than 0.4 were excluded (one item was omitted. Conclusion: Most survey questionnaires found in the existing literature have investigated the types of stressors experienced by parents with an infant in NICU. In this study, researchers offer a novel 11-item questionnaire designed to assess the level of stress among parents with a hospitalized infant in NICU.

  4. Acute medical assessment units: an efficient alternative to in-hospital acute medical care.

    LENUS (Irish Health Repository)

    Watts, M

    2011-02-01

    Acute Medical Assessment Units (AMAUs) are being proposed as an alternative to congested Emergency Departments (EDs for the assessment of patients with a range of acute medical problems. We retrospectively reviewed the discharge destination of patients referred to a newly established AMAU during a six-month period. During the same period we contrasted activity in the ED for a similar group of patients. 1,562 patients were assessed in the AMAU. 196 (12.5%) were admitted to an in-patient bed and 1,148 (73.5%) were entered into specific diagnosis-driven out-patient pathways. 1,465 patients attended the ED and 635 (43.3%) were admitted. Out-patient alternatives to expensive in-patient care need to be provided at the \\'coal face" of acute referral. The AMAU provides this, and as a consequence admission rates are relatively low. This is achieved by directly communicating with GPs, accessing senior clinical decision makers, and providing immediate access to diagnostically driven outpatient pathways.

  5. Learning to "Swim" with the Experts: Experiences of Two Patient Co-Investigators for a Project Funded by the Patient-Centered Outcomes Research Institute.

    Science.gov (United States)

    Robbins, Michele; Tufte, Janice; Hsu, Clarissa

    2016-01-01

    The Patient-Centered Outcomes Research Institute (PCORI), established in 2010, launched a new model of incorporating stakeholder perspectives into health care research. To ensure that PCORI-funded studies address issues important to health care consumers, all projects must fully involve patients and other stakeholders in every step of the research process: from planning and design to implementation and dissemination of results.As members of the first cohort of PCORI-funded researchers, our team was on the forefront of developing new approaches to engaging patients in research. One innovation we pioneered was the creation of a "patient co-investigator" role for two nonscientists who were recruited to be active members of the research team throughout the project. This commentary, based on our experiences, aims to help other research teams to 1) understand how to effectively collaborate with stakeholder team members such as patients; 2) anticipate possible challenges; and 3) offer tools for the orientation, training, and integration of patients into a scientific team. Written from the perspective of two PCORI patient co-investigators, our commentary provides lessons learned and recommendations about incorporating nonscientists into research teams.Specifically, we suggest recruiting people with a record of relevant volunteer experience and commitment; establishing a formal application process that provides candidates with details about expectations and responsibilities; and providing comprehensive orientation with ongoing training, encouragement, and support. We hope the points in this commentary help research teams that are incorporating patient co-investigators move toward a positive and productive experience. PMID:27083011

  6. Learning to “Swim” with the Experts: Experiences of Two Patient Co-Investigators for a Project Funded by the Patient-Centered Outcomes Research Institute

    Science.gov (United States)

    Robbins, Michele; Tufte, Janice; Hsu, Clarissa

    2016-01-01

    The Patient-Centered Outcomes Research Institute (PCORI), established in 2010, launched a new model of incorporating stakeholder perspectives into health care research. To ensure that PCORI-funded studies address issues important to health care consumers, all projects must fully involve patients and other stakeholders in every step of the research process: from planning and design to implementation and dissemination of results. As members of the first cohort of PCORI-funded researchers, our team was on the forefront of developing new approaches to engaging patients in research. One innovation we pioneered was the creation of a “patient co-investigator” role for two nonscientists who were recruited to be active members of the research team throughout the project. This commentary, based on our experiences, aims to help other research teams to 1) understand how to effectively collaborate with stakeholder team members such as patients; 2) anticipate possible challenges; and 3) offer tools for the orientation, training, and integration of patients into a scientific team. Written from the perspective of two PCORI patient co-investigators, our commentary provides lessons learned and recommendations about incorporating nonscientists into research teams. Specifically, we suggest recruiting people with a record of relevant volunteer experience and commitment; establishing a formal application process that provides candidates with details about expectations and responsibilities; and providing comprehensive orientation with ongoing training, encouragement, and support. We hope the points in this commentary help research teams that are incorporating patient co-investigators move toward a positive and productive experience. PMID:27083011

  7. Assessment of food, nutrition, and physical activity practices in Oklahoma child-care centers.

    Science.gov (United States)

    Sisson, Susan B; Campbell, Janis E; May, Kellie B; Brittain, Danielle R; Monroe, Lisa A; Guss, Shannon H; Ladner, Jennifer L

    2012-08-01

    The purpose of the current study was to determine the obesogenic practices in all-day child-care centers caring for preschool-aged children. This study used a cross-sectional, self-reported survey mailed to centers across Oklahoma (n=314). Frequency of responses and χ(2) were calculated comparing region and star rating. Items where the majority of centers frequently report best practices include: daily fruits served (76%), daily nonfried vegetables served (71%), rarely/never served sugary drinks (92%), rarely/never used food to encourage good behaviors (88%), staff join children at table most of the time (81%), staff rarely eat different foods in view of children (69%), visible self-serve or request availability of water (93%), regular informal communication about healthy eating (86%), opportunities for outdoor play (95%), not withholding activity for punishment (91%), accessible play equipment (59% to 80% for different types of equipment), and minimization of extended sitting time (78%). Practices where centers can improve include increasing variety of vegetables (18%), reducing frequency of high-fat meats served (74% serve more than once per week), increasing high-fiber and whole-grain foods (35% offer daily), serving style of "seconds" (28% help kids determine whether they are still hungry), nonfood holiday celebrations (44% use nonfood treats), having toys and books that encourage healthy eating (27%) and physical activity (25%) in all rooms in the center, a standard nutrition (21%) and physical education (50%) curriculum, and following a written physical activity policy (43%). Practitioners can use these data to develop benchmarks and interventions, as this was the first study to assess statewide obesogenic practices in child care. PMID:22818731

  8. Assessment of hand hygiene compliance after hand hygiene education among health care workers in Cambodia.

    Science.gov (United States)

    Sansam, Sim; Yamamoto, Eiko; Srun, Sok; Sinath, Yin; Moniborin, Mey; Bun Sim, Kheang; Reyer, Joshua A; Yoshida, Yoshitoku; Hamajima, Nobuyuki

    2016-05-01

    Health care-associated infection (HCAI) is the most frequent adverse event for hospitalized patients. Hand hygiene is a simple and effective solution to protect patients from HCAI. This study aimed to introduce hand hygiene to health care workers based on the World Health Organization guideline for reducing HCAI in Cambodia and to assess their behavioral patterns on hand hygiene. All health care workers at Kampong Cham provincial hospital had lectures and practice on hand hygiene in January 2012. The surveys for hand hygiene compliance (HHC) were performed after 6 months, 1 year and 2 years, respectively. The number of surgical site infections (SSI) was counted in 2011 and 2014. Our analysis used the data of 58 workers, who were observed at all three points, although 139 workers were observed during the study period. The average of HHC at 6 months, 1 year and 2 years were 62.37%, 85.76% and 80.36%, respectively. The improved group (HHC 2 years/1 year≧1) had 32 workers, whereas the worsened group (HHC 2 years/1 yearsex, age or occupations. The improved group had more workers of General (31.2% vs. 19.2%), Surgical (25.0% vs. 11.5%) and Infection (21.9% vs. 11.5%) categories compared to the worsened group. The incidence of SSI was improved from 32.26% in 2011 to 0.97% in 2014. Our results suggest that the education and the survey on hand hygiene are effective for reducing HCAI in Cambodia. PMID:27303102

  9. Implementation of TeleCare services: benefit assessment and organisational models.

    Science.gov (United States)

    Stroetmann, Karl A; Stroetmann, Veli N; Westerteicher, Chris

    2003-01-01

    All industrial societies are ageing. This has profound socio-economic and health sector implications. Innovative services based on Information Society Technologies (IST), like telehomecare are regarded as promising avenues to follow both to allow (national) health systems to cope with these challenges and to improve the quality of life of chronically ill and frail older citizens. The aim of the TEN-HMS project is to convincingly prove that telemonitoring of congestive heart failure (CHF) patients at home can improve medical outcome for these patients as well as their quality of life and the efficiency of healthcare delivery processes. But this will not (yet) be enough for the sustained success of such a service. Unless it takes into account the interests of the various players in the health care arena and a long-term Business Case can be proven, it will be very difficult to integrate such services into routine health care delivery processes. Before developing concrete delivery models for such a telemonitoring service, the "players" directly involved in such a service need to be identified--customers/patients, health services providers, IT services suppliers, and public/private insurance funds as payers--and their assessment perspectives considered. Then four concrete telemonitoring delivery models and their probability of success are discussed. Our analysis suggests that telemonitoring will presently only be successful if the service delivery model applied reflects national health system idiosyncrasies, takes into account established organisational boundaries and adapts to patient quality of life and health professional preferences. In the longer term, the new paradigm of seamless, patient-centred care will, however, require new, more efficient service delivery models integrating all aspects of the health services value chain. PMID:15537237

  10. Assessment of surfactant use in preterm infants as a marker of neonatal intensive care unit quality

    Directory of Open Access Journals (Sweden)

    Lorch Scott A

    2011-01-01

    Full Text Available Abstract Background Proposed neonatal quality measures have included structural measures such as average daily census, and outcome measures such as mortality and rates of complications of prematurity. However, process measures have remained largely unexamined. The objective of this research was to examine variation in surfactant use as a possible process measure of neonatal quality. Methods We obtained data on infants 30 to 34 weeks gestation admitted with respiratory distress syndrome (RDS within 48 hours of birth to 16 hospitals participating in the Pediatric Health Information Systems database from 2001-2006. Models were developed to describe hospital variation in surfactant use and identify patient and hospital predictors of use. Another cohort of all infants admitted within 24 hours of birth was used to obtain adjusted neonatal intensive care unit (NICU mortality rates. To assess the construct validity of surfactant use as a quality metric, adjusted hospital rates of mortality and surfactant use were compared using Kendall's tau. Results Of 3,633 infants, 46% received surfactant. For individual hospitals, the adjusted odds of surfactant use varied from 2.2 times greater to 5.9 times less than the hospital with the median adjusted odds of surfactant use. Increased annual admissions of extremely low birth weight infants to the NICU were associated with greater surfactant use (OR 1.80, 95% CI 1.02-3.19. The correlation between adjusted hospital rates of surfactant use and in-hospital mortality was 0.37 (Kendall's tau p = 0.051. Conclusions Though results were encouraging, efforts to examine surfactant use in infants with RDS as a process measure reflecting quality of care revealed significant challenges. Difficulties related to adequate measurement including defining RDS using administrative data, accounting for care received prior to transfer, and adjusting for severity of illness will need to be addressed to improve the utility of this

  11. Workshop: health technology assessment of integrated home care for frial elder somatic patients

    Science.gov (United States)

    Larsen, Torben; Santana, Silvina

    2012-01-01

    Background The fragmented delivery of healthcare and social services as advanced by WHO 2002. Objectives This project of international collaboration assesses integrated home care (IHC) for frail elder somatic patients as compared to usual hospital care. Methods The HTA follows the special application for Tele-medicine (MAST). An introductory literature review identified stroke, heart failure (HF) and COPD as prototypes of IHC. Pre-existing evidence has been complemented by additional trials and surveys. Results 1. Definition/organization of IHC: Is carried out by a multidisciplinary team visiting the home Considers effectiveness, quality, access and user satisfaction in an economic way and uses Tele-facilities as far as they serve these goals Has finance across organizational settings. 2. Clinical effectiveness of IHC for moderately disabled patients by 6–12 months follow-up: Stroke: In 14 randomized trials (n=2139) intervention patients were by meta-analysis significantly less likely (p=0.001) to be dead or dependent compared with conventional care. HF: 2 RCT (n=386) demonstrate each a significant reduction of all-cause readmissions (p=0.003 and p=0.001). COPD: 5 studies (2 RCT, 2 cohorts and 1 CT) (n=1249) demonstrate each a significant reduction in readmissions/total admission days (p<0.05). 3. Health economic evaluation: For each selected condition the first year benefit surmounts the costs of intervention using the Dutch Standardization by Oostenbrink as a common price catalogue across resources/trials/countries. 4. Patient satisfaction: Focus group interviews confirm literature findings of very good satisfaction by IHC both among patients/carers and health professionals. Discussion Calculated net savings of 1450€ per patient in IHC are not supposed to materialize in ‘cool’- cash but enables local negotiation of adapted solutions with a minimum of national legislation/finance (Meso-strategy of dissemination). Implications IHC is an approach to clinical

  12. Assessing the HIV Care Continuum in Latin America: progress in clinical retention, cART use and viral suppression

    OpenAIRE

    Rebeiro, Peter F.; Carina Cesar; Shepherd, Bryan E.; Raquel B De Boni; Cortés, Claudia P.; Fernanda Rodriguez; Pablo Belaunzarán-Zamudio; Pape, Jean W; Denis Padgett; Daniel Hoces; McGowan, Catherine C; Pedro Cahn

    2016-01-01

    Introduction: We assessed trends in HIV Care Continuum outcomes associated with delayed disease progression and reduced transmission within a large Latin American cohort over a decade: clinical retention, combination antiretroviral therapy (cART) use and viral suppression (VS). Methods: Adults from Caribbean, Central and South America network for HIV epidemiology clinical cohorts in seven countries contributed data between 2003 and 2012. Retention was defined as two or more HIV care visits an...

  13. Assessment of oral self-care in patients with periodontitis: a pilot study in a dental school clinic in Japan

    OpenAIRE

    Masuda Hitomi; Hayakawa Hiroki; Matsumoto Shinya; Ueshima Fumie; Kikuchi Momomi; Saito Atsushi; Makiishi Takemi

    2009-01-01

    Abstract Background Oral hygiene education is central to every stage of periodontal treatment. Successful management of periodontal disease depends on the patient's capacity for oral self-care. In the present study, the oral self-care and perceptions of patients attending a dental school clinic in Japan were assessed using a short questionnaire referring to existing oral health models. Methods A cross-sectional study design was used. The study population consisted of sixty-five patients (age ...

  14. Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness

    OpenAIRE

    Corner, Evelyn J; Soni, Neil; Handy, Jonathan M.; Stephen J Brett

    2014-01-01

    Introduction Intensive care unit-acquired weakness (ICU-AW) is common in survivors of critical illness, resulting in global weakness and functional deficit. Although ICU-AW is well described subjectively in the literature, the value of objective measures has yet to be established. This project aimed to evaluate the construct validity of the Chelsea Critical Care Physical Assessment tool (CPAx) by analyzing the association between CPAx scores and hospital-discharge location, as a measure of fu...

  15. Assessing predictors of delayed antenatal care visits in Rwanda: a secondary analysis of Rwanda demographic and health survey 2010

    OpenAIRE

    Manzi, Anatole; Munyaneza, Fabien; Mujawase, Francisca; Banamwana, Leonidas; Sayinzoga, Felix; Thomson, Dana R; Ntaganira, Joseph; Hedt-Gauthier, Bethany L

    2014-01-01

    Background Early initiation of antenatal care (ANC) can reduce common maternal complications and maternal and perinatal mortality. Though Rwanda demonstrated a remarkable decline in maternal mortality and 98% of Rwandan women receive antenatal care from a skilled provider, only 38% of women have an ANC visit in their first three months of pregnancy. This study assessed factors associated with delayed ANC in Rwanda. Methods This is a cross-sectional study using data collected during the 2010 R...

  16. Assessing predictors of delayed antenatal care visits in Rwanda: a secondary analysis of Rwanda demographic and health survey 2010

    OpenAIRE

    Manzi, Anatole; Munyaneza, Fabien; Mujawase, Francisca; Banamwana, Leonidas; Sayinzoga, Felix; Thomson, Dana R; Ntaganira, Joseph; Hedt-Gauthier, Bethany L

    2014-01-01

    Background: Early initiation of antenatal care (ANC) can reduce common maternal complications and maternal and perinatal mortality. Though Rwanda demonstrated a remarkable decline in maternal mortality and 98% of Rwandan women receive antenatal care from a skilled provider, only 38% of women have an ANC visit in their first three months of pregnancy. This study assessed factors associated with delayed ANC in Rwanda. Methods: This is a cross-sectional study using data collected during the 2010...

  17. Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery

    OpenAIRE

    Khan, Ashiya; Amitava, Abadan Khan; Rizvi, Syed Ali Raza; Siddiqui, Ziya; Kumari, Namita; Grover, Shivani

    2015-01-01

    Context: Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery. Aims: To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS). Settings and Design: Prospective randomized controlled trial. Tertiary care hospital setting. Subjects and Methods: A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block r...

  18. Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery

    OpenAIRE

    Ashiya Khan; Abadan Khan Amitava; Syed Ali Raza Rizvi; Ziya Siddiqui; Namita Kumari; Shivani Grover

    2015-01-01

    Context : Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery. Aims: To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS). Settings and Design: Prospective randomized controlled trial. Tertiary care hospital setting. Subjects and Methods: A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block ...

  19. Local prioritisation work in health care--assessment of an implementation process.

    Science.gov (United States)

    Waldau, Susanne

    2007-05-01

    Political, horizontal prioritisation requires knowledge on local health care resource use on unit or patient group level. This in turn requires unit level structures (meeting forums) and processes for creation of knowledge and continuous, open decision-making on prioritisation. Ideally, for decisions to be legitimate, such procedures should meet the "Accountability for reasonableness"-criteria of Daniels and Sabin [Daniels N. Accountability for reasonableness. Establishing a fair process for priority setting is easier than agreeing on principles. British Medical Journal 2000;321:1300-1]. A strategy, aiming at shaping such an organisational culture, was developed and set to work within a regional health care organisation, responsible for around 250000 inhabitants. This pilot study regarding topic and methodology assesses the changes of knowledge in open prioritisation as well as structures, processes for and results of such work on unit level in that organisation 1998 through early 2005. Initial interviews and two consecutive surveys were analysed. Results indicate that only early adopters respond to the surveys and among them a growing knowledge in priority setting, acceptance of personal leadership for local priority setting work and recognition of a need for adequate structures and processes. Among respondents, one could note a development: A tentative model expressing different positions towards prioritisation was developed. PMID:16824642

  20. Assessment of the Efficiency of Tobacco Cessation Counseling in Primary Care.

    Science.gov (United States)

    El-Shahawy, Omar; Shires, Deirdre A; Elston Lafata, Jennifer

    2016-09-01

    Clinical Practice Guidelines for Treating Tobacco Use and Dependence advocate for using counseling targeted at tobacco users' motivation to quit during each office visit. We evaluate tobacco use screening and counseling interventions delivered during routine periodic health examinations by 44 adult primary care physicians practicing in 22 clinics of a large health system in southeast Michigan. 484 office visits were audio-recorded and transcribed. For this study, current tobacco users (N = 91) were identified using pre-visit surveys and audio-recordings. Transcripts were coded for the delivery of tobacco-related counseling interventions. The extent to which counseling interventions were used and/or targeted to the patients' readiness to quit was the main outcome measure. The majority of tobacco users (n = 77) had their tobacco use status assessed, and most received some sort of tobacco-related counseling (n = 74). However, only 15% received the recommended counseling targeted to their readiness to quit. On the other hand, 19% received less counseling than recommended given their readiness to quit, 7% received only nonindicated counseling, and 59% received nonindicated counseling in addition to indicated counseling. Results illustrate physicians' commitment to cessation counseling and also identify potential opportunities to improve the efficiency of tobacco-related counseling in primary care. PMID:26290271

  1. Point-of-care outcome assessment in the cancer clinic: Audit of data quality

    International Nuclear Information System (INIS)

    Background and purpose: To assess the completeness and accuracy of stage and outcome data in the Anthology of Outcomes (AOs), a prospective point-of-care physician-collected electronic data system for patients at Princess Margaret Hospital. Material and methods: A random sample of 10% of the AO cases registered between July 2003 and December 2005 was drawn. An audit was conducted of the AO data compared with chart review and cancer registry. Results: The AO system was applied first to a head and neck (HN) cancer patient cohort. From 1152 HN cases, 120 were audited. TNM stage was recorded in all cases. Discrepancy was found between the AO and primary data sources in 3-13% of cases. Physician review showed a 3% error rate in overall stage recorded in the AO. Sixty-two outcomes in 43 patients were found on chart review. No outcomes were incorrectly recorded in the AO. Nineteen (31%) outcomes in 17 patients were missed in the AO. Conclusions: Our experience has demonstrated the feasibility of real-time outcome recording at point-of-care. New processes needed to improve the completeness of capture of patient outcomes in the AO have more recently been introduced. This successful system has been expanded to other disease sites.

  2. Assessment of Patient Safety Culture in Primary Health Care Settings in Kuwait

    Directory of Open Access Journals (Sweden)

    Maha Mohamed Ghobashi

    2014-01-01

    Full Text Available Background Patient safety is critical component of health care quality. We aimed to assess the awareness of primary healthcare staff members about patient safety culture and explore the areas of deficiency and opportunities for improvement concerning this issue.Methods: This descriptive cross sectional study surveyed 369 staff members in four primary healthcare centers in Kuwait using self-administered “Hospital Survey on Patient Safety Culture” adopted questionnaire. The total number of respondents was 276 participants (response rate = 74.79%.Results: Five safety dimensions with lowest positivity (less than 50% were identified and these are; the non – punitive response to errors, frequency of event reporting, staffing, communication openness, center handoffs and transitions with the following percentages of positivity 24%, 32%, 41%, 45% and 47% respectively. The dimensions of highest positivity were teamwork within the center’s units (82% and organizational learning (75%.Conclusion: Patient safety culture in primary healthcare settings in Kuwait is not as strong as improvements for the provision of safe health care. Well-designed patient safety initiatives are needed to be integrated with organizational policies, particularly the pressing need to address the bioethical component of medical errors and their disclosure, communication openness and emotional issues related to them and investing the bright areas of skillful organizational learning and strong team working attitudes.    

  3. Assessment Of Nurses Performance During Cardiopulmonary Resuscitation In Intensive Care Unit And Cardiac Care Unit At The Alexandria Main University Hospital.

    Directory of Open Access Journals (Sweden)

    Dr. Nagla Hamdi Kamal Khalil El- Meanawi

    2015-08-01

    Full Text Available Abstract Background Cardiopulmonary resuscitation one of the most emergency management the nurse has a pivotal role and should be highly qualified in performing these procedures. The aim of the study is to assess performance of nurses during Cardio pulmonary resuscitation for patient with cardiac arrest In Intensive Care Unit and Cardiac Care Unit at the Alexandria main university hospital. To answer the question what are the most common area of satisfactory and area of neglection in nurses performance during Cardio Pulmonary Resuscitation. The sample consists of 53 staff nurses working in Intensive care unit amp cardiac care unit at Alexandria main university hospital. The tools of data collection were structured of questionnaire sheet and observational cheek list. The results showed that unsatisfactory performance between nurses in both units. The study concluded that all nurses need to improve their performance during cardiopulmonary resuscitation for patient with cardiac arrest it is crucial for nursing staff to participate in CPR courses in order to refresh and update their theoretical knowledge and performance skills and consequently to improve the safety and effectiveness of care. The study recommended that continuous evaluation of nurses knowledge and performance is essential the optimal frequency with which CPR training should be implemented at least every 6 months in order to avoid deterioration in nurses CPR knowledge and skills.

  4. Assessment of biomedical waste management practices in a tertiary care teaching hospital in Ludhiana

    Directory of Open Access Journals (Sweden)

    Savan Sara Mathew

    2011-08-01

    Full Text Available Biomedical waste (BMW is waste generated during diagnosis, treatment or immunization of human beings or animals, or in research activities pertaining thereto, or in the production and testing of biologicals, and is contaminated with human fluids.1 Though 75-80% of wastes generated from hospitals are non-infectious, 20-25% is hazardous.2 It is a potential health hazard to health workers, public, flora and fauna of the area.3 The Government of India has given specifications for hospital waste management under the Environment (Protection Act Biomedical Waste (Management and Handling Rules 1998.4 The present study was undertaken to assess the knowledge and practices regarding BMW management amongst staff of a large tertiary care teaching hospital in Ludhiana, with about 700 beds which, according to its Chief Maintenance Officer, generates about 70 kg biomedical waste per day.

  5. Can Health Technology Assessment (HTA) provide a solution to tackle the increasing health-care expenditure in India?

    Science.gov (United States)

    Dang, Amit; Vallish, B N

    2016-01-01

    The private health-care system in India is effective but expensive. Due to the absence of a comprehensive and well-penetrated insurance scheme that caters to the majority of the Indian population, most of the private health care consultations are out-of-pocket (OOP), and this is pushing many people to poverty. In this article, we describe the concept of health technology assessment (HTA), and review its possible role in improving the health-care system in India. We additionally comment on its present status and possible role of its implementation in the Indian context. PMID:27350708

  6. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model : A Qualitative Study

    NARCIS (Netherlands)

    Spoorenberg, Sophie L. W.; Wynia, Klaske; Fokkens, Andrea S.; Slotman, Karin; Kremer, Hubertus P. H.; Reijneveld, Sijmen A.

    2015-01-01

    Background Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this stu

  7. Data analysis methods for assessing palliative care interventions in one-group pre–post studies

    Science.gov (United States)

    Ioroi, Takeshi; Kakuma, Tatsuyuki; Sakashita, Akihiro; Miki, Yuki; Ohtagaki, Kanako; Fujiwara, Yuka; Utsubo, Yuko; Nishimura, Yoshihiro; Hirai, Midori

    2015-01-01

    Objectives: Studies of palliative care are often performed using single-arm pre–post study designs that lack causal inference. Thus, in this study, we propose a novel data analysis approach that incorporates risk factors from single-arm studies instead of using paired t-tests to assess intervention effects. Methods: Physical, psychological and social evaluations of eligible cancer inpatients were conducted by a hospital-based palliative care team. Quality of life was assessed at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer QLQ-C15-PAL. Among 35 patients, 9 were discharged within 1 week and 26 were included in analyses. Structural equation models with observed measurements were applied to estimate direct and indirect intervention effects and simultaneously consider risk factors. Results: Parameters were estimated using full models that included associations among covariates and reduced models that excluded covariates with small effects. The total effect was calculated as the sum of intervention and covariate effects and was equal to the mean of the difference (0.513) between pre- and post-intervention quality of life (reduced model intervention effect, 14.749; 95% confidence intervals, −4.407 and 33.905; p = 0.131; covariate effect, −14.236; 95% confidence interval, −33.708 and 5.236; p = 0.152). Conclusion: Using the present analytical method for single-arm pre–post study designs, factors that modulate effects of interventions were modelled, and intervention and covariate effects were distinguished based on structural equation model. PMID:27092261

  8. Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition

    Directory of Open Access Journals (Sweden)

    Latour Judith

    2009-07-01

    Full Text Available Abstract Background The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs. Methods The methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002–2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT, were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis. Results Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%. Indicators for the appropriateness of care showed less reliability. Conclusion Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT

  9. Assessment of Patients that Request Prescription by Primary Care Physicians' Views

    Directory of Open Access Journals (Sweden)

    Sebahat Gucuk

    2011-04-01

    Full Text Available Objective: In this study it was aimed to assess the request of patients that admitted for prescription and to determine the situation regarding to the effect of present health system on primary care services. Materials and Methods: Patients admitted to Van Mother-Child Health and Family Planning center for prescription in 5 workdays between 1 and 8 February 2010 were included into the cross-sectional study. A questionnaire was performed to the participants, including information about the health insurance, residence, time to come to the last control of the patient that request prescription, by whom and when the medication was recommended, demand of health insurance abuse, number of medications, whether information about the medication prescribed was given by the physician or not. Results: A total of 441 participants, 41.5’% of them were admitted for prescription of their own medications, 45.8% for prescription of their first-degree relatives’ medication. The 79.4% of them were from urban, 20.6% from rural areas, and 58.5% of them were examined at secondary care unit, 32% at private hospitals. Health insurance of patients whose medications were prescribed at the last three days was green card with a rate of 86.5%. The 65.3% of medications requested were Rx drugs, 34.7% were over the counter. The 15.6% of the participants requested the medication to be prescribed over the health insurance of the people other than the patient that use medication. The 68.4% of participants that requested Rx drugs were informed by the physician. A significant association was found with those who requested Rx drugs and over the counter drugs regarding to be informed about medications (p=0.0001. Conclusion: The low socioeconomic level and education level, society and the multiplicity of health problems in our region, increase the burden on health care facilities especially on primary care units [TAF Prev Med Bull 2011; 10(2.000: 149-154

  10. Development of the dementia assessment sheet for community-based integrated care system.

    Science.gov (United States)

    Awata, Shuichi; Sugiyama, Mika; Ito, Kae; Ura, Chiaki; Miyamae, Fumiko; Sakuma, Naoko; Niikawa, Hirotoshi; Okamura, Tsuyoshi; Inagaki, Hiroki; Ijuin, Mutsuo

    2016-03-01

    A series of our studies on the development of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21) were reviewed. Study 1: to examine the distribution of scores and internal reliability of DASC-21, trained nurses and researchers visited the homes of 1341 participants aged 65 years and older and living in the community. The nurses interviewed the participants and, when possible, their family members, to complete the DASC-21. Then, the Mini-Mental State Examination was carried out to select the participants of study 2. Study 2: to examine the concurrent and discriminant validity, experienced psychiatrists and psychologists, who were blind to the findings of study 1, visited the homes of 131 subjects who were selected from the participants of study 1 and completed the Clinical Dementia Rating (CDR), the Mini-Mental State Examination and the Frontal Assessment Battery (FAB). Cronbach's coefficient alpha of the DASC-21 was 0.808-0.950. Scores of the DASC-21 significantly correlated with CDR total and box scores, Mini-Mental State Examination and Frontal Assessment Battery. In an analysis of variance, CDR had the main effect on the score of the DASC-21. Receiver operating characteristic analysis showed that the DASC-21 had sufficient discriminatory ability between dementia (CDR1+) and non-dementia (CDR0 or CDR0.5; area under the curve = 0.804-0.895). When using a cut-off point of 30/31, sensitivity was 83.3-94.1% and specificity was 77.3-86.4%. The DASC-21 has sufficient reliability and validity as a tool to evaluate impairments in daily functioning and in cognitive functions, to detect dementia, and to assess the severity of dementia in the community. Geriatr Gerontol Int 2016; 16 (Suppl. 1): 123-131. PMID:27018290

  11. Assessment of knowledge attitude and practice towards hepatitis B among health care workers in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Farhana Siraj

    2016-01-01

    Results: This cross sectional prospective study was conducted in the Department of Obstetrics and Gynecology Govt. Medical College Srinagar from January to June 2015. 150 health care professionals were taken for the study. Knowledge regarding disease and transmission was fairly good. Regarding vaccination status 42.02% of medical and 29.60% of paramedical staff was fully vaccinated, the most common reason for non compliance being ignorance of importance of vaccination. Awareness of patients' vaccination status was also low. Conclusions: Due to low vaccine-compliance, Health care workers (HCW continue to be at the risk of occupational HBV infection. Regular Health education highlighting occupational risk of HBV, accessibility of vaccine, and mandatory vaccination of HCW is recommended to prevent Hepatitis B infection. [Int J Reprod Contracept Obstet Gynecol 2016; 5(1.000: 58-61

  12. Developing a patient-centered outcome measure for complementary and alternative medicine therapies I: defining content and format

    Directory of Open Access Journals (Sweden)

    Ritenbaugh Cheryl

    2011-12-01

    Full Text Available Abstract Background Patients receiving complementary and alternative medicine (CAM therapies often report shifts in well-being that go beyond resolution of the original presenting symptoms. We undertook a research program to develop and evaluate a patient-centered outcome measure to assess the multidimensional impacts of CAM therapies, utilizing a novel mixed methods approach that relied upon techniques from the fields of anthropology and psychometrics. This tool would have broad applicability, both for CAM practitioners to measure shifts in patients' states following treatments, and conventional clinical trial researchers needing validated outcome measures. The US Food and Drug Administration has highlighted the importance of valid and reliable measurement of patient-reported outcomes in the evaluation of conventional medical products. Here we describe Phase I of our research program, the iterative process of content identification, item development and refinement, and response format selection. Cognitive interviews and psychometric evaluation are reported separately. Methods From a database of patient interviews (n = 177 from six diverse CAM studies, 150 interviews were identified for secondary analysis in which individuals spontaneously discussed unexpected changes associated with CAM. Using ATLAS.ti, we identified common themes and language to inform questionnaire item content and wording. Respondents' language was often richly textured, but item development required a stripping down of language to extract essential meaning and minimize potential comprehension barriers across populations. Through an evocative card sort interview process, we identified those items most widely applicable and covering standard psychometric domains. We developed, pilot-tested, and refined the format, yielding a questionnaire for cognitive interviews and psychometric evaluation. Results The resulting questionnaire contained 18 items, in visual analog scale format

  13. Improving patient-centeredness of fertility care using a multifaceted approach: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Huppelschoten Aleida G

    2012-09-01

    Full Text Available Abstract Background Beside traditional outcomes of safety and (cost-effectiveness, the Institute of Medicine states patient-centeredness as an independent outcome indicator to evaluate the quality of healthcare. Providing patient-centered care is important because patients want to be heard for their ideas and concerns. Healthcare areas associated with high emotions and intensive treatment periods could especially benefit from patient-centered care. How care can become optimally improved in patient-centeredness is unknown. Therefore, we will conduct a study in the context of Dutch fertility care to determine the effects of a multifaceted approach on patient-centeredness, patients’ quality of life (QoL and levels of distress. Our aims are to investigate the effectiveness of a multifaceted approach and to identify determinants of a change in the level of patient-centeredness, patients’ QoL and distress levels. This paper presents the study protocol. Methods/Design In a cluster-randomized trial in 32 Dutch fertility clinics the effects of a multifaceted approach will be determined on the level of patient-centeredness (Patient-centredness Questionnaire – Infertility, patients’ QoL (FertiQoL and levels of distress (SCREENIVF. The multifaceted approach includes audit and feedback, educational outreach visits and patient-mediated interventions. Potential determinants of a change in patient-centeredness, patients’ QoL and levels of distress will be collected by an addendum to the patients’ questionnaire and a professionals’ questionnaire. The latter includes the Organizational Culture Assessment Instrument about the clinic’s culture as a possible determinant of an increase in patient-centered care. Discussion The study is expected to yield important new evidence about the effects of a multifaceted approach on levels of patient-centeredness, patients’ QoL and distress in fertility care. Furthermore, determinants associated with a change

  14. Assessment and Availability of Trauma Care Services in a District Hospital of South India; A Field Observational Study

    Directory of Open Access Journals (Sweden)

    Pallavi Sarji Uthkarsh

    2016-04-01

    Full Text Available Objective: To assess the availability of trauma care services in a district referral hospital of Southern India. Methods: This was a cross-sectional study being performed during 2013 in a tertiary healthcare centre in Southern Indian. A detailed assessment of trauma care services was done in a 400 bed speciality hospital which is an apex referral hospital in the public health system using a check list based on WHO guidelines for evaluation of essential trauma care services, along with in-depth interviews of hospital stake holders and key informants. Results: The hospital had physical infrastructure in terms of emergency room, inpatient wards, operation theatres, intensive care unit and blood bank facilities. The recently constructed designated building for trauma care services was not operational and existing facilities were used beyond capacity. A designated trauma team was lacking and speciality services for managing polytrauma were deficient and thus, existing personnel were performing multiple tasks. Neurosurgeons and rehabilitative nursing staff were unavailable, and a radiographer was not available on a 24/7 basis. Existing nursing personnel had not received any formal training in trauma care and standard operating protocols were not available for trauma care. Resources for acute resuscitation were partially adequate. The hospital lacked adequate resources to manage head, abdomen, chest and spine injuries, and most of the polytrauma cases were referred to nearby city hospitals. Conclusion: District hospital, the only referral hospital in public health system for trauma victims of that region, had inadequate resources to manage trauma victims, which was probably responsible for delay in trauma care, improper referrals, high cost of care and poor outcomes.

  15. Complex Care Management to Decrease Emergency Department Utilization: A Case Study of the Homeless Patient Aligned Care Team Demonstration Project at VA Greater Los Angeles Healthcare System

    OpenAIRE

    Patel, Beena Ishwar

    2013-01-01

    This quality improvement (QI) dissertation is a case study of the homeless-oriented Patient Centered Medical Home demonstration program, referred to as the Homeless Patient Aligned Care Team (HPACT) at West Los Angeles VA Medical Center (WLA). The WLA HPACT program was implemented to address the complex needs of the homeless and at-risk for homelessness population using the Patient Centered Medical Home model (PCMH) - a multi-disciplinary, team-based approach to primary care. Unlike tradition...

  16. Xurography as a Rapid Fabrication Alternative for Point-of-Care Devices: Assessment of Passive Micromixers

    Science.gov (United States)

    Martínez-López, J. Israel; Mojica, Mauricio; Rodríguez, Ciro A.; Siller, Héctor R.

    2016-01-01

    Despite the copious amount of research on the design and operation of micromixers, there are few works regarding manufacture technology aimed at implementation beyond academic environments. This work evaluates the viability of xurography as a rapid fabrication tool for the development of ultra-low cost microfluidic technology for extreme Point-of-Care (POC) micromixing devices. By eschewing photolithographic processes and the bulkiness of pumping and enclosure systems for rapid fabrication and passively driven operation, xurography is introduced as a manufacturing alternative for asymmetric split and recombine (ASAR) micromixers. A T-micromixer design was used as a reference to assess the effects of different cutting conditions and materials on the geometric features of the resulting microdevices. Inspection by stereographic and confocal microscopy showed that it is possible to manufacture devices with less than 8% absolute dimensional error. Implementation of the manufacturing methodology in modified circular shape- based SAR microdevices (balanced and unbalanced configurations) showed that, despite the precision limitations of the xurographic process, it is possible to implement this methodology to produce functional micromixing devices. Mixing efficiency was evaluated numerically and experimentally at the outlet of the microdevices with performances up to 40%. Overall, the assessment encourages further research of xurography for the development of POC micromixers. PMID:27196904

  17. E-assessment of prior learning : a pilot study of interactive assessment of staff with no formal education who are working in Swedish elderly care

    OpenAIRE

    Nilsson, Annika; Andren, Marianne; Engström, Maria

    2014-01-01

    Background The current paper presents a pilot study of interactive assessment using information and communication technology (ICT) to evaluate the knowledge, skills and abilities of staff with no formal education who are working in Swedish elderly care. Methods Theoretical and practical assessment methods were developed and used with simulated patients and computer-based tests to identify strengths and areas for personal development among staff with no formal education. Results Of the 157 sta...

  18. A Long-Term Care—Comprehensive Geriatric Assessment (LTC-CGA) Tool: Improving Care for Frail Older Adults?

    Science.gov (United States)

    Marshall, Emily G.; Clarke, Barry S.; Varatharasan, Nirupa; Andrew, Melissa K.

    2015-01-01

    Background Most older adults living in long-term care facilities (LTCF) are frail and have complex care needs. Holistic understanding of residents’ health status is key to providing good care. Comprehensive Geriatric Assessment (CGA) is a valid assessment method which aims to embrace complexity. Here we aimed to study a CGA that has been modified for use in long-term care (the LTC-CGA) and to investigate its acceptability and usefulness to stakeholders and users. Methods This mixed methods study, conducted in 10 LTCFs in Halifax, Nova Scotia, reviewed 598 resident charts from pre- and post-implementation of the LTC-CGA. Qualitative methods explored stakeholder perspectives (physicians, nurses, paramedics, administrators, residents and families) though focus groups. Results The LTC-CGA was present in 78% of LTCF charts in the post -implementation, period though it did not appear in acute care charts of transferred residents, despite the intention that it accompany residents between care sites. Some items had suboptimal completion rates (e.g., Advance Directives at 56.4%), though these were located in other sections of the LTCF chart (98.2%). Nevertheless, qualitative findings suggest the LTC-CGA describes a clinical baseline health status which enabled timely and informed clinical decision-making. Conclusions The LTC-CGA is a useful resource whose full capacity may not yet have been realized. PMID:25825606

  19. Physical activity assessed in routine care predicts mortality after a COPD hospitalisation

    Directory of Open Access Journals (Sweden)

    Marilyn L. Moy

    2016-03-01

    Full Text Available The independent relationship between physical inactivity and risk of death after an index chronic obstructive pulmonary disease (COPD hospitalisation is unknown. We conducted a retrospective cohort study in a large integrated healthcare system. Patients were included if they were hospitalised for COPD between January 1, 2011 and December 31, 2011. All-cause mortality in the 12 months after discharge was the primary outcome. Physical activity, expressed as self-reported minutes of moderate to vigorous physical activity (MVPA, was routinely assessed at outpatient visits prior to hospitalisation. 1727 (73% patients were inactive (0 min of MVPA per week, 412 (17% were insufficiently active (1–149 min of MVPA per week and 231 (10% were active (≥150 min of MVPA per week. Adjusted Cox regression models assessed risk of death across the MVPA categories. Among 2370 patients (55% females and mean age 73±11 years, there were 464 (20% deaths. Patients who were insufficiently active or active had a 28% (adjusted HR 0.72 (95% CI 0.54–0.97, p=0.03 and 47% (adjusted HR 0.53 (95% CI 0.34–0.84, p<0.01 lower risk of death, respectively, in the 12 months following an index COPD hospitalisation compared to inactive patients. Any level of MVPA is associated with lower risk of all-cause mortality after a COPD hospitalisation. Routine assessment of physical activity in clinical care would identify persons at high risk for dying after COPD hospitalisation.

  20. Assessment of adverse drug reactions based on spontaneous signals at secondary care public hospital

    Directory of Open Access Journals (Sweden)

    S Ponnusankar

    2015-01-01

    Full Text Available Adverse drug reactions are considered to be among the leading causes of morbidity and mortality. Approximately 5-25% of hospital admissions are due to adverse drug reactions and 6-15% of hospitalized patients experience serious adverse drug reactions, causing significant prolongation of hospital stay. Thus this study was aimed at determining adverse drug reactions by conducting spontaneous reporting in secondary care Govt. District Head Quarters Hospital at Ooty. A prospective Spontaneous Adverse Drug Reaction reporting study was conducted over a period of 12 months from July 2012 to June 2013. The assessment, categorization, causality, severity and preventability were assessed using standard criteria. A total of 47 suspected adverse drug reactions were reported during the study period. Over all incidences was 1.29% among the study population. Antibiotics (31.91% were the class of drug most commonly involved, while ciprofloxacin (14.89% was the most frequently reported. Type H (Hypersensitivity reactions (51.06% accounted for majority of the reports and a greater share of the adverse drug reactions are probable (89.36% based on causality assessment. Mild reactions accounted 82.97% based on modified Hartwig and Siegel severity scale. In 76.59% of the reports, the reaction was considered to be preventable based on Schumock and Thornton preventability scale. The implementation of monitoring based on spontaneous reporting will be useful for the detection and evaluation is associated with increase in morbidity and duration of hospitalization. This study also has established the vital role of clinical pharmacist in the adverse drug reaction monitoring program.

  1. Improving patient-centeredness of fertility care using a multifaceted approach: study protocol for a randomized controlled trial

    OpenAIRE

    Huppelschoten Aleida G; van Duijnhoven Noortje TL; Hermens Rosella PMG; Verhaak Chris; Kremer Jan AM; Nelen Willianne LDM

    2012-01-01

    Abstract Background Beside traditional outcomes of safety and (cost-)effectiveness, the Institute of Medicine states patient-centeredness as an independent outcome indicator to evaluate the quality of healthcare. Providing patient-centered care is important because patients want to be heard for their ideas and concerns. Healthcare areas associated with high emotions and intensive treatment periods could especially benefit from patient-centered care. How care can become optimally improved in p...

  2. Assessing undergraduate nursing students' knowledge, attitudes, and cultural competence in caring for lesbian, gay, bisexual, and transgender patients.

    Science.gov (United States)

    Strong, Kristy L; Folse, Victoria N

    2015-01-01

    Lesbian, gay, bisexual, and transgender (LGBT) patients experience barriers to health care that include fear of discrimination, as well as insensitivity and lack of knowledge about LGBT-specific health needs among providers. This study examined the effectiveness of an educational intervention designed to improve knowledge and attitudes of baccalaureate nursing students regarding LGBT patient care. Education focused on key terminology, health disparities, medical needs of transgender patients, and culturally sensitive communication skills for competent LGBT patient care. Knowledge level and attitudes were evaluated before and after the intervention using a survey based on a modified Attitudes Toward Lesbians and Gay Men Scale and two assessment tools developed for this study. A statistically significant increase in positive attitudes and knowledge level was found immediately after the intervention. Findings from this study support the inclusion of education related to LGBT patient health care in undergraduate nursing curricula to promote cultural competence and sensitivity. PMID:25535762

  3. Exploring the Utility of Ultra-Brief Delirium Assessments in a Nonintensive Care Geriatric Population: The GEM Study

    OpenAIRE

    Powers, James S.; Doering, Tracey; Gordon, Sharon; Svetlana K Eden; Shintani, Ayumi; Schnelle, John

    2012-01-01

    Objective: To determine how an ultra-brief structured tool that would require usually less than a minute for delirium assessment compares with a clinical assessment based on Diagnostic and Statistical Manual-IV (DSM-IV) in a geriatric postacute care (PAC) rehabilitation unit. Design: Prospective observational cohort study. Setting: Postacute geriatric hospital ward of a Veteran’s Affairs hospital. Participants: Consecutively admitted patients between 50 and 100 years old for inpatient postacu...

  4. Risk assessment of parents' concerns at 18 months in preventive child health care predicted child abuse and neglect

    OpenAIRE

    Staal, I.I.E.; Hermanns, J.M.A.; Schrijvers, A.J.P.; Stel, van, H.F.

    2013-01-01

    Objective: As child maltreatment has a major impact, prevention and early detection of parenting problems are of great importance. We have developed a structured interview which uses parents’ concerns for a joint needs assessment by parents and a child health care nurse, followed by a professional judgment on the risk level of future parenting and developmental problems: the Structured Problem Analysis of Raising Kids (SPARK). Previous results have shown that the risk assessment of the SPARK ...

  5. ASSESSMENT OF COMPLIANCE TO TREATMENT AMONG AMBULATORY ASTHMATIC PATIENTS IN A SECONDARY HEALTH CARE FACILITY IN NIGERIA

    OpenAIRE

    S. J. Showande et al.

    2012-01-01

    This study assessed the level of compliance using three different methods: pill count, self report and peak expiratory flow rate, in asthmatic patients attending a secondary health care facility. Self report (using a pre-tested structured questionnaire), peak expiratory flow rate and pill count were used to assess patient’s compliance and identify the factors which may be responsible for non compliance. Measurement of peak expiratory flow rate and the pill count were done at two different occ...

  6. Surveying Consumer Satisfaction to Assess Managed-Care Quality: Current Practices

    OpenAIRE

    Gold, Marsha; Wooldridge, Judith

    1995-01-01

    Growing interest in using consumer satisfaction information to enhance quality of care and promote informed consumer choice has accompanied recent expansions in managed care. This article synthesizes information about consumer satisfaction surveys conducted by managed-care plans, government and other agencies, community groups, and purchasers of care. We discuss survey content, methods, and use of consumer survey information. Differences in the use of consumer surveys preclude one instrument ...

  7. Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research.

    OpenAIRE

    Alexander, G R; Kotelchuck, M

    2001-01-01

    Despite the widespread use of prenatal care, the evidence for its effectiveness remains equivocal and its primary purpose and effects continue to be a subject of debate. To provide some perspective on why the effectiveness and organization of prenatal care continue to be debated, the authors (a) briefly review the history of the development of prenatal care in the US; (b) attempt to conceptually define prenatal care in terms of its utilization, content, and quality; and, (c) highlight some of...

  8. Prenatal care in the primary health care network in FortalezaCE: an assessment of the structure, process and results

    Directory of Open Access Journals (Sweden)

    Rebeca Silveira Rocha

    2012-09-01

    Full Text Available Objective: To evaluate the prenatal care assistance in the primary health care network in Fortaleza-CE, considering the structure, process and results. Methods: A cross sectional descriptive study, of quantitative approach, performed between October 2009 and February 2011, in 30 Health Units randomly selected, keeping the ratio for each Regional Executive Secretary. For analysis of the structure, the information obtained was scored and classified as: excellent, satisfactory, precarious or insufficient. The form used was submitted to four experts for validation. In evaluating the process and results, data was available by the Municipal Health Secretary of Fortaleza for obtainance of the indicators recommended by the Ministry of Health. Results: There was, in general, a satisfactory structure. As for the process and result, we obtained: pregnant women who had, at least, six prenatal visits (7.6%; pregnant women who received tetanus immunization (22.8%; newborns with congenital syphilis (1.4%; newborns with neonatal tetanus (0%; maternal mortality rate (78.5% in 2008 and 51% in 2009 and total neonatal mortality rate (10.1% in 2008 and 11.2% in 2009. Conclusions: Despite good results with regard to the structure, the reflections on the process and outcome indicators were not positive, with low rates compared to those expected by the World Health Organization or the Ministry of Health, or in comparison with other regions.

  9. Algorithms and Care Pathways for Assessment and Counseling for Domestic Violence.

    Science.gov (United States)

    Miller, Thomas W.; Veltkamp, Lane J.

    Health care providers recognize the importance of standards of care and standardized models of evaluation and intervention on cases of domestic violence. Examined are algorithms and care pathways being utilized to assure consistency in the evaluation and interventions offered where the spectrum symptoms of domestic violence are identified in the…

  10. The Development of an ICF-Oriented, Adaptive Physician Assessment Instrument of Mobility, Self-care, and Domestic Life

    Science.gov (United States)

    Farin, Erik; Fleitz, Annette

    2009-01-01

    The objective of this study was development and psychometric testing of an adaptive, International Classification of Functioning, Disability, and Health (ICF)-oriented questionnaire to be processed by the rehabilitation physician that aids in assessing mobility, self-care, and domestic life (Moses-Physician). The intent is to develop a physician…

  11. Validation and Evaluation of Two Observational Pain Assessment Tools in a Trauma and Neurosurgical Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Jane Topolovec-Vranic

    2013-01-01

    Full Text Available BACKGROUND: Studies have demonstrated that patients in the intensive care unit experience high levels of pain. While many of these patients are nonverbal at some point during their stay, there are few valid tools available to assess pain in this group.

  12. New Mexico Look for the STARS--AIM HIGH: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

    This paper presents a profile of New Mexico's Look for the STARS--AIM HIGH 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)…

  13. Risk assessment of parents' concerns at 18 months in preventive child health care predicted child abuse and neglect

    NARCIS (Netherlands)

    I.I.E. Staal; J.M.A. Hermanns; A.J.P. Schrijvers; H.F. van Stel

    2013-01-01

    Objective: As child maltreatment has a major impact, prevention and early detection of parenting problems are of great importance. We have developed a structured interview which uses parents’ concerns for a joint needs assessment by parents and a child health care nurse, followed by a professional j

  14. Patient-centered clinical impact of incidentally detected abnormalities on chest CT scans

    Directory of Open Access Journals (Sweden)

    Sherine G. Moftah

    2014-09-01

    Conclusion: The clinically significant different incidental abnormalities on chest CT scans represented 10.4% of all incidental findings, 3.3% were due to malignancies. The clinical impact of incidental abnormalities on chest CT may be of utmost importance on patient care.

  15. Primary care assessment instruments for patients at risk of, or with, persistent pain: opportunistic findings from a systematic literature review

    Directory of Open Access Journals (Sweden)

    Karen Grimmer-Somers

    2009-06-01

    Full Text Available Karen Grimmer-Somers1, Saravana Kumar1, Nic Vipond2, Gillian Hall21Centre for Allied Health Evidence, University of South Australia, Australia; 2Accident Compensation Corporation, Wellington, New ZealandBackground: Early identification in primary care settings of individuals with, or at-risk of, developing persistent pain, is important to limit development of disability. There is little information to assist primary care providers to choose or deliver relevant, efficient, and soundly constructed assessment instruments for this purpose.Objective: We recently published the findings of a literature review, which produced a compendium of assessment instruments to identify adults with, or at-risk of developing, persistent pain of noncancer origin. This paper reports on instruments opportunistically identified during this review which may be appropriate to primary health care settings for early identification of such patients.Results: One hundred sixteen potentially useful instruments were initially identified in the review, measuring pain severity, psychological distress, functional capacity, quality of life or multidimensional constructs of persistent pain. Following a series of steps, 45 instruments were shortlisted, with sound clinical utility and strong psychometric properties. Of these, 16 instruments were appropriate to primary health care settings because of simple wording, brief items, short administration time, and ease of scoring.Conclusion: No one assessment instrument captured all constructs of persistent pain. The 16 instruments provide a broad choice for primary care clinicians to assist with early identification of adults at risk of, or with persistent pain.Keywords: adults with persistent pain, primary health care assessment, early identification

  16. Organization Complexity and Primary Care Providers' Perceptions of Quality Improvement Culture Within the Veterans Health Administration.

    Science.gov (United States)

    Korom-Djakovic, Danijela; Canamucio, Anne; Lempa, Michele; Yano, Elizabeth M; Long, Judith A

    2016-03-01

    This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation. PMID:25414376

  17. Home and community based care program assessment for people living with HIV/AIDS in Arba Minch, Southern Ethiopia

    Directory of Open Access Journals (Sweden)

    Zerfu Taddese

    2012-06-01

    Full Text Available Abstract Background People Living with HIV/AIDS (PLWHA require significant care and support; however, most care needs are still unmet. To our knowledge, no studies have described the activities and challenges of care services in Ethiopia. Our objective was to assess the status, shortcomings and prospects of care and support services provided to PLWHA in the town of Arba Minch, Ethiopia, and surrounding areas. Methods A cross-sectional quantitative study combined with qualitative methods was conducted in Southern Ethiopia among 226 randomly selected PLWHAs and 10 service providers who were purposively selected. Data was collected using a pre-tested structured interview questionnaire and in-depth interview guideline. Quantitative data was analyzed using SPSS windows based statistical software while qualitative data was analyzed manually using thematic framework analysis. Results A total of 226 PLWHAs were interviewed. Socio-economic support (material and income generating activities was being received by 108 (47.8% of the respondents, counseling services (e.g. psychological support were being received 128(56.6%, 144 (63.7% alleviation of stigma and discrimination as human right and legal support for study participants. Inadequate external financial support, lack of proper referral systems between different care providers were among the reasons identified for the low quality and redundancy of care and support activities. Nonetheless, many opportunities and prospects, including easily accessible care receivers (PLWHA, good political and societal will were also implicated. Conclusion Care and support services provided to PLWHAs in the study area are by far lower in terms of coverage and quantity. Strategies for improvement could be facilitated given the observed political will, social support and access to care givers.

  18. Occurrence, fate and risk assessment of personal care products in river-groundwater interface.

    Science.gov (United States)

    Serra-Roig, Maria Pau; Jurado, Anna; Díaz-Cruz, M Silvia; Vázquez-Suñé, Enric; Pujades, Estanislao; Barceló, Damià

    2016-10-15

    This work presents the occurrence and fate of selected personal care products (PCPs) in the urban river-groundwater interface. To this end, urban river and groundwater samples were collected in Sant Adrià del Besòs (NE of Spain) and a total of 16 PCPs were analyzed including benzophenone derivatives, camphor derivatives, p-aminobenzoic acid derivatives, triazoles and parabens in three different campaigns (from May 2010 to July 2014). These compounds reach the aquifer through the recharge of Besòs River that receives large amounts of effluents from waste water treatment plants. Results have shown that most of the compounds were not or barely detected (maximum concentrations around 200ng/L) in groundwater samples during the different sampling campaigns. Only two triazoles, namely benzotriazole (BZT) and methyl benzotriazol (MeBZT) were found at high concentrations in groundwater samples (maximum concentration around 2000ng/L). The fate of PCPs in the aquifer was assessed using mixing analysis considering the seasonal variability of the Besòs River. Overall, measured groundwater concentrations were significantly much lower than those estimated by the mixing of the river water. This observation suggested that most of the PCPs are naturally removed when river water infiltrates the aquifer. However, some compounds were more persistent in the aquifer. These compounds were in descending order: the triazoles BZT and MeBZT followed by the camphor derivative 4MBC and the paraben MePB. The measured concentrations allowed us to assess the environmental risk posed by the selected UV-filters and parabens in the river and groundwater samples. Hazard Quotients (HQs) for different aquatic species were calculated in order to characterize the ecotoxicity potential of the studied compounds in the river-groundwater interface. HQ values were always below 1 indicating that at the concentrations observed in the surface or aquifer water of Besòs River these compounds pose no risk to

  19. Cardiac Risk Assessment, Morbidity Prediction, and Outcome in the Vascular Intensive Care Unit.

    LENUS (Irish Health Repository)

    Dover, Mary

    2013-09-17

    Objectives: The aim of this study is to examine the predictive value of the Lee revised cardiac risk index (RCRI) for a standard vascular intensive care unit (ICU) population as well as assessing the utility of transthoracic echocardiography and the impact of prior coronary artery disease (CAD) and coronary revascularization on patient outcome. Design: This is a retrospective review of prospectively maintained Vascubase and prospectively collected ICU data. Materials and Methods: Data from 363 consecutive vascular ICU admissions were collected. Findings were used to calculate the RCRI, which was then correlated with patient outcomes. All patients were on optimal medical therapy (OMT) in the form of cardioselective β-blocker, aspirin, statin, and folic acid. Results: There was no relationship found between a reduced ejection fraction and patient outcome. Mortality was significantly increased for patients with left ventricular hypertrophy (LVH) as identified on echo (14.9% vs 6.5%, P = .028). The overall complication rates were significantly elevated for patients with valvular dysfunction. Discrimination for the RCRI on receiver-operating characteristic analysis was poor, with an area under the receiver-operating characteristic curve of .621. Model calibration was reasonable with an Hosmer-Lemeshow Ĉ statistic of 2.726 (P = .256). Of those with known CAD, 41.22% of the patients receiving best medical treatment developed acute myocardial infarction (AMI) compared to 35.3% of those who previously underwent percutaneous cardiac intervention and 23.5% of those who had undergone coronary artery bypass grafting. There was 3-fold increase in major adverse clinical events in patients with troponin rise and LVH. Conclusions: The RCRI\\'s discriminatory capacity is low, and this raises difficulties in assessing cardiac risk in patients undergoing vascular intervention. The AMI is highest in the OMT group without prior cardiac intervention, which mandates protocols to

  20. Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment

    Directory of Open Access Journals (Sweden)

    Peiris David

    2012-10-01

    Full Text Available Abstract Background Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. In this qualitative study we explored Aboriginal Medical Service (AMS staff views on factors needed to improve chronic care systems and assessed their relevance to the new policy environment. Methods Two theories informed the study: (1 ‘candidacy’, which explores “the ways in which people’s eligibility for care is jointly negotiated between individuals and health services”; and (2 kanyini or ‘holding’, a Central Australian philosophy which describes the principle and obligations of nurturing and protecting others. A structured health systems assessment, locally adapted from Chronic Care Model domains, was administered via group interviews with 37 health staff in six AMSs and one government Indigenous-led health service. Data were thematically analysed. Results Staff emphasised AMS health care was different to private general practices. Consistent with kanyini, community governance and leadership, community representation among staff, and commitment to community development were important organisational features to retain and nurture both staff and patients. This was undermined, however, by constant fear of government funding for AMSs being withheld. Staff resourcing, information systems and high-level leadership were perceived to be key drivers of health care quality. On-site specialist services, managed by AMS staff, were considered an enabling strategy to increase specialist access. Candidacy theory suggests the above factors influence whether a service is ‘tractable’ and ‘navigable’ to its users. Staff also described entrenched patient discrimination in hospitals and the need to expend considerable effort to reinstate care. This suggests that Aboriginal and Torres Strait Islander people are still

  1. Assessment of mothers’ satisfaction with the care of maternal care in Specialized Educational-Medical Centers in obstetrics and gynecological disease in Northwest, Iran

    Directory of Open Access Journals (Sweden)

    Simin Taghavi

    2015-06-01

    Full Text Available Introduction: Patients satisfaction includes the assessment of healthcare which she/he received. This study aims at assessment of mothers’ satisfaction with the care of maternal care in Specialized Educational-Medical Centers in obstetrics and gynecological disease in Northwest, Iran. Methods: In an analytic-descriptive cross-sectional study, 1000 female patients who admitted in educational-medical centers of Northwest were studied during a 2 years period (2010-2012. They asked to fill a 34-item closed-answer questionnaire (ranking from very unsatisfied to very satisfied responses following their discharge. Validity of the questionnaire was improved by gynecologist’s experts comments, and reliability of the questionnaire were assessed by test-retest methods (α = 0.946. Results: The satisfaction score (satisfied or very satisfied responses were 61.2, 55.8, 61.8 and 59.5 percent for admitting process, primary care services, treatments and therapeutic interventions and overall, respectively. The satisfaction score for access to doctors was highest in the morning and lowest at the night shifts. The satisfaction score about the personnel’s behavior was lowest during the night shifts. The satisfaction score about the residents’ behavior was highest for the morning shifts. There was no significant difference between the three working shifts regarding psychological feelings, humanitarian respect, and issues like nutrition and private and public hygiene. There was a significant direct correlation between the mean score of satisfaction and patients’ age (Spearman’s rho = 0.117, P < 0.001. Conclusion: The satisfaction level of patients hospitalized in Northwest of Iran's Hospitals was intermediate. Planning new strategies in this regard with emphasis on the main limitations may improve the satisfaction rate in the future.

  2. A consensus approach to wound care in epidermolysis bullosa

    Science.gov (United States)

    Pope, Elena; Lara-Corrales, Irene; Mellerio, Jemima; Martinez, Anna; Schultz, Gregory; Burrell, Robert; Goodman, Laurie; Coutts, Patricia; Wagner, John; Allen, Upton; Sibbald, Gary

    2013-01-01

    Background Wound care is the cornerstone of treatment for patients with epidermolysis bullosa (EB); however, there are currently no guidelines to help practitioners care for these patients. Objectives The objective of this study was to generate a list of recommendations that will enable practitioners to better care for patients with EB. Methods An expert panel generated a list of recommendations based on the best evidence available. The recommendations were translated into a survey, and sent to other EB experts to generate consensus using an online-based modified Delphi method. The list was refined and grouped into themes and specific recommendations. Results There were15 respondents (45% response rate), with significant experience in the EB field (>10 years [67%]). Respondents included physicians (67%), nurses (17%), and allied health professionals (7%). There was more than 85% agreement for all the proposed items. These were further refined and grouped into 5 main themes (assessment and management of factors that impair healing, patient-centered concerns, local wound care, development of an individualized care plan, and organizational support) and 17 specific recommendations. Limitations There is a paucity of scientific evidence with most recommendations based on expert opinion. Conclusions These recommendations will provide practitioners with a framework for caring for these patients. Additional scientific research including effectiveness studies for everyday practice and expert consensus, may further refine these recommendations. PMID:22387035

  3. Quality of Care for Patients with Type 2 Diabetes Mellitus in Dubai: A HEDIS-Like Assessment

    Directory of Open Access Journals (Sweden)

    Shelagh M. Szabo

    2015-01-01

    Full Text Available Objective. As little data are available on the quality of type 2 diabetes mellitus (T2DM care in the Arabian Gulf States, we estimated the proportion of patients receiving recommended monitoring at the Dubai Hospital for T2DM over one year. Methods. Charts from 150 adults with T2DM were systematically sampled and quality of care was assessed during one calendar year, using a Healthcare Effectiveness Data and Information Set- (HEDIS- like assessment. Screening for glycosylated haemoglobin (HbA1c, low-density lipoprotein (LDL, blood pressure, retinopathy, and nephropathy was considered. Patients were classified based on their most recent test in the period, and predictors of receiving quality care were examined. Results. Mean age was 58 years (standard deviation (SD: 12.4 years and 33% were males. Over the year, 98% underwent HbA1c screening (50% had control and 28% displayed poor control; 91% underwent LDL screening (65% had control; 55% had blood pressure control; 30% had retinopathy screening; and 22% received attention for nephropathy. No individual characteristics examined predicted receiving quality care. Conclusion. Some guideline monitoring was conducted for most patients; and rates of monitoring for selected measures were comparable to benchmarks from the United States. Greater understanding of factors leading to high adherence would be useful for other areas of preventive care and other jurisdictions.

  4. The role of palliative care in population management and accountable care organizations.

    Science.gov (United States)

    Smith, Grant; Bernacki, Rachelle; Block, Susan D

    2015-06-01

    By 2021, health care spending is projected to grow to 19.6% of the GDP, likely crowding out spending in other areas. The 2010 Affordable Care Act (ACA) attempts to curb health care spending by incentivizing high-value care through the creation of Accountable Care Organizations (ACOs), which assume financial risk for patient outcomes. With this financial risk, health systems creating ACOs will be motivated to pursue innovative care models that maximize the value of care. Palliative care, as an emerging field with a growing evidence base, is positioned to improve value in ACOs by increasing high-quality care and decreasing costs for the sickest patients. ACO leaders may find palliative care input valuable in optimizing high-quality patient-centered care in the accountable care environment; however, palliative care clinicians will need to adopt new models that extrapolate their direct patient care skills to population management strategies. We propose that palliative care specialists take on responsibilities for working with ACO leaders to broaden their mission for systemwide palliative care for appropriate patients by prospectively identifying patients with a high risk of death, high symptom burden, and/or significant psychosocial dysfunction, and developing targeted, "triggered" interventions to enhance patient-centered, goal-consistent, coordinated care. Developing these new population management competencies is a critical role for palliative care teams in the ACO environment. PMID:25723619

  5. An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh

    OpenAIRE

    Hoque Dewan ME; Rahman Muntasirur; Billah Sk Masum; Savic Michael; Karim AQM Rezaul; Chowdhury Enayet K; Hossain Altaf; Musa SAJ Md; Kumar Harish; Malhotra Sudhansh; Matin Ziaul; Raina Neena; Weber Martin W.; El Arifeen Shams

    2012-01-01

    Abstract Background Quality hospital care is important in ensuring that the needs of severely ill children are met to avert child mortality. However, the quality of hospital care for children in developing countries has often been found poor. As the first step of a country road map for improving hospital care for children, we assessed the baseline situation with respect to the quality of care provided to children under-five years age in district and sub-district level hospitals in Bangladesh....

  6. The Patients Assessment Chronic Illness Care (PACIC questionnaire in The Netherlands: a validation study in rural general practice

    Directory of Open Access Journals (Sweden)

    Hermsen Jan

    2008-09-01

    Full Text Available Abstract Background Many patients with chronic illness receive health care in primary care settings, so a challenge is to provide well-structured chronic care in these settings. Our aim was to develop and test a Dutch version of the PACIC questionnaire, a measure for patient reported structured chronic care. Methods Observational study in 165 patients with diabetes or COPD from four general practices (72% response rate. Patients completed a written questionnaire, which included instruments for assessing chronic illness care (PACIC, evaluations of general practice (Europep, enablement (PEI, and individual characteristics. Results The patients had a mean age of 68.0 years and 47% comprised of women. Twenty-two to 35% of responding patients did not provide answers to specific items in the PACIC. In 11 items the lowest answering category was used by 30% or more of the responders and in 6 items the highest answering category was used by this number of responders. Principal factor analysis identified the previously defined five domains reasonably well. Cronbach's alpha per domain varied from 0.71 to 0.83, and the intraclass coefficient from 0.66 to 0.91. Diabetes patients reported higher presence of structured chronic care for 14 out of the 20 PACIC items. The effect of patient evaluations of general practice on the PACIC score was positive (b = 0.72, p Conclusion A translated and validated Dutch version of the PACIC questionnaire is now available. Further research on its validity is recommended.

  7. Safety assessment of personal care products/cosmetics and their ingredients

    International Nuclear Information System (INIS)

    We attempt to review the safety assessment of personal care products (PCP) and ingredients that are representative and pose complex safety issues. PCP are generally applied to human skin and mainly produce local exposure, although skin penetration or use in the oral cavity, on the face, lips, eyes and mucosa may also produce human systemic exposure. In the EU, US and Japan, the safety of PCP is regulated under cosmetic and/or drug regulations. Oxidative hair dyes contain arylamines, the most chemically reactive ingredients of PCP. Although arylamines have an allergic potential, taking into account the high number of consumers exposed, the incidence and prevalence of hair dye allergy appears to be low and stable. A recent (2001) epidemiology study suggested an association of oxidative hair dye use and increased bladder cancer risk in consumers, although this was not confirmed by subsequent or previous epidemiologic investigations. The results of genetic toxicity, carcinogenicity and reproductive toxicity studies suggest that modern hair dyes and their ingredients pose no genotoxic, carcinogenic or reproductive risk. Recent reports suggest that arylamines contained in oxidative hair dyes are N-acetylated in human or mammalian skin resulting in systemic exposure to traces of detoxified, i.e. non-genotoxic, metabolites, whereas human hepatocytes were unable to transform hair dye arylamines to potentially carcinogenic metabolites. An expert panel of the International Agency on Research of Cancer (IARC) concluded that there is no evidence for a causal association of hair dye exposure with an elevated cancer risk in consumers. Ultraviolet filters have important benefits by protecting the consumer against adverse effects of UV radiation; these substances undergo a stringent safety evaluation under current international regulations prior to their marketing. Concerns were also raised about the safety of solid nanoparticles in PCP, mainly TiO2 and ZnO in sunscreens. However

  8. Safety assessment of personal care products/cosmetics and their ingredients.

    Science.gov (United States)

    Nohynek, Gerhard J; Antignac, Eric; Re, Thomas; Toutain, Herve

    2010-03-01

    We attempt to review the safety assessment of personal care products (PCP) and ingredients that are representative and pose complex safety issues. PCP are generally applied to human skin and mainly produce local exposure, although skin penetration or use in the oral cavity, on the face, lips, eyes and mucosa may also produce human systemic exposure. In the EU, US and Japan, the safety of PCP is regulated under cosmetic and/or drug regulations. Oxidative hair dyes contain arylamines, the most chemically reactive ingredients of PCP. Although arylamines have an allergic potential, taking into account the high number of consumers exposed, the incidence and prevalence of hair dye allergy appears to be low and stable. A recent (2001) epidemiology study suggested an association of oxidative hair dye use and increased bladder cancer risk in consumers, although this was not confirmed by subsequent or previous epidemiologic investigations. The results of genetic toxicity, carcinogenicity and reproductive toxicity studies suggest that modern hair dyes and their ingredients pose no genotoxic, carcinogenic or reproductive risk. Recent reports suggest that arylamines contained in oxidative hair dyes are N-acetylated in human or mammalian skin resulting in systemic exposure to traces of detoxified, i.e. non-genotoxic, metabolites, whereas human hepatocytes were unable to transform hair dye arylamines to potentially carcinogenic metabolites. An expert panel of the International Agency on Research of Cancer (IARC) concluded that there is no evidence for a causal association of hair dye exposure with an elevated cancer risk in consumers. Ultraviolet filters have important benefits by protecting the consumer against adverse effects of UV radiation; these substances undergo a stringent safety evaluation under current international regulations prior to their marketing. Concerns were also raised about the safety of solid nanoparticles in PCP, mainly TiO(2) and ZnO in sunscreens. However

  9. Improvements in the quality of co-ordination of nursing care following implementation of the Resident Assessment Instrument in Dutch nursing homes.

    NARCIS (Netherlands)

    Achterberg, W.P.; Holtkamp, C.C.M.; Kerkstra, A.; Pot, A.M.; Ooms, M.E.; Ribbe, M.W.

    2001-01-01

    Aim: To study the effect of implementation of the Resident Assessment Instrument (RAI) on the quality of co-ordination of nursing care in Dutch nursing homes. Background: The Resident Assessment Instrument (RAI) was designed to improve the quality of care and quality of life in nursing homes. Until

  10. The Staffordshire Arthritis, Musculoskeletal, and Back Assessment (SAMBA) Study: a prospective observational study of patient outcome following referral to a primary-secondary care musculoskeletal interface service

    OpenAIRE

    Jordan Kelvin P; Hider Samantha L; Dawes Peter; Zwierska Irena; Roddy Edward; Packham Jon; Stevenson Kay; Hay Elaine

    2010-01-01

    Abstract Background Recent healthcare policy has shifted the management of musculoskeletal conditions in the UK away from secondary care towards Clinical Assessment and Treatment Services at the primary-secondary care interface. However, little is known about the outcome of patients with musculoskeletal conditions referred from primary care to Clinical Assessment and Treatment Services or how best to identify those patients at high risk of poor outcome in this setting. We describe the protoco...

  11. Geriatric pain competencies and knowledge assessment for nurses in long term care settings

    OpenAIRE

    Swafford, Kristen L.; Miller, Lois L.; Herr, Keela; Forcucci, Chris; Kelly, Anne Marie L.; Bakerjian, Debra

    2014-01-01

    Pain in older adults is a prevalent problem that affects quality of life and challenges nurses, particularly those caring for older adults living in long term care settings. Despite the national priority of pain management, insufficient knowledge of nurses about geriatric pain is a documented barrier to effective geriatric pain management in all long term care settings. To address this knowledge gap, a website (GeriatricPain.org) was developed by the National Geriatric Pain Collaborative with...

  12. Wait Times for Sleep Apnea Care in Ontario: A Multidisciplinary Assessment

    OpenAIRE

    Rotenberg, Brian W; George, Charles F.; Sullivan, Kevin M; Eric Wong

    2010-01-01

    BACKGROUND: Obstructive sleep apnea (OSA) is a highly prevalent disorder that is associated with significant patient morbidity and societal burden. In general, wait times for health care in Ontario are believed to be lengthy; however, many diseases lack specific corroborative wait time data.OBJECTIVE: To characterize wait times for OSA care in Ontario.METHODS: Cross-sectional survey. A survey tool was designed and validated to question physicians involved in OSA care about the length of the w...

  13. Validation of a New Instrument for Self-Assessment of Nurses’ Core Competencies in Palliative Care

    OpenAIRE

    Kari Slåtten; Ove Hatlevik; Lisbeth Fagerström

    2014-01-01

    Competence can be seen as a prerequisite for high quality nursing in clinical settings. Few research studies have focused on nurses’ core competencies in clinical palliative care and few measurement tools have been developed to explore these core competencies. The purpose of this study was to test and validate the nurses’ core competence in palliative care (NCPC) instrument. A total of 122 clinical nurse specialists who had completed a postbachelor program in palliative care at two university...

  14. Dare to Care, Care to Perform

    DEFF Research Database (Denmark)

    Giangreco, Antonio; Sebastiano, Antnio; Carugati, Andrea

    2010-01-01

    -driven modernization process of an Italian nursing home. Based on qualitative research methods, our aim is to identify what are the elements of a designing approach of an IT-tool meant to enhance a process of modernization in a health care organization. Our results show that a patient-centered, user-friendly, bottomup...... designed and results-driven tool is more likely to be beneficial for the patients and the users and therefore, for the organization at large. This study contributes to the extant literature on health care management providing the alternative view that, if the tool is designed around and for the individuals...... (patients and users), then it will produce positive results for the organization. In other words, who dares to care, will perform....

  15. Assessment and determinants of airborne bacterial and fungal concentrations in different indoor environments: Homes, child day-care centres, primary schools and elderly care centres

    Science.gov (United States)

    Madureira, Joana; Paciência, Inês; Rufo, João Cavaleiro; Pereira, Cristiana; Teixeira, João Paulo; de Oliveira Fernandes, Eduardo

    2015-05-01

    Until now the influence of risk factors resulting from exposure to biological agents in indoor air has been far less studied than outdoor pollution; therefore the uncertainty of health risks, and how to effectively prevent these, remains. This study aimed (i) to quantify airborne cultivable bacterial and fungal concentrations in four different types of indoor environment as well as to identify the recovered fungi; (ii) to assess the impact of outdoor bacterial and fungal concentrations on indoor air; (iii) to investigate the influence of carbon dioxide (CO2), temperature and relative humidity on bacterial and fungal concentrations; and (iv) to estimate bacterial and fungal dose rate for children (3-5 years old and 8-10 years old) in comparison with the elderly. Air samples were collected in 68 homes, 9 child day-care centres, 20 primary schools and 22 elderly care centres, in a total of 264 rooms with a microbiological air sampler and using tryptic soy agar and malt extract agar culture media for bacteria and fungi growth, respectively. For each building, one outdoor representative location were identified and simultaneously studied. The results showed that child day-care centres were the indoor microenvironment with the highest median bacterial and fungal concentrations (3870 CFU/m3 and 415 CFU/m3, respectively), whereas the lowest median concentrations were observed in elderly care centres (222 CFU/m3 and 180 CFU/m3, respectively). Indoor bacterial concentrations were significantly higher than outdoor concentrations (p < 0.05); whereas the indoor/outdoor ratios for the obtained fungal concentrations were approximately around the unit. Indoor CO2 levels were associated with the bacterial concentration, probably due to occupancy and insufficient ventilation. Penicillium and Cladosporium were the most frequently occurring fungi. Children's had two times higher dose rate to biological pollutants when compared to adult individuals. Thus, due to children

  16. [Development of a Conceptual Framework for the Assessment of Chronic Care in the Spanish National Health System].

    Science.gov (United States)

    Espallargues, Mireia; Serra-Sutton, Vicky; Solans-Domènech, Maite; Torrente, Elena; Moharra, Montse; Benítez, Dolors; Robles, Noemí; Domíngo, Laia; Escarrabill Sanglas, Joan

    2016-01-01

    The aim was to develop a conceptual framework for the assessment of new healthcare initiatives on chronic diseases within the Spanish National Health System. A comprehensive literature review between 2002 and 2013, including systematic reviews, meta-analysis, and reports with evaluation frameworks and/or assessment of initiatives was carried out; integrated care initiatives established in Catalonia were studied and described; and semistructured interviews with key stakeholders were performed. The scope and conceptual framework were defined by using the brainstorming approach.Of 910 abstracts identified, a total of 116 studies were included. They referred to several conceptual frameworks and/or assessment indicators at a national and international level. An overall of 24 established chronic care initiatives were identified (9 integrated care initiatives); 10 in-depth interviews were carried out. The proposed conceptual framework envisages: 1)the target population according to complexity levels; 2)an evaluation approach of the structure, processes, and outcomes considering the health status achieved, the recovery process and the maintenance of health; and 3)the dimensions or attributes to be assessed. The proposed conceptual framework will be helpful has been useful to develop indicators and implement them with a community-based and result-oriented approach and a territorial or population-based perspective within the Spanish Health System. This will be essential to know which are the most effective strategies, what are the key elements that determine greater success and what are the groups of patients who can most benefit. PMID:27382930

  17. "Yeah, I Like It!" Assessing What Children Think of Child Care

    Science.gov (United States)

    Godfrey, Michael; Cemore, Joanna

    2005-01-01

    Children behave differently when they spend the day in child care and knowing their ideas about care is vital to understanding their happiness, continued development and learning. In this article, the authors share their methods and acquired wisdom about surveying young children, as well as the results of their study--what children think about…

  18. License-Exempt Child Care Providers: A Needs Assessment for Designing an Implementation Model

    Science.gov (United States)

    Roseburr, Linda Joyce

    2008-01-01

    Many children from low-income families appear to be not receiving quality child care from their license-exempt subsidized child-care providers. The purpose of this qualitative case study was to obtain data from a sample of license-exempt providers/caregivers and parents from a mailed self-administered survey and telephone interview. Four research…

  19. Assessing Indigent Health Care Needs and Use of County Health Services.

    Science.gov (United States)

    Brown, E. Richard; Cousineau, Michael R.

    In 1982 California eliminated 250,000 "medically indigent adults" (MIAs) from the Medi-Cal program and transferred responsibility for their care to the counties, along with about 70% of what the state would have spent on their care had they remained in the Medi-Cal program. There is far greater variability among the counties in benefits,…

  20. An Instrument to Assess the Obesogenic Environment of Child Care Centers

    Science.gov (United States)

    Ward, Dianne; Hales, Derek; Haverly, Katie; Marks, Julie; Benjamin, Sara; Ball, Sarah; Trost, Stewart

    2008-01-01

    Objectives: To describe protocol and interobserver agreements of an instrument to evaluate nutrition and physical activity environments at child care. Methods: Interobserver data were collected from 9 child care centers, through direct observation and document review (17 observer pairs). Results: Mean agreement between observer pairs was 87.26%…

  1. Cancer survivors and their partners: the assessment of unmet supportive care needs

    International Nuclear Information System (INIS)

    Our understanding of unmet supportive care needs of cancer survivors and their partners is limited. Most studies have focused on needs of patients undergoing treatment and on Quality of life or patient satisfaction. For the purpose of this research, cancer survivors are defined as persons who received a cancer diagnosis at least one year previously and are disease free. The aim of this study is to develop measures to assess unmet needs in survivors and their partners. After developing the questionnaire items it was piloted for validity in a wide sample of cancer patients from the radiation oncology department. 105 patients, all women, 101 with breast cancer and 40 partners participated. Psychological morbidity of depression and anxiety was recorded and was low. Quality of life for both survivors and partners was close to the US population mean. For patients top 4 unmet needs was 1. Anxiety about cancer returning (35%), current information (21%), understandable information (28%), ongoing case manager (25%). Unmet needs for partners were 1. Need to know all the doctors were communication (3.2%), need for local health services (2.8%), current information (2.1%) and help with managing concerns about the cancer returning (2.1%). 73% of partners reported at least one positive outcome from their partner's experience, significantly more than the survivors. In conclusion, interim analysis of the questionnaire reveals validity. Survivors report ongoing high levels of unmet needs 3-9 years after cancer diagnosis ( 30%). Less than 4% of partners report such unmet needs. There is significant correlation between needs of partners and survivors, many of which relate to issues of ongoing support and information delivery

  2. Assessment of spontaneous pneumothorax in adults in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Aparup Dhua

    2015-01-01

    Full Text Available Context: Pneumothorax continues to be a major cause of morbidity and mortality among respiratory patients, but there is a paucity of data regarding etiology, clinical profile, management, and outcome of spontaneous pneumothorax (SP, from this part of the world. Aims: To assess the patients of spontaneous pneumothorax in adults with special reference to the etiology, clinical presentation, management, and outcome of SP. Settings and Design: Prospective, observational study conducted in a tertiary care institution over a period of one year. Materials and Methods: All adult patients of SP attending the department of pulmonary medicine in a tertiary hospital were studied and detailed clinical, radiological, and management data were recorded and analyzed. Results: Sixty consecutive patients, who satisfied the inclusion criteria were included in the study. Among them 10 had primary spontaneous pneumothorax (PSP and 50 had secondary spontaneous pneumothorax (SSP. The overall male to female ratio was 4:1. The mean age of the PSP patients was 26.3 ± 2.19 years, whereas, that of the SSP patients was 53.42 ± 2.07 years (P < 0.0001. Seventy percent of the patients were smokers. The most common clinical manifestation of PSP was chest pain (80% in contrast to dyspnea in SSP (96%. The most common cause of SSP (42% was found to be chronic obstructive pulmonary disease (COPD followed by pulmonary tuberculosis (30%. The cases were managed with intercostal tube drainage (85%, simple aspiration (8.33%, and observation (6.67%. Full expansion of the lung was noted in 91.67% of the cases. Conclusion: Spontaneous pneumothorax was more common in men. SSP was far more common in this study, and the predominant underlying cause of SSP was COPD, which surpassed tuberculosis as the leading cause of SSP. This is in contrast to the results from previous studies done in our country. Intercostal tube drainage was the mainstay of treatment and the response was good.

  3. Infection control in delivery care units, Gujarat state, India: A needs assessment

    Directory of Open Access Journals (Sweden)

    Ramani KV

    2011-05-01

    Full Text Available Abstract Background Increasingly, women in India attend health facilities for childbirth, partly due to incentives paid under government programs. Increased use of health facilities can alleviate the risks of infections contracted in unhygienic home deliveries, but poor infection control practices in labour and delivery units also cause puerperal sepsis and other infections of childbirth. A needs assessment was conducted to provide information on procedures and practices related to infection control in labour and delivery units in Gujarat state, India. Methods Twenty health care facilities, including private and public primary health centres and referral hospitals, were sampled from two districts in Gujarat state, India. Three pre-tested tools for interviewing and for observation were used. Data collection was based on existing infection control guidelines for clean practices, clean equipment, clean environment and availability of diagnostics and treatment. The study was carried out from April to May 2009. Results Seventy percent of respondents said that standard infection control procedures were followed, but a written procedure was only available in 5% of facilities. Alcohol rubs were not used for hand cleaning and surgical gloves were reused in over 70% of facilities, especially for vaginal examinations in the labour room. Most types of equipment and supplies were available but a third of facilities did not have wash basins with "hands-free" taps. Only 15% of facilities reported that wiping of surfaces was done immediately after each delivery in labour rooms. Blood culture services were available in 25% of facilities and antibiotics are widely given to women after normal delivery. A few facilities had data on infections and reported rates of 3% to 5%. Conclusions This study of current infection control procedures and practices during labour and delivery in health facilities in Gujarat revealed a need for improved information systems

  4. Knowledge based ranking algorithm for comparative assessment of post-closure care needs of closed landfills

    International Nuclear Information System (INIS)

    Post-closure care (PCC) activities at landfills include cap maintenance; water quality monitoring; maintenance and monitoring of the gas collection/control system, leachate collection system, groundwater monitoring wells, and surface water management system; and general site maintenance. The objective of this study was to develop an integrated data and knowledge based decision making tool for preliminary estimation of PCC needs at closed landfills. To develop the decision making tool, 11 categories of parameters were identified as critical areas which could affect future PCC needs. Each category was further analyzed by detailed questions which could be answered with limited data and knowledge about the site, its history, location, and site specific characteristics. Depending on the existing knowledge base, a score was assigned to each question (on a scale 1-10, as 1 being the best and 10 being the worst). Each category was also assigned a weight based on its relative importance on the site conditions and PCC needs. The overall landfill score was obtained from the total weighted sum attained. Based on the overall score, landfill conditions could be categorized as critical, acceptable, or good. Critical condition indicates that the landfill may be a threat to the human health and the environment and necessary steps should be taken. Acceptable condition indicates that the landfill is currently stable and the monitoring should be continued. Good condition indicates that the landfill is stable and the monitoring activities can be reduced in the future. The knowledge base algorithm was applied to two case study landfills for preliminary assessment of PCC performance.

  5. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies

    OpenAIRE

    Gusmao-Flores, Dimitri; Salluh, Jorge Ibrain Figueira; Chalhub, Ricardo Ávila; Lucas C Quarantini

    2012-01-01

    Introduction Delirium is a frequent form of acute brain dysfunction in critically ill patients, and several detection tools for it have been developed for use in the Intensive Care Unit (ICU). The objective of this study is to evaluate the current evidence on the accuracy of the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for the diagnosis of delirium in critically ill patients. Methods A systematic review was condu...

  6. Distraction: an assessment of smartphone usage in health care work settings

    Directory of Open Access Journals (Sweden)

    Gill PS

    2012-08-01

    Full Text Available Preetinder S Gill,1 Ashwini Kamath,2 Tejkaran S Gill31College of Technology, Eastern Michigan University, Ypsilanti, MI, USA; 2School of Information, University of Texas, Austin, TX, USA; 3College of Engineering, University of Michigan, Ann Arbor, MI, USAAbstract: Smartphone use in health care work settings presents both opportunities and challenges. The benefits could be severely undermined if abuse and overuse are not kept in check. This practice-focused research paper examines the current panorama of health software applications. Findings from existing research are consolidated to elucidate the level and effects of distraction in health care work settings due to smartphone use. A conceptual framework for crafting guidelines to regulate the use of smartphones in health care work settings is then presented. Finally, specific guidelines are delineated to assist in creating policies for the use of smartphones in a health care workplace.Keywords: smartphone, health care, distraction, workplace, mobile apps, health informatics

  7. Quality of life assessment in advanced cancer patients treated at home, an inpatient unit, and a day care center

    Directory of Open Access Journals (Sweden)

    Leppert W

    2014-05-01

    Full Text Available Wojciech Leppert,1 Mikolaj Majkowicz,2 Maria Forycka,1 Eleonora Mess,3 Agata Zdun-Ryzewska2 1Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland; 2Department of Quality of Life Research, Gdansk Medical University, Gdansk, Poland; 3Palliative Care Nursing Department, Wroclaw Medical University, Wroclaw, Poland Aim of the study: To assess quality of life (QoL in cancer patients treated at home, at an in-patient palliative care unit (PCU, and at a day care center (DCC. Patients and methods: QoL was assessed in advanced cancer patients at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL, the Edmonton Symptom Assessment System (ESAS, and the Karnofsky Performance Status (KPS scale. Results: A total of 129 patients completed the study, with 51 patients treated at home, 51 patients treated at the PCU, and 27 patients at DCC. In the EORTC QLQ-C15-PAL, improvement in functional and symptom scales was observed except in physical functioning and fatigue levels; patients at DCC had a better physical functioning, global QoL, appetite, and fatigue levels. In the ESAS, improvement in all items was found except for drowsiness levels, which was stable in patients treated at DCC and deteriorated in home and PCU patients. Higher activity, better appetite and well-being, and less drowsiness were observed in patients treated at DCC. KPS was better in DCC patients compared to those treated at home and at the PCU; the latter group deteriorated. Conclusions: QoL improved in all patient groups, with better results in DCC patients and similar scores in those staying at home and at the PCU. Along with clinical assessment, baseline age, KPS, physical and emotional functioning may be considered when assigning patients to care at a DCC, PCU, or at home. Keywords: oncology, patient care

  8. Obstetric care providers are able to assess psychosocial risks, identify and refer high-risk pregnant women: validation of a short assessment tool – the KINDEX Greek version

    OpenAIRE

    Spyridou, Andria; Schauer, Maggie; Ruf-Leuschner, Martina

    2015-01-01

    Background Prenatal assessment for psychosocial risk factors and prevention and intervention is scarce and, in most cases, nonexistent in obstetrical care. In this study we aimed to evaluate if the KINDEX, a short instrument developed in Germany, is a useful tool in the hands of non-trained medical staff, in order to identify and refer women in psychosocial risk to the adequate mental health and social services. We also examined the criterion-related concurrent validity of the tool through a ...

  9. Primary care nursing role and care coordination: an observational study of nursing work in a community health center.

    Science.gov (United States)

    Anderson, Daren R; St Hilaire, Daniel; Flinter, Margaret

    2012-05-01

    Care coordination is a core element of the Patient-Centered Medical Home and requires an effective, well educated nursing staff. A greater understanding of roles and tasks currently being carried out by nurses in primary care is needed to help practices determine how best to implement care coordination and transform into PCMHs. We conducted an observational study of primary care nursing in a Community Health Center by creating a classification schema for nursing responsibilities, directly observing and tracking nurses' work, and categorizing their activities. Ten nurses in eight different practice sites were observed for a total of 61 hours. The vast majority of nursing time was spent in vaccine and medication administration; telephone work; and charting and paper work, while only 15% of their time was spent in activity that was classified broadly as care coordination. Care coordination work appeared to be subsumed by other daily tasks, many of which could have been accomplished by other, lesser trained members of the health care team. Practices looking to implement care coordination need a detailed look at work flow, task assignments, and a critical assessment of staffing, adhering to the principal of each team member working to the highest level of his or her education and license. Care coordination represents a distinct responsibility that requires dedicated nursing time, separate from the day to day tasks in a busy practice. To fully support these new functions, reimbursement models are needed that support such non visit-based work and provide incentives to coordinate and manage complex cases, achieve improved clinical outcomes and enhance efficiency of the health system. This article describes our study methods, data collection, and analysis, results, and discussion about reorganizing nursing roles to promote care coordination. PMID:22686111

  10. Innovative Strategies Designed to Improve Adult Pneumococcal Immunizations in Safety Net Patient-Centered Medical Homes.

    Science.gov (United States)

    Park, Nina J; Sklaroff, Laura Myerchin; Gross-Schulman, Sandra; Hoang, Khathy; Tran, Helen; Campa, David; Scheib, Geoffrey; Guterman, Jeffrey J

    2016-08-01

    Streptococcus pneumoniae is a principal cause of serious illness, including bacteremia, meningitis, and pneumonia, worldwide. Pneumococcal immunization is proven to reduce morbidity and mortality in high-risk adult and elderly populations. Current pneumococcal vaccination practices are suboptimal in part because of recommendation complexity, the high cost of provider-driven immunization interventions, and outreach methods that are not patient-centric. These barriers are amplified within the safety net. This paper identifies efforts by the Los Angeles County Department of Health Services to increase pneumococcal immunization rates for adult indigent patient populations. A 4-part approach will be used to increase vaccination rates: (1) protocol driven care, (2) staff education, (3) electronic identification of eligible patients, and (4) automated patient outreach and scheduling. The proposed analytics plan and potential for scalability are described. (Population Health Management 2016;19:240-247). PMID:26824148

  11. Primary care physicians’ perspectives on computer-based health risk assessment tools for chronic diseases: a mixed methods study

    Directory of Open Access Journals (Sweden)

    Teja Voruganti

    2015-09-01

    Full Text Available Background Health risk assessment tools compute an individual’s risk of developing a disease. Routine use of such tools by primary care physicians (PCPs is potentially useful in chronic disease prevention. We sought physicians’ awareness and perceptions of the usefulness, usability and feasibility of performing assessments with computer-based risk assessment tools in primary care settings.Methods Focus groups and usability testing with a computer-based risk assessment tool were conducted with PCPs from both university-affiliated and community-based practices. Analysis was derived from grounded theory methodology.Results PCPs (n = 30 were aware of several risk assessment tools although only select tools were used routinely. The decision to use a tool depended on how use impacted practice workflow and whether the tool had credibility. Participants felt that embedding tools in the electronic medical records (EMRs system might allow for health information from the medical record to auto-populate into the tool. User comprehension of risk could also be improved with computer-based interfaces that present risk in different formats.Conclusions In this study, PCPs chose to use certain tools more regularly because of usability and credibility. Despite there being differences in the particular tools a clinical practice used, there was general appreciation for the usefulness of tools for different clinical situations. Participants characterised particular features of an ideal tool, feeling strongly that embedding risk assessment tools in the EMR would maximise accessibility and use of the tool for chronic disease management. However, appropriate practice workflow integration and features that facilitate patient understanding at point-of-care are also essential. 

  12. Creating archetypes for patient assessment with nurses to facilitate shared patient centred care in the older person

    OpenAIRE

    Hussey, Pamela

    2010-01-01

    The process of what information is captured in documenting patient care assessment and how it is summarised, communicated and interpreted by nurses across different healthcare services is the main focus of this thesis. Currently in Ireland, systems within the domain of healthcare are undergoing transformation. Existing practices where health information is collected at one local health organisation level and often duplicated across differing services will not support the strategic goals of th...

  13. Assessment of knowledge on causes and care of neonatal jaundice at the Nigerian primary and secondary health institutions

    OpenAIRE

    Olusegun Joseph Adebami

    2015-01-01

    Background: Neonatal jaundice is the most common condition that requires medical attention in new-borns. However, missed diagnosis of jaundice, poor monitoring, and prescriptions of wrong and ineffective medications by the health workers for jaundice are known to be responsible for the persistence of acute bilirubin encephalopathy in the sub region. Therefore, the aim of the present study was therefore to assess the knowledge in the care of neonatal jaundice at the primary and secondary heal...

  14. Improving Pathways to Assessment and Care for Infants of Substance Abusing Mothers: Are We Getting It Right?

    OpenAIRE

    Joanna Alexander; Shanti Raman; Terence Yoong; Belinda Mawhinney

    2015-01-01

    There is documented correlation between parental substance abuse, child maltreatment, and poor outcomes. In two health districts in Sydney, Australia (Site A and B), specialised clinics were established to provide comprehensive assessments for infants of substance abusing mothers (ISAM). We aimed to determine whether there was a difference in outcomes between infants who attended clinic versus those who did not; and to identify differences in the pathways to care between sites. We analysed ch...

  15. Assessing the Effectiveness of an Educational Program on Compliance with Hand Hygiene in a Pediatric Intensive Care Unit

    OpenAIRE

    Charalampia Nteli; Petros Galanis; Despoina Koumpagioti; Georgios Poursanidis; Eleni Panagiotopoulou; Vasiliki Matziou

    2014-01-01

    Objective. To identify the impact of an educational intervention on compliance of health professionals with hand hygiene. Method. The survey involved nurses, doctors, and physiotherapists who work in pediatric intensive care unit of a pediatric hospital. A multifaceted hand hygiene educational program was introduced with compliance assessed during successive observational surveys. Results. The total healthcare professionals’ compliance increased from 31.8% in the baseline period to 51.5% imme...

  16. Assessment of the health care waste generation rates and its management system in hospitals of Addis Ababa, Ethiopia, 2011

    OpenAIRE

    Debere Mesfin Kote; Gelaye Kassahun Alemu; Alamdo Andamlak Gizaw; Trifa Zemedu Mehamed

    2013-01-01

    Abstract Background Healthcare waste management options are varying in Ethiopia. One of the first critical steps in the process of developing a reliable waste management plan requires a widespread understanding of the amount and the management system. This study aimed to assess the health care waste generation rate and its management system in some selected hospitals located in Addis Ababa, Ethiopia. Methods Six hospitals in Addis Ababa, (three private and three public), were selected using s...

  17. Focus group reflections on the current and future state of cognitive assessment tools in geriatric health care

    OpenAIRE

    Whitehead JC; Gambino SA; Richter JD; Ryan JD

    2015-01-01

    Jocelyne C Whitehead,1 Sara A Gambino,1 Jeffrey D Richter,2 Jennifer D Ryan1,3,41Rotman Research Institute, Baycrest, 2Independent Human Factors Consultant, Toronto, ON, Canada; 3Department of Psychology, 4Department of Psychiatry, University of Toronto, Toronto, ON, CanadaObjective: This study provides insight into the thoughts and opinions of geriatric health-care professionals toward cognitive assessments and the use of emerging technologies, such as eye-tracking, to supplement current too...

  18. Emergency and urgent care capacity in a resource-limited setting: an assessment of health facilities in western Kenya

    OpenAIRE

    Burke, Thomas F.; Hines, Rosemary; Ahn, Roy; Walters, Michelle; Young, David; Anderson, Rachel Eleanor; Tom, Sabrina M; Clark, Rachel; Obita, Walter; Nelson, Brett D

    2014-01-01

    Objective: Injuries, trauma and non-communicable diseases are responsible for a rising proportion of death and disability in low-income and middle-income countries. Delivering effective emergency and urgent healthcare for these and other conditions in resource-limited settings is challenging. In this study, we sought to examine and characterise emergency and urgent care capacity in a resource-limited setting. Methods: We conducted an assessment within all 30 primary and secondary hospitals an...

  19. Emergency and urgent care capacity in a resource-limited setting: an assessment of health facilities in western Kenya

    OpenAIRE

    Burke, Thomas F.; Hines, Rosemary; Ahn, Roy; Walters, Michelle; Young, David; Anderson, Rachel Eleanor; Tom, Sabrina M; Clark, Rachel; Obita, Walter; Nelson, Brett D

    2014-01-01

    Objective Injuries, trauma and non-communicable diseases are responsible for a rising proportion of death and disability in low-income and middle-income countries. Delivering effective emergency and urgent healthcare for these and other conditions in resource-limited settings is challenging. In this study, we sought to examine and characterise emergency and urgent care capacity in a resource-limited setting. Methods We conducted an assessment within all 30 primary and secondary hospitals and ...

  20. Patient safety and patient assessment in pre-hospital care: a study protocol

    OpenAIRE

    Andersson Hagiwara, Magnus; Nilsson, Lena; Stromsoe, Anneli; Axelsson, Christer; Kangstrom, Anna; Herlitz, Johan

    2016-01-01

    Background: Patient safety issues in pre-hospital care are poorly investigated. The aim of the planned study is to survey patient safety problems in pre-hospital care in Sweden. Methods/Design: The study is a retro-perspective structured medical record review based on the use of 11 screening criteria. Two instruments for structured medical record review are used: a trigger tool instrument designed for pre-hospital care and a newly development instrument designed to compare the pre-hospital as...