WorldWideScience

Sample records for care quality improvement

  1. Does Audit Improve the Quality of Care?

    OpenAIRE

    Areti Tsaloglidou

    2009-01-01

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

  2. Nationwide quality improvement in lung cancer care

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  3. Does Audit Improve the Quality of Care?

    Directory of Open Access Journals (Sweden)

    Areti Tsaloglidou

    2009-01-01

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

  4. Health care quality improvement publication trends.

    Science.gov (United States)

    Sun, Gordon H; MacEachern, Mark P; Perla, Rocco J; Gaines, Jean M; Davis, Matthew M; Shrank, William H

    2014-01-01

    To analyze the extent of academic interest in quality improvement (QI) initiatives in medical practice, annual publication trends for the most well-known QI methodologies being used in health care settings were analyzed. A total of 10 key medical- and business-oriented library databases were examined: PubMed, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, Scopus, the Cochrane Central Register of Controlled Trials, ABI/INFORM, and Business Source Complete. A total of 13 057 articles were identified that discuss at least 1 of 10 well-known QI concepts used in health care contexts, 8645 (66.2%) of which were classified as original research. "Total quality management" was the only methodology to demonstrate a significant decline in publication over time. "Continuous quality improvement" was the most common topic of study across all publication years, whereas articles discussing Lean methodology demonstrated the largest growth in publication volume over the past 2 decades. Health care QI publication volume increased substantially beginning in 1991.

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

    Science.gov (United States)

    Kraynack, Nathan C; McBride, John T

    2009-10-01

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

  6. Early Palliative Care Improves Patients' Quality of Life

    Science.gov (United States)

    ... fullstory_160885.html Early Palliative Care Improves Patients' Quality of Life Also increases chances of having end-of-life ... incurable cancer helps patients cope and improves their quality of life, a new study shows. It also leads to ...

  7. Improving quality of care through improved audit and feedback

    Directory of Open Access Journals (Sweden)

    Hysong Sylvia J

    2012-05-01

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

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

    OpenAIRE

    Lobo, Claudia

    2002-01-01

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

  9. Family physicians improve patient health care quality and outcomes.

    Science.gov (United States)

    Bowman, Marjorie A; Neale, Anne Victoria

    2013-01-01

    This issue exemplifies family physicians' ability to provide great care and to continuously improve. For example, beyond other specialty care, the care provided by family physicians is associated with improved melanoma diagnosis and outcomes and improved preventive services for those with a history of breast cancer. Electronic health records are providing new avenues to both assess outcomes and influence care. However, to truly reward quality care, simplistic and readily measurable items such as laboratory results or assessment of the provision of preventive services must be adjusted for risk. Health insurance influences classic preventive care services more than personal health behaviors. The care provided at federally qualified health centers throughout the nation is highly appreciated by the people they serve and is not plagued by the types of disparities in other settings.

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

    Science.gov (United States)

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

    2013-03-01

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

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

    Science.gov (United States)

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

    2013-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Cathy Kande

    2014-01-01

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

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

    Science.gov (United States)

    O'Quinn, Lucy P; Giambra, Barbara K

    2014-01-01

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

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

    NARCIS (Netherlands)

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

    2003-01-01

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

  15. Improving Quality of Emergency Care Through Integration of Mental Health.

    Science.gov (United States)

    Okafor, Martha; Wrenn, Glenda; Ede, Victor; Wilson, Nana; Custer, William; Risby, Emile; Claeys, Michael; Shelp, Frank E; Atallah, Hany; Mattox, Gail; Satcher, David

    2016-04-01

    The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department's throughput.

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

    Science.gov (United States)

    Chassin, Mark R

    2013-10-01

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

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

    OpenAIRE

    Popa-Velea, O; Purcărea, VL

    2014-01-01

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

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

    Science.gov (United States)

    Baker, R

    2000-06-01

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

  19. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities.

    Science.gov (United States)

    Greene, Laurence; Moreo, Kathleen

    2015-01-01

    Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high-quality

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

    NARCIS (Netherlands)

    J.M. Cramm (Jane); A.P. Nieboer (Anna)

    2013-01-01

    markdownabstract__Abstract__ Objective. Investigate whether high-quality chronic care delivery improved the experiences of patients. Design. This study had a longitudinal design. Setting and Participants. We surveyed professionals and patients in 17 disease management programs targeting patients wi

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-10-15

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

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

    International Nuclear Information System (INIS)

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    and assess the implementation process and effectiveness on quality of ANC in Jimma, Ethiopia. METHODS: The intervention comprised trainings, supervisions, equipment, development of health education material, and adaption of guidelines. It was implemented at public facilities and control sites were included...... of intervention on various outcomes was significantly modified by maternal education. CONCLUSION: The quality of care can be improved in some important aspects with limited resources. Moreover, the study provides strategic perspectives on how to facilitate improved quality of ANC....

  5. Improving Quality of Care in Peptic Ulcer Bleeding

    DEFF Research Database (Denmark)

    Rosenstock, Steffen J; Møller, Morten H; Larsson, Heidi Jeanet;

    2013-01-01

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

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

    OpenAIRE

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

    2015-01-01

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

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

    OpenAIRE

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

    1992-01-01

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

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

    Science.gov (United States)

    Conrad, Douglas A; Perry, Lisa

    2009-01-01

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

  9. Improving diabetic foot screening at a primary care clinic: A quality improvement project

    Science.gov (United States)

    Allen, Michelle L.; Gunst, Colette

    2016-01-01

    Background Foot screening is an important part of diabetic care as it prevents significant morbidity, loss of function and mortality from diabetic foot complications. However, foot screening is often neglected. Aim This project was aimed at educating health care workers (HCWs) in a primary health care clinic to increase diabetic foot screening practices. Setting A primary health care clinic in the Western Cape province of South Africa Methods A quality improvement project was conducted. HCWs’ needs were assessed using a questionnaire. This was followed by focus group discussions with the HCWs, which were recorded, transcribed and assessed using a general inductive approach. An intervention was designed based on common themes. Staff members were trained on foot screening and patient information pamphlets and screening tools were made available to all clinic staff. Thirty-two consecutive diabetic patient folders were audited to compare screening in 2013 with that in 2014 after initiation of the quality improvement cycle. Results HCWs’ confidence in conducting foot screening using the diabetic foot assessment questionnaire improved markedly after training. Diabetic foot screening practices increased from 9% in 2013 to 69% in 2014 after the first quality improvement cycle. A strengths, opportunities, aspirations and results (SOAR) analysis showed promise for continuing quality improvement cycles. Conclusion The findings showed a significant improvement in the number of diabetic patients screened. Using strategic planning with appreciative intent based on SOAR, proved to be motivational and can be used in the planning of the next cycle. PMID:27608673

  10. Improving the quality of care in Chinese family planning programme.

    Science.gov (United States)

    Jiang, Y; Geng, Q; Haffey, J; Douglas, E

    1994-10-01

    The Chinese State Family Planning Commission (SFPC) is the government department responsible for coordinating and implementing the national population and family planning programs. The commission includes about 300,000 family planning workers and 50 million volunteers. Community workers provide IEC and technical services to couples of reproductive age. In July 1991, SFPC began a five year project to train rural family planning workers in contraceptive technology and interpersonal communication and counseling. These workers were important because of their service to a population of 800 million or 75% of total population. The training program was part of an effort to standardize training and institutionalize it throughout the country. The project involved 20 pilot training stations in 19 provinces. The primary task was to train family planning workers at the grassroots level. 80,000 persons were expected to be trained during the five years. Activities included a training needs assessment, development of training curricula and programs, training of workers, and monitoring and evaluation. Training techniques and topics will include participatory training methods, interpersonal communication and counseling, development of audience based training methods, issues of contraceptive choice and quality of care, and counseling issues such as sexually transmitted disease and HIV infection prevention. About 40,000 family planning workers and volunteers were trained by 1992 in counties, townships, and villages. Trainees learned about "informed choice" and the importance of counseling. Feedback from training activities focused on the appreciation for the participatory training methods such as brainstorming, case study, and role play. Workers appreciated the process involved in training as well as the information received. Evaluation showed that clients improved their knowledge and had positive interactions with workers.

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

    OpenAIRE

    Ikkersheim, David E; van de Pas, Harm

    2012-01-01

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

  12. Improving patient care through student leadership in team quality improvement projects.

    Science.gov (United States)

    Tschannen, Dana; Aebersold, Michelle; Kocan, Mary Jo; Lundy, Francene; Potempa, Kathleen

    2015-01-01

    In partnership with a major medical center, senior-level nursing students completed a root cause analysis and implementation plan to address a unit-specific quality issue. To evaluate the project, unit leaders were asked their perceptions of the value of the projects and impact on patient care, as well as to provide exemplars depicting how the student root cause analysis work resulted in improved patient outcome and/or unit processes. Liaisons noted benefits of having an RCA team, with positive impact on patient outcomes and care processes.

  13. CPI (clinical practice improvement): improving quality and decreasing cost in managed care.

    Science.gov (United States)

    Horn, S D

    1995-07-01

    The focus on quality has never been greater. As a result, a new concept, clinical practice improvement (CPI), is emerging. Clinical practice improvement is the application of the scientific method to the day-to-day practice of medicine and can be employed in all health care settings: inpatient or ambulatory, large or small. According to the author, CPI has proved to be effective in reducing costs and improving outcomes because it requires the committed support of clinicians who are involved directly in the process of designing studies, analyzing data, and developing more efficient forms of treatment in their own organizations. PMID:10143825

  14. Improving quality of care in substance abuse treatment using five key process improvement principles.

    Science.gov (United States)

    Hoffman, Kim A; Green, Carla A; Ford, James H; Wisdom, Jennifer P; Gustafson, David H; McCarty, Dennis

    2012-07-01

    Process and quality improvement techniques have been successfully applied in health care arenas, but efforts to institute these strategies in alcohol and drug treatment are underdeveloped. The Network for the Improvement of Addiction Treatment (NIATx) teaches participating substance abuse treatment agencies to use process improvement strategies to increase client access to, and retention in, treatment. NIATx recommends five principles to promote organizational change: (1) understand and involve the customer, (2) fix key problems, (3) pick a powerful change leader, (4) get ideas from outside the organization, and (5) use rapid cycle testing. Using case studies, supplemented with cross-agency analyses of interview data, this paper profiles participating NIATx treatment agencies that illustrate successful applications of each principle. Results suggest that organizations can successfully integrate and apply the five principles as they develop and test change strategies, improving access and retention in treatment, and agencies' financial status. Upcoming changes requiring increased provision of behavioral health care will result in greater demand for services. Treatment organizations, already struggling to meet demand and client needs, will need strategies that improve the quality of care they provide without significantly increasing costs. The five NIATx principles have potential for helping agencies achieve these goals.

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

    OpenAIRE

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

    2011-01-01

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

  16. Using a big conversation to improve care quality.

    Science.gov (United States)

    Boyd, Maggie

    The Collaboration for Leadership in Applied Health Research and Care (CLAHRC) compiled a report on the day, in which it noted: "The overriding result was one of inspiration through being heard, having honest, genuine and open dialogue and positively engaging with like-minded people. The event gave many the confidence to try to take things forward and influence others, and there was a sense of the event being an opportunity that gave hope for the future." The next step is to set up a "nursing cabinet"--a stakeholder board that will oversee work to improve "care through the patients' eyes". This will involve health professionals, academics, voluntary organisations and patient groups. Box 1 outlines key actions taken as a result of the event. The report on the day's findings is available on the trust website. PMID:22667075

  17. The national improvement partnership network: state-based partnerships that improve primary care quality.

    Science.gov (United States)

    Shaw, Judith S; Norlin, Chuck; Gillespie, R J; Weissman, Mark; McGrath, Jane

    2013-01-01

    Improvement partnerships (IPs) are a model for collaboration among public and private organizations that share interests in improving child health and the quality of health care delivered to children. Their partners typically include state public health and Medicaid agencies, the local chapter of the American Academy of Pediatrics, and an academic health care organization or children's hospital. Most IPs also engage other partners, including a variety of public, private, and professional organizations and individuals. IPs lead and support measurement-based, systems-focused quality improvement (QI) efforts that primarily target primary care practices that care for children. Their projects are most often conducted as learning collaboratives that involve a team from each of 8 to 15 participating practices over 9 to 12 months. The improvement teams typically include a clinician, office manager, clinical staff (nurses or medical assistants), and, for some projects, a parent; the IPs provide the staff and local infrastructure. The projects target clinical topics, chosen because of their importance to public health, local clinicians, and funding agencies, including asthma, attention-deficit/hyperactivity disorder, autism, developmental screening, obesity, mental health, medical home implementation, and several others. Over the past 13 years, 19 states have developed (and 5 are exploring developing) IPs. These organizations share similar aims and methods but differ substantially in leadership, structure, funding, and longevity. Their projects generally engage pediatric and family medicine practices ranging from solo private practices to community health centers to large corporate practices. The practices learn about the project topic and about QI, develop specific improvement strategies and aims that align with the project aims, perform iterative measures to evaluate and guide their improvements, and implement systems and processes to support and sustain those improvements

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

    OpenAIRE

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

    2016-01-01

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

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

    OpenAIRE

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

    2016-01-01

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

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

    OpenAIRE

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

    2008-01-01

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

  1. Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care.

    Science.gov (United States)

    Percival, Nikki; O'Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

    2016-01-01

    Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers. PMID:27066470

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

    Directory of Open Access Journals (Sweden)

    Katharin eHermenau

    2015-07-01

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

  3. Quality Improvement in Critical Care: Selection and Development of Quality Indicators

    Directory of Open Access Journals (Sweden)

    Carla A. Chrusch

    2016-01-01

    Full Text Available Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts.

  4. Quality Improvement in Critical Care: Selection and Development of Quality Indicators.

    Science.gov (United States)

    Chrusch, Carla A; Martin, Claudio M; Project, The Quality Improvement In Critical Care

    2016-01-01

    Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts.

  5. 45 CFR 98.51 - Activities to improve the quality of child care.

    Science.gov (United States)

    2010-10-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  7. Ensuring quality cancer care: a follow-up review of the Institute of Medicine's 10 recommendations for improving the quality of cancer care in America.

    Science.gov (United States)

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

    2012-05-15

    Responding to growing concerns regarding the safety, quality, and efficacy of cancer care in the United States, the Institute of Medicine (IOM) of the National Academy of Sciences commissioned a comprehensive review of cancer care delivery in the US health care system in the late 1990s. The National Cancer Policy Board (NCPB), a 20-member board with broad representation, performed this review. In its review, the NCPB focused on the state of cancer care delivery at that time, its shortcomings, and ways to measure and improve the quality of cancer care. The NCPB described an ideal cancer care system in which patients would have equitable access to coordinated, guideline-based care and novel therapies throughout the course of their disease. In 1999, the IOM published the results of this review in its influential report, Ensuring Quality Cancer Care. The report outlined 10 recommendations, which, when implemented, would: 1) improve the quality of cancer care, 2) increase the current understanding of quality cancer care, and 3) reduce or eliminate access barriers to quality cancer care. Despite the fervor generated by this report, there are lingering doubts regarding the safety and quality of cancer care in the United States today. Increased awareness of medical errors and barriers to quality care, coupled with escalating health care costs, has prompted national efforts to reform the health care system. These efforts by health care providers and policymakers should bridge the gap between the ideal state described in Ensuring Quality Cancer Care and the current state of cancer care in the United States.

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem

    2008-06-01

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

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

    Science.gov (United States)

    Sewell, N

    1997-01-01

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

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

    OpenAIRE

    Darko Gvozdanovi_; Miroslav Kon_ar; Vinko Kojund_i_; Hrvoje Jezid_i_

    2007-01-01

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

  12. Improving Quality of Care in Renal Replacement Therapy Using a Collaborative Approach

    OpenAIRE

    Azri Mohamed Nache

    2012-01-01

    AbstractImproving Quality of Care in Renal Replacement Therapy Using a Collaborative ApproachAzri Mohamed Nache, MB ChB MRCPUnder direction of Professor Ruth BoadenMaster of Philosophy Business and Management, University of ManchesterOctober 2012Introduction:In the past few decades, there have been rapid advances in knowledge of best practice in all areas within healthcare. Despite this, a large gap remains between what is best practice and the care that actually received by patients. Quality...

  13. Improving quality of care in renal replacement therapy using collaborative approach

    OpenAIRE

    Nache, Azri

    2012-01-01

    Improving Quality of Care in Renal Replacement Therapy Using a Collaborative ApproachAzri Mohamed Nache, MB ChB MRCPUnder direction of Professor Ruth BoadenMaster of Philosophy Business and Management, University of ManchesterOctober 2012Introduction:In the past few decades, there have been rapid advances in knowledge of best practice in all areas within healthcare. Despite this, a large gap remains between what is best practice and the care that actually received by patients.Quality improvem...

  14. Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations

    Science.gov (United States)

    Andrulis, Dennis P.; Brach, Cindy

    2016-01-01

    Objective To understand the interrelationship of literacy, culture, and language and the importance of addressing their intersection. Methods Health literacy, cultural competence, and linguistic competence strategies to quality improvement were analyzed. Results Strategies to improve health literacy for low-literate individuals are distinct from strategies for culturally diverse and individuals with limited English proficiency (LEP). The lack of integration results in health care that is unresponsive to some vulnerable groups’ needs. A vision for integrated care is presented. Conclusion Clinicians, the health care team, and health care organizations have important roles to play in addressing challenges related to literacy, culture, and language. PMID:17931131

  15. Impact of quality circles for improvement of asthma care: results of a randomized controlled trial.

    NARCIS (Netherlands)

    Schneider, A.; Wensing, M.J.P.; Biessecker, K.; Quinzler, R.; Kaufmann-Kolle, P.; Szecsenyi, J.

    2008-01-01

    RATIONALE AND AIMS: Quality circles (QCs) are well established as a means of aiding doctors. New quality improvement strategies include benchmarking activities. The aim of this paper was to evaluate the efficacy of QCs for asthma care working either with general feedback or with an open benchmark. M

  16. The Impact of Elderly Care Competence and Quality Improvement Programme in Four Swedish Municipalities

    Science.gov (United States)

    Westerberg, Kristina; Hjelte, Jan

    2013-01-01

    During a number of years Swedish municipalities have work with improvement of competence and long-term quality in elderly care. The overall aim of the present study was to compare different learning activities (workplace improvement and/or courses), and to relate these activities to learning climate, learning strategies, and perception of care…

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

    Directory of Open Access Journals (Sweden)

    McSherry R

    2016-02-01

    Full Text Available Robert McSherry,1 Paddy Pearce2 1School of Health and Social Care, University of Teesside, Middlesbrough, 2PKP Consulting, Yarm, United Kingdom Abstract: The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor, along with the importance clinical leadership plays in the provision of quality care improvement and outcomes. Clinical leaders are not predefined roles but emerge from the complex clinical setting by gaining an acquired expertise and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders are effective in facilitating innovation and change through improvement. This is achieved by recognizing, influencing, and empowering individuals through effective communication in order to share and learn from and with each other in practice. The challenge for health care organizations in regard to creating organizational cultures where a duty of candor exists is not to reinvent the wheel by turning something that is simple into something complex, which can become confusing to health care workers, patients, and the public. By focusing on the clinical leader's role and responsibilities we would argue they play a crucial and pivotal role in influencing, facilitating, supporting, and monitoring that this duty of candor happens in practice. This may be possible by highlighting where and how the duty of candor can be aligned within existing clinical governance frameworks. Keywords: governance

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

    OpenAIRE

    Wilcock, Peter M; Campion-Smith, Charles; Head, Michael

    2002-01-01

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

  19. Facilitators and barriers to applying a national quality registry for quality improvement in stroke care

    OpenAIRE

    Eldh, Ann Catrine; Fredriksson, Mio; Halford, Christina; Wallin, Lars; Dahlström, Tobias; Vengberg, Sofie; Winblad, Ulrika

    2014-01-01

    Background: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. Methods: A strategic sample was drawn of 8 hospitals in 4 county council...

  20. Through Their Eyes: Lessons Learned Using Participatory Methods in Health Care Quality Improvement Projects.

    Science.gov (United States)

    Balbale, Salva N; Locatelli, Sara M; LaVela, Sherri L

    2016-08-01

    In this methodological article, we examine participatory methods in depth to demonstrate how these methods can be adopted for quality improvement (QI) projects in health care. We draw on existing literature and our QI initiatives in the Department of Veterans Affairs to discuss the application of photovoice and guided tours in QI efforts. We highlight lessons learned and several benefits of using participatory methods in this area. Using participatory methods, evaluators can engage patients, providers, and other stakeholders as partners to enhance care. Participant involvement helps yield actionable data that can be translated into improved care practices. Use of these methods also helps generate key insights to inform improvements that truly resonate with stakeholders. Using participatory methods is a valuable strategy to harness participant engagement and drive improvements that address individual needs. In applying these innovative methodologies, evaluators can transcend traditional approaches to uniquely support evaluations and improvements in health care. PMID:26667882

  1. Academic Detailing in Diabetes: Using Outreach Education to Improve the Quality of Care.

    Science.gov (United States)

    Fischer, Michael A

    2016-10-01

    Most diabetes care is provided in primary care settings, but typical primary care clinicians struggle to keep up with the latest evidence on diabetes screening, pharmacotherapy, and monitoring. Accordingly, many patients with diabetes are not receiving optimal guideline-based therapy. Relying on front-line clinicians on their own to assess the huge volume of new literature and incorporate it into their practice is unrealistic, and conventional continuing medical education has not proven adequate to address gaps in care. Academic detailing, direct educational outreach to clinicians that uses social marketing techniques to provide specific evidence-based recommendations, has been proven in clinical trials to improve the quality of care for a range of conditions. By directly engaging with clinicians to assess their needs, identify areas for change in practice, and provide them with specific tools to implement these changes, academic detailing can serve as a tool to improve care processes and outcomes for patients with diabetes. PMID:27586191

  2. Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care.

    Directory of Open Access Journals (Sweden)

    Henry T Stelfox

    Full Text Available Large amounts of scientific evidence are generated, but not implemented into patient care (the 'knowledge-to-care' gap. We identified and prioritized knowledge-to-care gaps in critical care as opportunities to improve the quality and value of healthcare.We used a multi-method community-based participatory research approach to engage a Network of all adult (n = 14 and pediatric (n = 2 medical-surgical intensive care units (ICUs in a fully integrated geographically defined healthcare system serving 4 million residents. Participants included Network oversight committee members (n = 38 and frontline providers (n = 1,790. Network committee members used a modified RAND/University of California Appropriateness Methodology, to serially propose, rate (validated 9 point scale and revise potential knowledge-to-care gaps as priorities for improvement. The priorities were sent to frontline providers for evaluation. Results were relayed back to all frontline providers for feedback.Initially, 68 knowledge-to-care gaps were proposed, rated and revised by the committee (n = 32 participants over 3 rounds of review and resulted in 13 proposed priorities for improvement. Then, 1,103 providers (62% response rate evaluated the priorities, and rated 9 as 'necessary' (median score 7-9. Several factors were associated with rating priorities as necessary in multivariable logistic regression, related to the provider (experience, teaching status of ICU and topic (strength of supporting evidence, potential to benefit the patient, potential to improve patient/family experience, potential to decrease costs.A community-based participatory research approach engaged a diverse group of stakeholders to identify 9 priorities for improving the quality and value of critical care. The approach was time and cost efficient and could serve as a model to prioritize areas for research quality improvement across other settings.

  3. Interdisciplinary teamwork and the power of a quality improvement collaborative in tertiary neonatal intensive care units.

    Science.gov (United States)

    Grover, Theresa R; Pallotto, Eugenia K; Brozanski, Beverly; Piazza, Anthony J; Chuo, John; Moran, Susan; McClead, Richard; Mingrone, Teresa; Morelli, Lorna; Smith, Joan R

    2015-01-01

    Significant gaps in healthcare quality and outcomes can be reduced via quality improvement collaboratives (QICs), which improve care by leveraging data and experience from multiple organizations.The Children's Hospital Neonatal Consortium Collaborative Initiatives for Quality Improvement team developed an infrastructure for neonatal QICs. We describe the structure and components of an effective multi-institutional neonatal QIC that implemented the "SLUG Bug" project designed to reduce central line-associated bloodstream infections (CLABSIs).The operational infrastructure of SLUG Bug involved 17 tertiary care neonatal intensive care units with a goal to reduce CLABSI in high-risk neonates. Clinical Practice Recommendations were produced, and the Institute of Healthcare Improvement Breakthrough Series provided the framework for the collaborative. Process measures studied the effectiveness of the collaborative structure.CLABSI rates decreased by 20% during a 12-month study period. Compliance bundle reporting exceeded 80%. A QIC score of 2.5 or more ("improvement") was achieved by 94% of centers and a score 4 or more ("significant improvement") was achieved by 35%.Frequent interactive project meetings, well-defined project metrics, continual shared learning opportunities, and individual team coaching were key QIC success components. Through a coordinated approach and committed leadership, QICs can effectively implement change and improve the care of neonates with complex diagnoses and rare diseases. PMID:25919608

  4. Quality Improvement for Cardiovascular Disease Care in Low- and Middle-Income Countries: A Systematic Review

    Science.gov (United States)

    Lee, Edward S.; Vedanthan, Rajesh; Jeemon, Panniyammakal; Kamano, Jemima H.; Kudesia, Preeti; Rajan, Vikram; Engelgau, Michael; Moran, Andrew E.

    2016-01-01

    Background The majority of global cardiovascular disease (CVD) burden falls on people living in low- and middle-income countries (LMICs). In order to reduce preventable CVD mortality and morbidity, LMIC health systems and health care providers need to improve the delivery and quality of CVD care. Objectives As part of the Disease Control Priorities Three (DCP3) Study efforts addressing quality improvement, we reviewed and summarized currently available evidence on interventions to improve quality of clinic-based CVD prevention and management in LMICs. Methods We conducted a narrative review of published comparative clinical trials that evaluated efficacy or effectiveness of clinic-based CVD prevention and management quality improvement interventions in LMICs. Conditions selected a priori included hypertension, diabetes, hyperlipidemia, coronary artery disease, stroke, rheumatic heart disease, and congestive heart failure. MEDLINE and EMBASE electronic databases were systematically searched. Studies were categorized as occurring at the system or patient/provider level and as treating the acute or chronic phase of CVD. Results From 847 articles identified in the electronic search, 49 met full inclusion criteria and were selected for review. Selected studies were performed in 19 different LMICs. There were 10 studies of system level quality improvement interventions, 38 studies of patient/provider interventions, and one study that fit both criteria. At the patient/provider level, regardless of the specific intervention, intensified, team-based care generally led to improved medication adherence and hypertension control. At the system level, studies provided evidence that introduction of universal health insurance coverage improved hypertension and diabetes control. Studies of system and patient/provider level acute coronary syndrome quality improvement interventions yielded inconclusive results. The duration of most studies was less than 12 months. Conclusions The

  5. Implementing large-scale quality improvement – lessons from the productive ward: Releasing time to care

    OpenAIRE

    Morrow, Elizabeth; Robert, Glenn; Maben, Jill; Griffiths, Peter

    2011-01-01

    Purpose: This paper is concerned with facilitating large-scale quality improvement in health care, and specifically understanding more about the known challenges associated with implementation of Lean innovations: receptivity, the complexity of adoption processes, evidence of the innovation, and embedding change. Lessons are drawn from the implementation of The Productive Ward: Releasing Time to CareTM programme in English hospitals. Design/participants: The study which the paper draws up...

  6. Scotland's Knowledge Network: translating knowledge into action to improve quality of care.

    Science.gov (United States)

    Wales, A; Graham, S; Rooney, K; Crawford, A

    2012-11-01

    The Knowledge Network (www.knowledge.scot.nhs.uk) is Scotland's online knowledge service for health and social care. It is designed to support practitioners to apply knowledge in frontline delivery of care, helping to translate knowledge into better health-care outcomes through safe, effective, person-centred care. The Knowledge Network helps to combine the worlds of evidence-based practice and quality improvement by providing access to knowledge about the effectiveness of clinical interventions ('know-what') and knowledge about how to implement this knowledge to support individual patients in working health-care environments ('know-how'). An 'evidence and guidance' search enables clinicians to quickly access quality-assured evidence and best practice, while point of care and mobile solutions provide knowledge in actionable formats to embed in clinical workflow. This research-based knowledge is complemented by social networking services and improvement tools which support the capture and exchange of knowledge from experience, facilitating practice change and systems improvement. In these cases, the Knowledge Network supports key components of the knowledge-to-action cycle--acquiring, creating, sharing and disseminating knowledge to improve performance and innovate. It provides a vehicle for implementing the recommendations of the national Knowledge into Action review, which outlines a new national approach to embedding knowledge in frontline practice and systems improvement.

  7. Using the Vascular Quality Initiative to improve quality of care and patient outcomes for vascular surgery patients.

    Science.gov (United States)

    Bensley, Rodney P; Beck, Adam W

    2015-06-01

    The Society for Vascular Surgery Vascular Quality Initiative (VQI) is a collaborative network of vascular specialists from various specialties that seeks to improve the quality and safety of vascular care by sharing data among physicians, medical centers, and regions. Working under a Patient Safety Organization designation by the Agency for Healthcare Research and Quality, the VQI provides a protected environment where data can be pooled and evaluated for trends that might provide opportunities to improve the care we provide our patients. Since its inception in 2011, this national organization has grown rapidly and now involves >300 medical centers that are separated into 18 active regional groups who meet twice yearly to discuss quality improvement. The structure of the VQI provides a powerful platform for data collection and analysis, and has allowed the development of a large body of literature that demonstrates the importance and benefits of participation. Here we provide a brief overview of the VQI to date.

  8. Quality Control, Quality Assurance, and Quality Improvement-What is the Difference and Why Should Compounding Pharmacies Care?

    Science.gov (United States)

    Cabaleiro, Joe

    2009-01-01

    This article provides scenarios of three different pharmacies in the areas of quality control, quality assurance, and quality improvement. The scenarios show the importance that each pharmacy placed on a problem of dented capsules and the potential impact that an unresolved problem can have on a compounding pharmacy's business. Although this article focuses on one particular procedure, the purpose of th article is to help pharmacists understand the differences between quality control, quality assurance, and quality improvement. PMID:23966522

  9. Improving quality in systems of care: solving complicated challenges with simulation-based continuing professional development.

    Science.gov (United States)

    Dow, Alan W; Salas, Eduardo; Mazmanian, Paul E

    2012-01-01

    The delivery of quality health care depends on the successful interactions of practitioners, teams, and systems of care comprising culture. Designing educational programs to improve these interactions is a major goal of continuing professional development, and one approach for educational planners to effect desired changes is simulation-based education. Because simulation-based education affords an opportunity for educators to train health care professionals in environments that resemble clinical practice, this instructional method allows planners to integrate overarching priorities for improvement in health care practice with the training goals of individuals. Educational planners should consider how to structure scenarios to meet training objectives based on the complicated interactions within the health care system. To optimize the benefit of simulation-based experiences, evidence and insights from industrial and organizational psychology, as well as from human factors studies, provide guidance to the planning process, and interdisciplinary studies of complex health care systems can help produce educational programs that improve the quality of health care delivery. PMID:23280525

  10. Occurrence and prevention of surgical adverse events for quality improvement of surgical care.

    NARCIS (Netherlands)

    Zegers, M.; Bruijne, M.C. de; Wagner, C.; Groenewegen, P.P.; Wal, G. van der

    2008-01-01

    Objective: To assess the occurrence, impact, type of adverse outcomes, causes and preventability of surgical adverse events (AEs) among hospitalised patients for quality improvement of surgical care. Methods: A retrospective patient records review study was performed in a random sample of 7926 patie

  11. Using COPE To Improve Quality of Care: The Experience of the Family Planning Association of Kenya.

    Science.gov (United States)

    Bradley, Janet

    1998-01-01

    COPE (Client-Oriented, Provider-Efficient) methodology, a self-assessment tool that has been used in 35 countries around the world, was used to improve the quality of care in family planning clinics in Kenya. COPE involves a process that legitimately invests power with providers and clinic-level staff. It gives providers more control over their…

  12. Improving the quality of palliative care for ambulatory patients with lung cancer

    DEFF Research Database (Denmark)

    von Plessen, Christian; Aslaksen, Aslak

    2005-01-01

    and energy in organisational aspects of care that could be better used in direct interaction with patients. DESIGN: Quality improvement study using direct observation and run and flow charts, and focus group meetings with patients and families regarding perceptions of the clinic and with staff regarding...... satisfaction with working conditions. SETTING: Thoracic oncology outpatient clinic at a Norwegian university hospital where patients receive chemotherapy and complementary palliative care. KEY MEASURES FOR IMPROVEMENT: Waiting time and time wasted during consultations; calmer working situation at the clinic...

  13. Activity cost analysis: a tool to cost medical services and improve quality of care.

    Science.gov (United States)

    Udpa, S

    2001-01-01

    This paper suggests an activity-based cost (ABC) system as the appropriate cost accounting system to measure and control costs under the microstatistical episode of care (EOC) paradigm suggested by D. W. Emery (1999). ABC systems work well in such an environment because they focus on activities performed to provide services in the delivery of care. Thus, under an ABC system it is not only possible to accurately cost episodes of care but also to more effectively monitor and improve the quality of care. Under the ABC system, costs are first traced to activities and then traced from the activities to units of episodic care using cost drivers based on the consumption of activity resources.

  14. The new health-care quality: value, outcomes, and continuous improvement.

    Science.gov (United States)

    O'Connor, S J; Lanning, J A

    1991-01-01

    No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa. PMID:10118887

  15. The new health-care quality: value, outcomes, and continuous improvement.

    Science.gov (United States)

    O'Connor, S J; Lanning, J A

    1991-01-01

    No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa.

  16. Evolution and Initial Experience of a Statewide Care Transitions Quality Improvement Collaborative: Preventing Avoidable Readmissions Together.

    Science.gov (United States)

    Axon, R Neal; Cole, Laura; Moonan, Aunyika; Foster, Richard; Cawley, Patrick; Long, Laura; Turley, Christine B

    2016-02-01

    Increasing scrutiny of hospital readmission rates has spurred a wide variety of quality improvement initiatives. The Preventing Avoidable Readmissions Together (PART) initiative is a statewide quality improvement learning collaborative organized by stakeholder organizations in South Carolina. This descriptive report focused on initial interventions with hospitals. Eligible participants included all acute care hospitals plus home health organizations, nursing facilities, hospices, and other health care organizations. Measures were degree of statewide participation, curricular engagement, adoption of evidence-based improvement strategies, and readmission rate changes. Fifty-nine of 64 (92%) acute care hospitals and 9 of 10 (90%) hospital systems participated in collaborative events. Curricular engagement included: webinars and coaching calls (49/59, 83%), statewide in-person meetings (35/59, 59%), regional in-person meetings (44/59, 75%), and individualized consultations (46/59, 78%). Among 34 (58%) participating hospitals completing a survey at the completion of Year 1, respondents indicated complete implementation of multidisciplinary rounding (58%), post-discharge telephone calls (58%), and teach-back (32%), and implementation in process of high-quality transition records (52%), improved discharge summaries (45%), and timely follow-up appointments (39%). A higher proportion of hospitals had significant decreases (≥10% relative change) in all-cause readmission rates for acute myocardial infarction (55.6% vs. 30.4%, P=0.01), heart failure (54.2% vs. 31.7%, P=0.09), and chronic obstructive pulmonary disease (41.7% vs. 33.3%, P=0.83) between 2011-2013 compared to earlier (2009-2011) trends. Focus on reducing readmissions is driving numerous, sometimes competing, quality improvement initiatives. PART successfully engaged the majority of acute care facilities in one state to harmonize and accelerate adoption of evidence-based care transitions strategies. PMID:26102592

  17. Quality improvement programme for diabetes care in family practice settings in Dubai.

    Science.gov (United States)

    Khattab, M S; Swidan, A M; Farghaly, M N; Swidan, H M; Ashtar, M S; Darwish, E A; Al Mazrooei, A K; Mohammad, A A

    2007-01-01

    A continuous quality improvement programme for the care of registered diabetes patients was introduced in 16 government-affiliated primary health care centres in Dubai. Quality improvement teams were formed, clinical guidelines and information systems were developed, diabetes nurse practitioners were introduced and a team approach was mobilized. Audits before and after the introduction of the scheme showed significant improvements in rates of recording key clinical indicators and in their outcomes. For example, the proportion of patients with glycosylated haemoglobin levels < 7% increased from 20.6% to 31.7% and with LDL cholesterol < 100 mg/dL increased from 20.8% to 33.6%. Mean systolic blood pressure of registered patients fell from 135.3 mmHg to 133.2 mmHg.

  18. 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

    2016-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Lee Martin

    2011-10-01

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

  20. Improving health care quality and safety: the role of collective learning

    Directory of Open Access Journals (Sweden)

    Singer SJ

    2015-11-01

    Full Text Available Sara J Singer,1–4 Justin K Benzer,4–6 Sami U Hamdan4,6 1Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; 2Department of Medicine, Harvard Medical School, Boston, MA, USA; 3Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA; 4Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA; 5VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; 6Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA Abstract: Despite decades of effort to improve quality and safety in health care, this goal feels increasingly elusive. Successful examples of improvement are infrequently replicated. This scoping review synthesizes 76 empirical or conceptual studies (out of 1208 originally screened addressing learning in quality or safety improvement, that were published in selected health care and management journals between January 2000 and December 2014 to deepen understanding of the role that collective learning plays in quality and safety improvement. We categorize learning activities using a theoretical model that shows how leadership and environmental factors support collective learning processes and practices, and in turn team and organizational improvement outcomes. By focusing on quality and safety improvement, our review elaborates the premise of learning theory that leadership, environment, and processes combine to create conditions that promote learning. Specifically, we found that learning for quality and safety improvement includes experimentation (including deliberate experimentation, improvisation, learning from failures, exploration, and exploitation, internal and external knowledge acquisition, performance monitoring and comparison, and training. Supportive learning environments are characterized by team characteristics like psychological

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  2. Quality Improvement in Acute Ischemic Stroke Care in Taiwan: The Breakthrough Collaborative in Stroke.

    Science.gov (United States)

    Hsieh, Fang-I; Jeng, Jiann-Shing; Chern, Chang-Ming; Lee, Tsong-Hai; Tang, Sung-Chun; Tsai, Li-Kai; Liao, Hsun-Hsiang; Chang, Hang; LaBresh, Kenneth A; Lin, Hung-Jung; Chiou, Hung-Yi; Chiu, Hou-Chang; Lien, Li-Ming

    2016-01-01

    In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010-2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006-08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time ≤60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, p<0.001). The quarterly composite measures also improved significantly during the BTS-Stroke activity. In conclusion, a BTS collaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States. PMID:27487190

  3. Improving surgeon wellness: The second victim syndrome and quality of care.

    Science.gov (United States)

    Marmon, Louis M; Heiss, Kurt

    2015-12-01

    Improving quality of care logically involves optimizing the duty-readiness and well-being of the healthcare provider. Medical errors and poor outcomes adversely impact the involved providers, especially surgeons, as well as the patients and their families. Unfortunately our current system does little to support these "second victims" who experience various degrees of emotional and psychological stresses including confusion, loss of confidence, and debilitating anxiety. These factors contribute to the alarmingly high rates of professional "burnout," substance abuse, and suicide of healthcare providers as well as increase the likelihood of subsequent medical errors. Mindful efforts to improve the healthcare culture and develop personal support systems can help surgeons become more resilient, provide higher quality patient care, and have longer productive professional lives. Institutional support systems are also necessary to assist "second victims" to recover from the impact of an adverse patient event. PMID:26653167

  4. Improving the quality of discharge care for the homeless: a patient-centered approach.

    Science.gov (United States)

    Greysen, S Ryan; Allen, Rebecca; Rosenthal, Marjorie S; Lucas, Georgina I; Wang, Emily A

    2013-05-01

    Homeless patients are at risk for low-quality discharge care, yet there are limited patient-centered data to guide improvement. We explored relationships between assessment of housing status by hospital staff and quality of discharge care using quantitative and qualitative data from interviews and chart reviews with 98 homeless patients: 80% male, mean homelessness 2.8 years, mean age 44. Patient-reported performance of discharge care varied substantially across seven domains from 16-75% and chart review documented lower performance than patient report. Over half (56%) were not asked about their housing status and multivariable logistic regression showed assessment of housing status was independently associated with higher performance in five domains: discussions about cost of medications, physical activity levels, diet, transportation, and mental health follow-up. Qualitative data revealed patient concerns about stigmatization from disclosure of housing status. Our findings suggest that addressing housing status in acute care settings while avoiding stigmatization may improve discharge care for homeless patients.

  5. Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians.

    Science.gov (United States)

    Durey, Angela; Wynaden, Dianne; Thompson, Sandra C; Davidson, Patricia M; Bessarab, Dawn; Katzenellenbogen, Judith M

    2012-06-01

    Well-documented health disparities between Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) and non-Aboriginal Australians are underpinned by complex historical and social factors. The effects of colonisation including racism continue to impact negatively on Aboriginal health outcomes, despite being under-recognised and under-reported. Many Aboriginal people find hospitals unwelcoming and are reluctant to attend for diagnosis and treatment, particularly with few Aboriginal health professionals employed on these facilities. In this paper, scientific literature and reports on Aboriginal health-care, methodology and cross-cultural education are reviewed to inform a collaborative model of hospital-based organisational change. The paper proposes a collaborative model of care to improve health service delivery by building capacity in Aboriginal and non-Aboriginal personnel by recruiting more Aboriginal health professionals, increasing knowledge and skills to establish good relationships between non-Aboriginal care providers and Aboriginal patients and their families, delivering quality care that is respectful of culture and improving Aboriginal health outcomes. A key element of model design, implementation and evaluation is critical reflection on barriers and facilitators to providing respectful and culturally safe quality care at systemic, interpersonal and patient/family-centred levels. Nurses are central to addressing the current state of inequity and are pivotal change agents within the proposed model. PMID:22530862

  6. Quality Improvement in Acute Ischemic Stroke Care in Taiwan: The Breakthrough Collaborative in Stroke

    Science.gov (United States)

    Chern, Chang-Ming; Lee, Tsong-Hai; Tang, Sung-Chun; Tsai, Li-Kai; Liao, Hsun-Hsiang; Chang, Hang; LaBresh, Kenneth A.; Lin, Hung-Jung; Chiou, Hung-Yi; Chiu, Hou-Chang; Lien, Li-Ming

    2016-01-01

    In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010–2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006–08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time ≤60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, pcollaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States. PMID:27487190

  7. The Excellent Care for All Act's quality improvement plans: reflections on the first year.

    Science.gov (United States)

    Kutty, Sudha; Ladak, Nizar; Muskat, Cyrelle; Paul, Jillian; Orchard, Margo

    2012-01-01

    In 2010, Ontario passed the Excellent Care for All Act (the EFCA Act). Although the purpose of the Act was clear, the legislation itself was relatively non-prescriptive in relation to the mandatory quality improvement plans (QIPs), and hospitals needed direction on how to proceed. A task group was established to develop a common provincial QIP template, along with guidance, support and educational materials. The template was field tested across the province and, subsequently, all hospitals developed their QIPs, posted them publicly, and submitted them to Health Quality Ontario (HQO). Despite challenges including short time frames, limitations in data availability and a variance of skills in performance measurement, the implementation of QIPs in hospitals was a success. Success is part could be attributed to a strong tripartite partnership and good communication channels with hospitals. Hospitals with the most effective QIPs were those whose leaders used the opportunity of a provincially mandated QIP as a lever to drive and legitimize the need to have conversations regarding quality from the boardroom down to the front line. As organizations continue to develop and implement their QIPs, we will see this tremendous quality improvement effort sustained. The QIPs will remain a significant transformational lever to engage the system in improving performance and achieving excellent care for all.

  8. Improving health care quality through culturally competent physicians: leadership and organizational diversity training

    Directory of Open Access Journals (Sweden)

    Irwin B Horwitz

    2011-02-01

    Full Text Available Irwin B Horwitz1, Marilyn Sonilal2, Sujin K Horwitz31Cameron School of Business, University of St. Thomas, Houston, TX, USA; 2School of Public Health, University of Texas, Houston, TX, USAAbstract: The growing diversity of the population has resulted in substantial challenges for the US health care system. A substantial body of evidence has identified significant disparities in health care among culturally and ethnically diverse patients, irrespective of income, that negatively affects such factors as diagnostic precision, quality of care, adherence to healing protocols, and overall treatment outcomes. Diversity has also been shown to compromise the functionality of health care teams that are increasingly comprised of members with culturally different backgrounds, in which diversity produces misunderstanding and conflict. Many of the problems stem from a lack of cultural competence among both physicians and teams under their supervision. To reduce the numerous problems resulting from inadequate cultural competence among health care professionals, this article examines ways in which the issues of diversity can be effectively addressed in health care institutions. It is advocated that physicians adopt a proactive transformational leadership style to manage diversity because of its emphasis on understanding and aligning follower values which lie at the heart of diversity-related misunderstandings. It is also held that for leadership training among physicians to be fully effective, it should be integrated with organizational-wide diversity programs. By doing so, the complimentary effect could result in comprehensive change, resulting in substantial improvements in the quality of health care for all patients.Keywords: leadership, diversity, health care, disparities, medical education

  9. The Role of the Psychosocial Dimension in the Improvement of Quality of Care: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Makivić Irena

    2016-03-01

    Full Text Available The aim of our systematic review was to analyse the published literature on the psychosocial dimension of care in family medicine and its relationship with quality of care. We wanted to find out whether there is any evidence on the psychosocial approach in (family medicine. The recommended bio-psycho-social approach, besides the biomedical model of illness, takes into account several co-influencing psychological, sociological and existential factors. An online search of nine different databases used Boolean operators and the following selection criteria: the paper contained information on the holistic approach, quality indicators, family medicine, patient-centred care and/or the bio-psycho-social model of treatment. We retrieved 743 papers, of which 36 fulfilled our inclusion criteria. Including the psychosocial dimension in patient management has been found to be useful in the prevention and treatment of physical and psychiatric illness, resulting in improved social functioning and patient satisfaction, reduced health care disparities, and reduced annual medical care charges. The themes of patient-centred, behavioural or psychosocial medicine were quite well presented in several papers. We could not find any conclusive evidence of the impact of a holistic biopsycho-social-approach. Weak and variable definitions of psychosocial dimensions, a low number of welldesigned intervention studies, and low numbers of included patients limited our conclusions.

  10. Using risk contracting to reduce service use, improve quality, and strengthen primary care.

    Science.gov (United States)

    Lazaroff, Alan

    2013-10-01

    The high costs of American health care, the related problem of the uninsured, and the grim fiscal prognosis of Medicare and Medicaid are among the most pressing challenges facing the United States today. A solution to the cost problem that does not reduce access or quality is sought by those at all points on the political spectrum. This article discusses the experience of an independent practice association that has collaborated with a related business partner and a health plan to improve the quality of care of 16,000 Medicare Advantage beneficiaries while substantially reducing hospitalization rates and overall service use. The capacity to reduce service use frees funds that are used to support the infrastructure for high-value care and to reward those who provide it. Higher performing primary care, supported by changes in payment, has driven a sustainable business model that preserves the option of independent practice for physicians. We are now testing competencies developed for Medicare Advantage in the Pioneer Accountable Care Organization program, which preserves the broad patient choice that is an important feature of traditional Medicare.

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

    Directory of Open Access Journals (Sweden)

    Linda Gask

    2007-03-01

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

  12. Cross-border care and healthcare quality improvement in Europe: the MARQuIS research project.

    Science.gov (United States)

    Suñol, R; Garel, P; Jacquerye, A

    2009-02-01

    Citizens are increasingly crossing borders within the European Union (EU). Europeans have always been free to travel to receive care abroad, but if they wished to benefit from their statutory social protection scheme, they were subject to their local or national legislation on social protection. This changed in 1991 with the European Court of Justice defining healthcare as a service, starting a debate on the right balance between different principles in European treaties: movement of persons, goods and services, versus the responsibility of member states to organise their healthcare systems. Simultaneously, cross-border cooperation has developed between member states. In this context, patient mobility has become a relevant issue on the EU's agenda. The EU funded a number of Scientific Support to Policies (SSP) activities within the Sixth Framework Programme, to provide the evidence needed by EU policy makers to deal with issues that European citizens face due to enhanced mobility in Europe. One SSP project "Methods of Assessing Response to Quality Improvement Strategies" (MARQuIS), focused on cross-border care. It aimed to assess the value of different quality strategies, and to provide information needed when: (1) countries contract care for patients moving across borders; and (2) individual hospitals review the design of their quality strategies. This article describes the European context related to healthcare, and its implications for cross-border healthcare in Europe. The background information demonstrates a need for further research and development in this area. PMID:19188459

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

    Directory of Open Access Journals (Sweden)

    Darko Gvozdanovi_

    2007-09-01

    Full Text Available In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1 to provide efficient healthcare-related data management in support of decision-making processes; (2 to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution.

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

    Science.gov (United States)

    Gvozdanović, Darko; Koncar, Miroslav; Kojundzić, Vinko; Jezidzić, Hrvoje

    2007-01-01

    In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1) to provide efficient healthcare-related data management in support of decision-making processes; (2) to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS) on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories) into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution. PMID:18005567

  15. Computer network for improving quality and efficiency of children's primary health care

    Science.gov (United States)

    Deutsch, Larry

    1995-10-01

    Health care is at its best when both the practitioner and patient are well-informed. In many central urban and remote rural areas, however, health care is characterized by a lack of continuity and coordination among providers. In these areas, a local information infrastructure and a patient-centered system of primary care are missing. Decision-making and ability to follow through is hampered, with limited involvement of patients in planning care and insufficient aggregate data for cost analysis, outcome research, community health planning, and other purposes. A Children's Health Network has been designed to extend current information technology to these underserved areas. Our approach to improving quality of individual care and controlling costs emphasizes use of computerized clinical information networks for better decision making and continuity, and secondarily through data aggregation for financial, research, and public health functions. This is in distinction to information systems centered on billing and administrative needs and to cost-control efforts which rely on fiscal and managerial ('gatekeeper') mechanisms. A uniform data base among sites serving the same population will answer several clinical and public health needs.

  16. Measuring Quality Across Three Child Care Quality Rating and Improvement Systems: Findings from Secondary Analyses.

    OpenAIRE

    Lizabeth Malone; Gretchen Kirby; Pia Caronongan; Kimberly Boller; Kathryn Tout

    2011-01-01

    This report presents findings from an exploratory analysis of administrative data from three QRISs. The analyses examine the prevalence of quality components across centers and how they combine to result in an overall rating level and to predict observed quality.

  17. Clinical informatics to improve quality of care: a population-based system for patients with diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Rajeev Chaudhry

    2009-06-01

    Conclusions A clinical informatics system, used to deliver proactive, co-ordinated care to a population of patients with diabetes mellitus, can improve process and also quality outcome measures. Larger studies are needed to confirm these early findings.

  18. How Well Is Quality Improvement Described in the Perioperative Care Literature? A Systematic Review

    Science.gov (United States)

    Jones, Emma L.; Lees, Nicholas; Martin, Graham; Dixon-Woods, Mary

    2016-01-01

    Abstract Background Quality improvement (QI) approaches are widely used across health care, but how well they are reported in the academic literature is not clear. A systematic review was conducted to assess the completeness of reporting of QI interventions and techniques in the field of perioperative care. Methods Searches were conducted using Medline, Scopus, the Cochrane Central Register of Controlled Trials, the Cochrane Effective Practice and Organization of Care database, and PubMed. Two independent reviewers used the Template for Intervention Description and Replication (TIDieR) checklist, which identifies 12 features of interventions that studies should describe (for example, How: the interventions were delivered [e.g., face to face, internet]), When and how much: duration, dose, intensity), to assign scores for each included article. Articles were also scored against a small number of additional criteria relevant to QI. Results The search identified 16,103 abstracts from databases and 19 from other sources. Following review, full-text was obtained for 223 articles, 100 of which met the criteria for inclusion. Completeness of reporting of QI in the perioperative care literature was variable. Only one article was judged fully complete against the 11 TIDieR items used. The mean TIDieR score across the 100 included articles was 6.31 (of a maximum 11). More than a third (35%) of the articles scored 5 or lower. Particularly problematic was reporting of fidelity (absent in 74% of articles) and whether any modifications were made to the intervention (absent in 73% of articles). Conclusions The standard of reporting of quality interventions and QI techniques in surgery is often suboptimal, making it difficult to determine whether an intervention can be replicated and used to deliver a positive effect in another setting. This suggests a need to explore how reporting practices could be improved. PMID:27066922

  19. Editorial: Advances in healthcare provider and patient training to improve the quality and safety of patient care

    OpenAIRE

    Borycki, Elizabeth M

    2015-01-01

    This special issue of the Knowledge Management & E-Learning: An International Journal is dedicated to describing “Advances in Healthcare Provider and Patient Training to Improve the Quality and Safety of Patient Care.” Patient safety is an important and fundamental requirement of ensuring the quality of patient care. Training and education has been identified as a key to improving healthcare provider patient safety competencies especially when working with new technologies such as electronic ...

  20. The improving care in chronic obstructive lung disease study: CAROL improving processes of care and quality of life of COPD patients in primary care: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Steurer-Stey, C.; Markun, S.; Lana, K.D.; Frei, A.; Held, U.; Wensing, M.J.; Rosemann, T.J.

    2014-01-01

    BACKGROUND: The Swiss health ministry launched a national quality program 'QualiCCare' in 2011 to improve health care for patients with COPD.The aim of this study is to determine whether participation in the COPD quality initiative ('QualiCCare') improves adherence to recommended clinical processes

  1. Nine states' use of collaboratives to improve children's health care quality in medicaid and CHIP.

    Science.gov (United States)

    Devers, Kelly J; Foster, Leslie; Brach, Cindy

    2013-01-01

    We examine quality improvement (QI) collaboratives underway in 9 states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. A total of 147 diverse, child-serving practices were participating in the collaboratives. We conducted 256 semistructured interviews with key stakeholders from March to August 2012-2 years into the 5-year demonstration projects-and analyzed states' grant applications, operating plans, and progress reports. The collaboratives have multiple complex aims. In addition to developing patient-centered medical home (PCMH) capability, some states use collaboratives to familiarize practices with CMS's Initial Core Set of Children's Health Care Quality Measures, practice-level quality measurement, and improving QI knowledge and skills. The duration of the collaboratives is longer than other well-known collaborative models. Collaboratives also vary in their methods for targeting areas for improvement and strategies for motivating practice recruitment and engagement. States also vary with respect to the other strategies they use to support QI and PCMH development. All states supplement the collaboratives with practice facilitation; the majority utilized practice-level parent engagement, but only 4 used workforce augmentation (ie, providing care coordinators and QI specialists). Practice staff highly valued aspects of the collaboratives and supplemental strategies, including the opportunity to work with experts and other child-serving practices; states' efforts to provide stipends and align demonstration efforts with other professional requirements or programs; receipt of relevant, customized QI materials; opportunities to learn how care coordinators or QI specialists might work in their practice without the risk of hiring them; and satisfaction from learning more about quality measures, QI concepts and techniques, critical medical home components, and how to identify PCMH capacity and

  2. A Proposed mHealth Model for Improving the Quality Care in Hospitals

    Directory of Open Access Journals (Sweden)

    Hussain Abu-Dalbouh

    2014-02-01

    Full Text Available As the hospitals face increasing demands to participate in a wide range of quality improvement activities, the role and influence of physicians and nurses in these efforts is also increasing. The growing population has led to increase the number of patients in hospital. Therefore, healthcare workers have to see more patients and do more with each patient than ever before. Thus, Hospitals confront challenges with regard tracking patient condition, share information about the patient and difficulty follow up all patients with the lack of the number of specialist physician at all levels. This marks mobile devices an important opportunity for the next generation healthcare delivery. This study proposed a mobile health model that could support hospitals in tracking patient’s progress and improve the quality care in hospitals. It allows physicians and nurses to track the patients’ conditions more efficiently and easily. It also able to assist in crucial clinical decisions 24/7 and available on call wherever physicians to manage their care process from start to finish and from inside and outside the hospital.

  3. Applicability of the ReproQ client experiences questionnaire for quality improvement in maternity care.

    Science.gov (United States)

    Scheerhagen, Marisja; van Stel, Henk F; Tholhuijsen, Dominique J C; Birnie, Erwin; Franx, Arie; Bonsel, Gouke J

    2016-01-01

    Background. The ReproQuestionnaire (ReproQ) measures the client's experience with maternity care, following the WHO responsiveness model. In 2015, the ReproQ was appointed as national client experience questionnaire and will be added to the national list of indicators in maternity care. For using the ReproQ in quality improvement, the questionnaire should be able to identify best and worst practices. To achieve this, ReproQ should be reliable and able to identify relevant differences. Methods and Findings. We sent questionnaires to 17,867 women six weeks after labor (response 32%). Additionally, we invited 915 women for the retest (response 29%). Next we determined the test-retest reliability, the Minimally Important Difference (MID) and six known group comparisons, using two scorings methods: the percentage women with at least one negative experience and the mean score. The reliability for the percentage negative experience and mean score was both 'good' (Absolute agreement = 79%; intraclass correlation coefficient = 0.78). The MID was 11% for the percentage negative and 0.15 for the mean score. Application of the MIDs revealed relevant differences in women's experience with regard to professional continuity, setting continuity and having travel time. Conclusions. The measurement characteristics of the ReproQ support its use in quality improvement cycle. Test-retest reliability was good, and the observed minimal important difference allows for discrimination of good and poor performers, also at the level of specific features of performance. PMID:27478690

  4. Prescription for antibiotics at drug shops and strategies to improve quality of care and patient safety

    DEFF Research Database (Denmark)

    Mbonye, Anthony K; Buregyeya, Esther; Rutebemberwa, Elizeus;

    2016-01-01

    OBJECTIVES: The main objective of this study was to assess practices of antibiotic prescription at registered drug shops with a focus on upper respiratory tract infections among children in order to provide data for policy discussions aimed at improving quality of care and patient safety in the p......OBJECTIVES: The main objective of this study was to assess practices of antibiotic prescription at registered drug shops with a focus on upper respiratory tract infections among children in order to provide data for policy discussions aimed at improving quality of care and patient safety......, available antibiotics, knowledge on treatment of pneumonia in children aged antibiotic. RESULTS: A total of 170 registered drug shops were surveyed between August and October 2014. The majority of drug shops, 93.......5% were prescribing antibiotics, especially amoxicillin and trimethoprim-sulfamethoxazole (septrin). The professional qualification of a provider was significantly associated with this practice, p=0.04; where lower cadre staff (nursing assistants and enrolled nurses) overprescribed antibiotics. A third...

  5. Improving palliative care.

    LENUS (Irish Health Repository)

    Moran, Sue

    2009-05-01

    Any service improvement project requires planning, action and evaluation. Using a recognised quality improvement framework can offer a structured approach to implementing and assessing changes to patient care. This article describes how use of the Deming Cycle has helped to identify nurses\\' learning needs.

  6. [Quality of health care].

    Science.gov (United States)

    Medina, J L; De Melo, P C

    2000-01-01

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

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

    Science.gov (United States)

    Santiago, J M

    1999-12-01

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

  8. An innovative telemedicine knowledge translation program to improve quality of care in intensive care units: protocol for a cluster randomized pragmatic trial

    OpenAIRE

    Pinto Ruxandra; Hales Brigette; Dainty Katie; Scales Damon C; Fowler Robert A; Adhikari Neill KJ; Zwarenstein Merrick

    2009-01-01

    Abstract Background There are challenges to timely adoption of, and ongoing adherence to, evidence-based practices known to improve patient care in the intensive care unit (ICU). Quality improvement initiatives using a collaborative network approach may increase the use of such practices. Our objective is to evaluate the effectiveness of a novel knowledge translation program for increasing the proportion of patients who appropriately receive the following six evidence-based care practices: ve...

  9. [The transformation of the healthcare model in Catalonia to improve the quality of care].

    Science.gov (United States)

    Padrosa, Josep Maria; Guarga, Àlex; Brosa, Francesc; Jiménez, Josep; Robert, Roger

    2015-11-01

    The changes taking place in western countries require health systems to adapt to the public's evolving needs and expectations. The healthcare model in Catalonia is undergoing significant transformation in order to provide an adequate response to this new situation while ensuring the system's sustainability in the current climate of economic crisis. This transformation is based on converting the current disease-centred model which is fragmented into different levels, to a more patient-centred integrated and territorial care model that promotes the use of a shared network of the different specialities, the professionals, resources and levels of care, entering into territorial agreements and pacts which stipulate joint goals or objectives. The changes the Catalan Health Service (CatSalut) has undergone are principally focused on increasing resolution capacity of the primary level of care, eliminating differences in clinical practice, evolving towards more surgery-centred hospitals, promoting alternatives to conventional hospitalization, developing remote care models, concentrating and organizing highly complex care into different sectors at a territorial level and designing specific health codes in response to health emergencies. The purpose of these initiatives is to improve the effectiveness, quality, safety and efficiency of the system, ensuring equal access for the public to these services and ensuring a territorial balance. These changes should be facilitated and promoted using several different approaches, including implementing shared access to clinical history case files, the new model of results-based contracting and payment, territorial agreements, alliances between centres, harnessing the potential of information and communications technology and evaluation of results. PMID:26711056

  10. [The transformation of the healthcare model in Catalonia to improve the quality of care].

    Science.gov (United States)

    Padrosa, Josep Maria; Guarga, Àlex; Brosa, Francesc; Jiménez, Josep; Robert, Roger

    2015-11-01

    The changes taking place in western countries require health systems to adapt to the public's evolving needs and expectations. The healthcare model in Catalonia is undergoing significant transformation in order to provide an adequate response to this new situation while ensuring the system's sustainability in the current climate of economic crisis. This transformation is based on converting the current disease-centred model which is fragmented into different levels, to a more patient-centred integrated and territorial care model that promotes the use of a shared network of the different specialities, the professionals, resources and levels of care, entering into territorial agreements and pacts which stipulate joint goals or objectives. The changes the Catalan Health Service (CatSalut) has undergone are principally focused on increasing resolution capacity of the primary level of care, eliminating differences in clinical practice, evolving towards more surgery-centred hospitals, promoting alternatives to conventional hospitalization, developing remote care models, concentrating and organizing highly complex care into different sectors at a territorial level and designing specific health codes in response to health emergencies. The purpose of these initiatives is to improve the effectiveness, quality, safety and efficiency of the system, ensuring equal access for the public to these services and ensuring a territorial balance. These changes should be facilitated and promoted using several different approaches, including implementing shared access to clinical history case files, the new model of results-based contracting and payment, territorial agreements, alliances between centres, harnessing the potential of information and communications technology and evaluation of results.

  11. Care articulation by the Family Physician: improvement in the quality of life in terminal patient

    Directory of Open Access Journals (Sweden)

    Luís Filipe Cavadas

    2011-02-01

    Full Text Available Introduction: According to the definition of the role of the Family Physician (FP presented in the statement of the European Wonca 2002, one of her/his features is the ability of coordination of care, and management of the interface with other specialties. However, there are serious problems of coordination between the levels of assistance, as showed by the discontinuity of care when patients are hospitalized. With the aim of raising awareness and analyze a particular case of interface between the Primary Health Care (PHC and Hospital, and how important is the success of a good collaboration, this case is reported. Description of case: Male, 50 years old, caucasian race, inserted into a nuclear family in the stage VI Duvall’s cycle. A gastric adenocarcinoma by his FP was diagnosed at 49 years old. The patient was referenced to urgent consultation of general surgery. With various surgical complications he had a long internment. A poorly differentiated and infiltrating gastric carcinoma at the stage T3 N1 Mx, with poor prognosis, was confirmed. There was serious lack of interface and gaps in information between the hospital and the PHC. There was a bad care of the patient, with worsening of his condition. At the insistence of the FP, the articulation becomes effective and there was improved in quality of care and of the general condition of the patient. Conclusion: A proper interface and coordination of care contributed to better quality of life and satisfaction of patients, with positive repercussions for their families, to health professionals involved and to the National Health Service. The completion of the FP core competencies will only be possible when his/her proper function will be recognized and known by all the other health professionals.Note: The speciality physician denomination changes according to the country; in Brazil, it receives the name of Medicina de Família e Comunidade. In Portugal, country of the author of this paper

  12. Improving stroke care: Quality of care and health education in patients with a stroke or transient ischemic attack

    NARCIS (Netherlands)

    E. Maasland (Lisette)

    2011-01-01

    textabstractThis thesis focuses on the applicability of results of clinical trials of stroke and TIA patients in everyday practice and on measurement of quality of stroke care. A third aim is to further expand an underexposed aspect of stroke care, namely health education in stroke patients. Chapter

  13. Quality improvement of microsurgery through telecommunication--the postoperative care after microvascular transfer of intestine.

    Science.gov (United States)

    Chen, Hung-Chi; Kuo, Hsin-Chih; Chung, Kuo-Piao; Chen, Shih-Heng; Tang, Yueh-Bih; Su, Syi

    2012-02-01

    The purpose of this report is to describe the use of telecommunication to improve the quality of postoperative care following microsurgery, especially following microvascular transfer of intestinal transfer for which shortening of ischemia time is of utmost importance to achieve high success rate. From 2003 to 2009 microvascular transfer of intestinal flaps had been performed in 112 patients. After surgery the patients were put in intensive care unit and the flaps were checked every 1 hour. The image for circulatory status of the flaps was sent directly to the attending surgeon for judgment. The information was sent through intranet and the surgeon can get access to the intranet through internet if necessary. Among the 112 cases, there were 9 cases of reexploration. The average duration between the time of problem detection and the time of starting reexploration was 54 min in 7 cases, and other 2 cases were delayed to enter the operating room which had been occupied by other cases of major trauma. Only two flaps were lost completely, two patients developed narrowing at the junction of cervical esophagus and thoracic esophagus. The rate of salvage for intestinal flap is apparently higher than those reported in the literature. In the postoperative management of microsurgery in ICU, telecommunication can help to reduce the ischemia time after vascular compromise in the transfer of free intestinal flap. Telecommunication is really an easy and effective tool in improving the outcome of reconstructive surgery.

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

    DEFF Research Database (Denmark)

    Tøttenborg, Sandra Søgaard; Thomsen, Reimar W.; Nielsen, Henrik;

    2013-01-01

    using data from the Danish Clinical Register of COPD (DrCOPD). Since 2008 the register has systematically monitored and audited the use of recommended processes of COPD care. RESULTS: Substantial improvements were observed for all processes of care and registration fulfillment increased to well above 85...... of care fulfillment between regions and hospital clinics still existed in 2011. The proportion of patients with mild- to moderate COPD increased during the study period (pimportant processes of care, the present study indicates...

  15. Improving assisted living care.

    Science.gov (United States)

    Gregory, Nancy; Gesell, Sabina B; Widmer, Tom

    2007-01-01

    In the absence of a national measurement system, private vendors of satisfaction measurement and improvement services have played a crucial role in the quality movement in the assisted living industry. Survey responses from 175 resident-family dyads at 20 facilities were analyzed to identify priorities for service improvement from the customers' perspective. They include improving care provided by aides and management, meal service, and activities. Practical solutions for addressing these issues are presented.

  16. Health care quality improvement in the emergency department: a reengineering approach.

    Science.gov (United States)

    Schaming, J S; Gulati, A

    1998-05-01

    Most health care organization processes can be compared with those in typical engineering, manufacturing, and service businesses, and improvement can be achieved in health care by means of many of the tools that are commonly found in non-health care industries. In fact, it may prove beneficial for health care organizations to consider obtaining help from professionals outside health care because such individuals probably will not have preconceived ideas about process improvement in such organizations. The article provides a success story in a health care process improvement effort that was undertaken by engineers in a large Los Angeles regional hospital in 1993. It discusses specific steps that were taken to obtain and synthesize data, achieve employee and management buy-in, analyze processes for strengths and improvement opportunities, assess customer satisfaction, implement changes, and measure results. PMID:10179278

  17. Application of evidence-based urology in improving quality of care

    OpenAIRE

    Panda, Arabind; Dorairajan, L. N.; Kumar, Santosh

    2007-01-01

    Evidence-based medicine requires use of the best available evidence for optimal patient care. Increasingly scarce resources and escalating demands on time have led to emphasis on effective treatment. Opinion is slowly yielding to high-quality existent evidence. It is important that urologists adapt to these changes for them to deliver optimum care to the patients. This article discusses the levels of evidence, the nature of desirable evidence, means of assessing quality of clinical trials and...

  18. Cohorting Dengue Patients Improves the Quality of Care and Clinical Outcome.

    Directory of Open Access Journals (Sweden)

    Lucy C S Lum

    2015-06-01

    shock. The highest haematocrit was significantly higher post-intervention but the lowest total white cell counts and platelet counts remained unchanged. A significant and progressive reduction in the use of platelet transfusions occurred, from 21.7% pre-intervention to 14.6% in 2005 and 5.2% in 2006 post-intervention, p<0.001. Likewise, the use of plasma transfusion decreased significantly from 6.1% pre-intervention to 4.0% and 1.6% in the post-intervention years of 2005 and 2006 respectively, p<0.001. The duration of intravenous fluid therapy decreased from 3 days pre-intervention to 2.5 days (p<0.001 post-intervention; the length of hospital stay reduced from 4 days pre- to 3 days (p<0.001 post-intervention and the rate of intensive care admission from 5.8% pre to 2.6% and 2.5% post-intervention, p = 0.005.Cohorting adult dengue patients under a dedicated and trained team of doctors and nurses led to a substantial improvement in quality of care and clinical outcome.

  19. Improving quality for maternal care - a case study from Kerala, India

    Science.gov (United States)

    Vlad, Ioana; Paily, VP; Sadanandan, Rajeev; Cluzeau, Françoise; Beena, M; Nair, Rajasekharan; Newbatt, Emma; Ghosh, Sujit; Sandeep, K; Chalkidou, Kalipso

    2016-01-01

    Background: The implementation of maternal health guidelines remains unsatisfactory, even for simple, well established interventions. In settings where most births occur in health facilities, as is the case in Kerala, India, preventing maternal mortality is linked to quality of care improvements. Context: Evidence-informed quality standards (QS), including quality statements and measurable structure and process indicators, are one innovative way of tackling the guideline implementation gap. Having adopted a zero tolerance policy to maternal deaths, the Government of Kerala worked in partnership with the Kerala Federation of Obstetricians & Gynaecologists (KFOG) and NICE International to select the clinical topic, develop and initiate implementation of the first clinical QS for reducing maternal mortality in the state. Description of practice: The NICE QS development framework was adapted to the Kerala context, with local ownership being a key principle. Locally generated evidence identified post-partum haemorrhage as the leading cause of maternal death, and as the key priority for the QS. A multidisciplinary group (including policy-makers, gynaecologists and obstetricians, nurses and administrators) was established. Multi-stakeholder workshops convened by the group ensured that the statements, derived from global and local guidelines, and their corresponding indicators were relevant and acceptable to clinicians and policy-makers in Kerala. Furthermore, it helped identify practical methods for implementing the standards and monitoring outcomes. Lessons learned: An independent evaluation of the project highlighted the equal importance of a strong evidence-base and an inclusive development process. There is no one-size-fits-all process for QS development; a principle-based approach might be a better guide for countries to adapt global evidence to their local context.

  20. Student evaluation of a primary care clerkship: quality assurance and identification of potential for improvement

    Directory of Open Access Journals (Sweden)

    Himmel Wolfgang

    2009-04-01

    Full Text Available Abstract Background In Germany, like many other countries, general practice clerkships have only recently become mandatory during medical education. The biggest challenges for the organisation of such clerkships are achieving a minimum level of standardisation, and developing and maintaining a system of quality assurance. The aim of this study is to assess the instructional quality in teaching practices using a benchmark system. Methods Before commencing, students anonymously assessed the importance of core aspects of the mandatory primary care clerkship. After the clerkship, they evaluated learning opportunities and teaching performance. Based on this data, a benchmark system was developed to identify areas of strength and weakness for all practices as well as individual teaching practices. Results A total of 695 students evaluated 97 general practices belonging to a teaching network. Prior to the clerkship, most students considered recognition of frequent diseases (85% and communication skills (65% the most important learning goals. After the clerkship, nearly 90% of students confirmed that the general practitioner (GP was good or excellent at teaching these two goals but only two-thirds thought the GP's teaching performance good or excellent in preventive medicine and screening. In an exemplary analysis, we identified the 2 best and the 2 worst practices that consistently received scores far above or below average, respectively. Conclusion We were able to identify areas of weakness in teaching and identified specific GPs who did not meet the students' needs and expectations. This evaluation seems to be a useful quality assurance tool to identify the potential for improvement and faculty development.

  1. Improving quality for maternal care - a case study from Kerala, India [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Ioana Vlad

    2016-02-01

    Full Text Available Background: The implementation of maternal health guidelines remains unsatisfactory, even for simple, well established interventions. In settings where most births occur in health facilities, as is the case in Kerala, India, preventing maternal mortality is linked to quality of care improvements. Context: Evidence-informed quality standards (QS, including quality statements and measurable structure and process indicators, are one innovative way of tackling the guideline implementation gap. Having adopted a zero tolerance policy to maternal deaths, the Government of Kerala worked in partnership with the Kerala Federation of Obstetricians & Gynaecologists (KFOG and NICE International to select the clinical topic, develop and initiate implementation of the first clinical QS for reducing maternal mortality in the state. Description of practice: The NICE QS development framework was adapted to the Kerala context, with local ownership being a key principle. Locally generated evidence identified post-partum haemorrhage as the leading cause of maternal death, and as the key priority for the QS. A multidisciplinary group (including policy-makers, gynaecologists and obstetricians, nurses and administrators was established. Multi-stakeholder workshops convened by the group ensured that the statements, derived from global and local guidelines, and their corresponding indicators were relevant and acceptable to clinicians and policy-makers in Kerala. Furthermore, it helped identify practical methods for implementing the standards and monitoring outcomes. Lessons learned: An independent evaluation of the project highlighted the equal importance of a strong evidence-base and an inclusive development process. There is no one-size-fits-all process for QS development; a principle-based approach might be a better guide for countries to adapt global evidence to their local context.

  2. A Blueprint for Early Care and Education Quality Improvement Initiatives. Publication #2015-07

    Science.gov (United States)

    Tout, Kathryn; Epstein, Dale; Soli, Meg; Lowe, Claire

    2015-01-01

    As Quality Rating and Improvement Systems (QRIS) continue to launch and mature across states, questions emerge from stakeholders about how to design and implement effective quality improvement (QI) initiatives that accompany a QRIS. Funders, policymakers, and program developers with limited resources are looking to invest in activities that will…

  3. Quality improvement as an investment.

    Science.gov (United States)

    Weeks, William B

    2002-01-01

    Health care organizations are experiencing increasing internal and external pressures to improve the quality of care that they provide. However, there is not a framework that can be used to help understand the value of quality improvement projects and to prioritize competing projects. By understanding the current processes, costs and outcomes of care, enumerating the costs and benefits of change, anticipating the timing of the costs and benefits, and performing a financial analysis, quality improvement efforts can be evaluated as investments. Only by understanding and adapting to the financial environments in which health care organizations operate can continuous quality improvement in health care succeed. PMID:12512466

  4. Improving Access to Quality Care in Family Planning: WHO's Four Cornerstones of Evidence-based Guidance

    Institute of Scientific and Technical Information of China (English)

    Shang-chun WU; Yan ZOU; K Church; O Meirik

    2007-01-01

    The four cornerstones of guidance in technique service of family planning are established by WHO based on high quality evidences. They have been updated according to the appearing new evidences, and the consensuses were reached by the international experts in this field. The four documents include Medical Eligibility Criteria for Contraceptive Use, Selected Practice Recommendations for Contraceptive Use, Decision-making Tool for Family Planning Clients and Providers and The Global Handbook for Family Planning Providers. The first two documents mainlyface to the policy-makers and programme managers and were treated as the important references for creating the local guideline. The other two documents were developed for the front-line health-care and family planning providers at different levels, which include plenty of essential technical information to help providers improve their ability in service delivery and counselling. China paid great attention to the introduction and application of WHO guidelines. As soon as the newer editions of these documents were available, the Chinese version would be followed. WHO guidelines have been primarily adapted with the newly issued national guideline, The Clinical Practical Skill Guidelines- Family Planning Part, which was established by China Medical Association. At the same time, the WHO guidelines have been introduced to some of the linicians and family planning providers at different levels. In the future, more special training courses will be introduced to the township level based on the needs of grassroot providers.

  5. Diabetes care may be improved with Steno Quality Assurance Tool--a self-assessment tool in diabetes management

    DEFF Research Database (Denmark)

    Bjerre-Christensen, Ulla; Nielsen, Annemette Anker; Binder, Christian;

    2014-01-01

    UNLABELLED: To evaluate if improvements in the quality of diabetes care in Indian clinics can be obtained by simple self-surveillance PC-based software. METHOD: Nineteen Indian diabetes clinics were introduced to the principles of quality assurance (QA), and to a software program, the Steno Quality...... patients (baseline) and 4440 (follow-up). The average examination frequency per clinic of the following indicators increased significantly: lipid examination (72-87%) (p=0.007), foot examination (80-94%) (p=0.02), HbA1c investigation (59-77%) (p=0.006), and urine albumin excretion investigation (72-87%) (p.......002). CONCLUSION: Quality of diabetes care can be improved by applying SQAT, a QA self-surveillance software that enables documentation of changes in process and outcome indicators....

  6. Palliative home care intervention to improve the quality of life of women with advanced breast cancer

    International Nuclear Information System (INIS)

    The quality of life is affected frequently observed in women with advanced breast cancer and is considered a leading indicator of effectiveness of palliative care. A descriptive, quasi-experimental study is presented ex-ante / ex-post, by applying open-ended interviews to explore the effects on the processes of adaptation of each patient and a self-administrable scale identified specific dimensions of quality of life, satisfaction with care and overall quality of life. The intervention was performed palliative home care to 52 women, according to the damages identified in the baseline diagnosis. The overall strategy included four steps: clinical and socio-demographic characterization of women; identification of the effects on the processes of adaptation by the theoretical model of Roy and dimensions of quality of life frequently affected, to design individually oriented actions on the drive shaft of Nursing Interventions Classification and evaluation of results intervention. The dimensions achieved higher frequency of involvement were: behavior, physical symptoms, pain interference and leisure activities, social life and family. Data were analyzed with qualitative methodologies and uni and multivariate statistical processing. After the intervention favorable changes in adaptive processes and dimensions of quality of life were observed; well as in the assessment of overall satisfaction with life. It was interesting that the dimensions of satisfaction assessed at the end of the intervention obtained an unfavorable assessment, outcome associated with sociodemographic variables. (author)

  7. Improved cytodiagnostics and quality of patient care through double reading of selected cases by an expert cytopathologist

    NARCIS (Netherlands)

    Kuijpers, Chantal C H J; Visser, Mike; Sie-Go, Daisy M D S; de Leeuw, Henk; de Rooij, Mathilda J.; van Diest, Paul J.; Jiwa, Mehdi

    2015-01-01

    Double reading may be a valuable tool for improving the quality of patient care by restoring diagnostic errors before final sign-out, but standard double reading would significantly increase costs of pathology. The aim of this study was to assess the added value of routine double reading of defined

  8. An innovative telemedicine knowledge translation program to improve quality of care in intensive care units: protocol for a cluster randomized pragmatic trial

    Directory of Open Access Journals (Sweden)

    Pinto Ruxandra

    2009-02-01

    Full Text Available Abstract Background There are challenges to timely adoption of, and ongoing adherence to, evidence-based practices known to improve patient care in the intensive care unit (ICU. Quality improvement initiatives using a collaborative network approach may increase the use of such practices. Our objective is to evaluate the effectiveness of a novel knowledge translation program for increasing the proportion of patients who appropriately receive the following six evidence-based care practices: venous thromboembolism prophylaxis; ventilator-associated pneumonia prevention; spontaneous breathing trials; catheter-related bloodstream infection prevention; decubitus ulcer prevention; and early enteral nutrition. Methods and design We will conduct a pragmatic cluster randomized active control trial in 15 community ICUs and one academic ICU in Ontario, Canada. The intervention is a multifaceted videoconferenced educational and problem-solving forum to organize knowledge translation strategies, including comparative audit and feedback, educational sessions from content experts, and dissemination of algorithms. Fifteen individual ICUs (clusters will be randomized to receive quality improvement interventions targeting one of the best practices during each of six study phases. Each phase lasts four months during the first study year and three months during the second. At the end of each study phase, ICUs are assigned to an intervention for a best practice not yet received according to a random schedule. The primary analysis will use patient-level process-of-care data to measure the intervention's effect on rates of adoption and adherence of each best practice in the targeted ICU clusters versus controls. Discussion This study design evaluates a new system for knowledge translation and quality improvement across six common ICU problems. All participating ICUs receive quality improvement initiatives during every study phase, improving buy-in. This study design

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

    OpenAIRE

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

    2014-01-01

    Background Depression is a major cause of morbidity and cost in primary care patient populations. Successful depression improvement models, however, are complex. Based on organizational readiness theory, a practice’s commitment to change and its capability to carry out the change are both important predictors of initiating improvement. We empirically explored the links between relative commitment (i.e., the intention to move forward within the following year) and implementation capability. Me...

  10. Improving the quality of health care in the United States of America: the need for a multi-level approach.

    Science.gov (United States)

    Mechanic, David

    2002-07-01

    Serious efforts to address quality require coordinated, multi-faceted, multi-level strategies that address the organisational environments and cultures that affect how care is provided. Most efforts over the past 50 years to improve the care provided by physicians and other clinicians have been individually rather than system based. Such individual interventions to modify physician behaviour typically have only modest effects whether considering the recognition and treatment of depression in primary care, following established practice guidelines, carrying out preventive interventions, monitoring and managing chronic illness appropriately, or managing pain and end-of-life care. It is increasingly recognised that quality of care is a property of health systems. Internal efforts to shape clinical routines, such as performance incentives and disease-management approaches, and external inducements and constraints that shape how clinical contexts are organised and function are equally relevant. Internal factors include the skills training of clinical personnel, organisational procedures and mechanisms to coordinate care and prevent errors, implementation of best practices, effective use of informational technologies and appropriate incentives. External factors include broader financial and reimbursement mechanisms, regulatory arrangements that protect access and patient rights in situations of vulnerability and performance-based contracts. The mobilisation of effective advocacy, independent and non-profit statutory watchdog organisations, and good consumer information can facilitate and reinforce quality efforts. System integration is admittedly difficult, and always incomplete, but movement toward this goal is an essential strategic objective.

  11. Closing the delivery gaps in pediatric HIV care in Togo, West Africa: using the care delivery value chain framework to direct quality improvement.

    Science.gov (United States)

    Fiori, Kevin; Schechter, Jennifer; Dey, Monica; Braganza, Sandra; Rhatigan, Joseph; Houndenou, Spero; Gbeleou, Christophe; Palerbo, Emmanuel; Tchangani, Elfamozo; Lopez, Andrew; Bensen, Emily; Hirschhorn, Lisa R

    2016-03-01

    Providing quality care for all children living with HIV/AIDS remains a global challenge and requires the development of new healthcare delivery strategies. The care delivery value chain (CDVC) is a framework that maps activities required to provide effective and responsive care for a patient with a particular disease across the continuum of care. By mapping activities along a value chain, the CDVC enables managers to better allocate resources, improve communication, and coordinate activities. We report on the successful application of the CDVC as a strategy to optimize care delivery and inform quality improvement (QI) efforts with the overall aim of improving care for Pediatric HIV patients in Togo, West Africa. Over the course of 12 months, 13 distinct QI activities in Pediatric HIV/AIDS care delivery were monitored, and 11 of those activities met or exceeded established targets. Examples included: increase in infants receiving routine polymerase chain reaction testing at 2 months (39-95%), increase in HIV exposed children receiving confirmatory HIV testing at 18 months (67-100%), and increase in patients receiving initial CD4 testing within 3 months of HIV diagnosis (67-100%). The CDVC was an effective approach for evaluating existing systems and prioritizing gaps in delivery for QI over the full cycle of Pediatric HIV/AIDS care in three specific ways: (1) facilitating the first comprehensive mapping of Pediatric HIV/AIDS services, (2) identifying gaps in available services, and (3) catalyzing the creation of a responsive QI plan. The CDVC provided a framework to drive meaningful, strategic action to improve Pediatric HIV care in Togo. PMID:27391996

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

    Directory of Open Access Journals (Sweden)

    Kumpf, Oliver

    2014-12-01

    Full Text Available [english] Introduction: Quality improvement and safety in intensive care are rapidly evolving topics. However, there is no gold standard for assessing quality improvement in intensive care medicine yet. In 2007 a pilot project in German intensive care units (ICUs started using voluntary peer reviews as an innovative tool for quality assessment and improvement. We describe the method of voluntary peer review and assessed its feasibility by evaluating anonymized peer review reports and analysed the thematic clusters highlighted in these reports.Methods: Retrospective data analysis from 22 anonymous reports of peer reviews. All ICUs – representing over 300 patient beds – had undergone voluntary peer review. Data were retrieved from reports of peers of the review teams and representatives of visited ICUs. Data were analysed with regard to number of topics addressed and results of assessment questionnaires. Reports of strengths, weaknesses, opportunities and threats (SWOT reports of these ICUs are presented. Results: External assessment of structure, process and outcome indicators revealed high percentages of adherence to predefined quality goals. In the SWOT reports 11 main thematic clusters were identified representative for common ICUs. 58.1% of mentioned topics covered personnel issues, team and communication issues as well as organisation and treatment standards. The most mentioned weaknesses were observed in the issues documentation/reporting, hygiene and ethics. We identified several unique patterns regarding quality in the ICU of which long-term personnel problems und lack of good reporting methods were most interestingConclusion: Voluntary peer review could be established as a feasible and valuable tool for quality improvement. Peer reports addressed common areas of interest in intensive care medicine in more detail compared to other methods like measurement of quality indicators.

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

    Science.gov (United States)

    Kumpf, Oliver; Bloos, Frank; Bause, Hanswerner; Brinkmann, Alexander; Deja, Maria; Marx, Gernot; Kaltwasser, Arnold; Dubb, Rolf; Muhl, Elke; Greim, Clemens-A.; Weiler, Norbert; Chop, Ines; Jonitz, Günther; Schaefer, Henning; Felsenstein, Matthias; Liebeskind, Ursula; Leffmann, Carsten; Jungbluth, Annemarie; Waydhas, Christian; Pronovost, Peter; Spies, Claudia; Braun, Jan-Peter

    2014-01-01

    Introduction: Quality improvement and safety in intensive care are rapidly evolving topics. However, there is no gold standard for assessing quality improvement in intensive care medicine yet. In 2007 a pilot project in German intensive care units (ICUs) started using voluntary peer reviews as an innovative tool for quality assessment and improvement. We describe the method of voluntary peer review and assessed its feasibility by evaluating anonymized peer review reports and analysed the thematic clusters highlighted in these reports. Methods: Retrospective data analysis from 22 anonymous reports of peer reviews. All ICUs – representing over 300 patient beds – had undergone voluntary peer review. Data were retrieved from reports of peers of the review teams and representatives of visited ICUs. Data were analysed with regard to number of topics addressed and results of assessment questionnaires. Reports of strengths, weaknesses, opportunities and threats (SWOT reports) of these ICUs are presented. Results: External assessment of structure, process and outcome indicators revealed high percentages of adherence to predefined quality goals. In the SWOT reports 11 main thematic clusters were identified representative for common ICUs. 58.1% of mentioned topics covered personnel issues, team and communication issues as well as organisation and treatment standards. The most mentioned weaknesses were observed in the issues documentation/reporting, hygiene and ethics. We identified several unique patterns regarding quality in the ICU of which long-term personnel problems und lack of good reporting methods were most interesting Conclusion: Voluntary peer review could be established as a feasible and valuable tool for quality improvement. Peer reports addressed common areas of interest in intensive care medicine in more detail compared to other methods like measurement of quality indicators. PMID:25587245

  14. 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

  15. A multi-faceted intervention to implement guideline care and improve quality of care for older people who present to the emergency department with falls

    Directory of Open Access Journals (Sweden)

    Nagree Yusuf

    2011-01-01

    Full Text Available Abstract Background Guidelines recommend that older people should receive multi-factorial interventions following an injurious fall however there is limited evidence that this is routine practice. We aimed to improve the delivery of evidence based care to patients presenting to the Emergency Department (ED following a fall. Methods A prospective before and after study was undertaken in the ED of a medium-sized hospital in Perth, Western Australia. Participants comprised 313 community-dwelling patients, aged 65 years and older, presenting to ED as a result of a fall. A multi-faceted strategy to change practice was implemented and included a referral pathway, audit and feedback and additional falls specialist staff. Key measures to show improvements comprised the proportion of patients reviewed by allied health, proportion of patients referred for guideline care, quality of care index, all determined by record extraction. Results Allied health staff increased the proportion of patients being reviewed from 62.7% in the before period to 89% after the intervention (P Conclusions A multi-faceted change strategy was associated with an improvement in allied health in ED prioritizing the review of ED fallers as well as subsequent referral for comprehensive geriatric care. The processes of multi-disciplinary care also improved, indicating improved care received by the patient.

  16. Video laryngoscopy in pre-hospital critical care – a quality improvement study

    OpenAIRE

    Rhode, Marianne Grønnebæk; Vandborg, Mads Partridge; Bladt, Vibeke; Rognås, Leif

    2016-01-01

    Background Pre-hospital endotracheal intubation is challenging and repeated endotracheal intubation is associated with increased morbidity and mortality. We investigated whether the introduction of the McGrath MAC video laryngoscope as the primary device for pre-hospital endotracheal intubation could improve first-pass success rate in our anaesthesiologist-staffed pre-hospital critical care services. We also investigated the incidence of failed pre-hospital endotracheal intubation, the use of...

  17. How can we improve outcomes for patients and families under palliative care? implementing clinical audit for quality improvement in resource limited settings

    Directory of Open Access Journals (Sweden)

    Lucy Selman

    2010-01-01

    Full Text Available Palliative care in India has made enormous advances in providing better care for patients and families living with progressive disease, and many clinical services are well placed to begin quality improvement initiatives, including clinical audit. Clinical audit is recognized globally to be essential in all healthcare, as a way of monitoring and improving quality of care. However, it is not common in developing country settings, including India. Clinical audit is a cyclical activity involving: identification of areas of care in need of improvement, through data collection and analysis utilizing an appropriate questionnaire; setting measurable quality of care targets in specific areas; designing and implementing service improvement strategies; and then re-evaluating quality of care to assess progress towards meeting the targets. Outcome measurement is an important component of clinical audit that has additional advantages; for example, establishing an evidence base for the effectiveness of services. In resource limited contexts, outcome measurement in clinical audit is particularly important as it enables service development to be evidence-based and ensures resources are allocated effectively. Key success factors in conducting clinical audit are identified (shared ownership, training, managerial support, inclusion of all members of staff and a positive approach. The choice of outcome measurement tool is discussed, including the need for a culturally appropriate and validated measure which is brief and simple enough to incorporate into clinical practice and reflects the holistic nature of palliative care. Support for clinical audit is needed at a national level, and development and validation of an outcome measurement tool in the Indian context is a crucial next step.

  18. Editorial: Advances in healthcare provider and patient training to improve the quality and safety of patient care

    Directory of Open Access Journals (Sweden)

    Elizabeth M. Borycki

    2015-09-01

    Full Text Available This special issue of the Knowledge Management & E-Learning: An International Journal is dedicated to describing “Advances in Healthcare Provider and Patient Training to Improve the Quality and Safety of Patient Care.” Patient safety is an important and fundamental requirement of ensuring the quality of patient care. Training and education has been identified as a key to improving healthcare provider patient safety competencies especially when working with new technologies such as electronic health records and mobile health applications. Such technologies can be harnessed to improve patient safety; however, if not used properly they can negatively impact on patient safety. In this issue we focus on advances in training that can improve patient safety and the optimal use of new technologies in healthcare. For example, use of clinical simulations and online computer based training can be employed both to facilitate learning about new clinical discoveries as well as to integrate technology into day to day healthcare practices. In this issue we are publishing papers that describe advances in healthcare provider and patient training to improve patient safety as it relates to the use of educational technologies, health information technology and on-line health resources. In addition, in the special issue we describe new approaches to training and patient safety including, online communities, clinical simulations, on-the-job training, computer based training and health information systems that educate about and support safer patient care in real-time (i.e. when health professionals are providing care to patients. These educational and technological initiatives can be aimed at health professionals (i.e. students and those who are currently working in the field. The outcomes of this work are significant as they lead to safer care for patients and their family members. The issue has both theoretical and applied papers that describe advances in patient

  19. Can Ranking Hospitals on the Basis of Patients' Travel Distances Improve Quality of Care?

    OpenAIRE

    Kessler, Daniel P.

    2005-01-01

    Conventional outcomes report cards-- public disclosure of information about the patient-background-adjusted health outcomes of individual hospitals and physicians -- may help improve quality, but they may also encourage providers to "game" the system by avoiding sick and/or seeking healthy patients. In this paper, I propose an alternative approach: ranking hospitals on the basis of the travel distances of their Medicare patients. At least in theory, a distance report card could dominate conve...

  20. Improving the quality of obstetric care for women with obstructed labour in the national referral hospital in Uganda: lessons learnt from criteria based audit

    OpenAIRE

    Kayiga, Herbert; Ajeani, Judith; Kiondo, Paul; Kaye, Dan K

    2016-01-01

    Background Obstructed labour remains a major cause of maternal morbidity and mortality whose complications can be reduced with improved quality of obstetric care. The objective was to assess whether criteria-based audit improves quality of obstetric care provided to women with obstructed labour in Mulago hospital, Uganda. Methods Using criteria-based audit, management of obstructed labour was analyzed prospectively in two audits. Six standards of care were compared. An initial audit of 180 pa...

  1. No technological innovation is a panacea: a case series in quality improvement for primary care mental health services.

    Science.gov (United States)

    Horwitz, Sarah McCue; Hoagwood, Kimberly Eaton; Garner, Andrew; Macknin, Michael; Phelps, Thomas; Wexberg, Steven; Foley, Conrad; Lock, Joseph C; Hazen, Jacalyn E; Sturner, Raymond; Howard, Barbara; Kelleher, Kelly J

    2008-09-01

    Evaluations of quality improvement efforts targeted at mental health services in primary care pediatrics are rare. We evaluated a short-targeted educational session, a Web-based system, the Child Health and Development Interactive System, and a local area mental health services resource guide. Most physicians believed the information in the educational session was at least somewhat likely to change their practice. However, only 9.2% of the families invited to complete the Web-based system did so. Physicians found access to the Web-based system time consuming and, because the billing code for the screening activity was carved out of most of Ohio's privately-insured contract, physicians received no reimbursement for the screenings. Physicians were unenthusiastic about the local resource guide because the resources were not rated for quality. This quality improvement effort demonstrates that there are not easy solutions to practice change and highlights the need for implementation support when introducing new technology.

  2. Evaluating the effectiveness of a tailored multifaceted performance feedback intervention to improve the quality of care: protocol for a cluster randomized trial in intensive care

    Directory of Open Access Journals (Sweden)

    Westert Gert P

    2011-10-01

    Full Text Available Abstract Background Feedback is potentially effective in improving the quality of care. However, merely sending reports is no guarantee that performance data are used as input for systematic quality improvement (QI. Therefore, we developed a multifaceted intervention tailored to prospectively analyzed barriers to using indicators: the Information Feedback on Quality Indicators (InFoQI program. This program aims to promote the use of performance indicator data as input for local systematic QI. We will conduct a study to assess the impact of the InFoQI program on patient outcome and organizational process measures of care, and to gain insight into barriers and success factors that affected the program's impact. The study will be executed in the context of intensive care. This paper presents the study's protocol. Methods/design We will conduct a cluster randomized controlled trial with intensive care units (ICUs in the Netherlands. We will include ICUs that submit indicator data to the Dutch National Intensive Care Evaluation (NICE quality registry and that agree to allocate at least one intensivist and one ICU nurse for implementation of the intervention. Eligible ICUs (clusters will be randomized to receive basic NICE registry feedback (control arm or to participate in the InFoQI program (intervention arm. The InFoQI program consists of comprehensive feedback, establishing a local, multidisciplinary QI team, and educational outreach visits. The primary outcome measures will be length of ICU stay and the proportion of shifts with a bed occupancy rate above 80%. We will also conduct a process evaluation involving ICUs in the intervention arm to investigate their actual exposure to and experiences with the InFoQI program. Discussion The results of this study will inform those involved in providing ICU care on the feasibility of a tailored multifaceted performance feedback intervention and its ability to accelerate systematic and local quality

  3. Quality improvement techniques to improve patient satisfaction.

    Science.gov (United States)

    Torres, E Joseph; Guo, Kristina L

    2004-01-01

    This paper describes several approaches for implementing quality improvement initiatives to improve patient satisfaction, which enables health-care organizations to position themselves for success in today's global and increasingly competitive environment. Specifically, measuring the views of patients, improving patient satisfaction through a community-wide effort, and using a Six Sigma program are discussed. Each of these programs can be an effective mechanism for quality improvement. A key component to quality improvement techniques involves collaborative efforts by all health-care professionals and managers as they seek to increase patient satisfaction. PMID:15552388

  4. How Kaiser Permanente uses video ethnography of patients for quality improvement, such as in shaping better care transitions.

    Science.gov (United States)

    Neuwirth, Esther B; Bellows, Jim; Jackson, Ana H; Price, Patricia M

    2012-06-01

    Keeping patients and caregivers at the center of quality improvement is critical. Kaiser Permanente's Care Management Institute adapted video ethnography to achieve this aim, using video to capture interviews with-and observations of-patients and caregivers, identify patient-centered improvement opportunities, and communicate them effectively to clinical and administrative leaders and front-line staff. This method is particularly effective for helping understand the needs of frail elders, patients nearing the end of life, those with multiple chronic conditions, and other vulnerable people who are not well represented in focus groups and patient advisory councils. As part of an initiative to improve care transitions for elders with heart failure, video ethnography contributed to greatly reduced thirty-day hospital readmission rates, helping reduce readmissions at one medical center from 13.6 percent to 9 percent in six months. It also helped improve the reliability of the readmissions reduction program. When embedded within an established quality improvement framework, video ethnography can be an effective tool for innovating new solutions, improving existing processes, and spreading knowledge about how best to meet patient needs.

  5. Quality of Diabetes Care in Germany Improved from 2000 to 2007 to 2014, but Improvements Diminished since 2007. Evidence from the Population-Based KORA Studies

    Science.gov (United States)

    Knoll, Gabriella; Schunk, Michaela; Meisinger, Christa; Huth, Cornelia; Holle, Rolf

    2016-01-01

    Objective Little is known about the development of the quality of diabetes care in Germany. The aim of this study is to analyze time trends in patient self-management, physician-delivered care, medication, risk factor control, complications and quality of life from 2000 to 2014. Methods Analyses are based on data from individuals with type 2 diabetes of the population-based KORA S4 (1999–2001, n = 150), F4 (2006–2008, n = 203), FF4 (2013/14, n = 212) cohort study. Information on patient self-management, physician-delivered care, medication, risk factor control and quality of life were assessed in standardized questionnaires and examinations. The 10-year coronary heart disease (CHD) risk was calculated using the UKPDS risk engine. Time trends were analyzed using multivariable linear and logistic regression models adjusted for age, sex, education, diabetes duration, and history of cardiovascular disease. Results From 2000 to 2014 the proportion of participants with type 2 diabetes receiving oral antidiabetic/cardio-protective medication and of those reaching treatment goals for glycemic control (HbA1c<7%, 60% to 71%, p = 0.09), blood pressure (<140/80 mmHg, 25% to 69%, p<0.001) and LDL cholesterol (<2.6 mmol/l, 13% to 27%, p<0.001) increased significantly. However, improvements were generally smaller from 2007 to 2014 than from 2000 to 2007. Modeled 10-year CHD risk decreased from 30% in 2000 to 24% in 2007 to 19% in 2014 (p<0.01). From 2007 to 2014, the prevalence of microvascular complications decreased and quality of life increased, but no improvements were observed for the majority of indicators of self-management. Conclusion Despite improvements, medication and risk factor control has remained suboptimal. The flattening of improvements and deteriorations in quality of (self-) care since 2007 indicate that more effort is needed to improve quality of care and patient self-management. Due to selection or lead time bias an overestimation of quality of care

  6. Defining Quality Child Care: Multiple Stakeholder Perspectives

    Science.gov (United States)

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

    2007-01-01

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

  7. “Making a difference” – Medical students’ opportunities for transformational change in health care and learning through quality improvement projects

    OpenAIRE

    Bergh, Anne-Marie; Bac, Martin; Hugo, Jannie; Sandars, John

    2016-01-01

    Background Quality improvement is increasingly becoming an essential aspect of the medical curriculum, with the intention of improving the health care system to provide better health care. The aim of this study was to explore undergraduate medical students’ experiences of their involvement in quality improvement projects during a district health rotation. Methods Student group reports from rotations in learning centres of the University of Pretoria in Mpumalanga Province, South Africa were an...

  8. Validation of Quality Rating and Improvement Systems for Early Care and Education and School-Age Care. Research-to-Policy, Research-to-Practice Brief. OPRE 2012-29

    Science.gov (United States)

    Zellman, Gail L.; Fiene, Richard

    2012-01-01

    Quality Rating and Improvement Systems (QRIS) for early care and education and school age care programs are designed to collect information about quality and to use that information to produce program-level ratings, which are the foundation of a QRIS. The ratings are intended to make program quality transparent for parents and other stakeholders…

  9. “SHOUT” to improve the quality of care delivered to patients with acute kidney injury at Great Western Hospital

    Science.gov (United States)

    Brady, Paul; Gorham, James; Kosti, Angeliki; Seligman, William; Courtney, Alona; Mazan, Karolina; Paterson, Stuart; Ramcharitar, Steve; Chandrasekaran, Badri; Juniper, Mark; Greamspet, Mala; Daniel, Jessica; Chalstrey, Sue; Ahmed, Ijaz; Dasgupta, Tanaji

    2015-01-01

    Acute kidney injury (AKI) affects up to 20% of all patients admitted to hospital, and is associated with a higher risk of adverse clinical outcomes, increased healthcare costs, as well as long term risks of chronic kidney disease and end stage renal failure. The aim of this project was to improve the quality of care for patients with AKI admitted to the acute medical unit (AMU) at the Great Western Hospital (GWH). We assessed awareness and self reported confidence among physicians in our Trust, in addition to basic aspects of care relevant to AKI on our AMU. A multifaceted quality improvement strategy was developed, which included measures to improve awareness such as a Trust wide AKI awareness day, and reconfiguring the admission proforma on our AMU in order to enhance risk assessment, staging, and early response to AKI. Ancillary measures such as the dissemination of flashcards for lanyards containing core information were also used. Follow up assessments showed that foundation year one (FY1) doctors’ self reported confidence in managing AKI increased from 2.8 to 4.2, as measured on a five point Likert scale (P=0.0003). AKI risk assessment increased from 13% to 57% (P=0.07) following a change in the admission proforma. Documentation of the diagnosis of AKI increased from 66% to 95% (P=0.038) among flagged patients. Documentation of urine dip results increased from 33% to 73% (P=0.01), in addition to a rise in appropriate referral for specialist input, although this was not statistically significant. Our results suggest that using the twin approaches of improving awareness, and small changes to systemic factors such as modification of the admission proforma, can lead to significant enhancements in the quality of care of patients with AKI. PMID:26734401

  10. Primary care quality management in Uzbekistan.

    OpenAIRE

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

    2008-01-01

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

  11. Potential access to primary health care: what does the National Program for Access and Quality Improvement data show?

    Science.gov (United States)

    Uchôa, Severina Alice da Costa; Arcêncio, Ricardo Alexandre; Fronteira, Inês Santos Estevinho; Coêlho, Ardigleusa Alves; Martiniano, Claudia Santos; Brandão, Isabel Cristina Araújo; Yamamura, Mellina; Maroto, Renata Melo

    2016-01-01

    Objective: to analyze the influence of contextual indicators on the performance of municipalities regarding potential access to primary health care in Brazil and to discuss the contribution from nurses working on this access. Method: a multicenter descriptive study based on secondary data from External Evaluation of the National Program for Access and Quality Improvement in Primary Care, with the participation of 17,202 primary care teams. The chi-square test of proportions was used to verify differences between the municipalities stratified based on size of the coverage area, supply, coordination, and integration; when necessary, the chi-square test with Yates correction or Fisher's exact test were employed. For the population variable, the Kruskal-Wallis test was used. Results: the majority of participants were nurses (n=15.876; 92,3%). Statistically significant differences were observed between the municipalities in terms of territory (p=0.0000), availability (p=0.0000), coordination of care (p=0.0000), integration (p=0.0000) and supply (p=0.0000), verifying that the municipalities that make up area 6 tend to have better performance in these dimensions. Conclusion: areas 4,5 and 6 performed better in every analyzed dimension, and the nurse had a leading role in the potential to access primary health care in Brazil. PMID:26959332

  12. Potential access to primary health care: what does the National Program for Access and Quality Improvement data show?

    Directory of Open Access Journals (Sweden)

    Severina Alice da Costa Uchôa

    2016-01-01

    Full Text Available Objective: to analyze the influence of contextual indicators on the performance of municipalities regarding potential access to primary health care in Brazil and to discuss the contribution from nurses working on this access. Method: a multicenter descriptive study based on secondary data from External Evaluation of the National Program for Access and Quality Improvement in Primary Care, with the participation of 17,202 primary care teams. The chi-square test of proportions was used to verify differences between the municipalities stratified based on size of the coverage area, supply, coordination, and integration; when necessary, the chi-square test with Yates correction or Fisher's exact test were employed. For the population variable, the Kruskal-Wallis test was used. Results: the majority of participants were nurses (n=15.876; 92,3%. Statistically significant differences were observed between the municipalities in terms of territory (p=0.0000, availability (p=0.0000, coordination of care (p=0.0000, integration (p=0.0000 and supply (p=0.0000, verifying that the municipalities that make up area 6 tend to have better performance in these dimensions. Conclusion: areas 4,5 and 6 performed better in every analyzed dimension, and the nurse had a leading role in the potential to access primary health care in Brazil.

  13. Improving the Quality of Outpatient Diabetes Care Using an Information Management System

    Science.gov (United States)

    Weissmann, Joerg; Mueller, Angelika; Messinger, Diethelm; Parkin, Christopher G.; Amann-Zalan, Ildiko

    2015-01-01

    Background: This study aimed to evaluate the effects of information management system (IMS) use with individuals with type 1 and type 2 diabetes who were treated in outpatient settings. Methods: In this 7-month, prospective, observational study, 965 adults with diabetes, mean (SD) baseline HbA1c 8.61(1.2)% (70.6[13.1] mmol/mol), were recruited from 132 outpatient care centers in Germany and Denmark. HbA1c was measured at baseline, month 4, and month 7. IMS reports were generated from uploaded self-monitored blood glucose data and therapy adjustments were documented at months 1 and 4. Hypoglycemic events were documented. Results: Mean (SD) HbA1c decreased from baseline in type 1 and type 2 diabetes patients at month 4 (–0.61[1.03]% (–6.7[11.3] mmol/mol), n = 213; –0.88[1.22]% (–9.6[13.3] mmol/mol), n = 589, respectively) and month 7 (–0.64[1.02]% (–7.0[11.1] mmol/mol), n = 219; –0.93[1.27]% (–10.2[13.9] mmol/mol), n = 594, respectively), all P < .0001, with no increase in hypoglycemic events. Therapy was adjusted in 106(42.7)% type 1 and 349(52.4)% type 2 diabetes patients at months 1 and 105(42.3)% type 1 and 282(42.3)% type 2 diabetes patients at month 4. Physicians used IMS reports to make therapy adjustments in 90% of patients at month 1 and 86% of patients at month 4. Conclusions: Integration of the IMS into outpatient care facilitates significant improvements in glycemic control. PMID:26224760

  14. Do strategies to improve quality of maternal and child health care in lower and middle income countries lead to improved outcomes? A review of the evidence.

    Directory of Open Access Journals (Sweden)

    Zoe Dettrick

    Full Text Available OBJECTIVES: Efforts to scale-up maternal and child health services in lower and middle income countries will fail if services delivered are not of good quality. Although there is evidence of strategies to increase the quality of health services, less is known about the way these strategies affect health system goals and outcomes. We conducted a systematic review of the literature to examine this relationship. METHODS: We undertook a search of MEDLINE, SCOPUS and CINAHL databases, limiting the results to studies including strategies specifically aimed at improving quality that also reported a measure of quality and at least one indicator related to health system outcomes. Variation in study methodologies prevented further quantitative analysis; instead we present a narrative review of the evidence. FINDINGS: Methodologically, the quality of evidence was poor, and dominated by studies of individual facilities. Studies relied heavily on service utilisation as a measure of strategy success, which did not always correspond to improved quality. The majority of studies targeted the competency of staff and adequacy of facilities. No strategies addressed distribution systems, public-private partnership or equity. Key themes identified were the conflict between perceptions of patients and clinical measures of quality and the need for holistic approaches to health system interventions. CONCLUSION: Existing evidence linking quality improvement strategies to improved MNCH outcomes is extremely limited. Future research would benefit from the inclusion of more appropriate indicators and additional focus on non-facility determinants of health service quality such as health policy, supply distribution, community acceptability and equity of care.

  15. Nine States’ Use of Collaboratives to Improve Children’s Health Care Quality in Medicaid and CHIP

    Science.gov (United States)

    Devers, Kelly J.; Foster, Leslie; Brach, Cindy

    2016-01-01

    We examine quality improvement (QI) collaboratives underway in 9 states participating in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. A total of 147 diverse, child-serving practices were participating in the collaboratives. We conducted 256 semistructured interviews with key stakeholders from March to August 2012—2 years into the 5-year demonstration projects—and analyzed states’ grant applications, operating plans, and progress reports. The collaboratives have multiple complex aims. In addition to developing patient-centered medical home (PCMH) capability, some states use collaboratives to familiarize practices with CMS’s Initial Core Set of Children’s Health Care Quality Measures, practice-level quality measurement, and improving QI knowledge and skills. The duration of the collaboratives is longer than other well-known collaborative models. Collaboratives also vary in their methods for targeting areas for improvement and strategies for motivating practice recruitment and engagement. States also vary with respect to the other strategies they use to support QI and PCMH development. All states supplement the collaboratives with practice facilitation; the majority utilized practice-level parent engagement, but only 4 used work-force augmentation (ie, providing care coordinators and QI specialists). Practice staff highly valued aspects of the collaboratives and supplemental strategies, including the opportunity to work with experts and other child-serving practices; states’ efforts to provide stipends and align demonstration efforts with other professional requirements or programs; receipt of relevant, customized QI materials; opportunities to learn how care coordinators or QI specialists might work in their practice without the risk of hiring them; and satisfaction from learning more about quality measures, QI concepts and techniques, critical medical home components, and how to identify PCMH

  16. Identifying health care quality attributes.

    Science.gov (United States)

    Ramsaran-Fowdar, Roshnee R

    2005-01-01

    Evaluating health care quality is important for consumers, health care providers, and society. Developing a measure of health care service quality is an important precursor to systems and organizations that value health care quality. SERVQUAL has been proposed as a broad-based measure of service quality that may be applicable to health care settings. Results from a study described in this paper verify SERVQUAL dimensions, but demonstrate additional dimensions that are specific to health care settings. PMID:16318013

  17. Reducing unnecessary hospital days to improve quality of care through physician accountability: a cluster randomised trial

    Directory of Open Access Journals (Sweden)

    Caminiti Caterina

    2013-01-01

    Full Text Available Abstract Background Over 20% of hospital bed use is inappropriate, implying a waste of resources and the increase of patient iatrogenic risk. Methods This is a cluster, pragmatic, randomised controlled trial, carried out in a large University Hospital of Northern Italy, aiming to evaluate the effect of a strategy to reduce unnecessary hospital days. The primary outcome was the percentage of patient-days compatible with discharge. Among secondary objectives, to describe the strategy’s effect in the long-term, as well as on hospital readmissions, considered to be a marker of the quality of hospital care. The 12 medical wards with the longest length of stay participated. Effectiveness was measured at the individual level on 3498 eligible patients during monthly index days. Patients admitted or discharged on index days, or with stay >90 days, were excluded. All ward staff was blinded to the index days, while staff in the control arm and data analysts were blinded to the trial’s objectives and interventions. The strategy comprised the distribution to physicians of the list of their patients whose hospital stay was compatible with discharge according to a validated Delay Tool, and of physician length of stay profiles, followed by audits managed autonomously by the physicians of the ward. Results During the 12 months of data collection, over 50% of patient-days were judged to be compatible with discharge. Delays were mainly due to problems with activities under medical staff control. Multivariate analysis considering clustering showed that the strategy reduced patient-days compatible with discharge by 16% in the intervention vs control group, (OR=0.841; 95% CI, 0.735 to 0.963; P=0.012. Follow-up at 1 year did not yield a statistically significant difference between the percentages of patient-days judged to be compatible with discharge between the two arms (OR=0.818; 95% CI, 0.476 to 1.405; P=0.47. There was no significant difference in 30-day

  18. Palliative Care Improves Survival, Quality of Life in Advanced Lung Cancer | Division of Cancer Prevention

    Science.gov (United States)

    Results from the first randomized clinical trial of its kind have revealed a surprising and welcome benefit of early palliative care for patients with advanced lung cancer—longer median survival. Although several researchers said that the finding needs to be confirmed in other trials of patients with other cancer types, they were cautiously optimistic that the trial results could influence oncologists’ perceptions and use of palliative care. |

  19. A “best practices” strategy to improve quality in Medicaid managed care plans

    OpenAIRE

    Brodsky, Karen L.; Baron, Richard J.

    2000-01-01

    Medicaid managed care is delivered through organizations operating in very heterogeneous environments that confront similar barriers to success. Because Medicaid managed care is implemented differently in each state, health plans have been isolated from each other and have not had an opportunity to learn how others may have surmounted commonly encountered barriers. After interviewing Medicaid health plan medical directors, we developed a learning collaborative model based on shared categories...

  20. 落实优质护理提高呼吸内科护理质量%Implementing High Quality Care to Improve the Quality of Care in Department of Respiratory Medicine

    Institute of Scientific and Technical Information of China (English)

    陈心容; 何剑

    2012-01-01

    Refer to the first batch of high quality care demonstration ward experience, the paper summed up the practice of quality of care in department of respiratory medicine from seven aspects including developing activity plans f reforming the scheduling mode, strengthening the nurse - patient communication, implementation of basic nursing care and specialist care, strengthening health education management and improvement of the performance appraisal system.%参照第一批优质护理服务示范病房工作经验,从制定活动计划、改变排班模式、加强护患沟通、落实基础护理、落实专科护理、强化健康教育管理、完善绩效考核制度等7方面,总结了呼吸内科开展优质护理服务的主要做法.

  1. Value of a mobile information system to improve quality of care by community health workers

    Directory of Open Access Journals (Sweden)

    Mark Tomlinson

    2013-04-01

    Full Text Available Background: We will be unable to achieve sustained impact on health outcomes with community health worker (CHW-based interventions unless we bridge the gap between small scale efficacy studies and large scale interventions. Effective strategies to support the management of CHWs are central to bridging the gap. Mobile phones are broadly available, particularly in low and middle income countries (LAMIC, where the penetration rate approaches 100%.Objectives: In this article, we describe how mobile phones and may be combined with mobile web-based technology to assist in the management of CHWs in two projects in South Africa.Methods: This article is a descriptive study, drawing lessons from two randomised controlled trials outlining how a mobile phone information system can be utilised to enhance the quality of health interventions. We organised our comprehensive management and supervision system around a previously published management framework. The system is composed of mobile phones utilised by CHWs and a web-based interface utilised by CHW supervisors. Computerised algorithms were designed with intervention and assessment protocols to aid in the real-time supervision and management of CHWs.Results: Community health workers used mobile phones to initiate intervention visits and trigger content to be delivered during the course of intervention visits. Supervisors used the web-based interface for real-time monitoring of the location, timing and content of intervention visits. Additional real-time support was provided through direct support calls in the event of crises in the field.Conclusion: Mobile phone-based information system platforms offer significant opportunities to improve CHW-delivered interventions. The extent to which these efficiency gains can be translated into realised health gains for communities is yet to be tested.

  2. Quality assurance in the ambulatory care setting.

    Science.gov (United States)

    Tyler, R D

    1989-01-01

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

  3. 刍议如何提高护士护理质量%Discussion on How to Improve the Quality of Nursing Care

    Institute of Scientific and Technical Information of China (English)

    黄慧明

    2013-01-01

    医院护士的护理质量的高低直接影响到医疗质量,也直接影响到医院的声誉。而护士的护理质量则是由护士的综合素质所决定的,因此要想提高医院的护士护理质量,就要提高护士的综合素质。%Hospital nurses directly af ects the quality of care to the medical quality,but also directly af ect the hospital's reputation.The quality of care for nurses by nurses is the overal quality of the decision,so in order to improve the quality of care hospital nurse,it is necessary to improve the overal quality of nurses.

  4. Does a competitive voucher program for adolescents improve the quality of reproductive health care? A simulated patient study in Nicaragua

    Directory of Open Access Journals (Sweden)

    Gorter Anna C

    2006-08-01

    Full Text Available Abstract Background Little is known about how sexual and reproductive (SRH health can be made accessible and appropriate to adolescents. This study evaluates the impact and sustainability of a competitive voucher program on the quality of SRH care for poor and underserved female adolescents and the usefulness of the simulated patient (SP method for such evaluation. Methods 28,711 vouchers were distributed to adolescents in disadvantaged areas of Managua that gave free-of-charge access to SRH care in 4 public, 10 non-governmental and 5 private clinics. Providers received training and guidelines, treatment protocols, and financial incentives for each adolescent attended. All clinics were visited by female adolescent SPs requesting contraception. SPs were sent one week before, during (with voucher and one month after the intervention. After each consultation they were interviewed with a standardized questionnaire. Twenty-one criteria were scored and grouped into four categories. Clinics' scores were compared using non-parametric statistical methods (paired design: before-during and before-after. Also the influence of doctors' characteristics was tested using non-parametric statistical methods. Results Some aspects of service quality improved during the voucher program. Before the program started 8 of the 16 SPs returned 'empty handed', although all were eligible contraceptive users. During the program 16/17 left with a contraceptive method (p = 0.01. Furthermore, more SPs were involved in the contraceptive method choice (13/17 vs.5/16, p = 0.02. Shared decision-making on contraceptive method as well as condom promotion had significantly increased after the program ended. Female doctors had best scores before- during and after the intervention. The improvements were more pronounced among male doctors and doctors older than 40, though these improvements did not sustain after the program ended. Conclusion This study illustrates provider

  5. A public-private trauma center network in Florida harnesses data to improve care quality for an aging population.

    Science.gov (United States)

    DuVernay, Christina

    2013-12-01

    As the US population ages, trauma systems face new challenges in addition to the long-standing problem of access. Patients ages sixty-five and older are more likely than younger patients to fall and suffer serious injury or death as a result. This older patient population, when compared with younger cohorts, suffers higher mortality rates, has more comorbidities-diabetes, cancer, and heart conditions being the more serious among them-and takes more medications, which can complicate treatment. The University of South Florida (USF) Medical School and the HCA hospital system have partnered to create a network of five trauma centers in underserved areas of the state to increase access to trauma care for all Floridians while maintaining a special focus on geriatric trauma care. Collecting and analyzing data for improving care quality and undertaking research is a central aim of the partnership. Based on their research findings, trauma surgeons in the USF/HCA Trauma Network have identified best practices and codified them in standard operating procedures. PMID:24301397

  6. Changing hospital care: evaluation of a multi-layered organisational development and quality improvement programme

    NARCIS (Netherlands)

    Dückers, M.L.A

    2009-01-01

    In the last decades many different policy changes have been initiated in the Dutch hospital sector to optimise health care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment-combinations, intensified monitori

  7. Competency in health care management: a training model in epidemiologic methods for assessing and improving the quality of clinical practice through evidence-based decision making.

    Science.gov (United States)

    Hudak, R P; Jacoby, I; Meyer, G S; Potter, A L; Hooper, T I; Krakauer, H

    1997-01-01

    This article describes a training model that focuses on health care management by applying epidemiologic methods to assess and improve the quality of clinical practice. The model's uniqueness is its focus on integrating clinical evidence-based decision making with fundamental principles of resource management to achieve attainable, cost-effective, high-quality health outcomes. The target students are current and prospective clinical and administrative executives who must optimize decision making at the clinical and managerial levels of health care organizations.

  8. Barriers and facilitators to evidence based care of type 2 diabetes patients : experiences of general practitioners participating to a quality improvement program

    NARCIS (Netherlands)

    Goderis, G.; Borgermans, L.D.A.; Mathieu, C.; Broeke, C. Van Den; Hannes, K.; Heyrman, J.; Grol, R.P.T.M.

    2009-01-01

    ABSTRACT: OBJECTIVE: To evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs) who participated in an 18-month quality improvement program (QIP). This QIP was implemented to promote compliance with international guidelines. METHODS: Twenty

  9. A brief Patient-Reported Outcomes Quality of Life (PROQOL instrument to improve patient care.

    Directory of Open Access Journals (Sweden)

    Jennifer L Ridgeway

    2013-11-01

    Full Text Available Jeff Sloan and colleagues describe the development of the Patient-Reported Outcomes Quality of Life (PROQOL instrument, which captures and stores patient-recorded outcomes in the medical record for patients with diabetes. Please see later in the article for the Editors' Summary.

  10. Improving the quality of geriatric nursing care: enduring outcomes from the geriatric nursing education consortium.

    Science.gov (United States)

    Gray-Miceli, Deanna; Wilson, Laurie Dodge; Stanley, Joan; Watman, Rachael; Shire, Amy; Sofaer, Shoshanna; Mezey, Mathy

    2014-01-01

    The nation's aging demography, few nursing faculty with gerontological nursing expertise, and insufficient geriatric content in nursing programs have created a national imperative to increase the supply of nurses qualified to provide care for older adults. Geriatric Nursing Education Consortium (GNEC), a collaborative program of the John A. Hartford Foundation, the American Association of Colleges of Nursing, and the New York University (NYU) Nursing Hartford Institute for Geriatric Nursing, was initiated to provide faculty with the necessary skills, knowledge, and competency to implement sustainable curricular innovations in care of older adults. This article describes the background, step-by-step process approach to the development of GNEC evidence-based curricular materials, and the dissemination of these materials through 6-, 2-, and a half-day national Faculty Development Institutes (FDIs). Eight hundred eight faculty, representing 418 schools of nursing, attended. A total of 479 individuals responded to an evaluation conducted by Baruch College that showed faculty feasibility to incorporate GNEC content into courses, confidence in teaching and incorporating content, and overall high rating of the GNEC materials. The impact of GNEC is discussed along with effects on faculty participants over 2 years. Administrative- and faculty-level recommendations to sustain and expand GNEC are highlighted. PMID:25455325

  11. Improved quality of care for patients undergoing an abdominoperineal excision for rectal cancer

    NARCIS (Netherlands)

    Bokkerink, G.M.J.; Buijs, E.F.; Ruijter, W. de; Rosman, C.; Sietses, C.; Strobel, R.; Heisterkamp, J.; Nagtegaal, I.D.; Bremers, A.J.A.; Wilt, J.H.W. de

    2015-01-01

    INTRODUCTION: New diagnostics, the emergence of total mesorectal excision and neoadjuvant treatments have improved outcome for patients with rectal cancer. Patients with distal rectal cancer undergoing an abdominoperineal excision seem to do worse compared to those treated with sphinctersparing tech

  12. Navigator Approach to Improve Quality of Care for Vulnerable Populations in Mexico.

    Science.gov (United States)

    Ramos, Rebeca; Ferreira-Pinto, João; Loza, Oralia

    2015-01-01

    For nearly 30 years, Programa Compañeros Inc (Compañeros) has worked in Ciudad Juarez, Chihuahua, Mexico, to ensure that vulnerable populations can exercise their rights to receive HIV and substance abuse prevention and treatment services. Compañeros staff has worked to ameliorate the negative results that limit access to care to the most vulnerable individuals: those who are poor, homeless, sex workers, addicted, and others whose life context put them at greater risk for being infected with HIV. With support from the MAC AIDS Foundation, Compañeros has expanded its capacity to deliver services to persons living with HIV/AIDS (PLWHA) and to HIV-vulnerable populations. This short communication describes findings from an internal evaluation conducted to investigate the effectiveness of the MAC AIDS-funded navigator-based program implemented at Compañeros. PMID:26242198

  13. Designing a multifaceted quality improvement intervention in primary care in a country where general practice is seeking recognition: the case of Cyprus

    Directory of Open Access Journals (Sweden)

    Stoffers Henri E

    2008-08-01

    Full Text Available Abstract Background Quality Improvement Interventions require significant financial investments, and therefore demand careful consideration in their design in order to maximize potential benefits. In this correspondence we present the methodological approach of a multifaceted quality improvement intervention aiming to improve quality of care in primary care, properly tailored for a country such as Cyprus where general practice is currently seeking recognition. Methods Our methodological approach was focused on the design of an open label, community-based intervention controlled trial using all patients from two urban and two rural public primary care centers diagnosed with hypertension and type II diabetes mellitus. The design of our intervention was grounded on a strong theoretical framework that included the Unified Theory of Acceptance and Use of Technology, and the Chronic Care Model, which synthesize evidence-based system changes in accordance with the Theory of Planned Behavior and the Theory of Reasoned Action. The primary outcome measure was improvement in the quality of care for two chronic diseases evaluated through specific clinical indicators, as well as the patient satisfaction assessed by the EUROPEP questionnaire and additional personal interviews. Results We designed a multifaceted quality improvement intervention model, supported by a varying degree of scientific evidence, tailored to local needs and specific country characteristics. Overall, the main components of the intervention were the development and adoption of an electronic medical record and the introduction of clinical guidelines for the management of the targeted chronic diseases facilitated by the necessary model of organizational changes. Conclusion Health planners and policy makers need to be aware of the potential use of certain theoretical models and applied methodology as well as inexpensive tools that may be suitably tailored to the local needs, in order to

  14. Investigating organizational quality improvement systems, patient empowerment, organizational culture, professional involvement and the quality of care in European hospitals: the 'Deepening our Understanding of Quality Improvement in Europe (DUQuE)' project.

    OpenAIRE

    Groene, O.; Klazinga, N; Wagner, C.; Arah, OA; Thompson, A; Bruneau, C.; Suñol, R.; Deepening our Understanding of Quality Improvement in Europe Res

    2010-01-01

    Hospitals in European countries apply a wide range of quality improvement strategies. Knowledge of the effectiveness of these strategies, implemented as part of an overall hospital quality improvement system, is limited.

  15. A case study approach to understand how quality improvement methods led to improvements in primary care for insomnia

    OpenAIRE

    Siriwardena, A Niroshan; Tilling, Michelle; Togher, Fiona; Davy, Zowie; Dyas, Jane; Middleton, Hugh; Orner, Roderick

    2011-01-01

    Context: The Resources for Effective Sleep Treatment (REST) project was conducted in Lincolnshire, UK from 2007-2010. Its aim was to develop and evaluate new approaches to implementing sleep assessment methods and non-pharmacological treatments for insomnia into routine general practice. Problem: Sleep problems are common affecting 30% of the population in the previous year. Many insomnia sufferers present to general practice but patients and clinicians feel that primary care management sh...

  16. Progressive Mobility Protocol Reduces Venous Thromboembolism Rate in Trauma Intensive Care Patients: A Quality Improvement Project.

    Science.gov (United States)

    Booth, Kathryn; Rivet, Josh; Flici, Richelle; Harvey, Ellen; Hamill, Mark; Hundley, Douglas; Holland, Katelyn; Hubbard, Sandra; Trivedi, Apurva; Collier, Bryan

    2016-01-01

    The intensive care unit (ICU) trauma population is at high risk for complications associated with immobility. The purpose of this project was to compare ICU trauma patient outcomes before and after implementation of a structured progressive mobility (PM) protocol. Outcomes included hospital and ICU stays, ventilator days, falls, respiratory failure, pneumonia, or venous thromboembolism (VTE). In the preintervention cohort, physical therapy (PT) consults were placed 53% of the time. This rose to more than 90% during the postintervention period. PT consults seen within 24 hr rose from a baseline 23% pre- to 74%-94% in the 2 highest compliance postintervention months. On average, 40% of patients were daily determined to be too unstable for mobility per protocol guidelines-most often owing to elevated intracranial pressure. During PM sessions, there were no adverse events (i.e., extubation, hypoxia, fall). There were no significant differences in clinical outcomes between the 2 cohorts regarding hospital and ICU stays, average ventilator days, mortality, falls, respiratory failure, or pneumonia overall or within ventilated patients specifically. There was, however, a difference in the incidence of VTE between the preintervention cohort (21%) and postintervention cohort (7.5%) (p = .0004). A PM protocol for ICU trauma patients is safe and may reduce patient deconditioning and VTE complications in this high-risk population. Multidisciplinary commitment, daily protocol reinforcement, and active engagement of patients/families are the cornerstones to success in this ICU PM program. PMID:27618376

  17. Quality of diabetes care in general practice

    OpenAIRE

    van Bruggen, J.A.R.

    2009-01-01

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

  18. The effectiveness of computer reminders for improving quality assessment for point-of-care testing in general practice - a randomized controlled trial

    DEFF Research Database (Denmark)

    Kousgaard, Marius Brostrøm; Siersma, Volkert Dirk; Reventlow, Susanne;

    2013-01-01

    for improving adherence to a quality assessment scheme for point-of-care testing in general practice. METHOD: The study was conducted as a randomized controlled crossover trial among general practices in the Capital Region of Denmark. The intervention consisted of sending computer reminders (Com...... reminders on adherence to the quality assessment scheme for point-of-care testing. Thus, computer reminders seem to be useful for supporting the implementation of relatively simple procedures for quality and safety. TRIAL REGISTRATION: ClinicalTrials.gov: http://NCT01152177....

  19. SveDem, the Swedish Dementia Registry - a tool for improving the quality of diagnostics, treatment and care of dementia patients in clinical practice.

    Directory of Open Access Journals (Sweden)

    Dorota Religa

    Full Text Available The Swedish Dementia Registry (SveDem was developed with the aim to improve the quality of diagnostic work-up, treatment and care of patients with dementia disorders in Sweden.SveDem is an internet based quality registry where several indicators can be followed over time. It includes information about the diagnostic work-up, medical treatment and community support (www.svedem.se. The patients are diagnosed and followed-up yearly in specialist units, primary care centres or in nursing homes.The database was initiated in May 2007 and covers almost all of Sweden. There were 28 722 patients registered with a mean age of 79.3 years during 2007-2012. Each participating unit obtains continuous online statistics from its own registrations and they can be compared with regional and national data. A report from SveDem is published yearly to inform medical and care professionals as well as political and administrative decision-makers about the current quality of diagnostics, treatment and care of patients with dementia disorders in Sweden.SveDem provides knowledge about current dementia care in Sweden and serves as a framework for ensuring the quality of diagnostics, treatment and care across the country. It also reflects changes in quality dementia care over time. Data from SveDem can be used to further develop the national guidelines for dementia and to generate new research hypotheses.

  20. Can reproductive health voucher programs improve quality of postnatal care? A quasi-experimental evaluation of Kenya's safe motherhood voucher scheme.

    Directory of Open Access Journals (Sweden)

    Claire Watt

    Full Text Available This study tests the group-level causal relationship between the expansion of Kenya's Safe Motherhood voucher program and changes in quality of postnatal care (PNC provided at voucher-contracted facilities. We compare facilities accredited since program inception in 2006 (phase I and facilities accredited since 2010-2011 (phase II relative to comparable non-voucher facilities. PNC quality is assessed using observed clinical content processes, as well as client-reported outcome measures. Two-tailed unpaired t-tests are used to identify differences in mean process quality scores and client-reported outcome measures, comparing changes between intervention and comparison groups at the 2010 and 2012 data collection periods. Difference-in-differences analysis is used to estimate the reproductive health (RH voucher program's causal effect on quality of care by exploiting group-level differences between voucher-accredited and non-accredited facilities in 2010 and 2012. Participation in the voucher scheme since 2006 significantly improves overall quality of postnatal care by 39% (p=0.02, where quality is defined as the observable processes or components of service provision that occur during a PNC consultation. Program participation since phase I is estimated to improve the quality of observed maternal postnatal care by 86% (p=0.02, with the largest quality improvements in counseling on family planning methods (IRR 5.0; p=0.01 and return to fertility (IRR 2.6; p=0.01. Despite improvements in maternal aspects of PNC, we find a high proportion of mothers who seek PNC are not being checked by any provider after delivery. Additional strategies will be necessary to standardize provision of packaged postnatal interventions to both mother and newborn. This study addresses an important gap in the existing RH literature by using a strong evaluation design to assess RH voucher program effectiveness on quality improvement.

  1. Can reproductive health voucher programs improve quality of postnatal care? A quasi-experimental evaluation of Kenya's safe motherhood voucher scheme.

    Science.gov (United States)

    Watt, Claire; Abuya, Timothy; Warren, Charlotte E; Obare, Francis; Kanya, Lucy; Bellows, Ben

    2015-01-01

    This study tests the group-level causal relationship between the expansion of Kenya's Safe Motherhood voucher program and changes in quality of postnatal care (PNC) provided at voucher-contracted facilities. We compare facilities accredited since program inception in 2006 (phase I) and facilities accredited since 2010-2011 (phase II) relative to comparable non-voucher facilities. PNC quality is assessed using observed clinical content processes, as well as client-reported outcome measures. Two-tailed unpaired t-tests are used to identify differences in mean process quality scores and client-reported outcome measures, comparing changes between intervention and comparison groups at the 2010 and 2012 data collection periods. Difference-in-differences analysis is used to estimate the reproductive health (RH) voucher program's causal effect on quality of care by exploiting group-level differences between voucher-accredited and non-accredited facilities in 2010 and 2012. Participation in the voucher scheme since 2006 significantly improves overall quality of postnatal care by 39% (p=0.02), where quality is defined as the observable processes or components of service provision that occur during a PNC consultation. Program participation since phase I is estimated to improve the quality of observed maternal postnatal care by 86% (p=0.02), with the largest quality improvements in counseling on family planning methods (IRR 5.0; p=0.01) and return to fertility (IRR 2.6; p=0.01). Despite improvements in maternal aspects of PNC, we find a high proportion of mothers who seek PNC are not being checked by any provider after delivery. Additional strategies will be necessary to standardize provision of packaged postnatal interventions to both mother and newborn. This study addresses an important gap in the existing RH literature by using a strong evaluation design to assess RH voucher program effectiveness on quality improvement.

  2. Retaining caregivers, improving care.

    Science.gov (United States)

    Bodwell, Wendy; Dent, Sara; Grant, Tracie; Hammerly, Milt; Mamula, Jeanie

    2006-01-01

    Text Summary In 2004, Centura Health's long-term care centers took part in a pilot project, sponsored by the Centers for Medicare & Medicaid Services, called "Improving Nursing Home Culture through Workforce Retention." A 30-member team comprising Centura leaders and long-term facility staff looked at Centura's eight participating facilities through residents' and employees' eyes. The goal of the team's reflection and subsequent changes was to create a culture in which decisions are focused on resident care and organizational policies are based on respect for employees. At the end of the first year, residents seemed happier and employee satisfaction and involvement increased at all eight Centura facilities. PMID:16519278

  3. Barriers and facilitators to evidence based care of type 2 diabetes patients: experiences of general practitioners participating to a quality improvement program

    Directory of Open Access Journals (Sweden)

    Hannes Karen

    2009-07-01

    Full Text Available Abstract Objective To evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs who participated in an 18-month quality improvement program (QIP. This QIP was implemented to promote compliance with international guidelines. Methods Twenty out of the 120 participating GPs in the QIP underwent semi-structured interviews that focused on three questions: 'Which changes did you implement or did you observe in the quality of diabetes care during your participation in the QIP?' 'According to your experience, what induced these changes?' and 'What difficulties did you experience in making the changes?' Results Most GPs reported that enhanced knowledge, improved motivation, and a greater sense of responsibility were the key factors that led to greater compliance with diabetes care guidelines and consequent improvements in diabetes care. Other factors were improved communication with patients and consulting specialists and reliance on diabetes nurse educators. Some GPs were reluctant to collaborate with specialists, and especially with diabetes educators and dieticians. Others blamed poor compliance with the guidelines on lack of time. Most interviewees reported that a considerable minority of patients were unwilling to change their lifestyles. Conclusion Qualitative research nested in an experimental trial may clarify the improvements that a QIP may bring about in a general practice, provide insight into GPs' approach to diabetes care and reveal the program's limits. Implementation of a QIP encounters an array of cognitive, motivational, and relational obstacles that are embedded in a patient-healthcare provider relationship.

  4. Using mixed methods for evaluating the effect of a quality improvement collaborative for management of sleep problems presenting to primary care

    OpenAIRE

    Siriwardena, A Niroshan; Tilling, Michelle; Ward, Kate; Togher, Fiona

    2010-01-01

    Context This improvement project was set in Lincolnshire, a large rural county in the East Midlands with high prescribing rates of hypnotic drugs compared with the rest of England. Eight general practices volunteered to participate in a Quality Improvement Collaborative (QIC) designed to improve management of sleep problems in patients presenting to primary care. Problem Sleep problems are common affecting around 40% of adults in the UK. Insomnia has considerable resource implicati...

  5. Does a competitive voucher program for adolescents improve the quality of reproductive health care? A simulated patient study in Nicaragua.

    NARCIS (Netherlands)

    Meuwissen, L.E.; Gorter, A.C.; Kester, A.D.M.; Knottnerus, J.A.

    2006-01-01

    Background: Little is known about how sexual and reproductive (SRH) health can be made accessible and appropriate to adolescents. This study evaluates the impact and sustainability of a competitive voucher program on the quality of SRH care for poor and underserved female adolescents and the usefuln

  6. Challenging stereotypes and changing attitudes: Improving quality of care for people with hepatitis C through Positive Speakers programs.

    Science.gov (United States)

    Brener, Loren; Wilson, Hannah; Rose, Grenville; Mackenzie, Althea; de Wit, John

    2013-01-01

    Positive Speakers programs consist of people who are trained to speak publicly about their illness. The focus of these programs, especially with stigmatised illnesses such as hepatitis C (HCV), is to inform others of the speakers' experiences, thereby humanising the illness and reducing ignorance associated with the disease. This qualitative research aimed to understand the perceived impact of Positive Speakers programs on changing audience members' attitudes towards people with HCV. Interviews were conducted with nine Positive Speakers and 16 of their audience members to assess the way in which these sessions were perceived by both speakers and the audience to challenge stereotypes and stigma associated with HCV and promote positive attitude change amongst the audience. Data were analysed using Intergroup Contact Theory to frame the analysis with a focus on whether the program met the optimal conditions to promote attitude change. Findings suggest that there are a number of vital components to this Positive Speakers program which ensures that the program meets the requirements for successful and equitable intergroup contact. This Positive Speakers program thereby helps to deconstruct stereotypes about people with HCV, while simultaneously increasing positive attitudes among audience members with the ultimate aim of improving quality of health care and treatment for people with HCV.

  7. Applicability of two brief evidence-based interventions to improve sleep quality in inpatient mental health care.

    Science.gov (United States)

    de Niet, Gerrit; Tiemens, Bea; van Achterberg, Theo; Hutschemaekers, Giel

    2011-10-01

    The present study explored the applicability of two brief evidence-based interventions to improve sleep quality in inpatient psychiatry. The study involved three comparable admission wards of a psychiatric hospital. Stimulus control was introduced at the first ward, and music-assisted relaxation at the second. At the third ward, no intervention was introduced. A mixed-method study was employed. We found that nurses share the opinion that both interventions can be applied, but patients are hard to motivate. They perceived the lack of available time, busyness at the ward, and the lack of cooperation of patients as the main obstacles. The perception of a successful implementation is correlated with the perception of gained attention for sleep problems, the perception of increased care options, and the impression of effectiveness. Qualitative data showed that the effectiveness of the interventions was compromised by operational issues, commitment issues, adaptation to contextual limitations, and conflicting individual beliefs. We concluded that music-assisted relaxation is applicable in inpatient psychiatry. The application of stimulus control met with insurmountable operational issues. The nursing team is a very important factor for the implementation of evidence-based interventions at ward level. The lack of a shared urge for change and responsibility for continuity are important factors contributing to failure. PMID:21418492

  8. Hospice enrollment saves money for Medicare and improves care quality across a number of different lengths-of-stay.

    Science.gov (United States)

    Kelley, Amy S; Deb, Partha; Du, Qingling; Aldridge Carlson, Melissa D; Morrison, R Sean

    2013-03-01

    Despite its demonstrated potential to both improve quality of care and lower costs, the Medicare hospice benefit has been seen as producing savings only for patients enrolled 53-105 days before death. Using data from the Health and Retirement Study, 2002-08, and individual Medicare claims, and overcoming limitations of previous work, we found $2,561 in savings to Medicare for each patient enrolled in hospice 53-105 days before death, compared to a matched, nonhospice control. Even higher savings were seen, however, with more common, shorter enrollment periods: $2,650, $5,040, and $6,430 per patient enrolled 1-7, 8-14, and 15-30 days prior to death, respectively. Within all periods examined, hospice patients also had significantly lower rates of hospital service use and in-hospital death than matched controls. Instead of attempting to limit Medicare hospice participation, the Centers for Medicare and Medicaid Services should focus on ensuring the timely enrollment of qualified patients who desire the benefit. PMID:23459735

  9. Healthcare quality improvement programme improves monitoring of people with diabetes

    NARCIS (Netherlands)

    Denig, Petra

    2004-01-01

    Question. Does a healthcare quality improvement programme, incorporating education and claims-based feedback about practice-specific models of monitoring diabetes care, increase the regularity with which primary care physicians assess people with diabetes mellitus receiving Medicare benefits? Study

  10. Patient Empowerment Improved Perioperative Quality of Care in Cancer Patients Aged ≥ 65 Years - A Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Maren Schmidt

    functional capacity measured by the Timed Up and Go-test by multiple robust regressions.Patient empowerment through information booklet and diary keeping did not shorten the postoperative LOS in elderly onco-surgical patients, but improved quality of care regarding postoperative pain. Postoperative length of stay is influenced by pre-operative nutritional state, pre-operative functional impairment, severity of surgery, and length of anesthesia.Clinicaltrials.gov. Identifier NCT01278537.

  11. Perceptions of women, nurses, midwives and doctors about the use of video during birth to improve quality of care : focus group discussions

    NARCIS (Netherlands)

    van Lonkhuijzen, L.; Groenewout, M.; Schreuder, A.; Zeeman, G.; Scherpbier, A.; Aukes, L.; van den Berg, P.

    2011-01-01

    Please cite this paper as: van Lonkhuijzen L, Groenewout M, Schreuder A, Zeeman G, Scherpbier A, Aukes L, van den Berg P. Perceptions of women, nurses, midwives and doctors about the use of video during birth to improve quality of care: focus group discussions. BJOG 2011; DOI:10.1111/j.1471-0528.201

  12. 践行优质护理 提升护理服务质量%Implementing Quality Care to Improve the Quality of Nursing Service

    Institute of Scientific and Technical Information of China (English)

    卢敏; 杨笑雪; 牛素桃; 袁佳琳; 宋敏

    2012-01-01

    Combined with implementation practice of quality nursing in neurosurgery ICU, the study summed up the quality care practice from six aspects: establishment and improvement of the rules and regulations and strictly enforcement; intensive training and actively transformation of ideas; implementation of the hierarchical management of nurses; simplification of nursing documentation; implementation of basic nursing and strengthening the details of service; clear and definite logo and implementation of error management.%结合神经外科ICU实施优质护理的实践,从建立健全规章制度并严格执行;强化培训,积极转变观念;落实护士分层管理;简化护理文书书写;落实基础护理,强化细节服务;明确标识,落实差错管理等6方面,总结了优质护理的主要经验.

  13. The dynamic system of parental work of care for children with special health care needs: A conceptual model to guide quality improvement efforts

    Directory of Open Access Journals (Sweden)

    Hexem Kari R

    2011-10-01

    Full Text Available Abstract Background The work of care for parents of children with complex special health care needs may be increasing, while excessive work demands may erode the quality of care. We sought to summarize knowledge and develop a general conceptual model of the work of care. Methods Systematic review of peer-reviewed journal articles that focused on parents of children with special health care needs and addressed factors related to the physical and emotional work of providing care for these children. From the large pool of eligible articles, we selected articles in a randomized sequence, using qualitative techniques to identify the conceptual components of the work of care and their relationship to the family system. Results The work of care for a child with special health care needs occurs within a dynamic system that comprises 5 core components: (1 performance of tasks such as monitoring symptoms or administering treatments, (2 the occurrence of various events and the pursuit of valued outcomes regarding the child's physical health, the parent's mental health, or other attributes of the child or family, (3 operating with available resources and within certain constraints (4 over the passage of time, (5 while mentally representing or depicting the ever-changing situation and detecting possible problems and opportunities. These components interact, some with simple cause-effect relationships and others with more complex interdependencies. Conclusions The work of care affecting the health of children with special health care needs and their families can best be understood, studied, and managed as a multilevel complex system.

  14. Quality of acute stroke care improvement framework for the Paul Coverdell National Acute Stroke Registry: facilitating policy and system change at the hospital level.

    Science.gov (United States)

    LaBresh, Kenneth A

    2006-12-01

    The Paul Coverdell National Acute Stroke Registry prototypes baseline data collection demonstrated a significant gap in the use of evidenced-based interventions. Barriers to the use of these interventions can be characterized as relating to lack of knowledge, attitudes, and ineffective behaviors and systems. Quality improvement programs can address these issues by providing didactic presentations to disseminate the science and peer interactions to address the lack of belief in the evidence, guidelines, and likelihood of improved patient outcomes. Even with knowledge and intention to provide evidenced-based care, the absence of effective systems is a significant behavioral barrier. A program for quality improvement that includes multidisciplinary teams of clinical and quality improvement professionals has been successfully used to carry out redesign of stroke care delivery systems. Teams are given a methodology to set goals, test ideas for system redesign, and implement those changes that can be successfully adapted to the hospital's environment. Bringing teams from several hospitals together substantially accelerates the process by sharing examples of successful change and by providing strategies to support the behavior change necessary for the adoption of new systems. The participation of many hospitals also creates momentum for the adoption of change by demonstrating observable and successful improvement. Data collection and feedback are useful to demonstrate the need for change and evaluate the impact of system change, but improvement occurs very slowly without a quality improvement program. This quality improvement framework provides hospitals with the capacity and support to redesign systems, and has been shown to improve stroke care considerably, when coupled with an Internet-based decision support registry, and at a much more rapid pace than when hospitals use only the support registry. PMID:17178313

  15. Cardiovascular disease prevention in rural Nigeria in the context of a community based health insurance scheme: QUality Improvement Cardiovascular care Kwara-I (QUICK-I

    Directory of Open Access Journals (Sweden)

    Alli Shade

    2011-03-01

    Full Text Available Abstract Background Cardiovascular diseases (CVD are a leading contributor to the burden of disease in low- and middle-income countries. Guidelines for CVD prevention care in low resource settings have been developed but little information is available on strategies to implement this care. A community health insurance program might be used to improve patients' access to care. The operational research project "QUality Improvement Cardiovascular care Kwara - I (QUICK-I" aims to assess the feasibility of CVD prevention care in rural Nigeria, according to international guidelines, in the context of a community based health insurance scheme. Methods/Design Design: prospective observational hospital based cohort study. Setting: a primary health care centre in rural Nigeria. Study population: 300 patients at risk for development of CVD (patients with hypertension, diabetes, renal disease or established CVD who are enrolled in the Hygeia Community Health Plan. Measurements: demographic and socio- economic data, physical and laboratory examination, CVD risk profile including screening for target organ damage. Measurements will be done at 3 month intervals during 1 year. Direct and indirect costs of CVD prevention care will be estimated. Outcomes: 1 The adjusted cardiovascular quality of care indicator scores based on the "United Kingdom National Health Services Quality and Outcome Framework". 2 The average costs of CVD prevention and treatment per patient per year for patients, the clinic and the insurance company. 3 The estimated net health care costs of standard CVD prevention care per quality-adjusted life year gained. Analysis: The primary outcomes, the score on CVD quality indicators and cost data will be descriptive. The quality scores and cost data will be used to describe the feasibility of CVD prevention care according to international guidelines. A cost-effectiveness analysis will be done using a Markov model. Discussion Results of QUICK-I can

  16. Identifying tools and strategies to provide quality oncology care

    OpenAIRE

    Ganz, PA

    2013-01-01

    This session of the ASCO Quality Symposium provided an opportunity to examine a variety of research and quality improvement strategies aimed at improving the quality of cancer care along the continuum.

  17. The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: a qualitative study.

    Science.gov (United States)

    Rix, Elizabeth F; Barclay, Lesley; Stirling, Janelle; Tong, Allison; Wilson, Shawn

    2015-01-01

    Chronic kidney disease has a higher prevalence in Indigenous populations globally. The incidence of end-stage kidney disease in Australian Aboriginal people is eight times higher than non-Aboriginal Australians. Providing services to rural and remote Aboriginal people with chronic disease is challenging because of access and cultural differences. This study aims to describe and analyze the perspectives of Aboriginal patients' and health care providers' experience of renal services, to inform service improvement for rural Aboriginal hemodialysis patients. We conducted a thematic analysis of interviews with Aboriginal patients (n = 18) receiving hemodialysis in rural Australia and health care providers involved in their care (n = 29). An overarching theme of avoiding the "costly" crisis encompassed four subthemes: (1) Engaging patients earlier (prevent late diagnosis, slow disease progression); (2) flexible family-focused care (early engagement of family, flexibility to facilitate family and cultural obligations); (3) managing fear of mainstream services (originating in family dialysis experiences and previous racism when engaging with government organizations); (4) service provision shaped by culture (increased home dialysis, Aboriginal support and Aboriginal-led cultural education). Patients and health care providers believe service redesign is required to meet the needs of Aboriginal hemodialysis patients. Participants identified early screening and improving the relationship of Aboriginal people with health systems would reduce crisis entry to hemodialysis. These strategies alongside improving the cultural competence of staff would reduce patients' fear of mainstream services, decrease the current emotional and family costs of care, and increase efficiency of health expenditure on a challenging and increasingly unsustainable treatment system.

  18. The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: a qualitative study.

    Science.gov (United States)

    Rix, Elizabeth F; Barclay, Lesley; Stirling, Janelle; Tong, Allison; Wilson, Shawn

    2015-01-01

    Chronic kidney disease has a higher prevalence in Indigenous populations globally. The incidence of end-stage kidney disease in Australian Aboriginal people is eight times higher than non-Aboriginal Australians. Providing services to rural and remote Aboriginal people with chronic disease is challenging because of access and cultural differences. This study aims to describe and analyze the perspectives of Aboriginal patients' and health care providers' experience of renal services, to inform service improvement for rural Aboriginal hemodialysis patients. We conducted a thematic analysis of interviews with Aboriginal patients (n = 18) receiving hemodialysis in rural Australia and health care providers involved in their care (n = 29). An overarching theme of avoiding the "costly" crisis encompassed four subthemes: (1) Engaging patients earlier (prevent late diagnosis, slow disease progression); (2) flexible family-focused care (early engagement of family, flexibility to facilitate family and cultural obligations); (3) managing fear of mainstream services (originating in family dialysis experiences and previous racism when engaging with government organizations); (4) service provision shaped by culture (increased home dialysis, Aboriginal support and Aboriginal-led cultural education). Patients and health care providers believe service redesign is required to meet the needs of Aboriginal hemodialysis patients. Participants identified early screening and improving the relationship of Aboriginal people with health systems would reduce crisis entry to hemodialysis. These strategies alongside improving the cultural competence of staff would reduce patients' fear of mainstream services, decrease the current emotional and family costs of care, and increase efficiency of health expenditure on a challenging and increasingly unsustainable treatment system. PMID:25056441

  19. The PAMINO-project: evaluating a primary care-based educational program to improve the quality of life of palliative patients

    Directory of Open Access Journals (Sweden)

    Engeser Peter

    2007-05-01

    Full Text Available Abstract Background The care of palliative patients challenges the health care system in both quantity and quality. Especially the role of primary care givers needs to be strengthened to provide them with the knowledge and the confidence of applying an appropriate end-of-life care to palliative patients. To improve health care services for palliative patients in primary care, interested physicians in and around Heidelberg, Germany, are enabled to participate in the community-based program 'Palliative Medical Initiative North Baden (PAMINO' to improve their knowledge in dealing with palliative patients. The impact of this program on patients' health and quality of life remains to be evaluated. Methods/Design The evaluation of PAMINO is a non-randomized, controlled study. Out of the group of primary care physicians who took part in the PAMINO program, a sample of 45 physicians and their palliative patients will be compared to a sample of palliative patients of 45 physicians who did not take part in the program. Every four weeks for 6 months or until death, patients, physicians, and the patients' family caregivers in both groups answer questions to therapy strategies, quality of life (QLQ-C15-PAL, POS, pain (VAS, and burden for family caregivers (BSFC. The inclusion of physicians and patients in the study starts in March 2007. Discussion Although participating physicians value the increase in knowledge they receive from PAMINO, the effects on patients remain unclear. If the evaluation reveals a clear benefit for patients' quality of life, a larger-scale implementation of the program is considered. Trial registration: The study was registered at ‘current controlled trials (CCT’, registration number: ISRCTN78021852.

  20. A cluster-randomised trial of staff education to improve the quality of life of people with dementia living in residential care: the DIRECT study.

    Directory of Open Access Journals (Sweden)

    Christopher Beer

    Full Text Available BACKGROUND: The Dementia In Residential care: EduCation intervention Trial (DIRECT was conducted to determine if delivery of education designed to meet the perceived need of GPs and care staff improves the quality of life of participants with dementia living in residential care. METHODOLOGY/PRINCIPAL FINDINGS: This cluster-randomised controlled trial was conducted in 39 residential aged care facilities in the metropolitan area of Perth, Western Australia. 351 care facility residents aged 65 years and older with Mini-Mental State Examination ≤ 24, their GPs and facility staff participated. Flexible education designed to meet the perceived needs of learners was delivered to GPs and care facility staff in intervention groups. The primary outcome of the study was self-rated quality of life of participants with dementia, measured using the QOL-Alzheimer's Disease Scale (QOL-AD at 4 weeks and 6 months after the conclusion of the intervention. Analysis accounted for the effect of clustering by using multi-level regression analysis. Education of GPs or care facility staff did not affect the primary outcome at either 4 weeks or 6 months. In a post hoc analysis excluding facilities in which fewer than 50% of staff attended an education session, self-rated QOL-AD scores were 6.14 points (adjusted 95%CI 1.14, 11.15 higher at four-week follow-up among residents in facilities randomly assigned to the education intervention. CONCLUSION: The education intervention directed at care facilities or GPs did not improve the quality of life ratings of participants with dementia as a group. This may be explained by the poor adherence to the intervention programme, as participants with dementia living in facilities where staff participated at least minimally seemed to benefit. TRIAL REGISTRATION: ANZCTR.org.au ACTRN12607000417482.

  1. Primary care quality management in Slovenia.

    NARCIS (Netherlands)

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

    2008-01-01

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

  2. The effectiveness of computer reminders versus postal reminders for improving quality assessment for point-of-care testing in primary care

    DEFF Research Database (Denmark)

    Siersma, Volkert; Kousgaard, Marius Brostrøm; Reventlow, Susanne;

    2015-01-01

    Rationale, aims and objectives: This study aimed to evaluate the relative effectiveness of electronic and postal reminders for increasing adherence to the quality assurance programme for the international normalized ratio (INR) point-of-care testing (POCT) device inprimary care. Methods: All 213...... (Postal) if they did not perform a split test to check the quality of their INR POCT for each calendar month. The adherence of the practices was tracked during the subsequent 8 months subdivided into two 4-month periods both without intervention. Outcomes were measures of split test procedure adherence....... Results: Both interventions were associated with an increase in adherence to the split test procedure – a factor 6.00 [95% confidence interval (CI) 4.46–7.72] and 8.22 [95% CI5.87–11.52] for ComRem and Postal, respectively – but there is no evidence that one of the interventions was more effective than...

  3. Orthogeriatric care: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Tarazona-Santabalbina FJ

    2016-06-01

    Full Text Available Francisco José Tarazona-Santabalbina,1,2 Ángel Belenguer-Varea,1,2 Eduardo Rovira,1,2 David Cuesta-Peredó1,21Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera, 2Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, SpainAbstract: Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. Keywords: hip fractures, geriatric assessment, orthogeriatric care, recovery of function, mortality

  4. Applicability of two brief evidence-based interventions to improve sleep quality in inpatient mental health care

    NARCIS (Netherlands)

    Niet, G.J. De; Tiemens, B.G.; Achterberg, T. van; Hutschemaekers, G.

    2011-01-01

    The present study explored the applicability of two brief evidence-based interventions to improve sleep quality in inpatient psychiatry. The study involved three comparable admission wards of a psychiatric hospital. Stimulus control was introduced at the first ward, and music-assisted relaxation at

  5. How to Begin a Quality Improvement Project.

    Science.gov (United States)

    Silver, Samuel A; Harel, Ziv; McQuillan, Rory; Weizman, Adam V; Thomas, Alison; Chertow, Glenn M; Nesrallah, Gihad; Bell, Chaim M; Chan, Christopher T

    2016-05-01

    Quality improvement involves a combined effort among health care staff and stakeholders to diagnose and treat problems in the health care system. However, health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts. This article familiarizes health care professionals with how to begin a quality improvement project. The initial steps involve forming an improvement team that possesses expertise in the quality of care problem, leadership, and change management. Stakeholder mapping and analysis are useful tools at this stage, and these are reviewed to help identify individuals who might have a vested interest in the project. Physician engagement is a particularly important component of project success, and the knowledge that patients/caregivers can offer as members of a quality improvement team should not be overlooked. After a team is formed, an improvement framework helps to organize the scientific process of system change. Common quality improvement frameworks include Six Sigma, Lean, and the Model for Improvement. These models are contrasted, with a focus on the Model for Improvement, because it is widely used and applicable to a variety of quality of care problems without advanced training. It involves three steps: setting aims to focus improvement, choosing a balanced set of measures to determine if improvement occurs, and testing new ideas to change the current process. These new ideas are evaluated using Plan-Do-Study-Act cycles, where knowledge is gained by testing changes and reflecting on their effect. To show the real world utility of the quality improvement methods discussed, they are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). This provides an example that kidney health care professionals can use to begin their own quality improvement projects.

  6. How to Begin a Quality Improvement Project.

    Science.gov (United States)

    Silver, Samuel A; Harel, Ziv; McQuillan, Rory; Weizman, Adam V; Thomas, Alison; Chertow, Glenn M; Nesrallah, Gihad; Bell, Chaim M; Chan, Christopher T

    2016-05-01

    Quality improvement involves a combined effort among health care staff and stakeholders to diagnose and treat problems in the health care system. However, health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts. This article familiarizes health care professionals with how to begin a quality improvement project. The initial steps involve forming an improvement team that possesses expertise in the quality of care problem, leadership, and change management. Stakeholder mapping and analysis are useful tools at this stage, and these are reviewed to help identify individuals who might have a vested interest in the project. Physician engagement is a particularly important component of project success, and the knowledge that patients/caregivers can offer as members of a quality improvement team should not be overlooked. After a team is formed, an improvement framework helps to organize the scientific process of system change. Common quality improvement frameworks include Six Sigma, Lean, and the Model for Improvement. These models are contrasted, with a focus on the Model for Improvement, because it is widely used and applicable to a variety of quality of care problems without advanced training. It involves three steps: setting aims to focus improvement, choosing a balanced set of measures to determine if improvement occurs, and testing new ideas to change the current process. These new ideas are evaluated using Plan-Do-Study-Act cycles, where knowledge is gained by testing changes and reflecting on their effect. To show the real world utility of the quality improvement methods discussed, they are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). This provides an example that kidney health care professionals can use to begin their own quality improvement projects. PMID:27016497

  7. Management strategies to effect change in intensive care units: lessons from the world of business. Part II. Quality-improvement strategies.

    Science.gov (United States)

    Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

    2014-03-01

    The success of quality-improvement projects relies heavily on both project design and the metrics chosen to assess change. In Part II of this three-part American Thoracic Society Seminars series, we begin by describing methods for determining which data to collect, tools for data presentation, and strategies for data dissemination. As Avedis Donabedian detailed a half century ago, defining metrics in healthcare can be challenging; algorithmic determination of the best type of metric (outcome, process, or structure) can help intensive care unit (ICU) managers begin this process. Choosing appropriate graphical data displays (e.g., run charts) can prompt discussions about and promote quality improvement. Similarly, dashboards/scorecards are useful in presenting performance improvement data either publicly or privately in a visually appealing manner. To have compelling data to show, ICU managers must plan quality-improvement projects well. The second portion of this review details four quality-improvement tools-checklists, Six Sigma methodology, lean thinking, and Kaizen. Checklists have become commonplace in many ICUs to improve care quality; thinking about how to maximize their effectiveness is now of prime importance. Six Sigma methodology, lean thinking, and Kaizen are techniques that use multidisciplinary teams to organize thinking about process improvement, formalize change strategies, actualize initiatives, and measure progress. None originated within healthcare, but each has been used in the hospital environment with success. To conclude this part of the series, we demonstrate how to use these tools through an example of improving the timely administration of antibiotics to patients with sepsis. PMID:24601668

  8. Management strategies to effect change in intensive care units: lessons from the world of business. Part II. Quality-improvement strategies.

    Science.gov (United States)

    Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

    2014-03-01

    The success of quality-improvement projects relies heavily on both project design and the metrics chosen to assess change. In Part II of this three-part American Thoracic Society Seminars series, we begin by describing methods for determining which data to collect, tools for data presentation, and strategies for data dissemination. As Avedis Donabedian detailed a half century ago, defining metrics in healthcare can be challenging; algorithmic determination of the best type of metric (outcome, process, or structure) can help intensive care unit (ICU) managers begin this process. Choosing appropriate graphical data displays (e.g., run charts) can prompt discussions about and promote quality improvement. Similarly, dashboards/scorecards are useful in presenting performance improvement data either publicly or privately in a visually appealing manner. To have compelling data to show, ICU managers must plan quality-improvement projects well. The second portion of this review details four quality-improvement tools-checklists, Six Sigma methodology, lean thinking, and Kaizen. Checklists have become commonplace in many ICUs to improve care quality; thinking about how to maximize their effectiveness is now of prime importance. Six Sigma methodology, lean thinking, and Kaizen are techniques that use multidisciplinary teams to organize thinking about process improvement, formalize change strategies, actualize initiatives, and measure progress. None originated within healthcare, but each has been used in the hospital environment with success. To conclude this part of the series, we demonstrate how to use these tools through an example of improving the timely administration of antibiotics to patients with sepsis.

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

    Directory of Open Access Journals (Sweden)

    Gaye Alioune

    2009-09-01

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

  10. The effect of a complementary e-learning course on implementation of a quality improvement project regarding care for elderly patients: a stepped wedge trial

    Directory of Open Access Journals (Sweden)

    Van de Steeg Lotte

    2012-03-01

    Full Text Available Abstract Background Delirium occurs frequently in elderly hospitalised patients and is associated with higher mortality, increased length of hospital stay, functional decline, and admission to long-term care. Healthcare professionals frequently do not recognise delirium, indicating that education can play an important role in improving delirium care for hospitalised elderly. Previous studies have indicated that e-learning can provide an effective way of educating healthcare professionals and improving quality of care, though results are inconsistent. Methods and design This stepped wedge cluster randomised trial will assess the effects of a complementary delirium e-learning course on the implementation of quality improvement initiative, which aims to enhance the recognition and management of delirium in elderly patients. The trial will be conducted in 18 Dutch hospitals and last 11 months. Measurements will be taken in all participating wards using monthly record reviews, in order to monitor delivered care. These measurements will include the percentage of elderly patients who were screened for the risk of developing delirium, use of the Delirium Observation Screening scale, use of nursing or medical interventions, and the percentage of elderly patients who were diagnosed with delirium. Data regarding the e-learning course will be gathered as well. These data will include user characteristics, information regarding use of the course, delirium knowledge before and after using the course, and the attitude and intentions of nurses concerning delirium care. Setting The study will be conducted in internal medicine and surgical wards of eighteen hospitals that are at the beginning stages of implementing the Frail Elderly Project in the Netherlands. Discussion Better recognition of elderly patients at risk for delirium and subsequent care is expected from the introduction of an e-learning course for nurses that is complementary to an existing quality

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

    Science.gov (United States)

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

    2014-09-01

    District level healthcare serves as a nexus between community and district level facilities. Inputs at the district level can be broadly divided into governance and accountability mechanisms; leadership and supervision; financial platforms; and information systems. This paper aims to evaluate the effectivness of district level inputs for imporving maternal and newborn health. We considered all available systematic reviews published before May 2013 on the pre-defined district level interventions and included 47 systematic reviews. Evidence suggests that supervision positively influenced provider's practice, knowledge and client/provider satisfaction. Involving local opinion leaders to promote evidence-based practice improved compliance to the desired practice. Audit and feedback mechanisms and tele-medicine were found to be associated with improved immunization rates and mammogram uptake. User-directed financial schemes including maternal vouchers, user fee exemption and community based health insurance showed significant impact on maternal health service utilization with voucher schemes showing the most significant positive impact across all range of outcomes including antenatal care, skilled birth attendant, institutional delivery, complicated delivery and postnatal care. We found insufficient evidence to support or refute the use of electronic health record systems and telemedicine technology to improve maternal and newborn health specific outcomes. There is dearth of evidence on the effectiveness of district level inputs to improve maternal newborn health outcomes. Future studies should evaluate the impact of supervision and monitoring; electronic health record and tele-communication interventions in low-middle-income countries. PMID:25208460

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

    Science.gov (United States)

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

    2014-09-01

    District level healthcare serves as a nexus between community and district level facilities. Inputs at the district level can be broadly divided into governance and accountability mechanisms; leadership and supervision; financial platforms; and information systems. This paper aims to evaluate the effectivness of district level inputs for imporving maternal and newborn health. We considered all available systematic reviews published before May 2013 on the pre-defined district level interventions and included 47 systematic reviews. Evidence suggests that supervision positively influenced provider's practice, knowledge and client/provider satisfaction. Involving local opinion leaders to promote evidence-based practice improved compliance to the desired practice. Audit and feedback mechanisms and tele-medicine were found to be associated with improved immunization rates and mammogram uptake. User-directed financial schemes including maternal vouchers, user fee exemption and community based health insurance showed significant impact on maternal health service utilization with voucher schemes showing the most significant positive impact across all range of outcomes including antenatal care, skilled birth attendant, institutional delivery, complicated delivery and postnatal care. We found insufficient evidence to support or refute the use of electronic health record systems and telemedicine technology to improve maternal and newborn health specific outcomes. There is dearth of evidence on the effectiveness of district level inputs to improve maternal newborn health outcomes. Future studies should evaluate the impact of supervision and monitoring; electronic health record and tele-communication interventions in low-middle-income countries.

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

    Science.gov (United States)

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

    2014-09-01

    Most of the maternal and newborn deaths occur at birth or within 24 hours of birth. Therefore, essential lifesaving interventions need to be delivered at basic or comprehensive emergency obstetric care facilities. Facilities provide complex interventions including advice on referrals, post discharge care, long-term management of chronic conditions along with staff training, managerial and administrative support to other facilities. This paper reviews the effectiveness of facility level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined facility level interventions and included 32 systematic reviews. Findings suggest that additional social support during pregnancy and labour significantly decreased the risk of antenatal hospital admission, intrapartum analgesia, dissatisfaction, labour duration, cesarean delivery and instrumental vaginal birth. However, it did not have any impact on pregnancy outcomes. Continued midwifery care from early pregnancy to postpartum period was associated with reduced medical procedures during labour and shorter length of stay. Facility based stress training and management interventions to maintain well performing and motivated workforce, significantly reduced job stress and improved job satisfaction while the interventions tailored to address identified barriers to change improved the desired practice. We found limited and inconclusive evidence for the impacts of physical environment, exit interviews and organizational culture modifications. At the facility level, specialized midwifery teams and social support during pregnancy and labour have demonstrated conclusive benefits in improving maternal newborn health outcomes. However, the generalizability of these findings is limited to high income countries. Future programs in resource limited settings should utilize these findings to implement relevant interventions tailored to their needs

  14. Using patients’ experiences to identify priorities for quality improvement in breast cancer care: patient narratives, surveys or both?

    Directory of Open Access Journals (Sweden)

    Tsianakas Vicki

    2012-08-01

    Full Text Available Abstract Background Patients’ experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes. This paper explores the relative value of surveys and detailed patient narratives in identifying priorities for improving breast cancer services as part of a quality improvement process. Methods One dataset was collected using a narrative interview approach, (n = 13 and the other using a postal survey (n = 82. Datasets were analyzed separately and then compared to determine whether similar priorities for improving patient experiences were identified. Results There were both similarities and differences in the improvement priorities arising from each approach. Day surgery was specifically identified as a priority in the narrative dataset but included in the survey recommendations only as part of a broader priority around improving inpatient experience. Both datasets identified appointment systems, patients spending enough time with staff, information about treatment and side effects and more information at the end of treatment as priorities. The specific priorities identified by the narrative interviews commonly related to ‘relational’ aspects of patient experience. Those identified by the survey typically related to more ‘functional’ aspects and were not always sufficiently detailed to identify specific improvement actions. Conclusions Our analysis suggests that whilst local survey data may act as a screening tool to identify potential problems within the breast cancer service, they do not always provide sufficient detail of what to do to improve that service. These findings may have wider applicability in other services. We recommend using an initial preliminary survey, with better use of survey open comments, followed by an in-depth qualitative analysis to help deliver improvements to relational and functional aspects of patient

  15. 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

  16. Measuring team factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

    OpenAIRE

    Brennan, Sue E; Bosch, Marije; Buchan, Heather; Green, Sally E

    2013-01-01

    Background Measuring team factors in evaluations of Continuous Quality Improvement (CQI) may provide important information for enhancing CQI processes and outcomes; however, the large number of potentially relevant factors and associated measurement instruments makes inclusion of such measures challenging. This review aims to provide guidance on the selection of instruments for measuring team-level factors by systematically collating, categorizing, and reviewing quantitative self-report instr...

  17. Continuous quality improvement

    NARCIS (Netherlands)

    Rohlin, Madeleine; Schaub, Rob M.H.; Holbrook, Peter; Leibur, Edvitar; Lévy, Gérard; Roubalikova, Lenka; Nilner, Maria; Roger-Leroi, Valerie; Danner, Gunter; Iseri, Haluk; Feldman, Cecile

    2002-01-01

    Versch. in: Eur J Dent Educ; 6 (Suppl. 3): 67–77 Continuous quality improvement (CQI) can be envisaged as a circular process of goal-setting, followed by external and internal evaluations resulting in improvements that can serve as goals for a next cycle. The need for CQI is apparent, because of pub

  18. Results of a sector-wide quality improvement initiative for substance-abuse care: an uncontrolled before-after study in Catalonia, Spain

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    Colom Joan

    2010-10-01

    Full Text Available Abstract Background The Health Department of the Regional Government of Catalonia, Spain, issued a quality plan for substance abuse centers. The objective of this paper is to evaluate the impact of a multidimensional quality improvement initiative in the field of substance abuse care and to discuss potentials and limitations for further quality improvement. Methods The study uses an uncontrolled, sector-wide pre-post design. All centers providing services for persons with substance abuse issues in the Autonomous Community of Catalonia participated in this assessment. Measures of compliance were developed based on indicators reported in the literature and by broad stakeholder involvement. We compared pre-post differences in dimension-specific and overall compliance-scores using one-way ANOVA for repeated measures and the Friedman statistic. We described the spread of the data using the inter-quartile range and the Fligner-Killen statistic. Finally, we adjusted compliance scores for location and size using linear and logistic regression models. Results We performed a baseline and follow up assessment in 22 centers for substance abuse care and observed substantial and statistically significant improvements for overall compliance (pre: 60.9%; post: 79.1% and for compliance in the dimensions 'care pathway' (pre: 66.5%; post: 83.5% and 'organization and management' (pre: 50.5%; post: 77.2%. We observed improvements in the dimension 'environment and infrastructure' (pre: 81.8%; post: 95.5% and in the dimension 'relations and user rights' (pre: 66.5%; post: 72.5%; however, these were not statistically significant. The regression analysis suggests that improvements in compliance are positively influenced by being located in the Barcelona region in case of the dimension 'relations and user rights'. Conclusion The positive results of this quality improvement initiative are possibly associated with the successful involvement of stakeholders, the consciously

  19. Improved wound care product

    DEFF Research Database (Denmark)

    2012-01-01

    The present invention pertains to use of sodium diacetate (NaHAc 2) as an antimicrobial agent against bacteria growing in biofilms. The aspects of the invention include a wound care product comprising sodium diacetate, a kit comprising a wound care product,and a methodof treating an infected wound....

  20. System level action required for wide-scale improvement in quality of primary healthcare: synthesis of feedback from an interactive process to promote dissemination and use of aggregated quality of care data

    Directory of Open Access Journals (Sweden)

    Jodie eBailie

    2016-05-01

    Full Text Available IntroductionThere is an enduring gap between recommended practice and care that is actually delivered; and there is wide variation between primary healthcare (PHC centres in delivery of care. Where aspects of care are not being done well across a range of PHC centres, this is likely due to inadequacies in the broader system. This paper aims to describe stakeholders’ perceptions of the barriers and enablers to addressing gaps in Australian Aboriginal and Torres Strait Islander chronic illness care and child health, and to identify key drivers for improvement.MethodsThis paper draws on data collected as part of a large scale continuous quality improvement project in Australian Indigenous PHC settings. We undertook a qualitative assessment of stakeholder feedback on the main barriers and enablers to addressing gaps in care for Aboriginal and Torres Strait Islander children and in chronic illness care. Themes on barriers and enablers were further analysed to develop a ‘driver diagram’, an improvement tool used to locate barriers and enablers within causal pathways, (as primary and secondary drivers, enabling them to be targeted by tailored interventions. ResultsWe identified five primary drivers and eleven secondary drivers of high quality care, and associated strategies that have potential for wide-scale implementation to address barriers and enablers for improving care. Perceived barriers to addressing gaps in care included both health system and staff attributes. Primary drivers were: staff capability to deliver high quality care; availability and use of clinical information systems and decision support tools; embedding of quality improvement processes and data driven decision making; appropriate and effective recruitment and retention of staff; and community capacity, engagement and mobilisation for health. Suggested strategies included mechanisms for increasing clinical supervision and support, staff retention, reorientation of service

  1. Interactive dissemination: engaging stakeholders in the use of aggregated quality improvement data for system-wide change in Australian Indigenous primary health care

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    Alison eLaycock

    2016-05-01

    Full Text Available BackgroundIntegrating theory when developing complex quality improvement interventions can help to explain clinical and organizational behavior, inform strategy selection and understand effects. This paper describes a theory-informed interactive dissemination strategy. Using aggregated quality improvement data, the strategy seeks to engage stakeholders in wide-scale data interpretation and knowledge sharing focused on achieving wide-scale improvement in primary health care quality. MethodsAn iterative process involving diverse stakeholders in Australian Aboriginal and Torres Strait Islander healthcare delivery uses aggregated audit data collected across key areas of care. Phases of reporting and online feedback are used to identify: 1 priority areas for improvement; 2 health centre, system and staff attributes that may be important in addressing the identified priority evidence-practice gaps, and; 3 strategies that could be introduced or strengthened to enable improvement. A developmental evaluation is being used to refine engagement processes and reports as the project progresses. DiscussionThis innovative dissemination approach is being used to encourage wide-scale interpretation and use of service performance data by policy-makers, managers and other stakeholders, and to document knowledge about how to address barriers to achieving change. Through the developmental evaluation, the project provides opportunities to learn about stakeholders’ needs in relation to the way data and findings are described and distributed, and elements of the dissemination strategy and report design that impact on the useability and uptake of findings.ConclusionsThe project can contribute to knowledge about how to facilitate interactive wide-scale dissemination and about using data to co-produce knowledge to improve healthcare quality.

  2. 'There's only one enabler; come up, help us': staff perspectives of barriers and enablers to continuous quality improvement in Aboriginal primary health-care settings in South Australia.

    Science.gov (United States)

    Newham, Jo; Schierhout, Gill; Bailie, Ross; Ward, Paul R

    2016-01-01

    This paper presents the findings from a qualitative study, which sought to investigate the barriers and enablers to implementation of a continuous quality improvement (CQI) program by health-care professionals in Aboriginal primary health-care services in South Australia. Eighteen semi-structured interviews across 11 participating services were conducted alongside CQI implementation activities. Multiple barriers exist, from staff perspectives, which can be categorised according to different levels of the primary health-care system. At the macro level, barriers related to resource constraints (workforce issues) and access to project support (CQI coordinator). At the meso level, barriers related to senior level management and leadership for quality improvement and the level of organisational readiness. At the micro level, knowledge and attitudes of staff (such as resistance to change; lack of awareness of CQI) and lack of team tenure were cited as the main barriers to implementation. Staff identified that successful and sustained implementation of CQI requires both organisational systems and individual behaviour change. Improvements through continuing regional level collaborations and using a systems approach to develop an integrated regional level CQI framework, which includes building organisational and clinic team CQI capacity at the health centre level, are recommended. Ideally, this should be supported at the broader national level with dedicated funding. PMID:25719603

  3. 'There's only one enabler; come up, help us': staff perspectives of barriers and enablers to continuous quality improvement in Aboriginal primary health-care settings in South Australia.

    Science.gov (United States)

    Newham, Jo; Schierhout, Gill; Bailie, Ross; Ward, Paul R

    2016-01-01

    This paper presents the findings from a qualitative study, which sought to investigate the barriers and enablers to implementation of a continuous quality improvement (CQI) program by health-care professionals in Aboriginal primary health-care services in South Australia. Eighteen semi-structured interviews across 11 participating services were conducted alongside CQI implementation activities. Multiple barriers exist, from staff perspectives, which can be categorised according to different levels of the primary health-care system. At the macro level, barriers related to resource constraints (workforce issues) and access to project support (CQI coordinator). At the meso level, barriers related to senior level management and leadership for quality improvement and the level of organisational readiness. At the micro level, knowledge and attitudes of staff (such as resistance to change; lack of awareness of CQI) and lack of team tenure were cited as the main barriers to implementation. Staff identified that successful and sustained implementation of CQI requires both organisational systems and individual behaviour change. Improvements through continuing regional level collaborations and using a systems approach to develop an integrated regional level CQI framework, which includes building organisational and clinic team CQI capacity at the health centre level, are recommended. Ideally, this should be supported at the broader national level with dedicated funding.

  4. Policies to improve end-of-life decisions in Flemish hospitals: communication, training of health care providers and use of quality assessments

    Directory of Open Access Journals (Sweden)

    Noortgate Nele

    2009-12-01

    Full Text Available Abstract Background The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. Developing end-of-life policies in hospitals is a first step towards improving the quality of medical decision-making at the end-of-life. Implementation of policies through quality assessments, communication and the training and education of health care providers is equally important in improving actual end-of-life practice. The aim of the present study is to report on the existence and nature of end-of-life policy implementation activities in Flemish acute hospitals. Methods A cross-sectional mail survey was sent to all acute hospitals (67 main campuses in Flanders (Belgium. The questionnaire asked about hospital characteristics, the prevalence of policies on five types of end-of-life decisions: euthanasia, palliative sedation, alleviation of symptoms with possible life-shortening effect, do-not-resuscitate decision, and withdrawing or withholding of treatment, the internal and external communication of these policies, training and education on aspects of end-of-life care, and quality assessments of end-of-life care on patient and family level. Results The response rate was 55%. Results show that in 2007 written policies on most types of end-of-life decisions were widespread in acute hospitals (euthanasia: 97%, do-not-resuscitate decisions: 98%, palliative sedation: 79%. While standard communication of these policies to health care providers was between 71% and 91%, it was much lower to patients and/or family (between 17% and 50%. More than 60% of institutions trained and educated their caregivers in different aspects on end-of-life care. Assessment of the quality of these different aspects at patient and family level occurred in 25% to 61% of these hospitals. Conclusions Most Flemish acute hospitals have developed a policy on end-of-life practices

  5. Improving Palliative Care Team Meetings: Structure, Inclusion, and "Team Care".

    Science.gov (United States)

    Brennan, Caitlin W; Kelly, Brittany; Skarf, Lara Michal; Tellem, Rotem; Dunn, Kathleen M; Poswolsky, Sheila

    2016-07-01

    Increasing demands on palliative care teams point to the need for continuous improvement to ensure teams are working collaboratively and efficiently. This quality improvement initiative focused on improving interprofessional team meeting efficiency and subsequently patient care. Meeting start and end times improved from a mean of approximately 9 and 6 minutes late in the baseline period, respectively, to a mean of 4.4 minutes late (start time) and ending early in our sustainability phase. Mean team satisfaction improved from 2.4 to 4.5 on a 5-point Likert-type scale. The improvement initiative clarified communication about patients' plans of care, thus positively impacting team members' ability to articulate goals to other professionals, patients, and families. We propose several recommendations in the form of a team meeting "toolkit." PMID:25794871

  6. Quality of care indicators in rectal cancer.

    Science.gov (United States)

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

    2011-09-01

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

  7. IMPROVING CONCEPTUAL DESIGN QUALITY

    DEFF Research Database (Denmark)

    Bush, Stuart; Robotham, Antony John

    1999-01-01

    This paper will consider how Quality Function Deployment (QFD) and Design for Manufacture and Assembly (DFMA) processes can be used to improve the design quality of products at the concept stage. We appreciate that both QFD and DFMA are techniques that have been used for some time by mature product...... quality is maintained in design project work. The projects described have been carried out with products manufactured by small to medium sized enterprises (SME's), where we have found significant opportunities for product improvement. The quantitative nature of DFMA analysis results allows the novice...... developers, and the successes achieved using each have been widely reported. Here, though, we will share our experiences of using these tools with novice designers, i.e. student engineers.The use of both QFD and DFMA has proven to be a valuable approach for ensuring that a balanced consideration of design...

  8. Strategies for improving the quality of health care in maternal and child health in low- and middle-income countries: an overview of systematic reviews.

    Science.gov (United States)

    Althabe, Fernando; Bergel, Eduardo; Cafferata, María Luisa; Gibbons, Luz; Ciapponi, Agustín; Alemán, Alicia; Colantonio, Lisandro; Palacios, Alvaro Rodríguez

    2008-01-01

    There are many systematic reviews of continuing education programmes and educational strategies for quality improvement in health care. Most of the reviewed studies are one-off evaluations rather than impact evaluations with long-term follow-up. There are few systematic reviews of organisational, financial and regulatory interventions, and few high-quality studies. These interventions are probably as or more important than educational strategies, although they are less well evaluated. Few studies have been undertaken in low- and middle-income countries (LMIC) or that address maternal and child health (MCH). Thus, the results of the available studies and reviews need to be interpreted cautiously when applied to LMIC. Interactive workshops, reminders and multifaceted interventions can improve professional practice, and they generally have moderate effects. Educational outreach visits consistently improve prescribing but have variable effects on other behaviours. Audit and feedback interventions have variable effects on professional practice, but most often these are small to moderate effects. Mass-media and patient-mediated interventions may change professional practice. Multifaceted interventions that combine several quality-improvement strategies are also effective but may not be more so than single interventions. While all of these strategies are applicable to MCH in LMIC, the applicability of the results to rural settings, in particular, may be limited. Use of these strategies could exacerbate inequalities, and this should be taken into consideration when planning implementation. Scaling up and sustainability may be difficult to achieve in LMIC contexts and need careful consideration. The use of financial interventions has not been well studied; financial incentives and disincentives may be difficult to use effectively and efficiently, although their impact on practice needs to be considered. Organisational interventions are likely to be important, given that

  9. Practical Approaches to Quality Improvement for Radiologists.

    Science.gov (United States)

    Kelly, Aine Marie; Cronin, Paul

    2015-10-01

    Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. PMID:26466176

  10. Interventions designed to improve the quality and efficiency of medication use in managed care: A critical review of the literature – 2001–2007

    Directory of Open Access Journals (Sweden)

    Soumerai Stephen B

    2008-04-01

    Full Text Available Abstract Background Managed care organizations use a variety of strategies to reduce the cost and improve the quality of medication use. The effectiveness of such policies is not well understood. The objective of this research was to update a previous systematic review of interventions, published between 1966 and 2001, to improve the quality and efficiency of medication use in the US managed care setting. Methods We searched MEDLINE and EMBASE for publications from July 2001 to January 2007 describing interventions targeting drug use conducted in the US managed care setting. We categorized studies by intervention type and adequacy of research design using commonly accepted criteria. We summarized the outcomes of well-controlled strategies and documented the significance and magnitude of effects for key study outcomes. Results We identified 164 papers published during the six-year period. Predominant strategies were: educational interventions (n = 20, including dissemination of educational materials, and group or one-to-one educational outreach; monitoring and feedback (n = 22, including audit/feedback and computerized monitoring; formulary interventions (n = 66, including tiered formulary and patient copayment; collaborative care involving pharmacists (n = 15; and disease management with pharmacotherapy as a primary focus (n = 41, including care for depression, asthma, and peptic ulcer disease. Overall, 51 studies met minimum criteria for methodological adequacy. Effective interventions included one-to-one academic detailing, computerized alerts and reminders, pharmacist-led collaborative care, and multifaceted disease management. Further, changes in formulary tier-design and related increases in copayments were associated with reductions in medication use and increased out-of-pocket spending by patients. The dissemination of educational materials alone had little or no impact, while the impact of group education was inconclusive. Conclusion

  11. Measuring Quality Improvement in Acute Ischemic Stroke Care: Interrupted Time Series Analysis of Door-to-Needle Time

    Directory of Open Access Journals (Sweden)

    Anne Margreet van Dishoeck

    2014-06-01

    Full Text Available Background: In patients with acute ischemic stroke, early treatment with recombinant tissue plasminogen activator (rtPA improves functional outcome by effectively reducing disability and dependency. Timely thrombolysis, within 1 h, is a vital aspect of acute stroke treatment, and is reflected in the widely used performance indicator ‘door-to-needle time' (DNT. DNT measures the time from the moment the patient enters the emergency department until he/she receives intravenous rtPA. The purpose of the study was to measure quality improvement from the first implementation of thrombolysis in stroke patients in a university hospital in the Netherlands. We further aimed to identify specific interventions that affect DNT. Methods: We included all patients with acute ischemic stroke consecutively admitted to a large university hospital in the Netherlands between January 2006 and December 2012, and focused on those treated with thrombolytic therapy on admission. Data were collected routinely for research purposes and internal quality measurement (the Erasmus Stroke Study. We used a retrospective interrupted time series design to study the trend in DNT, analyzed by means of segmented regression. Results: Between January 2006 and December 2012, 1,703 patients with ischemic stroke were admitted and 262 (17% were treated with rtPA. Patients treated with thrombolysis were on average 63 years old at the time of the stroke and 52% were male. Mean age (p = 0.58 and sex distribution (p = 0.98 did not change over the years. The proportion treated with thrombolysis increased from 5% in 2006 to 22% in 2012. In 2006, none of the patients were treated within 1 h. In 2012, this had increased to 81%. In a logistic regression analysis, this trend was significant (OR 1.6 per year, CI 1.4-1.8. The median DNT was reduced from 75 min in 2006 to 45 min in 2012 (p Conclusion and Implications: The DNT steadily improved from the first implementation of thrombolysis. Specific

  12. Evaluation of a training program for health care workers to improve the quality of care for rape survivors: a quasi-experimental design study in Morogoro, Tanzania

    Directory of Open Access Journals (Sweden)

    Muzdalifat Abeid

    2016-06-01

    Full Text Available Background: Sexual violence against women and children in Tanzania and globally is a human rights violation and a developmental challenge. Objective: The aim of this study was to assess the impact of training health professionals on rape management. The specific objectives were to evaluate the changes of knowledge and attitudes toward sexual violence among a selected population of health professionals at primary health care level. Design: A quasi-experimental design using cross-sectional surveys was conducted to evaluate health care workers’ knowledge, attitude, and clinical practice toward sexual violence before and after the training program. The study involved the Kilombero (intervention and Ulanga (comparison districts in Morogoro region. A total of 151 health professionals at baseline (2012 and 169 in the final assessment (2014 participated in the survey. Data were collected using the same structured questionnaire. The amount of change in key indicators from baseline to final assessment in the two areas was compared using composite scores in the pre- and post-interventions, and the net intervention effect was calculated by the difference in difference method. Results: Overall, there was improved knowledge in the intervention district from 55% at baseline to 86% and a decreased knowledge from 58.5 to 36.2% in the comparison area with a net effect of 53.7% and a p-value less than 0.0001. The proportion of participants who exhibited an accepting attitude toward violence declined from 15.3 to 11.2% in the intervention area but increased from 13.2 to 20.0% in the comparison area. Conclusions: Training on the management of sexual violence is feasible and the results indicate improvement in healthcare workers’ knowledge and practice but not attitudes. Lessons learned from this study for successful replication of such an intervention in similar settings require commitment from those at strategic level within the health service to ensure that

  13. Evaluation of a training program for health care workers to improve the quality of care for rape survivors: a quasi-experimental design study in Morogoro, Tanzania

    Science.gov (United States)

    Abeid, Muzdalifat; Muganyizi, Projestine; Mpembeni, Rose; Darj, Elisabeth; Axemo, Pia

    2016-01-01

    Background Sexual violence against women and children in Tanzania and globally is a human rights violation and a developmental challenge. Objective The aim of this study was to assess the impact of training health professionals on rape management. The specific objectives were to evaluate the changes of knowledge and attitudes toward sexual violence among a selected population of health professionals at primary health care level. Design A quasi-experimental design using cross-sectional surveys was conducted to evaluate health care workers’ knowledge, attitude, and clinical practice toward sexual violence before and after the training program. The study involved the Kilombero (intervention) and Ulanga (comparison) districts in Morogoro region. A total of 151 health professionals at baseline (2012) and 169 in the final assessment (2014) participated in the survey. Data were collected using the same structured questionnaire. The amount of change in key indicators from baseline to final assessment in the two areas was compared using composite scores in the pre- and post-interventions, and the net intervention effect was calculated by the difference in difference method. Results Overall, there was improved knowledge in the intervention district from 55% at baseline to 86% and a decreased knowledge from 58.5 to 36.2% in the comparison area with a net effect of 53.7% and a p-value less than 0.0001. The proportion of participants who exhibited an accepting attitude toward violence declined from 15.3 to 11.2% in the intervention area but increased from 13.2 to 20.0% in the comparison area. Conclusions Training on the management of sexual violence is feasible and the results indicate improvement in healthcare workers’ knowledge and practice but not attitudes. Lessons learned from this study for successful replication of such an intervention in similar settings require commitment from those at strategic level within the health service to ensure that adequate resources are

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

    Science.gov (United States)

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

    2011-03-01

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

  15. A review on laboratory tests’ utilization: A trigger for cutting costs and quality improvement in health care settings

    Science.gov (United States)

    Meidani, Zahra; Farzandipour, Mehrdad; Farrokhian, Alireza; Haghighat, Masomeh

    2016-01-01

    Background: Considering the role of laboratory tests as a central part of controlling health expenditure, this study intends to investigate laboratory tests overutilization in Iran to pave the way for future interventions. Methods: Inappropriate laboratory utilization was reviewed in a cross-sectional survey through the retrospective analysis of 384 medical records at a tertiary center. To pave the way for future intervention, overutilization tests were classified into two categories, inappropriate and inefficient, and then they were analyzed. Frequency analysis was used to analysis patient’s age, gender, hospital wards, length of stay, and diagnosis as well as inappropriate test and inefficient tests. Results: A total of 143 (1.50 %) of the tests were inefficient and was ordered due to laboratory errors including hemolysis, inefficient sampling, or absurd results. 2522 (26.40%) of the tests were inappropriate and stem from failure to meet medical/clinical appropriateness criteria. Conclusion: Whereas, inappropriate test ordering was more frequent than inefficient tests, the initial improvement strategy should focus on physicians’ test ordering behavior through conducting proper teaching strategies, ongoing audit and educational feedback, implementing health information technology tools and employing laboratory practice guidelines (LPGs) and testing algorithms. Conducting continuous quality improvement cycle for laboratory services and training of personnel involved in blood sampling is recommended for inefficient tests. PMID:27493909

  16. Can clinical use of Social Media improve quality of care in mental Health? A Health Technology Assessment approach in an Italian mental health service.

    Science.gov (United States)

    Di Napoli, Wilma Angela; Nollo, Giandomenico; Pace, Nicola; Torri, Emanuele

    2015-09-01

    Clinical use of modern Information and Communication Technologies such as Social Media (SM) can easily reach and empower groups of population at risk or affected by chronic diseases, and promote improvement of quality of care. In the paper we present an assessment of SM (i.e. e-mails, websites, on line social networks, apps) in the management of mental disorders, carried out in the Mental Health Service of Trento (Italy) according to Health Technology Assessment criteria. A systematic review of literature was performed to evaluate technical features, safety and effectiveness of SM. To understand usage rate and attitude towards new social technologies of patients and professionals, we performed a context analysis by a survey conducted over a group of 88 psychiatric patients and a group of 35 professionals. At last, we made recommendations for decision makers in order to promote SM for the management of mental disorders in a context of prioritization of investments in health care. PMID:26417743

  17. Information technology implementing globalization on strategies for quality care provided to children submitted to cardiac surgery: International Quality Improvement Collaborative Program - IQIC

    Directory of Open Access Journals (Sweden)

    Adilia Maria Pires Sciarra

    2014-03-01

    Full Text Available Introduction: Congenital heart diseases are the world's most common major birth defect, affecting one in every 120 children. Ninety percent of these children are born in areas where appropriate medical care is inadequate or unavailable. Objective: To share knowledge and experience between an international center of excellence in pediatric cardiac surgery and a related program in Brazil. Methods: The strategy used by the program was based on long-term technological and educational support models used in that center, contributing to the creation and implementation of new programs. The Telemedicine platform was used for real-time monthly broadcast of themes. A chat software was used for interaction between participating members and the group from the center of excellence. Results: Professionals specialized in care provided to the mentioned population had the opportunity to share to the knowledge conveyed. Conclusion: It was possible to observe that the technological resources that implement the globalization of human knowledge were effective in the dissemination and improvement of the team regarding the care provided to children with congenital heart diseases.

  18. Tracking the quality of care for sick children using lot quality assurance sampling: targeting improvements of health services in Jigawa, Nigeria.

    Directory of Open Access Journals (Sweden)

    Edward Adekola Oladele

    Full Text Available BACKGROUND: In Nigeria, 30% of child deaths are due to malaria. The National Malaria Control Program of Nigeria (NMCP during 2009 initiated a program to improve the quality of paediatric malaria services delivered in health facilities (HF. This study reports a rapid approach used to assess the existing quality of services in Jigawa state at decentralised levels of the health system. METHODS: NMCP selected Lot Quality Assurance Sampling (LQAS to identify the variation in HF service quality among Senatorial Districts (SD. LQAS was selected because it was affordable and could be used by local health workers (HW in a population-based survey. NMCP applied a 2-stage LQAS using a structured Rapid Health Facility Assessment (R-HFA tool to identify high and low performing SD for specified indicators. FINDINGS: LQAS identified variations in HF performance (n = 21 and enabled resources to be targeted to address priorities. All SD exhibited deficient essential services, supplies and equipment. Only 9.7% of HF had Artemisinin-based Combination Therapies and other first-line treatments for childhood illnesses. No SD and few HF exhibited adequate HW performance for the assessment, treatment or counselling of sick children. Using the IMCI algorithm, 17.5% of HW assessed the child's vaccination status, 46.8% assessed nutritional status, and 65.1% assessed children for dehydration. Only 5.1% of HW treatments were appropriate for the assessment. Exit interviews revealed that 5.1% of caregivers knew their children's illness, and only 19.9% could accurately describe how to administer the prescribed drug. CONCLUSION: This R-HFA, using LQAS principles, is a rapid, simple tool for assessing malaria services and can be used at scale. It identified technical deficiencies that could be corrected by improved continuing medical education, targeted supervision, and recurrent R-HFA assessments of the quality of services.

  19. Online Dementia Care Training for Healthcare Teams in Continuing and Long-Term Care Homes: A Viable Solution for Improving Quality of Care and Quality of Life for Residents

    Science.gov (United States)

    MacDonald, Colla J.; Stodel, Emma J.; Casimiro, Lynn

    2006-01-01

    The purpose of this research was to design, develop, deliver, and evaluate an online dementia care program aimed at enabling healthcare teams deliver better service to residents with dementia in continuing (CC) and long-term care (LTC) facilities. A Community-Based Participatory Research (CBPR) orientation (Minkler & Wallerstein, 2003) was adopted…

  20. Improving stroke care for patients at Cavan hospital [poster

    LENUS (Irish Health Repository)

    Murugasu, G Dr.

    2013-07-01

    Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.

  1. 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.

  2. Modalities of hemodialysis: Quality improvement

    Directory of Open Access Journals (Sweden)

    Ayman Karkar

    2012-01-01

    Full Text Available Hemodialysis (HD treatment had, over many years, improved the survival rate of patients with end-stage renal disease. However, standard or conventional HD prescription is far from being optimal in replacing the function of normal kidneys. Its unphysiologic clearance pattern and inability to remove all types and sizes of uremic toxins results in inter- and intra-dialysis complications and an unacceptably high rate of cardiovascular morbidity and mortality. Efficiency of HD can be improved by increasing blood and dialysate flow rates, dialyzer size and surface area and duration and frequency of dialysis sessions. Home HD, where short daily or long slow nocturnal HD sessions can conveniently be performed, provides an excellent option for quality of life improvement and reduction in morbidity and mortality. Recent innovations in the specifications of HD machines and improvement in dialysis membranes characteristics and water treatment technology paved the way for achieving quality HD. These advancements have resulted in efficient implementation of adsorption, diffusion and/or convection principles using adsorption HD, hemofiltration, hemodiafiltration (HDF and online HDF modalities in order to achieve optimum HD. Implementation of these innovations resulted in better quality care achievements in clinical practice and reduction in morbidity and mortality rates among HD patients.

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

    Science.gov (United States)

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

    2016-01-01

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

  4. Improving care efficiency in a radiotherapy center using Lean philosophy

    OpenAIRE

    Trilling, Lorraine; Pellet, Bertrand; Delacroix, Sabine; Colella Fleury, Hélène; Marcon, Eric

    2010-01-01

    In the field of health care, as in production or services, there is a need for tailor made methodology to help managers improving quality of care as well as efficiency of the organization. Quality Improvement (QI) has become a major preoccupation in the current context where hospitals and health care services need to provide a high level of care and a welcoming environment for patients while reducing costs and maintaining a pleasant work atmosphere for staff. In this paper we present how, wit...

  5. The QICKD study protocol: a cluster randomised trial to compare quality improvement interventions to lower systolic BP in chronic kidney disease (CKD in primary care

    Directory of Open Access Journals (Sweden)

    du Bois Elizabeth

    2009-07-01

    Full Text Available Abstract Background Chronic kidney disease (CKD is a relatively newly recognised but common long-term condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal services, which are often located in tertiary centres, inconvenient for patients, and wasteful of resources. National and international CKD guidelines include quality targets for primary care. However, there have been no rigorous evaluations of strategies to implement these guidelines. This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progression Design Cluster randomised controlled trial (CRT Methods This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education. The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interventions. An additional 10 practices per arm will receive a questionnaire to measure any change in confidence in managing CKD. Follow up will take place over two years. Outcomes will be measured using anonymised routinely collected data extracted from practice computer systems. Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years. Secondary outcomes will include biomedical outcomes and markers of quality, including practitioner confidence in managing CKD. A small

  6. The use of Health Care Financing Administration data for the development of a quality improvement project on the treatment of anemia.

    Science.gov (United States)

    Eggers, P W; Greer, J; Jencks, S

    1994-08-01

    The Health Care Financing Administration maintains a wide array of data systems that are essential to the functioning of the Medicare program. These data, collected and maintained for the purposes of ensuring entitlements and payment for services, also can be used to monitor programmatic changes and to define potential problem areas. The end-stage renal disease (ESRD) Program Management and Medical Information System (PMMIS) is a subset of the larger Medicare statistical system. It is a historic record of all Medicare ESRD beneficiaries dating back to 1978. Basic Medicare enrollment information on ESRD beneficiaries is enhanced with the addition of information on the cause of renal failure, type of dialysis therapy, transplantation history, and cause of death. The ESRD PMMIS has been put to a number of uses in the past decade or so, ranging from basic descriptive epidemiology to analyses of mortality rates to assessments of programmatic issues such as the composite rate and dialyzer reuse. Because of the limited clinical detail in the PMMIS, there are many specific questions that cannot be adequately addressed. With approval of the Food and Drug Administration and Medicare coverage of erythropoietin, a erythropoietin monitoring system was developed to assess utilization trends of this anemia control drug. Within a few months it became evident that dosing levels for erythropoietin were much lower than expected from the clinical trials. Following a change in the payment method from a fixed amount to one based on dose level, dosing has increased markedly. However, hematocrit levels still remain below optimal levels. This lack of hematocrit response has led the Health Care Financing Administration, in concert with the renal community, to target anemia control as a potential health care quality improvement project. This paper presents an example of the type of data presentation that can be derived from the current PMMIS. The Health Standards and Quality Bureau has made

  7. 糖尿病护理小组对提高糖尿病护理质量的影响研究%The Influence of Diabetes care team to improve the quality of diabetes care

    Institute of Scientific and Technical Information of China (English)

    徐丽萍

    2015-01-01

    目的:分析研究糖尿病护理小组对提高糖尿病护理质量的影响,旨在提高糖尿病患者的护理质量。方法该院于2014年1月开始建立糖尿病护理小组,选取该院2014年1月—8月收治的糖尿病患者85例,作为观察组,进行护理探究。另外,选取去年同期收治的糖尿病患者85例,作为对照组。回顾性分析其临床资料及诊治经过,对比两组患者血糖控制情况及护理满意度。结果糖尿病护理小组成立后,观察组85例患者,各项指标均有很大程度的改善,评分较治疗前比较显著提高,差异有统计学意义(P<0.05)。且组间比较来看,观察组改善情况显著优于对照组,差异有统计学意义(P<0.05)。满意度调查方面,观察组临床总满意度为95.3%,显著高于对照组的80.0%,差异有统计学意义(P<0.05)。结论成立糖尿病护理小组,可有效提高了糖尿病患者的临床护理质量,增加各科室护理人员糖尿病护理知识,改善糖尿病患者生活质量,临床意义重大,应广泛在临床护理中应用。%Objective To analyze the impact of diabetes research diabetes care team to improve the quality of care, aimed at im-proving the quality of care for patients with diabetes. Methods: The hospital in January 2014 to start building diabetes care team, our hospital from January 2014 to August 2014 were treated 85 cases of diabetes, as the observation group, nursing explore. Also, choose the same period last year admitted 85 cases of diabetes [as a control group Given group name], as a control group. A retro-spective analysis of the clinical data and treatment after comparing two groups of patients with blood glucose control and nursing satisfaction. Results Diabetes Care Group was established in the observation group 85 patients, before improving the indicators are to a large extent, the scores improved significantly compared with treatment comparison, the

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

    Science.gov (United States)

    Brower, Mary R.; Sull, Theresa M.

    2003-01-01

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

  9. Quality Indicators for Hospital Care: Reliability and validity

    OpenAIRE

    Fischer, Claudia

    2015-01-01

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

  10. Atrial fibrillation care improvement collaborative

    OpenAIRE

    Robelia, Paul; Kopecky, Stephen; Thacher, Tom

    2015-01-01

    Atrial fibrillation (AF) is an increasingly common cardiac arrhythmia. Many patients with new onset or recurrent AF present to the emergency department and are subsequently admitted to the hospital and seen by cardiology specialists for follow up. In an attempt to address this high utilization of acute health care resources, reduce costs, and improve patient care, our institution instituted a collaborative project between the departments of emergency medicine, cardiology, family medicine, and...

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

    Science.gov (United States)

    Ndoro, Samuel

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

  12. A Data-Feedback Method Used by Staff in Day-Care Centres to Improve the Quality of Their Work.

    Science.gov (United States)

    Hedin, Anna; Ekholm, Bodil

    1989-01-01

    A data feedback method based on observations of daily activities was tested in 11 Swedish day care centers. Advantages and disadvantages of the use of data collectors from different organizational levels were studied. Hindrances to the change process are discussed. (NH)

  13. 护理层级管理在提高临床护理服务质量中的作用分析%Care Level Management Role in Improving Quality of Care in Clinical Analysis

    Institute of Scientific and Technical Information of China (English)

    倪慧英

    2015-01-01

    目的:分析护理层级管理在提高临床护理服务质量中的作用。方法选取2012年5月-2014年5月在该院工作的54名护理人员作为研究对象,其中2012年5月-2013年4月在岗的26名护理人员为对照组,2013年5月-2014年5月在岗的28名护理人员为观察组。对照组护理人员未采用护理层级管理模式对患者实施护理,观察组护理人员均采用护理层级管理模式对患者实施护理,对比两组院内感染情况、护理服务质量及患者对护理服务的满意率。结果观察组院内感染情况、护理服务质量及患者对护理服务的满意率优于对照组,两组数据组间差异均有统计学意义(P<0.05)。结论采用护理层级管理模式实施护理能减少患者出现院内感染,提高临床护理服务质量及患者对护理服务的满意率。%Objective To analyze the role of nursing in improving clinical care level management of quality of service. Methods May 2012- May 2014 in the hospital 54 nurses working as a research object, which in May 2012-April 2013 in the post of the 26 nurses for the control group, in May 2013-May 2014 in the post of the 28 nurses in the observation group. Nursing care in the control group did not use hierarchical management model of care for patients with the observa-tion group care nurses are used to implement hierarchical management model of care for patients, comparing two groups of nosocomial infection, satisfaction and quality of care patients care. Results The nosocomial infection, quality of care and patient satisfaction rate for care than the control group, the difference between the two data sets were statistically significant (P<0.05). Conclusion The use of nursing care hierarchical management model implemented to reduce nosocomial infections in patients, improve clinical care and patient satisfaction rate the quality of service for care services.

  14. ‘Tempos’ management in primary care: a key factor for classifying adverse events, and improving quality and safety

    OpenAIRE

    Amalberti, R.; Brami, J

    2012-01-01

    Background The role of time management in safe and efficient medicine is important but poorly incorporated into the taxonomies of error in primary care. This paper addresses the lack of time management, presenting a framework integrating five time scales termed ‘Tempos’ requiring parallel processing by GPs: the disease's tempo (unexpected rapid evolutions, slow reaction to treatment); the office's tempo (day-to-day agenda and interruptions); the patient's tempo (time to express symptoms, comp...

  15. IS TOTAL QUALITY MANAGEMENT/ CONTINOUS QUALITY IMPROVEMENT OR QUALITY ASSURANCE APPLICABLE IN HEALTH SERVICES?

    OpenAIRE

    Sidin, Andi Indahwaty

    2015-01-01

    In modern society, people are likely to be consumerism. They tend to be concerned about the quality of goods or services. In the same way, health care had to pay attention as the patients seem to be familiarized with health services quality. Health care has tried to adapt TQM/Continuous Quality Improvement (CQI) as well as Quality Assurance (QA) which is also adapted from manufacturing. However, some characteristics in the health industry are dissimilar to manufacturing. It can be explained ...

  16. Assesment of interprofessional training methodology in professional education as a potential tool to improve patient safety and quality of care

    OpenAIRE

    Pathak, Yashwant; Groshev, Anastasia

    2014-01-01

    Study Objectives: Systematic current literature analysis: Does interprofessional training significantly improve the team communication? - Team member awareness (pre-and post-training survey scores) - Communication Does interprofessional training significantly improve healthcare safety? - Morbidity/mortality - Adverse events (nosocomial infections, serious safety events) - Hospital stay (in-patient setting)

  17. Shared Decision Making in Neonatal Quality Improvement.

    Science.gov (United States)

    Warren, Jamie B; Wiggins, Nikki

    2016-01-01

    Since the Institute of Medicine published Crossing the Quality Chasm in 2001, healthcare systems have become more focused on improving the quality of healthcare delivery. At Oregon Health & Science University and Doernbecher Children's Hospital, we recognize the need to take an interprofessional, team-based approach to improving the care we provide to our current and future patients. We describe here an ongoing quality improvement project in the Doernbecher Neonatal Intensive Care Unit (NICU), with specific attention to the factors we believe have contributed to the implementation and early success of the project. These factors include the history of quality improvement work in our NICU and in the field of neonatology, the "dyad leadership" structure under which we operate in our NICU, and our developing understanding of the concept of "team intelligence." These elements have led to the formation of a team that can practice shared decision making and work as one to realize a shared goal. PMID:27465457

  18. Quality and quality improvement in forensic mental health evaluations.

    Science.gov (United States)

    Wettstein, Robert M

    2005-01-01

    Despite the growing attention to quality and quality improvement in health care in the United States, forensic psychiatry has yet to incorporate relevant developments and information and make quality an important item on the agenda. This article reviews the empirical research regarding the perceived quality of forensic evaluations, which has primarily examined criminal rather than civil forensic evaluations. Beyond the available research, many important policy and empirical questions must be addressed, including the definition of a quality forensic evaluation, the process used to access quality, the indicators and measures used, the methods that provide incentives for performing quality evaluations, the role of forensic psychiatry training programs, and the role of the American Academy of Psychiatry and the Law (AAPL) or other professional organizations in the quality improvement enterprise.

  19. Building a mission for quality care.

    Science.gov (United States)

    Peterson, R

    1999-12-01

    Clearly, there is a benefit to the group process in helping to establish teamwork. Teamwork and cooperation can assist with promoting effective communication, improving work quality, and building a sense of well-being within the group. With this cooperation, setting goals and looking toward the future can become a reality. Once goals are set, then developing a professional image can begin. Developing a mission statement can be an effective means to help create that professional image. Having the opportunity to develop a mission for a patient care area and articulating it through a mission statement coalesces the values, beliefs, and philosophy of a group of neuroscience staff. The following is the mission statement developed by the neurosciences unit at the University of Wisconsin Hospital and Clinics: We, the staff of UWHC Neuroscience unit embrace a vision of excellence in health care for all. Our mission is to deliver consistent quality patient care, while fostering our own professional growth. As caring healers, teachers and patient advocates in an ever-changing health care environment, we are empowered by the code for nurses. Within our scope of practice, we strive to maintain a balance of basic human respect and dignity for patients and their families in their quest for wellness, adaptation, rehabilitation or comfort care. It is our hope that patients and families will work with the health care team to construct a plan of care that best meets the patient's needs and goals. We are committed to accommodate special communication, religious or cultural needs of patients and their families. Our final acknowledgment is to ourselves, as members of the health care team. We celebrate the dignity of the staff by recognizing each individual as a special person capable of making unique and significant contributions to the unit. PMID:10726245

  20. Quality Indicators for Hospital Care : Reliability and validity

    NARCIS (Netherlands)

    C. Fischer (Claudia)

    2015-01-01

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

  1. A web-based laboratory information system to improve quality of care of tuberculosis patients in Peru: functional requirements, implementation and usage statistics

    Directory of Open Access Journals (Sweden)

    Yale Gloria

    2007-10-01

    Full Text Available Abstract Background Multi-drug resistant tuberculosis patients in resource-poor settings experience large delays in starting appropriate treatment and may not be monitored appropriately due to an overburdened laboratory system, delays in communication of results, and missing or error-prone laboratory data. The objective of this paper is to describe an electronic laboratory information system implemented to alleviate these problems and its expanding use by the Peruvian public sector, as well as examine the broader issues of implementing such systems in resource-poor settings. Methods A web-based laboratory information system "e-Chasqui" has been designed and implemented in Peru to improve the timeliness and quality of laboratory data. It was deployed in the national TB laboratory, two regional laboratories and twelve pilot health centres. Using needs assessment and workflow analysis tools, e-Chasqui was designed to provide for improved patient care, increased quality control, and more efficient laboratory monitoring and reporting. Results Since its full implementation in March 2006, 29,944 smear microscopy, 31,797 culture and 7,675 drug susceptibility test results have been entered. Over 99% of these results have been viewed online by the health centres. High user satisfaction and heavy use have led to the expansion of e-Chasqui to additional institutions. In total, e-Chasqui will serve a network of institutions providing medical care for over 3.1 million people. The cost to maintain this system is approximately US$0.53 per sample or 1% of the National Peruvian TB program's 2006 budget. Conclusion Electronic laboratory information systems have a large potential to improve patient care and public health monitoring in resource-poor settings. Some of the challenges faced in these settings, such as lack of trained personnel, limited transportation, and large coverage areas, are obstacles that a well-designed system can overcome. e-Chasqui has the

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

    OpenAIRE

    Dishoeck, Anne-Margreet

    2015-01-01

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

  3. Prevention of pressure ulcers in patients with hip fractures : Definition, measurement and improvement of the quality of care

    OpenAIRE

    Gunningberg, Lena

    2000-01-01

    The aims of the present thesis were to survey the prevalence and incidence ofpressure ulcers in patients with hip fracture and to investigate nursing staffknowledge and documentation regarding pressure ulcer prevention for the samepatient group. Another aim was to test the effect of three preventive interventions:risk assessment and pressure ulcer grading, a pressure-reducing mattress and aneducational programme. Experimental, comparative and descriptive designs wereused and quality improveme...

  4. Evaluation of a training program for health care workers to improve the quality of care for rape survivors: a quasi-experimental design study in Morogoro, Tanzania

    OpenAIRE

    Abeid, Muzdalifat; Muganyizi, Projestine; Mpembeni, Rose; Darj, Elisabeth; Axemo, Pia

    2016-01-01

    Background: Sexual violence against women and children in Tanzania and globally is a human rights violation and a developmental challenge.Objective: The aim of this study was to assess the impact of training health professionals on rape management. The specific objectives were to evaluate the changes of knowledge and attitudes toward sexual violence among a selected population of health professionals at primary health care level.Design: A quasi-experimental design using cross-sectional survey...

  5. Preanalytical quality improvement : in quality we trust

    NARCIS (Netherlands)

    Lippi, Giuseppe; Becan-McBride, Kathleen; Behulova, Darina; Bowen, Raffick A.; Church, Stephen; Delanghe, Joris; Grankvist, Kjell; Kitchen, Steve; Nybo, Mads; Nauck, Matthias; Nikolac, Nora; Palicka, Vladimir; Plebani, Mario; Sandberg, Sverre; Simundic, Ana-Maria

    2013-01-01

    Total quality in laboratory medicine should be defined as the guarantee that each activity throughout the total testing process is correctly performed, providing valuable medical decision-making and effective patient care. In the past decades, a 10-fold reduction in the analytical error rate has bee

  6. Applying quality improvement methods to address gaps in medicines reconciliation at transfers of care from an acute UK hospital

    OpenAIRE

    Marvin, Vanessa; Kuo, Shirley; Poots, Alan J; Woodcock, Thomas; Vaughan, Louella; Bell, Derek

    2016-01-01

    Objectives Reliable reconciliation of medicines at admission and discharge from hospital is key to reducing unintentional prescribing discrepancies at transitions of healthcare. We introduced a team approach to the reconciliation process at an acute hospital with the aim of improving the provision of information and documentation of reliable medication lists to enable clear, timely communications on discharge. Setting An acute 400-bedded teaching hospital in London, UK. Participants The effec...

  7. [How to write, how to implement and how to evaluate a practice guideline in order to improve quality of care?].

    Science.gov (United States)

    Moret, L; Lefort, C; Terrien, N

    2012-11-01

    Initiatives of clinical practices improvement have been gradually developing in France for 20 years. Nevertheless, effective implementation of change is still difficult for numerous reasons. The use of clinical practices guidelines is one of the different ways of improvement. It is however necessary to adapt these national guidelines to the specificities of the hospital and the team, to ensure implementation and appropriation by the professionals. These recommendations are thus translated into applicable and concrete standard operating procedures. These documents have to be built by and for the concerned professionals. They are also communication and training tools, precise, directive, uniform in terms of presentation and attractive visually. Once drafted, they have to be distributed widely to the professionals to facilitate implementation. The simple distribution of the recommendations is insufficient to modify the clinical practices and require association of several methods of promotion for an optimal appropriation. How then to make sure of their effective use? Practices evaluation is one of the steps of continuous professional development, including continuous training and analysis of clinical practices by using methods promoted by the "Haute Autorité de santé". One of them is the clinical audit; use of method assessing non-pertinent treatment is interesting too. Analysis of the non-conformities and gaps between theory and practice allows identifying various possible causes (professional, institutional, organizational or personal) in order to implement corrective action plans, in a logic of continuous improvement. PMID:23039956

  8. To strengthen management, to improve the quality of nursing care%加强护理管理,提高护理质量

    Institute of Scientific and Technical Information of China (English)

    蒋贤竹

    2009-01-01

    目的:探讨影响护理安全的因素及其预防方法.方法:通过开展安全教育、规范管理制度等措施加强护理安全管理.结果:护理工作面广、琐碎复杂、存在不安全因素较多,直接影响患者疾病的康复,从细节上落实护理安全管理,保证患者的安全.结论:护理人员在实际工作中应加强工作责任心,预防不安全隐患,提高护理质量.%Objective:Nursing safety management is to ensure the quality of nursing, preventing and reducing is medical accidents and medical remedy the important link of the points.Methods:Through education and standardized management system safety measures to enhance safety management.Results:The nurse face,trivial,unsafe factors exist complex,directly affects patients recover from the disease,the implementation details,ensure the safety management of nursing care of patients.Conclusion:The nursing staff in actual work should strengthen the responsibility,prevent not safe hidden trouble,improve the quality of nursing.

  9. Oversight on the borderline: Quality improvement and pragmatic research.

    Science.gov (United States)

    Finkelstein, Jonathan A; Brickman, Andrew L; Capron, Alexander; Ford, Daniel E; Gombosev, Adrijana; Greene, Sarah M; Iafrate, R Peter; Kolaczkowski, Laura; Pallin, Sarah C; Pletcher, Mark J; Staman, Karen L; Vazquez, Miguel A; Sugarman, Jeremy

    2015-10-01

    Pragmatic research that compares interventions to improve the organization and delivery of health care may overlap, in both goals and methods, with quality improvement activities. When activities have attributes of both research and quality improvement, confusion often arises about what ethical oversight is, or should be, required. For routine quality improvement, in which the delivery of health care is modified in minor ways that create only minimal risks, oversight by local clinical or administrative leaders utilizing institutional policies may be sufficient. However, additional consideration should be given to activities that go beyond routine, local quality improvement to first determine whether such non-routine activities constitute research or quality improvement and, in either case, to ensure that independent oversight will occur. This should promote rigor, transparency, and protection of patients' and clinicians' rights, well-being, and privacy in all such activities. Specifically, we recommend that (1) health care organizations should have systematic policies and processes for designating activities as routine quality improvement, non-routine quality improvement, or quality improvement research and determining what oversight each will receive. (2) Health care organizations should have formal and explicit oversight processes for non-routine quality improvement activities that may include input from institutional quality improvement experts, health services researchers, administrators, clinicians, patient representatives, and those experienced in the ethics review of health care activities. (3) Quality improvement research requires review by an institutional review board; for such review to be effective, institutional review boards should develop particular expertise in assessing quality improvement research. (4) Stakeholders should be included in the review of non-routine quality improvement and quality improvement-related research proposals. Only by doing

  10. Hospital value-based purchasing (VBP) program: measurement of quality and enforcement of quality improvement.

    Science.gov (United States)

    Szablowski, Katarzyna M

    2014-01-01

    VBP program is a novel medicare payment estimatin tool used to encourage clinical care quality improvement as well as improvement of patient experience as a customer of a health care system. The program utilizes well established tools of measuring clinical care quality and patient satisfaction such as the hospital IQR program and HCAHPS survey to estimate Medicare payments and encourage hospitals to continuosly improve the level of care they provide. PMID:24600783

  11. Hospital value-based purchasing (VBP) program: measurement of quality and enforcement of quality improvement.

    Science.gov (United States)

    Szablowski, Katarzyna M

    2014-01-01

    VBP program is a novel medicare payment estimatin tool used to encourage clinical care quality improvement as well as improvement of patient experience as a customer of a health care system. The program utilizes well established tools of measuring clinical care quality and patient satisfaction such as the hospital IQR program and HCAHPS survey to estimate Medicare payments and encourage hospitals to continuosly improve the level of care they provide.

  12. Can the availability of unrestricted financial support improve the quality of care of thalassemics in a center with limited resources? A single center study from India

    Directory of Open Access Journals (Sweden)

    Prantar Chakrabarti

    2012-12-01

    Full Text Available Comprehensive management of thalassemia demands a multidisciplinary approach, sufficient financial resources, carefully developed expertise of the care givers, as well as significant compliance on the patients’ part. Studies exploring the utility of unrestricted financing within the existing infrastructure, for the management of thalassemia, particularly in the context of a developing country, are scarce. This study aimed to assess the impact of sponsored comprehensive care compared to the routine care of thalassemics provided at Institute of Haematology and Transfusion Medicine, Kolkata, India. Two hundred and twenty patients were selected for the study and distributed in two arms. Regular monthly follow up was done including a Health Related Quality of Life (HRQoL assessment with SF 36 v2 (validated Bengali version. Patients receiving sponsored comprehensive care showed a significant improvement in the mean hemoglobin levels and decrease in mean ferritin. HRQoL assessment revealed a better score in the physical domain though the mental health domain score was not significantly better at nine months. Unrestricted financial support in the form of comprehensive care has a positive impact on the thalassemia patients in a developing country not only in terms of clinical parameters but also in health related quality of life. 地中海贫血症的综合管理需要多学科的研究方法、充足的财政资源,护理人员应具备丰富的专业知识,并且患者应尽可能服从安排。探讨现有基础设施内无限制财政支持的实用性和地中海贫血症管理(尤其是在发展中国家)的研究甚少。 此研究旨在评估与印度加尔各答血液及输血医学会提供的地中海贫血症常规护理相比,综合护理对患者的影响 。 此研究筛选了 220名患者,并分为两组进行研究。每月定期跟进两组患者情况,包括使用第2版SF 36(经验证的孟加拉语版本)进行

  13. Strong Primary Care is that one which has instruments that allow measuring the quality it offers (to improve it continuously

    Directory of Open Access Journals (Sweden)

    Juan Gérvas

    2013-10-01

    de la de Estonia (país báltico, ex república soviética de la extinta dictadura comunista: en el primer caso logran realizarse plenamente, mientras que en el segundo quedan socialmente relegados2;• El aumento de las expectativas sociales en lo que respecta a salud y bienestar vital. Los individuos y poblaciones han visto cambios casi “milagrosos”, como una apendicitis intervenida quirúrgicamente y de forma indolora, o una crisis de depresión grave curada con la medicación correspondiente, o la vacuna infantil contra el sarampión, y por todo ello es fácil que esperen la progresiva eliminación de todo dolor, sufrimiento y enfermedad, e, incluso, la inmortalidad. Siguiendo esta lógica, lo que se espera es la juventud eterna. También han visto la transformación en la oferta de servicios, que se vuelven más inmediatos y accesibles; por ejemplo, el servicio a domicilio abarca desde libros comprados por Internet a comida encargada por teléfono. En esta lógica resulta absurda la existencia de “colas” (“listas de espera” para ser atendido en el sistema sanitario, o incluso el hecho de tener que desplazarse para recibir tales servicios.Los cambios señalados (y otros muchos más exigen la mejora en la respuesta sanitaria. Sobre todo, “piden” una Atención Primaria fuerte1,3. Tal Atención Primaria tiene instrumentos para medir la calidad de los servicios que ofrece y así poder introducir los cambios precisos con los que dar respuestas apropiadas a problemas cada vez más complejos. Barbara Starfield destacó en este campo, de elaboración de conceptos, medidas e instrumentos, para medir la calidad de los servicios prestados en Atención Primaria. Por ejemplo con el “Primary Care Assessment Tool” (PCATool4. Un buen ejemplo es el presente número de la “Revista de la Sociedad Brasileña de Medicina Familiar y Comunitaria”, donde se presentan los resultados prácticos de su aplicación en Brasil. Con ello se demuestra que la Atenci

  14. Current concept review: quality and process improvement in orthopedics

    Directory of Open Access Journals (Sweden)

    Pinney SJ

    2015-12-01

    Full Text Available Stephen J Pinney,1 Alexandra E Page,2 David S Jevsevar,3 Kevin J Bozic4 1Department of Orthopaedic Surgery, St Mary's Medical Center, San Francisco, CA, USA; 2Orthopaedic Surgery, AAOS Health Care Systems Committee, San Diego, CA, USA; 3Department of Orthopaedics, Geisel School of Medicine, Dartmouth University, Hanover, NH, USA; 4Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Austin, TX, USAAbstract: Multiple health care stakeholders are increasingly scrutinizing musculoskeletal care to optimize quality and cost efficiency. This has led to greater emphasis on quality and process improvement. There is a robust set of business strategies that are increasingly being applied to health care delivery. These quality and process improvement tools (QPITs have specific applications to segments of, or the entire episode of, patient care. In the rapidly changing health care world, it will behoove all orthopedic surgeons to have an understanding of the manner in which care delivery processes can be evaluated and improved. Many of the commonly used QPITs, including checklist initiatives, standardized clinical care pathways, lean methodology, six sigma strategies, and total quality management, embrace basic principles of quality improvement. These principles include focusing on outcomes, optimizing communication among health care team members, increasing process standardization, and decreasing process variation. This review summarizes the common QPITs, including how and when they might be employed to improve care delivery. Keywords: clinical care pathway, musculoskeletal care, outcomes, quality management, six sigma, lean thinking

  15. Development and testing of the Dementia Symptom Management at Home (DSM-H) program: An interprofessional home health care intervention to improve the quality of life for persons with dementia and their caregivers.

    Science.gov (United States)

    Brody, Abraham A; Guan, Carrie; Cortes, Tara; Galvin, James E

    2016-01-01

    Home health care agencies are increasingly taking care of sicker, older patients with greater comorbidities. However, they are unequipped to appropriately manage these older adults, particular persons living with dementia (PLWD). We therefore developed the Dementia Symptom Management at Home (DSM-H) Program, a bundled interprofessional intervention, to improve the care confidence of providers, and quality of care delivered to PLWD and their caregivers. We implemented the DSM-H with 83 registered nurses, physical therapists, and occupational therapists. Overall, there was significant improvement in pain knowledge (5.9%) and confidence (26.5%), depression knowledge (14.8%) and confidence (36.1%), and neuropsychiatric symptom general knowledge (16.8%), intervention knowledge (20.9%), attitudes (3.4%) and confidence (27.1%) at a statistical significance of (P < .0001). We also found significant differences between disciplines. Overall, this disseminable program proved to be implementable and improve clinician's knowledge and confidence in caring for PLWD, with the potential to improve quality of care and quality of life, and decrease costs. PMID:26922312

  16. Improving Demand-oriented Quality Care in Family Planning--A Review of Practice and Experience in Family Planning Programme of Qianjiang, Hubei

    Institute of Scientific and Technical Information of China (English)

    Jia-yuan LIAO; Meng-ye PENG; Er-sheng GAO

    2003-01-01

    @@ With the mainstreaming being the demand from the people at reproductive age, we systematically analyzed the ideas and ways to implement quality care (QC) in family planning (FP) in Qianjiang, including advocating the conception of quality care, carrying out health education and counseling, strengthening capacity building of service system and reforming measurement of the evaluation and other aspects. The demand-oriented QC in FP has met personalized and verified demands from people of reproductive age satisfactorily, and kept the fertility rate at a lower level while uplifting satisfaction of the public. The demand-oriented QC in FP in Qianjiang county proved to be a successful and great worth practice.

  17. Structuring diabetes care in general practices: many improvements, remaining challenges.

    LENUS (Irish Health Repository)

    Jennings, S

    2009-08-07

    BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.

  18. Carepaths: a framework for quality patient care

    International Nuclear Information System (INIS)

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

  19. Effective Marketing of Quality Child Care.

    Science.gov (United States)

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

    1984-01-01

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

  20. Dairy processing, Improving quality

    NARCIS (Netherlands)

    Smit, G.

    2003-01-01

    This book discusses raw milk composition, production and quality, and reviews developments in processing from hygiene and HACCP systems to automation, high-pressure processing and modified atmosphere packaging.

  1. The potential for integrated care programmes to improve quality of care as assessed by patients with COPD: early results from a real-world implementation study in The Netherlands

    Directory of Open Access Journals (Sweden)

    Jane Murray Cramm

    2012-09-01

    Full Text Available Objective: We investigated whether patients with chronic obstructive pulmonary disease (COPD who were enrolled in disease-management programmes (DMPs felt that they received a better quality of care than non-enrolled COPD patients.  Methods: Our cross-sectional study was performed among patients ('n' = 665 enrolled in four DMPs in The Netherlands. We also evaluated COPD patients ('n' = 227 not enrolled in such programmes. Patients' assessment of chronic-illness care (PACIC was measured with a 20-item questionnaire. The instrument had five pre-defined domains: patient activation (three items, delivery-system/practice design (three items, goal setting/tailoring (five items, problem solving/contextual (four items, and follow-up/coordination (five items.  Results: The mean overall PACIC score (scale: 1-5 of enrolled DMP patients was 2.94, and that of non-enrolled DMP patients was 2.73 ('p' ≤ 0.01. Differences in the same direction were found in the subscales of patient activation ('p' ≤ 0.01, delivery-system/practice design ('p' ≤ 0.001, and problem solving/contextual ('p' ≤ 0.001.  Conclusions: Our results suggest that even in the early stages of implementation, DMPs for COPD may significantly improve care.

  2. Narrative methods in quality improvement research.

    Science.gov (United States)

    Greenhalgh, T; Russell, J; Swinglehurst, D

    2005-12-01

    This paper reviews and critiques the different approaches to the use of narrative in quality improvement research. The defining characteristics of narrative are chronology (unfolding over time); emplotment (the literary juxtaposing of actions and events in an implicitly causal sequence); trouble (that is, harm or the risk of harm); and embeddedness (the personal story nests within a particular social, historical and organisational context). Stories are about purposeful action unfolding in the face of trouble and, as such, have much to offer quality improvement researchers. But the quality improvement report (a story about efforts to implement change), which is common, must be distinguished carefully from narrative based quality improvement research (focused systematic enquiry that uses narrative methods to generate new knowledge), which is currently none. We distinguish four approaches to the use of narrative in quality improvement research--narrative interview; naturalistic story gathering; organisational case study; and collective sense-making--and offer a rationale, describe how data can be collected and analysed, and discuss the strengths and limitations of each using examples from the quality improvement literature. Narrative research raises epistemological questions about the nature of narrative truth (characterised by sense-making and emotional impact rather than scientific objectivity), which has implications for how rigour should be defined (and how it might be achieved) in this type of research. We offer some provisional guidance for distinguishing high quality narrative research in a quality improvement setting from other forms of narrative account such as report, anecdote, and journalism. PMID:16326792

  3. Medicaid Adult Health Care Quality Measures

    Data.gov (United States)

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

  4. Enforcing Quality Metrics over Equipment Utilization Rates as Means to Reduce Centers for Medicare and Medicaid Services Imaging Costs and Improve Quality of Care

    Directory of Open Access Journals (Sweden)

    Amit Sura

    2011-01-01

    On examining quality metrics, such as appropriateness criteria and pre-authorization, promising results have ensued. The development and enforcement of appropriateness criteria lowers overutilization of studies without requiring unattainable fixed rates. Pre-authorization educates ordering physicians as to when imaging is indicated.

  5. Analysing Maternal Employment and Child Care Quality

    OpenAIRE

    Akgündüz, Yusuf

    2014-01-01

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

  6. TOTAL QUALITY AND WORK ORGANISATION IN HEALTH CARE FIRMS

    OpenAIRE

    Gianfranco Corio

    1997-01-01

    [The area of organisation is the one to work in so as to improve products/services in health care firms, and to establish the transformation of professional behaviour. The actions and roles of middle management as a strategic entity in the case of the set-up of programs for improvement based on Total Quality. Total Quality as a strategic factor in health care firms with regard to management and as a basic component for "purchasing" decisions made by external customers.

  7. Quality and safety in anesthesia and perioperative care

    CERN Document Server

    Ruskin, Keith J; Rosenbaum, Stanley H

    2016-01-01

    Quality and Safety in Anesthesia and Perioperative Care offers practical suggestions for improving quality of care and patient safety in the perioperative setting. The book highlights concepts such as situation awareness, staff resource management, threat and error management, checklists, explicit practices for monitoring, and safety culture. Quality and Safety in Anesthesia and Perioperative Care is a must-have resource for those preparing for the quality and safety questions on the American Board of Anesthesiology certification examinations and clinicians and trainees in all practice setting

  8. Reduced HIV symptoms and improved health-related quality of life correlate with better access to care for HIV-1 infected women: the ELLA study

    Directory of Open Access Journals (Sweden)

    Robert Baran

    2014-11-01

    Full Text Available Introduction: Global HIV-1 prevalence is 35.3 million [1]; women comprise >50% of those infected. The majority of women may lack regular care and only one-fourth are virologically suppressed [2]. ELLA is a cross-sectional, non-interventional study conducted across Europe, Latin America, Canada and Asia that describes barriers to care for HIV-infected women and associations with disease stage, symptoms and health-related quality of life (HRQoL. Methods: HIV-infected women eligible for ELLA (≥18 years completed: Barrier to Care Scale (BACS comprising 12 items in four domains (Index range 0–12, Overall range 1–4, greater=more barriers, Overall score ≥2 considered severe; AIDS Clinical Trials Group (ACTG Health Status Assessment comprising 21 items assessing 9 HRQoL domains (range 0–100, greater=better; and ACTG Symptom Distress Module comprising 20 symptoms rated on bother (range 0–4, greater=more bother. Healthcare providers documented medical history and HIV clinical data. Correlations of BACS response and last reported VL/CD4 count with HIV symptoms and HRQoL were analyzed. Spearman rank order was used to test correlations with statistical significance set at p50 years; 47.7% education <12 years; 36% unemployed; 82.9% urban residence. HIV was acquired heterosexually in 83.0%; 88.2% of subjects were on ART; 57.5% had VL<50 c/ml; mean CD4 was 540.5 c/µL. Mean [SD] BACS Index and Overall scores were 6.19 [3.47] (N=1818 and 2.09 [0.71] (N=1922, respectively. Stigma was a prominent barrier. Lower (better BACS Index and Overall scores correlated with better HRQoL on all nine domains (p<0.0001. Lower VL and greater CD4 count were both correlated with better HRQoL for eight of nine domains (p<0.04, p≤0.0002, respectively excepting pain. Lower BACS Index and Overall scores correlated with fewer symptom count and less symptom bother (p<0.0001. Fewer symptom count and less symptom bother correlated with better HRQoL on all nine domains (p<0

  9. The effect of a complementary e-learning course on implementation of a quality improvement project regarding care for elderly patients: a stepped wedge trial

    OpenAIRE

    Van de Steeg Lotte; Langelaan Maaike; Ijkema Roelie; Wagner Cordula

    2012-01-01

    Abstract Background Delirium occurs frequently in elderly hospitalised patients and is associated with higher mortality, increased length of hospital stay, functional decline, and admission to long-term care. Healthcare professionals frequently do not recognise delirium, indicating that education can play an important role in improving delirium care for hospitalised elderly. Previous studies have indicated that e-learning can provide an effective way of educating healthcare professionals and ...

  10. 落实优质护理提升服务质量%Implementing High Quality Care to Improve Service Quality

    Institute of Scientific and Technical Information of China (English)

    张玉莲; 刘红梅; 苟宁

    2012-01-01

    从改革护理管理体制,建立长效激励机制;改革护理工作模式,全面落实责任制整体护理;加强服务内涵建设,全面改善患者服务体验;构建科学管理机制,提高护理管理水平;建立多元化培训体系,强化护理队伍建设等方面,全面落实了优质护理,使患者、护士、医生及医院满意度显著提高.实践证明,开展优质护理不仅有利于护理质量的持续改进,也有利于整体医疗质量的全面提升.%We built up perfect and scientific management mechanisms, nursing staff increases effect incentive mechanism, job connotation construction mechanism, the diversified nursing team training mechanism, logistics guarantee mechanism etc. By reforming nursing management system and the nursing job pattern, we practiced the high quality nursing serves in all —direction. As a result, the patients', nurses', doctors' and our hospital's satisfaction degree increased evidently. It was proved that, the high grade nursing service was beneficial not only to nursing job, but also to the overall medical quality.

  11. Improving depression care: barriers, solutions, and research needs.

    Science.gov (United States)

    Von Korff, M; Katon, W; Unützer, J; Wells, K; Wagner, E H

    2001-06-01

    Potential solutions for barriers to improved organization of care of depressive illness were identified. These included (1) aligning efforts to improve depression care with broader strategies for improving care of other chronic conditions; (2) increasing the availability of depression case management services in primary care; (3) developing registries and reminder systems to ensure active follow-up of depressed patients; (4) achieving agreement on how depression outcomes should be measured to provide outcomes-based performance standards; (5) providing greater support from mental health specialists for management of depressed patients by primary care providers; (6) campaigns to reduce the stigma associated with treatment of depressive illness; (7) increased dissemination of interventions that activate and empower patients managing a depressive illness; (8) redefining the lack of time of primary care providers for high-quality depression care as issues in organization of care and provider training; and (9) development of incentives (organizational or financial) for high-quality depression care. Research needs were identified according to what has been learned to date. Identified research needs included: studies of approaches to organization of case management, research in new populations (e.g., new diagnostic groups, rural populations, the disadvantaged, the elderly, and those with chronic medical illnesses), research on stepped care and relapse prevention strategies, evaluation of the societal benefits of improved depression care, and multisite trials and meta-analytic approaches that can provide adequate statistical power to assess societal benefits of improved care.

  12. Is health care ready for Six Sigma quality?

    Science.gov (United States)

    Chassin, M R

    1998-01-01

    Serious, widespread problems exist in the quality of U.S. health care: too many patients are exposed to the risks of unnecessary services; opportunities to use effective care are missed; and preventable errors lead to injuries. Advanced practitioners of industrial quality management, like Motorola and General Electric, have committed themselves to reducing the frequency of defects in their business processes to fewer than 3.4 per million, a strategy known as Six Sigma Quality. In health care, quality problems frequently occur at rates of 20 to 50 percent, or 200,000 to 500,000 per million. In order to approach Six Sigma levels of quality, the health care sector must address the underlying causes of error and make important changes: adopting new educational models; devising strategies to increase consumer awareness; and encouraging public and private investment in quality improvement. PMID:9879303

  13. Is health care ready for Six Sigma quality?

    Science.gov (United States)

    Chassin, M R

    1998-01-01

    Serious, widespread problems exist in the quality of U.S. health care: too many patients are exposed to the risks of unnecessary services; opportunities to use effective care are missed; and preventable errors lead to injuries. Advanced practitioners of industrial quality management, like Motorola and General Electric, have committed themselves to reducing the frequency of defects in their business processes to fewer than 3.4 per million, a strategy known as Six Sigma Quality. In health care, quality problems frequently occur at rates of 20 to 50 percent, or 200,000 to 500,000 per million. In order to approach Six Sigma levels of quality, the health care sector must address the underlying causes of error and make important changes: adopting new educational models; devising strategies to increase consumer awareness; and encouraging public and private investment in quality improvement.

  14. Position of the American Dietetic Association: Liberalization of the diet prescription improves quality of life for older adults in long-term care.

    Science.gov (United States)

    Niedert, Kathleen C

    2005-12-01

    It is the position of the American Dietetic Association (ADA) that the quality of life and nutritional status of older residents in long-term care facilities may be enhanced by liberalization of the diet prescription. The Association advocates the use of qualified dietetics professionals to assess and evaluate the need for medical nutrition therapy according to each person's individual medical condition, needs, desires, and rights. In 2003, ADA designated aging as its second "emerging" area. Nutrition care in long-term settings must meet two goals: maintenance of health and promotion of quality of life. The Nutrition Care Process includes assessment of nutritional status through development of an individualized nutrition intervention plan. Medical nutrition therapy must balance medical needs and individual desires and maintain quality of life. The recent paradigm shift from restrictive institutions to vibrant communities for older adults requires dietetics professionals to be open-minded when assessing risks vs benefits of therapeutic diets, especially for frail older adults. Food is an essential component of quality of life; an unacceptable or unpalatable diet can lead to poor food and fluid intake, resulting in weight loss and undernutrition and a spiral of negative health effects. Facilities are adopting new attitudes toward providing care. "Person-centered" or "resident-centered care" involves residents in decisions about schedules, menus, and dining locations. Allowing residents to participate in diet-related decisions can provide nutrient needs, allow alterations contingent on medical conditions, and simultaneously increase the desire to eat and enjoyment of food, thus decreasing the risks of weight loss, undernutrition, and other potential negative effects of poor nutrition and hydration.

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

    OpenAIRE

    Duan, Xia; Shi, Yan

    2014-01-01

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

  16. Quality of Care in Historical Perspective.

    Science.gov (United States)

    Prochner, Larry

    1996-01-01

    Examines the quality of care in two mid-19th-century day nurseries in North America. Finds that quality was associated with saving children's lives within a context of charity-based social welfare. The concern for the health and safety of children led to the entrenchment of a custodial model of child care, which proved resilient into the 20th…

  17. NETWORKS AND QUALITY IMPROVEMENT

    Directory of Open Access Journals (Sweden)

    Miodrag Hadžistević

    2009-12-01

    Full Text Available Tools used in the past to analyze business value creation, such as value chain and process models, are simply too slow, inadequate, or inappropriate to address this new level of business complexity. In stead of that, company has to find way to create quality management system in a multi-layered supply chain. The problem can be solved by networking in the cluster. Cluster can be known as a competitive cooperation in the purpose to gain higher level of competitiveness and success. Bat there is another problem: Organization of the production process in a company is extremely complex process itself, and when we transfer it to the cluster level, we get a complex task which is difficult to solve. For that purpose, this paper analyses the conditions and possibilities that would enable those structures to adapt to changes in the surroundings - flexibility and management adequacy of production and organizational structures - by creating network value system.

  18. A collaborative quality improvement model and electronic community of practice to support sepsis management in emergency departments: investigating care harmonization for provincial knowledge translation.

    Science.gov (United States)

    Ho, Kendall; Marsden, Julian; Jarvis-Selinger, Sandra; Novak Lauscher, Helen; Kamal, Noreen; Stenstrom, Rob; Sweet, David; Goldman, Ran D; Innes, Grant

    2012-01-01

    Emergency medicine departments within several organizations are now advocating the adoption of early intervention guidelines for patients with the signs and symptoms of sepsis. This proposed research will lead to a comprehensive understanding of how diverse emergency department (ED) sites across British Columbia (BC), Canada, engage in a quality improvement collaborative to lead to improvements in time-based process measures and clinical outcomes for septic patients in EDs. To address the challenge of sepsis management, in 2007, the BC Ministry of Health began working with emergency health professionals, including health administrators, to establish a provincial ED collaborative: Evidence to Excellence (E2E). The E2E initiative employs the Institute for Healthcare Improvement (IHI) model and is supported by a Web-based community of practice (CoP) in emergency medicine. It aims to (1) support clinicians in accessing and applying evidence to clinical practice in emergency medicine, (2) support system change and clinical process improvement, and (3) develop resources and strategies to facilitate knowledge translation and process improvement. Improving sepsis management is one of the central foci of the E2E initiative. The primary purpose of our research is to investigate whether the application of sepsis management protocols leads to improved time-based process measures and clinical outcomes for patients presenting to EDs with sepsis. Also, we seek to investigate the implementation of sepsis protocols among different EDs. For example: (1) How can sepsis protocols be harmonized among different EDs? (2) What are health professionals' perspectives on interprofessional collaboration with various EDs? and (3) What are the factors affecting the level of success among EDs? Lastly, working in collaboration with the BC Ministry of Health as our policy-maker partner, the research will investigate how the demonstrated efficacy of this research can be applied on a provincial and

  19. 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

  20. Quality in the provision of headache care. 1

    DEFF Research Database (Denmark)

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

    2012-01-01

    Widely accepted quality indicators for headache care would provide a basis not only for assessment of care but also, and more importantly, for its improvement. The objective of the study was to identify and summarize existing information on such indicators: specifically, did indicators exist, how...

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

    OpenAIRE

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

    2013-01-01

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

  2. Quality and Profitability improvement by Technical Audit

    Directory of Open Access Journals (Sweden)

    Prof. Srivastava S. B.

    2009-10-01

    Full Text Available This paper is aimed for finding the Quality and Profitability Improvement by Technical Audit, through a case study and further establishing the relationship between the product quality, profitability and technical audit. Quality audit generates the report of non conformance which basically represents the deviation from committed quality of products, or in short, it may be called as postmortem of product quality. By virtue of quality audit, the commitment, implementation and follow up for product quality are aligned. This delivers a good quality of product to the customers and thus the customer is benefited. In industries, Quality Inspectors are giving their decision for quality of product in two categories, "ACCEPTED" or "REJECTED". The accepted products are coming to the customers and the rejected products become the burden / problem to the manufacturers.If accepted product quantity is within the “NORMS”, no one cares regarding the rejected product quantities, what so ever. When the rejected product quantity increases beyond the “NORMS”, the analysis process starts to find out the reasons of rejections. Sometimes, it becomes too late to search out the reasons of rejections and survival of the industry becomes a problem. By technical audit and audit report implementation such type of conditions can be avoided and controlled.Basically, Quality is the function of Man, Machine, Materials, Methods, Movement, Manufacturing Processes, Monitoring and Management (8 M’s. If the technicality of 8 M’s is corrected by Technical Audit, the product quality will improve automatically and the profitability of the organization will improve. In short it can be solicited that if 8 M’s are all right, the product quality and profitability will automatically be set right. This may become an important aspect in the scenario of Indian Industries. The findings are supported by a case study of a Process Plant (Slag Dryer of a reputed Indian Industry.

  3. Accelerating patient-care improvement in the ED.

    Science.gov (United States)

    Forrester, Nancy E

    2003-08-01

    Quality improvement is always in the best interest of healthcare providers. One hospital examined the patient-care delivery process used in its emergency department to determine ways to improve patient satisfaction while increasing the effectiveness and efficiency of healthcare delivery. The hospital used activity-based costing (ABC) plus additional data related to rework, information opportunity costs, and other effectiveness measures to create a process map that helped it accelerate diagnosis and improve redesign of the care process. PMID:12938618

  4. Big data analytics to improve cardiovascular care: promise and challenges.

    Science.gov (United States)

    Rumsfeld, John S; Joynt, Karen E; Maddox, Thomas M

    2016-06-01

    The potential for big data analytics to improve cardiovascular quality of care and patient outcomes is tremendous. However, the application of big data in health care is at a nascent stage, and the evidence to date demonstrating that big data analytics will improve care and outcomes is scant. This Review provides an overview of the data sources and methods that comprise big data analytics, and describes eight areas of application of big data analytics to improve cardiovascular care, including predictive modelling for risk and resource use, population management, drug and medical device safety surveillance, disease and treatment heterogeneity, precision medicine and clinical decision support, quality of care and performance measurement, and public health and research applications. We also delineate the important challenges for big data applications in cardiovascular care, including the need for evidence of effectiveness and safety, the methodological issues such as data quality and validation, and the critical importance of clinical integration and proof of clinical utility. If big data analytics are shown to improve quality of care and patient outcomes, and can be successfully implemented in cardiovascular practice, big data will fulfil its potential as an important component of a learning health-care system. PMID:27009423

  5. Big data analytics to improve cardiovascular care: promise and challenges.

    Science.gov (United States)

    Rumsfeld, John S; Joynt, Karen E; Maddox, Thomas M

    2016-06-01

    The potential for big data analytics to improve cardiovascular quality of care and patient outcomes is tremendous. However, the application of big data in health care is at a nascent stage, and the evidence to date demonstrating that big data analytics will improve care and outcomes is scant. This Review provides an overview of the data sources and methods that comprise big data analytics, and describes eight areas of application of big data analytics to improve cardiovascular care, including predictive modelling for risk and resource use, population management, drug and medical device safety surveillance, disease and treatment heterogeneity, precision medicine and clinical decision support, quality of care and performance measurement, and public health and research applications. We also delineate the important challenges for big data applications in cardiovascular care, including the need for evidence of effectiveness and safety, the methodological issues such as data quality and validation, and the critical importance of clinical integration and proof of clinical utility. If big data analytics are shown to improve quality of care and patient outcomes, and can be successfully implemented in cardiovascular practice, big data will fulfil its potential as an important component of a learning health-care system.

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

    Science.gov (United States)

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

    1988-01-01

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

  7. Schizophrenia in the Netherlands: Continuity of Care with Better Quality of Care for Less Medical Costs

    Science.gov (United States)

    van der Lee, Arnold; de Haan, Lieuwe; Beekman, Aartjan

    2016-01-01

    Background Patients with schizophrenia need continuous elective medical care which includes psychiatric treatment, antipsychotic medication and somatic health care. The objective of this study is to assess whether continuous elective psychiatric is associated with less health care costs due to less inpatient treatment. Methods Data concerning antipsychotic medication and psychiatric and somatic health care of patients with schizophrenia in the claims data of Agis Health Insurance were collected over 2008–2011 in the Netherlands. Included were 7,392 patients under 70 years of age with schizophrenia in 2008, insured during the whole period. We assessed the relationship between continuous elective psychiatric care and the outcome measures: acute treatment events, psychiatric hospitalization, somatic care and health care costs. Results Continuous elective psychiatric care was accessed by 73% of the patients during the entire three year follow-up period. These patients received mostly outpatient care and accessed more somatic care, at a total cost of €36,485 in three years, than those without continuous care. In the groups accessing fewer or no years of elective care 34%-68% had inpatient care and acute treatment events, while accessing less somatic care at average total costs of medical care from €33,284 to €64,509. Conclusions Continuous elective mental and somatic care for 73% of the patients with schizophrenia showed better quality of care at lower costs. Providing continuous elective care to the remaining patients may improve health while reducing acute illness episodes. PMID:27275609

  8. Quality Rating and Improvement Systems and Children's Cognitive Development

    Science.gov (United States)

    Jeon, Lieny; Buettner, Cynthia K.

    2015-01-01

    Background: Providing enriched learning environments is important to stimulating children's development in early childhood. Early child-care policymakers in many states in the US have adopted Quality Rating and Improvement Systems (QRIS) as a way to verify quality of child care and to support children's school readiness. Objective: The purpose of…

  9. Designing a quality improvement intervention: a systematic approach

    OpenAIRE

    Bokhoven, M.A. van; Kok, G.; Van der Weijden, T.

    2003-01-01

    

 Most quality improvement or change management interventions are currently designed intuitively and their results are often disappointing. While improving the effectiveness of interventions requires systematic development, no specific methodology for composing intervention strategies and programmes is available. This paper describes the methodology of systematically designing quality of care improvement interventions, including problem analysis, intervention design and pretests. Several the...

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

    OpenAIRE

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

    2014-01-01

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

  11. Scaling up the Quality of Care Approach

    Institute of Scientific and Technical Information of China (English)

    XieZhenming

    2005-01-01

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

  12. Rice Quality Improvement in China

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ 1. Demand for high quality rice in China Rice is the leading cereal crop that contributes about 40% of the national grain production in China. The total output and areas rank the first and the second position in the world, respectively. In recent years, rice production grows steadily, but the quality improvement has been lagged and the quality becomes a limiting factor. As the grain supply exceeding the demand and the grain price plummeted, the State Council put forward expanding China′ s ongoing reform of the grain distribution system in 1998. Along with the foodstuff circulating system reform and market driving, the structure of rice production is adjusted,the planting acreage of early indica rice with poor quality decreased, and that of japonica rice in north China with good quality increased. With the challenge of China joining the WTO, Chinese government starts to pay premium on good quality rice.

  13. Mobile phones improve antenatal care attendance in Zanzibar

    DEFF Research Database (Denmark)

    Lund, Stine; Nielsen, Birgitte B; Hemed, Maryam;

    2014-01-01

    BACKGROUND: Applying mobile phones in healthcare is increasingly prioritized to strengthen healthcare systems. Antenatal care has the potential to reduce maternal morbidity and improve newborns' survival but this benefit may not be realized in sub-Saharan Africa where the attendance and quality...... measure was four or more antenatal care visits during pregnancy. Secondary outcome measures were tetanus vaccination, preventive treatment for malaria, gestational age at last antenatal care visit, and antepartum referral. RESULTS: The mobile phone intervention was associated with an increase in antenatal...... care attendance. In the intervention group 44% of the women received four or more antenatal care visits versus 31% in the control group (OR, 2.39; 95% CI, 1.03-5.55). There was a trend towards improved timing and quality of antenatal care services across all secondary outcome measures although...

  14. Quality improvement in neurology: dementia management quality measures.

    Science.gov (United States)

    Odenheimer, Germaine; Borson, Soo; Sanders, Amy E; Swain-Eng, Rebecca J; Kyomen, Helen H; Tierney, Samantha; Gitlin, Laura; Forciea, Mary Ann; Absher, John; Shega, Joseph; Johnson, Jerry

    2014-03-01

    Professional and advocacy organizations have long urged that dementia should be recognized and properly diagnosed. With the passage of the National Alzheimer's Project Act in 2011, an Advisory Council for Alzheimer's Research, Care, and Services was convened to advise the Department of Health and Human Services. In May 2012, the Council produced the first National Plan to address Alzheimer's disease, and prominent in its recommendations is a call for quality measures suitable for evaluating and tracking dementia care in clinical settings. Although other efforts have been made to set dementia care quality standards, such as those pioneered by RAND in its series Assessing Care of Vulnerable Elders (ACOVE), practitioners, healthcare systems, and insurers have not widely embraced implementation. This executive summary (full manuscript available at www.neurology.org) reports on a new measurement set for dementia management developed by an interdisciplinary Dementia Measures Work Group (DWG) representing the major national organizations and advocacy organizations concerned with the care of individuals with dementia. The American Academy of Neurology (AAN), the American Geriatrics Society, the American Medical Directors Association, the American Psychiatric Association, and the American Medical Association-convened Physician Consortium for Performance Improvement led this effort. The ACOVE measures and the measurement set described here apply to individuals whose dementia has already been identified and properly diagnosed. Although similar in concept to ACOVE, the DWG measurement set differs in several important ways; it includes all stages of dementia in a single measure set, calls for the use of functional staging in planning care, prompts the use of validated instruments in patient and caregiver assessment and intervention, highlights the relevance of using palliative care concepts to guide care before the advanced stages of illness, and provides evidence-based support

  15. Quality of care in sickle cell disease

    Science.gov (United States)

    Evensen, Christian T.; Treadwell, Marsha J.; Keller, San; Levine, Roger; Hassell, Kathryn L.; Werner, Ellen M.; Smith, Wally R.

    2016-01-01

    Abstract Documented deficiencies in adult sickle cell disease (SCD) care include poor access to knowledgeable providers and inadequate treatment in emergency departments (EDs). The aim of this study was to create patient-reported outcome measures of the quality of ambulatory and ED care for adults with SCD. We developed and pilot tested SCD quality of care questions consistent with Consumer Assessments of Healthcare Providers and Systems surveys. We applied psychometric methods to develop scores and evaluate reliability and validity. The participants of this study were adults with SCD (n = 556)—63% aged 18 to 34 years; 64% female; 64% SCD-SS—at 7 US sites. The measure used was Adult Sickle Cell Quality of Life Measurement information system Quality of Care survey. Most participants (90%) reported at least 1 severe pain episode (pain intensity 7.8 ± 2.3, 0–10 scale) in the past year. Most (81%) chose to manage pain at home rather than the ED, citing negative ED experiences (83%). Using factor analysis, we identified Access, Provider Interaction, and ED Care composites with reliable scores (Cronbach α 0.70–0.83) and construct validity (r = 0.32–0.83 correlations with global care ratings). Compared to general adult Consumer Assessments of Healthcare Providers and Systems scores, adults with SCD had worse care, adjusted for age, education, and general health. Results were consistent with other research reflecting deficiencies in ED care for adults with SCD. The Adult Sickle Cell Quality of Life Measurement Quality of Care measure is a useful self-report measure for documenting and tracking disparities in quality of SCD care. PMID:27583862

  16. Improving Customer Service in Elderly Care

    OpenAIRE

    Nielsen, Chris

    2015-01-01

    The elderly care sector is increasingly facing more competition and demanding customers. This leads to a growing pressure on elderly care home providers to find new and improved solutions that will enhance their level of customer service. The will ensure that the elderly service provider is remaining competitive in the elderly care service marketplace. The purpose of this thesis is to identify areas for improvements and propose implementable solutions for enhancing the elderly care custom...

  17. Monitoring and improving care in thoracic surgery

    OpenAIRE

    Numan, R.C.

    2016-01-01

    Quality of Care (QoC) plays a central role in the way healthcare is delivered. In the world of thoracic surgery for lung cancer, surgeons are faced with complex and sometimes high-risk surgical resections on an aging patient population with an increasing incidence of frail physical health. This increasing complexity demands a multidisciplinary approach rearranging pre-, peri- and postoperative care in a way safety, efficiency and high quality are guaranteed. The safety and quality of healthca...

  18. Improving organizational climate for excellence in patient care.

    Science.gov (United States)

    Arnold, Edwin

    2013-01-01

    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance. PMID:23903945

  19. Improving organizational climate for excellence in patient care.

    Science.gov (United States)

    Arnold, Edwin

    2013-01-01

    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance.

  20. The potential for integrated care programmes to improve quality of care as assessed by patients with COPD: early results from a real-world implementation study in The Netherlands

    NARCIS (Netherlands)

    J.M. Cramm (Jane); M.P.M.H. Rutten-van Mölken (Maureen); A.P. Nieboer (Anna)

    2012-01-01

    textabstractObjective: We investigated whether patients with chronic obstructive pulmonary disease (COPD) who were enrolled in disease-management programmes (DMPs) felt that they received a better quality of care than non-enrolled COPD patients. Methods: Our cross-sectional study was performed among

  1. Social support during intensive care unit stay might improve mental impairment and consequently health-related quality of life in survivors of severe acute respiratory distress syndrome

    OpenAIRE

    Deja, Maria; Denke, Claudia; Weber-Carstens, Steffen; Schröder, Jürgen; Pille, Christian E; Hokema, Frank; Falke, Konrad J; Kaisers, Udo

    2006-01-01

    Introduction We investigated health-related quality of life (HRQoL) and persistent symptoms of post-traumatic stress disorder (PTSD) in long-term survivors of acute respiratory distress syndrome (ARDS). We wished to evaluate the influence of PTSD on HRQoL and to investigate the influence of perceived social support during intensive care unit (ICU) treatment on both PTSD symptoms and HRQoL. Methods In ARDS patients we prospectively measured HRQoL (Medical Outcomes Study 36-Item Short Form; SF-...

  2. An electronic dashboard to improve nursing care.

    Science.gov (United States)

    Tan, Yung-Ming; Hii, Joshua; Chan, Katherine; Sardual, Robert; Mah, Benjamin

    2013-01-01

    With the introduction of CPOE systems, nurses in a Singapore hospital were facing difficulties monitoring key patient information such as critical tasks and alerts. Issues include unfriendly user interfaces of clinical systems, information overload, and the loss of visual cues for action due to paperless workflows. The hospital decided to implement an interactive electronic dashboard on top of their CPOE system to improve visibility of vital patient data. A post-implementation survey was performed to gather end-user feedback and evaluate factors that influence user satisfaction of the dashboard. Questionnaires were sent to all nurses of five pilot wards. 106 valid responses were received. User adoption was good with 86% of nurses using the dashboard every shift. Mean satisfaction score was 3.6 out of 5. User satisfaction was strongly and positively correlated to the system's perceived impact on work efficiency and care quality. From qualitative feedback, nurses generally agreed that the dashboard had improved their awareness of critical patient issues without the hassle of navigating a CPOE system. This study shows that an interactive clinical dashboard when properly integrated with a CPOE system could be a useful tool to improve daily patient care. PMID:23920542

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

    Science.gov (United States)

    Kiguli, Julie; Ekirapa-Kiracho, Elizabeth; Okui, Olico; Mutebi, Aloysius; Macgregor, Hayley; Pariyo, George William

    2009-01-01

    This paper examines the community's perspectives and perceptions on quality of health care delivery in two Uganda districts. The paper addresses community concerns on service quality. It focuses on the poor because they are a vulnerable group and often bear a huge burden of disease. Community views were solicited and obtained using eight focus group discussions, six in-depth and 12 key informant interviews. User perceptions and definitions of the quality of health services depended on a number of variables related to technical competence, accessibility to services, interpersonal relations and presence of adequate drugs, supplies, staff, and facility amenities. Results indicate that service delivery to the poor in the general population is perceived to be of low quality. The factors that were mentioned as affecting the quality of services delivered were inadequate trained health workers, shortage of essential drugs, poor attitude of the health workers, and long distances to health facilities. This paper argues that there should be an improvement in the quality of health services with particular attention being paid to the poor. Despite wide focus on improvement of the existing infrastructure and donor funding, there is still low satisfaction with health services and poor perceived accessibility. PMID:19936148

  4. Molecular imaging in quality health care

    International Nuclear Information System (INIS)

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

  5. 基层医院提高基础护理质量的管理策略%Management strategies of improving the quality of basic nursing care in the grass - roots hospital

    Institute of Scientific and Technical Information of China (English)

    郑珊红

    2011-01-01

    Objective: To explore the management strategies of improving the quality of basic nursing care in the grass -roots hospital. Methods: The new strategies of basic nursing care was applied to 40 patients in the observation group in accordance with the requirements of high quality nursing engineering and basic nursing care was given to the 40 patients in the control group by following the traditional method of nursing care management. The quality of nursing care, patient's satisfaction and complaints, adverse events and the rate of nosocomial infection were analyzed in both groups. Results: The quality of basic nursing care and patient's satisfaction was significantly higher and the number of complaints, adverse events and the rate of noscomial infection were obviously fewer and lower in the observation group than those in the control group ( P < 0.05 ). Conclusion: The effective quality control strategies of basic nursing care are the effective measures to improve the quality of basic nursing care.%目的:探讨基层医院提高基础护理质量的管理对策.方法:将观察组40例患者按照优质护理服务工程要求,实施新的基础护理质量控制策略,强化落实基础护理.将对照组40例按照传统的护理管理方法实施基础护理.分析两组患者基础护理质量、护理工作满意度、护理投诉、不良事件、医院感染率等情况.结果:实验组基础护理质量、患者满意度明显高于对照组,护理投诉和不良事件例数、医院感染率明显低于对照组(P<0.05).结论:有效的基础护理质量控制策略,是提高基础护理质量的有效措施.

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

    Science.gov (United States)

    Fiscella, Kevin; Sanders, Mechelle R

    2016-01-01

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

  7. Quality of newborn care at birth

    OpenAIRE

    Becker, AJ; Marchant, T

    2014-01-01

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

  8. Predictors of Quality in Family Child Care

    Science.gov (United States)

    Doherty, Gillian; Forer, Barry; Lero, Donna S.; Goelman, Hillel; LaGrange, Annette

    2006-01-01

    This study of 231 regulated family child care providers proposed a theoretical model to explore the effects on quality of: (1) provider level of general education; (2) provider degree of intentionality; (3) provider training and experience in family child care; (4) provider use of support services; and (5) provider work environment. Hierarchical…

  9. Analysing Maternal Employment and Child Care Quality

    NARCIS (Netherlands)

    Akgündüz, Yusuf

    2014-01-01

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

  10. IMPROVING QUALITY MANAGEMENT IN PANIFICATION

    Directory of Open Access Journals (Sweden)

    Cornelia Petroman

    2010-12-01

    Full Text Available Consumers of panification products (as well as consumers of any other type of product or service are concerned about the quality of the products they purchase. Implementing the quality management system in the food industry is not compulsory, but it can bring about numerous, palpable benefits, particularly in reducing the amount of acryl amide. It is a modern system allowing the management analysis aiming at checking and reaching the goals to define new objectives, and the continuous improvement of the quality of processes and products.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

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

    Science.gov (United States)

    Holthof, B

    1991-08-01

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

  13. Guidelines for appraisal and publication of PDSA quality improvement.

    Science.gov (United States)

    Speroff, Theodore; James, Brent C; Nelson, Eugene C; Headrick, Linda A; Brommels, Mats

    2004-01-01

    Plan-do-study-act (PDSA) quality improvement is the application of the scientific method to implement and test the effects of change ideas on the performance of the health care system. Users of quality improvement could benefit with markers to gauge the "best" science. Four core questions can determine the value of a quality improvement study: Is the quality improvement study pertinent and relevant? Are the results valid? Are appropriate criteria used to interpret the results? Will the study help you with your practice or organization of care? A set of guidelines is provided to help answer these questions. Similar guidelines exist for randomized clinical trials and clinical-epidemiologic observational studies. Analogous to these existing research guidelines, the PDSA quality improvement guidelines will provide researchers and reviewers with succinct standards of methodological rigor to assist in critical appraisal of quality improvement protocols and publications.

  14. Quality of care in Crohn’s disease

    Institute of Scientific and Technical Information of China (English)

    Govind; K; Makharia

    2014-01-01

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

  15. Practice of High-Quality Care to Improve the Quality of Pediatric Out-Patient Infusion%践行优质护理提高儿科门诊输液质量

    Institute of Scientific and Technical Information of China (English)

    牛倩; 张玉莲; 张西嫔

    2012-01-01

    如何在门诊开展优质护理是值得探讨的课题.主要从以下几方面实行了优质护理:组织学习,认真领会优质护理精神;改革护理服务模式,落实区域责任包干制;改革护士排班模式,明确职责;落实基础护理;建立健全绩效考核制度等.%How to carry out high - quality care in outpatient is a worth discussing topic* High - quality care was implemented mainly from the following aspects: organizational learning to seriously understand the quality care mentally; reform of the care model v and the implementation of regional responsibility contract system; reform of the nurse scheduling model, and a clear mandate; the implementation of basic nursing care; establishment of a sound performance appraisal system.

  16. Quality Improvement Practices and Trends

    DEFF Research Database (Denmark)

    Dahlgaard, Jens J.; Hartz, Ove; Edgeman, Rick L.

    1998-01-01

    professor, as well as key individuals from various industries. In addition to the above activities, Rick will be working with the European Foundation for Quality Management on their "European Master's Programme in Total Quality Management." That program involves a consortium of European universities. Rick......The following article, "Quality Improvement Practices and Trends in Denmark," is the first in a series of papers arranged for and co-authored by Dr. Rick L. Edgeman. Rick is a member of QE's Editorial Board and is on sabbatical from Colorado State University. During the year, Rick and his family...... has begun the process of developing a comparable consortium of American universities for the same purpose-- an activity which is cosponsored by the Education Division of the American Society for Quality (ASQ)....

  17. Continuous improvement of software quality

    Energy Technology Data Exchange (ETDEWEB)

    Sivertsen, Terje

    1999-04-15

    The present report is the first Halden Work Report delivered from the OECD Halden Reactor Project's research activity on formal methods and software quality. Of particular concern in this activity is to reach a consensus between regulators, licensees and the nuclear industry on questions related to the effective, industrial use of formal methods. The report gives considerable attention to the importance of continuous improvement as a characteristic of a living software quality system, and to the need of providing a basis for software process/product quality integration. In particular, the report discusses these aspects from the perspectives of defect prevention, formal methods, Total Quality Management (TQM), and Bayesian Belief Nets. Another concern is to promote controlled experiments on the use of new methods, techniques, and tools. This is achieved partly by reviewing suggestions on the collection and experimental use of data, and by surveying a number of metrics believed to have some potential for comparison studies (author) (ml)

  18. Evaluating the effectiveness of a multifaceted, multilevel continuous quality improvement program in primary health care: developing a realist theory of change

    OpenAIRE

    Schierhout, Gill; Hains, Jennifer; Si, Damin; Kennedy, Catherine; Cox, Rhonda; Kwedza, Ru; O’Donoghue, Lynette; Fittock, Marea; Brands, Jenny; Lonergan, Katherine; Dowden, Michelle; Bailie, Ross

    2013-01-01

    Background Variation in effectiveness of continuous quality improvement (CQI) interventions between services is commonly reported, but with little explanation of how contextual and other factors may interact to produce this variation. Therefore, there is scant information available on which policy makers can draw to inform effective implementation in different settings. In this paper, we explore how patterns of change in delivery of services may have been achieved in a diverse range of health...

  19. Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members

    OpenAIRE

    Kimberly Ramsbottom; Mary Lou Kelley

    2014-01-01

    Long term care (LTC) homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP) important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descript...

  20. Evidence-based medicine and quality of care.

    Science.gov (United States)

    Dickenson, Donna; Vineis, Paolo

    2002-01-01

    In this paper we set out to examine the arguments for and against the claim that Evidence-Based Medicine (EBM) will improve the quality of care. In particular, we examine the following issues: 1. Are there hidden ethical assumptions in the methodology of EBM? 2. Is there a tension between the duty of care and EBM? 3. How can patient preferences be incorporated into quality guidelines and effectiveness studies? 4. Is there a tension between the quality of a particular intervention and overall quality of care? 5. Are certain branches of medicine and patient groups innately or prima facie disadvantaged by a shift to EBM? In addition we consider a case study in the ethics of EBM, on a clinical trial concerning the collection of umbilical cord blood in utero and ex utero, during or after labour in childbirth.

  1. The Improvement of Services Quality

    Directory of Open Access Journals (Sweden)

    Cristian-Ştefan Craciun

    2013-01-01

    Full Text Available In the last decades, there was a strong national and international tendency to increase the services role in the economic social life. The technical progress, the enhancing social division of labor and the increase of demand both from the population and entrepreneurs led to the services development and diversification. Due to the recent radical changes in all economic, political and social fields, the economic agents’ goal to gain a rapid and substantial profit was gradually replaced by the fierce struggle for quality domination among competitors. Therefore, there is an increasing need to find more effective ways to improve the services quality, such as training and motivating the staff and implementing a quality management system.

  2. A Model to Improve the Quality Products

    Directory of Open Access Journals (Sweden)

    Hasan GOKKAYA

    2010-08-01

    Full Text Available The topic of this paper is to present a solution who can improve product qualityfollowing the idea: “Unlike people who have verbal skills, machines use "sign language"to communicate what hurts or what has invaded their system’. Recognizing the "signs"or symptoms that the machine conveys is a required skill for those who work withmachines and are responsible for their care and feeding. The acoustic behavior of technical products is predominantly defined in the design stage, although the acoustic characteristics of machine structures can be analyze and give a solution for the actual products and create a new generation of products. The paper describes the steps intechnological process for a product and the solution who will reduce the costs with the non-quality of product and improve the management quality.

  3. Shipbuilding pipeline production quality improvement

    Directory of Open Access Journals (Sweden)

    T. Buksa

    2010-06-01

    Full Text Available Purpose: The pipeline production is one of major processes in shipbuilding industry. Quality improvement and risk assessment in this process can yield significant savings, both in terms of internal quality costs as well as in terms of customer satisfactions.Design/methodology/approach: Shipbuilding pipeline production quality improvement has been carried out by application of FMEA (Failure Mode and Effect Analysis method. For the successful implementation of FMEA method it is necessary to identify process failure modes or possibility of the appearance of non-compliance, as well as their possible causes. For qualitative analysis of key input variables of the process, in the paper is used Ishikawa diagram and p-chart.Findings: It is shown that proposed approach to risk assessment in shipbuilding pipeline production is applicable to real casa scenario. The analysis has identified the points in the process with the highest probability of occurrence of nonconformities, or the highest risk for error.Research limitations/implications: As the experimenting has been conducted in shipyard, within production process, research schedule must have been set in accordance with production pace. Also, due to character of production process the data collecting was adopted to the production plan in that particular moment.Practical implications: Dealing with causes of potential nonconformities in the process can significantly contribute to the reliability and robustness of the process. Corrective actions that have been taken based on results of analysis significantly contributed to the level of quality in the pipeline production process.Originality/value: The pepper is dealing with a well known method applied in different production environment that are mostly conservative in production approach. It was shown that successful application of proposed approach can yield benefits especially in improved quality of produced pipelines within shipbuilding industry.

  4. Engaging Clinical Nurses in Quality Improvement Projects.

    Science.gov (United States)

    Moore, Susan; Stichler, Jaynelle F

    2015-10-01

    Clinical nurses have the knowledge and expertise required to provide efficient and proficient patient care. Time and knowledge deficits can prevent nurses from developing and implementing quality improvement or evidence-based practice projects. This article reviews a process for professional development of clinical nurses that helped them to define, implement, and analyze quality improvement or evidence-based practice projects. The purpose of this project was to educate advanced clinical nurses to manage a change project from inception to completion, using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) Change Acceleration Process as a framework. One-to-one mentoring and didactic in-services advanced the knowledge, appreciation, and practice of advanced practice clinicians who completed multiple change projects. The projects facilitated clinical practice changes, with improved patient outcomes; a unit cultural shift, with appreciation of quality improvement and evidence-based projects; and engagement with colleagues. Project outcomes were displayed in poster presentations at a hospital exposition for knowledge dissemination. PMID:26430867

  5. Accountability for quality of care: Monitoring all aspects of quality across a framework adapted for action.

    Science.gov (United States)

    Hulton, Louise; Matthews, Zoë; Bandali, Sarah; Izge, Abubakar; Daroda, Ramatu; Stones, William

    2016-01-01

    Quality of care is essential to maternal and newborn survival. The multidimensional nature of quality of care means that frameworks are useful for capturing it. The present paper proposes an adaptation to a widely used quality of care framework for maternity services. The framework subdivides quality into two inter-related dimensions-provision and experience of care-but suggests adaptations to reflect changes in the concept of quality over the past 15years. The application of the updated framework is presented in a case study, which uses it to measure and inform quality improvements in northern Nigeria across the reproductive, maternal, newborn, and child health continuum of care. Data from 231 sampled basic and comprehensive emergency obstetric and newborn care (BEmONC and CEmONC) facilities in six northern Nigerian states showed that only 35%-47% of facilities met minimum quality standards in infrastructure. Standards for human resources performed better with 49%-73% reaching minimum standards. A framework like this could form the basis for a certification scheme. Certification offers a practical and concrete opportunity to drive quality standards up and reward good performance. It also offers a mechanism to strengthen accountability. PMID:26723043

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

  8. Adherence and quality of care in IBD

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  9. The emerging EU quality of care policy

    DEFF Research Database (Denmark)

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

    2013-01-01

    Despite the fact that Member States and many citizens of the EU like to keep healthcare a foremost national competence and the EU treaties state that Member States remain primarily responsible for the organization and delivery of health care services, the European Union (EU) has expanded its...... involvement in healthcare policy over the last twenty years. Based on interviews and document and literature analysis we show that the scope of EU involvement has widened from public health and access to care, to quality of care. In this paper we concentrate on the latter. Focusing on the recent EU...

  10. [Strategies for improving care of oncologic patients: SHARE Project results].

    Science.gov (United States)

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients.

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

    NARCIS (Netherlands)

    A.M. van Dishoeck (Anne-Margreet)

    2015-01-01

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

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

  13. Examining Pre-School Classroom Quality in a Statewide Quality Rating and Improvement System

    Science.gov (United States)

    Jeon, Lieny; Buettner, Cynthia K.; Hur, Eunhye

    2014-01-01

    Background: Research has documented the importance of high-quality early childhood experiences in preparing children for school. Quality rating and improvement systems (QRIS) have recently emerged in many states as a way to build quality of child care and to promote better child outcomes. Objective: The goal of this study was to determine if…

  14. 提高临床护理管理质量避免护患纠纷的体会%Experience for improving the quality of clinical care management to avoid nursing disputes

    Institute of Scientific and Technical Information of China (English)

    程凤丽

    2014-01-01

    Objective:To investigate the relationship between the quality of clinical care management and nurse-patient disputes. Methods:The clinical reasons for complaint in care management quality were analyzed and summarized. Results:The complaint focused on medical fees, service attitude, communication skills, legal awareness and business skills. Conclusion:To improve the quality of clinical care management is the key to reduce the nurse-patient disputes.%目的:探讨临床护理管理质量与护患纠纷的关系。方法:对临床护理管理质量方面的投诉原因进行分析、总结。结果:投诉主要集中在医疗收费、服务态度、沟通技巧、法律意识及业务能力。结论:提高临床护理管理质量是减少护患纠纷的关键。

  15. The organization of multidisciplinary care teams: modeling internal and external influences on cancer care quality.

    Science.gov (United States)

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

    2010-01-01

    Quality cancer treatment depends upon careful coordination between multiple treatments and treatment providers, the exchange of technical information, and regular communication between all providers and physician disciplines involved in treatment. This article will examine a particular type of organizational structure purported to regularize and streamline the communication between multiple specialists and support services involved in cancer treatment: the multidisciplinary treatment care (MDC) team. We present a targeted review of what is known about various types of MDC team structures and their impact on the quality of treatment care, and we outline a conceptual model of the connections between team context, structure, process, and performance and their subsequent effects on cancer treatment care processes and patient outcomes. Finally, we will discuss future research directions to understand how MDC teams improve patient outcomes and how characteristics of team structure, culture, leadership, and context (organizational setting and local environment) contribute to optimal multidisciplinary cancer care.

  16. Integration of quality improvement and cost-efficiency through industrial improvement techniques

    OpenAIRE

    Vink, Jasper

    2016-01-01

    Jasper P Vink,1 Maxime T Rigaudy,1,2 Karl O Elmqvist11Imperial College Business School, Imperial College London, London, 2Hull York Medical School, York, UKIn this journal, Crema and Verbano1 discussed the importance of defining quality of health care and how quality can be improved through various industrial instruments and techniques. Quality of health care is a heavily debated topic that requires a wide scope of considerations across the many stakeholders of the health system. We acknowled...

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

    OpenAIRE

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ed Kelley

    2004-07-01

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

  19. Power Quality Improvement Using UPQC

    Directory of Open Access Journals (Sweden)

    K. Kalaipriya

    2014-05-01

    Full Text Available This paper presents the power quality improvement using UPQC. UPQC consists of series inverter, shunt inverter and capacitance. Every inverter connected with pulse generator for switching on. UPQC is especially obtained to resolve different kind of power quality drawback like reactive power compensation, voltage interruption and harmonics. DVR is connected in series to deliver the active and reactive power to distribution network. DC-link capacitors stay high as a result of the DVR needs a minimum amount of DC-link voltage to compensate sag. So, DC –link voltage is connected with PV module to reduce the cost. Design of UPQC device with multi-bus system obtained using MATLAB/SIMULINK and simulation results are mentioned to support the developed conception.

  20. Home Care Nursing Improves Cancer Symptom Management

    Science.gov (United States)

    Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.

  1. Integrating Comprehensive Reform with Quality of Care

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

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

  2. Improving Compliance with NICE Guidelines on Parkinson's isease: A Quality Improvement Study

    OpenAIRE

    Agha, Riaz; Edison, Eric; Fielder Camm, Christian; Cheng, Lisa; Gajendragadkar, Pushpaj; Borland, Colin

    2012-01-01

    Parkinson's disease can progressively affect daily function and multidisciplinary teamwork is essential to provide high quality care. The National Institute of Health and Clinical Excellence (NICE) issued guidelines regarding diagnosis, follow-up, and multidisciplinary care. This quality improvement project sought to measure and improve the compliance of service provision against the guidelines. In total, 3 audit cycles were completed. Each audit involved reviewing notes of patients attending...

  3. Quality of care for hypertension in the United States

    Directory of Open Access Journals (Sweden)

    LaPuerta Pablo

    2005-01-01

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  5. Incorporating health care quality into health antitrust law

    Directory of Open Access Journals (Sweden)

    Schneider Helen

    2008-04-01

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

  6. Nursing home closures and quality of care.

    Science.gov (United States)

    Castle, Nicholas G

    2005-02-01

    The purpose of this research is to examine the relationship between quality of care in nursing homes and their likelihood of closure. We hypothesize that lower-quality facilities will be more likely to close than higher-quality facilities. Using the rates of physical restraint use, urethral catheterization, contractures, pressure ulcers, and psychotropic medication use as quality measures from approximately 12,000 facilities from 1992 to 1998, the author examine cross-sectional and change score relationships between these measures and a nursing home's likelihood of closure. The descriptive analysis shows that 621 nursing homes closed in this time period, and the results for physical restraint use were robust in their positive association with closures in most analyses lending some support for this study's hypothesis. However, overall, the author concludes that nursing facility closures are relatively rare events. And the likelihood of closure, even for poor-quality facilities, is low. PMID:15643031

  7. 持续质量改进理论在妇幼保健院处方点评中的应用%Application of Continuous Quality Improvement Theory in Prescription Comments in Maternal and Children Health Care Hospital

    Institute of Scientific and Technical Information of China (English)

    李艳; 朱华威

    2012-01-01

    OBJECTIVE: To investigate the application of continuous quality improvement theory in prescription comments in outpatient department of maternal and child health care hospital. METHODS: Based on PDCA cycle method, the outpatient prescriptions were commented in respects of Plan, Do, Check and Action. We conducted continuous quality management, found out the specific performance of the unqualified prescription, analyzed the possible causes, made improvement plan and achieved goal, cleared and defined responsible person. We took a random sample of 1 800 outpatient prescriptions within 9 months after continuous quality improvement (200 prescriptions each month), and calculated the monthly qualified rate of prescription. RESULTS: The qualified rate of outpatient prescriptions had been improved from 55% before quality improvement to 60% , 65% , 85% , 86% , 88%, 90%, 95%, 99% and 99% from Jan. To Sept. After quality improvement (P<0.05). CONCLUSION: Application of continuous quality improvement in the comments of outpatient prescription can effectively improve the quality of outpatient prescription and rational drug use.%目的:探讨持续质量改进理论在妇幼保健院门诊处方点评中的应用.方法:基于PDCA循环法,对门诊处方点评工作采取计划、执行、检查和行动4个阶段的过程管理,通过找出不合格处方的表现、分析原因、制定改进措施及目标、明确责任人进行持续质量改进.随机抽取改进后9个月的门诊处方1800张(每月200张)统计每月处方合格率.结果:门诊处方合格率由改进前的55%提高到改进后1-9月的60%、65%、85%、86%、88%、90%、95%、99%、99%(P<0.05).结论:在门诊处方点评中引进持续质量改进管理方法,提高了门诊处方的质量,促进了合理用药.

  8. A Randomized Controlled Trial on the Usefulness of Mobile Text Phone Messages to Improve the Quality of Care of HIV and AIDS Patients in Cameroon

    Science.gov (United States)

    Nsagha, Dickson Shey; Lange, Innocent; Fon, Peter Nde; Nguedia Assob, Jules Clement; Tanue, Elvis Asangbeng

    2016-01-01

    Background: HIV and AIDS are major public health problems in the world and Africa. In Cameroon, the HIV prevalence is 5.1%. Cellphones have been found to be useful in the provision of modern health care services using short message services (SMS). This study assessed the effectiveness of SMS in improving the adherence of people living with HIV and AIDS to their treatment and care in Cameroon. Methods: This intervention study used a randomized controlled trial design. Ninety participants seeking treatment at the Nkwen Baptist Health Center were recruited between August and September 2011 using a purposive sampling method. They were randomly allocated into the intervention and control groups, each containing 45 participants. In the intervention group, each participant received four SMSs per week at equal intervals for four weeks. The patients were investigated for adherence to ARVs by evaluating the number of times treatment and medication refill appointments were missed. Data were collected using an interviewer-administered questionnaire before and after intervention and analysed on STATA. Results: The baseline survey indicated that there were 55(61.1%) females and 35(38.9%) males aged 23 - 62 years; the mean age was 38.77 ± 1.08. Most participants were teachers [12 (13.3%)], farmers [11 (12.2%)], and businessmen [24 (26.7%)]. Adherence to ARVs was 64.4% in the intervention group and 44.2% in the control group (p = 0.05). 2(4.4%) patients in the control group failed to respect their drug refill appointments while all the 45(100%) participants in the intervention group respected their drug refill appointments. 54.17% of married people and 42.9% of the participants with primary and secondary levels of education missed their treatment. Key reasons for missing treatment were late home coming (54%), forgetfulness (22.5%), and travelling out of station without medication (17.5%). Other factors responsible for non-adherence included involvement in outdoor business (60

  9. Quality and Value in an Evolving Health Care Landscape.

    Science.gov (United States)

    Kamal, Robin N

    2016-07-01

    Demonstrating and improving value of care continues to be increasingly important in hand surgery. To prepare for emerging models that transition payment from volume to value, hand surgeons will benefit from a clear understanding of quality, cost, and value. National organizations and both public and private payers increasingly advocate for patient-reported outcome measures for pay for reporting and pay for performance initiatives. These are intended to incentivize providers and health systems to improve patient-centered care while minimizing costs. Appreciating the limitations to using patient-reported outcomes in hand surgery can ensure hand surgery is appropriately assessed in novel payment models. PMID:27374791

  10. Stability and Patterns of Classroom Quality in German Early Childhood Education and Care

    Science.gov (United States)

    Kuger, Susanne; Kluczniok, Katharina; Kaplan, David; Rossbach, Hans-Guenther

    2016-01-01

    Many education systems worldwide have dedicated a significant amount of resources to improve quality levels in early childhood education and care. Research can contribute to this goal by providing information about conditions of high-quality education and care and reasons for changes in the quality provided to children. This study therefore…

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

    Science.gov (United States)

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

    2010-01-01

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

  12. 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.

  13. Orthogeriatric care: improving patient outcomes

    OpenAIRE

    Tarazona-Santabalbina, Francisco J.

    2016-01-01

    Francisco José Tarazona-Santabalbina,1,2 Ángel Belenguer-Varea,1,2 Eduardo Rovira,1,2 David Cuesta-Peredó1,21Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera, 2Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, SpainAbstract: Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements i...

  14. Using Quality Function Deployment to Improve Reference Services Quality

    OpenAIRE

    Pao-Long Chang; Pao-Nuan Hsieh

    1996-01-01

    Much research has been conducted regarding how reference librarians can evaluate and improve the quality of the answers they provide to users' inquiries. There has been considerably less discussion, however, concerning how to improve the quality of the delivery of those answers, and to upgrade the overall quality of reference services as a whole. Suggestions for improving the quality of service contained within the business literature may be applied to improve library services as well. In thi...

  15. Using implementation science to improve urologic oncology care.

    Science.gov (United States)

    Skolarus, Ted A; Sales, Anne E

    2016-09-01

    There are many gaps between recommended urologic cancer care and real-world practice. Although we increasingly define these quality gaps because of our growing health services research capacity in urologic oncology, we often fall short in translating these findings into effective interventions and strategies to reduce gaps in care. In this article, we highlight implementation research as a logical next step for translating our health services research findings into effective individual and organizational behavior change strategies to improve quality of care. We explain how implementation research focuses on different, upstream outcomes from our clinical outcomes to get the right care to the right patient at the right time. Lastly, we share information about resources and training for those interested in learning more about this emerging, transdisciplinary field. PMID:27401405

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

    OpenAIRE

    Heidari Gorji, Ali Morad; Farooquie, Jamal A

    2011-01-01

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

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

    OpenAIRE

    Heidari Gorji Ali; Farooquie Jamal A

    2011-01-01

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

  18. 基于服务质量差距模型改进医疗护理服务质量%Based on service quality gap model to improve medical care service Quality

    Institute of Scientific and Technical Information of China (English)

    陶小红; 时维东

    2011-01-01

    基于服务质量差距模型理论,分析了在医疗护理服务质量中差距产生的原因.就弥合这些差距,从了解患者实际期望、制订合理服务标准、强化服务质量水平、规范服务营销行为4个方面提出了建议,旨在通过重视需求、尊重患者、有效沟通、合理营销改进医疗护理质量,使医院提高服务质量更具针对性、科学性和有效性.%Based on service quality gap model theory, the causes of gap in medical and nursing service quality were analyzed. To bridge these gap, suggestions were proposed from four aspects of understanding patients'actual expectations, developing reasonable service standards, improving service quality levels,and specifying service marketing behaviors which aimed at improving medical and nursing quality by emphasizing demands, respecting patients, effective communication, and reasonable marketing,so as to make the efforts of service quality improvement more purposeful,scientific and effective.

  19. Quality of Care and Job Satisfaction in the European Home Care Setting: Research Protocol

    OpenAIRE

    Van Eenoo, Liza; Roest, Henriëtte van der; van Hout, Hein; Declercq, Anja

    2016-01-01

    Introduction: Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care.Aim: This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of six...

  20. Quality of Care and Job Satisfaction in the European Home Care Setting: Research Protocol

    OpenAIRE

    Liza Van Eenoo; Henriëtte van der Roest; Hein van Hout; Anja Declercq

    2016-01-01

    Introduction: Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care. Aim: This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of si...

  1. 'Wading through treacle': quality improvement lessons from the frontline.

    Science.gov (United States)

    Roueche, Alice; Hewitt, Jocelyn

    2012-03-01

    In a time of financial uncertainty and structural reform, the National Health Service (NHS) in England needs clinical leadership to help improve the quality of patient care. Increasingly, leadership development is being targeted at doctors in postgraduate training to help prepare them for their future leadership roles as consultants and general practitioners. However, there is a risk that we are missing an opportunity here by failing to recognise the role that doctors in training can play now, during their training. As our frontline clinicians they have a unique view of the health service and the inefficiencies therein. The London Deanery has been running an educational programme called Beyond Audit to provide doctors in training with quality improvement skills. During this programme we have been given a unique insight into NHS systems as viewed by junior doctors. They have identified a wide range of small system problems that, when combined, result in large-scale inefficiency and prevent the delivery of high quality patient care. These problems they identify have implications for cost, efficiency, patient safety, team-working and patient experience. Any attempt to improve the quality of care delivered in the NHS needs to look at the system from the point of view of those delivering the care, including our doctors in postgraduate training. By empowering them to make improvements to the systems that they see, there is the potential to make significant improvement in the quality of patient care that they deliver. PMID:22198901

  2. Monitoring and improving care in thoracic surgery

    NARCIS (Netherlands)

    R.C. Numan

    2016-01-01

    Quality of Care (QoC) plays a central role in the way healthcare is delivered. In the world of thoracic surgery for lung cancer, surgeons are faced with complex and sometimes high-risk surgical resections on an aging patient population with an increasing incidence of frail physical health. This incr

  3. Improving Depression Care Through an Online Learning Collaborative.

    Science.gov (United States)

    Starkey, Melissa; Wiest, Dawn; Qaseem, Amir

    2016-01-01

    Depression is a leading cause of disability worldwide, and many internists diagnose and treat depression. This study aimed to examine the impact of a practice improvement intervention on screening and managing patients with depression in primary care. This pre-post study design included a physician practice survey designed to capture what the physicians believed they were doing in practice, a chart audit tool to capture what physicians were actually doing in practice, and an intervention that included an evidence-based educational program, online toolkit, and practice improvement coaching conference calls that promoted group learning. Following completion of the intervention, participants increasingly used the Patient Health Questionnaire-9 to detect, diagnose, and gauge treatment success for depression and reported increased use of guidelines and team-based care. Although barriers to improving depression care exist, this study suggests that evidence-based quality improvement programs can positively affect practice. PMID:25351473

  4. Solutions to Improve Educational Management Quality

    OpenAIRE

    Ramezan Jahanian; Masoomeh Motahari

    2013-01-01

    Nowadays, enhancing the quality in educational systems of different countries has gained especial importance and stand. Improving utilizing and increasing the quality in our country’s educational system is felt too. One of the utilizing factors in education system is to improve the educational management quality.In this article, effective factors in educational management quality and one of its improving solutions, thorough management quality, is analyzed.

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

    OpenAIRE

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

    2012-01-01

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

  6. Improving Health and Quality of Life

    Science.gov (United States)

    ... Fatigue Syndrome (CFS) Share Compartir Improving Health and Quality of Life On this Page Cognitive Behavioral Therapy (CBT) Support ... and improve their ability to function and their quality of life. Doctors may refer some of their CFS patients ...

  7. Cardiovascular disease prevention in rural Nigeria in the context of a community based health insurance scheme: QUality improvement cardiovascular care Kwara-I (QUICK-I)

    NARCIS (Netherlands)

    M. Hendriks (Maaike); L.M. Brewster (Lizzy); F.W.N.M. Wit (Ferdinand); O.A. Bolarinwa (Oladimeji Akeem); A.O. Odusola (Aina Olufemi); E. Orlewska (William Ken); N. Bindraban (Navin); A. Vollaard (Albert); S. Alli (Shade); P. Adenusi (Peju); K. Agbede (Kayode); T.M. Akande (Tanimola); J. Lange (Joep); C. Schultsz (Constance)

    2011-01-01

    textabstractBackground: Cardiovascular diseases (CVD) are a leading contributor to the burden of disease in low- and middle-income countries. Guidelines for CVD prevention care in low resource settings have been developed but little information is available on strategies to implement this care. A co

  8. Cardiovascular disease prevention in rural Nigeria in the context of a community based health insurance scheme: QUality Improvement Cardiovascular care Kwara-I (QUICK-I)

    NARCIS (Netherlands)

    M. Hendriks; L. Brewster; F. Wit; O.A. Bolarinwa; A.O. Odusola; W. Redekop; N. Bindraban; A. Vollaard; S. Alli; P. Adenusi; K. Agbede; T. Akande; J. de Lange; C. Schultsz

    2011-01-01

    Background: Cardiovascular diseases (CVD) are a leading contributor to the burden of disease in low- and middle-income countries. Guidelines for CVD prevention care in low resource settings have been developed but little information is available on strategies to implement this care. A community heal

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  11. Quality improvement 101 for surgeons: Navigating the alphabet soup.

    Science.gov (United States)

    Santore, Matthew T; Islam, Saleem

    2015-12-01

    It is a fundamental value of the surgical profession to improve care for its patients. In the last 100 years, the principles of prospective quality improvement have started to work their way into the traditional method of retrospective case review in morbidity and mortality conference. This article summarizes the history of "improvement science" and its intersection with the field of surgery. It attempts to clarify the principles and jargon that may be new or confusing to surgeons with a different vocabulary and experience. This is done to bring the significant power and resources of improvement science to the traditional efforts to improve surgical care. PMID:26653158

  12. Competition and quality in home health care markets.

    Science.gov (United States)

    Jung, Kyoungrae; Polsky, Daniel

    2014-03-01

    Market-based solutions are often proposed to improve health care quality; yet evidence on the role of competition in quality in non-hospital settings is sparse. We examine the relationship between competition and quality in home health care. This market is different from other markets in that service delivery takes place in patients' homes, which implies low costs of market entry and exit for agencies. We use 6 years of panel data for Medicare beneficiaries during the early 2000s. We identify the competition effect from within-market variation in competition over time. We analyze three quality measures: functional improvements, the number of home health visits, and discharges without hospitalization. We find that the relationship between competition and home health quality is nonlinear and its pattern differs by quality measure. Competition has positive effects on functional improvements and the number of visits in most ranges, but in the most competitive markets, functional outcomes and the number of visits slightly drop. Competition has a negative effect on discharges without hospitalization that is strongest in the most competitive markets. This finding is different from prior research on hospital markets and suggests that market-specific environments should be considered in developing polices to promote competition.

  13. Closing The Gap: Improving Trauma Care On The Ukrainian Battlefield.

    Science.gov (United States)

    Stacey, Stephen K; Jones, Peter H

    2016-01-01

    Since early 2014, Ukraine has been involved in a violent social and political revolution that has taken more than 7,000 lives. Many of these deaths were due to limited field medical care and prolonged evacuation times because the Ukrainian military has been slow to adopt standard combat medical processes. We deployed with the US Army's 173rd Airborne Brigade to train soldiers in the National Guard of Ukraine (NGU) on combat first aid. We discovered that a major deficiency limiting the quality of trauma care and evacuation is an endemic lack of prior coordination and planning. The responsibility for this coordination falls on military leaders; therefore, we delivered medical operations training to officers of the NGU unit and observed great improvement in medical care sustainment. We recommend systematic leader education in best medical practices be institutionalized at all levels of the Ukrainian Army to foster sustained improvement and refinement of trauma care. PMID:27045509

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

    OpenAIRE

    Werner, Claudia Denise

    2014-01-01

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

  15. Rationale, design and conduct of a comprehensive evaluation of a primary care based intervention to improve the quality of life of osteoarthritis patients. The PraxArt-project: a cluster randomized controlled trial [ISRCTN87252339

    Directory of Open Access Journals (Sweden)

    Muth Christiane

    2005-07-01

    Full Text Available Abstract Background Osteoarthritis (OA has a high prevalence in primary care. Conservative, guideline orientated approaches aiming at improving pain treatment and increasing physical activity, have been proven to be effective in several contexts outside the primary care setting, as for instance the Arthritis Self management Programs (ASMPs. But it remains unclear if these comprehensive evidence based approaches can improve patients' quality of life if they are provided in a primary care setting. Methods/Design PraxArt is a cluster randomised controlled trial with GPs as the unit of randomisation. The aim of the study is to evaluate the impact of a comprehensive evidence based medical education of GPs on individual care and patients' quality of life. 75 GPs were randomised either to intervention group I or II or to a control group. Each GP will include 15 patients suffering from osteoarthritis according to the criteria of ACR. In intervention group I GPs will receive medical education and patient education leaflets including a physical exercise program. In intervention group II the same is provided, but in addition a practice nurse will be trained to monitor via monthly telephone calls adherence to GPs prescriptions and advices and ask about increasing pain and possible side effects of medication. In the control group no intervention will be applied at all. Main outcome measurement for patients' QoL is the GERMAN-AIMS2-SF questionnaire. In addition data about patients' satisfaction (using a modified EUROPEP-tool, medication, health care utilization, comorbidity, physical activity and depression (using PHQ-9 will be retrieved. Measurements (pre data collection will take place in months I-III, starting in June 2005. Post data collection will be performed after 6 months. Discussion Despite the high prevalence and increasing incidence, comprehensive and evidence based treatment approaches for OA in a primary care setting are neither established nor

  16. How to Sustain Change and Support Continuous Quality Improvement.

    Science.gov (United States)

    Silver, Samuel A; McQuillan, Rory; Harel, Ziv; Weizman, Adam V; Thomas, Alison; Nesrallah, Gihad; Bell, Chaim M; Chan, Christopher T; Chertow, Glenn M

    2016-05-01

    To achieve sustainable change, quality improvement initiatives must become the new way of working rather than something added on to routine clinical care. However, most organizational change is not maintained. In this next article in this Moving Points in Nephrology feature on quality improvement, we provide health care professionals with strategies to sustain and support quality improvement. Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation. The National Health Service Sustainability Model is reviewed as one example to help identify issues that affect long-term success of quality improvement projects. Tools to help sustain improvement include process control boards, performance boards, standard work, and improvement huddles. Process control and performance boards are methods to communicate improvement results to staff and leadership. Standard work is a written or visual outline of current best practices for a task and provides a framework to ensure that changes that have improved patient care are consistently and reliably applied to every patient encounter. Improvement huddles are short, regular meetings among staff to anticipate problems, review performance, and support a culture of improvement. Many of these tools rely on principles of visual management, which are systems transparent and simple so that every staff member can rapidly distinguish normal from abnormal working conditions. Even when quality improvement methods are properly applied, the success of a project still depends on contextual factors. Context refers to aspects of the local setting in which the project operates. Context affects resources, leadership support, data infrastructure, team motivation, and team performance. For these reasons, the same project may thrive in a supportive context and fail in a different context. To demonstrate the practical applications of these quality improvement principles, these principles are

  17. Reductions in inpatient mortality following interventions to improve emergency hospital care in Freetown, Sierra Leone.

    OpenAIRE

    Clark, M.; Spry, E.; Daoh, K.; Baion, D.; Skordis-Worrall, J

    2012-01-01

    Background The demand for high quality hospital care for children in low resource countries is not being met. This paper describes a number of strategies to improve emergency care at a children's hospital and evaluates the impact of these on inpatient mortality. In addition, the cost-effectiveness of improving emergency care is estimated. Methods and Findings A team of local and international staff developed a plan to improve emergency care for children arriving at The Ola During Children's H...

  18. Effect of quality control circle activity for improving self-care ability of colostomy patients%品管圈活动在提高肠造口病人自我护理能力中的作用

    Institute of Scientific and Technical Information of China (English)

    陈幸幸; 吴佳丽; 廖庆萍; 谭静; 刘艾; 何金艳

    2014-01-01

    [目的]探讨品管圈活动在提高肠造口病人自我护理能力中的作用。[方法]成立品管圈,以提高造口病人自我护理能力为目标。通过调查、原因分析、对策制定及实施、效果确认等方法,观察自我护理能力情况。[结果]开展品管圈活动后肠造口病人自我护理能力评分高于对照组,能够独立更换造口袋的人数多于对照组,造口相关知识的掌握情况优于对照组,差异有统计学意义(P<0.05)。[结论]品管圈活动的开展,可以提高肠造口病人的自我护理能力,改善病人的生活质量。%Objective:To probe into the effect of quality control circle activity for improving self care ability of colostomy patients.Methods: QCC was founded to improve the self care ability of colostomy patients. The investigation,causative analysis,development and implementation of countermeasures,and effect confirmation were used to observe the self care ability.Results:After QCC activity,self care ability score of colostomy patients in observation group was higher than that of control group.the number of people who can replace ostomy bag independently was more than that of control group,grasping ostomy related knowledge was better than that in control group,the difference was statistically significant(P <0.05).Conclusion:QCC activity can improve the self care ability and quality of life of colostomy patients.

  19. Asan Medical Information System for Healthcare Quality Improvement

    OpenAIRE

    Ryu, Hyeon Jeong; Kim, Woo Sung; Lee, Jae Ho; Min, Sung Woo; Kim, Sun Ja; Lee, Yong Su; Lee, Young Ha; Nam, Sang Woo; Eo, Gi Seung; Seo, Sook Gyoung; Nam, Mi Hyun

    2010-01-01

    Objectives This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. Methods Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. Results AMI...

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

    NARCIS (Netherlands)

    Pieterse, Quirine Dionne

    2007-01-01

    To improve quality of cancer care treatment-related information is needed. This could be acquired by registries. Since January 1984, the Leiden University Medical Center (LUMC) collects prospectively more than 200 relevant clinical and pathological parameters of women with cervical cancer treated in

  1. Dimensions of health care system quality in Finland

    OpenAIRE

    Jenni Pääkkönen; Timo Seppälä

    2012-01-01

    This paper evaluates the determinants of quality - cost relationship in primary health care. We first summarize information from various indicators of care by principal component analysis (PCA), effectively producing quality of care indicators: accessibility, coverage and allocative efficiency. We then regress the costs of care against these indicators to evaluate their relationship. Our results suggest that PCA may be used to produce quality of care indicators. Furthermore, the relationship ...

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

    OpenAIRE

    Manuela Pessanha; Cecília Aguiar; Joaquim Bairrão

    2007-01-01

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

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

    Science.gov (United States)

    Le Rouge, Cynthia; De Leo, Gianluca

    2008-01-01

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

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

    OpenAIRE

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

    2015-01-01

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

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

    Science.gov (United States)

    Le Rouge, Cynthia; De Leo, Gianluca

    2008-11-06

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

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

    Science.gov (United States)

    Griffith, Deloris G.

    1986-01-01

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

  7. Helping You Choose Quality Hospice Care

    Science.gov (United States)

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

  8. Improving outcomes in lung cancer: the value of the multidisciplinary health care team.

    Science.gov (United States)

    Denton, Eve; Conron, Matthew

    2016-01-01

    Lung cancer is a major worldwide health burden, with high disease-related morbidity and mortality. Unlike other major cancers, there has been little improvement in lung cancer outcomes over the past few decades, and survival remains disturbingly low. Multidisciplinary care is the cornerstone of lung cancer treatment in the developed world, despite a relative lack of evidence that this model of care improves outcomes. In this article, the available literature concerning the impact of multidisciplinary care on key measures of lung cancer outcomes is reviewed. This includes the limited observational data supporting improved survival with multidisciplinary care. The impact of multidisciplinary care on other benchmark measures of quality lung cancer treatment is also examined, including staging accuracy, access to diagnostic investigations, improvements in clinical decision making, better utilization of radiotherapy and palliative care services, and improved quality of life for patients. Health service research suggests that multidisciplinary care improves care coordination, leading to a better patient experience, and reduces variation in care, a problem in lung cancer management that has been identified worldwide. Furthermore, evidence suggests that the multidisciplinary model of care overcomes barriers to treatment, promotes standardized treatment through adherence to guidelines, and allows audit of clinical services and for these reasons is more likely to provide quality care for lung cancer patients. While there is strengthening evidence suggesting that the multidisciplinary model of care contributes to improvements in lung cancer outcomes, more quality studies are needed. PMID:27099511

  9. Quality indicators for international benchmarking of mental health care

    DEFF Research Database (Denmark)

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

    2006-01-01

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

  10. Evidence-Based Practice and Quality Improvement in Nursing Education.

    Science.gov (United States)

    Balakas, Karen; Smith, Joan R

    2016-01-01

    For more than a decade, nursing education has experienced several significant changes in response to challenges faced by healthcare organizations. Accrediting organizations have called for improved quality and safety in care, and the Institute of Medicine has identified evidence-based practice and quality improvement as 2 core competencies to include in the curricula for all healthcare professionals. However, the application of these competencies reaches far beyond the classroom setting. For nurses to possess the knowledge, skills, and attitudes to apply evidence-based practice and quality improvement to the real-world setting, academic-clinical institution partnerships are vital. PMID:27465447

  11. Continuous improvement and TQM in health care: an emerging operational paradigm becomes a strategic imperative.

    Science.gov (United States)

    Swinehart, K; Green, R F

    1995-01-01

    Argues that US health care is in a state of crisis. Escalating costs account for 13 per cent of GNP, making health care the third largest industry in the USA, and spending is expected to increase. Claims health-care providers need to control rising costs, improve productivity and flexibility, adopt appropriate technologies, and maintain competitive levels of quality and value. States that TQM may provide an environment that will focus on quality of patient care and continuous quality improvement at all levels of the organization including the governing body, the administrative, managerial, and clinical areas. Any new national or state health-care plan will force providers to be more efficient while maintaining quality standards. Concludes that it will be strategically imperative that health-care providers ranging from family physicians to major medical centres and suppliers ranging from laboratories to pharmaceutical firms establish methods for making rapid continuous improvement and total quality management the cornerstone of the strategic planning process.

  12. Evaluation of a combined strategy directed towards health-care professionals and patients with chronic obstructive pulmonary disease (COPD: Information and health education feedback for improving clinical monitoring and quality-of-life

    Directory of Open Access Journals (Sweden)

    Ferro Juan J

    2009-12-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is a health problem that is becoming increasingly attended-to in Primary Care (PC. However, there is a scarcity of health-care programs and studies exploring the implementation of Clinical Practice Guidelines (CPG. The principal objective of the present study is to evaluate the effectiveness of a combined strategy directed towards health-care professionals and patients to improve the grade of clinical control and the quality-of-life (QoL of the patients via a feedback on their state-of-health. A training plan for the health-care professionals is based on CPG and health education. Method/Design Multi-centred, before-after, quasi experimental, prospective study involving an intervention group and a control group of individuals followed-up for 12 months. The patients receive attention from urban and semi-urban Primary Care Centres (PCC within the administrative area of the Costa de Ponent (near Barcelona. All the pacients corresponding to the PCC of one sub-area were assigned to the intervention group and patients from the rest of sub-areas to the group control. The intervention includes providing data to the health-care professionals (clinician/nurse derived from a clinical history and an interview. A course of training focused on aspects of CPG, motivational interview and health education (tobacco, inhalers, diet, physical exercise, physiotherapy. The sample random includes a total of 801 patients (≥ 40 years of age, recorded as having COPD, receiving attention in the PCC or at home, who have had at least one clinical visit, and who provided written informed consent to participation in the study. Data collected include socio-demographic characteristics, drug treatment, exacerbations and hospital admissions, evaluation of inhaler use, tobacco consumption and life-style and health-care resources consumed. The main endpoints are dyspnoea, according to the modified scale of the Medical

  13. Improving childhood nutrition and wellness in South Africa: involving mothers/caregivers of malnourished or HIV positive children and health care workers as co-designers to enhance a local quality improvement intervention

    OpenAIRE

    van Deventer, Claire; Robert, Glenn Brian; Wright, Anne

    2016-01-01

    Background: A significant proportion of children admitted to a hospital in a South African sub-district in 2010 were severely malnourished and - when concurrently HIV positive - were not correctly initiated on antiretroviral therapy.Audit data over a subsequent four year period revealed that 60 % of malnourished children admitted to the hospital were HIV positive. To supplement an ongoing local quality improvement (QI) intervention addressing poor nutritional outcomes in children in this sett...

  14. Towards improvement in quality assurance

    International Nuclear Information System (INIS)

    This first document in the series of the International Nuclear Safety Advisory Group (INSAG) Technical Notes is a general guideline for the establishment of effective quality assurance procedures at nuclear facilities. It sets out primary requirements such as quality objectives, methods for measuring the effectiveness of the quality assurance programme, priority of activities in relation to importance of safety of items, motivation of personnel

  15. Quality improvement through the paradigm of learning

    OpenAIRE

    Hafford-Letchfield, Trish; Lavender, Peter

    2015-01-01

    Purpose - If we are to achieve meaningful participation and co-production for older people in care, more radical approaches are required. This project explores an innovation where older people using social care were matched to community based learning mentors to develop partnerships within which learning interventions were facilitated. We explore how the concept of learning might be used as a paradigm to raise the quality of care in institutionalised settings using a co-productive and relati...

  16. Nursing care quality: a concept analysis

    Directory of Open Access Journals (Sweden)

    Virya Koy

    2015-08-01

    Full Text Available The purpose of this paper is to provide a clear definition of nursing care quality that contributes to the formulation, application, and measurement of quality nursing outcomes for patients, organisations, and nursing staff. It also indicates the manner in which, by using the definition, empirically based operational definitions can be developed for different operational environments and settings. The study employed a concept analysis methodology to extract terms, attributes, antecedents, and consequences (outcomes from relevant literature databases. The analysis identified nine attributes: nurse competency performance, met nursing care needs, good experiences for patients, good leadership, staff characteristics, preconditions of care, physical environment, progress of nursing process, and cooperation with relatives. Antecedences include nurse-staffing levels, positive practice environment, and nursing turnover. Consequences include patient safety, patient satisfaction, nursing outcomes, nurse satisfaction, and budget management. Because of the breadth and depth of modern nursing practice, further research and development of the concept is required. [Int J Res Med Sci 2015; 3(8.000: 1832-1838

  17. Improving perioperative care for adolescent idiopathic scoliosis patients: the impact of a multidisciplinary care approach

    Science.gov (United States)

    Borden, Timothy C; Bellaire, Laura L; Fletcher, Nicholas D

    2016-01-01

    The complex nature of the surgical treatment of adolescent idiopathic scoliosis (AIS) requires a wide variety of health care providers. A well-coordinated, multidisciplinary team approach to the care of these patients is essential for providing high-quality care. This review offers an up-to-date overview of the numerous interventions and safety measures for improving outcomes after AIS surgery throughout the perioperative phases of care. Reducing the risk of potentially devastating and costly complications after AIS surgery is the responsibility of every single member of the health care team. Specifically, this review will focus on the perioperative measures for preventing surgical site infections, reducing the risk of neurologic injury, minimizing surgical blood loss, and preventing postoperative complications. Also, the review will highlight the postoperative protocols that emphasize early mobilization and accelerated discharge. PMID:27695340

  18. Continuous quality improvement in the ambulatory endoscopy center.

    Science.gov (United States)

    Johanson, John F

    2002-04-01

    What does quality assessment have to do with the practicing gastroenterologist? Why should one spend the time and effort to incorporate CQI activities into an already busy practice? First and foremost, quality improvement should directly benefit the patient by ensuring that they receive the highest quality of care possible. For example, comparing endoscopic use or outcomes, such as procedure success or complications, with national standards or other endoscopists in the same community may identify physicians who could benefit from additional training. Similar analyses may likewise identify outstanding physicians who might serve as resources for other physicians. Surveys of patient satisfaction may reveal deficiencies, which might be unknown to a physician who is otherwise technically excellent; deficiencies that would never have been uncovered by traditional measures of quality. Second, applying the techniques of CQI to study one's own practice can provide a competitive edge when vying for managed care or corporate contracts. In this regard, CQI can be used to document physician or practice performance through tracking of endoscopic use, procedure success and complication rates, and patient satisfaction. Finally, the rising concern among various patient advocacy groups has led to an increased emphasis on quality improvement, and in most cases it is a required activity as part of the accreditation process. Steps to quality improvement There is more to quality improvement than simply selecting and implementing a performance improvement plan. A number of steps have been suggested to achieve fundamental improvement in the quality of medical care [3]. The first is to use outcomes management for improvement rather than for judgment. One of the major criticisms of QA is that it will be used to judge physicians providing care. It is feared that CQI will be used to identify poor performers who will then be punished. This strategy leads to fear and inhibits an honest pursuit

  19. Identifying variations in quality of care in Queensland hospitals.

    Science.gov (United States)

    Duckett, Stephen J; Coory, Michael; Sketcher-Baker, Kirstine

    2007-11-19

    Identifying and acting on variations from good practice is one of the critical tasks of clinical governance. We describe one aspect of Queensland's post-Bundaberg clinical governance arrangements: the use of variable life-adjusted displays (VLADs) to monitor outcomes of care in the 87 largest public and private hospitals in Queensland, which together account for 83% of all hospital activity. VLAD control charts were created for 31 clinical indicators using routinely collected data, and are disseminated monthly. About a third of hospitals had a run of cases in the 3-year period that flagged at the 30% level (local level investigation). For three indicators, about one in five hospitals had sufficiently cumulatively more deaths than statistically expected that the hospital was highlighted for state-wide review. VLADs do not provide definitive answers about the quality of care. They are used to develop ideas about why variations in reported outcomes occur and suggest possible solutions, be they ways of improving data quality, improving casemix adjustment, or implementing system changes to improve quality of care. Critical to the approach is that there is not just monitoring - the monitoring is tied in with systems that ensure that investigation, learning and action occur as a result of a flag. PMID:18021046

  20. Quality control circle care in improving the application of the success rate of breastfeeding%品管圈护理在提高母乳喂养成功率中的应用

    Institute of Scientific and Technical Information of China (English)

    唐彦梅

    2015-01-01

    目的:探讨品管圈活动在提高母乳喂养成功率中的应用。方法:成立品管圈活动小组,并对产科病区住院分娩的产妇进行随机分组:一组为对照组,按产科护理常规进行护理,指导相关知识;另一组为观察组,成立品管圈小组对孕产妇进行护理。结果:观察组与对照组产妇在出院时母乳喂养相关知识知晓率分别是100%、80.24%,母乳喂养成功率分别是80.86%、61.72%,产妇乳房胀痛发生率分别是26.54%、59.88%。观察组产妇母乳喂养技巧正确掌握情况明显高于对照组,差异具有统计学意义(P<0.05)。结论:品管圈活动能明显提高母乳喂养的成功率,值得推广。%ObjectiveTo explore quality control activities in the application of improve the success rate of breastfeeding.Methods Set up quality management circle activity group, and the maternity ward in the hospital childbirth puerpera were randomly assigned: a group for the control group, according to obstetric care routine care, guidance related knowledge; Another group as the observation group, set up quality management circle group of maternal care.Results Observing group and control group in the hospital maternal breastfeeding knowledge awareness were 100%, 80.24%, breastfeeding success rate were 80.86%, 61.72%, the incidence of maternal breast tenderness is 26.54%, 59.88% respectively. Maternal breastfeeding skills correctly grasp situation observation group was obviously higher than that of control group, difference has statistical significance (P < 0.05).Conclusions Quality management circle activity can significantly improve the success rate of the breastfeeding is worth promoting.

  1. Improving the quality of health care : using international collaboration to inform guideline programmes by founding the Guidelines International Network (G-I-N)

    NARCIS (Netherlands)

    Ollenschlager, G; Marshall, C; Qureshi, S; Rosenbrand, K; Burgers, J; Makela, M; Slutsky, J

    2004-01-01

    Clinical practice guidelines are regarded as powerful tools to achieve effective health care. Although many countries have built up experience in the development, appraisal, and implementation of guidelines, until recently there has been no established forum for collaboration at an international lev

  2. The effect of a complementary e-learning course on implementation of a quality improvement project regarding care for elderly patients: a stepped wedge trial.

    NARCIS (Netherlands)

    Steeg, L. van de; Langelaan, M.; IJkema, R.; Wagner, C.

    2012-01-01

    Background: Delirium occurs frequently in elderly hospitalised patients and is associated with higher mortality, increased length of hospital stay, functional decline, and admission to long-term care. Healthcare professionals frequently do not recognise delirium, indicating that education can play a

  3. Does rehabilitation meet the needs of care and improve the quality of life of patients with schizophrenia or other chronic mental disorders?

    NARCIS (Netherlands)

    van Busschbach, J; Wiersma, D

    2002-01-01

    The effectiveness of a rehabilitation intervention (Boston University Model) was investigated in a one-year prospective naturalistic study among 35 clients with mainly psychotic or affective disorders and dependent on mental health care with at least one hospital admission in the past five years. Re

  4. CARE kV—智能最佳kV扫描技术——降低剂量的同时提高图像质量%CARE kV-Intelligent Optimal kV Scanning Technology: Reducing X-ray Dose and Improving CT Image Quality Synchronously

    Institute of Scientific and Technical Information of China (English)

    徐卓东

    2012-01-01

    本文介绍了CARE kV-智能最佳kV扫描技术的工作原理和应用意义.作为CT业界唯一地能够根据检查目的和受检者个体情况自动设置最佳kV值的CT扫描技术,CARE kV不但能够最优化CT扫描的个性化辐射剂量水平,降低受检者接受的辐射剂量,而且同时也能够提高CT图像质量.CARE kV的使用还可以减少造影剂使用的总量、浓度和注射速率.%The paper introduced CARE kV-Intelligent optimal kV scanning technology, mainly focusing on its principle and applications. CARE kV is an unique low dose technology that can optimize and patient's customized radiation dose by using optimized kV setting based on CT examination destination and patient's conditions. CARE kV can reduce patient's radiation dose and improve CT image quality synchronously. CARE kV also has positive function of reducing the volume/concentration/injection speed of contrast media during CT contrast examination.

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

    OpenAIRE

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

    2008-01-01

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

  6. Quality of diabetes care in general practice

    NARCIS (Netherlands)

    van Bruggen, J.A.R.

    2009-01-01

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

  7. Improving Midwifery Care in Ugandan Public Hospitals: The Midwives’ Perspective

    Science.gov (United States)

    Nabirye, Rose C.; Beinempaka, Florence; Okene, Cindrella; Groves, Sara

    2016-01-01

    Background A serious shortage of nurses and midwives in public hospitals has been reported in Uganda. In addition, over 80% of the nurses and midwives working in public hospitals have been found to have job stress and only 17% to be satisfied on the job. Stress and lack of job satisfaction affect quality of nursing and midwifery care and puts patients’ lives at risk. This is coupled with rampant public outcry about the deteriorating nursing and midwifery care in Ugandan public hospitals. Objective To explore factors that result in poor quality of midwifery care and strategies to improve this care from the perspective of the midwives. Method It was a qualitative exploratory design. Participants were midwives and their supervisors working in four Regional Referral hospitals in Uganda. Data was collected by FGDs and KIIs. Content analysis was used to analyze the transcribed data from the voice recordings. Results Four major themes emerged from the study. They were organizational (poor work environment and lack of materials/equipment), professional (midwives’ attitudes, lack of supervision), public/consumer issues (interference) and policy issues (remuneration, promotion and retirement). Conclusions and implications for Practice Midwives love their work but they need support to provide quality care. Continuous neglect of midwives’ serious concerns will lead to more shortages as more dissatisfied midwives leave service.

  8. The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

    OpenAIRE

    Armstrong, Susan J; Laetitia C. Rispel; Loveday Penn-Kekana

    2015-01-01

    Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospital...

  9. The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

    OpenAIRE

    Armstrong, Susan J; Laetitia C. Rispel; Penn-Kekana, Loveday

    2015-01-01

    Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals.Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals.Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals ...

  10. Physical Activity Improves Quality of Life

    Science.gov (United States)

    ... Workplace Food and Beverage Toolkit Physical activity improves quality of life Updated:Mar 2,2015 Do you want to ... illnesses and diseases associated with aging and maintains quality of life and independence longer for seniors So why not ...

  11. A Systems Approach to Improving Rural Care in Ethiopia

    OpenAIRE

    Bradley, Elizabeth H.; Byam, Patrick; Alpern, Rachelle; Thompson, Jennifer W.; Zerihun, Abraham; Abeb, Yigeremu; Leslie A Curry

    2012-01-01

    Background Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation i...

  12. Quantitative comparison of measurements of urgent care service quality.

    Science.gov (United States)

    Qin, Hong; Prybutok, Victor; Prybutok, Gayle

    2016-01-01

    Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality. PMID:26950539

  13. Quantitative comparison of measurements of urgent care service quality.

    Science.gov (United States)

    Qin, Hong; Prybutok, Victor; Prybutok, Gayle

    2016-01-01

    Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.

  14. Approaching the Practice Quality Improvement Project in Interventional Radiology.

    Science.gov (United States)

    Reis, Stephen P; White, Benjamin; Sutphin, Patrick D; Pillai, Anil K; Kalva, Sanjeeva P; Toomay, Seth M

    2015-12-01

    An important component of maintenance of certification and quality improvement in radiology is the practice quality improvement (PQI) project. In this article, the authors describe several methodologies for initiating and completing PQI projects. Furthermore, the authors illustrate several tools that are vital in compiling, analyzing, and presenting data in an easily understandable and reproducible manner. Last, they describe two PQI projects performed in an interventional radiology division that have successfully improved the quality of care for patients. Using the DMAIC (define, measure, analyze, improve, control) quality improvement framework, interventional radiology throughput has been increased, to lessen mediport wait times from 43 to 8 days, and mediport infection rates have decreased from more than 2% to less than 0.4%. PMID:26337461

  15. Nursing Special Check in Pain Continuous Improvement in the Quality of Care%护理专项检查在疼痛护理质量持续改进中的应用

    Institute of Scientific and Technical Information of China (English)

    王凤玲

    2015-01-01

    Objective To evaluate the effect of treatments applied special inspection commission of pain in the quality of care.Methods Develop a special checklist pain care in accordance with the relevant standards and requirements, by hand from pain pain assessment, treatment and care measures, knowledge of missionary pain, pain records, nurses pain related knowledge mastery, team management, pain postoperative pain nursing special inspection.Results Pain assessment, treatment and care measures, pain knowledge missionary, pain records, nurses pain related knowledge mastery, pain management team qualified rate from 47%, 58%, 5%, 28%, 54%, 23% upgrade to 97%, 98%, 99%, 95%, 96%, 97%.ConclusionNursing special inspection, pain care quality improvement has been sustained and effective.%目的:探讨护理专项检查在提升疼痛护理质量的应用效果。方法依照相关标准与要求制定疼痛护理专项检查表,由专人从疼痛评估、治疗及护理措施、疼痛知识宣教、疼痛记录、护理人员疼痛相关知识掌握程度、疼痛团队管理等方面进行术后疼痛护理专项检查。结果疼痛评估、治疗及护理措施、疼痛知识宣教、疼痛记录、护理人员疼痛相关知识掌握程度、疼痛团队管理合格率分别从47%、58%、52%、28%、54%、23%提升到97%、98%、99%、95%、96%、97%。结论通过护理专项检查,疼痛护理质量得到了持续有效改进。

  16. Improving patient satisfaction with ambulatory surgical care through quality control circle activities%开展品管圈活动提升门诊手术患者满意度

    Institute of Scientific and Technical Information of China (English)

    张健; 白晓霞

    2013-01-01

    Objective To explore the effect of quality control circle (QCC) activities on patient satisfaction with ambulatory surgical care.Methods The operating room nursing staff formed a QCC,delved into problems affecting patient satisfaction with ambulatory surgical care,and formulated solutions to the problems through brainstorming.They put forward improvement schemes and put them into practice.Results Patient overall satisfaction with ambulatory surgical care increased from (6.80 ± 0.57) points before QCC activities to (7.41±0.44) points after the activities,with significant difference found in the scores (P<0.01).Nurses' consciousness in participating nursing management,and job satisfaction were enhanced,and staff's enthusiasm,creativity,and initiative were fully exercised.Conclusion QCC activities help improve quality of ambulatory surgical care and patient satisfaction.%目的 探讨品管圈活动用于提升门诊手术患者满意度的效果.方法 由手术室一线护理人员组成品管圈小组,通过脑力激荡,讨论分析门诊手术患者满意度不高的原因,制订相应的整改措施并组织实施.结果 门诊手术患者总体满意度由活动前(6.80±0.57)分提高到活动后的(7.41±0.44)分,效果显著(P<0.01);护理人员参与护理管理的意识和工作满足感增强,护理人员的积极性、创造性、主动性得到充分发挥.结论 品管圈活动的开展,有利于提高门诊手术服务质量、提升门诊手术患者满意度.

  17. Quality indicators in breast cancer care.

    Science.gov (United States)

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

    2010-09-01

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

  18. Health care quality in NHS hospitals.

    Science.gov (United States)

    Youssef, F N; Nel, D; Bovaird, T

    1996-01-01

    Hospitals provide the same type of service, but they do not all provide the same quality of service. No one knows this better than patients. Reports the results of a market research exercise initiated to ascertain the different factors which patients of health care identify as being necessary to provide error-free service quality in the NHS hospitals. To measure patients' satisfaction with NHS hospitals, the internationally-used market research technique called SERVQUAL was used in order to measure patients' expectations before admission, record their perceptions after discharge from the hospital, and then to close the gap between them. This technique compares expectations with perceptions of service received across five broad dimensions of service quality, namely: tangibility; reliability; responsiveness; assurance; and empathy. This analysis covered 174 patients who had completed the SERVQUAL questionnaire, including patients who had had treatment in surgical, orthopaedic, spinal injury, medicinal, dental and other specialties in the West Midlands region. Recorded the average weighted NHS service quality score overall for the five dimensions as significantly negative.

  19. Health care quality in NHS hospitals.

    Science.gov (United States)

    Youssef, F N; Nel, D; Bovaird, T

    1996-01-01

    Hospitals provide the same type of service, but they do not all provide the same quality of service. No one knows this better than patients. Reports the results of a market research exercise initiated to ascertain the different factors which patients of health care identify as being necessary to provide error-free service quality in the NHS hospitals. To measure patients' satisfaction with NHS hospitals, the internationally-used market research technique called SERVQUAL was used in order to measure patients' expectations before admission, record their perceptions after discharge from the hospital, and then to close the gap between them. This technique compares expectations with perceptions of service received across five broad dimensions of service quality, namely: tangibility; reliability; responsiveness; assurance; and empathy. This analysis covered 174 patients who had completed the SERVQUAL questionnaire, including patients who had had treatment in surgical, orthopaedic, spinal injury, medicinal, dental and other specialties in the West Midlands region. Recorded the average weighted NHS service quality score overall for the five dimensions as significantly negative. PMID:10156537

  20. 探讨血透室护理流程管理对提高护理质量的影响%Investigation of Impact on Improving the Quality of Care by Hemodialysis Room Nursing Process Management

    Institute of Scientific and Technical Information of China (English)

    杨桂珠

    2013-01-01

    Objective to analyze the ef ect of hemodialysis room nursing process management on the quality of nursing care. Method comparison before and after the implementation of nursing process management of nurses in various aspects ability, nursing and nursing satisfaction. Result There is an obvious gap between the results before and after the implementation of nursing process management of nurses in various aspects ability, nursing quality and nursing satisfaction, the p value is less than 0.05, there was statistical significance. Conclusion the hemodialysis room nursing process management can ef ectively improve the quality of nursing in hemodialysis room.%目的:分析血透室采用护理流程管理对护理质量的影响。方法比较实施护理流程管理前后护士的各方面能力、护理的情况和护理满意度。结果实施护理流程管理前后护士的各方面能力、护理的质量和护理满意度有明显的差距,P值<0.05,有统计学意义。结论血透室实施护理流程管理能够有效的提高血透室的护理质量。

  1. Quality Aspects of Maternal Health Care in Tanzania

    OpenAIRE

    Urassa, David Paradiso

    2004-01-01

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

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

    OpenAIRE

    Chin, WY; Lam, CLK; Lo, SV

    2011-01-01

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

  3. Improving the Quality of Electric Energy to Electric Arc Furnace

    Directory of Open Access Journals (Sweden)

    Adrian-Ioan Toma

    2011-10-01

    Full Text Available This paper presents a study of power quality problems created by an electric arc furnace (EAF with eccentric bottom tap (EBT at power system. The analysis have been done to EAF of 100 t capacity used for steel melting. Experimental results show this EAF is substantial source of electric disturbances, such as voltage fluctuations, flicker, harmonics, and unbalance between phases. Improvement of the quality of electric energy at EAF imposes a careful technical and economical analysis. Of all possible solutions for improvement of the power quality for an EAF (passive filter, STATCOM or SVC, SVC is the ideal solution.

  4. Quality improvement practices and trends in Denmark

    DEFF Research Database (Denmark)

    Dahlgaard, Jens Jørn; Hartz, Ove; Edgeman, Rick L.

    1998-01-01

    It is now well known that the history of quality improvement is neither uniquely American, nor uniquely Japanese, although the contributions from these two nations have received more attention perhaps than those originating elsewhere. This is the first in a series of articles intended to increase...... awareness of quality improvement practices and trends in various European nations, with particular emphasis on western Europe and Scandinavia. Herein the recent history of quality improvement in Denmark is explored and the quality improvement efforts in two Danish companies are chronicled. It is hoped...

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

    Science.gov (United States)

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

    2013-10-01

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

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

    Science.gov (United States)

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

    2013-10-01

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

  7. A cluster randomized trial to improve adherence to evidence-based guidelines on diabetes and reduce clinical inertia in primary care physicians in Belgium: study protocol [NTR 1369].

    NARCIS (Netherlands)

    Borgermans, L.D.A.; Goderis, G.; Broeke, C.V.; Mathieu, C.; Aertgeerts, B.; Verbeke, G.; Carbonez, A.; Ivanova, A.; Grol, R.P.T.M.; Heyrman, J.

    2008-01-01

    ABSTRACT: BACKGROUND: Most quality improvement programs in diabetes care incorporate aspects of clinician education, performance feedback, patient education, care management, and diabetes care teams to support primary care physicians. Few studies have applied all of these dimensions to address clini

  8. Self-reported quality care for knee osteoarthritis

    DEFF Research Database (Denmark)

    Østerås, N; Jordan, K P; Clausen, B;

    2015-01-01

    OBJECTIVES: To assess and compare patient perceived quality of osteoarthritis (OA) management in primary healthcare in Denmark, Norway, Portugal and the UK. METHODS: Participants consulting with clinical signs and symptoms of knee OA were identified in 30 general practices and invited to complete......% (IQR 28%, 64%; range 0-100%) for the total sample with relatively similar medians across three of four countries. Achievement rates on individual QIs showed a large variation ranging from 11% (referral to services for losing weight) to 67% (information about the importance of exercise) with significant...... differences in achievement rates between the countries. CONCLUSIONS: The results indicated a potential for improvement in OA care in all four countries, but for somewhat different aspects of OA care. By exploring these differences and comparing healthcare services, ideas may be generated on how the quality...

  9. Off-Hours Admission and Acute Stroke Care Quality

    DEFF Research Database (Denmark)

    Kristiansen, Nina Sahlertz; Mainz, Jan; Nørgård, Bente Mertz;

    2014-01-01

    stroke care processes, including the effect of a systematic quality improvement program, and to examine 30 days case-fatality. Methods-A population-based historical cohort study, including patients admitted to Danish hospitals with a first ever acute stroke (January 1, 2003, to December 31, 2011; N=64...... of care. However, the admission time-related differences in care were substantially reduced over time, and the differences in 30 days case-fatality appeared primarily to be explained by differences in stroke severity....... 975). Off-hours were weekends and evening and nighttime shifts on weekdays. Compliance with performance measures was compared using general linear modeling, and odds ratios for 30 days case-fatality were obtained using multivariable logistic regression. Results-Patients admitted off-hours had a lower...

  10. CONTINUOUS IMPROVEMENT THROUGH INTEGRATION OF QUALITY TOOLS

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    The relationship between major quality tools such as quality function development (QFD),failure mode and effects analysis (FMEA), design of experiments (DOE) and statistical process control (SPC) is analyzed through an extensive review of the literature and the concurrent quality engineering philosophy, and a basic structure for the integration of quality tools is presented. An integrated quality management system (IQMS) is developed using C++ Builder, nmning in the Windows 2000 Server environment with the basic internet connections, and SQL Server 2000 as the platform for developing the database. An illustrative example applying IQMS to the continuous quality improvement for a crane equipment manufacturing is reported. The result shows that the application of IQMS can optimize the process of design and manufacturing, shorten the cycle time of product, reduce the cost, and realize quality improvement continuously. The proposed integrated framework with IQMS is believed to be applicable to continuous quality improvement in many manufacturing companies.

  11. Diffusion of a quality improvement programme among allied health professionals.

    NARCIS (Netherlands)

    Sluijs, E.M.; Dekker, J.

    1999-01-01

    Objective: To assess the diffusion of a quality improvement (QI) programme among allied health professions in The Netherlands. Design: Descriptive study, based on a questionnaire distributed to allied health professionals; response rate, 63%. Settings and participants: All subsectors in health care

  12. 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.

  13. Combining business process and data discovery techniques for analyzing and improving integrated care pathways

    NARCIS (Netherlands)

    J. Poelmans; G. Dedene; G. Verheyden; H. van der Mussele; S. Viaene; E. Peters

    2010-01-01

    Hospitals increasingly use process models for structuring their care processes. Activities performed to patients are logged to a database but these data are rarely used for managing and improving the efficiency of care processes and quality of care. In this paper, we propose a synergy of process min

  14. The process of managerial control in quality improvement initiatives.

    Science.gov (United States)

    Slovensky, D J; Fottler, M D

    1994-11-01

    The fundamental intent of strategic management is to position an organization with in its market to exploit organizational competencies and strengths to gain competitive advantage. Competitive advantage may be achieved through such strategies as low cost, high quality, or unique services or products. For health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations, continually improving both processes and outcomes of organizational performance--quality improvement--in all operational areas of the organization is a mandated strategy. Defining and measuring quality and controlling the quality improvement strategy remain problematic. The article discusses the nature and processes of managerial control, some potential measures of quality, and related information needs. PMID:10138526

  15. Systems for Quality Assurance in Mental Health Services: A Strategy for Improvement.

    Science.gov (United States)

    Jessee, William F.; Morgan-Williams, Gale

    1987-01-01

    Discusses need for systems-based approach to quality assurance in mental health services, which can provide useful information to administrators and practitioners as they work to maintain or improve quality of care provided to patients. Introduces generic model for monitoring and evaluating quality of care and discusses potential barriers to its…

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

    DEFF Research Database (Denmark)

    Møller, Morten Hylander; Larsson, Heidi Jeanet; Rosenstock, Steffen Jais;

    2013-01-01

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

  17. Internal quality audit and quality standards as a method of quality improvement at the Department of Ophthalmology, University Hospital.

    Science.gov (United States)

    Nasić, Mirjana; Pokupec, Rajko; Katusić, Damir; Miklić, Pavle; Suić, Ivan; Galić, Slobodan

    2005-01-01

    Quality assessment of clinical health care with the programme of quality standard is a method of health management, through which better efficiency and safety of health outcomes can be achieved. In the period from 2002 to 2004, a pilot program of quality has been carried out on the Department of Ophthalmology, University Hospital Center in Zagreb. Seven internal audit teams of hospital commission and teams of hospital departments were evaluating introducing practice for quality standards every three months. In the period of two years improvement in all standards of quality has been noticed (expressed in percent of progress towards the ideal result of 100%): personnel 20%, patient rights 15%, medical equipment 40%, quality of emergency service 60%, implementation of clinical guidelines and criteria for elective admission 55%, quality of risk prevention 70%, quality of medical records 60%. The two-years-improvement dynamics of about 46%, first year 24%.

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

    Science.gov (United States)

    Ossebaard, Hans C; Van Gemert-Pijnen, Lisette

    2016-06-01

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

  19. Finding a balance between "value added" and feeling valued: revising models of care. The human factor of implementing a quality improvement initiative using Lean methodology within the healthcare sector.

    Science.gov (United States)

    Deans, Rachel; Wade, Shawna

    2011-01-01

    Growing demand from clients waiting to access vital services in a healthcare sector under economic constraint, coupled with the pressure for ongoing improvement within a multi-faceted organization, can have a significant impact on the front-line staff, who are essential to the successful implementation of any quality improvement initiative. The Lean methodology is a management system for continuous improvement based on the Toyota Production System; it focuses on two main themes: respect for people and the elimination of waste or non-value-added activities. Within the Lean process, value-added is used to describe any activity that contributes directly to satisfying the needs of the client, and non-value-added refers to any activity that takes time, space or resources but does not contribute directly to satisfying client needs. Through the revision of existing models of service delivery, the authors' organization has made an impact on increasing access to care and has supported successful engagement of staff in the process, while ensuring that the focus remains on the central needs of clients and families accessing services. While the performance metrics continue to exhibit respectable results for this strategic priority, further gains are expected over the next 18-24 months.

  20. A systems approach to improving rural care in Ethiopia.

    Directory of Open Access Journals (Sweden)

    Elizabeth H Bradley

    Full Text Available BACKGROUND: Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI, we identified PHCUs with consistently higher performance (n = 2, most improved performance (n = 3, or consistently lower performance (n = 2 in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51, we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1 managerial problem solving capacity, 2 relationship with the woreda (district health office, and 3 community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, and PHCU communities' leadership, particularly religious leadership, were strongly engaged with the health improvement effort. Distance from the nearest city, quality of roads and transportation, and cultural norms did not differ substantially among PHCUs. CONCLUSIONS/SIGNIFICANCE: Effective health strengthening efforts may require intensive

  1. Rethinking Quality and Improvement in Higher Education

    Science.gov (United States)

    Houston, Don

    2008-01-01

    Purpose: The purpose of this paper is to critically review dominant conceptions of and approaches to quality in higher education. It suggests an alternative approach with potential to shift the focus of quality activities from accountability and control to improvement. Design/methodology/approach: The applicability and limits of quality concepts…

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

    Directory of Open Access Journals (Sweden)

    Nissanholtz-Gannot Rachel

    2012-06-01

    Full Text Available Abstract Background Since 2000, Israel has had a national program for ongoing monitoring of the quality of the primary care services provided by the country's four competing non-profit health plans. Previous research has demonstrated that quality of care has improved substantially since the program's inception and that the program enjoys wide support among health plan managers. However, prior to this study there were anecdotal and journalistic reports of opposition to the program among primary care physicians engaged in direct service delivery; these raised serious questions about the extent of support among physicians nationally. Goals To assess how Israeli primary care physicians experience and rate health plan efforts to track and improve the quality of care. Method The study population consisted of primary care physicians employed by the health plans who have responsibility for the quality of care of a panel of adult patients. The study team randomly sampled 250 primary-care physicians from each of the four health plans. Of the 1,000 physicians sampled, 884 met the study criteria. Every physician could choose whether to participate in the survey by mail, e-mail, or telephone. The anonymous questionnaire was completed by 605 physicians – 69% of those eligible. The data were weighted to reflect differences in sampling and response rates across health plans. Main findings The vast majority of respondents (87% felt that the monitoring of quality was important and two-thirds (66% felt that the feedback and subsequent remedial interventions improved medical care to a great extent. Almost three-quarters (71% supported continuation of the program in an unqualified manner. The physicians with the most positive attitudes to the program were over age 44, independent contract physicians, and either board-certified in internal medicine or without any board-certification (i.e., residents or general practitioners. At the same time, support for the

  3. Community Partners in Care: Leveraging Community Diversity to Improve Depression Care for Underserved Populations

    OpenAIRE

    Khodyakov, Dmitry; Mendel, Peter; Dixon, Elizabeth; Jones, Andrea; Masongsong, Zoe; Wells, Kenneth

    2009-01-01

    Research suggests that the quality and outcomes of depression treatment for adults can be substantially improved through “collaborative care” programs. However, there is a lack of resources required to implement such programs in vulnerable communities. Our paper examines the planning phase of the Community Partners in Care (CPIC) initiative, which addresses this problem through a unique approach in which academic institutions partner directly with a wide range of community-based and service o...

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

    OpenAIRE

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

    1998-01-01

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

  5. Evaluating the Quality of the Child Care in Finland

    Science.gov (United States)

    Hujala, Eeva; Fonsen, Elina; Elo, Janniina

    2012-01-01

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

  6. Why we need interprofessional education to improve the delivery of safe and effective care

    Directory of Open Access Journals (Sweden)

    Scott Reeves

    2016-03-01

    Full Text Available Interprofessional education (IPE is an activity that involves two or more professions who learn interactively together to improve collaboration and the quality of care. Research has continually revealed that health and social care professionals encounter a range of problems with interprofessional coordination and collaboration which impact on the quality and safety of care. This empirical work resulted in policymakers across health care education and practice to invest in IPE to help resolve this collaborative failures. It is anticipated that IPE will provide health and social care professionals with the abilities required to work together effectively in providing safe high quality care to patients. Through a discussion of a range of key professional, educational and organization issues related to IPE, this paper argues that this form of education is an important strategy to improve the delivery of safe and effective care

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

    OpenAIRE

    Abrahamsen Grøndahl, Vigdis

    2012-01-01

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

  8. Quality of management in the health care system.

    Science.gov (United States)

    Borgenhammar, E

    1990-01-01

    Quality of management is a necessary, yet not sufficient, prerequisite in quality of care. There are two main approaches to improved quality. One is the individualist approach, where the role of the manager is emphasized. The other is the contextual approach. Focus is on managerial prerequisites such as organizational structure, culture, participation in decision making, and use of management time. Individualist as well as contextualist approaches are presented. Each decade during the 20th century has had its own "pet theory" regarding what problems the manager should allocate time on. A study of 41 Nordic public health researchers illustrates that cost-benefit analysis is the best known of ten theories. Management ethics, with the manager as ideologist, is seen as particularly demanding on managerial creativity.

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

    OpenAIRE

    Chirkov Vitaliy Anatolievich; Breusov Aleksey Vasilievich

    2013-01-01

    In work are presented the main results received during social and hygienic research, directed on studying and comparison of level of a salary of the medical personnel of a number of treatment-and-prophylactic establishments of the Moscow region and quality of the medical care rendered to patients are presented. Estimating results of examination of quality of medical care in the studied medical institutions from medical insurance companies, it should be noted that improvements of quality of me...

  10. Point-of-care technology: integration for improved delivery of care.

    Science.gov (United States)

    Gregory, Debbie; Buckner, Martha

    2014-01-01

    The growing complexity of technology, equipment, and devices involved in patient care delivery can be staggering and overwhelming. Technology is intended to be a tool to help clinicians, but it can also be a frustrating hindrance if not thoughtfully planned and strategically aligned. Critical care nurses are key partners in the collaborations needed to improve safety and quality through health information technology (IT). Nurses must advocate for systems that are interoperable and adapted to the context of care experiences. The involvement and collaboration between clinicians, information technology specialists, biomedical engineers, and vendors has never been more relevant and applicable. Working together strategically with a shared vision can effectively provide a seamless clinical workflow, maximize technology investments, and ultimately improve patient care delivery and outcomes. Developing a strategic integrated clinical and IT roadmap is a critical component of today's health care environment. How can technology strategy be aligned from the executive suite to the bedside caregiver? What is the model for using clinical workflows to drive technology adoption? How can the voice of the critical care nurse strengthen this process? How can success be assured from the initial assessment and selection of technology to a sustainable support model? What is the vendor's role as a strategic partner and "co-caregiver"?

  11. Point-of-care technology: integration for improved delivery of care.

    Science.gov (United States)

    Gregory, Debbie; Buckner, Martha

    2014-01-01

    The growing complexity of technology, equipment, and devices involved in patient care delivery can be staggering and overwhelming. Technology is intended to be a tool to help clinicians, but it can also be a frustrating hindrance if not thoughtfully planned and strategically aligned. Critical care nurses are key partners in the collaborations needed to improve safety and quality through health information technology (IT). Nurses must advocate for systems that are interoperable and adapted to the context of care experiences. The involvement and collaboration between clinicians, information technology specialists, biomedical engineers, and vendors has never been more relevant and applicable. Working together strategically with a shared vision can effectively provide a seamless clinical workflow, maximize technology investments, and ultimately improve patient care delivery and outcomes. Developing a strategic integrated clinical and IT roadmap is a critical component of today's health care environment. How can technology strategy be aligned from the executive suite to the bedside caregiver? What is the model for using clinical workflows to drive technology adoption? How can the voice of the critical care nurse strengthen this process? How can success be assured from the initial assessment and selection of technology to a sustainable support model? What is the vendor's role as a strategic partner and "co-caregiver"? PMID:24896558

  12. Medicaid and the Cost of Improving Access to Nursing Home Care

    OpenAIRE

    Gertler, Paul J.

    1989-01-01

    In this paper I show that the Medicaid program can improve the access of financially indigent patients to nursing home care by raising the rate of return paid on Medicaid patients' care, but only at the cost of lower quality of care. To quantify the policy tradeoff, I derive expressions for the elasticity of access with respect to total Medicaid expenditures and the elasticity of access with respect to quality. These elasticities expressions are complicated by the fact that Medicaid payment f...

  13. Improvement of clinical quality indicators through reorganization of the acute care by establishing an emergency department-a register study based on data from national indicators

    DEFF Research Database (Denmark)

    Mattsson, Maria Søe; Mattsson, N.; Jørsboe, H. B.

    2014-01-01

    of an ED. Patients admitted at Nykobing Falster Hospital in 2008 or 2012 were included in the study and data reports from the national databases (RKKP) regarding stroke, COPD, heart failure, bleeding and perforated ulcer or hip fracture were analysed. Holbk Hospital works as a control hospital. Chi......-square test was used for analysing significant differences from pre-and post intervention and Z-test to compare the experimental groups to the control group (HOL). P ...-intervention data were compared for both NFS and HOL (p = 0.024). Conclusions: During the organisation of the new EDs, several of the indicators improved and the overall 30 days mortality decreased in the five diseases. The development of a common set of indicators for monitoring acute treatment at EDs in Denmark...

  14. Is Health Care Ready for Six Sigma Quality?

    OpenAIRE

    Chassin, Mark R.

    1998-01-01

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

  15. The Impact Of Medicare ACOs On Improving Integration And Coordination Of Physical And Behavioral Health Care.

    Science.gov (United States)

    Fullerton, Catherine A; Henke, Rachel M; Crable, Erica; Hohlbauch, Andriana; Cummings, Nicholas

    2016-07-01

    The accountable care organization (ACO) model holds the promise of reducing costs and improving the quality of care by realigning payment incentives to focus on health outcomes instead of service volume. One key to managing the total cost of care is improving care coordination for and treatment of people with behavioral health disorders. We examined qualitative data from ninety organizations participating in Medicare ACO demonstration programs from 2012 through 2015 to determine whether and how they focused on behavioral health care. These ACOs had mixed degrees of engagement in improving behavioral health care for their populations. The biggest challenges included a lack of behavioral health care providers, data availability, and sustainable financing models. Nonetheless, we found substantial interest in integrating behavioral health care into primary care across a majority of the ACOs. PMID:27385242

  16. TECHNOLOGICAL MEASURES TO IMPROVE AUTOMOTIVE PRODUCT QUALITY

    OpenAIRE

    Gladkov, V.; Kruglov, S.

    2010-01-01

    The paper examines the basic technological measures aimed at improving product quality in automotive industry. While paying due attention to solving organizational and technological problems, including the development of certification systems for production processes, it is also necessary to improve the technical standards of specific technologies, equipment and materials as they largely determine product quality. Special emphasis is given to the importance of improving the production of auto...

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

    Science.gov (United States)

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

    2011-01-01

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

  18. Quality of Care and Job Satisfaction in the European Home Care Setting: Research Protocol

    Directory of Open Access Journals (Sweden)

    Liza Van Eenoo

    2016-08-01

    Full Text Available Introduction: Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care. Aim: This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of six European countries. Methods: Data on elements at the macro-level (policy, meso-level (care organisations and micro-level (clients are of importance in determining job satisfaction and quality of care. Macro-level indicators will be identified in a previously published literature review. At meso- and micro-level, data will be collected by means of two questionnaires utilsed with both care organisations and care professionals, and by means of interRAI Home Care assessments of clients. The client assessments will be used to calculate quality of care indicators. Subsequently, data will be analysed by means of linear and stepwise multiple regression analyses, correlations and multilevel techniques. Conclusions and Discussion: These results can guide health care policy makers in their decision making process in order to increase the quality of home care in their organisation, in their country or in Europe.

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

    OpenAIRE

    Felt-Lisk, Suzanne

    2000-01-01

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

  20. Understanding organizational and cultural premises for quality of care in nursing homes: an ethnographic study

    OpenAIRE

    Nakrem, Sigrid

    2015-01-01

    Background Internationally, there are concerns about the quality of care in nursing homes. The concept of ‘corporate culture’ as an internal variable could be seen as the means to improve quality of care and quality of life for the residents. The aim of this article was to describe the nursing home culture from the staff’s perspective and to include how the residents describe quality of care. Methods An ethnographic design was employed. A purposive sample of four municipal public nursing home...

  1. 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)…

  2. Can Technology Improve the Quality of Colonoscopy?

    Science.gov (United States)

    Thirumurthi, Selvi; Ross, William A; Raju, Gottumukkala S

    2016-07-01

    In order for screening colonoscopy to be an effective tool in reducing colon cancer incidence, exams must be performed in a high-quality manner. Quality metrics have been presented by gastroenterology societies and now include higher adenoma detection rate targets than in the past. In many cases, the quality of colonoscopy can often be improved with simple low-cost interventions such as improved procedure technique, implementing split-dose bowel prep, and monitoring individuals' performances. Emerging technology has expanded our field of view and image quality during colonoscopy. We will critically review several technological advances in the context of quality metrics and discuss if technology can really improve the quality of colonoscopy.

  3. The Pediatrix BabySteps Data Warehouse and the Pediatrix QualitySteps improvement project system--tools for "meaningful use" in continuous quality improvement.

    Science.gov (United States)

    Spitzer, Alan R; Ellsbury, Dan L; Handler, Darren; Clark, Reese H

    2010-03-01

    The Pediatrix BabySteps Clinical Data Warehouse (CDW) is a rich and novel tool allowing unbiased extraction of information from an entire neonatal population care by physicians and advanced practice nurses in Pediatrix Medical Group. Because it represents the practice of newborn medicine ranging from small community intensive care units to some of the largest neonatal intensive care units in the United States, it is highly representative of scope of practice in this country. Its value in defining outcome measures, quality improvement projects, and research continues to grow annually. Now coupled with the BabySteps QualitySteps program for defined clinical quality improvement projects, it represents a robust methodology for meaningful use of an electronic health care record, as designated during this era of health care reform. Continued growth of the CDW should result in continued important observations and improvements in neonatal care.

  4. Improving quality at many levels. Profamilia's experience in Colombia.

    Science.gov (United States)

    Trias, M; Plata, M I

    1994-01-01

    Profamilia, the Colombian family planning association and the country's largest family planning provider, began diversifying its services in 1982 to offer prenatal care services as well as general medical consultations. The organization has since attempted to integrate quality assurance at all levels of operation. Specifically, Profamilia is aiming to provide care which is of sustainably high quality to satisfy present clients and attract new ones without overtaxing available organization resources, thereby prompting the eventual financial collapse of the programs and the failure to increase coverage especially among the middle and lower classes of the country. Drawing from the credo of modern corporate enterprise, "the client is always right," Profamilia listens and responds to clients' needs with the goal of making their satisfaction the ultimate objective. Moreover, organization staff receive regular training to motivate their receptiveness to client needs, while the pursuit of quality exists as a major goal at the managerial level. Profamilia regards quality maintenance and improvement as indispensable in program sustainability.

  5. Quality indicators and performance measures in diabetes care.

    Science.gov (United States)

    Aron, David C

    2014-03-01

    The operations of any portion of the healthcare delivery system, eg, ambulatory care, the consultation and referral process, or hospital care, are critically dependent upon their control systems. The quality of health care produced by the system and its components is also subject to "control." One of the regulatory mechanisms involves performance measures. The development of good measures of quality is a complex and dynamic process. Within endocrinology, most measures have addressed diabetes care and most quality measurement in diabetes has focused on the ambulatory setting and mainly includes measures of process and intermediate outcomes. This review addresses quality and performance measures for diabetes, their development, characteristics, use, misuse, and future prospects.

  6. [Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

    Science.gov (United States)

    Godény, Sándor

    2012-02-01

    The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

  7. Understanding uptake of continuous quality improvement in Indigenous primary health care: lessons from a multi-site case study of the Audit and Best Practice for Chronic Disease project

    Directory of Open Access Journals (Sweden)

    Togni Samantha

    2010-03-01

    Full Text Available Abstract Background Experimentation with continuous quality improvement (CQI processes is well underway in Indigenous Australian primary health care. To date, little research into how health organizations take up, support, and embed these complex innovations is available on which services can draw to inform implementation. In this paper, we examine the practices and processes in the policy and organisational contexts, and aim to explore the ways in which they interact to support and/or hinder services' participation in a large scale Indigenous primary health care CQI program. Methods We took a theory-driven approach, drawing on literature on the theory and effectiveness of CQI systems and the Greenhalgh diffusion of innovation framework. Data included routinely collected regional and service profile data; uptake of tools and progress through the first CQI cycle, and data collected quarterly from hub coordinators on their perceptions of barriers and enablers. A total of 48 interviews were also conducted with key people involved in the development, dissemination, and implementation of the Audit and Best Practice for Chronic Disease (ABCD project. We compiled the various data, conducted thematic analyses, and developed an in-depth narrative account of the processes of uptake and diffusion into services. Results Uptake of CQI was a complex and messy process that happened in fits and starts, was often characterised by conflicts and tensions, and was iterative, reactive, and transformational. Despite initial enthusiasm, the mixed successes during the first cycle were associated with the interaction of features of the environment, the service, the quality improvement process, and the stakeholders, which operated to produce a set of circumstances that either inhibited or enabled the process of change. Organisations had different levels of capacity to mobilize resources that could shift the balance toward supporting implementation. Different forms of

  8. The impact of leadership qualities on quality management improvement

    Directory of Open Access Journals (Sweden)

    Radoslaw Wolniak

    2011-12-01

    Full Text Available Currently, the importance of leadership is considered more and more often in quality management. The need of an appropriate leader has been already emphasized in ISO 9000 standards, in TQM philosophy as well as in different models of improvement which are used in the methodologies of prizing quality. Yet, it is in the concept of TQL where the attitude based on the need of leadership in an organization has achieved its best-developed, full shape. On the basis of the conducted studies, the following publication presents the analysis of the dependence between leadership qualities of managers and the improvement of quality management. There has been an attempt to define the qualities, which a manager being responsible for quality management, should have.

  9. The impact of leadership qualities on quality management improvement

    Directory of Open Access Journals (Sweden)

    Ph. D. Radoslaw Wolniak

    2011-05-01

    Full Text Available Currently, the importance of leadership is considered more and more often in quality management. The need of an appropriate leader has been already emphasized in ISO 9000 standards, in TQM philosophy as well as in different models of improvement which are used in the methodologies of prizing quality. Yet, it is in the concept of TQL where the attitude based on the need of leadership in an organization has achieved its best-developed, full shape. On the basis of the conducted studies, the following publication presents the analysis of the dependence between leadership qualities of managers and the improvement of quality management. There has been an attempt to define the qualities, which a manager being responsible for quality management, should have.

  10. Quality-control analytical methods: continuous quality improvement.

    Science.gov (United States)

    Venti, Eden M

    2006-01-01

    It is vital that all compounding pharmacies have a continuous quality improvement program in place by way of standard operating procedures to assure that patients receive high-quality preparations. The program should take into consideration any federal and state regulatory requirements, as well as professional association expectations. Quality control measurements and regular review of those measurements are the foundations of a good quality plan. All pharmacy personnel should be aware of the importance of reporting potential internal quality concerns or problems and should be encouraged to do so without fear of repercussions. Ideally, an error-free compounding pracitice would be the goal. Since this is not practical, quality issues should not be viewed as problems, but as opportunities to improve compounding practices by correcting, before they become pervasive, the processes used in the preparation of prescriptions. PMID:23974418

  11. 改进血液标本流程管理在危急值护理质量控制中的应用%Application of improved blood specimen process management in critical care quality control

    Institute of Scientific and Technical Information of China (English)

    郑春敏

    2015-01-01

    With the development of the modern emergency medicine, the function of the test "critical value" has become increasingly prominent. The core of process management is process oriented and scientific management to "customer satis-faction"as the goal. In clinical nursing work, there are many problems in quality control of critical value, nursing staff plays an important role in the critical value reporting system, for better service for patients, improve the technical level of all nursing staff, we have to improve the quality of nursing care, and ensure medical safety.%随着现代急救医学的发展,检验"危急值"的作用已日益凸显.流程管理的核心是以流程为导向,以"顾客满意"为目标进行科学管理.在临床护理工作中,危急值的质量控制方面存在较多不足,护理人员在危急值报告制度执行中发挥着重要作用,为更好的为患者服务,提高全体护理人员的技术水平,该研究在血液标本的采集、存放、运送以及危急值报告处理流程方面进行改进,使护理专科水平有很大程度提高,确保医疗安全.

  12. Quality of Care Is Improved by Rapid Short Incubation MALDI-ToF Identification from Blood Cultures as Measured by Reduced Length of Stay and Patient Outcomes as Part of a Multi-Disciplinary Approach to Bacteremia in Pediatric Patients

    Science.gov (United States)

    Armstrong, Amanda; Schaus, David

    2016-01-01

    Sepsis has seen an incremental increase in cases of about 13% annually in the USA and accounts for approximately 4400 deaths among pediatric patients. Early identification of the specific pathogen allows the clinician to ensure that the antibiotic coverage is optimal, an intervention that has been shown to improve patient outcomes in sepsis. Our study’s objective was to assess the impact of a rapid Bruker MALDI-Tof identification protocol on pediatric sepsis cases by assessing various indicators. We assessed the quality of care by measuring the following indicators; time to identification of the pathogen, initiation of the most appropriate antibiotic, length of stay (LOS) in hospital and patient outcomes, using a retrospective review over three consecutive years. In total 92 pediatric patients, similar in age and gender distributions were assessed; 37 in 2012, 33 in 2013 and 22 in 2014. The introduction of MALDI-TOF identification in 2013 led to a significant decrease in time to identify a pathogen by 21.03 hours (p = 1.95E-05). A short incubation MALDI-TOF identification protocol in 2014 further reduced time to identification by 17.75 hours (p = 2.48E-3). Overall in 2014 this led to a trend to earlier optimization of antibiotics by 20.2 hours (p = 0.14) and a reduction in length of stay after the implementation of MALDI-ToF identification in 2013 of 3.07 days and a further reduction of 8.92 days after the introduction of the rapid short incubation identification protocol using MALDI-Tof in 2014 (P = 0.12). By evaluating the subgroup of patients where antibiotics were changed, our study confirmed that patients received appropriate therapy 48.8% (20.2 hours) earlier compared to conventional methods leading to a decrease in length of stay of 23.65 days after the implementation of MALDI-ToF identification and a further reduction of 9.82 days in 2014 compared to 2012 (p = 0.02). In 2014 outcomes between the patients needing a change in their antibiotic compared to

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

    DEFF Research Database (Denmark)

    Ingeman, A.; Pedersen, Lars; Hundborg, Heidi Holmager;

    2008-01-01

    National Indicator Project, a quality improvement initiative with participation of all Danish hospital departments caring for patients with stroke, we identified 29,573 patients hospitalized with stroke between January 13, 2003 and October 31, 2005. Quality of care was measured in terms of 7 specific......-response relationship between the number of quality of care criteria met and mortality; the lowest mortality rate was found among patients whose care met all criteria compared with patients whose care failed to meet any criteria (ie, adjusted 30-day mortality rate ratios: 0.45, 95% confidence interval: 0.24-0.66). When......Background: The relationship between process and outcome measures among patients with stroke is unclear. Objectives: To examine the association between quality of care and mortality among patients with stroke in a nationwide population-based follow-up study. Methods: Using data from The Danish...

  14. Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members

    Directory of Open Access Journals (Sweden)

    Kimberly Ramsbottom

    2014-01-01

    Full Text Available Long term care (LTC homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descriptive study conducted 34 individual semistructured interviews in two LTC homes, located in Canada. The participants were 31 family members and three staff, consisting of a front line care worker, a registered nurse, and a nurse practitioner. All participants perceived ACP conversations as valuable to provide “resident-centred care”; however, none of the participants had a good understanding of ACP, limiting its effectiveness. Strategies generated through the research to improve ACP were as follows: educating families and staff on ACP and end-of-life care options; better preparing staff for ACP conversations; providing staff skills training and guidelines; and LTC staff initiating systematic, proactive conversations using careful timing. These strategies can guide quality improvement of palliative care and development of ACP tools and resources specific to the LTC home sector.

  15. Health Care Spending and Quality in Year 1 of the Alternative Quality Contract

    Science.gov (United States)

    Song, Zirui; Safran, Dana Gelb; Landon, Bruce E.; He, Yulei; Ellis, Randall P.; Mechanic, Robert E.; Day, Matthew P.; Chernew, Michael E.

    2012-01-01

    Background In 2009, Blue Cross Blue Shield of Massachusetts (BCBS) implemented a global payment system called the Alternative Quality Contract (AQC). Provider groups in the AQC system assume accountability for spending, similar to accountable care organizations that bear financial risk. Moreover, groups are eligible to receive bonuses for quality. Methods Seven provider organizations began 5-year contracts as part of the AQC system in 2009. We analyzed 2006–2009 claims for 380,142 enrollees whose primary care physicians (PCPs) were in the AQC system (intervention group) and for 1,351,446 enrollees whose PCPs were not in the system (control group). We used a propensity-weighted difference-in-differences approach, adjusting for age, sex, health status, and secular trends to isolate the treatment effect of the AQC in comparisons of spending and quality between the intervention group and the control group. Results Average spending increased for enrollees in both the intervention and control groups in 2009, but the increase was smaller for enrollees in the intervention group — $15.51 (1.9%) less per quarter (P = 0.007). Savings derived largely from shifts in outpatient care toward facilities with lower fees; from lower expenditures for procedures, imaging, and testing; and from a reduction in spending for enrollees with the highest expected spending. The AQC system was associated with an improvement in performance on measures of the quality of the management of chronic conditions in adults (P<0.001) and of pediatric care (P = 0.001), but not of adult preventive care. All AQC groups met 2009 budget targets and earned surpluses. Total BCBS payments to AQC groups, including bonuses for quality, are likely to have exceeded the estimated savings in year 1. Conclusions The AQC system was associated with a modest slowing of spending growth and improved quality of care in 2009. Savings were achieved through changes in referral patterns rather than through changes in

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

    Directory of Open Access Journals (Sweden)

    Restuccia Joseph D

    2012-09-01

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

  17. Continuous quality improvement of colorectal cancer screening

    Institute of Scientific and Technical Information of China (English)

    Mariusz; Madalinski

    2013-01-01

    Quality assurance is a key issue in colorectal cancer screening, because effective screening is able to improve primary prevention of the cancer. The quality measure may be described in terms:how well the screening test tells who truly has a disease (sensitivity) and who truly does not have a disease (specificity). This paper raises concerns about identification of the optimal screening test for colorectal cancer. Colonoscopy vs flexible sigmoidoscopy in colorectal cancer screening has been a source of ongoing debate. A multicentre randomised controlled trial comparing flexible sigmoidoscopy with usual care showed that flexible sigmoidoscopy screening is able to diminish the incidence of distal and proximal colorectal cancer, and also mortality related to the distal colorectal cancer. However, colonoscopy provides a more complete examination and remains the more sensitive exam than flexible sigmoidoscopy. Moreover, colonoscopy with polypectomy significantly reduces colorectal cancer incidence and colorectal cancer-related mortality in the general population. The article considers the relative merits of both methods and stresses an ethical aspect of patient’s involvement in decision-making. Patients should be informed not only about tests tolerability and risk of endoscopy complications, but also that different screening tests for bowel cancer have different strength to exclude colonic cancer and polyps. The authorities calculate effectiveness and costs of the screening tests, but patients may not be interested in statistics regarding flexible sigmoidoscopy screening and from an ethical point of view, they have the right to chose colonoscopy, which is able to exclude a cancer and precancerous lesions in the whole large bowel.

  18. Ten tips for incorporating scientific quality improvement into everyday work.

    Science.gov (United States)

    Goldmann, Don

    2011-04-01

    Healthcare personnel often find it challenging to incorporate disciplined quality improvement into their daily work. Planning, managing and completing improvement projects with sufficient rigour to generate credible evidence and potentially publishable knowledge are even more difficult. Nonetheless, careful set-up and agile leveraging of existing resources and expertise can lead to surprisingly robust results. Project designs that integrate data collection with the work itself are especially helpful. Although the general perception is that top-flight journals are loath to publish the results of quality improvement work, accumulating experience suggests that this hurdle can be overcome. The Standards for Quality Improvement Reporting Excellence guidelines provide a promising framework for crafting publications that can meet the exacting standards of peer-reviewed journals. PMID:21450777

  19. Quality measurement and system change of cancer care delivery.

    Science.gov (United States)

    Haggstrom, David A; Doebbeling, Bradley N

    2011-12-01

    Cancer care quality measurement and system change may serve as a case example for larger possibilities in the health care system related to other diseases. Cancer care quality gaps and variation exist across both technical and patient-centered cancer quality measures, especially among vulnerable populations. There is a need to develop measures that address the following dimensions of quality and its context: disparities, overuse, patient-centeredness, and uncertainty. Developments that may promote system change in cancer care delivery include changes in the information market, organizational accountability, and consumer empowerment. Information market changes include public cancer care quality reporting, enabled by health information exchange, and incentivized by pay-for-performance. Moving organizational accountability, reimbursement, and quality measurement from individual episodes of care to multiple providers providing coordinated cancer care may address quality gaps associated with the fragmentation of care delivery. Consumer empowerment through new technologies, such as personal health records, may lead to the collection of patient-centered quality measures and promote patient self-management. Across all of these developments, leadership and ongoing research to guide informed system changes will be necessary to transform the cancer care delivery system.

  20. Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples

    OpenAIRE

    McDermott Robyn; Thompson Sandra; Weeramanthri Tarun; Connors Christine; Anderson Ian; Nagel Tricia; Scrimgeour David J; Rowley Kevin; Semmens James; Shannon Cindy; Si Damin; Bailie Ross; Burke Hugh; Moore Elizabeth; Leon Dallas

    2010-01-01

    Abstract Background Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE) project has facilitated the implementation of modern Continuous Quality Improvement (CQI) approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermedia...