Quality indicators can be used within healthcare to measure and benchmark performance. Variations in the access and quality of healthcare for musculoskeletal conditions highlights the need for a nationally agreed set of indicators.

The study's primary aim was to develop a set of care quality themes and indicators for musculoskeletal community care.

An online Delphi process was used, that included clinicians, managers, researchers, and patients. In round one, participants rated 79 indicators, across six care quality themes, for their importance to quality community musculoskeletal care. Following this, participants discussed the results of the first round in an online panel and then re-rated indicators in a second-round survey. The panel discussion focused on a) the importance rating of indicators, and b) the wording of care quality themes. Consensus for high importance was set at ≥60% in both rounds of the study.

Forty-six individuals participated in the first round of the study, with 21 participating in the second round. After the second round, six care quality themes emerged: 1) Optimising patient access and assessment, 2) Optimising patient education, self-management, and rehabilitation, 3) Optimising personalised care, 4) Optimising diagnosis, imaging, investigation, and referrals, 5) Optimising patient experience and outcomes, and 6) Population health relevant to musculoskeletal conditions. Within the six themes, 59 indicators were ranked as highly important.

This study has developed a set of care quality themes and indicators for community musculoskeletal care. In the next stage of indicator development, real-world data will be used to validate the indicators across several constructs.

Substance use disorder (SUD) is clinically under-detected and under-documented. We built and validated machine learning (ML) models to estimate SUD prevalence from electronic health record (EHR) data and to assess variation in facility-level SUD identification using clinically documented diagnoses vs model-based estimated prevalence.

Predictors included demographics, SUD-related diagnoses and healthcare utilisation. The criterion outcome for model development was prevalent SUD assessed via a patient survey across 30 geographically representative Veterans Health Administration (VA) sites (n=5989 patients). We split the data into training and testing datasets and built a series of ML models using cross-validation to minimise over-fitting. We selected the final model based on its performance in predicting SUD in the testing dataset. Using the final model, we estimated SUD prevalence at all 30 sites. We then compared facilities based on SUD identification using two alternative SUD identification measures: the facility-level SUD diagnosis rate and model-based estimated SUD prevalence.

The best-performing LASSO model with n=61 predictors doubled the sensitivity for classifying SUD relative to a model with only documented SUD diagnoses (0.682 vs 0.331). Across the 30 sites, SUD diagnosis rates ranged from 6.4%-13.9% and predicted SUD prevalence ranged from 9.7-16.0%. The difference in facility-level SUD identification (observed diagnosis rate minus predicted prevalence) ranged from -7.2 to +1.3 percentage points. Comparing facilities' rank ordering on documented SUD diagnosis rates vs estimated SUD prevalence, 16 out of 30 sites had a ranking that changed by at least a quintile (ie, 6 places or more).

This analysis shows that use of model-based performance measures may help address measurement blind spots that arise due to differences in diagnostic accuracy across sites. Although model-based estimates better estimate SUD prevalence relative to diagnoses alone for facility quality assessment, further improvements and individual SUD detection both require enhanced direct screening for non-alcohol drug use.

The purpose of this study was to describe the experiences of pediatric nurses providing direct care in a variety of settings during the first two years of the COVID-19 pandemic.

This was a qualitative descriptive study. Donabedian's Quality Framework for the Evaluation of Healthcare was used to guide the design. Purposive sampling was used to recruit 24 direct care nurses from inpatient and outpatient settings within one healthcare system. Semi-structured, audio-recorded interviews were conducted in-person or via a virtual platform from November 2021 through March 2022.

Four major themes were determined across all settings and included: 1) adapting to continuous change, 2) needing effective communication, 3) triggering moral distress, and 4) searching for relief. Fifteen subthemes emerged from the major themes.

The impact of the COVID-19 pandemic on pediatric nurses has been profound. Given the opportunity, pediatric nurses clearly articulated the personal and professional challenges they faced throughout the pandemic, how they navigated them, and how they hope healthcare systems will handle crises in the future.

The future of pediatric nursing depends on the engagement and support for direct care nurses to practice their profession and meet the needs of both patients and families. Leaders and nurses working together are integral to this future. Nurses want leaders to be present and listen, to value their opinions and to engage them in decision-making that impacts their practice. They need leaders at all levels to understand their work environment and to advocate and support their mental health through readily available resources.

Surgical process models (SPM) are simplified representations of operations and their visualization by surgical workflow management systems (SWMS), and offer a solution to enhance communication and workflow.

A 1:1 randomized controlled trial was conducted. A SPM consisting of six surgical steps was defined to represent the surgical procedure. The primary outcome, termed "deviation" measured the difference between actual and planned surgery duration. Secondary outcomes included stress levels of the operating team and complications. Analyses employed Welch t-tests and linear regression models.

18 procedures were performed with a SWMS and 18 without. The deviation showed no significant difference between the intervention and control group. Stress levels (TLX score) of the team remained largely unaffected. Duration of operation steps defined by SPM allows a classification of all liver procedures into three phases: The Start Phase (low IQR of operation time), the Main Phase (high IQR of operation time) and the End Phase (low IQR of operation time).

This study presents a novel SPM for open liver resections visualized by a SWMS. No significant reduction of deviations from planned operation time was observed with system use. Stress levels of the operation team were not influenced by the SWMS.

To determine structural and process readiness for postpartum haemorrhage (PPH) care at referral-level facilities in Ghana and Uganda to identify opportunities for strengthening.

Mixed-methods cross-sectional study.

Three districts in Ghana and two in Uganda.

Nine hospitals in Ghana and seven in Uganda; all hospitals had theoretical capacity for caesarean section and blood transfusion.

We deployed a modular quantitative health facility assessment to explore structural readiness (drugs, equipment, staff) complemented by in-depth interviews with maternity health service providers to understand process readiness (knowledge, attitudes, and practices as related to World Health Organization [WHO] guidance on PPH care).

Availability of essential structural components needed to support key PPH processes of care.

In both countries, there was generally good structural readiness for PPH care. However, key common gaps included inadequate staffing (especially specialist physicians), and unavailability of blood for transfusion. Interviews highlighted particularly good process readiness in the provision of uterotonics, recognising and responding to retained placenta, and repairing tears. However, there were clear gaps in the utilisation of tranexamic acid and uterine balloon tamponade.

We have identified good structural and process readiness across both Ghanaian and Ugandan health facilities to support PPH responses. However, some key missed opportunities-to align with current WHO guidance on providing bundles of interventions for PPH care-could be strengthened with minimal investment but promising impact.

To understand, based on the literature, how to implement the role of a clinical nurse specialist (CNS) in the hospital setting.

A scoping review was conducted following the methodological framework of Arksey and O'Malley and the Joanna Briggs Institute.

The search was conducted during March and April 2023 and was updated in November 2023. Electronic searches were conducted in the following major databases: PubMed, CINAHL, Web of Science, Scopus, PsycINFO, and Cochrane Library. Additionally, a "snowballing" strategy was used. A critical reading was conducted using the Joanna Briggs Institute methodological quality criteria. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for the Scoping Review guidelines were used.

Eleven relevant studies were included in this review. The primary results are presented in 4 sections related to the framework, process, components, and evaluation of the implementation of the CNS role. The findings of the reviewed studies suggest that the implementation process of the CNS is cyclical, variable, context-dependent, and multifactorial and can be assessed using the indicators of structure, process, and outcome.

This scoping review provides relevant information to support the design of implementation and evaluation strategies for the role of the CNS in the hospital context. Based on the findings of the reviewed studies, a comprehensive strategy is suggested for implementing the role of the CNS in a hospital setting.

To identify, appraise, and synthesize common themes from quality indicator (QI) sets designed for the assessment, management, and rehabilitation of musculoskeletal (MSK) conditions in primary and community care contexts.

A systematic search was performed on six databases (MEDLINE, EMBASE, AMED, Web of Sciences Core Collection, The Cochrane Library, and The Health Management Information Consortium), public repositories, and the websites of organizations involved in the reporting of MSK QIs.

Potential QI sources were screened for relevance using an a priori criteria. After the screening of 1493 titles, abstracts, 71 articles were reviewed independently by two authors, of which 25 met our criteria and were therefore included within the review.

The development of the QI sets was appraised using the AIRE instrument. Key characteristics of QI sets were extracted and tabulated. Nine out of 25 QI sets had "high" developmental methodology quality. A total of 410 QIs were identified from 25 QI sets.

A narrative synthesis was undertaken to identify common themes among QIs. Themes were mapped against improvement drivers mentioned in recent British primary/community MSK care policy directives. Finally, "Draft Indicators" were synthesized from common themes identified. Eleven overarching themes were synthesized: policy and governance; optimizing access and provision of care; staffing and spending; optimizing assessment and diagnosis; optimizing patient education and self-management; pharmacology and injection guideline adherence; optimizing personalized care; optimizing imaging, investigations, and referral; public health management relevant to MSK conditions; optimizing patient experience; and optimizing patient outcomes.

This review has identified common themes among QIs that focus on optimizing assessment, investigations, and treatment decisions for the primary/community care of MSK conditions. This work represents a valuable resource to commissioners, service managers, and clinicians internationally who resource, monitor, manage, assess, and rehabilitate individuals with MSK conditions.

Inconsistencies in DNP project identification and scope, and the demands of the DNP project on faculty remain a source of ongoing challenges and discussion in DNP education. Additionally, the demands on organizational resources generated by student DNP projects strain the already stressed post-pandemic healthcare system. At the same time, the need for more student project sites is growing along with the increasing number of DNP programs. Engaging students to conduct comprehensive evaluations as a DNP project option is a strategy to meet this demand for projects that also offers significant benefits for organizational partners. However, few articles highlight the role of a comprehensive evaluation as a DNP Project. This article discusses the value of comprehensive evaluation projects using an evaluation framework or model and appropriate methodologies to meet the criteria for DNP projects. We share outcome data and exemplars of successful evaluation projects in several settings.

People with hand osteoarthritis (OA) often have poor access to recommended treatments. To enhance care quality, quality indicators (QIs) based on clinical recommendations are essential. Current QI sets, like the Osteoarthritis Quality Indicator Questionnaire (OA-QI v.2), primarily address hip- and knee OA, and not hand OA.

To adapt the OA-QI v.2 for assessing patient-reported quality of hand OA care.

We used the OA-QI v.2. set as a starting point and adapted it to reflect hand OA care. A literature search was performed to identify potential QIs for hand OA following the Rand/UCLA Appropriateness method. A European expert panel, comprising researchers, clinicians, and patient research partners, participated in online meetings to discuss adaptation and suggest new QIs based on treatment recommendations for hand OA, and anonymously rated each suggested QI regarding its importance, validity, usefulness, and feasibility. Consensus was defined by predefined rating cut-off scores. The adapted questionnaire was translated from English into Norwegian. Cognitive debriefing interviews with Norwegian and UK hand OA patients were conducted to ensure clarity.

Our initial literature search provided 1670 articles, with none describing relevant QIs. After three voting rounds, sixteen QI items reached consensus, reflecting current hand OA care standards. Items were generally well understood, requiring only minor clarity amendments after patient interviews (N ​= ​28).

The OA-QI v.2 was successfully adapted into a 16-item Hand OA-QI set ensuring alignment with international care standards for hand OA through literature review, international expert panels and patient feedback on language and layout.

This study aimed to determine the effect of nurses' work environment, individual and work schedule features on the rationing of nursing care.

Rationing of nursing care is a concern in healthcare settings worldwide, as it is associated with negative outcomes for both patients and nursing staff.

Little is known about the precursors of rationing of nursing care in developing countries.

This descriptive, correlational and cross-sectional study was conducted with 405 nurses in Türkiye. Data were collected Nurse Information Form, Basel Extent of Rationing of Nursing Care-R and Nursing Work Index-The Practice Work Environment Scale. The study was reported following the STROBE and RANCARE guideline.

Nurses' mean rationing of nursing care score was 1.58 ± 0.59, and the mean work environment perception score was 2.58 ± 0.47, with no statistically significant relationship between the scale scores. However, working ward, working hours and working schedule significantly affected the total rationing of nursing care scores.

In this study, contrary to the literature, no relationship was found between the rationing of nursing care and the perception of the work environment. Supporting the literature, nurses' individual/work schedule features affected the rationing of nursing care.

Improving nurses' work schedule features and nurse staffing may help reduce the rationing of nursing care.

This study emphasised the importance of nurses' work schedule features and nurse staffing in the rationing of nursing care. The data from this study can guide nurse managers in identifying factors related to work schedules that may affect the rationing of nursing care and strategies to follow to make the necessary improvements.

Inflammatory bowel disease (IBD) is a complex chronic disease estimated to affect almost 1% of the Western population, where proactive care has largely replaced a reactive approach. Whilst there have also been great strides in new care models and therapies, care quality, and outcomes are poorly known, leaving us designing and delivering services without an effective feedback loop. Quality of care, guidelines, consensus statements, and standards will each be discussed, as a solid understanding of these concepts is essential. Assessing quality involves measuring the 3 core domains of structure, process, and outcomes. Benchmarking is an extension of quality assessment, which is recurrent or continuous and enables transparent, valid comparisons of quality between care sites. Assessment of QUALITY and BENCHMARKING are resource intensive unless processes are automated and use routinely collected data generated in the moments of care. Digital tools now provide realistic opportunities to make this affordable and sustainable, though concerns around privacy and security hamper solutions, whilst siloed data within institutions restrict comparative use. One novel solution to enable IBD benchmarking has been developed in Australia and New Zealand (ANZ). Crohn's Colitis Care (CCCare) is a cloud-based, IBD-specific EMR, now being used in routine care documentation at 22 sites across ANZ. De-identified data feed from CCCare's clinical module into a Clinical Quality Registry, in which audit, research, and benchmarking can be performed. The pathway from conception to implementation will be presented. Lessons learnt from the ANZ benchmarking journey will be discussed and suggestions for an effective global approach to IBD data will be proposed.

While the nurse practice environment's vital role in shaping patient care outcomes is well established, the precise mechanisms through which it influences missed nursing care remain unexplored. Hence, this study examined the mediating role of adherence to clinical safety guidelines in the relationship between the nurse practice environment and missed nursing care.

This descriptive, cross-sectional study involved 1237 nurses from 11 governorates in the Sultanate of Oman. Data were collected using three standardized scales: the Patient Safety Adherence Scale, the Practice Environment Scale of the Nursing Work Index, and the Missed Nursing Care Scale.

A favorable nurse practice environment was associated with higher adherence to clinical safety guidelines (β = 2.492, p < 0.001) and a lower frequency of missed nursing care (β = -0.2919, p = 0.015). Adherence to clinical safety guidelines partially mediated the relationship between the nurse practice environment and missed nursing care (β = -0.055, p < 0.001).

Enhancing the nurse practice environment plays a crucial role in improving nurses' adherence to clinical safety guidelines, which in turn reduces compromised nursing care.

Healthcare administrators and policymakers should prioritize improving working conditions to enhance nurses' adherence to clinical safety guidelines, thereby minimizing the occurrence of missed care and improving overall patient outcomes.

Individuals with a difference of sex development (DSD) face complex medical and psychosocial challenges, which can make it difficult to provide care tailored to their needs and in line with guidelines. The DSDCare project in Germany regularly evaluates the quality of care for people with DSD, focusing on patient satisfaction as a key indicator of care quality.

Nationwide, longitudinal, multicentre observational study in Germany, including people with DSD.

Since May 2021, ten specialised DSD centres have been recruiting individuals with DSD and collecting patient-related medical data in a registry. Participants and legal guardians, in the case of minors, complete a questionnaire about satisfaction with care using the Y/CHC-SUN questionnaire. Both medical and self-reported data were merged and analysed descriptively.

Between May 2021 and December 2023, 141 adults and 232 parents completed the questionnaire. Of these, 81.9% of adults and 86.4% of parents reported being 'very' or 'extremely satisfied' with their healthcare. Satisfaction scores in the dimensions 'doctor's behaviour' and 'patient-centred care' were very high for both adults and parents, while the dimensions 'clinical environment', 'diagnosis/information' and 'coordination' were rated slightly lower. Some participants expressed unmet needs for DSD training, psychological counselling, contact with self-advocacy groups and, in the case of adults, nutritional counselling.

Individuals with DSD treated at specialised DSD centres in Germany report high satisfaction with their care. The next step is to ensure that all individuals with DSD have access to a specialised centre to where their care needs can be met.

Several international guidelines provide recommendations for the management of individuals with DSD. Previous studies examining the evolution of management practices in response to these guidelines have concluded that while some are being implemented, others are not, with notable regional variations. In addition, there is limited understanding of satisfaction with care from the perspective of adults and, in particular, from parents of children with DSD, which is a key indicator of quality of care. Consequently, our study focused on patient-related outcomes and experiences, as well as on identifying unmet needs to enhance the quality of care for individuals with DSD in Germany.

National cancer audits and registers have highlighted significant national and international variation in patient care and outcomes. Quality Improvement (QI) is mandated in radiation oncology but the interventions designed to support QI in this field remain poorly understood. This paper seeks to assess the types of QI interventions in radiation oncology, the QI evaluation design and their impact on process of care measures and patient-related outcomes. MEDLINE and EMBASE were searched systematically for studies of QI interventions in radiation oncology between 2000 and 2024. The studies needed to identify the quantitative or qualitative impact of the QI intervention on process of care measures or patient-related outcomes. Study results were summarised using narrative synthesis and appraised using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS). 26 papers were included in the analysis. The majority of studies were conducted in the USA (n = 13) and in Europe (n = 7), with only two studies conducted at a national level. Ten studies covered all tumour types, with six specifically focusing on head and neck cancers, two each on prostate and nasopharyngeal cancers, and one study each examining lung, cervical, rectal, and breast cancers. The aspects of care evaluated most frequently were those relating to reducing waiting times or increasing utilisation of radiotherapy as per guidelines (n = 15), followed by those seeking to reduce radiotherapy contouring variability (n = 5) and those involving the management of symptoms during or after radiotherapy treatment (n = 6). Only 42 % of studies reported funding, with the most frequent funding source being national, government or federal (n = 6). All QI interventions across the 26 studies were successful as they resulted in an improvement in a process or patient-related outcome measure. The studies scored between 10 and 15 out of 16, according to the QI-MQCS criteria. Despite substantial investments in cancer research and development, there is a scarcity of information on how to enhance the quality of care in radiation oncology. While there are examples of national cancer audits and registers in a number of countries, much of the research in QI interventions is being conducted in the USA. This situation underscores the need for more comprehensive, well-funded studies and improved training for clinicians to conduct high-quality improvement activities and research. There should be a greater emphasis on the substantial gains that can be achieved by improving existing care in terms of access and outcomes, rather than solely focusing on innovation.

The number of quality indicators for which clinicians need to record data is increasing. For many indicators, there are concerns about their efficacy. This study aimed to determine whether working with only a consensus-based core set of quality indicators in the intensive care unit (ICU) reduces the time spent on documenting performance data and administrative burden of ICU professionals, and if this is associated with more joy in work without impacting the quality of ICU care.

Between May 2021 and June 2023, ICU clinicians of seven hospitals in the Netherlands were instructed to only document data for a core set of quality indicators. Time spent on documentation, administrative burden and joy in work were collected at three time points with validated questionnaires. Longitudinal data on standardised mortality rates (SMR) and ICU readmission rates were gathered from the Dutch National Intensive Care registry. Longitudinal effects and differences in outcomes between ICUs and between nurses and physicians were statistically tested.

A total of 390 (60%), 291 (47%) and 236 (40%) questionnaires returned at T0, T1 and T2. At T2, the overall median time spent on documentation per day was halved by 30 min (p<0.01) and respondents reported fewer unnecessary and unreasonable administrative tasks (p<0.01). Almost one-third still experienced unnecessary administrative tasks. No significant changes over time were found in joy in work, SMR and ICU readmission.

Implementing a core set of quality indicators reduces the time ICU clinicians spend on documentation and administrative burden without negatively affecting SMR or ICU readmission rates. Time savings can be invested in patient care and improving joy in work in the ICU.

Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive muscle weakness, a decline in quality of life, and premature mortality. This study aims to evaluate the perceived quality of healthcare and the experience of DMD patients and their caregivers in Mexico, comparing governmental and non-profit healthcare institutions using a newly designed assessment instrument.

In a cross-sectional study, data were gathered from 91 participants through an online self-administered questionnaire informed by the Donabedian model and six dimensions of healthcare quality.

Analysis revealed two key mediating factors: perceived quality of healthcare and patient experience. The Mann-Whitney U test showed that non-profit organizations were perceived to provide superior quality care in both aspects (p < 0.05), notably regarding healthcare professionals' preparedness and other domains of quality. However, the patient-centered care domain indicated that the importance of quality domains may vary according to cultural and social contexts. In Mexico, the humanistic approach of healthcare professionals appeared to compensate for shortcomings in timely diagnosis and other quality domains. This emphasizes the necessity for enhanced patient education and healthcare evaluation, and it highlights that patient satisfaction does not always correlate with high-quality healthcare. The developed instrument can further aid in understanding the experiences of DMD patients across different countries and cultures.

In low-income countries such as the Democratic Republic of the Congo (DRC), the strategies implemented to combat tuberculosis (TB) are threatened by the emergence of non-communicable diseases (NCDs), such as diabetes mellitus (DM). Very little data on the implementation of services to manage TB-DM are generally available in these low-income countries. The aim of this study was therefore to assess the level of implementation of DM screening and treatment activities in TB unit clinics (TUCs) in Lubumbashi, DRC.

A cross-sectional study was conducted using the Service Availability and Readiness Assessment (SARA) questionnaire from June to July 2023. Fourteen tracer items, divided into 4 domains-i) guidelines and staff, ii) basic equipment, iii) diagnostic capacity, and iv) drugs and products-were assessed. The readiness indices were compared according to the managerial instance and the activity package organized in each of the selected TUCs. A Chi2 test with a significance level set at p = 0.05 was used for this comparison, and Cronbach's α coefficient was calculated to estimate the reliability or consistency of the questionnaire.

Of the 35 TUCs visited, 19 (54.3%) were public health facilities, and 20 (57.1%) had a supplementary package of activities (SPA). The readiness of TUCs for providing DM diagnostic and treatment services was around 50%. A statistically significant difference was observed based on the managerial instance overseeing the TUC (p = 0.00) and the package of activities offered within these institutions (p = 0.00).

The current study has underscored the limited capability of TUCs in Lubumbashi to provide services for managing TB-DM comorbidity in DRC. It is imperative to implement strategies aimed at enhancing this capacity and taking into account the local context and influencing factors.

The conversion of General Out-patient Clinics (GOPC) into COVID-19 designated clinics played a crucial role in combating COVID-19 pandemic in Hong Kong in 2022. This qualitative research aimed to contribute valuable perspectives from doctors on the operations of designated clinics for the preparedness of future outbreaks and health emergencies.

This research adopted an interpretive phenomenological approach. Participants were purposively recruited from the doctors who worked in designated clinics during the COVID-19 pandemic in the Cluster of New Territories West, Hong Kong. Individual semi-structured interviews were conducted using an interview guide informed by the researchers' past experiences and the Donabedian framework. The verbatim transcripts were imported into NVivo 12 for data organizing, coding and thematic analysis.

Sixteen participants were recruited and interviewed until data sufficiency. Eight themes were elicited and grouped under the three domains of the Donabedian framework: structure (availability of facilities, supportive training and education, and flexible manpower allocation), process (challenges in clinical practices, communication and collaboration, and effectiveness of operations), and outcome (patient outcomes and impact to healthcare workers).

Overall, participants thought that the operations in the designated clinics were smooth, efficient, and achieving satisfactory outcomes. However, improvements could be made in upgrading facilities to better manage more severe future outbreaks, enhancing government roles in information centralization and public communication and improving collaboration between designated clinics and ambulance services. This research provided valuable insights for the preparedness of future outbreaks and health emergencies.

An evaluation system for comprehensively measuring medical insurance fund operational performance under China's Diagnosis Related Groups (DRG) payment reform holds critical theoretical and practical significance, especially for enhancing the efficiency of medical insurance fund utilization and the quality of healthcare services. However, few studies undertake performance evaluations of medical insurance funds under DRG payments, especially those incorporating the Analytic Hierarchy Process (AHP)-Entropy Weight Method (EWM)- Fuzzy Comprehensive Evaluation (FCE) method model.

This study utilizes operational data from medical insurance funds across eight cities in S Province, China, from 2020 to 2022. It develops an innovative performance evaluation system for medical insurance funds utilizing the AHP-EWM-FCE evaluation method. Finally, it explores the key influencing factors by applying the Tobit regression model.

As the reform of DRG payment methods has advanced, the operational performance scores related to the management, fundraising, utilization, and satisfaction of DRG medical insurance funds have consistently improved. Notably, the comprehensive indexes of QD and JN cities exhibit significant comparative advantages, resulting in higher performance evaluation scores for their medical insurance funds. Additionally, the performance scores assessed by the proposed evaluation system align closely with actual operational outcomes. Regression analysis further indicates that medical service capability is the key determinant influencing the operational performance of medical insurance funds.

This study develops a novel evaluation system for measuring medical insurance funds' operational performance. The insights can help proactively foster the high-quality development of these funds, and modernization of the medical insurance governance system and governance capabilities; stimulate the fund's productivity; and enhance the health and wellbeing of people.

This article aims to examine patient safety in general practice during COVID-19.

In total, 5489 GP practices from 37 European countries and Israel filled in the online self-reported PRICOV-19 survey between November 2020 and December 2021. The outcome measures include 30 patient safety indicators on structure, process, and outcome.

The data showed that structural problems often impeded patient safety during COVID-19, as 58.6% of practices (3209/5479) reported limitations related to their building or infrastructure. Nevertheless, GP practices rapidly changed their processes, including the appointment systems. Implementation proved challenging as, although 76.1% of practices (3751/4932) developed a protocol to answer calls from potential COVID patients, only 34.4% (1252/3643) always used it. The proportion of practices reported having sufficient protected time in general practitioners' schedules to review guidelines remained consistent when comparing the pre-COVID (34.2%,1647/4813) with the COVID period (33.2%,1600/4813). Overall, 42.8% of practices (1966/4590) always informed home care services when patients were diagnosed with COVID-19, while this decreased to 30.1% for other major infectious diseases (1341/4458). Most practices reported at least one incident of delayed care in patients with an urgent condition, most often because the patient did not come to the practice sooner (60.4%, 2561/4237). Moreover, 31.1% of practices (1349/4199) always organized a team discussion when incidents happened. Overall, large variations were found across countries and patient safety indicators.

The results demonstrated that European GP practices adopted numerous measures to deliver safe care during COVID-19. However, multilayered interventions are needed to improve infection control and GP practice accessibility in future pandemics.

Despite many quality initiatives at the primary health care (PHC) level, little is known about the actual quality of care of patients diagnosed with hypertension in South Africa. This study aimed to develop quality indicators for hypertension management at the PHC level to improve the quality of care and patient outcomes. The RAND/UCLA Appropriateness Method, comprising two rounds, was used to develop clear, appropriate, and feasible evidence-based quality indicators for hypertension. In Round 1, a 9-point scale was used by a panel of 11 members to rate clarity and appropriateness of 102 hypertension quality indicator statements, grouped under 9 dimensions of quality hypertension management, using an online MS Excel® spreadsheet. In Round 2, 9 of the same panellists discussed all indicators and rated their appropriateness and feasibility during a remote online, interactive face-to-face MS Teams® meeting. Statements rated ≥7-9 with agreement were defined as either appropriate or feasible. The panel rated 46 hypertension quality indicator statements ≥7-9 with agreement for the appropriate and feasible measurement of the management of hypertension: monitoring (n = 16), review (n = 5), lifestyle advice (n = 9), tests (n = 7), intermediate outcomes (n = 6), referrals (n = 2) and practice/facility structures (n = 1). No indicator statements were rated both appropriate and feasible for measuring blood pressure levels and treatment. If applied, these indicators would improve monitoring and management of patients with hypertension, patient outcomes, and data quality in South Africa and result in more efficient use of scarce resources. This study can be replicable for improving care of other non-communicable diseases across Africa.

At a London-based hospital, a validated ward-based clinical pharmacy activity collection tool has been used to monitor activities of clinical pharmacy teams across all settings, including ambulatory care services. No data confirm its representativeness for the full range of ambulatory clinical pharmacy services, and pharmacists share this concern.

This study aimed to identify the range of clinical pharmacy activities in ambulatory care, assess the suitability of the existing ward-based tool for capturing these activities, and recommend modifications.

Non-participant direct observations were conducted to record pharmacists' clinical activities in ambulatory clinics and multidisciplinary meetings. These observations were compared to the existing ward-based tool to identify discrepancies. Semi-structured interviews with eight ambulatory pharmacists were transcribed verbatim and thematically analysed inductively to explore the tool's representativeness of their routine clinical activities.

Twenty-nine clinical pharmacy activities were observed in ambulatory services. Only fifteen were captured by the existing tool, with therapy monitoring and recommending therapeutic changes not accurately captured. Pharmacists agreed that the tool was not fully representative and included irrelevant activities. Four common uncaptured activities were multidisciplinary meeting-specific activities, arranging laboratory tests, monitoring patient outcomes, and liaising with community healthcare professionals. This study identified 33 candidate ambulatory clinical pharmacy activities.

The existing ward-based tool does not fully capture the full range of ambulatory care clinical pharmacy activities, highlighting the need for an improved tool. Pharmacists recommended including the uncaptured activities. The candidate activities provide a foundation for standardised measurement of relevant ambulatory care activities to enable effective workforce deployment and improve patient outcomes.

Congenital cardiac anesthesiologists practice in a unique environment with high risk for morbidity and mortality. Quality metrics can be used to focus clinical initiatives on evidence-based care and provide a target for local quality improvement measures. However, there has been no comprehensive review on appropriate quality metrics for congenital cardiac anesthesia to date. Members of the Quality and Safety Committee for the Congenital Cardiac Anesthesia Society proposed 31 possible candidate topics for metrics. Using a scoping review strategy, 3649 abstracts were reviewed with 30 articles meeting final criteria. Of these, 5 candidate metrics were unanimously proposed for local collection and national benchmarking efforts: use of a structured handover in the intensive care unit, use of an infection prevention bundle, use of blood conservation strategies, early extubation of cardiopulmonary bypass cases, and cardiac arrest under the care of a cardiac anesthesiologist. Many metrics were excluded due to a lack of primary data and perceived complexity beyond the scope of cardiac anesthesia practice. There is a need to develop more primary data including linking process measures with outcomes, developing risk-stratification for our patients, and collecting national data for benchmarking purposes.

The Centers for Medicare & Medicaid Services (CMS) implemented chemotherapy measures (OP-35) to reduce potentially preventable emergency department visits (PPEDVs) and hospitalizations. This study evaluated the validity of the OP-35 measure in identifying PPEDVs among patients with cancer.

This is a cross-sectional study, which used data from the 2012-2022 National Hospital Ambulatory Medical Care Survey. ED visits are assessed and compared on the basis of three measures: immediacy using Emergency Severity Index (ESI), disposition (discharge v hospitalization), and OP-35 criteria.

Between 2012 and 2022, a weighted sample of 46,723,524 ED visits were made by patients with cancer. Among reported ESI cases, 25.2% (8,346,443) was high urgency. In addition, 30.3% (14,135,496) of ED visits among patients with cancer led to hospitalizations. Using the OP-35 measure, it was found that 20.85% (9,743,977) was PPEDVs. A 21.9% (10,232,102) discrepancy between discharge diagnosis (CMS billing codes) and chief complaints was identified. Further analysis showed that 19.2% (1,872,556) of potentially preventable ED visits (CMS OP-35) were high urgency and 32.6% (3,181,280) resulted in hospitalization.

The CMS approach to identifying PPEDVs has limitations. First, it may overcount preventable visits by including high-urgency or hospitalization-requiring cases. Second, relying on final diagnoses for retrospective preventability judgment can be misleading as they may not reflect the initial reason for the visit. In addition, differentiating causes for ED visits in patients with cancer undergoing various treatments is challenging as the approach does not distinguish between chemotherapy-related complications and others. Identification inconsistencies arise because of varying coding practices and chosen preventable conditions, lacking consensus and alignment with specific hospital or patient needs. Finally, the model fails to consider crucial nonclinical factors like social support, economic barriers, and alternative care access, potentially unfairly penalizing hospitals serving underserved populations.

To evaluate the quality of care, particularly in the case of new forms of healthcare interventions, the healthcare services to be provided are defined and documented in advance. The presented explanatory sequential mixed methods design combines quantitative and qualitative data collection and the analysis enables a deeper understanding of a new healthcare intervention. Using the example of the POET-Pain project, which investigates the effect of a perioperative transitional pain service (TPS), the methodological application of the explanatory sequential mixed methods design is demonstrated in order to present the structural and process evaluation of the new healthcare intervention (in this case TPS) and to understand its influence on the quality of care. The mixed methods design presented enables the results of the quantitative phase to be interpreted and expanded in depth using qualitative data, which leads to a comprehensive understanding of the subject matter (second pillar of health services research).

Each year, 5.3 million children under 5 years of age die in low-resource settings, often due to delayed recognition of disease severity, inadequate treatment, or a lack of supplies. We describe the use of a comprehensive digital facility-readiness survey tool, recently developed by the Pediatric Sepsis Data CoLaboratory, which aims to identify target areas for quality improvement related to pediatric emergency and critical care.

Facility-readiness surveys were conducted at six sub-Saharan African hospitals providing pediatric emergency and critical care in Uganda (n = 4) and Cameroon (n = 2). The tool is a 2-phase survey to assess readiness to provide pediatric essential emergency and critical care: (1) an "environmental scan," focusing on infrastructure, availability, and functionality of resources, and (2) an "observational scan" assessing the quality and safety of care through direct observation of patients receiving treatment for common diseases. Data were captured in a mobile application and the findings analyzed descriptively.

Varying levels of facility readiness to provide pediatric emergency care were observed. Only 1 of 6 facilities had a qualified staff member to assess children for danger signs upon arrival, and only 2 of 6 had staff with skills to manage emergency conditions. Only 21% of essential medicines required for pediatric emergency and critical care were available at all six facilities. Most facilities had clean running water and soap or disinfectants, but most also experienced interruptions to their electricity supply. Less than half of patients received an appropriate discharge note and fewer received counseling on postdischarge care; follow-up was arranged in less than a quarter of cases.

These pilot findings indicate that facilities are partially equipped and ready to provide pediatric emergency and critical care. This facility-readiness tool can be utilized in low-resource settings to assist hospital administrators and policymakers to determine priority areas to improve quality of care for the critically ill child.

With growing recognition of the influence that social risks, such as food insecurity and housing instability, have on individual and population health, social risk screening and social care interventions have proliferated across the health system. Social needs intervention research on screening and referral in specialty care is limited, despite evidence that social needs influence access to and outcomes of surgical and specialty care.

This study is a qualitative, formative evaluation of a quality improvement-oriented social needs screening and referral pilot program implemented in a bariatric surgery practice and aims to share lessons related to the structure and process components of a quality improvement (QI) framework.

Semistructured interviews revealed variation in patient eligibility for resources and highlighted the need for enhanced staff capacity and data system integration. In addition, process-related themes including patient hesitation toward referrals, variability in screening pathways, and uncertainty surrounding communication practices emerged in qualitative analyses.

Implementation of social needs screening and referral programs in specialty care setting is feasible but requires unique structure and process-related considerations. Incorporating QI infrastructure into these programs allows for continuous evaluation of program processes and can be used to evaluate the impact of these programs on health outcomes.

This study aims to construct a training course and quality evaluation index system for chronic disease Medication Therapy Management service (MTMs) that is suitable for China's national conditions. It seeks to provide tools and a scientific foundation for assessing the quality of MTMs training.

Drawing from domestic and international literature and combining with the practice of chronic disease medication management by Chinese pharmacists, a preliminary framework for the evaluation index system was established. The Delphi method was used to solicit expert opinions, evaluate and improve the evaluation index system. Indicator weights were determined by using the Analytic Hierarchy Process (AHP).

Both rounds of expert inquiry achieved a positive degree of 100% (18/18 experts). The authority coefficients (Cr) were 0.90 and 0.91 respectively. The Kendall coordination coefficients (Kendall's W) of the second and third-level indicators for the first round of inquiry were 0.230 and 0.189, while those for the second round were 0.326 and 0.213. Finally, an MTMs training course and training quality evaluation index system was structured, comprising 3 first-level indicators, 11 second-level indicators, and 39 third-level indicators.

The evaluation index system constructed in this study is scientifically robust and rational, offering a foundation to standardize MTMs training practices effectively.

to explore the nurses' perceptions among the quality of care to stroke patients in a public hospital in Northern Honduras.

a descriptive phenomenological study was carried out. The data collection was conducted by means of depth- interviews to 20 general nurses from the emergency and clinical medicine departments from the Atlántida General Hospital. Data analysis was by thematic technique.

the research found three key themes, and 10 subthemes, which illustrated the quality of stroke patients care in a general hospital from Honduras. The finding points up the theme "negative outcomes regarding the structure dimension of the patient care units", which means the failure to improve or maintain the quality of healthcare. Likewise, "positive outcomes regarding the nursing process", defined as pleasant and helpful among the care of stroke patients, such as ethical and humanized caring, and activities on promoting patient self-care with involvement of the relatives.

the results indicate that Honduran nurses do not have qualified graduate training in critical care, which is a limitation that compromises the quality of care. Therefore, it is recommended to have clear organization structures and better resources managing, consequently, it may increase user satisfaction, as well as reducing hospital stays.

Health and social service research impact analysis play a pivotal role in demonstrating research value. Impact analysis of programs, interventions, or policies in real-world settings is complex. There are many implementation evaluation theories, models, and frameworks (TMF) and researchers find choosing one challenging. Our objective was to systematically scope TMFs, review and chart key components of the process of implementation impact analysis to identify gaps.

A scoping review was undertaken and reported using PRISMA-ScR guidelines.

Systematic literature searches were conducted for impact analysis and impact assessment TMFs in MEDLINE, SCOPUS databases, hand searches, and expert directed search (2010-2024). Peer-reviewed articles were eligible for inclusion if they described an implementation evaluation TMF in English and used in the real world. Data extracted by the study team was charted in an Excel spreadsheet.

The review identified 71 relevant papers which included a theory (n = 6), model (n = 14), or framework (n = 51). Most considered resources and/or results, whereas only 25 % considered implementation process components. Ten frameworks were deemed comprehensive and covered at least two phases of implementation and five components. Most frameworks had not developed or tested practical tools to facilitate use of the framework.

No frameworks were identified that incorporated all phases of implementation, nor key components of the process in each phase of implementation research. The findings highlight the need to identify key components and develop a taxonomy, glossary and tools to assess the process components of implementation in real world settings.

The lack of evidence synthesis studies on the role of psychiatric mental health nursing in the context of psychiatric home hospitalization underscores the limited research on nurses providing care in these teams, particularly concerning their experiences and responsibilities and the actual role of nurses in this context. This knowledge has the potential to improve the quality of mental healthcare by guiding nursing practices. Objective: To map the concepts related to the role of mental health nurses in psychiatric home hospitalization. Methods: A scoping review was conducted using the methodology proposed by the JBI, involving five methodological stages. No search limits were applied except for language. Results: The review identified five key dimensions of nursing in psychiatric home hospitalization: satisfaction; care models; the therapeutic relationship; the care environment; the organization of care. These interconnected dimensions influence quality care. Satisfaction among nurses, patients, and families is associated with improved outcomes and reduced stigma. The therapeutic relationship is characterized by a humanistic approach, emphasizing dialogue, empathy, and shared decision making. Additionally, the importance of care organization is highlighted, including individualized care plans, medication management, and intersectoral collaboration. Discussion: The five nursing dimensions align with the Quality Standards of the Portuguese Nursing Council and are consistent with the scientific literature. Conclusions: Although there is a shortage of studies on this topic, this review allows for the synthesis of nursing interventions and reflection on the paradigm shift in care within the scope of psychiatric mental health nursing interventions. Future studies highlighting the value of mental health nursing interventions, with a particular focus on nursing-sensitive indicators and employing quantitative or mixed methods, will be crucial to furthering the analysis conducted thus far.

Patient satisfaction and experience are key outcomes of healthcare and can be computed as powerful measures of service quality. Understand what affects them is essential for service quality improvement. Investigating whether the care setting (i.e., medical or surgical) can impact the patients' perception of the quality can be also important for the actionability of this data. The aim is to explore which experiential factors should be prioritized to improve patient satisfaction with hospitalization service, using experience items as intermediate results and considering different settings.

Patient-reported experience measures are used in an Italian region. This study uses the optimization approach to identify factors of healthcare user experience affecting and enhancing satisfaction.

The results confirm that, among the significant determinants of satisfaction, some specific experiential aspects emerged as the potential primary focus to be prioritized in improvement actions. These aspects vary according to the specific departmental area.

The study presents an optimization model directly informed by healthcare service users, utilizing their insights to drive healthcare delivery improvements. It emphasizes the necessity of not only collect patient perspectives but also applying different methodologies to understand what matters to patients and what interventions could be prioritized, and to strategically use diverse insights to enhance the delivery of healthcare services and patient experience and satisfaction.

Patients need to be supported in combining treatment with daily life. However, measurement of supportive care indicators related to treatment-related side effects is under-reported. This review aimed to identify a list of quality indicators for managing cancer treatment-induced toxicities for adult patients with cancer.

A review was conducted on PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews, and Embase from September 26, 2013 to December 26, 2023. Published English articles that developed or analyzed quality indicators of managing cancer treatment-induced toxicities for adult patients with cancer were selected. The identified indicators were classified according to Donabedian's model for quality of care in healthcare.

Forty-two indicators (4 structural, 27 process, and 11 outcome indicators) in 18 articles were identified. Eight articles (44.4%) were from North America, four (22.2%) from Europe, two (11.1%) from Oceania, two (11.1%) from Asia, and one (5.6%) from Africa; 64.3% of the indicators were process indicators based on guidelines. The prevalence of patient symptoms determined using a patient-reported outcome measure was proposed as an outcome indicator. In seven studies (38.9%), these indicators were selected by multidisciplinary experts. None of the studies involved patients or family members in the indicator selection process.

The quality of supportive care should be improved by measuring these indicators, considering the patient's needs for supportive care at each hospital such that patients can continue their lives while undergoing treatment.

Based on the socio-ecological model of health, socioeconomic policy is an important determinant of population health. Spending decisions by public health units (PHU) have been shown to be associated with population health outcomes. Some studies have found greater PHU spending to be associated with improved population health, while others report mixed findings, warranting further research. The objective of this study was to investigate the association between per capita PHU spending and self-reported substance use among Canadian adolescents.

Cross-sectional, multilevel modelling was conducted using student data from the 7th wave (2018/19) of the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behaviour (COMPASS) study, as well as spending data from the audited financial statements of Ontario's PHUs. The sample included 29,056 students in grades 9-12 attending 61 secondary schools in 15 PHUs across Ontario. Substance use was measured as the self-reported use of alcohol, cannabis, cigarettes and e-cigarettes, at least once per month on average.

Approximately 50 % of the study sample was female and the majority identified as being White. Per capita spending ranged from $54.07 to $224.95, with a median spending amount of $89.62. The highest quartile of PHU spending was significantly associated with higher alcohol use (adjusted odds ratio (AOR): 1.41, 95 % CI: 1.04, 1.91), binge drinking (AOR: 1.71, 95 % CI: 1.18, 2.48), and cigarette use (AOR: 2.19, 95 % CI: 1.23, 3.91) in adolescents, while the second highest quartile was associated with lower e-cigarette use (AOR: 0.74, 95 % CI: 0.56, 0.98), relative to the lowest quartile.

Public health spending is associated with adolescent substance use. The present study reports mixed results, warranting further prospective research to explore the directions and mechanisms of the associations found.

The integration of herbal and orthodox medicines has gained momentum in global health, ensuring improved management of infectious diseases like malaria. This study explored the experiences of medical herbalists working in Ghana's diverse ecological zones to understand the contributions of integrated healthcare to malaria control.

A phenomenological design was employed to conduct in-depth interviews with 19 purposively sampled medical herbalists. Framework analytical approach and Donabedian's conceptual framework for quality of care were utilised in analysing the data.

Findings revealed high awareness of integrated healthcare practices among participants. Medical herbalists perceived integrated care as instrumental in enhancing malaria management through factors such as improved quality assurance, increased accessibility to integrated health facilities, patient-centred care, follow-up practices, and opportunities for continuous professional development. However, structural and process-related challenges were identified, including inadequate healthcare personnel, medicines, and equipment. Additionally, limited promotional activities, non-comprehensive National Health Insurance Scheme (NHIS), and ineffective referral systems were recognised as barriers hindering the effectiveness of the integrated system and its potential contribution to malaria control.

Although national and health system-based challenges have thwarted the importance of integration on malaria control, medical herbalists feel optimistic about the intervention. To optimise the effectiveness of integrated healthcare in controlling malaria in Ghana would require policy modification and implementation. Future research could focus on developing healthcare frameworks, particularly for malaria, that prioritise quality service delivery within an integrated system.

Research suggests that nursing facility structural characteristics are important contributors toward residents' quality of care. We use 2021 data from 220 Maryland nursing facilities to examine associations between two different quality-of-care metrics: family satisfaction and Care Compare five-star quality ratings. We used descriptive statistics to explore differences in quality metrics across facility ownership (for-profit vs. non-profit), geographic location (urban vs. rural), and resident census (1-60, 61-120, and 121+). Relationships were examined across overall ratings, as well as across subdomains of the two frameworks (e.g., staffing). Family members of residents in non-profit, rural, and low-census facilities rated facilities higher. Non-profit and low-resident census facilities were more likely to be rated four or five stars, while no significant association was observed across geographic location, or interactions across structural factors. Findings emphasize the need for comprehensive quality-of-care frameworks that explore quality care across stakeholders and types of facilities.

Cancer requires interdisciplinary intersectoral care. The Care Coordination Instrument (CCI) captures patients' perspectives on cancer care coordination. We aimed to translate, adapt, and validate the CCI for Germany (CCI German version).

The original English version contains 29 items in three domains, measured on a 4-point Likert scale (strongly disagree to strongly agree). Validation was conducted in three phases (mixed methods): (I) translation; (II) adaptation: pilot testing and revision in an iterative process using semi-structured, cognitive interviews with patients and professionals (physicians specializing in cancer), with interviews transcribed and qualitatively analyzed by inductive coding; and (III) validation: quantitative validation performed online (LimeSurvey), of at least 80 German patients, each with common cancer (breast, prostate) and rare cancer (different entities), with examination of factor structure (factor analysis) and determination of internal consistency (Cronbach's α) as well as potential influencing factors such as gender, education, or migration background (multivariable regression).

Six patients and six professionals tested the translated instrument for comprehensibility, readability, and acceptability. Two items were consistently problematic for interviewees. A 31-item version (29 items + 2 alternative items) was validated in 192 patients. The alternative items had a higher variance in response behavior and were better understood; therefore, they replaced the two problematic items. However, the three original domains could not be confirmed statistically. Exploratively, a two-factorial structure (with cross-loadings) emerged, which can be interpreted as "communication/information" (16 items) and "need-based navigation" (17 items). Overall, the instrument had a high internal consistency (total score α = 0.931, M = 47.16, SD = 14.25; communication/information α = 0.924, M = 30.14, SD = 8.93; need-based navigation α = 0.868, M = 23.99, SD = 8.37). Significant factors on the care coordination score are treatment location (hospital vs. private practice oncologist M = -9.83 score points, p = 0.011) and gender (women vs. men M = 8.92 score points, p = 0.002).

The CCI German version is a valid instrument for measuring patients' perceptions of cancer care coordination. Both domains reflect important aspects of care. The sensitivity of the CCI should be examined in future studies involving different cancer entities.

This study aimed to grasp the third delay using an observational method of actual nurses/midwives' practice overtime during care provision to emergency obstetric patients in a tertiary referral national hospital.

A prospective quantitative design was employed to observe the 24-h obstetric triage process from February 4 to March 7, 2023.

This study involved observations of 120 obstetric patients with mean maternal age of 29.1 years (SD = 5.5); 81.6% were between 20 and 35 years, 14.2% were over 35 years, and 4.2% were under 20 years. There were 99 (82.5%) pregnant women: 67.7% were preterm, 29.3% term, and 3% postdate, and there were 21 (17.5%) postpartum women. Initial diagnoses were postpartum hemorrhage, 9 (7.5%), antepartum hemorrhage, 15 (12.5%), eclampsia, 13 (10.8), severe preeclampsia, 19 (15.9), preeclampsia, 12 (10%), obstructed labor, 3 (2.5%), previous scar, 13 (10.8%), and others, 36 (30%). Waiting time was within 15 minutes for 30.8% of the observations. Median waiting time from registration to consultation was 9 min. Interquartile range (IQR) for postpartum hemorrhage was 3.5-23.5 min, and IQR for eclampsia was 11.5-117.5. There were no maternal deaths during the 24-h observation of each obstetric patient.

The obstetric triage process requires additional training for triaging time-sensitive obstetric complications; the wide IQR of waiting time indicated management misalignments thus causing the third delay. The clinical priority of obstetric patients with leading risk factors for morbidity and mortality, such as hypertensive disorders of pregnancy and hemorrhage, needs to be approached within a continuum of care.

As the pharmaceutical industry advances towards more patient-focused product development, it is well recognized that meaningful patient engagement is required for the authentic patient voice to inform research and regulatory decisions. However, for this to happen systematically and consistently across the industry, there is still a need to evaluate and communicate the value of patient engagement to all stakeholders. Evaluating engagement also informs process improvement, elevating the value further. We describe the development of a conceptual, yet practical, framework for measuring the impact of engagement to achieve this. The framework depicts how metrics can be used to capture and assess the inputs, outputs, and value of patient engagement across the medicines lifecycle. Although conceived in the context of systems and processes within one company, Novartis, the framework was co-created with patient advisors and designed to be both patient-relevant and adaptable for any pharmaceutical organization. The adoption and evolution of the framework will help to demonstrate the value-to patients, healthcare systems, and businesses-of integrating patient engagement into core activities across the medicines lifecycle. We encourage the pharmaceutical industry to apply impact measurement to build a robust evidence base, through measuring, publishing, and communicating the value of patient engagement.

This article explores the importance of connecting gaps and outcomes to ensure delivery of quality professional development activities. Designing and implementing activities to close or narrow gaps and produce measurable outcomes supports the value of nursing professional development in advancing goals of departments, organizations, and consumer health. Implications for professional development associates as well as novice, competent, and advanced nursing professional development practitioners are addressed.

Maternal mortality rates are unacceptably high in Nigeria. Understanding women's satisfaction with the maternity health system is fundamental, as perceived quality of care is a determinant of service utilisation and improved birth outcomes.

This systematic review aims to explore patients' satisfaction with maternal healthcare in Nigeria, examining the measurement, determinants, and outcomes of satisfaction.

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.

Searches were conducted in Embase, Maternity and Infant Care, Global Health, Ovid, Africa Journals Online, Cochrane Central Register of Controlled Trials, MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Google Scholar, alongside citation searches of relevant studies.

Original studies assessing patient satisfaction with maternal health services in Nigeria were included. There were no restrictions on study design types. Studies were excluded if they did not clearly define how satisfaction was measured or did not focus on the maternal health service domains under review (ie, antenatal, delivery, and/or postnatal care).

Key information relevant to this study was extracted into an Excel spreadsheet and narratively synthesised. The Quality Assessment for Diverse Studies tool was used to appraise the quality of the selected literature.

Maternal care satisfaction (MCS) ratings are high in Nigeria, but this may either indicate genuine positive experiences or be influenced by measurement-related biases. Several factors determine women's satisfaction with maternity services. Key factors influencing MCS in Nigeria are positive client-provider relationships, a favourable hospital environment with easy accessibility and affordable care costs. While our study demonstrated a correlation between MCS and socioeconomic and demographic factors, there is no complete consensus within the literature about this correlation. Furthermore, patient satisfaction was associated with women's future health-seeking behaviour and willingness to recommend care to others.

Understanding the multifaceted nature of MCS determinants and outcomes can better equip us to provide the support and care that mothers need to thrive. The findings from this study can inform policy, improve health responsiveness and ensure that women are provided with satisfactory and patient-centred maternity care, hence leading to a decline in poor pregnancy outcomes in Nigeria. It also highlights the need for robust methodologies that accurately measure women's experiences, which is essential for enhancing the quality of maternal health services.

A protocol was developed for this study and published on PROSPERO, the International Prospective Register of Systematic Reviews (CRD42023414771).

This study aimed to evaluate the service quality in Iranian hospitals from patients' perspectives based on the SERVQUAL model.

A thorough exploration of online electronic databases, including Scopus, PubMed, Web of Science, IranMedex, and the Scientific Information Database (SID), was undertaken using keywords extracted from Medical Subject Headings such as "Quality of Health Care," "Hospital," and "Patients" spanning from the earliest available records up to August 11, 2023.

In the context of 25 cross-sectional studies encompassing a collective participant pool of 8021 hospitalized patients in Iranian medical facilities, an assessment of patients' perspectives on the quality of hospital services revealed a mean perception score of 3.54 (SE = 0.08). Concurrently, the mean expectation score for the quality of services was determined to be 4.43 (SE = 0.06). Using the SERVQUAL model, the overall disparity between patients' perceptions and expectations was calculated as -0.89. Subsequent examination of specific dimensions within the SERVQUAL framework revealed gaps between patients' perceptions and expectations in the tangibility dimension (-0.84), reliability dimension (-0.94), responsiveness dimension (-0.91), assurance dimension (-0.89), and empathy dimension (-0.82).

Therefore, healthcare administrators consider the study's findings as a motivating force to initiate measures aimed at improving service quality in Iranian hospitals. Tackling the recognized shortcomings and areas requiring enhancement holds the promise of raising patient satisfaction levels and, consequently, improving overall healthcare outcomes.