WorldWideScience

Sample records for quality of health care

  1. What is Good Quality of Health Care?

    Directory of Open Access Journals (Sweden)

    Magne Nylenna

    2015-03-01

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

  2. 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.

  3. Quality of Big Data in health care.

    Science.gov (United States)

    Sukumar, Sreenivas R; Natarajan, Ramachandran; Ferrell, Regina K

    2015-01-01

    The current trend in Big Data analytics and in particular health information technology is toward building sophisticated models, methods and tools for business, operational and clinical intelligence. However, the critical issue of data quality required for these models is not getting the attention it deserves. The purpose of this paper is to highlight the issues of data quality in the context of Big Data health care analytics. The insights presented in this paper are the results of analytics work that was done in different organizations on a variety of health data sets. The data sets include Medicare and Medicaid claims, provider enrollment data sets from both public and private sources, electronic health records from regional health centers accessed through partnerships with health care claims processing entities under health privacy protected guidelines. Assessment of data quality in health care has to consider: first, the entire lifecycle of health data; second, problems arising from errors and inaccuracies in the data itself; third, the source(s) and the pedigree of the data; and fourth, how the underlying purpose of data collection impact the analytic processing and knowledge expected to be derived. Automation in the form of data handling, storage, entry and processing technologies is to be viewed as a double-edged sword. At one level, automation can be a good solution, while at another level it can create a different set of data quality issues. Implementation of health care analytics with Big Data is enabled by a road map that addresses the organizational and technological aspects of data quality assurance. The value derived from the use of analytics should be the primary determinant of data quality. Based on this premise, health care enterprises embracing Big Data should have a road map for a systematic approach to data quality. Health care data quality problems can be so very specific that organizations might have to build their own custom software or data

  4. Experience and perspectives of quality of health care in Nigerian ...

    African Journals Online (AJOL)

    Medical education and health service management policy appear to support the ... that the quality of care in rural hospitals' is lower than that provided in larger ... Some indicators were suggested for measuring the quality of rural health care.

  5. Hospital heterogeneity: what drives the quality of health care.

    Science.gov (United States)

    Ali, Manhal; Salehnejad, Reza; Mansur, Mohaimen

    2017-04-24

    A major feature of health care systems is substantial variation in health care quality across hospitals. The quality of stroke care widely varies across NHS hospitals. We investigate factors that may explain variations in health care quality using measures of quality of stroke care. We combine NHS trust data from the National Sentinel Stroke Audit with other data sets from the Office for National Statistics, NHS and census data to capture hospitals' human and physical assets and organisational characteristics. We employ a class of non-parametric methods to explore the complex structure of the data and a set of correlated random effects models to identify key determinants of the quality of stroke care. The organisational quality of the process of stroke care appears as a fundamental driver of clinical quality of stroke care. There are rich complementarities amongst drivers of quality of stroke care. The findings strengthen previous research on managerial and organisational determinants of health care quality.

  6. Quality of health care: the responsibility of health care professionals in delivering high quality services.

    Science.gov (United States)

    Giangrande, A

    1998-11-01

    According to a recent definition, quality of care consists of the degree to which health services increase the likelihood of desired health outcomes and are consistent with current professional knowledge; a definition that introduces both requirements of outcomes and the appropriateness of the process used. Clearly many different figures are interested in quality assessment initiatives in the health care field and these include patients, administrators and doctors each having different perspective. Doctors obviously pay greater attention to technical quality and results, giving greater emphasis to the health of the individual patient, tending to give priority to technical excellence and interaction between patient and doctor. Although the perspective of health care professionals is widely acknowledged to be important and useful, other perspectives on quality have been emphasised in recent years. The most important of these is the recognition that care must be responsive to the preferences and values of the consumers of health care services. In complete harmony with one's own professional commitment, the attention to the perspectives of patients must give physician the chance to identify methods of measuring and verifying quality which take account of the expectations of the many groups with an interest in improving the functioning of the health system. A global approach in the health field is needed the more specialization advances. The quality of medicine lies in its capacity to integrate what science says is appropriate and to be recommended, what can be reconciled with human rights and the self determination of the patient and what can be achieved by optimising available resources. In this complex context, the doctor could take on both the role of the person who decides on the use of resources and the one of social mediator.

  7. 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....

  8. Towards evaluation of the quality of care in health centres.

    Science.gov (United States)

    Saturno, P J

    1995-01-01

    There is wide acknowledgement that quality assurance is desirable in primary health care. Considerable success has been achieved in this field by the Iberian Programme of Training and Implementation of Quality Assurance Activities in Primary Health Care, the basis for which is outlined below.

  9. 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...

  10. Community Perceptions on the Provision of Quality Health Care in ...

    African Journals Online (AJOL)

    2014-10-02

    Oct 2, 2014 ... people with respect to their perceived quality of health care received at health facilities. ... 2003, and, passed into law, legislative instrument, LI 1809 in 2004 ... For this reason, the authors argue that, in trying to understand the.

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

    Directory of Open Access Journals (Sweden)

    N. V. Tretyakova

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    N. V. Tretyakova

    2015-03-01

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

  13. Patient satisfaction with quality of primary health care in Benghazi ...

    African Journals Online (AJOL)

    2010-10-21

    Oct 21, 2010 ... concerted efforts to manage health care services and to regain the lost trust. ... Objectives: To assess patient satisfaction with quality of PHC assessed in terms of (a) customer profile, ... behavior; interaction effect; type and location of facility; place of ... of care at PHC level by (a) strengthening health admin-.

  14. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

    OpenAIRE

    Okoli Ugo; Eze-Ajoku Ezinne; Oludipe Modupe; Spieker Nicole; Ekezie Winifred; Ohiri Kelechi

    2016-01-01

    Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...

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

    OpenAIRE

    N. V. Tretyakova; V. A. Fedorov

    2013-01-01

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

  16. [Quality evaluation of health care service for adolescents].

    Science.gov (United States)

    Costa, M C; Formigli, V L

    2001-04-01

    To evaluate the technical and scientific quality of care provided adolescents, pregnant adolescents and their offspring by the Emaús community's health service in Belém, state of Pará, Brazil, between 1994 and 1996. Data for population and health care assessment were collected from medical records and compared with the PAHO/WHO and Brazilian Ministry of Health guidelines. The following features were satisfactory: anthropometric measurements and sexual maturity in adolescent health care program; visits scheduling, weight and blood pressure recording and proceedings in the event of medical problem in prenatal care; early registration in the health program, completing of the immunization schedule, weight and motor development recording and adequacy of medical visits in children care. Other aspects were less satisfactory, such as poor recording of clinical procedures and high level of inadequate or partially adequate procedures for the adolescent group; late admission to prenatal care and low recording of pregnant anti-tetanus immunization in prenatal care; high prevalence of early weaning and poor recording of children's height. This easy-to-perform assessment allowed to evaluate the quality of care provided and made it possible to reallocate services and medical procedures to offer health care service better organized and of better quality to meet the population needs.

  17. Global trend in quality of health care delivery in the 21 st century ...

    African Journals Online (AJOL)

    Global trend in quality of health care delivery in the 21 st century. ... health care services without concern for quality is unprofessional and potentially deadly. ... antecedents with emphasis on the most current models of quality health care.

  18. [Nosocomial infections and quality of health care].

    Science.gov (United States)

    Navarrete-Navarro, S; Rangel-Frausto, M S

    1999-01-01

    The main objective of a hospital-acquired infections control program is to decrease the risk of acquisition and the morbidity and costs associated. The organization of a team with technical and humanistic leadership is essential. Every infection control program must also develop strategies that allow: a) identification of the problems, b) to establish the importance of each one, c) to determine their causes, d) to develop solutions and e) the evaluation of the recommended solutions. The development of technical and humanistic abilities by the leader and the members of the team, and the use of the tools mentioned above have produced the only validate and highly effective program of quality improvement in the hospital.

  19. 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.

  20. 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...

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

    Science.gov (United States)

    Fumić, Nera; Marinović, Marin; Brajan, Dolores

    2014-10-01

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

  2. [Perception of health care quality by patients with chronic conditions].

    Science.gov (United States)

    Couillerot-Peyrondet, A-L; Midy, F; Bruneau, C

    2011-02-01

    Patient opinion is becoming ever more important when considering healthcare quality and the reforms required to improve healthcare quality. The main aim of this study was to explore factors determining perceived healthcare quality among patients with chronic diseases. Data are drawn from the survey carried out in 2008 by the Commonwealth Fund, in partnership with the French Superior Health Authority (Haute Autorité de santé). The prospective telephone survey targeted adults in eight countries who had serious health problems (chronic or severe disease, declared poor state of health, hospital admission or major surgery). Of the 1202 French respondents, 851 had at least one diagnosed chronic disease. A multinomial logistic model was used to identify the relationship between perceived healthcare quality and patients' recent experience with the healthcare system. People with chronic disease in general perceived that healthcare quality was excellent (45%) or good (44%). Only 11% of respondents judged it to be average or poor. There was a hint of "could do better", for example when considering podology and ophthalmology follow-up in diabetes or the management of multiple medications. The explanatory model revealed a positive correlation between excellent perceived healthcare quality and a strong doctor-patient relationship, taking into account both the length of this relationship and the ability of the doctor to involve the patient at all stages of decision-making concerning therapeutic management. There was no major link between the perceived quality of care and objective care quality, the quality of procedures, the cost of care to the patient or how frequently patients access the healthcare system. The quality of the relationship between the patient and his/her doctor is a determining factor in the patient's judgement of the quality of healthcare he/she receives. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  3. 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.

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

    Science.gov (United States)

    Hsieh, Chang-Ming

    2009-01-01

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

  5. Quality of care offered to children attending primary health care ...

    African Journals Online (AJOL)

    antibiotic was prescribed in almost half (65/141) of the consultations, but antibiotic use was unwarranted in one-third of these cases. ... study population consisted of public PHC clinics within the .... health record) was requested in just two-thirds (95/141) of .... leading to widespread antibiotic resistance.10 At PHC clinics in.

  6. [Quality of health care, accreditation, and health technology assessment in Croatia: role of agency for quality and accreditation in health].

    Science.gov (United States)

    Mittermayer, Renato; Huić, Mirjana; Mestrović, Josipa

    2010-12-01

    Avedis Donabedian defined the quality of care as the kind of care, which is expected to maximize an inclusive measure of patient welfare, after taking into account the balance of expected gains and losses associated with the process of care in all its segments. According to the World Medical Assembly, physicians and health care institutions have an ethical and professional obligation to strive for continuous quality improvement of services and patient safety with the ultimate goal to improve both individual patient outcomes as well as population health. Health technology assessment (HTA) is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner, with the aim to formulate safe and effective health policies that are patient focused and seek to achieve the highest value. The Agency for Quality and Accreditation in Health was established in 2007 as a legal, public, independent, nonprofit institution under the Act on Quality of Health Care. The Agency has three departments: Department of Quality and Education, Department of Accreditation, and Department of Development, Research, and Health Technology Assessment. According to the Act, the Agency should provide the procedure of granting, renewal and cancellation of accreditation of healthcare providers; proposing to the Minister, in cooperation with professional associations, the plan and program for healthcare quality assurance, improvement, promotion and monitoring; proposing the healthcare quality standards as well as the accreditation standards to the Minister; keeping a register of accreditations and providing a database related to accreditation, healthcare quality improvement, and education; providing education in the field of healthcare quality assurance, improvement and promotion; providing the HTA procedure and HTA database, supervising the healthcare insurance

  7. Total quality management in behavioral health care.

    Science.gov (United States)

    Sluyter, G V

    1998-01-01

    The literature on total quality management or continuous quality improvement in the behavioral health care field is just beginning to emerge. Although most of the evidence on its effectiveness remains anecdotal, it seems clear that it can work in behavioral health care organizations with strong leadership support and a long-term commitment.

  8. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

    Directory of Open Access Journals (Sweden)

    Okoli Ugo

    2016-08-01

    Full Text Available Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004 and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

  9. 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.

  10. Quality of Prenatal Care Services in Karabuk Community Health Center

    Directory of Open Access Journals (Sweden)

    Binali Catak

    2012-04-01

    Full Text Available The aim of the study was to evaluate the quality and quantity of prenatal care services according to gestastional week in Karabuk Community Health Center (CHC. Methods: In this descriptive study 365 pregnant women was selected as sample among 753 pregnant women registered at Karabuk CHC in 18/01/2011. 93.0% of women in the selected sample has been visited in their homes and the face to face interviews were done. The questionnaire was prepared according to Prenatal Care Management Guidelines (PCMG of Ministry of Health. Findings The number of follow-ups was not complete in 23.7% of 15-24 month, 34.4% of 25-32 month, 52,1% of 33-42 month pregnant women. At least four follow-up visits were completed only in 66,7% of postpartum women. Timing of first visit was after 15th week in 15,6% of women. In follow up visits 62.5% of of women’s height were never measured, in 13,0% the women hearth sound of infants didn’t monitored at least once. Laboratory test numbers were under the level required by PCMG. The delivery conditions weren’t planned in 41,8% of last trimester and postpartum women and training about breastfeeding wasn’t given to 15,5 of the same group. Result In family medicine model in Karabuk CHC developments in number of prenatal follow-up visits were observed, but no substantial improvements were found in quality of prenatal visits. Regular in service trainings shoud be given to family doctors and midwives. The use of prenatal care guideline published by MoH should be increased. Keywords: Prenatal care, pregnancy, timing of first visit, qality of prenatal care [TAF Prev Med Bull 2012; 11(2.000: 153-162

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

    Directory of Open Access Journals (Sweden)

    Sakineh Aghazadeh

    2015-07-01

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

  12. eHealth, care and quality of life

    CERN Document Server

    Capello, Fabio; Manca, Marco

    2014-01-01

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

  13. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    NARCIS (Netherlands)

    W.M. Looman (Willemijn); I.N. Fabbricotti (Isabelle); R. Huijsman (Robbert)

    2014-01-01

    markdownabstract__Abstract__ Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months. Intervention: Frailty w

  14. Total quality management in health care.

    Science.gov (United States)

    McDonald, S C

    1994-01-01

    Total quality management (TQM), continuous quality improvement (CQI) and quality control are terms that are becoming very familiar to workers in the health care environment. The purpose of this article is to discuss these terms and the concepts they describe. The origins of TQM and the keen interest in its application to the health care environment today are addressed. In other environments, TQM has shown significant increases in productivity while increasing effectiveness. Its application to the health care environment is the provision of the best possible care through continuously improving service to meet or exceed the needs and expectations of the customer. The customer in the health care environment could be the patient, staff, physician and community serviced by the hospital. Characteristics of the new organizational structure are reviewed. Established techniques and processes are commonly used to identify process-improvement opportunities to assist the manager in continuously evaluating quality trends.

  15. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Science.gov (United States)

    2010-10-01

    ... QIO interpretations on the quality of health care. Subject to the procedures for disclosure and notice... interpretations and generalizations on the quality of health care that identify a particular institution. ... 42 Public Health 4 2010-10-01 2010-10-01 false Disclosure of QIO interpretations on the quality...

  16. Quality systems in Dutch health care institutions.

    NARCIS (Netherlands)

    Casparie, A.F.; Sluijs, E.M.; Wagner, C.; Bakker, D.H. de

    1997-01-01

    The implementation of quality systems in Dutch health care was supervised by a national committee during 1990-1995. To monitor the progress of implementation a large survey was conducted in the beginning of 1995. The survey enclosed all subsectors in health care. A postal questionnaire-derived fr

  17. THE CONCEPT OF QUALITY IN THE FUNCTION OF SECONDARY HEALTH CARE

    Directory of Open Access Journals (Sweden)

    Agneza Aleksijević

    2017-01-01

    Full Text Available Te paper brings an overview of basic approaches to the concept of quality and quality management in order to improve secondary health care. We observe the concept of quality from the perspective of accreditation, categorization and certification of health institutions in the secondary health care. Quality health care is one that meets the needs of users and professional needs, achieves its goals and uses resources in the most efficient manner. Quality in health care is an example of good practice of adopting and improving standards, processes and outcomes. Improving quality requires knowledge and skills with an emphasis on lifelong learning and adjustment to patient’s needs and values. Quality is the responsibility of all individuals within the organization. Poor quality is expensive because of the inaction of people within the system. Te Heath Care Quality Act has determined the principles and the system of measures for achieving and improving quality. These are the measures for achieving quality health care and the implementation of the principles of efficiency and effectiveness of the quality of health care procedures at all levels of health care, the principles of orientation to the patient as well as the principle of patient safety. Te implementation of quality systems results in some new expenditures and every expense incurred is in the function of creation and production of goods and services. In medical institutions we provide health services and thus achieve income. Expenses have to be calculated into the price if we want to generate profit.

  18. Association Between Health Plan Exit From Medicaid Managed Care and Quality of Care, 2006-2014.

    Science.gov (United States)

    Ndumele, Chima D; Schpero, William L; Schlesinger, Mark J; Trivedi, Amal N

    2017-06-27

    State Medicaid programs have increasingly contracted with insurers to provide medical care services for enrollees (Medicaid managed care plans). Insurers that provide these plans can exit Medicaid programs each year, with unclear effects on quality of care and health care experiences. To determine the frequency and interstate variation of health plan exit from Medicaid managed care and evaluate the relationship between health plan exit and market-level quality. Retrospective cohort of all comprehensive Medicaid managed care plans (N = 390) during the interval 2006-2014. Plan exit, defined as the withdrawal of a managed care plan from a state's Medicaid program. Eight measures from the Healthcare Effectiveness Data and Information Set were used to construct 3 composite indicators of quality (preventive care, chronic disease care management, and maternity care). Four measures from the Consumer Assessment of Healthcare Providers and Systems were combined into a composite indicator of patient experience, reflecting the proportion of beneficiaries rating experiences as 8 or above on a 0-to-10-point scale. Outcome data were available for 248 plans (68% of plans operating prior to 2014, representing 78% of beneficiaries). Of the 366 comprehensive Medicaid managed care plans operating prior to 2014, 106 exited Medicaid. These exiting plans enrolled 4 848 310 Medicaid beneficiaries, with a mean of 606 039 beneficiaries affected by plan exits annually. Six states had a mean of greater than 10% of Medicaid managed care recipients enrolled in plans that exited, whereas 10 states experienced no plan exits. Plans that exited from a state's Medicaid market performed significantly worse prior to exiting than those that remained in terms of preventive care (57.5% vs 60.4%; difference, 2.9% [95% CI, 0.3% to 5.5%]), maternity care (69.7% vs 73.6%; difference, 3.8% [95% CI, 1.7% to 6.0%]), and patient experience (73.5% vs 74.8%; difference, 1.3% [95% CI, 0.6% to 1

  19. Informal payments and the quality of health care: Mechanisms revealed by Tanzanian health workers.

    Science.gov (United States)

    Mæstad, Ottar; Mwisongo, Aziza

    2011-02-01

    Informal payments for health services are common in many transitional and developing countries. The aim of this paper is to investigate the nature of informal payments in the health sector of Tanzania and to identify mechanisms through which informal payments may affect the quality of health care. Our focus is on the effect of informal payments on health worker behaviours, in particular the interpersonal dynamics among health workers at their workplaces. We organised eight focus groups with 58 health workers representing different cadres and levels of care in one rural and one urban district in Tanzania. We found that health workers at all levels receive informal payments in a number of different contexts. Health workers sometimes share the payments received, but only partially, and more rarely within the cadre than across cadres. Our findings indicate that health workers are involved in 'rent-seeking' activities, such as creating artificial shortages and deliberately lowering the quality of service, in order to extract extra payments from patients or to bargain for a higher share of the payments received by their colleagues. The discussions revealed that many health workers think that the distribution of informal payments is grossly unfair. The findings suggest that informal payments can impact negatively on the quality of health care through rent-seeking behaviours and through frustrations created by the unfair allocation of payments. Interestingly, the presence of corruption may also induce non-corrupt workers to reduce the quality of care. Positive impacts can occur because informal payments may induce health workers to increase their efforts, and maybe more so if there is competition among health workers about receiving the payments. Moreover, informal payments add to health workers' incomes and might thus contribute to retention of health workers within the health sector.

  20. Creating a Patient-Centered Health Care Delivery System: A Systematic Review of Health Care Quality From the Patient Perspective.

    Science.gov (United States)

    Mohammed, Khaled; Nolan, Margaret B; Rajjo, Tamim; Shah, Nilay D; Prokop, Larry J; Varkey, Prathibha; Murad, Mohammad H

    2016-01-01

    Patient experience is one of key domains of value-based purchasing that can serve as a measure of quality and be used to improve the delivery of health services. The aims of this study are to explore patient perceptions of quality of health care and to understand how perceptions may differ by settings and condition. A systematic review of multiple databases was conducted for studies targeting patient perceptions of quality of care. Two reviewers screened and extracted data independently. Data synthesis was performed following a meta-narrative approach. A total of 36 studies were included that identified 10 quality dimensions perceived by patients: communication, access, shared decision making, provider knowledge and skills, physical environment, patient education, electronic medical record, pain control, discharge process, and preventive services. These dimensions can be used in planning and evaluating health care delivery. Future research should evaluate the effect of interventions targeting patient experience on patient outcomes.

  1. Physicians' perceptions about the quality of primary health care services in transitional Albania

    NARCIS (Netherlands)

    Kellici, Neritan; Dibra, Arvin; Mihani, Joana; Kellici, Suela; Burazeri, Genc

    2015-01-01

    AIM: To date, the available information regarding the quality of primary health care services in Albania is scarce. The aim of our study was to assess the quality of primary health care services in Albania based on physicians' perceptions towards the quality of the services provided to the general p

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

    Science.gov (United States)

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

    2013-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Rashmi

    2010-01-01

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

  4. Two-Year Impact of the Alternative Quality Contract on Pediatric Health Care Quality and Spending

    Science.gov (United States)

    Song, Zirui; Chernew, Michael E.; Landon, Bruce E.; McNeil, Barbara J.; Safran, Dana G.; Schuster, Mark A.

    2014-01-01

    OBJECTIVE: To examine the 2-year effect of Blue Cross Blue Shield of Massachusetts’ global budget arrangement, the Alternative Quality Contract (AQC), on pediatric quality and spending for children with special health care needs (CSHCN) and non-CSHCN. METHODS: Using a difference-in-differences approach, we compared quality and spending trends for 126 975 unique 0- to 21-year-olds receiving care from AQC groups with 415 331 propensity-matched patients receiving care from non-AQC groups; 23% of enrollees were CSHCN. We compared quality and spending pre (2006–2008) and post (2009–2010) AQC implementation, adjusting analyses for age, gender, health risk score, and secular trends. Pediatric outcome measures included 4 preventive and 2 acute care measures tied to pay-for-performance (P4P), 3 asthma and 2 attention-deficit/hyperactivity disorder quality measures not tied to P4P, and average total annual medical spending. RESULTS: During the first 2 years of the AQC, pediatric care quality tied to P4P increased by +1.8% for CSHCN (P < .001) and +1.2% for non-CSHCN (P < .001) for AQC versus non-AQC groups; quality measures not tied to P4P showed no significant changes. Average total annual medical spending was ∼5 times greater for CSHCN than non-CSHCN; there was no significant impact of the AQC on spending trends for children. CONCLUSIONS: During the first 2 years of the contract, the AQC had a small but significant positive effect on pediatric preventive care quality tied to P4P; this effect was greater for CSHCN than non-CSHCN. However, it did not significantly influence (positively or negatively) CSHCN measures not tied to P4P or affect per capita spending for either group. PMID:24366988

  5. Quality of psoriasis care in Germany: results of the national health care study "PsoHealth3".

    Science.gov (United States)

    Langenbruch, Anna; Radtke, Marc Alexander; Jacobi, Arnd; Purwins, Sandra; Haack, Kristina; Reich, Kristian; Stroemer, Klaus; Mrowietz, Ulrich; Augustin, Matthias

    2016-08-01

    Two national surveys conducted in 2005 and 2007 indicated deficits in psoriasis care and induced the composition of the ''National Goals for Health Care in Psoriasis 2010-2015''. The aim of this work was to (1) evaluate the quality of care for patients with psoriasis in Germany, (2) compare this with prior psoriasis studies PsoHealth1 (2005) and PsoHealth2 (2007), and (3) review the implementation of national treatment goals. By means of a cross sectional study the following indicators of health care quality were collected: psoriasis severity (Psoriasis Area Severity Index (PASI) and proportion of PASI >20), quality of life (Dermatology Life Quality Index (DLQI) were corporated: proportion of DLQI >10), previous systemic treatment, inpatient treatment, and days absent from work due to psoriasis. Between January 2013 and March 2014, 1265 patients from 82 dermatological centres were included (mean age of 52 years). 9.2 % had a PASI >20 (2007: 11.6 %; 2005: 17.8 %). 21.3 % reported strong quality of life restrictions (DLQI >10) (2007: 28.2 %; 2005: 34.0 %). 59.5 % had received a systemic treatment at least once within the last 5 years (2007: 47.3 %; 2005: 32.9 %). 20.1 % were treated inpatient within the last 5 years (2007: 20.1 %; 2005: 26.9 %). The current data indicate a better health care situation for psoriasis in Germany. The implementation of the S3-Guideline and the ''National Goals for Health Care in Psoriasis 2010-2015'' could have been contributing factors.

  6. The effect of financial incentives on the quality of health care provided by primary care physicians.

    Science.gov (United States)

    Scott, Anthony; Sivey, Peter; Ait Ouakrim, Driss; Willenberg, Lisa; Naccarella, Lucio; Furler, John; Young, Doris

    2011-09-07

    The use of blended payment schemes in primary care, including the use of financial incentives to directly reward 'performance' and 'quality' is increasing in a number of countries. There are many examples in the US, and the Quality and Outcomes Framework (QoF) for general practitioners (GPs) in the UK is an example of a major system-wide reform. Despite the popularity of these schemes, there is currently little rigorous evidence of their success in improving the quality of primary health care, or of whether such an approach is cost-effective relative to other ways to improve the quality of care. The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians (PCPs) and to identify:i) the different types of financial incentives that have improved quality;ii) the characteristics of patient populations for whom quality of care has been improved by financial incentives; andiii) the characteristics of PCPs who have responded to financial incentives. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library), MEDLINE, HealthSTAR, EMBASE, CINAHL, PsychLIT, and ECONLIT. Searches of Internet-based economics and health economics working paper collections were also conducted. Finally, studies were identified through the reference lists of retrieved articles, websites of key organisations, and from direct contact with key authors in the field. Articles were included if they were published from 2000 to August 2009. Randomised controlled trials (RCT), controlled before and after studies (CBA), and interrupted time series analyses (ITS) evaluating the impact of different financial interventions on the quality of care delivered by primary healthcare physicians (PCPs). Quality of care was defined as patient reported outcome

  7. Which doctor for primary health care? Quality of care and non-physician clinicians in India.

    Science.gov (United States)

    Rao, Krishna D; Sundararaman, T; Bhatnagar, Aarushi; Gupta, Garima; Kokho, Puni; Jain, Kamlesh

    2013-05-01

    The scarcity of rural physicians in India has resulted in non-physician clinicians (NPC) serving at primary health centers (PHC). This study examines the clinical competence of NPCs and physicians serving at PHCs to treat a range of medical conditions. The study is set in Chhattisgarh state, where physicians (medical officers) and NPCs: Rural Medical Assistants (RMA), and Indian system of medicine physicians (AYUSH Medical Officers) serve at PHCs. Where no clinician is available, Paramedics (pharmacists and nurses) usually provide care. In 2009, PHCs in Chhattisgarh were stratified by type of clinical care provider present. From each stratum a representative sample of PHCs was randomly selected. Clinical vignettes were used to measure provider competency in managing diarrhea, pneumonia, malaria, TB, preeclampsia and diabetes. Prescriptions were analyzed. Overall, the quality of medical care was low. Medical Officers and RMAs had similar average competence scores. AYUSH Medical Officers and Paramedicals had significantly lower average scores compared to Medical Officers. Paramedicals had the lowest competence scores. While 61% of Medical Officer and RMA prescriptions were appropriate for treating the health condition, only 51% of the AYUSH Medical Officer and 33% of the prescriptions met this standard. RMAs are as competent as physicians in primary care settings. This supports the use of RMA-type clinicians for primary care in areas where posting Medical Officers is difficult. AYUSH Medical Officers are less competent and need further clinical training. Overall, the quality of medical care at PHCs needs improvement.

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

    Science.gov (United States)

    West, Christopher E.

    2010-01-01

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

  9. Policy Statement--Using personal health records to improve the quality of health care for children.

    Science.gov (United States)

    2009-07-01

    A personal health record (PHR) is a repository of information from multiple contributors (eg, patient, family, guardians, physicians, and other health care professionals) regarding the health of an individual. The development of electronic PHRs presents new opportunities and challenges to the practice of pediatrics. This policy statement provides recommendations for actions that pediatricians can take to support the development and use of PHRs for children. Pediatric health care professionals must become actively involved in developing and adopting PHRs and PHR systems. The American Academy of Pediatrics supports development of: educational programs for families and clinicians on effective and efficient use of PHRs; incentives to facilitate PHR use and maintenance; and child- and adolescent-friendly standards for PHR content, portability, security, and privacy. Properly designed PHR systems for pediatric care can empower patients. PHRs can improve access to health information, improve coordination of preventive health and health maintenance activities, and support emergency and disaster management activities. PHRs provide support for the medical home for all children, including those with special health care needs and those in foster care. PHRs can also provide information to serve as the basis for pediatric quality improvement efforts. For PHRs to be adopted sufficiently to realize these benefits, we must determine how best to support their development and adoption. Privacy and security issues, especially with regard to children and adolescents, must be addressed.

  10. Patients' perceptions of service quality dimensions: an empirical examination of health care in New Zealand.

    Science.gov (United States)

    Clemes, M D; Ozanne, L K; Laurensen, W L

    2001-01-01

    The 1984 liberalization of the New Zealand economy has resulted in a health care sector that has become very competitive (Zwier and Clarke, 1999). The private sector is now able to supply health care services and, as a result, a greater value is being placed on patient satisfaction (Zwier and Clarke, 1999). However, despite the increasing focus on customer satisfaction, research into health care patients' perceptions of the dimensions of service quality is scarce. This can be problematic, as quality of care is an essential issue in the strategic marketing of health care services (Turner and Pol, 1995). This study takes a step towards addressing this deficiency by identifying patients' perceptions of the dimensions of service quality in health care. The findings of this study are based on the empirical analysis of a sample of 389 respondents interviewed by telephone. The findings indicate that the service quality dimensions identified in this health care specific study differ in number and dimensional structure from the widely adopted service quality dimensions first identified by Parasuraman, Berry and Zeithaml (1988): reliability, responsiveness, assurance, empathy and tangibles. The service quality dimensions identified in this study were: reliability, tangibles, assurance, empathy, food, access, outcome, admission, discharge and responsiveness. In addition, health care patients perceive the service quality dimensions relating to the core product in health care delivery (for example, outcome and reliability) as more important than the service quality dimensions relating to the peripheral product in health care delivery (for example, food, access and tangibles). Finally, the results of this study suggest that patients with different geographic, demographic, and behavioristic characteristics have different needs and wants during health care delivery and therefore perceive different service quality dimensions as important.

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

    Science.gov (United States)

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

    2014-01-01

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

  12. [Health care related e-health applications and quality of life: empirical results and conceptual perspectives].

    Science.gov (United States)

    Muehlan, Holger; Schmidt, Silke

    2013-09-01

    As for other health care services, e-Health applications are implemented with the general objective to improve the quality of life of their users. This holds not equally true for all applications, but it is frequently stated for patient-side e-Health services.A descriptive review of the literature indicates that in general there is no substantial impact of selected e-Health applications on patient-reported quality of life. Moreover, empirical findings are insufficient or lacking for several e-Health applications. Patient satisfaction is more often included in e-Health studies investigating the impact of e-Health applications on patient-reported outcomes, whereas patient-reported experiences are increasingly important.Given the diversity of e-Health applications and respective intended outcomes, it is concluded that the assessment of quality of life should become more context-sensitive and application-specific, including domains and facets that are specifically appropriate to e-Health settings. Moreover, patient-reported experiences (e. g. patient safety) should be taken into account.

  13. 42 CFR 476.72 - Review of the quality of care of risk-basis health maintenance organizations and competitive...

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Review of the quality of care of risk-basis health... Quality Improvement Organizations (QIOs) General Provisions § 476.72 Review of the quality of care of risk... MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY...

  14. 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...

  15. Quality of Primary Health Care for children and adolescents living with HIV 1

    Science.gov (United States)

    do Nascimento, Leticia; de Paula, Cristiane Cardoso; Magnago, Tania Solange Bosi de Souza; Padoin, Stela Maris de Mello; Harzheim, Erno; da Silva, Clarissa Bohrer

    2016-01-01

    Abstract Objective: to evaluate the quality of health care for children and adolescents living with HIV, among the different types of Primary Health Care services of Santa Maria, Rio Grande do Sul. Method: cross-sectional study, developed with 118 Primary Health Care professionals. The Primary Care Evaluation Instrument, Professional version, was used. For verification of the variables associated with the high score, Poisson Regression was used. Results: the professionals of the Family Health Strategy, when compared to those of the Primary Health Units, obtained a greater degree of orientation to primary care, both for the overall score and for the derived attributes score, as well as for the integrality and community orientation attributes. A specialization in Primary Health Care, other employment and a statutory work contract were associated with quality of care. Conclusion: the Family Health Strategy was shown to provide higher quality health care for children and adolescents living with HIV, however, the coverage is still low. The need was highlighted to expand this coverage and invest in vocational training directed toward Primary Care and making the professionals effective, through public selection procedure, as well as an improvement program that recognizes the care requirements, in these settings, of children and adolescents infected with HIV. PMID:27579927

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

    Science.gov (United States)

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

    2016-01-01

    Patients may be the most reliable reporters of some aspects of the health care process; their perspectives should be considered when pursuing changes to improve patient safety. The authors evaluated the association between patients' perceived health care quality and self-reported medical, medication, and laboratory errors in a multinational sample. The analysis was conducted using the 2010 Commonwealth Fund International Health Policy Survey, a multinational consumer survey conducted in 11 countries. Quality of care was measured by a multifaceted construct developed using Rasch techniques. After adjusting for potentially important confounding variables, an increase in respondents' perceptions of care coordination decreased the odds of self-reporting medical errors, medication errors, and laboratory errors (P < .001). As health care stakeholders continue to search for initiatives that improve care experiences and outcomes, this study's results emphasize the importance of guaranteeing integrated care.

  17. Using social determinants of health to link health workforce diversity, care quality and access, and health disparities to achieve health equity in nursing.

    Science.gov (United States)

    Williams, Shanita D; Hansen, Kristen; Smithey, Marian; Burnley, Josepha; Koplitz, Michelle; Koyama, Kirk; Young, Janice; Bakos, Alexis

    2014-01-01

    It is widely accepted that diversifying the nation's health-care workforce is a necessary strategy to increase access to quality health care for all populations, reduce health disparities, and achieve health equity. In this article, we present a conceptual model that utilizes the social determinants of health framework to link nursing workforce diversity and care quality and access to two critical population health indicators-health disparities and health equity. Our proposed model suggests that a diverse nursing workforce can provide increased access to quality health care and health resources for all populations, and is a necessary precursor to reduce health disparities and achieve health equity. With this conceptual model as a foundation, we aim to stimulate the conceptual and analytical work-both within and outside the nursing field-that is necessary to answer these important but largely unanswered questions.

  18. 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

  19. Effects of an Integrated Care System on quality of care and satisfaction for children with special health care needs.

    Science.gov (United States)

    Knapp, Caprice; Madden, Vanessa; Sloyer, Phyllis; Shenkman, Elizabeth

    2012-04-01

    To assess the effects of an Integrated Care System (ICS) on parent-reported quality of care and satisfaction for Children with Special Health Care Needs (CSHCN). In 2006 Florida reformed its Medicaid program in Broward and Duval counties. Children's Medical Services Network (CMSN) chose to participate in the reform and developed an ICS for CSHCN. The ICS ushered in several changes such as more prior approval requirements and closing of the provider network. Telephone surveys were conducted with CMSN parents whose children reside in the reform counties and parents whose children reside outside of the reform counties in 2006 and 2007 (n = 1,727). Results from multivariate quasi-experimental models show that one component of parent-report quality of care, customer service, increased. Following implementation of the ICS, customer service increased by 0.22 points. After implementation of the ICS, parent-reported quality and satisfaction were generally unaffected. Although significant increases were not seen in the majority of the quality and satisfaction domains, it is nonetheless encouraging that parents did not report negative experiences with the ICS. It is important to present these interim findings so that progress can be monitored and decision-makers can begin to consider if the program should be expanded statewide.

  20. QUALITY MANAGEMENT IN HEALTH CARE - CONTRIBUTING TO PATIENT SAFETY AND EFFICIENCY OF BUSINESS OPERATION

    OpenAIRE

    Nevenka Kovac

    2014-01-01

    In order to ensure efficient and effective health care, of equal high quality and accessibility, at all the levels of healthcare and across the entire Croatian territory, all operators in health services are required to establish, develop and maintain a system for assuring and improving the quality in healthcare. Legal requirement to introduce quality management systems into healthcare institutions notwithstanding, a quality management system is equally important in regard to the provision of...

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

    Directory of Open Access Journals (Sweden)

    Klomp Helena

    2010-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Robin C Nesbitt

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

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

    Science.gov (United States)

    Nesbitt, Robin C; Lohela, Terhi J; Manu, Alexander; Vesel, Linda; Okyere, Eunice; Edmond, Karen; Owusu-Agyei, Seth; Kirkwood, Betty R; Gabrysch, Sabine

    2013-01-01

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

  4. The contribution of human resources for health to the quality of care in Indonesia.

    Science.gov (United States)

    Barber, Sarah L; Gertler, Paul J; Harimurti, Pandu

    2007-01-01

    Using a representative sample of public facilities surveyed in 1993 and 1997, we took advantage of exogenous changes imposed on the Indonesian health system to evaluate the contribution of physicians, nurses, and midwives to the quality of primary care. We found that quality depends on the availability, type, and number of health workers, which, in turn, is affected by public policies about deployment. We conclude that staff deployment could be refined by analyses of the skill-mix needed to provide quality care. Professional nurses in particular could play an important role in promoting quality.

  5. Influence of national culture on the social construction of health care quality

    OpenAIRE

    Aldousari, Abdulrahman

    2015-01-01

    The purpose of this study is to examine how national culture influences the social constructions of health care quality in the Kuwaiti primary care. Kuwait has a well- developed primary care system, offering a wide range of services in practices distributed throughout the nation, throughout the day, and on a walk-in basis. Despite its extended hours, relative comprehensiveness and affordability, the primary care service in Kuwait appears to be poorly received by the public. This study employe...

  6. [Internal audit--the foundation of healthcare quality management in health care].

    Science.gov (United States)

    Smiianov, V A

    2014-01-01

    The paper proved the need for internal audit as the basis for quality control of medical care in a health facility, developed the project milestones and explains what needs to be taken into account at every stage during its implementation.

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

    OpenAIRE

    Moreira Philippe; Suh Siri; Ly Moussa

    2007-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Luker JA

    2011-07-01

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

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

    Science.gov (United States)

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

    2016-05-12

    The introduction of health insurance in Ghana in 2003 has resulted in a tremendous increase in utilization of health services. However, concerns are being raised about the quality of patient care. Some of the concerns include long waiting times, verbal abuse of patients by health care providers, inadequate physical examination by doctors and discrimination of insured patients. The study compares perceptions of quality of care between insured and uninsured out-patients in selected hospitals in Ghana to determine whether there is any unequal treatment between insured and uninsured patients in terms of quality of care, as empirical and anecdotal evidence seem to suggest. A cross-sectional survey of 818 out-patients was conducted in 17 general hospitals from three regions of Ghana. These are the Upper East, Brong Ahafo and Central Regions. Convenience sampling was employed to select the patients in exit interviews. Descriptive statistics, including frequency distributions, means and standard deviations, were used to describe socio-economic and demographic characteristics of respondents. Factor analysis was used to determine distinct quality of care constructs; t-test statistic was used to test for differences in quality perceptions between the insured and uninsured patients; and regression analysis was used to test the association between health insurance and quality of care. Overall, there was no significant difference in perceptions of quality between insured and uninsured patients. However, there was a significant difference between insured and uninsured patients in respect of financial access to care. The major quality of care concern affecting all patients was the problem of inadequate resources, especially lack of doctors, lack of drugs and other basic supplies and equipment to work with. It was concluded that generally, insured and uninsured patients are not treated unequally, contrary to prevailing anecdotal and empirical evidence. On the contrary, quality of

  10. Effects of physician joint ventures on health care costs, access, and quality: exploring some issues.

    Science.gov (United States)

    Ahern, M; Scott, E

    1992-01-01

    Increasingly, physicians are joint-venturing with health care businesses such as physical therapy centers, diagnostic imaging centers, ambulatory surgical centers, and other services. Simultaneously, outpatient costs have been rising. Theoretical and empirical evidence, including results of an exploratory survey of experts, indicate that these two events are linked. Specifically, joint ventures between referring physicians and health care businesses often appear to increase costs, increase utilization, reduce quality of care, and reduce access.

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    Gezahegn Gebrekidan

    2014-01-01

    Full Text Available Ensuring provision of good quality tuberculosis (TB care, especially in private for profit health facilities, is an important component of TB control strategy to reduce poor medical practice which results in multidrug resistant TB (MDR-TB. The aim of this study was to investigate quality of TB care in private health facilities of Addis Ababa. A facility based cross-sectional study was conducted based on Donabedian’s structure-process-outcome model of health care quality. Quality of care was determined by adherence to National TB Program guidelines, treatment success rate, and client satisfaction. Exit interview was conducted on 292 patients on the intensive phase of treatment and 384 patient records were reviewed in eight private health facilities. Initial diagnostic AFB test was done for 95.4% of pulmonary TB patients. Most important components of TB care recommended by national guidelines were delivered for a significant proportion of patients. Majority (75% of the clients were found to be satisfied with each component of TB care. The treatment success rate was 90.9%. The quality of TB care was fairly good. However, only 77.7% of the patients were counseled for HIV testing. Strengthening HIV counseling and testing, tackling shortage of streptomycin and laboratory reagent at private TB clinic is crucial.

  13. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    Directory of Open Access Journals (Sweden)

    Wilhelmina Mijntje Looman

    2014-12-01

    Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months.Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files.Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis.Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is required

  14. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    Directory of Open Access Journals (Sweden)

    Wilhelmina Mijntje Looman

    2014-12-01

    Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months. Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files. Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis. Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is

  15. 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

  16. Coverage and quality of antenatal care provided at primary health care facilities in the 'Punjab' province of 'Pakistan'.

    Directory of Open Access Journals (Sweden)

    Muhammad Ashraf Majrooh

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

  17. 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

  18. 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

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

    Directory of Open Access Journals (Sweden)

    Heidari Gorji Ali

    2011-12-01

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

  20. Experiencing health care service quality: through patients' eyes.

    Science.gov (United States)

    Schembri, Sharon

    2015-02-01

    The primary aim of the present study was to consider health care service quality from the patients' perspective, specifically through the patient's eyes. A narrative analysis was performed on 300 patient stories. This rigorous analysis of patient stories is designed to identify and describe health care service quality through patients' eyes in an authentic and accurate, experiential manner. The findings show that there are variant and complex ways that patients experience health care service quality. Patient stories offer an authentic view of the complex ways that patients experience health care service quality. Narrative analysis is a useful tool to identify and describe how patients experience health care service quality. Patients experience health care service quality in complex and varying ways.

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

    Directory of Open Access Journals (Sweden)

    Ahmed M S A Mansur

    2014-12-01

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

  2. Issues of quality and consumer rights in the health care market.

    Science.gov (United States)

    Copeland, C

    1998-04-01

    This Issue Brief describes how the structure of the health care market has changed in the recent years. It outlines the growth in managed care and the changes in the types of managed care plans available. In addition, it discusses the issue of quality in the health care market. It also includes an overview of the legislative topics and issues relating to quality and consumer rights that policymakers are currently considering. Growth in national health expenditures, the medical care price index, and employer health care costs has slowed significantly since 1990. This decreased growth has coincided with substantial increases in managed care plan enrollment. The percentage of employees enrolled in managed care plans increased from 48 percent to 85 percent from 1992 to 1997. Quality is a multidimensional concept. Although individuals may agree on its components, they may disagree on the relative importance of these components. Therefore, disagreement exists not only on how to measure quality but also on how it is defined. Consequently, policy decisions need to be based on an evaluation of a particular law's effect as opposed to its stated goal or intent. This distinction is important because a law that addresses access or consumer rights does not necessarily address the quality of care a consumer receives. Ultimately, whether an individual believes that a law truly addresses quality will depend in a large part on his or her subjective opinion of what quality entails. To date, comparison of the quality of managed care plans with that of fee-for-service plans has not produced results that uniformly differentiate between these two plan types in either a positive or a negative way. In addition, it is important to note that the current debate on the quality of care provided in the health care market is not new to the present managed care era. The regulations and mandates discussed in this report would not guarantee increased quality in the health care market, unless quality

  3. Use of quality measures for Medicaid behavioral health services by state agencies: implications for health care reform.

    Science.gov (United States)

    Seibert, Julie; Fields, Suzanne; Fullerton, Catherine Anne; Mark, Tami L; Malkani, Sabrina; Walsh, Christine; Ehrlich, Emily; Imshaug, Melina; Tabrizi, Maryam

    2015-06-01

    The structure-process-outcome quality framework espoused by Donabedian provides a conceptual way to examine and prioritize behavioral health quality measures used by states. This report presents an environmental scan of the quality measures and satisfaction surveys that state Medicaid managed care and behavioral health agencies used prior to Medicaid expansion in 2014. Data were collected by reviewing online documents related to Medicaid managed care contracts for behavioral health, quality strategies, quality improvement plans, quality and performance indicators data, annual outcomes reports, performance measure specification manuals, legislative reports, and Medicaid waiver requests for proposals. Information was publicly available for 29 states. Most states relied on process measures, along with some structure and outcome measures. Although all states reported on at least one process measure of behavioral health quality, 52% of states did not use any outcomes measures and 48% of states had no structure measures. A majority of the states (69%) used behavioral health measures from the National Committee for Quality Assurance's Healthcare Effectiveness Data and Information Set, and all but one state in the sample (97%) used consumer experience-of-care surveys. Many states supplemented these data with locally developed behavioral health indicators that rely on administrative and nonadministrative data. State Medicaid agencies are using nationally recognized as well as local measures to assess quality of behavioral health care. Findings indicate a need for additional nationally endorsed measures in the area of substance use disorders and treatment outcomes.

  4. Quality Assessment of Family Planning Sterilization Services at Health Care Facilities: Case Record Audit.

    Science.gov (United States)

    Mathur, Medha; Goyal, Ram Chandra; Mathur, Navgeet

    2017-05-01

    Quality of sterilization services is a matter of concern in India because population control is a necessity. Family Planning Sterilization (FPS) services provided at public health care facilities need to be as per Standard Operating Procedures. To assess the quality of FPS services by audit of case records at selected health care facilities. This cross-sectional study was conducted for two and a half year duration at selected public health care facilities of central India by simple random sampling where FPS services were provided. As per the standards of Government of India, case records were audited and compliance was calculated to assess the quality of services. Results of record audit were satisfactory but important criteria like previous contraceptive history and postoperative counselling were found to be deviated from standards. At Primary Health Centres (PHCs) only 89.5% and at Community Health Centres (CHCs) 58.7% of records were having details of previous contraceptive history. Other criteria like mental illness (only 70% at CHCs) assessment were also inadequate. Although informed consent was found to be having 100% compliance in all records. Quality of care in FPS services is the matter of concern in present scenario for better quality of services. This study may enlighten the policy makers regarding improvements needed for providing quality care.

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

    Science.gov (United States)

    Vladislavovna Doubova Dubova, Svetlana; Flores-Hernández, Sergio; Rodriguez-Aguilar, Leticia; Pérez-Cuevas, Ricardo

    2010-02-10

    1) To design and validate indicators to measure the quality of the process of care that climacteric stage women receive in family medicine clinics (FMC). 2) To assess the quality of care that climacteric stage women receive in FMC. 3) To determine the association between quality of care and health-related quality of life (HR-QoL) among climacteric stage women. The study had two phases: I. Design and validation of indicators to measure the quality of care process by using the RAND/UCLA Appropriateness Method. II. Evaluation of the quality of care and its association with HR-QoL through a cross-sectional study conducted in two FMC located in Mexico City that included 410 climacteric stage women. The quality of care was measured by estimating the percentage of recommended care received (PRCR) by climacteric stage women in three process components: health promotion, screening, and treatment. The HR-QoL was measured using the Cervantes scale (0-155). The association between quality of care and HR-QoL was estimated through multiple linear regression analysis. The lowest mean of PRCR was for the health promotion component (24.1%) and the highest for the treatment component (86.6%). The mean of HR-QoL was 50.1 points. The regression analysis showed that in the treatment component, for every 10 additional points of the PRCR, the global HR-QoL improved 2.8 points on the Cervantes scale (coefficient -0.28, P < 0.0001). The indicators to measure quality of care for climacteric stage women are applicable and feasible in family medicine settings. There is a positive association between the quality of the treatment component and HR-QoL; this would encourage interventions to improve quality of care for climacteric stage women.

  6. Can branding by health care provider organizations drive the delivery of higher technical and service quality?

    Science.gov (United States)

    Snihurowych, Roman R; Cornelius, Felix; Amelung, Volker Eric

    2009-01-01

    Despite the widespread use of branding in nearly all other major industries, most health care service delivery organizations have not fully embraced the practices and processes of branding. Facilitating the increased and appropriate use of branding among health care delivery organizations may improve service and technical quality for patients. This article introduces the concepts of branding, as well as making the case that the use of branding may improve the quality and financial performance of organizations. The concepts of branding are reviewed, with examples from the literature used to demonstrate their potential application within health care service delivery. The role of branding for individual organizations is framed by broader implications for health care markets. Branding strategies may have a number of positive effects on health care service delivery, including improved technical and service quality. This may be achieved through more transparent and efficient consumer choice, reduced costs related to improved patient retention, and improved communication and appropriateness of care. Patient satisfaction may be directly increased as a result of branding. More research into branding could result in significant quality improvements for individual organizations, while benefiting patients and the health system as a whole.

  7. Structural violence and simplified paternalistic ideas of patient empowerment decreases health care access, quality & outcome for ethnic minority patients

    DEFF Research Database (Denmark)

    Sodemann, Morten

    Increasing complexity of health care organization, rapid hyperspecialization of medical care, lack of ’patient literacy’ and pressure on patients to take over responsibility, challenges political dreams of equal access to patient centered high quality secure care....

  8. Quality assurance in health care: past, present and future.

    Science.gov (United States)

    Bilawka, E; Craig, B J

    2003-08-01

    Quality of health care delivery is a growing concern globally given current budget restraints and increasing demands on health care providers. The variety of quality assurance and quality management activities equals the numerous ways health care practitioners of all genres provide health care. Dental hygienists around the world must be knowledgeable about quality assurance and management in health care as it is a significant factor in the evolution of the dental hygiene profession and the quality of oral health care provided by dental hygienists. The objective of this research was to conduct a literature review on quality assurance and quality management. A MEDLINE search from 1966 to 2002 was conducted. The search resulted in approximately 145 articles. Additional references from works generated by the search were also obtained. The literature revealed information on the background and history of quality assurance and quality management. Much of the literature was devoted to discussions of the validity, reliability and effectiveness of most prominent quality management activities being utilised in health care today. The investigation revealed numerous issues and barriers surrounding quality management. This article concludes with suggestions for future directions of quality assurance and quality management.

  9. Health information technology and quality of health care: strategies for reducing disparities in underresourced settings.

    Science.gov (United States)

    Millery, Mari; Kukafka, Rita

    2010-10-01

    Health information technology (health IT) has potential for facilitating quality improvement and reducing quality disparities found in underresourced settings (URSs). With this systematic literature review, complemented by key informant interviews, the authors sought to identify evidence regarding health IT and quality outcomes in URSs. The review included 105 peer-reviewed studies (2004-2009) in all settings. Only 15 studies included URSs, and 8 focused on URSs. Based on literature across settings, most evidence was available for quality impact of order entry, clinical decision support systems, and computerized reminders. Study designs were predominantly quasi-experimental (37%) or descriptive (35%); 90% of the studies focused on the microsystem level of quality improvement, indicating a need for expanding research into patient experience and organizational and environmental levels. Key informants highlighted organizational partnerships and health IT champions and emphasized that for health IT to have an impact on quality, there must be an organizational culture of quality improvement.

  10. Defining and using quality of life: a survey of health care professionals.

    Science.gov (United States)

    McKevitt, C; Redfern, J; La-Placa, V; Wolfe, C D A

    2003-12-01

    'Quality of life' is an important but poorly defined outcome in health and health care research. We sought to identify stroke professionals' definitions of quality of life and views of the purpose of its assessment. Using issues identified during in-depth interviews with stroke care professionals, we designed a postal survey questionnaire. Participants were asked to define quality of life, identify the purposes of assessing it and report experiences of measuring patient quality of life. Comparisons between professional groups were analysed using chi-squared tests of significance. Care of the elderly physicians, physiotherapists and occupational therapists in the UK. Of 2793 questionnaires distributed, 1572 were returned (56% response rate). Quality of life was defined in terms of 'happiness' by 72%; 25% included social well-being; 25% included physical abilities. Most (91%) identified 'asking patients' as an effective way to assess quality of life; 40% using standardized measures. Half those who reported using quality of life measures experienced difficulties, including being unsure about which measure to use and concerns about validity. The idea of quality of life as happiness dominated responders' definitions. We argue that the term may be used in both a technical sense (an outcome) and in a broad colloquial sense, without necessarily distinguishing between the two. Clarification of the concept and its uses is required if recent calls to introduce quality of life assessment in clinical care are to be feasible.

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

    Directory of Open Access Journals (Sweden)

    Moreira Philippe

    2007-11-01

    Full Text Available Abstract Background In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers' competence. In response to this challenge, Management Sciences for Health (MSH has implemented a program of formative supervision. This multifaceted, problem-solving approach collects data on quality of care, improves technical competence, and engages the community in improving reproductive health care. Methods This study evaluated changes in service quality and community involvement after two rounds of supervision in 45 health facilities in four districts of Senegal. We used checklists to assess quality in four areas of service delivery: infrastructure, staff and services management, record-keeping, and technical competence. We also measured community involvement in improving service quality using the completion rates of action plans. Results The most notable improvement across regions was in infection prevention. Management of staff, services, and logistics also consistently improved across the four districts. Record-keeping skills showed variable but lower improvement by region. The completion rates of action plans suggest that communities are engaged in improving service quality in all four districts. Conclusion Formative supervision can improve the quality of reproductive health services, especially in areas where there is on-site skill building and refresher training. This approach can also mobilize communities to participate in improving service quality.

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

    Science.gov (United States)

    Suh, Siri; Moreira, Philippe; Ly, Moussa

    2007-11-29

    In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers' competence. In response to this challenge, Management Sciences for Health (MSH) has implemented a program of formative supervision. This multifaceted, problem-solving approach collects data on quality of care, improves technical competence, and engages the community in improving reproductive health care. This study evaluated changes in service quality and community involvement after two rounds of supervision in 45 health facilities in four districts of Senegal. We used checklists to assess quality in four areas of service delivery: infrastructure, staff and services management, record-keeping, and technical competence. We also measured community involvement in improving service quality using the completion rates of action plans. The most notable improvement across regions was in infection prevention.Management of staff, services, and logistics also consistently improved across the four districts. Record-keeping skills showed variable but lower improvement by region. The completion rates of action plans suggest that communities are engaged in improving service quality in all four districts. Formative supervision can improve the quality of reproductive health services, especially in areas where there is on-site skill building and refresher training. This approach can also mobilize communities to participate in improving service quality.

  13. Quality of drug prescription in primary health care facilities in ...

    African Journals Online (AJOL)

    DR Marwa

    1Ilemela District Hospital, P.O. Box 735, Mwanza, Tanzania. 2Catholic ... prolonged hospital stay and consequently an increased cost of disease management in patients ... WHO/INRUD primary health facility prescribing indicators that monitor ...

  14. Satisfaction with access to and quality of health care among Medicare enrollees in a health maintenance organization.

    Science.gov (United States)

    Meng, Y Y; Jatulis, D E; McDonald, J P; Legorreta, A P

    1997-04-01

    This study was designed to determine the levels and predictors of Medicare enrollees' satisfaction with access to medical care and quality of health care in a health maintenance organization. Data collected by an instrument adapted from the Group Health Association of America's Consumer Satisfaction Survey were analyzed after being linked with administrative data. In general, Medicare enrollees reported high satisfaction with both access to and quality of health care. Most members (96%) rated skill, experience, and training of physicians and the friendliness and courtesy of the staff favorably. A lower percentage of members (77%) rated favorably the ability to contact a physician after hours. Levels of satisfaction were essentially not explained by patient characteristics such as age, sex, geographic region, medications, or utilization. Stepwise regression identified the ease of arranging appointments as the strongest predictor of satisfaction, with access to care and outcomes of medical care as the strongest predictor of overall satisfaction with quality of health care. These findings indicate that items that members rated least favorably, such as ability to contact a physician after hours, added little to the prediction of satisfaction with access to and quality of health care.

  15. MetroHealth Care Plus: Effects Of A Prepared Safety Net On Quality Of Care In A Medicaid Expansion Population.

    Science.gov (United States)

    Cebul, Randall D; Love, Thomas E; Einstadter, Douglas; Petrulis, Alice S; Corlett, John R

    2015-07-01

    Studies of Medicaid expansion have produced conflicting results about whether the expansion is having a positive impact on health and the cost and efficiency of care delivery. To explore the issue further, we examined MetroHealth Care Plus, a Centers for Medicare and Medicaid Services (CMS) waiver program in Ohio composed of three safety-net organizations that enrolled 28,295 uninsured poor patients in closed-panel care during 2013. All participating organizations used electronic health records and patient-centered medical homes, publicly reported performance in a regional health improvement collaborative, and accepted a budget-neutral cap approved by CMS. We compared changes between 2012 and 2013 in achieving quality standards for diabetes and hypertension among 3,437 MetroHealth Care Plus enrollees to changes among 1,150 patients with the same conditions who remained uninsured in both years. Compared to continuously uninsured patients with diabetes, MetroHealth Care Plus enrollees with diabetes improved significantly more on composite standards of care and intermediate outcomes. Among enrollees with hypertension, blood pressure control improvements were insignificantly larger than those in the continuously uninsured group with hypertension. Across all 28,295 enrollees, 2013 total costs of care were 28.7 percent below the budget cap, providing cause for optimism that a prepared safety net can meet the challenges of Medicaid expansion. Project HOPE—The People-to-People Health Foundation, Inc.

  16. Quality of Health Management Information System for Maternal & Child Health Care in Haryana State, India

    Science.gov (United States)

    Sharma, Atul; Rana, Saroj Kumar; Prinja, Shankar; Kumar, Rajesh

    2016-01-01

    Background Despite increasing importance being laid on use of routine data for decision making in India, it has frequently been reported to be riddled with problems. Evidence suggests lack of quality in the health management information system (HMIS), however there is no robust analysis to assess the extent of its inaccuracy. We aim to bridge this gap in evidence by assessing the extent of completeness and quality of HMIS in Haryana state of India. Methods Data on utilization of key maternal and child health (MCH) services were collected using a cross-sectional household survey from 4807 women in 209 Sub-Centre (SC) areas across all 21 districts of Haryana state. Information for same services was also recorded from HMIS records maintained by auxiliary nurse midwives (ANMs) at SCs to check under- or over-recording (Level 1 discordance). Data on utilisation of MCH services from SC ANM records, for a subset of the total women covered in the household survey, were also collected and compared with monthly reports submitted by ANMs to assess over-reporting while report preparation (Level 2 discordance) to paint the complete picture for quality and completeness of routine HMIS. Results Completeness of ANM records for various MCH services ranged from 73% for DPT1 vaccination dates to 94.6% for dates of delivery. Average completeness level for information recorded in HMIS was 88.5%. Extent of Level 1 discordance for iron-folic acid (IFA) supplementation, 3 or more ante-natal care (ANC) visits and 2 Tetanus toxoid (TT) injections was 41%, 16% and 2% respectively. In 48.2% cases, respondents from community as well as HMIS records reported at least one post-natal care (PNC) home visit by ANM. Extent of Level 2 discordance ranged from 1.6% to 6%. These figures were highest for number of women who completed IFA supplementation, contraceptive intra-uterine device insertion and provision of 2nd TT injection during ANC. Conclusions HMIS records for MCH services at sub-centre level

  17. The relationship of quality and price of the psychostimulants cocaine and amphetamine with health care outcomes.

    Science.gov (United States)

    Brunt, Tibor M; van Laar, Margriet; Niesink, Raymond J M; van den Brink, Wim

    2010-09-01

    A major component of the illicit drug market can be subcategorized as the psychostimulant drug market, with cocaine and amphetamine as popular constituents. In The Netherlands, an increase in both health care outcomes addiction treatment and hospital admissions was noted for both amphetamine and cocaine throughout a period of 17 years (1992-2008). Both cocaine price and quality showed a decrease in The Netherlands during the studied period. We used time-series regression analysis to investigate whether price or quality of the drugs were associated with health care outcomes. Drug seizures were also added to the time-series regressions in order to check for possible effects of drug availability and supply. Price and quality of cocaine were strongly associated with health care outcomes of addiction treatment and hospital admissions. Price of amphetamine also showed a decrease during these 17 years, but was associated with an increase in addiction treatment only. Other amphetamine market variables did not show any relationship with the health care outcomes. It could be stated that following basic market logics does not apply equally to all psychostimulants of abuse. Other factors might play a role, such as the addictiveness or desirability of a specific drug in question. This finding is supportive of the dynamics of the illicit psychostimulant market affecting actual use and thereby health care outcomes. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  18. 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.

  19. Quality in health care and globalization of health services: accreditation and regulatory oversight of medical tourism companies.

    Science.gov (United States)

    Turner, Leigh G

    2011-02-01

    Patients are crossing national borders in search of affordable and timely health care. Many medical tourism companies are now involved in organizing cross-border health services. Despite the rapid expansion of the medical tourism industry, few standards exist to ensure that these businesses organize high-quality, competent international health care. Addressing the regulatory vacuum, 10 standards are proposed as a framework for regulating the medical tourism industry. Medical tourism companies should have to undergo accreditation review. Care should be arranged only at accredited international health-care facilities. Standards should be established to ensure that clients of medical tourism companies make informed choices. Continuity of care needs to become an integral feature of cross-border care. Restrictions should be placed on the use of waiver of liability forms by medical tourism companies. Medical tourism companies must ensure that they conform to relevant legislation governing privacy and confidentiality of patient information. Restrictions must be placed on the types of health services marketed by medical tourism companies. Representatives of medical tourism agencies should have to undergo training and certification. Medical travel insurance and medical complications insurance should be included in the health-care plans of patients traveling for care. To protect clients from financial losses, medical tourism companies should be mandated to contribute to compensation funds. Establishing high standards for the operation of medical tourism companies should reduce risks facing patients when they travel abroad for health care.

  20. CLIENT SATISFACTION AND PERCEPTIONS ABOUT QUALITY OF HEALTH CARE AT A PRIMARY HEALTH CENTRE OF DELHI, INDIA

    Directory of Open Access Journals (Sweden)

    N Rasheed

    2012-10-01

    Full Text Available Background: Quality of services shows a variation between the client and the provider. Therefore, it needs to be explored whether the quality of care or the lack of quality can explain the utilization of government health care. Objectives:This paper attempts to assess the utilization of health services and client satisfaction for services provided by a Primary Health Centre (PHC at Delhi, India. Setting and design: The study was a facility based cross sectional study. Exit interviews were conducted among 400 patients seeking outdoor patient department (OPD services of thePHC Palam, New Delhi from May 2010 to November 2010. Material and Methods: Exit interviews were conducted among the patients at each of the service delivery points in the PHC to assess the utilization of services and the satisfaction of clients with the available services. Results: Most respondents rated the services to be of good quality on various parameters of health delivery. The PHC was the preferred health facility (98% for treatment seeking in comparison to other healthcare facilities in the area.The main factors affecting utilization of primary health care services provided by the government were easy accessibility, low cost, less waiting time, and presence of co-operative health personnel. Conclusion:Provision of quality primary healthcare services to clients can result in better utilization of services at the primary level, thereby reducing the unnecessary burden of secondary and tertiary level facilities in addition to improving the health status of the community.

  1. Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center

    Directory of Open Access Journals (Sweden)

    Manulik S

    2016-08-01

    Full Text Available Stanisław Manulik,1 Joanna Rosińczuk,2 Piotr Karniej3 1Non-Public Health Care Institution, “Ambulatory of Cosmonauts” Ltd. Liability Company, 2Department of Nervous System Diseases, Faculty of Health Science, 3Department of Organization and Management, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland Introduction: Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services.Objectives: The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services.Materials and methods: The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected.Results: All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel.Conclusion: Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility. Keywords: health care service quality, patients’ expectations, qualitative priorities, outpatient health care facilities

  2. 2014 Child and Adult Health Care Quality Measures

    Data.gov (United States)

    U.S. Department of Health & Human Services — Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2014 reporting. Dataset contains...

  3. 2015 Child and Adult Health Care Quality Measures

    Data.gov (United States)

    U.S. Department of Health & Human Services — Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2015 reporting. Source: Mathematica...

  4. Governing Ideals of Good Care: Quality improvement in mental health care

    NARCIS (Netherlands)

    T. Broer (Tineke)

    2012-01-01

    textabstractIn the spring of 2008 I attended a conference on the use of coercion in mental health care. A healthcare worker who was also a “practicing patient”, as the program told us, held an impressive lecture that captured the audience from the moment the woman walked to the front. She referred

  5. The governance of quality management in dutch health care: new developments and strategic challenges.

    Science.gov (United States)

    Maarse, J A M; Ruwaard, D; Spreeuwenberg, C

    2013-01-01

    This article gives a brief sketch of quality management in Dutch health care. Our focus is upon the governance of guideline development and quality measurement. Governance is conceptualized as the structure and process of steering of quality management. The governance structure of guideline development in the Netherlands can be conceptualized as a network without central coordination. Much depends upon the self-initiative of stakeholders. A similar picture can be found in quality measurement. Special attention is given to the development of care standards for chronic disease. Care standards have a broader scope than guidelines and take an explicit patient perspective. They not only contain evidence-based and up-to-date guidelines for the care pathway but also contain standards for self-management. Furthermore, they comprise a set of indicators for measuring the quality of care of the entire pathway covered by the standard. The final part of the article discusses the mission, tasks and strategic challenges of the newly established National Health Care Institute (Zorginstituut Nederland), which is scheduled to be operative in 2013.

  6. The impact of safety and quality of health care on Chinese nursing career decision-making.

    Science.gov (United States)

    Zhu, Junhong; Rodgers, Sheila; Melia, Kath M

    2014-05-01

    The aim of the study was to understand why nurses leave nursing practice in China by exploring the process from recruitment to final exit. This report examines the impact of safety and quality of health care on nursing career decision-making from the leavers' perspective. The nursing shortage in China is more serious than in most developed countries, but the loss of nurses through voluntarily leaving nursing practice has not attracted much attention. This qualitative study draws on a grounded theory approach. In-depth interviews with 19 nurses who have left nursing practice and were theoretically sampled from one provincial capital city in Mainland China. 'Loss of confidence in the safety and quality of health care' became one of the main categories from all leavers' accounts of their decision to leave nursing practice. It emerged from three themes 'Perceiving risk in clinical practice', 'Recognising organisational barriers to safety' and 'Failing to meet expectations of patients'. The findings indicate that the essential work value of nursing to the leavers is the safety and quality of care for their patients. When nurses perceived that they could not fulfil this essential work value in their nursing practice, some of them could not accept the compromise to their value of nursing and left voluntarily to get away from the physical and mental stress. However, some nurses had to stay and accept the limitations on the safety and quality of health care. The study suggests that well-qualified nurses voluntarily leaving nursing practice is a danger signal for patients and hospitals, and has caused deterioration in nursing morale for both current and potential nursing workforces. It suggests that safety and quality of health care could be improved when individual nurses are empowered to exercise nursing autonomy with organisational and managerial support. The priority retention strategies need to remove organisational barriers to the safety and quality of health care

  7. Perceived quality of health care services among people with osteoarthritis – results from a nationwide survey

    Directory of Open Access Journals (Sweden)

    Grønhaug G

    2015-09-01

    Full Text Available Gudmund Grønhaug,1 Jon Hagfors,2 Ingebjørg Borch,2 Nina Østerås,1 Kåre Birger Hagen11National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 2Norwegian Rheumatism Association, Oslo, NorwayObjective: To assess the perceived quality of care received by people with osteoarthritis (OA in Norway and explore factors associated with the quality of care.Methods: A national survey in which members of the Norwegian Rheumatism Association with OA registered as their main diagnosis completed a questionnaire. The perceived quality of care was reported on a 17-item OsteoArthritis Quality Indicator questionnaire, covering both pharmacological and non-pharmacological aspects of OA care. In addition, the four-page questionnaire covered areas related to demographic characteristics, the location and impact of the OA, and utilization and satisfaction with health care services. The quality of care is calculated as pass rates, where the numerator represents the number of indicators passed and the denominator represents the number of eligible persons.Results: In total, 1,247 participants (response rate 57% completed the questionnaire. Mean age was 68 years (standard deviation 32 and 1,142 (92% were women. Respondents reported OA in hand only (12.4%, hip only (7.3%, knee only (10.4%, in two locations (42% or all three locations (27%. The overall OsteoArthritis Quality Indicator pass rate was 47% (95% confidence interval [CI] 46%–48%, and it was higher for pharmacological aspects (53% [51%–54%] than for non-pharmacological aspects of care (44% [43%–46%]. The pass rate for the individual quality indicators ranged from 8% for “referral for weight reduction” to 81% for “receiving advice about exercises”. Satisfaction with care was strongly associated with perceived quality. The pass rate for those who were “very satisfied” was 33% (25%–40% higher than those who were “very unsatisfied” with care.Conclusion: While the OA

  8. Measuring service quality of public dental health care facilities in Kelantan, Malaysia.

    Science.gov (United States)

    John, Jacob; Yatim, Fekriah Mohd; Mani, Shani Ann

    2011-09-01

    This study investigates patients' expectations and perceptions of service quality in public dental health care and measures their "satisfaction gap." This descriptive study involved 481 dental outpatients in Kelantan, Malaysia. A modified SERVQUAL 20-item instrument was used to assess patients' expectations before and perceptions after receiving dental treatment. The "satisfaction gap" was then measured. showed that patients visiting for management of dental pain were more satisfied (P = .007) than those visiting with appointment. The most significant service quality dimensions were related to responsiveness, assurance, and empathy of the dental health care providers. There was a significant difference between the patients' expectations and their perceptions of service provided (P < .01) with regard to all dimensions. In conclusion, dental service providers should give emphasis to the compassionate and emotional aspects of care and to remember that they are integral components of quality service.

  9. Relationships between technical efficiency and the quality and costs of health care in Italy†

    Science.gov (United States)

    Nuti, S.; Daraio, C.; Speroni, C.; Vainieri, M.

    2011-01-01

    Objectives This paper reports the measurement of technical efficiency of Tuscan Local Health Authorities and its relationship with quality and appropriateness of care. Design First, a bias-corrected measure of technical efficiency was developed using the bootstrap technique applied to data envelopment analysis. Then, correlation analysis was used to investigate the relationships among technical efficiency, quality and appropriateness of care. Setting and Participants These analyses have been applied to the Local Health Authorities of Tuscany Region (Italy), which provide not only hospital inpatient services, but also prevention and primary care. All top managers of Tuscan Local Health Authorities were involved in selection of the inputs and outputs for calculating technical efficiency. Main Outcome Measures The main measures used in this study are volume, quality and appropriateness indicators monitored by the multidimensional performance evaluation system developed in the Tuscany Region. Results On average, Tuscan Local Health Authorities experienced 14(%) of bias-corrected inefficiency in 2007. Correlation analyses showed a significant negative correlation between per capita costs and overall performance. No correlation was found in 2007 between technical efficiency and overall performance or between technical efficiency and per capita costs. Conclusions Technical efficiency cannot be considered as an extensive measure of healthcare performance, but evidence shows that Tuscan Local Health Authorities have room for improvement in productivity levels. Indeed, correlation findings suggest that, to pursue financial sustainability, Local Health Authorities mainly have to improve their performance in terms of quality and appropriateness. PMID:21454349

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

    Science.gov (United States)

    Khan, Arshia A.

    2012-01-01

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

  11. Governance of quality of care: a qualitative study of health service boards in Victoria, Australia

    Science.gov (United States)

    Bismark, Marie M; Studdert, David M

    2014-01-01

    Objectives To describe the engagement of health service boards with quality-of-care issues and to identify factors that influence boards’ activities in this area. Methods We conducted semistructured interviews with 35 board members and executives from 13 public health services in Victoria, Australia. Interviews focused on the role currently played by boards in overseeing quality of care. We also elicited interviewees’ perceptions of factors that have influenced their current approach to governance in this area. Thematic analysis was used to identify key themes from interview transcripts. Results Virtually all interviewees believed boards had substantial opportunities to influence the quality of care delivered within the service, chiefly through setting priorities, monitoring progress, holding staff to account and shaping culture. Perceived barriers to leveraging this influence included insufficient resources, gaps in skills and experience among board members, inadequate information on performance and regulatory requirements that miss the mark. Interviewees converged on four enablers of more effective quality governance: stronger regional collaborations; more tailored board training on quality issues; smarter use of reporting and accreditation requirements; and better access to data that was reliable, longitudinal and allowed for benchmarking against peer organisations. Conclusions Although health service boards are eager to establish quality of care as a governance priority, several obstacles are blocking progress. The result is a gap between the rhetoric of quality governance and the reality of month-to-month activities at the board level. The imperative for effective board-level engagement in this area cannot be met until these barriers are addressed. PMID:24327735

  12. [Health policies and politicized health? An analysis of sexual and reproductive health policies in Peru from the perspective of medical ethics, quality of care, and human rights].

    Science.gov (United States)

    Miranda, J Jaime; Yamin, Alicia Ely

    2008-01-01

    Health professionals view medical ethics as a discipline that provides the basis for more adequate patient care. In recent years the concepts of quality of care and human rights - with their attending discourses - have joined the concept of medical ethics among the paradigms to consider in care for humans both at the individual and health policy levels. The current study seeks to analyze such paradigms, based on a case study of sexual and reproductive health policies in Peru in the last 10 years.

  13. Health providers' perception of quality of care for neonates in health facilities in a municipality in Southern Ghana.

    Science.gov (United States)

    Elikplim Pomevor, Kokui; Adomah-Afari, Augustine

    2016-10-10

    Purpose The purpose of this paper is to assess available human resources for neonatal care and their skills, in order to explore health providers' perceptions of quality of neonatal care in health facilities in Ghana. Design/methodology/approach Data were gathered using qualitative interviews with health providers working in the maternity and paediatric wards and midwives; direct observation; and documentary review at a regional hospital, a municipal hospital and four health centres in a municipality in a region in Southern Ghana. Data were analysed using thematic framework through the process of coding in six phases to create and establish meaningful patterns. Findings The study revealed that health providers were concerned about the number of staff available, their competence and also equipment available for them to work more efficiently. Some essential equipment for neonatal care was either not available or was non-functional where it was available, while aseptic procedures were not adhered to. Moreover, personal protective equipment such as facemask, caps, aprons were not used except in the labour wards where staff had to change their footwear before entering. Research limitations/implications Limited number of health providers and facilities used, lack of exploration of parents of neonates' perspective of quality of neonatal care in this study and other settings, including the teaching hospitals. The authors did not examine issues related to the ineffective use of IV cannulation for neonates by nurses as well as referral of neonates. Additionally, the authors did not explore the perspectives of management of the municipal and regional health directorates or policy makers of the Ministry of Health and Ghana Health Service regarding the shortage of staff, inadequate provision of medical equipment and infrastructure. Practical implications This paper suggests the need for policy makers to redirect their attention to the issues that would improve the quality of

  14. Health systems, quality of health care, and translational cancer research: the role of the Istituto Superiore Sanità - Rome.

    Science.gov (United States)

    Ricciardi, Walter

    2015-01-01

    Faced with the challenge of ensuring high-quality and cost-effective health systems in the context of persistent financial crisis, a global strategy for cancer prevention and treatment represents a priority for public health bodies and governments. The key goals for the initiative are to define standards of cancer prevention and care while leveraging the continuous progress of biomedical research in the interest of public health. In Italy, the establishment of a network of Comprehensive Cancer Centres (CCC) named the Alliance Against Cancer (ACC) is an important initiative taken by the Ministry of Health to foster common strategies for enhancing the quality of oncology research and care at the national level. The Istituto Superiore di Sanità (ISS) has played an important role in supporting ACC activities through a special national program called ISS for ACC, launched by the Italian Ministry of Health in 2006. A similar role has been pursued in subsequent initiatives, including ISS support for a project aimed at providing international accreditation of the CCC of the ACC, funded by the Italian Ministry of Health. The results of this initiative, reported in the current issue of Tumori, are especially significant since specific indicators of quality for research and cancer care have been successfully defined for all the participating institutes. As the leading technical and scientific body of the Italian National Health Service, the ISS will continue to play a proactive role in supporting national networks and strategic national and international initiatives aimed at promoting public health.

  15. Identification of patient's requirements in quality management system in health care institutions.

    Science.gov (United States)

    Kaźmierczak, Daniel; Bogusz-Czerniewicz, Marta

    2011-12-16

    To present the solutions implemented in health care institution in the context of identification of patient's requirements, and evaluation of the level of patients' satisfaction in accordance with the requirements of ISO norm 9001:2008 based on the experience of GPCC. The fundamental mechanisms behind the free market, such as competition, start applying also to the public health sector. Health service providers are gradually realising that patients are actual clients of health care institutions, with physicians, nurses, supporting personnel, registration officers and other staff responding to patients demand for medical and auxiliary services (e.g. exam registration, provision of information). PN-EN ISO 9001:2009 "Quality Management Systems. Requirements", relevant literature and documentation of quality management system from the GPCC. The review of relevant literature and legal requirements; interpretation of provisions in relation to the functioning of health care institutions. Model of identification of patient's requirements and satisfaction in accordance with the requirements of ISO 9001:2008 has been elaborated and implemented in the GPCC. The identification of patient's requirements is much more complicated than evaluating the same parameters in manufacturing companies. In the context of medical services one should be aware of the subjectivity of patient's feelings, the psycho-social status and the general state of health during his or her treatment. Therefore, the identification of patient's requirements and satisfaction must be carefully thought out, implemented and regularly improved.

  16. The use of negative indexes of health to evaluate quality of care in a primary-care group practice.

    Science.gov (United States)

    Heineken, P A; Charles, G; Stimson, D H; Wenell, C; Stimson, R H

    1985-03-01

    A quality assessment method using negative indexes of health as a measure of the quality of medical care was applied in a hospital-based primary-care group practice. During a 5-year period, records of 1,147 patients were analyzed. The study led to several observations regarding the use of this method in this setting: 1) The negative indexes of health method encourages physicians to include both primary and secondary preventive measures in their practice of medicine and to see their role as a broad one, from providing good care to individual patients to influencing public policy. 2) Most medical records do not now contain all the data required for use of this method. 3) In cases where this method identifies only a few instances of possibly preventable disease or untimely death, it is impossible to know whether the care is good and the method of evaluation is sensitive, or whether the care is poor and the method is insensitive to deficiencies in care.

  17. A search for the "Holy Grail" of health care: a correlation between quality and profitability.

    Science.gov (United States)

    Gillean, John; Shaha, Steve; Sampanes, Eileen; Mullins, Catherine

    2006-12-01

    In a study by CHRISTUS Health, data from 18 acute care facilities revealed that numerous indicators of clinical quality were significantly correlated with measures of business success. Results suggest that timely and appropriate interventions, coupled with timely and complete documentation, are correlated with improved business performance. The correlations between quality and financial performance make intuitive sense based on the observation that diligence in clinical processes can produce better information to support financial processes.

  18. Assessing the quality of care in a new nation: South Sudan's first national health facility assessment.

    Science.gov (United States)

    Berendes, Sima; Lako, Richard L; Whitson, Donald; Gould, Simon; Valadez, Joseph J

    2014-10-01

    We adapted a rapid quality of care monitoring method to a fragile state with two aims: to assess the delivery of child health services in South Sudan at the time of independence and to strengthen local capacity to perform regular rapid health facility assessments. Using a two-stage lot quality assurance sampling (LQAS) design, we conducted a national cross-sectional survey among 156 randomly selected health facilities in 10 states. In each of these facilities, we obtained information on a range of access, input, process and performance indicators during structured interviews and observations. Quality of care was poor with all states failing to achieve the 80% target for 14 of 19 indicators. For example, only 12% of facilities were classified as acceptable for their adequate utilisation by the population for sick-child consultations, 16% for staffing, 3% for having infection control supplies available and 0% for having all child care guidelines. Health worker performance was categorised as acceptable in only 6% of cases related to sick-child assessments, 38% related to medical treatment for the given diagnosis and 33% related to patient counselling on how to administer the prescribed drugs. Best performance was recorded for availability of in-service training and supervision, for seven and ten states, respectively. Despite ongoing instability, the Ministry of Health developed capacity to use LQAS for measuring quality of care nationally and state-by-state, which will support efficient and equitable resource allocation. Overall, our data revealed a desperate need for improving the quality of care in all states. © 2014 John Wiley & Sons Ltd.

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

    Directory of Open Access Journals (Sweden)

    Asharaf Abdul Salam

    2010-10-01

    Full Text Available Introduction: The Libyan National Health System (LNHS is debated for the paradox of its performance versus impact. It has poor performance, but the national health statistics are good and competitive. There are concerted efforts to manage health care services and to regain the lost trust. A primary health care (PHC system that focuses on preventive and promotive care is the core focus of LNHS efforts. Objectives: To assess patient satisfaction with quality of PHC assessed in terms of (a customer profile, (b patient satisfaction, and (c health care-seeking behavior. Methodology: A sample of nine health centers and seven polyclinics from various locations in Benghazi, Libya were selected for gathering information by structured face-to-face interviews. A total of 310 beneficiaries were interviewed by using an Arabic translation of the Charleston Psychiatric Outpatient Satisfaction Scale. Results: The beneficiaries appear to be quite satisfied with the quality of services. Geographical zone, marital status of beneficiary, and type of facility are satisfaction-related factors. There are preferences for facilities located within the City Centre over those located elsewhere. There is also an interaction effect of the geographical zone and the type of facility in creating differences in satisfaction. Conclusions: A customer-friendly facility concept that emphasizes reception, physician interaction, and cordiality shall add value. Polyclinics require more attention as does the Al Slawy area. A few utility services might also be considered.

  20. Assessing systems quality in a changing health care environment: the 2009-10 national survey of children with special health care needs.

    Science.gov (United States)

    Strickland, Bonnie B; Jones, Jessica R; Newacheck, Paul W; Bethell, Christina D; Blumberg, Stephen J; Kogan, Michael D

    2015-02-01

    To provide a national, population-based assessment of the quality of the health care system for children and youth with special health care needs using a framework of six health care system quality indicators. 49,242 interviews with parents of children with special health care needs from the 2009-10 National Survey of Children with Special Health Care Needs (NS-CSHCN) were examined to determine the extent to which CSHCN had access to six quality indicators of a well-functioning system of services. Criteria for determining access to each indicator were established and applied to the survey data to estimate the proportion of CSHCN meeting each quality indicator by socio-demographic status and functional limitations. 17.6% of CSHCN received care consistent with all six quality indicators. Results for each component of the system quality framework ranged from a high of 70.3% of parents reporting that they shared decision-making with healthcare providers to a low of 40% of parents reporting receipt of services needed for transition to adult health care. Attainment rates were lower for CSHCN of minority racial and ethnic groups, those residing in households where English was not the primary language, those in lower income households, and those most impacted by their health condition. Only a small proportion of CSHCN receive all identified attributes of a high-quality system of services. Moreover, significant disparities exist whereby those most impacted by their conditions and those in traditionally disadvantaged groups are served least well by the current system. A small proportion of CSHCN appear to remain essentially outside of the system, having met few if any of the elements studied.

  1. Variation in quality of preventive care for well adults in Indigenous community health centres in Australia

    Directory of Open Access Journals (Sweden)

    Hains Jenny

    2011-06-01

    Full Text Available Abstract Background Early onset and high prevalence of chronic disease among Indigenous Australians call for action on prevention. However, there is deficiency of information on the extent to which preventive services are delivered in Indigenous communities. This study examined the variation in quality of preventive care for well adults attending Indigenous community health centres in Australia. Methods During 2005-2009, clinical audits were conducted on a random sample (stratified by age and sex of records of adults with no known chronic disease in 62 Indigenous community health centres in four Australian States/Territories (sample size 1839. Main outcome measures: i adherence to delivery of guideline-scheduled services within the previous 24 months, including basic measurements, laboratory investigations, oral health checks, and brief intervention on lifestyle modification; and ii follow-up of abnormal findings. Results Overall delivery of guideline-scheduled preventive services varied widely between health centres (range 5-74%. Documentation of abnormal blood pressure reading ([greater than or equal to]140/90 mmHg, proteinuria and abnormal blood glucose ([greater than or equal to]5.5 mmol/L was found to range between 0 and > 90% at the health centre level. A similarly wide range was found between health centres for documented follow up check/test or management plan for people documented to have an abnormal clinical finding. Health centre level characteristics explained 13-47% of variation in documented preventive care, and the remaining variation was explained by client level characteristics. Conclusions There is substantial room to improve preventive care for well adults in Indigenous primary care settings. Understanding of health centre and client level factors affecting variation in the care should assist clinicians, managers and policy makers to develop strategies to improve quality of preventive care in Indigenous communities.

  2. Hidden consequences of success in pediatrics: parental health-related quality of life—results from the Care Project

    NARCIS (Netherlands)

    Hatzmann, J.; Heymans, H.S.A.; Ferrer-i-Carbonell, A.; van Praag, B.M.S.; Grootenhuis, M.A.

    2008-01-01

    CONTEXT. The number of parents who care for a chronically ill child is increasing. Because of advances in medical care, parental caring tasks are changing. A detailed description of parental health-related quality of life will add to the understanding of the impact of caring for a chronically ill ch

  3. Psychosocial work conditions and quality of life among primary health care employees: a cross sectional study.

    Science.gov (United States)

    Teles, Mariza Alves Barbosa; Barbosa, Mirna Rossi; Vargas, Andréa Maria Duarte; Gomes, Viviane Elizângela; Ferreira, Efigênia Ferreira e; Martins, Andréa Maria Eleutério de Barros Lima; Ferreira, Raquel Conceição

    2014-05-15

    Workers in Primary Health Care are often exposed to stressful conditions at work. This study investigated the association between adverse psychosocial work conditions and poor quality of life among Primary Health Care workers. This cross-sectional study included all 797 Primary Health Care workers of a medium-sized city, Brazil: doctors, nurses, nursing technicians and nursing assistants, dentists, oral health technicians, and auxiliary oral hygienists, and community health workers. Data were collected by interviews. Quality of life was assessed using the WHOQOL-BREF; general quality of life, as well as the physical, psychological, social and environmental domains were considered, with scores from 0 to 100. Higher scores indicate a better quality of life. Poor quality of life was defined by the lowest quartiles of the WHOQOL score distributions for each of the domains. Adverse psychosocial work conditions were investigated by the Effort-Reward Imbalance model. Associations were verified using multiple logistic regression. Poor quality of life was observed in 117 (15.4%) workers. Workers with imbalanced effort-reward (high effort/low reward) had an increased probability of general poor quality of life (OR = 1.91; 1.07–3.42), and in the physical (OR = 1.62; 1.02–2.66), and environmental (OR = 2.39; 1.37–4.16) domains; those with low effort/low reward demonstrated a greater probability of poor quality of life in the social domain (OR = 1.82; 1.00–3.30). Workers with overcommitment at work had an increased likelihood of poor quality of life in the physical (OR = 1.55, 1.06–2.26) and environmental (OR = 1.69; 1.08–2.65) domains. These associations were independent of individual characteristics, job characteristics, lifestyle, perception of general health, or psychological and biological functions. There is an association between adverse psychosocial work conditions and poor quality of life among Primary Health Care workers.

  4. 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.

  5. Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center.

    Science.gov (United States)

    Manulik, Stanisław; Rosińczuk, Joanna; Karniej, Piotr

    2016-01-01

    Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services. The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services. The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected. All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel. Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility.

  6. Impact of healthcare informatics on quality of patient care and health services

    CERN Document Server

    Srinivasan Sridhar, Divya

    2013-01-01

    Recent healthcare reform and its provisions have pushed health information technology (HIT) into the forefront. Higher life expectancies, fewer medical errors, lower costs, and improved transparency are all possible through HIT. Taking an integrated approach, Impact of Healthcare Informatics on Quality of Patient Care and Health Services examines the various types of organizations, including nonprofit hospitals, for-profit hospitals, community health centers, and government hospitals. By doing so, it provides you with a comparative perspective of how different organizations adapt and use the t

  7. Internal marketing: creating quality employee experiences in health care organizations.

    Science.gov (United States)

    Masri, Maysoun Dimachkie; Oetjen, Dawn; Rotarius, Timothy

    2011-01-01

    To cope with the recent challenges within the health care industry, health care managers need to engage in the internal marketing of their various services. Internal marketing has been used as an effective management tool to increase employees' motivation, satisfaction, and productivity (J Mark Commun. 2010;16(5):325-344). Health care managers should understand that an intense focus on internal marketing factors will lead to a quality experience for employees that will ultimately have a positive effect on the patient experiences.

  8. Quality of Diabetes Care in Primary Health Centres in North Al-Batinah of Oman

    Science.gov (United States)

    Al-Shafaee, Mohammed; Al-Farsi, Yousuf; Al-Kaabi, Yousuf; Banerjee, Yajnavalka; Al-Zadjali, Najat; Al-Zakwani, Ibrahim

    2014-01-01

    Objective: To assess the quality of diabetic care provided in primary health care settings in Oman. Methods: This was a cross-sectional study of randomly selected 500 patients with diabetes mellitus (DM) attending 6 primary care diabetic clinics in the north Al-Batinah region of Oman from January to December 2010. Nine standards on the quality of diabetes care were audited. Results: The mean age of the sample was 51±13 years, ranging from 15 to 87 years; the majority (61%) were females. The mean duration of DM was 4±3 years, ranging from 1 to 18 years. Seventy-seven percent of the patients attended diabetic clinics at least 4 times per year. Of the 9 assessed diabetic standards, HbA1c was documented in 33% of the patients, body mass index in 12%, low-density lipoprotein cholesterol (LDL-C) in 40%, urinary albumin:creatinine ratio in 28%, creatinine in 63% and blood pressure (BP) in 96%. Optimal control among the documented indicators was noted in 32, 21, 25, 85, 95 and 19%, respectively. Twenty percent of the patients had their ECGs done while only 39% of the patients had foot examination. No patient had attained control in all of HbA1c., BP and LDL-C. Conclusion: There is a gap between the recommended DM care guidelines and current practice with consequent poor quality of care in these patients. PMID:25024774

  9. The entrance of "the economic man" in Health Care Quality - a Danish case study

    DEFF Research Database (Denmark)

    Peyton, Margit Malmmose

    qualitative to quantitative outputs. The output measures form the foundation for a number of decisions such as allocation of human resources and funding. The purpose of this paper is to show how performance measurements have had a dominant impact on different stakeholders and their influences, which...... furthermore has had an impact on the perceived concept of service and service quality. The following research questions will be addressed: Is there a change in the relative power construction of stakeholders within the Danish health care system over the period of 2002-2008? If so, what effect has this change...... influences the other discourses and the text written on health care. The economic focus on numbers and quantitative output seems to have a large effect on the concept of service quality from being qualitative to becoming quantitative. This seems to work against the initial aim of restructuring the health...

  10. Patient satisfaction analysis on service quality of dental health care based on empathy and responsiveness

    Science.gov (United States)

    Dewi, Fellani Danasra; Sudjana, Grita; Oesman, Yevis Marty

    2011-01-01

    Background: Transformation of health care is underway from sellers’ market to consumers’ market, where the satisfaction of the patients’ need is a primary concern while defining the service quality. Hence, commitment to provide a high-quality service and achieving patients’ satisfaction becomes an important issue for dental health care provider. The aim of this research is to investigate the quality of dental health care service based on empathy and responsiveness aspects. Methods: A total of 90 questionnaires were completed by the dental patients who came to dental polyclinic located in Government Hospital, West Java, Indonesia. The questionnaire was concerned on two dimensions of service quality model, i.e. empathy and responsiveness. The obtained data were analyzed using inferential statistics (t test) and also descriptive statistics with importance–performance analysis. Results: All the attributes tested by t test showed that perception and expectation differed significantly, except for responsiveness, i.e. ability of dental assistants in assisting the dentist (t test 0.505dentist (t test 4.700). Conclusion: It can be inferred from IPA that priority should be given to dentist's communication and dental assistant's knowledge toward patient's needs to enhance the service quality. PMID:22135687

  11. Risk Selection Threatens Quality Of Care For Certain Patients: Lessons From Europe's Health Insurance Exchanges.

    Science.gov (United States)

    van de Ven, Wynand P M M; van Kleef, Richard C; van Vliet, Rene C J A

    2015-10-01

    Experience in European health insurance exchanges indicates that even with the best risk-adjustment formulas, insurers have substantial incentives to engage in risk selection. The potentially most worrisome form of risk selection is skimping on the quality of care for underpriced high-cost patients--that is, patients for whom insurers are compensated at a rate lower than the predicted health care expenses of these patients. In this article we draw lessons for the United States from twenty years of experience with health insurance exchanges in Europe, where risk selection is a serious problem. Mistakes by European legislators and inadequate evaluation criteria for risk selection incentives are discussed, as well as strategies to reduce risk selection and the complex trade-off among selection (through quality skimping), efficiency, and affordability. Recommended improvements to the risk-adjustment process in the United States include considering the adoption of risk adjusters used in Europe, investing in the collection of data, using a permanent form of risk sharing, and replacing the current premium "band" restrictions with more flexible restrictions. Policy makers need to understand the complexities of regulating competitive health insurance markets and to prevent risk selection that threatens the provision of good-quality care for underpriced high-cost patients. Project HOPE—The People-to-People Health Foundation, Inc.

  12. Composite indicator to evaluate quality of municipal management of primary health care.

    Science.gov (United States)

    Scaratti, Dirceu; Calvo, Maria Cristina Marino

    2012-06-01

    To develop a composite indicator to evaluate the quality of municipal management of primary health care. The evaluation model focuses on aspects of health system management. Fifty-five performance indicators were used and classified according to the criteria of relevance, effectiveness, efficacy and efficiency. The measures were aggregated through an additive data envelopment analysis model for measures of value, merit and quality. Data was utilized from 36 municipalities in Santa Catarina State (Southern Brazil), with populations between 10 thousand and 50 thousand residents in 2006. The results are presented as monotonic measures over the interval [0, 1] (score = 1: efficient; other values: inefficient). Five municipalities had a score of 1 in the quality of management for actions promoting access, while eight municipalities received a score of 1 in the quality of management of actions for service provision; the other municipalities were classified as inefficient (score management in primary health care can be evaluated with a composite indicator, constructed through linear programming techniques, which simultaneously considers the criteria of relevance, effectiveness, efficacy and efficiency and expresses them as measures of value, merit and quality.

  13. 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.

  14. Quality of care and its determinants in longer term mental health facilities across Europe; a cross-sectional analysis

    NARCIS (Netherlands)

    Killaspy, Helen; Cardoso, Graca; White, Sarah; Wright, Christine; Caldas de Almeida, Jose Miguel; Turton, Penny; Taylor, Tatiana L.; Schuetzwohl, Matthias; Schuster, Mirjam; Cervilla, Jorge A.; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Alexiev, Spiridon; Mezzina, Roberto; Ridente, Pina; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Adamowski, Tomasz; Ploumpidis, Dimitris; Gonidakis, Fragiskos; King, Michael

    2016-01-01

    Background: The Quality Indicator for Rehabilitative Care (QuIRC) is an international, standardised quality tool for the evaluation of mental health facilities that provide longer term care. Completed by the service manager, it comprises 145 items that assess seven domains of care: living environmen

  15. [Position of guidelines under new law: consequences of new legislation on health care quality].

    Science.gov (United States)

    Legemaate, Johan

    2014-01-01

    Recent legislation in the Netherlands has led to the creation of an institute for health care quality ('Zorginstituut Nederland'). This institute maintains a public register of medical practice guidelines. The legislation does not influence the legal position of these guidelines, but may lead to problems with regard to the process of developing guidelines, and to the authority of the institute to accept guidelines without the full cooperation of the medical profession.

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

    Directory of Open Access Journals (Sweden)

    Kwedza Ru K

    2011-03-01

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

  17. The effects of health information technology on the costs and quality of medical care.

    Science.gov (United States)

    Agha, Leila

    2014-03-01

    Information technology has been linked to productivity growth in a wide variety of sectors, and health information technology (HIT) is a leading example of an innovation with the potential to transform industry-wide productivity. This paper analyzes the impact of health information technology (HIT) on the quality and intensity of medical care. Using Medicare claims data from 1998 to 2005, I estimate the effects of early investment in HIT by exploiting variation in hospitals' adoption statuses over time, analyzing 2.5 million inpatient admissions across 3900 hospitals. HIT is associated with a 1.3% increase in billed charges (p-value: 5.6%), and there is no evidence of cost savings even five years after adoption. Additionally, HIT adoption appears to have little impact on the quality of care, measured by patient mortality, adverse drug events, and readmission rates.

  18. Nurse health-related quality of life: associations with patient and ward characteristics in Japanese general acute care wards.

    Science.gov (United States)

    Oyama, Yumiko; Yonekura, Yuki; Fukahori, Hiroki

    2015-09-01

    To investigate the factors affecting nurse health-related quality of life (HRQOL) by considering the patient characteristics and ward characteristics. Nurse health-related quality of life is an important health outcome, and should be promoted for quality nursing care. This cross-sectional study was conducted on nurses who work in general acute care wards in three university hospitals in metropolitan Japan. Multilevel analysis was conducted to investigate possible factors related to nurse health-related quality of life. Nurses who worked at a ward had a significantly lower physical health score (β = -0.13, P characteristics. Further large-scale studies are needed in order to investigate the effect of hospital characteristics on nurse health-related quality of life. Increasing the number of nurses' aides and delegating assistance with ADL to them could support nurse health-related quality of life in the acute care setting. © 2014 John Wiley & Sons Ltd.

  19. Assessing the quality of care for the elderly in services from public primary health care in Porto Alegre, Brazil

    Directory of Open Access Journals (Sweden)

    Elise Botteselle de Oliveira

    2013-09-01

    Full Text Available Introduction: The aging population creates a greater demand creates a greater demand for health services and becomes a challenge for the health care system. Primary Health Care (PHC plays a fundamental role in promoting healthy aging and controlling multi-morbidity. Objective: To assess the quality of care provided to elderly patients in public PHC in Porto Alegre, Rio Grande do Sul state, Brazil. Methods: A cross-sectional population-based study carried out in 2007, with interviews conducted with 212 elderly patients from four types of municipal public services: Primary Health Centers, Family Health Strategy teams, the “Conceição” Hospital Community Health Service (CH/CHS, and the “Murialdo” School Health Center. Results: There were significant differences between the centers investigated regarding the following attributes: Access-utilization, Longitudinality, Care coordination and information systems, and Family and community orientation. The CH/CHS showed prevalence of 55.8% (p<0.001 for the overall PHC high score - higher figures in comparison with the other services. The overall score of preventive practices showed a significant association with the services to the overall PHC score, with an average of 3.9 (CI 95%=3.60-4.32 among the elderly who presented low scores and 5.9 (CI 95%=5.3-6.5 among those presenting high scores. Discussion: The results show low scores in all types of services. The services with a high overall PHC score present higher preventive practice prevalence. Conclusions: PHC-oriented services are more effective and offer greater quality of preventive care recommended for the elderly.

  20. SEQUenCE: a service user-centred quality of care instrument for mental health services.

    Science.gov (United States)

    Hester, Lorraine; O'Doherty, Lorna Jane; Schnittger, Rebecca; Skelly, Niamh; O'Donnell, Muireann; Butterly, Lisa; Browne, Robert; Frorath, Charlotte; Morgan, Craig; McLoughlin, Declan M; Fearon, Paul

    2015-08-01

    To develop a quality of care instrument that is grounded in the service user perspective and validate it in a mental health service. The instrument (SEQUenCE (SErvice user QUality of CarE)) was developed through analysis of focus group data and clinical practice guidelines, and refined through field-testing and psychometric analyses. All participants were attending an independent mental health service in Ireland. Participants had a diagnosis of bipolar affective disorder (BPAD) or a psychotic disorder. Twenty-nine service users participated in six focus group interviews. Seventy-one service users participated in field-testing: 10 judged the face validity of an initial 61-item instrument; 28 completed a revised 52-item instrument from which 12 items were removed following test-retest and convergent validity analyses; 33 completed the resulting 40-item instrument. Test-retest reliability, internal consistency and convergent validity of the instrument. The final instrument showed acceptable test-retest reliability at 5-7 days (r = 0.65; P Service Satisfaction Scale (r = 0.84, P service user perspective and suitable for routine use. It may serve as a useful tool in individual care planning, service evaluation and research. The instrument was developed and validated with service users with a diagnosis of either BPAD or a psychotic disorder; it does not yet have established external validity for other diagnostic groups. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  1. [Advanced nursing practice: a must for the quality of care and mental health services].

    Science.gov (United States)

    Ricard, Nicole; Page, Claire; Laflamme, France

    2014-01-01

    New professional legislation and reorganization of mental health services have had a significant influence on mental health nursing practice. Many nurses have demonstrated clinical leadership and have been able to adapt their services to the needs of the population specially in the primary health care setting. However, many believe that the role of nurses is not sufficiently known and optimally utilized in mental health services. In this article we take a critical look at the mental health nursing practice in Quebec and at the essential requirements for its development. This review aims to: 1) describe current trends in the changing roles and the modernization of mental health nursing practice in Quebec, 2) provide an overview of the development of advanced nursing practice and its impact on the quality of mental health services; 3) clarify the concept of advanced nursing practice and position its development in Quebec and 4) propose various strategies for optimizing the role of nurses and their complementarity with other professionals providing mental health services. This review presents innovative practices developed by nurses in the context of the restructuring of mental health services. For example, new nursing roles have been developed to improve the collaboration with general practitioners groups in primary care settings and facilitate the evaluation and monitoring of patient presenting medical and psychological problems. Another interesting innovation was set up by nurses in developing a new service to allow timely access to integrated care for patients with substance abuse and mental health problems. The various testimonies reported in this article illustrate the potential contribution of these nursing innovations in improving the mental health services in Quebec. Also, in few countries, the reform of mental health services has been a good time to recognize this potential. Thus, some countries have repositioned the role of mental health nurses and

  2. Health related quality of life and care dependency among elderly hospital patients: an international comparison.

    Science.gov (United States)

    Dijkstra, Ate; Hakverdioğlu, Gülendam; Muszalik, Marta; Andela, Richtsje; Korhan, Esra Akın; Kędziora-Kornatowska, Kornelia

    2015-01-01

    Many countries in Europe and the world have to cope with an aging population. Although health policy in many countries aims at increasing disability-free life expectancy, elderly patients represent a significant proportion of all patients admitted to different hospital departments. The aim of the research was to investigate the relationship between health-related quality of life (HRQOL) and the care dependency status among elderly hospital patients. In 2012, a descriptive survey was administered to a convenience sample of 325 elderly hospital patients (> 60 years) from The Netherlands (N = 125), from Poland (N = 100), and from Turkey (N = 100). We employed the Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System and the Care Dependency Scale. FACIT is a collection of HRQOL questionnaires that assess multidimensional health status in people with various chronic illnesses. From demographic variables, gender (female) (r = -0.13, p Poland and Turkey) and functional wellbeing (The Netherlands) are significantly associated with the decrease in care dependency status. Thus, the FACIT variables are the most powerful indicators for care dependency. The study provides healthcare professionals insight into improvement of quality of care in all three countries.

  3. 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

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

    Science.gov (United States)

    Mainz, Jan; Kristensen, Solvejg; Bartels, Paul

    2015-12-01

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

  5. Impact of rural residence and health system structure on quality of liver care.

    Directory of Open Access Journals (Sweden)

    Catherine Rongey

    Full Text Available BACKGROUND: Specialist physician concentration in urban areas can affect access and quality of care for rural patients. As effective drug treatment for hepatitis C (HCV becomes increasingly available, the extent to which rural patients needing HCV specialists face access or quality deficits is unknown. We sought to determine the influence of rural residency on access to HCV specialists and quality of liver care. METHODS: The study used a national cohort of 151,965 Veterans Health Administration (VHA patients with HCV starting in 2005 and followed to 2009. The VHA's constant national benefit structure reduces the impact of insurance as an explanation for observed disparities. Multivariate cox proportion regression models for each quality indicator were performed. RESULTS: Thirty percent of VHA patients with HCV reside in rural and highly rural areas. Compared to urban residents, highly rural (HR 0.70, CI 0.65-0.75 and rural (HR 0.96, CI 0.94-0.97 residents were significantly less likely to access HCV specialty care. The quality indicators were more mixed. While rural residents were less likely to receive HIV screening, there were no significant differences in hepatitis vaccinations, endoscopic variceal and hepatocellular carcinoma screening between the geographic subgroups. Of note, highly rural (HR 1.31, CI 1.14-1.50 and rural residents (HR 1.06, CI 1.02-1.10 were more likely to receive HCV therapy. Of those treated for HCV, a third received therapy from a non-specialist provider. CONCLUSION: Rural patients have less access to HCV specialists, but this does not necessarily translate to quality deficits. The VHA's efforts to improve specialty care access, rural patient behavior and decentralization of HCV therapy beyond specialty providers may explain this contradiction. Lessons learned within the VHA are critical for US healthcare systems restructuring into accountable care organizations that acquire features of integrated systems.

  6. Impact of Rural Residence and Health System Structure on Quality of Liver Care

    Science.gov (United States)

    Rongey, Catherine; Shen, Hui; Hamilton, Nathan; Backus, Lisa I.; Asch, Steve M.; Knight, Sara

    2013-01-01

    Background Specialist physician concentration in urban areas can affect access and quality of care for rural patients. As effective drug treatment for hepatitis C (HCV) becomes increasingly available, the extent to which rural patients needing HCV specialists face access or quality deficits is unknown. We sought to determine the influence of rural residency on access to HCV specialists and quality of liver care. Methods The study used a national cohort of 151,965 Veterans Health Administration (VHA) patients with HCV starting in 2005 and followed to 2009. The VHA’s constant national benefit structure reduces the impact of insurance as an explanation for observed disparities. Multivariate cox proportion regression models for each quality indicator were performed. Results Thirty percent of VHA patients with HCV reside in rural and highly rural areas. Compared to urban residents, highly rural (HR 0.70, CI 0.65-0.75) and rural (HR 0.96, CI 0.94-0.97) residents were significantly less likely to access HCV specialty care. The quality indicators were more mixed. While rural residents were less likely to receive HIV screening, there were no significant differences in hepatitis vaccinations, endoscopic variceal and hepatocellular carcinoma screening between the geographic subgroups. Of note, highly rural (HR 1.31, CI 1.14-1.50) and rural residents (HR 1.06, CI 1.02-1.10) were more likely to receive HCV therapy. Of those treated for HCV, a third received therapy from a non-specialist provider. Conclusion Rural patients have less access to HCV specialists, but this does not necessarily translate to quality deficits. The VHA's efforts to improve specialty care access, rural patient behavior and decentralization of HCV therapy beyond specialty providers may explain this contradiction. Lessons learned within the VHA are critical for US healthcare systems restructuring into accountable care organizations that acquire features of integrated systems. PMID:24386420

  7. Quality of life and use of health care resources among patients with chronic depression

    Directory of Open Access Journals (Sweden)

    Villoro R

    2016-09-01

    Full Text Available Renata Villoro,1 María Merino,1 Alvaro Hidalgo-Vega,2 1Department of Health Economics, Instituto Max Weber, Madrid, 2Department of Economics and Finance, University of Castilla-La Mancha, Toledo, Spain Purpose: This study estimates the health-related quality of life and the health care resource utilization of patients diagnosed with chronic depression (CD in Spain. Patients and methods: We used the Spanish National Health Survey 2011–2012, a cross-sectional survey representative at the national level, that selects people aged between 18 and 64 years (n=14,691. We estimated utility indices through the EuroQol five-dimensional descriptive system questionnaire included in the survey. We calculated percentage use of health care resources (medical visits, hospitalizations, emergency services, and drug consumption and average number of resources used when available. A systematic comparison was made between people diagnosed with CD and other chronic conditions (OCCs. The chi-square test, Mann–Whitney U-test, and Kruskal–Wallis test were used to determine the statistical significance of differences between comparison groups. Multivariate analyses (Poisson regression, logistic regression, and linear regression were also carried out to assess the relationship between quality of life and consumption of health care resources. Results: Approximately, 6.1% of the subjects aged between 18 and 64 years were diagnosed with CD (average age 48.3±11 years, 71.7% females. After controlling for age, sex, and total number of comorbidities, a diagnosis of CD reduced utility scores by 0.09 (P<0.05 vs OCCs, and increased the average number of hospitalizations by 15%, the average number of days at hospital by 51%, and the average number of visits to emergency services by 15% (P<0.05. CD also increased the average number of visits to secondary care by 14% and visits to general practitioners by 4%. People with CD had a higher probability of consuming drugs than

  8. Quality of Care and Disparities in Obstetrics.

    Science.gov (United States)

    Howell, Elizabeth A; Zeitlin, Jennifer

    2017-03-01

    Growing attention is being paid to obstetric quality of care as patients are pressing the health care system to measure and improve quality. There is also an increasing recognition of persistent racial and ethnic disparities prevalent in obstetric outcomes. Yet few studies have linked obstetric quality of care with racial and ethnic disparities. This article reviews definitions of quality of care, health disparities, and health equity as they relate to obstetric care and outcomes; describes current efforts and challenges in obstetric quality measurement; and proposes 3 steps in an effort to develop, track, and improve quality and reduce disparities in obstetrics. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Helping States enhance health care quality through technical assistance.

    Science.gov (United States)

    Martinez-Vidal, Enrique; Gauthier, Anne K; DiVincenzo, Allison

    2010-01-01

    For the money spent on health care in the United States, far better quality of care should be expected. The Commonwealth Fund and AcademyHealth have created the State Quality Improvement Institute to assist states in implementing sustainable quality improvement strategies. Lessons have emerged about the role of states in advancing fundamental and systemic changes in the way care is delivered, as well as how providers are organized and compensated. The experiences of states participating in the institute may offer insights for other states seeking to achieve similar goals.

  10. Health-related quality of life after prolonged pediatric intensive care unit stay.

    LENUS (Irish Health Repository)

    Conlon, Niamh P

    2012-02-01

    OBJECTIVE: To investigate the long-term health-related quality of life (HRQOL) outcomes for patients requiring at least 28 days of pediatric intensive care. DESIGN: Retrospective cohort and prospective follow-up study. SETTING: A 21-bed pediatric intensive care unit (PICU) in a university-affiliated, tertiary referral pediatric hospital. PATIENTS: One hundred ninety-three patients who spent 28 days or longer in the PICU between January 1, 1997 and December 31, 2004. INTERVENTIONS: Quality of life was measured using the Pediatric Quality of Life Inventory (Peds QL 4.0) parent-proxy version at 2 to 10 yrs after discharge. The PedsQL 4.0 is a modular measure of HRQOL, which is reliable in children aged 2 to 18 yrs. It generates a total score and physical, emotional, social, school, and psychosocial subscores. MEASUREMENTS AND MAIN RESULTS: Of the 193 patients, 41 died during their PICU admission and 27 died between PICU discharge and follow-up. Quality of life questionnaires were posted to parents of 108 of the 125 survivors and 70 were returned completed. Forty children (57.1%) had scores indicating a normal quality of life, whereas 30 (42.9%) had scores indicating impaired HRQOL. Of these, 14 (20%) had scores indicating poor quality of life with ongoing disabling health problems requiring hospitalization or the equivalent. CONCLUSIONS: Our results indicate that, while long PICU stay is associated with significant mortality, the long-term HRQOL is normal for the majority of surviving children.

  11. Service quality perceptions in primary health care centres in Greece.

    Science.gov (United States)

    Papanikolaou, Vicky; Zygiaris, Sotiris

    2014-04-01

    The paper refers to the increased competition between health care providers and the need for patient-centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients' perceptions rather than expectations. THIS paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations-perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. © 2012 John Wiley & Sons Ltd.

  12. Service quality perceptions in primary health care centres in Greece

    Science.gov (United States)

    Papanikolaou, Vicky; Zygiaris, Sotiris

    2012-01-01

    Abstract Context  The paper refers to the increased competition between health care providers and the need for patient‐centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. Objective  To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. Strategy  SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. Results  The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients’ perceptions rather than expectations. Discussion and conclusions  This paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations–perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. PMID:22296402

  13. Lack of impact of electronic health records on quality of care and outcomes for ischemic stroke.

    Science.gov (United States)

    Joynt, Karen E; Bhatt, Deepak L; Schwamm, Lee H; Xian, Ying; Heidenreich, Paul A; Fonarow, Gregg C; Smith, Eric E; Neely, Megan L; Grau-Sepulveda, Maria V; Hernandez, Adrian F

    2015-05-12

    Electronic health records (EHRs) may be key tools for improving the quality of health care, particularly for conditions for which guidelines are rapidly evolving and timely care is critical, such as ischemic stroke. The goal of this study was to determine whether hospitals with EHRs differed on quality or outcome measures for ischemic stroke from those without EHRs. We studied 626,473 patients from 1,236 U.S. hospitals in Get With the Guidelines-Stroke (GWTG-Stroke) from 2007 through 2010, linked with the American Hospital Association annual survey to determine the presence of EHRs. We conducted patient-level logistic regression analyses for each of the outcomes of interest. A total of 511 hospitals had EHRs by the end of the study period. Hospitals with EHRs were larger and were more often teaching hospitals and stroke centers. After controlling for patient and hospital characteristics, patients admitted to hospitals with EHRs had similar odds of receiving "all-or-none" care (odds ratio [OR]: 1.03; 95% CI: 0.99 to 1.06; p=0.12), of discharge home (OR: 1.02; 95% CI: 0.99 to 1.04; p=0.15), and of in-hospital mortality (OR: 1.01; 95% CI: 0.96 to 1.05; p=0.82). The odds of having a length of stay>4 days was slightly lower at hospitals with EHRs (OR: 0.97; 95% CI: 0.95 to 0.99; p=0.01). In our sample of GWTG-Stroke hospitals, EHRs were not associated with higher-quality care or better clinical outcomes for stroke care. Although EHRs may be necessary for an increasingly high-tech, transparent healthcare system, as currently implemented, they do not appear to be sufficient to improve outcomes for this important disease. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  14. Working Overtime in Community Mental Health: Associations With Clinician Burnout and Perceived Quality of Care.

    Science.gov (United States)

    Luther, Lauren; Gearhart, Timothy; Fukui, Sadaaki; Morse, Gary; Rollins, Angela L; Salyers, Michelle P

    2016-10-27

    Objective: Funding cuts have increased job demands and threatened clinicians' ability to provide high-quality, person-centered care. One response to increased job demands is for clinicians to work more than their official scheduled work hours (i.e., overtime). We sought to examine the frequency of working overtime and its relationships with job characteristics, work-related outcomes, and quality of care in community health clinicians. Method: One hundred eighty-two clinicians completed demographic and job characteristics questions and measures of burnout, job satisfaction, turnover intention, work-life conflict, and perceived quality of care. Clinicians also reported the importance of reducing stress and their confidence in reducing their stress. Clinicians who reported working overtime were compared to clinicians that did not on demographic and job characteristics and work-related outcomes. Results: Ninety-four clinicians (52%) reported working overtime in a typical week. Controlling for exempt status and group differences in time spent supervising others, those working overtime reported significantly increased burnout and work-life conflict and significantly lower job satisfaction and quality of care than those not working overtime. Clinicians working overtime also reported significantly greater importance in reducing stress but less confidence in their ability to reduce stress than those not working overtime. There were no significant group differences for turnover intention. Conclusion and Implications for Practice: Working overtime is associated with negative consequences for clinician-related work outcomes and perceived quality of care. Policies and interventions aimed at reducing overtime and work-related stress and burnout may be warranted in order to improve quality of care. (PsycINFO Database Record

  15. Intensive care delirium - effect on memories and health-related quality of life - a follow-up study

    DEFF Research Database (Denmark)

    Svenningsen, Helle; Tønnesen, Else K; Videbech, Poul

    2013-01-01

    delirium, memories and health-related quality needs further investigation. DESIGN: We used an observational multicentre design with telephone interviews. METHODS: Adult intensive care unit patients (n = 360) were consecutively recruited and interviewed using the intensive care unit-Memory Tool one week...... nondelirious patients up to six months postintensive care unit discharge. Delirium, memories and intensive care unit diaries with follow-up did not affect health-related quality of life and healthcare dependency. Memories of delusions might have an impact on patients assessed as nondelirious. CONCLUSIONS: More......AIMS AND OBJECTIVES: To investigate the effects of delirium in the intensive care unit on health-related quality of life, healthcare dependency and memory after discharge and to explore the association between health-related quality of life and memories, patient diaries and intensive care unit...

  16. The quality of care delivered to Parkinson's disease patients in the U.S. Pacific Northwest Veterans Health System

    OpenAIRE

    2006-01-01

    Abstract Background Parkinson's disease (PD) is the second most common chronic neurological disorder of the elderly. Despite the fact that a comprehensive review of general health care in the United States showed that the quality of care delivered to patients usually falls below professional standards, there is limited data on the quality of care for patients with PD. Methods Using the administrative database, the Pacific Northwest Veterans Health Administration (VHA) Data Warehouse, a popula...

  17. Health care, quality certification and institutional support: a focus on primary health care in Brazil

    Directory of Open Access Journals (Sweden)

    Antônio Thomaz Gonzaga da Matta-Machado

    2016-05-01

    Full Text Available Objective. To provide an overview of the distribution of institutional support in primary care in Brazil and to identify associations between the activities of institutional support and the outcome of the certification of the National Programme for Improving Access and Quality in Primary Health Care (PMAQ. Materials and methods. A cross-sectional study was conducted through interviews with 16 960 profes- sionals in Brazil in 2012. To examine the relationship between the received support and the quality of health care it was made a multiple binary logistic regression. Results. A positive relationship between high-level support and certification in the sub-dimensions analyzed was observed: women and child care, diabetes mellitus/ hypertension and mental health. The support activities which contributed most were: self-assessment, shared assessment, targeted workshops and training. Conclusion. Institutional support activities have helped to improve the quality and access of the population to healthcare in the country.

  18. Measuring tangibility and assurance as determinants of service quality for public health care in South Africa

    Directory of Open Access Journals (Sweden)

    J. De Jager

    2007-12-01

    Full Text Available Purpose: The purpose of this research is to measure service quality offered to patients treated in a government controlled hospital in South Africa. Desig/Methodology/Approach: A service satisfaction survey was conducted amongst patients treated at a provincial hospital in Gauteng. The attitudes of the patients were tested regarding pre-identified service quality aspects related to health care. Tangibility and assurance categories are analysed for the purposes of this paper. A total of 583 in- and out-patients were selected at random and were personally interviewed. A five point Likert type scale was used to measure their expectations and perceived performance. Findings: These indicated patient dissatisfaction with both service quality dimensions measured, although significant differences exist between in- and out-patients. Personal safety and cleanliness of facilities were regarded as the most important variables in the assurance and tangibility dimensions. The level of satisfaction was the highest for clear information signage and communication at an understandable level in the tangibility-and assurance categories, respectively. Implications: This paper presents a comprehensive framework for prioritising important issues by provincial hospital management policy makers to satisfy patients' expectations and, because they have more authority over expenditure, the findings are important in the interest of supplying acceptable health care. Originality/Value: This study challenges existing work on health care services. Its significance lies in investigating the diversified health care needs and wants of various cultural groups in South Africa, because it focuses on service quality as experienced by in- and out-patients. It offers a new framework from an original South African perspective, focusing on differences and similarities between in- and outpatients of a Gauteng public hospital.

  19. Policy Effects on the Quality of Public Health Care: Evaluating Portuguese Public Hospitals’ Quality through Customers’ Views

    Directory of Open Access Journals (Sweden)

    Fonseca Jaime R. S.

    2015-12-01

    Full Text Available In this paper, public health care administration issues are reviewed and public hospital patients’ views on quality of health care are empirically tested. The purpose is to support the recommendation of new public policies that lead to better performance, if necessary. Hospital patients’ views on service quality were assessed through a questionnaire to estimate a global customer satisfaction measure. We argue that customer satisfaction should be measured through multiple indicators, as a latent variable. Thus, we considered the latent segment models (LSM approach to assess customer service satisfaction. We found a twosegment latent structure: segment 1, the satisfied, with 48 percent of patients, mostly male and middle-aged patients; and segment 2, the unsatisfied, with 52 percent of patients, mostly female and youngest/oldest patients.

  20. Referring Quality Assessment of Primary Health Care for Endocrinology in Rio Grande do Sul, Brazil.

    Science.gov (United States)

    Monteiro Grendene, Gabriela; Szczecinski Rodrigues, Átila; Katz, Natan; Harzheim, Erno

    2015-01-01

    This paper presents results of an assessment of the quality research of endocrinology referrals in the public health system in the state of Rio Grande do Sul. From the analysis of 4,458 requests for endocrinology referrals, it was found that 15% of referrals had insufficient information for evaluation and 71% showed no clinical justification for authorization of referencing. The partial results of the study indicated that the lack of information makes it impossible to clinically regulate these requests. The use of referencing protocols associated with telemedicine tools can assist doctors in primary health care in the clinical management and make access to specialized services more equitable and timely.

  1. 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.

  2. Effectiveness of educational communication interventions for health professionals to improve quality of care in emergency departments: a systematic review protocol.

    Science.gov (United States)

    Ding, Mingshuang; Bell, Anthony; Rixon, Sascha; Rixon, Andrew; Addae-Bosomprah, Hansel; Simon, Jane

    2016-04-01

    The objective of this review is to evaluate the effectiveness of educational communication interventions for health professionals in emergency departments. The end result is to identify the specific types of communication based educational strategies utilized by emergency department health care professionals to enhance the quality of care for patients.

  3. Price and quality transparency: how effective for health care reform?

    Science.gov (United States)

    Nyman, John A; Li, Chia-Hsuan W

    2009-07-01

    Many in Minnesota and the United States are promoting price and quality transparency as a means for reforming health care. The assumption is that with such information, consumers and providers would be motivated to change their behavior and this would lead to lower costs and higher-quality care.This article attempts to determine the extent to which publicizing information about the cost and quality of medical care does, in fact, improve quality and lower costs, and thus should be included in any reform strategy. The authors reviewed a number of studies and concluded that there is a general lack of empirical evidence on the effect of price transparency on health care costs and that the evidence on the effectiveness of quality transparency is mixed.

  4. Creating a culture for health care quality and safety.

    Science.gov (United States)

    Roberts, Velma; Perryman, Martha M

    2007-01-01

    Approximately 67% of hospital quality indicators require some type of laboratory testing to monitor compliance. Unfortunately, in many hospitals, laboratory data information systems remain an untapped resource in eliminating medical errors and improving patient safety. Using case scenarios, this article demonstrates potential consequences for patient safety and quality of care when information sharing between medical technologists and nurses is not a part of a hospital's culture. The outcome for this patient could have been avoided if a more inclusive health care quality and safety culture existed. Creating a culture for health care quality and safety requires consensus building by clinical and administrative leaders. Consensus building occurs by managing relationships among and between a team of independent, autonomous physicians, nurses, allied health professionals, and health care administrators. These relationships are built on mutual respect and effective communication. Creating a quality culture is a challenging but necessary prerequisite for eliminating medical errors and ensuring patient safety. Physician leaders promoting and advancing cultural change in clinical care from one of exclusive decision making authority to a culture that is based on shared decision making are a necessary first step. Shared decision making requires mutual respect, trust, confidentiality, responsiveness, empathy, effective listening, and communication among all clinical team members. Physician and administrative leaders with a focus on patient safety and a willingness to change will ensure a culture of health care quality and safety.

  5. Most Americans Do Not Believe That There Is An Association Between Health Care Prices And Quality Of Care.

    Science.gov (United States)

    Phillips, Kathryn A; Schleifer, David; Hagelskamp, Carolin

    2016-04-01

    Many organizations are developing health care price information tools for consumers. However, consumers may avoid low-price care if they perceive price to be associated with quality. We conducted a nationally representative survey to examine whether consumers perceive that price and quality are associated and whether the way in which questions are framed affects consumers' responses. Most Americans (58-71 percent, depending on question framing) did not think that price and quality are associated, but a substantial minority did perceive an association (21-24 percent) or were unsure whether there was one (8-16 percent). Responses to questions framed in terms of high price and high quality differed from responses to questions framed in terms of low price and low quality. People who had compared prices were more likely than those who had not compared prices to perceive that price and quality were associated. We explore implications of these findings, including how behavioral economics can inform approaches to helping consumers use price and quality information.

  6. Health Care of Latino Children with Autism and Other Developmental Disabilities: Quality of Provider Interaction Mediates Utilization

    Science.gov (United States)

    Parish, Susan; Magana, Sandra; Rose, Roderick; Timberlake, Maria; Swaine, Jamie G.

    2012-01-01

    This study examines access to, utilization of, and quality of health care for Latino children with autism and other developmental disabilities. We analyze data from the National Survey of Children with Special Health Care Needs (N = 4,414 children with autism and other developmental disabilities). Compared with White children, Latino children with…

  7. Quality of outpatient care provided to diabetic patients. A health maintenance organization experience.

    Science.gov (United States)

    Peters, A L; Legorreta, A P; Ossorio, R C; Davidson, M B

    1996-06-01

    To document the quality of diabetes care provided to patients in a large health maintenance organization (HMO) from 1 January 1993 to 1 January 1994 and compare it to the standards of the American Diabetes Association (ADA). To meet a Health Plan and Employer Data Information Set (HEDIS) requirement, a major HMO in California identified 14,539 members with diabetes and randomly selected 384 individuals for review. Charts were available on 353 of these patients, and after obtaining the information for the HEDIS review, additional information was extracted from the charts by an outside chart reviewer. This data set was used for an analysis of the quality of diabetic care provided by the participating medical groups to these HMO members during 1 year. Documentation of follow-up and measures of glycemic and lipid control was examined both for absolute values and for the frequency of measurement over the year. These results were compared to the ADA standards of care. Although patients averaged 4.5 visits to their primary care physicians (PCPs) over the year, 21% had one or fewer visits per year. Glycated hemoglobin levels were not documented in 56% of patients (ADA recommends two to four measurements per year), and of those with a glycated hemoglobin level measured. 39% had at least one value > or = 10%. Fasting plasma glucose concentrations were not documented in 65% of patients (four to six per year recommended). Foot exams (which should be performed at each regular visit) were not documented for 94% of patients. Urine protein measurements were not performed in 52% of patients. Additionally, many patients had elevated and untreated lipid abnormalities. In spite of the frequency of PCP visits during the year for many of these patients, diabetes management was inadequate. This lack of adequate preventive care will lead to an increased risk of the development of the acute and chronic complications of diabetes, creating an even greater future burden on the health care

  8. Call for information, call for quality in mental health care.

    Science.gov (United States)

    Lora, A

    2013-03-01

    The quality of routine mental health care is not optimal, it can vary greatly from region to region and among providers; in many occasions, it does not correspond to the standards of evidence-based mental health. To bridge this gap, the promotion of a systematic use of the information available for quality assurance would be most helpful, but measuring the quality of mental health care is particularly challenging. Quality measurement can play a key role in transforming health care systems, and the routine measurement of quality, using clinical indicators derived from evidence-based practice guidelines, is an important step to this end. In Italy, the use of clinical indicators is still sporadic: over the last 5 years only three projects have been aimed at analysing, in a structured way, the quality of care in severe mental illness, and two of these were led by the Italian Society of Psychiatric Epidemiology. Not only in Italy but also at global level there is an urgent need for the implementation of mental health information systems that could lead to a substantial improvement in information technology. Once this has been achieved, a common set of clinical indicators, agreed upon at the regional and national level and useful for benchmarking and for comparing mental health services, could be defined. Finally, using the implementation strategies, a system of quality improvement at both regional and local levels will be built.

  9. ADOLESCENTS WITH BEHAVIORAL PROBLEMS: PERSONALITY, QUALITY OF LIFE AND SOCIAL HEALTH CARE

    Directory of Open Access Journals (Sweden)

    S. Ya. Volgina

    2013-01-01

    Full Text Available Deviant behavior of adolescents is a serious social problem in today's society because of the significant prevalence of this phenomenon. Authors present the results of the study of adolescents with behavioral problems. Aim: optimization of medical and social care for adolescents with behavioral problems. Patients and methods: the authors studied the incidence of this condition among children aged from 15 to 17 years using the software package «SOC/PEDIATRIA-2». The features of the personality structure of adolescents with deviant behavior were revealed using the adopted Russian short version of MMPI-MINI-MULT. Demographic and social characteristics of the families of adolescents were assessed. SF-36 questionnaire was applied for the quality of life assessment of the studied category. Results: increasing morbidity among adolescents was revealed due to various reasons: economic, medical and social. The study allowed to develop personal characteristics of the criteria in order to timely identify adolescents with accentuated and psychopathological features. The characteristics of quality of life were used as criteria of health care for adolescents with behavioral problems. The measures for the prevention and correction of deviant behavior among adolescents were proposed, including intersectoral integration and active participation of family in the process of rehabilitation. Conclusions: it is necessary to identify adolescents with deviant behavior timely, followed by a set of measures to provide them with health and social care to protect their health.

  10. A critical study of quality parameters in health care establishment: developing an integrated quality model

    NARCIS (Netherlands)

    Azam, M.; Rahman, Z.; Talib, F.; Singh, K.J.

    2012-01-01

    PURPOSE: The purpose of this article is to identify and critically analyze healthcare establishment (HCE) quality parameters described in the literature. It aims to propose an integrated quality model that includes technical quality and associated supportive quality parameters to achieve optimum

  11. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions.

    Science.gov (United States)

    Frølich, Anne

    2012-02-01

    The quality of health care services offered to people suffering from chronic diseases often fails to meet standards in Denmark or internationally. The population consisting of people with chronic diseases is large and accounts for about 70% of total health care expenses. Given that resources are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved. The aim of this dissertation is to describe the effect of determinants, such as organisational structures and management practices including two selected incentives, on the quality of care in chronic diseases. The dissertation is based on four studies with the following purposes: 1) macro- or healthcare system-level identification of organisational structures and principles that affect the quality of health care services, based on a comparison of KP and the Danish health care system; 2) meso- or organisation-level identification of management practices with positive effects on screening rates for hemoglobin A1c and lipid profile in diabetes; 3) evaluation of the effect of the CCM on quality of health care services and continuity of care in a Danish setting; 4) micro- or practice-level evaluation of the

  12. Designing Excellence and Quality Model for Training Centers of Primary Health Care: A Delphi Method Study

    Directory of Open Access Journals (Sweden)

    Jafar-Sadegh TABRIZI

    2015-10-01

    Full Text Available Background: Excellence and quality models are comprehensive methods for improving the quality of healthcare. The aim of this study was to design excellence and quality model for training centers of primary health care using Delphi method. Methods: In this study, Delphi method was used. First, comprehensive information were collected using literature review. In extracted references, 39 models were identified from 34 countries and related sub-criteria and standards were extracted from 34 models (from primary 39 models. Then primary pattern including 8 criteria, 55 sub-criteria, and 236 standards was developed as a Delphi questionnaire and evaluated in four stages by 9 specialists of health care system in Tabriz and 50 specialists from all around the country.Results: Designed primary model (8 criteria, 55 sub-criteria, and 236 standards were concluded with 8 criteria, 45 sub-criteria, and 192 standards after 4 stages of evaluations by specialists. Major criteria of the model are leadership, strategic and operational planning, resource management, information analysis, human resources management, process management, costumer results, and functional results, where the top score was assigned as 1000 by specialists. Functional results had the maximum score of 195 whereas planning had the minimum score of 60. Furthermore the most and the least sub-criteria was for leadership with 10 sub-criteria and strategic planning with 3 sub-criteria, respectively. Conclusion: The model that introduced in this research has been designed following 34 reference models of the world. This model could provide a proper frame for managers of health system in improving quality. Keywords: Quality model, Excellence model, Training centers, Primary cares, Iran

  13. Health related quality of life in Critically ill Patients A study of health related quality of life in critically ill patients admitted on the Intensive Care

    NARCIS (Netherlands)

    J.G.M. Hofhuis (José)

    2008-01-01

    textabstractHealth related quality of life (HRQOL) is a relevant outcome measure for patients admitted to the intensive care unit (ICU). Long term outcome for physical and psychological factors, functional status and social interactions are becoming more and more important both for doctors and nurse

  14. Quality of internal communication in health care and the professional-patient relationship.

    Science.gov (United States)

    March Cerdá, Joan Carles; Prieto Rodríguez, María Angeles; Pérez Corral, Olivia; Lorenzo, Sergio Minué; Danet, Alina

    2010-01-01

    A study was undertaken for the purpose of describing internal communication and the professional-patient relationship and to establish a descriptive model of the interaction between these 2 variables. A nationwide survey was carried out in primary care and specialist care centers in Spain. A simple random sampling method was used with 1183 health care professionals. The data collection instrument was a Likert questionnaire that recorded information on the perceived quality of internal communication (0-100 scale), professional-patient relationships (0-100 scale), and sociodemographic variables. The results were analyzed using SPSS 15.0, performing mean comparisons and a suitable linear regression model.The total average of the quality of internal communication was 53.79 points, and that of the professional-patient relationships was 74.17 points. Sex made no statistically significant difference. Age shows that the older the participant, the better his/her opinion of internal communication and professional-patient relationships. Nursing staff had the highest opinion of internal communication and professional-patient relationships. The association between internal communication and professional-patient relationship was positive (R = 0.45).It was concluded that continuous exchange of information among health care professionals, together with learning and shared decision making or a positive emotional climate, is an element that will consolidate good professional-patient relationships and ensure patient satisfaction.

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

    Directory of Open Access Journals (Sweden)

    Jabir Maysoon

    2013-01-01

    Full Text Available Abstract Background The maternal near-miss concept has been developed as an instrument for assisting health systems to evaluate and improve their quality of care. Our study aimed at studying the characteristics and quality of care provided to women with severe complications in Baghdad through the use of the World Health Organization (WHO near-miss approach for maternal health. Methods This is a facility-based, cross-sectional study conducted in 6 public hospitals in Baghdad between March 1, 2010 and the June 30, 2010. WHO near-miss approach was utilized to analyze the data in terms of indicators of maternal near miss and access to and quality of maternal care. Results The maternal near-miss rate was low at 5.06 per 1,000 live births, while the overall maternal near miss: mortality ratio was 9:1. One third of the near-miss cases were referred from other facilities and the mortality index was the same for referred women and for in-hospital women (11%. The intensive care unit (ICU admission rate was 37% for women with severe maternal outcomes (SMO, while the overall admission rate was 0.28%. Anemia (55% and previous cesarean section (45% were the most common associated conditions with severe maternal morbidity. The use of magnesium sulfate for treatment of eclampsia, oxytocin for prevention and treatment of postpartum hemorrhage, prophylactic antibiotics during caesarean section, and corticosteroids for inducing fetal lung maturation in preterm birth is suboptimum. Conclusions The WHO near-miss approach allowed systematic identification of the roadblocks to improve quality of care and then monitoring the progress. Critical evidence-based practices, relevant to the management of women experiencing life-threatening conditions, are underused. In addition, possible limitations in the referral system result in a very high proportion of women presenting at the hospital already in a severe health condition (i.e. with organ dysfunction. A shortage of ICU

  16. A Survey of the quality of nursing care in several health districts in South Africa.

    Directory of Open Access Journals (Sweden)

    Naidoo Joanne R

    2004-02-01

    Full Text Available Abstract Background South Africa is currently focusing strongly on human resource development. The purpose of this study was to describe and compare the quality of nursing service and care in three health districts in the KwaZulu Natal Province. To identify deficiencies which could be addressed by education and training, it might be useful to measure the quality of care given by nurses. Methods From March to August 2002 a survey was done in six hospitals and six clinics in three health districts of the KwaZulu-Natal province of South Africa. Five different aspects of care was evaluated; hand-over from one nursing shift to another, implementation of universal precautions, patient satisfaction, nursing records, management of chronic illnesses. All these aspects were evaluated using checklists based on record reviews or direct observation, except for patient satisfaction, which was evaluated by questionnaires. Results The average scores on the different aspects varied from 11% (for nursing records to 73% (for management of chronic diseases. Specific problems became evident. In one district three out of four hand-overs between shifts of nurses scored less than 50%. In all three districts the use of protective gear scored low (43%. While the average score for management of chronic illnesses were high at 73%, the blood pressures of only 23% was within the target range, and the blood sugar of only 38% of patients were controlled. Patient satisfaction averaged 72% across the three districts. Conclusion The quality of care measurements identified specific training needs, but other management strategies are probably also indicated.

  17. Quality of primary health care and autonomous motivation for effective diabetes self-management among patients with type 2 diabetes

    OpenAIRE

    Koponen, Anne M; Nina Simonsen; Sakari Suominen

    2017-01-01

    This study showed, in line with self-determination theory, that of the six central quality dimensions of primary health care (access to care, continuity of care, diabetes counseling, autonomy support from one’s physician, trust, patient-centered care), autonomy support from one’s physician was most strongly associated with autonomous motivation (self-regulation) for effective diabetes self-management among patients with type 2 diabetes (n = 2866). However, overall support for diabetes care re...

  18. Impact of oral health care needs on health-related quality of life in adult HIV+ patients.

    Science.gov (United States)

    Sánchez, Gabriel A; D'Eramo, Luciana R; Lecumberri, Rodolfo; Squassi, Aldo F

    2011-01-01

    The aim of this work was to determine the social impact of oral conditions on health-related quality of life in adult HIV+ patients and create a predictive model. The oral health impact profile questionnaire OHIP-49 was randomly administered to 200 HIV+ adults patients of any age and either sex at the High Risk Patients Dental Care Unit (CLAPAR I), School of Dentistry, University of Buenos Aires. Argentina. For each of the 49 items, participants indicated their responses on a five point Likert-type frequency scale ranging from "never" to "very often". Oral health needs were assessed through the CCITN (Community Caries Index of Treatment Need) and CPITN (Community Periodontal Index of Treatment Need). The Mann-Whitney test was used to compare the OHIP-49 score between male and female respondents. The Kruskal-Wallis test was used to assess score differences among the OHIP-49 domains. Altogether, 50% of the respondents were male and 50% were female, aged 36.45 +/- 0.70 years and 38.03 +/- 0.78 years respectively. The assessment of oral health care needs revealed a great need for treatment. Mean CCITN was 11.15 +/- 0.35 and CPITN was 2.41 +/- 0.12. The average total OHIP-49 score (83) revealed a high level of social impact, which was higher for female compared to male respondents (Z(T) = 2.08, p = 0.037). The domains concerning functional limitation (domain 1), physical pain (domain 2) and psychological discomfort (domain 3) showed higher levels of social impact (H = 395.06, p < 0.0001). The social impact observed in these domains was higher for female compared to male patients. In the correlation analysis, oral conditions, age, gender and social impact were significantly associated. These results demonstrate that unmet oral health care need impairs the quality of life of HIV+ patients and suggest the need of comprehensive oral health care interventions.

  19. Psychosocial work environment and prediction of quality of care indicators in one Canadian health center.

    Science.gov (United States)

    Paquet, Maxime; Courcy, François; Lavoie-Tremblay, Mélanie; Gagnon, Serge; Maillet, Stéphanie

    2013-05-01

    Few studies link organizational variables and outcomes to quality indicators. This approach would expose operant mechanisms by which work environment characteristics and organizational outcomes affect clinical effectiveness, safety, and quality indicators. What are the predominant psychosocial variables in the explanation of organizational outcomes and quality indicators (in this case, medication errors and length of stay)? The primary objective of this study was to link the fields of evidence-based practice to the field of decision making, by providing an effective model of intervention to improve safety and quality. The study involved healthcare workers (n = 243) from 13 different care units of a university affiliated health center in Canada. Data regarding the psychosocial work environment (10 work climate scales, effort/reward imbalance, and social support) was linked to organizational outcomes (absenteeism, turnover, overtime), to the nurse/patient ratio and quality indicators (medication errors and length of stay) using path analyses. The models produced in this study revealed a contribution of some psychosocial factors to quality indicators, through an indirect effect of personnel- or human resources-related variables, more precisely: turnover, absenteeism, overtime, and nurse/patient ratio. Four perceptions of work environment appear to play an important part in the indirect effect on both medication errors and length of stay: apparent social support from supervisors, appreciation of the workload demands, pride in being part of one's work team, and effort/reward balance. This study reveals the importance of employee perceptions of the work environment as an indirect predictor of quality of care. Working to improve these perceptions is a good investment for loyalty and attendance. In general, better personnel conditions lead to fewer medication errors and shorter length of stay. © Sigma Theta Tau International.

  20. Nurses' sleep quality, work environment and quality of care in the Spanish National Health System: observational study among different shifts

    Science.gov (United States)

    Gómez-García, Teresa; Ruzafa-Martínez, María; Fuentelsaz-Gallego, Carmen; Madrid, Juan Antonio; Rol, Maria Angeles; Martínez-Madrid, María José; Moreno-Casbas, Teresa

    2016-01-01

    Objective The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work. Methods This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns. Results 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017). Conclusions Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The

  1. Best practices of total quality management implementation in health care settings.

    Science.gov (United States)

    Talib, Faisal; Rahman, Zillur; Azam, Mohammed

    2011-01-01

    Due to the growing prominence of total quality management (TQM) in health care, the present study was conducted to identify the set of TQM practices for its successful implementation in healthcare institutions through a systematic review of literature. A research strategy was performed on the selected papers published between 1995 and 2009. An appropriate database was chosen and 15 peer-reviewed research papers were identified through a screening process and were finally reviewed for this study. Eight supporting TQM practices, such as top-management commitment, teamwork and participation, process management, customer focus and satisfaction, resource management, organization behavior and culture, continuous improvement, and training and education were identified as best practices for TQM implementation in any health care setting. The article concludes with a set of recommendations for the future researchers to discuss, develop, and work upon in order to achieve better precision and generalizations.

  2. The structure, processes, and outcomes of Banner Health's corporate-wide strategy to improve health care quality.

    Science.gov (United States)

    Kirkman-Liff, Bradford

    2004-01-01

    Banner Health consists of 19 hospitals, 6 long-term care centers and a number of family health clinics, home care programs, and home medical equipment providers in 9 Western and Midwestern states. Banner Health has developed an integrated organization-wide effort called Care Management to simultaneously address quality and safety, reduce patient errors, and measure and report performance, outcomes, and patient satisfaction, while controlling costs through utilization management, care coordination, and performance improvement. Eleven functional areas were identified and more than 36 cross-functional and cross-facility work groups have been created. These work groups use a deliberate process in which knowledge is created, reviewed, synthesized, distributed, taught, and implemented within the system. Key lessons after the first 2 years of this effort are as follows: information sharing and collegial support can be established within newly merged organizations; there must be continued enhancement of both the accuracy and timeliness of data; the ability of health care professionals to understand and use sophisticated statistical tools has increased; a variety of methods should be used to distribute the knowledge products; and the strategy to have functional teams and work groups develop systemwide policies and toolkits but leave implementation to facility employees has worked relatively well.

  3. The entrance of "the economic man" in Health Care Quality - a Danish case study

    DEFF Research Database (Denmark)

    Peyton, Margit Malmmose

    qualitative to quantitative outputs. The output measures form the foundation for a number of decisions such as allocation of human resources and funding. The purpose of this paper is to show how performance measurements have had a dominant impact on different stakeholders and their influences, which...... furthermore has had an impact on the perceived concept of service and service quality. The following research questions will be addressed: Is there a change in the relative power construction of stakeholders within the Danish health care system over the period of 2002-2008? If so, what effect has this change...... of relative power had on the concept of service quality? Using Politt et al (1995) framework for the concept of service quality along with Lukes (1974/2005) third dimensional power concept, news media text is analysed in order to identify the dominant discursive power represented and its effect on the concept...

  4. 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.

  5. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne

    2012-01-01

    are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system...... in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear...... which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved....

  6. The importance of quality, access and price to health care consumers in Bulgaria: a self-explicated approach.

    Science.gov (United States)

    Pavlova, Milena; Groot, Wim; van Merode, Godefridus

    2003-01-01

    One approach to the problem of low patient satisfaction in Bulgaria is to identify attributes of health care services that the consumers value most and to focus on their improvement. Based on data from a household survey, this paper examines the importance that health care consumers attach to quality, access and price. The survey was conducted in 2000 among the population of the region of Varna (the third largest city in Bulgaria). The elicitation of attribute importance was based on a self-explicated method. To analyse the data, an ordered logit regression was performed. The analysis shows that clinical quality is the most valued characteristic by Bulgarian health care consumers compared with social quality, access and price. Given the poor quality of health care provision in Bulgaria, the allocation of revenues to its improvement appears to be essential in order to raise patient satisfaction and to enhance social efficiency.

  7. Advancing health care quality and safety through action learning.

    Science.gov (United States)

    Mathews, Simon; Golden, Sherita; Demski, Renee; Pronovost, Peter; Ishii, Lisa

    2017-05-02

    Purpose The purpose of this study is to demonstrate how action learning can be practically applied to quality and safety challenges at a large academic medical health system and become fundamentally integrated with an institution's broader approach to quality and safety. Design/methodology/approach The authors describe how the fundamental principles of action learning have been applied to advancing quality and safety in health care at a large academic medical institution. The authors provide an academic contextualization of action learning in health care and then transition to how this concept can be practically applied to quality and safety by providing detailing examples at the unit, cross-functional and executive levels. Findings The authors describe three unique approaches to applying action learning in the comprehensive unit-based safety program, clinical communities and the quality management infrastructure. These examples, individually, provide discrete ways to integrate action learning in the advancement of quality and safety. However, more importantly when combined, they represent how action learning can form the basis of a learning health system around quality and safety. Originality/value This study represents the broadest description of action learning applied to the quality and safety literature in health care and provides detailed examples of its use in a real-world context.

  8. Quality of Health Insurance Coverage and Access to Care for Children in Low-Income Families.

    Science.gov (United States)

    Kreider, Amanda R; French, Benjamin; Aysola, Jaya; Saloner, Brendan; Noonan, Kathleen G; Rubin, David M

    2016-01-01

    An increasing diversity of children's health coverage options under the US Patient Protection and Affordable Care Act, together with uncertainty regarding reauthorization of the Children's Health Insurance Program (CHIP) beyond 2017, merits renewed attention on the quality of these options for children. To compare health care access, quality, and cost outcomes by insurance type (Medicaid, CHIP, private, and uninsured) for children in households with low to moderate incomes. A repeated cross-sectional analysis was conducted using data from the 2003, 2007, and 2011-2012 US National Surveys of Children's Health, comprising 80,655 children 17 years or younger, weighted to 67 million children nationally, with household incomes between 100% and 300% of the federal poverty level. Multivariable logistic regression models compared caregiver-reported outcomes across insurance types. Analysis was conducted between July 14, 2014, and May 6, 2015. Insurance type was ascertained using a caregiver-reported measure of insurance status and each household's poverty status (percentage of the federal poverty level). Caregiver-reported outcomes related to access to primary and specialty care, unmet needs, out-of-pocket costs, care coordination, and satisfaction with care. Among the 80,655 children, 51,123 (57.3%) had private insurance, 11,853 (13.6%) had Medicaid, 9554 (18.4%) had CHIP, and 8125 (10.8%) were uninsured. In a multivariable logistic regression model (with results reported as adjusted probabilities [95% CIs]), children insured by Medicaid and CHIP were significantly more likely to receive a preventive medical (Medicaid, 88% [86%-89%]; P < .01; CHIP, 88% [87%-89%]; P < .01) and dental (Medicaid, 80% [78%-81%]; P < .01; CHIP, 77% [76%-79%]; P < .01) visits than were privately insured children (medical, 83% [82%-84%]; dental, 73% [72%-74%]). Children with all insurance types experienced challenges in access to specialty care, with caregivers of children

  9. Quality of primary health care and autonomous motivation for effective diabetes self-management among patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Anne M Koponen

    2017-05-01

    Full Text Available This study showed, in line with self-determination theory, that of the six central quality dimensions of primary health care (access to care, continuity of care, diabetes counseling, autonomy support from one’s physician, trust, patient-centered care, autonomy support from one’s physician was most strongly associated with autonomous motivation (self-regulation for effective diabetes self-management among patients with type 2 diabetes ( n  = 2866. However, overall support for diabetes care received from friends, family members, other patients with diabetes, and health care professionals may even play a greater role.

  10. Crossing the quality chasm: lessons from health care quality improvement efforts in England

    OpenAIRE

    Madhok, Rajan

    2002-01-01

    The second report from the US Institute of Medicine Crossing the Quality Chasm, highlighted the deficiencies in health care quality in the USA, analyzed the contributory factors, and proposed 13 recommendations for improvements. Clearly, the challenges are enormous. Can anything be learned from the experiences of other countries? This article describes the author's experiences of health care quality improvement efforts in the National Health Service in England and their implications for the U...

  11. The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care.

    Science.gov (United States)

    Norvoll, Reidun; Hem, Marit Helene; Pedersen, Reidar

    2017-03-01

    Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics (i.e., ethical theory, moral deliberation and clinical ethics support) in such initiatives. This study adds to this subject by exploring health professionals' descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried out in 2012 with key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed.

  12. Graduate Management Project. The Pursuit of Quality in Military Health Care: Are We Held to a Higher Standard?

    Science.gov (United States)

    2006-06-20

    devastating effects. A case in point is the 2001 collapse of Enron . In Quality in Military Health Care 16 opposition to this, welfare, efficiency, and...quality: Case studies and an analysis. Health Affairs, 22(2), 17-30. Mackenzie, G. C., with Hafken, M. (2002). Scandal Proof: Do Ethics Laws Make

  13. The contribution of quality to health services. Application of the quality management system ISO 9001:2008 in Intensive Care Unit of the General Hospital of Larissa

    OpenAIRE

    Dimitrios Patsios; Apostolos Komnos; Charilaos Apostolidis; Anastasia Mpalasopoulou

    2014-01-01

    In our country there have been many efforts in recent years to introduce laws that lead to the introduction of the concept of quality in the field of public hospitals. The implementation of health quality systems contributes to health care improvement, while the assessment of quality services is a basic tool in quality management. Purpose: The purpose of the study was to describe the benefits that can be gained by a public institute of health when a quality model is applied. Material and meth...

  14. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne

    2012-01-01

    which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved.......The quality of health care services offered to people suffering from chronic diseases often fails to meet standards in Denmark or internationally. The population consisting of people with chronic diseases is large and accounts for about 70% of total health care expenses. Given that resources...

  15. Contribution to systematic education of quality management in Slovak health care.

    Science.gov (United States)

    Rusnakova, V; Bacharova, L

    2001-01-01

    Of the study was to contribute to quality improvement initiatives in Slovak health services through systematic approach to the education and training in quality management (QM). Consequently, the main objectives were to analyse the content of the education in QM abroad, to conduct an audit of perceived training needs in Slovakia, and to propose the design of QM training programme to be applied within CME scheme based on the study results. Triangular method in the design of the study was implemented. Review of relevant information, data from the questionnaire and semi-structured interview in the sample of 67 Slovak trainees from Health Management School and School of Public Health--were adopted in complementary fashion. Highlighted in the survey are positive attitudes to training in quality management documented by the median score higher than 6 in all tested areas, on scale 0-10. No significant differences in profession groups as physicians, nurses, HC managers or among training institutions involved were displayed. However, potential obstacles were identified in deeper study using interviews. The absence of knowledge and skills in management in general and in quality management approaches especially are observed. Typically, the role of strategic planning is undermined. The large scale of quality management approaches is converted to problems of accreditation. Barriers to participative culture, innovation, devolution of accountability, resistance to change and to team based management are authentic findings as well. Drawn from the study were related to: fostering managers--"transformational leaders" for locally driven decision making in health care policy and practice; need of training activities for the continuing education in quality with respect to specific target groups interests and their level of knowledge in management; content of training oriented towards combination of rational utilization of information, critical analytical skills and planning for quality

  16. Preventable infant mortality and quality of health care: maternal perception of the child's illness and treatment

    Directory of Open Access Journals (Sweden)

    Salime Hadad

    2002-12-01

    Full Text Available This study used a qualitative methodology to analyze the discourse of mothers from Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil, whose infant children had died from what were considered avoidable causes (diarrhea, malnutrition, and pneumonia, seeking to elucidate the factors associated with utilization of health care services. Identification of the illness by the mother was related to perception of specific alterations in the child's state of health. Analysis of the alterations helped identify the principal characteristics ascribed to each alteration and their relationship to the search for treatment. The authors also studied the mother's assessment of treatment received at health care facilities; 43.0% of the cases involved problems related to the structure of health care services or the attending health care professionals. In 46.0% of the cases, mothers associated the child's death with flaws in the health care service. The study group showed a variety of interpretations of illness, often distinct from the corresponding biomedical concepts. The fact that attending health care personnel overlooked or underrated the mother's perception of the illness and the lack of communications between health care personnel and the child's family had an influence on the child's evolution and subsequent death.

  17. Preventable infant mortality and quality of health care: maternal perception of the child's illness and treatment

    Directory of Open Access Journals (Sweden)

    Hadad Salime

    2002-01-01

    Full Text Available This study used a qualitative methodology to analyze the discourse of mothers from Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil, whose infant children had died from what were considered avoidable causes (diarrhea, malnutrition, and pneumonia, seeking to elucidate the factors associated with utilization of health care services. Identification of the illness by the mother was related to perception of specific alterations in the child's state of health. Analysis of the alterations helped identify the principal characteristics ascribed to each alteration and their relationship to the search for treatment. The authors also studied the mother's assessment of treatment received at health care facilities; 43.0% of the cases involved problems related to the structure of health care services or the attending health care professionals. In 46.0% of the cases, mothers associated the child's death with flaws in the health care service. The study group showed a variety of interpretations of illness, often distinct from the corresponding biomedical concepts. The fact that attending health care personnel overlooked or underrated the mother's perception of the illness and the lack of communications between health care personnel and the child's family had an influence on the child's evolution and subsequent death.

  18. Quality management: patients reflections on health care at outpatient clinic of internal medicine department.

    Science.gov (United States)

    Ljubičić, Neven; Boban, Marko; Gaćina, Petar; Adzija, Jasminka; Benceković, Zeljka; Rajković, Ana

    2009-06-01

    Middle and older age group relative share in the community permanently grows. Those are commonly burdened with several chronic health conditions or elevated incidence of acute ones and in more frequent need for consulting health services. In the era of modern technical medicine, it is important to increase quality of services particularly patients orientated. Department of Internal Medicine developed questionnaire to assess reflections on medical care from the receiver of medical services point of view. Sample was formed from individuals that visited outpatient triage Unit (OTU) and voluntary enrolled, during period April 1-August 31, 2008 for any medical reason. Study population structure had similarly equally of both genders, socio-economical background, and was in age range 18-87. Questionnaire was developed by team of experienced personnel covering satisfaction on received medical care. There were 279 returned formulary in a sample of 6700 patients (4.18%). Patients visited OTU chiefly on behalf medical condition secondary to address of residency, followed by personal choice, on advice given by general practitioner, by emergency transportation services, or just due to earlier experiences. Regarding provided medical care extent, 4/5 of patients were examined in lesser than 2 hours, while total workup lasted mostly for 2-4, followed by over four. Over half of patients were moderate toward highly satisfied with provided medical information, personnel communication style and general reflection on all services while being in the Department premises. Astonishing proportion of patients (93%) was satisfied with positive personnel communication. Integration of patients' self-perceived reports about medical services in organizing process is inevitable for augmenting content and at the same time valuable for developing overall quality of treatment. Communication excellence is of premier importance and unavoidable for giving additional positive effect to remain health

  19. Investigating the Mechanism of Marital Mortality Reduction: The Transition to Widowhood and Quality of Health Care

    National Research Council Canada - National Science Library

    Lei Jin; Nicholas A. Chrisatakis

    2009-01-01

    .... We address whether the transition to widowhood affects the quality of care that individuals receive and explore the extent to which these changes mediate the elevated mortality hazard for the widowed...

  20. Association between obesity, quality of life, physical activity and health service utilization in primary care patients with osteoarthritis.

    NARCIS (Netherlands)

    Rosemann, T.J.; Grol, R.P.T.M.; Herman, K.; Wensing, M.J.P.; Szecsenyi, J.

    2008-01-01

    ABSTRACT: OBJECTIVE: To assess the association of obesity with quality of life, health service utilization and physical activity in a large sample of primary care patients with osteoarthritis (OA). METHODS: Data were retrieved from the PraxArt project, representing a cohort of 1021 primary care pati

  1. Improving Perinatal Mental Health Care for Women Veterans: Description of a Quality Improvement Program.

    Science.gov (United States)

    Katon, Jodie G; Lewis, Lacey; Hercinovic, Selma; McNab, Amanda; Fortney, John; Rose, Susan M

    2017-02-06

    Purpose We describe results from a quality improvement project undertaken to address perinatal mental healthcare for women veterans. Description This quality improvement project was conducted in a single VA healthcare system between 2012 and 2015 and included screening for depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) three times during the perinatal period, a dedicated maternity care coordinator (MCC), an on-site clinical social worker, and an on-site obstetrician/gynecologist (Ob/gyn). Information on prior mental health diagnosis was collected by the MCC or Ob/gyn. The prevalence of perinatal depressive symptoms and receipt of mental healthcare among those with such symptoms are reported by presence of a pre-pregnancy mental health diagnosis. Assessment Of the 199 women who used VA maternity benefits between 2012 and 2015, 56% (n = 111) had at least one pre-pregnancy mental health diagnosis. Compared to those without a pre-pregnancy mental health diagnosis, those with such a diagnosis were more likely to be screened for perinatal depressive symptoms at least once (61.5% vs. 46.8%, p = 0.04). Prevalence of depressive symptoms was 46.7% among those with a pre-pregnancy mental health diagnosis and 19.2% among those without. Among those with a pre-pregnancy mental health diagnosis and depressive symptoms (n = 35), 88% received outpatient mental healthcare and 77% met with the clinical social worker. Among those without a pre-pregnancy mental health diagnosis and depressive symptoms (n = 8), none received outpatient mental healthcare, but 77.8% met with the clinical social worker. Conclusion Improving perinatal mental healthcare for women veterans requires a multidisciplinary approach, including on-site integrated mental healthcare.

  2. Post abortion care quality status in health facilities of Guraghe zone, Ethiopia.

    Science.gov (United States)

    Tesfaye, Gezahegn; Oljira, Lemessa

    2013-07-23

    Unsafe abortion in the developing world accounts for 13% of all maternal deaths. Ethiopia is one of the developing countries with the highest maternal mortality ratio (673 per 100,000 live births) in the world. Unsafe abortion was estimated to account for 32% of all maternal deaths in Ethiopia. To assess post abortion care quality status in health facilities of Guraghe zone. A facility based cross-sectional study design with both quantitative and qualitative methods was conducted. Patient interview, direct service observation, provider self administered questionnaire and inventory of equipment and supplies were used for the assessment. Six health centers, two hospitals and 422 post-abortion patients were included in the study. Patient-provider interaction was generally satisfactory from the patient's perspective. The majority of the respondents (93.5%) said that they were treated with politeness and respect. More than half 226(56.5%) of the clients have received post abortion family planning. Overall, 83.5% of the patients were satisfied with the services. Those who said waiting time was long were less satisfied and unemployed women were more satisfied than others. The study has revealed several improvements as well as problems in the provision of post-abortion care service in the studied health facilities.

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

    Science.gov (United States)

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

    2014-10-01

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

  4. Measuring health-related quality of life in adults with chronic conditions in primary care settings

    Science.gov (United States)

    Hand, Carri

    2016-01-01

    Abstract Objective To describe health-related quality of life (HRQOL) conceptual frameworks, critically review 3 commonly used HRQOL scales relevant to adults with chronic conditions in primary care settings, and make recommendations for using HRQOL scales in primary care practice. Data sources Information was accessed regarding HRQOL conceptual and theoretical approaches. A comprehensive search strategy identified 3 commonly used scales that met the review criteria and evidence regarding use of the scales in adults with chronic conditions in community settings. Scale selection Scales were selected if they were designed for clinical use; were easy to administer; were generic and broad in content areas; and contained some individualized items. Scales were critiqued according to content development, theoretical basis, psychometric properties, scoring, feasibility, the concepts being measured, and the number of items that measured an individualized concept. Synthesis Early HRQOL approaches focused on health and functional status while recent approaches incorporate individualized concepts such as the person’s own values and the environment. The abbreviated World Health Organization Quality of Life Scale (WHOQOL-BREF), the 36-Item Short Form Health Survey (SF-36), and the Duke Health Profile were critiqued. All address physical, mental, and social domains, while the WHOQOL-BREF also addresses environment. Psychometric evidence supports use of the SF-36 and WHOQOL-BREF with this population. The SF-36 has the most evidence of responsiveness but has some floor and ceiling effects, while the WHOQOL-BREF does not appear to have floor or ceiling effects but has limited evidence of responsiveness. The WHOQOL-BREF has the highest proportion of individualized items. Conclusion Measurement of HRQOL in adults with chronic conditions can support patient management and contribute to primary care service evaluation. Scales that are based on a broad definition of health and that

  5. Racial and Ethnic Disparities in Quality of Health Care among Children with Autism and Other Developmental Disabilities

    Science.gov (United States)

    Magana, Sandra; Parish, Susan L.; Rose, Roderick A.; Timberlake, Maria; Swaine, Jamie G.

    2012-01-01

    We examined racial and ethnic disparities in quality of care for children with autism and other developmental disabilities and whether disparities varied for children with autism compared to children with other developmental disabilities. Analyzing data from the National Survey of Children with Special Health Care Needs (N = 4,414), we compared…

  6. Chronic care model in primary care: can it improve health-related quality of life?

    OpenAIRE

    Aryani FMY; Lee SWH; Chua SS; Kok LC; Efendie B; Paraidathathu T

    2016-01-01

    Faridah Md Yusof Aryani,1 Shaun Wen Huey Lee,2 Siew Siang Chua,3 Li Ching Kok,4 Benny Efendie,2 Thomas Paraidathathu5 1Pharmaceutical Services Division, Ministry of Health Malaysia, Petaling Jaya, 2School of Pharmacy, Monash University Malaysia, Bandar Sunway, 3Department of Pharmacy, Faculty of Medicine, University of Malaya, 4Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur, 5School of Pharmacy, Taylor’s University, Subang Jaya, Selangor, Malaysia Purpose: Chronic di...

  7. Why give birth in health facility? Users’ and providers’ accounts of poor quality of birth care in Tanzania

    Science.gov (United States)

    2013-01-01

    Background In Tanzania, half of all pregnant women access a health facility for delivery. The proportion receiving skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out to increase health facility deliveries by skilled care. The aim of this study was to describe the weaknesses in the provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric fistula, nurse-midwives at both BEmOC and CEmOC health facilities and local community members. Methods Semi-structured interviews involving 16 women affected by obstetric fistula and five nurse-midwives at maternity wards at both BEmOC and CEmOC health facilities, and Focus Group Discussions with husbands and community members were conducted between October 2008 and February 2010 at Comprehensive Community Based Rehabilitation in Tanzania and Temeke hospitals in Dar es Salaam, and Mpwapwa district in Dodoma region. Results Health care users and health providers experienced poor quality caring and working environments in the health facilities. Women in labour lacked support, experienced neglect, as well as physical and verbal abuse. Nurse-midwives lacked supportive supervision, supplies and also seemed to lack motivation. Conclusions There was a consensus among women who have suffered serious birth injuries and nurse midwives staffing both BEmOC and CEmOC maternity wards that the quality of care offered to women in birth was inadequate. While the birth accounts of women pointed to failure of care, the nurses described a situation of disempowerment. The bad birth care experiences of women undermine the reputation of the health care system, lower community expectations of facility birth, and sustain high rates of home deliveries. The only way to increase the rate of skilled attendance at birth in the current Tanzanian context is to make facility birth a safer alternative than home birth. The findings from this study

  8. Quality of antenatal care services at public health facilities of Bahir-Dar special zone, Northwest Ethiopia.

    Science.gov (United States)

    Ejigu, Tadese; Woldie, Mirkuzie; Kifle, Yibeltal

    2013-10-26

    Antenatal care (ANC) is one of the evidence based interventions to decrease the probability of bad health outcomes for mothers and their newborns. Effectiveness of antenatal care, however, relies on the quality of care provided during each antenatal care visit. Hence this study attempted to assess the quality of antenatal care services at public health facilities of Bahir-Dar special zone, North Western Ethiopia. A facility based cross-sectional study employing both quantitative and qualitative methods was conducted from March to April 2010 in Bahir-Dar special zone, North Western Ethiopia. Quality of care was measured as a proportion of patients receiving recommended components of care. To measure the indicators, data was collected from 369 pregnant women who attended ANC clinics in eight public health facilities, during the data collection period. Data were collected through exit interviews with ANC attendees, observation during consultation, and in-depth interviews with health care providers. Pregnant mothers attending ANC clinics were found to receive only part of recommended care components. Venereal Disease Research Laboratory (VDRL) test, blood group and Rhesus factor tests were done only for 73 (19.8%) and 133 (36.0%) of the women, respectively. Moreover 236 (64.0%) of the mothers missed the opportunity of receiving iron/folic acid supplement during their ANC visit. Three hundred fifty five (96.2%) of the women received tetanus toxoid vaccine. And only 226 (61.2%) of the women had their conjunctiva checked for anemia. Lack of reagents partly explained the problems observed in the provision of recommended care components. Almost half, 175 (47.7%) of the study women were not satisfied and a large proportion of mothers are missing opportunities to receive screening (like blood pressure and weight measurements) and preventive components of antenatal care (iron/folic acid supplementation). Therefore, efforts should be targeted to avoid missed opportunities by

  9. The contribution of quality to health services. Application of the quality management system ISO 9001:2008 in Intensive Care Unit of the General Hospital of Larissa

    Directory of Open Access Journals (Sweden)

    Dimitrios Patsios

    2014-10-01

    Full Text Available In our country there have been many efforts in recent years to introduce laws that lead to the introduction of the concept of quality in the field of public hospitals. The implementation of health quality systems contributes to health care improvement, while the assessment of quality services is a basic tool in quality management. Purpose: The purpose of the study was to describe the benefits that can be gained by a public institute of health when a quality model is applied. Material and methods: This paper focus on the application of the ISO 9001:2008 standard in the Intensive Care Unit of the General Hospital of Larissa during the years 2010-2012. The results and benefits of its implementation, recorded by measuring satisfaction of the relatives of the patients. The questionnaire Family Satisfaction with Care in the Intensive Care Unit (FS-ICU 24 and quality indicators were applied. The study sample was all the relatives of the patients hospitalized in ICU during 2010-2012. Descriptive statistics was performed. Results: Quality indicators were considerably improved after ISO implementation with SMR falling to 35% in 2012 (from 58% in 2007, thus being one of the lowest in Greece and below European ICU’s SMR mean value. Over 80% of patients’ relatives answered that Nursing and Medical care was “excellent” and over 10% characterized it as “very good”. Family members’ total satisfaction surpassed 90%. Medical and Nursing care were highly appreciated by family members (very positive attitude expressed by over 90% of participants and satisfaction from nursing services approaches 100%. Conclusion: The implementation of quality systems in healthcare organizations is not easy and has many dimensions. However, it offers competitive advantage, improves the efficiency and effectiveness of the health care service providers and substantially contributes to the improvement of the delivered heath care.

  10. 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

  11. Relationship among health-related quality of life, depression and awareness of home care services in elderly patients.

    Science.gov (United States)

    Polat, Ülkü; Bayrak Kahraman, Burcu; Kaynak, İlknur; Görgülü, Ümit

    2016-11-01

    The present descriptive study was carried out to determine the relationship between health-related quality of life, depression and awareness of home care services among elderly patients. Patients aged 65 years or older staying at the surgery and internal medicine clinics were included in the study. The "Patient Introduction Form," "Short Form-36 Quality of Life Questionnaire" and "Geriatric Depression Scale" were utilized in the collection of data. In the present study, it was determined that only approximately half of elderly patients (54.9%) knew the concept of home care, most of them had not previously received home care and requested home care related to medical care. The mean scores were lower in some areas of the quality of life questionnaire in some factors that could influence home care awareness. These factors were determined as: female sex, history of falling, chronic illness, functionally, moderately or severely dependent, no previous receipt of home care and wishing to receive home care. The home care requirement of elderly patients can be influenced by many physiological, psychological and social factors that can affect their quality of life. Thus, it is of utmost importance that medical professionals evaluate the quality of life of elderly individuals and its influencing factors. Geriatr Gerontol Int 2016; 16: 1211-1219. © 2015 Japan Geriatrics Society.

  12. The impact of health information technology on the quality of medical and health care: a systematic review.

    Science.gov (United States)

    Jamal, Aziz; McKenzie, Kirsten; Clark, Michele

    2009-01-01

    The aim of this study was to systematically review the published evidence of the impact of health information technology (HIT) or health information systems (HIS) on the quality of healthcare, focusing on clinicians's; adherence to evidence-based guidelines and the corresponding impact this had on patient clinical outcomes. The review covered the use of health information technologies and systems in both medical care (i.e. clinical and surgical) and other areas such as allied health and preventive services. Studies were included in the review if they examined the impact of Electronic Health Record (EHR), Computerised Provider Order-Entry (CPOE), or Decision Support System (DS); and if the primary outcomes of the studies were focused on the level of compliance with evidence-based guidelines among clinicians. Measurements considered relevant to the review were either of changes in clinical processes resulting from a change of the providers' behaviour, or of specific patient outcomes that demonstrated the effectiveness of a particular treatment given by providers. Of 23 studies included in the current review, 17 assessed the impact of HIT/HIS on health care practitioners' performance. A positive improvement, in relation to their compliance with evidence-based guidelines, was seen in 14 studies. Studies that included an assessment of patient outcomes, however, showed insufficient evidence of either clinically or statistically important improvements. Although the number of studies reviewed was relatively small, the findings demonstrated consistency with similar previous reviews of this nature in that wide scale use of HIT has been shown to increase clinician's adherence to guidelines.

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

    Directory of Open Access Journals (Sweden)

    Kuburović Nina

    2011-01-01

    Full Text Available Background/Aim. It is necessary to improve the quality of health care for children. Assessment data would provide new insights into better treatment outcomes. The aim of this descriptive study was to estimate and to compare applied quality indicators in five pediatric inpatient tertiary level institutions in Serbia during the period from January 1st to December 31st 2008. Methods. Quality data and indicators were collected in the Institute for Public Health of Serbia “Dr. Milan Jovanović Batut”. Descriptive statistics and chisquare test were used for data analysis. Results. The average length of stay (ALOS in pediatric departments was 7.51 ± 1.30 days (5.88-8.91 days. In the same period, ALOS in pediatric surgery departments was 5.85 ± 1.50 days (3.58-7.57 days. The average number of nurses per occupied bed was 0.76 ± 0.20 and 1.09 ± 0.36 in pediatric and in pediatric surgery departments, respectively. The number of operated patients per surgeon was in the range 51.0-160.5. The annual case fatality rate in pediatric departments was estimated to 0.72% ± 0.20%, whereas in pediatric surgery departments it was 0.34% ± 0.25%. The autopsy rate was estimated to 0.00%-63.16% in pediatric departments, and 37.14%-80.00% in pediatric surgery departments. There was statistically significant difference among the five hospitals regarding the following indicators of quality of work: total annual mortality rate of patients, autopsy rate, number of rate of patients, autopsy rate, number of patients referred to other institutions, both in pediatric and pediatric surgery departments. Conclusion. There is a significant difference among the five hospitals regarding indicators of quality of work. Obligatory set of quality indicators on the basis of legislative acts are the indicators of general quality of work in hospital. It is necessary to establish specific pediatric quality indicators and to define national standards related to these indicators.

  14. Total quality management and the Army health care system.

    Science.gov (United States)

    Jeffer, E K

    1991-10-01

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

  15. Situation analysis: assessing family planning and reproductive health services. Quality of care.

    Science.gov (United States)

    1997-01-01

    This issue of Population Briefs contains articles on researches conducted by the Population Council concerning the delivery of quality of care, contraceptive development, safe abortion, family planning, demography, and medical anthropology. The cover story focuses on a systematic data collection tool called Situation Analysis that helps managers in program evaluation. This tool has a handbook entitled "The Situation Analysis Approach to Assessing Family Planning and Reproductive Health Services" that contains all the information needed to conduct a Situation Analysis study. The second article reports about a new contraceptive method, the two-rod levonorgestrel, which was developed at the Population Council and was recently approved by the US Food and Drug Administration. The third article reports on a medical abortion procedure that was proven to be safe, effective, and acceptable to women in developing countries. Moreover, the fourth article presents initial findings of the Community Health and Family Planning Project conducted in Northern Ghana. The fifth article discusses the paper written by the Population Council demographer, Mark Montgomery entitled "Learning and lags in mortality perceptions". Finally, the sixth article deals with another paper that reports on women's health perceptions and reproductive health in the Middle East.

  16. Informal caregivers of people with an intellectual disability in England: health, quality of life and impact of caring.

    Science.gov (United States)

    Totsika, Vasiliki; Hastings, Richard P; Vagenas, Dimitrios

    2016-09-22

    There is wide variation in reported impact of caring on caregiver well-being, and often a negative appraisal of caregiving. Researchers are beginning to question the robustness of the evidence base on which negative appraisals are based. The present study aimed to draw on data from a population-representative sample to describe the health, quality of life and impact of caring of informal caregivers of people with an intellectual disability. Informal carers of people with intellectual disability (N = 260) were identified among 2199 carers in the English Survey of Carers in Households 2009/10. Generalised estimating equations explored the association between socio-demographic and caring profile with quality of life, physical health status, and impact on psychological health and personal life. Compared to other caregivers, providing care to a person with intellectual disability was not associated with reduced quality of life. There was an 82% increased risk of reporting poorer health status, even though poorer health was not likely to be attributed to care-giving. A higher risk of negative impact on personal life was seen in comparison with the wider group of caregivers, but not in comparison with more similar-sized caregiver groups (mental health or dementia). Carers of people with intellectual disability were more likely to be struggling financially and have a high caring load. These factors were systematically related to lower well-being. A uniformly negative appraisal of caring for people with intellectual disability was not supported by these English population-representative data. Poverty and long care-giving hours may make caregivers more susceptible to negative well-being. Support for caregivers of people with intellectual disability should focus on alleviating those two factors.

  17. Quality of Primary Health Care for children and adolescents living with HIV.

    Science.gov (United States)

    Nascimento, Leticia do; Paula, Cristiane Cardoso de; Magnago, Tania Solange Bosi de Souza; Padoin, Stela Maris de Mello; Harzheim, Erno; Silva, Clarissa Bohrer da

    2016-08-29

    to evaluate the quality of health care for children and adolescents living with HIV, among the different types of Primary Health Care services of Santa Maria, Rio Grande do Sul. cross-sectional study, developed with 118 Primary Health Care professionals. The Primary Care Evaluation Instrument, Professional version, was used. For verification of the variables associated with the high score, Poisson Regression was used. the professionals of the Family Health Strategy, when compared to those of the Primary Health Units, obtained a greater degree of orientation to primary care, both for the overall score and for the derived attributes score, as well as for the integrality and community orientation attributes. A specialization in Primary Health Care, other employment and a statutory work contract were associated with quality of care. the Family Health Strategy was shown to provide higher quality health care for children and adolescents living with HIV, however, the coverage is still low. The need was highlighted to expand this coverage and invest in vocational training directed toward Primary Care and making the professionals effective, through public selection procedure, as well as an improvement program that recognizes the care requirements, in these settings, of children and adolescents infected with HIV. avaliar a qualidade de atenção à saúde da criança e adolescente vivendo com HIV, entre os diferentes tipos de serviço de Atenção Primária à Saúde, de Santa Maria, Rio Grande do Sul. estudo transversal, desenvolvido com 118 profissionais da Atenção Primária à Saúde. Utilizou-se o Instrumento de Avaliação da Atenção Primária, versão Profissionais. Para verificação das variáveis associadas ao alto escore, foi utilizada a Regressão de Poisson. os profissionais da Estratégia Saúde da Família, quando comparados aos de Unidades Básicas de Saúde, obtiveram maior grau de orientação à atenção primária, tanto pelo escore geral quanto

  18. Barriers to accessing quality health care for cancer patients: a survey of members of the association of oncology social work.

    Science.gov (United States)

    Burg, Mary Ann; Zebrack, Brad; Walsh, Katherine; Maramaldi, Peter; Lim, Jung-Won; Smolinski, Kathryn M; Lawson, Kim

    2010-01-01

    The present article reports data from a cross-sectional survey of members of the Association of Oncology Social Work (AOSW) completed in May 2006. The purpose of the survey was to gather information on AOSW members' practice roles, the clients they serve, and their views on barriers cancer patients face in obtaining quality cancer care. The survey instrument was a self-administered 18-page survey disseminated online and by U.S. mail to members who did not provide e-mail addresses. The response rate to the survey was 62.3% (622/999). Reported barriers to quality cancer care are presented here in three categories: health system, social/environmental, and individual-level barriers. The majority of respondents reported health system barriers, specifically inadequate health insurance, as the major barrier to accessing quality health care for cancer patients. Among social/environmental barriers, inability to pay for treatment-related expenses was the major barrier. Among individual-level barriers, patients' fears and distress were the major barriers. The conclusions from this survey point to the critical role of oncology social workers in assisting cancer patients in overcoming the barriers to quality care and achieving optimum quality of life.

  19. Quality of Longer Term Mental Health Facilities in Europe : Validation of the Quality Indicator for Rehabilitative Care against Service Users' Views

    NARCIS (Netherlands)

    Killaspy, Helen; White, Sarah; Wright, Christine; Taylor, Tatiana L.; Turton, Penny; Kallert, Thomas; Schuster, Mirjam; Cervilla, Jorge A.; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Alexiev, Spiridon; Mezzina, Roberto; Ridente, Pina; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitris; Gonidakis, Fragiskos; Caldas-de-Almeida, Jose Miguel; Cardoso, Graca; King, Michael

    2012-01-01

    Background: The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise wit

  20. A national and state profile of leading health problems and health care quality for US children: key insurance disparities and across-state variations.

    Science.gov (United States)

    Bethell, Christina D; Kogan, Michael D; Strickland, Bonnie B; Schor, Edward L; Robertson, Julie; Newacheck, Paul W

    2011-01-01

    Parent/consumer-reported data is valuable and necessary for population-based assessment of many key child health and health care quality measures relevant to both the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 and the Patient Protection and Affordable Care Act of 2010 (ACA). The aim of this study was to evaluate national and state prevalence of health problems and special health care needs in US children; to estimate health care quality related to adequacy and consistency of insurance coverage, access to specialist, mental health and preventive medical and dental care, developmental screening, and whether children meet criteria for having a medical home, including care coordination and family centeredness; and to assess differences in health and health care quality for children by insurance type, special health care needs status, race/ethnicity, and/or state of residence. National and state level estimates were derived from the 2007 National Survey of Children's Health (N = 91,642; children aged 0-17 years). Variations between children with public versus private sector health insurance, special health care needs, specific conditions, race/ethnicity, and across states were evaluated using multivariate logistic regression and/or standardized statistical tests. An estimated 43% of US children (32 million) currently have at least 1 of 20 chronic health conditions assessed, increasing to 54.1% when overweight, obesity, or being at risk for developmental delays are included; 19.2% (14.2 million) have conditions resulting in a special health care need, a 1.6 point increase since 2003. Compared with privately insured children, the prevalence, complexity, and severity of health problems were systematically greater for the 29.1% of all children who are publicly insured children after adjusting for variations in demographic and socioeconomic factors. Forty-five percent of all children in the United States scored positively on a minimal quality

  1. 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.

  2. Quality of documentation of electronic medical information systems at primary health care units in Alexandria, Egypt.

    Science.gov (United States)

    Noureldin, M; Mosallam, R; Hassan, S Z

    2014-03-13

    Limited data are available about the implementation of electronic records systems in primary care in developing countries. The present study aimed to assess the quality of documentation in the electronic medical records at primary health care units in Alexandria, Egypt and to elicit physician's feedback on barriers and facilitators to the system. Data were collected at 7 units selected randomly from each administrative region and in each unit 50 paper-based records and their corresponding e-records were randomly selected for patients who visited the unit in the first 3 months of 2011. Administrative data were almost complete in both paper and e-records, but the completeness of clinical data varied between 60.0% and 100.0% across different units and types of record. The accuracy rate of the main diagnosis in e-records compared with paper-based records ranged between 44.0% and 82.0%. High workload and system complexity were the most frequently mentioned barriers to implementation of the e-records system.

  3. Quality of antenatal and childbirth care in rural health facilities in Burkina Faso, Ghana and Tanzania: an intervention study.

    Science.gov (United States)

    Duysburgh, Els; Temmerman, Marleen; Yé, Maurice; Williams, Afua; Massawe, Siriel; Williams, John; Mpembeni, Rose; Loukanova, Svetla; Haefeli, Walter E; Blank, Antje

    2016-01-01

    To assess the impact of an intervention consisting of a computer-assisted clinical decision support system and performance-based incentives, aiming at improving quality of antenatal and childbirth care. Intervention study in rural primary healthcare (PHC) facilities in Burkina Faso, Ghana and Tanzania. In each country, six intervention and six non-intervention PHC facilities, located in one intervention and one non-intervention rural districts, were selected. Quality was assessed in each facility by health facility surveys, direct observation of antenatal and childbirth care, exit interviews, and reviews of patient records and maternal and child health registers. Findings of pre- and post-intervention and of intervention and non-intervention health facility quality assessments were analysed and assessed for significant (P < 0.05) quality of care differences. Post-intervention quality scores do not show a clear difference to pre-intervention scores and scores at non-intervention facilities. Only a few variables had a statistically significant better post-intervention quality score and when this is the case this is mostly observed in only one study-arm, being pre-/post-intervention or intervention/non-intervention. Post-intervention care shows similar deficiencies in quality of antenatal and childbirth care and in detection, prevention, and management of obstetric complications as at baseline and non-intervention study facilities. Our intervention study did not show a significant improvement in quality of care during the study period. However, the use of new technology seems acceptable and feasible in rural PHC facilities in resource-constrained settings, creating the opportunity to use this technology to improve quality of care. © 2015 John Wiley & Sons Ltd.

  4. 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.

  5. Quality evaluation of health care offered by an Internal Medicine Department.

    Science.gov (United States)

    Bilora, F; Petrobelli, F; Leo, T; Fioretti, M; Boccioletti, V

    2001-03-01

    The aim of this work is to evaluate the quality and patients satisfaction for given services in an Internal Medicine Department during three months. A questionnaire was given to all the patients admitted to our Medicine Department to evaluate our strength and to correct weakness. Our patients assessed doctors and nursing staff for skill and dedication. They gave suggestions about hotel management: bathroom cleaning and number of beds in the same room. They also asked for a pharmacy and a post office inside the hospital. It appears that our ward gives a satisfactory health care situation. Some of our patients suggestions can be put into practice in a short time, while others require longer, depending on public resources and not on private, such as happens, on the contrary, in the United States.

  6. Perceptions of health care providers and patients on quality of care in maternal and neonatal health in fourteen Bangladesh government healthcare facilities: a mixed-method study.

    Science.gov (United States)

    Islam, Farzana; Rahman, Aminur; Halim, Abdul; Eriksson, Charli; Rahman, Fazlur; Dalal, Koustuv

    2015-06-19

    Bangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals. Both qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit interviews were conducted with 112 patients and their attendants from maternity, labor, and neonatal wards before being discharged from the hospitals. Eight physicians and four anthropologists collected data between November and December 2011 using pretested guidelines. The hospital staff identified several key factors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under use of patient-management protocols; a lack of training; and insufficient supervision. Doctors were unable to provide optimal care because of the high volume of patients. The exit interviews revealed that 85 % of respondents were satisfied with the hospital services received. Seven out of 14 respondents were satisfied with the cleanliness of the hospital facilities. More than half of the respondents were satisfied with the drugs they received. In half of the facilities, patients did not get an opportunity to ask the healthcare providers questions about their health

  7. Assessing the Quality and Value of Psychological Health Care in Civilian Health Plans: Lessons and Implications for the Military Health System

    Science.gov (United States)

    2015-01-01

    October 2009, p. 18. Derogatis, L. R., Administration, Scoring, and Procedures Manual 1, Baltimore, Md.: Clinical Psychometric Research, SCL-90-R...Evaluating the Quality of Medical Care,” Milbank Quarterly, Vol. 83, No. 4, December 2005, pp. 691–729. Duffy, F. F., H. Chung, M. Trivedi, D. S. Rae , D...Military Treatment Facility Mental Health Clinical Outcomes Guidance Memorandum, 2013. Ware, J. E., SF 36 Health Survey: Manual and Interpretation Guide

  8. Health Care Service Needs and Correlates of Quality of Life: A Case Study of Elderly Chinese Immigrants in Canada

    Science.gov (United States)

    Chow, Henry P. H.

    2012-01-01

    This study explored the health care service needs and the major correlates of quality of life among 127 community-dwelling elderly Chinese immigrants in a western Canadian city. Participants were interviewed in their homes by trained, bilingual interviewers employing a structured questionnaire that covered a wide range of topics including health…

  9. Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012)

    OpenAIRE

    Sergio Flores-Hernández; Saturno-Hernández, Pedro J.; Hortensia Reyes-Morales; Tonatiuh Barrientos-Gutiérrez; Salvador Villalpando; Mauricio Hernández-Ávila

    2015-01-01

    Background The quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico. Methods We conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of ca...

  10. Customer Quality during Prenatal Care in Health Care Centers in Tabriz City

    Directory of Open Access Journals (Sweden)

    Jafar Sadegh Tabrizi

    2015-07-01

    Full Text Available Background and Objectives :  Customer Quality (CQ refers to customer’s characteristics and is concerned with the knowledge, skills and confidence of health services customers who actively participate with health team in proper decision-making, appropriate activities and changing environment and health related behaviors. The purpose of this study was measuring customer quality of pregnant women during prenatal care. Materials and Methods :  This is a cross- sectional study which was conducted with the participation of 185 pregnant women who received prenatal care from urban health centers in Tabriz city. All participants were selected randomly from 40 health centers. Customer quality was measured based on CQMH-CQ questionnaire.  Questionnaire content validity was reviewed and confirmed by 10 experts and its reliability was confirmed based on Cronbach's alpha index (α = 0.714. Spss v.17 was used for data analysis. Results : According to the results, the mean score of customer quality among pregnant women was (11.29± 67.79   and only %14 of the participants reported the highest customer quality score and ability of continuity of care under stressful situations. There was a positive relationship between customer quality score and visiting midwife and a better evaluation of overall quality of care, but there was inverse relationship with early registration at health centers. Conclusion :  The participation of pregnant women in service delivery process and decision-making can promote costumer quality. Furthermore, training health care providers in empowering patients and using their abilities to improve quality of care and paying attention to patient-centered care will be helpful. ​

  11. Patients′ perception of the quality of malaria treatment in primary health care centers of Jos and Environs

    Directory of Open Access Journals (Sweden)

    N S Jimam

    2015-01-01

    Full Text Available Background: Though the fight against malaria continued to be on the increased, the disease still remains a major public health problem in many developing countries, especially in the rural areas. The extent of drug use and its effect is affected among other things by the pattern in which these drugs are prescribed by the health workers. Patients′ assessment of the quality of care depends on their ability to judge whether health care providers are adhering to the defined standard of care, hence it is necessary to assess the views of patients regarding the quality of care they received from the primary health care (PHC centers. Aim: This study aimed at evaluating consumer′s perception of the quality of malaria treatment in PHC centers of Jos and environs. Materials and Methods: Nine PHC centers were selected by multi-stage random sampling, five from Jos North and four from Jos South Local Government Areas of Plateau State. Patients of both sexes within the age range of 18 years and above who visited the PHC centers for malaria treatment were considered eligible to participate in the survey, provided that they were able to understand and respond to the interview questions. A semi-structured interviewer questionnaire which was adapted from previous health survey studies was administered to all the 249 eligible participants. The data collected were analyzed using the Statistical Package for Social Sciences (SPSS version 20.0 software programmer. Results: The result showed that there were no consistently significant differences (P > 0.05 regarding patient satisfaction between male and female patients across selected items in the various domains, that is, irrespective of respondents′ sex, their perception of the quality of health services rendered by PHCs was similar. Conclusion: It was therefore concluded that there was similar satisfaction level between the male and the female, though some key health services were not readily available in the

  12. Meaning and barriers to quality care service provision in Child and Adolescent Mental Health Services: Qualitative study of stakeholder perspectives.

    Science.gov (United States)

    Svirydzenka, Nadzeya; Ronzoni, Pablo; Dogra, Nisha

    2017-02-20

    Defining quality in health presents many challenges. The Institute of Medicine (IOM) defined quality clinical care as care that is equitable, timely, safe, efficient, effective and patient centred. However, it is not clear how different stakeholders within a child and adolescent mental health service (CAMHS) understand and/or apply this framework. This project aims to identify key stakeholders" understanding of the meaning of quality in the context of CAMHS. The study sample comprised of three groups: (i) patients and carers, (ii) CAMHS clinical staff, and (iii) commissioners (Total N = 24). Semi-structured interviews were used to collect data and thematic analysis was applied to explore participant's views on the meaning and measurement of quality and how these might reflect the IOM indicators and their relevance in CAMHS. An initial barrier to implementing quality care in CAMHS was the difficulty and limited agreement in defining the meaning of quality care, its measurement and implementation for all participants. Clinical staff defined quality as personal values, a set of practical rules, or clinical discharge rates; while patients suggested being more involved in the decision-making process. Commissioners, while supportive of adequate safeguarding and patient satisfaction procedures, did not explicitly link their view on quality to commissioning guidelines. Identifying practical barriers to implementing quality care was easier for all interviewees and common themes included: lack of meaningful measures, recourses, accountability, and training. All interviewees considered the IOM six markers as comprehensive and relevant to CAMHS. No respondent individually or within one stakeholder group identified more than a few of the indicators or barriers of a quality CAMHS service. However, the composite responses of the respondents enable us to develop a more complete picture of how to improve quality care in practice and guide future research in the area.

  13. Disparities in Health Care Quality Indicators among US Children with Special Health Care Needs According to Household Language Use

    Directory of Open Access Journals (Sweden)

    Stella Yu, ScD, MPH, Sue Lin, MS, Bonnie Strickland, PhD

    2015-10-01

    Full Text Available Background: Lower health care utilization and less favorable health outcomes have been demonstrated in children from Non-English Primary Language households (NEPL in previous studies. This study examines prevalence of health care quality indicators among US children with special health care needs (CSHCN and their association with household language use. Methods: We used data from the 2009-2010 National Survey of Children with Special Health Care Needs, restricted to an analytic sample of 40,242 children. Logistic regression models were used to examine the effects of primary household language on the attainment of the 6 health care quality indicators for CSHCN. Results: Compared to CSHCN from English primary language households (EPL, CSHCN from NEPL households had 31% higher odds of not feeling like partners in health care decision-making. They had 67% higher odds of lacking care through a medical home and 42% higher odds of reporting inadequate health insurance. NEPL children had 32% higher odds of not receiving early and continuous screening for special health care needs. NEPL youths had 69% higher odds of not receiving services for transition to adulthood. Minority race/ethnicity, lower income and families other than two biological parents all conferred additional risks to not attaining quality indicators. Publicly insured or uninsured CSHCN were also at higher risk. Conclusions and Global Health Implications: Our study provides compelling evidence that significant disparities exist for CSHCN by primary household language status across all health care quality indicators. Establishment of effective surveillance systems and targeting of outreach programs in both developed and developing countries may lead to improved understanding of health care needs and quality of services and reduction of health disparities for this underserved population.

  14. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne

    2012-01-01

    in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear...... which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved....

  15. Decreased health care quality associated with emergency department overcrowding.

    Science.gov (United States)

    Miró, O; Antonio, M T; Jiménez, S; De Dios, A; Sánchez, M; Borrás, A; Millá, J

    1999-06-01

    The objective of this study was to assess the influence of overcrowding on health care quality provided by emergency departments (ED). The study was carried out in an urban, university tertiary care hospital. All patients seen at the internal medicine unit (IMU) of the ED who returned during the following 72 hours, and those who died in the ED rooms were included in the study. During a consecutive period of 2 years (104 weeks), we prospectively quantified the number of weekly visits, revisits and deaths. We calculated revisit and mortality rates (in respect of percentage of all visited patients) for each week. Correlation between the number of weekly visits, and revisit and mortality rates was assessed using a simple linear regression model. We consigned 81,301 visits, 1137 revisits and 648 deaths; mean (+/- SD) number of weekly visits, revisits and deaths were 782 (68), 10.93 (3.97) and 6.23 (3.04) respectively; weekly revisit rate was 1.40% (0.48%) and weekly mortality rate was 0.79% (0.36%). We observed a significant, positive correlation between mortality rates and weekly number of visits (p = 0.01). Although a similar trend was also found for revisit rates, such an increase did not reach statistical significance (p = 0.06). It is concluded that since revisit and mortality rates constitute good health care quality markers, present data demonstrate that ED overcrowding implies a decrease in the health care quality provided by it.

  16. [Work schedules in the Hungarian health care system and the sleep quality of nurses].

    Science.gov (United States)

    Fusz, Katalin; Pakai, Annamária; Kívés, Zsuzsanna; Szunomár, Szilvia; Regős, Annamária; Oláh, András

    2016-03-06

    One way of ensuring the continuity of health care is the shift work, which is burdensome and it can lead to sleep disturbances. The aim of the study was to measure the typical Hungarian nursing shift systems in hospitals, to analyse the causes of irregular work schedules, and to compare the sleep quality of nurses in different work schedules. 236 head nurses filled out the national online survey, and 217 nurses in clinics of the University of Pécs filled the Hungarian version of Bergen Shift Work Sleep Questionnaire. The head nurses provided data of 8697 nurses's schedules. 51.89% of nurses work in flexible shift system. 1944 employees work in regular shift system, most of them in the following order: 12-hour day shift and 12-hour night shift, followed by a one- or two-day rest. Where there is no system of shifts, the most frequent causes are the needs of nurses and the nurse shortage. Nurses who are working in irregular shift system had worse sleep quality than nurses who are working in flexible and regular shift system (p = 0.044). It would be helpful if the least burdensome shift system could be established.

  17. Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

    OpenAIRE

    Travers Catherine M; Morris John N; Jones Richard N; Wright Olivia; Martin-Khan Melinda; Brand Caroline A; Tropea Joannne; Gray Leonard C

    2011-01-01

    Abstract Background Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to...

  18. Frontline staff motivation levels and health care quality in rural and urban primary health facilities: a baseline study in the Greater Accra and Western regions of Ghana.

    Science.gov (United States)

    Alhassan, Robert Kaba; Nketiah-Amponsah, Edward

    2016-12-01

    The population of Ghana is increasingly becoming urbanized with about 70 % of the estimated 26.9 million people living in urban and peri-urban areas. Nonetheless, eight out of the ten regions in Ghana remain predominantly rural where only 32.1 % of the national health sector workforce works. Doctor-patient ratio in a predominantly rural region is about 1:18,257 compared to 1:4,099 in an urban region. These rural-urban inequities significantly account for the inability of Ghana to attain the health related Millennium Development Goals (MDGs) before the end of 2015. To ascertain whether or not rural-urban differences exist in health worker motivation levels and quality of health care in health facilities accredited by the National Health Insurance Authority in Ghana. This is a baseline quantitative study conducted in 2012 among 324 health workers in 64 accredited clinics located in 9 rural and 7 urban districts in Ghana. Ordered logistic regression was performed to determine the relationship between facility geographic location (rural/urban) and staff motivation levels, and quality health care standards. Quality health care and patient safety standards were averagely low in the sampled health facilities. Even though health workers in rural facilities were more de-motivated by poor availability of resources and drugs than their counterparts in urban facilities (p facilities. For Ghana to attain the newly formulated sustainable development goals on health, there is the need for health authorities to address the existing rural-urban imbalances in health worker motivation and quality health care standards in primary healthcare facilities. Future studies should compare staff motivation levels and quality standards in accredited and non-accredited health facilities since the current study was limited to health facilities accredited by the National Health Insurance Authority.

  19. Improving the quality of cancer care in America through health information technology.

    Science.gov (United States)

    Feeley, Thomas W; Sledge, George W; Levit, Laura; Ganz, Patricia A

    2014-01-01

    A recent report from the Institute of Medicine titled Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, identifies improvement in information technology (IT) as essential to improving the quality of cancer care in America. The report calls for implementation of a learning healthcare IT system: a system that supports patient-clinician interactions by providing patients and clinicians with the information and tools necessary to make well informed medical decisions and to support quality measurement and improvement. While some elements needed for a learning healthcare system are already in place for cancer, they are incompletely implemented, have functional deficiencies, and are not integrated in a way that creates a true learning healthcare system. To achieve the goal of a learning cancer care delivery system, clinicians, professional organizations, government, and the IT industry will have to partner, develop, and incentivize participation.

  20. 78 FR 69418 - Patient Protection and Affordable Care Act; Exchanges and Qualified Health Plans, Quality Rating...

    Science.gov (United States)

    2013-11-19

    ... Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation; Final... state-of-science for measuring health care quality, science and technology do not yet allow us to...

  1. 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.

  2. Nursing home care: exploring the role of religiousness in the mental health, quality of life and stress of formal caregivers.

    Science.gov (United States)

    Lucchetti, G; Lucchetti, A L G; Oliveira, G R; Crispim, D; Pires, S L; Gorzoni, M L; Panicio, C R G; Koenig, H G

    2014-06-01

    Despite the high number of studies on family caregivers, there is little research on the impact of religiosity on formal caregiving (paid providers). We examine the role of religiousness in the mental health, quality of life and stress of nurse aides (NA) who provide care for patients in a nursing home. NA in a Brazilian nursing home were invited to participate. Because of its coping function, we hypothesized that religiousness was related to better mental health and quality of life. Linear regression was used to test this hypothesis and control for confounders. Compared with the Brazilian general population, NA scored higher on measures of religious involvement. Intrinsic religiosity was associated with better mental health and quality of life. Organizational religiosity was associated with better social functioning, better general mental health and fewer anxiety symptoms. Non-organizational religiosity (prayer), however, was associated with negative outcomes, such as higher stress, poorer general health perceptions and more anxiety symptoms. Most NA indicated that they had prayed for and with their patients. In conclusion, paid caregivers (NA) have a strong sense of religiousness, which plays an important role in many ways, including the type of care they provide, their mental health and their quality of life.

  3. Predictors of health-related quality of life in patients at risk for cardiovascular disease in European primary care.

    NARCIS (Netherlands)

    Ludt, S.; Wensing, M.J.P.; Szecsenyi, J.; Lieshout, J. van; Rochon, J.; Freund, T.; Campbell, S.M.; Ose, D.

    2011-01-01

    BACKGROUND: Cardiovascular risk management plays an important role in primary care. In patients at high risk for cardiovascular diseases (CVD) lifestyle and, where appropriate, medical interventions are recommended in guidelines. Health-related quality of life (HRQoL) is an important outcome in clin

  4. Quality and Safety in Health Care, Part IV: Quality and Cancer Care.

    Science.gov (United States)

    Harolds, Jay A

    2015-11-01

    The 1999 Institute of Medicine report Ensuring Quality Cancer Care discussed the difference between the actual cancer care received in the United States and the care that the patients should get, as well as some points to consider in delivering optimum care. In 2012, a follow-up review article in the journal Cancer entitled "Ensuring quality cancer care" indicated that there had been some interval progress, but more are needed to be done. The 2013 Institute of Medicine report Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis indicated that there are continuing major problems with cancer care and that they advocated a national system of quality reporting and a major information technology system to capture and help assess the data.

  5. Improve Quality of Life - additional criteria for health and social care information technology acceptance in an ageing world.

    Science.gov (United States)

    Monteiro, Jorge

    2012-01-01

    Reversing the rising cost of health and social systems is needed in ageing developed and developing countries. A new model of ageing is advocated by the World Health Organization. This new model asks for more personal health accountability and a more integrated approach on care and preventive cure. Information systems and technologies can play an important role in supporting the changes needed in order to have better and more sustainable health and social care systems. Using value and results for patients as criteria by which systems are accepted by users and by organizations can contribute to a value based competition in health and social care systems. The unified theory of acceptance and use of technology is presented, and the pertinence of adding an extension to the theory in order capture Quality of Life improvements expectations is explored.

  6. Defense Health Care: Availability and Quality Measurement of Women’s Health Care Services in U.S. Military Hospitals

    Science.gov (United States)

    2016-06-01

    not selected randomly, they do not constitute a representative sample of all domestic military hospitals, and the information obtained from these...clinical judgement . The MHS, the Military Services and NCR, and Individual Military Hospitals Used Quality Measures to Identify and Implement

  7. 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.

  8. The Effect of Physician Delegation to Other Health Care Providers on the Quality of Care for Geriatric Conditions

    Science.gov (United States)

    Lichtenstein, Brian J.; Reuben, David B.; Karlamangla, Arun S.; Han, Weijuan; Roth, Carol P.; Wenger, Neil S.

    2016-01-01

    OBJECTIVES to examine the effects of delegation on quality of care that patients receive for three common geriatric conditions: dementia, falls, and incontinence. DESIGN pooled analysis of 8 the Assessing Care of Vulnerable Elders (ACOVE) projects from 1998 to 2010. SETTING 15 ambulatory practice sites across the United States PARTICIPANTS 4,776 patients age ≥ 65 years, of mixed demographic backgrounds who participated in ACOVE studies. INTERVENTION multivariate analysis of prior ACOVE observation and intervention studies was conducted, with in addition to two retrospectively defined variables: “intent to delegate” and “maximum delegation” for each ACOVE quality indicator (QI). MEASUREMENTS The primary outcome for the study was QI pass probability, by level of delegation, for 47 ACOVE quality indicators. RESULTS A total of 4,776 patients were evaluated, with 16,204 QIs included for analysis. Across all studies, QI pass probabilities were 0.36 for physician-performed tasks; 0.55 for nurse practitioner (NP), physician assistant (PA), and registered nurse (RN)-performed tasks; and 0.61 for medical assistant (MA), or licensed vocational nurse (LVN)-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, or RNs was 1.37 (p = 0.055) CONCLUSIONS Delegation to non-physician providers is associated with higher quality of care for geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions among older adults. PMID:26480977

  9. Quality of life and its association with cardiovascular risk factors in a community health care program population

    Directory of Open Access Journals (Sweden)

    Luiz Mário Baptista Martinelli

    2008-01-01

    Full Text Available OBJECTIVE: To evaluate quality of life in a population that attended a specific community event on health care education, and to investigate the association of their quality of life with the presence of cardiovascular risk factors INTRODUCTION: Interest in health-related quality of life is growing worldwide as a consequence of increasing rates of chronic disease. However, little is known about the association between quality of life and cardiovascular risk factors. METHODS: This study included 332 individuals. Demographics, blood pressure, body mass index, and casual glycemia were evaluated. The brief version of the World Health Organization Quality of Life questionnaire on quality of life was given to them. The medians of the scores obtained for the physical, psychological, emotional, and environmental domains were used as cutoffs to define "higher" and "lower" scores. A multinomial logistic regression model was used to define the parameters associated with lower scores. RESULTS: Diabetes mellitus, dyslipidemia, and obesity were associated with lower scores in the physical domain. Dyslipidemia was also associeted with lower scores in the psychological domain. Male gender and regular physical activity had protective effects on quality of life. Aging was inversely associated with decreased quality of life in the environmental domain. CONCLUSION: The presence of cardiovascular risk factors is related to a decreased quality of life. Conversely, male gender and regular physical activity had protective effects on quality of life. These findings suggest that exercising should be further promoted by health-related public programs, with a special focus on women.

  10. Individualized care, quality of life and satisfaction with nursing care.

    Science.gov (United States)

    Suhonen, Riitta; Välimäki, Maritta; Leino-Kilpi, Helena

    2005-05-01

    This paper reports a study of the maintenance of individualized care from surgical patients' point of view and examines associations between individualized care, patient satisfaction with nursing care, and health-related quality of life. Rationale. There is preliminary evidence that individualized care is effective from patients' point of view, and is associated with improved patient outcomes, such as patient satisfaction and quality of life. However, individualized care has mainly been studied from the vantage-point of nurses' experiences. In this cross-sectional, descriptive, correlational study the data were collected with surgical adult patients (n = 279, response rate 93%) in surgical wards in Finland using self-administered questionnaires including the Individualized Care Scales, Patient-Satisfaction Scale, and Finnish versions of the Nottingham Health Profile and EuroQol 5D. Associations between individualized care, satisfaction with care and health-related quality of life were examined. Cronbach's alpha values and item analysis were used to evaluate the psychometric properties of the instruments, especially the Individualized Care Scales. The more often patients felt they received support for individuality through specific nursing interventions, the higher the individuality of care received. Secondly, the more individualized patients regarded their care, the higher the level of reported patient satisfaction with nursing care. However, the correlation between individualized care and health-related quality of life was fairly low, albeit statistically significant. Individualized care may produce positive outcomes, such as patient satisfaction. Further research is needed to explore individualized care in relation to health-related quality of life.

  11. Living with diabetes: quality of care and quality of life

    Directory of Open Access Journals (Sweden)

    Pilar Isla Pera

    2011-01-01

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

  12. Effect of Self–Care Educational Program to Improving Quality of Life among Elderly Referred to Health Centers in Zanjan

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    Fatemeh Salimi

    2015-09-01

    Full Text Available Background and Objectives: Since elderlies are susceptible to various impairments due to different physical and mental problems, they need more attention and abiding and efficient self-care program for their health promotion. The present study investigated the effect of self-care training program on quality of life of elderlies. Materials and Methods: This pre- and post-quasi-experimental study was carried out on 160 elderly clients selected from eight health care centers in Zanjan, Iran. The elderlies were selected by randomized sampling and assigned to two groups of experimental (n = 80 and control (n = 80 groups. The experimental group participated in the self-care training program for six sessions of one hour. The study instruments were questionnaires regarding demographic information and short-form health survey (SF-36. Data analysis was performed using SPSS-22 software by independent t-test, Mann-Whitney and chi-squared. Results: The finding showed a significant difference in mean scores of quality of life between the experimental and control groups after the intervention (P < 0.001. Conclusions: Self-care education to elderlies about the practices of proper nutrition, exercise, rest and medication can prevent several problems and help them to improve their quality of lives.

  13. Evaluation of service quality by using fuzzy MCDM: A case study in Iranian health-care centers

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    Leili Afkham

    2012-01-01

    Full Text Available Service quality plays an important role in health care systems since hospitals are responsible for people's lives. This study presents an effective approach for evaluating and comparing service qualities of four hospitals. Service quality consists of different attributes and many of them are intangible and difficult to measure. Therefore, we propose a fuzzy method to resolve the ambiguity of the concepts, which are associated with human judgments. SERVQUAL model is used to evaluate the respondents' judgments of service quality and multi attribute decision making approach is implemented for the comparison among hospitals. The paper use analytical hierarchy process (AHP for obtaining criteria weight and TOPSIS for ranking the cases.

  14. 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

  15. 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

  16. Quality of longer term mental health facilities in Europe: validation of the quality indicator for rehabilitative care against service users' views.

    Directory of Open Access Journals (Sweden)

    Helen Killaspy

    Full Text Available BACKGROUND: The Quality Indicator for Rehabilitative Care (QuIRC is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care. METHOD: At least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit's therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables. RESULTS: 1750/2495 (70% users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users' autonomy and experiences of care. Associations between QuIRC ratings and service users' ratings of their quality of life and the unit's therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning. A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy. CONCLUSIONS: Ratings of the quality of longer term mental health facilities made by service managers were positively associated with service users' autonomy and experiences of care

  17. Quality of Longer Term Mental Health Facilities in Europe: Validation of the Quality Indicator for Rehabilitative Care against Service Users’ Views

    Science.gov (United States)

    Killaspy, Helen; White, Sarah; Wright, Christine; Taylor, Tatiana L.; Turton, Penny; Kallert, Thomas; Schuster, Mirjam; Cervilla, Jorge A.; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Alexiev, Spiridon; Mezzina, Roberto; Ridente, Pina; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitris; Gonidakis, Fragiskos; Caldas-de-Almeida, José Miguel; Cardoso, Graça; King, Michael

    2012-01-01

    Background The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care. Method At least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit’s therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables. Results 1750/2495 (70%) users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users’ autonomy and experiences of care. Associations between QuIRC ratings and service users’ ratings of their quality of life and the unit’s therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning). A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy. Conclusions Ratings of the quality of longer term mental health facilities made by service managers were positively associated with service users’ autonomy and experiences of care

  18. Quality of longer term mental health facilities in Europe: validation of the quality indicator for rehabilitative care against service users' views.

    Science.gov (United States)

    Killaspy, Helen; White, Sarah; Wright, Christine; Taylor, Tatiana L; Turton, Penny; Kallert, Thomas; Schuster, Mirjam; Cervilla, Jorge A; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Alexiev, Spiridon; Mezzina, Roberto; Ridente, Pina; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitris; Gonidakis, Fragiskos; Caldas-de-Almeida, José Miguel; Cardoso, Graça; King, Michael

    2012-01-01

    The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care. At least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit's therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables. 1750/2495 (70%) users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users' autonomy and experiences of care. Associations between QuIRC ratings and service users' ratings of their quality of life and the unit's therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning). A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy. Ratings of the quality of longer term mental health facilities made by service managers were positively associated with service users' autonomy and experiences of care. Interventions that improve quality of care in these

  19. The Future of Health Care in the Kurdistan Region - Iraq: Toward an Effective, High-Quality System with an Emphasis on Primary Care.

    Science.gov (United States)

    Moore, Melinda; Anthony, C Ross; Lim, Yee-Wei; Jones, Spencer S; Overton, Adrian; Yoong, Joanne K

    2014-01-01

    At the request of the Kurdistan Regional Government (KRG), RAND researchers undertook a yearlong analysis of the health care system in the Kurdistan Region of Iraq, with a focus on primary care. RAND staff reviewed available literature on the Kurdistan Region and information relevant to primary care; interviewed a wide range of policy leaders, health practitioners, patients, and government officials to gather information and understand their priorities; collected and studied all available data related to health resources, services, and conditions; and projected future supply and demand for health services in the Kurdistan Region; and laid out the health financing challenges and questions. In this volume, the authors describe the strengths of the health care system in the Kurdistan Region as well as the challenges it faces. The authors suggest that a primary care-oriented health care system could help the KRG address many of these challenges. The authors discuss how such a system might be implemented and financed, and they make recommendations for better utilizing resources to improve the quality, access, effectiveness, and efficiency of primary care.

  20. Helping You Choose Quality Behavioral Health Care

    Science.gov (United States)

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

  1. Evaluating quality of care for patients with type 2 diabetes using electronic health record information in Mexico.

    Science.gov (United States)

    Pérez-Cuevas, Ricardo; Doubova, Svetlana V; Suarez-Ortega, Magdalena; Law, Michael; Pande, Aakanksha H; Escobedo, Jorge; Espinosa-Larrañaga, Francisco; Ross-Degnan, Dennis; Wagner, Anita K

    2012-06-06

    Several low and middle-income countries are implementing electronic health records (EHR). In the near future, EHRs could become an efficient tool to evaluate healthcare performance if appropriate indicators are developed. The aims of this study are: a) to develop quality of care indicators (QCIs) for type 2 diabetes (T2DM) in the Mexican Institute of Social Security (IMSS) health system; b) to determine the feasibility of constructing QCIs using the IMSS EHR data; and c) to evaluate the quality of care (QC) provided to IMSS patients with T2DM. We used a three-stage mixed methods approach: a) development of QCIs following the RAND-UCLA method; b) EHR data extraction and construction of indicators; c) QC evaluation using EHR data from 25,130 T2DM patients who received care in 2009. We developed 18 QCIs, of which 14 were possible to construct using available EHR data. QCIs comprised both process of care and health outcomes. Several flaws in the EHR design and quality of data were identified. The indicators of process and outcomes of care suggested areas for improvement. For example, only 13.0% of patients were referred to an ophthalmologist; 3.9% received nutritional counseling; 63.2% of overweight/obese patients were prescribed metformin, and only 23% had HbA1c IMSS. This information can be used to guide targeted interventions to improve QC.

  2. 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.

  3. Conclusions of the book "eHealth, care and quality of life"

    CERN Document Server

    Capello, Fabio; Manca, Marco

    2014-01-01

    The rising of a new era––mostly based on ICT tools and models––for health has brought new perspectives and new opportunities for the care. The implementation of eHealth models is likely to become the future of medicine, able to give new and more effective tools to the doctors and an active role to the patients. Nonetheless, many are the threats that lie beneath these new approaches. A systematic analysis by some of the experts in this field shows the critical issues that developers, decision-makers, and final users have to know and consider in order to avoid a waste of time, resources, and opportunities.

  4. Can care staff accurately assess health-related quality of life of care home residents? A secondary analysis of data from the OPERA trial.

    Science.gov (United States)

    Parker, Ben; Petrou, Stavros; Underwood, Martin; Madan, Jason

    2017-04-27

    To compare assessments of health-related quality of life outcomes of care home residents reported by residents and care staff acting as proxies. Linear regression and bivariate modelling of paired assessments from care home residents and care staff. 78 care homes in 2 regions in England. 556 care home residents aged 65 years or older and care staff. EQ-5D utility scores and responses to individual EQ-5D dimensions. The depression status, cognitive function, physical function, activities of daily living, social engagement, pain and dementia diagnosis of care home residents all predicted discrepancies in EQ-5D reporting. For residents with no depressive symptoms, care staff underestimated residents' mean EQ-5D utility score by 0.134 (95% CI 0.097 to 0.171) and for those with severe depressive symptoms they overstated mean utility scores by 0.222 (95% CI 0.104 to 0.339). With increasing levels of pain in residents the care staff progressively estimated EQ-5D utilities above self-reported values; by 0.236 (95% CI 0.003 to 0.469) in those with the second highest pain scores. For those with no cognitive impairment, proxies overstated mean utility scores by 0.097 (95% CI 0.049 to 0.146), while for those with severe cognitive impairment they underestimated mean utility scores by 0.192 (95% CI 0.143 to 0.241). Care home residents and staff appear to differ fundamentally in their assessment of the health-related quality of life, as measured by the EQ-5D, of residents with different levels of depression, pain and/or cognitive impairment. This could lead to interventions evaluated using proxy-based quality-adjusted life year estimates being wrongly rejected on cost-effectiveness grounds and may also make it difficult for carers to act as advocates with health and social care professionals for certain groups of residents. A more resident-focussed approach to assessment of health-related quality of life is needed. Published by the BMJ Publishing Group Limited. For permission

  5. [Can Quality of Life Be Measured in a Health Care Setting? History, Constraints and Possibilities].

    Science.gov (United States)

    Gamboa-Bernal, Gilberto A; Echarte-Alonso, Luis E

    2016-01-01

    Quality of life concepts and scales related to health (QLRH) are beginning to be customary in clinical practice and now play an important role in bioethical discussions, particularly concerning the management of terminal patients. This paper looks at how that concept has evolved and how it relates to the health-illness binomial. We illustrate some important complexities the notion of quality of life (QL) has borne since its inception and that make applicability in the health sciences difficult and, most of all, lead to tremendous biases. In our conclusions, we argue it is necessary to improve the concept of QL by including aspects and factors related to well-being. Although not entirely quantifiable, they give coherence and meaning to the patient data health professionals normally work with.

  6. The impact of electronic health records and teamwork on diabetes care quality.

    Science.gov (United States)

    Graetz, Ilana; Huang, Jie; Brand, Richard; Shortell, Stephen M; Rundall, Thomas G; Bellows, Jim; Hsu, John; Jaffe, Marc; Reed, Mary E

    2015-12-01

    Evidence of the impact electronic health records (EHRs) have on clinical outcomes remains mixed. The impact of EHRs likely depends on the organizational context in which they are used. This study focuses on one aspect of the organizational context: cohesion of primary care teams. We examined whether team cohesion among primary care team members changed the association between EHR use and changes in clinical outcomes for patients with diabetes. Retrospective longitudinal study. We combined provider-reported primary care team cohesion with lab values for patients with diabetes collected during the staggered EHR implementation (2005-2009). We used multivariate regression models with patient-level fixed effects to assess whether team cohesion levels changed the association between outpatient EHR use and clinical outcomes for patients with diabetes. Subjects were comprised of 80,611 patients with diabetes, in whom we measured changes in glycated hemoglobin (A1C) and low-density lipoprotein cholesterol (LDL-C). For A1C, EHR use was associated with an average decrease of 0.11% for patients with higher-cohesion primary care teams compared with a decrease of 0.08% for patients with lower-cohesion teams (difference = 0.02% in A1C; 95% CI, 0.01%-0.03%). For LDL-C, EHR use was associated with a decrease of 2.15 mg/dL for patients with higher-cohesion primary care teams compared with a decrease of 1.42 mg/dL for patients with lower-cohesion teams (difference = 0.73 mg/dL; 95% CI, 0.41-1.11 mg/dL). Patients cared for by higher cohesion primary care teams experienced modest but statistically significantly greater EHR-related health outcome improvements, compared with patients cared for by providers practicing in lower cohesion teams.

  7. Does training on performance based financing make a difference in performance and quality of health care delivery? Health care provider's perspective in Rungwe Tanzania.

    Science.gov (United States)

    Manongi, Rachel; Mushi, Declare; Kessy, Joachim; Salome, Saria; Njau, Bernard

    2014-04-04

    the potential of PBF to act as leverage for initiating innovative and proactive actions, which may motivate health personnel performance and quality of care in the study setting with minimal support. However, key policy issues at the national level should be addressed in order to exploit this opportunity.

  8. Quality evaluation in health care services based on customer-provider relationships.

    Science.gov (United States)

    Eiriz, Vasco; Figueiredo, José António

    2005-01-01

    To develop a framework for evaluating the quality of Portuguese health care organisations based on the relationship between customers and providers, to define key variables related to the quality of health care services based on a review of the available literature, and to establish a conceptual framework in order to test the framework and variables empirically. Systematic review of the literature. Health care services quality should not be evaluated exclusively by customers. Given the complexity, ambiguity and heterogeneity of health care services, the authors develop a framework for health care evaluation based on the relationship between customers (patients, their relatives and citizens) and providers (managers, doctors, other technical staff and non-technical staff), and considering four quality items (customer service orientation, financial performance, logistical functionality and level of staff competence). This article identifies important changes in the Portuguese health care industry, such as the ownership of health care providers. At the same time, customers are changing their attitudes towards health care, becoming much more concerned and demanding of health services. These changes are forcing Portuguese private and public health care organisations to develop more marketing-oriented services. This article recognises the importance of quality evaluation of health care services as a means of increasing customer satisfaction and organisational efficiency, and develops a framework for health care evaluation based on the relationship between customers and providers.

  9. The patient as the pivot point for quality in health care delivery.

    Science.gov (United States)

    Lengnick-Hall, C A

    1995-01-01

    Health care enterprises make comprehensive and durable changes in people. This human-centered purpose defines the fundamental nature of quality in health care settings. Traditional perspectives of quality and familiar views of customer satisfaction are inadequate to manage the complex relationships between the health care delivery firm and its patients. Patients play four roles in health care systems that must be reflected when defining and measuring quality in these settings: patient as supplier, patient as product, patient as participant, and patient as recipient. This article presents a conceptual model of quality that incorporates these diverse patient roles. The strategic and managerial implications of the model are also discussed.

  10. The quality of care delivered to Parkinson's disease patients in the U.S. Pacific Northwest Veterans Health System

    Directory of Open Access Journals (Sweden)

    Cheng Eric

    2006-07-01

    Full Text Available Abstract Background Parkinson's disease (PD is the second most common chronic neurological disorder of the elderly. Despite the fact that a comprehensive review of general health care in the United States showed that the quality of care delivered to patients usually falls below professional standards, there is limited data on the quality of care for patients with PD. Methods Using the administrative database, the Pacific Northwest Veterans Health Administration (VHA Data Warehouse, a population of PD patients with encounters from 10/1/98-12/31/04 were identified. A random sample of 350 patient charts underwent further review for diagnostic evaluation. All patients whose records revealed a physician diagnosis of definite or possible Idiopathic Parkinson's (IPD disease (n = 150 were included in a medical chart review to evaluate adherence to five evidence-based quality of care indicators. Results For those care indicators with good inter-rater reliability, 16.6% of care received by PD patients was adherent for annual depression screening, 23.4% of care was adherent for annual fall screening and, 67.3% of care was adherent for management of urinary incontinence. Patients receiving specialty care were more likely to be adherent with fall screening than those not receiving specialty care OR = 2.3, 95%CI = 1.2–4.2, but less likely to be adherent with management of urinary incontinence, OR = 0.3, 95%CI = 0.1–0.8. Patients receiving care outside the VA system were more likely to be adherent with depression screening OR = 2.4, 95%CI = >1.0–5.5 and fall screening OR = 2.2, 95%CI = 1.1–4.4. Conclusion We found very low rates of adherence for annual screening for depression and falls for PD patients but reasonable adherence rates for management of urinary incontinence. Interestingly, receiving concurrent specialty care did not necessarily result in higher adherence for all care indicators suggesting some coordination and role responsibility

  11. 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.

  12. Improving health promotion using quality improvement techniques in Australian Indigenous primary health care

    Directory of Open Access Journals (Sweden)

    Nikki ePercival

    2016-03-01

    Full Text Available While 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 centres. Our study objectives were to: (a describe the scope and quality of health promotion activities; (b describe the status of health centre system support for health promotion activities; and (c introduce a CQI intervention and examine the impact on health promotion activities and health centres systems over two years. Baseline assessments showed sub-optimal health centre 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 centre 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 centre 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 organisational and policy level barriers.

  13. [Professional communication in long term health care quality].

    Science.gov (United States)

    Martín Padilla, E; Sarmiento Medina, P; Ramírez Jaramillo, A

    2014-01-01

    To Identify aspects of professional communication that affect the quality of long-term care for patients with chronic illness or disabilities and their families, in the experience of health professionals, as input for the development of an assessment tool. Descriptive qualitative.The data was processed by performing an interpretative analysis from grounded theory. The participants included 12 health professionals (three doctors, three nurses, three therapists and three psychologists), who work at the Hospital of the Universidad de La Sabana, Chia, and other institutions in Bogota, Colombia,with more than five years experience in programs treating chronic disease or disability in hospital therapeutic contexts. Semi-structured interviews and a Delphi survey were used. Validation strategies included, theoretical sampling, script evaluation by judges, triangulation of data collection techniques, and interviewers. We defined specific aspects of professional communication that could optimize the quality of health care, in information management as well as in the relationships with patients and families. From these aspects, an explanatory matrix was designed with axes, categories, and codes as a support for the construction of tools. Health communication, in order to become a therapeutic support element, requires professional training in communication skills to give information in an understandable way, with emotional support and coping possibilities. It should include and involve the family in decision making. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

  14. A Comparative Study on the Effects of Self-Care Program Education Run by Health Volunteers and Health Care Staff on the Elderly\\'s Quality of Life

    Directory of Open Access Journals (Sweden)

    Fazlollah Ghofranipour

    2016-06-01

    Full Text Available Introduction: The diseases and problems due to ageing can affect the quality of life (QoL in the elderly. The aim of this study was to compare the effects of self-care program education run by health volunteers and healthcare staff on the QoL in the elderly. Methods: In this experimental, field trial study, 150 elderly people living in Mashhad were enrolled by multistage sampling in 2014. The participants were randomly assigned to three groups of 50 individuals in each; group A was educated by healthcare staff at healthcare centers, group B by health volunteers at the elderly's homes, and group C was control. The intervention groups (A and B attended two independent self-care education programs for one month. The data were gathered by the SF-36 questionnaire administered before and one month after the completion of the program. Data analysis was done by descriptive statistics [mean (standard deviation] and analytical statistics (independent samples t-test and Kruskal-Wallis H-test. Results: QoL score of the groups A, B, and C was derived 45.44±23.87, 45.36±23.81, and 45.38±23.83 before the intervention and 48.79±22.09, 63.15±19.03, and 46.08±22.67 after the intervention, respectively. The QoL score of the group B was significantly higher than the other two groups (P<0.05 after the intervention. Besides that, after the intervention, the mean scores of QoL and physical function, role-physical, role-emotional, social function, bodily pain, and general health increased significantly more markedly in the group B compared with the other two groups. Conclusion: Self-care education by the health volunteers was much more effective than that by healthcare staff. In addition, implementing the self-care education program contributed to improving QoL and therefore life satisfaction in the elderly.

  15. The comprehensive care in men’s health: an approach on quality of life

    Directory of Open Access Journals (Sweden)

    Gabriela Romano Oliveira

    2013-08-01

    Full Text Available Objective: To analyze men’s concepts and perceptions about quality of life. Methods: A descriptive and exploratory qualitative study in which we interviewed male dwellers assisted by the Family Health Strategy in a health center in the municipality of Marília, São Paulo state, integrated to the “Programa de Educação pelo Trabalho para a Saúde (PET-Saúde”. The Collective Subject Discourse construction technique was applied guided by the following questions: “What is quality of life?” and “How is your quality of life?” Results: The discourses analyzed showed that most men do not understand the broad sense of the quality of life concept, substantiating it predominantly in its biological dimensions. Conclusion: Men’s health policy is an important strategy for health promotion; however, it requires agility and creativity by primary healthcare staff to deal with men’s uniqueness and vulnerabilities.

  16. Quality of mental health care at a student-run clinic: care for the uninsured exceeds that of publicly and privately insured populations.

    Science.gov (United States)

    Liberman, Kate M; Meah, Yasmin S; Chow, Andrew; Tornheim, Jeffrey; Rolon, Omayra; Thomas, David C

    2011-10-01

    Diagnosing and treating depression in a primary care practice is an important, yet difficult task, especially for safety-net practices serving the uninsured. In the United States healthcare system, there is a mismatch between the need for mental health care and access to services. This disparity is most striking among the uninsured. Mental health disorders are more prevalent among the uninsured, and even when diagnosed with mental illness, they are less likely to obtain necessary treatment than insured patients. Given the increasing burden of depression on society, growing numbers of uninsured and negative repercussions of untreated mental illness, improvements in screening and management protocols are becoming more important in primary care practices serving this population. The quality of depression treatment at commercial and public insurance plans in New York City (NYC) and New York State (NYS) were compared to that of the East Harlem Health Outreach Partnership (EHHOP), the student-run clinic of the Mount Sinai School of Medicine. Based on the comparison, the study made recommendations for an integrated, on-site mental health service program at the community health clinic. A cohort of 49 depressed patients were evaluated and treated at the EHHOP clinic. The quality of the mental health care was evaluated according to variables from the Healthcare Effectiveness Data and Information Set (HEDIS). Indicators of quality included demographics, method of diagnosis, type of pharmacological treatment, referral to specialty care, patient adherence to follow-up care and adherence to pharmacologic treatment. When compared to insured patients in NYS, more EHHOP patients had the appropriate number of physician contacts after being diagnosed with depression than patients with commercial health plans (P = 0.008) and Medicaid (P = 0.09). Similarly, a greater number of EHHOP patients had better acute phase (P = 0.001; P = 0.096) and continuous phase (P = 0.049; P

  17. A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems

    NARCIS (Netherlands)

    Taylor, T.L.; Killaspy, H.; Wright, C.; Turton, P.; White, S.; Kallert, T.W.; Schuster, M.; Cervilla, J.A.; Brangier, P.; Raboch, J.; Kalisova, L.; Onchev, G.; Dimitrov, H.; Mezzina, R.; Wolf, Kinou; Wiersma, D.; Visser, E.; Kiejna, A.; Piotrowski, P.; Ploumpidis, D.; Gonidakis, F.; Caldas-de-Almeida, J.; Cardoso, G.; King, M.B.

    2009-01-01

    Background: A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to

  18. A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems

    NARCIS (Netherlands)

    Taylor, T.L.; Killaspy, H.; Wright, C.; Turton, P.; White, S.; Kallert, T.W.; Schuster, M.; Cervilla, J.A.; Brangier, P.; Raboch, J.; Kalisova, L.; Onchev, G.; Dimitrov, H.; Mezzina, R.; Wolf, Kinou; Wiersma, D.; Visser, E.; Kiejna, A.; Piotrowski, P.; Ploumpidis, D.; Gonidakis, F.; Caldas-de-Almeida, J.; Cardoso, G.; King, M.B.

    2009-01-01

    Background: A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to ident

  19. Association between costs and quality of acute myocardial infarction care hospitals under the Korea National Health Insurance program.

    Science.gov (United States)

    Kang, Hee-Chung; Hong, Jae-Seok

    2017-08-01

    If cost reductions produce a cost-quality trade-off, healthcare policy makers need to be more circumspect about the use of cost-effective initiatives. Additional empirical evidence about the relationship between cost and quality is needed to design a value-based payment system. We examined the association between cost and quality performances for acute myocardial infarction (AMI) care at the hospital level.In 2008, this cross-sectional study examined 69 hospitals with 6599 patients hospitalized under the Korea National Health Insurance (KNHI) program. We separately estimated hospital-specific effects on cost and quality using the fixed effect models adjusting for average patient risk. The analysis examined the association between the estimated hospital effects against the treatment cost and quality. All hospitals were distributed over the 4 cost × quality quadrants rather than concentrated in only the trade-off quadrants (i.e., above-average cost and above-average quality, below-average cost and below-average quality). We found no significant trade-off between cost and quality among hospitals providing AMI care in Korea.Our results further contribute to formulating a rationale for value-based hospital-level incentive programs by supporting the necessity of different approaches depending on the quality location of a hospital in these 4 quadrants.

  20. Strategies for the quality assessment of the health care service providers in the treatment of Gastric Cancer in Colombia.

    Science.gov (United States)

    Villamil, María Del Pilar; Barrera, David; Velasco, Nubia; Bernal, Oscar; Fajardo, Esteban; Urango, Carlos; Buitrago, Sebastian

    2017-09-15

    While, at its inception in 1993, the health care system in Colombia was publicized as a paradigm to be copied across the developing world, numerous problems in its implementation have led to, what is now, an inefficient and crisis-ridden health system. Furthermore, as a result of inappropriate tools to measure the quality of the health service providers, several corruption scandals have arisen in the country. This study attempts to tackle this situation by proposing a strategy for the quality assessment of the health service providers (Entidades Promotoras de Salud, EPS) in the Colombian health system. In particular, as a case study, the quality of the treatment of stomach cancer is analyzed. The study uses two complementary techniques to address the problem. These techniques are applied based on data of the treatment of gastric cancer collected on a nation-wide scale by the Colombian Ministry of Health and Welfare. First, Data Envelopment Analysis (DEA) and the Malmquist Index (MI) are used to establish the most efficient EPS's within the system, according to indicators such as opportunity indicators. Second, sequential clustering algorithm, related to process mining a field of data mining, is used to determine the medical history of all patients and to construct typical care pathways of the patients belonging to efficient and inefficient EPS's. Lastly, efforts are made to identify traits and differences between efficient and inefficient EPS's. Efficient and inefficient EPS were identified for the years 2010 and 2011. Additionally, a Malmquist Index was used to calculate the relative changes in the efficiency of the health providers. Using these efficiency rates, the typical treatment path of patients with gastric cancer was found for two EPSs: one efficient and another inefficient. Finally, the typical traits of the care pathways were established. Combining DEA and process mining proved to be a powerful approach understanding the problem and gaining valuable

  1. Quality of diabetes care and health insurance coverage: a retrospective study in an outpatient academic public hospital in Switzerland.

    Science.gov (United States)

    Jackson, Yves; Lozano Becerra, Juan Carlos; Carpentier, Marc

    2016-10-03

    Socioeconomic disadvantage is associated with an increased risk of adverse diabetes outcomes. In Switzerland, a country with theoretical universal healthcare coverage, people without health insurance face barriers in accessing to and in receiving standard quality care. The Geneva University Hospitals (HUG) have implemented policies aiming at reducing these gaps. We compared quality of diabetes care and ambulatory healthcare services utilization among insured and uninsured diabetic patients. This retrospective study linked health and administrative data of type 2 diabetic outpatients with at least one HbA1c test performed in 2012-2013 at HUG. Quality of care evaluation relied on processes (annual serum HbA1c, cholesterol and microalbuminuria tesing) and outcomes (HbA1c) assessment. Healthcare utilization was assessed by the number of ambulatory clinical and laboratory visits. Results were stratified by disease course (newly diagnosed versus prevalent diabetes). Of the 198 patients included, 80 (40.4 %) were uninsured. Both groups underwent annual testing of HbA1c, cholesterol, kidney function and microalbuminuria at comparably high rates and numbers of ambulatory visits did not significantly differ. After adjustments for age and sex, there were no significant differences in serum HbA1c between groups both in those with prevalent or with newly diagnosed diabetes. Initial medical intervention entailed comparable glycaemic improvement after 6 months in incident diabetes among insured and uninsured patients. This study did not find any difference in quality of diabetes care between insured and uninsured patients in a public hospital enforcing health-equity policies for access to and for delivery of standard diabetes care. It highlights the frontline role of public hospitals in contributing to care delivery equity even in countries with theoretical universal healthcare coverage.

  2. Service quality assessment of workers compensation health care delivery programs in New York using SERVQUAL.

    Science.gov (United States)

    Arunasalam, Mark; Paulson, Albert; Wallace, William

    2003-01-01

    Preferred provider organizations (PPOs) provide healthcare services to an expanding proportion of the U.S. population. This paper presents a programmatic assessment of service quality in the workers' compensation environment using two different models: the PPO program model and the fee-for-service (FFS) payor model. The methodology used here will augment currently available research in workers' compensation, which has been lacking in measuring service quality determinants and assessing programmatic success/failure of managed care type programs. Results indicated that the SERVQUAL tool provided a reliable and valid clinical quality assessment tool that ascertained that PPO marketers should focus on promoting physician outreach (to show empathy) and accessibility (to show reliability) for injured workers.

  3. Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

    Directory of Open Access Journals (Sweden)

    Travers Catherine M

    2011-10-01

    Full Text Available Abstract Background Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings. A barrier to using quality indicators is lack of access to routinely collected clinical data. The interRAI Acute Care (AC assessment system supports comprehensive geriatric assessment of older people within routine daily practice in hospital and includes process and outcome data pertaining to geriatric syndromes. This paper reports the study protocol for the development of aged care quality indicators for acute care hospitals. Methods/Design The study will be conducted in three phases: 1. Development of a preliminary inclusive set of quality indicators set based on a literature review and expert panel consultation, 2. A prospective field study including recruitment of 480 patients aged 70 years or older across 9 Australian hospitals. Each patient will be assessed on admission and discharge using the interRAI AC, and will undergo daily monitoring to observe outcomes. Medical records will be independently audited, and 3. Analysis and compilation of a definitive quality indicator set, including two anonymous voting rounds for quality indicator inclusion by the expert panel. Discussion The approach to quality indicators proposed in this protocol has four distinct advantages over previous efforts: the quality indicators focus on outcomes; they can be collected as part of a routinely applied clinical information and decision support system; the clinical data will be robust and will

  4. Health-related quality of life and health care use in cancer survivors compared with patients with chronic diseases.

    NARCIS (Netherlands)

    Heins, M.J.; Korevaar, J.C.; Hopman, E.P.C.; Donker, G.A.; Schellevis, F.G.; Rijken, P.M.

    2016-01-01

    BACKGROUND: The number of cancer survivors is steadily increasing and these patients often experience long-lasting health problems. To make care for cancer survivors sustainable for the future, it would be relevant to put the effects of cancer in this phase into perspective. Therefore, the authors c

  5. Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies.

    Directory of Open Access Journals (Sweden)

    Sima Berendes

    2011-04-01

    Full Text Available BACKGROUND: In developing countries, the private sector provides a substantial proportion of primary health care to low income groups for communicable and non-communicable diseases. These providers are therefore central to improving health outcomes. We need to know how their services compare to those of the public sector to inform policy options. METHODS AND FINDINGS: We summarised reliable research comparing the quality of formal private versus public ambulatory health care in low and middle income countries. We selected studies against inclusion criteria following a comprehensive search, yielding 80 studies. We compared quality under standard categories, converted values to a linear 100% scale, calculated differences between providers within studies, and summarised median values of the differences across studies. As the results for for-profit and not-for-profit providers were similar, we combined them. Overall, median values indicated that many services, irrespective of whether public or private, scored low on infrastructure, clinical competence, and practice. Overall, the private sector performed better in relation to drug supply, responsiveness, and effort. No difference between provider groups was detected for patient satisfaction or competence. Synthesis of qualitative components indicates the private sector is more client centred. CONCLUSIONS: Although data are limited, quality in both provider groups seems poor, with the private sector performing better in drug availability and aspects of delivery of care, including responsiveness and effort, and possibly being more client orientated. Strategies seeking to influence quality in both groups are needed to improve care delivery and outcomes for the poor, including managing the increasing burden of non-communicable diseases.

  6. Applicability of the 5S management method for quality improvement in health-care facilities: a review.

    Science.gov (United States)

    Kanamori, Shogo; Shibanuma, Akira; Jimba, Masamine

    2016-01-01

    The 5S management method (where 5S stands for sort, set in order, shine, standardize, and sustain) was originally implemented by manufacturing enterprises in Japan. It was then introduced to the manufacturing sector in the West and eventually applied to the health sector for organizing and standardizing the workplace. 5S has recently received attention as a potential solution for improving government health-care services in low- and middle-income countries. We conducted a narrative literature review to explore its applicability to health-care facilities globally, with a focus on three aspects: (a) the context of its application, (b) its impacts, and (c) its adoption as part of government initiatives. To identify relevant research articles, we researched public health databases in English, including CINAHL, PubMed, ScienceDirect, and Web of Science. We found 15 of the 114 articles obtained from the search results to be relevant for full-text analysis of the context and impacts of the 5S application. To identify additional information particularly on its adoption as part of government initiatives, we also examined other types of resources including reference books, reports, didactic materials, government documents, and websites. The 15 empirical studies highlighted its application in primary health-care facilities and a wide range of hospital areas in Brazil, India, Jordan, Senegal, Sri Lanka, Tanzania, the UK, and the USA. The review also found that 5S was considered to be the starting point for health-care quality improvement. Ten studies presented its impacts on quality improvements; the changes resulting from the 5S application were classified into the three dimensions of safety, efficiency, and patient-centeredness. Furthermore, 5S was adopted as part of government quality improvement strategies in India, Senegal, Sri Lanka, and Tanzania. 5S could be applied to health-care facilities regardless of locations. It could be not only a tool for health workers and

  7. Metasynthesis: Experiences of Women with Severe Maternal Morbidity and Their Perception of the Quality of Health Care.

    Directory of Open Access Journals (Sweden)

    Mohd Noor Norhayati

    Full Text Available To explore the experiences of women with severe maternal morbidity and their perception of the quality of health care.The exploration of factors associated with severe maternal morbidity has emerged as an alternative strategy in reducing maternal mortality. This approach is useful for the evaluation and improvement of maternal health services.Included a comprehensive search, appraisal of reports of qualitative studies, the classification of studies and the synthesis of findings.A literature search was conducted through nine databases for articles published between January 1980 and August 2013.The quality of included studies was assessed with a modified Critical Appraisal Skills Program tool. The synthesis applied a meta-ethnographic approach. It involved (1 identifying and comparing the findings; (2 creating a parsimonious thematic structure and (3 searching for disconfirming data.Nine studies published between 2005 and 2012, involving 292 women with severe maternal morbidity, were included. Three key themes were identified: 'provision of care', 'severe maternal morbidity' and 'health care seeking behavior'. Barriers to the access and utilization of heath care services were identified.The findings appear to suggest that mental and physical health outcomes of women who experienced severe maternal morbidity were poor. There is a need to identify the persistence and severity of these outcomes over a longer period of time. More realistic and less biased information may be obtained in community-based interviews. The impact of potential negative fetal outcomes would be a strong influencing factor for the women. These findings may help to increase awareness of the non-physical components of severe maternal morbidity and provide guidance for professionals regarding preventive measures.

  8. Reporting and use of the OECD Health Care Quality Indicators at national and regional level in 15 countries.

    Science.gov (United States)

    Rotar, Alexandru M; van den Berg, Michael J; Kringos, Dionne S; Klazinga, Niek S

    2016-06-01

    OECD member states are involved since 2003 in a project coordinated by the OECD on Health Care Quality Indicators (HCQI). All OECD countries are biennially requested by the OECD to deliver national data on the quality indicators for international benchmarking purposes. Currently, there is no knowledge whether the OECD HCQI information is used by the countries themselves for healthcare system accountability and improvement purposes. The objective of the study is to explore the reporting and use of OECD HCQI in OECD member-states. Data were collected through a questionnaire sent to all OECD member-states containing factual questions on the reporting on all OECD HCQ-indicators. Responses were received between June and December 2014. In this timeframe, two reminders were sent to the participants. The work progress was presented during HCQI Meetings in November 2014 and May 2015. Fifteen countries reported to have a total of 163 reports in which one or more HCQIs were reported. One hundred and sixteen were national and 47 were regional reports. Forty-nine reports had a general system focus, 80 were disease specific, 10 referred to a specific type of care setting, 22 were thematic and 2 were a combination of two (disease specific for a particular type of care and thematic for a specific type of care). Most reports were from Canada: 49. All 15 countries use one or more OECD indicators. The OECD quality indicators have acquired a clear place in national and regional monitoring activities. Some indicators are reported more often than others. These differences partly reflect differences between healthcare systems. Whereas some indicators have become very common, such as cancer care indicators, others, such as mental healthcare and patient experience indicators are relatively new and require some more time to be adopted more widely. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights

  9. Peer pressure and public reporting within healthcare setting: improving accountability and health care quality in hospitals.

    Science.gov (United States)

    Specchia, Maria Lucia; Veneziano, Maria Assunta; Cadeddu, Chiara; Ferriero, Anna Maria; Capizzi, Silvio; Ricciardi, Walter

    2012-01-01

    In the last few years, the need of public reporting of health outcomes has acquired a great importance. The public release of performance results could be a tool for improving health care quality and many attempts have been made in order to introduce public reporting programs within the health care context at different levels. It would be necessary to promote the introduction of a standardized set of outcome and performance measures in order to improve quality of health care services and to make health care providers aware of the importance of transparency and accountability.

  10. Health-related quality of life of patients 12 months following surgical intensive care discharge

    Directory of Open Access Journals (Sweden)

    F. Karachi

    2011-02-01

    Full Text Available Health  related  quality  of  life  (HRQoL  and  the  effect  of  selected  socio-demographic  and  clinical  intensive  care  variables  on  HRQoL of  patients  12  months  following  adult  surgical  intensive  care  unit  discharge in  the  Western  Cape  was  evaluated.  A  prospective  observational  study  was conducted.  The  sample  comprised  46  patients  who  had  survived  12  months following discharge. Structured telephonic interviews were conducted using a self-developed  and  SF-36v2  HRQoL  questionnaire.  Data  was  analyzed  using Stastica 7 and values were accepted as significant at the 5% level. Low mean HRQoL  domain  scores  (43%  -  53%  were  found  implying  a  poor  HRQoL outcome. Physical functioning [43.5%], Role Play [44.5%] and Role Emotion [43.1%] scores were specifically lower than the other HRQoL domain scores. Age and severity of illness scores (APACHE II were significantly associated with the social functioning (p=0.01 and physical functioning (p=0.02 scores  respectively. APACHE  II  may  be  a  useful  contributor  in  predicting  long-term  physical  functioning  outcomes  in  patients  following  surgical  ICU  discharge.  The  HRQoL  outcomes  are  slightly  lower  than  that  found  for  inter-national ICU populations however responses in the domains affected are comparable. Low physical functioning, role play  and  role  emotion  scores  indicate  a  need  for  further  physical  and  emotional  rehabilitation  following  surgical  ICU discharge.

  11. 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.

  12. An Approach Based on TRIZ Methodology and SERVQUAL Scale to Improve the Quality of Health-Care Service: A Case Study

    OpenAIRE

    2012-01-01

    A new innovative approach based on theory of inventive problem solving (TRIZ) and the quality service measurement scale (SERVQUAL) is proposed to improve the quality of health-care service. TRIZ is used at a wide range of area in industrialized countries to solve problems, while SERVQUAL is used very extensively to measure quality of service sector (especially in health-care service) by many researchers. Su et al. (2008) proposed a systematic framework based on TRIZ to solve the service quali...

  13. Access and Quality of HIV-Related Point-of-Care Diagnostic Testing in Global Health Programs.

    Science.gov (United States)

    Fonjungo, Peter N; Boeras, Debrah I; Zeh, Clement; Alexander, Heather; Parekh, Bharat S; Nkengasong, John N

    2016-02-01

    Access to point-of-care testing (POCT) improves patient care, especially in resource-limited settings where laboratory infrastructure is poor and the bulk of the population lives in rural settings. However, because of challenges in rolling out the technology and weak quality assurance measures, the promise of human immunodeficiency virus (HIV)-related POCT in resource-limited settings has not been fully exploited to improve patient care and impact public health. Because of these challenges, the Joint United Nations Programme on HIV/AIDS (UNAIDS), in partnership with other organizations, recently launched the Diagnostics Access Initiative. Expanding HIV programs, including the "test and treat" strategies and the newly established UNAIDS 90-90-90 targets, will require increased access to reliable and accurate POCT results. In this review, we examine various components that could improve access and uptake of quality-assured POC tests to ensure coverage and public health impact. These components include evaluation, policy, regulation, and innovative approaches to strengthen the quality of POCT. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  14. Improving children's obesity-related health care quality: process outcomes of a cluster-randomized controlled trial.

    Science.gov (United States)

    Taveras, Elsie M; Marshall, Richard; Horan, Christine M; Gillman, Matthew W; Hacker, Karen; Kleinman, Ken P; Koziol, Renata; Price, Sarah; Rifas-Shiman, Sheryl L; Simon, Steven R

    2014-01-01

    To examine the extent to which an intervention using electronic decision support delivered to pediatricians at the point-of-care of obese children, with or without direct-to-parent outreach, improved health care quality measures for child obesity. Process outcomes from a three-arm, cluster-randomized trial from 14 pediatric practices in Massachusetts were reported. Participants were 549 children aged 6-12 years with body mass index (BMI) ≥ 95th percentile. In five practices (Intervention-1), pediatricians receive electronic decision support at the point-of-care. In five other practices (Intervention-2), pediatricians receive point-of-care decision support and parents receive information about their child's prior BMI before their scheduled visit. Four practices receive usual care. The main outcomes were Healthcare Effectiveness Data and Information Set (HEDIS) performance measures for child obesity: documentation of BMI percentile and use of counseling codes for nutrition or physical activity. Compared to the usual care condition, participants in Intervention-2, but not Intervention-1, had substantially higher odds of use of HEDIS codes for BMI percentile documentation (adjusted OR: 3.97; 95% CI: 1.92, 8.23) and higher prevalence of use of HEDIS codes for counseling for nutrition or physical activity (adjusted predicted prevalence 20.3% [95% CI 8.5, 41.2] for Intervention -2 vs. 0.0% [0.0, 2.0] for usual care). An intervention that included both decision support for clinicians and outreach to parents resulted in improved health care quality measures for child obesity. © 2013 The Obesity Society.

  15. The impact of perceived social support and sense of coherence on health-related quality of life in multimorbid primary care patients

    NARCIS (Netherlands)

    Vogel, I.; Miksch, A.; Goetz, K.; Ose, D.; Szecsenyi, J.; Freund, T.

    2012-01-01

    This study explores the impact of perceived social support and sense of coherence as positive resources for health-related quality of life in multimorbid primary care patients. We analysed cross-sectional survey data on health-related quality of life (EQ-5D), perceived social support (FSozU-K22),

  16. Integration of HIV care into maternal health services: a crucial change required in improving quality of obstetric care in countries with high HIV prevalence.

    Science.gov (United States)

    Madzimbamuto, Farai D; Ray, Sunanda; Mogobe, Keitshokile D

    2013-06-10

    The failure to reduce preventable maternal deaths represents a violation of women's right to life, health, non-discrimination and equality. Maternal deaths result from weaknesses in health systems: inadequate financing of services, poor information systems, inefficient logistics management and most important, the lack of investment in the most valuable resource, the human resource of health workers. Inadequate senior leadership, poor communication and low staff morale are cited repeatedly in explaining low quality of healthcare. Vertical programmes undermine other service areas by creating competition for scarce skilled staff, separate reporting systems and duplication of training and tasks. Confidential enquiries and other quality-improvement activities have identified underlying causes of maternal deaths, but depend on the health system to respond with remedies. Instead of separate vertical programmes for management of HIV, tuberculosis, and reproductive health, integration of care and joint management of pregnancy and HIV would be more effective. Addressing health system failures that lead to each woman's death would have a wider impact on improving the quality of care provided in the health service as a whole. More could be achieved if existing resources were used more effectively. The challenge for African countries is how to get into practice interventions known from research to be effective in improving quality of care. Advocacy and commitment to saving women's lives are crucial elements for campaigns to influence governments and policy -makers to act on the findings of these enquiries. Health professional training curricula should be updated to include perspectives on patients' rights, communication skills, and integrated approaches, while using adult learning methods and problem-solving techniques. In countries with high rates of Human Immunodeficiency Virus (HIV), indirect causes of maternal deaths from HIV-associated infections now exceed direct causes

  17. Comparative health care information: consumer quality index (CQI) information on differences between providers.

    NARCIS (Netherlands)

    Damman, O.C.; Stubbe, J.H.; Triemstra, A.H.M.; Spreeuwenberg, P.; Delnoij, D.M.J.

    2007-01-01

    Background: Public reporting on health care performances has become an important quality-improvement instrument. In the Netherlands, consumer quality index (CQI) questionnaires are currently being used to assess patients’ experiences with various domains of the health care system. An important quest

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

    Directory of Open Access Journals (Sweden)

    AM Mosadegh Rad

    2005-10-01

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

  19. Pros and cons of vitamin D measurements: essential component of quality health care

    Directory of Open Access Journals (Sweden)

    Meena K. Yadav

    2016-04-01

    Full Text Available Accuracy in vitamin D measurement is very important because methods used by various laboratories have no uniformities; of course it is choice of individuals but quality in care matters. There are five different types of Vitamin D but D2 and D3 are the only types that human can use. Earlier researchers have documented that vitamin D3 is better absorbed and utilized than D2. Studies have showed that vitamin D promoting normal blood glycation, immunity, mood swing and other unusual clinical conditions. It is observed from many reports that the effectiveness of D3 provides the most benefit for the human body but there is quite variations in predictive values of different methods. [Int J Res Med Sci 2016; 4(4.000: 1307-1308

  20. 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.

  1. Strengthening of primary health care: Key to deliver inclusive health care

    Directory of Open Access Journals (Sweden)

    Rajiv Yeravdekar

    2013-01-01

    Full Text Available Inequity and poverty are the root causes of ill health. Access to quality health services on an affordable and equitable basis in many parts of the country remains an unfulfilled aspiration. Disparity in health care is interpreted as compromise in ′Right to Life.′ It is imperative to define ′essential health care,′ which should be made available to all citizens to facilitate inclusivity in health care. The suggested methods for this include optimal utilization of public resources and increasing public spending on health care. Capacity building through training, especially training of paramedical personnel, is proposed as an essential ingredient, to reduce cost, especially in tertiary care. Another aspect which is considered very important is improvement in delivery system of health care. Increasing the role of ′family physician′ in health care delivery system will improve preventive care and reduce cost of tertiary care. These observations underlie the relevance and role of Primary health care as a key to deliver inclusive health care. The advantages of a primary health care model for health service delivery are greater access to needed services; better quality of care; a greater focus on prevention; early management of health problems; and cumulative improvements in health and lower morbidity as a result of primary health care delivery.

  2. 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.

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

    Directory of Open Access Journals (Sweden)

    Mark Tomlinson

    2013-02-01

    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.

  4. A Structural Equation Model Linking Health Literacy to Self-efficacy, Self-care Activities, and Health-related Quality of Life in Patients with Type 2 Diabetes.

    Science.gov (United States)

    Lee, Eun-Hyun; Lee, Young Whee; Moon, Seung Hei

    2016-03-01

    Health literacy has been attracting increasing attention because low health literacy is considered an important predictor of adverse health outcomes in many chronic conditions, including diabetes. However, it is unclear how health literacy is associated with health outcomes. The purpose of this study was to formulate a hypothetical structural equation model linking health literacy to self-efficacy, self-care activities, and health-related quality of life (HRQOL) in patients with type 2 diabetes. A cross-sectional survey design was employed, and 459 patients with type 2 diabetes were recruited from outpatient clinics in two university hospitals. The patients completed a pack of questionnaires. The hypothetical model was tested using structural equation modeling analysis. The values of multiple fit indices indicated that the proposed model provided a good fit to the data. Health literacy exerted not only a direct effect on self-care activities, but also an indirect effect on self-care activities via self-efficacy. However, health literacy exerted only an indirect effect on HRQOL. This structural model was invariant across hemoglobin-A1c-controlled and hemoglobin-A1c-uncontrolled groups. Based on R(2) values, the final model accounted for 20.0% of the variance in self-efficacy, 61.0% of the variance in self-care activities, and 16.0% of the variance in HRQOL. This study suggests that self-care activities are crucial to the link between health literacy and HRQOL. Both health literacy and self-efficacy need to be considered in clinical practice for enhancing self-care activities in patients with type 2 diabetes. This approach may ultimately improve HRQOL in these patients. Copyright © 2016. Published by Elsevier B.V.

  5. 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.

  6. Health-Related Quality of Life of Latin-American Immigrants and Spanish-Born Attended in Spanish Primary Health Care: Socio-Demographic and Psychosocial Factors

    Science.gov (United States)

    Salinero-Fort, Miguel Ángel; Gómez-Campelo, Paloma; Bragado-Alvárez, Carmen; Abánades-Herranz, Juan Carlos; Jiménez-García, Rodrigo; de Burgos-Lunar, Carmen

    2015-01-01

    Background This study compares the health-related quality of life of Spanish-born and Latin American-born individuals settled in Spain. Socio-demographic and psychosocial factors associated with health-related quality of life are analyzed. Methods A cross-sectional Primary Health Care multi center-based study of Latin American-born (n = 691) and Spanish-born (n = 903) outpatients from 15 Primary Health Care Centers (Madrid, Spain). The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) was used to assess health-related quality of life. Socio-demographic, psychosocial, and specific migration data were also collected. Results Compared to Spanish-born participants, Latin American-born participants reported higher health-related quality of life in the physical functioning and vitality dimensions. Across the entire sample, Latin American-born participants, younger participants, men and those with high social support reported significantly higher levels of physical health. Men with higher social support and a higher income reported significantly higher mental health. When stratified by gender, data show that for men physical health was only positively associated with younger age. For women, in addition to age, social support and marital status were significantly related. Both men and women with higher social support and income had significantly better mental health. Finally, for immigrants, the physical and mental health components of health-related quality of life were not found to be significantly associated with any of the pre-migration factors or conditions of migration. Only the variable “exposure to political violence” was significantly associated with the mental health component (p = 0.014). Conclusions The key factors to understanding HRQoL among Latin American-born immigrants settled in Spain are age, sex and social support. Therefore, strategies to maintain optimal health outcomes in these immigrant communities should include public policies on

  7. Impact of Prosthetic Care on Oral Health Related Quality of Life - A Follow-Up Study

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    S Geetha

    2013-01-01

    Full Text Available Objective: To measure the impact of the type of prosthetic treatment on oral health related quality of life (OHR QoL using 0ral Health impact Profile-14(0HIP-14. Materials & Method: A follow-up study was conducted amongst 105 patients attending the Department of Prosthodontics of M.R Ambedkar Dental College & Hospital, Bangalore for replacement of missing teeth. Initially, they were interviewed by a single calibrated interviewer to collect demographic details and subsequently, OHIP-14 questionnaire was used to assess their pre- prosthetic and one month post-prosthetic quality of life. Information regarding dentate status and type of prostheses was collected from their case records and based on this information the patients were divided into 3 groups i.e., Complete Denture (CD group, Removable Partial Denture (RPD group and Fixed Partial Denture (FPD group. Analysis of Variance (ANOVA test was used to compare between groups using SPSS version 20. Results: This study revealed that there was improved taste sensation (0.82±0.76, less irritability with others (1.61±0.49, more comfortable to eat (1.42±0.70, less self-conscious (1.48±0.61, had a satisfactory diet (1.58±0.61 and less embarrassment (1.36±0.5 among the CD group as compared RPD and FPD groups. Conclusions: The results indicated that the type of prostheses placed had a major influence on improving OHR QoL among denture users.

  8. The Eye of the Beholder: A Discussion of Value and Quality From the Perspective of Families of Children and Youth With Special Health Care Needs.

    Science.gov (United States)

    Anderson, Betsy; Beckett, Julie; Wells, Nora; Comeau, Meg

    2017-05-01

    There is broad agreement that increasing the cost-effectiveness and quality of health care services, thereby achieving greater value, is imperative given this country's current spiraling costs and poor health outcomes. However, how individuals or stakeholder groups define value may differ significantly. Discussion of value in the context of health care, in particular value-based purchasing and value-based insurance design, must acknowledge that there is no universal consensus definition as to what constitutes value. To date, the consumer perspective has been underrepresented in discussions of value-based strategies such as pay for performance, capitated and bundled payments, and high-deductible health plans, which have been driven primarily by payers and providers. This article will discuss 3 elements of value from the perspective of families of children and youth with special health care needs: the role of families in the delivery of care, consumer perspectives on what constitutes quality for children and youth with special health care needs, and health care and health care financing literacy, decision-making, and costs. The undervalued contributions made by family members in the delivery and oversight of pediatric care and the importance of partnering with them to achieve the goals of the Triple Aim are stressed. The article closes with a discussion of recommendations for a future policy and research agenda related to advancing the integration of the consumer perspective into value-based purchasing and value-based insurance design. Copyright © 2017 by the American Academy of Pediatrics.

  9. Evaluating the Impact of Parent-Reported Medical Home Status on Children's Health Care Utilization, Expenditures, and Quality: A Difference-in-Differences Analysis with Causal Inference Methods.

    Science.gov (United States)

    Han, Bing; Yu, Hao; Friedberg, Mark W

    2017-04-01

    To evaluate the effects of the parent-reported medical home status on health care utilization, expenditures, and quality for children. Medical Expenditure Panel Survey (MEPS) during 2004-2012, including a total of 9,153 children who were followed up for 2 years in the survey. We took a causal difference-in-differences approach using inverse probability weighting and doubly robust estimators to study how changes in medical home status over a 2-year period affected children's health care outcomes. Our analysis adjusted for children's sociodemographic, health, and insurance statuses. We conducted sensitivity analyses using alternative statistical methods, different approaches to outliers and missing data, and accounting for possible common-method biases. Compared with children whose parents reported having medical homes in both years 1 and 2, those who had medical homes in year 1 but lost them in year 2 had significantly lower parent-reported ratings of health care quality and higher utilization of emergency care. Compared with children whose parents reported having no medical homes in both years, those who did not have medical homes in year 1 but gained them in year 2 had significantly higher ratings of health care quality, but no significant differences in health care expenditures and utilization. Having a medical home may help improve health care quality for children; losing a medical home may lead to higher utilization of emergency care. © Health Research and Educational Trust.

  10. Quality of health care in inflammatory bowel disease: developement of a reliable questionnaire (QUOTE-IBD) and first results.

    NARCIS (Netherlands)

    Eijk, I. van der; Sixma, H.; Smeets, T.; Veloso, F.T.; Odes, S.; Montague, S.; Fornaciari, G.; Moum, B.; Stockbrugger, R.; Russel, M.

    2001-01-01

    OBJECTIVES: As inflammatory bowel disease is a chronic disorder, usually with an early onset in life, quality of care plays an important role for patients. The aim of this study was to develop a questionnaire to measure quality of care through the eyes of patients with inflammatory bowel disease. ME

  11. Expectations of health care quality among rural Maya villagers in Sololá Department, Guatemala: a qualitative analysis.

    Science.gov (United States)

    Ippolito, Matthew; Chary, Anita; Daniel, Michael; Barnoya, Joaquin; Monroe, Anne; Eakin, Michelle

    2017-03-14

    Indigenous populations in Latin America have worse health outcomes than their nonindigenous counterparts. Differences in access to and use of biomedical resources may explain some of the observed disparities. Efforts to address these differences could be aided in part by better understanding the socio-medical contexts in which they occur. We performed a qualitative analysis of field notes collected during a 2008 program evaluation of a health post in a rural Maya village in Sololá Department, Guatemala. Forty-one interviews were conducted among a community-based convenience sample of adult men and women. Interviews focused on experiences, perceptions, and behaviors related to the local biomedical and ethnomedical health care resources. Penetrance of the local health post was high, with most (90%) of respondents having accessed it within the prior five years. The prevailing attitude toward the health post was positive. We identified facilitators and barriers to health post use that corresponded with three thematic areas: clinic operations, visits and consultations, and medical resources. Proximity to the home, free consultations and medications, and social support services were among the most commonly cited facilitators. Barriers included limited clinic hours, medication stock-outs, provision of care that did not meet patient expectations, and unavailability of diagnostic tests. In a rural Maya community in Guatemala, operational and quality-based factors, independent of sociocultural considerations, informed the perception of and decision to access biomedical resources. Interventions that address these factors may increase health care utilization and alleviate some of the health disparities that accompany indigeneity in Guatemala and similar contexts.

  12. A framework for performance and data quality assessment of Radio Frequency IDentification (RFID) systems in health care settings.

    Science.gov (United States)

    van der Togt, Remko; Bakker, Piet J M; Jaspers, Monique W M

    2011-04-01

    RFID offers great opportunities to health care. Nevertheless, prior experiences also show that RFID systems have not been designed and tested in response to the particular needs of health care settings and might introduce new risks. The aim of this study is to present a framework that can be used to assess the performance of RFID systems particularly in health care settings. We developed a framework describing a systematic approach that can be used for assessing the feasibility of using an RFID technology in a particular healthcare setting; more specific for testing the impact of environmental factors on the quality of RFID generated data and vice versa. This framework is based on our own experiences with an RFID pilot implementation in an academic hospital in The Netherlands and a literature review concerning RFID test methods and current insights of RFID implementations in healthcare. The implementation of an RFID system within the blood transfusion chain inside a hospital setting was used as a show case to explain the different phases of the framework. The framework consists of nine phases, including an implementation development plan, RFID and medical equipment interference tests, data accuracy- and data completeness tests to be run in laboratory, simulated field and real field settings. The potential risks that RFID technologies may bring to the healthcare setting should be thoroughly evaluated before they are introduced into a vital environment. The RFID performance assessment framework that we present can act as a reference model to start an RFID development, engineering, implementation and testing plan and more specific, to assess the potential risks of interference and to test the quality of the RFID generated data potentially influenced by physical objects in specific health care environments. Copyright © 2010 Elsevier Inc. All rights reserved.

  13. Quality of trauma care and trauma registries.

    Science.gov (United States)

    Pino Sánchez, F I; Ballesteros Sanz, M A; Cordero Lorenzana, L; Guerrero López, F

    2015-03-01

    Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  14. Role of health-related quality of life measures in the routine care of people with multiple sclerosis

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    Solari Alessandra

    2005-03-01

    Full Text Available Abstract Health-related quality of life instruments are expected to be of particular value in routine care of people with multiple sclerosis (MS, where they may facilitate the detection of disease aspects that would otherwise go unrecognised, help clinicians appreciate patient priorities particularly in terms of treatment goals, facilitate physician-patient communication, and promote shared decision-making. However, it appears that these instruments are little used routine clinical approaches to people with MS. To address this issue, I performed a bibliographic search of studies that evaluated the efficacy of generic or disease-specific health-related quality of life (HRQOL instruments in MS clinical practice from clinicians' or patients' perspectives. I found only one cross-sectional study, which compared preferences for three instruments, and assessed acceptability in people with MS. Reasons for lack of transfer of HRQOL measurements to clinical practice may be cultural, methodological, or practical. With regard to MS, the proliferation of instruments seems to constitute a barrier, with no particular instrument having gained wide popularity or consensus. Other barriers are lack of resources for the administration, collection and storage of the data, and inability of clinicians to score, interpret, and use HRQOL instrument to guide clinical care. It is therefore important to refine existing tools, extending clinical validation to wider contexts and cultures. More studies assessing acceptability and clinicians' and patients' preferences for different instruments are also required.

  15. Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview.

    Science.gov (United States)

    Nair, Manisha; Yoshida, Sachiyo; Lambrechts, Thierry; Boschi-Pinto, Cynthia; Bose, Krishna; Mason, Elizabeth Mary; Mathai, Matthews

    2014-05-22

    Conduct a global situational analysis to identify the current facilitators and barriers to improving quality of care (QoC) for pregnant women, newborns and children. Metareview of published and unpublished systematic reviews and meta-analyses conducted between January 2000 and March 2013 in any language. Assessment of Multiple Systematic Reviews (AMSTAR) is used to assess the methodological quality of systematic reviews. Health systems of all countries. Study outcome: QoC measured using surrogate indicators--effective, efficient, accessible, acceptable/patient centred, equitable and safe. Conducted in two phases (1) qualitative synthesis of extracted data to identify and group the facilitators and barriers to improving QoC, for each of the three population groups, into the six domains of WHO's framework and explore new domains and (2) an analysis grid to map the common facilitators and barriers. We included 98 systematic reviews with 110 interventions to improve QoC from countries globally. The facilitators and barriers identified fitted the six domains of WHO's framework--information, patient-population engagement, leadership, regulations and standards, organisational capacity and models of care. Two new domains, 'communication' and 'satisfaction', were generated. Facilitators included active and regular interpersonal communication between users and providers; respect, confidentiality, comfort and support during care provision; engaging users in decision-making; continuity of care and effective audit and feedback mechanisms. Key barriers identified were language barriers in information and communication; power difference between users and providers; health systems not accounting for user satisfaction; variable standards of implementation of standard guidelines; shortage of resources in health facilities and lack of studies assessing the role of leadership in improving QoC. These were common across the three population groups. The barriers to good-quality

  16. Measuring unmet needs to assess the quality of home health care.

    NARCIS (Netherlands)

    Veer, A.J.E. de; Bakker, D.H. de

    1994-01-01

    Until now home care research has been primarily focused on functional limitations. The instrument presented in this article also takes into account needs for psychosocial care, extra information, nursing care, and extra arrangements such as adaptations of the house. Elderly people with a chronic dis

  17. Evaluating quality of dental care among patients with diabetes: Adaptation and testing of a dental quality measure in electronic health records.

    Science.gov (United States)

    Neumann, Ana; Kalenderian, Elsbeth; Ramoni, Rachel; Yansane, Alfa; Tokede, Bunmi; Etolue, Jini; Vaderhobli, Ram; Simmons, Kristen; Even, Joshua; Mullins, Joanna; Kumar, Shwetha; Bangar, Suhasini; Kookal, Krishna; White, Joel; Walji, Muhammad

    2017-09-01

    Patients with diabetes are at increased risk of developing oral complications, and annual dental examinations are an endorsed preventive strategy. The authors evaluated the feasibility and validity of implementing an automated electronic health record (EHR)-based dental quality measure to determine whether patients with diabetes received such evaluations. The authors selected a Dental Quality Alliance measure developed for claims data and adapted the specifications for EHRs. Automated queries identified patients with diabetes across 4 dental institutions, and the authors manually reviewed a subsample of charts to evaluate query performance. After assessing the initial EHR measure, the authors defined and tested a revised EHR measure to capture better the oral care received by patients with diabetes. In the initial and revised measures, the authors used EHR automated queries to identify 12,960 and 13,221 patients with diabetes, respectively, in the reporting year. Variations in the measure scores across sites were greater with the initial measure (range, 36.4-71.3%) than with the revised measure (range, 78.8-88.1%). The automated query performed well (93% or higher) for sensitivity, specificity, and positive and negative predictive values for both measures. The results suggest that an automated EHR-based query can be used successfully to measure the quality of oral health care delivered to patients with diabetes. The authors also found that using the rich data available in EHRs may help estimate the quality of care better than can relying on claims data. Detailed clinical patient-level data in dental EHRs may be useful to dentists in evaluating the quality of dental care provided to patients with diabetes. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

  18. [The quality of chronic care in Germany].

    Science.gov (United States)

    Fullerton, Birgit; Nolte, Ellen; Erler, Antje

    2011-01-01

    Over the last ten years changes in the legal framework of the German health care system have promoted the development of new health service models to improve chronic care. Recent innovations include the nation-wide introduction of disease management programmes (DMPs), integrated care contracts, community nurse programmes, the introduction of General Practitioner (GP)-centred care contracts, and new opportunities to offer interdisciplinary outpatient care in polyclinics. The aim of this article is to describe the recent developments regarding both the implementation of new health care models by statutory health insurance companies and their evaluation. As part of a European project on the development and validation of disease management evaluation methods (DISMEVAL), we carried out a selective literature search to identify relevant models and evaluation studies. However, on the basis of the currently available evaluation and study results it is difficult to judge whether these developments have actually led to an improvement in the quality of chronic care in Germany. Only for DMPs, evaluation is legally mandatory; its methods are inappropriate, though, for studying the effectiveness of DMPs. Further study results on the effectiveness of DMPs mostly focus on the DMP Diabetes mellitus type II and show consistent improvements regarding process parameters such as regular routine examinations, adherence to treatment guidelines, and quality of life. More research will be needed to determine whether DMPs can also help reduce the incidence of secondary disease and mortality in the long term.

  19. Osteoarthritis: quality of life, comorbidities, medication and health service utilization assessed in a large sample of primary care patients

    Directory of Open Access Journals (Sweden)

    Szecsenyi Joachim

    2007-06-01

    Full Text Available Abstract Objective To assess the gender related impact of osteoarthritis (OA on quality of life (QoL and health service utilization (HSU of primary care patients in Germany. Methods Cross sectional study with 1250 OA patients attending 75 primary care practices from March to May 2005. QoL was assessed using the GERMAN-AIMS2-SF. Data about comorbidities, prescriptions, health service utilization, and physical activity were obtained by questioning patients or from the patients' medical files. Depression was assessed by means of the Patient Health Questionnaire (PHQ-9. Results 1021 (81.7% questionnaires were returned. 347 (34% patients were male. Impact of OA on QoL was different between gender: women achieved significantly higher scores in the AIMS 2-SF dimensions lower body (p Conclusion The extent to which OA impacts men and women differs in primary care patients. This might have resulted in the revealed differences in the pharmacological treatment and the HSU. Further research is needed to confirm our findings and to assess causality.

  20. Physical Activity, Energy Expenditure, Nutritional Habits, Quality of Sleep and Stress Levels in Shift-Working Health Care Personnel

    Science.gov (United States)

    Vogt, Lena Johanna; Gärtner, Simone; Hannich, Hans Joachim; Steveling, Antje; Lerch, Markus M.

    2017-01-01

    Background Among health care personnel working regular hours or rotating shifts can affect parameters of general health and nutrition. We have investigated physical activity, sleep quality, metabolic activity and stress levels in health care workers from both groups. Methods We prospectively recruited 46 volunteer participants from the workforce of a University Medical Department of which 23 worked in rotating shifts (all nursing) and 21 non-shift regular hours (10 nursing, 13 clerical staff). All were investigated over 7 days by multisensory accelerometer (SenseWear Bodymedia® armband) and kept a detailed food diary. Physical activity and resting energy expenditure (REE) were measured in metabolic equivalents of task (METs). Quality of sleep was assessed as Pittsburgh Sleeping Quality Index and stress load using the Trier Inventory for Chronic Stress questionnaire (TICS). Results No significant differences were found for overall physical activity, steps per minute, time of exceeding the 3 METs level or sleep quality. A significant difference for physical activity during working hours was found between shift-workers vs. non-shift-workers (ppersonnel (median = 1.5 METs SE = 0.07, p<0.05). Non-shift-working nurses had a significantly lower REE than the other groups (p<0.05). The proportion of fat in the diet was significantly higher (p<0.05) in the office worker group (median = 42% SE = 1.2) whereas shift-working nurses consumed significantly more carbohydrates (median = 46% SE = 1.4) than clerical staff (median = 41% SE = 1.7). Stress assessment by TICS confirmed a significantly higher level of social overload in the shift working group (p<0.05). Conclusion In this prospective cohort study shift-working had no influence on overall physical activity. Lower physical activity during working hours appears to be compensated for during off-hours. Differences in nutritional habits and stress load warrant larger scale trials to determine the effect on implicit health

  1. Keys to successful implementation of a French national quality indicator in health care organizations: a qualitative study.

    Science.gov (United States)

    Waelli, Mathias; Gomez, Marie-Léandre; Sicotte, Claude; Zicari, Adrian; Bonnefond, Jean-Yves; Lorino, Philippe; Minvielle, Etienne

    2016-10-06

    Several countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs). However, a prerequisite to quality improvement is successful local QI implementation. The aim of this study was to explore the pathway through which a mandatory QI of the French national public reporting system, namely the quality of the anesthesia file (QAF), was put into practice. Seven ethnographic case studies in French HCOs combining in situ observations and 37 semi-structured interviews. A significant proportion of potential QAF users, such as anesthetists or other health professionals were often unaware of quality data. They were, however, involved in improvement actions to meet the QAF criteria. In fact, three intertwined factors influenced QAF appropriation by anesthesia teams and impacted practice. The first factor was the action of clinical managers (chief anesthetists and head of department) who helped translate public policy into local practice largely by providing legitimacy by highlighting the scientific evidence underlying QAF, achieving consensus among team members, and pointing out the value of QAF as a means of work recognition. The two other factors related to the socio-material context, namely the coherence of information systems and the quality of interpersonal ties within the department. Public policy tends to focus on the metrological validity of QIs and on ranking methods and overlooks QI implementation. However, effective QI implementation depends on local managerial activity that is often invisible, in interaction with socio-material factors. When developing national quality improvement programs, health authorities might do well to specifically target these clinical managers who act as invaluable mediators. Their key role should be acknowledged and they ought to be provided with adequate resources.

  2. The emerging EU quality of care policy

    DEFF Research Database (Denmark)

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

    2013-01-01

    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......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...... and desirability of the EU's involvement is clearly needed, also considering the differences in quality of care policies between and within EU Member States. Both arguments in favour and against further EU involvement are discussed in this paper...

  3. Survivorship care plan preferences of cancer survivors and health care providers: a systematic review and quality appraisal of the evidence.

    Science.gov (United States)

    Klemanski, Dori L; Browning, Kristine K; Kue, Jennifer

    2016-02-01

    The purpose of this systematic review was to describe and examine the current use of treatment summaries and survivorship care plans (TSs/SCPs) for cancer survivors, as well as to summarize and critically assess relevant literature regarding their preferences and usefulness. There is a knowledge gap regarding the preferences of stakeholders as to what is useful on a treatment summary or survivorship care plan. A systematic review of eligible manuscripts was conducted using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Relevant studies were identified via PubMed, CINAHL Plus, and the Cochrane Library from 2005 through 2013. Eligible studies were critically appraised with qualitative and quantitative appraisal tools. There were 29 studies included in this review; 19 were quantitative. Survivors and primary care physicians preferred a printable format delivered 0 to 6 months posttreatment and highlighting signs and symptoms of recurrence, late, and long-term effects, and recommendations for healthy living. Oncology providers supported the concept of treatment summary and survivorship care plan but reported significant barriers to their provision. No studies incorporated caregiver perspectives of treatment summary and survivorship care plan. This systematic review did not reveal conclusive evidence regarding the needs of survivors or providers regarding treatment summaries and survivorship care plans. A lack of rigorous studies contributed to this. Treatment summaries and survivorship care plans are useful for cancer survivors; however, future rigorous studies should be conducted to identify and prioritize the preferences of survivors regarding these.

  4. Community perception of quality of (primary health care services in a rural area of Limpopo Province, South Africa: a qualitative study

    Directory of Open Access Journals (Sweden)

    T-AB Mashego

    2005-09-01

    Full Text Available The aim of the study was to survey perceptions of quality of (primary health care services provided in rural communities in the Limpopo province. Ten focus groups discussions were held with community members chosen by convenience from public places from four villages in the central region of the Limpopo Province. The sample included 42 women and 34 men (76 participants. Results indicated perceived quality discussed within the following categories: (1 conduct of staff (reception, communication, discrimination, care and compassion, respect for privacy, (2 technical care (examination, explanation of treatment, responsiveness, treatment outcomes, (3 health care facility, (4 health care organisation, (5 drugs (availability, explanation, effectiveness, payment, and (6 waiting time. The findings suggest some satisfaction with free basic and preventive health care and social services provided but there is a need to look closely into the interpersonal dimension of the services provided, provision of medication with adequate explanation to patients on the medication given, and on structural aspects, there is need for the government to give support to the clinics to provide adequate services. Improving drug availability, interpersonal skills (including attitudes towards patients and technical care have been identified as the three main priorities for enhancing perceived quality of primary health care and health policy action.

  5. Recertification of primary health care professionals.

    NARCIS (Netherlands)

    Boeringa, F.H.; Sluijs, E.M.

    1993-01-01

    This bibliography contains literature about certification- and recertification of health care professionals. Certification and recertification are increasingly being used as quality assurance systems for professionals. As such (re)certification does fit in with the current developments towards quali

  6. Setting up a health care quality management system in a multidisciplinary clinical research center

    Directory of Open Access Journals (Sweden)

    L. V. Laktionova

    2013-01-01

    Full Text Available The paper discusses the issues of setting up a quality management system in a multidisciplinary specialized clinical research center. It describes the experience with information technologies used in a prophylactic facility to set up effective out- and inpatient health care control. Measures to optimize work under present-day conditions to upgrade the quality of health care are given using the federal health facility as an example.

  7. Adverse childhood experiences, mental health, and quality of life of Chilean girls placed in foster care: An exploratory study.

    Science.gov (United States)

    Seiler, Annina; Kohler, Stefanie; Ruf-Leuschner, Martina; Landolt, Markus A

    2016-03-01

    In Latin America, little research has been conducted regarding exposure to adverse childhood experiences (ACEs), mental health, and health-related quality of life (HRQoL) among foster children. This study examined the association between ACEs and mental health, posttraumatic stress disorder (PTSD), and HRQoL in Chilean foster girls relative to age-matched Chilean family girls. Data were obtained from 27 Chilean foster girls and 27 Chilean girls ages 6 to 17 years living in family homes. Standardized self- and proxy-report measures were used. Foster girls reported more ACEs than controls in terms of familial and nonfamilial sexual abuse and both emotional and physical neglect. Girls living in foster care had a significantly higher rate of PTSD, displayed greater behavioral and emotional problems, and reported a lower HRQoL. Analysis confirmed the well-known cumulative risk hypothesis by demonstrating a significant positive association between the number of ACEs and PTSD symptom severity and a significant negative association with HRQoL. Chilean foster girls endured more ACEs that impair mental health and HRQoL than age-matched peers living with their families. These findings have implications for out-of-home care services in Latin America, highlighting the need to implement not only appropriate trauma-focused treatments but also appropriate prevention strategies. (c) 2016 APA, all rights reserved).

  8. Use of quality information in decision-making about health and social care services--a systematic review.

    Science.gov (United States)

    Turnpenny, Agnes; Beadle-Brown, Julie

    2015-07-01

    User choice and personalisation have been at the centre of health and social care policies in many countries. Exercising choice can be especially challenging for people with long-term conditions (LTC) or disabilities. Information about the quality, cost and availability of services is central to user choice. This study used systematic review methods to synthesise evidence in three main areas: (i) how people with LTC or disabilities and their family carers find and access information about the quality of services; (ii) how quality information is used in decision-making; and (iii) what type of quality information is most useful. Quality information was defined broadly and could include formal quality reports (e.g. inspection reports, report cards, etc.), information about the characteristics of a service or provider (e.g. number and qualifications of staff, facilities, etc.) and informal reports about quality (e.g. personal experience, etc.). Literature searches were carried out using electronic databases in January 2012. Thirteen papers reporting findings from empirical studies published between 2001 and 2012 were included in the review. The majority of papers (n = 9) had a qualitative design. The analysis highlighted the use of multiple sources of information in decision-making about services and in particular the importance of informal sources and extended social networks in accessing information. There is limited awareness and use of 'official' and online information sources. Service users or family carers place greater emphasis on general information and structural indicators. Clinical or quality-of-life outcomes are often difficult to interpret and apply. Trust emerged a key issue in relation to quality information. Experiential and subjective information is highly valued and trusted. Various barriers to the effective use of quality information in making choices about services are identified. Implications for policy and future research are discussed.

  9. 38 CFR 52.120 - Quality of care.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Quality of care. 52.120... FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.120 Quality of care. Each participant must receive, and the program management must provide, the necessary care and services to...

  10. [Reorganizing the management of specialist uro-andrologic ultrasound health-care service: impact on professional quality].

    Science.gov (United States)

    Dell'Atti, Lucio; Russo, Gian Rosario

    2011-01-01

    The process of organizing a ultrasound service nowadays can be improved by properly managing the user's request, the speed of response and safety, the standardization of methods and skills. The outpatients at our uro-andrologic ultrasound clinic (O.U. of Urology in Ferrara) received a questionnaire each; we administered a total of 640 questionnaires. The number of questionnaires collected was 532. Patients were asked to give an assessment of services using a qualitative method according to a 4-parameter response scale: very satisfied, satisfied, dissatisfied, very dissatisfied. The identification of indicators to be monitored by the user's perceived quality was accomplished by establishing the correlation coefficient between different parameters of analysis and an overall rating of the sample. Some of these parameters were: the relationship with the practitioner, the availability of doctors, the ability of doctors for reassurance, the completeness of information and facilities hygiene conditions. When these parameters vary, positively or negatively, also the citizen's overall opinion changes. The customer satisfaction is an important component of the quality of care, it represents both an indicator of the effectiveness of health intervention and the ability to meet quality requirements of the health service organization. The objective of an ultrasound service should be to provide, within a reasonable timeframe, the supply of high quality with qualified personnel, with adequate tools and procedures.

  11. The new architects of health care reform.

    Science.gov (United States)

    Schaeffer, Leonard D

    2007-01-01

    Rising health care costs have been an issue for decades, yet federal-level health care reform hasn't happened. Support for reform, however, has changed. Purchasers fear that health care cost growth is becoming unaffordable. Research on costs and quality is questioning value. International comparisons rank the United States low on important health system performance measures. Yet it is not these factors but the unsustainable costs of Medicare and Medicaid that will narrow the window for health care stakeholders to shape policy. Unless the health care system is effectively reformed, sometime after the 2008 election, budget hawks and national security experts will eventually combine forces to cut health spending, ultimately determining health policy for the nation.

  12. A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination.

    Science.gov (United States)

    Joshi, Chandni; Russell, Grant; Cheng, I-Hao; Kay, Margaret; Pottie, Kevin; Alston, Margaret; Smith, Mitchell; Chan, Bibiana; Vasi, Shiva; Lo, Winston; Wahidi, Sayed Shukrullah; Harris, Mark F

    2013-11-07

    Refugees have many complex health care needs which should be addressed by the primary health care services, both on their arrival in resettlement countries and in their transition to long-term care. The aim of this narrative synthesis is to identify the components of primary health care service delivery models for such populations which have been effective in improving access, quality and coordination of care. A systematic review of the literature, including published systematic reviews, was undertaken. Studies between 1990 and 2011 were identified by searching Medline, CINAHL, EMBASE, Cochrane Library, Scopus, Australian Public Affairs Information Service - Health, Health and Society Database, Multicultural Australian and Immigration Studies and Google Scholar. A limited snowballing search of the reference lists of all included studies was also undertaken. A stakeholder advisory committee and international advisers provided papers from grey literature. Only English language studies of evaluated primary health care models of care for refugees in developed countries of resettlement were included. Twenty-five studies met the inclusion criteria for this review of which 15 were Australian and 10 overseas models. These could be categorised into six themes: service context, clinical model, workforce capacity, cost to clients, health and non-health services. Access was improved by multidisciplinary staff, use of interpreters and bilingual staff, no-cost or low-cost services, outreach services, free transport to and from appointments, longer clinic opening hours, patient advocacy, and use of gender-concordant providers. These services were affordable, appropriate and acceptable to the target groups. Coordination between the different health care services and services responding to the social needs of clients was improved through case management by specialist workers. Quality of care was improved by training in cultural sensitivity and appropriate use of interpreters. The

  13. 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

  14. 42 CFR 483.25 - Quality of care.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Quality of care. 483.25 Section 483.25 Public...) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term Care Facilities § 483.25 Quality of care. Each resident must receive and the facility must provide...

  15. Toward an Educated Health Consumer: Mass Communication and Quality in Medical Care. Fogarty International Series on the Teaching of Preventive Medicine. Volume 7.

    Science.gov (United States)

    Marshall, Carter L.

    Focus in this preventive medicine monograph for health professionals is on consumer health education and the current and potential effects of mass communication on the quality of medical care. Following an introduction, the content is presented in four chapters. Chapter 1 covers the state of the art in consumer health education and discusses three…

  16. Position statement on interdisciplinary team training in geriatrics: an essential component of quality health care for older adults.

    Science.gov (United States)

    2014-05-01

    Interdisciplinary team training (IDT) is an important component of ensuring quality geriatric care delivery, which can be complex and time intensive, requiring coordination of many medical, psychosocial, and therapeutic interventions and professionals. The Partnership for Health in Aging (PHA), a loose coalition of more than 30 organizations representing healthcare professionals who care for older adults supported by the American Geriatrics Society, identified IDT training in geriatrics as a priority area in addressing the geriatrics workforce shortage described in the 2008 Institute of Medicine report, Retooling for An Aging America: Building the Health Care Workforce. A PHA Workgroup on Interdisciplinary Team Training in Geriatrics was convened to review the literature focused on geriatrics IDT training and to develop a position statement that would inform and influence groups involved in the development and expansion of academic and continuing education programs in IDT training, including professional associations, credentialing and licensing bodies, accreditation organizations, and university administrators. There are significant challenges to expanding the development and implementation of geriatrics IDT training for health professionals, and such training will be successful only with substantial and sustained advocacy from the above professional groups. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  17. Providing Culturally Competent Care for LGBTQ Youth in School-Based Health Centers: A Needs Assessment to Guide Quality of Care Improvements.

    Science.gov (United States)

    Garbers, Samantha; Heck, Craig J; Gold, Melanie A; Santelli, John S; Bersamin, Melina

    2017-01-01

    School-based health centers (SBHCs) can take specific steps to provide culturally competent care for lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth, potentially impacting well-being. A needs assessment survey was conducted among a convenience sample of SBHC administrators and medical directors to assess climates and actions supportive of LGBTQ quality medical care. Half (53%) of the SBHCs surveyed ( N = 66) reviewed print materials for negative LGBTQ stereotypes, and 27.3% conducted exhaustive materials review. Regional differences were detected: 46.2% of Southern SBHCs conducted any materials review compared to 91.3% in the West and all in the East and Midwest (χ(2), p LGBTQ youth. On intake forms, 85.4% included preferred names, but only 23.5% included preferred pronoun. There are significant gaps in the extent to which SBHCs provide culturally competent care. These findings can guide future training and advocacy.

  18. Developing cross-sectoral quality assurance for cataract surgery in the statutory quality assurance program of the German health care system: Experiences and lessons learned.

    Science.gov (United States)

    Bramesfeld, Anke; Pauletzki, Jürgen; Behrenz, Lars; Szecsenyi, Joachim; Willms, Gerald; Broge, Björn

    2015-08-01

    Since 2001, statutory external quality assurance (QA) for hospital care has been in place in the German health system. In 2009, the decision was taken to expand it to cross-sectoral procedures. This novel and unprecedented form of national QA aims at (1) making the quality procedures comparable that are provided both in inpatient and outpatient care, (2) following-up outcomes of hospital care after patients' discharge and (3) measuring the quality of complex treatment chains across interfaces. As a pioneer procedure a QA procedure in cataract surgery QA was developed. Using this as an example, challenges of cross-sectoral QA are highlighted. These challenges relate, in particular, to three technical problems: triggering cases for documentation, following-up patients' after hospital discharge, and the burden of documentation in outpatient care. These problems resulted finally in the haltering of the development of the QA procedure. However, the experiences gained with this first development of cross-sectoral QA inspired the reorientation and further development of the field in Germany. Future cross-sectoral QA will rigorously aim at keeping burden of documentation small. It will draw data for QA mainly at three sources: routine data, patient surveys and peer reviews using indicators. Policy implications of this reorientation are discussed.

  19. Closing the quality gap: revisiting the state of the science (vol. 1: bundled payment: effects on health care spending and quality).

    Science.gov (United States)

    Hussey, Peter S; Mulcahy, Andrew W; Schnyer, Christopher; Schneider, Eric C

    2012-08-01

    "Bundled payment" is a method in which payments to health care providers are related to the predetermined expected costs of a grouping, or "bundle," of related health care services. The intent of bundled payment systems is to decrease health care spending while improving or maintaining the quality of care. To systematically review studies of the effects of bundled payment on health care spending and quality, and to examine key design and contextual features of bundled payment programs and their association with program effectiveness. Electronic literature search of PubMed® and the Cochrane Library for studies published between 1985 and 2011. Title and abstract review followed by full-text review to identify studies that assessed the effect of bundled payment on health care spending and/or quality. Two authors independently abstracted data on study design, intervention design, context, comparisons, and findings. Reviewers rated the strength of individual studies as well as the strength and applicability of the body of evidence overall. Differences between reviewers were reconciled by consensus. Studies were categorized by bundled payment program and narratively summarized. We reviewed 58 studies, excluding studies of the Medicare Inpatient Prospective Payment System, for which we reviewed 4 review articles. Most studies (57 of 58) were observational or descriptive; 1 study employed randomization of providers, and none employed random assignment of patients to treatment and control groups. The included studies examined 20 different bundled payment interventions, 16 of which focused on single institutional providers. The introduction of bundled payment was associated with: (1) reductions in health care spending and utilization, and (2) inconsistent and generally small effects on quality measures. These findings were consistent across different bundled payment programs and settings, but the strength of the body of evidence was rated as low, due mainly to concerns

  20. Availability, utilisation and quality of maternal and neonatal health care services in Karamoja region, Uganda: a health facility-based survey

    OpenAIRE

    Wilunda, Calistus; Oyerinde, Koyejo; Putoto, Giovanni; Lochoro, Peter; Dall?Oglio, Giovanni; Manenti, Fabio; Segafredo, Giulia; Atzori, Andrea; Criel, Bart; Panza, Alessio; Quaglio, Gianluca

    2015-01-01

    Background Maternal mortality is persistently high in Uganda. Access to quality emergency obstetrics care (EmOC) is fundamental to reducing maternal and newborn deaths and is a possible way of achieving the target of the fifth millennium development goal. Karamoja region in north-eastern Uganda has consistently demonstrated the nation?s lowest scores on key development and health indicators and presents a substantial challenge to Uganda?s stability and poverty eradication ambitions. The objec...

  1. Availability, utilisation and quality of maternal and neonatal health care services in Karamoja region, Uganda: a health facility-based survey

    OpenAIRE

    Wilunda, Calistus; Oyerinde, Koyejo; Putoto, Giovanni; Lochoro, Peter; Dall’Oglio, Giovanni; Manenti, Fabio; Segafredo, Giulia; Atzori, Andrea; Criel, Bart; Panza, Alessio; Quaglio, Gianluca

    2015-01-01

    Background Maternal mortality is persistently high in Uganda. Access to quality emergency obstetrics care (EmOC) is fundamental to reducing maternal and newborn deaths and is a possible way of achieving the target of the fifth millennium development goal. Karamoja region in north-eastern Uganda has consistently demonstrated the nation’s lowest scores on key development and health indicators and presents a substantial challenge to Uganda’s stability and poverty eradication ambitions. The objec...

  2. A review of national policies and strategies to improve quality of health care and patient safety: a case study from Lebanon and Jordan.

    Science.gov (United States)

    El-Jardali, Fadi; Fadlallah, Racha

    2017-08-16

    Improving quality of care and patient safety practices can strengthen health care delivery systems, improve health sector performance, and accelerate attainment of health-related Sustainability Development Goals. Although quality improvement is now prominent on the health policy agendas of governments in low- and middle-income countries (LMICs), including countries of the Eastern Mediterranean Region (EMR), progress to date has not been optimal. The objective of this study is to comprehensively review existing quality improvement and patient safety policies and strategies in two selected countries of the EMR (Lebanon and Jordan) to determine the extent to which these have been institutionalized within existing health systems. We used a mixed methods approach that combined documentation review, stakeholder surveys and key informant interviews. Existing quality improvement and patient safety initiatives were assessed across five components of an analytical framework for assessing health care quality and patient safety: health systems context; national policies and legislation; organizations and institutions; methods, techniques and tools; and health care infrastructure and resources. Both Lebanon and Jordan have made important progress in terms of increased attention to quality and accreditation in national health plans and strategies, licensing requirements for health care professionals and organizations (albeit to varying extents), and investments in health information systems. A key deficiency in both countries is the absence of an explicit national policy for quality improvement and patient safety across the health system. Instead, there is a spread of several (disjointed) pieces of legal measures and national plans leading to fragmentation and lack of clear articulation of responsibilities across the entire continuum of care. Moreover, both countries lack national sets of standardized and applicable quality indicators for performance measurement and benchmarking

  3. Raziskava o zagotavljanju kakovosti v slovenskem osnovnem zdravstvu = Primary health care quality management project.

    NARCIS (Netherlands)

    Bulc, M.; Kersnik, J.; Boerma, W.; Pellny, M.

    2009-01-01

    Background: The article summarizes the main results of the WHO Primary Care Quality Management project, which has been implemented as a pilot study to identify and support mechanisms for quality management in primary health care. Material and methods: The project was commissioned by WHO Europe and c

  4. Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries

    Science.gov (United States)

    de Graft-Johnson, Joseph; Vesel, Linda; Rosen, Heather E; Rawlins, Barbara; Abwao, Stella; Mazia, Goldy; Bozsa, Robert; Mwebesa, Winifrede; Khadka, Neena; Kamunya, Rosemary; Getachew, Ashebir; Tibaijuka, Gaudiosa; Rakotovao, Jean Pierre; Tekleberhan, Alemnesh

    2017-01-01

    Objective To present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills. Design Cross-sectional observational health facility assessment. Setting Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania. Participants Health workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed. Main outcome measures Indicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation. Results Sterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly. Conclusions The findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have

  5. Spiritual Care Education of Health Care Professionals

    Directory of Open Access Journals (Sweden)

    Donia Baldacchino

    2015-05-01

    Full Text Available Nurses and health care professionals should have an active role in meeting the spiritual needs of patients in collaboration with the family and the chaplain. Literature criticizes the impaired holistic care because the spiritual dimension is often overlooked by health care professionals. This could be due to feelings of incompetence due to lack of education on spiritual care; lack of inter-professional education (IPE; work overload; lack of time; different cultures; lack of attention to personal spirituality; ethical issues and unwillingness to deliver spiritual care. Literature defines spiritual care as recognizing, respecting, and meeting patients’ spiritual needs; facilitating participation in religious rituals; communicating through listening and talking with clients; being with the patient by caring, supporting, and showing empathy; promoting a sense of well-being by helping them to find meaning and purpose in their illness and overall life; and referring them to other professionals, including the chaplain/pastor. This paper outlines the systematic mode of intra-professional theoretical education on spiritual care and its integration into their clinical practice; supported by role modeling. Examples will be given from the author’s creative and innovative ways of teaching spiritual care to undergraduate and post-graduate students. The essence of spiritual care is being in doing whereby personal spirituality and therapeutic use of self contribute towards effective holistic care. While taking into consideration the factors that may inhibit and enhance the delivery of spiritual care, recommendations are proposed to the education, clinical, and management sectors for further research and personal spirituality to ameliorate patient holistic care.

  6. Perception of quality in a Radiation Oncology Department: Is it different for patients and health care providers?

    Directory of Open Access Journals (Sweden)

    T Kataria

    2016-01-01

    Full Text Available Aim: Patient satisfaction is increasingly being identified as an important benchmark in health care industry. Studies addressing patients' perceptions of quality are available but there is paucity of data regarding the perception of health care providers towards their own services. This study was undertaken to compare the satisfaction level between the patients and the staff from a Radiation Oncology Department.Materials and Methods: A common 16-item questionnaire addressing various aspects of patient care was served to 40 patients and 40 staff members. The responses were statistically evaluated to assess the satisfaction level among the two groups and the scores were compared to assess the agreement between two groups.Results: Overall, satisfaction level of both groups regarding quality of services ranged from “good” to “excellent”. A high level of agreement was observed between the two groups. The physician's ability to give an explanation to patients, helping attitude of the staff and the staff's concern for patient safety were the most satisfying features of the department while inconvenience during scheduling of appointments, billing and registration process, status of the changing rooms and inter-department coordination were the least satisfying features.Conclusion: A high level of satisfaction may be achieved from the consumers if service providers are trained to assess the needs and expectations of consumers and to critically evaluate themselves. The service provider's perception regarding their own services may serve as a preliminary indicator of overall quality. Future studies with more participants in different setting may further explore this hypothesis.

  7. Quality of antenatal care provided by nurse midwives in an Urban health centre with regard to low-risk antenatal mothers

    Directory of Open Access Journals (Sweden)

    Ruby Angeline Pricilla

    2017-01-01

    Full Text Available Background:India contributes to 19% of the global maternal deaths. Good quality antenatal care can prevent maternal deaths by early detection of complications and maintaining maternal health. There are few studies documenting quality of antenatal care in India. This study aimed to document the antenatal services provided by nurse midwives to low-risk pregnant mothers from an urban population. Aims: The primary objective was to describe the quality of the antenatal care provided by nurse midwives of an urban health centre with regard to low-risk mothers. The secondary objective was to document the maternal and early neonatal outcomes of the enrolled mothers during the period of study. Methods: This prospective cohort study was done on 200 pregnant women who had antenatal care by nurse midwives between April 2014 and November 2014. The quality of care was assessed by a checklist adapted from World Health Organization (WHO. Results: We report that the quality of antenatal care for all domains was above 90% except for the health education domain, which was poor with regard to breastfeeding and family planning in the enrolled 200 pregnant women. Conclusion: Our study concluded that trained nurse midwives when regularly monitored, audited and linked with reliable referral facilities can deliver good quality antenatal care.

  8. Social support network, mental health and quality of life: a cross-sectional study in primary care

    Directory of Open Access Journals (Sweden)

    Flávia Batista Portugal

    Full Text Available The objective of this study was to identify the association between emotional distress and social support networks with quality of life in primary care patients. This was a cross-sectional study involving 1,466 patients in the cities of São Paulo and Rio de Janeiro, Brazil, in 2009/2010. The General Health Questionnaire, the Hospital Anxiety and Depression Scale and the brief version of the World Health Organization Quality of Life Instrument were used. The Social Support Network Index classified patients with the highest and lowest index as socially integrated or isolated. A bivariate analysis and four multiple linear regressions were conducted for each quality of life outcome. The means scores for the physical, psychological, social relations, and environment domains were, respectively, 64.7; 64.2; 68.5 and 49.1. In the multivariate analysis, the psychological domain was negatively associated with isolation, whereas the social relations and environment domains were positively associated with integration. Integration and isolation proved to be important factors for those in emotional distress as they minimize or maximize negative effects on quality of life.

  9. Quality of labeling on dispensed medicines and associated factors among public health care facilities in Bahir dar city, Northwest Ethiopia

    Directory of Open Access Journals (Sweden)

    Wubante Demilew Nigussie

    2014-03-01

    Full Text Available Purpose: To determine the quality of labeling on dispensed medicines and identify the associated factors among public health facilities in Bahir Dar city. Methods: A cross sectional study was conducted from August 5 to 20, 2013 at selected health care facilities in Bahir Dar city. Simple random sampling and systematic random sampling techniques was used to select health facilities and dispensing encounters respectively. Data was collected from non participatory observations of the drug dispensing process using check list. Data was entered into EPI Info (version 3.5.2 and analyzed using SPSS version 16. Bivariate and multivariate regression analysis was computed to test the strength of association and level of significance. P-value <0.05 was considered as statistical significant. Results: A total of 400 dispensing encounters and 636 drugs dispensed were observed in eight (8 outpatient pharmacies. The percentage of drugs adequately labeled was 32.2%. Drugs adequate labeling score was higher in private health facilities (39.3% compared to government health facilities (25.83%. The name, strength and dosage form of the drugs were labeled in 95.6%, 90% and 85.8% respectively. Differences in dispenser work experiences (AOR = 2.99, CI: 1.67 – 5.37, average dispensing time (AOR = 6.22, CI: 3.08-12.57, average consultation time (AOR=3.42, CI: 1.64-7.13, level of health facility (AOR = 4.31, CI 1.94 – 9.59 and type of health facilities (AOR = 4.29, CI 1.72 – 10.66 were found to be independently associated factors for quality of labeling score. Conclusion: The quality of labeling on dispensed medicines was not adequate. Dispenser work experiences, average dispensing time, average consultation time, level of health facility and type of health facilities were found to be significant factors for quality of labeling score. Therefore, attention should be given to strong skill development, increasing manpower and implementation of regular monitoring for the

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

    OpenAIRE

    Schyve, Paul M.

    2007-01-01

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

  11. Language differences as a barrier to quality and safety in health care: the Joint Commission perspective.

    Science.gov (United States)

    Schyve, Paul M

    2007-11-01

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

  12. Adoption and Usage of mHealth Technology on Quality and Experience of Care Provided by Frontline Workers: Observations From Rural India.

    Science.gov (United States)

    Kaphle, Sangya; Chaturvedi, Sharad; Chaudhuri, Indrajit; Krishnan, Ram; Lesh, Neal

    2015-05-28

    mHealth apps are deployed with the aim of improving access, quality, and experience of health care. It is possible that any mHealth intervention can yield differential impacts for different types of users. Mediating and determining factors, including personal and socioeconomic factors, affect technology adoption, the way health workers leverage and use the technology, and subsequently the quality and experience of care they provide. To develop a framework to assess whether mHealth platforms affect the quality and experience of care provided by frontline workers, and whether these effects on quality and experience are different depending on the level of technology adoption and individual characteristics of the health worker. Literacy, education, age, and previous mobile experience are identified as individual factors that affect technology adoption and use, as well as factors that affect the quality and experience of care directly and via the technology. Formative research was conducted with 15 community health workers (CHWs) using CommCare, an mHealth app for maternal and newborn care, in Bihar, India. CHWs were first classified on the level of CommCare adoption using data from CommCareHQ and were then shadowed on home visits to evaluate their levels of technology proficiency, and the quality and experience of care provided. Regression techniques were employed to test the relationships. Out of all the CHWs, 2 of them refused to participate in the home visits, however, we did have information on their levels of technology adoption and background characteristics, which were included in the analysis as relevant. Level of technology adoption was important for both quality and experience of care. The quality score for high users of CommCare was higher by 33.4% (P=.04), on average, compared to low users of CommCare. Those who scored higher on CommCare proficiency also provided significantly higher quality and experience of care, where an additional point in CommCare

  13. Interpreting the quality of health care database studies on the comparative effectiveness of oral anticoagulants in routine care

    Directory of Open Access Journals (Sweden)

    Schneeweiss S

    2013-09-01

    Full Text Available Sebastian Schneeweiss, Krista F Huybrechts, Joshua J Gagne Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA Background: Dabigatran, an oral direct thrombin inhibitor, has now been available for 2 years in the US for the prevention of stroke in patients with nonvalvular atrial fibrillation, and direct Xa inhibitors are also starting to enter the market. Studies examining the effects of new oral anticoagulants in health care databases are beginning to emerge. The purpose of this study was to describe the validity of early published observational studies on the comparative safety and effectiveness of new oral anticoagulants in patients with atrial fibrillation. Methods: We identified published nonrandomized post-marketing studies (articles or conference abstracts or posters and critically appraised their internal validity, with a particular focus on their ability to control confounding and other biases. Results: Two full-length journal articles, three conference posters, two conference presentation abstracts, and a US Food and Drug Administration analysis form the basis of the early comparative effectiveness and safety experience with new oral anticoagulants. Some published studies exhibit substantial biases and have insufficient precision for several important endpoints. Several studies suffer from biases arising from comparing ongoing users of the older drug, warfarin, who seem to tolerate it, to initiators of the new treatment who may have switched from warfarin or have had no prior experience with anticoagulants. Analyses tended to not adjust or not adjust adequately for confounding, and unsound propensity score application was also observed. Several studies introduced selection bias by excluding patients who died during follow-up and by restricting the study population to those with continuous database enrollment following cohort entry. We

  14. The Quality of Healthcare Service Delivery in Nigeria: An Assessment of the Availability of Some Basic Medical Devices/Equipment in the Primary Health Care Centres in Delta State

    OpenAIRE

    Omuta GED

    2016-01-01

    Background: Ordinarily, accessibility implies locational proximity. However, this study limits its use to the quality of what is accessed. There is, therefore, service-delivery inaccessibility, when health care seekers can only access poor quality service, because of the poor quality of the equipment at the disposal of primary health care centres. Service-delivery equipment are, therefore, surrogate indicators of the quality of the health care services that are geographically accessible. Meth...

  15. Child Care and Mothers' Mental Health: Is High-Quality Care Associated with Fewer Depressive Symptoms?

    Science.gov (United States)

    Gordon, Rachel A.; Usdansky, Margaret L.; Wang, Xue; Gluzman, Anna

    2011-01-01

    Finding high-quality child care may pose financial and logistical challenges and create ongoing emotional strains for some mothers. We use the Study of Early Child Care and Youth Development to ask (a) are child-care settings that mothers select on the basis of their own perceptions of quality rated more highly by independent observers (and more…

  16. The importance of quality, access and price to health care consumers in Bulgaria: A self-explicated approach'

    NARCIS (Netherlands)

    Pavlova, M.; Groot, W.J.N.; van Merode, F.

    2003-01-01

    One approach to the problem of low patient satisfaction in Bulgaria is to identify attributes of health care services that the consumers value most and to focus on their improvement. Based on data from a household survey, this paper examines the importance that health care consumers attach to qualit

  17. The importance of quality, access and price to health care consumers in Bulgaria: A self-explicated approach'

    NARCIS (Netherlands)

    Pavlova, M.; Groot, W.J.N.; van Merode, F.

    2003-01-01

    One approach to the problem of low patient satisfaction in Bulgaria is to identify attributes of health care services that the consumers value most and to focus on their improvement. Based on data from a household survey, this paper examines the importance that health care consumers attach to

  18. An Assessment of the Electric Power Quality and Electrical Installation Impacts on Medical Electrical Equipment Operations at Health Care Facilities

    Directory of Open Access Journals (Sweden)

    Mário C.G. Ramos

    2009-01-01

    Full Text Available Problem statement: Medical electrical equipments at health care facilities presented malfunction and wrong medical information due to poor electric power quality and to inadequate electrical Installations. Some equipment such as X-ray, computerized axial tomography and magnetic resonance imaging are considered as polluting ones due to their high amount of harmonics and voltage transients produced on the electrical power supply when in operation, while other equipments, connected to the same power supply, are considered sensitive or victim ones, presenting failure or producing wrong. Approach: The effects on some sensitive medical electrical equipment were verified in a controlled environment at energy quality technological center of the technical school of the University of Sao Paulo. A heart monitor, pulmonary ventilator and pulse oxymeter equipment types were submitted to a controlled voltage supply with high harmonic content and voltage sags. The test methodology used simulated conditions based on Brazilian NBR standards, ANSI/IEEE Std. 519, IEC 60601 and IEC 61000-4-11 standards. Results: The results of the polluting equipment current consumption measurements as well as the three sensitive equipments tested were presented and discussed. The pulmonary ventilator presented problems that range from stoppage to expiratory valve blockage and alarm system failures. The pulse oxymeter presented display malfunctions and it was extremely sensitive to voltage sags. The heart monitor maintained steady operation in all test cases. Conclusion/Recommendations: In spite of several existing recommendations and standards for testing medical electrical equipments, there is a lack of standard related to test cases considering the effects of high harmonic and voltage sags. The quality of electrical installation in health care facilities needs to be improved to reduce risks to the patients and to provide better health treatment.

  19. Implementation and quality monitoring of e-communication across health care sectors

    DEFF Research Database (Denmark)

    Nicolaisen, Anne; Qvist, Peter

    and municipalities. The Sam:Bo agreement comprises guidelines for clinical pathways that involves more than one of the participating stakeholders and specified quality standards for the content and timeliness of information exchange across sectors. Part of the Sam:Bo agreement is the implementation of quality...... monitoring of specified quality standards. Objective: To monitor the implementation and quality of the Sam:Bo e-communication Method: An explicit audit performed in all local municipalities and at selected hospital departments from all hospital units in the Region of Southern Denmark. The audit was conducted...... in January-March 2015. Data will be analysed at the regional Centre for Quality. Results from each hospital and local municipalities will be presented at local audit meetings, in which challenges to address and subsequent initiatives are discussed. Results: The audit is ongoing and results will be presented...

  20. End-stage renal disease: a proving ground for quality improvement in health care.

    Science.gov (United States)

    Rutherford, W E; Gibney, R

    1997-05-01

    This article chronicles the health care quality improvement efforts that relate to patients with end stage renal disease (ESRD). The emphasis is on quality improvement as a management system as opposed to the quality improvements that resulted from strictly technical dialysis-related issues. The government has exercised considerable oversight on the ESRD program because of its growth and cost. History has shown that quality assurance (QA) has had little effect on improving quality or decreasing cost. The philosophy, methods, and tools of continuous quality improvement (CQI) have been shown to work in health care. CQI is a management system that offers hope for higher quality affordable health care. Computer technology is at last sophisticated enough to permit the collection of large amounts of clinical data at the point of care. This will permit CQI methods and tools to be applied generally at reasonable costs. Physicians in general and nephrologists in particular are beginning to understand the managed care environment. They are beginning to understand the paradigm shift that is required to effect the changes necessary for physicians to assume their leadership role in health care. This article reviews the quality efforts of the past and present. It discusses the strengths and weaknesses of efforts to improve quality and lastly presents a vision for the future.

  1. The provision and impact of online patient access to their electronic health records (EHR and transactional services on the quality and safety of health care: systematic review protocol

    Directory of Open Access Journals (Sweden)

    Freda Mold

    2013-09-01

    Full Text Available Background Innovators have piloted improvements in communication, changed patterns of practice and patient empowerment from online access to electronic health records (EHR. International studies of online services, such as prescription ordering, online appointment booking and secure communications with primary care, show good uptake of email consultations, accessing test results and booking appointments; when technologies and business process are in place. Online access and transactional services are due to be rolled out across England by 2015; this review seeks to explore the impact of online access to health records and other online services on the quality and safety of primary health care.Objective To assess the factors that may affect the provision of online patient access to their EHR and transactional services, and the impact of such access on the quality and safety of health care.Method Two reviewers independently searched 11 international databases during the period 1999–2012. A range of papers including descriptive studies using qualitative or quantitative methods, hypothesis-testing studies and systematic reviews were included. A detailed eligibility criterion will be used to shape study inclusion .A team of experts will review these papers for eligibility, extract data using a customised extraction form and use the Grading of Recommendations Assessment, Development and Evaluation (GRADE instrument to determine the quality of the evidence and the strengths of any recommendation. Data will then be descriptively summarised and thematically synthesised. Where feasible, we will perform a quantitative meta-analysis.Prospero (International Prospective Register of Systematic Reviews registration number: crd42012003091.

  2. Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia

    Science.gov (United States)

    Almutairi, Khalid M.

    2015-01-01

    Objectives: To identify, synthesize, and summarize issues and challenges related to the culture and language differences of the health workforce in Saudi Arabia. Methods: A comprehensive systematic review was conducted in May 2014 to locate published articles. Two independent researchers in consultation with several experts used 4 electronic databases (ISI Web of Knowledge, Science Direct, PubMed, and Cochrane) to scrutinize articles published from January 2000 - March 2014. Each of the studies was given a quality assessment rating of weak, moderate, or strong, and was evaluated for methodological soundness using Russell and Gregory’s criteria. Results: The online literature search identified 12 studies that met the inclusion criteria. Lack of knowledge of non-Muslim nurses or culture in Saudi Arabia, difficulties in achieving cultural competence, and culture shock were documented as cultural difference factors. Issues in language difference include the clarity of language use by health care providers in giving information and providing adequate explanation regarding their activities. Conclusion: The available information provided by this review study shows that there is a communication barrier between patients and health care workers such as healthcare workers demonstrate low cultural competency. Despite the fact that the government provides programs for expatriate healthcare workers, there is a need to further improve educational and orientation programs regarding the culture and language in Saudi Arabia. PMID:25828278

  3. Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia.

    Science.gov (United States)

    Almutairi, Khalid M

    2015-04-01

    To identify, synthesize, and summarize issues and challenges related to the culture and language differences of the health workforce in Saudi Arabia. A comprehensive systematic review was conducted in May 2014 to locate published articles. Two independent researchers in consultation with several experts used 4 electronic databases (ISI Web of Knowledge, Science Direct, PubMed, and Cochrane) to scrutinize articles published from January 2000 - March 2014. Each of the studies was given a quality assessment rating of weak, moderate, or strong, and was evaluated for methodological soundness using Russell and Gregory's criteria. The online literature search identified 12 studies that met the inclusion criteria. Lack of knowledge of non-Muslim nurses or culture in Saudi Arabia, difficulties in achieving cultural competence, and culture shock were documented as cultural difference factors. Issues in language difference include the clarity of language use by health care providers in giving information and providing adequate explanation regarding their activities. The available information provided by this review study shows that there is a communication barrier between patients and health care workers such as healthcare workers demonstrate low cultural competency. Despite the fact that the government provides programs for expatriate healthcare workers, there is a need to further improve educational and orientation programs regarding the culture and language in Saudi Arabia.

  4. 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.

  5. Team-based efforts to improve quality of care, the fundamental role of ethics, and the responsibility of health managers: monitoring and management strategies to enhance teamwork.

    Science.gov (United States)

    Kossaify, A; Hleihel, W; Lahoud, J-C

    2017-09-27

    Highlight the importance of teamwork in health care institutions by performing a review and discussion of the relevant literature. Review paper. A MEDLINE/Pubmed search was performed starting from 1990, and the terms 'team, teamwork, managers, healthcare, and cooperation' were searched in titles, abstracts, keywords, and conclusions; other terms 'patient safety, ethics, audits and quality of care' were specifically searched in abstracts and were used as additional filters criteria to select relevant articles. Thirty-three papers were found relevant; factors affecting the quality of care in health care institutions are multiple and varied, including issues related to individual profile, to administrative structure and to team-based effort. Issues affecting teamwork include mainly self-awareness, work environment, leadership, ethics, cooperation, communication, and competition. Moreover, quality improvement plans aiming to enhance and expand teams are essential in this context. Team monitoring and management are vital to achieve efficient teamwork with all the required qualities for a safer health system. In all cases, health managers' responsibility plays a fundamental role in creating and sustaining a teamwork atmosphere. Teamwork is known to improve outcomes in medicine, whether at the clinical, organizational, or scientific level. Teamwork in health care institutions must increasingly be encouraged, given that individual effort is often insufficient for optimal clinical outcome. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  6. Teaching quality essentials: the effectiveness of a team-based quality improvement curriculum in a tertiary health care institution.

    Science.gov (United States)

    Majka, Andrew J; Cook, Katlyn E; Lynch, Stacia L; Garovic, Vesna D; Ghosh, Amit K; West, Colin P; Feyereisn, Wayne L; Paat, John J; Williams, Brandon J; Hale, Curt W; Botz, Catherine T; Phul, Ashley E; Mueller, Paul S

    2013-01-01

    A unique quality improvement (QI) curriculum was implemented within the Division of General Internal Medicine to improve QI knowledge through multidisciplinary, team-based education, which also met the QI requirement for the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) and the Mayo Quality Fellows program. Participants completed up to 4 QI learning modules, including pretest and posttest assessments. A participant who successfully completed all 4 modules received certification as a Silver Quality Fellow and credit toward the quality requirement for ABIM MOC. Of 62 individuals invited to participate, 33 (53%) completed all 4 modules and corresponding pretests and posttests. Participants substantially improved knowledge in all 4 quality modules. Study group participants' pretest scores averaged 71.0%, and their posttest scores averaged 92.7%. Posttest scores of reference group participants compared favorably, averaging 89.2%. Initial assessments showed substantial knowledge improvements and successful implementation of staff-developed QI projects.

  7. Availability, utilisation and quality of maternal and neonatal health care services in Karamoja region, Uganda: a health facility-based survey.

    Science.gov (United States)

    Wilunda, Calistus; Oyerinde, Koyejo; Putoto, Giovanni; Lochoro, Peter; Dall'Oglio, Giovanni; Manenti, Fabio; Segafredo, Giulia; Atzori, Andrea; Criel, Bart; Panza, Alessio; Quaglio, Gianluca

    2015-04-08

    Maternal mortality is persistently high in Uganda. Access to quality emergency obstetrics care (EmOC) is fundamental to reducing maternal and newborn deaths and is a possible way of achieving the target of the fifth millennium development goal. Karamoja region in north-eastern Uganda has consistently demonstrated the nation's lowest scores on key development and health indicators and presents a substantial challenge to Uganda's stability and poverty eradication ambitions. The objectives of this study were: to establish the availability of maternal and neonatal healthcare services at different levels of health units; to assess their utilisation; and to determine the quality of services provided. A cross sectional study of all health facilities in Napak and Moroto districts was conducted in 2010. Data were collected by reviewing clinical records and registers, interviewing staff and women attending antenatal and postnatal clinics, and by observation. Data were summarized using frequencies and percentages and EmOC indicators were calculated. There were gaps in the availability of essential infrastructure, equipment, supplies, drugs and staff for maternal and neonatal care particularly at health centres (HCs). Utilisation of the available antenatal, intrapartum, and postnatal care services was low. In addition, there were gaps in the quality of care received across these services. Two hospitals, each located in the study districts, qualified as comprehensive EmOC facilities. The number of EmOC facilities per 500,000 population was 3.7. None of the HCs met the criteria for basic EmOC. Assisted vaginal delivery and removal of retained products were the most frequently missing signal functions. Direct obstetric case fatality rate was 3%, the met need for EmOC was 9.9%, and 1.7% of expected deliveries were carried out by caesarean section. To reduce maternal and newborn morbidity and mortality in Karamoja region, there is a need to increase the availability and the

  8. Demand assessment and price-elasticity estimation of quality-improved primary health care in Palestine: a contribution from the contingent valuation method.

    Science.gov (United States)

    Mataria, Awad; Luchini, Stéphane; Daoud, Yousef; Moatti, Jean-Paul

    2007-10-01

    This paper proposes a new methodology to assess demand and price-elasticity for health care, based on patients' stated willingness to pay (WTP) values for certain aspects of health care quality improvements. A conceptual analysis of how respondents consider contingent valuation (CV) questions allowed us to specify a probability density function of stated WTP values, and consequently, to model a demand function for quality-improved health care, using a parametric survival approach. The model was empirically estimated using a CV study intended to assess patients' values for improving the quality of primary health care (PHC) services in Palestine. A random sample of 499 individuals was interviewed following medical consultation in four PHC centers. Quality was assessed using a multi-attribute approach; and respondents valued seven specific quality improvements using a decomposed valuation scenario and a payment card elicitation technique. Our results suggest an inelastic demand at low user fees levels, and when the price-increase is accompanied with substantial quality-improvements. Nevertheless, demand becomes more and more elastic if user fees continue to rise. On the other hand, patients' reactions to price-increase turn out to depend on their level of income. Our results can be used to design successful health care financing strategies that include a consideration of patients' preferences and financial capacities.

  9. 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.

  10. Using Web sites on quality health care for teaching consumers in public libraries.

    Science.gov (United States)

    Oermann, Marilyn H; Lesley, Marsha L; VanderWal, Jillon S

    2005-01-01

    More and more consumers are searching the Internet for health information. Health Web sites vary in quality, though, and not all consumers are aware of the need to evaluate the information they find on the Web. Nurses and other health providers involved in patient education can evaluate Web sites and suggest quality sites for patients to use. This article describes a project we implemented in 2 public libraries to educate consumers about quality health care and patient safety using Web sites that we had evaluated earlier. Participants (n = 103) completed resources on health care quality, questions patients should ask about their diagnoses and treatment options, changes in Medicare and Medicare options or ways to make their health benefits work for them, and tips to help prevent medical errors. Most consumers were highly satisfied with the Web sites and the information they learned on quality care from these resources. Many participants did not have Internet access at home or work and instead used the library to search the Web. Information about the Web sites used in this project and other sites on quality care can be made available in libraries and community settings and as part of patient education resources in hospitals. The Web provides easy access for consumers to information about patient safety initiatives and health care quality in general.

  11. 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

  12. The health mediators-qualified interpreters contributing to health care quality among Romanian Roma patients.

    Science.gov (United States)

    Roman, Gabriel; Gramma, Rodica; Enache, Angela; Pârvu, Andrada; Moisa, Ştefana Maria; Dumitraş, Silvia; Ioan, Beatrice

    2013-11-01

    In order to assure optimal care of patients with chronic illnesses, it is necessary to take into account the cultural factors that may influence health-related behaviors, health practices, and health-seeking behavior. Despite the increasing number of Romanian Roma, research regarding their beliefs and practices related to healthcare is rather poor. The aim of this paper is to present empirical evidence of specificities in the practice of healthcare among Romanian Roma patients and their caregivers. Using a qualitative exploratory descriptive design, this study is based on data gathered through three focus groups with 30 health mediators in the counties of Iasi and Cluj (Romania). We identified various barriers to access to healthcare for Roma patients: lack of financial resources and health insurance coverage, lack of cognitive resources or lack of personal hygiene, but also important cultural issues, such as the shame of being ill, family function, disclosure of disease-related information, patient's autonomy, attitudes towards illness and health practices, that should be considered in order to create a culturally sensitive environment in Romanian medical facilities:… The role of the health mediators within the context of cultural diversity is also discussed, as cultural brokers contributing to health care quality among Romanian Roma patients Bridging cultural differences may improve patient-healthcare provider relationships, but may have limited impact in reducing ethnic disparities, unless coupled with efforts of Roma communities to get involved in creating and implementing health policies.

  13. Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012)

    Science.gov (United States)

    Flores-Hernández, Sergio; Saturno-Hernández, Pedro J.; Reyes-Morales, Hortensia; Barrientos-Gutiérrez, Tonatiuh; Villalpando, Salvador; Hernández-Ávila, Mauricio

    2015-01-01

    Background The quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico. Methods We conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (≥ 20 years) with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c) was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear) with combined data files, including survey year as covariate to assess change. Results Global quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension) were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94). Age more than 65 years old, the type of health subsystem, gender (males), and high socio-economic status were also significantly associated to glycemic control. Conclusions Quality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care. PMID:26230991

  14. Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012.

    Directory of Open Access Journals (Sweden)

    Sergio Flores-Hernández

    Full Text Available The quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico.We conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (≥ 20 years with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear with combined data files, including survey year as covariate to assess change.Global quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94. Age more than 65 years old, the type of health subsystem, gender (males, and high socio-economic status were also significantly associated to glycemic control.Quality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care.

  15. Association between sense of coherence and health-related quality of life among primary care patients with chronic musculoskeletal pain.

    Science.gov (United States)

    Chumbler, Neale R; Kroenke, Kurt; Outcalt, Samantha; Bair, Matthew J; Krebs, Erin; Wu, Jingwei; Yu, Zhangsheng

    2013-12-26

    Sense of Coherence (SOC) is a measure of an individual's capacity to use various coping mechanisms and resources when faced with a stressor. Chronic pain is one of the most prevalent and disabling conditions in clinical practice. This study examines the extent to which a strong SOC is associated with less pain and better health related quality of life (HRQoL) among patients with chronic pain. We analyzed data from the Stepped Care to Optimize Pain care Effectiveness (SCOPE) trial which enrolled 250 patients with persistent (3 months or longer) musculoskeletal pain who were receiving care in an United States Department of Veterans Affairs (VA) primary care clinic. The abbreviated three-item SOC scale was used to measure personal coping capability. Participants were categorized into Strong SOC (score 0-1) and Weak SOC (score 2-6). The Brief Pain Inventory (BPI) was used to assess the severity and disability associated with pain. Additionally, pain self-efficacy (ASES) and catastrophizing (CSQ) were assessed. HRQoL was assessed with the 36-item Short-Form Health Survey (SF-36) social functioning, vitality, and general health subscales. Multiple linear regression models were performed to examine whether SOC was independently associated with pain-specific and HRQoL outcomes, after adjusting for sociodemographic and socioeconomic characteristics, medical comorbidities and major depression. Of the 250 study patients, 61% had a strong SOC whereas 39% had a weak SOC. Multivariable linear regression analysis showed that a strong SOC was significantly associated with better general health, vitality, social functioning and pain self-efficacy as well as less pain catastrophizing. These significant findings were partially attenuated, but remained statistically significant, after controlling for major depression. SOC was not significantly associated with pain severity or pain disability. A strong SOC is associated with better HRQoL and self-efficacy as well as less

  16. Improving quality of care in maternal, newborn and child health: opportunities and challenges for India

    Directory of Open Access Journals (Sweden)

    K Jayanna

    2013-12-01

    Full Text Available Each year, more than 500000 mothers and nearly 4 million newborns die across the world due to causes related to pregnancy and child birth. 95% of these deaths occur in African and Asian countries (1. Deaths of newborns within the first 28 days contribute to 40% of all the under five deaths and a further three-fourth of the neonatal deaths occur within the first seven days after birth. While there has been considerable progress in the reduction of child deaths (13.2 million in 1990 to 9.2 million in 2007, the pace of reduction of maternal deaths has been slower (1. The causes of deaths are well known; effective preventive and curative interventions are available to address the causes of maternal, newborn and child deaths. While the countries are scaling up interventions, the lack of adequate focus on the quality of these interventions may affect the achievement of millennium development goals (MDG 4 and 5 targets for children and mothers respectively (2.  However, there have been attempts in the recent past to develop and study the feasibility of newer quality improvement tools and processes, especially in the context of developing countries (2. Audits have offered promise in this regard particularly, standards/criterion based audits (2. Developing a culture of quality within facilities and healthcare systems through the establishment of quality improvement teams and through identified champions is an important requisite for sustaining the focus on quality (3. 

  17. Mental Health Services in Special Education: An Analysis of Quality of Care

    Science.gov (United States)

    Santiago, Catherine DeCarlo; Kataoka, Sheryl H.; Forness, Steven R.; Miranda, Jeanne

    2014-01-01

    This article presents a collaborative study conducted in a large urban school district, in which the authors surveyed 55 clinicians within the special education system, with a focus on the mental health services provided to students who were receiving related-services counseling as a mandated component of their individualized education plan.…

  18. What does quality of care mean for maternal health providers from two vulnerable states of India? Case study of Bihar and Jharkhand.

    Science.gov (United States)

    Karvande, Shilpa; Sonawane, Devendra; Chavan, Sandeep; Mistry, Nerges

    2016-02-20

    Quality instillation has its own challenges, facilitators and barriers in various settings. This paper focuses on exploration of quality components related to practices, health system challenges and quality enablers from providers' perspectives with a focus on maternal health studied through a pilot research conducted in 2012-2013 in two states of India-Bihar and Jharkhand-with relatively poor indicators for maternal health. Qualitative data through in-depth interviews of 49 health providers purposively selected from various cadres of public health system in two districts each from Bihar and Jharkhand states was thematically analysed using MAXQDA Version 10. Maternity management guidelines developed by the National Health Mission, India, were considered as a tool to learn instillation of quality in provision of health services in various selected health facilities. Infrastructure, human resources, equipments and materials, drugs, training capacity and health information systems were described as health system challenges by medical and paramedical health providers. On a positive note, the study findings simultaneously identified quality enablers such as appreciation of public-private partnerships, availability of clinical guidelines in the form of wall posters in health facilities, efforts to translate knowledge and evidence through practice and enthusiasm towards value of guidelines. Against the backdrop of quality initiatives in the country to foster United Health Care (UHC), frontline health providers' perspectives about quality and safety need to be considered and utilized. The provision of adequate health infrastructure, strong health management information system, introduction of evidence-based education and training with supportive supervision must constitute parallel efforts.

  19. [Quality control and assessment of qualitative interview in health care research].

    Science.gov (United States)

    Xie, Yan-ming; Liao, Xing

    2008-07-01

    It is not finally concluded how to standardize the use of qualitative research in the world. Qualitative researchers disagree with each other about this issue. As we know, there have been a large number of articles written in different ways about qualitative research due to the "flexibility", one of its features. Qualitative research is quite different from quantitative research which is easy to control its quality and quality assessment. A series of criteria has been set up for quantitative research. However qualitative research needs to be improved in these aspects, in which qualitative interviews are mostly used at home and abroad at present. Hence, it becomes an important and urgent issue for qualitative researchers to standardly control and assess the quality of qualitative interview.

  20. Publication guidelines for quality improvement studies in health care: evolution of the SQUIRE project.

    Science.gov (United States)

    Davidoff, Frank; Batalden, Paul; Stevens, David; Ogrinc, Greg; Mooney, Susan E

    2009-01-19

    In 2005 we published draft guidelines for reporting studies of quality improvement, as the initial step in a consensus process for development of a more definitive version. The current article contains the revised version, which we refer to as standards for quality improvement reporting excellence (SQUIRE). This narrative progress report summarises the special features of improvement that are reflected in SQUIRE, and describes major differences between SQUIRE and the initial draft guidelines. It also briefly describes the guideline development process; considers the limitations of and unresolved questions about SQUIRE; describes ancillary supporting documents and alternative versions under development; and discusses plans for dissemination, testing, and further development of SQUIRE.

  1. A Disproportionate Burden of Care: Gender Differences in Mental Health, Health-Related Quality of Life, and Social Support in Mexican Multiple Sclerosis Caregivers

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    Paul B. Perrin

    2015-01-01

    Full Text Available Background. Multiple sclerosis (MS rates in Latin America are increasing, and caregivers there experience reduced mental and physical health. Based on rigid gender roles in Latin America, women more often assume caregiving duties, yet the differential impact on women of these duties is unknown. Methods. This study examined gender differences in mental health (Patient Health Questionnaire-9, Satisfaction with Life Scale, Rosenberg Self-Esteem Scale, State-Trait Anxiety Inventory, and Zarit Burden Inventory, health-related quality of life (HRQOL; Short Form-36, and social support (Interpersonal Support Evaluation List-12 in 81 (66.7% women Mexican MS caregivers. Results. As compared to men caregivers, women had lower mental health (p=0.006, HRQOL (p<0.001, and social support (p<0.001. This was partially explained by women caregivers providing care for nearly twice as many hours/week as men (79.28 versus 48.48, p=0.018 and for nearly three times as many months (66.31 versus 24.30, p=0.002. Conclusions. Because gender roles in Latin America influence women to assume more substantial caregiving duties, MS caregiver interventions in Latin America—particularly for women caregivers—should address the influence of gender-role conformity on care and psychosocial functioning.

  2. [The Federal Law "On the fundamentals of health protection of citizen in the Russian Federation" and the issues of management of medical care quality].

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    Lindenbraten, A P

    2012-01-01

    The article deals with the analysis of main statutory provisions of the Federal Law of the Russian Federation No 323-FZ of 21.11.2011 "On the fundamentals of health protection of citizen in the Russian Federation", concerning the issue of medical care quality.

  3. Assessment of the quality of antenatal care services provided by health workers using a mobile phone decision support application in northern Nigeria: a pre/post-intervention study.

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    Marion McNabb

    Full Text Available Given the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre.Using the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care.Overall, the quality score increased from 13.3 at baseline to 17.2 at endline (p<0.0001, out of a total possible score of 25, with the most significant improvements related to health counseling, technical services provided, and quality of health education.These study results suggest that the introduction of a low-cost mobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes.

  4. Assessing Quality across Health Care Subsystems in Mexico

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    Puig, Andrea; Pagán, José A.; Wong, Rebeca

    2012-01-01

    Recent healthcare reform efforts in Mexico have focused on the need to improve the efficiency and equity of a fragmented healthcare system. In light of these reform initiatives, there is a need to assess whether healthcare subsystems are effective at providing high-quality healthcare to all Mexicans. Nationally representative household survey data from the 2006 Encuesta Nacional de Salud y Nutrición (National Health and Nutrition Survey) were used to assess perceived healthcare quality across different subsystems. Using a sample of 7234 survey respondents, we found evidence of substantial heterogeneity in healthcare quality assessments across healthcare subsystems favoring private providers over social security institutions. These differences across subsystems remained even after adjusting for socioeconomic, demographic, and health factors. Our analysis suggests that improvements in efficiency and equity can be achieved by assessing the factors that contribute to heterogeneity in quality across subsystems. PMID:19305224

  5. The impact of perceived social support and sense of coherence on health-related quality of life in multimorbid primary care patients.

    Science.gov (United States)

    Vogel, Ines; Miksch, Antje; Goetz, Katja; Ose, Dominik; Szecsenyi, Joachim; Freund, Tobias

    2012-12-01

    This study explores the impact of perceived social support and sense of coherence as positive resources for health-related quality of life in multimorbid primary care patients. We analysed cross-sectional survey data on health-related quality of life (EQ-5D), perceived social support (FSozU-K22), sense of coherence (SOC-L9), social demographics and self reported morbidity of 103 multimorbid patients from 10 general practices in Germany. A multiple linear regression model was used to determine the impact of social support and sense of coherence on the health-related quality of life while controlling for age, sex, educational level, marital status and number of chronic conditions. In the final regression model, higher sense of coherence scores were associated with higher health-related quality of life scores (standardized ß 0.34, p life scores (standardized ß -0.41, p life scores (standardized ß 0.35, p sense of coherence which is a potential resource for improving health-related quality of life in multimorbid primary care patients. It emerged as a significant element contributing to the prediction of health-related quality of life. This issue may indicate the importance of internal resources for multimorbid patients.

  6. Project-based teaching in health informatics: a course on health care quality improvement.

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    Moehr, J R; Berenji, G R; Green, C J; Kagolovsky, Y

    2001-01-01

    Teaching the skills and knowledge required in health informatics [1] is a challenge because the skill of applying knowledge in real life requires practice. We relate the experience with introducing a practice component to a course in "Health Care Quality Improvement". Working health care professionals were invited to bring an actual quality problem from their place of work and to work alongside students in running the problem through a quality improvement project lifecycle. Multiple technological and process oriented teaching innovations were employed including project sessions in observation rooms, video recording of these sessions, generation of demonstration examples and distance education components. Both students and their collaborators from the work place developed proficiency in applying quality improvement methods as well as in experiencing the realities of group processes, information gaps and organizational constraints. The principles used to achieve high involvement of the whole class, the employed resources and technical support are described. The resulting academic and practical achievements are discussed in relation to the alternative instructional modalities, and with respect to didactic implications for similar endeavors and beyond to other fields such as systems engineering.

  7. Informatics Implementation in the Veterans Health Administration (VHA) Healthcare System to Improve Quality of Care

    Science.gov (United States)

    Doebbeling, Bradley N.; Vaughn, Thomas E.; McCoy, Kimberly D.; Glassman, Peter

    2006-01-01

    We describe VHA’s information technology (IT) implementation from the providers’ perspective, and identify factors influencing its effective implementation to improve care. We surveyed a stratified random national sample of 4227 clinicians from three VHA primary care provider groups: 1) physicians; 2) nurse practitioners, physician assistants; and 3) nurses. Facility-level IT support availability was rated across six dimensions: 1) access to literature/evidence, 2) computerized decision support, 3) computerized clinical data, 4) error reduction, 5) provider communication, and 6) patient communication. Factor analysis identified a 5-item scale (IT clinical support, α = 0.76). Generalized estimating equation models identified factors influencing IT clinical support. Complete data from 123 hospitals (1777 providers) were included. The final model showed IT clinical support was higher in hospitals that were urban (p<0.05) and had cooperative cultures (p<0.01). Opportunities exist to enhance effective use of IT to support clinical decision making, electronic communication with patients and access to recommendations while delivering care. PMID:17238332

  8. Nurse reported quality of care: a measure of hospital quality.

    Science.gov (United States)

    McHugh, Matthew D; Stimpfel, Amy Witkoski

    2012-12-01

    As the primary providers of round-the-clock bedside care, nurses are well positioned to report on hospital quality of care. Researchers have not examined how nurses' reports of quality correspond with standard process or outcomes measures of quality. We assess the validity of evaluating hospital quality by aggregating hospital nurses' responses to a single item that asks them to report on quality of care. We found that a 10% increment in the proportion of nurses reporting excellent quality of care was associated with lower odds of mortality and failure to rescue; greater patient satisfaction; and higher composite process of care scores for acute myocardial infarction, pneumonia, and surgical patients. Nurse reported quality of care is a useful indicator of hospital performance. Copyright © 2012 Wiley Periodicals, Inc.

  9. Quality end-of-life care: A global perspective

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    Singer Peter A

    2002-07-01

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

  10. Quality end-of-life care: A global perspective.

    Science.gov (United States)

    Singer, Peter A; Bowman, Kerry W

    2002-07-25

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

  11. The role of nursing informatics on promoting quality of health care and the need for appropriate education.

    Science.gov (United States)

    Darvish, Asieh; Bahramnezhad, Fatemeh; Keyhanian, Sara; Navidhamidi, Mojdeh

    2014-06-25

    In today's dynamic health systems, technology plays an important role in education and nursing work. So it seems necessary to study the role of nurses and highlight the need for appropriate information technology educational programs to integrate with the ever-increasing pace of technology. A review accompanied by an extensive literature search in databases and a library search focused on the keywords were used. The criteria used for selecting studies primarily focused on nursing informatics and the importance of expertise in the effective use of information technology in all aspects of the nursing profession. In a critical assessment of emerging technologies, the key elements of nursing informatics implementation were considered as healthcare promotion, advanced systems, internet and network. In view of the nature and the development of the information age, it is required to receive necessary IT training for all categories of nurses. Due to the fast development of technology, in order to effectively take advantage of information technology in nursing outcome and quality of health care and to empower nurses; educational arrangement is recommended to set short-term and long-term specialized courses focusing on four target groups: studying, working, graduate, senior undergraduate, and graduate doctoral. The result of this study is expected to assist educational providers with program development.

  12. 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

  13. Children's Health, Access to Services and Quality of Care. Revised Executive Summary.

    Science.gov (United States)

    Dutton, Diana B.

    This research investigated factors affecting children's health, based on empirical analyses of data from Washington, D.C. and national data. By most measures, poor children experience disproportionate morbidity and mortality. Yet certain ear and vision problems exhibit a U-shaped relation to family income in both national statistics and the…

  14. Quality of diabetes care in Arab Americans.

    Science.gov (United States)

    Berlie, Helen D; Herman, William H; Brown, Morton B; Hammad, Adnan; Jaber, Linda A

    2008-02-01

    The quality of care received by Arab American patients with type 2 diabetes residing in a city with a large migrant Arab population has not been examined. Arab American adults with a self-reported diagnosis of diabetes were identified in a rigorous cross-sectional, population-based epidemiologic study conducted in Dearborn, MI. Quality of diabetes care was determined by assessing adherence to the American Diabetes Association (ADA) clinical practice recommendations. The Third National Health and Nutrition Examination Survey (NHANES) and the Behavioral Risk Factor Surveillance System (BRFSS) provided data for a national comparison. Among the 53 participants, mean age was 59+/-12 years and the mean duration of diabetes was 11.3+/-13.3 years. The ADA goal for an A1c of Arab American subjects studied were treated less aggressively with pharmacologic agents than recommended by the ADA. 26% of the Arab Americans had an A1c>9.5% as compared to 18% of the national population. Arab Americans generally had worse blood pressure control but better lipid control compared to the national sample. This is the first report of the quality of diabetes care in an Arab American population, and demonstrates sub-optimal quality of care according to the ADA clinical practice recommendations.

  15. Health-related quality of life and rehabilitation cost following intensive care unit stay in multiple trauma patients.

    Science.gov (United States)

    Stergiannis, Pantelis; Katsoulas, Theodoros; Fildissis, George; Intas, George; Galanis, Peter; Kosta, Natalia; Zidianakis, Vasilios; Baltopoulos, George

    2014-01-01

    The objective of this study was to assess changes in health-related quality of life (HRQOL) in multiple trauma patients due to motor vehicle crashes during a follow-up period of 2 years after discharge from an intensive care unit (ICU) and the effect of income and financial cost of rehabilitation in HRQOL. The study was a prospective observational study of multiple trauma patients from January 2009 to January 2011 who were hospitalized in a general, medical, and surgical ICU of a district hospital in Athens, Greece. Eighty-five patients with multiple traumas due to motor vehicle crashes and with an ICU stay of more than 24 hours were included in the study. HRQOL was assessed by a general questionnaire, the EuroQol 5D. Increased monthly household income and absence of traumatic brain injuries were associated with an improved EQ-VAS score. The frequency of severe problems in mobility, self-care, usual activities, pain/discomfort, and anxiety/depression decreased over time. The financial cost of rehabilitation was initially high but decreased over time. Severely injured victims of motor vehicle crashes suffer from serious problems in terms of HRQOL which is gradually improved even 2 years after hospital discharge. In addition, HRQOL is significantly related to income. Resources use