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Kumah A, Aidoo LA, Amesawu VE, Issah AR, Nutakor HS. Assessment of Structural and Process Factors in Delivering Quality Adolescent Sexual and Reproductive Health Services in Ghana. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2024; 7:1-8. [PMID: 38406655 PMCID: PMC10887489 DOI: 10.36401/jqsh-23-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/19/2023] [Accepted: 10/16/2023] [Indexed: 02/27/2024]
Abstract
Introduction Sexual and reproductive health services are often underserved to adolescents in many societies. For many of these sexually active adolescents, reproductive health services such as the provision of contraception and treatment for sexually transmitted infections, either are not available or are provided in a way that makes adolescents feel unwelcome and embarrassed. This study assessed the structural and process factors available in delivering quality adolescent sexual and reproductive health (ASRH) services in health facilities across three regions in Ghana. Methods A facility-based descriptive cross-sectional study assessed the structural and process factors available for delivering quality adolescent sexual reproductive health services in 158 selected health facilities across three regions (Oti, Eastern, and Volta) of Ghana. A simple random sampling by balloting was used to select the health facilities and a total of 158 adolescents who used ASRH services in the selected facilities were sampled for an existing interview. The Donabedian model of quality assessment was adopted and modified into an assessment tool and a questionnaire to assess the selected health facilities and respondents. The Statistical Package for the Social Sciences (SPSS) version 20.0 was used to analyze the data collected and the findings presented in the tables. Results The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. A proportion of 85 (53.50%) of the facilities assessed did not have separate spaces for delivering services for adolescents. All 158 health facilities had the National Health Insurance Scheme (NHIS) covering contraceptive/family planning services for adolescents. Most (128, 81.01%) facilities had available educational materials on ASRH but were not made available for take home by adolescents. The findings indicated that most respondents did not require parental, spouse, or guardian consent before using ASRH services. The average waiting time for adolescents to be attended to by service providers was ≤30 minutes. Conclusions The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. ASRH services, particularly contraceptive/family planning services, were well integrated into NHIS to improve access and utilization by adolescents.
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Affiliation(s)
| | | | - Vera Edem Amesawu
- Department of Population and Reproductive Health, University of Ghana, Legon, Ghana
| | - Abdul-Razak Issah
- Department of Health Information Management, College of Health, Yamfo, Ghana
| | - Hillary Selassi Nutakor
- Department of Addiction, Recovery and Rehabilitation, Accra Psychiatric Hospital, Accra, Ghana
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Ducas RA, Mao T, Beauchesne L, Silversides C, Dore A, Ganame J, Alonso-Gonzalez R, Keir M, Muhll IV, Grewal J, Williams A, Dehghani P, Siu S, Johri A, Bedard E, Therrien J, Hayami D, Kells C, Marelli A. Adult Congenital Heart Disease Care in Canada: Has Quality of Care Improved in the Last Decade? Can J Cardiol 2024; 40:138-147. [PMID: 37924967 DOI: 10.1016/j.cjca.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/12/2023] [Accepted: 08/04/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Patients with adult congenital heart disease (ACHD) are at increased risk of comorbidity and death compared with the age-matched population. Specialized care is shown to improve survival. The purpose of this study was to analyze current measures of quality of care in Canada compared with those published by our group in 2012. METHODS A survey focusing on structure and process measures of care quality in 2020 was sent to 15 ACHD centres registered with the Canadian Adult Congenital Heart Network. For each domain of quality, comparisons were made with those published in 2012. RESULTS In Canada, 36,708 patients with ACHD received specialized care between 2019 and 2020. Ninety-five cardiologists were affiliated with ACHD centres. The median number of patients per ACHD clinic was 2000 (interquartile range [IQR]: 1050, 2875). Compared with the 2012 results, this represents a 68% increase in patients with ACHD but only a 19% increase in ACHD cardiologists. Compared with 2012, all procedural volumes increased with cardiac surgeries, increasing by 12% and percutaneous intervention by 22%. Wait time for nonurgent consults and interventions all exceeded national recommendations by an average of 7 months and had increased compared with 2012 by an additional 2 months. Variability in resources were noted across provincial regions. CONCLUSIONS Over the past 10 years, ACHD care gaps have persisted, and personnel and infrastructure have not kept pace with estimates of ACHD population growth. Strategies are needed to improve and reduce disparity in ACHD care relative to training, staffing, and access to improved care for Canadians with ACHD.
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Affiliation(s)
- Robin A Ducas
- Department of Internal Medicine, Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Tony Mao
- Department of Internal Medicine, Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Luc Beauchesne
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Candice Silversides
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, University of Toronto, Toronto, Ontario, Canada
| | - Annie Dore
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Rafael Alonso-Gonzalez
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jasmine Grewal
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Williams
- Memorial University, St John's, Newfoundland, Canada
| | - Payam Dehghani
- Prairie Vascular Research Inc, Adult Congenital Heart Disease, Regina, Saskatchewan, Canada
| | - Samuel Siu
- Western University, London, Ontario, Canada
| | - Amer Johri
- Queen's University, Kingston, Ontario, Canada
| | - Elisabeth Bedard
- Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Judith Therrien
- Jewish General Hospital, McGill Adult Unit for Congenital Heart Disease (MAUDE Unit), McGill University, Montréal, Québec, Canada
| | - Doug Hayami
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Ariane Marelli
- Jewish General Hospital, McGill Adult Unit for Congenital Heart Disease (MAUDE Unit), McGill University, Montréal, Québec, Canada
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León-García M, Wieringa TH, Espinoza Suárez NR, Hernández-Leal MJ, Villanueva G, Singh Ospina N, Hidalgo J, Prokop LJ, Rocha Calderón C, LeBlanc A, Zeballos-Palacios C, Brito JP, Montori VM. Does the duration of ambulatory consultations affect the quality of healthcare? A systematic review. BMJ Open Qual 2023; 12:e002311. [PMID: 37875307 PMCID: PMC10603464 DOI: 10.1136/bmjoq-2023-002311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/23/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The objective is to examine and synthesise the best available experimental evidence about the effect of ambulatory consultation duration on quality of healthcare. METHODS We included experimental studies manipulating the length of outpatient clinical encounters between adult patients and clinicians (ie, therapists, pharmacists, nurses, physicians) to determine their effect on quality of care (ie, effectiveness, efficiency, timeliness, safety, equity, patient-centredness and patient satisfaction). INFORMATION SOURCES Using controlled vocabulary and keywords, without restriction by language or year of publication, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews and Scopus from inception until 15 May 2023. RISK OF BIAS Cochrane Risk of Bias instrument. DATA SYNTHESIS Narrative synthesis. RESULTS 11 publications of 10 studies explored the relationship between encounter duration and quality. Most took place in the UK's general practice over two decades ago. Study findings based on very sparse and outdated evidence-which suggested that longer consultations improved indicators of patient-centred care, education about prevention and clinical referrals; and that consultation duration was inconsistently related to patient satisfaction and clinical outcomes-warrant low confidence due to limited protections against bias and indirect applicability to current practice. CONCLUSION Experimental evidence for a minimal or optimal duration of an outpatient consultation is sparse and outdated. To develop evidence-based policies and practices about encounter length, randomised trials of different consultation lengths-in person and virtually, and with electronic health records-are needed. TRIAL REGISTRATION NUMBER OSF Registration DOI:10.17605/OSF.IO/EUDK8.
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Affiliation(s)
- Montserrat León-García
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Thomas H Wieringa
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University, Leiden, Netherlands
| | - Nataly R Espinoza Suárez
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- VITAM Research Center for Sustainable Health, Quebec Integrated University Health and Social Services; Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - María José Hernández-Leal
- Department of Economics. Research Centre on Economics and Sustainability (ECO-SOS). Research Group on Statistics, Economic Evaluation and Health (GRAEES), Faculty of Business and Economics. Rovira i Virgili University, Reus, Spain
| | - Gemma Villanueva
- Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
- Cochrane Response, London, UK
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jessica Hidalgo
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry J Prokop
- Mayo Clinic Libraries, Mayo Clinic, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudio Rocha Calderón
- Department of Preventive Medicine, University Hospital of Bellvitge, IDIBELL, Barcelona, Catalunya, Spain
| | - Annie LeBlanc
- VITAM Research Center for Sustainable Health, Quebec Integrated University Health and Social Services; Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Claudia Zeballos-Palacios
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Pablo Brito
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Alzerwi NAN. Flexner has fallen: Transitions in medical education system across time, a gradual return to pre-Flexnerian state (de-Flexnerization). World J Clin Cases 2023; 11:4966-4974. [PMID: 37583863 PMCID: PMC10424023 DOI: 10.12998/wjcc.v11.i21.4966] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/29/2023] [Accepted: 07/03/2023] [Indexed: 07/26/2023] Open
Abstract
The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner, his public disclosure of the poor conditions at many medical schools provided a means to galvanize all the constituencies needed for reform to occur. He could say what other reformers could not, due to their links to the medical education community. But now we are again going back to a pre-Flexnerian state due to multiple reasons such as gradually diminishing importance of basic science subjects for the students, the decline in the number and quality of investigator initiated research among clinical researchers, lesser emphasis to bedside training by means of detailed clinical examination and making appropriate observation of signs to reach to a diagnosis rather than over reliance on the laboratory tests and radiological modalities for the diagnosis, poor exposure to basic clinical skills starting from college throughout residency and the trend of disrespect and absenteeism from both theoretical and clinical/practical classes. The attitude of students is just to complete their required attendance so that they are not barred from appearing in examinations. This de-Flexnerization trend and regression to pre-Flexnerian era standards, ideologies, structures, processes, and attitudes, are bound to beget pre-Flexnerian outcomes, for you get what you designed for.
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Affiliation(s)
- Nasser A N Alzerwi
- Department of Surgery, Majmaah University, Majmaah 11952, Riyadh, Saudi Arabia
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Yin C, Li J, Meng W, Hou S, Liu D, Liu M, Yu L, Guo R, Han X, Liu M. Trends in care quality in China from 2011 to 2017: An analysis based on the National Specific (Single) Disease Monitoring System. J Glob Health 2023; 13:04045. [PMID: 37114729 PMCID: PMC10141559 DOI: 10.7189/jogh.13.04045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Background The Ministry of Health of China conducted a study targeting in single-disease quality control in 2009, aimed to strengthen quality management and improve health care services. This study retrospectively investigated the trends of quality indicators for six monitored diseases 2011-2017 to evaluate the improvement of care quality for the first batch of single-disease. Methods We extracted data from the National Specific (Single) Disease Monitoring System for 2011-2017. We focused on six conditions: acute myocardial infarction, heart failure, community-acquired pneumonia, coronary artery bypass graft, hip / knee replacement, and acute ischemic stroke. A total of 56 quality indicators (QIs) were adopted to monitor the quality change and determine the trends in care quality. We also calculated the hospital process composite performance (HPCP) using a denominator-based weighting method for each hospital per year. The estimated annual percentage changes (EAPC) 2011-2017 were calculated at national and regional levels. Results The results showed that use of four QIs had significant downward trends, whereas 25 QIs (including reversed indicators) showed significant upward trends from 2011 to 2017. The greatest improvement was observed in CAP-4 (antibiotic treatment within four hours after admission to the hospital for critical pneumonia) in the central region (EAPC = 48.36, 95% CI = 15.92-89.87); while the largest decrease appeared in AIS-1 (thrombolytic therapy within 4.5 hours of symptom onset) in the western region (EAPC = -13.44, 95% CI = -24.98,-0.11). An increased HPCP was observed in four diseases nationwide, but not for acute myocardial infarction and heart failure. However, there were significant differences across regions in the process of care and outcomes, with the performance of Eastern and Western regions showing remarkable advantages compared with the Central region. Conclusions We provide evidence for major advancement in care quality in China nationwide. However, the improvement of care in China was unbalanced geographically and should be carefully considered. Future challenges include expanding the coverage of quality monitoring, greater delivery efficiency, and region-balanced health care.
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Capolupo N, Virglerová Z, Adinolfi P. Managing TQM's soft side: an explorative study of social care multiservice organizations. TQM JOURNAL 2023. [DOI: 10.1108/tqm-01-2022-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
PurposeThis paper explores total quality management (TQM) soft domain efficacy in social care organizations to determine the extent to which an organization's project success may stem from soft TQM critical success factors (CSFs).Design/methodology/approachNon-structured interviews were conducted with 16 managers overseeing the prosthetic device regeneration project of the Italian local health unit (located in Salerno) to explore which soft factors could contribute to the success of a social care multifunctional organization.FindingsOrganizations' handling of certain projects, such as pivoting on soft TQM issues, may allow them to be configured as multiservice organizations. Therefore, a conceptual model of a multiservice social care organization is proposed.Practical implicationsFrom a managerial perspective, this study presents an interesting success case of a multiservice social care organization with a total annual expenditure of €20 million on prosthetic assistance. Preliminary data show a 13% reduction in public expenditure for Salerno's local health unit via a refurbishment project.Originality/valueThe paper contributes to the soft TQM literature debate: although Italian local health professionals appear aware of soft TQM issues' implementation and consciously apply them in their organization and projects, this occurs more with specific CSFs emerging from the literature. Therefore, this article paves the way for further quantitative and theoretical investigations on the adoption of TQM soft issues in social care organizations' performance measurement.
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Acceptability of the 'Crisis Toolbox': a skills-based intervention delivered in a Crisis Resolution and Home Treatment Team during COVID-19. Community Ment Health J 2022; 58:1487-1494. [PMID: 35366118 PMCID: PMC8976273 DOI: 10.1007/s10597-022-00963-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 01/27/2023]
Abstract
Crisis Resolution and Home Treatment Teams (CRHTTs) provide 24-hour, seven day per week support for people in crisis. The COVID-19 pandemic has placed significant demand on urgent care and increased the need for brief interventions in CRHTT settings with flexible methods of delivery. This evaluation aimed to examine client satisfaction with the 'Crisis Toolbox' (CTB), a brief, skills-based intervention delivered in one CRHTT during COVID-19. All participants who received the CTB completed a satisfaction questionnaire. Descriptive statistics were calculated to quantify acceptability and qualitative themes were generated using thematic analysis. Fifty-eight people participated, all of whom reported high levels of satisfaction with the CTB. Four qualitative themes also emerged relating to 'Active ingredients of the CTB', 'The therapeutic relationship', 'Service-user preferences' and 'Expectations and continuity of care'. The CTB appears to be a valued intervention. Further research is now needed to assess its clinical impact and effect on operational indicators.
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Mendlovic J, Mimouni FB, Arad I, Heiman E. Trends in Health Quality-Related Publications Over the Past Three Decades: Systematic Review. Interact J Med Res 2022; 11:e31055. [PMID: 36194464 PMCID: PMC9579930 DOI: 10.2196/31055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 05/03/2022] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background Quality assessment in health care is a process of planned activities with the ultimate goal of achieving a continuous improvement of medical care through the evaluation of structure, process, and outcome measures. Physicians and health care specialists involved with quality issues are faced with an enormous and nearly always increasing amount of literature to read and integrate. Nevertheless, the novelty and quality of these articles (in terms of evidence-based medicine) has not been systematically assessed and described. Objective The objective of this study was to test the hypothesis that the number of high-evidence journal articles (according to the pyramid of evidence), such as randomized control trials, systematic reviews, and ultimately, practice guidelines, increases over time, relative to lower-evidence journal articles, such as editorials, reviews, and letters to the editors. Methods We used PubMed database to retrieve relevant articles published during the 31-year period between January 1, 1989, and December 31, 2021. The search was conducted in April 2022. We used the keywords “quality care,” “quality management,” “quality indicators,” and “quality improvement” and limited the search fields to title and abstract in order to limit our search results to articles nearly exclusively related to health care quality. Results During this 31-year evaluation period, there was a significant cubic increase in the total number of publications, reviews, clinical trials (peaking in 2017, with a sharp decline until 2021), controlled trials (peaking in 2016, with a sharp drop until 2021), randomized controlled trials (peaking in 2017, with a sharp drop until 2021), systematic reviews (nearly nonexistent in the 1980s through 1990s to a peak of 222 in 2021), and meta-analyses (from nearly none in the 1980s through 1990s to a peak of approximately 40 per year in 2020). There was a linear increase in practice guidelines from none during 1989-1991 to approximately 25 per year during 2019-2021, including a cubic increase in editorials, peaking in 2021 at 125 per year, and in letters to the editor, peaking at 50-78 per year in the last 4 years (ie, 2018-2021). Conclusions Over the past 31 years, the field of quality in health care has seen a significant yearly increase of published original studies with a relative stagnation since 2015. We suggest that contributors to this dynamic field of research should focus on producing more evidence-based publications and guidelines.
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Affiliation(s)
| | | | - Iris Arad
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Eyal Heiman
- Shaare Zedek Medical Center, Jerusalem, Israel
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Tsangaris E, Edelen M, Means J, Gregorowitsch M, O'Gorman J, Pattanaik R, Dominici L, Hassett M, Witkowski ML, Schrieber K, Frank E, Carnie M, Pusic A. User-centered design and agile development of a novel mobile health application and clinician dashboard to support the collection and reporting of patient-reported outcomes for breast cancer care. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000119. [PMID: 35464815 PMCID: PMC8987795 DOI: 10.1136/bmjsit-2021-000119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives There is a need for advancements in health information technology that will transform how patient-reported outcomes (PRO) data are collected, reported, and used in breast cancer care. The objective of this study was to develop an innovative and customizable platform, called imPROVE to support PRO uptake in breast cancer care. Design User-centered design and agile development were employed. Recurrent stakeholder meetings with experts in the field of breast cancer care, in-depth one-on-one qualitative interviews with a clinical sample of patients with breast cancer, and focus groups with Dana-Farber/Harvard Cancer Center (DF/HCC) Breast Cancer Advisory Group members, were used to elicit feedback for the design features and functions of a patient mobile application and clinician dashboard. Setting This study was conducted at two academic hospitals in the USA. Participants Participants included experts in the field of breast cancer care, value-based healthcare, and health information technology, a clinical sample of patients with breast cancer, and members of the DF/HCC Breast Cancer Advisory Group. Main outcome measures imPROVE incorporates the International Consortium for Health Outcomes Measurement (ICHOM) breast cancer standard outcome set as well as the complete BREAST-Q Breast Cancer Module. Results Feedback was elicited from eight stakeholder meetings (n=28 members), interviews with a clinical sample of patients (n=28), and two focus groups with members of the DF/HCC Breast Cancer Advisory Group (n=17 members in each focus group). Participant feedback led to the development of a patient mobile application consisting of five components (myCare, myStory, myResources, myCommunity, and myNotes) and a clinician dashboard that includes an overview table and individual patient profiles with data displays. Conclusions imPROVE has the potential to transform the way we deliver care to patients. Developed from best practices in user-centered design, agile development, and qualitative methods; imPROVE addresses the needs of multiple stakeholders, including patients, clinicians, healthcare administrators, and researchers.
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Affiliation(s)
- Elena Tsangaris
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maria Edelen
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jessica Means
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Madelijn Gregorowitsch
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joanna O'Gorman
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rakasa Pattanaik
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Laura Dominici
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Michael Hassett
- Department of Medical Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary Lynch Witkowski
- Institute for Strategy & Competitiveness, Harvard Business School, Boston, Massachusetts, USA
| | - Kristen Schrieber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth Frank
- Dana Farber/Harvard Cancer Center Breast Cancer Advocates, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Martha Carnie
- Dana Farber/Harvard Cancer Center Breast Cancer Advocates, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Andrea Pusic
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Pietsch B, Perleth M, Matthias K. G-BA, IQWiG und IQTIG: qualitativ hochwertige Entscheidungen für eine qualitativ hochwertige Patientenversorgung. Public Health 2022. [DOI: 10.1016/b978-3-437-22262-7.00044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Dahdah N, Kung SC, Friedman KG, Marelli A, Gordon JB, Belay ED, Baker AL, Kazi DS, White PH, Tremoulet AH. Falling Through the Cracks: The Current Gap in the Health Care Transition of Patients With Kawasaki Disease: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2021; 10:e023310. [PMID: 34632822 PMCID: PMC8751858 DOI: 10.1161/jaha.121.023310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Health care transition (HCT) is a period of high vulnerability for patients with chronic childhood diseases, particularly when patients shift from a pediatric to an adult care setting. An increasing number of patients with Kawasaki disease (KD) who develop medium and large coronary artery aneurysms (classified by the American Heart Association according to maximal internal coronary artery diameter Z‐scores ≥5 and ≥10, respectively) are becoming adults and thus undergoing an HCT. However, a poor transition to an adult provider represents a risk of loss to follow‐up, which can result in increasing morbidity and mortality. Methods and Results This scientific statement provides a summary of available literature and expert opinion pertaining to KD and HCT of children as they reach adulthood. The statement reviews the existing life‐long risks for patients with KD, explains current guidelines for long‐term care of patients with KD, and offers guidance on assessment and preparation of patients with KD for HCT. The key element to a successful HCT, enabling successful transition outcomes, is having a structured intervention that incorporates the components of planning, transfer, and integration into adult care. This structured intervention can be accomplished by using the Six Core Elements approach that is recommended by the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians. Conclusions Formal HCT programs for patients with KD who develop aneurysms should be established to ensure a smooth transition with uninterrupted medical care as these youths become adults.
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Roberson D, Newman DK, Ziemba JB, Wein A, Stambakio H, Hamilton RG, Callender L, Holderbaum L, King T, Jackson A, Tran T, Lin G, Smith AL. Results of the patient report of intermittent catheterization experience (PRICE) study. Neurourol Urodyn 2021; 40:2008-2019. [PMID: 34516673 DOI: 10.1002/nau.24786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 02/02/2023]
Abstract
AIMS Patient satisfaction is paramount to health-related quality of life (HR-QoL) outcomes. High quality, quantitative data from the US describing patients' actual experiences, difficulties, and HR-QoL while on an intermittent self-catheterization (ISC) regimen is very scarce. Our objective was to better understand patient practices with and attitudes towards ISC. METHODS This is a cross-sectional, multi-centered, clinical study of adult men and women performing ISC in the United States. Data collected included demographics, medical history, catheter characteristics, specific self-catheterization habits and two validated HR-QoL questionnaires: The Intermittent Self-Catheterization Questionnaire (ISC-Q) and the Intermittent Catheterization Difficulty Questionnaire (ICDQ). RESULTS Two hundred participants were recruited from six sites; 70.0% were male, 73.5% were Caucasian with a median age was 51.0 years (range 19-90 years). The ISC-Q showed that the vast majority of participants reported ease with ISC (82.0% satisfaction score) had confidence in their ability to perform ISC (91.9% satisfaction score); yet, many felt self-conscious about doing so (58.3% satisfaction score) and had concerns about long-term adverse effects (58.1% satisfaction score). The ICDQ indicated little to no difficulty for most participants with all routine ISC practices. A small minority of participants reported some difficulty with a "blocking sensation" during initiation of catheterization, leg spasticity, and painful catheterization. Multivariate linear regression results are also reported. DISCUSSION/CONCLUSION Participants are confident with ISC and have little overall difficulty, which may be a product of successful education and/or catheter design. urinary tract infections (UTIs) were common (yet variable) and may contribute to the noted long-term ISC concerns. Limitations exist including various selection biases leading to concerns of external validity. Future educational interventions in this population may further improve HR-QoL, optimize UTIs prevention, and diminish concerns with long-term ISC.
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Affiliation(s)
- Daniel Roberson
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diane K Newman
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justin B Ziemba
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alan Wein
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hanna Stambakio
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rita G Hamilton
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA
| | - Librada Callender
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA
| | - Leah Holderbaum
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA
| | - Tamara King
- Shepherd Multispecialty Clinic, Shepherd Center, Inc., Atlanta, Georgia, USA
| | - Angela Jackson
- Department of Urology, University of South Florida, Tampa, Florida, USA
| | - Thanh Tran
- Department of Urology, University of South Florida, Tampa, Florida, USA
| | - George Lin
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abstract
Intermittent self-catheterisation (ISC) is now considered the standard of care for most patients with neurological conditions and associated lower urinary tract disorders. Numerous societies, led by the International Continence Society, are in agreement on the effectiveness of ISC. Use of intermittent catheters is reported to reduce the risk of catheter-associated urinary tract infection compared with indwelling urinary catheters while improving patient comfort and quality of life. However, previous studies have shown that, despite the benefits of ISC, it will not guarantee behavior change and the integration of this procedure into the daily life of patients. Patients may encounter internal (related to the patient themselves) and external (related to their environment) difficulties. Identifying these obstacles early will help promoting ISC success. This review aims to identify internal and external barriers related to ISC and to propose adequate solutions to avoid them.
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Affiliation(s)
- Salma Balhi
- Department of Epidemiology and Public Health, Faculty of Medicine of Tunis, Tunis, Tuinisia
| | - Rym Baati Arfaoui
- Urodynamics and Functional Exploration Unit, Charles Nicolle Hospital, Tunis, Tunisia
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Adjusting Client-Level Risks Impacts on Home Care Organization Ranking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115502. [PMID: 34063743 PMCID: PMC8196673 DOI: 10.3390/ijerph18115502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022]
Abstract
Quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) offer the opportunity to assess home care quality and compare home care organizations’ (HCOs) performance. For fair comparisons, providers’ QI rates must be risk-adjusted to control for different case-mix. The study’s objectives were to develop a risk adjustment model for worsening or onset of urinary incontinence (UI), measured with the RAI-HC QI bladder incontinence, using the database HomeCareData and to assess the impact of risk adjustment on quality rankings of HCOs. Risk factors of UI were identified in the scientific literature, and multivariable logistic regression was used to develop the risk adjustment model. The observed and risk-adjusted QI rates were calculated on organization level, uncertainty addressed by nonparametric bootstrapping. The differences between observed and risk-adjusted QI rates were graphically assessed with a Bland-Altman plot and the impact of risk adjustment examined by HCOs tertile ranking changes. 12,652 clients from 76 Swiss HCOs aged 18 years and older receiving home care between 1 January 2017, and 31 December 2018, were included. Eight risk factors were significantly associated with worsening or onset of UI: older age, female sex, obesity, impairment in cognition, impairment in hygiene, impairment in bathing, unsteady gait, and hospitalization. The adjustment model showed fair discrimination power and had a considerable effect on tertile ranking: 14 (20%) of 70 HCOs shifted to another tertile after risk adjustment. The study showed the importance of risk adjustment for fair comparisons of the quality of UI care between HCOs in Switzerland.
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Gadolin C, Eriksson E, Alexandersson P. Coordination of paediatric oncology care: an explorative Swedish case study. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-10-2020-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The aim of this paper is to empirically describe and analyze factors deemed to be relevant for the successful provision of coordinated paediatric oncology care by physicians and nurses involved.
Design/methodology/approach
A qualitative case study primarily consisting of interviews.
Findings
The paper's findings indicate that certain factors (i.e. distinct mission, clear treatment protocols and support from external stakeholders) relevant for the provision of coordinated paediatric oncology care have not received sufficient attention in previous research. In addition, emphasis is placed on the necessity of facilitating constructive working relationships and a bottom-up perspective when pursuing improved care coordination.
Originality/value
The factors described and analyzed may act as insights for how paediatric oncology might be improved in terms of care coordination and thus facilitate care integration. In addition, the paper's findings identify factors relevant for further empirical studies in order to delineate their generalizability.
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TAYLOR LAURENA, BYHOFF ELENA. Money Moves the Mare: The Response of Community-Based Organizations to Health Care's Embrace of Social Determinants. Milbank Q 2021; 99:171-208. [PMID: 33420728 PMCID: PMC7984660 DOI: 10.1111/1468-0009.12491] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Policy Points Health policies that encourage health and social integration can induce community-based organizations (CBOs) to adopt new ways of working from health care organizations, including their language, staffing patterns, and metrics. These changes can be explained by CBOs' perceptions that health care organizations may provide new sources of revenue. While the welfare implications of these changes are not yet known, policymakers should consider balancing the benefits of professionalizing CBOs against the risks of medicalizing them. CONTEXT Recent health policies incentivize health care providers to collaborate with community-based organizations (CBOs), such as food pantries and homeless shelters, to address patients' social determinants of health (SDOH). The perspectives of health care leaders on these policy changes have been studied, but the perspectives of CBO managers have not. METHODS Our research question was: How are CBOs in Massachusetts perceiving and responding to new Medicaid policies that encourage collaboration between health care organizations and CBOs? We interviewed 46 people in leadership positions at CBOs in Massachusetts for approximately an hour each. We analyzed these data abductively, meaning that we iterated between inductively coding transcripts and consulting existing theories and frameworks. FINDINGS We found evidence of a knowing-doing gap among CBOs. Even though CBOs value their distinctiveness and autonomy from health care, they have undertaken a series of organizational changes in response to the new Medicaid policy that make their organizations appear more like health care organizations. These changes include adopting new performance metrics, hiring clinical staff to the board and senior management positions, and using medical language to describe nonmedical work. Drawing on institutional theory, we suggest that the nonprofits undertake such changes in an effort to demonstrate legitimacy to health care organizations, who may be able to provide new sources of critically needed revenue. CONCLUSIONS Massachusetts CBOs perceive health systems as potential sources of revenue, due in part to an ongoing Medicaid redesign that encourages the integration of health and social services. This perception is driving CBOs to appear more like health care organizations, but the impacts of these changes on welfare remain unknown.
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Affiliation(s)
| | - ELENA BYHOFF
- Department of MedicineTufts University School of Medicine and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
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Huang MM, Cheaib JG, Su ZT, Biles MJ, Sharma R, Zhang A, Singla N, Bass EB, Pierorazio PM. Assessing quality of care in the diagnosis and treatment of early-stage testicular cancer: A critical review and summary. Urol Oncol 2021; 39:400-408. [PMID: 33642227 DOI: 10.1016/j.urolonc.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the current literature on quality of care in the diagnosis and management of early-stage testicular cancer. METHODS PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies on quality of care in testicular cancer diagnosis and management from January 1980 to August 2018. Major overlapping themes related to quality of care in the diagnosis and management of TGCT were identified and evidence related to these themes were abstracted. EVIDENCE 62 studies were included in the review. A number of themes were identified including (1) trends in survival and outcomes, (2) management patterns, (3) adherence to evidence-based clinical guidelines, (4) delays in care, (5) treatment complications and toxicities, (6) sociodemographic factors, (7) volume of patients treated, (8) gaps in provider knowledge and medical errors, and (9) multidisciplinary approaches to care. EVIDENCE SUMMARY As survival for patients with testicular cancer improves, there has been a greater emphasis on other components of quality of care, such as reducing treatment toxicity and minimizing delays in diagnosis. Efforts to meet these goals include encouragement of adherence to evidence-based guidelines, greater utilization of surveillance, and promotion of multidisciplinary team-based care. Although outcomes have improved, social determinants of health, such as insurance status, race, and geographical residence all may influence survival and cancer-related outcomes. Additionally, qualitative review indicates patients who receive care at high-volume institutions appear to experience better outcomes than those treated at smaller centers. CONCLUSIONS As outcomes and survival improve for patients with testicular cancer, quality of care has become an important consideration. Future avenues of research on this topic include identifying an appropriate balance between centralization of care and expanding access to underserved areas, minimizing delays in care, ensuring greater adherence to clinical guidelines, and addressing sociodemographic and racial disparities in outcomes.
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Affiliation(s)
- Mitchell M Huang
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph G Cheaib
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zhuo T Su
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael J Biles
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ritu Sharma
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allen Zhang
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Nirmish Singla
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric B Bass
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
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Marani H, Evans JM, Palmer KS, Brown A, Martin D, Ivers NM. Divergent notions of "quality" in healthcare policy implementation: a framing perspective. J Health Organ Manag 2021; ahead-of-print. [PMID: 33440089 DOI: 10.1108/jhom-09-2020-0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This paper examines how "quality" was framed in the design and implementation of a policy to reform hospital funding and associated care delivery. The aims of the study were: (1) To describe how government policy-makers who designed the policy and managers and clinicians who implemented the policy framed the concept of "quality" and (2) To explore how frames of quality and the framing process may have influenced policy implementation. DESIGN/METHODOLOGY/APPROACH The authors conducted a secondary analysis of data from a qualitative case study involving semi-structured interviews with 45 purposefully selected key informants involved in the design and implementation of the quality-based procedures policy in Ontario, Canada. The authors used framing theory to inform coding and analysis. FINDINGS The authors found that policy designers perpetuated a broader frame of quality than implementers who held more narrow frames of quality. Frame divergence was further characterized by how informants framed the relationship between clinical and financial domains of quality. Several environmental and organizational factors influenced how quality was framed by implementers. ORIGINALITY/VALUE As health systems around the world increasingly implement new models of governance and financing to strengthen quality of care, there is a need to consider how "quality" is framed in the context of these policies and with what effect. This is the first framing analysis of "quality" in health policy.
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Affiliation(s)
- Husayn Marani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Women's College Hospital Research Institute, Women's College Hospital, Toronto, Canada
| | - Jenna M Evans
- DeGroote School of Business, McMaster University, Hamilton, Canada
| | - Karen S Palmer
- Women's College Hospital Research Institute, Women's College Hospital, Toronto, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Adalsteinn Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Danielle Martin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Women's College Hospital Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, Canada
| | - Noah M Ivers
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Women's College Hospital Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, Canada
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Asefa G, Atnafu A, Dellie E, Gebremedhin T, Aschalew AY, Tsehay CT. Health System Responsiveness for HIV/AIDS Treatment and Care Services in Shewarobit, North Shewa Zone, Ethiopia. Patient Prefer Adherence 2021; 15:581-588. [PMID: 33727803 PMCID: PMC7955722 DOI: 10.2147/ppa.s300825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/25/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Health System Responsiveness is the key objective of the health system used to fulfil patients' universal legitimate expectations. However, the health system's responsiveness to HIV/AIDS was not assessed in Ethiopia. Therefore, this study aimed at assessing the health system responsiveness of HIV/AIDS treatment and care services and associated factors in the public health facilities of Shewarobit town, Ethiopia. PATIENTS AND METHODS An institution-based cross-sectional study was employed from 15 February to 15 April 2020 in the public health facilities of Shewarobit town. The data were collected among 416 randomly selected Anti-Retroviral Therapy (ART) users using an interviewer-administered questionnaire. Responsiveness was measured using 27 Likert scale questions across seven responsiveness domains. A binary logistic regression model was fitted. A p-value of less than 0.05 and AOR with a 95% confidence interval (CI) was used to declare the associated factors in the final multivariable logistic regression analysis. RESULTS The overall health system responsiveness was 55.3% (95% CI: 50.6-59.8). High performance of responsiveness was found on confidentiality, respect, and communication domains, whereas poor responsiveness was achieved in prompt attention and choice domains. Participants aged 50+ years (AOR:2.48, 95% CI, 1.12-5.54), perceived good health (AOR: 3.10, 95% CI: 1.75-5.48), patients' satisfaction with care (AOR: 2.98, 95% CI: 1.35-6.54) and history of visiting traditional healers (AOR: 2.50, 95% CI:1.51-4.17) were factors associated with health system responsiveness of HIV/AIDS treatment and care services in the study area. CONCLUSIONS Unacceptable responsive performance was found in choice and prompt attention domains. Participants' age, perceived health status, history of visiting traditional healers, and patient satisfaction were factors that affect responsiveness in the study area. Thus, providing training, frequent supportive supervision, improving community awareness, and incorporating traditional healers in the modern health system would enhance the health system responsiveness in Ethiopia.
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Affiliation(s)
- Getachew Asefa
- Shewarobit Primary Hospital, Shewarobit, North Shewa Zone Administration, Amhara National Regional State, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endalkachew Dellie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaye Gebremedhin
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Andualem Yalew Aschalew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chalie Tadie Tsehay
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Chalie Tadie Tsehay University of Gondar, P.O. Box: 196, Gondar, Ethiopia Email
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Selecting home care quality indicators based on the Resident Assessment Instrument-Home Care (RAI-HC) for Switzerland: A public health and healthcare providers' perspective. PLoS One 2020; 15:e0244577. [PMID: 33378348 PMCID: PMC7773259 DOI: 10.1371/journal.pone.0244577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 12/13/2020] [Indexed: 12/27/2022] Open
Abstract
Background Despite an increasing importance of home care, quality assurance in this healthcare sector in Switzerland is hardly established. In 2010, Swiss home care quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) were developed. However, these QIs have not been revised since, although internationally new RAI-HC QIs have emerged. The objective of this study was to assess the appropriateness of RAI-HC QIs to measure quality of home care in Switzerland from a public health and healthcare providers’ perspective. Methods First, the appropriateness of RAI-HC QIs, identified in a recent systematic review, was assessed by a multidisciplinary expert panel based on the RAND/UCLA Appropriateness Method taking into account indicators’ public health relevance, potential of influence, and comprehensibility. Second, the QIs selected by the experts were afterwards rated regarding their relevance, potential of influence, and practicability from a healthcare providers’ perspective in focus groups with home care nurses based on the Nominal-Group-Technique. Data were analyzed using median scores and the Disagreement Index. Results 18 of 43 RAI-HC QIs were rated appropriate by the experts from a public health perspective. The 18 QIs cover clinical, psychosocial, functional and service use aspects. Seven of the 18 QIs were subsequently rated appropriate by home care nurses from a healthcare providers’ perspective. The focus of these QIs is narrow, because three of seven QIs are pain-related. From both perspectives, the majority of RAI-HC QIs were rated inappropriate because of insufficient potential of influence, with healthcare providers rating them more critically. Conclusions The study shows that the appropriateness of RAI-HC QIs differs according to the stakeholder perspective and the intended use of QIs. The findings of this study can guide policy-makers and home care organizations on selecting QIs and to critically reflect on their appropriate use.
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Gurvitz M, Lui GK, Marelli A. Adult Congenital Heart Disease—Preparing for the Changing Work Force Demand. Cardiol Clin 2020; 38:283-294. [DOI: 10.1016/j.ccl.2020.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Campeau L, Shamout S, Baverstock RJ, Carlson KV, Elterman DS, Hickling DR, Steele SS, Welk B. Canadian Urological Association Best Practice Report: Catheter use. Can Urol Assoc J 2020; 14:E281-E289. [PMID: 32432528 DOI: 10.5489/cuaj.6697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Lysanne Campeau
- Division of Urology, Department of Surgery, Montreal Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Samer Shamout
- Division of Urology, Department of Surgery, Montreal Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Richard J Baverstock
- vesia [Alberta Bladder Centre] and Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Kevin V Carlson
- vesia [Alberta Bladder Centre] and Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Dean S Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Duane R Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Blayne Welk
- Division of Urology, Department of Surgery, University of Western Ontario, London, ON, Canada
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Abstract
This paper sets out a conceptual framework by which quality improvement in primary dental care can be approached. We argue that seeking a unified definition for quality in dentistry is a distraction to the more important end of quality improvement. An approach to quality improvement that interfaces Donabedian's domains of structure, process and outcome with various dimensions of quality gives a rational approach by which quality can be assessed and improved. The importance of valid, evidence driven indicators and methods for their implementation in primary dental care is described. Further work is required in order to identify which dimensions of dentistry are most important, but the Institute of Medicine's dimensions of safety, effectiveness, patient centreedness, timeliness, equity, efficiency are a good starting point. Trying to develop an absolute list of dimensions of quality should not distract from implementing an approach-based paradigm of quality improvement. Bioinformatics offers new solutions by which quality measures may be implemented and reported in the primary care setting. The focus of future research should be in implementing data-driven quality indicators at the level of the primary care practitioner.
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Darney BG, Kapp N, Andersen K, Baum SE, Blanchard K, Gerdts C, Montagu D, Chakraborty NM, Powell B. Definitions, measurement and indicator selection for quality of care in abortion. Contraception 2019; 100:354-359. [DOI: 10.1016/j.contraception.2019.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 11/25/2022]
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The acceptance and applicability of a patient-reported experience measurement tool in oncological care: a descriptive feasibility study in northern Germany. BMC Health Serv Res 2019; 19:786. [PMID: 31675968 PMCID: PMC6825358 DOI: 10.1186/s12913-019-4646-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are tools for assessing outcomes of and experiences with health care from the patient's perspective. In Germany, PROMs are widely used in research for evaluating patient outcomes and quality of care. However, the application of PREMs is rather scant, especially in oncology. The study aimed to assess the feasibility of patient-centred quality evaluation in oncological care in Germany using the German adaptation of the Danish National Cancer Patient Questionnaire. This questionnaire is a PREM/PROM-tool addressing patients of all cancer sites and covering the entire cancer patient pathway. METHODS The Danish National Cancer Patient Questionnaire was translated into German via forward-backward translation. Face-validity was tested among three cancer patients in a conventional pre-test. The German adaptation contains 99 questions. A pilot test was carried out among 245 newly diagnosed breast and colorectal cancer patients in the German federal state Schleswig-Holstein. Patients were recruited via clinics participating in the Oncological Care Registry (12 specialised units in seven hospitals) and contacted six to nine months after diagnosis. Response behaviour and response patterns were compared to the Danish study population (n = 1964). RESULTS The willingness among clinicians to support patient recruitment as well as the response rate of patients to the questionnaire was high (65%). Moreover, response behaviour and response patterns of German and Danish patients were consistent. Despite the generally good response behaviour of patients to the single items, the authors observed that questions assessing the diagnostic process did not fully capture German pathways. Only 19.3% of the German patients stated that their diagnostic process was initiated by a visit to a general practitioner (GP) in contrast to 52% in Denmark. The assessment of patient experiences in the diagnostic phase heavily focuses on experiences in general practice, which does not seem appropriate in the German health care setting. CONCLUSION The translation was successful, and the feasibility of a future large-scale study within existing structures is given. However, some modifications of questions heavily related to the Danish health care system, especially referring to the diagnostic phase, are necessary.
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Choi Y, Park M, Kang DH, Lee J, Moon JY, Ahn H. The quality of dying and death for patients in intensive care units: a single center pilot study. Acute Crit Care 2019; 34:192-201. [PMID: 31723928 PMCID: PMC6849018 DOI: 10.4266/acc.2018.00374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/16/2019] [Accepted: 05/03/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To identify the necessary care for dying patients in intensive care units (ICUs), we designed a retrospective study to evaluate the quality of dying and death (QODD) experienced by the surrogates of patients with medical illness who died in the ICU of a tertiary referral hospital. METHODS To achieve our objective, the authors compared the QODD scores as appraised by the relatives of patients who died of cancer under hospice care with those who died in the ICU. For this study, a Korean version of the QODD questionnaire was developed, and individual interviews were also conducted. RESULTS Sixteen people from the intensive care group and 23 people from the hospice care group participated in the survey and completed the questionnaire. The family members of patients who died in the ICU declined participation at a high rate (50%), with the primary reason being to avoid bringing back painful memories (14 people, 87.5%). The relatives of the intensive care group obtained an average total score on the 17-item QODD questionnaire, which was significantly lower than that of the relatives of the hospice group (48.7±15.5 vs. 60.3±14.8, P=0.03). CONCLUSIONS This work implies that there are unmet needs for the care of dying patients and for the QODD in tertiary hospital ICUs. This result suggests that shared decision making for advance care planning should be encouraged and that education on caring for dying patients should be provided to healthcare professionals to improve the QODD in Korean ICUs.
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Affiliation(s)
- Yanghwan Choi
- Department of Burn and Critical Care, Bestian Hospital, Osong, Korea
| | - Myoungrin Park
- Department of Internal Medicine, Daejeon Veterans Hospital, Daejeon, Korea
| | - Da Hyun Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jooseon Lee
- Hospital Ethics Committee, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Young Moon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Heejoon Ahn
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Byrne MJ, Tickle M, Glenny AM, Campbell S, Goodwin T, O’Malley L. A systematic review of quality measures used in primary care dentistry. Int Dent J 2019; 69:252-264. [PMID: 30430563 PMCID: PMC9378976 DOI: 10.1111/idj.12453] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION 'Quality' in primary care dentistry is poorly defined. There are significant international efforts focussed on developing quality measures within dentistry. The aim of this research was to identify measures used to assess quality in primary care dentistry and categorise them according to which dimensions of quality they attempt to measure. METHODS Quality measures were identified from the peer-reviewed and grey literature. Peer-reviewed papers describing the development and validation of measures were identified using a structured literature search. Measures from the grey literature were identified using structured searches and direct contact with dental providers and institutions. Quality measures were categorised according to domains of structure, process and outcome and by disaggregated dimensions of quality. RESULTS From 22 studies, 11 validated measure sets (comprising nine patient satisfaction surveys and two practice assessment instruments) were identified from the peer-reviewed literature. From the grey literature, 24 measure sets, comprising 357 individual measures, were identified. Of these, 96 addressed structure, 174 addressed process and 87 addressed outcome. Only three of these 24 measure sets demonstrated evidence of validity testing. The identified measures failed to address dimensions of quality, such as efficiency and equity. CONCLUSIONS There has been a proliferation in the development of dental quality measures in recent years. However, this development has not been guided by a clear understanding of the meaning of quality. Few existing measures have undergone rigorous validity or reliability testing. A consensus is needed to establish a definition of quality in dentistry. Identification of the important dimension of quality in dentistry will allow for the production of a core quality measurement set.
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Affiliation(s)
- Matthew J. Byrne
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Martin Tickle
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stephen Campbell
- NIHR Patient Safety Translational Research Centre, Division of Population Health, HSR & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tom Goodwin
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lucy O’Malley
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Affiliation(s)
- P. Jo Armes
- Department of Palliative Care and Policy, Guy's, King's & St Thomas’ School of Medicine & Dentistry, St Christopher's Hospice, London, UK
| | - Irene J. Higginson
- Department of Palliative Care and Policy, Guy's, King's & St Thomas’ School of Medicine & Dentistry, St Christopher's Hospice, London, UK
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Haugland H, Uleberg O, Klepstad P, Krüger A, Rehn M. Quality measurement in physician-staffed emergency medical services: a systematic literature review. Int J Qual Health Care 2019; 31:2-10. [PMID: 29767795 PMCID: PMC6387994 DOI: 10.1093/intqhc/mzy106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 02/14/2018] [Accepted: 04/25/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Quality measurement of physician-staffed emergency medical services (P-EMS) is necessary to improve service quality. Knowledge and consensus on this topic are scarce, making quality measurement of P-EMS a high-priority research area. The aim of this review was to identify, describe and evaluate studies of quality measurement in P-EMS. DATA SOURCES The databases of MEDLINE and Embase were searched initially, followed by a search for included article citations in Scopus. STUDY SELECTION The study eligibility criteria were: (1) articles describing the use of one quality indicator (QI) or more in P-EMS, (2) original manuscripts, (3) articles published from 1 January 1968 until 5 October 2016. The literature search identified 4699 records. 4543 were excluded after reviewing title and abstract. An additional 129 were excluded based on a full-text review. The remaining 27 papers were included in the analysis. Methodological quality was assessed using an adapted critical appraisal tool. DATA EXTRACTION The description of used QIs and methods of quality measurement was extracted. Variables describing the involved P-EMSs were extracted as well. RESULTS OF DATA SYNTHESIS In the included papers, a common understanding of which QIs to use in P-EMS did not exist. Fifteen papers used only a single QI. The most widely used QIs were 'Adherence to medical protocols', 'Provision of advanced interventions', 'Response time' and 'Adverse events'. CONCLUSION The review demonstrated a lack of shared understanding of which QIs to use in P-EMS. Moreover, papers using only one QI dominated the literature, thus increasing the risk of a narrow perspective in quality measurement. Future quality measurement in P-EMS should rely on a set of consensus-based QIs, ensuring a comprehensive approach to quality measurement.
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Affiliation(s)
- Helge Haugland
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway
| | - Andreas Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marius Rehn
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
- Division of Emergencies and Critical Care, Department of Anaesthesia, Oslo University Hospital, Oslo, Norway
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Ridgeway G, Nørgaard M, Rasmussen TB, Finkle WD, Pedersen L, Bøtker HE, Sørensen HT. Benchmarking Danish hospitals on mortality and readmission rates after cardiovascular admission. Clin Epidemiol 2019; 11:67-80. [PMID: 30655706 PMCID: PMC6324920 DOI: 10.2147/clep.s189263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to examine hospital performance measures that account more comprehensively for unique mixes of patients' characteristics. Design Nationwide cohort registry-based study within a population-based health care system. Participants In this study, 331,513 patients discharged with a primary cardiovascular diagnosis from 1 of 26 Danish hospitals during 2011-2015 were included. Data covering all Danish hospitals were drawn from the Danish National Patient Registry and the Danish National Health Service Prescription Database. Main outcome measures Thirty-day post-admission mortality rates, 30-day post-discharge readmission rates, and the associated numbers needed to harm were measured. Methods For each index hospital, we used a non-parametric logistic regression model to compute propensity scores. Propensity score weighted patients treated at other hospitals collectively resembled patients treated at the index hospital in terms of age, sex, primary discharge diagnosis, diagnosis history, medications, previous cardiac procedures, and comorbidities. Outcomes for the weighted patients treated at other hospitals formed benchmarks for the index hospital. Doubly robust regression formally tested whether the outcomes of patients at the index hospital differed from the outcomes of the patients used to form the benchmarks. For each index hospital, we computed the false discovery rate, ie, the probability of being incorrect if we claimed the hospital differed from its benchmark. Results Five hospitals exceeded their benchmark for 30-day mortality rates, with the number needed to harm ranging between 55 and 137. Seven hospitals exceeded their benchmark for readmission, with the number needed to harm ranging from 22 to 71. Our benchmarking approach flagged fewer hospitals as outliers compared with conventional regression methods. Conclusion Conventional methods flag more hospitals as outliers than our benchmarking approach. Our benchmarking approach accounts more thoroughly for differences in hospitals' patient case mix, reducing the risk of false-positive selection of suspected outliers. A more comprehensive system of hospital performance measurement could be based on this approach.
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Affiliation(s)
- Greg Ridgeway
- Department of Criminology, University of Pennsylvania, Philadelphia, PA, USA, .,Department of Statistics, University of Pennsylvania, Philadelphia, PA, USA, .,Consolidated Research, Inc., Los Angeles, CA, USA,
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Bøjer Rasmussen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars Pedersen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Pap R, Lockwood C, Stephenson M, Simpson P. Indicators to measure prehospital care quality: a scoping review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:2192-2223. [PMID: 30439748 DOI: 10.11124/jbisrir-2017-003742] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The purpose of this scoping review was to locate, examine and describe the literature on indicators used to measure prehospital care quality. INTRODUCTION The performance of ambulance services and quality of prehospital care has traditionally been measured using simple indicators, such as response time intervals, based on low-level evidence. The discipline of paramedicine has evolved significantly over the last few decades. Consequently, the validity of utilizing such measures as holistic prehospital care quality indicators (QIs) has been challenged. There is growing interest in finding new and more significant ways to measure prehospital care quality. INCLUSION CRITERIA This scoping review examined the concepts of prehospital care quality and QIs developed for ambulance services. This review considered primary and secondary research in any paradigm and utilizing any methods, as well as text and opinion research. METHODS Joanna Briggs Institute methodology for conducting scoping reviews was employed. Separate searches were conducted for two review questions; review question 1 addressed the definition of prehospital care quality and review question 2 addressed characteristics of QIs in the context of prehospital care. The following databases were searched: PubMed, CINAHL, Embase, Scopus, Cochrane Library and Web of Science. The searches were limited to publications from January 1, 2000 to the day of the search (April 16, 2017). Non-English articles were excluded. To supplement the above, searches for gray literature were performed, experts in the field of study were consulted and applicable websites were perused. RESULTS Review question 1: Nine articles were included. These originated mostly from England (n = 3, 33.3%) and the USA (n = 3, 33.3%). Only one study specifically aimed at defining prehospital care quality. Five articles (55.5%) described attributes specific to prehospital care quality and four (44.4%) articles considered generic healthcare quality attributes to be applicable to the prehospital context. A total of 17 attributes were identified. The most common attributes were Clinical effectiveness (n = 17, 100%), Efficiency (n = 7, 77.8%), Equitability (n = 7, 77.8%) and Safety (n = 6, 66.7%). Timeliness and Accessibility were referred to by four and three (44.4% and 33.3%) articles, respectively.Review question 2: Thirty articles were included. The predominant source of articles was research literature (n = 23; 76.7%) originating mostly from the USA (n = 13; 43.3%). The most frequently applied QI development method was a form of consensus process (n = 15; 50%). A total of 526 QIs were identified. Of these, 283 (53.8%) were categorized as Clinical and 243 (46.2%) as System/Organizational QIs. Within these categories respectively, QIs related to Out-of-hospital cardiac arrest (n = 57; 10.8%) and Time intervals (n = 75; 14.3%) contributed the most. The most commonly addressed prehospital care quality attributes were Appropriateness (n = 250, 47.5%), Clinical effectiveness (n = 174, 33.1%) and Accessibility (n = 124, 23.6%). Most QIs were process indicators (n = 386, 73.4%). CONCLUSION Whilst there is paucity in research aiming to specifically define prehospital care quality, the attributes of generic healthcare quality definitions appear to be accepted and applicable to the prehospital context. There is growing interest in developing prehospital care QIs. However, there is a need for validation of existing QIs and de novo development addressing broader aspects of prehospital care.
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Affiliation(s)
- Robin Pap
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
- School of Science and Health, Western Sydney University, Sydney, Australia
| | - Craig Lockwood
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Matthew Stephenson
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Paul Simpson
- School of Science and Health, Western Sydney University, Sydney, Australia
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Escobar GJ, Baker JM, Turk BJ, Draper D, Liu V, Kipnis P. Comparing Hospital Processes and Outcomes in California Medicare Beneficiaries: Simulation Prompts Reconsideration. Perm J 2018; 21:16-084. [PMID: 29035176 DOI: 10.7812/tpp/16-084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This article is not a traditional research report. It describes how conducting a specific set of benchmarking analyses led us to broader reflections on hospital benchmarking. We reexamined an issue that has received far less attention from researchers than in the past: How variations in the hospital admission threshold might affect hospital rankings. Considering this threshold made us reconsider what benchmarking is and what future benchmarking studies might be like. Although we recognize that some of our assertions are speculative, they are based on our reading of the literature and previous and ongoing data analyses being conducted in our research unit. We describe the benchmarking analyses that led to these reflections. OBJECTIVES The Centers for Medicare and Medicaid Services' Hospital Compare Web site includes data on fee-for-service Medicare beneficiaries but does not control for severity of illness, which requires physiologic data now available in most electronic medical records.To address this limitation, we compared hospital processes and outcomes among Kaiser Permanente Northern California's (KPNC) Medicare Advantage beneficiaries and non-KPNC California Medicare beneficiaries between 2009 and 2010. METHODS We assigned a simulated severity of illness measure to each record and explored the effect of having the additional information on outcomes. RESULTS We found that if the admission severity of illness in non-KPNC hospitals increased, KPNC hospitals' mortality performance would appear worse; conversely, if admission severity at non-KPNC hospitals' decreased, KPNC hospitals' performance would appear better. CONCLUSION Future hospital benchmarking should consider the impact of variation in admission thresholds.
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Affiliation(s)
- Gabriel J Escobar
- Regional Director for Hospital Operations Research for The Permanente Medical Group, Inc, at the Division of Research in Oakland, CA.
| | - Jennifer M Baker
- Public Health Program Specialist for Contra Costa Public Health Clinic Services in Martinez, CA.
| | | | - David Draper
- Professor of Applied Mathematics and Statistics at the University of California, Santa Cruz.
| | - Vincent Liu
- Regional Director for Hospital Advanced Analytics for The Permanente Medical Group, Inc, at the Division of Research in Oakland, CA.
| | - Patricia Kipnis
- Principal Statistician for Decision Support at Kaiser Foundation Health Plan.
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Gadolin C. Professional employees’ strategic employment of the managerial logic in healthcare. QUALITATIVE RESEARCH IN ORGANIZATIONS AND MANAGEMENT: AN INTERNATIONAL JOURNAL 2018. [DOI: 10.1108/qrom-02-2016-1359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to describe and analyze how physicians and nurses strategically employ the managerial logic.Design/methodology/approachA qualitative case study incorporating interviews and observations.FindingsNeither physicians nor nurses were prone to strategically employing the managerial logic. However, when doing so nurses were able to acknowledge the legitimacy of managerial impact on practice, whereas the physicians were not. Consequently, physicians might find other, more subtle, ways to strategically employ the managerial logic.Originality/valueThis paper argues for and makes explicit the applicability of qualitative methods in order to delineate actors’ strategic use of available and accessible institutional logics, the conditions for such usage, as well as the multiplicity of actors’ interactions that needs to be taken into account when conducting qualitative data analysis of such occurrences. By the merits of the qualitative research approach utilized in this study, novel insights concerning the strategic use of the managerial logic in the everyday work of physicians and nurses were obtainable. These insights emphasize the necessity of acknowledging situational, organizational and institutional context, incorporating inter-professional power discrepancies and relationsvis-à-vismanagers.
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Affiliation(s)
- L Licitra
- Division of Medical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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Giangrande A. Quality of Health Care: The Responsibility of Health Care Professionals in Delivering High Quality Services. Int J Artif Organs 2018. [DOI: 10.1177/039139889802101107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A. Giangrande
- Nephrology and Dialysis Departments, Azienda Ospedaliera “Ospedale di Circolo” di Busto Arsizio, Busto Arsizio - Italy
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Zoccali C. Medical Knowledge, Quality of Life and Accreditation of Quality in Health Care the Perspective of the Clinical Nephrologist. Int J Artif Organs 2018. [DOI: 10.1177/039139889802101119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- C. Zoccali
- Division of Nephrology, and CNR Center of Clinical Physiology, Reggio Calabria - Italy
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Naudé A, Bornman J. Measuring Instrument for Ethical Sensitivity in the Therapeutic Sciences. THE JOURNAL OF CLINICAL ETHICS 2017. [DOI: 10.1086/jce2017284290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Mutemwa R, Mayhew SH, Warren CE, Abuya T, Ndwiga C, Kivunaga J. Does service integration improve technical quality of care in low-resource settings? An evaluation of a model integrating HIV care into family planning services in Kenya. Health Policy Plan 2017; 32:iv91-iv101. [PMID: 29194543 PMCID: PMC5886058 DOI: 10.1093/heapol/czx090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 12/29/2022] Open
Abstract
The aim of this study was to investigate association between HIV and family planning integration and technical quality of care. The study focused on technical quality of client-provider consultation sessions. The cross-sectional study observed 366 client-provider consultation sessions and interviewed 37 health care providers in 12 public health facilities in Kenya. Multilevel random intercept and linear regression models were fitted to the matched data to investigate relationships between service integration and technical quality of care as well as associations between facility-level structural and provider factors and technical quality of care. A sensitivity analysis was performed to test for hidden bias. After adjusting for facility-level structural factors, HIV/family planning integration was found to have significant positive effect on technical quality of the consultation session, with average treatment effect 0.44 (95% CI: 0.63-0.82). Three of the 12 structural factors were significantly positively associated with technical quality of consultation session including: availability of family planning commodities (9.64; 95% CI: 5.07-14.21), adequate infrastructure (5.29; 95% CI: 2.89-7.69) and reagents (1.48; 95% CI: 1.02-1.93). Three of the nine provider factors were significantly positively associated with technical quality of consultation session: appropriate provider clinical knowledge (3.14; 95% CI: 1.92-4.36), job satisfaction (2.02; 95% CI: 1.21-2.83) and supervision (1.01; 95% CI: 0.35-1.68), while workload (-0.88; 95% CI: -1.75 to - 0.01) was negatively associated. Technical quality of the client-provider consultation session was also determined by duration of the consultation and type of clinic visit and appeared to depend on whether the clinic visit occurred early or later in the week. Integration of HIV care into family planning services can improve the technical quality of client-provider consultation sessions as measured by both health facility structural and provider factors.
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Affiliation(s)
- Richard Mutemwa
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Susannah H Mayhew
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Charlotte E Warren
- Population Council, 4301 Connecticut Avenue NW, Suite 280 Washington, DC 20008 United States
| | - Timothy Abuya
- Population Council, Ralph Bunche Rd, Upper Hill, Nairobi, Kenya
| | - Charity Ndwiga
- Population Council, Ralph Bunche Rd, Upper Hill, Nairobi, Kenya
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Koschorke M, Leitner L, Sadri H, Knüpfer SC, Mehnert U, Kessler TM. Intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity incontinence: do we need urodynamic investigation for outcome assessment? BJU Int 2017; 120:848-854. [DOI: 10.1111/bju.13976] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Miriam Koschorke
- Neuro-Urology; Spinal Cord Injury Center and Research; University of Zürich; Balgrist University Hospital; Zürich Switzerland
- Department of Urology; University Hospital Pedro Ernesto; Rio de Janeiro Brazil
| | - Lorenz Leitner
- Neuro-Urology; Spinal Cord Injury Center and Research; University of Zürich; Balgrist University Hospital; Zürich Switzerland
- Department of Urology; University Hospital Basel; Basel Switzerland
| | - Helen Sadri
- Neuro-Urology; Spinal Cord Injury Center and Research; University of Zürich; Balgrist University Hospital; Zürich Switzerland
| | - Stephanie C. Knüpfer
- Neuro-Urology; Spinal Cord Injury Center and Research; University of Zürich; Balgrist University Hospital; Zürich Switzerland
| | - Ulrich Mehnert
- Neuro-Urology; Spinal Cord Injury Center and Research; University of Zürich; Balgrist University Hospital; Zürich Switzerland
| | - Thomas M. Kessler
- Neuro-Urology; Spinal Cord Injury Center and Research; University of Zürich; Balgrist University Hospital; Zürich Switzerland
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Ngantcha M, Le-Pogam MA, Calmus S, Grenier C, Evrard I, Lamarche-Vadel A, Rey G. Hospital quality measures: are process indicators associated with hospital standardized mortality ratios in French acute care hospitals? BMC Health Serv Res 2017; 17:578. [PMID: 28830422 PMCID: PMC5568353 DOI: 10.1186/s12913-017-2534-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/14/2017] [Indexed: 01/24/2023] Open
Abstract
Background Results of associations between process and mortality indicators, both used for the external assessment of hospital care quality or public reporting, differ strongly across studies. However, most of those studies were conducted in North America or United Kingdom. Providing new evidence based on French data could fuel the international debate on quality of care indicators and help inform French policy-makers. The objective of our study was to explore whether optimal care delivery in French hospitals as assessed by their Hospital Process Indicators (HPIs) is associated with low Hospital Standardized Mortality Ratios (HSMRs). Methods The French National Authority for Health (HAS) routinely collects for each hospital located in France, a set of mandatory HPIs. Five HPIs were selected among the process indicators collected by the HAS in 2009. They were measured using random samples of 60 to 80 medical records from inpatients admitted between January 1st, 2009 and December 31, 2009 in respect with some selection criteria. HSMRs were estimated at 30, 60 and 90 days post-admission (dpa) using administrative health data extracted from the national health insurance information system (SNIIR-AM) which covers 77% of the French population. Associations between HPIs and HSMRs were assessed by Poisson regression models corrected for measurement errors with a simulation-extrapolation (SIMEX) method. Results Most associations studied were not statistically significant. Only two process indicators were found associated with HSMRs. Completeness and quality of anesthetic records was negatively associated with 30 dpa HSMR (0.72 [0.52–0.99]). Early detection of nutritional disorders was negatively associated with all HSMRs: 30 dpa HSMR (0.71 [0.54–0.95]), 60 dpa HSMR (0.51 [0.39–0.67]) and 90 dpa HSMR (0.52 [0.40–0.68]). Conclusion In absence of gold standard of quality of care measurement, the limited number of associations suggested to drive in-depth improvements in order to better determine associations between process and mortality indicators. A smart utilization of both process and outcomes indicators is mandatory to capture aspects of the hospital quality of care complexity. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2534-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marcus Ngantcha
- Inserm, CépiDc (Epidemiology center on medical causes of death), Kremlin-Bicêtre, France.
| | - Marie-Annick Le-Pogam
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne University (UNIL), Lausanne, Switzerland
| | - Sophie Calmus
- Haute Autorité de santé (HAS), Service des indicateurs pour l'amélioration de la qualité et de la sécurité des Soins (SIPAQSS), Saint-Denis La Plaine, France
| | - Catherine Grenier
- Haute Autorité de santé (HAS), Service des indicateurs pour l'amélioration de la qualité et de la sécurité des Soins (SIPAQSS), Saint-Denis La Plaine, France
| | - Isabelle Evrard
- Haute Autorité de santé (HAS), Service des indicateurs pour l'amélioration de la qualité et de la sécurité des Soins (SIPAQSS), Saint-Denis La Plaine, France
| | - Agathe Lamarche-Vadel
- Inserm, CépiDc (Epidemiology center on medical causes of death), Kremlin-Bicêtre, France.,Université Paris Sud, Kremlin-Bicêtre, France
| | - Grégoire Rey
- Inserm, CépiDc (Epidemiology center on medical causes of death), Kremlin-Bicêtre, France.
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Pap R, Lockwood C, Stephenson M, Simpson P. Indicators to measure pre-hospital care quality: a scoping review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:1537-1542. [PMID: 28628513 DOI: 10.11124/jbisrir-2016-003141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2024]
Abstract
REVIEW QUESTION/OBJECTIVE The current scoping review seeks to locate, examine and describe international literature on indicators used to measure pre-hospital care quality. Specifically, the review will.
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Affiliation(s)
- Robin Pap
- 1Joanna Briggs Institute, School of Health and Medical Sciences, University of Adelaide, Adelaide, Australia 2School of Science and Health, Western Sydney University, Sydney, Australia
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van den Driessen Mareeuw FA, Hollegien MI, Coppus AMW, Delnoij DMJ, de Vries E. In search of quality indicators for Down syndrome healthcare: a scoping review. BMC Health Serv Res 2017; 17:284. [PMID: 28420357 PMCID: PMC5395825 DOI: 10.1186/s12913-017-2228-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 04/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The medical care chain around Down syndrome (DS) is complex, with many multidisciplinary challenges. The current quality of care is unknown. Outcome-oriented quality indicators have the potential to improve medical practice and evaluate whether innovations are successful. This is particularly interesting for the evolving care for people with DS and intellectual disabilities (ID). The aim of this study was to identify existing indicators for medical DS care, by reviewing the literature. METHODS We systematically searched six databases (PubMed, EMBASE, Web of Science, CINAHL, PsycINFO, Google Scholar) for studies concerning the development and implementation of quality indicators for DS and/or ID care, published until February 1st 2015. The scoping review method was used, including systematic data extraction and stakeholder consultation. RESULTS We identified 13 studies concerning quality indicators for ID care that obtained data originating from questionnaires (patient/family/staff), medical files and/or national databases. We did not find any indicator sets specifically for DS care. Consulted stakeholders did not come up with additional indicator sets. Existing indicators for ID care predominantly focus on support services. Indicators in care for people with ID targeting medical care are scarce. Of the 70 indicators within the 13 indicator sets, 10% are structure indicators, 34% process, 32% outcome and 24% mixed. Ten of the 13 sets include indicators on the WHO quality dimensions 'patient-centeredness', 'effectiveness' and 'efficiency' of care. 'Accessibility' is covered by nine sets, 'equitability' by six, and 'safety' by four. Most studies developed indicators in a multidisciplinary manner in a joint effort with all relevant stakeholders; some used focus groups to include people with ID. CONCLUSION To our knowledge, this is the first review that searched for studies on quality indicators in DS care. Hence, the study contributes to existing knowledge on DS care as well as on measuring quality of care. Future research should address the development of a compact set of quality indicators for the DS care chain as a whole. Indicators should preferably be patient-centred and outcome-oriented, including user perspectives, while developed in a multidisciplinary way to achieve successful implementation.
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Affiliation(s)
- Francine A. van den Driessen Mareeuw
- Tranzo, Scientific Center for Care and Welfare, Faculty of Social and Behavioural Sciences, Tilburg University, PO Box 90153 (T-329), 5000 LE Tilburg, The Netherlands
- Department of Paediatrics, Jeroen Bosch Hospital, ´s-Hertogenbosch, The Netherlands
| | - Mirjam I. Hollegien
- Tranzo, Scientific Center for Care and Welfare, Faculty of Social and Behavioural Sciences, Tilburg University, PO Box 90153 (T-329), 5000 LE Tilburg, The Netherlands
- Department of Paediatrics, Jeroen Bosch Hospital, ´s-Hertogenbosch, The Netherlands
- Severinus, Centre for the Intellectually Disabled, Veldhoven, The Netherlands
| | - Antonia M. W. Coppus
- Dichterbij, Center for the Intellectually Disabled, Gennep, The Netherlands
- Department for Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Diana M. J. Delnoij
- Tranzo, Scientific Center for Care and Welfare, Faculty of Social and Behavioural Sciences, Tilburg University, PO Box 90153 (T-329), 5000 LE Tilburg, The Netherlands
- Institute for Health Care Quality, National Health Care Institute, Diemen, The Netherlands
| | - Esther de Vries
- Tranzo, Scientific Center for Care and Welfare, Faculty of Social and Behavioural Sciences, Tilburg University, PO Box 90153 (T-329), 5000 LE Tilburg, The Netherlands
- Department of Paediatrics, Jeroen Bosch Hospital, ´s-Hertogenbosch, The Netherlands
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Gupta M, Donovan EF, Henderson Z. State-based perinatal quality collaboratives: Pursuing improvements in perinatal health outcomes for all mothers and newborns. Semin Perinatol 2017; 41:195-203. [PMID: 28646987 PMCID: PMC11009783 DOI: 10.1053/j.semperi.2017.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
State-based perinatal quality collaboratives (SPQC) have become increasingly widespread in the United States. Whereas the first was launched in 1997, today over 40 states have SPQCs that are actively working or are in development. Despite great variability in the structure and function of SPQCs among states, many have seen their efforts lead to significant improvements in the care of mothers and newborns. Clinical topics targeted by SPQCs have included nosocomial infection in newborns, human milk use, neonatal abstinence syndrome, early term deliveries without a medical indication, maternal hemorrhage, and maternal hypertension, among others. While each SPQC uses approaches suited to its own context, several themes are common to the goals of all SPQCs, including developing obstetric and neonatal partnerships; including families as partners; striving for participation by all providers; utilizing rigorous quality improvement science; maintaining close partnerships with public health departments; and seeking population-level improvements in health outcomes.
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Affiliation(s)
- Munish Gupta
- Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215.
| | - Edward F Donovan
- Executive Committee, Colorado Perinatal Care Quality Collaborative, Denver, CO
| | - Zsakeba Henderson
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
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Svirydzenka N, Ronzoni P, Dogra N. Meaning and barriers to quality care service provision in Child and Adolescent Mental Health Services: Qualitative study of stakeholder perspectives. BMC Health Serv Res 2017; 17:151. [PMID: 28219392 PMCID: PMC5319051 DOI: 10.1186/s12913-017-2080-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Defining quality in health presents many challenges. The Institute of Medicine (IOM) defined quality clinical care as care that is equitable, timely, safe, efficient, effective and patient centred. However, it is not clear how different stakeholders within a child and adolescent mental health service (CAMHS) understand and/or apply this framework. This project aims to identify key stakeholders" understanding of the meaning of quality in the context of CAMHS. METHOD The study sample comprised of three groups: (i) patients and carers, (ii) CAMHS clinical staff, and (iii) commissioners (Total N = 24). Semi-structured interviews were used to collect data and thematic analysis was applied to explore participant's views on the meaning and measurement of quality and how these might reflect the IOM indicators and their relevance in CAMHS. RESULTS An initial barrier to implementing quality care in CAMHS was the difficulty and limited agreement in defining the meaning of quality care, its measurement and implementation for all participants. Clinical staff defined quality as personal values, a set of practical rules, or clinical discharge rates; while patients suggested being more involved in the decision-making process. Commissioners, while supportive of adequate safeguarding and patient satisfaction procedures, did not explicitly link their view on quality to commissioning guidelines. Identifying practical barriers to implementing quality care was easier for all interviewees and common themes included: lack of meaningful measures, recourses, accountability, and training. All interviewees considered the IOM six markers as comprehensive and relevant to CAMHS. CONCLUSIONS No respondent individually or within one stakeholder group identified more than a few of the indicators or barriers of a quality CAMHS service. However, the composite responses of the respondents enable us to develop a more complete picture of how to improve quality care in practice and guide future research in the area.
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Greco PM. Is good enough, good enough? Am J Orthod Dentofacial Orthop 2017; 151:242. [PMID: 28153150 DOI: 10.1016/j.ajodo.2016.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 11/28/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Peter M Greco
- Department of Orthodontics, University of Pennsylvania, Philadelphia, Pa; private practice, Philadelphia, Pa
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Portela MC, Lima SML, Martins M, Travassos C. Improvement Science: conceptual and theoretical foundations for its application to healthcare quality improvement. CAD SAUDE PUBLICA 2016; 32Suppl 2:e00105815. [PMID: 27828676 DOI: 10.1590/0102-311x00105815] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 02/01/2016] [Indexed: 11/22/2022] Open
Abstract
The development and study of healthcare quality improvement interventions have been reshaped, moving from more intuitive approaches, dominated by biomedical vision and premised on easy transferability, to gradually acknowledge the need for more planning and systematization, with greater incorporation of the social sciences and enhancement of the role of context. Improvement Science has been established, with a conceptual and methodological framework for such studies. Considering the incipient of the debate and scientific production on Improvement Science in Brazil, this article aims to expound its principal conceptual and theoretical fundamentals, focusing on three central themes: the linkage of different disciplines; recognition of the role of context; and the theoretical basis for the design, implementation, and evaluation of interventions. Resumo: O desenvolvimento e estudo de intervenções para a melhoria do cuidado de saúde tem ganhado novo contorno, movendo-se das abordagens mais intuitivas, com domínio da visão biomédica e assentadas no pressuposto de fácil transferibilidade, para gradativamente reconhecer a necessidade de mais planejamento e sistematização, com maior incorporação das ciências sociais e valorização do papel do contexto. A Ciência da Melhoria do Cuidado de Saúde vem se estabelecendo, propiciando referencial conceitual e metodológico para tais estudos. Considerando a incipiência do debate e produção sobre Ciência da Melhoria do Cuidado de Saúde no Brasil, este artigo objetiva discorrer sobre as principais bases conceituais e teóricas que a sustentam, com foco em três temas centrais: a articulação de diferentes disciplinas; o reconhecimento do papel do contexto; e o embasamento teórico para o desenho, implementação e avaliação das intervenções.
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Affiliation(s)
| | - Sheyla Maria Lemos Lima
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Mônica Martins
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Claudia Travassos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Ogaji DS, Giles S, Daker-White G, Bower P. Findings and Predictors of Patient-Reported Experience of Primary Health Care in Nigeria. J Patient Exp 2016; 3:69-80. [PMID: 28725841 PMCID: PMC5513649 DOI: 10.1177/2374373516667005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The study reports findings and patients' characteristics that predict their experiences of primary health care (PHC) in Nigeria. METHODS A cross-sectional survey of 1680 patients attending 24 primary health centers in 6 states from the 6 geopolitical subdivisions in Nigeria. The patient evaluation scale was used for exit survey of patients' experiences with PHC. Categorical findings and mean ratings on experiences of PHC were analyzed using both descriptive and inferential statistics. RESULTS The mean response rate was 98%, and most respondents were female (73%) and married (72%). A higher proportion of patients gave positive feedback on their relationships with staff (84%) than they did available space in the waiting area (60%). Higher self-rated health status and nonpayment for care at the point of receipt were consistent predictors of positive patient experiences from the multilevel analysis. CONCLUSION Study reported findings and drivers of patient experiences with PHC. Aspects of PHC showing less positive patient experiences and some patients' factors associated with these are amenable to change and can form the focus of quality improvement actions.
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Affiliation(s)
- Daprim S Ogaji
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Department of Preventive and Social Medicine, University of Port Harcourt, Port Harcourt, Nigeria
| | - Sally Giles
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Gavin Daker-White
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Coffin CS, Saunders C, Thomas CM, Loewen AHS, Ghali WA, Campbell NRC. Validity of ICD-9-CM Administrative Data for Determining Eligibility for Pneumococcal Vaccination Triggers. Am J Med Qual 2016; 20:158-63. [PMID: 15951522 DOI: 10.1177/1062860604274380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to evaluate the efficacy of medical record administrative data as coded by the International Classification of Diseases, Ninth Revision, for triggering pneumococcal vaccination reminders of patients following discharge from a tertiary care adult teaching hospital. A retrospective computerized search was conducted using administrative discharge data to detect patients admitted to the medical teaching unit who met clinical criteria for pneumococcal vaccination according to Canadian immunization guidelines. For identification of persons eligible for vaccination, administrative discharge data showed a sensitivity of 83% (confidence interval [CI], 0.73-0.92) and a specificity of 78% (CI, 0.64-0.91), with a positive predictive value of 87% (CI, 0.83-0.90) and a negative predictive value of 72% (CI, 0.58-0.86). The reasonably high specificity and sensitivity of diagnostic codes in administrative data could be used to trigger appropriate pneumococcal vaccination among eligible patients after hospital discharge.
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Affiliation(s)
- Carla S Coffin
- Department of Medicine, University of Calgary, Alberta T2N 4N1, Canada
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More Than 15 Years of Experience with Intradetrusor OnabotulinumtoxinA Injections for Treating Refractory Neurogenic Detrusor Overactivity: Lessons to Be Learned. Eur Urol 2016; 70:522-8. [DOI: 10.1016/j.eururo.2016.03.052] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/31/2016] [Indexed: 01/23/2023]
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Nissanholtz-Gannot R, Goldman D, Rosen B, Kay C, Wilf-Miron R. How Do Primary Care Physicians Perceive the Role of Nurses in Quality Measurement and Improvement? The Israeli Story. Front Public Health 2016; 4:124. [PMID: 27446892 PMCID: PMC4916176 DOI: 10.3389/fpubh.2016.00124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/01/2016] [Indexed: 11/13/2022] Open
Abstract
Background Israel has boasted a highly effective national quality monitoring program for community-based health services since 2004. The program involves ongoing monitoring of the quality of selected services provided by Israeli health plans and includes approximately 70 indicators. Objective To analyze Israeli primary care physicians’ (PCPs) perceptions of nurses’ roles in the national quality monitoring program and their contribution to improving health-care quality. Design A cross sectional survey using self-reported questionnaire. Setting Four Israeli health plans, covering 100% of the Israeli population. Participants A representative sample of 1,000 Israeli PCPs. Response rate of 69% (605 out of the 884 physicians who met the study criteria). Methods A questionnaire combined with closed questions on the attitudes and behaviors of the physicians regarding nurses’ involvement in quality monitoring and open questions about the changes that had made in their practice as a result of the quality monitoring program. Results Most respondents (74%) agreed that nurses contribute to practice quality and share responsibility for improving quality measures. Physicians who felt that quality monitoring improved the quality of care and those who supported the program were more likely to consider that nurses shared responsibility for the quality of care. However, in open-ended questions about the changes they made in their practices as a result of the program, they made minimal reference to the importance of nurses and their contribution to improved quality indicators. Conclusion There was a disparity between the closed-ended and open-ended questions regarding the way physicians depicted the role of nurses in quality monitoring and improvement. This disparity may be due to the fact that physicians do not yet fully appreciate the growing involvement of nurses in these areas.
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Affiliation(s)
- Rachel Nissanholtz-Gannot
- Department of Health Management, Ariel University, University Hill, Ariel, Israel; Smokler Centre for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel
| | | | - Bruce Rosen
- Smokler Centre for Health Policy Research, Myers-JDC-Brookdale Institute , Jerusalem , Israel
| | - Calanit Kay
- Community Health Services, Clalit Health Services , Tel Aviv , Israel
| | - Rachel Wilf-Miron
- The Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel; The School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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