Braspenning, Jozé C. C.; Wolters, René J.; Bouma, Margriet; de Grauw, Wim J. C.; Wensing, Michel
Abstract Objective. Randomized trials showed that changes in healthcare organization improved diabetes care. This study aimed to identify which organizational determinants were associated with patient outcomes in routine diabetes care. Design. Observational study, in which multilevel regression analyses were applied to examine the impact of 12 organizational determinants on diabetes care as separate measures and as a composite score. Setting. Primary care practices in the Netherlands. Subjects. 11,751 patients with diabetes in 354 practices. Main outcome measures. Patients’ recorded glycated hemoglobin (HbA1c), systolic blood pressure, and serum cholesterol levels. Results. A higher score on the composite measure of organizational determinants was associated with better control of systolic blood pressure (p = 0.017). No effects on HbA1C or cholesterol levels were found. Exploration of specific organizational factors found significant impact of use of an electronic patient registry on HbA1c (OR = 1.80, 95% CI 1.12–2.88), availability of patient leaflets on systolic blood pressure control (OR = 2.59, 95% CI 1.06–6.35), and number of hours’ nurse education on cholesterol control (OR = 2.51, 95% CI 1.02–6.15). Conclusion. In routine primary care, it was found that favorable healthcare organization was associated with a number of intermediate outcomes in diabetes care. This finding lends support to the findings of trials on organizational changes in diabetes care. Notably, the composite measure of organizational determinants had most impact. PMID:25264939
Siebum, Wim; Pijl, Ysbrand J.; de Wolf, G. Sander
Routine outcome monitoring (ROM) is used to improve quality of health care by improving the process of care. ROM was introduced nationwide in mental health care in the Netherlands with the primary goal of enhancing the quality of treatment. This study aims to establish the impact of ROM on the
Theiss, Stephan; Günzel, Franziska; Storm, Anna
: Routine clinical data from the HELIOS hospital information system were compared before and after implementation of the NeuroNet concept, including neurologic acute stroke teleconsultations, standard operating procedures, and peer review quality management in 3 hospital cohorts: 5 comprehensive stroke...... for thrombolytic therapy in comprehensive stroke centers compared to NeuroNet hospitals was reduced from 3.7 to 1.3 between 2006 and 2009. Comprehensive stroke care coding according to German Diagnosis Related Groups definitions increased by 45% in NeuroNet (P ...: Routine clinical data on in-hospital mortality, the rate of thrombolytic therapy, and comprehensive stroke care coding reflect different aspects of acute stroke care improvement related to the implementation of the telemedical NeuroNet concept and unified quality management (standard operating procedure...
Eagar, Kathy; Watters, Prue; Currow, David C; Aoun, Samar M; Yates, Patsy
Australia is leading the way in establishing a national system (the Palliative Care Outcomes Collaboration - PCOC) to measure the outcomes and quality of specialist palliative care services and to benchmark services across the country. This article reports on analysis of data collected routinely at point-of-care on 5939 patients treated by the first fifty one services that voluntarily joined PCOC. By March 2009, 111 services have agreed to join PCOC, representing more than 70% of services and more than 80% of specialist palliative care patients nationally. All states and territories are involved in this unique process that has involved extensive consultation and infrastructure and close collaboration between health services and researchers. The challenges of dealing with wide variation in outcomes and practice and the progress achieved to date are described. PCOC is aiming to improve understanding of the reasons for variations in clinical outcomes between specialist palliative care patients and differences in service outcomes as a critical step in an ongoing process to improve both service quality and patient outcomes.
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.
Onta, S R; Sabroe, S; Hansen, E H
different vaccines during one year was obtained from three sources: 1) the Immunization REgister of three Primary Health Care Service Outlets (PHCSOs) where each immunized child is recorded; 2) monthly PHC Reports, which are based on the Immunization Register; 3) monthly DHO Reports, which are based...... on the above PHC Reports (the DHO reports are the source of official statistics). The number of children in the PHC Reports was higher than the number in the Immunization REgisters for all vaccines. The number of immunizations in the DHO Reports was higher than the number in the PHC Reports for BCG, DPT......, and measles; the number was lower for poliomyelitis. The overall number of immunizations was higher in the DHO Reports than in the Immunization Registers, by 31% for BCG, 44% for DPT, 155% for polio, and 71% for measles. We conclude that the official report overestimates the immunization coverage...
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
Full Text Available Abstract Background Not all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem. The purpose of this study was to assess the utility of various data sources in providing feedback on the quality of cancer care. Methods Published clinical practice guidelines were used to obtain a list of processes-of-care of interest to clinicians. These were assigned to one of four data categories according to their availability and the marginal cost of using them for feedback. Results Only 8 (3% of 243 processes-of-care could be measured using population-based registry or administrative inpatient data (lowest cost. A further 119 (49% could be measured using a core clinical registry, which contains information on important prognostic factors (e.g., clinical stage, physiological reserve, hormone-receptor status. Another 88 (36% required an expanded clinical registry or medical record review; mainly because they concerned long-term management of disease progression (recurrences and metastases and 28 (11.5% required patient interview or audio-taping of consultations because they involved information sharing between clinician and patient. Conclusion The advantages of population-based cancer registries and administrative inpatient data are wide coverage and low cost. The disadvantage is that they currently contain information on only a few processes-of-care. In most jurisdictions, clinical cancer registries, which can be used to report on many more processes-of-care, do not cover smaller hospitals. If we are to provide feedback about all patients, not just those in larger academic hospitals with the most developed data systems, then we need to develop sustainable population-based data systems that capture information on prognostic factors at the time of initial diagnosis and information on management of disease progression.
be replicated, the way they are influenced by the organisation and the way they influence health care professionals. Design/methodology/approach: Theory of routines is systematically applied to the concept of care pathways in order to develop theoretically derived propositions. Findings: Care pathways mirror...
Ney, JP; Van Der Goes, DN; Nuwer, MR; Nelson, L; Eccher, MA
Objectives: To evaluate the effect of intensive care unit continuous EEG (cEEG) monitoring on inpatient mortality, hospital charges, and length of stay. Methods: A retrospective cross-sectional study was conducted using the Nationwide Inpatient Sample, a dataset representing 20% of inpatient discharges in nonfederal US hospitals. Adult discharge records reporting mechanical ventilation and EEG (routine EEG or cEEG) were included. cEEG was compared with routine EEG alone in association with th...
Schermer, T.R.J.; Crockett, A.J.; Poels, P.J.P.; Dijke, J.J. van; Akkermans, R.P.; Vlek, H.F.; Pieters, W.R.
BACKGROUND: Spirometry is an indispensable tool for diagnosis and monitoring of chronic airways disease in primary care. AIM: To establish the quality of routine spirometry tests in general practice, and explore associations between test quality and patient characteristics. DESIGN OF STUDY: Analysis
Assessing the quality of life of adults with chronic respiratory diseases in routine primary care: construction and first validation of the 10-Item Respiratory Illness Questionnaire-monitoring 10 (RIQ-MON10).
Jacobs, J.E.; Maille, A.R.; Akkermans, R.P.; Weel, C. van; Grol, R.P.T.M.
BACKGROUND: As doctors' judgements about the burden of a disease often differ from patients' own assessments a manageable method to incorporate the latter into routine care might support patient-centered decision-making. For this purpose we shortened the 55-Item Quality of Life for Respiratory
Schermer, Tjard RJ; Crockett, Alan J; Poels, Patrick JP; van Dijke, Jacob J; Akkermans, Reinier P; Vlek, Hans F; Pieters, Willem R
Background Spirometry is an indispensable tool for diagnosis and monitoring of chronic airways disease in primary care. Aim To establish the quality of routine spirometry tests in general practice, and explore associations between test quality and patient characteristics. Design of study Analysis of routine spirometry test records. Setting Fifteen general practices which had a working agreement with a local hospital pulmonary function laboratory for spirometry assessment regarding test quality and interpretation. Method Spirometry tests were judged by a pulmonary function technician and a chest physician. Proportions of test adequacy were analysed using markers for manoeuvre acceptability and test reproducibility derived from the 1994 American Thoracic Society spirometry guideline. Associations between quality markers and age, sex, and severity of obstruction were examined using logistic regression. Results Practices performed a mean of four (standard deviation = 2) spirometry tests per week; 1271 tests from 1091 adult patients were analysed; 96.4% (95% confidence interval [CI] = 95.6 to 97.2) of all tests consisted of ≥3 blows. With 60.6% of tests, forced expiratory time was the marker with the lowest acceptability rate. An overall 38.8% (95% CI = 36.0 to 41.6) of the tests met the acceptability as well as reproducibility criteria. Age, sex, and severity of obstruction were associated with test quality markers. Conclusion The quality of routine spirometry tests was better than in previous reports from primary care research settings, but there is still substantial room for improvement. Sufficient duration of forced expiratory time is the quality marker with the highest rate of inadequacy. Primary care professionals should be aware of patient characteristics that may diminish the quality of their spirometry tests. Further research is needed to establish to what extent spirometry tests that are inadequate, according to stringent international expert criteria
Ong, Jeremy; Brennsteiner, Alex; Chow, Elizabeth; Hebert, Randy S
The quality of communication and support provided to families is associated with greater satisfaction with hospice care. Prior work has not explored whether the predictors of family satisfaction are different in different hospice care settings. The study objective was to explore whether correlates of family satisfaction are different in general inpatient hospice care versus routine home hospice care. Survey data from bereaved family members of approximately 1600 patients from a nonprofit, midsized hospice in western Pennsylvania were used. Data was obtained from Family Evaluation of Hospice Care (FEHC) survey responses from 2008-2013 and separated into two groups, general inpatient hospice care and routine home hospice care. The analysis was completed using a binomial logistic regression model. Three variables were associated with greater overall satisfaction in both care settings: being kept informed about the patient's condition (adjusted odds ratio [AOR]: 9.64, CI: 6.56-14.36); being provided with clear/consistent information (AOR: 2.34, CI: 1.47-3.72); and the perception that patients were provided with adequate treatment for anxiety (AOR: 2.64, CI: 1.19-5.81). Two variables, sufficient discussion with hospice team members concerning family members' religious or spiritual beliefs (AOR: 1.64, CI: 1.17-2.30) and being provided with the correct amount of emotional support after the patient's death (AOR: 2.01, CI: 1.10-3.66), were correlated with greater satisfaction in routine home hospice care only. Good communication is strongly associated with greater family satisfaction across hospice care settings. Hospices must ensure that they provide patients and families with consistent information and support.
de Wit, M.; Winterdijk, P.; Aanstoot, H.J.; Anderson, B.; Danne, T.; Deeb, L.; Lange, K.; Nielsen, A.O.; Skovlund, S.; Peyrot, M.; Snoek, F.J.
Aim: It is recommended to assess health-related quality of life (HRQoL) in teenagers with diabetes as part of their ongoing medical care. Here, we describe the development and psychometric evaluation of the Monitoring Individual Needs in Diabetes Youth Questionnaire (MY-Q), a multi-dimensional
Scullin, Claire; Hogg, Anita; Luo, Ruoyin; Scott, Michael G; McElnay, James C
Previous service development work in the area of integrated medicines management (IMM) has demonstrated clear quality improvements in a targeted group of patients within a hospital in Northern Ireland. In order to determine whether this programme could be transferable to routine practice and thereby assess its generalizability, research has been carried out to quantify the health care benefits of incorporating the concept of IMM as routine clinical practice. The IMM programme of care was delivered to all eligible patients (subject to inclusion criteria) across two hospital sites in Northern Ireland during normal pharmacy opening hours. All patients were followed up for a period of 12 months from their time of hospital admission. All patient data were collected using the custom-designed Electronic Pharmacist Intervention Clinical System at each stage of their hospital journey, that is, admission, inpatient stay and discharge. Patients who received the IMM service benefited from a reduced length of hospital stay on their reference admission (1.42 days; P = 0.020) as well as a reduced length of stay during the first rehospitalization (5.86 days; P = 0.013). There was also a trend of a reduced number of readmissions and a longer time to readmission during the 12-month follow-up period. Potential significant opportunity cost savings were demonstrated as well as a significant improvement in medication appropriateness (discharge vs. reference admission). The IMM programme of care has proven to be transferable to routine hospital care within two hospitals in Northern Ireland. It is anticipated that this current research will further inform the development of IMM as routine clinical practice across Northern Ireland and beyond. © 2011 Blackwell Publishing Ltd.
Peterson-Sweeney, Kathleen; Halterman, Jill S; Conn, Kelly; Yoos, H Lorrie
This article provides the results of a study utilizing baseline data from the School-Based Asthma Therapy Trial, an ongoing comprehensive school-based intervention for urban children. We examined the effect of family routines as measured by the Asthma Routines Questionnaire on asthma care measures of trigger control and medication adherence, as well as on parental quality of life. We found that families with more asthma routines had better adherence with preventive medications (r = .36) and less exposure to environmental triggers (r = -.22). These findings suggest that assisting families in developing routines around asthma care might improve preventive care for urban youth. Copyright © 2010 Elsevier Inc. All rights reserved.
Fiese, Barbara H; Wamboldt, Frederick S; Anbar, Ran D
To develop a reliable measure of asthma management routines and examine its association with health care utilization, medical adherence, and quality of life. Families (n = 153) with a child with asthma, drawn from two sites, participated in the study. Parents completed the Asthma Routines Questionnaire, Adherence to Clinical Trials interview, Functional Severity of Asthma Questionnaire, and Caregiver Quality of Life. Children completed the Pediatric Quality of Life. Electronic monitoring of medication use over a period of 12 months was available for children at one study site. A principal component factor analysis revealed two dimensions to the Asthma Routines Questionnaire: Medication Routines and Routine Burden. Medication Routines were related to medical adherence and to health care utilization. Routine Burden was related to caregiver and child quality of life. The Asthma Routine Questionnaire holds promise as a reliable assessment of family practices related to medication use. The emotional burden of daily care can be distinguished from medication use, which is more closely linked to adherence issues. Targeted questions during regular care may reveal family routine practices amenable to intervention.
Vis, J Y; Huisman, A
Verification of hematology analyzers (automated blood cell counters) is mandatory before new hematology analyzers may be used in routine clinical care. The verification process consists of several items which comprise among others: precision, accuracy, comparability, carryover, background and linearity throughout the expected range of results. Yet, which standard should be met or which verification limit be used is at the discretion of the laboratory specialist. This paper offers practical guidance on verification and quality control of automated hematology analyzers and provides an expert opinion on the performance standard that should be met by the contemporary generation of hematology analyzers. Therefore (i) the state-of-the-art performance of hematology analyzers for complete blood count parameters is summarized, (ii) considerations, challenges, and pitfalls concerning the development of a verification plan are discussed, (iii) guidance is given regarding the establishment of reference intervals, and (iv) different methods on quality control of hematology analyzers are reviewed. © 2016 John Wiley & Sons Ltd.
Vis, J Y; Huisman, A|info:eu-repo/dai/nl/255170653
Verification of hematology analyzers (automated blood cell counters) is mandatory before new hematology analyzers may be used in routine clinical care. The verification process consists of several items which comprise among others: precision, accuracy, comparability, carryover, background and
Mansano-Schlosser, Thalyta Cristina; dos Santos, Ariene Angelini; Camargo-Rossignolo, Simone de Oliveira; Freitas, Denise Cuoghi de Carvalho Veríssimo; Lorenz, Vera Regina; Ceolim, Maria Filomena
This is a descriptive cross-sectional study, which aimed to identify the perception of nursing home elderly residents related to the chronological organization of their daily routines and to their sleep quality...
Accuracy and Quality of Routine Immunisation Data Monitoring System in two South-Eastern Districts of Nigeria. ... Methods A validated methodology of immunisation Data Quality Audit was used. All the Health Facilities (HFs) conducting immunisation in OGB (28) and ONN (20) as well as the two LGAs' Immunisation Units ...
Wright, Diane; Pincombe, Jan; McKellar, Lois
Listening to women as part of their antenatal care has been recognized as valuable in understanding the woman's needs. Conversations as part of routine antenatal interactions offer ideal opportunities for women to express themselves and for midwives to learn about the woman's issues and concerns. The antenatal visit and the convention of antenatal consultations for midwives have not been well explored or defined and much of what takes place replicate medical consultative processes. As a consequence, there is little to assist midwives construct woman-centred care consultations for their routine antenatal care practice. This study showed how some practices were better in promoting the woman's voice and woman-centred care in the hospital setting. Contemporary focused ethnography using both interview and observations, explored how midwives from six different public antenatal clinics in South Australia organized their antenatal care consultations with pregnant women. Thematic analysis of the data provided insights into professional interpretation of woman-centred practice. How midwives interacted with women during routine antenatal care events demonstrated that some practices in a hospital setting could either support or undermine a woman-centred philosophy. Individual midwives adopted practices according to their own perceptions of actions and behaviors that were considered to be in accordance with the philosophy of woman-centred care. Information arising from this study has shown ways midwives may arrange antenatal care consultations to maximize women's participation. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Hetland, Merete Lund; Jensen, Dorte Vendelbo; Krogh, Niels Steen
, little is known about the feasibility of a T2T strategy in patients with rheumatoid arthritis (RA) treated in routine care. The aim of the present study was to (i) present the annual number of patients included in DANBIO between 2006 and 2013 and their disease characteristics and (ii) estimate coverage...
Nickelsen, Niels Christian Mossfeldt
Care routines, feeding assistive robotics and the disabled body Niels Christian Mossfeldt NickelsenAbstract for 4S, Barcelona, track 62. Short abstract 300 signs including spacesSeveral feeding assistive robotics are described in the literature, but few studies have explored the reception. I report...
Westland, Heleen; Schröder, Carin D; de Wit, Jessica; Frings, Judith; Trappenburg, Jaap C A; Schuurmans, Marieke J
To examine how and to what extent self-management support, including behaviour change support, is provided by primary care nurses in routine consultations with chronically ill patients. Observational study design. Routine consultations of primary care nurses in the Netherlands with chronically ill patients were audio-taped and analysed. The analysis identified health topics addressed according to health care standards, self-management topics addressed using a validated set of topics, and behaviour change techniques (BCTs) using the Behaviour Change Techniques Taxonomy v1. Seventy-eight routine consultations of 17 primary care nurses with chronically ill patients were included in the analysis. Nurses addressed both health topics and self-management topics in brief, fragmented, and often inconsistent manners. Dietary intake and physical activity were the most frequently addressed topics. Nurses applied 21 BCTs to target behaviour change, but the use of these techniques was mainly inconsistent and implicit. The most consistently used BCTs were review behaviour goal(s) (56.4%) and feedback on behaviour (51.3%). Nurses addressed both health topics and self-management topics in their routine consultations. The duration, frequency, and number of addressed topics differed throughout the consultations. Nurses tended to prioritize the monitoring and optimization of patients' medical treatment and provided limited self-management support. Nurses seldom deepened their focus on behaviour change and infrequently used effective techniques to support this change. Adoption of self-management in primary care, including behaviour change, might be enhanced if nurses consistently and explicitly use effective BCTs in their consultations. Statement of contribution What is already known on this subject? Primary care nurses play a pivotal role in self-management support for patients with a chronic condition. Adequate self-management support requires nurses to activate patients and enhance
Background: Primary care for frail older people is reported to be suboptimal. A transition toward proactive patient-centred care is needed. We investigated the effectiveness of U-PRIM, a frailty screening intervention based on routine care data, and of U-PRIM followed by U-CARE, a nurse-led
Good Quality is an assemblage ethnography of how sperm banking came to be routinized in China. Based on 8 years of episodic fieldwork at China’s oldest and largest sperm bank in Changsha, Hunan province, the book meticulously chronicles how, beginning in the early 1980s, a unique style of sperm b...... banking would emerge in China, shaped by the cultural, juridical, economic and social configurations that make up China’s restrictive reproductive complex....
Full Text Available The determination of the sensorial quality of wines is of great interest for wine consumers and producers since it declares the quality in most of the cases. The sensorial assays carried out by a group of experts are time-consuming and expensive especially when dealing with large batches of wines. Therefore, an attempt was made to assess the possibility of estimating the wine sensorial quality with using routinely measured chemical descriptors as predictors. For this purpose, 131 Slovenian red wine samples of different varieties and years of production were analysed and correlation and principal component analysis were applied to find inter-relations between the studied oenological descriptors. The method of artificial neural networks (ANNs was utilised as the prediction tool for estimating overall sensorial quality of red wines. Each model was rigorously validated and sensitivity analysis was applied as a method for selecting the most important predictors. Consequently, acceptable results were obtained, when data representing only one year of production were included in the analysis. In this case, the coefficient of determination (R2 associated with training data was 0.95 and that for validation data was 0.90. When estimating sensorial quality in categorical form, 94 % and 85 % of correctly classified samples were achieved for training and validation subset, respectively.
Dark, Frances; Whiteford, Harvey; Ashkanasy, Neal M; Harvey, Carol; Crompton, David; Newman, Ellie
Treatment outcomes for people diagnosed with psychosis remain suboptimal due in part to the limited systematic application of evidence based practice (Adm Policy Ment Health, 36: 1-7, 2009) . The Implementation science literature identifies a number of factors organisationally that need to be considered when planning to introduce a particular EBP. Profiling these organisational characteristics at baseline, prior to commencement of service reform can determine the focus of a subsequent implementation plan. This study examined the organisational baseline factors existing in two services promoting the routine use of cognitive interventions for psychosis. One of the services studied has since undertaken organisational structural reform to facilitate the greater uptake of Evidence Based Practice (EBP). The results of this study were used to design an implementation strategy to make cognitive therapies a part of routine psychosis care. One hundred-and-six mental health staff from two metropolitan mental health services in Australia was surveyed to ascertain their attitudes, competencies and interest in Cognitive Behavioural Therapy for psychosis (CBTp) and Cognitive Remediation Therapy (CRT). In addition perceptions of organisational values were profiled using the Organisational Culture Profile (OCP). Fifty five participants were excluded because they completed less than 50% of the survey. The final sample consisted of 51 participants. 48.1% of surveys were completed. Over 50% of staff were interested in CBTp and CRT approaches to psychosis. Staff were aware of existing CBTp and CRT programs but these were not uniformly available throughout the services. Fourteen percent of staff identified as CBT therapist and 35% were trained CRT facilitators. Only 12% of staff were receiving therapy specific supervision. The Organisational Culture Profile (OCP) at baseline revealed highest scores amongst leadership, planning, and humanistic workplace domains, with communication
Eagar, Kathy; Trauer, Tom; Mellsop, Graham
To examine the performance of two widely used outcome measures in public adult mental health services. As part of a larger study, clinical staff in eight New Zealand District Health Board areas collected consumer outcomes data for a period of 6 months. Among other measures, the Health of the Nation Outcome Scales (HoNOS) and Life Skills Profile (LSP-16) were completed at the start and end of episodes of care, as well as at 90-day reviews. The performance of these two measures was examined in relation to compliance with the data collection protocol, item completion rates, certain psychometric properties, the relationship between them and the relationship of each instrument to the age, sex, principal psychiatric diagnosis and legal status of the consumer. Compliance with the HoNOS was superior to the LSP-16, but the reverse was true for completion. The two instruments were strongly correlated, but not enough to suggest that one may substitute for the other. A five-subscale structure for the HoNOS was supported. Certain HoNOS subscales were associated with age, but the total score was not, and differences between the sexes were small. Some large diagnostic differences were observed on both instruments. All LSP-16 summary scores and all HoNOS summary scores apart from Depression were higher (worse) in involuntary episodes. Only one LSP-16 item, relating to work potential, was related to age and men generally scored higher (worse) than women. From a technical perspective, the HoNOS and LSP-16 appear suitable for routine collection. New Zealand has adopted the HoNOS for routine use but not the LSP-16 because of local concerns about its appropriateness and acceptability. The clinician-rated measures reported here need to be complemented by both consumer-rated and family/carer measures.
Purpose: To evaluate the use of routine diagnostic tools among community pharmacists in Ibadan,. Nigeria. Methods: ... measurements in this setting is recommended by ... Development. Majority of respondents used routine diagnostic tools in their pharmacies. These tools included blood pressure monitors (87.6%), glucose.
Stevens, Gabrielle; Thompson, Rachel; Watson, Bernadette; Miller, Yvette D
Participation in decision-making, supported by comprehensive and quality information provision, is increasingly emphasised as a priority for women in maternity care. Patient decision aids are tools that can offer women greater access to information and guidance to participate in maternity care decision-making. Relative to their evaluation in controlled settings, the implementation of patient decision aids in routine maternity care has received little attention and our understanding of which approaches may be effective is limited. This paper critically discusses the application of patient decision aids in routine maternity care and explores viable solutions for promoting their successful uptake. A range of patient decision aids have been developed for use within maternity care, and controlled trials have highlighted their positive impact on the decision-making process for women. Nevertheless, evidence of successful patient decision aid implementation in real world health care settings is lacking due to practical and ideological barriers that exist. Patient-directed social marketing campaigns are a relatively novel approach to patient decision aid delivery that may facilitate their adoption in maternity care, at least in the short-term, by overcoming common implementation barriers. Social marketing may also be particularly well suited to maternity care, given the unique characteristics of this health context. The potential of social marketing campaigns to facilitate patient decision aid adoption in maternity care highlights the need for pragmatic trials to evaluate their effectiveness. Identifying which sub-groups of women are more or less likely to respond to these strategies will further direct implementation. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Olga, Balafa; Fotis, Zarzoulas; Margarita, Ikonomou; Sofia, Xiromeriti; Konstantinos, Siamopoulos
Although guidelines suggest the routine use of mupirocin or gentamicin at the exit site of PD catheter, our PD unit has been using chlorhexidine gluconate 0.5 % as exit-site care protocol. The aim of this study was to ascertain whether mupirocin application is superior to the traditionally applied chlorhexidine-regarding prevention of exit-site infections and peritonitis in our unit. Stable incident and prevalent patients of our unit were randomized to apply mupirocin or chlorhexidine at exit site. The study started on July 1, 2010, and continued till December 2014. End point was the first episode of exit-site infection or peritonitis. Sixty-two patients (mean age 58.5 ± 14.6 years) were randomized. At the end of follow-up, there were 33 patients on mupirocin treatment and 29 on chlorhexidine. The two groups had no differences in age, sex, PD vintage or PD mode. The only difference between the two groups was the percentage of patients with diabetes, 28 % in chlorhexidine group versus 10 % in mupirocin group. Mean time of follow-up was 28.46 ± 16.37 months. Twenty-four episodes of infections (peritonitis and exit site) were recorded. Time to first infection episode was 32 months in mupirocin group (95 % CI 21.4-42.5) versus 29 months (95 % CI 8.6-49.4) in chlorhexidine group. The Kaplan-Meier survival analysis revealed no difference in the infections between the two protocols (log-rank test, p = 0.477). Mupirocin is not superior in preventing infections comparing with chlorhexidine in this cohort of patients.
Hofmann, Sonja; Hess, Stephanie; Klein, Carsten; Lindena, Gabriele; Radbruch, Lukas; Ostgathe, Christoph
Anxiety is one of the most common psychological symptoms in patients in a palliative care situation. This study aims to develop a predictive model for anxiety using data from the standard documentation routine. Data sets of palliative care patients collected by the German quality management benchmarking system called Hospice and Palliative Care Evaluation (HOPE) from 2007 to 2011 were randomly divided into a training set containing two-thirds of the data and a test set with the remaining one-third. We dichotomized anxiety levels, proxy rated by medical staff using the validated HOPE Symptom and Problem Checklist, into two groups with no or mild anxiety versus moderate or severe anxiety. Using the training set, a multivariable logistic regression model was developed by backward stepwise selection. Predictive accuracy was evaluated by the area under the receiver operating characteristic curve (AUC) based on the test set. An analysis of 9924 data sets suggests a predictive model for anxiety in patients receiving palliative care which contains gender, age, ECOG, living situation, pain, nausea, dyspnea, loss of appetite, tiredness, need for assistance with activities of daily living, problems with organization of care, medication with sedatives/anxiolytics, antidepressants, antihypertensive drugs, laxatives, and antibiotics. It results in a fair predictive value (AUC = 0.72). Routinely collected data providing individual-, disease- and therapy-related information contain valuable information that is useful for the prediction of anxiety risks in patients receiving palliative care. These findings could thus be advantageous for providing appropriate support for patients in palliative care settings and should receive special attention in future research.
Davies, Joanna M; Gao, Wei; Sleeman, Katherine E; Lindsey, Katie; Murtagh, Fliss E; Teno, Joan M; Deliens, Luc; Wee, Bee; Higginson, Irene J; Verne, Julia
Palliative and end of life care is essential to healthcare systems worldwide, yet a minute proportion of research funding is spent on palliative and end of life care research. Routinely collected health and social care data provide an efficient and useful opportunity for evaluating and improving care for patients and families. There are excellent examples of routine data research in palliative and end of life care, but routine data resources are widely underutilised. We held four workshops on using routinely collected health and social care data in palliative and end of life care. Researchers presented studies from the UK, USA and Europe. The aim was to highlight valuable examples of work with routine data including work with death registries, hospital activity records, primary care data and specialist palliative care registers. This article disseminates that work, describes the benefits of routine data research and identifies major challenges for the future use of routine data, including; access to data, improving data linkage, and the need for more palliative and end of life care specific data. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Slåtten, Kari; Fagerström, Lisbeth; Hatlevik, Ove Edvard
This paper examines how clinical nurse specialists assessed their competences in relief of symptoms, and explores factors affecting good care routines in palliative care. A prospective survey among 235 former post-bachelor (response rate 50.6 %) students at two university colleges in Norway. Correlations between the measured concepts showed a medium to high correlation between all five competences. Use of care routines correlated with all the other factors. The ability to identify lack of care showed significant correlation with one concept: time available for nursing. The results from the regression analysis supported a model with good care routines as a dependent variable (F=22.59, df=91, Pcare routines. Competences dealing with mouth problems, nausea, anxiety and the use of the Edmonton symptom assessment system (ESAS) had a positive effect on care routines. On the other hand, the ability to identify lack of care had a significant negative effect on the use of care routines. The importance of systematic assessment of the palliative patient;s care needs and symptom management are emphasized, and use of the ESAS, and good care routines was affected by post-bachelor competences.
Khera, Nandita; Holland, Jimmie C; Griffin, Joan M
Financial burden from cancer treatment is increasingly being recognized as a threat to optimal access, quality, and outcomes of cancer care for patients. Although research in the area is moving at a fast pace, multiple questions remain unanswered, such as how to practically integrate the assessment and management of financial burden into routine health care delivery for patients with cancer. Although psychological distress screening for patients undergoing cancer treatment now is commonplace, the authors raise the provocative idea of universal screening for financial distress to identify and assist vulnerable groups of patients. Herein, the authors outline the arguments to support screening for financial burden in addition to psychological distress, examining it as an independent patient-reported outcome for all patients with cancer at various time points during their treatment. The authors describe the proximal and downstream impact of such a strategy and reflect on some challenges and potential solutions to help integrate this concept into routine cancer care delivery. Cancer 2017;123:4092-4096. © 2017 American Cancer Society. © 2017 American Cancer Society.
Hunt, Jennifer M; Lumley, Judith
To describe the variability and evidence base of recommendations in Australian protocols and national policies about six aspects of routine antenatal care. Comparison of recommendations from local protocols, national guidelines and research about number of visits, screening for gestational diabetes (GDM), syphilis, hepatitis C (HCV), and HIV, and advice on smoking cessation. Australian public hospitals with more than 200 births/year, some smaller hospitals in each State and Territory, and all Divisions of General Practice were contacted in 1999 and 2000. We reviewed 107 protocols, which included 80% of those requested from hospitals and 92% of those requested from Divisions. Frequency and consistency of recommendations. Recommendations about syphilis testing were notable in demonstrating consistency between local protocols, national policies and research evidence. Most protocols recommended screening for GDM, despite lack of good evidence of its effectiveness in improving outcomes. Specific approaches to screening for GDM varied widely. Coverage and specific recommendations about testing for HIV and HCV were also highly variable. Smoking-cessation information and advice was rarely included, despite good evidence of the effectiveness of interventions in improving outcomes. No national policies about the number of routine visits and smoking cessation could be identified. There were inconsistent national policies for both HIV and GDM screening. Antenatal care recommended in protocols used in Australia varies, and is not always consistent with national policies or research evidence. Producing and disseminating systematic reviews of research evidence and national guidelines might reduce this variability and improve the quality of Australian antenatal care.
Webb, Heather; Street, Jackie; Marshall, Helen
Immunization against pertussis, influenza, and rubella reduces morbidity and mortality in pregnant women and their offspring. Health care professionals (HCPs) caring for women perinatally are uniquely placed to reduce maternal vaccine preventable diseases (VPDs). Despite guidelines recommending immunization during the perinatal period, maternal vaccine uptake remains low. This qualitative study explored the role of obstetricians, general practitioners, and midwives in maternal vaccine uptake. Semi-structured interviews (n = 15) were conducted with perinatal HCPs at a tertiary maternity hospital in South Australia. HCPs were asked to reflect on their knowledge, beliefs, and practice relating to immunization advice and vaccine provision. Interviews were transcribed and coded using thematic analysis. Data collection and analysis was an iterative process, with collection ceasing with theoretical saturation. Participants unanimously supported maternal vaccination as an effective way of reducing risk of disease in this vulnerable population, however only rubella immunity detection and immunization is embedded in routine care. Among these professionals, delegation of responsibility for maternal immunization was unclear and knowledge about maternal immunization was variable. Influenza and pertussis vaccine prevention measures were not included in standard pregnancy record documentation, information provision to patients was "ad hoc" and vaccinations not offered on-site. The key finding was that the incorporation of maternal vaccinations into standard care through a structured process is an important facilitator for immunization uptake. Incorporating vaccine preventable disease management measures into routine obstetric care including incorporation into the Pregnancy Record would facilitate HCPs in implementing recommendations. Rubella prevention provides a useful 'template' for other vaccines.
Kamal, Arif H.; Hanson, Laura C.; Casarett, David J.; Dy, Sydney M.; Pantilat, Steven Z.; Lupu, Dale; Abernethy, Amy P.
Palliative medicine must prioritize the routine assessment of the quality of clinical care we provide. This includes regular assessment, analysis, and reporting of data on quality. Assessment of quality informs opportunities for improvement and demonstrates to our peers and ourselves the value of our efforts. In fact, continuous messaging of the value of palliative care services is needed to sustain our discipline; this requires regularly evaluating the quality of our care. As the reimbursement mechanisms for health care in the United States shift from fee-for-service to fee-for-value models, palliative care will be expected to report robust data on quality of care. We must move beyond demonstrating to our constituents (including patients and referrers), “here is what we do,” and increase the focus on “this is how well we do it” and “let’s see how we can do it better.” It is incumbent on palliative care professionals to lead these efforts. This involves developing standardized methods to collect data without adding additional burden, comparing and sharing our experiences to promote discipline-wide quality assessment and improvement initiatives, and demonstrating our intentions for quality improvement on the clinical frontline. PMID:25057987
Kamal, Arif H; Hanson, Laura C; Casarett, David J; Dy, Sydney M; Pantilat, Steven Z; Lupu, Dale; Abernethy, Amy P
Palliative medicine must prioritize the routine assessment of the quality of clinical care we provide. This includes regular assessment, analysis, and reporting of data on quality. Assessment of quality informs opportunities for improvement and demonstrates to our peers and ourselves the value of our efforts. In fact, continuous messaging of the value of palliative care services is needed to sustain our discipline; this requires regularly evaluating the quality of our care. As the reimbursement mechanisms for health care in the U.S. shift from fee-for-service to fee-for-value models, palliative care will be expected to report robust data on quality of care. We must move beyond demonstrating to our constituents (including patients and referrers), "here is what we do," and increase the focus on "this is how well we do it" and "let us see how we can do it better." It is incumbent on palliative care professionals to lead these efforts. This involves developing standardized methods to collect data without adding additional burden, comparing and sharing our experiences to promote discipline-wide quality assessment and improvement initiatives, and demonstrating our intentions for quality improvement on the clinical frontline. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Fridh, Isabell; Forsberg, Anna; Bergbom, Ingegerd
The purpose of this study was to describe family care routines and to explore environmental factors when patients die in Swedish intensive care units (ICUs). The main research questions were: what are the physical environmental circumstances and facilities when caring for patients in end-of-life and are there any routines or guidelines when caring for dying patients and their families? A questionnaire was sent to 79 eligible Swedish ICUs in December 2003, addressed to the unit managers. The response rate was 94% (n = 74 units). The findings show that, despite recommendations highlighting the importance of privacy for dying ICU patients and their families, only 11% of the respondents stated that patients never died in shared rooms in their ICU. If a patient dies in a shared room, nurses strive to ensure a dignified goodbye by moving the body to an empty room or to one specially designated for this purpose. The majority (76%) of the units had waiting rooms within the ICU. The study also revealed that there is a need for improvements in the follow-up routines for bereaved families. Many units reported (51%) that they often or almost always offer a follow-up visit, although in most cases the bereaved family had to initiate the follow-up by contacting the ICU. Guidelines in the area of end-of-life care were used by 25% of the ICUs. Further research is necessary to acquire a deeper knowledge of the circumstances under which patients die in ICUs and what impact the ICU environment has on bereaved families.
... leadership positions are very important to maintaining quality care in the nursing home. Here are some things to look for ... symptoms, and health problems. May 2013 Ensuring Quality Nursing Home Care Expert information from Healthcare Professionals Who Specialize in ...
Pino Sánchez, F I; Ballesteros Sanz, M A; Cordero Lorenzana, L; Guerrero López, F
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.
Kaye, Deborah R; Syrjamaki, John; Ellimootil, Chad; Schervish, Edward W; Solomon, M Hugh; Linsell, Susan; Montie, James E; Miller, David C; Dupree, James M
To evaluate the statistical association between routine home health use after prostatectomy, short-term surgical outcomes, and payments. We identified all men who underwent a robotic radical prostatectomy from 04/01/2014 through 10/31/2015 in the Michigan Urological Surgery Improvement Collaborative (MUSIC) with insurance from Medicare or a large commercial payer. We calculated rates of "routine" home care use after prostatectomy by urology practice. We defined "routine" home care as home care initiated within four days of discharge among patients discharged without a pelvic drain. We then compared ED visits, readmissions, prolonged catheter use, catheter reinsertion rates, and 90- day episode payments, unadjusted and in a propensity-adjusted analysis, for those who did and did not receive home care. We identified 647 patients, of whom 13% received "routine" home health care. At the practice level, the use of routine home care after prostatectomy varied from 0 to 53% (p=0.05) (mean: 3.6%, median: 0%). Unadjusted, patients with routine home care had increased ED visits within 16 days (15.5% vs 6.9%, p 16 days (3.6% vs 3.0%, p=0.79) and need for catheter replacement (1.2% vs 2.5%, p=0.46), and a trend toward decreased readmissions (0 vs 4.1%, p=0.06). Only the increased ED visits remained significant in adjusted analyses (pHome health had an average payment of $1,000 per episode. Thirteen percent of patients received "routine" home health care after prostatectomy, without improved outcomes. Patients don't require "routine" home health care to improve short-term outcomes after radical prostatectomy. Copyright © 2017 Elsevier Inc. All rights reserved.
McLaren, Zoë M; Sharp, Alana R; Zhou, Jifang; Wasserman, Sean; Nanoo, Ananta
To assess the performance of healthcare facilities by means of indicators based on guidelines for clinical care of TB, which is likely a good measure of overall facility quality. We assessed quality of care in all public health facilities in South Africa using graphical, correlation and locally weighted kernel regression analysis of routine TB test data. Facility performance falls short of national standards of care. Only 74% of patients with TB provided a second specimen for testing, 18% received follow-up testing and 14% received drug resistance testing. Only resistance testing rates improved over time, tripling between 2004 and 2011. National awareness campaigns and changes in clinical guidelines had only a transient impact on testing rates. The poorest performing facilities remained at the bottom of the rankings over the period of study. The optimal policy strategy requires both broad-based policies and targeted resources to poor performers. This approach to assessing facility quality of care can be adapted to other contexts and also provides a low-cost method for evaluating the effectiveness of proposed interventions. Devising targeted policies based on routine data is a cost-effective way to improve the quality of public health care provided. © 2016 John Wiley & Sons Ltd.
Richards David A
Full Text Available Abstract Background In the United Kingdom, clinical guidelines recommend that services for depression and anxiety should be structured around a stepped care model, where patients receive treatment at different 'steps,' with the intensity of treatment (i.e., the amount and type increasing at each step if they fail to benefit at previous steps. There are very limited data available on the implementation of this model, particularly on the intensity of psychological treatment at each step. Our objective was to describe patient pathways through stepped care services and the impact of this on patient flow and management. Methods We recorded service design features of four National Health Service sites implementing stepped care (e.g., the types of treatments available and their links with other treatments, together with the actual treatments received by individual patients and their transitions between different treatment steps. We computed the proportions of patients accessing, receiving, and transiting between the various steps and mapped these proportions visually to illustrate patient movement. Results We collected throughput data on 7,698 patients referred. Patient pathways were highly complex and very variable within and between sites. The ratio of low (e.g., self-help to high-intensity (e.g., cognitive behaviour therapy treatments delivered varied between sites from 22:1, through 2.1:1, 1.4:1 to 0.5:1. The numbers of patients allocated directly to high-intensity treatment varied from 3% to 45%. Rates of stepping up from low-intensity treatment to high-intensity treatment were less than 10%. Conclusions When services attempt to implement the recommendation for stepped care in the National Institute for Health and Clinical Excellence guidelines, there were significant differences in implementation and consequent high levels of variation in patient pathways. Evaluations driven by the principles of implementation science (such as targeted planning
Adam, Taghreed; Manzi, Fatuma; Schellenberg, Joanna Armstrong; Mgalula, Leslie; de Savigny, Don; Evans, David B.
OBJECTIVE: The Integrated Management of Childhood Illness (IMCI) strategy is designed to address the five leading causes of childhood mortality, which together account for 70% of the 10 million deaths occurring among children worldwide annually. Although IMCI is associated with improved quality of care, which is a key determinant of better health outcomes, it has not yet been widely adopted, partly because it is assumed to be more expensive than routine care. Here we report the cost of IMCI compared with routine care in four districts in the United Republic of Tanzania. METHODS: Total district costs of child care were estimated from the societal perspective as the sum of child health-care costs incurred in a district at the household level, primary health-facility level and hospital level. We also included administrative and support costs incurred by national and district administrations. The incremental cost of IMCI is the difference in costs of child health-care between districts with and without IMCI, after standardization for population size. FINDINGS: The annual cost per child of caring for children less than five years old in districts with IMCI was USD 11.19, 44% lower than the cost in the districts without IMCI (USD 16.09). Much of the difference was due to higher rates of hospitalization of children less than 5 years old in the districts without IMCI. Not all of this difference can be attributed to IMCI but even when differences in hospitalization rates are excluded, the cost per child was still 6% lower in IMCI districts. CONCLUSION:IMCI was not associated with higher costs than routine child health-care in the four study districts in the United Republic of Tanzania. Given the evidence of improved quality of care in the IMCI districts, the results suggest that cost should not be a barrier to the adoption and scaling up of IMCI. PMID:15976878
Since June 9, 1999 the Oregon Department of Transportation (ODOT) has implemented the Routine Road Maintenance: Water Quality and Habitat Guide Best Management Practices (the Guide), and is considered the cornerstone of the ODOT'd Office of Maintenan...
Goodacre, S; Nicholl, J; Dixon, S.; Cross, E; Angelini, K.; Arnold, J.; Revill, S.; Locker, T; Capewell, S J; Quinney, D.; Campbell, S.; Morris, F
Objectives To measure the effectiveness and cost effectiveness\\ud of providing care in a chest pain observation unit compared\\ud with routine care for patients with acute, undifferentiated chest\\ud pain.\\ud Design Cluster randomised controlled trial, with 442 days\\ud randomised to the chest pain observation unit or routine care,\\ud and cost effectiveness analysis from a health service costing\\ud perspective.\\ud Setting The emergency department at the Northern General\\ud Hospital, Sheffield, U...
Rodney A. Lambert
Full Text Available Routine general practice (GP care is rarely comprehensively described in clinical trials. This paper examines routine GP care within the lifestyle approach to managing panic (LAMP study. The aim of this paper is to describe/discuss routine GP care for panic disorder (PD patients within both study arms in the LAMP study. An unblinded pragmatic randomised controlled trial in 15 East of England GP practices (2 primary care trusts. Participants met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for PD with/without agoraphobia. Follow-up measures recorded at 20 weeks/10 months following randomisation. Control arm, unrestricted routine GP care (practice appointments, referrals and prescriptions. Trial arm, occupational therapyled lifestyle treatment comprising lifestyle review of fluid intake, diet pattern, exercise, caffeine, alcohol and nicotine. Primary outcome measure: beck anxiety inventory. At baseline, participants attended 2-3 times more GP appointments than population average, reducing at 10 months to 1.6 times population average for routine GP care and 0.97 population average for lifestyle arm. At 10 months, 33% fewer referrals (6 referrals; 0 mental health than at baseline (9 referrals; 2 mental health were made for lifestyle arm patients compared with 42% increase (from 12 referrals; 8 mental health at baseline to 17 referrals; 7 mental health in GP care arm. Selective serotonin reuptake inhibitors were prescribed most often. Benzodiazepines and beta-blockers were prescribed more often than tricyclic against current clinical guidelines. In conclusion, we found that PD patients at baseline were high healthcare resource users. Treatment in both study arms reduced resource use. Routine GP care requires further review for this patient group.
Background In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views. Methods This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice). Results The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice. Conclusions This study shows that from the perspective of multimorbid patients receiving care in German
Full Text Available Abstract Background Specialist physicians provide a large share of outpatient health care for children and adolescents in the United States, but little is known about the nature and content of these services in the ambulatory setting. Our objective was to quantify and characterize routine and co-managed pediatric healthcare as provided by specialists in community settings. Methods Nationally representative data were obtained from the National Ambulatory Medical Care Survey for the years 2002-2006. We included office based physicians (excluding family physicians, general internists and general pediatricians, and a representative sample of their patients aged 18 or less. Visits were classified into mutually exclusive categories based on the major reason for the visit, previous knowledge of the health problem, and whether the visit was the result of a referral. Primary diagnoses were classified using Expanded Diagnostic Clusters. Physician report of sharing care for the patient with another physician and frequency of reappointments were also collected. Results Overall, 41.3% out of about 174 million visits were for routine follow up and preventive care of patients already known to the specialist. Psychiatry, immunology and allergy, and dermatology accounted for 54.5% of all routine and preventive care visits. Attention deficit disorder, allergic rhinitis and disorders of the sebaceous glands accounted for about a third of these visits. Overall, 73.2% of all visits resulted in a return appointment with the same physician, in half of all cases as a result of a routine or preventive care visit. Conclusion Ambulatory office-based pediatric care provided by specialists includes a large share of non referred routine and preventive care for common problems for patients already known to the physician. It is likely that many of these services could be managed in primary care settings, lessening demand for specialists and improving coordination of care.
Bokhour, Barbara G; Solomon, Jeffrey L; Knapp, Herschel; Asch, Steven M; Gifford, Allen L
Approximately 21% of the 1.1 million HIV-infected persons in the United States are unaware of their HIV status. The Centers for Disease Control (CDC) recommend routine opt-out HIV testing for all patients aged 13-64. Yet little is known about patient and provider perspectives on routine HIV testing. We sought to understand patient and provider perspectives on the adoption of routine HIV testing within the US Department of Veterans Affairs. We conducted four focus groups with patients and two focus groups with primary care providers to explore perceptions of, communication about, and barriers and facilitators to routine HIV testing in primary care. Convenience sample of patients and primary care providers at two geographically diverse Veterans' Affairs Medical Centers. We conducted grounded thematic analyses of transcribed audio-recordings of focus groups to identify major themes, identifying similarities and differences between patient and provider perspectives. Patients and providers concurred that implementation of routine HIV testing, treating HIV like other chronic diseases, and removing requirements for written informed consent and pre-test counseling were of benefit to patients and to public health. Patients, however, wished to have HIV testing routinely offered by providers so that they could decide whether or not to be tested. Veterans also stated that routinizing testing would help destigmatize HIV. Six steps to communicating about routine testing ("the 6 R's") were identified. Patients and providers appear ready for implementation of routine HIV testing. However, providers should use patient-centered communication strategies to ease patients' concerns about confidentiality and stigma associated with HIV disease.
Aim Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers' knowledge of management of routine labour, emergency obstetric care and emergency ...
Großimlinghaus, I; Falkai, P; Gaebel, W; Hasan, A; Jänner, M; Janssen, B; Reich-Erkelenz, D; Grüber, L; Böttcher, V; Wobrock, T; Zielasek, J
Prior to nationwide implementation, the feasibility of newly developed quality indicators must be assessed. The aim of this multicenter feasibility test was an evaluation of the measurability of cross-sectoral quality indicators for depression and schizophrenia by means of routine data. The feasibility of the quality indicators was assessed in ten specialist clinics for psychiatry and psychotherapy by means of retrospective analyses of anonymous routine data. The data were extracted from the routine clinical documentation of the hospital information systems and the data from the admission and discharge sheets of the basic documentation in psychiatry (BADO) were additionally used for some clinics. Analyses were conducted for all cases of adults diagnosed with depression or schizophrenia within predefined assessment periods. In total five indicators for depression and nine indicators for schizophrenia were assessed and evaluated as measurable or measurable to a limited extent, sometimes with slight adaptations in the operationalization of the indicator. Due to variations in documentation, some indicators could not be calculated for all clinics. Most indicators could be collated with the data from the BADO. An assessment of indicators that measure quality-relevant aspects of care in depression and schizophrenia, is partially feasible by means of current routine data documentation analysis from the participating clinics. However, differing documentation methodologies in the participating clinics impeded a uniform assessment; therefore, for the implementation of nationwide minimum standards for the quality assurance of mental healthcare, a uniform cross-sectoral documentation methodology should be adapted to consensus and relevant quality indicators. The BADO appears to be a suitable instrument for this purpose.
Updegraff, Kimberly A; Kuo, Sally I-Chun; McHale, Susan M; Umaña-Taylor, Adriana J; Wheeler, Lorey A
To investigate the prospective associations between Mexican-origin mothers' and fathers' traditional cultural values and young adults' health and dental care utilization and to test the moderating role of youth gender. Mexican-origin parents and youth (N = 246 families) participated in home interviews and provided self-reports of parents' cultural values (time 1) and young adults' health status and routine health and dental care (time 2; 5 years later). Logistic regressions tested parents' traditional cultural values as predictors of routine health and dental care, accounting for parent nativity, parent acculturation, family socioeconomic status, youth gender, youth age, and youth physical health status. We also tested whether youth gender moderated the associations between parents' cultural values and young adults' routine care. Young adults whose mothers endorsed strong familism values when they were in mid-to-late adolescence were more likely to report at least one routine physician visit in the past year as young adults (odds ratio [OR] = 3.47, 95% confidence interval [CI]: 1.23-9.83, p = .019). Furthermore, for females only, mothers' more traditional gender role attitudes predicted reduced odds of receiving routine health (OR = .22; 95% CI: .08-.64, p = .005) and dental care (OR = .26; 95% CI: .09-.75, p health care utilization among Mexican-origin young adults, during a period of increased risk for health-compromising behaviors and reduced access to care. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Nancarrow, Susan A
For over a decade, organizations have attempted to include the measurement and reporting of health outcome data in contractual agreements between funders and health service providers, but few have succeeded. This research explores the utility of collecting health outcomes data that could be included in funding contracts for an Australian Community Care Organisation (CCO). An action-research methodology was used to trial the implementation of outcome measurement in six diverse projects within the CCO using a taxonomy of interventions based on the International Classification of Function. The findings from the six projects are presented as vignettes to illustrate the issues around the routine collection of health outcomes in each case. Data collection and analyses were structured around Donabedian's structure-process-outcome triad. Health outcomes are commonly defined as a change in health status that is attributable to an intervention. This definition assumes that a change in health status can be defined and measured objectively; the intervention can be defined; the change in health status is attributable to the intervention; and that the health outcomes data are accessible. This study found flaws with all of these assumptions that seriously undermine the ability of community-based organizations to introduce routine health outcome measurement. Challenges were identified across all stages of the Donabedian triad, including poor adherence to minimum dataset requirements; difficulties standardizing processes or defining interventions; low rates of use of outcome tools; lack of value of the tools to the service provider; difficulties defining or identifying the end point of an intervention; technical and ethical barriers to accessing data; a lack of standardized processes; and time lags for the collection of data. In no case was the use of outcome measures sustained by any of the teams, although some quality-assurance measures were introduced as a result of the project.
Full Text Available Background: a secondary pre-specified analysis of the UPLIFT cohort demonstrated that the inclusion of tiotropium bromide in the routine care of GOLD stage II (moderate chronic obstructive pulmonary disease (COPD patients is associated with stronger improvements of survival, quality of life, and exacerbation rate than those shown in the total cohort; in this subgroup, tiotropium furthermore induces a significant reduction in the rate of FEV1 decline.Objective: to adapt the Spiriva® model, originally built to evaluate cost-effectiveness of tiotropium inclusion in the general COPD population, to GOLD II patients.Methods: the Spiriva® model is a probabilistic Markov patient-level simulation developed over a lifetime horizon to compare outcomes associated with the inclusion of tiotropium in routine care (RC for COPD treatment with those obtained with RC alone. Patients are characterised by gender, age, height, smoking status and FEV1. Model structure and sources have been maintained unvaried, except for demographic characteristics, specific for GOLD II patients, as extrapolated from an Italian observational study, and tiotropium efficacy, based on the secondary analysis of GOLD II UPLIFT patients. As in the original model, only direct health care costs are considered.Results: patients treated with tiotropium on average (95% CI gain 0.70 (0.00/7.23 LYs or 0.77 (0.02/4.67 QALYs compared to RC. The incremental lifetime cost is € 3,520 (-6,391/26,686, meaning that the incremental cost required to gain a QALY (incremental cost-effectiveness ratio – ICER is equal to € 4,548. Sensitivity analysis shows that tiotropium has a 50% probability of being cost-effective for a willingness-to-pay (WTP around 4,600 €/QALY; 100% probability is achieved with a WTP of € 9,300.Conclusions: the adoption of a strategy based on the inclusion of tiotropium from the early COPD stages represents good value for money in Italy, as the ICER estimated for GOLD II
Tonyan, Holli A.
Eco(logical)-cultural Theory suggests that a daily routine results from individuals adapting cultural ideas to the constraints of a local context or ecology. Using Ecocultural Theory, this research examined family child care providers' descriptions of daily activities and overall approach to understand cultural models. The results highlighted a…
Goekoop-Ruiterman, Y. P. M.; de Vries-Bouwstra, J. K.; Kerstens, P. J. S. M.; Nielen, M. M. J.; Vos, K.; van Schaardenburg, D.; Speyer, I.; Seys, P. E. H.; Breedveld, F. C.; Allaart, C. F.; Dijkmans, B. A. C.
To compare the efficacy of Disease Activity Score (DAS)-driven therapy and routine care in patients with recent-onset rheumatoid arthritis. Patients with recent-onset rheumatoid arthritis receiving traditional antirheumatic therapy from either the BeSt study, a randomised controlled trial comparing
Chua, Jacquelin R; Castrejon, Isabel; Pincus, Theodore
Pain is the most common basis for visits to a rheumatologist, and reduction of pain is a primary goal of clinical care. Pain is assessed optimally by the patient on a self-report questionnaire. In clinical trials and other clinical research concerning pain and pain relief, detailed questionnaires are generally completed by patients. However, in routine clinical care, pain is generally assessed only according to narrative descriptions by the physician, and only a minority of settings assess pain using a standard, quantitative measure. Accurate, standard, quantitative assessment of pain in routine care is easily assessed in all patients with all diagnoses on a 0-10 visual analogue scale (VAS), by asking each patient to complete a 2-page multidimensional health assessment questionnaire/routine assessment of patient index data 3 (MDHAQ/RAPID3) at all visits. The MDHAQ includes VAS for pain, patient global assessment, and fatigue, as well as a quantitative physical function scale, RAPID3, review of systems, and recent medical history. The questionnaire provides the doctor with a 10-15 second overview of medical history data that otherwise would require about 10-15 minutes of conversation, saving time for the doctor and patient to focus on the most prominent concerns for the visit. MDHAQ scores from patients with 10 different rheumatic diagnoses, and specific data indicating similarity of scores in patients with osteoarthritis versus rheumatoid arthritis on the same questionnaire, are presented to illustrate the value of the MDHAQ in routine care.
Xpert MTB/RIF (Xpert) offers rapid detection of Mycobacterium tuberculosis and rifampicin resistance. However, little is known about routine point-of-care (POC) use in high TB/HIV burden settings. We describe our experiences of launching Xpert as the POC, initial diagnostic for all TB suspects at a primary healthcare clinic ...
Kovacs, F M; Seco, J; Royuela, A; Betegon, J N; Sánchez-Herráez, S; Meli, M; Martínez Rodríguez, M E; Núñez, M; Álvarez-Galovich, L; Moyá, J; Sánchez, C; Luna, S; Borrego, P; Moix, J; Rodríguez-Pérez, V; Torres-Unda, J; Burgos-Alonso, N; Gago-Fernández, I; González-Rubio, Y; Abraira, V
The objective of this study was to estimate the association between sleep quality (SQ) and improvements in low back pain (LBP) and disability, among patients treated for LBP in routine practice. This prospective cohort study included 461 subacute and chronic LBP patients treated in 11 specialized centres, 14 primary care centres and eight physical therapy practices across 12 Spanish regions. LBP, leg pain, disability, catastrophizing, depression and SQ were assessed through validated questionnaires upon recruitment and 3 months later. Logistic regression models were developed to assess: (1) the association between the baseline score for SQ and improvements in LBP and disability at 3 months, and (2) the association between improvement in SQ and improvements in LBP and disability during the follow-up period. Seventy-three per cent of patients were subacute. Median scores at baseline were four points for both pain and disability, as assessed with a visual analog scale and the Roland-Morris Questionnaire, respectively. Regression models showed (OR [95% CI]) that baseline SQ was not associated with improvements in LBP (0.99 [0.94; 1.06]) or in disability (0.99 [0.93; 1.05]), although associations existed between 'improvement in SQ' and 'improvement in LBP' (4.34 [2.21; 8.51]), and 'improvement in SQ' and 'improvement in disability' (4.60 [2.29; 9.27]). Improvement in SQ is associated with improvements in LBP and in disability at 3-month follow-up, suggesting that they may reflect or be influenced by common factors. However, baseline SQ does not predict improvements in pain or disability. In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability. © 2017 European Pain Federation - EFIC®.
Helping You Choose Quality Behavioral Health Care Selecting quality behavioral health care services for yourself, a relative or friend requires special ... for and what to ask will help you choose an organization that provides safe, quality care, treatment ...
Abma, T.A.; Oeseburg, B.; Widdershoven, G.A.M.; Verkerk, M.
Tineke A Abma, Barth Oeseburg, Guy AM Widdershoven, Marian VerkerkMedical Humanities/EMGO Institute, VU Medical Center, Amsterdam, The NetherlandsAbstract: In health care, relationships between patients or disabled persons and professionals are at least co-constitutive for the quality of care. Many patients complain about the contacts and communication with caregivers and other professionals. From a care-ethical perspective a good patient-professional relationship requires a process of negoti...
Thumfart, Julia; Reindl, Tobias; Rheinlaender, Cornelia; Müller, Dominik
Paediatric palliative care is no longer restricted to patients with cancer and has been extended to patients with other chronic conditions, such as cystic fibrosis or neuromuscular disorders. This review focused on the current state of palliative care for children and adolescents with chronic kidney disease (CKD). We assessed the literature on CKD published up to August 2017. All the papers, except one from 1996, were published this century. This review discusses the role that palliative care plays in the process of decision-making and explores the possibilities of implementing palliative care into the routine therapy of affected patients and providing support for their families. Offering early palliative care as an integral part of the kidney, supportive care provided by the nephrology care team is both necessary and feasible for patients with CKD. As a minimum, a specialised palliative care team should be involved in patients with multiple comorbidities, in conservative treatment scenarios and in acute life-threatening complications. Further studies and guidelines are required to improve the care of patients with CKD and their families. Supportive palliative care should be implemented into the routine care of patients with life-limiting kidney disease. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Arnett, Kelly; Sudore, Rebecca L; Nowels, David; Feng, Cindy X; Levy, Cari R; Lum, Hillary D
Interprofessional health care team members consider advance care planning (ACP) to be important, yet gaps remain in systematic clinical routines to support ACP. A clearer understanding of the interprofessional team members' perspectives on ACP clinical routines in diverse settings is needed. One hundred eighteen health care team members from community-based clinics, long-term care facilities, academic clinics, federally qualified health centers, and hospitals participated in a 35-question, cross-sectional online survey to assess clinical routines, workflow processes, and policies relating to ACP. Respondents were 53% physicians, 18% advanced practice nurses, 11% nurses, and 18% other interprofessional team members including administrators, chaplains, social workers, and others. Regarding clinical routines, respondents reported that several interprofessional team members play a role in facilitating ACP (ie, physician, social worker, nurse, others). Most (62%) settings did not have, or did not know of, policies related to ACP documentation. Only 14% of settings had a patient education program. Two-thirds of the respondents said that addressing ACP is a high priority and 85% felt that nonphysicians could have ACP conversations with appropriate training. The clinical resources needed to improve clinical routines included training for providers and staff, dedicated staff to facilitate ACP, and availability of patient/family educational materials. Although interprofessional health care team members consider ACP a priority and several team members may be involved, clinical settings lack systematic clinical routines to support ACP. Patient educational materials, interprofessional team training, and policies to support ACP clinical workflows that do not rely solely on physicians could improve ACP across diverse clinical settings.
Kane, Pauline M; Daveson, Barbara A; Ryan, Karen; McQuillan, Regina; Higginson, Irene J; Murtagh, Fliss E M
Over the history of palliative care provision in Ireland, services have predominantly provided care to those with cancer. Previous estimates of palliative care need focused primarily on specialist palliative care and included only a limited number of nonmalignant diseases. The primary aim of this study was to estimate the potential population with generalist and/or specialist palliative care needs in Ireland using routine mortality data inclusive of nonmalignant conditions. The secondary aim was to consider the quality of Irish data available for this population-based estimate. Irish routine mortality data (2007-2011) were analyzed for malignant and nonmalignant conditions recognized as potentially requiring palliative care input, using specific International Statistical Classification of Diseases and Related Health Problems-10th Revision codes. The method developed by Murtagh et al. was used to give a population-based palliative care needs estimate, encompassing generalist and specialist palliative care need. During the period 2007-2011, there were 141,807 deaths. Eighty percent were from conditions recognized as having associated palliative care needs, with 41,253 (30%) deaths from cancer and 71,226 (50%) deaths from noncancer conditions. The majority of deaths, 81% (91,914), were among those ≥65 years. There was a 13.9% (901) increase in deaths of those ≥85 years. Deaths from dementia increased by 51.3%, with an increase in deaths from neurodegenerative disease (42.8%) and cancer (9.5%). Future palliative care policy decisions in Ireland must consider the rapidly aging Irish population with the accompanying increase in deaths from cancer, dementia, and neurodegenerative disease and associated palliative care need. New models of palliative care may be required to address this. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Lingner, Heidrun; Aumann, Ines; Wacker, Margarethe; Kreuter, Michael; Leidl, Reiner; von der Schulenburg, J-Matthias Graf; Welte, Tobias
Reliable current information is needed for daily patient care and the health system, but comprehensive data, especially from primary care, are scarce and/or hard to access. The BeoNet Register-Database (BNR) aims to depict quality of medical care in Germany using routine data and with no additional documentation or costs for GPs. Registry design, data structure and database use will be demonstrated using chronic obstructive lung disease (COPD) as an example. The BNR is moving through pilot- and roll-out phases. Participating practices provide standardized information about (1) master data (2) practice profile (3) infrastructure and documentation systems. The routinely documented data will be pseudonymized before transmission via standardized secure interfaces to the registry database. Practices can participate in studies in cooperation with BNR if informed consent is obtained from the patients. The registry data will be linked with questionnaires on health care utilization, quality of life and disease-specific parameters. Researchers and physicians can access quasi anonymized data in specific datasets extracted from the registry. Regular automatic data quality checks and feedback from GPs, patients and researchers enhance the quality of the registry. Performance and data analysis are continuously optimized. The data security concept has been approved and ethical approval is on hand. GPs, pediatricians and pneumologists from Hanover, Munich and Heidelberg participated in the pilot phase. The registry database currently holds 98497 patient IDs and related information. BNR contains more than the standard billing data collected by health insurers. The data are applicable to a wide range of health practices, health care and economics and disease development questions. Questionnaires have been generated, tested and are being distributed. First descriptive analyses of prevalence, age and gender have been performed. Quality and validity checks have been implemented. 2016
Tineke A Abma
Full Text Available Tineke A Abma, Barth Oeseburg, Guy AM Widdershoven, Marian VerkerkMedical Humanities/EMGO Institute, VU Medical Center, Amsterdam, The NetherlandsAbstract: In health care, relationships between patients or disabled persons and professionals are at least co-constitutive for the quality of care. Many patients complain about the contacts and communication with caregivers and other professionals. From a care-ethical perspective a good patient-professional relationship requires a process of negotiation and shared understanding about mutual normative expectations. Mismatches between these expectations will lead to misunderstandings or conflicts. If caregivers listen to the narratives of identity of patients, and engage in a deliberative dialogue, they will better be able to attune their care to the needs of patients. We will illustrate this with the stories of three women with multiple sclerosis. Their narratives of identity differ from the narratives that caregivers and others use to understand and identify them. Since identities give rise to normative expectations in all three cases there is a conflict between what the women expect of their caregivers and vice-versa. These stories show that the quality of care, defined as doing the right thing, at the right time, in the right way, for the right person, is dependent on the quality of caring relationships.Keywords: ethics of care, dialogue, responsibilities, narratives, relationships
Holloway, Susan D.; Domínguez-Pareto, Irenka; Cohen, Shana R.; Kuppermann, Miriam
Previous studies indicate that families construct daily routines that enable the household to function smoothly and promote family quality of life. However, we know little about how activities are distributed between parents caring for a child with an intellectual disability (ID), particularly in Latino families. To address this gap, we…
Gameiro, S; Boivin, J; Dancet, E; de Klerk, C; Emery, M; Lewis-Jones, C; Thorn, P; Van den Broeck, U; Venetis, C; Verhaak, C M; Wischmann, T; Vermeulen, N
Based on the best available evidence in the literature, what is the optimal management of routine psychosocial care at infertility and medically assisted reproduction (MAR) clinics? Using the structured methodology of the Manual for the European Society of Human Reproduction and Embryology (ESHRE) Guideline Development, 120 recommendations were formulated that answered the 12 key questions on optimal management of routine psychosocial care by all fertility staff. The 2002 ESHRE Guidelines for counselling in infertility has been a reference point for best psychosocial care in infertility for years, but this guideline needed updating and did not focus on routine psychosocial care that can be delivered by all fertility staff. This guideline was produced by a group of experts in the field according to the 12-step process described in the ESHRE Manual for Guideline Development. After scoping the guideline and listing a set of 12 key questions in PICO (Patient, Intervention, Comparison and Outcome) format, thorough systematic searches of the literature were conducted; evidence from papers published until April 2014 was collected, evaluated for quality and analysed. A summary of evidence was written in a reply to each of the key questions and used as the basis for recommendations, which were defined by consensus within the guideline development group (GDG). Patient and additional clinical input was collected during the scoping and the review phase of the guideline development. The guideline group, comprising psychologists, two medical doctors, a midwife, a patient representative and a methodological expert, met three times to discuss evidence and reach consensus on the recommendations. 120 recommendations that aim at guiding fertility clinic staff in providing optimal evidence-based routine psychosocial care to patients dealing with infertility and MAR. The guideline is written in two sections. The first section describes patients' preferences regarding the psychosocial
Jackson, Holly; Barnett, Lauren A; Jordan, Kelvin P; Dziedzic, Krysia S; Cottrell, Elizabeth; Finney, Andrew G; Paskins, Zoe; Edwards, John J
To determine common patterns of recorded primary care for osteoarthritis (OA), and patient and provider characteristics associated with the quality of recorded care. An observational study nested within a cluster-randomised controlled trial. Eight UK general practices who were part of the Management of Osteoarthritis in Consultations study. Patients recorded as consulting within the eight general practices for clinical OA. Achievement of seven quality indicators of care (pain/function assessment, information provision, exercise/weight advice, analgesics, physiotherapy), recorded through an electronic template or routinely recorded in the electronic healthcare records, was identified for patients aged ≥45 years consulting over a 6-month period with clinical OA. Latent class analysis was used to cluster patients based on care received. Clusters were compared on patient and clinician-level characteristics. 1724 patients (median by practice 183) consulted with clinical OA. Common patterns of recorded quality care were: cluster 1 (38%, High ) received most quality indicators of care; cluster 2 (11%, Moderate ) had pain and function assessment, and received or were considered for other indicators; cluster 3 (17%, Low ) had pain and function assessment, and received or were considered for paracetamol or topical non-steroidal anti-inflammatory drugs; cluster 4 (35%, None ) had no recorded quality indicators. Patients with higher levels of recorded care consulted a clinician who saw more patients with OA, consulted multiple times and had less morbidity. Those in the High cluster were more likely to have recorded diagnosed OA and have knee/hip OA. Patterns of recorded care for OA fell into four natural clusters. Appropriate delivery of core interventions and relatively safe pharmacological options for OA are still not consistently recorded as provided in primary care. Further research to understand clinical recording behaviours and determine potential barriers to quality
Sprenger, Martin; Robausch, Martin; Moser, Adrian
Open debates about the reduction of low-value services, unnecessary diagnostic tests and ineffective therapeutic procedures and initiatives like "Choosing Wisely "in the USA and Canada are still absent in Austria. The objectives of this study are: (i) to establish a list of ineffective or low-value services possibly provided in Austrian primary care, (ii) to explore how many of these services are quantifiable using routine data and (iii) to estimate the number of affected beneficiaries and avoidable costs arising from the provision of these services. In May 2014, we identified low-value care services relevant for primary care in Austria. For our analysis we used routine data sets from the Austrian health insurance. All analysis refer to the insured population of the Lower Austrian Sickness Fund (n = 1 168 433) in the year 2013. (i) We found 453 low-value services possibly offered in Austrian primary care. (ii) Only 34 (7.5%) services were quantifiable using routine data. (iii) In the year 2013, these 34 services were provided to at least 246 131 beneficiaries and the estimated avoidable costs arising were at least 11.38 million Euros. This accounts for 1.2% of overall spending of the Lower Austrian Sickness Fund for drugs and services provided by primary care doctors in the year 2013. The absence of a homogeneous, transparent and accessible coding system for diagnosis in Austrian primary care restrained our assessment. However, our study findings illustrate the potential utility and limitations of using claims-based measures to identify low-value care. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Effect of early intensive multifactorial therapy compared with routine care on self-reported health status, general well-being, diabetes-specific quality of life and treatment satisfaction in screen-detected type 2 diabetes mellitus patients (ADDITION-Europe): a cluster-randomised trial.
Van den Donk, Maureen; Griffin, Simon J; Stellato, Rebecca K; Simmons, Rebecca K; Sandbæk, Annelli; Lauritzen, Torsten; Khunti, Kamlesh; Davies, Melanie J; Borch-Johnsen, Knut; Wareham, Nicholas J; Rutten, Guy E H M
The study aimed to examine the effects of intensive treatment (IT) vs routine care (RC) on patient-reported outcomes after 5 years in screen-detected diabetic patients. In a pragmatic, cluster-randomised, parallel-group trial, 343 general practices in Denmark, Cambridge and Leicester (UK) and the Netherlands were randomised to screening for type 2 diabetes mellitus plus IT of multiple risk factors in people 40-69 years without known diabetes (n = 1,678 patients) or screening plus RC (n = 1,379 patients). Practices were randomised in a 1:1 ratio according to a computer-generated list. Diabetes mellitus was diagnosed according to WHO criteria. Exclusions were: life expectancy Treatment targets for IT were: HbA1c 120/80 mmHg, ACE inhibitors were recommended. After 2003, the treatment algorithm recommended statins to all patients with cholesterol of ≥3.5 mmol/l. Outcome measures were: health status (Euroqol 5 Dimensions [EQ-5D]) at baseline and at follow-up; and health status (36-item Short Form Health Survey [SF-36] and Euroquol Visual Analogue Scale [EQ-VAS]), well-being (12-item Short Form of the Well-Being Questionnaire), diabetes-specific quality of life (Audit of Diabetes-Dependent Quality of Life) and satisfaction with diabetes treatment (Diabetes Treatment Satisfaction Questionnaire) at follow-up. At baseline, standardised self-report questionnaires were used to collect information. Questionnaires were completed at the same health assessment visit as the anthropometric and biochemical measurements. The patients and the staff assessing the outcomes were unaware of the group assignments. Participants were followed for a mean of 5.7 years. Outcome data were available for 1,250 participants in the intensive treatment group (74%) and 967 participants in the routine care group (70%). The estimated differences in means from the four centres were pooled using random effects meta-analysis. Baseline EQ-5D level was used as a covariate in all analyses. EQ-5
Stiglmayr, Christian; Stecher-Mohr, Julia; Wagner, Till; Meiβner, Jeannette; Spretz, Doreen; Steffens, Christiane; Roepke, Stefan; Fydrich, Thomas; Salbach-Andrae, Harriet; Schulze, Julian; Renneberg, Babette
Dialectical behavior therapy (DBT) has been proven to be an efficacious treatment for borderline personality disorder (BPD) in several randomized controlled trials (RCTs). However, generalizability of this outcome to the routine health care (effectiveness) has rarely been investigated to date. The aim of this study is to examine the effectiveness of DBT for BPD under the routine health care situation in Germany. The study has a longitudinal design over a course of four years with six assessment points. In this paper, results for the first year of treatment are reported. Outcome was assessed at four times throughout an initial phase (of up to five therapy-sessions) and an additional 12 months of therapy. Overall, n =78 patients started the study, 47 patients completed one year of treatment. Dependent variables were number and duration of inpatient treatment stays, number of suicide attempts and non-suicidal self-injury, severity of borderline symptoms, depression, level of dissociation, and general psychopathology. Patients significantly improved regarding self-injurious behaviors, number of inpatient hospital stays, severity of borderline symptoms and psychopathology. At the end of the first treatment year, 77% of the patients no longer met criteria for BPD diagnosis. Fewer therapy discontinuations by patients were observed when therapists participated in consultation teams. Under routine mental health care conditions in Germany, outpatient DBT leads to positive results comparable to those reported in other effectiveness studies and in randomized controlled trials.
Full Text Available Background. Little is known about the clinical impact of new root canal preparation systems in general dental practice under routine care conditions. Therefore, we compared hand instrumentation (H with Reciproc (R (VDW, Munich, Germany preparation. The outcomes were endodontic related pain and oral health related quality of life (OHRQoL, evaluation of the procedures by the patients and the strain felt by the dentists during root canal therapy. Methods. Six dentists participated in the trial as practitioner–investigators. In the first phase of the trial they prepared root canals with H and in the second phase with R. The patients documented their pain felt with a visual analogue scale (VAS 100 and OHRQoL with the German short version of the oral health impact profile (OHIP-G-14 before treatment and before the completion of therapy and answered questions about how they experienced the treatment. The dentists documented their physical strain during treatment. Results. A total of 137 patients were included in the evaluation. 66 patients were treated with H, 71 with R. Pain reduction was 32.6 (SD 32.9 VAS (H vs. 29.4 (SD 26.9 VAS (R (p = 0.550, and the improvement of the OHIP-14 score was 5.5 (SD 9.2 (H vs. 6.7 (SD 7.4 (R (p = 0.383. There were no statistical differences in both groups. Significantly fewer patients felt stressed by the duration of treatment with R as with H (p = 0.018. Significantly more dentists reported that their general physical strain and the strain on their fingers were less severe with R than with H (p = 0.013 and p < 0.001. Discussion. H as well as R effectively reduced endodontic related pain and OHRQoL without statistical differences. R has advantages in terms of how patients experience the treatment and regarding the physical strain felt by the dentists.
Full Text Available INTRODUCTION: Despite the increasing incidence of melanoma little is known about patients' emotional distress associated with this disease. Supplemented by the problem list (PL, the distress thermometer (DT is a recommended screening instrument to measure psychosocial distress in cancer patients. Our objective was to explore the acceptance and the feasibility of the DT and PL as a concise screening tool in an ambulatory setting for routine care and to elucidate determinants of distress in melanoma patients with regard to sociodemographic and clinical variables. METHODS: Consecutive melanoma outpatients were asked to complete the DT with the PL prior to their scheduled consultation. Demographic and clinical data were obtained from the patients' charts. Clinical data included melanoma stage, time since diagnosis, previous treatment, current treatment, and other cancer disease. RESULTS: Out of 734 patients recruited into the study, 520 patients (71% completed both the DT and the PL. Forty-seven percent met the ≥5 cut-off score for distress. Younger and employed patients reported higher distress than older and retired patients. A cut-off score of ≥5 was closely associated with self-reported emotional sources of distress, with practical problems, especially at work, family problems (dealing with the partner, and physical problems like pain, appearance, getting around, and nausea. Apart from higher distress under current systemic treatment, no associations were found between distress and clinical data. CONCLUSION: The DT together with the PL seems to be an economically reasonable screening tool to measure psychosocial distress in melanoma patients. In particular, younger melanoma patients who are currently employed are prone to experience distress at some point after diagnosis, but there appears to be almost no association between clinical data and the extent of distress. To characterize the impact of distress on disease outcome and quality of
This article reviews routine quality-control (QC) procedures for current nuclear medicine instrumentation, including the survey meter, dose calibrator, well counter, intraoperative probe, organ ("thyroid") uptake probe, gamma-camera, SPECT and SPECT/CT scanner, and PET and PET/CT scanner. It should be particularly useful for residents, fellows, and other trainees in nuclear medicine, nuclear cardiology, and radiology. The procedures described and their respective frequencies are presented only as general guidelines.
This article reviews routine quality-control (QC) procedures for current nuclear medicine instrumentation, including the survey meter, dose calibrator, well counter, intraoperative probe, organ (“thyroid”) uptake probe, γ-camera, SPECT and SPECT/CT scanner, and PET and PET/CT scanner. It should be particularly useful for residents, fellows, and other trainees in nuclear medicine, nuclear cardiology, and radiology. The procedures described and their respective frequencies are presented only as...
Daly, Justine B; Mackenzie, Lisa J; Freund, Megan; Wolfenden, Luke; Roseby, Robert; Wiggers, John H
Reducing child exposure to tobacco smoke is a public health priority. Guidelines recommend that health care professionals in child health settings should address tobacco smoke exposure (TSE) in children. To determine the effectiveness of interventions delivered by health care professionals who provide routine child health care in reducing TSE in children. A secondary analysis of 57 trials included in a 2014 Cochrane review and a subsequent extended search was performed. Controlled trials (published through June 2015) of interventions that focused on reducing child TSE, with no restrictions placed on who delivered the interventions, were identified. Secondary data extraction was performed in August 2015. Controlled trials of routine child health care delivered by health care professionals (physicians, nurses, medical assistants, health educators, and dieticians) that addressed the outcomes of interest (TSE reduction in children and parental smoking behaviors) were eligible for inclusion in this review and meta-analysis. Study details and quality characteristics were independently extracted by 2 authors. If outcome measures were sufficiently similar, meta-analysis was performed using the random-effects model by DerSimonian and Laird. Otherwise, the results were described narratively. The primary outcome measure was reduction in child TSE. Secondary outcomes of interest were parental smoking cessation, parental smoking reduction, and maternal postpartum smoking relapse prevention. Sixteen studies met the selection criteria. Narrative analysis of the 6 trials that measured child TSE indicated no intervention effects relative to comparison groups. Similarly, meta-analysis of 9 trials that measured parental smoking cessation demonstrated no overall intervention effect (n = 6399) (risk ratio 1.05; 95% CI, 0.74-1.50; P = .78). Meta-analysis of the 3 trials that measured maternal postpartum smoking relapse prevention demonstrated a significant overall intervention effect (n
Glèlè Ahanhanzo, Yolaine; Ouendo, Edgard-Marius; Kpozèhouen, Alphonse; Levêque, Alain; Makoutodé, Michel; Dramaix-Wilmet, Michèle
Health information systems in developing countries are often faulted for the poor quality of the data generated and for the insufficient means implemented to improve system performance. This study examined data quality in the Routine Health Information System in Benin in 2012 and carried out a cross-sectional evaluation of the quality of the data using the Lot Quality Assurance Sampling method. The results confirm the insufficient quality of the data based on three criteria: completeness, reliability and accuracy. However, differences can be seen as the shortcomings are less significant for financial data and for immunization data. The method is simple, fast and can be proposed for current use at operational level as a data quality control tool during the production stage. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.
Kamal, Arif H; Nicolla, Jonathan M; Power, Steve
Rapid changes in how palliative care clinicians are evaluated and paid present an imperative for clinicians to adeptly and routinely perform quality improvement in usual practice. Like empathic communication and facilitating goals of care discussions, quality improvement skills must be learned, honed, and practiced, so identifying problems and brainstorming solutions becomes a natural component of delivering serious illness care. Using our experience in both failures and successes in performing quality improvement, here we provide a prioritized list of 10 pearls specifically aimed to palliative care and hospice professionals. We aim to demystify quality improvement, highlight areas where rigor and a systematic approach are needed for success, and offer our own lessons learned and mistakes made to promote success for our colleagues and our field. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Roomaney, Rifqah A; Pillay-van Wyk, Victoria; Awotiwon, Oluwatoyin F; Nicol, Edward; Joubert, Jané D; Bradshaw, Debbie; Hanmer, Lyn A
Routine health information systems (RHISs) provide data that are vital for planning and monitoring individual health. Data from RHISs could also be used for purposes for which they were not originally intended, provided that the data are of sufficient quality. For example, morbidity data could be used to inform burden of disease estimations, which serve as important evidence to prioritize interventions and promote health. The objective of this study was to identify and assess published quantitative assessments of data quality related to patient morbidity in RHISs in use in South Africa. We conducted a review of literature published between 1994 and 2014 that assessed the quality of data in RHISs in South Africa. World Health Organization (WHO) data quality components were used as the assessment criteria. Of 420 references identified, 11 studies met the inclusion criteria. The studies were limited to tuberculosis and HIV. No study reported more than 3 WHO data quality components or provided a quantitative assessment of quality that could be used for burden of disease estimation. The included studies had limited geographical focus and evaluated different source data at different levels of the information system. All studies reported poor data quality. This review confirmed concerns about the quality of data in RHISs, and highlighted the need for a comprehensive evaluation of the quality of patient-level morbidity data in RHISs in South Africa.
McHugh, Matthew D.; Stimpfel, Amy Witkoski
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...
Heyer, K; Herberger, K; Protz, K; Mayer, A; Dissemond, J; Debus, S; Augustin, M
Standards for basic documentation and the course of treatment increase quality assurance and efficiency in health care. To date, no standards for the treatment of patients with leg ulcers are available in Germany. The aim of the study was to develop standards under routine conditions in the documentation of patients with leg ulcers. This article shows the recommended variables of a "standard dataset" and a "minimum dataset". Consensus building among experts from 38 scientific societies, professional associations, insurance and supply networks (n = 68 experts) took place. After conducting a systematic international literature research, available standards were reviewed and supplemented with our own considerations of the expert group. From 2012-2015 standards for documentation were defined in multistage online visits and personal meetings. A consensus was achieved for 18 variables for the minimum dataset and 48 variables for the standard dataset in a total of seven meetings and nine online Delphi visits. The datasets involve patient baseline data, data on the general health status, wound characteristics, diagnostic and therapeutic interventions, patient reported outcomes, nutrition, and education status. Based on a multistage continuous decision-making process, a standard in the measurement of events in routine care in patients with a leg ulcer was developed.
Post, Stephen G; Ng, Lauren E; Fischel, Janet E; Bennett, Mary; Bily, Linda; Chandran, Latha; Joyce, Jeremiah; Locicero, Briana; McGovern, Kelly; McKeefrey, Robyn L; Rodriguez, Jackie V; Roess, Michael W
We believe that this study represents an innovative approach to clarifying the definitions of routine, empathic and compassionate health care, as well as of sympathy. We emphasize the importance of affective empathy and its intensification in the context of patient suffering (compassion), without abandoning the ideal of clinical equanimity. We develop a pedagogical model for clinicians and trainees who are weaker in their empathic skills that includes four levels of growth. We clarify representative obstacles to empathic and compassionate care in education and clinical practice. We summarize the four beneficiaries of empathic and compassionate care (clinicians, patients, trainees, institutions). We suggest areas for future research, including the development of a compassion scale and conclude with a statement on how the conceptual and professional confusion we address adversely impacts patients and trainees. The article represents the consensus work of a group of health care professionals and students at Stony Brook University Hospital and School of Medicine who have been engaged in this project for several years through the Center for Medical Humanities, Compassionate Care, and Bioethics, established in August of 2008. We discern a shift away from concepts of clinical empathy and compassionate care that deny a significant place for an affective component and that idealize 'detachment'. © 2014 John Wiley & Sons, Ltd.
Xia, Jun; Chen, Su-Feng; Xu, Fei; Zhou, Yong-Lie
Sigma metrics were applied to evaluate the performance of 20 routine chemistry assays, and individual quality control criteria were established based on the sigma values of different assays. Precisions were expressed as the average coefficient variations (CVs) of long-term two-level chemistry controls. The biases of the 20 assays were obtained from the results of trueness programs organized by National Center for Clinical Laboratories (NCCL, China) in 2016. Four different allowable total error (TEa) targets were chosen from biological variation (minimum, desirable, optimal), Clinical Laboratory Improvements Amendments (CLIA, US), Analytical Quality Specification for Routine Analytes in Clinical Chemistry (WS/T 403-2012, China) and the National Cholesterol Education Program (NECP). The sigma values from different TEa targets varied. The TEa targets for ALT, AMY, Ca, CHOL, CK, Crea, GGT, K, LDH, Mg, Na, TG, TP, UA and Urea were chosen from WS/T 403-2012; the targets for ALP, AST and GLU were chosen from CLIA; the target for K was chosen from desirable biological variation; and the targets for HDL and LDL were chosen from the NECP. Individual quality criteria were established based on different sigma values. Sigma metrics are an optimal tool to evaluate the performance of different assays. An assay with a high value could use a simple internal quality control rule, while an assay with a low value should be monitored strictly. © 2017 Wiley Periodicals, Inc.
Freter, Susan; Koller, Katalin; Dunbar, Michael; MacKnight, Chris; Rockwood, Kenneth
To compare the feasibility (adherence) and effectiveness (prevalence of delirium, length of stay, mortality, discharge site) of delirium-friendly preprinted postoperative orders (PPOs) for individuals with hip fracture, administered by regular orthopedic nurses, with routine postoperative orders. Pragmatic clinical trial to evaluate a quality improvement intervention. Tertiary care hospital. Individuals aged 65 and older admitted for hip fracture repair (N = 283). PPOs with delirium-friendly options and doses for nighttime sedation, analgesia, and nausea and attention to catheter removal and bowel movements. Adherence to PPO was compared with adherence to routine orders. Drug doses were recorded. Presence of delirium was documented using the Confusion Assessment Method and the Mini-Mental State Examination on postoperative Days 1, 3, and 5. Length of stay, discharge site, and in-hospital mortality were recorded. Orthopedic nurses adhered reasonably well with delirium-friendly PPOs. Of 283 participants, 42% developed postoperative delirium, with significantly less delirium in the intervention group (intervention 33%, control 51%, P = .001). The effect of the intervention was stronger in individuals with preexisting dementia (intervention 60%, control 97%, P delirium had longer hospital stays and were more likely to die or be discharged to a nursing home, but there was no significant between-group difference in these outcomes. It is possible to introduce delirium-friendly PPOs into routine post-hip fracture care in a representative elderly population including individuals with dementia. Delirium-friendly PPOs executed by regular nursing staff resulted in a significant reduction in postoperative delirium but no difference in other outcomes. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.
Yuan, Frank; Chung, Kevin C
Quality in health care has been sluggish to adapt to the changing landscape, leading to lapses in the successful delivery of care. Consequently, quality of care has come under intense scrutiny in the past decade, resulting in the creation of various federally funded and nonprofit organizations aimed at assessing and implementing systematic quality improvements. In this article, the authors examine the evolution of quality in health care relative to established quality control measures in other sectors, different ways of assessing quality, and the current state of the health care system.
Full Text Available Based upon an expert survey and consensus method, Sabine Gabrysch and colleagues recommend new signal functions to monitor and track facilities' provision of routine and emergency newborn care.
Akachi, Yoko; Kruk, Margaret E
The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact.
Full Text Available Hair care is a significant international industry – estimated to be worth over £1.44 billion in contemporary Britain (Mintel 2015. Given this, it is perhaps not so surprising to learn that British women spend on average £40,000 on their hair over a lifetime (Sharkey 2014. However, despite women's preoccupation with hair, social science research has paid little attention to this area (McCracken 1997; Cox 1999. Most previous studies have examined the changing nature of styles and fashion, offering valuable insights into its symbolic, ritualistic and religious nature and in turn demonstrating the conspicuous aspects of hair (Cox 1999; Biddle-Perry and Cheang 2008. While the public nature of hair has been documented, what is rarely explored is the private world of hair care, often part of a wider network of day-to-day domestic routines (Shove 2003.
Lyngsøe, Bente Kjær; Vestergaard, Claus Høstrup; Rytter, Dorte
.17) at the 5-year visit. Furthermore, the risk of missing at least four of the seven childcare visits was higher for children of females with maternal depression (RR = 1.16, 95% CI = 1.13 to 1.19). CONCLUSION: Maternal depression seems to compromise CCP attendance. These findings suggest a need for careful......BACKGROUND: Depression is a common and potentially debilitating illness worldwide. Attendance to routine childcare appointments is a key point of interest in the effort to improve the health and care for families facing depression. AIM: To evaluate the association between maternal depression...... and offspring non-attendance to the Danish childcare and vaccination programme (CCP) for children from 0-5 years of age. The CCP consists of seven separate visits and several vaccinations. To investigate if exposure to recent and previous depression may affect attendance differently. DESIGN AND SETTING...
Tao, L; Wilson, E C F; Wareham, N J
extrapolated to 30 years using the UKPDS outcomes model (version 1.3) (long-term analysis; n = 999). All costs were transformed to the UK 2009/10 price level. Results Adjusted incremental costs to the NHS were £285, £935, £1190 and £1745 over a 1-, 5-, 10- and 30-year time horizon, respectively (discounted......Aims To examine the short- and long-term cost-effectiveness of intensive multifactorial treatment compared with routine care among people with screen-detected Type 2 diabetes. Methods Cost–utility analysis in ADDITION-UK, a cluster-randomized controlled trial of early intensive treatment in people...... with screen-detected diabetes in 69 UK general practices. Unit treatment costs and utility decrement data were taken from published literature. Accumulated costs and quality-adjusted life years (QALYs) were calculated using ADDITION-UK data from 1 to 5 years (short-term analysis, n = 1024); trial data were...
Lane, Christianne J.; Williams, Marian E.; Dawson, Michael E.; Polido, José C.; Cermak, Sharon A.
Background. Children with autism spectrum disorders (ASD) commonly exhibit uncooperative behaviors which impede oral care. Previous studies have utilized dentist-report measures of uncooperative behaviors in children with ASD but none have utilized an objective measure of children's behavior or a physiological measure of distress. This study investigated behavioral and physiological distress in children with ASD during routine oral care and examined factors associated with this distress. Methods. Participants were 44 children (n = 22 typical, n = 22 ASD) aged 6–12 receiving routine dental cleanings. Behavioral and physiological measures of stress and anxiety were collected during dental cleanings. Results. Children with ASD exhibited greater distress, compared to the typical group, on dentist-report and researcher-coded measures of overt distress behaviors and on physiological measures. Correlations between physiological and behavioral measures of distress were found in the ASD but not in the typical group. Behavioral distress was correlated with age in the typical group and with expressive communication ability and sensory processing difficulties in the ASD group; physiological distress was correlated with parent-report of anxiety in the typical group and sensory processing difficulties in the ASD group. Conclusions. Novel strategies may be required to decrease behavioral and physiological distress in children with ASD in the dental clinic. PMID:25114916
Leah I. Stein
Full Text Available Background. Children with autism spectrum disorders (ASD commonly exhibit uncooperative behaviors which impede oral care. Previous studies have utilized dentist-report measures of uncooperative behaviors in children with ASD but none have utilized an objective measure of children’s behavior or a physiological measure of distress. This study investigated behavioral and physiological distress in children with ASD during routine oral care and examined factors associated with this distress. Methods. Participants were 44 children (n=22 typical, n=22 ASD aged 6–12 receiving routine dental cleanings. Behavioral and physiological measures of stress and anxiety were collected during dental cleanings. Results. Children with ASD exhibited greater distress, compared to the typical group, on dentist-report and researcher-coded measures of overt distress behaviors and on physiological measures. Correlations between physiological and behavioral measures of distress were found in the ASD but not in the typical group. Behavioral distress was correlated with age in the typical group and with expressive communication ability and sensory processing difficulties in the ASD group; physiological distress was correlated with parent-report of anxiety in the typical group and sensory processing difficulties in the ASD group. Conclusions. Novel strategies may be required to decrease behavioral and physiological distress in children with ASD in the dental clinic.
Frare, Mara; Axia, Giovanna; Battistella, Pier Antonio
To identify the relationship between headache severity, child coping, and quality of life (QoL) in the context of everyday family life. In the pediatric headache research only 3 studies have examined children's coping strategies and only 4 studies considered QoL. A sample of 48 Italian families with children seeking treatment for primary headaches was interviewed using an adaptation of the Ecocultural Family Interview (EFI). The EFI is a parent interview that explores the daily routines of family life in which the child and parent participate and the main concerns regarding how that routine is organized. As expected the Lisrel analyses consistently showed that QoL is affected by a child's coping abilities in a causal direction. Headache frequency and duration have a significant impact on a child's QoL. The family daily routine influences significantly both the child's coping ability and QoL. Surprisingly enough, children's coping strategies are not related to headache severity. More research is needed on the causal factors influencing child's ability to cope with pain, and in particular more attention should be devoted to the contextual and family factors related to pediatric headache.
Salomon, Say; Frankel, Hilary; Chuang, Elizabeth; Eti, Serife; Selwyn, Peter
Left-ventricular assist devices (LVADs) are increasingly used to improve quality of life for end-stage heart failure patients. The Joint Commission now requires pre-implantation palliative care assessment, however many palliative care teams have little experience providing this service. To describe the integration of palliative services at one Center of Excellence for Heart and Vascular Care. This is a retrospective chart review of all patients receiving LVADs at a single urban academic medical center from 1/2015 to 9/2016. Palliative care needs and services provided are described. Two case presentations illustrate the collaboration between the cardiothoracic and palliative care teams. 51 patients were included. Of those, 28 received a palliative care consultation during this roll-out period. The rate of consultation rose from 35% to 71% as work flows improved with institutional commitment. Symptom assessment, psychosocial assessment and advance care planning (ACP) were always performed (n=28, 100%). More than half of patients were evaluated for dyspnea (n=20, 71%), fatigue (n=18, 64%) and pain (n=16, 57%). Consults centered around ACP, and very few patients (n=7, 25%) required palliative care follow up. Palliative consultation did not delay LVAD placement. Although palliative care consultants provided initial evaluation and management of multiple symptoms, there was not a large ongoing need. Integration of palliative services into the care of patients receiving LVADs can be incorporated into the workflow of the cardiothoracic and palliative care teams, resulting in improved ACP for all patients receiving LVADs and better care coordination for patients at end of life. Copyright © 2018. Published by Elsevier Inc.
Biester, D J; Duggan, M; Perkins, M; Powers, L K; Classick, S
SOURCE AND PURPOSE: Constraints in the healthcare delivery system are resulting in unprecedented challenges to quality nursing care. In response to concerns expressed by readers in a JSPN survey, we solicited input from prominent SPN members. Quality care can be sustained through nurses' creativity, flexibility, leadership, and collaboration. The context for quality care is an organizational environment with attention to critical analysis, careful resource utilization, and improved outcomes. Nurses can not only maintain premium standards of quality care but, by assuming leadership, help shape the future of health care.
Feazell, G Landon; Marren, John P
Powerful forces are converging in US health care to finally cause recognition of the inherently logical relationship between quality and money. The forces, or marketplace "drivers," which are converging to compel recognition of the relationship between cost and quality are: (1) the increasing costs of care; (2) the recurrence of another medical malpractice crisis; and (3) the recognition inside and outside of health care that quality is inconsistent and unacceptable. It is apparent that hospital administrators, financial officers, board members, and medical staff leadership do not routinely do two things: (1) relate quality to finance; and (2) appreciate the intra-hospital structural problems that impede quality attainment. This article discusses these factors and offers a positive method for re-structuring quality efforts and focusing the hospital and its medical staff on quality. The simple but compelling thesis of the authors is that health care must immediately engage in the transformation to making quality of medical care the fundamental business strategy of the organization.
Willer, C; Swart, E
In an epidemiological context arthrosis is becoming more important due to demographic changes. This study describes the routine medical treatment of patients with arthrosis. Claims data of a German statutory health insurance fund for the period from 2005 to 2008 were analyzed. All insured patients aged 60 years and older residing in Kinzigtal were included. In detail all 1,551 insured persons with a validated ambulatory diagnosis of gonarthrosis or coxarthrosis (ICD-10: M16/M17) were analyzed. The treatment prevalence of arthrosis documented by practice-based physicians rose from 14 % (60-69 years old) to 25 % (80 years and older). At least one hospital admission between 2006 and 2008 was documented for two thirds of the patients whereby 86 and 95 patients were admitted because of coxarthrosis or gonarthrosis, respectively. A total of 112 and 96 insured patients received an implantation or revision of an endoprosthesis of the hip or knee, respectively. The need for nursing care did not decrease in cases of surgical compared to conservative treatment. Claims data allow a differentiated analysis of medical treatment and quality of care as well as a comparison of alternatives of medical care for patients with arthrosis. Results of such analyses can be used to identify patients with increased vulnerability.
Calabrese, Sarah K; Krakower, Douglas S; Mayer, Kenneth H
More than 3 decades since its emergence in the United States, HIV continues to spread and disproportionately affect socially marginalized groups. Preexposure prophylaxis (PrEP), a highly effective prevention strategy federally approved since 2012, could fundamentally alter the course of the epidemic. However, PrEP's potential has not been fully realized, in part because health care providers have been slow to adopt PrEP in clinical practice and have been selective in their discussion of PrEP with patients. This nonstandardized approach has constrained PrEP access. PrEP access has not only been inadequate but also inequitable, with several groups in high need showing lower rates of uptake than do their socially privileged counterparts. Recognizing these early warning signs that current approaches to PrEP implementation could exacerbate existing HIV disparities, we call on health professionals to integrate PrEP into routine preventive health care for adult patients-particularly in primary care, reproductive health, and behavioral health settings. Drawing on the empirical literature, we present 4 arguments for why doing so would improve access and access equity, and we conclude that the benefits clearly outweigh the challenges.
Berger-Jenkins, Evelyn; McCord, Mary; Gallagher, Trish; Olfson, Mark
Despite evidence for its feasibility, the usage of mental health screening in primary care practices with overburdened providers and few referral options remains unclear. This study explores the effects of routine screening on mental health problem identification and management in a low-resource setting. Medical records of 5 to 12 year-old children presenting for well visits before and after screening was implemented were reviewed. Multivariate logistic regression was used to explore associations between study period and identification/management practices. Changes in the number of visits and wait times for a co-located referral service were assessed post hoc. Parents disclosed more mental health problems, and providers initiated more workups but referred fewer patients after screening was implemented. The proportion of new visits and wait times for the referral service did not change. Even in low-resource settings, screening may facilitate parental disclosure and increase clinical attention to mental health problems without overburdening referral services.
Sparks, Toni; Kawi, Jennifer; Menzel, Nancy Nivison; Hartley, Kendall
Fibromyalgia management remains complicated and challenging. Health information technology is an evidence-based, nonpharmacological self and symptom management strategy, but few studies have evaluated its feasibility for managing fibromyalgia patients in clinical practice. FibroGuide is an example of an evidence-based, interactive, and computer-based program comprised of 10 educational modules on fibromyalgia. Study aims were to: (1) develop a process for implementing FibroGuide into the routine care of patients with fibromyalgia, (2) evaluate the overall impact on fibromyalgia before and after a 12-week implementation, and (3) assess patient perspectives on using FibroGuide health information technology to assist in self-management. In this pilot study, 35 participants with fibromyalgia were recruited from an Advanced Practice Registered Nurse's outpatient clinic. Using a descriptive design, quantitative data analysis was employed to address study aims. Based on data collection pre- and post-intervention using paired samples testing, a statistically significant change (p = .017) was observed in overall fibromyalgia impact (improved symptom severity, activity, and function). Majority felt that FibroGuide was helpful as part of their routine care, and nearly half reported that it assisted in their self-management. Although 65% noted that technology was an effective and efficient way to receive education for fibromyalgia management, 57% preferred talking to healthcare providers. Larger longitudinal studies are needed on the use of health information technology in fibromyalgia, evaluating both statistical and clinical significance, while decreasing barriers to participant use for this promising adjunct to clinical management. Providers need to be well educated on supporting self-management strategies and health information technology. Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
The early childhood workforce is routinely demonstrated as being central to the quality of early childhood education and care (ECEC). Frequently, discussions of quality focus on structural features of training, such as level and duration. However, the literature demonstrates that quality extends beyond the structural and that early childhood…
Maloney, T.J.; Ludtke, A.S.; Krizman, T.L.
The US. Geological Survey operates a quality- assurance program based on the analyses of reference samples for the National Water Quality Laboratory in Arvada, Colorado, and the Quality of Water Service Unit in Ocala, Florida. Reference samples containing selected inorganic, nutrient, and low ionic-strength constituents are prepared and disguised as routine samples. The program goal is to determine precision and bias for as many analytical methods offered by the participating laboratories as possible. The samples typically are submitted at a rate of approximately 5 percent of the annual environmental sample load for each constituent. The samples are distributed to the laboratories throughout the year. Analytical data for these reference samples reflect the quality of environmental sample data produced by the laboratories because the samples are processed in the same manner for all steps from sample login through data release. The results are stored permanently in the National Water Data Storage and Retrieval System. During water year 1991, 86 analytical procedures were evaluated at the National Water Quality Laboratory and 37 analytical procedures were evaluated at the Quality of Water Service Unit. An overall evaluation of the inorganic (major ion and trace metal) constituent data for water year 1991 indicated analytical imprecision in the National Water Quality Laboratory for 5 of 67 analytical procedures: aluminum (whole-water recoverable, atomic emission spectrometric, direct-current plasma); calcium (atomic emission spectrometric, direct); fluoride (ion-exchange chromatographic); iron (whole-water recoverable, atomic absorption spectrometric, direct); and sulfate (ion-exchange chromatographic). The results for 11 of 67 analytical procedures had positive or negative bias during water year 1991. Analytical imprecision was indicated in the determination of two of the five National Water Quality Laboratory nutrient constituents: orthophosphate as phosphorus and
This study was not able to document statistically significant clinical effect of iCBT with minimal therapist contact compared to a waiting list control group in a specialised anxiety clinic in routine care. However, a large and significant effect was seen on self-reported quality of life. Although these results offer an interesting perspective on iCBT in specialised care, they should be interpreted with caution, due to the limitations of the study. A large scale fully powered RCT is recommended.
Johnson-Agbakwu, Crista E; Allen, Jennifer; Nizigiyimana, Jeanne F; Ramirez, Glenda; Hollifield, Michael
Posttraumatic stress disorder (PTSD), anxiety, and depression are common mental health disorders in the refugee population. High rates of violence, trauma, and PTSD among refugee women remain unaddressed. The process of implementing a mental health screening tool among multiethnic, newly arrived refugee women receiving routine obstetric and gynecologic care in a dedicated refugee women's health clinic is described. The Refugee Health Screener-15 (RHS-15) is a culturally responsive, efficient, validated screening instrument that detects symptoms of emotional distress across diverse refugee populations and languages. An interdisciplinary community partnership was established with a local behavioral health services agency to facilitate the referral of women scoring positive on the RHS-15. Staff and provider training sessions, as well as the incorporation of bicultural, multilingual cultural health navigators, greatly facilitated linguistically appropriate care coordination for refugee women in a culturally sensitive manner. Twenty-six (23.2%) of the 112 women who completed the RHS-15 scored positive, of which 14 (53.8%) were Iraqi, 1 (3.8%) was Burmese, and 3 (11.5%) were Somali. Among these 26 women, 8 (30.8%) are actively receiving mental health services and 5 (19.2%) have appointments scheduled. However, 13 (50%) are not enrolled in mental health care because of either declining services (46.2%) or a lack of insurance (53.8%). Screening for mental disorders among refugee women will promote greater awareness and identify those individuals who would benefit from further mental health evaluation and treatment. Sustainable interdisciplinary models of care are necessary to promote health education, dispel myths, and reduce the stigma of mental health. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Johnson-Agbakwu, Crista E.; Allen, Jennifer; Nizigiyimana, Jeanne F.; Ramirez, Glenda; Hollifield, Michael
Posttraumatic stress disorder (PTSD), anxiety, and depression are the most common mental health disorders in the refugee population. High rates of violence, trauma, and PTSD among refugee women remain unaddressed. The process of implementing a mental health screening tool among multi-ethnic, newly-arrived refugee women receiving routine obstetric and gynecologic care in a dedicated refugee women’s health clinic is described. The Refugee Health Screener-15 (RHS-15) is a culturally-responsive, efficient, validated screening instrument that detects symptoms of emotional distress across diverse refugee populations and languages. An interdisciplinary community partnership was established with a local behavioral health services agency to facilitate the referral of women scoring positive on the RHS-15. Staff and provider training sessions, as well as the incorporation of bi-cultural, multi-lingual Cultural Health Navigators, greatly facilitated linguistically-appropriate care coordination for refugee women in a culturally sensitive manner. Twenty-six (23.2%) of the 112 women who completed the RHS-15 scored positive; of which 14 (53.8%) were Iraqi, one (3.8%) was Burmese, and three (11.5%) were Somali. Among these 26 women, eight (30.8%) are actively receiving mental health services, and five (19.2%) have appointments scheduled. However 13 (50%) are not enrolled in mental health care due to either declining services (46.2%), or a lack of insurance (53.8%). Screening for mental disorders among refugee women will promote greater awareness and identify those individuals who would benefit from further mental health evaluation and treatment. Sustainable interdisciplinary models of care are necessary to promote health education, dispel myths and reduce the stigma of mental health. PMID:25383999
Skinnars Josefsson, Malin; Nydahl, M.; PERSSON I.; Mattsson Sydner, Y.
Objectives The aim is to explore the effects of antecedent, structural and process quality indicators of nutritional care practice on meal satisfaction and screened nutritional status among older adults in residential care homes. Design Data for this Swedish cross-sectional study regarding older adults living in residential care homes were collected by i) a national questionnaire, ii) records from the quality registry Senior Alert, iii) data from an Open Comparison survey of elderly care in 2...
Diabetes mellitus is a common disorder of glucose metabolism that is increasingly prevalent in the Irish population. It is associated with a range of complications leading to substantial morbidity and mortality. A less well-recognized complication of diabetes is periodontal disease. This is a chronic inflammatory disease affecting the periodontium, the specialized group of tissues that surround and support the teeth, including the gingiva (gums) and alveolar bone. Periodontal disease affects patients with diabetes with a greater prevalence and incidence than non-diabetic patients, and can itself exert negative effects on glucose control in people with diabetes. The National Clinical Programme for Diabetes in Ireland aims to reduce the morbidity and mortality associated with diabetes, which includes the development and dissemination of guidelines supporting integrated care. Based on the bidirectional relationship between diabetes mellitus and periodontal disease, we recommend that an oral health evaluation, as well as any necessary onward referral, be incorporated into the Irish recommendations for routine diabetes care, as part of the National Clinical Programme.
Stephanie M Allen
Full Text Available Measurement of Emergency Obstetric Care capability is common, and measurement of newborn and overall routine childbirth care has begun in recent years. These assessments of facility capabilities can be used to identify geographic inequalities in access to functional health services and to monitor improvements over time. This paper develops an approach for monitoring the childbirth environment that accounts for the delivery caseload of the facility.We used data from the Kenya Service Provision Assessment to examine facility capability to provide quality childbirth care, including infrastructure, routine maternal and newborn care, and emergency obstetric and newborn care. A facility was considered capable of providing a function if necessary tracer items were present and, for emergency functions, if the function had been performed in the previous three months. We weighted facility capability by delivery caseload, and compared results with those generated using traditional "survey weights".Of the 403 facilities providing childbirth care, the proportion meeting criteria for capability were: 13% for general infrastructure, 6% for basic emergency obstetric care, 3% for basic emergency newborn care, 13% and 11% for routine maternal and newborn care, respectively. When the new caseload weights accounting for delivery volume were applied, capability improved and the proportions of deliveries occurring in a facility meeting capability criteria were: 51% for general infrastructure, 46% for basic emergency obstetric care, 12% for basic emergency newborn care, 36% and 18% for routine maternal and newborn care, respectively. This is because most of the caseload was in hospitals, which generally had better capability. Despite these findings, fewer than 2% of deliveries occurred in a facility capable of providing all functions.Reporting on the percentage of facilities capable of providing certain functions misrepresents the capacity to provide care at the
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...
van Cranenburgh, Oda D; Smets, Ellen M A; de Rie, Menno A; Sprangers, Mirjam A G; de Korte, John
Chronic skin diseases have a negative impact on patients' health-related quality of life (HRQoL). Patient education might contribute to HRQoL improvement. We developed a web-based, educational, HRQoL intervention for patients with a chronic skin disease. We aimed to assess 1) the feasibility of implementing the intervention in routine dermatological practice and patients' daily life, and 2) the acceptance of the intervention by health care providers and patients. Additionally, we aimed to create a patient user profile. We conducted an observational pilot study at 6 dermatological centres, including 105 outpatients. Implementation in routine practice was feasible and acceptable to health care providers. However, implementation in patients' daily life was found not to be entirely feasible. Perceived relevance by patients was low, though patients rated the intervention as convenient and attractive. No univocal user profile was found. Suggestions for improvements of the intervention, e.g. tailoring and adding blended learning components, are discussed.
... care? • How long has the hospice been in business? • How often will a nurse or social worker ... the service follows rules for patient safety and quality. Go to Quality Check ® at www. qualitycheck. org ...
Lindh, Marianne; Kihlgren, Annica; Perseius, Kent-Inge
The aim of the study was to describe factors influencing compliance to hygiene routines in community care in Swedish municipalities from the perspective of medically responsible nurses (MRN). A web-based questionnaire was sent to all MRNs in Swedish municipalities, N = 268. Beside demographical background data, the questionnaire contained two core open-ended questions generating free text data. Data were analysed with descriptive statistics and qualitative content analysis. Four categories of factors were found: resources, management, staff and external factors. All four categories contained subcategories. To some extent, the challenges to uphold adequate compliance to hygiene routines seem different in community care than in hospitals. Resources regarding equipment and supplies seem as an uncertain asset and uneven distributed among municipalities. Home likeness was seen as a major obstacle for upholding adequate hygiene routines. To uphold sufficient hygiene routines in a person's home or in a home-like environment might be one of the major challenges for community health care in the future. The MRN's narratives suggest that Registered Nurses have a key role in upholding sufficient hygiene in community care. This report might contribute in providing them with more knowledge to take on this urgent task. © 2012 Nordic College of Caring Science.
Valk, J.W.; Ploetz, F.B.; Schuerman, F.A.B.A.; Vught, H. van [Dept. of Paediatric Intensive Care, Utrecht (Netherlands); Kramer, P.P.G.; Beek, E.J.A. [Dept. of Radiology, University Medical Centre, Wilhelmina Children' s Hospital, Utrecht (Netherlands)
Background. In many paediatric intensive care units (PICUs) chest X-ray films (CXRs) are required as part of the daily examination or after completion of invasive procedures. Objective. First, to evaluate if the American College of Radiology (ACR) guidelines for adult patients are appropriate for paediatric pa- tients. Second, to assess the diagnostic efficacy of the CXRs. Materials and methods. One-hundred-seventy-four CXRs acquired in 74 patients, either routinely or after invasive procedures, were analysed. The indication of the obtained CXRs, or the absence of indication in patients in whom no CXRs was taken, was compared with ACR guidelines. The position of medical devices was evaluated. Changes in cardiopulmonary status were noted. Results. Sixty-seven percent of the CXRs were in accordance with the ACR guidelines, and in 74 % of pa- tients in whom no CXRs were taken this was also in accordance with these guidelines. Sixteen percent of the endotracheal tubes, 23 % of central venous lines and 15 % of nasogastric tubes were malpositioned. Changes in cardiopulmonary status, after the initial film, were noted in 63 %. Conclusions. The indications for the majority of CXRs in our PICU appeared to be in accordance with ACR guidelines. The high percentage of malpositioned tubes and lines and the number of cardiopulmonary changes on CXRs in a PICU underline the value of these films. Adjustments of the ACR guidelines for particular groups of paediatric patients may limit the number of CXRs taken and may further increase diagnostic efficacy. (orig.)
McMenamin, D; Rainey, O; Evans, G
This paper describes and audits a novel method of health care screening in a military setting and questions the validity of the current PULHHEEMS system. The system involves screening patients at entry into an establishment with the aim of making them fit for task. A retrospective DMICP case note review was conducted over 3 months following the introduction of the NewJoiners Routine (NJR), to assess the level of positive screening findings, and the number of medical interventions that resulted from this screening. Key Performance Indicators (KPIs) were also assessed during the time frame of the audit. 131/194 (67.5%) had an unmet health need/ positive screening finding. This led to 66 medical interventions in 54 (25.7%) patients. KPIs during this period were markedly improved. Although not conclusive, this audit strongly suggests an improvement in culture in making personnel fit for task, and reflects the medical evidence of moving away from asymptomatic periodic health screening to targeted health screening.
Le Guen, M; Nicolas-Robin, A; Lebard, C; Arnulf, I; Langeron, O
Post-anaesthesia care units (PACUs) with 24/7 activity and consequently artificial light and noise may disturb the sleep of patients who require prolonged medical supervision. After one postoperative night, we compared sleep quality in patients with and without noise (earplug) and light (eye mask) protection. After ethical board approval, 46 patients without any neurological or respiratory failure undergoing major non-cardiac surgery were prospectively included. They were randomized to sleep with or without protective devices during the first postoperative night in the PACU. Sleep quality was simultaneously measured by sleep-quality scales (Spiegel score and Medical Outcomes Study Sleep), nurses' assessment, and through a wrist actigraph (Actiwatch). Secondary outcomes such as pain control and nocturnal activity were recorded. Comparisons between groups were made by Student's t-test or non-parametric test for repeated measures as appropriate (SPSS 10.0). A P-value Earplugs and eye masks applied in the PACU during the first postoperative night significantly preserve sleep quality. Such non-invasive and cheap devices may be generalized in the PACU or in intensive care units.
Urbano, Nicoletta; Modoni, Sergio
The digital autoradiography system is currently used in nuclear medicine for quantitative imaging of radioactivity distribution (thin layer chromatography samples, tissue sections, and cell cultures). The aim of this study was to define a set of tests for setting up a specific acceptance testing procedure and routine quality controls for this instrument. Over a 3-month period, we analyzed the active components of the instrument (phosphor screen and photometer) by using suitable self-manufactured equipment (phantoms, lead plate, lead cylinder, and photographic paper) required to realize, in a routine quality program, the following tests: integral uniformity (IU) and differential uniformity (DU) in a useful field of view (UFOV) and a central field of view (CFOV), resolution, geometric linearity, and sensitivity. Screen IU was 19.7 ± 2.3% (UFOV) and 11.1 ± 3.7% (CFOV). Screen DU ranged between 1.6 ± 1.1 and 1.8 ± 0.9% for UFOV and between 1.2 ± 0.4 and 1.4 ± 0.6% for CFOV. Screen resolution measured as full-width at half-maximum was 1.94 ± 0.08 mm. Screen sensitivity was 505.1 ± 10.4 digital light units and ranged between -3.15 and +3.49% with reference to the mean of measured values. Photometer IU was 17.4 ± 0.2% (UFOV) and 13.7 ± 1.1% (CFOV). Photometer DU ranged between 1.9 ± 0.9 and 2.3 ± 1.2% for UFOV and between 1.9 ± 0.8 and 2.1 ± 1.1% for CFOV. Photometer resolution was good (full-width at half-maximum =0.5 ± 0.076 mm). Our results suggest that the methodology we propose could be an easy, accurate, quick, and low-cost tool to guarantee the correct instrument basic function.
Boerma, W.G.W.; Kringos, D.S.; Verschuuren, M.; Pellny, M.; Baymirova, L.
The Uzbek government has a central role in primary care quality management. On paper, many quality management structures and procedures exist. Now, primary care practice should follow, as NIVEL research – done on the initiative of the World Health Organisation (WHO) – has shown. The results have
Child Trends, 2010
This paper presents a profile of Iowa's Child Care Quality Rating System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile is divided into the following categories: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family Child Care Programs;…
Cawthon, Courtney; Mion, Lorraine C; Willens, David E; Roumie, Christianne L; Kripalani, Sunil
Patients with inadequate health literacy often have poorer health outcomes and increased utilization and costs. The Institute of Medicine has recommended that health literacy assessment be incorporated into health care information systems, which would facilitate large-scale studies of the effects of health literacy, as well as evaluation of system interventions to improve care by addressing health literacy. As part of the Health Literacy Screening (HEALS) study, a Brief Health Literacy Screen (BHLS) was incorporated into the electronic health record (EHR) at a large academic medical center. Changes were implemented to the nursing intake documentation across all adult hospital units, the emergency department, and three primary care practices. The change involved replacing previous education screening items with the BHLS. Implementation was based on a quality improvement framework, with a focus on acceptability, adoption, appropriateness, feasibility, fidelity and sustainability. Support was gained from nursing leadership, education and training was provided, a documentation change was rolled out, feedback was obtained, and uptake of the new health literacy screening items was monitored. Between November 2010 and April 2012, there were 55,611 adult inpatient admissions, and from November 2010 to September 2011, 23,186 adult patients made 39,595 clinic visits to the three primary care practices. The completion (uptake) rate was 91.8% for the hospital and 66.6% for the outpatient clinics. Although challenges exist, it is feasible to incorporate health literacy screening into clinical assessment and EHR documentation. Next steps are to evaluate the association of health literacy with processes and outcomes of care across inpatient and outpatient populations.
Full Text Available -Quality Assessment in the Primary care Dear Editor; I have read the article titled as “Implementation of Rogi Kalyan Samiti (RKS at Primary Health Centre Durvesh” with great interest. Shrivastava et all concluded that assessment mechanism for the achievement of objectives for the suggested RKS model was not successful (1. Hereby I would like to emphasize the importance of quality assessment (QA especially in the era of newly established primary care implementations in our country. Promotion of quality has been fundamental part of primary care health services. Nevertheless variations in quality of care exist even in the developed countries. Accomplishment of quality in the primary care has some barriers like administration and directorial factors, absence of evidence-based medicine practice lack of continuous medical education. Quality of health care is no doubt multifaceted model that covers all components of health structures and processes of care. Quality in the primary care set up includes patient physician relationship, immunization, maternal, adolescent, adult and geriatric health care, referral, non-communicable disease management and prescribing (2. Most countries are recently beginning the implementation of quality assessments in all walks of healthcare. Organizations like European society for quality and safety in family practice (EQuiP endeavor to accomplish quality by collaboration. There are reported developments and experiments related to the methodology, processes and outcomes of quality assessments of health care. Quality assessments will not only contribute the accomplishment of the program / project but also detect the areas where obstacles also exist. In order to speed up the adoption of QA and to circumvent the occurrence of mistakes, health policy makers and family physicians from different parts of the world should share their experiences. Consensus on quality in preventive medicine implementations can help to yield
Linder, R; Horenkamp-Sonntag, D; Engel, S; Schneider, U; Verheyen, F
Background and Problem: Acute nonspecific back pain disorders are typically self-limiting. According to the national guideline low back pain, only in case of clinical suspicion of a serious course radiological imaging should take place immediately. Otherwise, the guideline recommends waiting at least six weeks. Using Statutory Health Insurance (SHI) routine data of the Techniker Krankenkasse we analyzed how many of the insured persons suffering from acute back pain for the first time with no indication of a serious outcome received a non-indicated diagnostic imaging. In about 10 % diagnostic imaging is conducted after initial diagnosis. If an imaging is carried out, roughly one third of these cases takes place ahead of time or is completely unnecessary. Methodically this is a very conservative estimation, thus it seems likely that the extent of overdiagnosis in actual medical care situation is even larger. Every third patient who received radiological diagnostics due to first acute nonspecific back pain underwent the procedure more quickly than recommended (less than six weeks). Overdiagnosis is not only economically problematic but also with respect to patient orientation and patient safety. It may cause substantial damage to patients - either by the use of diagnostics itself or by means of therapies initiated after diagnostics. © Georg Thieme Verlag KG Stuttgart · New York.
Morelli, Sandra; Giordano, Andrea; Giansanti, Daniele
Both in real-time and "store & forward" tele-echocardiography (T-E), a coding process has to be applied to the echocardiographic videoclips in order to limit the bandwidth needed and adapt it to the bandwidths furnished by network providers. The compression process degrades the videoclips, affecting thus the quality of the videoclips and potentially compromising the diagnostic accuracy of the T-E. In this work the authors investigated on the use of automatic tools for the video quality assessment by means of objective methods with particular care to the role of the system administrator. As the use of tests on video quality assessment (based on subjective methods) is hampered by the high number of needed resources (persons, laboratories and time). The use of valid objective methods is thus desirable. The study reviewed different tools with this specific aim. One of the more suitable tool was found to be represented by a software package designed by the Institute of Telecommunication Sciences and the National Telecommunication and Information Administration, the NTIA/ITS VQM tool. This tool gives back objective-quantitative data as outcomes, however embeds models emulating the subjective perception. This study reviewed and analyzed in depth the functionalities of the tool to improve the image quality in TE over the network. The tool was also found suitable for a more general process of T-E assessment, from a health technology assessment (HTA) perspective.
Full Text Available Both in real-time and "store & forward" tele-echocardiography (T-E, a coding process has to be applied to the echocardiography videoclips in order to limit the bandwidth needed and adapt it to the bandwidths furnished by network providers. The compression process degrades the videoclips, affecting thus the quality of the videoclips and potentially compromising the diagnostic accuracy of the T-E. In this work the authors investigated on the use of automatic tools for the video quality assessment by means of objective methods with particular care to the role of the system administrator. As the use of tests on video quality assessment (based on subjective methods is hampered by the high number of needed resources (persons, laboratories and time. The use of valid objective methods is thus desirable. The study reviewed different tools with this specific aim. One of the more suitable tool was found to be represented by a software package designed by the Institute of Telecommunication Sciences and the National Telecommunication and Information Administration, the NTIA/ITS VQM tool. This tool gives back objective-quantitative data as outcomes, however embeds models emulating the subjective perception. This study reviewed and analyzed in depth the functionalities of the tool to improve the image quality in TE over the network. The tool was also found suitable for a more general process of T-E assessment, from a health technology assessment (HTA perspective.
van der Burg, Pauline S.; de Jongh, Frans H.; Miedema, Martijn; Frerichs, Inez; van Kaam, Anton H.
During routine nursing care, preterm infants are often placed in lateral position for several hours, but the effect of this procedure on regional lung volume and ventilation is unknown. In our study we examined this effect during 3 hrs of lateral positioning in stable preterm infants. Preterm
van der Burg, P.S.; de Jongh, Franciscus H.C.; Miedema, M.; Frerichs, I.; van Kaam, A.H.
Introduction During routine nursing care, preterm infants are often placed in lateral position for several hours, but the effect of this procedure on regional lung volume and ventilation is unknown. In our study we examined this effect during 3 hrs of lateral positioning in stable preterm
van den Hoofdakker, B.J.; Nauta, M.H.; van der Veen-Mulders, L.; Sytema, S.; Emmelkamp, P.M.G.; Minderaa, R.B.; Hoekstra, P.J.
Objective To investigate predictors and moderators of outcome of behavioral parent training (BPT) as adjunct to ongoing routine clinical care (RCC), versus RCC alone. Methods We randomly assigned 94 referred children (4-12 years) with attention-deficit/hyperactivity disorder (ADHD) to BPT plus RCC
Sun, W.; Guo, J.; Li, X.; Zhao, Y.; Chen, H.; Wu, G.
Objectives Oral diseases are associated with adverse pregnancy outcomes. The routine utilization of dental care (RUDC) during pregnancy is an effective way to improve pregnant women’s oral health, and thus safeguard the health of their babies. As China has one fifth of the world’s population, it is
Gameiro, S.; Boivin, J.; Dancet, E.; Klerk, C. de; Emery, M.; Lewis-Jones, C.; Thorn, P.; Broeck, U. Van den; Venetis, C.; Verhaak, C.M.; Wischmann, T.; Vermeulen, N.
STUDY QUESTION: Based on the best available evidence in the literature, what is the optimal management of routine psychosocial care at infertility and medically assisted reproduction (MAR) clinics? SUMMARY ANSWER: Using the structured methodology of the Manual for the European Society of Human
Gameiro, S.; Boivin, J.; Dancet, E.; de Klerk, C.; Emery, M.; Lewis-Jones, C.; Thorn, P.; van den Broeck, U.; Venetis, C.; Verhaak, C. M.; Wischmann, T.; Vermeulen, N.
Based on the best available evidence in the literature, what is the optimal management of routine psychosocial care at infertility and medically assisted reproduction (MAR) clinics? Using the structured methodology of the Manual for the European Society of Human Reproduction and Embryology (ESHRE)
Abstract Elderly people, because of the frail health condition and consequent problems, have in most cases substantial difficulties living at home. Despite the need for widened nursing home custody, the field of quality institutional elderly care in Slovenia in the past did not undergo comprehensive research. The purpose of this two-part study was to investigate the quality of institutional elderly care and elderly care offered in Slovenian nursing homes. Additional purpose was to eval...
Full Text Available Despite the high coverage of directly observed treatment short-course (DOTS, tuberculosis (TB continues to affect 10.4 million people each year, and kills 1.8 million. High TB mortality, the large number of missing TB cases, the emergence of severe forms of drug resistance, and the slow decline in TB incidence indicate that merely expanding the coverage of TB services is insufficient to end the epidemic. In the era of the End TB Strategy, we need to think beyond coverage and start focusing on the quality of TB care that is routinely offered to patients in high burden countries, in both public and private sectors. In this review, current evidence on the quality of TB care in high burden countries, major gaps in the quality of care, and some novel efforts to measure and improve the quality of care are described. Based on systematic reviews on the quality of TB care or surrogates of quality (e.g., TB diagnostic delays, analyses of TB care cascades, and newer studies that directly measure quality of care, it is shown that the quality of care in both the public and private sector falls short of international standards and urgently needs improvement. National TB programs will therefore need to systematically measure and improve quality of TB care and invest in quality improvement programs.
Willebrand, Mimmie; Sjöberg, Folke; Huss, Fredrik; Sveen, Josefin
To describe parents' perceived quality of pediatric burn care and evaluate factors associated with differences in perceived quality among parents. 62 parents of children with burns were recruited on a Swedish national basis 0.8 to 5.6years after the child's injury. Measures were an adaptation of the Quality of Care Indices - Parent questionnaire consisting of 8 subscales and one overall question, the Impact of Event Scale -Revised, Montgomery Åsberg Depression Rating Scale, and Injury-specific fear-avoidance. Ratings of quality of care were high, especially regarding Staff Attitudes, Medical Treatment, and Caring Processes. Overall satisfaction rated from 1 to 10 was on average 9.1 (SD=1.2). Overall satisfaction and specific indices of Quality of care were not associated with burn severity, parent gender, or parent age. However, Quality of care was associated with current symptoms of posttraumatic stress and depression, and parents of girls expressed being less satisfied with Participation. Parents' perceived quality of care is associated with psychological health, but not with characteristics of the child's injury or age. The results suggest that burn care can improve by involving parents of girls more and by being more attentive towards parents who themselves appear stressed or worried. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.
Jakobsen, Erik Winther; Green, Anders; Oesterlind, Kell
To improve prognosis and quality of lung cancer care the Danish Lung Cancer Group has developed a strategy consisting of national clinical guidelines and a clinical quality and research database. The first edition of our guidelines was published in 1998 and our national lung cancer registry...... was opened for registrations in 2000. This article describes methods and results obtained by multidisciplinary collaboration and illustrates how quality of lung cancer care can be improved by establishing and monitoring result and process indicators....
Rizzello, Anna; Di Pierro, Donato; Lodi, Filippo; Trespidi, Silvia; Cicoria, Gianfranco; Pancaldi, Davide; Nanni, Cristina; Marengo, Mario; Marzola, Maria Cristina; Al-Nahhas, Adil; Rubello, Domenico; Boschi, Stefano
Scintigraphic imaging of infection and inflammation with 67Ga-citrate is an established and powerful diagnostic tool in the management of patients with infectious or inflammatory diseases. 68Ga is a short-lived positron-emitting radionuclide (half-life 67.6 min, positron energy 2.92 MeV), which allows better imaging qualities than 67Ga using the high spatial resolution and the quantitative features of PET. The aim of this study was to develop a method of synthesis for 68Ga citrate with high and reproducible radiochemical yield using a commercial 68Ga-labelling module. The resultant 68Ga citrate would be suitable for use in the detection of infectious or inflammatory diseases in routine clinical practice. A simplified method of producing 68Ga citrate is described. Radiochemical purity, pyrogen testing were performed as per the standard protocols. After performing 10 syntheses of 68Ga citrate, the radiochemical yield was 64.1+/-6.0% (mean+/-standard deviation) with an average activity of 971.2+/-103.4 MBq available for labelling. Radiochemical purity determined by instant thin-layer chromatography-silica gel was higher than 98%. All the synthesized products were found to be sterile and pyrogen-free. In this study, the quality control step provided good and reproducible results. This is worth noting, especially in view of the stringent new rules adopted in most European countries for the in-house good manufacturing practice (GMP) synthesis of radiopharmaceuticals. The high radiochemical yield and purity showed that this method is a reliable tool for the production of 68Ga citrate to be used in the detection of inflammatory and infectious diseases using high resolution and qualitative PET.
Baat, C. de; Witter, D.J.; Keltjens, H.M.A.M.; Creugers, N.H.J.
Following treatment with a removable partial denture, routine oral examinations are required to stabilize the existing condition in a sustainable way and to make possible the timely treatment of anomalies which have appeared. In cases of problems assessed during a routine oral examination in
Tavares, Alze Pereira Dos Santos; Paparelli, Carolina; Kishimoto, Carolina Sassaki; Cortizo, Silvia Avo; Ebina, Karen; Braz, Mariana Sarkis; Mazutti, Sandra Regina Gonçalves; Arruda, Marcio José Cristiano; Antunes, Bárbara
Gathering clinical evidence data on patients' palliative care needs is paramount to identify changes in outcomes over time and maintaining on-going quality improvement. Implementation of patient-centred outcome measures has been widely recommended. The routine use of these instruments in daily practice is challenging and not widespread. To implement a patient-centred outcome measure in daily practice and fulfil one quality indicator: improve pain during the 72 h after admission, in at least 75% of patients. An observational prospective study. The Palliative care Outcome Scale was used at admission (T0), third day (T1) and weekly. Hospital palliative care unit with 17 individual rooms. All patients admitted to the unit were included in the study. Preliminary results ( N = 84) revealed inconsistent and missing data (14%). Symptoms were sub-optimally controlled by T1. Processes changed, and only a team member could apply Palliative care Outcome Scale. Doctors were encouraged to grasp the meaning of Palliative care Outcome Scale results for each patient. The post-pilot included 317 patients. No missing data occurred. There was an improvement in most items between T0 and T1: 'pain' and 'other symptoms' presented statistical significant differences ( p palliative care service is feasible and improves quality of care. Controlling high pain at T0 improved (>80%) by T1. Results became more consistent and symptom control was improved overall. Patients are evaluated based on holistic domains by an interdisciplinary team and we have added a much needed measure to help guide improvement of the quality of care provided.
Full Text Available Introduction: Clinical laboratories performing routine HIV-1 genotyping antiviral drug resistance (DR testing need reliable and up-to-date information systems to provide accurate and timely test results to optimize antiretroviral treatment in HIV-1-infected patients. Materials and Methods: Three software applications were used to compare DR profiles generated from the analysis of HIV-1 protease (PR and reverse transcriptase (RT gene sequences obtained by Sanger sequencing assay in 100 selected clinical plasma samples from March 2013 through May 2014. Interpretative results obtained from the Trugene HIV-1 Genotyping assay (TG; Guidelines v17.0 were compared with a newly FDA-registered data processing module (DPM v1.0 and the research-use-only ViroScore-HIV (VS software, both of which use the latest versions of Stanford HIVdb (SD v7.0 and geno2pheno (G2P v3.3 interpretive algorithms (IA. Differences among the DR interpretive algorithms were compared according to drug class (NRTI, NNRTI, PI and each drug. HIV-1 tropism and integrase inhibitor resistance were not evaluated (not available in TG. Results: Overall, only 17 of the 100 TG sequences obtained yielded equivalent DR profiles among all 3 software applications for every IA and for all drug classes. DPM and VS generated equivalent results with >99.9% agreement. Excluding AZT, DDI, D4T and rilpivirine (not available in G2P, ranges of agreement in DR profiles among the three IA (using the DPM are shown in Table 1. Conclusions: Substantial discrepancies (<75% agreement exist among the three interpretive algorithms for ETR, while G2P differed from TG and SD for resistance to TDF and TPV/r. Use of more than one DR interpretive algorithm using well-validated software applications, such as DPM v1.0 and VS, would enable clinical laboratories to provide clinically useful and accurate DR results for patient care needs.
Meyer-Zehnder, B; Barandun Schäfer, U; Albisser Schleger, H; Reiter-Theil, S; Pargger, H
2012). The duration of these discussions ranged from 30 to 60 min. On average 6.2 persons took part, including 2.7 nurses and 3.2 physicians. Of the 41 patients (16 female, 25 male) for whom a discussion was carried out, 23 died during the continued hospital stay. The respondents (response rate 52 %) assessed the benefit for patients and team as high (slightly higher benefit for physicians than nurses) and 55 % of physicians and 71 % of nurses perceived a reduction in the burden of decision-making in difficult cases due to the case discussions. All physicians and 66 % of the nurses reported an improvement in the cooperation between the professional groups and 80 % of the nurses and more than half of the physicians noticed an increase in their own ethical competence. A methodically structured ethical decision-making process can and should be integrated into the clinical routine. This process requires a fixed place in everyday practice and the defined responsibility for the actual organization and performance. Support by medical and nursing management personnel is also essential for the implementation. The regular occurrence of ethical case discussions among the care team relieves the participants and improves collaboration between nurses and physicians.
Schlebusch, L.; Samuels, A. E.; Dada, S.
Background: The purpose of this study was to investigate the relationship between family routines, cognitive appraisal of the impact of autism spectrum disorders (ASD) on the family and family quality of life (FQOL) in families raising children with ASD in South Africa. Methods: A sample of 180 families of young children with ASD who were…
Chassin, Mark R
Nearly fourteen years ago the Institute of Medicine's report, To Err Is Human: Building a Safer Health System, triggered a national movement to improve patient safety. Despite the substantial and concentrated efforts that followed, quality and safety problems in health care continue to routinely result in harm to patients. Desired progress will not be achieved unless substantial changes are made to the way in which quality improvement is conducted. Alongside important efforts to eliminate preventable complications of care, there must also be an effort to seriously address the widespread overuse of health services. That overuse, which places patients at risk of harm and wastes resources at the same time, has been almost entirely left out of recent quality improvement endeavors. Newer and much more effective strategies and tools are needed to address the complex quality challenges confronting health care. Tools such as Lean, Six Sigma, and change management are proving highly effective in tackling problems as difficult as hand-off communication failures and patient falls. Finally, the organizational culture of most American hospitals and other health care organizations must change. To create a culture of safety, leaders must eliminate intimidating behaviors that suppress the reporting of errors and unsafe conditions. Leaders must also hold everyone accountable for adherence to safe practices.
Full Text Available Abstract Background After primary treatment for breast cancer, patients are recommended to use hospital follow-up care routinely. Long-term data on the utilization of this follow-up care are relatively rare. Methods Information regarding the utilization of routine hospital follow-up care was retrieved from hospital documents of 662 patients treated for breast cancer. Utilization of hospital follow-up care was defined as the use of follow-up care according to the guidelines in that period of time. Determinants of hospital follow up care were evaluated with multivariate analysis by generalized estimating equations (GEE. Results The median follow-up time was 9.0 (0.3-18.1 years. At fifth and tenth year after diagnosis, 16.1% and 33.5% of the patients had less follow-up visits than recommended in the national guideline, and 33.1% and 40.4% had less frequent mammography than recommended. Less frequent mammography was found in older patients (age > 70; OR: 2.10; 95%CI: 1.62-2.74, patients with comorbidity (OR: 1.26; 95%CI: 1.05-1.52 and patients using hormonal therapy (OR: 1.51; 95%CI: 1.01-2.25. Conclusions Most patients with a history of breast cancer use hospital follow-up care according to the guidelines. In older patients, patients with comorbidity and patients receiving hormonal therapy yearly mammography is performed much less than recommended.
Notz, K; Dubb, R; Kaltwasser, A; Hermes, C; Pfeffer, S
Treatment success in hospitals, particularly in intensive care units, is directly tied to quality of structure, process, and outcomes. Technological and medical advancements lead to ever more complex treatment situations with highly specialized tasks in intensive care nursing. Quality criteria that can be used to describe and correctly measure those highly complex multiprofessional situations have only been recently developed and put into practice.In this article, it will be shown how quality in multiprofessional teams can be definded and assessed in daily clinical practice. Core aspects are the choice of a nursing theory, quality assurance measures, and quality management. One possible option of quality assurance is the use of standard operating procedures (SOPs). Quality can ultimately only be achieved if professional groups think beyond their boundaries, minimize errors, and establish and live out instructions and SOPs.
Yildiz, Ozkan; Demirörs, Onur
Existing quality models focus on some specific diseases, clinics or clinical areas. Although they contain structure, process, or output type measures, there is no model which measures quality of health care processes comprehensively. In addition, due to the not measured overall process quality, hospitals cannot compare quality of processes internally and externally. To bring a solution to above problems, a new model is developed from software quality measures. We have adopted the ISO/IEC 9126 software quality standard for health care processes. Then, JCIAS (Joint Commission International Accreditation Standards for Hospitals) measurable elements were added to model scope for unifying functional requirements. Assessment (diagnosing) process measurement results are provided in this paper. After the application, it was concluded that the model determines weak and strong aspects of the processes, gives a more detailed picture for the process quality, and provides quantifiable information to hospitals to compare their processes with multiple organizations.
Skinnars Josefsson, M; Nydahl, M; Persson, I; Mattsson Sydner, Y
The aim is to explore the effects of antecedent, structural and process quality indicators of nutritional care practice on meal satisfaction and screened nutritional status among older adults in residential care homes. Data for this Swedish cross-sectional study regarding older adults living in residential care homes were collected by i) a national questionnaire, ii) records from the quality registry Senior Alert, iii) data from an Open Comparison survey of elderly care in 2013/2014. The data represented 1154 individuals in 117 of 290 Swedish municipalities. Meal satisfaction (%) and adequate nutritional status, screened by the Mini Nutritional Assessment Short Form (MNA-SF), were the two outcome variables assessed through their association with population density of municipalities and residents' age, together with 12 quality indicators pertaining to structure and process domains in the Donabedian model of care. Meal satisfaction was associated with rural and urban municipalities, with the structure quality indicators: local food policies, private meal providers, on-site cooking, availability of clinical/community dietitians, food service dietitians, and with the process quality indicators: meal choice, satisfaction surveys, and 'meal councils'. Adequate nutritional status was positively associated with availability of clinical/community dietitians, and energy and nutrient calculated menus, and negatively associated with chilled food production systems. Municipality characteristics and structure quality indicators had the strongest associations with meal satisfaction, and quality indicators with local characteristics emerge as important for meal satisfaction. Nutritional competence appears vital for residents to be well-nourished.
Skolarus, Ted A; Holmes-Rovner, Margaret; Northouse, Laurel L; Fagerlin, Angela; Garlinghouse, Carol; Demers, Raymond Y; Rovner, David R; Darwish-Yassine, May; Wei, John T
Primary care providers often care for men with prostate cancer due to its prolonged clinical course and an increasing number of survivors. However, their attitudes and care patterns are inadequately studied. In this context, we surveyed primary care providers regarding the scope of their prostate cancer survivorship care. The 2006 Early Detection and Screening for Prostate Cancer Knowledge, Attitudes and Practice Survey conducted by the Michigan Public Health Institute investigated the beliefs and practice patterns of primary care providers in Michigan. We evaluated responses from 902 primary care providers regarding the timing and content of their prostate cancer survivorship care and relationships with specialty care. Two-thirds (67.6%) of providers cared for men during and after prostate cancer treatment. Providers routinely inquired about incontinence, impotence and bowel problems (83.3%), with a few (14.2%) using surveys to measure symptoms. However, only a minority felt 'very comfortable' managing the side effects of prostate cancer treatment. Clear plans (76.1%) and details regarding management of treatment complications (65.2%) from treating specialists were suboptimal. Nearly one-half (45.1%) of providers felt it was equally appropriate for them and treating specialists to provide prostate cancer survivorship care. Primary care providers reported that prostate cancer survivorship care is prevalent in their practice, yet few felt very comfortable managing side effects of prostate cancer treatment. To improve quality of care, implementing prostate cancer survivorship care plans across specialties, or transferring primary responsibility to primary care providers through survivorship guidelines, should be considered. Copyright © 2013 Elsevier Inc. All rights reserved.
Ahnert, Markus; Marx, Conrad; Krebs, Peter; Kuehn, Volker
This paper presents a simple method for the generation of continuous influent quality datasets for wastewater treatment plants (WWTPs) that is based on incomplete available routine data, only, without referring to any further measurement. In the approach, Weibull-distributed random data are fitted to the available routine data, such that the resulting distribution of influent quality data shows the identical statistical characteristics. Beside the description of the method, this paper contains a comprehensive analysis of robustness and universality of the approach. It is shown that incomplete datasets with only 10% remaining influent quality data can be filled with this method with nearly the same statistical parameters as the original data. In addition, the use with datasets of different WWTP plants sizes results always in a good agreement between original and filled datasets.
Grøndahl, Vigdis Abrahamsen; Fagerli, Liv Berit
Purpose The purpose of this paper is to explore potential differences in how nursing home residents rate care quality and to explore cluster characteristics. Design/methodology/approach A cross-sectional design was used, with one questionnaire including questions from quality from patients' perspective and Big Five personality traits, together with questions related to socio-demographic aspects and health condition. Residents ( n=103) from four Norwegian nursing homes participated (74.1 per cent response rate). Hierarchical cluster analysis identified clusters with respect to care quality perceptions. χ2 tests and one-way between-groups ANOVA were performed to characterise the clusters ( pclusters were identified; Cluster 1 residents (28.2 per cent) had the best care quality perceptions and Cluster 2 (67.0 per cent) had the worst perceptions. The clusters were statistically significant and characterised by personal-related conditions: gender, psychological well-being, preferences, admission, satisfaction with staying in the nursing home, emotional stability and agreeableness, and by external objective care conditions: healthcare personnel and registered nurses. Research limitations/implications Residents assessed as having no cognitive impairments were included, thus excluding the largest group. By choosing questionnaire design and structured interviews, the number able to participate may increase. Practical implications Findings may provide healthcare personnel and managers with increased knowledge on which to develop strategies to improve specific care quality perceptions. Originality/value Cluster analysis can be an effective tool for differentiating between nursing homes residents' care quality perceptions.
The contributions in this thesis revolve around mothers' employment and child care quality. The first topic of interest is how mothers' employment is affected by modern child care services and parental leave entitlements. There is already an extensive literature on the effects of modern social
Festin Karin; Ekberg Kerstin; Ståhle Agneta; Bendtsen Preben; Leijon Matti E; Nilsen Per
Background: Written prescriptions of physical activity, so‐called physical activity referral (PAR) schemes, have increased in popularity in recent years. Such schemes have mostly been evaluated in terms of efficacy. This study reports on a Swedish PAR scheme implemented in routine primary health care (PHC) measuring patients’ self‐reported adherence to physical activity prescriptions. The aim of this study was to evaluate adherence to physical activity prescriptions issued in everyday PHC at ...
Sanjuan-Szklarz, W Fabiola; Hoser, Anna A; Gutmann, Matthias; Madsen, Anders Østergaard; Woźniak, Krzysztof
Single-crystal X-ray diffraction structural results for benzidine dihydrochloride, hydrated and protonated N,N,N,N-peri(dimethylamino)naphthalene chloride, triptycene, dichlorodimethyltriptycene and decamethylferrocene have been analysed. A critical discussion of the dependence of structural and thermal parameters on resolution for these compounds is presented. Results of refinements against X-ray data, cut off to different resolutions from the high-resolution data files, are compared to structural models derived from neutron diffraction experiments. The Independent Atom Model (IAM) and the Transferable Aspherical Atom Model (TAAM) are tested. The average differences between the X-ray and neutron structural parameters (with the exception of valence angles defined by H atoms) decrease with the increasing 2θmax angle. The scale of differences between X-ray and neutron geometrical parameters can be significantly reduced when data are collected to the higher, than commonly used, 2θmax diffraction angles (for Mo Kα 2θmax > 65°). The final structural and thermal parameters obtained for the studied compounds using TAAM refinement are in better agreement with the neutron values than the IAM results for all resolutions and all compounds. By using TAAM, it is still possible to obtain accurate results even from low-resolution X-ray data. This is particularly important as TAAM is easy to apply and can routinely be used to improve the quality of structural investigations [Dominiak (2015 ▸). LSDB from UBDB. University of Buffalo, USA]. We can recommend that, in order to obtain more adequate (more accurate and precise) structural and displacement parameters during the IAM model refinement, data should be collected up to the larger diffraction angles, at least, for Mo Kα radiation to 2θmax = 65° (sin θmax/λ data collected to the lower 2θmax angles. Also the results of translation-libration-screw (TLS) analysis and vibrational entropy values are more
de Baat, C; Witter, D J; Keltjens, H M A M; Creugers, N H J
Following treatment with a removable partial denture, routine oral examinations are required to stabilize the existing condition in a sustainable way and to make possible the timely treatment of anomalies which have appeared. In cases of problems assessed during a routine oral examination in relation to the removable partial dentures, maintenance, restorative and prosthetic treatment may be indicated. Maintenance treatments are indicated for small and easily retrievable alterations. In removable partial denture treatment, adequate space between prepared tooth and denture is essential. Possible prosthetic treatments of a removable partial denture are relining, rebasing, improving or renewing the maxillomandibular relation, repairment, and extension.
Martin, Graham P; Weaver, Simon; Currie, Graeme; Finn, Rachael; McDonald, Ruth
The need for organizational innovation as a means of improving health-care quality and containing costs is widely recognized, but while a growing body of research has improved knowledge of implementation, very little has considered the challenges involved in sustaining change - especially organizational change led 'bottom-up' by frontline clinicians. This study addresses this lacuna, taking a longitudinal, qualitative case-study approach to understanding the paths to sustainability of four organizational innovations. It highlights the importance of the interaction between organizational context, nature of the innovation and strategies deployed in achieving sustainability. It discusses how positional influence of service leads, complexity of innovation, networks of support, embedding in existing systems, and proactive responses to changing circumstances can interact to sustain change. In the absence of cast-iron evidence of effectiveness, wider notions of value may be successfully invoked to sustain innovation. Sustainability requires continuing effort through time, rather than representing a final state to be achieved. Our study offers new insights into the process of sustainability of organizational change, and elucidates the complement of strategies needed to make bottom-up change last in challenging contexts replete with competing priorities.
Schiøtz, Michaela L.; Høst, Dorte; Christensen, Mikkel B.
BACKGROUND: Multimorbidity is becoming increasingly prevalent and presents challenges for healthcare providers and systems. Studies examining the relationship between multimorbidity and quality of care report mixed findings. The purpose of this study was to investigate quality of care for people...... with multimorbidity in the publicly funded healthcare system in Denmark. METHODS: To investigate the quality of care for people with multimorbidity different groups of clinicians from the hospital, general practice and the municipality reviewed records from 23 persons with multimorbidity and discussed them in three...... focus groups. Before each focus group, clinicians were asked to review patients' medical records and assess their care by responding to a questionnaire. Medical records from 2013 from hospitals, general practice, and health centers in the local municipality were collected and linked for the 23 patients...
Firth-Cozens, J; Mowbray, D
The importance of good leadership is becoming increasingly apparent within health care. This paper reviews evidence which shows that it has effects, not only on financial management, but on the quality of care provided. Some theories of leadership are discussed, primarily in terms of how different types of leaders might affect quality in different ways, including the effects that they might have on the stress or wellbeing of their staff which, in turn, is related to the quality of care produced. Finally, the conflicts shown in terms of leadership within the context of health care are discussed, leading to the conclusion that development programmes must be specially tailored to address the complexities of this arena.
Lankheet, Nienke A G; Knapen, Lotte M; Schellens, Jan H M; Beijnen, Jos H; Steeghs, Neeltje; Huitema, Alwin D R
BACKGROUND: The objectives of this study were to evaluate the plasma concentrations of the tyrosine kinase inhibitors (TKIs), imatinib, erlotinib, and sunitinib, in a cohort of patients with cancer in routine clinical practice and to find the possible factors related to plasma concentrations below
Lankheet, N.; Knapen, L.M.; Schellens, J.H.; Beijnen, J.H.; Steeghs, N.; Huitema, A.D.
BACKGROUND: The objectives of this study were to evaluate the plasma concentrations of the tyrosine kinase inhibitors (TKIs), imatinib, erlotinib, and sunitinib, in a cohort of patients with cancer in routine clinical practice and to find the possible factors related to plasma concentrations below
Siebig, Sylvia; Reng, Michael; Gantner, Martin; Langgartner, Julia
Outcome after in-hospital resuscitation with survival rates between 14-17% still remains poor. Structured documentation of in-hospital cardiac arrest especially in Germany is rare and inhomogeneous. Documentation of in-hospital emergency situations (I-ES) may help to develop organizational structures, to collect information of treatment after resuscitation and therefore, improve patient's outcome. The aim of this study was to evaluate the documentation quality and user's acceptance after the implementation of an in-house emergency (IHE) protocol used by the authors' internal medicine emergency team (ET). Analysis of IHE protocols and discharge letters of 65 patients between August 2004 and December 2007 at a university medical center. The IHE protocol was used in 65% of all emergency calls with a completion rate of 80% of all available documentation categories. Especially documentation of drugs given, their dosage and the general course of action was incomplete. In 25% the discharge letters did not contain information about the I-ES. Implementation of the authors' IHE protocol, designed in close accordance with the DIVI (German Interdisciplinary Association of Intensive Care and Emergency Medicine) out-of-hospital emergency protocol, helps to collect important data in I-ES. Usage of the protocol resulted in better documentation of emergency situations in contrast to the information found in discharge letters alone. Nevertheless, documentation of I-ES still needs to be improved, especially concerning the completeness of records.
Full Text Available Background: Access to affordable and quality health care is one of the most important ways for reducing maternal and child mortality. The purpose of this study was to provide strategies to promote the quality of care during childbirth in Lorestan province in 2011. Materials and Methods: This research was a mixed method (quantitative, qualitative, study in which quality of 200 care during childbirth in hospitals of Lorestan Province were evaluated. Data gathered through self-made tools (Checklists prepared according to the guidelines of the ministry of health. Descriptive statistics and SPSS software were used to data analysis.In the second part of the study which was qualitative, interview with service providers, hospital officials and high-ranking officials of Lorestan university of medical sciences (decision makers was used to discuss strategies to improve the quality of care. Results: The results showed that the care of the first stage delivery in %54.5, second stage %57 and third stage 66% were in accordance with the desired status and care in this three stages was of moderate quality. Based on the interviews, the officials who are in charge of Lorestan university of medical sciences, proposed strategies such as financial incentives and in-service training of midwives as suitable strategies to improve quality of services. Conclusion: According to the results, strategies such as financial incentives, increased use of private sector services to reduce the workload of the public sector and increase of quality and use of more in-service training, to improve the quality of services, are recommended.
Full Text Available Triage in Preventive Child Health Care (PCH assessments could further the efficient use of human resources and budgets and therefore make extra care possible for children with specific needs. We assessed the costs of routine PCH assessments with and without triage for children aged 5/6 years and 10/11 years. In a triage approach, PCH assistants conduct pre-assessments to identify children requiring follow-up assessments by a physician or nurse. In the usual approach, all children are assessed by a physician and an assistant (children aged 5/6 years or a nurse (children aged 10/11 years.All the direct costs of conducting routine PCH assessments with the triage and usual approach were assessed using a bottom-up micro-costing approach. In four PCH services in the Netherlands, two using triage and two the usual approach, professionals completed questionnaires about time spent on assessments, including time related to non-attendance at assessments, the referral of children and administration.The projected costs for PCH professionals working on PCH assessments amounted to €5.2 million per cohort of 100,000 children aged 5/6 years in the triage approach, and €7.6 million in the usual approach. The projected costs in both approaches for children aged 10/11 years were about €4 million per 100,000 children.The triage approach to PCH resulted in a projected cost reduction of about one-third, compared with usual practice, for routine assessments by physicians of children aged 5/6 years. There are minimal cost savings in the group of children aged 10/11 years when nurses are involved and so other considerations such as workforce shortages would be required to justify a change to a triage approach. Further research is needed to investigate the differences in costs of care after the completion of the routine assessments.
Conducting small randomised controlled trials (RCTs) 'nested' in routine clinical practice is ideal for family practitioners, non-academics and young researchers, who often are required to complete a 'small-scale' research project for their master's (MMed) theses. These trials have the potential to produce good outcomes that ...
Chassin Mark R
Full Text Available Abstract Israel has made impressive progress in improving performance on key measures of the quality of health care in the community in recent years. These achievements are all the more notable given Israel's modest overall spending on health care and because they have accrued to virtually the entire population of the country. Health care systems in most developed nations around the world find themselves in a similar position today with respect to health care quality. Despite significantly increased improvement efforts over the past decade, routine safety processes, such as hand hygiene and medication administration, fail routinely at rates of 30% to 50%. People with chronic diseases experience preventable episodes of acute illness that require hospitalization due to medication mix-ups and other failures of outpatient management. Patients continue to be harmed by preventable adverse events, such as surgery on the wrong part of the body and fires in operating theaters. Health care around the world is not nearly as safe as other industries, such as commercial aviation, that have mastered highly effective ways to manage serious hazards. Health care organizations will have to undertake three interrelated changes to get substantially closer to the superlative safety records of other industries: leadership commitment to zero major quality failures, widespread implementation of highly effective process improvement methods, and the adoption of all facets of a culture of safety. Each of these changes represents a major challenge to the way today's health care organizations plan and carry out their daily work. The Israeli health system is in an enviable position to implement these changes. Universal health insurance coverage, the enrolment of the entire population in a small number of health plans, and the widespread use of electronic health records provide advantages available to few other countries. Achieving and sustaining levels of safety comparable
An, Selena J; George, Asha S; LeFevre, Amnesty E; Mpembeni, Rose; Mosha, Idda; Mohan, Diwakar; Yang, Ann; Chebet, Joy; Lipingu, Chrisostom; Baqui, Abdullah H; Killewo, Japhet; Winch, Peter J; Kilewo, Charles
Integration of HIV into RMNCH (reproductive, maternal, newborn and child health) services is an important process addressing the disproportionate burden of HIV among mothers and children in sub-Saharan Africa. We assess the structural inputs and processes of care that support HIV testing and counselling in routine antenatal care to understand supply-side dynamics critical to scaling up further integration of HIV into RMNCH services prior to recent changes in HIV policy in Tanzania. This study, as a part of a maternal and newborn health program evaluation in Morogoro Region, Tanzania, drew from an assessment of health centers with 18 facility checklists, 65 quantitative and 57 qualitative provider interviews, and 203 antenatal care observations. Descriptive analyses were performed with quantitative data using Stata 12.0, and qualitative data were analyzed thematically with data managed by Atlas.ti. Limitations in structural inputs, such as infrastructure, supplies, and staffing, constrain the potential for integration of HIV testing and counselling into routine antenatal care services. While assessment of infrastructure, including waiting areas, appeared adequate, long queues and small rooms made private and confidential HIV testing and counselling difficult for individual women. Unreliable stocks of HIV test kits, essential medicines, and infection prevention equipment also had implications for provider-patient relationships, with reported decreases in women's care seeking at health centers. In addition, low staffing levels were reported to increase workloads and lower motivation for health workers. Despite adequate knowledge of counselling messages, antenatal counselling sessions were brief with incomplete messages conveyed to pregnant women. In addition, coping mechanisms, such as scheduling of clinical activities on different days, limited service availability. Antenatal care is a strategic entry point for the delivery of critical tests and counselling messages
Foebel, A.D.; van Hout, H.P.J.; van der Roest, H.G.; Topinkova, E.; Garms-Homolova, V.; Frijters, D.H.M.; Finne-Soveri, H.; Jonsson, P.V.; Hirdes, J.P.; Bernabei, R.; Onder, G.
Background: Evaluating the quality of care provided to older individuals is a key step to ensure that needs are being met and to target interventions to improve care. To this aim, interRAI's second-generation home care quality indicators (HCQIs) were developed in 2013. This study assesses the
Simon de Lusignan
Conclusion Adopting an ontology-driven approach to case finding could improve the quality of disease registers and of research based on routine data. It would offer considerable advantages over using limited datasets to define cases. This approach should be considered by those involved in research and quality improvement projects which utilise routine data.
Chan, S; Siou, G; Welch, A; Powell, S
Supraglottoplasty for the treatment of laryngomalacia has little current evidence regarding post-operative care. Our study aimed to: (1) retrospectively assess what proportion of patients required paediatric intensive care unit level of care; (2) identify pre-operative predictive factors common to these cases; and (3) report patient outcomes at six weeks' follow up. A 10-year retrospective case series analysis was conducted of all patients diagnosed with laryngomalacia and subsequently treated with supraglottoplasty. Paediatric intensive care unit level of care was defined as the need for intubation or tracheostomy, positive pressure ventilation, multiple doses of nebulised adrenaline, and oxygen dependency beyond 12 hours. Forty-two patients (19 males, 23 females) were identified; 28.5 per cent of cases met our criteria for paediatric intensive care unit level of care. A low pre-operative oxygen saturation was the only significant risk factor that predicted a future need for paediatric intensive care unit level of care (p = 0.0008). This is the first study published in the UK to suggest the importance of pre-operative oxygen saturation as a predictor of a future need for paediatric intensive care unit level of care.
González-Méndez, María Isabel; López-Rodríguez, Luís
The care quality has gradually been placed in the center of the health system, reaching the patient safety a greater role as one of the key dimensions of quality in recent years. The monitoring, measurement and improvement of safety and quality of care in the Intensive Care Unit represent a great challenge for the critical care community. Health interventions carry a risk of adverse events or events that can cause injury, disability and even death in patients. In Intensive Care Unit, the severity of the critical patient, communication barriers, a high number of activities per patient per day, the practice of diagnostic procedures and invasive treatments, and the quantity and complexity of the information received, among others, put at risk these units as areas for the occurrence of adverse events. This article presents some of the strategies and interventions proposed and tested internationally to optimize the care of critical patients and improve the safety culture in the Intensive Care Unit. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
Gupta, B S; Shrestha, S; Thulung, B K
Quality nursing care remains an important role for patients because nurses are involved in almost every aspect of client's care in hospital. Nurses interact with patients more often than any other health care personnel in a hospital. Patients express their requirements in terms of what they need, want, prefer, expect and demand with respect to the nursing service they receive. The main objective of this study was to identify the Patient's Perception towards Quality Nursing Care. A descriptive quantitative and qualitative research design was adopted; study areas were Bir-hospital and Tribhuvan University Teaching Hospital (TUTH). Non probability purposive sampling technique with semi structured interview questionnaire including Likert Scale was used to collect the data. Descriptive and inferential statistics were used for analysis. Overall perception of respondents about nursing care (nurses' behavior, safety and security and admission procedure) is positive as 182 (91%) perceived positively, whereas 18 (9%) perceived negatively (not positive). There is no significant difference of perception in relation to total nursing care by sex, education and occupation status of the respondents as highest percentage of respondents had positive perception. It can be concluded that most of the respondents showed positive attitude towards quality nursing care in both hospitals.
The most popular contraceptive methods in Ecuador are female sterilization, the IUD, and the oral contraceptive pill. 13.2% of contraceptive acceptors in Ecuador are served by APROFE. Earning a reputation for quality services since its establishment more than thirty years ago, the organization reaches its clients through its twenty clinics, three pap smear labs, twelve clinic laboratories, one mobile clinic, and a boat. The oral contraceptive pill can be readily obtained at pharmacies with neither prescription nor medical attention. The IUD, however, is most popular at APROFE's clinics. Clients believe the IUD to be of higher quality because medical personnel are involved in its procurement by acceptors. APROFE also provides information and counseling on all contraceptive methods to its clients. APROFE has done much to make family planning and reproductive health services available to the women of Ecuador through an innovative community-based approach integrating education and activities to empower women. APROFE runs one of the oldest programs in Latin America dedicated to women. Covering approximately 1000 women annually, the program is based in a marginal area of Guayaquil, the most populated city of Ecuador, and aims to raise the status of women. The program is comprised of training in traditional crafts to help women earn income, self-esteem workshops, education on gender and rights, and the provision of family planning information and services.
Jeon, Sangchoon; Rosenthal, Marjorie S.
Objectives. We assessed the prevalence of regulatory noncompliance of licensed child care centers and identified factors associated with improved compliance. Methods. We analyzed 676 routine, unannounced reports of child care centers collected by the Connecticut Department of Public Health licensing specialists over a 2-year time period, included characteristics of centers, and created categories of regulations. Results. The sample included 41% of licensed child care centers. Of the 13 categories of regulations in the analyses, 7 categories (outdoor safety, indoor safety, indoor health, child and staff documentation, emergency preparedness, infant-toddler indoor health, and infant-toddler indoor safety) had regulations with center noncompliance greater than 10%. Playground hazard-free was the regulation with the highest frequency (48.4%) of noncompliance. Compliance with the regulation for 20 hours of continuing education per year for child care providers was the characteristic most frequently associated with regulations compliance. Conclusions. Efforts to support continuing education of child care providers are essential to improve and sustain healthy and safe early-care and education programs. Analyses of state child care licensing inspection reports provide valuable data and findings for strategic planning efforts. PMID:23948016
Ängerud, Karin Hellström; Boman, Kurt; Brännström, Margareta
The complex needs of people with chronic heart failure (HF) place great demands on their family members, and it is important to ask family members about their perspectives on the quality of HF care. To describe family members' perceptions of quality of HF care in an outpatient setting. A cross-sectional study using a short form of the Quality from Patients' Perspective (QPP) questionnaire for data collection. The items in the questionnaire measure four dimensions of quality, and each item consists of both the perceived reality of the care and its subjective importance. The study included 57 family members of patients with severe HF in NYHA class III-IV. Family members reported areas for quality improvements in three out of four dimensions and in dimensionless items. The lowest level of perceived reality was reported for treatment for confusion and loss of appetite. Treatment for shortness of breath, access to the apparatus and access to equipment necessary for medical care were the items with the highest subjective importance for the family members. Family members identified important areas for quality improvement in the care for patients with HF in an outpatient setting. In particular, symptom alleviation, information to patients, patient participation and access to care were identified as areas for improvements. Thus, measuring quality from the family members' perspective with the QPP might be a useful additional perspective when it comes to the planning and implementation of changes in the organisation of HF care. © 2017 Nordic College of Caring Science.
Strychowsky, Julie E; Albert, David; Chan, Kenny; Cheng, Alan; Daniel, Sam J; De Alarcon, Alessandro; Garabedian, Noel; Hart, Catherine; Hartnick, Christopher; Inglis, Andy; Jacobs, Ian; Kleinman, Monica E; Mehta, Nilesh M; Nicollas, Richard; Nuss, Roger; Pransky, Seth; Russell, John; Rutter, Mike; Schilder, Anne; Thompson, Dana; Triglia, Jean-Michel; Volk, Mark; Ward, Bob; Watters, Karen; Wyatt, Michelle; Zalzal, George; Zur, Karen; Rahbar, Reza
To develop consensus recommendations for peri-operative tracheotomy care in pediatric patients. Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. The consensus recommendations herein represent the first publication by the group. Consensus recommendations including pre-operative, intra-operative, and post-operative considerations, as well as sedation and nutrition management are described. These recommendations are based on the collective opinion of the IPOG members and are targeted to (i) otolaryngologists who perform tracheotomies on pediatric patients, (ii) intensivists who are involved in the shared-care of these patients, and (iii) allied health professionals. Pediatric peri-operative tracheotomy care consensus recommendations are aimed at improving patient-centered care in this patient population. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Min, Lillian; Cryer, Henry; Chan, Chiao-Li; Roth, Carol; Tillou, Areti
Background Older trauma injury patients had improved recovery after we implemented routine geriatric consultation for patients ≥ age 65 at a level-1 academic trauma center. The intervention aimed to improve quality of geriatric care. However, the specific care processes that improved are unknown. Study Design Prospective observation comparing medical care after (December 2007-November 2009) versus before (December 2006-November 2007) implementation of the geriatric consult-based intervention. To measure quality-of-care (QOC) we used 33 previously-validated care-process quality indicators (QIs) from the Assessing the Care of Vulnerable Elders (ACOVE) study, measured by review of medical records for 76 Geriatric Consult [GC] versus 71 control group patients. As pre-specified subgroup analyses, we aggregated QIs by type: geriatric (e.g., delirium screening) versus non-geriatric condition-based care (e.g., thrombosis prophylaxis) and compared QI scores by type of care. Last, we aggregated QI scores into overall, geriatric, and non-geriatric QOC scores for each patient (# QIs passed/# QIs eligible), and compared patient-level QOC for the GC versus control group, adjusting for age, gender, ethnicity, comorbidity, and injury severity. Results 63% of the GC versus 11% of the control group patients received a geriatric consultation. We evaluated 2505 QIs overall (1664 geriatric-type and 841 non-geriatric QIs). In general, fewer geriatric-type QIs were passed than non-geriatric QIs (71% vs 81%, pgeriatric-QOC for the GC (74%) compared to the control group (68%, pgeriatric QOC for older trauma patients. PMID:25840534
Sukumar, Sreenivas R; Natarajan, Ramachandran; Ferrell, Regina K
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
Klompas, Michael; Speck, Kathleen; Howell, Michael D; Greene, Linda R; Berenholtz, Sean M
Regular oral care with chlorhexidine gluconate is standard of care for patients receiving mechanical ventilation in most hospitals. This policy is predicated on meta-analyses suggesting decreased risk of ventilator-associated pneumonia, but these meta-analyses may be misleading because of lack of distinction between cardiac surgery and non-cardiac surgery studies, conflation of open-label vs double-blind investigations, and insufficient emphasis on patient-centered outcomes such as duration of mechanical ventilation, length of stay, and mortality. To evaluate the impact of routine oral care with chlorhexidine on patient-centered outcomes in patients receiving mechanical ventilation. PubMed, Embase, CINAHL, and Web of Science from inception until July 2013 without limits on date or language. Randomized clinical trials comparing chlorhexidine vs placebo in adults receiving mechanical ventilation. Of 171 unique citations, 16 studies including 3630 patients met inclusion criteria. Eligible trials were independently identified, evaluated for risk of bias, and extracted by 2 investigators. Differences were resolved by consensus. We stratified studies into cardiac surgery vs non-cardiac surgery and open-label vs double-blind investigations. Eligible studies were pooled using random-effects meta-analysis. Ventilator-associated pneumonia, mortality, duration of mechanical ventilation, intensive care unit and hospital length of stay, antibiotic prescribing. There were fewer lower respiratory tract infections in cardiac surgery patients randomized to chlorhexidine (relative risk [RR], 0.56 [95% CI, 0.41-0.77]) but no significant difference in ventilator-associated pneumonia risk in double-blind studies of non-cardiac surgery patients (RR, 0.88 [95% CI, 0.66-1.16]). There was no significant mortality difference between chlorhexidine and placebo in cardiac surgery studies (RR, 0.88 [95% CI, 0.25-2.14]) and nonsignificantly increased mortality in non-cardiac surgery studies (RR
John, Dolly A.; de Castro, A.B.; Duran, Bonnie; Martin, Diane P.
Using data from 1,530 Asian respondents of the 2002-2003 National Latino and Asian American Study, we examined how nativity and occupational class are associated with uninsurance, no routine physical check-up in the past year and no dental/eye exam use in the past year using weighted multivariate logistic regression models. Recent immigrants had increased odds of uninsurance and no dental/eye exam use than US-born Asians which became nonsignificant after controlling for occupational class and...
Watzke, Birgit; Heddaeus, Daniela; Steinmann, Maya; König, Hans-Helmut; Wegscheider, Karl; Schulz, Holger; Härter, Martin
Depression is a widespread and serious disease often accompanied by a high degree of suffering and burden of disease. The lack of integration between different care providers impedes guideline-based treatment. This constitutes substantial challenges for the health care system and also causes considerable direct and indirect costs. To face these challenges, the aim of this project is the implementation and evaluation of a guideline-based stepped care model for depressed patients with six treatment options of varying intensity and setting, including low-intensity treatments using innovative technologies. The study is a randomized controlled intervention trial of a consecutive sample of depressive patients from primary care assessed with a prospective survey at four time-standardized measurement points within one year. A cluster randomization at the level of participating primary care units divides the general practitioners into two groups. In the intervention group patients (n = 660) are treated within the stepped care approach in a multiprofessional network consisting of general practitioners, psychotherapists, psychiatrists and inpatient care facilities, whereas patients in the control condition (n = 200) receive routine care. The main research question concerns the effectiveness of the stepped-care model from baseline to t3 (12 months). Primary outcome is the change in depressive symptoms measured by the PHQ-9; secondary outcomes include response, remission and relapse, functional quality of life (SF-12 and EQ-5D-3 L), other clinical and psychosocial variables, direct and indirect costs, and the incremental cost-effectiveness ratio. Furthermore feasibility and acceptance of the overall model as well as of the separate treatment components are assessed. This stepped care model integrates all primary and secondary health care providers involved in the treatment of depression; it elaborates innovative and evidence-based treatment elements, follows a stratified
Isaac, Jermel Kyri; Sanchez, Travis H; Brown, Emily H; Thompson, Gina; Sanchez, Christina; Fils-Aime, Stephany; Maria, Jose
New York State adopted a new HIV testing law in 2010 requiring medical providers to offer an HIV test to all eligible patients aged 13-64 years during emergency room or ambulatory care visits. Since then, Wyckoff Heights Medical Center (WHMC) in Brooklyn, New York, began implementing routine HIV screening organization-wide using a compliance, behavior-modification, and continuous quality-improvement process. WHMC first implemented HIV screening in the emergency department (ED) and evaluated progress with the following monthly indicators: HIV tests offered, HIV tests accepted, HIV tests ordered (starting in December 2013), HIV tests administered, positive HIV tests, and linkage to HIV care. Compliance with the delivery of HIV testing was determined by the proportion of patients who, after accepting a test, received one. During August 2013 through July 2014, of 57,852 eligible patients seen in the WHMC ED, a total of 31,423 (54.3%) were offered an HIV test. Of those, 8,229 (26.2%) patients accepted a test. Of those, 6,114 (74.3%) underwent a test. A total of 26 of the 6,114 patients tested (0.4%) had a positive test, and 24 of the 26 HIV-positive patients were linked to HIV medical care. By July 2014, the monthly proportion of patients offered a test was 62%; the proportion of those offered a test who had a test ordered was 98%, and the proportion of those with a test ordered who were tested was 81%. Testing compliance increased substantially at the WHMC ED, from 77% in December 2013 to >98% in July 2014. Using compliance-monitoring, behavior-modification, and continuous quality-improvement processes produced substantial increases in offers and HIV test completion. WHMC is replicating this approach across departments, and other hospitals implementing routine HIV screening programs should consider this approach as well.
Pellesi, L; Benemei, S; Favoni, V; Lupi, C; Mampreso, E; Negro, A; Paolucci, M; Steiner, T J; Ulivi, M; Cevoli, S; Guerzoni, S
Headache disorders are highly prevalent, and have a substantial and negative impact on health worldwide. They are largely treatable, but differences in structure, objectives, organization and delivery affect the quality of headache care. In order to recognize and remedy deficiencies in care, the Global Campaign against Headache, in collaboration with the European Headache Federation, recently developed a set of quality indicators for headache services. These require further assessment to demonstrate fitness for purpose. This is their first implementation to evaluate quality in headache care as a multicentre national study. Between September and December 2016, we applied the quality indicators in six Italian specialist headache centres (Bologna, Firenze, Modena, Padova, Roma Campus Bio-Medico and Roma Sapienza). We used five previously developed assessment instruments, translated into Italian according to Lifting The Burden's translation protocol for hybrid documents. We took data from 360 consecutive patients (60 per centre) by questionnaire and from their medical records, and by different questionnaires from their health-care providers (HCPs), including physicians, nurses, psychologists and nursing assistants. The findings, comparable between centres, confirmed the feasibility and practicability of using the quality indicators in Italian specialist headache centres. The questionnaires were easily understood by HCPs and patients, and were not unduly time-consuming. Diagnoses were almost all (> 97%) according to ICHD criteria, and routinely (100%) reviewed during follow-up. Diagnostic diaries were regularly used by 96% of physicians. Referral pathways from primary to specialist care existed in five of the six clinics, as did urgent referral pathways. Instruments to assess disability and quality of life were not used regularly, a deficiency that needs to be addressed. This Italy-wide survey confirmed in six specialist centres that the headache service quality
Sheikh, Sana; Qureshi, Rahat Najam; Khowaja, Asif Raza; Salam, Rehana; Vidler, Marianne; Sawchuck, Diane; von Dadelszen, Peter; Zaidi, Shujat; Bhutta, Zulfiqar
Maternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagnosis and treatment of pre-eclampsia and eclampsia and current management practices. We conducted a mixed method study in the districts of Hyderabad and Matiari in Sindh province, Pakistan. Focus group discussions and interviews were conducted with community health care providers, which included Lady Health Workers and their supervisors; traditional birth attendants and facility care providers. In total seven focus groups and 26 interviews were conducted. NVivo 10 was used for analysis and emerging themes and sub-themes were drawn. All participants were providing care for pregnant women for more than a decade except one traditional birth attendant and two doctors. The most common cause of pre-eclampsia mentioned by community health care providers was stress of daily life: the burden of care giving, physical workload, short birth spacing and financial constraints. All health care provider groups except traditional birth attendants correctly identified the signs, symptoms, and complications of pre-eclampsia and eclampsia and were referring such women to tertiary health facilities. Only doctors were aware that magnesium sulphate is recommended for eclampsia management and prevention; however, they expressed fears regarding its use at first and secondary level health facilities. This study found several gaps in knowledge regarding aetiology, diagnosis and treatment of pre-eclampsia among health care providers in Sindh. Findings suggest that lesser knowledge regarding management of pre
Introduction. The introduction of structural adjustment programmes (SAP) by OAU in the 1980s, influenced by donor countries as a condition for further funding, has led to the most dramatic change in the quality of care in. Africa's agricultural systems in recent decades (Msolla, 1995). “A free market policy” as a component of ...
Despite relatively generous coverage of the over-65 population, Danish home help services receive regular criticism in the media and public opinion polls. Perhaps as a consequence, reforms of Danish home care policy for senior citizens have placed strong emphasis on quality since the 1990s....... This reform strategy represents a shift from the welfare state modernisation program of the 1980s, which built mainly on economic strategies of cost-efficiency and New Public Management (NPM) princi-ples, including contract management and performance management. Recent reforms have instead attempted...... to increase the overall quality of care by increasing the transparency at the political, administrative and user levels. However, reforms have revolved around conflicting principles of standardisation and the individualisation of care provision and primarily succeeded in increasing the political and ad...
Jorgensen, Mikaela; Siette, Joyce; Georgiou, Andrew; Warland, Andrew; Westbrook, Johanna
To examine home care service-related and person-based factors associated with time to entry into permanent residential aged care. Longitudinal cohort study using routinely collected client management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. A total of 1116 people aged 60 years and older who commenced home care services for higher-level needs between July 1, 2015 and June 30, 2016. Survival analysis methods were used to examine service-related and person-based factors that were associated with time between first home care service and entry into permanent residential aged care. Predictors included service hours per week, combination of service types, demographics, needs, hospital leave, and change in care level. Cluster analysis was used to determine patterns of types of services used. By December 31, 2016, 21.1% of people using home care services had entered into permanent residential care (n = 235). After adjusting for significant factors such as age and care needs, each hour of service received per week was associated with a 6% lower risk of entry into residential care (hazard ratio = 0.94, 95% confidence interval 0.90-0.98). People who were predominant users of social support services, those with an identified carer, and those born in a non-main English-speaking country also remained in their own homes for longer. Greater volume of home care services was associated with significantly delayed entry into permanent residential care. This study provides much-needed evidence about service outcomes that could be used to inform older adults' care choices. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.
As the number of positions decreases, the workload becomes more stressful for nurses left to pick up the slack. Mistakes are made, patient complaints increase as tensions rise, and the quality of nursing care decreases. The use of contingency staffing and overtime may increase as the workforce is reduced. Lack of job security forces acceptance of overtime, leaving less time for family life which may lead to resentment. The success of an organization is linked to employees' willingness to perform and use their skills. With deteriorating attitudes, employees will not perform at maximum effectiveness. Services do not meet established standards or customer expectations and are reflected in negative customer feedback and decreasing revenues. "There are no quick fixes. Tossing out last month's 'cure' to usher in this month's idea is a big waste of time" (Austin, 1994, p. 19). The impact from layoffs has long-lasting effects on employees, their families, and the community. Support for those displaced, and for those retained, provides a release for pent-up emotions and allows employees to get on with the work at hand. Workforce reductions will continue with the decrease in funding and the decline in patient census, but it is imperative that the quality of care be maintained. Registered nurses cannot be replaced at the bedside by UAP who do not have the specialized knowledge and skills required to provide safe and effective care (Thomas, 1995). Efforts to cut costs should be directed toward decreasing waste and eliminating redundant work, not at decreasing the number of RNs. The RN must remain the primary caregiver at the bedside to maintain quality care. Changes that remove the RN from the bedside will influence the quality of care that patients receive in the future. Increased demands and fewer, less-experienced staff result in less time for patient care. One negative patient outcome can be much more costly, directly and indirectly, than the salaries of several staff
Rotzinger, Aurélie; Cavassini, Matthias; Bugnon, Olivier; Schneider, Marie Paule
Background Medication adherence is crucial for successful treatment. Various methods exist for measuring adherence, including electronic drug monitoring, pharmacy refills, pill count, and interviews. These methods are not equivalent, and no method can be considered as the gold standard. A combination of methods is therefore recommended. Objective To develop an algorithm for the management of routinely collected adherence data and to compare persistence and implementation curves using post-algorithm data (reconciled data) versus raw electronic drug monitoring data. Setting A community pharmacy located within a university medical outpatient clinic in Lausanne, Switzerland. Methods The algorithm was developed to take advantage of the strengths of each available adherence measurement method, with electronic drug monitoring as a cornerstone to capture the dynamics of patient behaviour, pill count as a complementary objective method to detect any discrepancy between the number of openings measured by electronic monitoring and the number of pills ingested per opening, and annotated interviews to interpret the discrepancy. The algorithm was tested using data from patients taking lopinavir/r and having participated in an adherence-enhancing programme for more than 3 months. Main outcome measure Adherence was calculated as the percentage of persistent patients (persistence) and the proportion of days with correct dosing over time (implementation) from inclusion to the end of the median follow-up period. Results A 10-step algorithm was established. Among 2041 analysed inter-visit periods, 496 (24 %) were classified as inaccurate, among which 372 (75 %) could be reconciled. The average implementation values were 85 % (raw data) and 91 % (reconciled data) (p drug monitoring, pill count and patient interviews is possible within the setting of a medication adherence clinic. Electronic drug monitoring underestimates medication adherence, affecting subsequent analysis of
Cortes, Alma Ester
There are a limited number of programs as well as a limited structural capacity for children under four. Research indicates that 22% of four-year old children are enrolled in preschool (College Board, 2008). Currently, The United States lacks a unified system for families with children under the age of three, with opportunities to attend center-based care or specific programming (Magnuson & Waldfogel, 2005). Not all families have access to high quality care. Intervention programs that focus ...
Fiederling, Jonas; Ulrich, Cornelia M; Hemminki, Kari; Haug, Ulrike
Family history of cancer (FHC) is important in the context of cancer prevention and risk counselling, but there is a lack of information about its consideration in medical routine. We aimed to characterize how FHC is assessed and taken into account in the primary care setting in Germany. We conducted a mail survey among 285 office-based physicians in south-west Germany. We sent a questionnaire to randomly selected general practitioners, dermatologists, gastroenterologists, gynaecologists, urologists and pulmonologists, asking about collection of information on FHC and implications for preventive counselling. A total of 207 physicians returned the questionnaire (response rate 73%), of whom 71% reported asking for FHC routinely, 17% reported using a standardized tool to collect the information and 35% reported regularly updating it. Implications of a positive FHC for counselling were heterogeneous, with priority on recommendations for screening. Referral to genetic counselling was considered by 34% of physicians, mainly gastroenterologists and gynaecologists. In the primary care setting in Germany, FHC is considered an important topic, but there is a lack of standardization in collecting the information and heterogeneity on the implications for counselling. Options to improve this situation, such as the implementation of standardized tools or centralized counselling systems, are needed.
Strychowsky, Julie E; Albert, David; Chan, Kenny; Cheng, Alan; Daniel, Sam J; De Alarcon, Alessandro; Garabedian, Noel; Hart, Catherine; Hartnick, Christopher; Inglis, Andy; Jacobs, Ian; Kleinman, Monica E; Mehta, Nilesh M; Nicollas, Richard; Nuss, Roger; Pransky, Seth; Russell, John; Rutter, Mike; Schilder, Anne; Thompson, Dana; Triglia, Jean-Michel; Volk, Mark; Ward, Bob; Watters, Karen; Wyatt, Michelle; Zalzal, George; Zur, Karen; Rahbar, Reza
OBJECTIVES: To develop consensus recommendations for peri-operative tracheotomy care in pediatric patients. METHODS: Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the
Helms, Peter J; Ekins Daukes, Suzie; Taylor, Michael W; Simpson, Colin R; McLay, James S
The majority of medicines prescribed for children are prescribed in primary care for common acute and chronic conditions. This is in contrast to prescribing in secondary care where the population of children admitted is small but where a large number of different medicines are prescribed to treat more serious and less common conditions. Data on prescribing was extracted from the General Practice Administration System for Scotland (GPASS) for the year November 1999 to October 2000 and prescribing patterns for children aged 0-16 years expressed as percentages. A comparison of age specific consultations for asthma, as an example of a common paediatric condition, was also made between two separate general practice data sets, the General Practice Research Database (GRPD) and the continuous morbidity recording (CMR) subset of GPASS. Of 214 medicines investigated for unlicensed and off-label prescribing no unlicensed prescribing was identified. Off-label prescribing due to age was most common among younger and older children. The most common reasons for off-label prescriptions were, in order of frequency, lower than recommended dose, higher than recommended dose, below the recommended age, and unlicensed formulation. Age and gender specific consultations for asthma were similar in the two representative databases, GPRD and CMR, both showing disappearance of the male predominance in the teenage years. Large primary care data sets available within a unified health care system such as the UK National Health Service (NHS) are likely to be broadly compatible and produce similar results. The prescribing of off-label medicines to children is common in primary care, most commonly due to prescribing out with the recommended dosage regimen.
Jacobsen, Paul B; Lee, Ji-Hyun; Fulp, William; Siegel, Erin M; Shibata, David; Laronga, Christine; Gray, Jhanelle; Tanvetyanon, Tawee; Schreiber, Fred; Brown, Richard; Levine, Richard; Cartwright, Thomas; Abesada-Terk, Guillermo; Kim, George; Alemany, Carlos; Faig, Douglas; Sharp, Philip; Markham, Merry-Jennifer; Malafa, Mokenge
Identifying and addressing psychosocial concerns is increasingly recognized as an important aspect of cancer care that needs to be improved. As part of the Florida Initiative for Quality Cancer Care, medical record reviews were conducted to evaluate cancer care, including psychosocial care, at oncology practices in Florida in 2006. Results were subsequently disseminated to the practices, and performance was reassessed at the same practices in 2009. Data were available for patients with colorectal, breast, and non-small-cell lung cancer first seen by a medical oncologist in 2006 (n = 1,609) and 2009 (n = 1,720) at the same 10 practice sites. Performance on each psychosocial indicator was evaluated for overall change over time and for variability in change based on practice site and cancer type. The percentage of patients identified as having a problem in emotional well-being increased significantly over time, from 24% to 31% among those assessed (P = .002) and from 13% to 16% overall (P = .026). In contrast, there no significant changes over time in assessment of emotional well-being (53% to 51%, P = .661) or in action taken to address problems (57% to 45%, P = .098). Findings suggest more intensive efforts than audit and feedback will be required to improve the quality of psychosocial care and that greater recognition of problems with emotional well-being may tax the ability of practices to link patients with appropriate services. Systematic research is needed to identify and disseminate effective strategies for implementing routine assessment of well-being and addressing the increased demands for care this will generate. Copyright © 2015 by American Society of Clinical Oncology.
Pouwer, F; Snoek, Frank J
OBJECTIVES: To develop a brief measure of patients' evaluation of the quality of diabetes care and to study predictors of consumers' rating of the quality of diabetes care. DESIGN: A prospective design. SUBJECTS: 176 adults with type 1 (39%) or type 2 (61%) diabetes. MAIN MEASURES: Demographic...... care. CONCLUSIONS: The PEQD comprises different aspects of quality of diabetes care and can be regarded as a suitable instrument for evaluating patients' judgements about the quality of their care....
Jensen, Hanne Irene; Gerritsen, Rik T; Koopmans, Matty
PURPOSE: The purpose of the study is to adapt and provide preliminary validation for questionnaires evaluating families' experiences of quality of care for critically ill patients in the intensive care unit (ICU). MATERIALS AND METHODS: This study took place in 2 European ICUs. Based on literature...... and qualitative interviews, we adapted 2 previously validated North American questionnaires: "Family Satisfaction with the ICU" and "Quality of Dying and Death." Family members were asked to assess relevance and understandability of each question. Validation also included test-retest reliability and construct...... validity. RESULTS: A total of 110 family members participated. Response rate was 87%. For all questions, a median of 97% (94%-99%) was assessed as relevant, and a median of 98% (97%-100%), as understandable. Median ceiling effect was 41% (30%-47%). There was a median of 0% missing data (0%-1%). Test...
Goelman, Hillel; Doherty, Gillian; Lero, Donna S.; LaGrange, Annette; Tougas, Jocelyne
Canadian experts in diverse fields as well as people concerned about social justice and cohesion have identified quality child care as a crucial component in addressing a variety of broad societal goals. This study explored the relationships between child care center quality and: center characteristics; teaching staff wages and working conditions;…
Landier, Jordi; Akonde, Alain; Pizzocolo, Cecilia; Haidara, Ibrahim; Drabo, Mahamadou; Pizarro, Louis; Fontanet, Arnaud; Katlama, Christine; Madec, Yoann
In sub-Saharan Africa, while antiretroviral therapy (ART) becomes widely available, access to biological measurements to monitor patients under ART remains scarce, making the management of ART difficult. We described the management of switching to second-line ART where HIV care is provided mainly in secondary health-care structures, in the region of Segou, Mali. Of 865 patients, followed under ART for a median time of 15 months, 40 switched to second-line ART (3.3 switches/100 person years). Reason for switching was failure in 18 patients (after 21 months in median) and severe intolerance in 13 (after three months in median). Switching to second-line ART occurred earlier when motivated by intolerance than by failure. The low rate of switch compares well with other studies, but was low compared to the expected rate of failure, and may indicate that physicians are reluctant to switch ART when treatment options are limited.
Claessen, S.J.J.; Francke, A.L.; Sixma, H.J.; de Veer, A.J.E.; Deliens, L.
Background: The Consumer Quality Index Palliative Care (CQ-index PC) is a structured questionnaire for measuring the quality of palliative care from the perspective of care users. CQ-indices assess which care aspects need quality improvement by relating answers about actual care experiences to
Claessen, S.J.J.; Francke, A.L.; Sixma, H.J.; Veer, A.J.E. de; Deliens, L.
Background: The Consumer Quality Index Palliative Care (CQ-index PC) is a structured questionnaire for measuring the quality of palliative care from the perspective of care users. CQ-indices assess which care aspects need quality improvement by relating answers about actual care experiences to
Rossum, Huub H van; Kemperman, Hans
General application of a moving average (MA) as continuous analytical quality control (QC) for routine chemistry assays has failed due to lack of a simple method that allows optimization of MAs. A new method was applied to optimize the MA for routine chemistry and was evaluated in daily practice as continuous analytical QC instrument. MA procedures were optimized using an MA bias detection simulation procedure. Optimization was graphically supported by bias detection curves. Next, all optimal MA procedures that contributed to the quality assurance were run for 100 consecutive days and MA alarms generated during working hours were investigated. Optimized MA procedures were applied for 24 chemistry assays. During this evaluation, 303,871 MA values and 76 MA alarms were generated. Of all alarms, 54 (71%) were generated during office hours. Of these, 41 were further investigated and were caused by ion selective electrode (ISE) failure (1), calibration failure not detected by QC due to improper QC settings (1), possible bias (significant difference with the other analyzer) (10), non-human materials analyzed (2), extreme result(s) of a single patient (2), pre-analytical error (1), no cause identified (20), and no conclusion possible (4). MA was implemented in daily practice as a continuous QC instrument for 24 routine chemistry assays. In our setup when an MA alarm required follow-up, a manageable number of MA alarms was generated that resulted in valuable MA alarms. For the management of MA alarms, several applications/requirements in the MA management software will simplify the use of MA procedures.
Full Text Available Rigid endoscopes degrade during clinical use due to sterilization, ionizing radiation and mechanical forces. Despite visual checks on functionality at the department of sterilization, surgeons are still confronted with suboptimal instruments as it is difficult to assess this degradation in an objective manner. To guarantee that endoscopes have sufficient optical quality for minimal invasive surgery, an experimental opto-electronic test bench has been developed in order to be used at the department of sterilization. Transmission of illumination fibres and lens contrast values are stored in a database to enable empirical criteria to reject endoscope for further clinical usage or to accept endoscopes after repair. Results of the test bench are given for an eight month period, where a trained operator performed 1599 measurements on 46 different types. Stability of the system, trends in quality of clinical endoscopes, and effect of repair or replacement were assessed. Although the period was too short to draw firm conclusions, a slow downwards trend in quality of clinically used endoscopes could be observed. Also, endoscopes generally improve in quality after repair or replacement, while endoscope replacement seems to slightly outperform endoscope repair. To optimize the measurement process, a new system is being developed requiring less user interaction and measuring more optical parameters of an endoscope. By commercializing this system, we hope that measurements at different hospitals will give improved insight which acceptance and rejection criteria to use and which factors (usage, cleaning protocol, and brands determine the economic lifetime of endoscopes.
Wientjes, Rens; Noordmans, Herke J; van der Eijk, Jerine A J; van den Brink, Henk
Rigid endoscopes degrade during clinical use due to sterilization, ionizing radiation and mechanical forces. Despite visual checks on functionality at the department of sterilization, surgeons are still confronted with suboptimal instruments as it is difficult to assess this degradation in an objective manner. To guarantee that endoscopes have sufficient optical quality for minimal invasive surgery, an experimental opto-electronic test bench has been developed in order to be used at the department of sterilization. Transmission of illumination fibres and lens contrast values are stored in a database to enable empirical criteria to reject endoscope for further clinical usage or to accept endoscopes after repair. Results of the test bench are given for an eight month period, where a trained operator performed 1599 measurements on 46 different types. Stability of the system, trends in quality of clinical endoscopes, and effect of repair or replacement were assessed. Although the period was too short to draw firm conclusions, a slow downwards trend in quality of clinically used endoscopes could be observed. Also, endoscopes generally improve in quality after repair or replacement, while endoscope replacement seems to slightly outperform endoscope repair. To optimize the measurement process, a new system is being developed requiring less user interaction and measuring more optical parameters of an endoscope. By commercializing this system, we hope that measurements at different hospitals will give improved insight which acceptance and rejection criteria to use and which factors (usage, cleaning protocol, and brands) determine the economic lifetime of endoscopes.
Shvartzman, P; Borkan, J M; Stoliar, L; Peleg, A; Nakar, S; Nir, G; Tabenkin, H
The aim of this study was to explore the impact of male prostatic symptoms on their partners' quality of life, daily routines and family relationships. A structured telephone interview study was carried out on a random sample of 215 of the wives and partners of men aged 50 years or older drawn from those registered at four family medicine centres in Israel. They were asked about sleep disturbances, number of night-time wakings, and the effect on sexual relations, travel, entertainment, family and social relationships. The vast majority of women (86%) were affected by their partners' prostatism, with multiple consequences for their daily routines, quality of life and relationships. Sleep was the area of greatest concern, with 46% of women regularly waking due to their partners' urination disorder. The women reported other limitations: 37% noted problems with sexual functioning; 17% were unable to take long trips with partners; 10% could not visit places without toilets; while 8% were unable to go to the cinema or theatre. Women felt that their partners' prostatic symptoms were also to be blamed for upsetting family relationships (10%) and relationships with friends (16%). There was near total correspondence between women and their male partners regarding the effects of prostatic symptoms. Prostatism has an impact on men and women; strategies that consider the whole couple should be developed and utilized when considering treatment options.
Penne, E. Lars; Visser, Linda; van den Dorpel, Marinus A.; van der Weerd, Neelke C.; Mazairac, Albert H. A.; van Jaarsveld, Brigit C.; Koopman, Marion G.; Vos, Pieter; Feith, Geert W.; Kremer Hovinga, T; van Hamersvelt, Henk W.; Wauters, Inge M.; Bots, Michiel L.; Nube, Menso J.; ter Wee, Piet M.; Blankestijn, Peter J.; Grooteman, Muriel P. C.
During online hemodiafiltration, patients are directly infused with sterile substitution solutions to maintain fluid balance. Adequate water treatment and a well-organized quality control process are essential to provide non-pyrogenic fluids with consistent optimal quality. We sought to assess water
Penne, E. Lars; Visser, Linda; van den Dorpel, Marinus A.; van der Weerd, Neelke C.; Mazairac, Albert H. A.; van Jaarsveld, Brigit C.; Koopman, Marion G.; Vos, Pieter; Feith, Geert W.; Kremer Hovinga, Ton K.; van Hamersvelt, Henk W.; Wauters, Inge M.; Bots, Michiel L.; Nubé, Menso J.; ter Wee, Piet M.; Blankestijn, Peter J.; Grooteman, Muriel P. C.
During online hemodiafiltration, patients are directly infused with sterile substitution solutions to maintain fluid balance. Adequate water treatment and a well-organized quality control process are essential to provide non-pyrogenic fluids with consistent optimal quality. We sought to assess water
Penne, E.L.; Visser, L.; Dorpel, M.A. van den; Weerd, N.C. van der; Mazairac, A.H.; Jaarsveld, B.C. van; Koopman, M.G.; Vos, P.; Feith, G.W.; Kremer Hovinga, T.K.; Hamersvelt, H.W. van; Wauters, I.M.; Bots, M.L.; Nube, M.J.; Wee, P.M. ter; Blankestijn, P.J.; Grooteman, M.P.C.
During online hemodiafiltration, patients are directly infused with sterile substitution solutions to maintain fluid balance. Adequate water treatment and a well-organized quality control process are essential to provide non-pyrogenic fluids with consistent optimal quality. We sought to assess water
Geitung, Jonn Terje (Department of Radiology, Haraldspass Deaconess (University) Hospital (Norway); Department of Surgical Sciences, University of Bergen (Norway)), Email: email@example.com; Eikeland, Joakim (Department of Public Health and Primary Health Care, University of Bergen (Norway)); Rosland, Jan Henrik (Department of Public Health and Primary Health Care, University of Bergen (Norway); Sunniva Clinic for Palliative Care, Haraldsplass Deaconess (University) Hospital (Norway))
Background. Whole-body MRI (WBMRI) has become an accessible method for detecting different types of pathologies both in the skeleton and the viscera, which may explain painful conditions, for example tumors and inflammation. Purpose. To assess a possible value of using WBMRI in order to improve palliative care. Material and Methods. Twenty patients (all eligible patients) admitted to the Department for Palliative Care were consecutively included in this study. They underwent a modified WBMRI, with fewer and shorter pulse sequences than in a standard WBMRI, to reduce patient stress. However, the patients' physicians were to exclude patients where little might be obtained and discomfort, distress, and pain could be induced. The treating physicians registered clinical utility directly after receiving the MRI report in a questionnaire. The registration was repeated after ended treatment. Results. Eighty percent had new findings detected, and 40% of the patients had a change in treatment due to the MRI result, mainly changes in analgesics and/or radiation therapy. Conclusion. The WBMRI helped the clinicians to improve treatment and a majority of the patients benefited from this. In eight patients the treatment was changed due to the results. The clinical value (utility) was indicated to be high
Pinto, Andrew D; Glattstein-Young, Gabriela; Mohamed, Anthony; Bloch, Gary; Leung, Fok-Han; Glazier, Richard H
Detailed data on social determinants of health can facilitate the identification of inequities in access to health care. We report on a sociodemographic data collection tool used in a family medicine clinic. Four major health organizations in Toronto collaborated to identify a set of 14 questions that covered a range of social determinants of health. These were translated into 13 languages. This survey was self-administered using an electronic tablet to a convenience sample of 407 patients in the waiting room of a primary care clinic. Data were uploaded directly to the electronic medical record. The rate of valid responses provided for each question was high, ranging from 84% to 100%. The questions with the highest number of patients selecting "do not know" and "prefer not to answer" pertained to disabilities and income. Patients reported finding the process acceptable. In subsequent implementation across 5 clinics, 10,536 patients have been surveyed; only 724 (6.9%) declined to participate. Collecting data on social determinants of health through a self-administered survey, and linking them to a patient's chart, is feasible and acceptable. A modified survey is now administered to all patients. Such data are already being used to identify health inequities, develop novel interventions, and evaluate their impact on health outcomes. © Copyright 2016 by the American Board of Family Medicine.
Ibáñez Pradas, Vicente; Pérez Montejano, Rut
Trauma care in Spain is not provided in specific centres, which means that health professionals have limited contact to trauma patients. After the setting up of a training program in paediatric trauma, the aim of this study was to evaluate the quality of the initial care provided to these patients before they were admitted to the paediatric intensive care unit (PICU) of a third level hospital (trauma centre), as an indirect measurement of the increase in the number of health professionals trained in trauma. Two cohorts of PICU admissions were reviewed, the first one during the four years immediately before the training courses started (Group 1, period 2001-2004), and the second one during the 4 years (Group 2, period 2012-2015) after nearly 500 professionals were trained. A record was made of the injury mechanism, attending professional, Glasgow coma score (GCS), and paediatric trauma score (PTS). Initial care quality was assessed using five indicators: use of cervical collar, vascular access, orotracheal intubation if GCS ≤ 8, gastric decompression if PTS≤8, and number of actions carried out from the initial four recommended (neck control, provide oxygen, get vascular access, provide IV fluids). Compliance was compared between the 2 periods. A P<.05 was considered statistically significant. A total of 218 patient records were analysed, 105 in Group 1, and 113 in Group 2. The groups showed differences both in injury mechanism and in initial care team. A shift in injury mechanism pattern was observed, with a decrease in car accidents (28% vs 6%; P<.0001). Patients attended to in low complexity hospitals increased from 29.4% to 51.9% (P=.008), and their severity decreased when assessed using the GCS ≤ 8 (29.8% vs 13.5%; P=.004), or PTS≤8 (48.5% vs 29.7%; P=.005). As regards quality indicators, only the use of neck collar improved its compliance (17.3% to 32.7%; P=.01). Patients who received no action in the initial care remained unchanged (19% vs 11%%; P=.15
Doherty, Anne M; Gayle, Carol; Morgan-Jones, Ruth; Archer, Nicola; Laura-Lee; Ismail, Khalida; Werner, Anne
Many people with persistent suboptimal diabetes control also have psychiatric morbidity and social problems which interfere with their ability to self-manage their diabetes. Current models of care in the UK do not integrate these different dimensions of care or address inequalities between physical and mental health. 3DFD (3 Dimensions of Care For Diabetes) integrated medical, psychological, and social care in diabetes for patients with persistent suboptimal glycemic control (HbA1c > 75 mmol/mol) despite guideline-based routine diabetes care, to improve glycemic control, reduce psychological distress, and improve social functioning. The service delivered interventions including brief psychological therapies, mental health assessments, psychotropic medications, and social support, enhanced by patient-led case conferences aiming to optimize diabetes care. 3DFD measured changes in HbA1c, psychological functioning, quality of life, rates of unscheduled care, and levels of engagement with routine diabetes care at baseline and at 12 months. At 12-month follow-up, 3DFD patients achieved significant reductions in HbA1c of 15 mmol/mol, International Federation of Clinical Chemistry (1.4% Diabetes Control and Complications Trial) and improvements in depression scores and patient satisfaction. This model of care demonstrates that integrated care can improve diabetes outcomes in people with psychological and social comorbidities. © The Author(s) 2015.
Wu, Jianmin; Grannis, Shaun J; Xu, Huiping; Finnell, John T
Accurately predicting future frequent emergency department (ED) utilization can support a case management approach and ultimately reduce health care costs. This study assesses the feasibility of using routinely collected registration data to predict future frequent ED visits. Using routinely collected registration data in the state of Indiana, U.S.A., from 2008, we developed multivariable logistic regression models to predict frequent ED visits in the subsequent two years. We assessed the model's accuracy using Receiver Operating Characteristic (ROC) curves, sensitivity, and positive predictive value (PPV). Strong predictors of frequent ED visits included age between 25 and 44 years, female gender, close proximity to the ED (less than 5 miles traveling distance), total visits in the baseline year, and respiratory and dental chief complaint syndromes. The area under ROC curve (AUC) ranged from 0.83 to 0.92 for models predicting patients with 8 or more visits to 16 or more visits in the subsequent two years, suggesting acceptable discrimination. With 25 % sensitivity, the model predicting frequent ED use as defined as 16 or more visits in 2009 and 2010 had a PPV of 59.5 % and specificity of 99.9 %. The "adjusted" PPV of this model, which includes patients having 8 or more visits, is 81.9 %. We demonstrate a strong association between predictor variables present in registration data and frequent ED use. The algorithm's performance characteristics suggest that it is technically feasible to use routinely collected registration data to predict future frequent ED use.
Sage, William M; Kalyan, Dev N
The competitive benefits of pay-for-performance (P4P) financial incentives are widely assumed. These incentives can affect health care through several mechanisms, however, not all of which involve competition. This insight has three implications. First, federal antitrust enforcement should continue to scrutinize P4P arrangements. Second, government needs to play a larger role in P4P than through antitrust oversight. Third, widespread enthusiasm for a particular health policy reform does not relieve policy makers of the obligation to understand its theoretical basis.
Konrad, Jana; Loos, Sabine; Neumann, Petra
with severe mental illness across Europe over a measurement period of one year. METHODS: Self-ratings of the HA by 588 people with severe mental illness who participated in a multicentre European study (CEDAR; ISRCTN75841675) were examined using latent class analysis. RESULTS: Four main patterns of alliance...... of life. CONCLUSIONS: Results support findings from psychotherapy research about a predominantly stable course of the helping alliance in patients with severe mental illness over time. Implications for research and practice indicate to turn the attention to subgroups with noticeable courses.......PURPOSE: The helping alliance (HA) between patient and therapist has been studied in detail in psychotherapy research, but less is known about the HA in long-term community mental health care. The aim of this study was to identify typical courses of the HA and their predictors in a sample of people...
Kennedy, Denise M; Nordrum, Jon T; Edwards, Frederick D; Caselli, Richard J; Berry, Leonard L
A framework for improving health care service quality was implemented at a 12-provider family medicine practice in 2010. A national patient satisfaction research vendor conducted weekly telephone surveys of 840 patients served by that practice: 280 patients served in 2009, and 560 served during 2010 and 2011. After the framework was implemented, the proportion of "excellent" ratings of provider service (the highest rating on a 5-point scale) increased by 5% to 9%, most notably thoroughness (P = .04), listening (P = .04), and explaining (P = .04). Other improvements included prompt test result notification and telephone staff courtesy (each by 10%, P = .02), as well as teamwork (by 8%, P = .04). Overall quality increased by 10% (P = .01), moving the practice from the 68th to the 91st percentile of medical practices in the research vendor's database. Improvements in patient satisfaction suggest that this framework may be useful in value-based payment models. © 2014 by the American College of Medical Quality.
van Dijk-de Vries, Anneke; van Bokhoven, Marloes A.; de Jong, Sabine; Metsemakers, Job F. M.; Verhaak, Peter P. M.; van der Weijden, Trudy; van Eijk, Jacques Th. M.
Background: Patients with type 2 diabetes mellitus face several emotional and social consequences of their chronic illness in their everyday life. Symptoms of distress and depression are prevalent. For providing psychosocial self-management support, nurses in primary care were trained to identify
Vries, A. De; Bokhoven, M.A. van; Jong, S. de; Metsemakers, J.F.M.; Verhaak, P.F.; Weijden, T.T. van der; Eijk, J.Th.M. van
BACKGROUND: Patients with type 2 diabetes mellitus face several emotional and social consequences of their chronic illness in their everyday life. Symptoms of distress and depression are prevalent. For providing psychosocial self-management support, nurses in primary care were trained to identify
Dijk-de Vries, A. van; Bokhoven, M.A. van; Jong, S. de; Metsemakers, J.F.M.; Verhaak, P.F.M.; Weijden, T. van der; Eijk, J.T.M. van
Background: Patients with type 2 diabetes mellitus face several emotional and social consequences of their chronic illness in their everyday life. Symptoms of distress and depression are prevalent. For providing psychosocial self-management support, nurses in primary care were trained to identify
Flannery, Dustin D; Brandsma, Erik; Saslow, Judy; Mackley, Amy B; Paul, David A; Aghai, Zubair H
To determine if infants diagnosed with urinary tract infection (UTI) in the neonatal intensive care unit (NICU) require a routine voiding cystourethrogram (VCUG). Retrospective data analysis from three centers for infants admitted to the NICU born between 2000 and 2013 and diagnosed with UTI. One hundred twenty-six infants from three centers were diagnosed with UTI during their hospitalization. Renal ultrasound (RUS) was performed in 115 infants (91.2%), of which 69 (60%) were abnormal. Mild to moderate hydronephrosis or pelviectasis were the most common abnormalities identified (n = 34, 30%). There were 14 infants (12%) with severe abnormalities on RUS. VCUG was performed in 71 infants (56%), of which 3 (4%) were interpreted as abnormal with grade 2 vesicoureteral reflux (VUR) or less (2 infants normal RUS and 1 infant abnormal RUS). More than 50% of infants with a UTI had an abnormal RUS but severe abnormalities were found only in 11% of infants. Only 4% of infants with UTI had VUR, none of these infants had severe VUR on VCUG. A routine VCUG after UTI in the NICU has a low yield and may be reserved for infants with severe or persistent abnormalities on RUS.
Mears, Molly; Coonrod, Dean V; Bay, R Curtis; Mills, Terry E; Watkins, Michelle C
To compare endorsement rates obtained with audio computer-assisted self-interview versus routine prenatal history. A crosssectional study compared items captured with the routine history to those captured with a computer interview (computer screen displaying and computer audio reading questions, with responses entered by touch screen). The subjects were women (n=174) presenting to a public hospital clinic for prenatal care. The prevalence of positive responses using the computer interview was significantly greater (p history for induced abortion (16.8% versus 4.0%), lifetime smoking (12.8% versus 5.2%), intimate partner violence (10.0% versus 2.4%), ectopic pregnancy (5.2% versus 1.1%) and family history of mental retardation (6.7% versus 0.6%). Significant differences were not found for history of spontaneous abortion, hypertension, epilepsy, thyroid disease, smoking during pregnancy, gynecologic surgery, abnormal Pap test, neural tube defect or cystic fibrosis family history. However, in all cases, prevalence was equal or greater with the computer interview. Women were more likely to report sensitive and high-risk behavior, such as smoking history, intimate partner violence and elective abortion, with the computer interview. The computer interview displayed equal or increased patient reporting of positive responses and may therefore be an accurate method of obtaining an initial history.
Regaira Martínez, E; Sola Iriarte, M; Goñi Viguria, R; Del Barrio Linares, M; Margall Coscojuela, M A; Asiain Erro, M C
The evaluation made by the patients on the quality of service received is important to introduce improvement strategies in the care quality. 1. To evaluate the care quality through the analysis of the differences obtained between expectations and perceptions, that the patients have of the service received in the ICU. 2. To analyze if there is any relationship between care quality evaluated by the patients and the sociodemographic variables. A total of 86 patients who were conscious and oriented during their stay in the ICU were studied prospectively. At 24h of the discharge from the ICU, the SERVQUAL (Service Quality) scale, adapted for the hospital setting by Babakus and Mangold (1992), was applied. This scale measures the care quality based on the difference in scores obtained between expectations and perceptions of the patients. The positive scores indicate that the perceptions of the patients exceed their expectations. The scale has 5 dimensions: Tangibility, Reliability, Responsiveness, Assurances and Empathy. It includes 15 items for perceptions and the same for expectations, with 5 grades of response (1 totally disagree - 5 totally agree). The mean score of perceptions 66.92) exceeded that of the expectations (62.30). The mean score of the difference between perceptions and expectations for the total of the SERVQUAL scale was 4.62. It was also positive for each one of the dimensions: Tangibility=1.44, Reliability=0.53, Responsiveness=0.95, Assurances=0.99, Empathy=0.71. No statistically significant associations were found between care quality evaluated by the patients and the sociodemographic variables. The care quality perceived by the patients in the ICU exceeds their expectations, and had no relationship with the sociodemographic characteristics. Copyright 2009 Elsevier España, S.L. y SEEIUC. All rights reserved.
Molecular point-of-care testing for respiratory viruses versus routine clinical care in adults with acute respiratory illness presenting to secondary care: a pragmatic randomised controlled trial protocol (ResPOC).
Brendish, Nathan J; Malachira, Ahalya K; Clark, Tristan W
Respiratory viruses are associated with a huge socio-economic burden and are responsible for a large proportion of acute respiratory illness in hospitalised adults. Laboratory PCR is accurate but takes at least 24 h to generate a result to clinicians and antigen-based point-of-care tests (POCT) lack sensitivity. Rapid molecular platforms, such as the FilmArray Respiratory Panel, have equivalent diagnostic accuracy to laboratory PCR and can generate a result in 1 h making them deployable as POCT. Molecular point-of-care testing for respiratory viruses in hospital has the potential to improve the detection rate of respiratory viruses, improve the use of influenza antivirals and reduce unnecessary antibiotic use, but high quality randomised trials with clinically relevant endpoints are needed. The ResPOC study is a pragmatic randomised controlled trial of molecular point-of-care testing for respiratory viruses in adults with acute respiratory illness presenting to a large teaching hospital in the United Kingdom. Eligible participants are adults presenting with acute respiratory illness to the emergency department or the acute medicine unit. Participants are allocated 1:1 by internet-based randomisation service to either the intervention of a nose and throat swab analysed immediately on the FilmArray Respiratory Panel as a POCT or receive routine clinical care. The primary outcome is the proportion of patients treated with antibiotics. Secondary outcomes include turnaround time, virus detection, neuraminidase inhibitor use, length of hospital stay and side room use. Analysis of the primary outcome will be by intention-to-treat and all enrolled participants will be included in safety analysis. Multiple novel molecular POCT platforms for infections including respiratory viruses have been developed and licensed in the last few years and many more are in development but the evidence base for clinical benefit above standard practice is minimal. This randomised controlled
Garbarino, John R.; Taylor, Howard E.
A completely automated ICP-AES system is implemented by using a dedicated minicomputer. The minicomputer system provides ICP-AES spectrochemical data acquisition, processing and storage, control for an automatic sampler, real-time quality control, and automatic standardization. Checks made on the elemental spectrochemical data insure that all the results fall within the analytical range of the method. The automatic sampler is a modified commercially available sampler that permits computer control and continuously variable rinse und sample equilibration periods. Real-time quality control is based on results obtained for a check standard. analyzed periodically between unknown samples. Automatic standardization is implemented by using a computer-actuated stepper motor that drives a multi-position rotary valve. Rotating the valve to the desired port permits the chosen standard solution to be pumped to the nebulizer of the spectrometer. Experiments have shown that the automated ICP-AES system produces results similar in accuracy to the manually operated system in addition to providing improvements in manpower efficiency and sample throughput.
Amin, Alexandre; Bourget, Philippe; Vidal, Fabrice; Ader, Flavie
This study compares the performance of a reference method of HPLC to Raman spectroscopy (RS) for the analytical quality control (AQC) of therapeutic objects. We assessed a model consisting of a widely used antiviral drug, i.e., ganciclovir, which was compounded in a medical device and then transferred in a vacuum glass vial prior to analyses. As the aim of the alternative RS method is to replace the destructive, time-consuming HPLC method, requiring sample preparation, it needs to be demonstrated that RS performs at least as good as the HPLC method. Therefore, the two methods were validated by calculating the accuracy profile and provided excellent results for the analytical validation key criteria, i.e., trueness, precision and accuracy, ranging from 0.8 to 10mg/mL. The Spearman and Kendall correlation tests (p-value<1.10-15) and the statistical studies performed on the graphs confirm a strong correlation in the results between RS and the standard HPLC under the experimental conditions. These results confirmed the potential of this option for future applications, owing to its analytical and practical quality and its contributions to the safety of the medication circuit. This method also greatly contributes to the protection of caregivers and their working environment. Copyright © 2014 Elsevier B.V. All rights reserved.
Netherton, J K; Hetherington, L; Ogle, R A; Velkov, T; Baker, M A
Male infertility is a complex condition, and for the most part, all men produce defective spermatozoa, but infertile men have a tendency to produce more. Despite attempts to classify infertility, there is no definitive test. One approach would be to use protein biomarkers, however as yet, we still do not understand proteins that are differentially expressed within defective spermatozoa. As such, we took nine men (fertility status unknown) and used Percoll density gradients to isolate a population of good and poor quality sperm. For four of these men, we also obtained multiple ejaculations. The most noticeable difference between the Percoll-isolated fractions were motility and CMA3 staining. Whilst the good sperm fraction produced cells with at least 80% forward progressive motility and low levels of CMA3 staining, the poor quality sperm demonstrated less than 10% forward progressive motility and higher levels CMA3 staining. Using the technique of Sequential Window Activation of All Theoretical Mass spectra (SWATH-MS), we quantified 2774 proteins and found 171 proteins to be significantly more abundant in the good sperm fraction, whilst 104 proteins were significantly more abundant in the lower sperm fraction (adjusted Benjamini-Hochberg significance of p < 0.018, minimum 2-fold difference). © The Author(s) 2017. Published by Oxford University Press on behalf of Society for the Study of Reproduction. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Morra, S; Bughin, F; Solecki, K; Aboubadra, M; Lattuca, B; Gouzi, F; Macia, J-C; Cung, T-T; Cade, S; Cransac, F; Davy, J-M; Dauvilliers, Y; Corrado, D; Roubille, F
Increased evidence has shown that, despite the maximum care afforded to patients admitted with acute coronary syndromes (ACS), a residual risk of mortality remains, in which obstructive sleep apnoea (OSA) appears to be a largely undiagnosed factor, particularly in the intensive cardiac care unit (ICCU). The purpose of this study is to determine whether the systematic screening for sleep-disordered breathing (SDB) is feasible and may be recommended. The aims of our study are to determine: (1) The estimated prevalence of OSA in patients admitted to the ICCU for ACS determined by a validated, user-friendly portable screening device; (2) The feasibility of the screening in this context; (3) To assess any negative impact of OSA on the severity of ACS. This is an observational study of 101 patients admitted to the ICCU for ACS showing no clinical evidence of heart failure (HF). In the 24-72hours following admission, they underwent an overnight sleep study using a 3-channel portable screening device with automatic analysis. Sixty-two out of the 101 patients proved positive to the screening test, and its feasibility was acceptable. OSA patients tended to have greater peak levels of hs-cTnT (3685±3576ng/L versus 2830±3333ng/L, P=0.08) than the non-OSA group. Compared with the non-OSA group, OSA patients presented more severe ACS, with a greater average GRACE score at admission of 112.2±26.3 (versus 98.4±19.2, P<0.001). In the OSA group, we found a statistically significant inverse correlation between the apnoea-hypopnea index (AHI) and the left ventricular ejection fraction (LVEF) in the linear regression analysis (r=-0.26; P=0.037). A systematic screening of patients in the ICCU is acceptable. OSA is frequently found in the acute phase of ischaemic heart disease and its presence is associated with more severe ACS and a poorer left ventricle systolic function. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
van der Burg, Pauline S; de Jongh, Frans H; Miedema, Martijn; Frerichs, Inez; van Kaam, Anton H
During routine nursing care, preterm infants are often placed in lateral position for several hours, but the effect of this procedure on regional lung volume and ventilation is unknown. In our study we examined this effect during 3 hrs of lateral positioning in stable preterm infants. Preterm infants on non-invasive respiratory support were eligible for the study. Infants were placed in supine position and subsequently transferred to right or left lateral position, according to their individual routine nursing schedule. Changes in end-expiratory lung volume (EELV), tidal volume (VT ) and ventilation distribution were recorded using electrical impedance tomography (EIT), starting 10 min before and up to 180 min after the positional change. Additionally, oxygen requirement, transcutaneous oxygen saturation and respiratory rate were recorded. 15 infants were included (GA 28.9 ± 2.0 wk, BW 1167 ± 290 g). EELV increased significantly after changing to lateral position, stabilizing at a median value of 40.8 (IQR 29.0-99.3) AU/kg at 30 min. This increase could almost be exclusively attributed to the non-dependent lung regions. Tidal volume, oxygenation, and respiratory rate remained stable. Changing to the right, but not the left, lateral position resulted in a rapid but transient shift in ventilation to the dependent lung regions. After 180 min there were no differences in ventilation distribution between lateral and supine positioning. This study shows that lateral position up to 3 hours, as part of normal nursing care of preterm infants, has no adverse effects on lung volumes and its regional distribution. © 2015 Wiley Periodicals, Inc.
Prodinger, Birgit; Tennant, Alan; Stucki, Gerold; Cieza, Alarcos; Üstün, Tevfik Bedirhan
Our aim was to specify the requirements of an architecture to serve as the foundation for standardized reporting of health information and to provide an exemplary application of this architecture. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) served as the conceptual framework. Methods to establish content comparability were the ICF Linking Rules. The Rasch measurement model, as a special case of additive conjoint measurement, which satisfies the required criteria for fundamental measurement, allowed for the development of a common metric foundation for measurement unit conversion. Secondary analysis of data from the North Yorkshire Survey was used to illustrate these methods. Patients completed three instruments and the items were linked to the ICF. The Rasch measurement model was applied, first to each scale, and then to items across scales which were linked to a common domain. Based on the linking of items to the ICF, the majority of items were grouped into two domains, Mobility and Self-care. Analysis of the individual scales and of items linked to a common domain across scales satisfied the requirements of the Rasch measurement model. The measurement unit conversion between items from the three instruments linked to the Mobility and Self-care domains, respectively, was demonstrated. The realization of an ICF-based architecture for information on patients' functioning enables harmonization of health information while allowing clinicians and researchers to continue using their existing instruments. This architecture will facilitate access to comprehensive and consistently reported health information to serve as the foundation for informed decision-making. © The Author(s) 2016.
Full Text Available The article analyses the existing gap between the formal dimension of evidence-based medicine (EBM, as constituted by protocols, procedures, and guidelines, and actual professional practices in relation to a specific issue: the admission of patients to an intensive care unit (ICU. The results of a case study, carried out in the ICU of a hospital in the north of Italy between 2006 and 2007 are reported. The study was performed using ethnographic methods: participant observation, ethnographic interviews, and semi-structured interviews. Empirical data have been analysed using a grounded theory approach. The results show how three dimensions (macrosocial, organisational-interactional, and individual become intertwined with the operational guidelines that have been drafted on the basis of international evidence. The standardisation process that the guidelines presuppose results in the adoption of a variety of different local styles with respect to the approach that individual doctors take in relation to the admission of a patient to an ICU. These styles can range from strict adherence to the international criteria to a greater compliance with medical–legal, organisational, and individual needs. Furthermore, the results of the study demonstrate how relational knowledge, as a form of situated knowledge, can allow the personnel involved to activate local resources (organisational, professional, and personal in order to incorporate the formal prescriptions of EBM in professional practice. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1502261
Leemans, K.; Cohen, J.; Block, L. van den; Stichele, R. Vander; Francke, A.L.; Deliens, L.
Aims: Evaluation of quality of palliative care is an important condition to optimize and improve care. This study aims to develop a comprehensive set of quality indicators to monitor the quality of palliative care in Flanders, Belgium. Methods: An extensive literature review led to the
evaluate over all quality of TB care. Operational definition of quality of care, data collection and analysis. Three dimensions of quality of TB care; structure, process and outcome were assessed. The instruments used to assess structure- process- out come dimension were developed from published literature (8) and modified ...
Nagata, Koichi [Kameda Medical Center, Department of Radiology, Kamogawa, Chiba (Japan); Jichi Medical University, Department of Radiology, Tochigi (Japan); National Cancer Center, Cancer Screening Technology Division, Research Center for Cancer Prevention and Screening, Tokyo (Japan); Fujiwara, Masanori; Mogi, Tomohiro; Iida, Nao [Kameda Medical Center Makuhari, Department of Radiology, Chiba (Japan); Kanazawa, Hidenori; Sugimoto, Hideharu [Jichi Medical University, Department of Radiology, Tochigi (Japan); Mitsushima, Toru [Kameda Medical Center Makuhari, Department of Gastroenterology, Chiba (Japan); Lefor, Alan T. [Jichi Medical University, Department of Surgery, Tochigi (Japan)
To prospectively evaluate the radiation dose and image quality comparing low-dose CT colonography (CTC) reconstructed using different levels of iterative reconstruction techniques with routine-dose CTC reconstructed with filtered back projection. Following institutional ethics clearance and informed consent procedures, 210 patients underwent screening CTC using automatic tube current modulation for dual positions. Examinations were performed in the supine position with a routine-dose protocol and in the prone position, randomly applying four different low-dose protocols. Supine images were reconstructed with filtered back projection and prone images with iterative reconstruction. Two blinded observers assessed the image quality of endoluminal images. Image noise was quantitatively assessed by region-of-interest measurements. The mean effective dose in the supine series was 1.88 mSv using routine-dose CTC, compared to 0.92, 0.69, 0.57, and 0.46 mSv at four different low doses in the prone series (p < 0.01). Overall image quality and noise of low-dose CTC with iterative reconstruction were significantly improved compared to routine-dose CTC using filtered back projection. The lowest dose group had image quality comparable to routine-dose images. Low-dose CTC with iterative reconstruction reduces the radiation dose by 48.5 to 75.1 % without image quality degradation compared to routine-dose CTC with filtered back projection. (orig.)
Diez-Garcia Rosa; de Sousa Anete; Proença Rossana Pacheco da Costa; Leandro-Merhi Vania; Martinez Edson
Abstract Background Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals. Methods Investigation of the Hospital Food and Nutrition Service (HFNS) of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ) and hospital food service quality (FSQ). HFN...
Hermann, Richard C; Mattke, Soeren; Somekh, David
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....
Richards, Kyle A; Cesario, Stacy; Lim, Amy H; Best, Sara L; Deeren, Susan M; Bushman, Wade; Safdar, Nasia
Urinalysis (UA) and urine culture (UCx) are commonly performed tests in the urology clinic. Many of these urine studies are performed prior to the patient visit may not always be indicated, thus contributing to unintended consequences such as antibiotic use and costs without enhancing patient care. Our objective was to perform a quality improvement initiative aimed to assess the utility of routine UA/UCx. The practice pattern at our site's Veteran Affairs (VA) urology clinic prior to 2014 was to obtain routine UA/UCx on most clinic visits prior to patient evaluation. Starting in 2014, we designed an intervention whereby our nurse practitioner triaged all new patient referrals and selectively ordered UA/UCx. We performed multivariable logistic regression to assess for predictors of obtaining UA or UCx. A total of 1308 patients were seen in January-March 2013 and 1456 in June-August 2014 and were included in this analysis. Fewer patients in 2014 received UA (59.8% versus 70.0%, p < 0.001) and UCx (49.6% versus 64.2%, p < 0.001). There was a decreased odds of obtaining UA in 2014 (OR 0.52, p < 0.001) as well as a decreased odds of obtaining UCx in 2014 (OR0.38, p < 0.001) on multivariable logistic regression. The results of UA/UCx only rarely resulted in change of management in either cohort (3%). Selective ordering resulted in an estimated cost savings of $4915.08/month in UCx costs alone. Our quality improvement initiatives reduced rates of UA/UCx testing when providers assess patients prior to ordering these tests. The implication of this initiative is significant cost savings for the healthcare system.
Ruzek, Erik; Burchinal, Margaret; Farkas, George; Duncan, Greg J
Over half of the toddlers in the U.S. experience routine nonparental care, but much less is known about early care than about preschool care. This study analyzed 2-year-old child care and child outcome data from the nationally representative ECLS-B sample of children born in 2001. At two-years of age, 51% of children experienced exclusive parental care, 18% relative care, 15% family child care, and 16% center care. More children in nonparental care were in medium quality care (61%) than in high quality (26%) or low quality (13%) care. Low-income children were more likely than non-low income children to be cared for by their parents and, when in care, were more often in lower quality care. The impact of toddler care quality on cognitive skills was estimated using propensity score adjustments to account for potential selection confounds due to family and child characteristics. Children's cognitive scores were higher in high or medium quality care than in low quality care, but no evidence emerged suggesting that poverty moderated the quality effects. Nevertheless, this suggests that increasing the proportion of low-income children in high quality care could reduce the achievement gap because low-income children are very unlikely to experience high quality care.
Claessen, S.J.J.; Francke, A.L.; Sixma, H.J.; Veer, A.J.E. de; Deliens, L.
Background: The Consumer Quality Index Palliative Care (CQ-index PC) is a structured questionnaire for measuring the quality of palliative care from the perspective of care users. CQ-indices assess which care aspects need quality improvement by relating answers about actual care experiences to answers about the importance of certain aspects of care. Methods: To improve the chance that the new instrument has good content validity, a literature study and individual and group discussions were pe...
Modroño, Sagrario; Soldado, Ana; Martínez-Fernández, Adela; de la Roza-Delgado, Begoña
Significant advances achieved in different sensor technologies and computer processing data have made possible to respond the needs of livestock sector, providing precise and rapid information on feed composition, being an alternative to real time quality control on compound feed the use of handheld NIRS sensors. This work aimed to evaluate two hand-held portable NIR spectrophotometers for on-site and real time analysis of nutritive parameters in raw compound feed: Phazir 1624 Polychromix Inc (PhIR) and MicroNIR TM 1700 by JDSU (MICRO). For computing data, different combinations of pre-treatments and multivariate statistical methods have been assayed to extract the valuable information of spectra data and to develop appropriate calibrations. The calibration models displayed greatest predictive capacity for Crude Protein (CP), Crude Fiber (CF) and Starch (STCH) and the determination coefficients of cross validation were 0.90-0.88 for CP, 0.85-0.91 for CF, 0.89-0.88 and 0.89-0.91 for STCH using PhIR and MICRO instruments respectively. Dry Matter showed the lowest determination coefficients of cross validation 0.67-0.73. Accuracy achieved 99-101% for both NIRS instruments and no differences were found when applying t student -test comparing reference and predicted data. Results obtained with both instruments were compared by using standard deviation and not significant differences were observed at the 5% level. Results so far have demonstrated the potential of these handheld NIRS instruments proposed here to estimate the individual compound feeds composition changes at farms level instantly, time avoiding the disadvantage of moving the samples to the lab. Copyright © 2016 Elsevier B.V. All rights reserved.
Keller, H H; Vesnaver, E; Davidson, B; Allard, J; Laporte, M; Bernier, P; Payette, H; Jeejeebhoy, K; Duerksen, D; Gramlich, L
Malnutrition is common in acute care hospitals worldwide and nutritional status can deteriorate during hospitalisation. The aim of the present qualitative study was to identify enablers and challenges and, specifically, the activities, processes and resources, from the perspective of nutrition care personnel, required to provide quality nutrition care. Eight hospitals participating in the Nutrition Care in Canadian Hospitals study provided focus group data (n = 8 focus groups; 91 participants; dietitians, dietetic interns, diet technicians and menu clerks), which were analysed thematically. Five themes emerged from the data: (i) developing a nutrition culture, where nutrition practice is considered important to recovery of patients and teams work together to achieve nutrition goals; (ii) using effective tools, such as screening, evidence-based protocols, quality, timely and accurate patient information, and appropriate and quality food; (iii) creating effective systems to support delivery of care, such as communications, food production and delivery; (iv) being responsive to care needs, via flexible food systems, appropriate menus and meal supplements, up to date clinical care and including patient and family in the care processes; and (v) uniting the right person with the right task, by delineating roles, training staff, providing sufficient time to undertake these important tasks and holding staff accountable for their care. The findings of the present study are consistent with other work and provide guidance towards improving the nutrition culture in hospitals. Further empirical work on how to support successful implementation of nutrition care processes is needed. © 2013 The British Dietetic Association Ltd.
As the ethnic diversity of the U.S. population increases, there is a growing awareness of healthcare disparities and the need to address them. This position statement that the American Geriatrics Society (AGS) Ethnogeriatrics Committee developed outlines healthcare disparities in the United States and the minimum quality indicators that healthcare organizations and healthcare providers should adopt to ensure that all older adults receive care that is culturally appropriate and takes into account level of health literacy. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
Pineda, Carlos; Sandoval, Hugo
We present an overview of rheumatology practices in Mexico, describing the national health care system as segmented and fragmentary, with a population separated into 3 main categories, according to employment-based coverage and income level: (1) private sector, (2) Social Security System, and (3) public insurance subsector.The rheumatology practice in the public and private sectors are described. We estimate that between 85%-90% of Mexican rheumatologists have a mixed (public and private)-type practice. Payments to rheumatologists are not currently affected by quality and value metrics, with low penetrance of electronic health records. Recent changes and challenges to health insurance coverage are illustrated.
Foebel, Andrea D; van Hout, Hein P; van der Roest, Henriëtte G; Topinkova, Eva; Garms-Homolova, Vjenka; Frijters, Dinnus; Finne-Soveri, Harriet; Jónsson, Pálmi V; Hirdes, John P; Bernabei, Roberto; Onder, Graziano
Evaluating the quality of care provided to older individuals is a key step to ensure that needs are being met and to target interventions to improve care. To this aim, interRAI's second-generation home care quality indicators (HCQIs) were developed in 2013. This study assesses the quality of home care services in six European countries using these HCQIs as well as the two derived summary scales. Data for this study were derived from the Aged in Home Care (AdHOC) study - a cohort study that examined different models of community care in European countries. The current study selected a sub-sample of the AdHOC cohort from six countries whose follow-up data were complete (Czech Republic, Denmark, Finland, Germany, Italy and the Netherlands). Data were collected from the interRAI Home Care instrument (RAI-HC) between 2000 and 2002. The 23 HCQIs of interest were determined according to previously established methodology, including risk adjustment. Two summary measures, the Clinical Balance Scale and Independence Quality Scale were also determined using established methodology. A total of 1,354 individuals from the AdHOC study were included in these analyses. Of the 23 HCQIs that were measured, the highest proportion of individuals experienced declines in Instrumental Activities of Daily Living (IADLs) (48.4 %). Of the clinical quality indicators, mood decline was the most prevalent (30.0 %), while no flu vaccination and being alone and distressed were the most prevalent procedural and social quality indicators, respectively (33.4 and 12.8 %). Scores on the two summary scales varied by country, but were concentrated around the median mark. The interRAI HCQIs can be used to determine the quality of home care services in Europe and identify areas for improvement. Our results suggest functional declines may prove the most beneficial targets for interventions.
Puschner, Bernd; Becker, Thomas; Bauer, Stephanie
The German healthcare system offers comprehensive coverage for people with mental illness including inpatient, day hospital and outpatient services. These services are primarily financed through the statutory health and pension insurances. According to legal regulations, providers are required to base their services on current scientific evidence and to continuously assure the quality of their services. This paper gives an overview of recent initiatives to develop, evaluate and disseminate routine outcome measurement (ROM) in service settings in Germany. A large number of projects have shown outcome monitoring to be feasible, and that feedback of outcome may enhance routine care through an improved allocation of treatment resources. However, none of these initiatives have been integrated into routine care on a nationwide or trans-sectoral level, and their sustainability has been limited. This is due to various barriers in a fragmented mental health service system and to the lack of coordinated national or state-level service planning. The time is ripe for a concerted effort including policy-makers to pick up on these initiatives and move them towards wide-spread implementation in routine care accompanied by practice-oriented research including service user involvement.
Nagington, Maurice; Walshe, Catherine; Luker, Karen A
Quality of care is a prominent discourse in modern health-care and has previously been conceptualised in terms of ethics. In addition, the role of knowledge has been suggested as being particularly influential with regard to the nurse-patient-carer relationship. However, to date, no analyses have examined how knowledge (as an ethical concept) impinges on quality of care. Qualitative semi-structured interviews were conducted with 26 patients with palliative and supportive care needs receiving district nursing care and thirteen of their lay carers. Poststructural discourse analysis techniques were utilised to take an ethical perspective on the current way in which quality of care is assessed and produced in health-care. It is argued that if quality of care is to be achieved, patients and carers need to be able to redistribute and redevelop the knowledge of their services in a collaborative way that goes beyond the current ways of working. Theoretical works and extant research are then used to produce tentative suggestions about how this may be achieved. © 2015 The Authors Nursing Inquiry Published by John Wiley & Sons Ltd.
Whitebook, Marcy; And Others
The National Child Care Staffing Study explores the effect of teachers and teaching conditions on the caliber of center-based child care in the United States. The study raises concerns about the quality of services children receive, the education of staff, the work environment, low teachers' wages, and staff turnover. (BB)
Qin, Hong; Prybutok, Victor; Prybutok, Gayle
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.
Full Text Available Motivational interviewing (MI is a method for building motivation for behaviour change that has potential for use in respiratory contexts. There is a paucity of published research exploring the feasibility of this intervention from the clinicians' perspective. This study aimed to explore respiratory clinicians' views of MI: Is it perceived as useful? Could it be integrated into practice? What training would be required to make it part of routine care? Nine respiratory clinicians attended a one-day MI workshop and a semi-structured face-to-face interview two weeks later. All interviews were audio-recorded, transcribed verbatim and analysed with thematic analysis. Four main themes are presented-1 MI's suitability for use in respiratory contexts: participants saw potential in using MI to motivate their patients to engage with prescribed respiratory interventions, such as increased physical activity. Those who experimented with new skills post-workshop were encouraged by patient responsiveness and outcomes. 2 MI's relationship with routine clinical practice: some believed they already used elements of MI, but most participants felt MI was fundamentally 'different' to their normal style of working. 3 Implementation issues: additional time would need to be made available to enable an appropriate depth of conversation. 4 Training issues: Participants sensed the complexity of MI could make it difficult to learn and that it would take them time to become competent. On-going supervision was perceived as necessary. One key challenge identified was how to suppress behaviours that are antithetical to MI. These findings lend support to the feasibility of using MI in respiratory contexts such as pulmonary rehabilitation programmes, but highlight implementation and training issues that would need to be overcome. The insights have informed the development of another study, testing the effect of a tailored training package on MI skill, specifically for
Han, M C
The current status and directions for changes of issues related to quality care in health services in Asian countries--Malaysia, China, Singapore, Japan and Korea are overviewed. In countries with public sector dominated health care systems such as Malaysia. China and Singapore, governmental leadership in quality care is prominent along with legislative backup. Japan and Korea have private sector dominated health care systems and quality care activities are mainly carried out by non-governmental organisations. Hospital accreditation programs are in the developing stages in most countries, although China and Korea started in 1980. Most Asian countries are at the initial stages in quality care activities and focus has been placed on education and training. Asian countries are not exempted from efforts to enhance quality care activities and a new horizon in quality health care is emerging.
Sanchez, Alvaro; Grandes, Gonzalo; Cortada, Josep M; Pombo, Haizea; Martinez, Catalina; Corrales, Mary Helen; de la Peña, Enrique; Mugica, Justo; Gorostiza, Esther
routine primary care. Sources of heterogeneity and instability in these indicators may improve our understanding of factors required to attain adequate program adoption and implementation through improved implementation strategies.
Zuvela, Emily; Junk, Stephen; Moska, Natalie; Matson, Phillip
The usefulness of latex beads of defined concentration was assessed as a substitute for sperm in the performance of External Quality Assurance (EQA) and Internal Quality Control (IQC) of semen analysis. Within the EQA programme, mean±SEM bias (%) was significantly reduced in 2007 compared to 2002 for both specialist (6.0%±5.4% vs. 55.0%±5.9%) and non-specialist (18.4%±5.9% vs. 90.9%±13.4%) laboratories (both p<0.0001), indicating improved accuracy over time. Within the IQC programme, the beads were used in the appraisal of two scientists, one experienced and one inexperienced, against a known standard. Beads were also used to calibrate eleven counting chambers, resulting in one old chamber being discarded due to its poor performance. The present study has shown that the use of a defined concentration of beads is an excellent adjunct to IQC and EQA programmes enabling the performance of both people and equipment to be assessed in an objective manner.
Patrick Opiyo Owili
Full Text Available Improving access to delivery services does not guarantee access to quality obstetric care and better survival, and therefore, concerns for quality of maternal and newborn care in low- and middle-income countries have been raised. Our study explored characteristics associated with the quality of initial assessment, intrapartum, and immediate postpartum and newborn care, and further assessed the relationships along the continuum of care.The 2010 Service Provision Assessment data of Kenya for 627 routine deliveries of women aged 15-49 were used. Quality of care measures were assessed using recently validated quality of care measures during initial assessment, intrapartum, and postpartum periods. Data were analyzed with negative binomial regression and structural equation modeling technique.The negative binomial regression results identified a number of determinants of quality, such as the level of health facilities, managing authority, presence of delivery fee, central electricity supply and clinical guideline for maternal and neonatal care. Our structural equation modeling (SEM further demonstrated that facility characteristics were important determinants of quality for initial assessment and postpartum care, while characteristics at the provider level became more important in shaping the quality of intrapartum care. Furthermore we also noted that quality of initial assessment had a positive association with quality of intrapartum care (β = 0.71, p < 0.001, which in turn was positively associated with the quality of newborn and immediate postpartum care (β = 1.29, p = 0.004.A continued focus on quality of care along the continuum of maternity care is important not only to mothers but also their newborns. Policymakers should therefore ensure that required resources, as well as adequate supervision and emphasis on the quality of obstetric care, are available.
Schubert, Ingrid; Heymans, Lothar; Fessler, Joachim
The implementation of the general practitioners' (GPs) guideline for palliative care released in 2007 with consent of the developing group was accompanied by an anonymous and voluntary survey designed to assess acceptance and feasibility of the recommendations. 60 quality circles of the GP-based care program in Hesse which are run by the PMV research group were used for guideline implementation. The quality of the palliative care quality circle meeting itself was checked with a standardized questionnaire (feedback, n = 473 of 515 participating GPs). After several weeks, the follow-up questioning on acceptance of the corresponding guideline was performed (n = 391 of 440 attendees) using twelve items to evaluate the guideline recommendations. The closed questions were appraised employing a Likert scale and the open questions after classifying the free text in categories. 96% of the respondents considered palliative medicine to be important in daily routine. The majority agreed with form and content of this CME meeting (feedback, response rate 91%). The complexity, handling, and practical relevance of the guideline were evaluated positively (response rate 88%). 82% of GPs reported that they would recommend the guideline to colleagues. Specific, practical guideline recommendations on (non)pharmacological strategies in treating dyspnea, on reducing xerostomia and on comedication in the case of opioid treatment were confirmed by 80-94% of the participants, and 75-92% rated these recommendations as practical. The relevance of palliative care in daily routine was shown by the responses evaluating the quality circle session. The grade of acceptance of the guideline is comparable to the other GPs' guidelines with focus on pharmacotherapy. 10-13% of the respondents were not able to judge the relevance nor the practicability of selected recommendations. Future implementation should therefore consider attitude and experience with palliative care. To date, the questionnaires
Aktas, Demet; Terzioglu, Fusun
The purpose of the research was to determine the effect of home care service on the quality of life in patients with gynecological cancer. This randomized case control study was carried out in a womans hospital between September 2011 and February 2012. Women undergoing gynecological cancer treatment were separated into intervention and control groups, of 35 patients each. The intervention group was provided with nursing care service through hospital and home visits (1st, 12th weeks) within the framework of a specifically developed nursing care plan. The control group was monitored without any intervention through the hospital routine protocols (1st, 12th weeks). Data were collected using An Interview Form, Home Visit Monitoring Form and Quality of Life Scale/Cancer Survivors. Effects of home care service on the quality of life in gynecological cancer patients were investigated using chi-square tests, McNemar's test, independent t-test and ANOVA. This study found that the intervention group receiving home care service had a moderately high quality of life (average mean: 6.01±0.64), while the control group had comparatively lower quality (average mean: 4.35±0.79) within the 12 week post- discharge period (phome care services to be efficient in improving the quality of life in patients with gynecological cancer.
Full Text Available Objectives. To improve engagement with care and prevent psychiatric readmission, a transitional case management intervention has been established to link with primary and secondary care. The intervention begins during hospitalisation and ends one month after discharge. The goal of this study was to assess the effectiveness of this short intervention in terms of the level of engagement with outpatient care and the rate of readmissions during one year after discharge. Methods. Individuals hospitalised with common mental disorders were randomly assigned to be discharged to routine follow up by private psychiatrists or general practitioners with (n=51 or without (n=51 the addition of a transitional case management intervention. Main outcome measures were number of contacts with outpatient care and rate of readmission during twelve months after discharge.Results. Transitional case management patients reported more contacts with care service in the period between 1 to 3 month after discharge (p = .004. Later after discharge (3-12 month, no significant differences of number of contacts remained. The transitional case management intervention had no statistically significant beneficial impact on the rate of readmission (Hazard ratio = 0.585, p = .114.Conclusions. The focus on follow-up after discharge during hospitalisation leads to an increased short term rate of engagement with ambulatory care despite no differences between the two groups after 3 month of follow-up. This short transitional intervention did however not significantly reduce the rate of readmissions during the first year following discharge.Trial registration number. ClinicalTrials.gov Identifier NCT02258737.
Rapin, Joachim; D'Amour, Danielle; Dubois, Carl-Ardy
The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice...
On the occasion of Development Week in Canada, Dr. Remi Sogunro spoke in February, 1994, about the many achievements of quality primary health care and PLAN's strategy to achieve sustainability. In one generation, under-5 mortality has been cut by a third. Deaths from measles has been reduced from 2.5 million to 1 million a year. Skeletal deformities from polio also have been reduced from 1/2 million to less than 140,000. Despite all this, there is much more to be attained. 35,000 children under 5 die from preventable diseases every day in developing countries. The health community is working hard to address these silent emergencies. PLAN International's primary health care program targets the poor and undeserved populations where diseases are prevalent. The main focus of PLAN's programs are mothers and children who are most vulnerable to disease. Key interventions that PLAN gives priority to are childhood and maternal immunization programs, including pre- and post-natal care for mothers. Other interventions under PLAN's comprehensive primary health care program include: control of diarrheal diseases and acute respiratory infections, growth monitoring, nutrition and control of STDs and HIV/AIDS infection, water and sanitation, family planning information and educational services, and rehabilitation of the handicapped. "Go in search of people, begin with what they know, build on what they have," goes a Chinese proverb. This also summarizes PLAN's guiding principle for achieving sustainable development: the importance of investing in people. PLAN's programs in the field build partnerships and empower communities. PLAN's emphasis on institution-building and capacity-building with local institutions is an important part of organizational strategy to ensure sustained development. full text
Nagata, Koichi; Fujiwara, Masanori; Kanazawa, Hidenori; Mogi, Tomohiro; Iida, Nao; Mitsushima, Toru; Lefor, Alan T; Sugimoto, Hideharu
To prospectively evaluate the radiation dose and image quality comparing low-dose CT colonography (CTC) reconstructed using different levels of iterative reconstruction techniques with routine-dose CTC reconstructed with filtered back projection. Following institutional ethics clearance and informed consent procedures, 210 patients underwent screening CTC using automatic tube current modulation for dual positions. Examinations were performed in the supine position with a routine-dose protocol and in the prone position, randomly applying four different low-dose protocols. Supine images were reconstructed with filtered back projection and prone images with iterative reconstruction. Two blinded observers assessed the image quality of endoluminal images. Image noise was quantitatively assessed by region-of-interest measurements. The mean effective dose in the supine series was 1.88 mSv using routine-dose CTC, compared to 0.92, 0.69, 0.57, and 0.46 mSv at four different low doses in the prone series (p iterative reconstruction were significantly improved compared to routine-dose CTC using filtered back projection. The lowest dose group had image quality comparable to routine-dose images. Low-dose CTC with iterative reconstruction reduces the radiation dose by 48.5 to 75.1% without image quality degradation compared to routine-dose CTC with filtered back projection. • Low-dose CTC reduces radiation dose ≥ 48.5% compared to routine-dose CTC. • Iterative reconstruction improves overall CTC image quality compared with FBP. • Iterative reconstruction reduces overall CTC image noise compared with FBP. • Automated exposure control with iterative reconstruction is useful for low-dose CTC.
Rasmussen, Martin B; Stengaard, Carsten; Sørensen, Jacob T
OBJECTIVE: The purpose of this study was to determine the predictive value of routine prehospital point-of-care cardiac troponin T measurement for diagnosis and risk stratification of patients with suspected acute myocardial infarction. METHODS AND RESULTS: All prehospital emergency medical servi...... irrespective of the final diagnosis. Routine troponin measurement in the prehospital setting has a high predictive value and can be used to identify high-risk patients even before hospital arrival so that they may be re-routed directly for advanced care at an invasive centre.......OBJECTIVE: The purpose of this study was to determine the predictive value of routine prehospital point-of-care cardiac troponin T measurement for diagnosis and risk stratification of patients with suspected acute myocardial infarction. METHODS AND RESULTS: All prehospital emergency medical service...... vehicles in the Central Denmark Region were equipped with a point-of-care cardiac troponin T device (Roche Cobas h232) for routine use in all patients with a suspected acute myocardial infarction. During the study period, 1 June 2012-30 November 2015, prehospital point-of-care cardiac troponin T...
Abstract The German National Hospice and Palliative Care Register was implemented in 2011 by the German Association for Palliative Medicine to provide a nationwide description of the quality of hospice and palliative care. Every year, the register joints data of daily palliative care for a period of at least 3 months per year or up to 30 palliative care patients per palliative care service (palliative care units, hospices, palliative care teams and palliative counselling services). The reg...
Erharter, Astrid; Giesinger, Johannes; Kemmler, Georg; Schauer-Maurer, Gabriele; Stockhammer, Guenter; Muigg, Armin; Hutterer, Markus; Rumpold, Gerhard; Sperner-Unterweger, Barbara; Holzner, Bernhard
Computerized assessment of quality of life (QOL) in patients with brain tumors can be an essential part of quality assurance with regard to evidence-based medicine in neuro-oncology. The aim of this project was the implementation of a computer-based QOL monitoring tool in a neurooncology outpatient unit. A further aim was to derive reference values for QOL scores from the collected data to improve interpretability. Since August 2005, patients with brain tumors treated at the neuro-oncology outpatient unit of the Innsbruck Medical University were consecutively included in the study. QOL assessment (European Organisation for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire [QLQ-C30] plus the EORTC QLQ-brain cancer module [BN20]) was computer-based, using a software tool called the Computer-based Health Evaluation System. A total of 110 patients with primary brain tumors (49% female; mean [standard deviation] age 47.9 [12.6] years; main diagnoses: 30.9% astrocytoma, 17.3% oligodendroglioma, 17.3% glioblastoma, 13.6% meningioma) was included in the study. On average, QOL was assessed 4.74 times per patient, 521 times in total. The user-friendly software was successfully implemented and tested. The routine QOL assessment was found to be feasible and was well accepted by both physicians and patients. The software-generated graphic QOL profiles were found to be an important tool for screening patients for clinically relevant problems. Thus, computer-based QOL monitoring can contribute to an optimization of treatment (e.g., symptom management, psychosocial interventions) and facilitate data collection for research purposes. Copyright 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Jacobi, Catharina E.; Boshuizen, Hendriek C.; Rupp, Ines; Dinant, Huibert J.; van den Bos, Geertrudis A. M.
Objective. To identify health care aspects of inadequate quality in rheumatoid arthritis (RA) care from the perspective of patients, and to study to what extent patients' perspectives on quality of care are associated with patient characteristics. Design. Cross-sectional questionnaire survey
Zeraati, Mashaalah; Alavi, Negin Masoudi
Quality of nursing care measurement is essential in critical care units. The aim of this study was to develop a scale to measure the quality of nursing care in intensive care units (ICUs). The 68 items of nursing care standards in critical care settings were explored in a literature review. Then, 30 experts evaluated the items' content validity index (CVI) and content validity ratio (CVR). Items with a low CVI score (nursing care scale in ICU (Quality of Nursing Care Scale- ICU) that was developed in this research had acceptable CVI and CVR.
Bengtson, Angela M; Pence, Brian W; Mollan, Katie R; Edwards, Jessie K; Moore, Richard D; OʼCleirigh, Conall; Eaton, Ellen F; Eron, Joseph J; Kitahata, Mari M; Mathews, William C; Crane, Heidi; Mugavero, Michael J
Evidence about the effect of initiating efavirenz-containing combination antiretroviral therapy (ART) as the first-line therapy on suicidal thoughts remains conflicting. Using data from a cohort of HIV-infected adults enrolled in routine care across 5 sites in the United States, we included participants with a baseline patient-reported outcome measure and detectable viral load who initiated ART between 2011 and 2014. Participants were followed until the earliest of the following: first suicidal thoughts, discontinuation of initial ART regimen, death, loss to care (>12 months with no HIV appointments), or administrative censoring (2014-2015). Suicidal thoughts were measured using a Patient Health Questionnaire-9 item. We used weighted marginal structural Cox models to estimate the effect of initiating efavirenz-containing ART, versus efavirenz-free ART, on the hazard of active or passive suicidal thoughts after ART initiation, accounting for confounding by channeling bias. Overall, 597 participants were followed for a median of 19 months (13,132 total person-months); 147 (25%) initiated efavirenz-containing ART. At ART initiation, 38% of participants reported suicidal thoughts or depressive symptoms. Initiating efavirenz-based ART was associated with a hazard ratio (HR) for suicidal thoughts below the null in the crude analysis [HR, 0.88; 95% confidence interval (CI): 0.53 to 1.45] and above the null in the weighted analysis (HR, 1.21; 95% CI: 0.66 to 2.28). Among those with a prior mental health issue, the weighted HR was 1.76 (95% CI: 0.45 to 6.86). After accounting for measured channeling bias, we observed no strong evidence that initiating efavirenz-containing ART increased the hazard of suicidal thoughts.
Full Text Available OBJECTIVES: Oral diseases are associated with adverse pregnancy outcomes. The routine utilization of dental care (RUDC during pregnancy is an effective way to improve pregnant women's oral health, and thus safeguard the health of their babies. As China has one fifth of the world's population, it is especially meaningful to encourage RUDC there. However, the status of RUDC in China and the key underlying factors are largely unknown. METHODS: This cross-sectional survey investigated the current status of RUDC during pregnancy and the key underlying factors in Hangzhou City, Zhejiang Province, eastern China. We collected participants' demographics, individual oral-hygiene behaviors, individual lifestyle, oral-health conditions and attitudes, and also their RUDC during pregnancy. Binary Logistic Regression Analysis was used to analyze the key underlying factors. RESULTS: Only 16.70% of the participants reported RUDC during pregnancy. The percentage of RUDC was significantly lower among pregnant women with the following characteristics: aged 30 or less, an annual household income under $8,000, brushing once a day or less, never flossing or rinsing the mouth, paying no attention to pregnancy-related oral-health knowledge, and being dissatisfied with one's individual dental hygiene behavior. CONCLUSIONS: RUDC during pregnancy is very low in eastern China and is greatly influenced not only by a woman's age, annual income, individual hygiene behavior, but also by her attention and attitudes to oral health. To improve this population's access to and use of dental care during pregnancy, appropriate programs and policies are urgently needed.
Full Text Available Abstract Background Written prescriptions of physical activity have increased in popularity. Such schemes have mostly been evaluated in terms of efficacy in clinical trials. This study reports on a physical activity prescription referral scheme implemented in routine primary health care (PHC in Sweden. The aim of this study was to evaluate patients' self-reported adherence to physical activity prescriptions at 3 and 12 months and to analyse different characteristics associated with adherence to these prescriptions. Methods Prospective prescription data were obtained for the general population in 37 of 42 PHC centres in Östergötland County, during 2004. The study population consisted of 3300. Results The average adherence rate to the prescribed activity was 56% at 3 months and 50% at 12 months. In the multiple logistic regression models, higher adherence was associated with higher activity level at baseline and with prescriptions including home-based activities. Conclusions Prescription from ordinary PHC staff yielded adherence in half of the patients in this PAR scheme follow-up.
Leijon, Matti E; Bendtsen, Preben; Ståhle, Agneta; Ekberg, Kerstin; Festin, Karin; Nilsen, Per
Written prescriptions of physical activity have increased in popularity. Such schemes have mostly been evaluated in terms of efficacy in clinical trials. This study reports on a physical activity prescription referral scheme implemented in routine primary health care (PHC) in Sweden. The aim of this study was to evaluate patients' self-reported adherence to physical activity prescriptions at 3 and 12 months and to analyse different characteristics associated with adherence to these prescriptions. Prospective prescription data were obtained for the general population in 37 of 42 PHC centres in Ostergötland County, during 2004. The study population consisted of 3300. The average adherence rate to the prescribed activity was 56% at 3 months and 50% at 12 months. In the multiple logistic regression models, higher adherence was associated with higher activity level at baseline and with prescriptions including home-based activities. Prescription from ordinary PHC staff yielded adherence in half of the patients in this PAR scheme follow-up.
Scott, Vera; Azevedo, Virginia; Caldwell, Judy
To use a quality improvement approach to improve access to and quality of tuberculosis (TB) diagnosis and care in Cape Town. Five HIV/AIDS/sexually transmitted infections/TB (HAST) evaluations were conducted from 2008 to 2010, with interviews with 99 facility managers and a folder review of over 850 client records per evaluation cycle. The data were used in a local quality improvement process: sub-district workshops identified key weaknesses and facility managers drew up action plans. Lessons learnt and successful strategies were shared at quarterly district-wide HIV/TB meetings. Geographical access was good, but there were delays in treatment commencement times. Access for high-risk clients improved significantly with intensified TB case finding made routine in both the HIV counselling and testing and antiretroviral treatment (ART) services (p42% investigated and treated). Quality of care was mostly high at baseline (adherence to treatment protocols 95%). Measurement of body mass index improved from 20% to 62%. The assessment of contraception improved from 27% to 58%. Care for co-infected clients showed improved use of customised HIV stationery and increased assessment for ART eligibility. The HAST audit contributed to the improved TB cure rates by supplementing routine information and involving sub-district managers, facility managers and facility staff in a quality improvement process that identified local opportunities for programme strengthening.
Collins, Vikki K.
High-quality child care has been shown to improve the academic success and life adjustments of children living in poverty. During the past decade, many American states have adopted voluntary Quality Rating and Improvement (QRI) systems in an attempt to increase the level of quality in child care. Using data compiled by the National Association of…
Background: Drug therapy can improve a patient's quality of life and health outcomes if only used properly. However, data on prescription quality at primary health care facilities in Tanzania is scanty. The objective of this study was to assess the quality of drug prescriptions in selected health care facilities in two districts of ...
Mangione, Peter L.; Kriener-Althen, Kerry; Marcella, Jennifer
Research Findings: The quality of group care infants and toddlers experience relates to their concurrent and later development. Recent quality improvement initiatives point to the need for ecologically valid measures that assess the multifaceted nature of child care quality. In this article, we present the psychometric properties of an infant and…
Banta, H.D.; Beekum, W.T. van
Medical devices are now a pervasive part of modern medical care. They are in many cases associated with quality of care. In some cases, the use of devices has certainly improved quality. In other cases, devices can be associated with many problems. The approach to quality of devices has depended
Tolsgaard, Martin G; Tabor, Ann; Madsen, Mette E
-performed CLM was the most cost-effective strategy, whereas midwife-performed CLM was cost-effective for WTP values above EUR 0.73 minute(-1) . CONCLUSION: Cost-effectiveness models can be used to link quality of care to training costs. The example used in the present study demonstrated that different training......OBJECTIVE: To provide a model for conducting cost-effectiveness analyses in medical education. The model was based on a randomised trial examining the effects of training midwives to perform cervical length measurement (CLM) as compared with obstetricians on patients' waiting times. (CLM......), as compared with obstetricians. METHODS: The model included four steps: (i) gathering data on training outcomes, (ii) assessing total costs and effects, (iii) calculating the incremental cost-effectiveness ratio (ICER) and (iv) estimating cost-effectiveness probability for different willingness to pay (WTP...
Hansen, Peter Meredith; Peters, David H; Edward, Anbrasi; Gupta, Shivam; Arur, Aneesa; Niayesh, Haseebullah; Burnham, Gilbert
To identify factors associated with service quality provided by agencies implementing a basic package of health services in Afghanistan. Cross-sectional survey of outpatient health facilities, health workers, patients and caretakers. Primary health care facilities in every province of Afghanistan. Composite scale measuring the quality of clinical processes in four areas: patient histories, physical examinations, communication and time spent with patient. No difference in service quality was observed between male and female providers or between male and female patients, but when both the provider and patient were female quality was much higher. Overall, the quality of care at non-governmental organization and government-managed health facilities did not differ, but the poor received higher quality care at non-governmental facilities than at government facilities. Doctors provided higher quality care than lower level providers. Provision of six or more supervisory visits in the last 6 months was associated with higher service quality. Training doctors in integrated management of childhood illness was not associated with quality, but when lower level health workers received such training the quality of patient-provider communication was higher. Other recurrent inputs and geographic remoteness are not associated with the quality of care provided. The government's strategy to form partnerships with non-governmental organizations has led to higher quality of care provided to the poor. This represents a promising start in the reconstruction of Afghanistan's health system and provides useful evidence to other countries striving to increase access to quality care for the poor.
Adams, William G; Mann, Adriana M; Bauchner, Howard
To evaluate the quality of pediatric primary care, including preventive services, before and after the introduction of an electronic medical record (EMR) developed for use in an urban pediatric primary care center. A pre-postintervention analysis was used in the study. The intervention was a pediatric EMR. Routine health care maintenance visits for children lead risk assessment (RR: 106.54), exposure to domestic or community violence (RR: 35.19), guns in the home (RR: 58.11), behavioral or social developmental milestones (RR: 2.49), infant sleep position (RR: 9.29), breastfeeding (RR: 1.99), poison control (RR: 3.82), and child safety (RR: 1.29). Trends toward improved lead exposure, vision, and hearing screening were seen; however, differences were not significant. Users of the system reported that its use had improved the overall quality of care delivered, was well-accepted by families, and improved guidance quality; however, 5 of 7 users reported that eye-to-eye contact with patients was reduced, and 4 of 7 reported that use of the system increased the duration of visits (mean: 9.3 minutes longer). All users recommended continued use of the system. Use of the EMR in this study was associated with improved quality of care. This experience suggests that EMRs can be successfully used in busy urban pediatric primary care centers and, as recommended by the Institute of Medicine, must play a central role in the redesign of the US health care system.
M. de Mul (Marleen)
textabstractIt is no longer possible to ignore the issue of quality in health care. Care institutions strive to provide all patients with effective, efficient, safe, timely, patient-centered care. Increased attention for quality is also found in discussions regarding use of information
Newman, Kristine; Doran, Diane; Nagle, Lynn M
The purpose of the study was to examine the relationship between (1) critical care nurses' information-seeking behaviour and the non-routineness of tasks; and (2) the extent to which nurses' perception of their problem-solving abilities when completing patient care tasks, moderate the relationship between information-seeking behaviour and non-routineness of tasks. A cross-sectional survey design was used. A random sample (n = 177) of critical care nurses working in hospital settings was selected from the College of Nurses of Ontario (CNO) database. Descriptive statistics and multiple regression were used to analyze the data. Previous information-seeking training (p = 0.008), non-routineness of the task (p = 0.018), and the perception of the problem-solving ability domain of personal control (p = 0.040) had positive relationships with information-seeking behaviour. The development of problem-solving skills such as personal control, in addition to information-seeking training is essential so critical care nurses will have the skills to aid their information needs when faced with the completion of non-routine tasks.
Dukers-Muijrers, Nicole H. T. M.; Wolffs, Petra F. G.; Eppings, Lisanne; Götz, Hannelore M.; Bruisten, Sylvia M.; Schim van der Loeff, Maarten F.; Janssen, Kevin; Lucchesi, Mayk; Heijman, Titia; van Benthem, Birgit H.; van Bergen, Jan E.; Morre, Servaas A.; Herbergs, Jos; Kok, Gerjo; Steenbakkers, Mieke; Hogewoning, Arjan A.; de Vries, Henry J.; Hoebe, Christian J. P. A.
In women, anorectal infections with Chlamydia trachomatis (CT) are about as common as genital CT, yet the anorectal site remains largely untested in routine care. Anorectal CT frequently co-occurs with genital CT and may thus often be treated co-incidentally. Nevertheless, post-treatment detection
de Vries, A.; van Bokhoven, M.A.; Winkens, B.; Terluin, B.; Knottnerus, J.A.; van der Weijden, T.; van Eijk, J.T.M.
Objective: To evaluate the effectiveness of biopsychosocial Self-Management Support (SMS) delivered by practice nurses in routine diabetes care. Design: A pragmatic cluster-randomised controlled trial within a hybrid effectiveness-implementation study design. Practice nurses were cluster-randomised.
van den Hoofdakker, Barbara J.; Nauta, Maaike H.; van der Veen-Mulders, Lianne; Sytema, Sjoerd; Emmelkamp, Paul M. G.; Minderaa, Ruud B.; Hoekstra, Pieter J.
Objective To investigate predictors and moderators of outcome of behavioral parent training (BPT) as adjunct to ongoing routine clinical care (RCC), versus RCC alone. Methods We randomly assigned 94 referred children (4-12 years) with attention-deficit/hyperactivity disorder (ADHD) to BPT plus RCC
Koyio, L.N.; Kikwilu, E.N.; Mulder, J.; Frencken, J.E.F.M.
Objectives: To assess attitudes, subjective norms, and intentions of primary health-care (PHC) providers in performing routine oral examination for oropharyngeal candidiasis (OPC) during outpatient consultations. Methods: A 47-item Theory of Planned Behaviour-based questionnaire was developed and
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.
Full Text Available Introduction: Elderly people aged over 75 years with multifaceted care needs are often in need of hospital treatment. Transfer across care levels for this patient group increases the risk of adverse events. The aim of this paper is to establish knowledge of quality in transitional care of the elderly in two Norwegian hospital regions by identifying issues affecting the quality of transitional care and based on these issues suggest improvement measures.Methodology: Included in the study were elderly patients (75+ receiving health care in the municipality admitted to hospital emergency department or discharged to community health care with hip fracture or with a general medical diagnosis. Participant observations of admission and discharge transitions (n = 41 were carried out by two researchers.Results: Six main challenges with belonging descriptions have been identified: (1 next of kin (bridging providers, advocacy, support, information brokering, (2 patient characteristics (level of satisfaction, level of insecurity, complex clinical conditions, (3 health care personnel's competence (professional, system, awareness of others’ roles, (4 information exchange (oral, written, electronic, (5 context (stability, variability, change incentives, number of patient handovers and (6 patient assessment (complex clinical picture, patient description, clinical assessment.Conclusion: Related to the six main challenges, several measures have been suggested to improve quality in transitional care, e.g. information to and involvement of patients and next of kin, staff training, standardisation of routines and inter-organisational staff meetings.
Full Text Available Introduction: Elderly people aged over 75 years with multifaceted care needs are often in need of hospital treatment. Transfer across care levels for this patient group increases the risk of adverse events. The aim of this paper is to establish knowledge of quality in transitional care of the elderly in two Norwegian hospital regions by identifying issues affecting the quality of transitional care and based on these issues suggest improvement measures. Methodology: Included in the study were elderly patients (75+ receiving health care in the municipality admitted to hospital emergency department or discharged to community health care with hip fracture or with a general medical diagnosis. Participant observations of admission and discharge transitions (n = 41 were carried out by two researchers. Results: Six main challenges with belonging descriptions have been identified: (1 next of kin (bridging providers, advocacy, support, information brokering, (2 patient characteristics (level of satisfaction, level of insecurity, complex clinical conditions, (3 health care personnel's competence (professional, system, awareness of others’ roles, (4 information exchange (oral, written, electronic, (5 context (stability, variability, change incentives, number of patient handovers and (6 patient assessment (complex clinical picture, patient description, clinical assessment. Conclusion: Related to the six main challenges, several measures have been suggested to improve quality in transitional care, e.g. information to and involvement of patients and next of kin, staff training, standardisation of routines and inter-organisational staff meetings.
Award Number: W81XWH-11-1-0540 TITLE: Racial Disparities in the Quality of Prostate Cancer Care PRINCIPAL INVESTIGATOR: Nina Bickell CONTRACTING...11-1-0540 Racial Disparities in the Quality of Prostate Cancer Care 5b. GRANT NUMBER PC101939 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...the quality of prostate cancer care delivered may be contributing to the racial disparity in mortality. While it is clear that physician
Background Despite evidence that up to 35% of patients with cancer experience significant distress, access to effective psychosocial care is limited by lack of systematic approaches to assessment, a paucity of psychosocial services, and patient reluctance to accept treatment either because of perceived stigma or difficulties with access to specialist psycho-oncology services due to isolation or disease burden. This paper presents an overview of a randomised study to evaluate the effectiveness of a brief tailored psychosocial Intervention delivered by health professionals in cancer care who undergo focused training and participate in clinical supervision. Methods/design Health professionals from the disciplines of nursing, occupational therapy, speech pathology, dietetics, physiotherapy or radiation therapy will participate in training to deliver the psychosocial Intervention focusing on core concepts of supportive-expressive, cognitive and dignity-conserving care. Health professional training will consist of completion of a self-directed manual and participation in a skills development session. Participating health professionals will be supported through structured clinical supervision whilst delivering the Intervention. In the stepped wedge design each of the 5 participating clinical sites will be allocated in random order from Control condition to Training then delivery of the Intervention. A total of 600 patients will be recruited across all sites. Based on level of distress or risk factors eligible patients will receive up to 4 sessions, each of up to 30 minutes in length, delivered face-to-face or by telephone. Participants will be assessed at baseline and 10-week follow-up. Patient outcome measures include anxiety and depression, quality of life, unmet psychological and supportive care needs. Health professional measures include psychological morbidity, stress and burnout. Process evaluation will be conducted to assess perceptions of participation in the
Full Text Available Abstract Background Despite evidence that up to 35% of patients with cancer experience significant distress, access to effective psychosocial care is limited by lack of systematic approaches to assessment, a paucity of psychosocial services, and patient reluctance to accept treatment either because of perceived stigma or difficulties with access to specialist psycho-oncology services due to isolation or disease burden. This paper presents an overview of a randomised study to evaluate the effectiveness of a brief tailored psychosocial Intervention delivered by health professionals in cancer care who undergo focused training and participate in clinical supervision. Methods/design Health professionals from the disciplines of nursing, occupational therapy, speech pathology, dietetics, physiotherapy or radiation therapy will participate in training to deliver the psychosocial Intervention focusing on core concepts of supportive-expressive, cognitive and dignity-conserving care. Health professional training will consist of completion of a self-directed manual and participation in a skills development session. Participating health professionals will be supported through structured clinical supervision whilst delivering the Intervention. In the stepped wedge design each of the 5 participating clinical sites will be allocated in random order from Control condition to Training then delivery of the Intervention. A total of 600 patients will be recruited across all sites. Based on level of distress or risk factors eligible patients will receive up to 4 sessions, each of up to 30 minutes in length, delivered face-to-face or by telephone. Participants will be assessed at baseline and 10-week follow-up. Patient outcome measures include anxiety and depression, quality of life, unmet psychological and supportive care needs. Health professional measures include psychological morbidity, stress and burnout. Process evaluation will be conducted to assess perceptions
De Lusignan, Simon; Liyanage, Harshana; Di Iorio, Concetta Tania; Chan, Tom; Liaw, Siaw-Teng
The use of health data for public health, surveillance, quality improvement and research is crucial to improve health systems and health care. However, bodies responsible for privacy and ethics often limit access to routinely collected health data. Ethical approvals, issues around protecting privacy and data access are often dealt with by different layers of regulations, making approval processes appear disjointed. To create a comprehensive framework for defining the ethical and privacy status of a project and for providing guidance on data access. The framework comprises principles and related questions. The core of the framework will be built using standard terminology definitions such as ethics-related controlled vocabularies and regional directives. It is built in this way to reduce ambiguity between different definitions. The framework is extensible: principles can be retired or added to, as can their related questions. Responses to these questions should allow data processors to define ethical issues, privacy risk and other unintended consequences. The framework contains three steps: (1) identifying possible ethical and privacy principles relevant to the project; (2) providing ethics and privacy guidance questions that inform the type of approval needed; and (3) assessing case-specific ethics and privacy issues. The outputs from this process should inform whether the balance between public interests and privacy breach and any ethical considerations are tipped in favour of societal benefits. If they are then this should be the basis on which data access is permitted. Tightly linking ethical principles to governance and data access may help maintain public trust.
Goh Teik T
Full Text Available Abstract Background Attributes of teams could affect the quality of care delivered in primary care. The aim of this study was to systematically review studies conducted within the UK NHS primary care that have measured team climate using the Team Climate Inventory (TCI, and to describe, if reported, the relationship between the TCI and measures of quality of care. Findings The databases MEDLINE, EMBASE, and CINAHL were searched. The reference lists of included article were checked and one relevant journal was hand-searched. Eight papers were included. Three studies used a random sample; the remaining five used convenience or purposive samples. Six studies were cross sectional surveys, whilst two were before and after studies. Four studies examined the relationship between team climate and quality of care. Only one study found a positive association between team climate and higher quality care in patients with diabetes, positive patient satisfaction and self-reported effectiveness. Conclusion While the TCI has been used to measure team attributes in primary care settings in the UK it is difficult to generalise from these data. A small number of studies reported higher TCI scores being associated with only certain aspects of quality of care; reasons for the pattern of association are unclear. There are a number of methodological challenges to conducting such studies in routine service settings. Further research is needed in order to understand how to measure team functioning in relation to quality of care.
Gilbert, Julia; Ward, Louise; Gwinner, Karleen
Background The concept of quality nursing care in a dementia specific unit is perceived as being subject to the interpretation of individuals, nurses and healthcare organisations. As the number of dementia diagnoses increases, understanding what constitutes quality nursing care within dementia specific care units is vital to inform policy makers and healthcare organisations globally. Efforts to identify quality nursing care and improve dementia care within dementia specific care units, may significantly reduce the financial and emotional burden of care-giving and improve the quality of life for individuals living with dementia. This scoping review aimed to examine current literature to gain an understanding of what constitutes quality nursing care in a dementia specific care unit. Design and methods Five electronic databases (CINAHL, MEDLINE, ProQuest, Social Sciences Citation Index and Ovid) were used to search for articles published in English between 2011 and 2016 focusing on a definition of quality nursing care within dementia specific care units. Twenty journal articles were identified. From these articles, two content themes were identified: Challenges in the provision of quality nursing care in dementia specific care units, and Standardised approach to quality nursing care in a dementia specific care unit. The articles contained the following research designs, controlled pre-test and post-test design ( n = 1), focus group interviews ( n = 1), cross sectional survey ( n = 6), semi structured interviews ( n = 3), narrative review ( n = 1), survey ( n = 2), literature review ( n = 3), systematic review ( n = 1), and prospective longitudinal cohort study ( n = 2). Conclusions The concept of quality nursing care in a dementia specific unit remains subject to the interpretation of individuals, nurses and healthcare organisations, with current literature unable to provide a clear definition. Further research into what constitutes
All too often, the focus of the very clever strategy papers produced in the upper reaches of the health department is on the next grand plan. Some of these reforms have been catastrophic for the quality of service that patients experience at ward level. Of these, the contracting out culture introduced in the 1980s and the 1990s has been the worst. Researching my book, Hard work-life in low pay Britain, I took six jobs at around the minimum wage, including work as a hospital porter, as a hospital cleaner, and as a care assistant. These are jobs at the sharp end, up close and very personal to the patients, strongly influencing their experiences of the services they were using. Yet they are low paid, undervalued jobs that fall below the radar of the policy makers. In hospitals they need to be brought back in-house and integrated into a team ethos. Paying these people more would cost more, but it would also harvest great rewards by using their untapped commitment.
Bazzoli, Gloria J; Chen, Hsueh-Fen; Zhao, Mei; Lindrooth, Richard C
Concerns about deficiencies in the quality of care delivered in US hospitals grew during a time period when an increasing number of hospitals were experiencing financial problems. Our study examines a six-year longitudinal database of general acute care hospitals in 11 states to assess the relationship between hospital financial condition and quality of care. We evaluate two measures of financial performance: operating margin and a broader profitability measure that encompasses both operating and non-operating sources of income. Our model specification allows for gradual adjustments in quality-enhancing activities and recognizes that current realizations of patient quality may affect future financial performance. Empirical results suggest that there is a relationship between financial performance and quality of care, but not as strong as suggested in earlier research. Overall, our results suggest that deep financial problems that go beyond the patient care side of business may be important to prompting quality problems. Copyright (c) 2007 John Wiley & Sons, Ltd.
antibiotic was prescribed in almost half (65/141) of the consultations, but antibiotic use was unwarranted in one-third of these cases. Health ... with clearly defined and monitored standard clinical practice routines and norms, is required to change the status quo. Primary .... Although both dosage and frequency of antibiotic ...
Diamond-Smith, Nadia; Sudhinaraset, May; Montagu, Dominic
The majority of women in sub-Saharan Africa now deliver in a facility, however, little is known about the quality of services for maternal and newborn basic and emergency care, nor how this is associated with patient's perception of their experiences. Using data from the Service Provision Assessment (SPA) survey from Kenya 2010 and Namibia 2009, we explore whether facilities have the necessary signal functions for providing emergency and basic maternal (EmOC) and newborn care (EmNC), and antenatal care (ANC) using descriptives and multivariate regression. We explore differences by type of facility (hospital, center or other) and by private and public facilities. Finally, we see if patient satisfaction (taken from exit surveys at antenatal care) is associated with the quality of services (specific services provided). We find that most facilities do not have all of the signal functions, with 46 and 27 % in Kenya and 18 and 5 % in Namibia of facilities have high/basic scores in routine and emergency obstetric care, respectively. We found that hospitals preform better than centers in general and few differences emerged between public and private facilities. Patient perceptions were not consistently associated with services provided; however, patients had fewer complaints in private compared to public facilities in Kenya (-0.46 fewer complaints in private) and smaller facilities compared to larger in Namibia (-0.26 fewer complaints in smaller facilities). Service quality itself (measured in scores), however, was only significantly better in Kenya for EmOC and EmNC. This analysis sheds light on the inadequate levels of care for saving maternal and newborn lives in most facilities in two countries of Africa. It also highlights the disconnect between patients' perceptions and clinical quality of services. More effort is needed to ensure that high quality supply of services is present to meet growing demand as an increasing number of women deliver in facilities.
Liza Van Eenoo
Full Text Available Introduction: Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care. Aim: This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of six European countries. Methods: Data on elements at the macro-level (policy, meso-level (care organisations and micro-level (clients are of importance in determining job satisfaction and quality of care. Macro-level indicators will be identified in a previously published literature review. At meso- and micro-level, data will be collected by means of two questionnaires utilsed with both care organisations and care professionals, and by means of interRAI Home Care assessments of clients. The client assessments will be used to calculate quality of care indicators. Subsequently, data will be analysed by means of linear and stepwise multiple regression analyses, correlations and multilevel techniques. Conclusions and Discussion: These results can guide health care policy makers in their decision making process in order to increase the quality of home care in their organisation, in their country or in Europe.
Van Eenoo, Liza; van der Roest, Henriëtte; van Hout, Hein; Declercq, Anja
Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care. This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of six European countries. Data on elements at the macro-level (policy), meso-level (care organisations) and micro-level (clients) are of importance in determining job satisfaction and quality of care. Macro-level indicators will be identified in a previously published literature review. At meso- and micro-level, data will be collected by means of two questionnaires utilsed with both care organisations and care professionals, and by means of interRAI Home Care assessments of clients. The client assessments will be used to calculate quality of care indicators. Subsequently, data will be analysed by means of linear and stepwise multiple regression analyses, correlations and multilevel techniques. These results can guide health care policy makers in their decision making process in order to increase the quality of home care in their organisation, in their country or in Europe.
The US Geological Survey maintains a quality assurance program based on the analysis of reference samples for its National Water Quality Laboratory located in Denver, Colorado. Reference samples containing selected inorganic, nutrient, and precipitation (low-level concentration) constituents are prepared at the Survey 's Water Quality Services Unit in Ocala, Florida, disguised as routine samples, and sent daily or weekly, as appropriate, to the laboratory through other Survey offices. The results are stored permanently in the National Water Data Storage and Retrieval System (WATSTORE), the Survey 's database for all water data. These data are analyzed statistically for precision and bias. An overall evaluation of the inorganic major ion and trace metal constituent data for water year 1988 indicated a lack of precision in the National Water Quality Laboratory for the determination of 8 out of 58 constituents: calcium (inductively coupled plasma emission spectrometry), fluoride, iron (atomic absorption spectrometry), iron (total recoverable), magnesium (atomic absorption spectrometry), manganese (total recoverable), potassium, and sodium (inductively coupled plasma emission spectrometry). The results for 31 constituents had positive or negative bias during water year 1988. A lack of precision was indicated in the determination of three of the six nutrient constituents: nitrate plus nitrite nitrogen as nitrogen, nitrite nitrogen as nitrogen, and orthophosphate as phosphorus. A biased condition was indicated in the determination of ammonia nitrogen as nitrogen, ammonia plus organic nitrogen as nitrogen, and nitrate plus nitrite nitrogen as nitrogen. There was acceptable precision in the determination of all 10 constituents contained in precipitation samples. Results for ammonia nitrogen as nitrogen, sodium, and fluoride indicated a biased condition. (Author 's abstract)
Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Thermidor, Roody; Joseph, Jean Paul; Kruk, Margaret E
To develop a composite measure of primary care quality and apply it to Haiti's primary care system. Using the Primary Health Care Performance Initiative's framework, we defined four domains of primary care service delivery: (i) accessible care; (ii) effective service delivery; (iii) management and organization; and (iv) primary care functions. We gave each primary care facility in Haiti a quality score for each domain and overall, with poor, fair and good quality indicated by scores of 0.00-0.49, 0.50-0.74 and 0.75-1.00, respectively. We quantified access and effective access to primary care as the proportions of the population within 5 km of any primary care facility and a good facility, respectively. Of the 786 primary care facilities in Haiti in 2013, only 332 (43%) facilities were classified as good for accessible care. Fewer facilities were classified as good in the domains of effective service delivery (30; 4%), management and organization (91; 12%) and primary care functions (43; 5%). Although about 91% of the population lived within 5 km of a primary care facility, only an estimated 23% of the entire population - including just 5% of the rural population - had access to primary care of good quality. Despite an extensive network of health facilities, a minority of Haitians had access to a primary care facility of good quality. Such facilities were especially scarce in rural areas. Similar systematic analyses of the quality of primary care could inform national efforts to strengthen health systems.
Chen, Alex Y; Schrager, Sheree M; Mangione-Smith, Rita
A well-recognized gap exists in assessing and improving the quality of care for medically complex patients. Our objective was to examine evidence for primary care based on the patient-centered medical home model and to identify valid and meaningful quality measures for use in complex pediatric patients. We conducted literature searches on Medline and the National Quality Measures Clearinghouse for existing measures, as well as evidence to inform the development of new quality measures. We used a 3-step process to select relevant sources from published literature: (1) the titles were screened by 2 independent reviewers; (2) the abstracts were reviewed for quality-of-care contents or constructs; and (3) full-text articles were obtained and reviewed for measure specification. All materials were reviewed for the Oxford Centre For Evidence-Based Medicine level of evidence and for relevance to primary care of complex pediatric patients. A national expert panel was convened to evaluate and rate the measures by using the Rand/University of California Los Angeles Appropriateness Method. We presented 74 quality measures to the expert panel for review and discussion. The panel rated and accepted 35 measures as valid and feasible for assessing primary care quality in complex pediatric patients. The final set of quality measures was grouped in the following domains: primary care-general (14), patient/family-centered care (8), chronic care (2), coordination of care (9), and transition of care (2). By using the patient-centered medical home framework of accessible, continuous, family-centered, coordinated, and culturally effective care, a national expert panel selected 35 primary care quality measures for complex pediatric patients.
Singer Peter A
Full Text Available Abstract Background Quality end-of-life care has emerged as an important concept in industrialized countries. Discussion We argue quality end-of-life care should be seen as a global public health and health systems problem. It is a global problem because 85 % of the 56 million deaths worldwide that occur annually are in developing countries. It is a public health problem because of the number of people it affects, directly and indirectly, in terms of the well being of loved ones, and the large-scale, population based nature of some possible interventions. It is a health systems problem because one of its main features is the need for better information on quality end-of-life care. We examine the context of end-of-life care, including the epidemiology of death and cross-cultural considerations. Although there are examples of success, we could not identify systematic data on capacity for delivering quality end-of-life care in developing countries. We also address a possible objection to improving end-of-life care in developing countries; many deaths are preventable and reduction of avoidable deaths should be the focus of attention. Conclusions We make three recommendations: (1 reinforce the recasting of quality end-of-life care as a global public health and health systems problem; (2 strengthen capacity to deliver quality end-of-life care; and (3 develop improved strategies to acquire information about the quality of end-of-life care.
Singer, Peter A; Bowman, Kerry W
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.
Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace
Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…
May 22, 2017 ... asthma by spirometry (32%). Only 8% of the respondents with high knowledge reported a corresponding high quality of Asthma care. Conclusion: We concluded that although physicians in South-West Nigeria appear to have good knowledge, there are areas of gap in the quality of asthma care with regards ...
Havig Anders; Skogstad Anders; Kjekshus Lars; Romøren Tor
Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used ...
Introduction: Adequate knowledge of asthma management and adherence to international guidelines are known to increase the quality of care offered by Physicians. We conducted this study to assess the level of asthma knowledge and quality of care among physicians practicing in Ondo State. Methods: We conducted a ...
Saturno, P J
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.
Research suggests that the experience of being a lesbian or bisexual woman influences women's interactions with health care providers, and their perception of the quality of care. Limited research to date, however, has examined how ageing and sexuality mediates women's experiences of quality, when accessing health care in the community. To fill a gap in the literature, this study investigated older lesbian and bisexual women's perspectives on the meaning of quality of care in the context of receiving home care services. This was a qualitative single case study. Sixteen participants, aged 55-72 from Ontario, Canada, participated in semi-structured interviews between 2011 and 2012. The interviews were recorded and transcribed. The interview data were analysed using iterative thematic analysis and guided by a feminist ethic of care perspective. Participants described quality of care in ways that were in line with a feminist ethic of care; that is, they wanted care providers to be responsive and attentive to their needs, to involve them in the caring process and to demonstrate respect and caring. Participants also indicated that providers' comfort with, and knowledge of, sexual diversity was important for enabling quality of care. These findings deepen our understanding of how to support quality of care for this population through changes to provider education and training, and health policy. © 2015 Nordic College of Caring Science.
Marina Malanda, Nuria; López de Santa María, Elena; Gutiérrez, Asunción; Bayón, Juan Carlos; Garcia, Larraitz; Gáldiz, Juan B
Forced spirometry is essential for diagnosing respiratory diseases and is widely used across levels of care. However, several studies have shown that spirometry quality in primary care is not ideal, with risks of misdiagnosis. Our objective was to assess the feasibility and performance of a telemedicine-based training and quality assurance program for forced spirometry in primary care. The two phases included (1) a 9-month pilot study involving 15 centers, in which spirometry tests were assessed by the Basque Office for Health Technology Assessment, and (2) the introduction of the program to all centers in the Public Basque Health Service. Technicians first received 4 h of training, and, subsequently, they sent all tests to the reference laboratory using the program. Quality assessment was performed in accordance with clinical guidelines (A and B, good; C-F, poor). In the first phase, 1,894 spirometry tests were assessed, showing an improvement in quality: acceptable quality tests increased from 57% at the beginning to 78% after 6 months and 83% after 9 months (pspirometry tests were assessed after the inclusion of 36 additional centers, maintaining the positive trend (61%, 87%, and 84% at the same time points; pspirometry tests improved in all centers. (2) The program provides a tool for transferring data that allows monitoring of its quality and training of technicians who perform the tests. (3) This approach is useful for improving spirometry quality in the routine practice of a public health system.
Flatz, Aline; Casillas, Alejandra; Stringhini, Silvia; Zuercher, Emilie; Burnand, Bernard; Peytremann-Bridevaux, Isabelle
Low socioeconomic status is associated with higher prevalence of diabetes, worse outcomes, and worse quality of care. We explored the relationship between education, as a measure of socioeconomic status, and quality of care in the Swiss context. Data were drawn from a population-based survey of 519 adults with diabetes during fall 2011 and summer 2012 in a canton of Switzerland. We assessed patients and diabetes characteristics. Eleven indicators of quality of care were considered (six of process and five of outcomes of care). After bivariate analyses, regression analyses adjusted for age, sex, and diabetic complications were performed to assess the relationship between education and quality of care. Of 11 quality-of-care indicators, three were significantly associated with education: funduscopy (patients with tertiary versus primary education were more likely to get the exam: odds ratio, 1.8; 95% confidence interval [CI], 1.004-3.3) and two indicators of health-related quality of life (patients with tertiary versus primary education reported better health-related quality of life: Audit of Diabetes-Dependent Quality of Life: β=0.6 [95% CI, 0.2-0.97]; SF-12 mean physical component summary score: β=3.6 [95% CI, 0.9-6.4]). Our results suggest the presence of educational inequalities in quality of diabetes care. These findings may help health professionals focus on individuals with increased needs to decrease health inequalities.
Full Text Available Paper explains evolution of Global Quality Management Theory through changes of different quality management approaches in time and compares it to the evolution of Quality Management in Healthcare. Authors relied on already existing information and data sources published in scientific journals to define evolution paths and conduct their comparison to identify gaps and recommend improvements in Healthcare Quality Management. Additionally, four major activities that could improve healthcare quality management emerged from analysis, such as: mechanism for constant and systematic tracing errors, managing quality of supportive processes, control of outsource organizations and application of IT for quality assurance.
Donoghue, Elaine A
High-quality early education and child care for young children improves physical and cognitive outcomes for the children and can result in enhanced school readiness. Preschool education can be viewed as an investment (especially for at-risk children), and studies show a positive return on that investment. Barriers to high-quality early childhood education include inadequate funding and staff education as well as variable regulation and enforcement. Steps that have been taken to improve the quality of early education and child care include creating multidisciplinary, evidence-based child care practice standards; establishing state quality rating and improvement systems; improving federal and state regulations; providing child care health consultation; as well as initiating other innovative partnerships. Pediatricians have a role in promoting quality early education and child care for all children not only in the medical home but also at the community, state, and national levels. Copyright © 2017 by the American Academy of Pediatrics.
Tawfik, Daniel S; Sexton, John Bryan; Adair, Kathryn C; Kaplan, Heather C; Profit, Jochen
Quality improvement in health care is an ongoing challenge. Consideration of the context of the health care system is of paramount importance. Staff resilience and teamwork climate are key aspects of context that drive quality. Teamwork climate is dynamic, with well-established tools available to improve teamwork for specific tasks or global applications. Similarly, burnout and resilience can be modified with interventions such as cultivating gratitude, positivity, and awe. A growing body of literature has shown that teamwork and burnout relate to quality of care, with improved teamwork and decreased burnout expected to produce improved patient quality and safety. Copyright © 2017 Elsevier Inc. All rights reserved.
Arling, Greg; Kane, Robert L.; Mueller, Christine; Bershadsky, Julie; Degenholtz, Howard B.
Purpose: The purpose of this study was to determine the relationship between nursing home staffing level, care received by individual residents, and resident quality-related care processes and functional outcomes. Design and Methods: Nurses recorded resident care time for 5,314 residents on 156 units in 105 facilities in four states (Colorado,…
Weaver, Ruth Harding
Reviews research on characteristics and resources of family child caregivers providing high quality care. Focuses on regulation, lifelong learning in early childhood education, psychological well-being, commitment to child care, supportive child care connections, and a solid financial foundation. Maintains that consumer education can help parents…
Calnan, M.; Dickinson, M.; Manley, G.
Background - Systematic evidence about how the public and users perceive and experience the quality of general dental care is in short supply, particularly in light of the recent changes in the general dental service. The study reported here attempted to fill this gap. Objectives - To identify the criteria the public and users adopt in evaluating the quality of general dental care, and to identify the extent and nature of perceived concerns with general dental care. De...
Clark, Paul Alexander; Kaldenberg, Dennis O; Drain, Maxwell; Wolosin, Robert J
This study examines elderly and advanced elderly inpatients' perceptions of acute care service quality, prioritises opportunities for quality improvement, and assesses variation in patients' satisfaction with care. Psychometrically-validated postal questionnaires were sent to random samplings of patients discharged from the US acute care facilities in 2002 (n = 2,057,164). Quality improvement priorities among non-elderly (elderly (65-74 years), and advanced elderly (> 74 years) were similar but substantial variation was found comparing single items between age groups. Elderly and advanced elderly patients rated the quality of meals and rooms significantly lower than the non-elderly, and the advanced elderly rated treatment decision making involvement significantly lower than the other two age groups. The data reveals specific, actionable areas for quality improvement and a non-linear relationship between age and satisfaction. Findings question assumptions regarding older patients' evaluations of care and indicate directions for quality improvement that account for their unique needs.
Berglund, Helene; Wilhelmson, Katarina; Blomberg, Staffan; Dunér, Anna; Kjellgren, Karin; Hasson, Henna
To analyse frail older people's views of quality of care when receiving a comprehensive continuum of care intervention, compared with those of people receiving the usual care (control group). The intervention included early geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care-planning meetings in older people's own homes. Prior studies indicate that tailored/individualised care planning conducted by a case manager/coordinator often led to greater satisfaction with care planning among older people. However, there is no obvious evidence of any effects of continuum of care interventions on older people's views of quality of care. Randomised controlled study. Items based on a validated questionnaire were used in face-to-face interviews to assess older people's views of quality of care at three, six and 12 months after baseline. Older people receiving a comprehensive continuum of care intervention perceived higher quality of care on items about care planning (p ≤ 0·005), compared with those receiving the usual care. In addition, they had increased knowledge of whom to contact about care/service, after three and 12 months (p advantages of a combination of components such as organising care-planning meetings in older people's own homes, case management and interprofessional teamwork. The results have implications for policymakers, managers and professionals in the area of health and social care for older people to meet individual needs of frail older people. © 2013 John Wiley & Sons Ltd.
D. Stalpers (Dewi); R.A.M.M. Kieft (Renate A. M. M.); D. van der Linden (Dimitri); M.J. Kaljouw (Marian J.); M.J. Schuurmans (Marieke )
textabstractBackground: Nurse-sensitive indicators and nurses' satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between
Prof. Dr. Marieke J. Schuurmans; Marian J. Kaljouw; Renate A.M.M. Kieft; Dewi Stalpers; Dimitri van der Linden
Background: Nurse-sensitive indicators and nurses’ satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive
Stalpers, Dewi; Kieft, Renate A M M; Van Der Linden, Dimitri; Kaljouw, Marian J.; Schuurmans, Marieke J.
Background: Nurse-sensitive indicators and nurses' satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive
Porter, Toni; Reiman, Kayla; Nelson, Christina; Sager, Jessica; Wagner, Janna
This article presents findings from a quasi-experimental evaluation of quality with a sample of 28 family child care providers in the All Our Kin Family Child Care Network, a staffed family child care network which offers a range of services including relationship-based intensive consultation, and 20 family child care providers who had no…
Fleming, Mick; Hollins Martin, Caroline J; Martin, Colin R
Quality of life measures can be used by health professionals to assess effectiveness of nutritional interventions administered to palliative care patients. Stabilizing, maintaining and attempting to increase weight in palliative care patients through the support of oral feeding, and provision of artificial feeding, has been shown to mediate the metabolic and physical wasting effects of the disease process and improve general comfort. A quality of life instrument is a multi-dimensional questionnaire that health professionals can use to measure domains relating to physical, psychological and social aspects of living, and health and disease outcomes. There are three instruments specifically designed to assess quality of life in patients receiving palliative care. These are: The Palliative Care Quality of life Instrument, The Assessment of Quality of Life at the End of Life (AQEL), and The Spitzer Quality of Life Index (SQLI). General use quality of life measures are multifaceted; however, for use with palliative care patients, they have added dimensions of spirituality, existential issues (purpose and meaning of life), family members' perceptions of quality of care, symptom control and family support. Use of quality of life scales provides health professionals and organizations with an ideal measure for planning, targeting and evaluating health interventions.
Nagington, Maurice; Luker, Karen; Walshe, Catherine
Ethical care is beginning to be recognised as care that accounts for the views of those at the receiving end of care. However, in the context of palliative and supportive district nursing care, the patients' and their carers' views are seldom heard. This qualitative research study explores these views. Data were collected through semi-structured interviews with 26 patients with palliative and supportive care needs receiving district nursing care, and 13 of their carers. Participants were recruited via community nurses and hospices between September 2010 and October 2011. Post-structural discourse analysis is used to examine how discourses operate on a moral level. One discourse, 'busyness', is argued to preclude a moral form of nursing care. The discourse of friendship is presented to contrast this. Discussion explores Gallagher's 'slow ethics' and challenges the currently accepted ways of measuring to improve quality of care concluding that quality cannot be measured.
Li-Ying, Jason; Paunova, Minna; Egerod, Ingrid
Aims This study investigates the influence of intensive care unit nurses’ knowledge sharing behaviour on nurse innovation, given different conditions of care quality control. Background Health-care organisations face an increasing pressure to innovate while controlling care quality. We have little...... insight on how the control of care quality interacts with the knowledge sharing behaviour of intensive care nurses to affect their innovative behaviours. Methods We developed a multi-source survey study of more than 200 intensive care nurses at 22 intensive care units of 17 Danish hospitals. Two versions...... of the questionnaire were used – one designed for nurse employees and the other for the managing nurse(s). An ordinary least squares regression analysis was used to test the hypotheses. Results Different aspects of knowledge sharing affect innovation differently, depending on the strength of the control of care...
Jesus, Tiago Silva; Hoenig, Helen
There is substantial interest in mechanisms for measuring, reporting, and improving the quality of health care, including postacute care (PAC) and rehabilitation. Unfortunately, current activities generally are either too narrow or too poorly specified to reflect PAC rehabilitation quality of care. In part, this is caused by a lack of a shared conceptual understanding of what construes quality of care in PAC rehabilitation. This article presents the PAC-rehab quality framework: an evidence-based conceptual framework articulating elements specifically pertaining to PAC rehabilitation quality of care. The widely recognized Donabedian structure, process, and outcomes (SPO) model furnished the underlying structure for the PAC-rehab quality framework, and the International Classification of Functioning, Disability and Health (ICF) framed the functional outcomes. A comprehensive literature review provided the evidence base to specify elements within the SPO model and ICF-derived framework. A set of macrolevel-outcomes (functional performance, quality of life of patient and caregivers, consumers' experience, place of discharge, health care utilization) were defined for PAC rehabilitation and then related to their (1) immediate and intermediate outcomes, (2) underpinning care processes, (3) supportive team functioning and improvement processes, and (4) underlying care structures. The role of environmental factors and centrality of patients in the framework are explicated as well. Finally, we discuss why outcomes may best measure and reflect the quality of PAC rehabilitation. The PAC-rehab quality framework provides a conceptually sound, evidence-based framework appropriate for quality of care activities across the PAC rehabilitation continuum. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Goodson, Justin; Jang, Wooseung; Rantz, Marilyn
Purpose: The purpose of this research is twofold. The first purpose is to utilize a new methodology (Bayesian networks) for aggregating various quality indicators to measure the overall quality of care in nursing homes. The second is to provide new insight into the relationships that exist among various measures of quality and how such measures…
This research project relates to diabetes quality management in Dutch care groups (40-200 GP practices) and outpatient clinics. Improvement of quality management at an organisational level on top of the existing quality management in separate general practices is expected to be associated with
Wasiu L Adeyemo
Full Text Available Aim: The study was designed to explore the changes in oral health-related quality of life (QoL in the immediate postoperative period following routine (non-surgical dental extraction. Setting and Design: A prospective study carried out at the Oral and Maxillofacial Surgery clinic of the Lagos University Teaching Hospital, Nigeria. Materials and Methods: Subjects attending who required non-surgical removal of one or two teeth under local anesthesia were included in the study. A baseline QoL questionnaire (oral health impact profile-14 [OHIP-14] was filled by each patient just before surgery, and only those who were considered to have their QoL "not affected" (total score 14 or less were included in the study. After the extraction, each subject was given a modified form of "health related QoL" [OHIP-14]-instrument to be completed by the 3 rd day-after surgery, and were given the opportunity to review the questionnaire on the 7 th day postoperative review. Results: Total OHIP-14 scores ranged between 14 and 48 (mean ± SD, 26.2 ± 8.3. Majority of the subjects (60% reported, "a little affected." Only few subjects (5.8% reported, "not at all affected," and about 32% reported, "quite a lot." Summation of OHIP-14 scores revealed that QoL was "affected" in 41 subjects (34.2% and "not affected" in 79 subjects (65.8%. More than 30% of subjects reported that their ability to chew, ability to open the mouth and enjoyment of food were affected following tooth extraction. Few subjects (14-34% reported deterioration in their speech and less than 20% of subjects reported that change in their appearance was "affected." Only few subjects (12.5-15.1% reported sleep and duty impairment. Thirty-percent of subjects reported their inability to keep social activities, and 41% were not able to continue with their favorite sports and hobbies. Multiple regression analysis revealed no significant association between age, sex, indications for extraction, duration of
Bos, J.T.; Frijters, D.H.M.; Wagner, C.; Carpenter, I.; Finne-Soveri, H.; Topinkova, E.; Garms-Homolova, V.; Henrard, J.C.; Jonsson, P.V.; Sorbye, l.; Ljunggren, G.; Schroll, M.; Gambassi, G.; Bernabei, R.
BACKGROUND AND AIMS: The increase in the proportion of elderly people and a consequent increase in the demand for care have caused healthcare systems to become overloaded. This paper describes the use of Home Care Quality Indicators (HCQIs), derived from the Minimum Data Set for Home Care, for
Bos, J.T.; Frijters, D.H.; Wagner, C.; Carpenter, G.I.; Finne-Soveri, H.; Topinkova, E.; Garms-Homolova, V.; Henrard, J.C.; Jonsson, P.V.; Sorbye, L.; Ljunggren, G.; Schroll, M.; Gambassi, G.; Bernabei, R.
BACKGROUND AND AIMS: The increase in the proportion of elderly people and a consequent increase in the demand for care have caused healthcare systems to become overloaded. This paper describes the use of Home Care Quality Indicators (HCQIs), derived from the Minimum Data Set for Home Care, for
M. Hendriks; Dahlhaus-Booij, J.; Plass, A.M.
Objective: Clients’ perspective on the quality of audiology care has not been investigated thoroughly. Research has focused primarily on satisfaction with, and limitations of hearing aids. We developed a Consumer Quality Index (CQI) questionnaire ‘Audiology Care’ to systematically assess client experiences with audiology care. Design: The CQI Audiology Care was developed in three steps: (1) posing open-ended questions through e-mail (n = 14), (2) two small-scale surveys assessing psychometric...
Callahan, C M
Two million older Americans suffer from depression annually. Depression causes more functional impairment than many other common medical conditions and older adults have the highest rate of suicide in the United States. Although many of these patients fail to seek or fail to receive care for depression, the majority will be seen in primary care for the treatment of other conditions. To review the health services research on quality improvement for late life depression. Qualitative literature review. During the past 30 years, multiple educational and quality improvement interventions have been designed and tested to improve the recognition and treatment of depression in primary care settings. The findings from this large body of health services research suggest that: (1) the outcome of major depression in the usual care of primary care is typically poor; this is particularly true of late life depression; (2) informational support provided to primary care physicians is necessary but insufficient to improve the outcomes of late life depression in primary care; achieving guideline-level therapy requires the substantial participation of an informed and motivated patient working in concert with a health care team and health care system designed to care for chronic conditions; (3) up to 30% of older primary care patients will fail to respond to excellent guideline-level therapy provided in primary care; and (4) the latest quality improvement efforts focus not only on the clinical skills of primary care physicians, but also on patient's self-care and on innovative strategies to improve the system of care. Late life depression is often a chronic disease and outcomes research demonstrates that quality improvement efforts that focus resources on improving systems of care and the active participation of patients offer the best evidence of improved patient outcomes.
Krczal, Eva; Mock, Tina
In Austria, the recent evolution of primary healthcare centres offers a new alternative to the people. In order to become attractive to the people the service quality dimension offers various opportunities for Primary Care Centres. Incorporating the principle of Integrated Care they offer more convenient opening times and a better continuity of care than practices working on an individual basis. Considering the fact that people have a free choice of visiting care providers the service dimensi...
Parikh, Kavita; Marein-Efron, Gabriela; Huang, Shirley; O'Hare, Geraldine; Finalle, Rodney; Shah, Samir S
The objective of this study was to compare acute and chronic undernutrition rates before and after the introduction of a food-supplementation program as an adjunct to routine health care for children of migrant workers in the Dominican Republic. The cross-sectional study was conducted in five rural communities in the Dominican Republic. Children 18 years and younger were eligible if they received routine health care from local mobile clinics. Data were obtained before (2005) and after (2006) initiation of a food-supplementation program. chi(2) or Fisher exact tests were used for analysis. Among 175 children in 2005, 52% were female, and 59% were supplementation program. Rates of chronic undernutrition decreased from 33% to 18% after the initiation of the food-supplementation program (P = 0.003). Food supplementation in the context of routine health-care visits improved the nutritional status of children, and it warrants further exploration as a way to reduce childhood undernutrition in resource-scarce areas.
McIntosh, Nathalie; Oppel, Eva; Mohr, David; Meterko, Mark
Improving patient care quality in intensive care units is increasingly important as intensive care unit services account for a growing proportion of hospital services. Organizational factors associated with quality of patient care in such units have been identified; however, most were examined in isolation, making it difficult to assess the relative importance of each. Furthermore, though most intensive care units now use a closed model, little research has been done in this specific context. To examine the relative importance of organizational factors associated with patient care quality in closed intensive care units. In a national exploratory, cross-sectional study focused on intensive care units at US Veterans Health Administration acute care hospitals, unit directors were surveyed about nurse and physician staffing, work resources and training, patient care coordination, rounding, and perceptions of patient care quality. Administrative records yielded data on patient volume and facility teaching status. Descriptive statistics, bivariate analyses, and regression modeling were used for data analysis. Sixty-nine completed surveys from directors of closed intensive care units were returned. Regression model results showed that better patient care coordination (β = 0.43; P = .01) and having adequate work resources (β = 0.26; P = .02) were significantly associated with higher levels of patient care quality in such units (R2 = 0.22). Augmenting work resources and/or focusing limited hospital resources on improving patient care coordination may be the most productive ways to improve patient care quality in closed intensive care units. ©2017 American Association of Critical-Care Nurses.
Ross, Lone; Neergaard, Mette Asbjoern; Petersen, Morten Aagaard
BACKGROUND: The perspectives of patients and relatives are important in the improvement of the quality of health care. However, the quality of end-of-life care has not been systematically evaluated in Scandinavia. AIM: To develop or adapt and subsequently validate a questionnaire assessing....... RESULTS: Most of the important topics were covered by the Views of Informal Carers' Evaluation of Services-Short Form, but not all Danish settings (e.g. home care by a palliative team) were covered. These settings were added to the Views of Informal Carers' Evaluation of Services-Short Form, and a few...... the quality of end-of-life care in Denmark. The questionnaire was intended for bereaved relatives in order to assess the quality of care in the last 3 months of the patient's life and the circumstances surrounding death. DESIGN AND DATA SOURCES: Based on the literature and interviews with 15 bereaved...
Blum, Torsten G; Rich, Anna; Baldwin, David
. The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility...... study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide...... countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe....
Full Text Available Abstract Background Breast cancer in women is increasingly frequent, and care is complex, onerous and expensive, all of which lend urgency to improvements in care. Quality measurement is essential to monitor effectiveness and to guide improvements in healthcare. Methods Ten databases, including Medline, were searched electronically to identify measures assessing the quality of breast cancer care in women (diagnosis, treatment, followup, documentation of care. Eligible studies measured adherence to standards of breast cancer care in women diagnosed with, or in treatment for, any histological type of adenocarcinoma of the breast. Reference lists of studies, review articles, web sites, and files of experts were searched manually. Evidence appraisal entailed dual independent assessments of data (e.g., indicators used in quality measurement. The extent of each quality indicator's scientific validation as a measure was assessed. The American Society of Clinical Oncology (ASCO was asked to contribute quality measures under development. Results Sixty relevant reports identified 58 studies with 143 indicators assessing adherence to quality breast cancer care. A paucity of validated indicators (n = 12, most of which assessed quality of life, only permitted a qualitative data synthesis. Most quality indicators evaluated processes of care. Conclusion While some studies revealed patterns of under-use of care, all adherence data require confirmation using validated quality measures. ASCO's current development of a set of quality measures relating to breast cancer care may hold the key to conducting definitive studies.
Fraczak, Bogumiła; Stawska, Barbara
Elderly people need special and complex dental care. They have the right to a dignified life and for the dental care. In elderly the need for social and family support grows. However, many seniors live their last stages of life in the Social Care Houses. Governmental institutions fail to provide full support to seniors since almost the entire psychosocial domain is neglected. Social Care Houses, despite having the word "home" in its name, are only institutions providing the patients with nursing care. The aim of the work was to study the quality of life and psychosocial status in residents of Social Care Houses. The study enrolled 135 individuals aged from 66 to 87 years. It was found that the quality of life in residents of Social Care Houses was low and their psychosocial status was poor. Majority of the studied individuals did not like their life so far. They were overwhelmed by the feeling of tiredness, loneliness and fear about tomorrow. Despite feeling lonely the residents of Social Care Houses showed strong tendency towards isolation. Low psychical and physical activity influenced negatively the psychosocial status of the seniors. It seems that psychotherapists should be the staff members in the Social Care Houses. 1. The quality of pensioners' life in Social Care Houses does not offer happy existence to them. 2. The pensioners' psychosocial state is poor in Social Care Houses. 3. It seems that Social Care Houses should employ psychotherapists.
Nyman, John A; Li, Chia-Hsuan W
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.
Peters, Michele; Perera, Suraj; Loder, Elizabeth
Widely accepted quality indicators for headache care would provide a basis not only for assessment of care but also, and more importantly, for its improvement. The objective of the study was to identify and summarize existing information on such indicators: specifically, did indicators exist, how...... had they been developed, what aspects of headache care did they relate to and how and with what utility were they being used? A systematic review of the medical literature was performed. A total of 32 articles met criteria for inclusion. We identified 55 existing headache quality indicators of which...... 37 evaluated processes of headache care. Most were relevant only to specific populations of patients and to care delivered in high-resource settings. Indicators had been used to describe overall quality of headache care at a national level, but not systematically applied to the evaluation...
Simmons, Sandra F; Schnelle, John F
All long-term care facilities are supposed to engage in quality improvement activities in an effort to improve care quality. The purpose of this pilot study was to teach long-term care staff how to conduct continuous quality improvement (CQI) related to nutritional care. Research staff conducted CQI training in one 48-bed pilot site with designated staff members. Supervisory staff were taught a standardized direct observational protocol, which was implemented weekly by both facility and research staff, to monitor defined nutritional care processes under the control of direct care staff. In addition, direct care staff received feedback on a weekly basis about care process implementation. Following initial training and 12 weeks of CQI implementation, there were improvements in all 5 nutritional care processes related to the adequacy and quality of daily feeding assistance care provision according to both facility and research staff data. Weekly CQI implementation required approximately 1 hour of supervisory staff time and less than 15 minutes of direct care staff time to receive feedback. Both initial training and weekly CQI implementation were effective and required less than 2 hours of total staff time per week. Long-term care staff in this pilot site were able to improve nutritional care quality using a standardized direct observational protocol to guide CQI activities.
Koyio, Lucina N; Kikwilu, Emil; Mulder, Jan; Frencken, Jo E
To assess attitudes, subjective norms, and intentions of primary health-care (PHC) providers in performing routine oral examination for oropharyngeal candidiasis (OPC) during outpatient consultations. A 47-item Theory of Planned Behaviour-based questionnaire was developed and administered, in a cross-sectional survey, to 216 PHC providers (clinical officers and nurses) working in 54 clinics, dispensaries, and health centers in Nairobi Province in January 2010. The constructs - attitudes, subjective norms, and perceived behavioral control (dependent variables) - and their individual indirect (direct) items were analyzed for scores, internal validity, independent variables (district, gender, years of service, profession, and age), and contribution to intentions. Perceived behavioral control had low construct validity and was therefore removed from subsequent analyses. The questionnaire was completed by 195 participants (90 percent response rate). PHC provider's attitudes, subjective norms, and intentions to perform an oral examination during outpatient consultations were highly positive, with mean scores of 6.30 (0.82), 6.06 (1.07), and 5.6 (1.33), respectively, regardless of sociodemographic characteristics. Indirect attitude and subjective norms were strongly correlated to their individual items (r=0.63-0.79, Psubjective norms (P<0.0001) were both predictive of intentions. PHC providers were willing to integrate patients' oral health care into their routine medical consultations. Emphasizing the importance of detecting other oral problems and of the fact that routine oral examination for OPC is likely to give patients' fulfillment will enhance PHC providers' morale in performing routine oral examinations. Winning support from policy makers, their supervisors, specialists, and colleagues is important for motivating PHC providers to perform routine oral examinations for OPC at their workplaces. © 2012 American Association of Public Health Dentistry.
Gourin, Christine G; Herbert, Robert J; Fakhry, Carole; Quon, Harry; Kang, Hyunseok; Kiess, Ana P; Koch, Wayne M; Eisele, David W; Frick, Kevin D
To examine associations between quality of care, survival, and costs in elderly patients treated for oropharyngeal squamous cell cancer (OPSCC). Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data. We evaluated 666 patients diagnosed with OPSCC from 2004 to 2007 using multivariate regression and survival analysis. Using quality indicators derived from guidelines for recommended care, summary measures of quality were calculated for diagnosis, initial treatment, surveillance, treatment for recurrence, end-of-life care, performance, and an overall summary measure of quality. Higher-quality care was associated with significant differences in survival for initial treatment (hazard ratio [HR] = 0.55 [0.41 to 0.73]), surveillance (HR = 0.32 [0.22 to 0.48]), treatment of recurrence (HR = 2.37 [1.56 to 3.60]), performance measures (HR = 0.50 [0.36 to 0.69]), and the overall summary measure of quality (HR = 0.53 [0.39 to 0.71]). Higher-quality salvage surgery was associated with improved survival (HR = 0.16 [0.04 to 0.54]), whereas higher-quality chemotherapy given for recurrence was associated with worse survival (HR = 5.70 [1.92 to 16.94]). Overall, higher-quality care was not associated with differences in costs. Higher-quality care was associated with significantly lower mean incremental costs for treatment of recurrence and end-of-life care, and higher costs for diagnosis and surveillance. Higher-quality OPSCC care in elderly patients was associated with improved survival; however, higher-quality care was not associated with reduced costs, and higher-quality care for treatment of recurrence was associated with poorer survival, primarily due to poorer survival in patients treated with palliative chemotherapy. These data demonstrate a complex relationship between quality and costs in elderly OPSCC patients, which can be used to frame discussions of value and guide disease-specific quality-measure development. 2c
Scaccabarozzi, Gianlorenzo; Lovaglio, Pietro Giorgio; Limonta, Fabrizio; Floriani, Maddalena; Pellegrini, Giacomo
The complexity of end-of-life care, represented by a large number of units caring for dying patients, of different types of organizations motivates the importance of measure the quality of provided care. Despite the law 38/2010 promulgated to remove the barriers and provide affordable access to palliative care, measurement, and monitoring of processes of home care providers in Italy has not been attempted. Using data drawn by an institutional voluntary observatory established in Italy in 2013, collecting home palliative care units caring for people between January and December 2013, we assess the degree to which Italian home palliative care teams endorse a set of standards required by the 38/2010 law and best practices as emerged from the literature. The evaluation strategy is based on Rasch analysis, allowing to objectively measuring both performances of facilities and quality indicators' difficulty on the same metric, using 14 quality indicators identified by the observatory's steering committee. Globally, 195 home care teams were registered in the observatory reporting globally 40 955 cured patients in 2013 representing 66% of the population of home palliative care units active in Italy in 2013. Rasch analysis identifies 5 indicators ("interview" with caregivers, continuous training provided to medical and nursing staff, provision of specialized multidisciplinary interventions, psychological support to the patient and family, and drug supply at home) easy to endorse by health care providers and 3 problematic indicators (presence of a formally established Local Network of Palliative care in the area of reference, provision of the care for most problematic patient requiring high intensity of the care, and the percentage of cancer patient dying at Home). The lack of Local Network of Palliative care, required by law 38/2010, is, at the present, the main barrier to its application. However, the adopted methodology suggests that a clear roadmap for health facilities
... such as in: • doctor’s offices • health clinics • urgent care centers • ambulatory surgery centers The following questions can help you ... www. qualitycheck. org to find Joint Commission accredited ambulatory care centers. • Can you get a copy of the ...
Havig, Anders Kvale; Skogstad, Anders; Kjekshus, Lars Erik; Romøren, Tor Inge
Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r=0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is complex. Increasing staffing levels or the
Full Text Available Abstract Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78. Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses
Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is
Pahlavanzadeh, Saied; Asgari, Zohreh; Alimohammadi, Nasrollah
High level of stress in intensive care unit nurses affects the quality of their nursing care. Therefore, this study aimed to determine the effects of a stress management program on the quality of nursing care of intensive care unit nurses. This study is a randomized clinical trial that was conducted on 65 nurses. The samples were selected by stratified sampling of the nurses working in intensive care units 1, 2, 3 in Al-Zahra Hospital in Isfahan, Iran and were randomly assigned to two groups. The intervention group underwent an intervention, including 10 sessions of stress management that was held twice a week. In the control group, placebo sessions were held simultaneously. Data were gathered by demographic checklist and Quality Patient Care Scale before, immediately after, and 1 month after the intervention in both groups. Then, the data were analyzed by Student's t-test, Mann-Whitney, Chi-square, Fisher's exact test, and analysis of variance (ANOVA) through SPSS software version 18. Mean scores of overall and dimensions of quality of care in the intervention group were significantly higher immediately after and 1 month after the intervention, compared to pre-intervention (P quality of care in the intervention group was significantly higher immediately after and 1 month after the intervention, compared to the control group (P quality of care, the staffs are recommended to consider it in improvement of the quality of nursing care.
Aeyels, Daan; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Coeckelberghs, Ellen; Bruyneel, Luk; Vanhaecht, Kris
Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI. A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.
Bowers, John; Cheyne, Helen
UK health services are under pressure to make cost savings while maintaining quality of care. Typically reducing the length of time patients stay in hospital and increasing bed occupancy are advocated to achieve service efficiency. Around 800,000 women give birth in the UK each year making maternity care a high volume, high cost service. Although average length of stay on the postnatal ward has fallen substantially over the years there is pressure to make still further reductions. This paper explores and discusses the possible cost savings of further reductions in length of stay, the consequences for postnatal services in the community, and the impact on quality of care. We draw on a range of pre-existing data sources including, national level routinely collected data, workforce planning data and data from national surveys of women's experience. Simulation and a financial model were used to estimate excess demand, work intensity and bed occupancy to explore the quantitative, organisational consequences of reducing the length of stay. These data are discussed in relation to findings of national surveys to draw inferences about potential impacts on cost and quality of care. Reducing the length of time women spend in hospital after birth implies that staff and bed numbers can be reduced. However, the cost savings may be reduced if quality and access to services are maintained. Admission and discharge procedures are relatively fixed and involve high cost, trained staff time. Furthermore, it is important to retain a sufficient bed contingency capacity to ensure a reasonable level of service. If quality of care is maintained, staffing and bed capacity cannot be simply reduced proportionately: reducing average length of stay on a typical postnatal ward by six hours or 17% would reduce costs by just 8%. This might still be a significant saving over a high volume service however, earlier discharge results in more women and babies with significant care needs at home. Quality
Ian J Douglas
Full Text Available Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities.This was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM, hypertension, angina, myocardial infarction (MI, stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88-5.08. Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo and sleeve gastrectomy (6.29 kg/mo were associated with greater initial weight reduction than gastric banding (2.77 kg/mo. Protective hazard ratios (HRs were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55-0.83; hypertension, 0.35 (95% CI 0.27-0.45; angina, 0.59 (95% CI 0.40-0.87;MI, 0.28 (95% CI 0.10-0.74; and obstructive sleep apnoea, 0.55 (95% CI 0.40-0.87. Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84-12.62, and between bariatric surgery and the resolution of hypertension, with a HR of 5.64 (95% CI
Douglas, Ian J; Bhaskaran, Krishnan; Batterham, Rachel L; Smeeth, Liam
Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities. This was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM), hypertension, angina, myocardial infarction (MI), stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88-5.08). Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo) and sleeve gastrectomy (6.29 kg/mo) were associated with greater initial weight reduction than gastric banding (2.77 kg/mo). Protective hazard ratios (HRs) were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55-0.83); hypertension, 0.35 (95% CI 0.27-0.45); angina, 0.59 (95% CI 0.40-0.87);MI, 0.28 (95% CI 0.10-0.74); and obstructive sleep apnoea, 0.55 (95% CI 0.40-0.87). Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84-12.62), and between bariatric surgery and the resolution of hypertension, with a HR of 5.64 (95% CI 2
Douglas, Ian J.; Bhaskaran, Krishnan; Batterham, Rachel L.; Smeeth, Liam
Background Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities. Methods and Findings This was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM), hypertension, angina, myocardial infarction (MI), stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88–5.08). Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo) and sleeve gastrectomy (6.29 kg/mo) were associated with greater initial weight reduction than gastric banding (2.77 kg/mo). Protective hazard ratios (HRs) were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55–0.83); hypertension, 0.35 (95% CI 0.27–0.45); angina, 0.59 (95% CI 0.40–0.87);MI, 0.28 (95% CI 0.10–0.74); and obstructive sleep apnoea, 0.55 (95% CI 0.40–0.87). Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84–12.62), and between bariatric surgery and the resolution of
Peters, Michele; Jenkinson, Crispin; Perera, Suraj
services; (2) health professionals; (3) patients; (4) financial resources; (5) political agenda and legislation. An initial list of 160 putative quality indicators in 14 domains was reduced to 30 indicators in 9 domains. These gave rise to the following multidimensional definition of quality of headache......." Quality in headache care is multidimensional and resides in nine essential domains that are of equal importance. The indicators are currently being tested for feasibility of use in clinical settings.......The objective of this study was to define "quality" of headache care, and develop indicators that are applicable in different settings and cultures and to all types of headache. No definition of quality of headache care has been formulated. Two sets of quality indicators, proposed in the US and UK...
Edvardsson, David; Watt, Elizabeth; Pearce, Frances
To explore the extent to which patient ratings of perceived caring and person-centredness are associated with perceived nursing care quality in an acute hospital sample of inpatients. Self-reported patient experiences have had limited attention in conceptualizations of healthcare quality as described in policy and national standards, as well as in health and nursing care practice. The impact of central nursing concepts such as caring and person-centredness on patient ratings of nursing care quality is largely unknown. A descriptive non-experimental correlational design was used to collect and analyse data from a sample of Australian acute hospital inpatients (n = 210) in December 2012. The study collected self-report patient data through a study survey including demographic data and the Caring Behaviours Inventory, the Person-centred Climate Questionnaire, the SF-36 and the Distress thermometer. Descriptive statistics together with Pearson correlation and hierarchical linear regression were used. Perceived caring behaviours of staff and the person-centredness of wards were significantly associated with nursing care quality as evidenced by Pearson correlations being significant and exceeding the pre-set cut-off of r > 0·5. Staff caring behaviours and ward person-centredness also accounted for more than half of the total variance in perceived nursing care quality as evidenced by the final regression model. Knowledgeable and communicable staff, timeliness of assistance and environmental support stood out as most significantly related to patient perceived nursing care quality. Patient experiences of caring and person-centredness seem to have an influential role in the extent to which patients experience the quality of nursing care. Knowledgeable and communicable staff, timeliness of assistance and environmental support stand out as most significantly related to patient-perceived nursing care quality. © 2016 John Wiley & Sons Ltd.
Li-Ying, Jason; Paunova, Minna; Egerod, Ingrid
This study investigates the influence of intensive care unit nurses' knowledge sharing behaviour on nurse innovation, given different conditions of care quality control. Health-care organisations face an increasing pressure to innovate while controlling care quality. We have little insight on how the control of care quality interacts with the knowledge sharing behaviour of intensive care nurses to affect their innovative behaviours. We developed a multi-source survey study of more than 200 intensive care nurses at 22 intensive care units of 17 Danish hospitals. Two versions of the questionnaire were used - one designed for nurse employees and the other for the managing nurse(s). An ordinary least squares regression analysis was used to test the hypotheses. Different aspects of knowledge sharing affect innovation differently, depending on the strength of the control of care quality within the unit. The increasing pressures to implement the control of care quality and innovate may be conflicting, unless handled properly. Process control at intensive care units should be loosened, when personal interaction between intensive care nurses is encouraged to stimulate nurse innovations. Alternatively, managers may develop a climate where helping others, especially with younger colleagues, offsets the negative effects of strong process control. © 2016 John Wiley & Sons Ltd.
Schnelle, J F; Ouslander, J G; Buchanan, J; Zellman, G; Farley, D; Hirsch, S H; Reuben, D B
The number of nursing home (NH) residents enrolled in managed care plans (HMO) will increase, and there is concern that the quality of their medical care may be compromised by cost-containment pressures. In this study, we evaluated the medical care of residents enrolled in 3 health maintenance organizations (HMO) that developed specific long-term care programs. To compare the medical care received by NH residents enrolled in HMO and Fee-for-Service (FFS) plans with both objective process of care and consumer perception (subjective) measures. To describe the relationship between the objective and subjective measures. Number of primary care visits per month; process of medical care for 2 geriatric tracer conditions (falls, fevers); family and residents' perceptions of the adequacy of sickness episode management; and the frequency of primary provider visits. Quasi-experimental. HMO residents received more timely and appropriate responses to falls and fevers than did FFS residents. HMO residents also received more frequent routine visits by a primary care provider team consisting of a physician and nurse practitioner. Consumer perceptions of quality did not differ between the HMO and FFS groups. Families within both groups were significantly more positive than were residents about the frequency of visits by both physicians and nurse practitioners. Within the HMO group, both families and residents were more positive about the frequency of nurse practitioner visits than were physician visits even when the frequency of visits by the 2 providers were similar. Although the medical care received by HMO residents was better on most objective process measures than that received by FFS residents, consumer perceptions of care did not detect those differences. NH residents and families have different perceptions about the adequacy of visits by physicians and nurse practitioners, and both families and residents appear to have different expectations concerning how often they want
Amiri, Elham; Ebrahimi, Hossein; Vahidi, Maryam; Asghari Jafarabadi, Mohamad; Namdar Areshtanab, Hossein
To provide care with high quality, nurses face a number of moral issues requiring them to have moral abilities in professional performance. Moral sensitivity is the first step in moral performance. However, its relation to the quality of care patients receive is controversial. This study aims to determine the relationship between the moral sensitivity of nurses and the quality of care received by patients in the medical wards. A descriptive correlational study using validated tools, including Moral Sensitivity Questionnaire and the Quality Patient Quality Scale. Participants and research context: In total, 198 nurses and 198 patients in 17 medical wards of hospitals affiliated with Tabriz University of Medical Sciences, Iran. Ethical considerations: The study was reviewed and approved by the Ethics Committee of Tabriz University of Medical Sciences. The mean values of nurses' moral sensitivity and nurses' quality care were 136.47 ± 13.30 and 196.36 ± 44.10, respectively. There was no significant relationship between the patient care quality and nurses' moral sensitivity ( r = -.14, p = .5). However, there was a significant inverse relationship between the dimension of "Experiencing moral conflicts" and the overall score of quality care ( r = -.50, p = .04), the dimensions of "psychosocial ( r = -.50, p = .04)" and "physical ( r = -.50, p = .03)." Considering the significant inverse relationship between the score of patient quality care and the dimension of moral conflict experience, it seems when nurses make moral decisions, they experience a conflict between personal and professional values in their careers and thus experience moral tension. If this tension is not resolved properly, it can provide a way for them to distance themselves from patients, thereby making nurses indifferent to moral care.
Huotari, Päivi; Havrdová, Zuzana
Purpose The purpose of this paper is to describe how different stakeholders (society, managers, employees and clients) can together ensure the quality of care. Design/methodology/approach Qualitative data were collected from four focus group interviews conducted in three countries. All interviewees were pursuing a master's degree in social and/or health care management and had begun working in their field after completing their bachelor's degree. The data were analysed using inductive content analysis. Findings The society and managers are responsible for the care system as a whole and must apply system-oriented, rather than sector-oriented, thinking. Employees are responsible for ensuring the continuity of client services in their work, and managers and employees share the responsibility of achieving the organisational goals and quality standards. The clients are responsible for acting as responsible service users and providing the required information to obtain care. Communication was strongly emphasised in the data, and it necessitates cross-professional and organisational boundaries, professional and political boundaries, as well as boundaries between the professional and the client. Research limitations/implications Since the interviewees were all pursuing a master's degree in social and/or health care management, when reflecting on their work experience, they may have also been reflecting what they had learned in university. Practical implications This study emphasises the importance of collaboration and communication between stakeholders in ensuring the quality of care. Unpredictable economies, the ageing population and the ongoing integration and reorganisation of health and social care services in Europe highlight systematic and strategic approach in quality of care. Originality/value This paper claims that communication between different care stakeholders gives a more systematic and coherent framework for the quality of care. Quality of care is a
Busby, John; Purdy, Sarah; Hollingworth, William
Objectives To use geographic variation in unplanned ambulatory care sensitive condition admission rates to identify the clinical areas and patient subgroups where there is greatest potential to prevent admissions and improve the quality and efficiency of care. Methods We used English Hospital Episode Statistics data from 2011/2012 to describe the characteristics of patients admitted for ambulatory care sensitive condition care and estimated geographic variation in unplanned admission rates. We contrasted geographic variation across admissions with different lengths of stay which we used as a proxy for clinical severity. We estimated the number of bed days that could be saved under several scenarios. Results There were 1.8 million ambulatory care sensitive condition admissions during 2011/2012. Substantial geographic variation in ambulatory care sensitive condition admission rates was commonplace but mental health care and short-stay (care. Further work to explore the causes of these differences is required and should focus on mental health and short-stay admissions.
Full Text Available Abstract Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of
Travers Catherine M
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
In Scotland, geography and social conditions are placing demands on nurses' ingenuity. As RCN Scotland Director Theresa Fyffe says: 'Nurses in Scotland are constantly overcoming the challenges thrown at them by our health and social care system and diverse geography.
Iobst, Christopher A; Stillwagon, Matthew; Ryan, Deidre; Shirley, Eric; Frick, Steven L
occurred in 2 patients (2.4%). The procedure time ranged from 13 to 171 minutes, with a median time of 37 minutes. Total anesthesia time ranged from 32 to 233 minutes, with a median of 72 minutes. The number of outpatient follow-up visits ranged from 2 to 7 visits, with a median of 3 visits. The number of postoperative radiographs obtained ranged from 1 to 14, with a median of 3 studies. Four patients (5%) returned to the operating room for a repeat surgery. The survey responses from the surgeons at 6 different hospitals demonstrate that there is still considerable variation in care among surgeons, even for such a routine injury. Our chart review also revealed substantial variation in care with subsequent quality and cost-implications. The variations in operating room time, anesthesiology time, number of postoperative visits, number of radiographs ordered, and the initial intraoperative immobilization, all point to opportunities for standardization and lowering of costs. Level IV.
Chin, W Y; Lam, Cindy L K; Lo, S V
To review the literature regarding quality of care of nurse-led and allied health personnel-led primary care clinics with specific attention to the quality indicators for fall prevention, continence care, pulmonary rehabilitation, mental health, pharmaceutical care, and wound care services. Literature search from 1990 to 2010 including Ovid Medline, Cochrane Database, RAND (Research and Development) Corporation Health Database, the ACOVE (Assessing the Care of Vulnerable Elders) project and clinical guidelines from the United Kingdom, Australia, Canada, and the United States. This review was limited to studies involving adult, primary care patients. Where available, evidence from systematic reviews and meta-analyses were used to synthesise findings. Combinations of the following terms (and related terms) were used to identify studies: primary care, clinic, allied-health, nurse-led, fall prevention, continence care, incontinence, chronic obstructive pulmonary disorder, pulmonary disease, respiratory rehabilitation, mental health, mental wellbeing, depression, anxiety, wound care, leg ulcer, venous ulcer, dressings clinic, wound clinic, medication review, pharmacist-led, pharmaceutical care. A total of 21 international guidelines and 33 studies were selected for data synthesis. Despite a lack of consistent outcomes data, it is apparent that certain aspects of organisational structure and clinical care processes are important though not necessarily sufficient indicators of quality of care, because they themselves can influence care outcomes. Seven key factors were identified which seem important determinants of the quality of care provided by nurse- and allied health personnel-led clinics. Delivery of primary health care by nurse and allied health personnel-led teams is a well-established model, internationally. Evidence from the literature provides benchmarks for standards of good practice. Knowledge of factors influencing quality of care can assist the planning
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...
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...
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 2016 reporting. Source: Mathematica...
Wilson, Andrew; Tabrizi, Jafar Sadegh; Gholipour, Kamal; Farahbakhsh, Mostafa
Improving adherence to care standards is one way to improve quality of delivered care. This study aimed to determine the degree of providers' adherence to maternity care standards from the perspective of pregnant women. This cross-sectional study was conducted on 185 pregnant women in their ninth month of pregnancy who received maternity care from health centres in Tabriz, Iran. Participants were selected randomly from 40 health centres. Data collection used a researcher-developed questionnaire based on Iranian Ministry of Health (MOH) standards for maternity care. Questionnaire validity was reviewed and confirmed by 10 experts. About 69% of pregnant mothers during their 9-month pregnancy received at least six items of standard maternity care. Almost two-thirds of participants received recommended maternity care at or above minimal standards for some aspect, such as the number of care during pregnancy, referral to health centre physician, and weight and blood pressure measurement. Some other services such as measuring uterus height, review for oedema and varicosities, referral to a dentist, listening for fetal heart sound and vaginal examination, were reported at very low adherence to the Ministry of Health guidelines Conclusion: A notable proportion of pregnant mothers reported receiving suboptimal care indicating significant room for improving the quality of maternity care based on Iranian MOH standards and guidelines. The results indicate potential benefits from interventions to improve health care providers training and the awareness of pregnant women about the standards for good maternity care.
Lemoine, Marie-Hélène; Lemoine, Claude; Cyr, Claude
To measure parents' satisfaction with paediatric primary care quality and accessibility. High-quality paediatric primary care is a cornerstone of efforts to improve health outcomes and access to care, as well as to control health care spending. A strong primary care infrastructure is related to improved health outcomes, including an improved mortality rate. A cross-sectional survey using the Parents' Perception of Primary Care questionnaire and evidence-based items from the Rourke Baby Record were used to measure parents' satisfaction. Of 200 questionnaires sent, 130 were returned. The mean number of children per family was 1.7+/-0.8 (mean +/- SD). Sixty-six per cent of children received their primary care from general practitioners, 19% received their primary care from paediatricians, and 15% had no regular physician and identified other professionals (community nurses, midwives or chiropractors) as their primary care providers. Parents were questioned about their child's hearing in 66% of cases. Only 41% of parents received guidance about breastfeeding, 37% about adequate sleeping position, 17% about the dangers of second-hand smoke and 16% about car safety seats. The level of satisfaction with communication, contextual knowledge and coordination of care was higher for families followed by general practitioners and paediatricians than for families followed by nonphysicians. According to the Parents' Perception of Primary Care scores, the overall satisfaction with primary care was higher for care given by general practitioners and paediatricians than for care given by midwives or chiropractors, and intermediate when given by nurses. In this survey, the majority of children received their primary care from physicians, most commonly general practitioners. Parents' overall satisfaction regarding their infant's primary health care was higher when it was delivered by physicians than by alternative health care providers. Evidence-based guidance recommendations were
Full Text Available Recently, more and more attention has been paid to the quality of education in Slovenia, too. The author tries to show some areas of the education of adults in which systematic introducing and implementing (selfevaluation has been taking place for severa! years. (Selfevaluation is used for assessing the quality of ali processes which characterise an activity - from planning to introducing and implementing. The results of planned monitoring and assessing those processes are used for simultaneous upgrading, modifying and directing of the monitored activity. As an example the author presents some key determinants of quality which are used in the introduced national development projects of adult education.
Burston, Sarah; Chaboyer, Wendy; Gillespie, Brigid
To review nurse-sensitive indicators that may be suitable to assess nursing care quality. Patient safety concerns, fiscal pressures and patient expectation create a demand that healthcare providers demonstrate the quality of nursing care delivered. As a result, nurse managers are increasingly encouraged to provide evidence of nursing care quality. Nurse-sensitive indicators are being proposed as a means of meeting this need. Literature review. A review of the literature was conducted using CINAHL and MEDLINE from 2002-2011. Key search terms were nurs* and sensitive indicators, outcome measures, indicators, metrics and patient outcomes. Most of the research has examined the relationship between nursing structural variables and patient outcomes in acute care settings and have explored potential indicators for specific patient groups and nursing roles. When using nurse-sensitive indicators, issues concerning the selection, reporting and sustained use are important for nurse managers to consider. Evidence for the nurse-sensitivity of some commonly used indicators is inconsistent due to the disparity in definitions used, data collection and analysis methods. Further research on the application and implementation of these indicators is required to assist nurse managers in attempting to quantify the quality of nursing care. Nurses need to continue to strive to achieve agreement on the definitions of indicators, gather strong consistent evidence of nurse-sensitivity, resolve issues of regular data collection and consider selection, reporting and sustainment when implementing nurse-sensitive indicators. Once identified, nurse-sensitive indicators can be applied for quality improvement purposes, but consensus is required to fully realise their potential. Nurse managers need to be aware of the factors that can influence the use of indicators at unit level. Strategies need to be implemented to promote these indicators becoming integrated with routine nursing care. © 2013 John
Streit, Sven; da Costa, Bruno R.; Bauer, Douglas C.; Collet, Tinh-Hai; Weiler, Stefan; Zimmerli, Lukas; Frey, Peter; Cornuz, Jacques; Gaspoz, Jean-Michel; Battegay, Edouard; Kerr, Eve; Aujesky, Drahomir; Rodondi, Nicolas
Background Caring for patients with multimorbidity is common for generalists, although such patients are often excluded from clinical trials, and thus such trials lack of generalizability. Data on the association between multimorbidity and preventive care are limited. We aimed to assess whether comorbidity number, severity and type were associated with preventive care among patients receiving care in Swiss University primary care settings. Methods We examined a retrospective cohort composed of a random sample of 1,002 patients aged 50–80 years attending four Swiss university primary care settings. Multimorbidity was defined according to the literature and the Charlson index. We assessed the quality of preventive care and cardiovascular preventive care with RAND’s Quality Assessment Tool indicators. Aggregate scores of quality of provided care were calculated by taking into account the number of eligible patients for each indicator. Results Participants (mean age 63.5 years, 44% women) had a mean of 2.6 (SD 1.9) comorbidities and 67.5% had 2 or more comorbidities. The mean Charlson index was 1.8 (SD 1.9). Overall, participants received 69% of recommended preventive care and 84% of cardiovascular preventive care. Quality of care was not associated with higher numbers of comorbidities, both for preventive care and for cardiovascular preventive care. Results were similar in analyses using the Charlson index and after adjusting for age, gender, occupation, center and number of visits. Some patients may receive less preventive care including those with dementia (47%) and those with schizophrenia (35%). Conclusions In Swiss university primary care settings, two thirds of patients had 2 or more comorbidities. The receipt of preventive and cardiovascular preventive care was not affected by comorbidity count or severity, although patients with certain comorbidities may receive lower levels of preventive care. PMID:24760077
Full Text Available Caring for patients with multimorbidity is common for generalists, although such patients are often excluded from clinical trials, and thus such trials lack of generalizability. Data on the association between multimorbidity and preventive care are limited. We aimed to assess whether comorbidity number, severity and type were associated with preventive care among patients receiving care in Swiss University primary care settings.We examined a retrospective cohort composed of a random sample of 1,002 patients aged 50-80 years attending four Swiss university primary care settings. Multimorbidity was defined according to the literature and the Charlson index. We assessed the quality of preventive care and cardiovascular preventive care with RAND's Quality Assessment Tool indicators. Aggregate scores of quality of provided care were calculated by taking into account the number of eligible patients for each indicator.Participants (mean age 63.5 years, 44% women had a mean of 2.6 (SD 1.9 comorbidities and 67.5% had 2 or more comorbidities. The mean Charlson index was 1.8 (SD 1.9. Overall, participants received 69% of recommended preventive care and 84% of cardiovascular preventive care. Quality of care was not associated with higher numbers of comorbidities, both for preventive care and for cardiovascular preventive care. Results were similar in analyses using the Charlson index and after adjusting for age, gender, occupation, center and number of visits. Some patients may receive less preventive care including those with dementia (47% and those with schizophrenia (35%.In Swiss university primary care settings, two thirds of patients had 2 or more comorbidities. The receipt of preventive and cardiovascular preventive care was not affected by comorbidity count or severity, although patients with certain comorbidities may receive lower levels of preventive care.
Jørgensen, Mette; Mainz, Jan; Svendsen, Marie Louise
BACKGROUND: The effectiveness of systematic quality improvement initiatives in psychiatric care remains unclear. AIMS: To examine whether quality of care has changed following implementation of a systematic monitoring programme of hospital performance measures. METHOD: In a nationwide population-...... AND USAGE: © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence....
Grabowski, David C; O'Malley, A James; Afendulis, Christopher C; Caudry, Daryl J; Elliot, Amy; Zimmerman, Sheryl
Culture change models are intended to improve the quality of life for nursing home residents, but the impact of these models on quality of care is unknown. We evaluated the impact of the implementation of nursing home culture change on the quality of care, as measured by staffing, health-related survey deficiencies, and Minimum Data Set (MDS) quality indicators. From the Pioneer Network, we have data on whether facilities were identified by experts as "culture change" providers in 2004 and 2009. Using administrative data, we employed a panel-based regression approach in which we compared pre-post quality outcomes in facilities adopting culture change between 2004 and 2009 against pre-post quality outcomes for a propensity score-matched comparison group of nonadopters. Nursing homes that were identified as culture change adopters exhibited a 14.6% decrease in health-related survey deficiency citations relative to comparable nonadopting homes, while experiencing no significant change in nurse staffing or various MDS quality indicators. This research represents the first large-scale longitudinal evaluation of the association of culture change and nursing home quality of care. Based on the survey deficiency results, nursing homes that were identified as culture change adopters were associated with better care although the surveyors were not blind to the nursing home's culture change efforts. This finding suggests culture change may have the potential to improve MDS-based quality outcomes, but this has not yet been observed.
Wilson, Sarah J; Baxendale, Sallie; Barr, William; Hamed, Sherifa; Langfitt, John; Samson, Séverine; Watanabe, Masako; Baker, Gus A; Helmstaedter, Christoph; Hermann, Bruce P; Smith, Mary-Lou
The International League Against Epilepsy (ILAE) Diagnostic Methods Commission charged the Neuropsychology Task Force with the job of developing a set of recommendations to address the following questions: (1) What is the role of a neuropsychological assessment? (2) Who should do a neuropsychological assessment? (3) When should people with epilepsy be referred for a neuropsychological assessment? and (4) What should be expected from a neuropsychological assessment? The recommendations have been broadly written for health care clinicians in established epilepsy settings as well as those setting up new services. They are based on a detailed survey of neuropsychological assessment practices across international epilepsy centers, and formal ranking of specific recommendations for advancing clinical epilepsy care generated by specialist epilepsy neuropsychologists from around the world. They also incorporate the latest research findings to establish minimum standards for training and practice, reflecting the many roles of neuropsychological assessment in the routine care of children and adults with epilepsy. The recommendations endorse routine screening of cognition, mood, and behavior in new-onset epilepsy, and describe the range of situations when more detailed, formal neuropsychological assessment is indicated. They identify a core set of cognitive and psychological domains that should be assessed to provide an objective account of an individual's cognitive, emotional, and psychosocial functioning, including factors likely contributing to deficits identified on qualitative and quantitative examination. The recommendations also endorse routine provision of feedback to patients, families, and clinicians about the implications of the assessment results, including specific clinical recommendations of what can be done to improve a patient's cognitive or psychosocial functioning and alleviate the distress of any difficulties identified. By canvassing the breadth and depth
Johnson, Anna D.; Ryan, Rebecca M.; Brooks-Gunn, Jeanne
The federal child-care subsidy program represents one of the government's largest investments in early care and education, but little is known about whether it increases low-income children's access to higher quality child care. This study used newly available nationally representative data on 4-year-old children (N = 750) to investigate whether…
Claessen, Susanne J J; Francke, Anneke L; Sixma, Herman J; de Veer, Anke J E; Deliens, Luc
The Consumer Quality Index Palliative Care (CQ-index PC) is a structured questionnaire for measuring the quality of palliative care from the perspective of care users. CQ-indices assess which care aspects need quality improvement by relating answers about actual care experiences to answers about the importance of certain aspects of care. To improve the chance that the new instrument has good content validity, a literature study and individual and group discussions were performed, and a steering committee was consulted to establish the instrument's face and content validity. The questionnaire was administered to patients with a life expectancy of 6 months or less and/or who were receiving palliative treatment. Descriptive analyses were carried out on the items about actual care experiences and the importance of care aspects, and on 'need for improvement' scores. 15 care organisations participated. 133 patients met the inclusion criteria (net response n=85). Patients considered the following aspects the most important: 'offering help in good time in acute situations', 'caregivers having the necessary expertise' and 'caregivers taking the patient seriously'. The three care aspects with the highest 'need for improvement' scores were: 'support when the patient feels depressed', 'support when the patient is anxious' and 'support when the patient has shortness of breath'. The CQ-index PC provides opportunities for care organisations to assess which care aspects have the highest priority for quality improvement within their organisation. Further research is needed to assess whether the instrument has enough discriminative power to assess differences between organisations.
Background: Quality of care is a complex issue influenced by many factors. It is fundamental in assessing health care delivery in health facilities in developing countries. Health care workers' perceptions help policy makers and planners to identify bottlenecks in the system to improve utilisation and sustainability of health ...
F.W.G. Leebeek (Frank); K. Fischer (Kathelijn)
textabstractBackground. In the Netherlands, the first formal haemophilia comprehensive care centre was established in 1964, and Dutch haemophilia doctors have been organised since 1972. Although several steps were taken to centralise haemophilia care and maintain quality of care, treatment was still
Whitebook, Marcy, Comp.; And Others
This early childhood education text was designed to help students and child care staff become effective advocates for the improvement of quality, salaries, and working conditions in child care programs. Unit I provides literature on the issues affecting the child care field and focuses on strategies to improve salaries and working conditions.…
Ostergren, Carol S.; Riley, David A.; Wehmeier, Jenny M.
More high quality child care is needed in the United States. This article evaluates the Better Kid Care (BKC) program produced by Pennsylvania State University Extension. Child care staff in Wisconsin were interviewed about changes they had made in their early childhood programs following participation in the BKC program. Findings show that 2…
Cheng, Shou-Hsia; Wei, Yu-Jung; Chang, Hong-Jen
Quality of care rather than price is the main concern in health care. However, does price not matter at all? To investigate what quality and cost factors influence whether patients perceive health care services as expensive and will recommend a hospital to other patients, the authors analyzed data from a national survey of patients in Taiwan in 2002. A total of 6725 subjects returned questionnaires. Results from logistic regression models showed that (1) a patient's perception of expense was determined simultaneously with the perceived quality and the out-of-pocket price of care, (2) a patient's perception of hospital quality appeared to be the most important determinant for recommending a hospital, and(3) while the out-of-pocket price did not affect a patient's recommendation, the perceived expense of the services did. The perceived value rather than the price itself-is the essence of quality competition in Taiwan's health care market.
Kanters, Arielle; Mullard, Andrew J; Arambula, Jennifer; Fasbinder, Laurie; Krapohl, Greta; Wong, Sandra L; Campbell, Darrell A; Hendren, Samantha
Surgery remains the cornerstone therapy for colorectal cancer (CRC). This study assesses CRC quality measures for surgical cases in Michigan. In this retrospective cohort study, processes of care and outcomes for CRC resection cases were abstracted in 30 hospitals in the Michigan Surgical Quality Collaborative (2014-2015). Measures were case-mix and reliability adjusted, using logistic regression models. For 871 cases (640 colon cancer, 231 rectal cancer), adjusted morbidity (27.4%) and mortality rates (1.5%) were low. Adjusted process measures showed gaps in quality of care. Mesorectal excision was documented in 59.4% of rectal cancer (RC) cases, 65% of RC cases had sphincter preserving surgery, 18.7% of cases had quality of care measures for CRC, suggesting opportunity for regional quality improvement. Copyright © 2016 Elsevier Inc. All rights reserved.
Joachim Rapin; Danielle D’Amour; Carl-Ardy Dubois
The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. (2...
Hendriks, Michelle; Dahlhaus-Booij, Judith; Plass, Anne Marie
Clients' perspective on the quality of audiology care has not been investigated thoroughly. Research has focused primarily on satisfaction with, and limitations of hearing aids. We developed a Consumer Quality Index (CQI) questionnaire 'Audiology Care' to systematically assess client experiences with audiology care. The CQI Audiology Care was developed in three steps: (1) posing open-ended questions through e-mail (n = 14), (2) two small-scale surveys assessing psychometric properties of the questionnaire (n = 188) and importance of quality aspects (n = 118), and (3) a large-scale survey (n = 1793) assessing psychometric properties and discriminatory power of the questionnaire. People with complex hearing impairments and/or balance and communicative disorders who visited an audiology care centre during the past year. Important quality aspects were translated into seven reliable scales: accommodation and facilities, employees' conduct and expertise, arrangement of appointments, waiting times, client participation and effectiveness of treatment. Client experiences differed among the participating centres concerning accommodation and facilities, arrangement of appointments, waiting times and client participation. The CQI Audiology Care is a valid and reliable instrument to assess clients' experiences with audiology care. Future implementation will reveal whether results can be used to monitor and improve the quality of audiology care.
Full Text Available Abstract Background Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals. Methods Investigation of the Hospital Food and Nutrition Service (HFNS of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ and hospital food service quality (FSQ. HFNS was also evaluated with respect to human resources per hospital bed and per produced meal. Results Comparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p = 0.02 and per dietitian (p Conclusions Food and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent.
Diez-Garcia, Rosa Wanda; de Sousa, Anete Araújo; Proença, Rossana Pacheco da Costa; Leandro-Merhi, Vania Aparecida; Martinez, Edson Zangiacomi
Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals. Investigation of the Hospital Food and Nutrition Service (HFNS) of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ) and hospital food service quality (FSQ). HFNS was also evaluated with respect to human resources per hospital bed and per produced meal. Comparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p = 0.02) and per dietitian (p hospital type (general) and presence of a clinical dietitian. FSQ was affected by institution size: large and medium-sized hospitals were significantly better than small ones. Food and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent.
Blum, Torsten G; Rich, Anna; Baldwin, David; Beckett, Paul; De Ruysscher, Dirk; Faivre-Finn, Corinne; Gaga, Mina; Gamarra, Fernando; Grigoriu, Bogdan; Hansen, Niels C G; Hubbard, Richard; Huber, Rudolf Maria; Jakobsen, Erik; Jovanovic, Dragana; Konsoulova, Assia; Kollmeier, Jens; Massard, Gilbert; McPhelim, John; Meert, Anne-Pascale; Milroy, Robert; Paesmans, Marianne; Peake, Mick; Putora, Paul-Martin; Scherpereel, Arnaud; Schönfeld, Nicolas; Sitter, Helmut; Skaug, Knut; Spiro, Stephen; Strand, Trond-Eirik; Taright, Samya; Thomas, Michael; van Schil, Paul E; Vansteenkiste, Johan F; Wiewrodt, Rainer; Sculier, Jean-Paul
Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe. The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide variation in content and scope, as well as methodological quality but at the same time there was relevant duplication. The feasibility study demonstrated that it is, in principle, feasible to collect prospective demographic and clinical data on patients with lung cancer. Legal obligations vary among countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe.
Andersen, Christen Lykkegaard; Siersma, Volkert Dirk; Hasselbalch, Hans Carl
eosinophilia in routine blood samples as a potential biomarker of solid tumor development in a prospective design. MATERIAL AND METHODS: From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356 196 individuals with at least one differential cell count (DIFF) encompassing...... the eosinophil count during 2000-2007. From these, one DIFF was randomly chosen and categorized according to no (... was increased with mild eosinophilia [OR 1.93 (CI 1.29-2.89), p = 0.0013]. No associations with eosinophilia were observed for the remaining solid cancers. CONCLUSION: We demonstrate that eosinophilia in routine blood samples associates with an increased risk of bladder cancer. Our data emphasize...
Boucher, Nathan A; Mcmillen, Marvin A; Gould, James S
Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization's quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts.
Bruin-Kooistra, M. de; Amelink-Verburg, M.P.; Buitendijk, S.E.; Westert, G.P.
OBJECTIVE: To identify a set of indicators for monitoring the quality of maternity care for low-risk women provided by primary care midwives and general practitioners (GPs) in the Netherlands. DESIGN: A Project Group (midwives, GPs, policymakers and researchers) defined a long list of potential
and imposes a heavy financial burden on poor ... was to assess users' perceptions of quality of care given at outpatient department (OPD) at Kilosa ... Information on perceptions on care provider-patient interaction, cost of service, availability of medicines, equipment and health personnel was sought from the participants.
Objectives. To determine if a physician education programme and a structured consultation schedule would improve the quality of diabetes patient care in a diabetes clinic. Setting. Two tertiary care diabetes clinics at Kalafong Hospital, Pretoria. Study design. Quasi-experimental controlled before-and-after study. Methods.
The Research Connections collection contains records for more than 1,300 instruments that have been used to conduct studies in the child care and early education field. This bibliography provides records for instruments in the collection that can be used to observe child care quality in center-based settings serving infants and toddlers. In…
Objectives: To determine the quality of care provided by midwives in Soroti district; and specifically, to identify training needs, gaps in knowledge and other barriers to accessibility of emergency obstetric care (EmOC) services in Soroti district. Design: Cross-sectional descriptive study. Setting: One regional hospital, one ...
Satisfaction with Quality of Care Received by Patients without National Health Insurance Attending a Primary Care Clinic in a Resource.Poor Environment of a Tertiary Hospital in Eastern Nigeria in the Era of Scaling up the Nigerian Formal Sector Health In.
BACKGROUND: Chronic Non-Communicable Diseases are among the major causes of morbidity and mortality worldwide. However, access to and quality of health care for patients is very low in developing countries including Ethiopia. Hospitals and Health Centers are the main sources of health care for such patients in ...
It also assesses the extent of differences in service delivery and the impact these might have on outcomes. Methods: Data on all cancer ... to services available. Quality of care was assessed as superior at Tiyanjane, demonstrating the importance of multiple stakeholder involvement in the delivery of palliative care services.
Frandsen, Brigham R; Joynt, Karen E; Rebitzer, James B; Jha, Ashish K
To assess the relationship between care fragmentation and both quality and costs of care for commercially insured, chronically ill patients. We used claims data from 2004 to 2008 for 506,376 chronically ill, privately insured enrollees of a large commercial insurance company to construct measures of fragmentation. We included patients in the sample if they had chronic conditions in any of the following categories: cardiovascular disease, diabetes, asthma, arthritis, or migraine. We assigned each patient a fragmentation index based on the patterns of care of their primary care provider (PCP), with care patterns spread across a higher number of providers considered to be more fragmented. We used regression analysis to examine the relationship between fragmentation and both quality and cost outcomes. Patients of PCPs in the highest quartile of fragmentation had a higher chance of having a departure from clinical best practice (32.8%, vs 25.9% among patients of PCPs in the lowest quartile of fragmentation; P fragmentation had higher rates of preventable hospitalizations (9.1% in highest quartile vs 7.1% in lowest quartile; P fragmentation was associated with $4542 higher healthcare spending ($10,396 in the highest quartile vs $5854 in the lowest quartile; P < .001). We found similar or larger effects on quality and costs among patients when we examined the most frequently occurring disease groups individually. Chronically ill patients whose primary care providers offer highly fragmented care more often experience lapses in care quality and incur greater healthcare costs.
Perimal-Lewis, Lua; Teubner, David; Hakendorf, Paul; Horwood, Chris
Effective and accurate use of routinely collected health data to produce Key Performance Indicator reporting is dependent on the underlying data quality. In this research, Process Mining methodology and tools were leveraged to assess the data quality of time-based Emergency Department data sourced from electronic health records. This research was done working closely with the domain experts to validate the process models. The hospital patient journey model was used to assess flow abnormalities which resulted from incorrect timestamp data used in time-based performance metrics. The research demonstrated process mining as a feasible methodology to assess data quality of time-based hospital performance metrics. The insight gained from this research enabled appropriate corrective actions to be put in place to address the data quality issues. © The Author(s) 2015.
Bender, Miriam; Connelly, Cynthia D; Glaser, Dale; Brown, Caroline
The current fragmented healthcare system, characterized by a lack of collaborative, patient-centered care processes, creates significant barriers to providing quality patient care. The clinical nurse leader (CNL) is theorized to provide clinical leadership at the point-of-practice to maintain cross-disciplinary collaborative processes that lead to integrated quality care. The aim of this study was to assess the impact of CNL integration into an acute care microsystem on care quality, as measured by patient satisfaction with care. A short interrupted time series design was used to measure patient satisfaction with multiple aspects of care 10 months before and 12 months after integration of the CNL role on a progressive care unit, compared with a control unit. Data were obtained from Press Ganey surveys, and analysis was completed using a publicly available program for short time series data streams. Clinical nurse leader implementation was correlated with significantly improved patient satisfaction with admission processes (r = + .63, p = .02) and nursing care (r = +.75, p = .004), including skill level (r = .83, p = .003) and keeping patients informed (r = .70, p = .003). There was no significant correlation with improved patient satisfaction with physician care (r = .31, p = .14) or discharge processes (r = .33, p = .23) postimplementation. Control data showed no significant changes in patient satisfaction measures throughout the study time frame. The positive correlation between CNL-mediated collaborative care processes and improvements in patient satisfaction with care quality provides empirical evidence of outcomes achievable through CNL implementation. Research is needed to explore the full range of achievable outcomes and to determine the specific processes by which these outcomes are realized.
Growth monitoring and nutritional counselling at well child visits was generally inadequate, with not one of 11 children who qualified for food supplementation receiving it. Conclusion. The poor quality of PHC offered to children in the richest city in Africa is a sad indictment of the inability of health service providers to address ...
Stalpers, Dewi; Kieft, Renate A. M. M; Linden, Dimitri; Kaljouw, Marian J; Schuurmans, Marieke
.... However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive screening indicators and nurse-perceived quality of care. Methods...
Kooistra, Lisa C.; Ruwaard, Jeroen; Wiersma, Jenneke E.; Oppen, Patricia; van der Vaart, R.; van Gemert-Pijnen, Julia E.W.C.; Riper, Heleen
Background: Blended care combines face-to-face treatment with web-based components in mental health care settings. Blended treatment could potentially improve active patient participation, by letting patients work though part of the protocol autonomously. Further, blended treatment might lower the
Bergman, Simon; Deban, Melina; Martelli, Vanessa; Monette, Michèle; Sourial, Nadia; Hamadani, Fadi; Teasdale, Debby; Holcroft, Christina; Zakrzewski, Helena; Fraser, Shannon
Measuring the quality of surgical care is essential to identifying areas of weakness in the delivery of effective surgical care and to improving patient outcomes. Our objectives were to (1) assess the quality of surgical care delivered to adult patients; and (2) determine the association between quality of surgical care and postoperative complications. This retrospective, pilot, cohort study was conducted at a single university-affiliated institution. Using the institution's National Surgical Quality Improvement Program database (2009-2010), 273 consecutive patients ≥18 years of age who underwent elective major abdominal operations were selected. Adherence to 10 process-based quality indicators (QIs) was measured and quantified by calculating a patient quality score (no. of QIs passed/no. of QIs eligible). A pass rate for each individual QI was also calculated. The association between quality of surgical care and postoperative complications was assessed using an incidence rate ratio, which was estimated from a Poisson regression. The mean overall patient quality score was 67.2 ± 14.4% (range, 25-100%). The mean QI pass rate was 65.9 ± 26.1%, which varied widely from 9.6% (oral intake documentation) to 95.6% (prophylactic antibiotics). Poisson regression revealed that as the quality score increased, the incidence of postoperative complications decreased (incidence rate ratio, 0.19; P = .011). A sensitivity analysis revealed that this association was likely driven by the postoperative ambulation QI. Higher quality scores, mainly driven by early ambulation, were associated with fewer postoperative complications. QIs with unacceptably low adherence were identified as targets for future quality improvement initiatives. Copyright © 2014 Mosby, Inc. All rights reserved.
Schiøtz, Michaela L; Høst, Dorte; Christensen, Mikkel B; Domínguez, Helena; Hamid, Yasmin; Almind, Merete; Sørensen, Kim L; Saxild, Thomas; Holm, Rikke Høgsbro; Frølich, Anne
Multimorbidity is becoming increasingly prevalent and presents challenges for healthcare providers and systems. Studies examining the relationship between multimorbidity and quality of care report mixed findings. The purpose of this study was to investigate quality of care for people with multimorbidity in the publicly funded healthcare system in Denmark. To investigate the quality of care for people with multimorbidity different groups of clinicians from the hospital, general practice and the municipality reviewed records from 23 persons with multimorbidity and discussed them in three focus groups. Before each focus group, clinicians were asked to review patients' medical records and assess their care by responding to a questionnaire. Medical records from 2013 from hospitals, general practice, and health centers in the local municipality were collected and linked for the 23 patients. Further, two clinical pharmacologists reviewed the appropriateness of medications listed in patient records. The review of the patients' records conducted by three groups of clinicians revealed that around half of the patients received adequate care for the single condition which prompted the episode of care such as a hospitalization, a visit to an outpatient clinic or the general practitioner. Further, the care provided to approximately two-thirds of the patients did not take comorbidities into account and insufficiently addressed more diffuse symptoms or problems. The review of the medication lists revealed that the majority of the medication lists contained inappropriate medications and that there were incongruity in medication listed in the primary and secondary care sector. Several barriers for providing high quality care were identified. These included relative short consultation times in general practice and outpatient clinics, lack of care coordinators, and lack of shared IT-system proving an overview of the treatment. Our findings reveal quality of care deficiencies for
This article will give both examples and methods to use when providing services to individuals with a dual diagnosis of Down syndrome and Dementia. This is a prevalent issue that most care facilities are facing as the population with Down syndrome age. Staff training, schedule adjustments, living space adjustments and a new thought process…
Vollaard, Hans; van de Bovenkamp, Hester M.; Vrangbæk, Karsten
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 invo...
Electronic nursing documentation systems can facilitate complete, accurate, timely documentation practices, but without effective policies and procedures in place, a gap in practice exists and quality of care may be impacted. This systematic review of literature examined current evidence regarding electronic nursing documentation quality. General…
Background: The umpteenth threats to change of healthcare provider by dissatisfied patients on formal sector health insurance are well known and can be a proxy indicator for the need for quality improvement in service delivery. Objective: This study was aimed at evaluating patientsf satisfaction with quality of care provided ...
Original Article. [Downloaded free from http://www.amhsr.org on Tuesday, April 23, 2013, IP: 22.214.171.124] || Click here to download free Android application for this journal ... and hospital management on the quality of care provided with the aim of ..... behavior and coping mechanisms and overall quality of life of patients.
This presentation outlines the current position in England in respect of children's residential provision, takes a close look at leadership and resource issues as they relate to the quality of outcomes for young people and considers the prevailing issues in respect of the quality of care
Perception and Satisfaction with Quality of Antenatal Care Services among Pregnant Women at the University College Hospital, Ibadan, Nigeria. ... Items in the questionnaire included sociodemographic and obstetric variables, assessment of quality of amenities, waiting time and level of satisfaction. Data analysis was done ...
The interviews also explored the perspectives of individuals in each group on the broader question of what constitutes quality of care in a general sense. Their comments were subjected to qualitative analysis using SPSS software package. The different groups produced different views on what might determine the quality of ...
Good quality Antenatal Care (ANC) provides opportunity to detect and respond to risky maternal conditions. This study assessed quality of ANC services in eastern Uganda with a goal of benchmarking implications for interventions. Methods Data was collected from 15 health facilities in Eastern Uganda to establish capacity ...
Profit, Jochen; Gould, Jeffrey B.; Bennett, Mihoko; Goldstein, Benjamin A.; Draper, David; Phibbs, Ciaran S.; Lee, Henry C.
BACKGROUND Differences in neonatal intensive care unit (NICU) quality of care provided to very-low-birth-weight (VLBW; <1500g) infants may contribute to the persistence of racial/ethnic disparity. An examination of such disparities in a population-based sample across multiple dimensions of care and outcomes is lacking. METHODS Prospective observational analysis of 18,616 VLBW infants in 134 California NICUs between January 1, 2010 to December 31, 2014. We assessed quality of care delivery via the Baby-MONITOR, a composite indicator consisting of nine process and outcome measures of quality. For each NICU we calculated a risk adjusted composite and individual component quality score for each race/ethnicity. We standardized each score to the overall population to compare quality of care between and within NICUs. RESULTS We found clinically and statistically significant racial/ethnic variation in quality of care delivery between NICUs as well as within NICUs. Composite quality scores ranged by 5.26 standard units (range −2.30 to 2.96). Adjustment of Baby-MONITOR scores by race/ethnicity had only minimal effect on comparative assessments of NICU performance. Among subcomponents of the Baby-MONITOR, non-Hispanic White infants scored higher on measures of process compared with non-Hispanic Blacks and Hispanics. Compared with Whites, non-Hispanic Blacks scored higher on measures of outcome; Hispanics scored lower on seven of the nine Baby-MONITOR subcomponents. CONCLUSION Significant racial/ethnic variation in quality of care delivery exists between and within NICUs. Providing feedback of disparity scores to NICUs could serve as an important starting point for promoting improvement and reducing disparities. PMID:28847984
Lauritzen, Camilla; Reedtz, Charlotte; Van Doesum, Karin T M; Martinussen, Monica
Mental health problems are often transmitted from one generation to the next. This knowledge has led to changes in Norwegian legislation, making it mandatory to assess whether or not patients have children, and to provide necessary support for the children of mentally ill patients. The main purpose of this study was to evaluate the process of implementing new routines in adult mental health services to identify and support children of mentally ill parents. The design was a pre-test post-test study. The sample (N = 219 at pre-test and N = 185 at post-test) included mental health professionals in the largest hospital in the region, who responded to a web-based survey on the routines of the services, attitudes within the workforce capacity, worker's knowledge on the impact of parental mental illness on children, knowledge on legislation concerning children of patients, and demographic variables. The results of this study indicated that some changes are taking place in clinical practice in terms of increased identification of children. Adult mental health services providing support for the children was however not fully implemented as a new practice. The main finding in this study is that the identification frequency had increased significantly according to self-reported data since the Family Assessment Form was implemented. The increase in self-reported identification behavior is however taking place very slowly. Three years after the legislation was changed to making it mandatory to assess whether or not patients have children, it was still not fully incorporated in the routines of the entire workforce. In terms of support for the families affected by parental mental illness, the changes are not yet significant.
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
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.
Flöck, Anne; Tu, Ngoc-Chi; Rüland, Anna; Holzgreve, Wolfgang; Gembruch, Ulrich; Geipel, Annegret
Non-invasive prenatal tests (NIPT) for the determination of fetal aneuploidies from maternal blood are firmly established in clinical routine. For the first time, the accuracy of an NIPT for the determination of trisomies 21, 18 and 13 in singleton pregnancies was assessed by means of a prospective German-wide multicenter post-market clinical follow-up study, to reliably evaluate the quality in clinical routine. The study covered the indications for testing, the test results, the rate of invasive diagnostics and the pregnancy outcome. 2232 cases were tested for trisomy 21. Of these, 1946 cases were additionally examined for trisomy 18 and 13. Sensitivity and specificity for trisomy 21 (43/43) and for trisomy 13 (2/2) were 100%, for trisomy 18 the sensitivity was 80% (4/5) with a specificity of 99.8%. Three false-positive results for trisomy 18 were observed (FPR 0.15%). The no-call rate was 0.5%. In this subgroup, 27.3% (3/11) aneuploidies were diagnosed. The rate of invasive procedures was 2.6%. NIPT provides a very high quality for the fetal trisomies 21, 13 and 18 in clinical routine. The results support the recommendation that NIPT should be offered after genetic counseling and only in conjunction with a qualified ultrasound examination.
Netten, Ann; Trukeschitz, Birgit; Beadle-Brown, Julie; Forder, Julien; Towers, Ann-Marie; Welch, Elizabeth
quality ratings of care homes are used by decision makers in the absence of direct information about outcomes. However, there is little evidence about the relationship between regulators' ratings of homes and residents' quality of life outcomes. to capture social care-related quality of life (SCRQoL) outcomes for residents and investigate the relationship between outcomes and regulator quality ratings of homes. data were collected for 366 residents of 83 English care homes for older people inspected during 2008. Outcomes were measured using the Adult Social Care Outcomes Toolkit (ASCOT). Multivariate multilevel modelling was used to investigate the relationship between quality of life outcomes and star ratings of homes, controlling for resident and home characteristics. care homes were delivering substantial gains in SCRQoL, but were more successful in delivering 'basic' (e.g. personal cleanliness) than higher-order domains (e.g. social participation). Outcomes were associated with quality ratings of residential homes but not of nursing homes. the approach to providing quality ratings by the regulator in England is currently under review. Future quality indicators need to demonstrate their relationship with quality of life outcomes if they are to be a reliable guide to commissioners and private individuals purchasing care.
Yeaman, Paul A; Ford, James L; Kim, Kye Y
Providing quality palliative care is a daunting task profoundly impacted by diminished patient capacity at the end of life. Alzheimer disease (AD) is a disorder that erases our memories and is projected to increase dramatically for decades to come. By the time the patients with AD reach the end stage of the disease, the ability of patients to provide pertinent subjective complaints of pain and discomfort would have vanished. Historical perspectives of palliative care, exploration of the AD process, ethical issues, and crucial clinical considerations are provided to improve the understanding of disease progression and quality of care for patients with end-stage AD.
Mendes, Luis; Fradique, Maria de Jesus José Gil
The purpose of this paper is to investigate the extent to which nursing leadership, perceived by nursing staff, influences nursing quality. Data were collected between August and October 2011 in a Portuguese health center via a questionnaire completed by nurses. Our original sample included 283 employees; 184 questionnaires were received (65% response). The theoretical model presents reasonably satisfactory fit indices (values above literature reference). Path analysis between latent constructs clearly suggests that nursing leadership has a direct (beta = 0.724) and statistically significant (p = 0.007) effect on nursing quality. Results reinforce several ideas propagated throughout the literature, which suggests the relationship's relevance, but lacks empirical support, which this study corrects.
de Boer, Dolf; Hofstede, Jolien M; de Veer, Anke J E; Raijmakers, Natasja J H; Francke, Anneke L
Dying in the preferred setting is an indicator of good palliative care quality. Most people prefer to die at home. But does the quality of care as perceived by their relatives vary depending on the care setting that is the place of death? The aim is to compare (from the relatives perspective) whether there are perceived differences in the quality of palliative care between the settings in which people die. Multivariate linear regression analyses have been carried out using an existing dataset containing information collected using the relatives' version of the Consumer Quality Index (CQ-index) Palliative Care. The dataset includes 1368 relatives of patients with a wide variety of conditions who died in various locations: at home, in hospital, in residential care for the elderly, a hospice, palliative care unit or in another institution (e.g. institutions for people with intellectual disabilities or mental healthcare institutions). The relatives were the first contacts (family members or other people close to the patient) and they received the survey between 6 weeks and 6 months after the bereavement. Based on the raw data, differences between locations in terms of the perceived quality of care initially appeared inconsistent. The multivariate regression analyses however showed that relatives of people who died at home were generally the most positive about the palliative care that the patient and they themselves received when the patient was dying. The care provided by hospices also received a relatively good rating. In hospitals and in residential settings for care of the elderly, the care was rated less highly by the relatives. The quality of palliative care as experienced from the relatives' perspective is highest when the patient dies at home or in a hospice. This is an argument for letting people die at home, if they so wish, as far as possible and feasible.
Child Trends, 2010
This paper presents a profile of Mississippi's Quality Step System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Application…
Child Trends, 2010
This paper presents a profile of New Hampshire's Quality Rating System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…
Child Trends, 2010
This paper presents a profile of Illinois' Quality Counts prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family…
Child Trends, 2010
This paper presents a profile of Missouri's Quality Rating System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for…
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…
Paunova, Minna; Li-Ying, Jason; Egerod, Ingrid Eugenie
This study investigates the influence of nurse knowledge sharing behavior on nurse innovation, given different conditions of control of care quality within the intensive care unit (ICU). After conducting a number of interviews and a pilot study, we carried out a multi-source survey study of more...... than 200 nurses employed in 22 ICUs at 17 Danish hospitals. Overall, we find that knowledge sharing among individual ICU nurses has a positive impact on their innovation. Meanwhile, strong control of care quality makes this positive impact less effective. However, different aspects of knowledge sharing...... affect innovation differently, depending on the strength as well as type of control of care quality within the unit. Healthcare organizations face an increasing pressure to innovate while controlling and accounting for care quality. This study demonstrates that the increasing pressures to implement...
Papanikolaou, Vicky; Zygiaris, Sotiris
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.
Papanikolaou, Vicky; Zygiaris, Sotiris
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
van Bruggen, J.A.R.
In the Netherlands, a quality incentive is expected to ensue from improved collaboration between healthcare professionals. Whether this view is supported by sufficient evidence is, however, questionable. Therefore, the first study included in this thesis is a systematic review of studies on the
Hasman, A.; Safran, C.; Takeda, H.
OBJECTIVE: To discuss in what ways computer systems can contribute to the quality of healthcare and on which principles of informatics successful systems are based. METHODS: Part of the information was obtained via a literature search and part is based on the knowledge of the authors. RESULTS: The
Kowalczyk, Michał; Wrońska-Sewruk, Agnieszka; Nestorowicz, Andrzej
Nowadays, simple survival from a life threatening condition requiring treatment in an ICU, cannot be regarded as a sole indicator of the medical success. Patients expect to return to a more or less normal life, and to resume their daily activities. The aim of the study was to evaluate the health related quality of life (HRQOL) as a long-term indicator of successful outcome. The analyzed group consisted of patients treated over five years in ICUs of two different hospitals. Patients were asked to complete a questionnaire on the health related quality of life (HRQOL). Compared to the healthy population, the quality of life of patients treated in an ICU was significantly lower in all areas. The lowest results were noted in the physical and physiological aspects of patients who survived cardiac arrest and surgical procedures. There was no correlation found between quality of life and duration of ICU treatment. The HRQOL index correlated negatively with high APACHE II scores on admission. The HRQOL was also related to the pre-ICU health status and co-existing diseases.
van Dam, P A; Verkinderen, L; Hauspy, J; Vermeulen, P; Dirix, L; Huizing, M; Altintas, S; Papadimitriou, K; Peeters, M; Tjalma, W
Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. Assessment quality of care can be performed on different levels: national, regional, on a hospital basis or on an individual basis. It can be a mandatory or voluntary system. In all cases development of an adequate database for data extraction, and feedback of the findings is of paramount importance. In the present paper we performed a Medline search on "QIs and breast cancer" and "benchmarking and breast cancer care", and we have added some data from personal experience. The current data clearly show that the use of QIs for breast cancer care, regular internal and external audit of performance of breast units, and benchmarking are effective to improve quality of care. Adherence to guidelines improves markedly (particularly regarding adjuvant treatment) and there are data emerging showing that this results in a better outcome. As quality assurance benefits patients, it will be a challenge for the medical and hospital community to develop affordable quality control systems, which are not leading to excessive workload.
Edinger, Jack D.; Buysse, Daniel J.; Deriy, Ludmila; Germain, Anne; Lewin, Daniel S.; Ong, Jason C.; Morgenthaler, Timothy I.
The American Academy of Sleep Medicine (AASM) commissioned five Workgroups to develop quality measures to optimize management and care for patients with common sleep disorders including insomnia. Following the AASM process for quality measure development, this document describes measurement methods for two desirable outcomes of therapy, improving sleep quality or satisfaction, and improving daytime function, and for four processes important to achieving these goals. To achieve the outcome of improving sleep quality or satisfaction, pre- and post-treatment assessment of sleep quality or satisfaction and providing an evidence-based treatment are recommended. To realize the outcome of improving daytime functioning, pre- and post-treatment assessment of daytime functioning, provision of an evidence-based treatment, and assessment of treatment-related side effects are recommended. All insomnia measures described in this report were developed by the Insomnia Quality Measures Workgroup and approved by the AASM Quality Measures Task Force and the AASM Board of Directors. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with insomnia. Citation: Edinger JD, Buysse DJ, Deriy L, Germain A, Lewin DS, Ong JC, Morgenthaler TI. Quality measures for the care of patients with insomnia. J Clin Sleep Med 2015;11(3):311–334. PMID:25700881
Implementing a routine outcome assessment procedure to evaluate the quality of assistive technology service delivery for children with physical or multiple disabilities: Perceived effectiveness, social cost, and user satisfaction.
Desideri, Lorenzo; Bizzarri, Martina; Bitelli, Claudio; Roentgen, Uta; Gelderblom, Gert-Jan; de Witte, Luc
There is a lack of evidence on the effects and quality of assistive technology service delivery (ATSD). This study presents a quasi-experimental 3-months follow-up using a pre-test/post-test design aimed at evaluating outcomes of assistive technology (AT) interventions targeting children with physical and multiple disabilities. A secondary aim was to evaluate the feasibility of the follow-up assessment adopted in this study with a view to implement the procedure in routine clinical practice. Forty-five children aged 3-17 years were included. Parents were asked to complete the Individual Prioritised Problem Assessment (IPPA) for AT effectiveness; KWAZO (Kwaliteit van Zorg [Quality of Care]) and Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0 for satisfaction with ATSD; Siva Cost Analysis Instrument (SCAI) for estimating the social cost of AT interventions. At follow-up, 25 children used the AT recommended. IPPA effect sizes ranged from 1.4 to 0.7, showing a large effect of AT interventions. Overall, parents were satisfied with ATSD, but Maintenance, Professional Services, and AT Delivery were rated not satisfactory. SCAI showed more resources spent for AT intervention compared to human assistance without technological supports. AT may be an effective intervention for children with disabilities. Issues concerning responsiveness and feasibility of the IPPA and the SCAI instruments are discussed with a view to inform routine clinical practice.
Kooistra, L. C.; Ruwaard, J.; Wiersma, J. E.
the costs of mental health care, by reducing treatment duration and/or therapist contact. However, knowledge on blended care for depression is still limited. Objectives: To develop a blended cognitive behavioural treatment (bCBT) for depressed patients in an outpatient specialized mental health care centre...... and to conduct a preliminary evaluation of this bCBT protocol. Method: A bCBT protocol was developed, taking recommendations into account from depressed patients (n = 3) and therapists and experts in the field of e-health (n = 18). Next, an initial evaluation of integrated high-intensive bCBT was conducted...... with depressed patients (n = 9) in specialized mental health care. Patients' clinical profiles were established based on pre-treatment diagnostic information and patient self-reports on clinical measures. Patient treatment adherence rates were explored, together with patient ratings of credibility and expectancy...
Reddy, Ashok; Pollack, Craig E; Asch, David A; Canamucio, Anne; Werner, Rachel M
Primary care provider (PCP) turnover is common and can disrupt patient continuity of care. Little is known about the effect of PCP turnover on patient care experience and quality of care. To measure the effect of PCP turnover on patient experiences of care and ambulatory care quality. Observational, retrospective cohort study of a nationwide sample of primary care patients in the Veterans Health Administration (VHA). We included all patients enrolled in primary care at the VHA between 2010 and 2012 included in 1 of 2 national data sets used to measure our outcome variables: 326,374 patients in the Survey of Healthcare Experiences of Patients (SHEP; used to measure patient experience of care) associated with 8441 PCPs and 184,501 patients in the External Peer Review Program (EPRP; used to measure ambulatory care quality) associated with 6973 PCPs. Whether a patient experienced PCP turnover, defined as a patient whose provider (physician, nurse practitioner, or physician assistant) had left the VHA (ie, had no patient encounters for 12 months). Five patient care experience measures (from SHEP) and 11 measures of quality of ambulatory care (from EPRP). Nine percent of patients experienced a PCP turnover in our study sample. Primary care provider turnover was associated with a worse rating in each domain of patient care experience. Turnover was associated with a reduced likelihood of having a positive rating of their personal physician of 68.2% vs 74.6% (adjusted percentage point difference, -5.3; 95% CI, -6.0 to -4.7) and a reduced likelihood of getting care quickly of 36.5% vs 38.5% (adjusted percentage point difference, -1.1; 95% CI, -2.1 to -0.1). In contrast, PCP turnover was not associated with lower quality of ambulatory care except for a lower likelihood of controlling blood pressure of 78.7% vs 80.4% (adjusted percentage point difference, -1.44; 95% CI, -2.2 to -0.7). In 9 measures of ambulatory care quality, the difference between patients who experienced no
Green, Alexander R; Ngo-Metzger, Quyen; Legedza, Anna TR; Massagli, Michael P; Phillips, Russell S; Iezzoni, Lisa I
BACKGROUND Patients with limited English proficiency (LEP) have more difficulty communicating with health care providers and are less satisfied with their care than others. Both interpreter- and language-concordant clinicians may help overcome these problems but few studies have compared these approaches. OBJECTIVE To compare self-reported communication and visit ratings for LEP Asian immigrants whose visits involve either a clinic interpreter or a clinician speaking their native language. DESIGN Cross-sectional survey—response rate 74%. PATIENTS Two thousand seven hundred and fifteen LEP Chinese and Vietnamese immigrant adults who received care at 11 community-based health centers across the U.S. MEASUREMENTS Five self-reported communication measures and overall rating of care. RESULTS Patients who used interpreters were more likely than language-concordant patients to report having questions about their care (30.1% vs 20.9%, Pinterpreters highly (“excellent” or “very good”) were more likely to rate the health care they received highly (adjusted odds ratio 4.8, 95% confidence interval, 2.3 to 10.1). CONCLUSIONS Assessments of communication and health care quality for outpatient visits are similar for LEP Asian immigrants who use interpreters and those whose clinicians speak their language. However, interpreter use may compromise certain aspects of communication. The perceived quality of the interpreter is strongly associated with patients' assessments of quality of care overall. PMID:16307633
Schiøtz, Michaela L; Høst, Dorte; Christensen, Mikkel B
focus groups. Before each focus group, clinicians were asked to review patients' medical records and assess their care by responding to a questionnaire. Medical records from 2013 from hospitals, general practice, and health centers in the local municipality were collected and linked for the 23 patients...... the episode of care such as a hospitalization, a visit to an outpatient clinic or the general practitioner. Further, the care provided to approximately two-thirds of the patients did not take comorbidities into account and insufficiently addressed more diffuse symptoms or problems. The review......BACKGROUND: Multimorbidity is becoming increasingly prevalent and presents challenges for healthcare providers and systems. Studies examining the relationship between multimorbidity and quality of care report mixed findings. The purpose of this study was to investigate quality of care for people...
Toci, Ashley L; Hyer, J Madison; Silver, Richard M; Nietert, Paul J; Hant, Faye N
Among patients with systemic sclerosis (SSc), early recognition of potentially life-threatening organ involvement is critical. Because prompt recognition of early signs of organ involvement can dramatically alter a patient׳s outcome, it is crucial that patients and primary care providers (PCPs) recognize these symptoms. We conducted a survey of patients with SSc regarding their perceptions of the quality of their primary care, and whether or not they perceive the quality of their primary care to be impaired by their scleroderma diagnosis. A mail survey was sent to 525 patients with SSc seen at the Medical University of South Carolina. Questionnaire items addressed demographics and perceptions of their quality of their primary care. Of n = 140 respondents, most (74.5%) did not feel as though their diagnosis of SSc has resulted in barriers to appropriate or satisfactory care, and most (81.3%) answered that they had not ever felt as though their medical concerns were not being addressed because they had SSc. Perceptions of barriers were significantly (P < 0.05) associated with female sex and younger age, along with poorer overall quality of care and satisfaction with their primary care. Most patients with SSc value the quality of their primary care. However, some patients with SSc feel that their PCPs do not adequately monitor their blood pressure, reflux symptoms or shortness of breath. These results highlight the importance of PCPs in the overall care of patients with SSc and the need for continued education regarding close monitoring of signs and symptoms suggestive of possible life-threatening internal organ involvement. Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
Hegewald, Matthew J; Gallo, Heather M; Wilson, Emily L
Spirometry is necessary for the optimal management of patients with respiratory disease. The quality of spirometry performed in the primary care setting has been inconsistent. We aimed to evaluate spirometer accuracy, determine the clinical significance of inaccurate spirometers, and assess the quality of spirograms obtained in primary care offices. We tested 17 spirometers used in primary care offices with a waveform generator; accuracy and precision were assessed using American Thoracic Society criteria. The clinical significance of inaccurate instruments was determined by applying the FEV 1 /FVC error from an obstructed waveform to a clinical data set. Spirogram quality was determined by grading spirograms using acceptability and repeatability criteria. The relationship between the number of tests performed by a clinic and test quality was assessed. Only 1 of 17 spirometers met accuracy criteria, with mean errors for FVC, FEV 1 , and FEV 1 /FVC ranging from 1.7 to 3.1%. Applying the percentage error to a clinical data set resulted in 28% of tests being recategorized from obstructed to nonobstructed. Of the spirograms reviewed, 60% were considered acceptable for clinical use. There was no association between the number of tests performed by a clinic and spirometry quality. Most spirometers tested were not accurate. The magnitude of the errors resulted in significant changes in the categorization of patients with obstruction. Acceptable-quality tests were produced for only 60% of patients. Our results raise concerns regarding the utility of spirometry obtained in primary care offices without greater attention to quality assurance and training.
Krahn, Lois E.; Hershner, Shelley; Loeding, Lauren D.; Maski, Kiran P.; Rifkin, Daniel I.; Selim, Bernardo; Watson, Nathaniel F.
The American Academy of Sleep Medicine (AASM) commissioned a Workgroup to develop quality measures for the care of patients with narcolepsy. Following a comprehensive literature search, 306 publications were found addressing quality care or measures. Strength of association was graded between proposed process measures and desired outcomes. Following the AASM process for quality measure development, we identified three outcomes (including one outcome measure) and seven process measures. The first desired outcome was to reduce excessive daytime sleepiness by employing two process measures: quantifying sleepiness and initiating treatment. The second outcome was to improve the accuracy of diagnosis by employing the two process measures: completing both a comprehensive sleep history and an objective sleep assessment. The third outcome was to reduce adverse events through three steps: ensuring treatment follow-up, documenting medical comorbidities, and documenting safety measures counseling. All narcolepsy measures described in this report were developed by the Narcolepsy Quality Measures Work-group and approved by the AASM Quality Measures Task Force and the AASM Board of Directors. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with narcolepsy. Citation: Krahn LE, Hershner S, Loeding LD, Maski KP, Rifkin DI, Selim B, Watson NF. Quality measures for the care of patients with narcolepsy. J Clin Sleep Med 2015;11(3):335–355. PMID:25700880
Nakanishi, Miharu; Hirooka, Kayo; Morimoto, Yuko; Nishida, Atsushi
Palliative care for dementia includes psychosocial interventions as first-line treatment for challenging behaviour. However, the national dementia plan in Japan contradicts recommendations for palliative care for dementia. This study aimed to examine the association between care quality for patients with dementia and professional caregivers' perspectives regarding palliative care for dementia in Japanese community care settings. In total, 2116 professional caregivers from 329 agencies (217 in-home long-term care support providers; 29 small-scale, multiple home-care providers; and 83 group homes) in Tokyo prefecture, Japan, completed cross-sectional, paper-based questionnaires about 3603 people diagnosed with dementia, in May 2016. Quality of care measures included physical restraint and antipsychotic medication use and quality of life. Patients' quality of life was assessed via the Japanese version of the Alzheimer's Disease Health-related Quality of Life scale. The Japanese version of the Questionnaire on Palliative Care for Advanced Dementia was used to assess professional caregivers' knowledge and attitudes regarding palliative care for dementia. Professional caregivers' knowledge and attitudes regarding palliative care for dementia were positively associated with quality of life in patients with dementia. Physical restraint and antipsychotic medication were used regardless of professional caregivers' knowledge and attitudes. Professional caregivers' perspectives regarding palliative care for dementia could have exerted a positive effect on quality of life in patients with dementia. A national strategy for advocacy and the protection of adults is required to integrate several laws and guidelines and prevent the use of antipsychotics as a form of chemical restraint. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Full Text Available Abstract Background Many women in Sub-Saharan African countries do not receive key recommended interventions during routine antenatal care (ANC including information on pregnancy, related complications, and importance of skilled delivery attendance. We undertook a process evaluation of a successful cluster randomized trial testing the effectiveness of birth plans in increasing utilization of skilled delivery and postnatal care in Ngorongoro district, rural Tanzania, to document the time spent by health care providers on providing the recommended components of ANC. Methods The study was conducted in 16 health units (eight units in each arm of the trial. We observed, timed, and audio-recorded ANC consultations to assess the total time providers spent with each woman and the time spent for the delivery of each component of care. T-test statistics were used to compare the total time and time spent for the various components of ANC in the two arms of the trial. We also identified the topics discussed during the counselling and health education sessions, and examined the quality of the provider-woman interaction. Results The mean total duration for initial ANC consultations was 40.1 minutes (range 33-47 in the intervention arm versus 19.9 (range 12-32 in the control arm p Conclusion Although the implementation of birth plans in the intervention health units improved provider-women dialogue on skilled delivery attendance, most recommended topics critical to improving maternal and newborn survival were rarely covered.
Hendriks, M.; Dahlhaus-Booij, J.; Plass, A.M.
Objective: Clients’ perspective on the quality of audiology care has not been investigated thoroughly. Research has focused primarily on satisfaction with, and limitations of hearing aids. We developed a Consumer Quality Index (CQI) questionnaire ‘Audiology Care’ to systematically assess client
van Dillen, S M E; Noordman, J; van Dulmen, S; Hiddink, G J
To assess the quality of weight-loss counseling provided by Dutch primary care practice nurses (PNs) to overweight and obese patients including both PNs' compliance with the Five A's Model for behavioral counseling in primary care, and the use of different communication styles. In addition, relationships between PN/patient characteristics (including Five A's) and communication styles will be examined. In this observational study, 100 videotaped real-life consultations, collected in 2010/2011, were viewed using an observational checklist. Selection of consultations was based on PNs' registration of patient's complaint. The quality of weight-loss counseling was assessed by the Five A's Model (sequence of evidence-based practice behaviors that are effective for helping patients to change health behaviors) and by PNs' communication styles. Moreover, several PN and patient characteristics were registered. Descriptive statistics and logistic regression analysis were conducted with significance set at Pcounseling might be increased by routinely providing assistance in addressing barriers and securing support, and routinely reaching agreement with collaboratively set goals.
Britt, Christopher J; Chang, Hsien-Yen; Quon, Harry; Kang, Hyunseok; Kiess, Ana P; Eisele, David W; Frick, Kevin D; Gourin, Christine G
To examine associations between quality, complications, and costs in commercially insured patients treated for laryngeal cancer. Retrospective cross-sectional analysis of MarketScan Commercial Claim and Encounters data (Truven Health Analytics, Ann Arbor, Michigan, U.S.A.). We evaluated 10,969 patients diagnosed with laryngeal cancer from 2010 to 2012 using cross-tabulations and multivariate regression. Using quality indicators derived from guidelines for recommended care, summary measures of quality were calculated for diagnosis, initial treatment, surveillance, treatment for recurrence, performance, and an overall summary measure of quality. Higher-quality care in the initial treatment period was associated with lower odds of 30-day mortality (odds ratio [OR] = 0.21, 95% confidence interval [CI] [0.04-0.98]), surgical complications (OR = 0.39 [0.17-0.88]), and medical complications (OR = 0.68 [0.49-0.96]). Mean incremental 1-year costs were higher for higher-quality diagnosis ($20,126 [$14,785-$25,466]), initial treatment ($17,918 [$10,481-$25,355]), and surveillance ($25,424 [$20,014-$30,834]) quality indicators, whereas costs were lower for higher-quality performance measures (-$45,723 [-$56,246--$35,199]) after controlling for all other variables. Higher-quality care was associated with significant differences in mean incremental costs for initial treatment in surgical patients ($-37,303 [-$68,832--$5,775]), and for the overall summary measure of quality in patients treated nonoperatively ($10,473 [$1,121-$19,825]). After controlling for the overall summary measure of quality, costs were significantly lower for patients receiving high-volume surgical care (mean -$18,953 [-$28,381--$9,426]). Higher-quality larynx cancer care in commercially insured patients was associated with lower 30-day mortality and morbidity. High-volume surgical care was associated with lower 1-year costs, even after controlling for quality. These data have implications for discussions of
Anastassiou, George A
“Intelligent Routines II: Solving Linear Algebra and Differential Geometry with Sage” contains numerous of examples and problems as well as many unsolved problems. This book extensively applies the successful software Sage, which can be found free online http://www.sagemath.org/. Sage is a recent and popular software for mathematical computation, available freely and simple to use. This book is useful to all applied scientists in mathematics, statistics and engineering, as well for late undergraduate and graduate students of above subjects. It is the first such book in solving symbolically with Sage problems in Linear Algebra and Differential Geometry. Plenty of SAGE applications are given at each step of the exposition.
Rumbold, Alice R; Bailie, Ross S; Si, Damin; Dowden, Michelle C; Kennedy, Catherine M; Cox, Rhonda J; O'Donoghue, Lynette; Liddle, Helen E; Kwedza, Ru K; Thompson, Sandra C; Burke, Hugh P; Brown, Alex D H; Weeramanthri, Tarun; Connors, Christine M
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. 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. 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. Participating services had both strengths and weaknesses in the delivery of maternal health care. Increasing access to evidence-based screening and
Kwedza Ru K
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
Olufajo, Olubode A; Tulebaev, Samir; Javedan, Houman; Gates, Jonathan; Wang, Justin; Duarte, Maria; Kelly, Edward; Lilley, Elizabeth; Salim, Ali; Cooper, Zara
Although involvement of geriatricians in the care of older trauma patients is associated with changes in processes of care and improved outcomes, few geriatrician consultations were ordered on our service. Mandatory geriatric consults were initiated in September 2013 for all trauma patients 70 years and older admitted to our hospital. We prospectively collected data on patients admitted from October 2013 through September 2014 (postintervention) and compared their data with those of patients admitted from June 2011 through June 2012 (preintervention). We collected data on processes of care (DNR and do not intubate status, delirium, and referral for cognitive evaluation) and patient outcomes (mortality, readmission, and length of stay). Descriptive statistics and post-hoc power analyses were performed. There were 215 and 191 patients included in the preintervention and postintervention cohorts, respectively. After the intervention, geriatric consults increased from 3.26% to 100%. Patients with DNR and do not intubate status increased from 10.23% to 38.22% (p patients were needed to show statistically significant outcomes. The initiation of mandatory geriatric consults on our trauma service was associated with improved advance care planning and increased multidisciplinary care. Ensuring involvement of geriatricians can aid in reducing adverse outcomes among geriatric trauma patients. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Stewart, Karen; Hargreaves, Claire; Jasper, Rowan; Challis, David; Tucker, Sue; Wilberforce, Mark
This study examined the nature, extent and perceived quality of the support provided by community mental health teams for older people (CMHTsOP) to care home residents. A postal survey was sent to all CMHTsOP in England. Information was collected about teams' staffing and their involvement in case finding, assessment, medication reviews, care planning and training as well as team managers' rating of the perceived quality of the service they provided for care home residents. Data were analysed using chi-squared tests of association and ordinal regression. Responses were received from 225 (54%) CMHTsOP. Only 18 per cent of these teams contained staff with allocated time for care home work. Services for care home residents varied considerably between teams. Two-fifths of teams provided formal training to care home staff. Team managers were more likely to perceive the quality of their service to care homes as good if they had a systematic process in place for reviewing antipsychotic drugs or routine mental health reviews, including contact with a GP. The findings suggested that more evidence is needed on the best approach for supporting care home residents with mental health needs. Areas to consider are the potential benefits of training to care home staff and regular mental health reviews, utilising links between GPs and CMHTsOP. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.
Nembhard, Ingrid M; Northrup, Veronika; Shaller, Dale; Cleary, Paul D
The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. To evaluate the impact of collaborative membership on organizational climate for quality and service quality. Twenty-one clinics, 4 of which participated in a collaborative sponsored by the Institute for Clinical Systems Improvement. Pre-post design. Preassessments occurred 2 months before the collaborative began in January 2009. Postassessments of service quality and climate occurred about 6 months and 1 year, respectively, after the collaborative ended in January 2010. We surveyed clinic employees (eg, physicians, nurses, receptionists, etc.) about the organizational climate and patients about service quality. Prioritization of quality care, high-quality staff relationships, and open communication as indicators of quality-oriented climate and timeliness of care, staff helpfulness, doctor-patient communication, rating of doctor, and willingness to recommend doctor's office as indicators of service quality. There was no significant effect of collaborative membership on quality-oriented climate and mixed effects on service quality. Doctors' ratings improved significantly more in intervention clinics than in control clinics, staff helpfulness improved less, and timeliness of care declined more. Ratings of doctor-patient communication and willingness to recommend doctor were not significantly different between intervention and comparison clinics. Membership in the collaborative provided no significant advantage for improving quality-oriented climate and had equivocal effects on service quality.
Child care researchers divide child care quality into two separate categories: structural child care quality (adult-child ratios, class size, amount of physical space, etc.) and dynamic child care quality (number and quality of teacher-child relationships). A consensus has emerged in the child care literature that structural child care quality has no direct effect on children's developmental outcomes (e.g., language development, social development, school readiness) . Rather, structural child...
Yuguero, Oriol; Marsal, Josep Ramon; Buti, Miquel; Esquerda, Montserrat; Soler-González, Jorge
The doctor-patient relationship is a crucial aspect of primary-care practice Research on associations between quality of care provision and burnout and empathy in a primary care setting could improve this relationship. Cross-sectional study of family physicians (108) and nurses (112) of twenty-two primary care centers in the health district of Lleida, Spain. Empathy and burnout were measured using the Jefferson Physician Empathy Scale and the Maslach Burnout Inventory, while quality of care delivery was evaluated using Quality Standard Indicator scores. JPSE and MBI results were grouped into low, medium, and high scores to analyze associations with QSI scores and sociodemographic variables. The mean QSI score recorded for the family physicians and nurses was 665 (out of a total of 1000). Higher, albeit insignificant, QSI scores were observed for practitioners with high burnout. No differences were observed according to level of empathy (p > 0.05). The differences with respect to sex, age, and area of practice (urban vs rural center) were not significant. Practitioners with low empathy had higher QSI scores than those with high empathy (672.8 vs. 654.4) while those with high burnout had higher scores than those with low burnout (702 vs. 671). Burnout and empathy did not significantly influence quality of care delivery scores in 22 primary care centers. More studies, however, are needed to investigate the unexpected trend observed that suggests that physicians and nurses with higher levels of burnout provide higher quality care.
Satyanarayana, S.; Subbaraman, R.; Shete, P.; Gore, G.; Das, J.; Cattamanchi, A.; Mayer, K.; Menzies, D.; Harries, A. D.; Hopewell, P.; Pai, M.
SUMMARY BACKGROUND While Indian studies have assessed care providers’ knowledge and practices, there is no systematic review on the quality of tuberculosis (TB) care. METHODS We searched multiple sources to identify studies (2000–2014) on providers’ knowledge and practices. We used the International Standards for TB Care to benchmark quality of care. RESULTS Of the 47 studies included, 35 were questionnaire surveys and 12 used chart abstraction. None assessed actual practice using standardised patients. Heterogeneity in the findings precluded meta-analysis. Of 22 studies evaluating provider knowledge about using sputum smears for diagnosis, 10 found that less than half of providers had correct knowledge; 3 of 4 studies assessing self-reported practices by providers found that less than a quarter reported ordering smears for patients with chest symptoms. In 11 of 14 studies that assessed treatment, less than one third of providers knew the standard regimen for drug-susceptible TB. Adherence to standards in practice was generally lower than correct knowledge of those standards. Eleven studies with both public and private providers found higher levels of appropriate knowledge/practice in the public sector. CONCLUSIONS Available evidence suggests suboptimal quality of TB care, particularly in the private sector. Improvement of quality of care should be a priority for India. PMID:26056098
James, Katherine M; Cowl, Clayton T; Tilburt, Jon C; Sinicrope, Pamela S; Robinson, Marguerite E; Frimannsdottir, Katrin R; Tiedje, Kristina; Koenig, Barbara A
To assess the impact of direct-to-consumer (DTC) predictive genomic risk information on perceived risk and worry in the context of routine clinical care. Patients attending a preventive medicine clinic between June 1 and December 18, 2009, were randomly assigned to receive either genomic risk information from a DTC product plus usual care (n=74) or usual care alone (n=76). At intervals of 1 week and 1 year after their clinic visit, participants completed surveys containing validated measures of risk perception and levels of worry associated with the 12 conditions assessed by the DTC product. Of 345 patients approached, 150 (43%) agreed to participate, 64 (19%) refused, and 131 (38%) did not respond. Compared with those receiving usual care, participants who received genomic risk information initially rated their risk as higher for 4 conditions (abdominal aneurysm [P=.001], Graves disease [P=.04], obesity [P=.01], and osteoarthritis [P=.04]) and lower for one (prostate cancer [P=.02]). Although differences were not significant, they also reported higher levels of worry for 7 conditions and lower levels for 5 others. At 1 year, there were no significant differences between groups. Predictive genomic risk information modestly influences risk perception and worry. The extent and direction of this influence may depend on the condition being tested and its baseline prominence in preventive health care and may attenuate with time.
Pettersson, Karen Odberg; Johansson, Eva; Pelembe, Maria de Fatima M; Dgedge, Clemencia; Christensson, Kyllike
Our purpose in this study was to explore the midwives' perception of factors obstructing or facilitating their ability to provide quality perinatal care at a central labor ward in Maputo. In-depth interviews were undertaken with 16 midwives and were analyzed according to grounded theory technique. Barriers to provision of quality perinatal care were identified as follows: (i) the unsupportive environment, (ii) nonempowering and limited interaction with women in labor, (iii) a sense of professional inadequacy and inferiority, and (iv) nonappliance of best caring practices. A model based on the midwives' reflections on barriers to quality perinatal care and responses to these were developed. Actions aimed at overcoming the barriers were improvising and identifying areas in need of change. Identified evading actions were holding others accountable and yielding to dysfunction and structural control. In order to improve perinatal care, the midwives need to see themselves as change agents and not as victims of external and internal causal relationships over which they have no influence. It is moreover essential that the midwives chose actions aiming at overcoming barriers to quality perinatal care instead of choosing evading actions, which might jeopardize the health of the unborn and newborn infant. We suggest that local as well as national education programs need to correspond with existing reality, even if they provide knowledge that surpasses the present possibilities in practice. Quality of intrapartum and the immediate newborn care requires a supportive environment, however, which in the context of this study presented such serious obstacles that they need to be addressed on the national level. Structural and administrative changes are difficult to target as these depend on national organization of maternal health care (MHC) services and national health expenditures.
Saliba, Debra; Schnelle, John F
To identify quality indicators (QIs) that can be used to measure nursing home (NH) residential care processes. Modified-delphi panel process to rate potential QIs that were identified through reported interviews with residents and families and through a review of the scientific literature. Meetings of panel of experts. A national panel of nine experts in NH care rated potential QIs. A content expert and a clinical oversight committee performed external reviews. Panelists' median validity and importance ratings for each QI choice. The panel considered 64 choices for QI content and rated 28 of these as valid and important for measuring residential care quality. These 28 choices translated into 18 QIs. The external review process resulted in the addition of one QI that was not considered by the NH panel. The 19 indicators address areas identified as important by residents and proxies. Ten of these QIs were rated feasible to implement with current resources in average community NHs, and nine were rated feasible only in better NHs. The panelists identified nine as being measured most reliably by direct observations of care. Experts identified 19 specific care processes as valid and important measures of the quality of NH residential care. Nine of these QIs may be measured best by direct observation of NH care, rather than by interviews or review of existing NH records. Almost half of the QIs were viewed as discriminating between better and average NHs. The panel deemed that only well-staffed nursing homes could consistently implement nine of the QIs.
Full Text Available A fundamental paradox of the health care delivery systems in many industrialized nations is that desired population health metrics are often not achieved despite large expenditures in the health care delivery system. For example, the United States commits nearly 18% of its GDP to the health care delivery system, the largest amount of any nation, yet is 37th in achieving health or health care delivery metrics. This article addresses how general practice can be an important driver of population health in the Chinese health care delivery system through the application of quality improvement methods. The article shows examples of how the cause-and-effect diagram, the process map, and the plan, do, study, act (PDSA cycle are important techniques to assist primary care practitioners for improving population health.
Full Text Available Maternal auditory stimulation is playing an increasing role in neonatal critical care. The goal of this study was to determine the dose variability in the administration of Biological Maternal Sounds (BMS in Very Low Birth Weight (VLBW infants as part of routine clinical care in the Neonatal Intensive Care Unit (NICU. The BMS intervention aimed to provide infants with individualized and biologically appropriate auditory stimuli, featuring acoustic stimuli from their own mothers. Sixteen preterm infants, born between 26-32 weeks gestational age (GA and < 1,500 g, took part in this study. The study was conducted in a 46-bed, level-III NICU with four multi-patient pods. Mother’s voice and heartbeat sounds were recorded individually for each infant. Nurses were instructed to administer BMS 4x per 24-hour period by pressing play on an MP3 player connected to micro-speakers installed in the infant’s bed. BMS was initiated for each infant on approximately the sixth day of life (DOL (mean = 5.78 ± 2 and continued until NICU discharge (mean length of stay = 46.62 ± 27.28. On average, infants received 80% of the target BMS dose. There were no significant differences in BMS administration between nursing shift (day vs. night; p = 0.35, bed type (crib vs. isolette; p = .41, and respiratory support (on vs. off oxygen; p = .93. There was a slight increase in the number of times BMS was initiated on days without exams versus days with exams; however, this difference was not statistically significant (p = 0.07. This study demonstrated the successful incorporation of maternal sounds into routine daily care in VLBW infants as early as DOL six until NICU discharge. The effectiveness of BMS needs to be further evaluated in a randomized controlled trial.
Xiaoxiao Jiang; Louise L Hardy; Louise A Baur; Ding Ding; Ling Wang; Huijing Shi
.... This study reports on the sleep hygiene of urban Chinese school students, and investigates the relationship between habitual after-school activities and sleep duration, schedule and quality on a regular school day...
Jiang, Xiaoxiao; Hardy, Louise L; Baur, Louise A; Ding, Ding; Wang, Ling; Shi, Huijing
.... This study reports on the sleep hygiene of urban Chinese school students, and investigates the relationship between habitual after-school activities and sleep duration, schedule and quality on a regular school day...
Walter, Daniel; Dachs, Lydia; Faber, Martin; Goletz, Hildegard; Goertz-Dorten, Anja; Hautmann, Christopher; Kinnen, Claudia; Rademacher, Christiane; Schuermann, Stephanie; Metternich-Kaizman, Tanja Wolff; Doepfner, Manfred
Few studies have examined the effectiveness of outpatient cognitive-behavioral therapy (CBT) delivered in routine care settings for children and adolescents with mental disorders. This observational study examined changes in behavioral and emotional problems of adolescents with mental disorders during routine outpatient CBT delivered at a university outpatient clinic and compared them with a historical control group of youths who received academic tutoring of comparable length and intensity. Assessments were made at the start and end of treatment (pre- and post-assessment) using parent ratings of the German versions of the Child Behavior Checklist (CBCL) and self-ratings of the Youth Self-Report (YSR) scale. For the main analysis, 677 adolescents aged 11‒21 years had complete data. Changes from pre- to post-assessment showed significant reductions in mental health problems on both parent- and self-ratings. Pre- to post-effect sizes (Cohen's d) were small-to-medium for the total sample (d = 0.23 to d = 0.62) and medium-to-large for those adolescents rated in the clinical range on each (sub)scale at the start of treatment (d = 0.65 to d = 1.48). We obtained medium net effect sizes (d = 0.69) for the CBCL and YSR total scores when patients in the clinical range were compared to historical controls. However, a substantial part of the sample remained in the clinical range at treatment end. The results suggest that CBT is effective for adolescents with mental disorders when administered under routine care conditions but must be interpreted conservatively due to the lack of a direct control condition.
Wagner, Till; Fydrich, Thomas; Stiglmayr, Christian; Marschall, Paul; Salize, Hans-Joachim; Renneberg, Babette; Fleßa, Steffen; Roepke, Stefan
Societal cost-of-illness in a German sample of patients with borderline personality disorder (BPD) was calculated for 12 months prior to an outpatient Dialectical Behavior Therapy (DBT) program, during a year of DBT in routine outpatient care and during a follow-up year. We retrospectively assessed resource consumption and productivity loss by means of a structured interview. Direct costs were calculated as opportunity costs and indirect costs were calculated according to the Human Capital Approach. All costs were expressed in Euros for the year 2010. Total mean annual BPD-related societal cost-of-illness was €28026 (SD = €33081) during pre-treatment, €18758 (SD = €19450) during the DBT treatment year for the 47 DBT treatment completers, and €14750 (SD = €18592) during the follow-up year for the 33 patients who participated in the final assessment. Cost savings were mainly due to marked reductions in inpatient treatment costs, while indirect costs barely decreased. In conclusion, our findings provide evidence that the treatment of BPD patients with an outpatient DBT program is associated with substantial overall cost savings. Already during the DBT treatment year, these savings clearly exceed the additional treatment costs of DBT and are further extended during the follow-up year. Correspondingly, outpatient DBT has the potential to be a cost-effective treatment for BPD patients. Efforts promoting its implementation in routine care should be undertaken. Copyright © 2014 Elsevier Ltd. All rights reserved.
Shankar, Kalpana N; Bhatia, Bhavnit K; Schuur, Jeremiah D
Observers have cited a quality gap between the current emergency care and the needs of elderly adults in the emergency setting. The Institute of Medicine identified patient-centeredness as a vital aim of quality health care. To develop a patient-centered approach in the emergency setting, we must first understand the elderly patients' views of their emergency care. Thus, we performed a systematic review to synthesize the current knowledge about the elderly patient's preferences and views of their emergency care. Systematic review of qualitative studies and surveys addressing the elderly patients' views of their emergency care using PUBMED and CINAHL. Using meta-ethnography, we identified 6 broad themes about the elderly's perspectives of hospital-based emergency care. Of the 81 articles initially identified, our final review included 28 articles. We developed 6 themes of quality emergency care: (1) role of health care providers; (2) content of communication and patient education; (3) barriers to communication; (4) wait times; (5) physical needs in the emergency care setting; and (6) general elder care needs. Key findings were that emergency staff should (1) assume a leadership role with both the medical and social needs; (2) initiate communication frequently; (3) minimize potential barriers to communication; (4) check on patients during prolonged periods of waiting; (5) attend to distress caused by physical discomforts in the emergency care setting; and (6) address general elder care needs, including the care transition and involvement of caregivers when necessary. Current qualitative research on the views of the elderly patient to hospital-based emergency care reveals common themes that should be considered in efforts to improve delivery of care to the elderly patient. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
Wang, Wen-Liang; Chang, Hong-Jer; Liu, An-Chi; Chen, Yu-Wen
The purpose of this paper was to determine the criteria that reflect the quality of care provided by long-term care institutions. Research was conducted using a two-step procedure that first utilized the SERVQUAL model with Fuzzy Delphi Method to establish the proper criteria by which service quality could be measured. A total of 200 questionnaires were mailed to expert respondents, of which 89 were returned and 77 deemed valid for use in this study. We then applied the Multi-Criteria Decision Making Process to determine the degree of importance of each criterion to long-term care institution service quality planning work. Secondly, 200 questionnaires were distributed and 74 valid responses were returned. Based on the 5 SERVQUAL model constructs, this study found 17 of the 28 criteria, to be pertinent to nursing care quality, with those in the Responsiveness and Empathy domains being the ones most critical.
Koning, N.R; Moons, L.N.G; Büchner, F.L.; Helsper, C.W.; ten Teije, A.C.M.; Numans, M.E.
Background Early diagnosis of colorectal cancer (CRC) is likely to reduce burden of disease and improve treatment success. Estimation of the individual patient risk for CRC diagnostic determinants in a primary care setting has not been very successful as yet. The aim of our study is to improve
Teichgraeber, U.K.; Bittner, R.C.; Born, C.; Pinkernelle, J.G. [Klinik fuer Strahlenheilkunde, Charite Campus Virchow-Klinikum, Berlin (Germany); Barckow, D. [Charite Campus Virchow-Klinikum, Berlin (Germany). Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin
Utility and applicability of a mobile computer tomography system in intensive care. A report on Philips' mobile Tomoscan M spiral CT system in practice. [German] Nutzen und Anwendbarkeit eines mobil einsetzbaren CT-Geraetes im intensivmedizinischen Einsatz. Ein Praxisbericht ueber das mobile Spiral-CT-System Tomoscan M von Philips. (orig.)
Jones, Rupert C. M.; Price, David; Ryan, Dermot; Sims, Erika J.; von Ziegenweidt, Julie; Mascarenhas, Laurence; Burden, Anne; Halpin, David M. G.; Winter, Robert; Hill, Sue; Kearney, Matt; Holton, Kevin; Moger, Anne; Freeman, Daryl; Chisholm, Alison; Bateman, Eric D.; an den Berge, Maarten; Anzueto, Antonio; Augusti, Alvar; Bafadhel, Mona; Backer, Vibeke; Barnes, Peter J.; Becker, Allan; Bjermer, Leif; Brightling, Chris; Brusselle, Guy; Buist, Sonia; Calverley, Peter; Chavannes, Niels H.; Christoff, George; Bacharier, Leonard B.; Blakey, John; Bosnic-Anticevich, Sinthia; Bousquet, Jean; Briggs, Andy; Brown, Randall; Campbell, Jonathan; Chystyn, Henry; Clark, Noreen M.; Colice, Gene; Dima, Alexandra; Eakin, Michelle N.; Eid, Nemr; Ericksson, Göran; Griggs, Andy; Gryffudd-Jones, Kevin; Guilbert, Theresa; Haughney, John; Heaney, Liam; Holbrook, Janet; Holgate, Stephen; Israel, Elliot; Janson, Christer; Jenkins, Christine; Jones, Rupert; Josephs, Lynn; Kaplan, Alan; Krishnan, Jerry; Lange, Peter; Lavorini, Federico; Lisspers, Karin; Make, Barry; Martin, Richard; McIvor, Andrew; Miravitlles, Marc; Ohta, Ken; Hoe, Teoh Oon; Papi, Alberto; Papadopoulos, Nikos; Park, Hae-Sim; Pavord, Ian; Peters, Stephen P.; Phipatanakul, Wanda; Pinnock, Hilary; Pizzichini, Emilio; Popov, Todor; Postma, Dirkje S.; Rand, Cynthia; Reddel, Helen; Roche, Nicolas; Rodríguez, Miguel Román; Sears, Malcolm; Singh, Sally; Small, Iain; Soriano, Joan B.; Ställberg, Björn; Szefler, Stanley J.; Tassinari, Paolo; Thomas, Mike; Turner, Steve; Usmani, Omar; van Aalderen, Wim; van der Molen, Thys; van Ganse, Eric; Vestbo, Joergen; Virchow, Johann Christian; Vogelmeier, Claus; Wang, Chen; Wilson, Andrew; Wise, Robert; Wong, Gary; Yusuf, Osman; Zhong, N. S.
Background Patterns of health-care use and comorbidities present in patients in the period before diagnosis of chronic obstructive pulmonary disease (COPD) are unknown. We investigated these factors to inform future case-finding strategies. Methods We did a retrospective analysis of a clinical
Abbasi, Marjan; Khera, Sheny; Dabravolskaj, Julia; Xia, Linda
Improving Care Experiences, Efficiencies and Quality of Care for Seniors in Alberta Forum was held to explore the current challenges and opportunities in seniors' care. A diverse group of 53 attendees, representing a cross section of healthcare organizations, front-line healthcare providers, researchers and patients, participated in facilitative, small group discussions to share and propose solutions to barriers to coordinating and integrating care for the senior population across the continuum within the Edmonton zone, to comment on a standardized assessment that may inform integrated care and support planning and to outline steps towards health information continuity.
Full Text Available The in-hospital mortality (MIH is used as a performance indicator and quality healthcare in hospital. However, the majority of deaths resulted from an inevitable disease process (severity of cases and / or co-morbidity, and not medical errors or changes in the quality of care. This work aims to make a distribution of deaths in the Regional Hospital of Eastern, Al Farabi hospital and to highlight that more studies on the MIH are required consistently with detailed clinical data at the admission. The MIH showed its limitation as a health care indicator. The overall rate of in-hospital deaths within the Al Farabi hospital has averaged 2.4%, with 8.4% in the emergency unit, 28% in intensive care unit, 22% Neonatology unit, 1.6% in pediatric unit. The MIH may depend, firstly, on the condition of patients before hospitalization and secondly, on the conditions of their transfer from one institution to another that supports them as a last resort. Al Farabi hospital supports patients transferred from the provinces of the eastern region. Thus, 6% of patients who died in 2014 come from Berkane, 2% from Nador, 2% from Bouarfa, 4% from Taourirt and 2% from Jerrada. One might question about the procedures and the conditions of such transfers. In conclusion, the overall MIH measured from routine data do not allow proper comparison between hospitals or the assessment of the quality of care and patient safety in the hospital. To do so, we should ideally have detailed clinical data on admission (e.g. type of admission, age of patient, sex, comorbidity, .... The MIH is however an important indicator to consider as a tool to detect potential problems related to admission procedures and to suspect an area of "non-quality" in healthcare . The MIH is interesting for the patient and for the hospital because it serves the improvement of quality healthcare.
Duan, Xia; Shi, Yan
Background: The quality evaluation of nursing care is a key link in medical quality management. It is important and worth studying for the nursing supervisors to know the disadvantages during the process of quality evaluation of nursing care and then to improve the whole nursing quality. This study was to provide director insight on the current status of quality evaluation of nursing care from Nursing Quality Control Centers (NQCCs). Material and Methods: This qualitative study used a sample ...
Girbau, M B; Monedero, P; Centeno, C; Grupo Español de Cuidados Al Final de la Vida En, U C I
Good care for patients who die in intensive care should be pursued in the same way that excellence is sought in other clinical aspects. To assess the quality of clinical care given to patients who die in intensive care units (ICU) in Spain. Methodos. A retrospective observational cohort study of patients who died in the ICU based on a Spanish sample. Inclusion criteria were patients older than 18 years who died in ICU after a minimum stay of 24 hours. Consecutive admissions without exclusions were analyzed. Excellence criteria in intensive care were assessed by quality indicators and measures, related to end-of-life care, developed by the Robert Wood Johnson Foundation Critical Care Workgroup. Two hundred and eighty-two patients from 15 Spanish ICU were included. A median of 13% was observed in the achievement of the indicators. Almost all clinical records assessed both the patients' decision making capacity (96%) and their communication with families (98%), while a plan of care goals was achieved in only 50% of them. Only two ICU had open visiting policies. Distress assessment (48%) was better than that of pain assessment (28%). The absence of protocol for the withdrawal of life-sustaining treatments was observed in thirteen ICU. The indicators of emotional and spiritual support were achieved in less than 10%. The quality of end-of-life care in the participating ICU needs to be improved. The study identifies shortcomings and indicates existing resources in clinical practice from which a gradual improvement plan, adapted to the situation in each hospital, can be designed. The analysis, inexpensive in its implementation, offers an opportunity for improvement, a goal recommended by most professional societies of intensive care medicine. Key words. End-of-life care. Intensive care. Critical care. Palliative care. Quality improvement.
Kessell, Eric; Pegany, Vishaal; Keolanui, Beth; Fulton, Brent D; Scheffler, Richard M; Shortell, Stephen M
Accountable care organizations (ACOs) have proliferated under the Affordable Care Act (ACA). If ACOs are to improve health care quality<