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Raya Ortega L, Martínez Tapias J, Ferreras Fernández MJ, Jiménez-Navarro M, Ortega-Gómez A, Romero-Cuevas M, Gómez-Doblas JJ. In-Hospital Mortality and Costs of Added Morbidity in Heart Failure Patients at a University Hospital: A Retrospective Cross-Sectional Study. J Cardiovasc Dev Dis 2025; 12:185. [PMID: 40422956 DOI: 10.3390/jcdd12050185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 05/02/2025] [Accepted: 05/07/2025] [Indexed: 05/28/2025] Open
Abstract
BACKGROUND Heart failure (HF) is a leading cause of hospital admissions and in-hospital mortality among the elderly. This study aims to characterize HF patients admitted to Virgen de la Victoria University Hospital (HUVV), identify factors associated with in-hospital mortality and analyze the impact of added morbidity on healthcare costs. METHODS A cross-sectional study was conducted using data from the Minimum Basic Data Set (MBDS) at HUVV. We included all discharges with a primary diagnosis of HF in 2021. Logistic regression analysis was employed to identify factors associated with mortality, and cost analysis was performed to assess the economic impact of added morbidity. RESULTS A total of 731 hospital discharges for HF were analyzed, with a mortality rate of 14.77%. Mortality was significantly associated with age ≥ 75 years (OR = 4.12; p < 0.001), high or extreme severity (OR = 2.26 and 8.10, respectively; p < 0.001), and more than 10 diagnoses at discharge (OR = 2.95; p < 0.01). Treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) was associated with a reduced risk of death (OR = 0.29; p < 0.001). Hospital-acquired morbidity occurred in 27.22% of patients, resulting in an additional cost of EUR 152,780.61, representing a 3.8% increase over the total hospitalization costs. CONCLUSIONS In-hospital mortality in HF patients at HUVV is strongly associated with advanced age, disease severity, and multiple comorbidities. Treatment with ACEIs or ARBs was associated with a lower likelihood of in-hospital mortality. Preventable added morbidity was associated with increased healthcare costs, highlighting the importance of infection control measures and multidisciplinary management to potentially improve outcomes and reduce costs.
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Affiliation(s)
| | - Jesús Martínez Tapias
- Servicio de Admisión y Documentación Clínica, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | | | - Manuel Jiménez-Navarro
- Unidad de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), 29590 Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, 20971 Málaga, Spain
| | - Almudena Ortega-Gómez
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), 29590 Málaga, Spain
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN-ISCIII), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Miguel Romero-Cuevas
- Unidad de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), 29590 Málaga, Spain
| | - Juan José Gómez-Doblas
- Unidad de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), 29590 Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, 20971 Málaga, Spain
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Ameri K, Kwon M, Watanabe A, Wiseman SM. Thyroid cancer quality of care indicators: A scoping review. Am J Surg 2025; 243:116223. [PMID: 39890473 DOI: 10.1016/j.amjsurg.2025.116223] [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] [Received: 11/14/2024] [Revised: 12/30/2024] [Accepted: 01/23/2025] [Indexed: 02/03/2025]
Abstract
BACKGROUND Thyroid cancer, the most common endocrine malignancy, has highly variable practice patterns. This scoping review aimed to identify quantitative and qualitative quality of care indicators (QIs) essential for providing optimal care in thyroid cancer management. METHODS A comprehensive search across MEDLINE, EMBASE, PubMed, and Web of Science identified QIs defining structures, processes, and outcomes in five care phases: pre-diagnosis, diagnosis, treatment, post-treatment surveillance, and end-of-life care. RESULTS Of the 3,143 articles screened, 36 were included, yielding 135 unique QIs. Key diagnostic QIs were the use of a standardized ultrasound reporting system (n = 4), diagnostic fine needle aspiration biopsy (FNAB) (n = 3), and FNA cytology reporting with the Bethesda System (n = 3). Common treatment QIs included thyroidectomy by high-volume surgeons (≥10-32 cases/year) (n = 7), preoperative voice assessment for high-risk patients (n = 4), and recurrent laryngeal nerve monitoring (n = 3). Serum thyroglobulin (Tg) monitoring was the primary post-treatment QI for recurrence (n = 2). CONCLUSIONS Developing an evidence-based QI list can identify care gaps, direct targeted interventions, promote care standardization, and improve outcomes for thyroid cancer patients.
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Affiliation(s)
- Kimia Ameri
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Kwon
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Akie Watanabe
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada.
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Piekarska K, Bednarski P, Politynska B, Wojtukiewicz AM, Krzakowski M, Wojtukiewicz MZ. The Impact of Implementing Indicators of Quality of Oncological Care on Improving Patient Outcomes: A Cross-Sectional Review of Experiences from Countries Using Indicators in the Quality Assessment Process. Cancers (Basel) 2025; 17:1362. [PMID: 40282538 PMCID: PMC12026017 DOI: 10.3390/cancers17081362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Revised: 04/15/2025] [Accepted: 04/16/2025] [Indexed: 04/29/2025] Open
Abstract
The implementation of QIs in the pursuit of improving patient outcomes in oncological care has become a primary goal for many countries. The purpose of this cross-sectional review is to present the experiences of several countries that have implemented different strategies in using QIs to assess the quality of cancer care. Countries such as the United States, the United Kingdom, Canada, the Netherlands, Australia, and Israel have been pioneers in integrating QIs into their healthcare systems, which has led to significant improvements in the delivery of care. These indicators help assess adherence to clinical guidelines, timeliness of treatment, safety of practices, and overall patient survival. Data from these countries show that the use of QIs correlates with improved five-year survival rates, earlier diagnosis, better adherence to evidence-based treatment protocols, and increased patient satisfaction. For example, in the Netherlands and Germany, the introduction of quality cancer care programs has led to improved surgical outcomes and overall survival for patients with colorectal cancer. The United Kingdom and Denmark have reported improvements in waiting times for diagnosis and treatment, and in Israel, screening rates for breast and colorectal cancer increased after the introduction of QIs for monitoring these conditions. The current review highlights the fact that countries with robust reporting systems and national cancer registries with high levels of data completeness, such as Denmark, Sweden, and Norway, were able to effectively monitor outcomes and adjust clinical practices accordingly. The findings suggest that implementing QIs in cancer care not only improves clinical outcomes but also promotes accountability and stimulates improved healthcare, ensuring better long-term patient care. This study highlights the value of adopting QIs as a global standard for assessing cancer care.
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Affiliation(s)
- Karolina Piekarska
- Department of Oncology, Medical University of Bialystok, 15-027 Bialystok, Poland; (K.P.); (P.B.)
| | - Piotr Bednarski
- Department of Oncology, Medical University of Bialystok, 15-027 Bialystok, Poland; (K.P.); (P.B.)
| | - Barbara Politynska
- Department of Psychology and Philosophy, Medical University of Bialystok, 15-295 Bialystok, Poland (A.M.W.)
| | - Anna M. Wojtukiewicz
- Department of Psychology and Philosophy, Medical University of Bialystok, 15-295 Bialystok, Poland (A.M.W.)
| | | | - Marek Z. Wojtukiewicz
- Department of Oncology, Medical University of Bialystok, 15-027 Bialystok, Poland; (K.P.); (P.B.)
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Hesselink G, Verhage R, Westerhof B, Verweij E, Fuchs M, Janssen I, van der Meer C, van der Horst ICC, de Jong P, van der Hoeven JG, Zegers M. Reducing administrative burden by implementing a core set of quality indicators in the ICU: a multicentre longitudinal intervention study. BMJ Qual Saf 2025; 34:157-165. [PMID: 39214680 DOI: 10.1136/bmjqs-2024-017481] [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] [Received: 04/25/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The number of quality indicators for which clinicians need to record data is increasing. For many indicators, there are concerns about their efficacy. This study aimed to determine whether working with only a consensus-based core set of quality indicators in the intensive care unit (ICU) reduces the time spent on documenting performance data and administrative burden of ICU professionals, and if this is associated with more joy in work without impacting the quality of ICU care. METHODS Between May 2021 and June 2023, ICU clinicians of seven hospitals in the Netherlands were instructed to only document data for a core set of quality indicators. Time spent on documentation, administrative burden and joy in work were collected at three time points with validated questionnaires. Longitudinal data on standardised mortality rates (SMR) and ICU readmission rates were gathered from the Dutch National Intensive Care registry. Longitudinal effects and differences in outcomes between ICUs and between nurses and physicians were statistically tested. RESULTS A total of 390 (60%), 291 (47%) and 236 (40%) questionnaires returned at T0, T1 and T2. At T2, the overall median time spent on documentation per day was halved by 30 min (p<0.01) and respondents reported fewer unnecessary and unreasonable administrative tasks (p<0.01). Almost one-third still experienced unnecessary administrative tasks. No significant changes over time were found in joy in work, SMR and ICU readmission. CONCLUSIONS Implementing a core set of quality indicators reduces the time ICU clinicians spend on documentation and administrative burden without negatively affecting SMR or ICU readmission rates. Time savings can be invested in patient care and improving joy in work in the ICU.
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Affiliation(s)
- Gijs Hesselink
- Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rutger Verhage
- Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Eva Verweij
- Intensive Care, Bernhoven Hospital, Uden, The Netherlands
| | - Malaika Fuchs
- Intensive Care, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Inge Janssen
- Intensive Care, Maas Hospital Pantein, Boxmeer, The Netherlands
| | | | - Iwan C C van der Horst
- Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Paul de Jong
- Intensive Care, Slingeland Hospital, Doetinchem, The Netherlands
| | | | - Marieke Zegers
- Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Minamizaki M, Doi M, Kanoya Y. Development of management indicators of nursing for minimizing physical restraints focused on older adult patients hospitalized in acute care settings: A Delphi consensus study. PLoS One 2024; 19:e0306920. [PMID: 38985753 PMCID: PMC11236117 DOI: 10.1371/journal.pone.0306920] [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: 10/18/2023] [Accepted: 06/25/2024] [Indexed: 07/12/2024] Open
Abstract
Nursing management activities are important in influencing staff nurses' action to prevent or withdraw physical restraints. However, limited studies have been conducted empirically to determine the nursing management activities required for minimizing physical restraints. Therefore, there is a need for basic standards of nursing management activities to minimize physical restraints in acute care settings. This study aimed to develop nursing management indicators to minimize physical restraint (MaIN-PR) in hospitalized older adult patients in an acute care setting. It was conducted between June and October 2021 in Japan using a Delphi consensus approach. Fifty nurses working at top or middle management levels or as certified nurse specialists in gerontological nursing enrolled as participants. The potential indicators obtained from the literature review and interviews were organized inductively to develop two types of draft indicators: (1) 35 items for top management and (2) 33 items for middle management. We asked the nursing managers and certified nurse specialists in gerontological nursing to assess the validity of each indicator in three rounds. Of the 50 initial panelists, 12 from top management and 13 from middle management continued till the third round. MaIN-PR contained 35 indicators for top management and 28 indicators for middle management and were classified into the following six metrics: planning, motivating, training, commanding, organizing, and controlling. To the best of our knowledge, the current MaIN-PR are the first set of nursing management indicators for minimizing physical restraint, including perspectives on geriatric nursing in acute care settings. These indicators could guide both top and middle nursing management, thus supporting staff nurses' judgment in minimizing physical restraints to enhance the quality of older adult patient care.
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Affiliation(s)
- Maya Minamizaki
- Nursing Course, School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Mana Doi
- Chiba Faculty of Nursing, Tokyo Healthcare University, Funabashi, Chiba, Japan
| | - Yuka Kanoya
- Nursing Course, School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
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Ali D, Piffoux M. Methodological guide for assessing the carbon footprint of external beam radiotherapy: A single-center study with quantified mitigation strategies. Clin Transl Radiat Oncol 2024; 46:100768. [PMID: 38633470 PMCID: PMC11021844 DOI: 10.1016/j.ctro.2024.100768] [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: 12/15/2023] [Revised: 02/19/2024] [Accepted: 03/23/2024] [Indexed: 04/19/2024] Open
Abstract
Background and purposes Data on the carbon footprint of external beam radiotherapy (EBRT) are scarce. Reliable and exhaustive data, including a detailed carbon inventory, are needed to determine effective mitigation strategies. Materials and methods This study proposes a methodology for calculating the carbon footprint of EBRT and applies it to a single center. Mitigation strategies are derived from the carbon inventory, and their potential reductions are quantified whenever possible. Results The average emission per treatment and fraction delivered was 489 kg CO₂eq and 27 kg CO₂eq, respectively. Patient transportation (43 %) and the construction and maintenance of linear accelerators (LINACs) and scanners (17 %) represented the most significant components. Electricity, the only energy source used, accounted for only 2 % of emissions.Derived mitigation strategies include a data deletion policy (reducing emissions in 30 years by 12.5 %), geographical appropriateness (-12.2 %), transportation mode appropriateness (-9.3 %), hypofractionation (-5.9 %), decrease in manufacturers' carbon footprint (-5.2 %), and an increase in machine durability (-3.5 %). Conclusion Our findings indicate that a significant reduction in the carbon footprint of a radiotherapy unit can be achieved without compromising the quality of care.This study provides a methodology and a starting point for comparison and proposes and quantifies mitigation strategies, paving the way for others to follow.
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Affiliation(s)
- David Ali
- Centre de Radiothérapie et de Traitement des Tumeurs, Versailles, France
| | - Max Piffoux
- Département d’Oncologie Médicale, Hospices Civils de Lyon, CITOHL, Lyon, France
- Direction de la Recherche Clinique et de l’Innovation, Centre Léon Bérard, Lyon, France
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Moldovan F, Moldovan L. Assessment of Patient Matters in Healthcare Facilities. Healthcare (Basel) 2024; 12:325. [PMID: 38338210 PMCID: PMC10855928 DOI: 10.3390/healthcare12030325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Ensuring the sustainability of healthcare facilities requires the evaluation of patient matters with appropriate methods and tools. The objective of this research is to develop a new tool for assessing patient matters as a component of social responsibility requirements that contribute to the sustainability of healthcare facilities. MATERIALS AND METHODS We carried out an analytical observational study in which, starting from the domains of the reference framework for the sustainability of health facilities (economic, environmental, social, provision of sustainable medical care services and management processes), we designed indicators that describe patient matters. To achieve this, we extracted from the scientific literature the most recent data and aspects related to patient matters that have been reported by representative hospitals from all over the world. These were organized into the four sequences of the quality cycle. We designed the method of evaluating the indicators based on the information couple achievement degree-importance of the indicator. In the experimental part of the study, we validated the indicators for the evaluation of patient matters and the evaluation method at an emergency hospital with an orthopedic profile. RESULTS We developed the patient matters indicator matrix, the content of the 8 indicators that make it up, questions for the evaluation of the indicators, and the evaluation grids of the indicators. They describe five levels for each variable of the achievement degree-importance couple. The practical testing of the indicators at the emergency hospital allowed the calculation of sustainability indicators and the development of a prioritization matrix for improvement measures. CONCLUSIONS Indicators designed in this research cover social responsibility requirements that describe patient matters. They are compatible and can be used by health facilities along with other implemented national and international requirements. Their added value consists in promoting social responsibility and sustainable development of healthcare facilities.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics—Traumatology Department, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Liviu Moldovan
- Faculty of Engineering and Information Technology, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania;
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Clements W, Koukounaras J. Complications in Interventional Radiology: the role of clinical governance and iterative hospital systems in quality improvement. CVIR Endovasc 2023; 6:38. [PMID: 37542625 PMCID: PMC10404211 DOI: 10.1186/s42155-023-00388-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023] Open
Abstract
As modern Interventional Radiology (IR) evolves, and expands in scope and complexity, it will push the boundaries of existing literature. However, with all intervention comes risk and it is the shared judgement of the risk-benefit analysis which underpins the ethical and legal principles of care in IR.Complications in medicine are common, said to occur in 9.2% of in-hospital healthcare interactions. Healthcare complications also come at considerable cost. It is estimated that in the UK, prolonging hospital stays to manage complications can cost ₤2 billion per year.However, complications can't be viewed in isolation. Clinical governance is the umbrella within which complications are viewed. It can be defined as a broadly integrated and systematic approach to clinical care and accountability, that seeks to focus on quality of healthcare. This concept incorporates complications but acknowledges their interplay within a complex healthcare system in which negative adverse events are influenced by a range of intrinsic and extrinsic factors. It also includes the processes that result from monitoring and learning from complications, with feedback leading to systems-based improvements in care moving forward. The reality is that complications are uncommonly the result of medical negligence, but rather they are an unfortunate by-product of a healthcare industry with inherent risk.It is also important to remember that complications are not just a number on an audit sheet, but a potentially life-changing event for every patient that is affected. The events that follow immediately from an adverse outcome such as open disclosure are vital, and have implications for how that patient experiences healthcare and trusts healthcare professionals for the rest of their life. We must ensure that the patient and their family maintain trust in healthcare professionals into the future.Credentialling and accreditation are imperative for Interventional Radiologists to meet existing standards as well deal with challenging situations. These should integrate and align within the structure of an organization that has a safety and learning culture. It is the many layers of organisational clinical governance that arguably play the most important role in IR-related complications, rather than apportioning blame to an individual IR.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Rd, Melbourne, 3004, Australia.
- Department of Surgery, Monash University Central Clinical School, Melbourne, Australia.
- National Trauma Research Institute, Melbourne, Australia.
| | - Jim Koukounaras
- Department of Radiology, Alfred Health, 55 Commercial Rd, Melbourne, 3004, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Australia
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Giroux M, Sirois MJ, Gagnon MA, Émond M, Bérubé M, Morin M, Moore L. Identifying Quality Indicators for the Care of Hospitalized Injured Older Adults: A Scoping Review of the Literature. J Am Med Dir Assoc 2023; 24:929-936. [PMID: 37094747 DOI: 10.1016/j.jamda.2023.03.019] [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] [Received: 11/29/2022] [Revised: 03/01/2023] [Accepted: 03/12/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES Older adults represent more than 50% of trauma admissions in many high-income countries. Furthermore, they are at increased risk for complications, resulting in worse health outcomes than younger adults and a significant health care utilization burden. Quality indicators (QIs) are used to assess the quality of care in trauma systems, but few QIs reflect responses to older patients' specific needs. We aimed to (1) identify QIs used to assess acute hospital care for injured older patients, (2) assess support for identified QIs and, (3) identify gaps in existing QIs. DESIGN Scoping review of the scientific and gray literature. METHODS Selection and data extraction were performed by 2 independent reviewers. The level of support was assessed by the number of sources reporting QIs and whether they were developed according to scientific evidence, expert consensus, and patients' perspectives. RESULTS Of 10,855 identified studies, 167 were eligible. Among 257 different QIs identified, 52% were hip fracture specific. Gaps were identified for head injuries, rib, and pelvic ring fractures. Although 61% of QIs assessed care processes, 21% and 18% focused on structures and outcomes, respectively. Although most QIs were based on literature reviews and/or expert consensus, patients' perspective was rarely accounted for. The 15 QIs with the highest level of support included minimum time between emergency department arrival and ward admission, minimum time to surgery for fractures, assessment by a geriatrician, orthogeriatric review for hip fracture patients, delirium screening, prompt and appropriate analgesia, early mobilizations, and physiotherapy. CONCLUSION AND IMPLICATIONS Multiple QIs were identified, but their level of support was limited, and important gaps were identified. Future work should focus on achieving consensus for a set of QIs to assess the quality of trauma care to older adults. Such QIs could be used for quality improvement and ultimately improve outcomes for injured older adults.
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Affiliation(s)
- Marianne Giroux
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada.
| | - Marie-Josée Sirois
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada; Centre de recherche en santé durable VITAM - Centre intégré de santé et service sociaux de la capitale nationale, Quebec City, Quebec, Canada
| | - Marc-Aurèle Gagnon
- Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada
| | - Marcel Émond
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada; Centre de recherche en santé durable VITAM - Centre intégré de santé et service sociaux de la capitale nationale, Quebec City, Quebec, Canada
| | - Méanie Bérubé
- Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada; Faculty of Nursing, Université Laval, Québec City, Quebec, Canada
| | - Michèle Morin
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, Québec, Canada
| | - Lynne Moore
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada
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Antonacci G, Whitney J, Harris M, Reed JE. How do healthcare providers use national audit data for improvement? BMC Health Serv Res 2023; 23:393. [PMID: 37095495 PMCID: PMC10123973 DOI: 10.1186/s12913-023-09334-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Substantial resources are invested by Health Departments worldwide in introducing National Clinical Audits (NCAs). Yet, there is variable evidence on the NCAs' effectiveness and little is known on factors underlying the successful use of NCAs to improve local practice. This study will focus on a single NCA (the National Audit of Inpatient Falls -NAIF 2017) to explore: (i) participants' perspectives on the NCA reports, local feedback characteristics and actions undertaken following the feedback underpinning the effective use of the NCA feedback to improve local practice; (ii) reported changes in local practice following the NCA feedback in England and Wales. METHODS Front-line staff perspectives were gathered through interviews. An inductive qualitative approach was used. Eighteen participants were purposefully sampled from 7 of the 85 participating hospitals in England and Wales. Analysis was guided by constant comparative techniques. RESULTS Regarding the NAIF annual report, interviewees valued performance benchmarking with other hospitals, the use of visual representations and the inclusion of case studies and recommendations. Participants stated that feedback should target front-line healthcare professionals, be straightforward and focused, and be delivered through an encouraging and honest discussion. Interviewees highlighted the value of using other relevant data sources alongside NAIF feedback and the importance of continuous data monitoring. Participants reported that engagement of front-line staff in the NAIF and following improvement activities was critical. Leadership, ownership, management support and communication at different organisational levels were perceived as enablers, while staffing level and turnover, and poor quality improvement (QI) skills, were perceived as barriers to improvement. Reported changes in practice included increased awareness and attention to patient safety issues and greater involvement of patients and staff in falls prevention activities. CONCLUSIONS There is scope to improve the use of NCAs by front-line staff. NCAs should not be seen as isolated interventions but should be fully embedded and integrated into the QI strategic and operational plans of NHS trusts. The use of NCAs could be optimised, but knowledge of them is poor and distributed unevenly across different disciplines. More research is needed to provide guidance on key elements to consider throughout the whole improvement process at different organisational levels.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Julie Whitney
- Department of Physiotherapy, King's College London, London, UK
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, South Kensington, UK
| | - Julie E Reed
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Julie Reed Consultancy Ltd, London, UK
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Maheshwari K, Cywinski JB, Papay F, Khanna AK, Mathur P. Artificial Intelligence for Perioperative Medicine: Perioperative Intelligence. Anesth Analg 2023; 136:637-645. [PMID: 35203086 DOI: 10.1213/ane.0000000000005952] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The anesthesiologist's role has expanded beyond the operating room, and anesthesiologist-led care teams can deliver coordinated care that spans the entire surgical experience, from preoperative optimization to long-term recovery of surgical patients. This expanded role can help reduce postoperative morbidity and mortality, which are regrettably common, unlike rare intraoperative mortality. Postoperative mortality, if considered a disease category, will be the third leading cause of death just after heart disease and cancer. Rapid advances in technologies like artificial intelligence provide an opportunity to build safe perioperative practices. Artificial intelligence helps by analyzing complex data across disparate systems and producing actionable information. Using artificial intelligence technologies, we can critically examine every aspect of perioperative medicine and devise innovative value-based solutions that can potentially improve patient safety and care delivery, while optimizing cost of care. In this narrative review, we discuss specific applications of artificial intelligence that may help advance all aspects of perioperative medicine, including clinical care, education, quality improvement, and research. We also discuss potential limitations of technology and provide our recommendations for successful adoption.
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Affiliation(s)
| | | | | | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Outcomes Research Consortium, Cleveland, Ohio
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Hesselink G, Verhage R, Hoiting O, Verweij E, Janssen I, Westerhof B, Ambaum G, van der Horst ICC, de Jong P, Postma N, van der Hoeven JG, Zegers M. Time spent on documenting quality indicator data and associations between the perceived burden of documenting these data and joy in work among professionals in intensive care units in the Netherlands: a multicentre cross-sectional survey. BMJ Open 2023; 13:e062939. [PMID: 36878656 PMCID: PMC9990602 DOI: 10.1136/bmjopen-2022-062939] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES The number of indicators used to monitor and improve the quality of care is debatable and may influence professionals' joy in work. We aimed to assess intensive care unit (ICU) professionals' perceived burden of documenting quality indicator data and its association with joy in work. DESIGN Cross-sectional survey. SETTING ICUs of eight hospitals in the Netherlands. PARTICIPANTS Health professionals (ie, medical specialists, residents and nurses) working in the ICU. MEASUREMENTS The survey included reported time spent on documenting quality indicator data and validated measures for documentation burden (ie, such documentation being unreasonable and unnecessary) and elements of joy in work (ie, intrinsic and extrinsic motivation, autonomy, relatedness and competence). Multivariable regression analysis was performed for each element of joy in work as a separate outcome. RESULTS In total, 448 ICU professionals responded to the survey (65% response rate). The overall median time spent on documenting quality data per working day is 60 min (IQR 30-90). Nurses spend more time documenting these data than physicians (medians of 60 min vs 35 min, p<0.01). Most professionals (n=259, 66%) often perceive such documentation tasks as unnecessary and a minority (n=71, 18%) perceive them as unreasonable. No associations between documentation burden and measures of joy in work were found, except for the negative association between unnecessary documentations and sense of autonomy (β=-0.11, 95% CI -0.21 to -0.01, p=0.03). CONCLUSIONS Dutch ICU professionals spend substantial time on documenting quality indicator data they often regard as unnecessary. Despite the lacking necessity, documentation burden had limited impact on joy in work. Future research should focus on which aspects of work are affected by documentation burden and whether diminishing the burden improves joy in work.
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Affiliation(s)
- Gijs Hesselink
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Rutger Verhage
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Oscar Hoiting
- Department of Intensive Care Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Eva Verweij
- Department of Intensive Care Medicine, Bernhoven Hospital, Uden, The Netherlands
| | - Inge Janssen
- Department of Intensive Care Medicine, Maas Hospital Pantein, Boxmeer, The Netherlands
| | - Brigitte Westerhof
- Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Gilian Ambaum
- Department of Intensive Care Medicine, Rivierenland Hospital, Tiel, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands
| | - Paul de Jong
- Department of Intensive Care Medicine, Slingeland Hospital, Doetinchem, The Netherlands
| | - Nynke Postma
- Department of Intensive Care Medicine, Streekziekenhuis koningin Beatrix, Winterswijk, The Netherlands
| | - Johannes G van der Hoeven
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marieke Zegers
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Romanoff E, Zhuo J, Huang AC, Amador D, Otaki F, Kamal AN, Kathpalia P, Leiman DA. Achalasia Quality Indicator Adherence. Dig Dis Sci 2023; 68:389-395. [PMID: 36459295 DOI: 10.1007/s10620-022-07658-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 08/02/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Quality indicators (QIs) are formal ways to track health care performance and outcomes, guide quality improvement, and identify gaps in care delivery. We developed twelve quality indicators for achalasia management which cover the domains of patient education, diagnosis, and treatment of achalasia. AIM To determine adherence to established quality indicators for achalasia management. METHODS We performed a retrospective, multicenter evaluation of care patterns for adult patients greater than 18 years old with newly diagnosed achalasia from January 2018 to May 2020. A balanced random patient sample was obtained at four large academic medical centers. Independent electronic health record chart abstraction was performed using a standardized form to determine adherence to applicable QIs. Pooled and de-identified data were analyzed to identify gaps in care. RESULTS A total of 120 patients were included and the overall adherence to applicable quality indicators across all centers was 86%. The median follow-up for all patients from time of diagnosis to end of study was 511 days. Clinicians adhered to all applicable quality indicators in 49 patients (39%). The quality indicator domain with the poorest adherence was patient education (67%), with 50% of patients having had a documented discussion of the risks of gastroesophageal reflux disease following surgical or endoscopic myotomy. CONCLUSIONS Gaps in the quality of achalasia care delivery were identified, the largest of which relates to patient education about treatment risks. These findings highlight a potential area for future quality improvement studies and form the basis for developing fully specified quality measures.
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Affiliation(s)
- Emily Romanoff
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC, 27708, USA
| | - Justin Zhuo
- Department of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Annsa C Huang
- Division of Gastroenterology, UCSF, San Francisco, CA, 94143, USA
| | - Deron Amador
- Division of Gastroenterology, OHSU, Portland, OR, 97239, USA
| | - Fouad Otaki
- Division of Gastroenterology, OHSU, Portland, OR, 97239, USA
| | - Afrin N Kamal
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford, CA, 94305, USA
| | - Priya Kathpalia
- Division of Gastroenterology, UCSF, San Francisco, CA, 94143, USA
| | - David A Leiman
- Division of Gastroenterology, Duke University, Durham, NC, 27708, USA.
- Duke Clinical Research Institute, Durham, NC, 27708, USA.
- Division of Gastroenterology, Duke University School of Medicine, 200 Morris Street, Suite 6524, Durham, NC, 27701, USA.
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Muilwijk T, Akand M, Raskin Y, Jorissen C, Vander Eeckt K, Van Bruwaene S, Van Cleynenbreugel B, Joniau S, Van Der Aa F. Quality Control Indicators for Transurethral Resection of Bladder Tumor: Results from an Embedded Belgian Multicenter Prospective Registry. Eur Urol Oncol 2022:S2588-9311(22)00202-4. [PMID: 36543720 DOI: 10.1016/j.euo.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 10/26/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Quality control indicators (QCIs) can be used to objectively evaluate guideline adherence and benchmark quality among urologists and centers. OBJECTIVE To assess six QCIs for non-muscle-invasive bladder cancer (NMIBC) using a prospective registry of transurethral resection of bladder tumor (TURBT) procedures. DESIGN, SETTING, AND PARTICIPANTS Clinical data for TURBT cases were prospectively collected using electronic case report forms (eCRFs) embedded in the electronic medical record in three centers during 2013-2017. Pathological data were collected retrospectively. Patients with T0 disease or prior T2 disease were excluded. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We assessed six QCIs: complete resection (CR) status, presence of detrusor muscle (DM), re-TURBT, single instillation of mitomycin C (MMC), start of bacillus Calmette-Guérin (BCG) therapy, and therapy ≤6 wk after diagnosis. We assessed the quality of reporting on QCIs and compliance with QCIs, compared compliance between centers and over time, and investigated correlation between compliance and recurrence-free survival (RFS). RESULTS AND LIMITATIONS Data for 1350 TURBT procedures were collected, of which 1151 were included for 907 unique patients. The distribution of European Association of Urology risk categories after TURBT was 271 with low risk, 464 with intermediate risk, and 416 with high risk. The quality of reporting for two QCIs was suboptimal, at 35% for DM and 51% for BCG. QCI compliance was 97% for CR, 31% for DM, 65% for MMC, 33% for re-TURBT, 39% for BCG, and 88% for therapy ≤6 wk after diagnosis. Compliance with all QCIs differed significantly among centers. Compliance with MMC and re-TURBT increased significantly over time, which could be attributed to one center. Compliance with MMC was significantly correlated with RFS. The main study limitation is the retrospective collection of pathology data. CONCLUSIONS A TURBT registry consisting of eCRFs to collect pathology and outcome data allowed assessment of QCIs for NMIBC. Our study illustrates the feasibility of this approach in a real-life setting. Differences in performance on QCIs among centers can motivate urologists to improve their day-to-day care for patients with NMIBC, and can thus improve clinical outcomes. PATIENT SUMMARY Our study demonstrates that quality control indicators for treatment of bladder cancer not invading the bladder muscle can be evaluated using electronic medical records. We assessed results for 1151 procedures in 907 individual patients to remove bladder tumors between 2013 and 2017 at three centers in Belgium. Compliance with the quality control indicators differed between centers, increased over time, and was correlated with recurrence of disease.
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Amer F, Neiroukh H, Abuzahra S, AlHabil Y, Afifi M, Shellah D, Boncz I, Endrei D. Engaging patients in balanced scorecard evaluation - An implication at Palestinian hospitals and recommendations for policy makers. Front Public Health 2022; 10:1045512. [PMID: 36438272 PMCID: PMC9685805 DOI: 10.3389/fpubh.2022.1045512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction A balanced scorecard (BSC) is a comprehensive performance evaluation (PE) tool. A recent review summarized that a balanced consideration of PE from six perspectives in hospitals must be considered: financial, customer, internal, external, knowledge and growth, and managerial. However, patients were rarely engaged in BSC implementations. This research aims to engage Palestinian patients in BSC implementation to develop recommendations for policy makers. Methodology In this cross-sectional study, the BSC-PATIENT survey was distributed between January and October 2021. We evaluated patients' experiences and their attitudes toward BSC dimensions (BSCP ATT). The differences in evaluations based on admission status were analyzed using the Mann-Whitney U test. Causal relationships between patients' experiences and attitudes were analyzed using multiple linear regression. We tested the multicollinearity of the model. Path analysis was performed to understand the BSC strategic maps based on the Palestinian patients' evaluations. Results Out of 1,000 surveys, 740 were retrieved. The mean scores for Palestinian patient experiences evaluation showed that the services experience factor had the highest score (87.7 ± 17.7), and the patient care experience factor had the lowest score (57 ± 34.5). Patient experiences collectively predicted 56.4% of the variance in the BSCP ATT. The experience factors of information (β = 0.400, t = 13.543, P < 0.001), patient care (β = 0.241, t = 8.061, P < 0.001), services (β = 0.176, t = 6.497, P < 0.001), and building (β = 0.177, t = 6.308, P < 0.001) had the highest impact on BSCP ATT. The price had only a weak negative influence (β = -0.051, t = -2.040, P = 0.042). Accessibility to hospitals did not have any impact on BSCP ATT. Significant differences between inpatient and outpatients' evaluations in regard to experiences related to patient care (P = 0.042), services (P < 0.001), accessibility (P < 0.001), and BSCP ATT (P = 0.003) were found. Conclusion BSC-PATIENT successfully engaged patients in BSC PE at Palestinian hospitals. This research provides strong evidence for the impact of patients' information experience on their attitudes. Palestinian health policy makers must prioritize the design and delivery of patient education programs into their action plans and encourage a two-way information communication with patients. Strong evidence for patient care, services, and building experiences role in improving patients' attitudes was found. Managers should enhance patients' feedback and engagement culture in Palestinian hospitals.
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Affiliation(s)
- Faten Amer
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- School of Pharmacy, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Haroun Neiroukh
- School of Medicine, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Saad Abuzahra
- School of Medicine, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Yazan AlHabil
- School of Medicine, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Mufeeda Afifi
- School of Pharmacy, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Duha Shellah
- School of Medicine, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Imre Boncz
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Dóra Endrei
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
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Claessens F, Castro EM, Jans A, Jacobs L, Seys D, Van Wilder A, Brouwers J, Van der Auwera C, De Ridder D, Vanhaecht K. Patients' and kin's perspective on healthcare quality compared to Lachman's multidimensional quality model: Focus group interviews. PATIENT EDUCATION AND COUNSELING 2022; 105:3151-3159. [PMID: 35843847 DOI: 10.1016/j.pec.2022.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To identify key attributes of healthcare quality relevant to patients and kin and to compare them to Lachman's multidimensional quality model. METHODS Four focus groups with patients and kin were conducted using a semi-structured interview guide and a purposive sampling method. Classical content analysis and constant comparison method were used to focus data analysis on individual and group level. RESULTS Communication with patients, kin and professionals emerged as a new dimension from interview transcripts. Other identified key attributes largely corresponded with Lachman's multidimensional quality model. They were mainly classified in dimensions: 'Partnership and Co-Production', 'Dignity and Respect' and 'Effectiveness'. Technical quality dimensions were linked to organisational aspects of care in terms of staffing levels and time. The dimension 'Eco-friendly' was not addressed by patients or kin. CONCLUSIONS The results enhance the comprehension of healthcare quality and contribute to its academic understanding by validating Lachman's multidimensional quality model from patients' and kin's perspective. The model robustness is increased by including communication as a quality dimension surrounding technical domains and core values. PRACTICE IMPLICATIONS The key attributes can serve as a holistic framework for healthcare organisations to design their quality management system. An instrument can be developed to measure key attributes.
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Affiliation(s)
- Fien Claessens
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium.
| | - Eva Marie Castro
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Belgium
| | - Anneke Jans
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, Sint-Trudo Ziekenhuis, Sint-Truiden, Belgium
| | - Laura Jacobs
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Charlotte Van der Auwera
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium.
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Manalili K, Scott CM, O'Beirne M, Hemmelgarn BR, Santana MJ. Informing the implementation and use of person-centred quality indicators: a mixed methods study on the readiness, barriers and facilitators to implementation in Canada. BMJ Open 2022; 12:e060441. [PMID: 36008077 PMCID: PMC9422875 DOI: 10.1136/bmjopen-2021-060441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To ensure optimal implementation of person-centred quality indicators (PC-QIs), we assessed the readiness of Canadian healthcare organisations and explored their perceived barriers and facilitators to implementing and using PC-QIs. DESIGN Mixed methods. SETTING AND PARTICIPANTS Representatives of Canadian healthcare delivery and coordinating organisations that guide the development and/or implementation of person-centred care (PCC) measurement. Representatives from primary care clinics and organisations from the province of Alberta, Canada also participated. METHODS We conducted a survey with representatives of Canadian healthcare organisations. The survey comprised two sections that: (1) assessed readiness for using PC-QIs, and (2) were based on the Organizational Readiness for Change Assessment tool. We summarised the survey results using descriptive statistics. We then conducted follow-up interviews with organisations representing system and clinical-level perspectives to further explore barriers and facilitators to implementing PC-QIs. The interviews were informed by and analysed using the Consolidated Framework for Implementation Research. RESULTS Thirty-three Canadian regional healthcare organisations across all 13 provinces/territories participated in the survey. Only 5 of 26 PC-QIs were considered highly feasible to implement for 75% of organisations and included: coordination of care, communication, structures to report performance, engaging patients and caregivers and overall experience. A representative sample of 10 system-level organisations and 11 primary care organisations/clinics participated in the interviews. Key barriers identified were: resources and staff capacity for quality improvement, a shift in focus to COVID-19 and health provider motivation. Facilitators included: prioritisation of PCC measurement, leadership and champion engagement, alignment with ongoing provincial strategic direction and measurement efforts, and the use of technology for data collection, management and reporting. CONCLUSIONS Despite high interest and policy alignment to use PC-QI 'readiness' to implement them effectively remains a challenge. Organisations need to be supported to collect, use and report PCC data to make the needed improvements that matter to patients.
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Affiliation(s)
- Kimberly Manalili
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Catherine M Scott
- Sociology and Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Maeve O'Beirne
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Brenda R Hemmelgarn
- University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Maria-Jose Santana
- Community Health Sciences and Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Hargroves D, Lowe D, Wood M, Ray S. Networks for future healthcare. Future Healthc J 2022; 9:118-124. [DOI: 10.7861/fhj.2022-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Amer F, Hammoud S, Khatatbeh H, Lohner S, Boncz I, Endrei D. A systematic review: the dimensions to evaluate health care performance and an implication during the pandemic. BMC Health Serv Res 2022; 22:621. [PMID: 35534850 PMCID: PMC9081670 DOI: 10.1186/s12913-022-07863-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The balanced scorecard (BSC) has been implemented to evaluate the performance of health care organizations (HCOs). BSC proved to be effective in improving financial performance and patient satisfaction. AIM This systematic review aims to identify all the perspectives, dimensions, and KPIs that are vital and most frequently used by health care managers in BSC implementations. METHODS This systematic review adheres to PRISMA guidelines. The PubMed, Embase, Cochrane, and Google Scholar databases and Google search engine were inspected to find all implementations of BSC at HCO. The risk of bias was assessed using the nonrandomized intervention studies (ROBINS-I) tool to evaluate the quality of observational and quasi-experimental studies and the Cochrane (RoB 2) tool for randomized controlled trials (RCTs). RESULTS There were 33 eligible studies, of which we identified 36 BSC implementations. The categorization and regrouping of the 797 KPIs resulted in 45 subdimensions. The reassembly of these subdimensions resulted in 13 major dimensions: financial, efficiency and effectiveness, availability and quality of supplies and services, managerial tasks, health care workers' (HCWs) scientific development error-free and safety, time, HCW-centeredness, patient-centeredness, technology, and information systems, community care and reputation, HCO building, and communication. On the other hand, this review detected that BSC design modification to include external and managerial perspectives was necessary for many BSC implementations. CONCLUSION This review solves the KPI categorization dilemma. It also guides researchers and health care managers in choosing dimensions for future BSC implementations and performance evaluations in general. Consequently, dimension uniformity will improve the data sharing and comparability among studies. Additionally, despite the pandemic negatively influencing many dimensions, the researchers observed a lack of comprehensive HCO performance evaluations. In the same vein, although some resulting dimensions were assessed separately during the pandemic, other dimensions still lack investigation. Last, BSC dimensions may play an essential role in tackling the COVID-19 pandemic. However, further research is required to investigate the BSC implementation effect in mitigating the pandemic consequences on HCO.
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Affiliation(s)
- Faten Amer
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Pécs, Hungary.
| | - Sahar Hammoud
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Haitham Khatatbeh
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Szimonetta Lohner
- Clinical Center of the University of Pécs, Medical School, Cochrane Hungary, University of Pécs, Pécs, Hungary
| | - Imre Boncz
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Pécs, Hungary
| | - Dóra Endrei
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Pécs, Hungary
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A qualitative study of the perception of nursing home practitioners about the implementation of quality indicators for drug consumption in nursing homes. Aging Clin Exp Res 2022; 34:897-903. [PMID: 34613609 PMCID: PMC9076726 DOI: 10.1007/s40520-021-01989-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 09/20/2021] [Indexed: 11/06/2022]
Abstract
Introduction Nursing homes (NHs) are an ideal environment in which to implement interventions aimed at reducing inappropriate prescriptions. Quality indicators (QIs) may be useful to standardize practices, but it is unclear how they mediate change. In the framework of a quantitative study aimed at reducing the prescription of anticholinergic drugs among NH residents using QIs, we performed a qualitative study to describe the investigators’ perception of the utility of QIs. Methods Qualitative study using focus group methodology. Focus groups were recorded and transcribed, and analyzed by thematic analysis. Participants were purposefully recruited from among the medical directors of the NHs in the quantitative study. Results Five medical directors participated in two focus group meetings. The main themes to emerge were: (1) communication is key to introducing new practices and achieving lasting uptake; (2) improved coordination and communication provided useful information to help interpret the quantitative results observed: e.g., participants reported that they were able to obtain contextual and patient-specific information that explained why some prescribers had consistently, but justifiably “poor” performance on the quantitative indicators; (3) negative aspects reported included reluctance to change among prescribers and the tendency to shirk responsibility. Conclusion From the point of view of medical directors of NHs participating in an interventional program to reduce inappropriate prescriptions of anticholinergic drugs, the main factor driving the success of the program was communication, which is key to achieving adherence. Improved communication provides useful insights into the reasons why no quantitative reduction is observed in objective quality indicators.
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Zegers M, Veenstra GL, Gerritsen G, Verhage R, van der Hoeven H(J, Welker GA. Perceived Burden Due to Registrations for Quality Monitoring and Improvement in Hospitals: A Mixed Methods Study. Int J Health Policy Manag 2022; 11:183-196. [PMID: 32654430 PMCID: PMC9278598 DOI: 10.34172/ijhpm.2020.96] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 06/05/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Quality indicators are registered to monitor and improve the quality of care. However, the number and effectiveness of quality indicators is under debate, and may influence the joy in work of physicians and nurses. Empirical data on the nature and consequences of the registration burden are lacking. The aim of this study was to identify and explore healthcare professionals' perceived burden due to quality registrations in hospitals, and the effect of this burden on their joy in work. METHODS A mixed methods observational study, including participative observations, a survey and semi-structured interviews in two academic hospitals and one teaching hospital in the Netherlands. Study participants were 371 healthcare professionals from an intensive care unit (ICU), a haematology department and others involved in the care of elderly patients and patients with prostate or gastrointestinal cancer. RESULTS On average, healthcare professionals spend 52.3 minutes per working day on quality registrations. The average number of quality measures per department is 91, with 1380 underlying variables. Overall, 57% are primarily registered for accountability purposes, 19% for institutional governance and 25% for quality improvement objectives. Only 36% were perceived as useful for improving quality in everyday practice. Eight types of registration burden were identified, such as an excessive number of quality registrations, and the lack of usefulness for improving quality and inefficiencies in the registration process. The time healthcare professionals spent on quality registrations was not correlated with any measure of joy in work. Perceived unreasonable registrations were negatively associated with healthcare professionals' joy in work (intrinsic motivation and autonomy). Healthcare professionals experienced quality registrations as diverting time from patient care and from actually improving quality. CONCLUSION Registering fewer quality indicators, but more of what really matters to healthcare professionals, is key to increasing the effectiveness of registrations for quality improvement and governance. Also the efficiency of quality registrations should be increased through staffing and information and communications technology solutions to reduce the registration burden experienced by nurses and physicians.
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Affiliation(s)
- Marieke Zegers
- Department of Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gepke L. Veenstra
- Centre of Expertise on Quality and Safety, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gerard Gerritsen
- Department of Quality and Safety, Rijnstate Hospital, Arnhem, The Netherlands
| | - Rutger Verhage
- Department of Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans (J.G.) van der Hoeven
- Department of Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gera A. Welker
- Centre of Expertise on Quality and Safety, University Medical Centre Groningen, Groningen, The Netherlands
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22
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Noltes ME, Cottrell J, Madani A, Rotstein L, Gomez-Hernandez K, Devon K, Boggild MK, Goldstein DP, Wong EM, Brouwers AH, Kruijff S, Eskander A, Monteiro E, Pasternak JD. Quality Indicators for the Diagnosis and Management of Primary Hyperparathyroidism. JAMA Otolaryngol Head Neck Surg 2022; 148:209-219. [PMID: 34989783 DOI: 10.1001/jamaoto.2021.3858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Primary hyperparathyroidism (pHPT) is a common endocrine disorder with many diagnostic and treatment challenges. Despite high-quality guidelines, care is variable, and there is low adherence to evidence-based treatment pathways. Objective To develop quality indicators (QIs) to evaluate the diagnosis and treatment of pHPT that could measure, improve, and optimize quality of care and outcomes for patients with this disease. Design, Setting, and Participants This quality improvement study used a guideline-based approach to develop QIs that were ranked by a Canadian 9-member expert panel of 3 endocrinologists, 3 otolaryngologists, and 3 endocrine surgeons. Data were analyzed between September 2020 and May 2021. Main Outcomes and Measures Candidate indicators (CIs) were extracted from published primary hyperparathyroidism guidelines and summarized with supporting evidence. The 9-member expert panel rated each CI on the validity, reliability, and feasibility of measurement. Final QIs were selected from CIs using the modified RAND-University of California, Los Angeles appropriateness methodology. All panelists were then asked to rank the top 5 QIs for primary, endocrine, and surgical care. Results Forty QIs were identified and evaluated by the expert panel. After 2 rounds of evaluations and discussion, a total of 18 QIs were selected as appropriate measures of high-quality care. The top 5 QIs for primary, endocrine, and surgical care were selected following panelist rankings. Conclusions and Relevance This quality improvement study proposes 18 QIs for the diagnosis and management of pHPT. Furthermore, the top 5 QIs applicable to physicians commonly treating pHPT, including general physicians, internists, endocrinologists, otolaryngologists, and surgeons, are included. These QIs not only assess the quality of care to guide the process of improvement, but also can assess the implementation of evidence-based guideline recommendations. Using these indicators in clinical practice and health system registries can improve quality and cost-effectiveness of care for patients with pHPT.
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Affiliation(s)
- Milou E Noltes
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin Cottrell
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amin Madani
- University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lorne Rotstein
- University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Karen Devon
- University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada.,Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Miranda K Boggild
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Evelyn M Wong
- University Health Network, Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jesse D Pasternak
- University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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23
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Cortellazzi P, Carini D, Bolzoni L, Cattadori E, Randi V. Emilia-Romagna Regional Blood System accreditation as an example of improvement through application of specific requirements: a retrospective analysis. BMJ Open Qual 2021; 10:bmjoq-2021-001408. [PMID: 34810202 PMCID: PMC8609938 DOI: 10.1136/bmjoq-2021-001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 11/02/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Institutional accreditation in Italy represents the license given by a region to a public or private facility to provide services in the name and on behalf of the National Health Service. This study aims to evaluate the improvement of the Emilia-Romagna Regional Blood System and to highlight its unresolved issues, analysing non-conformities observed during accreditation and maintenance inspections between 2013 and 2018. METHODS All the Emilia-Romagna Regional Blood facilities were invited to participate in this study voluntarily and anonymously. Participants had to access a web application that we developed specifically. For each of the three inspections evaluated in this study, they had to enter data about the state of their organisation branches and non-conformities observed by regional inspectors. All data entered were finally exported from the web application database and analysed with spreadsheets. Statistical analysis was performed using Wilcoxon signed-rank test with continuity correction. RESULTS 17 structures took part in the study, with a total of 174 organisation branches. The number of branches changed over the years because of new openings and closures due to reorganisations or non-conformities that were too difficult to correct. Inspectors observed 2381 non-conformities (291 structural, 611 technological and 1479 organisational). As a result of accreditation inspections and consequent improvement actions, non-conformities were reduced by 88%. The most frequent non-conformities concerned the management software and the transportation of blood and blood components. CONCLUSION An improvement in the Emilia-Romagna Regional Blood System over time is evident: institutional accreditation certainly pushed it to change and overcome its problems to comply with specific requirements. The remaining non-conformities after the three inspections were mostly organisational and management software was the most critical issue. Despite these non-conformities, all currently active structures are accredited and guarantee high standards of quality and safety of products and services.
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Affiliation(s)
| | - Davide Carini
- Immunohaematology and Transfusion Medicine Unit, Azienda USL di Piacenza, Piacenza, Italy
| | - Luana Bolzoni
- Quality and Research Unit, Azienda USL di Piacenza, Piacenza, Italy
| | | | - Vanda Randi
- Regional Blood Centre, Emilia-Romagna Region, Bologna, Italy
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24
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Giltenane M, Sheridan A, Kroll T, Frazer K. Work environment challenging Irish public health nurses' care quality: First postnatal visit. Public Health Nurs 2021; 39:202-213. [PMID: 34672017 DOI: 10.1111/phn.12993] [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: 07/01/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Exploring views and experiences of public health nurses of their work environment and measurement of care practices at first postnatal visits. DESIGN An exploratory qualitative design. Data collected using four focus groups and analyzed using thematic analysis. SAMPLE Nineteen public health nurses from four health service regions in Ireland participated. RESULTS Two themes emerged. Theme one identified "challenges of providing a quality service." Public health nurses identified workload demands and that the working environment can detract from the ability to provide a quality service. Challenges within the home, language barriers, and lack of support from management were key issues. Theme two identified "challenges of measuring quality of public health nursing practice." While Measuring practice through quantitative outcomes such as key performance indicators were viewed as inadequate to measure the quality of care provided, positive views of using quality process indicators to measure the quality of their practice emerged. CONCLUSIONS Key issues concern the working environment of public health nurses and challenges of providing and measuring care practices. Absence of appropriate supports and resources means public health nurses work hard to provide quality care. Public health nurses were confident they would score high on quality process measurements of their practice.
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Affiliation(s)
- Martina Giltenane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Ann Sheridan
- Mental Health. Subject Head-Mental Health Nursing, Irish Institute of Mental Health Nursing, UCD School of Nursing, Midwifery & Health Systems, UCD Health Sciences Centre, University College Dublin, Belfield, Dublin, Ireland
| | - Thilo Kroll
- Health Systems Management, Research, Innovation and Impact, UCD School of Nursing, Midwifery and Health Systems, UCD Geary Institute for Public Policy, UCD Health Sciences Centre, University College Dublin (UCD), Belfield, Dublin, Ireland
| | - Kate Frazer
- Public Health and Community Nursing, European Academy Nursing Science, UCD Geary Institute Public Policy, UCD School of Nursing, Midwifery and Health Systems, UCD College of Health and Agricultural Sciences, Belfield, Dublin, Ireland
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25
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Pooni A, Schmocker S, Brown C, MacLean A, Hochman D, Williams L, Baxter N, Simunovic M, Liberman S, Drolet S, Neumann K, Jhaveri K, Kirsch R, Kennedy ED. Quality indicator selection for the Canadian Partnership against Cancer rectal cancer project: A modified Delphi study. Colorectal Dis 2021; 23:1393-1403. [PMID: 33626193 DOI: 10.1111/codi.15599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
AIM It is well established that (i) magnetic resonance imaging, (ii) multidisciplinary cancer conference (MCCs), (iii) preoperative radiotherapy, (iv) total mesorectal excision surgery and (v) pathological assessment as described by Quirke are key processes necessary for high quality, rectal cancer care. The objective was to select a set of multidisciplinary quality indicators to measure the uptake of these clinical processes in clinical practice. METHOD A multidisciplinary panel was convened and a modified two-phase Delphi method was used to select a set of quality indicators. Phase 1 included a literature review with written feedback from the panel. Phase 2 included an in-person workshop with anonymous voting. The selection criteria for the indicators were strength of evidence, ease of capture and usability. Indicators for which ≥90% of the panel members voted 'to keep' were selected as the final set of indicators. RESULTS During phase 1, 68 potential indicators were generated from the literature and an additional four indicators were recommended by the panel. During phase 2, these 72 indicators were discussed; 48 indicators met the 90% inclusion threshold and included eight pathology, five radiology, 11 surgical, six radiation oncology and 18 MCC indicators. CONCLUSION A modified Delphi method was used to select 48 multidisciplinary quality indicators to specifically measure the uptake of key processes necessary for high quality care of patients with rectal cancer. These quality indicators will be used in future work to identify and address gaps in care in the uptake of these clinical processes.
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Affiliation(s)
- Amandeep Pooni
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Selina Schmocker
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Carl Brown
- Department of Colorectal Surgery, St Paul's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anthony MacLean
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Hochman
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Lara Williams
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nancy Baxter
- University of Toronto, Toronto, ON, Canada.,Department of Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Marko Simunovic
- Department of Surgery, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Sender Liberman
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Sébastien Drolet
- Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Katerina Neumann
- Department of Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Kartik Jhaveri
- University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, Mount Sinai Hospital and Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Richard Kirsch
- University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Erin D Kennedy
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
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26
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Jamshidi B, Jamshidi Zargaran S, Bekrizadeh H, Rezaei M, Najafi F. Comparing length of hospital stay during COVID-19 pandemic in the USA, Italy and Germany. Int J Qual Health Care 2021; 33:6178233. [PMID: 33734378 PMCID: PMC7989213 DOI: 10.1093/intqhc/mzab050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/12/2021] [Accepted: 03/17/2021] [Indexed: 12/28/2022] Open
Abstract
Background COVID-19 is the most informative pandemic in history. These unprecedented recorded data give rise to some novel concepts, discussions, and models. Macroscopic modeling of the period of hospitalization is one of these new issues. Methods Modeling of the lag between diagnosis and death is done by using two classes of macroscopic analytical methods: the correlation-based methods based on Pearson, Spearman, and Kendall correlation coefficients, and the logarithmic methods of two types. Also, we apply eight weighted average methods to smooth the time series before calculating the distance. We consider five lags with the least distance. All the computations are conducted on Matlab R2015b. Results The length of hospitalization for the fatal cases in the USA, Italy, and Germany are 2–10, 1–6, and 5–19 days, respectively. Overall, this length in the USA is two days more than in Italy and five days less than in Germany. Conclusion We take the distance between the diagnosis and death as the length of hospitalization. There is a negative association between the length of hospitalization and the case fatality rate. Therefore, the estimation of the length of hospitalization by using these macroscopic mathematical methods can be introduced as an indicator to scale the success of the countries fighting the ongoing pandemic.
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Affiliation(s)
- Babak Jamshidi
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Juction of 22 Bahman, Kermanshah, Kermanshah province 59167-67159, Iran
| | - Shahriar Jamshidi Zargaran
- Department of Medical Engineering, Tehran University of Medical Sciences, Poursina St, Qods St, Enqelab St, Tehran, Tehran province 14176-13151, Iran
| | - Hakim Bekrizadeh
- Department of Statistics, Payame Noor University, Nakhl square, Artesh Blvd, Mini city, Tehran, Tehran province 4697-19395, Iran
| | - Mansour Rezaei
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Juction of 22 Bahman, Kermanshah, Kermanshah province 59167-67159, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Isar square, Kermanshah, Kermanshah province 67198-51351, Iran
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27
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Hirose Y, Shikino K, Ohira Y, Matsuoka S, Mikami C, Tsuchiya H, Yokokawa D, Ikegami A, Tsukamoto T, Noda K, Uehara T, Ikusaka M. Feedback of patient survey on medication improves the management of polypharmacy: a pilot trial. BMC FAMILY PRACTICE 2021; 22:42. [PMID: 33618675 PMCID: PMC7901107 DOI: 10.1186/s12875-021-01396-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022]
Abstract
Background Patient awareness surveys on polypharmacy have been reported previously, but no previous study has examined the effects of sending feedback to health professionals on reducing medication use. Our study aimed to conduct a patient survey to examine factors contributing to polypharmacy, feedback the results to health professionals, and analyze the resulting changes in the number of polypharmacy patients and prescribed medications. Methods After conducting a questionnaire survey of patients in Study 1, we provided its results to the healthcare professionals, and then surveyed the number of polypharmacy patients and oral medications using a before-after comparative study design in Study 2. In Study 1, we examined polypharmacy and its contributing factors by performing logistic regression analysis. In Study 2, we performed a t-test and a chi-square test. Results In the questionnaire survey, significant differences were found in the following 3 items: age (odds ratio (OR) = 3.14; 95% confidence interval (CI) = 2.01–4.91), number of medical institutions (OR = 2.34; 95%CI = 1.50–3.64), and patients’ difficulty with asking their doctors to deprescribe their medications (OR = 2.21; 95%CI = 1.25–3.90). After the feedback, the number of polypharmacy patients decreased from 175 to 159 individuals and the mean number of prescribed medications per patient decreased from 8.2 to 7.7 (p < 0.001, respectively). Conclusions Providing feedback to health professionals on polypharmacy survey results may lead to a decrease in the number of polypharmacy patients. Factors contributing to polypharmacy included age (75 years or older), the number of medical institutions (2 or more institutions), and patients’ difficulty with asking their physicians to deprescribe their medications. Feedback to health professionals reduced the percentage of polypharmacy patients and the number of prescribed medications. Trial registration UMIN. Registered 21 June 2020 - Retrospectively registered, https://www.umin.ac.jp/ctr/index-j.htm Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01396-x.
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Affiliation(s)
- Yuta Hirose
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba pref, Japan.
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba pref, Japan
| | - Yoshiyuki Ohira
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba pref, Japan.,Department of General Medicine, International University of Health and Welfare, Narita, Japan
| | | | | | | | - Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba pref, Japan
| | - Akiko Ikegami
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba pref, Japan
| | - Tomoko Tsukamoto
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba pref, Japan
| | - Kazutaka Noda
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba pref, Japan
| | - Takanori Uehara
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba pref, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba pref, Japan
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28
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Skyrud KD, Bukholm IRK. Correlation between compensated patient claims and 30-day mortality. Int J Qual Health Care 2021; 33:5903599. [PMID: 32909614 DOI: 10.1093/intqhc/mzaa111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/17/2020] [Accepted: 09/08/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To test if compensation claims from patients (reported to the Norwegian System of Patient Injury Compensation) are correlated with the existing quality indicator of 30-day mortality (based on data from Norwegian Patient Registry). This correlation has not been previously evaluated. DESIGN The association between patient claims and 30-day mortality at hospital trust level was assessed by the Pearson correlation coefficient. SETTING The Norwegian System of Patient Injury Compensation is a governmental agency under the Ministry of Health and Care Services and deals with patient-reported complaints about incorrect treatment in the public and private healthcare services. Patient-reported claims may be an indicator of healthcare quality, as 30-day mortality. PARTICIPANTS All 19 Norwegian hospital trusts. INTERVENTIONS : None. MAIN OUTCOME MEASURE Patient claims rates, 30-day mortality and Pearson correlation coefficient. RESULTS Both number of deaths within 30 days and number of claims have declined over time. High correlation (0.77, P < 0.001) was found between number of deaths within 30 days and the total number of claims. In addition, an even stronger association was found with approved claims, with a correlation coefficient of 0.83 (P < 0.001). Moreover, adjusted 30-day mortality was significantly correlated with the patient-claim rate using number of bed-days as denominator, but not when using number of discharges. CONCLUSIONS The results from the present study indicate an association between compensation claims from patients and 30-day mortality, suggesting that both parameters reflect the latent quality of care for the hospital trusts, but they may capture different aspects of care.
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Affiliation(s)
- Katrine Damgaard Skyrud
- Health Services Research, Health Services, Norwegian Institute of Public Health, Postbox 222 Skøyen, 0213 Oslo, Norway
| | - Ida Rashida Khan Bukholm
- Norwegian System of Patient Injury Compensation, Postboks 232 Skøyen, 0213 Oslo, Norway.,Faculty of Landscape and Society, Norwegian University of Life Sciences, Universitetstunet 3, 1430 Ås, Oslo, Norway .,Research Committee, Helgelandssykehuset HF, Postboks 601, 8607 Mo i Rana, Norway
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29
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Garduño-López AL, Acosta Nava VM, Castro Garcés L, Rascón-Martínez DM, Cuellar-Guzmán LF, Flores-Villanueva ME, Villegas-Sotelo E, Carrillo-Torres O, Vilchis-Sámano H, Calderón-Vidal M, Islas-Lagunas G, Richard Chapman C, Komann M, Meissner W, Baumbach P, Zaslansky R. Towards Better Perioperative Pain Management in Mexico: A Study in a Network of Hospitals Using Quality Improvement Methods from PAIN OUT. J Pain Res 2021; 14:415-430. [PMID: 33623424 PMCID: PMC7894852 DOI: 10.2147/jpr.s282850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022] Open
Abstract
Objective This was a pre–post study in a network of hospitals in Mexico-City, Mexico. Participants developed and implemented Quality Improvement (QI) interventions addressing perioperative pain management. Methods PAIN OUT, an international QI and research network, provided tools for web-based auditing and feedback of pain management and patient-reported outcomes (PROs) in the clinical routine. Ward- and patient-level factors were evaluated with multi-level models. Change in proportion of patients reporting worst pain ≥6/10 between project phases was the primary outcome. Results Participants created locally adapted resources for teaching and pain management, available to providers in the form of a website and a special issue of a national anesthesia journal. They offered teaching to anesthesiologists, surgeons, including residents, and nurses. Information was offered to patients and families. A total of 2658 patients were audited in 9 hospitals, between July 2016 and December 2018. Participants reported that the project made them aware of the importance of: training in pain management; auditing one’s own patients to learn about PROs and that QI requires collaboration between multi-disciplinary teams. Participants reported being unaware that their patients experienced severe pain and lacked information about pain treatment options. Worst pain decreased significantly between the two project phases, as did PROs related to pain interfering with movement, taking a deep breath/coughing or sleep. The opportunity of patients receiving information about their pain treatment options increased from 44% to 77%. Conclusions Patients benefited from improved care and pain-related PROs. Clinicians appreciated gaining increased expertise in perioperative pain management and methods of QI.
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Affiliation(s)
- Ana Lilia Garduño-López
- Department of Anesthesiology, Instituto Nacional de Ciencias Médicas y Nutrición "Dr. Salvador Zubirán", Mexico City, Mexico
| | - Victor Manuel Acosta Nava
- Department of Anesthesiology, Instituto Nacional de Ciencias Médicas y Nutrición "Dr. Salvador Zubirán", Mexico City, Mexico
| | - Lisette Castro Garcés
- Department of Anesthesiology, Instituto Nacional de Ciencias Médicas y Nutrición "Dr. Salvador Zubirán", Mexico City, Mexico
| | | | | | - Maria Esther Flores-Villanueva
- Department of Anesthesiology, Hospital General Regional No. 2" Dr. Guillermo Fajardo Ortíz" IMSS (Villacoapa), Mexico City, Mexico
| | - Elizabeth Villegas-Sotelo
- Department of Anesthesiology, Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas, Hospital General "Dr. Ruben Leñero", Mexico City, Mexico
| | - Orlando Carrillo-Torres
- Department of Anesthesiology Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Hugo Vilchis-Sámano
- Department of Orthopedics & Traumatology, Unidad Médica de Alta Especialidad del Hospital de Traumatología y Ortopedia Lomas Verdes (IMSS), Mexico City, Mexico
| | | | - Gabriela Islas-Lagunas
- Department of Anesthesiology Instituto Nacional de Enfermedades Respiratorias (INER), Mexico City, Mexico
| | - C Richard Chapman
- Pain Research Center, Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Marcus Komann
- Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
| | - Winfried Meissner
- Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
| | - Philipp Baumbach
- Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
| | - Ruth Zaslansky
- Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
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Van Schie P, Van Bodegom-Vos L, Zijdeman TM, Nelissen RGHH, Marang-Van De Mheen PJ. Awareness of performance on outcomes after total hip and knee arthroplasty among Dutch orthopedic surgeons: how to improve feedback from arthroplasty registries. Acta Orthop 2021; 92:54-61. [PMID: 33019821 PMCID: PMC7919881 DOI: 10.1080/17453674.2020.1827523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The Netherlands Registry of Orthopedic Implants (LROI) uses audit and feedback (A&F) as the strategy to improve performance outcomes after total hip and knee arthroplasty (THA/TKA). Effectiveness of A&F depends on awareness of below-average performance to initiate improvement activities. We explored the awareness of Dutch orthopedic surgeons regarding their performance on outcomes after THA/TKA and factors associated with this awareness.Methods - An anonymous questionnaire was sent to all 445 eligible Dutch orthopedic surgeons performing THA/TKA. To assess awareness on own surgeon-group performance, they were asked whether their 1-year THA/TKA revision rates over the past 2 years were below average (negative outlier), average (non-outlier), above average (positive outlier) in the funnel plot on the LROI dashboard, or did not know. Associations were determined with (1) dashboard login at least once a year (yes/no); (2) correct funnel-plot interpretation (yes/no) and; (3) recall of their 1-year THA/TKA revision rate (yes/no).Results - 44% of respondents started the questionnaire, 158 THA and 156 TKA surgeons. 55% of THA surgeons and 55% of TKA surgeons were aware of their performance. Surgeons aware of their performance more often logged in on the LROI dashboard, more often interpreted funnel plots correctly, and more often recalled their revision rate. 38% of THA and 26% of TKA surgeons scored "good" on all 3 outcomes.Interpretation - Only half of the orthopedic surgeons were aware of their performance status regarding outcomes after THA/TKA. This suggests that to increase awareness, orthopedic surgeons need to be actively motivated to look at the dashboard more frequently and educated on interpretation of funnel plots for audit and feedback to be effective.
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Affiliation(s)
- Peter Van Schie
- Department of Orthopedics, Leiden University Medical Centre, Leiden;,Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands,Correspondence:
| | - Leti Van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Tristan M Zijdeman
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Perla J Marang-Van De Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
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Suzanne Giesbers APM, Schouteten RLJ, Poutsma E, van der Heijden BIJM, van Achterberg T. Towards a better understanding of the relationship between feedback and nurses' work engagement and burnout: A convergent mixed-methods study on nurses' attributions about the 'why' of feedback. Int J Nurs Stud 2021; 117:103889. [PMID: 33631398 DOI: 10.1016/j.ijnurstu.2021.103889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies on the effects of providing feedback about quality improvement measures to nurses show mixed results and the factors explaining the variance in effects are not yet well-understood. One of the factors that could explain the variance in outcomes is how nurses perceive the feedback. It is not the feedback per se that influences nurses, and consequently their performance, but rather the way the feedback is perceived. OBJECTIVES This article aims to enhance our understanding of Human Resource attributions and employee engagement and burnout in a feedback environment. An in-depth study of nurses' attributions about the 'why' of feedback on quality measurements, and its relation to engagement and burnout, was performed. DESIGN AND METHODS A convergent mixed-methods, multiple case study design was used. Evidence was drawn from four comparable surgical wards within three teaching hospitals in the Netherlands that volunteered to participate in this study. Nurses on each ward were provided with oral and written feedback on quality measurements every two weeks, over a four month period. After this period, an online survey was distributed to all the nurses (n = 184) on the four participating wards. Data were collected from 91 nurses. Parallel to the survey, individual, semi-structured face-to-face interviews were conducted with eight nurses and their ward manager in each ward, resulting in interview data from 32 nurses and four ward managers. RESULTS Results show that nurses - both as a group and individually - make varying attributions about their managers' purpose in providing feedback on quality measurements. The feedback environment is associated to nurses' attributions and these attributions are related to nurses' burnout. CONCLUSIONS By showing that feedback on quality measurements can be attributed differently by nurses and that the feedback environment plays a role in this, the study provides an interesting mechanism for explaining how feedback is related to performance. Implications for theory, practice and future research are discussed.
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Affiliation(s)
- A P M Suzanne Giesbers
- Jeroen Bosch Hospital, PO Box 90153, NL-5200 ME 's Hertogenbosch, the Netherlands; Radboud University, Institute for Management Research, PO Box 9108, NL-6500 HK Nijmegen, the Netherlands
| | - Roel L J Schouteten
- Radboud University, Institute for Management Research, PO Box 9108, NL-6500 HK Nijmegen, the Netherlands.
| | - Erik Poutsma
- Radboud University, Institute for Management Research, PO Box 9108, NL-6500 HK Nijmegen, the Netherlands
| | - Beatrice I J M van der Heijden
- Radboud University, Institute for Management Research, PO Box 9108, NL-6500 HK Nijmegen, the Netherlands; Open University of the Netherlands, School of Management, PO Box 2960, NL-6401 DL Heerlen, the Netherlands; Ghent University, Faculty of Economics and Business Administration, 9000 Ghent, Belgium; Hubei University, Hubei Business School, Wuhan, 368 Youyi Ave., Wuchang District, Wuhan 430062, China; Kingston University, Kingston Business School, London KT11LQ, United Kingdom
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 35, 3000 Leuven, Belgium; Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, PO Box 9101, NL-6500 HB Nijmegen, the Netherlands; Uppsala University, Department of Public Health and Caring Sciences, Box 256, 751 05 Uppsala, Sweden
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Singh N, Kalyan G, Kaur S, Jayashree M, Ghai S. Quality Improvement Initiative to Reduce Intravenous Line-related Infiltration and Phlebitis Incidence in Pediatric Emergency Room. Indian J Crit Care Med 2021; 25:557-565. [PMID: 34177176 PMCID: PMC8196366 DOI: 10.5005/jp-journals-10071-23818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim and objective To reduce the incidence of infiltration and phlebitis by 50% over 2 months among children admitted to the emergency room (ER) of a tertiary care hospital. Materials and methods The study was conducted in the pediatric ER of a tertiary care hospital in North India. All children aged >28 days, receiving intravenous (IV) medication and/or fluids, were enrolled between June (2017) and September (2017). Existing practices of IV line insertion and maintenance were observed and recorded. The visual infusion phlebitis score and infiltration assessment scale were to grade the extent of two. The intervention classified as “IV line insertion and maintenance bundle” included the introduction of low-cost mobile sterile compartment trays, audit and feedback, organizational change, introduction of infection control nurse and quality improvement (QI) team formations were implement in different Plan-Do-Study-Act (PDSA) cycles. Reduction in the “incidence of phlebitis and infiltration” was outcome measures while “scores on checklist of IV line insertion and IV line maintenance and administration of drugs” were process measures. Result The process measures, for IV line insertion, maintenance and administration of drugs through IV line, revealed an increase in scores on the checklist. There was a significant decrease in the incidence of infiltration and phlebitis from 82.9 and 96.1% to 45 and 55%, respectively, postimplementation of all PDSA cycles. Conclusion Multifaceted QI IV line insertion and maintenance bundle reduced the incidence of infiltration and phlebitis. These interventions when integrated into daily work bundles along with continuous education and motivation help in sustaining the goal and attaining long-term success. How to cite this article Singh N, Kalyan G, Kaur S, Jayashree M, Ghai S. Quality Improvement Initiative to Reduce Intravenous Line-related Infiltration and Phlebitis Incidence in Pediatric Emergency Room. Indian J Crit Care Med 2021;25(5):557–565.
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Affiliation(s)
- Neelima Singh
- Department of Nursing, Vardhman Mahavir, Medical College and Safdarjung Hospital, New Delhi, India
| | - Geetanjli Kalyan
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Sukhwinder Kaur
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | | | - Sandhya Ghai
- National Institute of Nursing Education, PGIMER, Chandigarh, India
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Use of Provider Scorecards to Improve Early Postoperative Recovery-Initial Implementation Study. J Healthc Qual 2020; 43:240-248. [PMID: 33306521 DOI: 10.1097/jhq.0000000000000289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Intraoperative anesthetic technique directly impacts immediate postoperative recovery, yet there are few opportunities for anesthesiologists to receive feedback and no easily available benchmarks, making it difficult to reflect on one's own practice. This initial implementation study used retrospective data from 5,712 ambulatory surgery cases with healthy adult patients undergoing general anesthesia in 2018 at a large tertiary care academic center. It examines variation in practice among anesthesiologists for eight surgical specialties. Scorecards assessing intraoperative and postoperative opioids, antiemetics, nonopioid analgesics, regional blocks, recovery time, and severe postoperative pain compared with peers were given to anesthesiologists with prefeedback and postfeedback surveys assessing their attitudes toward feedback. Before receiving their scorecard, 71% of providers predicted their performance was average, and 29% predicted their performance was above average. After receiving their scorecards, 42% rated their quality of recovery as worse than expected, 42% rated it as expected, and 16% rated it as better than expected. Thirteen percent disagreed, 44% were neutral, and 44% agreed that this feedback will change their practice. Implementing a scorecard of patient-centered measures that shows where an anesthesiologist stands in the distribution of their peers was well-received, provides a benchmark, and has the potential to change practice.
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Schulz EB, Phillips F, Waterbright S. Case-mix adjusted postanaesthesia care unit length of stay and business intelligence dashboards for feedback to anaesthetists. Br J Anaesth 2020; 125:1079-1087. [PMID: 32863015 DOI: 10.1016/j.bja.2020.06.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Despite advances in business intelligence software and evidence that feedback to doctors can improve outcomes, objective feedback regarding patient outcomes for individual anaesthetists is hampered by lack of useful benchmarks. We aimed to address this issue by producing case-mix and risk-adjusted postanaesthesia care unit (PACU) length of stay (LOS) benchmarks for integration into modern reporting tools. METHODS We extended existing hospital information systems to calculate predicted PACU LOS using a neural network trained on patient age, surgery duration, sex, operating specialty, urgency, weekday, and insurance status (n=100 511). We then calculated the difference between observed mean and predicted PACU LOS for individual doctors, and compared the results with and without case-mix adjustment. We report practical implications of using visual analytics dashboards displaying the difference between observed and predicted PACU LOS to provide feedback to anaesthetic doctors. RESULTS The neural network accounted for over half of observed variation in individual doctors' mean PACU LOS (mean predicted and mean actual LOS Spearman's r2=0.57). Account for case-mix reduced apparent spread, with 80% of individual doctors falling in a band of 4.3 min after case-mix adjusting, compared with a range of 24 min without adjustment. Case-mix adjusting also identified different individual doctors as outliers (Weighted Cohen's kappa [κ]=0.27). Finally, we demonstrated that we were able to integrate the adjusted metrics into routine reporting tools. CONCLUSION With caution, case-mix adjustment of anaesthetic outcome measures such as PACU LOS potentially provides a useful continuous quality improvement tool. Unadjusted outcome measures are imprecise at best and misleading at worst.
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Affiliation(s)
- Erich B Schulz
- Department of Anaesthesia, Mater Health, Brisbane, Australia.
| | - Frank Phillips
- Department of Anaesthesia, Mater Health, Brisbane, Australia; Mater Clinical Unit, University of Queensland School of Medicine, Brisbane, Australia
| | - Siall Waterbright
- College of Arts and Social Sciences, Australian National University, Canberra, Australia
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Moick S, Hiesmayr M, Mouhieddine M, Kiss N, Bauer P, Sulz I, Singer P, Simon J. Reducing the knowledge to action gap in hospital nutrition care - Developing and implementing nutritionDay 2.0. Clin Nutr 2020; 40:936-945. [PMID: 32747205 DOI: 10.1016/j.clnu.2020.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS In hospital nutrition care the difficulty of translating knowledge to action often leads to inadequate management of patients with malnutrition. nutritionDay, an annual cross-sectional survey has been assessing nutrition care in healthcare institutions in 66 countries since 2006. While initial efforts led to increased awareness of malnutrition, specific local remedial actions rarely followed. Thus, reducing the Knowledge-to-action (KTA) gap in nutrition care requires more robust and focused strategies. This study describes the strategy, methods, instruments and experience of developing and implementing nutritionDay 2.0, an audit and feedback intervention that uses quality and economic indicators, feedback, benchmarking and self-defined action strategies to reduce the KTA gap in hospital nutrition care. METHODS We used an evidence based multi-professional mixed-methods approach to develop and implement nutritionDay 2.0 This audit and feedback intervention is driven by a Knowledge-to-Action framework complemented with robust stakeholder analysis. Further evidence was synthesized from the literature, online surveys, a pilot study, World Cafés and individual expert feedback involving international health care professionals, nutrition care scientists and patients. RESULTS The process of developing and implementing nutritionDay 2.0 over three years resulted in a new audit questionnaire based on 36 nutrition care quality and economic indicators at hospital, unit and patient levels, a new action-oriented feedback and benchmarking report and a unit-level personalizable action plan template. The evaluation of nutritionDay 2.0 is ongoing and will include satisfaction and utility of nutritionDay 2.0 tools and short-, mid- and long-term effects on the KTA gap. CONCLUSION In clinical practice, nutritionDay 2.0 has the potential to promote behavioural and practice changes and improve hospital nutrition care outcomes. In research, the data generated advances knowledge about institutional malnutrition and quality of hospital nutrition care. The ongoing evaluation of the initiative will reveal how far the KTA gap in hospital nutrition care was addressed and facilitate the understanding of the mechanisms needed for successful audit and feedback. TRIAL REGISTRATION Registration in clinicaltrials.gov: Identifier: NCT02820246.
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Affiliation(s)
- S Moick
- nutritionDay worldwide, Höfergasse 13/5, Vienna, 1090, Austria.
| | - M Hiesmayr
- Department Cardiac-, Thoracic-, Vascular Anaesthesia and Intensive Care and CEMSIIS, Medical University Vienna, Vienna, A-1090, Austria.
| | - M Mouhieddine
- Department Cardiac-, Thoracic-, Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, A-1090, Austria.
| | - N Kiss
- Department of Health Economics, Medical University Vienna, Vienna, A-1090, Austria.
| | - P Bauer
- Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, A-1090, Austria.
| | - I Sulz
- Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, A-1090, Austria.
| | - P Singer
- Department of General Intensive Care, Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Israel.
| | - J Simon
- Department of Health Economics, Medical University Vienna, Vienna, A-1090, Austria.
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Luyckx A, Wyckmans L, Bonte AS, Trinh XB, van Dam PA. Acceptability of quality indicators for the management of endometrial, cervical and ovarian cancer: results of an online survey. BMC Womens Health 2020; 20:151. [PMID: 32703282 PMCID: PMC7376904 DOI: 10.1186/s12905-020-00999-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/18/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Measuring quality indicators (QI's) is a tool to improve the quality of care. The aim of this study was to evaluate the acceptability of 36 QI's, defined after a literature search for the management of endometrial, cervical and ovarian cancer. Relevant specialists in the field of interest were surveyed. METHODS To quantify the opinions of these specialists, an online survey was sent out via mailing to members of gynaecological or oncological societies. The relevance of each QI was questioned on a scale from one to five (1 = irrelevant, 2 = less relevant, 3 = no opinion/neutral, 4 = relevant, 5 = very relevant). If a QI received a score of 4 or 5 in 65% or more of the answers, we state that the respondents consider this QI to be sufficiently relevant to use in daily practice. RESULTS The survey was visited 238 times and resulted in 53 complete responses (29 Belgian, 24 other European countries). The majority of the specialists were gynaecologists (45%). Five of the 36 QI's (13,9%) did not reach the cut-off of 65%: referral to a tertiary center, preoperative staging of endometrial cancer by MRI, preoperative staging of cervical cancer by positron-emission tomography, incorporation of intracavitary brachytherapy in the treatment of cervical cancer, reporting ASA and WHO score for each patient. After removing the 5 QI's that were not considered as relevant by the specialists and 3 additional 3 QI's that we were considered to be superfluous, we obtained an optimized QI list. CONCLUSION As QI's gain importance in gynecological oncology, their use can only be of value if they are universally interpreted in the same manner. We propose an optimized list of 28 QI's for the management of endometrial, cervical and ovarian cancer which responders of our survey found relevant. Further validation is needed to finalize and define a set of QI's that can be used in future studies, audits and benchmarking.
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Affiliation(s)
- Annemie Luyckx
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium
| | - Leen Wyckmans
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium
| | - Anne-Sophie Bonte
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium
| | - Xuan Bich Trinh
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium
- Centre for Oncological Research (CORE), University of Antwerp, B2610, Wilrijk, Belgium
| | - Peter A van Dam
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium.
- Centre for Oncological Research (CORE), University of Antwerp, B2610, Wilrijk, Belgium.
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Ziemann S, Coburn M, Rossaint R, Van Waesberghe J, Bürkle H, Fries M, Henrich M, Henzler D, Iber T, Karst J, Kunitz O, Löb R, Meißner W, Meybohm P, Mierke B, Pabst F, Schaelte G, Schiff J, Soehle M, Winterhalter M, Kowark A. Implementation of anesthesia quality indicators in Germany : A prospective, national, multicenter quality improvement study. Anaesthesist 2020; 70:38-47. [PMID: 32377798 PMCID: PMC8674175 DOI: 10.1007/s00101-020-00773-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In 2016 the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthetists (BDA) published 10 quality indicators (QI) to compare and improve the quality of anesthesia care in Germany. So far, there is no evidence for the feasibility of implementation of these QI in hospitals. OBJECTIVE This study tested the hypothesis that the implementation of the 10 QI is feasible in German hospitals. MATERIAL AND METHODS This prospective three-phase national multicenter quality improvement study was conducted in 15 German hospitals and 1 outpatient anesthesia center from March 2017 to February 2018. The trial consisted of an initial evaluation of pre-existing structures and processes by the heads of the participating anesthesia departments, followed by a 6-month implementation phase of the QI as well as a final re-evaluation phase. The implementation procedure was supported by web-based implementation aids ( www.qi-an.org ) and internal quality management programs. The primary endpoint was the difference in the number of implemented QI per center before and after implementation. Secondary endpoints were the number of newly implemented QI per center, the overall number of successful implementations of each QI, the identification of problems during the implementation as well as the kind of impediments preventing the QI implementation. RESULTS The average number of implemented QI increased from 5.8 to 6.8 (mean of the differences 1.1 ± 1.3; P < 0.01). Most frequently the QI perioperative morbidity and mortality report (5 centers) and the QI temperature management (4 centers) could be implemented. After the implementation phase, the QI incidence management and patient blood management were implemented in all 16 centers. Implementation of other quality indicators failed mainly due to a lack of time and lack of structural resources. CONCLUSION In this study the implementation of QI was proven to be mostly feasible in the participating German hospitals. Although several QI could be implemented with minor effort, more time, financial and structural resources would be required for some QI, such as the QI postoperative visit.
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Affiliation(s)
- S Ziemann
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - M Coburn
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - R Rossaint
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - J Van Waesberghe
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - H Bürkle
- Department of Anaesthesiology and Critical Care Medicine, Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - M Fries
- Department of Anaesthesiology, St. Vincenz Hospital Limburg, Limburg, Germany
| | - M Henrich
- Department of Anaesthesiology and Critical Care Medicine, St.-Vincentius Hospital Karlsruhe, Karlsruhe, Germany
| | - D Henzler
- Department of Anaesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Klinikum Herford, Ruhr-University Bochum, Herford, Germany
| | - T Iber
- Department of Anaesthesiology, Critical Care and Pain Medicine, Klinikum Mittelbaden, Baden-Baden, Germany
| | - J Karst
- Outpatient Anaesthesia Care Centre Karst, Berlin, Germany
| | - O Kunitz
- Department of Anaesthesiology and Critical Care Medicine, Klinikum Mutterhaus der Borromäerinnen, Trier, Germany
| | - R Löb
- Department of Anaesthesiology, Critical Care, Emergency and Pain Medicine, St. Barbara Hospital, Hamm, Germany
| | - W Meißner
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Jena, Jena, Germany
| | - P Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Würzburg, Würzburg, Germany
| | - B Mierke
- Department of Anaesthesiology and Critical Care Medicine, Hospital St. Elisabeth, Damme, Germany
| | - F Pabst
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Rostock, Rostock, Germany
| | - G Schaelte
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - J Schiff
- Department of Anaesthesiology and Surgical Intensive Care Medicine, Klinikum Stuttgart, Stuttgart, Germany
| | - M Soehle
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - M Winterhalter
- Department of Anaesthesiology and Pain Medicine, Klinikum Bremen-Mitte, Bremen, Germany
| | - A Kowark
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
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Ziemann S, Coburn M, Rossaint R, Van Waesberghe J, Bürkle H, Fries M, Henrich M, Henzler D, Iber T, Karst J, Kunitz O, Löb R, Meißner W, Meybohm P, Mierke B, Pabst F, Schaelte G, Schiff J, Soehle M, Winterhalter M, Kowark A. [Implementation of anesthesia quality indicators in Germany : A prospective, national, multicenter quality improvement study]. Anaesthesist 2020; 69:544-554. [PMID: 32617630 DOI: 10.1007/s00101-020-00775-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In 2016 the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthetists (BDA) published 10 quality indicators (QI) to compare and improve the quality of anesthesia care in Germany. So far, there is no evidence for the feasibility of implementation of these QI in hospitals. OBJECTIVE This study tested the hypothesis that the implementation of the 10 QI is feasible in German hospitals. MATERIAL AND METHODS This prospective three-phase national multicenter quality improvement study was conducted in 15 German hospitals and 1 outpatient anesthesia center from March 2017 to February 2018. The trial consisted of an initial evaluation of pre-existing structures and processes by the heads of the participating anesthesia departments, followed by a 6-month implementation phase of the QI as well as a final re-evaluation phase. The implementation procedure was supported by web-based implementation aids ( www.qi-an.org ) and internal quality management programs. The primary endpoint was the difference in the number of implemented QI per center before and after implementation. Secondary endpoints were the number of newly implemented QI per center, the overall number of successful implementations of each QI, the identification of problems during the implementation as well as the kind of impediments preventing the QI implementation. RESULTS The average number of implemented QI increased from 5.8 to 6.8 (mean of the differences 1.1 ± 1.3; P < 0.01). Most frequently the QI perioperative morbidity and mortality report (5 centers) and the QI temperature management (4 centers) could be implemented. After the implementation phase, the QI incidence management and patient blood management were implemented in all 16 centers. Implementation of other quality indicators failed mainly due to a lack of time and lack of structural resources. CONCLUSION In this study the implementation of QI was proven to be mostly feasible in the participating German hospitals. Although several QI could be implemented with minor effort, more time, financial and structural resources would be required for some QI, such as the QI postoperative visit.
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Affiliation(s)
- S Ziemann
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - M Coburn
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - R Rossaint
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - J Van Waesberghe
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - H Bürkle
- Klinik für Anästhesiologie und Intensivmedizin, Fakultät für Medizin, Universitätsklinikum, Freiburg, Freiburg, Deutschland
| | - M Fries
- Klinik für Anästhesiologie, St. Vincenz-Krankenhaus Limburg, Limburg, Deutschland
| | - M Henrich
- Klinik für Anästhesie, Intensiv- und Notfallmedizin, St.-Vincentius-Kliniken Karlsruhe, Karlsruhe, Deutschland
| | - D Henzler
- Klinik für Anästhesiologie, operative Intensiv‑, Rettungsmedizin und Schmerztherapie, Klinikum Herford, Ruhr-Universität Bochum, Herford, Deutschland
| | - T Iber
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum Mittelbaden, Baden-Baden, Deutschland
| | - J Karst
- Ambulantes Anästhesie MVZ Karst, Berlin, Deutschland
| | - O Kunitz
- Klinik für Anästhesie und Intensivmedizin, Klinikum Mutterhaus der Borromäerinnen, Trier, Deutschland
| | - R Löb
- Klinik für Anästhesiologie, Intensiv‑, Notfall- und Schmerzmedizin, St. Barbara-Klinik, Hamm, Deutschland
| | - W Meißner
- Klinik für Anästhesie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - P Meybohm
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - B Mierke
- Klinik für Anästhesie und Intensivmedizin, Krankenhaus St. Elisabeth, Damme, Deutschland
| | - F Pabst
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - G Schaelte
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - J Schiff
- Klinik für Anästhesiologie, operative Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Stuttgart, Stuttgart, Deutschland
| | - M Soehle
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - M Winterhalter
- Klinik für Anästhesiologie und Schmerztherapie, Klinikum Bremen-Mitte, Bremen, Deutschland
| | - A Kowark
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
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Bittencourt SDDA, Vilela MEDA, Marques MCDO, Santos AMD, Silva CKRTD, Domingues RMSM, Reis AC, Santos GLD. Labor and childbirth care in maternities participating in the "Rede Cegonha/Brazil": an evaluation of the degree of implementation of the activities. CIENCIA & SAUDE COLETIVA 2020; 26:801-821. [PMID: 33729338 DOI: 10.1590/1413-81232021263.08102020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/17/2020] [Indexed: 11/21/2022] Open
Abstract
Using a judgment framework, this article analyzes the degree of implementation of the best practices in labor and childbirth care contained in the guidelines of the Rede Cegonha (RC) across Brazil. The study eligibility criteria were public and mixed hospitals located in a health region with a RC action plan in place in 2015, resulting in a total of 606 facilities distributed across the country. Three different data collection methods were used: face-to-face interviews with managers, health professionals and puerperal women; document analysis; and on-site observation. The framework was built around the five guidelines of the Labor and Childbirth component of the RC. Degree of implantation was rated as follows: adequate; partially adequate and inadequate. The performance of maternity facilities was rated as partially adequate for all guidelines except for hospital environment, which was rated as inadequate. A huge variation in degree of implementation was observed across regions, with the South and Southeast being the best-performing regions in most items. The results reinforce the need for an ongoing evaluation of the actions developed by the RC to inform policy-making and the regulation of labor and childbirth care.
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Affiliation(s)
| | | | | | | | | | - Rosa Maria Soares Madeira Domingues
- Laboratório de Pesquisa Clínica em DST/Aids, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Ana Cristina Reis
- Escola Politécnica Joaquim Venâncio, Fiocruz. Rio de Janeiro RJ Brasil
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Combination of National Quality Assurance Data Collection With a Standard Operating Procedure in Community-Acquired Pneumonia: A Win-Win Strategy? Qual Manag Health Care 2020; 28:176-182. [PMID: 31246781 DOI: 10.1097/qmh.0000000000000220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The primary contact for German physicians with national quality assurance in community-acquired pneumonia (CAP) is frequently experienced as time-consuming obligatory documentation. Since the regular feedback loop stretches up to 18 months, the immediate impact on quality is perceived as rather low. Ultimately, a method leading to increase in the quality of data collection, clarification on expected clinical treatment standards, and improvement in the acceptance and feedback mechanism is needed. METHODS We developed a form merging data collection for quality indicators with a standard operating procedure (SOP) in CAP and implemented it in the daily routine of a university's department for internal medicine. Fulfillment of quality indicators before and after the implementation of the new form was measured. RESULTS Critical parameters such as the documentation of breathing rate and clinical parameters at discharge strongly improved after implementation of the intervention. Uncritical parameters showed slight improvement or stable results at a high level. CONCLUSION The combination of collection of quality data with a clinical SOP and context information may improve the impact of quality measures by increasing acceptance, quality of data capture, short-loop feedback, and possibly quality of care.
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Beaussier AL, Demeritt D, Griffiths A, Rothstein H. Steering by their own lights: Why regulators across Europe use different indicators to measure healthcare quality. Health Policy 2020; 124:501-510. [PMID: 32192738 PMCID: PMC7677115 DOI: 10.1016/j.healthpol.2020.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/01/2020] [Accepted: 02/24/2020] [Indexed: 01/21/2023]
Abstract
Indicator sets differ in how they define, measure, and assess healthcare quality. National sets shaped by varying governance traditions and healthcare system configuration. Targeting of quality dimensions and hospital activities shaped by system-specific ‘demand-side’ pressures. Measurement styles shaped by ‘supply-side’ constraints on data access and indicator construction. International benchmarking is easier when healthcare systems and governance traditions are similar. Despite widespread faith that quality indicators are key to healthcare improvement and regulation, surprisingly little is known about what is actually measured in different countries, nor how, nor why. To address that gap, this article compares the official indicator sets--comprising some 1100 quality measures-- used by statutory hospital regulators in England, Germany, France, and the Netherlands. The findings demonstrate that those countries’ regulators strike very different balances in: the dimensions of quality they assess (e.g. between safety, effectiveness, and patient-centredness); the hospital activities they target (e.g. between clinical and non-clinical activities and management); and the ‘Donabedian’ measurement style of their indicators (between structure, process and outcome indicators). We argue that these contrasts reflect: i) how the distinctive problems facing each country’s healthcare system create different ‘demand-side’ pressures on what national indicator sets measure; and ii) how the configuration of national healthcare systems and governance traditions create ‘supply-side’ constraints on the kinds of data that regulators can use for indicator construction. Our analysis suggests fundamental differences in the meaning of quality and its measurement across countries that are likely to impede international efforts to benchmark quality and identify best practice.
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Affiliation(s)
- Anne-Laure Beaussier
- Centre de Sociologie des Organisations (CSO), Sciences Po-CNRS, 19 Rue Amélie, 75007 Paris, France
| | - David Demeritt
- Department of Geography, King's College London, Strand, London WC2R 2LS, United Kingdom.
| | - Alex Griffiths
- Data Science Directorate, Statica Research, London, SE22 9PN, United Kingdom
| | - Henry Rothstein
- Department of Geography, King's College London, Strand, London WC2R 2LS, United Kingdom
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Gadeka DD, Esena RK. Quality of Care of Medical Imaging Services at a Teaching Hospital in Ghana: Clients' Perspective. J Med Imaging Radiat Sci 2020; 51:154-164. [PMID: 32081678 DOI: 10.1016/j.jmir.2019.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 11/29/2019] [Accepted: 12/06/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Ministry of Health of Ghana is committed to delivering client-focused, quality-driven, and results-oriented medical imaging services. However, there remained a lack of empirical evidence regarding the state of the various dimensions of quality needed to establish evidence-based strategies to strengthen the medical imaging system. This study assessed the quality of care of medical imaging services from clients' perspective at a teaching hospital in order to inform policy. METHODS This research was a descriptive cross-sectional study using a mixed method approach based on the dimensions of quality of care in medical imaging: capacity and sustainability, timeliness, safety, equity, patient centeredness, and effective communication. QUANTITATIVE METHOD A 5-point Likert scale questionnaire was used. A total of 191 clients aged ≥18 years were recruited during medical imaging services at the imaging department of the hospital. A simple random sampling technique was used to select participants. Data were analyzed using Stata version 13. Descriptive analyses were carried out. QUALITATIVE METHODS Purposive sampling strategy was applied to recruit 12 in-depth interview participants. Reflective interview guide starting with demographic characteristics and followed by the dimensions of quality of care was used. Qualitative data were analyzed using thematic analysis. QUANTITATIVE RESULTS Overall, there is low quality of care 2.8 (standard deviation [SD] = 0.6). There is low quality with regards to timeliness 2.8 (SD = 0.4), patient centeredness 2.7 (SD = 0.7), equity 2.8 (SD = 0.2), effective communication 2.7 (SD = 0.7), and safety 2.5 (SD = 0.3). Quality of care in relation to capacity and sustainability is high 3.4 (0.6). Only 73 (38.2%) of the clients are currently satisfied with the quality of care, and only 39.8% will recommend others to access care at the imaging department. Only 66 (34.6%) of clients are of the view that staff behavior instills confidence. QUALITATIVE RESULTS The qualitative study shows a lack of equity, timeliness, and patient-centeredness in terms of care and privacy. There is a perceived lack of compliance with radiation protection protocols, and there exist wide communication gaps between clients and staff. Furthermore, there is a lack of capacity and sustainability in relation to the reliability and availability of functional equipment. There is, however, high appraisal from clients regarding the neatness and availability of staff. CONCLUSION A majority of clients are not satisfied with the quality of care of the medical imaging services. Improved interaction with clients, availability of functional equipment, and effective communication during the care process between the patients and the imaging professionals such as provision of timely information during the waiting period and explanation of procedure will help enhance the quality of care.
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Affiliation(s)
- Dominic Dormenyo Gadeka
- Department of Health Policy Planning and Management, School of Public Health, University of Ghana, Legon-Accra, Ghana.
| | - Reuben K Esena
- Department of Health Policy Planning and Management, School of Public Health, University of Ghana, Legon-Accra, Ghana
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Tello JE, Barbazza E, Waddell K. Review of 128 quality of care mechanisms: A framework and mapping for health system stewards. Health Policy 2020; 124:12-24. [PMID: 31791717 PMCID: PMC6946442 DOI: 10.1016/j.healthpol.2019.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 10/29/2019] [Accepted: 11/18/2019] [Indexed: 12/30/2022]
Abstract
Health system stewards have the critical task to identify quality of care deficiencies and resolve underlying system limitations. Despite a growing evidence-base on the effectiveness of certain mechanisms for improving quality of care, frameworks to facilitate the oversight function of stewards and the use of mechanisms to improve outcomes remain underdeveloped. This review set out to catalogue a wide range of quality of care mechanisms and evidence on their effectiveness, and to map these in a framework along two dimensions: (i) governance subfunctions; and (ii) targets of quality of care mechanisms. To identify quality of care mechanisms, a series of searches were run in Health Systems Evidence and PubMed. Additional grey literature was reviewed. A total of 128 quality of care mechanisms were identified. For each mechanism, searches were carried out for systematic reviews on their effectiveness. These findings were mapped in the framework defined. The mapping illustrates the range and evidence for mechanisms varies and is more developed for some target areas such as the health workforce. Across the governance sub-functions, more mechanisms and with evidence of effectiveness are found for setting priorities and standards and organizing and monitoring for action. This framework can support system stewards to map the quality of care mechanisms used in their systems and to uncover opportunities for optimization backed by systems thinking.
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Affiliation(s)
- Juan E Tello
- Integrated Prevention and Control of NCDs Programme, Division of NCDs and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - Erica Barbazza
- Academic UMC, Department of Public Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; WHO European Centre for Primary Health Care, Almaty, Kazakhstan.
| | - Kerry Waddell
- McMaster Health Forum, McMaster University, Hamilton, Canada; WHO European Centre for Primary Health Care, Almaty, Kazakhstan.
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Michel P, Fraticelli L, Parneix P, Daucourt V, Farges O, Gasquet I, Occelli P, Ray-Coquard I, Duclos A, Bertillot H, Ceretti AM, Daucourt V, Delonca J, Duclos A, El Khoury C, Farges O, Gasquet I, Lajonchere JP, Luigi E, Michel P, Millat B, Parneix P, Ray-Coquard I, Woimant F, Aragona E, Baron-Gutty A, Fraticelli L. Assessing the performance of indicators during their life cycle: the mixed QUID method. Int J Qual Health Care 2019; 32:12-19. [DOI: 10.1093/intqhc/mzz090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/30/2019] [Accepted: 07/10/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Quality indicators (QI) are mandatory in French hospitals. After a decade of use, the Ministry of Health set up an expert workgroup to enhance informed decision-making regarding currently used national QI, i.e. to propose a decision of withdrawing, revising or continuing their use. We report the development of an integrated method for a comprehensive appraisal of quality/safety indicators (QI) during their life cycle, for three purposes, quality improvement, public disclosure and regulation purposes. The method was tested on 10 national QI on use for up to 10 years to identify operational issues.
Methods
A modified Delphi technique to select relevant criteria and a development of a mixed evaluation method by the workgroup. A ‘real-life’ test on 10 national QI.
Results
Twelve criteria were selected for the appraisal of QI used for regulation goals, 11 were selected for hospital improvement and seven for public disclosure. The perceived feasibility and relevance were studied including hospital workers, patients and health authorities professionals; the scientific soundness of the indicator development phase was reviewed by analyzing reference documents; the metrological performance (limited to the discriminatory power and dynamics of change during the life cycle dimensions) was analyzed on the national datasets.
Applied to the 10 QI, the workgroup proposed to withdraw four of them and to modify or suspend the six others.
Conclusions
The value of the method was supported by the clear-cut conclusions and endorsement of the proposed decisions by the health authorities.
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Affiliation(s)
- Philippe Michel
- Université de Lyon, Université Claude bernard Lyon1, Hesper EA F-69003, France
- Quality Safety and Customer Relationship Department, Hospices Civils de Lyon, F-69002, France
| | - Laurie Fraticelli
- Hospices Civils de Lyon; Université de Lyon, Université Claude Bernard Lyon1, Hesper EA F-69003, France
| | - Pierre Parneix
- South Western France Healthcare-Associated Infection Control Centre; CHU de Bordeaux, Place Amélie6raba-Léon, F - 33076, Bordeaux, France
| | - Valentin Daucourt
- Scientific Counselor, Réseau Qualité des Établissements de Bourgogne-Franche-Comté (RéQua), 26 rue Proudhon, F - 25000, Besançon, France
| | - Olivier Farges
- Department of Surgery, Hôpital Beaujon, APHP, UPNVS, F - 92118 Clichy, France
| | - Isabelle Gasquet
- Direction de l'Organisation Médicale et des Relations Avec les Universités, Assistance Publique - Hôpitaux de Paris, F - 75004, Paris, France
| | - Pauline Occelli
- Pôle de Santé Publique, Hospices Civils de Lyon; Univ Lyon, Université Claude Bernard Lyon1, Hesper EA 7425, F - 69003, Lyon, France
| | - Isabelle Ray-Coquard
- Oncologie Médicale, Centre Leon Bérard; Univ Lyon, Université Claude Bernard Lyon1, Hesper EA 7425, F - 69003, Lyon, France
| | - Antoine Duclos
- Pôle de Santé Publique, Hospices Civils de Lyon; Univ Lyon, Université Claude Bernard Lyon1, Hesper EA 7425, F – 69003, Lyon, France
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Sauro K, Ghali WA, Stelfox HT. Measuring safety of healthcare: an exercise in futility? BMJ Qual Saf 2019; 29:341-344. [PMID: 31796577 DOI: 10.1136/bmjqs-2019-009824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Khara Sauro
- Departments of Community Health Sciences, Surgery & Oncology, the O'Brien Institute for Public Health & the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - William A Ghali
- Departments of Community Health Sciences & Medicine, and the O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Departments of Critical Care Medicine & Community Health Sciences, and the O'Brien Institute for Public Health, Universty of Calgary, Calgary, Alberta, Canada
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Leggat S, Balding C. The impact of leadership churn on quality management in Australian hospitals. J Health Organ Manag 2019. [DOI: 10.1108/jhom-08-2018-0216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore the relationship between frequent turnover (churn) of the chief executive officer (CEO), quality manager and members of the governing board with the management of quality in eight Australian hospitals.
Design/methodology/approach
A mixed method three-year longitudinal study was conducted using validated quality system scales, quality indicators and focus groups involving over 800 board members, managers and clinical staff.
Findings
There were unexpected high levels of both governance and management churn over the three years. Churn among CEOs and quality managers was negatively associated with compliance in aspects of the quality system used to plan, monitor and improve quality of care. There was no relationship with the quality of care indicators. Staff identified lack of vision and changing priorities with high levels of churn, which they described as confusing and demotivating. There was no relationship with quality processes or quality indicators detected for churn among governing board members.
Practical implications
Governing boards must recognise the risks associated with management change and minimise these risks with robust clinical governance processes.
Originality/value
This research is the first that we are aware of that identifies the impact of frequent leadership turnover in the health sector on quality management.
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Leggat SG, Balding C. Bridging existing governance gaps: five evidence-based actions that boards can take to pursue high quality care. AUST HEALTH REV 2019; 43:126-132. [PMID: 29127953 DOI: 10.1071/ah17042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 09/28/2017] [Indexed: 11/23/2022]
Abstract
Objective To explore the impact of the organisational quality systems on quality of care in Victorian health services. Methods During 2015 a total of 55 focus groups were conducted with more than 350 managers, clinical staff and board members in eight Victorian health services to explore the effectiveness of health service quality systems. A review of the quality and safety goals and strategies outlined in the strategic and operating plans of the participating health services was also undertaken. Results This paper focuses on the data related to the leadership role of health service boards in ensuring safe, high-quality care. The findings suggest that health service boards are not fully meeting their governance accountability to ensure consistently high-quality care. The data uncovered major clinical governance gaps between stated board and executive aspirations for quality and safety and the implementation of these expectations at point of care. These gaps were further compounded by quality system confusion, over-reliance on compliance, and inadequate staff engagement. Conclusion Based on the existing evidence we propose five specific actions boards can take to close the gaps, thereby supporting improved care for all consumers. What is known about this topic? Effective governance is essential for high-quality healthcare delivery. Boards are required to play an active role in their organisation's pursuit of high quality care. What does this paper add? Recent government reports suggest that Australian health service boards are not fully meeting their governance requirements for high quality, safe care delivery, and our research pinpoints key governance gaps. What are the implications for practitioners? Based on our research findings we outline five evidence-based actions for boards to improve their governance of quality care delivery. These actions focus on an organisational strategy for high-quality care, with the chief executive officer held accountable for successful implementation, which is actively guided and monitored by the board.
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Affiliation(s)
- Sandra G Leggat
- La Trobe University, Department of Public Health, Bundoora, Vic. 3085, Australia. Email
| | - Cathy Balding
- La Trobe University, Department of Public Health, Bundoora, Vic. 3085, Australia. Email
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Sasaki N, Yamaguchi N, Okumura A, Yoshida M, Sugawara H, Imanaka Y. Does hospital information technology infrastructure promote the implementation of clinical practice guidelines? A multicentre observational study of Japanese hospitals. BMJ Open 2019; 9:e024700. [PMID: 31203235 PMCID: PMC6588970 DOI: 10.1136/bmjopen-2018-024700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES It remains unclear whether insufficient information technology (IT) infrastructure in hospitals hinders implementation of clinical practice guidelines (CPGs) and affects healthcare quality. The objectives of this study were to describe the present state of IT infrastructure provided in acute care hospitals across Japan and to investigate its association with healthcare quality. METHODS A questionnaire survey of hospital administrators was conducted in 2015 to gather information on hospital-level policies and elements of IT infrastructure. The number of positive responses by each respondent to the survey items was tallied. Next, a composite quality indicator (QI) score of hospital adherence to CPGs for perioperative antibiotic prophylaxis was calculated using administrative claims data. Based on this QI score, we performed a chi-squared automatic interaction detection (CHAID) analysis to identify correlates of hospital healthcare quality. The independent variables included hospital size and teaching status in addition to hospital policies and elements of IT infrastructure. RESULTS Wide variations were observed in the availability of various IT infrastructure elements across hospitals, especially in local area network availability and access to paid evidence databases. The CHAID analysis showed that hospitals with a high level of access to paid databases (p<0.05) and internet (p<0.05) were strongly associated with increased care quality in larger or teaching hospitals. CONCLUSIONS Hospitals with superior IT infrastructure may provide higher-quality care. This allows clinicians to easily access the latest information on evidence-based medicine and facilitate the dissemination of CPGs. The systematic improvement of hospital IT infrastructure may promote CPG use and narrow the evidence-practice gaps.
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Affiliation(s)
- Noriko Sasaki
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | | | | | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Walpole ET, Theile DE, Philpot S, Youl PH. Development and Implementation of a Cancer Quality Index in Queensland, Australia: A Tool for Monitoring Cancer Care. J Oncol Pract 2019; 15:e636-e643. [PMID: 31150310 DOI: 10.1200/jop.18.00372] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Many cancer-specific assessment tools to measure health care performance have been developed. However, reporting on quality indicators at a population level is uncommon. We describe the development and implementation of a Cancer Quality Index (CQI) and examine the sensitivity of the index to detect change over time. METHODS In developing the CQI, we reviewed existing indices, guidelines, and cancer care pathways. Our choice of indicators was additionally guided by the availability of population-wide data. A series of pilot indicators underwent trial use and were evaluated, and outcomes were discussed before a final set of indicators was established. The process was overseen by a clinician-led quality assurance committee that included hospital administrators and data custodians. RESULTS The CQI includes five quality dimensions and 16 indicators for public and private cancer services using population-wide information. The following are the five indicators: Effective, Efficient, Safe, Accessible, and Equitable. We demonstrated the sensitivity of the CQI to measure change over time by examining outcomes such as time to first treatment and 30-day surgical mortality, using linked cancer registry and health administrative data for 99,728 patients with cancer diagnosed between 2005 and 2009 and 2010 and 2014. CONCLUSION The CQI is a valuable tool to track progress in delivering safe, quality cancer care within health care services. Critical to its development and implementation has been the involvement of clinicians from several disciplines and the availability of population-based data. We found the CQI to be a sensitive tool able to detect changes over time.
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Affiliation(s)
- Euan T Walpole
- 1 Princess Alexandra Hospital, Brisbane, Queensland, Australia.,2 The University of Queensland, Brisbane, Queensland, Australia.,3 Metro South Hospital and Health Service, Queensland, Australia
| | - David E Theile
- 3 Metro South Hospital and Health Service, Queensland, Australia
| | - Shoni Philpot
- 3 Metro South Hospital and Health Service, Queensland, Australia
| | - Philippa H Youl
- 3 Metro South Hospital and Health Service, Queensland, Australia
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Al Kuwaiti A, Al Muhanna FA. Challenges facing healthcare leadership in attaining accreditation of teaching hospitals. Leadersh Health Serv (Bradf Engl) 2019; 32:170-181. [PMID: 30945601 DOI: 10.1108/lhs-01-2018-0002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This paper aims to examine the challenges faced by health-care leadership in teaching hospitals in attaining accreditation for their institutions. DESIGN/METHODOLOGY/APPROACH This paper is based on a study of current literature on health-care leadership, hospital accreditation and quality of patient care and identifies the challenges facing health-care leadership in attaining accreditation for teaching hospitals. FINDINGS Based on a review and analysis of literature, infrastructure, finance, legal support, workforce recruitment and training, documentation and technology are identified as challenges faced by health-care leadership in teaching hospitals. The key challenges facing health-care leadership with respect to medical education and clinical research are found to be integration of education into hospital operations, compliance with all regulatory and professional requirements and adequacy of resources in executing research programs. ORIGINALITY/VALUE This study draws the attention of health-care leadership in teaching hospitals on the challenges they face in obtaining accreditation for their institutions so that they may develop appropriate strategies to overcome them.
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Affiliation(s)
- Ahmed Al Kuwaiti
- College of Dentistry and Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University , Al Khobar, Saudi Arabia
| | - Fahd A Al Muhanna
- Department of Internal Medicine, Imam Abdulrahman Bin Faisal University , Dammam, Saudi Arabia
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