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Azadmanjir Z, Khormali M, Sadeghi-Naini M, Baigi V, Pirnejad H, Dashtkoohi M, Ghodsi Z, Jazayeri SB, Shakeri A, Mohammadzadeh M, Bagheri L, Lotfi MS, Daliri S, Azarhomayoun A, Sadeghi-Bazargani H, O'reilly G, Rahimi-Movaghar V. Post-discharge follow-up of patients with spine trauma in the National Spinal Cord Injury Registry of Iran during the COVID-19 pandemic: Challenges and lessons learned. Chin J Traumatol 2024; 27:173-179. [PMID: 38016878 PMCID: PMC11138348 DOI: 10.1016/j.cjtee.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/10/2023] [Accepted: 10/23/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE The purpose of the National Spinal Cord Injury Registry of Iran (NSCIR-IR) is to create an infrastructure to assess the quality of care for spine trauma and in this study, we aim to investigate whether the NSCIR-IR successfully provides necessary post-discharge follow-up data for these patients. METHODS An observational prospective study was conducted from April 11, 2021 to April 22, 2022 in 8 centers enrolled in NSCIR-IR, respectively Arak, Rasht, Urmia, Shahroud, Yazd, Kashan, Tabriz, and Tehran. Patients were classified into 3 groups based on their need for care resources, respectively: (1) non-spinal cord injury (SCI) patients without surgery (group 1), (2) non-SCI patients with surgery (group 2), and (3) SCI patients (group 3). The assessment tool was a self-designed questionnaire to evaluate the care quality in 3 phases: pre-hospital, in-hospital, and post-hospital. The data from the first 2 phases were collected through the registry. The post-hospital data were collected by conducting follow-up assessments. Telephone follow-ups were conducted for groups 1 and 2 (non-SCI patients), while group 3 (SCI patients) had a face-to-face visit. This study took place during the COVID-19 pandemic. Data on age and time interval from injury to follow-up were expressed as mean ± standard deviation (SD) and response rate and follow-up loss as a percentage. RESULTS Altogether 1538 telephone follow-up records related to 1292 patients were registered in the NSCIR-IR. Of the total calls, 918 (71.05%) were related to successful follow-ups, but 38 cases died and thus were excluded from data analysis. In the end, post-hospital data from 880 patients alive were gathered. The success rate of follow-ups by telephone for groups 1 and 2 was 73.38% and 67.05% respectively, compared to 66.67% by face-to-face visits for group 3, which was very hard during the COVID-19 pandemic. The data completion rate after discharge ranged from 48% - 100%, 22% - 100% and 29% - 100% for groups 1 - 3. CONCLUSIONS To improve patient accessibility, NSCIR-IR should take measures during data gathering to increase the accuracy of registered contact information. Regarding the loss to follow-ups of SCI patients, NSCIR-IR should find strategies for remote assessment or motivate them to participate in follow-ups through, for example, providing transportation facilities or financial support.
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Affiliation(s)
- Zahra Azadmanjir
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Khormali
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Sadeghi-Naini
- Department of Neurosurgery, Lorestan University of Medical Sciences, Khoram-Abad, Iran
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Habibollah Pirnejad
- Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran; Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Mohammad Dashtkoohi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Students Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Behnam Jazayeri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Aidin Shakeri
- Department of Neurosurgery, Arak University of Medical Sciences, Arak, Iran
| | | | - Laleh Bagheri
- Shahid Rahnemoun Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad-Sajjad Lotfi
- Trauma Nursing Research Centre, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Salman Daliri
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Amir Azarhomayoun
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Homayoun Sadeghi-Bazargani
- Research Center for Evidence Based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Gerard O'reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; National Trauma Research Institute, The Alfred, Melbourne, Australia
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Universal Scientific Education and Research Network (USERN), Tehran, Iran; Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran.
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Knop M, Mueller M, Kaiser S, Rester C. The impact of digital technology use on nurses' professional identity and relations of power: a literature review. J Adv Nurs 2024. [PMID: 38558440 DOI: 10.1111/jan.16178] [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: 09/27/2023] [Revised: 02/20/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
AIM This study seeks to review how the use of digital technologies in clinical nursing affects nurses' professional identity and the relations of power within clinical environments. DESIGN Literature review. DATA SOURCES PubMed and CINAHL databases were searched in April 2023. METHODS We screened 874 studies in English and German, of which 15 were included in our final synthesis reflecting the scientific discourse from 1992 until 2023. RESULTS Our review revealed relevant effects of digital technologies on nurses' professional identity and power relations. Few studies cover outcomes relating to identity, such as moral agency or nurses' autonomy. Most studies describe negative impacts of technology on professional identity, for example, creating a barrier between nurses and patients leading to decreased empathetic interaction. Regarding power relations, technologically skilled nurses can yield power over colleagues and patients, while depending on technology. The investigation of these effects is underrepresented. CONCLUSION Our review presents insights into the relation between technology and nurses' professional identity and prevalent power relations. For future studies, dedicated and critical investigations of digital technologies' impact on the formation of professional identity in nursing are required. IMPLICATIONS FOR THE PROFESSION Nurses' professional identity may be altered by digital technologies used in clinical care. Nurses, who are aware of the potential effects of digitized work environments, can reflect on the relationship of technology and the nursing profession. IMPACT The use of digital technology might lead to a decrease in nurses' moral agency and competence to shape patient-centred care. Digital technologies seem to become an essential measure for nurses to wield power over patients and colleagues, whilst being a control mechanism. Our work encourages nurses to actively shape digital care. REPORTING METHOD We adhere to the JBI Manual for Evidence Synthesis where applicable. EQUATOR reporting guidelines were not applicable for this type of review. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Michael Knop
- Faculty for Applied Healthcare Sciences, Deggendorf Institute of Technology, Deggendorf, Germany
| | | | | | - Christian Rester
- Faculty for Applied Healthcare Sciences, Deggendorf Institute of Technology, Deggendorf, Germany
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El-Amin A, Koehlmoos T, Yue D, Chen J, Cho NY, Benharash P, Franzini L. The Association of High-Quality Hospital Use on Health Care Outcomes for Pediatric Congenital Heart Defects in a Universal Health Care System. Mil Med 2024:usae026. [PMID: 38364865 DOI: 10.1093/milmed/usae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Congenital heart disease (CHD) has an incidence of 0.8% to 1.2% worldwide, making it the most common birth defect. Researchers have compared high-volume to low-volume hospitals and found significant hospital-level variation in major complications, health resource utilization, and mortality after CHD surgery. In addition, researchers found critical CHD patients at low-volume/non-teaching facilities to be associated with higher odds of inpatient mortality when compared to CHD patients at high-volume/teaching hospitals (odds ratio 1.76). We examined the effects of high-quality hospital (HQH) use on health care outcomes and health care costs in pediatric CHD care using an instrumental variable (IV) approach. MATERIALS AND METHODS Using nationwide representative claim data from the United States Military Health System from 2016 to 2020, TRICARE beneficiaries with a diagnosis of CHD were tabulated based on relevant ICD-10 (International Classification of Diseases, 10th revision) codes. We examined the relationships between annual readmissions, annual emergency room (ER) use, and mortality and HQH use. We applied both the naive linear probability model (LPM), controlling for the observed patient and hospital characteristics, and the two-stage least squares (2SLS) model, accounting for the unobserved confounding factors. The differential distance between the patient and the closest HQH at the index date and the patient and nearest non-HQH was used as the IV. This protocol was approved by the Institutional Review Board at the University of Maryland, College Park (Approval Number: 1576246-2). RESULTS The naive LPM indicated that HQH use was associated with a higher probability of annual readmissions (marginal effect, 18%; 95% CI, 0.12 to 0.23). The naive LPM indicated that HQH use was associated with a higher probability of mortality (marginal effect, 2.2%; 95% CI, 0.01 to 0.03). Using the differential distance of closest HQH and non-HQH, we identified a significant association between HQH use and annual ER use (marginal effect, -14%; 95% CI, -0.24 to -0.03). CONCLUSIONS After controlling for patient-level and facility-level covariates and adjusting for endogeneity, (1) HQH use did not increase the probability of more than one admission post 1-year CHD diagnosis, (2) HQH use lowered the probability of annual ER use post 1-year CHD diagnosis, and (3) HQH use did not increase the probability of mortality post 1-year CHD diagnosis. Patients who may have benefited from utilizing HQH for CHD care did not, alluding to potential barriers to access, such as health insurance restrictions or lack of patient awareness. Although we used hospital quality rating for congenital cardiac surgery as reported by the Society of Thoracic Surgeons, the contributing data span a 4-year period and may not reflect real-time changes in center performance. Since this study focused on inpatient care within the first-year post-initial CHD diagnosis, it may not reflect the full range of health system utilization. It is necessary for clinicians and patient advocacy groups to collaborate with policymakers to promote the development of an overarching HQH designation authority for CHD care. Such establishment will facilitate access to HQH for military beneficiary populations suffering from CHD.
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Affiliation(s)
- Amber El-Amin
- Center for Health Services Research, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD 20742, USA
| | - Tracey Koehlmoos
- Center for Health Services Research, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Dahai Yue
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD 20742, USA
| | - Jie Chen
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD 20742, USA
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA 90024, USA
| | - Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA 90024, USA
- Department of Surgery, University of California, Los Angeles, CA 90024, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA 90024, USA
- Department of Surgery, University of California, Los Angeles, CA 90024, USA
| | - Luisa Franzini
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD 20742, USA
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Rachmawaty R, Wahyudin E, Bukhari A, Sinrang AW, Satar GL, Juhran A. Healthcare Quality Received by Insured Patients in Two Indonesian Regional Public Hospitals. J Holist Nurs 2024:8980101241229481. [PMID: 38311909 DOI: 10.1177/08980101241229481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Background: Hospitals are required to improve the quality of health services provided to patients. Purpose: Evaluating and comparing the healthcare quality received by insured patients hospitalized in two Indonesian regional public hospitals. Methods: Secondary data analysis used the 2019 and 2020 Indonesian National Health Insurance e-claim databases of Hospital A and Hospital B. Descriptive and crosstabs analyses were used to determine INA-CBGs diagnoses that were categorized as high volume, high risk, and high cost. Results: The admissions that caused financial loss at the Hospital A were 21.1% in 2019 and 19.8% in 2020, while 30.3% in 2019 and 27.5% at the Hospital B. More than 60% of these admissions were placed in the 3rd class of inpatient wards of the two hospitals. Of these admissions, < 5% at the Hospital A and >5% at the Hospital B were readmitted within 30 days, although more than 90% were previously discharged based on physicians' approval. Conclusions: Inadequate healthcare quality received by insured patients. Hence, an integrated clinical pathways based professional nursing practice model is highly recommended to increase patient outcomes and decrease 30 days hospital readmission rates.
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Al-Yateem N, Ahmad A, Subu MA, Ahmed F, Dias JM, Hijazi H, Rahman SA, Saifan AR. Hearing the voices of adolescents: Evaluating the quality of care for young adults with chronic illnesses in the UAE. J Pediatr Nurs 2023; 73:204-210. [PMID: 37804541 DOI: 10.1016/j.pedn.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Quality care for adolescents and young adults with chronic illnesses has been under-explored in the United Arab Emirates (UAE) and internationally, especially from patients' perspectives. Most available international studies focused on quality of life and the transition to adulthood rather than service quality. AIM This research assesses care quality for adolescents with chronic illnesses in the UAE, aiming to understand their perspectives, appraise current practices, and identify service gaps. METHODS A cross-sectional survey employed a validated questionnaire examining 33 essential care components. Participants comprised 576 adolescents and young adults with chronic conditions from five UAE Emirates. RESULTS Participant's reports indicated that none of the 33 care elements were received consistently. Most participants (80.6%) reported crucial care aspects were absent, and across most investigated items, 19.4%-46.5% of participants reported receiving the services they were supposed to receive only some or many of the times, indicating significant areas for improvement. CONCLUSIONS Findings demonstrate significant care quality gaps for UAE's adolescents and young adults with chronic illnesses. These may critically affect their ability to manage their conditions and ensure holistic growth. These insights can guide healthcare enhancements tailored to this demographic. PRACTICE IMPLICATIONS There is an urgency for enhanced patient-centered care in UAE healthcare, emphasizing clinicians' roles in supporting adolescents with chronic illnesses, especially during transitions. Healthcare managers should prioritize standardized care policies, improved communication, and training that emphasizes consistent patient feedback and transition readiness. Further research into care gaps and tailored interventions within the region's distinct sociocultural setting is essential.
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Affiliation(s)
- Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; School of Nursing, Paramedicine and Healthcare Sciences, Faculty of Science and Health Charles Sturt University, ORANGE, NSW, Australia.
| | - Alaa Ahmad
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Muhamad Arsyad Subu
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Fatma Ahmed
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Jacqueline Maria Dias
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Heba Hijazi
- Department of Health Service Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Department of Health Management and Policy Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Syed Azizur Rahman
- Department of Health Service Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Ahmad Rajeh Saifan
- Faculty of Nursing, Applied Sciences Private University, Amman, , Jordan
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Farrokhi P, Zarei E, Bagherzadeh R, Irannejad B, Hashjin AA. Development and validation of primary health care quality assessment tool. BMC Health Serv Res 2023; 23:1156. [PMID: 37885033 PMCID: PMC10601108 DOI: 10.1186/s12913-023-10162-x] [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: 09/15/2022] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Assessing the quality of health services gives insights to managers about the status of services delivered by them, especially from the client's perspective. Although various tools have been developed to measure the quality of primary health care (PHC), no specific tool was found in this field in Iran. Therefore, the present study was conducted to develop and validate the quality assessment tool of PHC in Iran. METHODS This methodological study was conducted in 2021. In the first step, based on a literature review, an initial questionnaire was designed, and its face validity, content validity, construct validity, and reliability were evaluated. Descriptive tests, Kolmogorov-Smirnov, exploratory factor analysis, Kaiser-Myer-Olkin (KMO), and Cronbach's alpha were performed by using SPSS 22. RESULTS The initial questionnaire included 33 items, of which three items were removed due to inconsistency with factorization. The final questionnaire consisted of 30 items and nine dimensions: interaction, efficiency, timeliness, accuracy, consultation, tangibility, safety, accessibility, and environment. The KMO and Cronbach's alpha index values were 0.734 and 0.82, respectively, indicating acceptable reliability and validity. The developed dimensions represented about 73% of the total variance. CONCLUSION The designed questionnaire has relatively good validity and reliability and can be used to measure the quality of PHC and to identify weaknesses in service delivery. However, researchers should carefully examine it to enhance its applicability as a standard tool for measuring PHC quality.
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Affiliation(s)
- Pouria Farrokhi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Zarei
- Department of Health Service Management, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rafat Bagherzadeh
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Irannejad
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Asgar Aghaei Hashjin
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Chaudhry AS, Inata Y, Nakagami-Yamaguchi E. Quality analysis of the clinical laboratory literature and its effectiveness on clinical quality improvement: a systematic review. J Clin Biochem Nutr 2023; 73:108-115. [PMID: 37700849 PMCID: PMC10493209 DOI: 10.3164/jcbn.23-22] [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: 04/01/2023] [Accepted: 04/29/2023] [Indexed: 09/14/2023] Open
Abstract
Quality improvement in clinical laboratories is crucial to ensure accurate and reliable test results. With increasing awareness of the potential adverse effects of errors in laboratory practice on patient outcomes, the need for continual improvement of laboratory services cannot be overemphasized. A literature search was conducted on PubMed and a web of science core collection between October and February 2021 to evaluate the scientific literature quality of clinical laboratory quality improvement; only peer-reviewed articles written in English that met quality improvement criteria were included. A structured template was used to extract data, and the papers were rated on a scale of 0-16 using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS). Out of 776 studies, 726 were evaluated for clinical laboratory literature quality analysis. Studies were analyzed according to the quality improvement and control methods and interventions, such as training, education, task force, and observation. Results showed that the average score of QI-MQCS for quality improvement papers from 1981-2000 was 2.5, while from 2001-2020, it was 6.8, indicating continuous high-quality improvement in the clinical laboratory sector. However, there is still room to establish a proper system to judge the quality of clinical laboratory literature and improve accreditation programs within the sector.
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Affiliation(s)
- Ahmed Shabbir Chaudhry
- Department of Medical Quality and Safety Science, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Yu Inata
- Department of Medical Quality and Safety Science, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
- Department of Intensive Care Medicine, Osaka Women’s and Children’s Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Etsuko Nakagami-Yamaguchi
- Department of Medical Quality and Safety Science, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Ngune I, Myers H, Cole A, Palamara P, Redknap R, Roche M, Twigg D. Developing nurse-sensitive outcomes in acute inpatient mental health settings-A systematic review. J Clin Nurs 2023; 32:6254-6267. [PMID: 36915223 DOI: 10.1111/jocn.16679] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/14/2022] [Accepted: 01/30/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND While nurse-sensitive outcomes (NSOs) are well established in numerous health settings, to date there is no indicator suite of NSOs for inpatient mental health settings. AIM To assess the relationship between nursing variables and patient outcomes in acute inpatient mental health settings to determine which outcomes can be used as indicators of the quality of nursing care. METHODS Databases accessed were CINAHL, MEDLINE, PsycINFO and EMBASE, last searched in May 2022. The review followed the 2020 PRISMA checklist for systematic reviews. Papers published between 1995 and 2022, conducted in acute mental health care units were included. The quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool. A meta-analysis was not possible because of the large number of variables and measurement inconsistencies. RESULTS A total of 57 studies were reviewed. Studies were categorised according to whether they found a significant or non-significant relationship between nurse variables and patient outcomes. Seven outcomes-aggression, seclusion, restraint, absconding, pro-re-nata medications, special observations and self-harm-were identified. For each outcome, there were significant findings for several nurse variables indicating that all included outcomes could be used as NSOs. However, evidence for aggression, seclusion and restraint use as suitable NSOs was more robust than the evidence for self-harm, absconding, pro-re-nata medications and special observations. CONCLUSION All the seven outcomes can all be used to develop an NSO indicator suite in mental health inpatient settings. More work is needed to establish high-quality studies to clearly demonstrate the relationship between these outcome measures and changes in nurse variables such as nurse staffing, skill mix, work environment, nurse education and nurse experience. PATIENT AND PUBLIC CONTRIBUTION Patient or public contribution was not possible because of the type of the variables being explored.
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Affiliation(s)
- Irene Ngune
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Helen Myers
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Amanda Cole
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Peter Palamara
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robina Redknap
- Western Australia Department of Health, Perth, Western Australia, Australia
| | - Michael Roche
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Diane Twigg
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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Al-Moteri M, Alzahrani AA, Althobiti ES, Plummer V, Sahrah AZ, Alkhaldi MJ, Rajab EF, Alsalmi AR, Abdullah ME, Abduelazeez AEA, Caslangen MZM, Ismail MG, Alqurashi TA. The Road to Developing Standard Time for Efficient Nursing Care: A Time and Motion Analysis. Healthcare (Basel) 2023; 11:2216. [PMID: 37570456 PMCID: PMC10418769 DOI: 10.3390/healthcare11152216] [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: 06/26/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: The amount of time nurses spend with their patients is essential to improving the quality of patient care. Studies have shown that nurses spend a considerable amount of time on a variety of activities--which are often not taken into account while estimating nurse-to-patient care time allocation--that could potentially be eliminated, combined or delegated with greater productivity. The current study aimed to calculate standard time for each activity category by quantifying the amount of time required by nurses to complete an activity category and determine the adjustment time that can be given during work, as well as determine factors that can be altered to improve the efficiency of nursing care on inpatient general wards of a governmental hospital. (2) Method: A time and motion study was conducted over two weeks using 1-to-1 continuous observations of nurses as they performed their duties on inpatient general wards, while observers recorded each single activity, and specifically the time and movements required to complete those activities. (3) Result: There was 5100 min of observations over 10 working days. Nurses spent 69% (330 min) of time during their 8 h morning shift on direct patient care, (19.4%) ward/room activities (18%), documentation (14%), indirect patient care (12%) and professional communication (5%). Around 94 min of activities seem to be wasted and can be potentially detrimental to nurses' overall productivity and threaten patient care quality. The standard number of hours that represents the best estimate of a general ward nurse regarding the optimal speed at which the staff nurse can provide care related activities was computed and proposed. (4) Conclusions: The findings obtained from time-motion studies can help in developing more efficient and productive nursing work for more optimal care of patients.
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Affiliation(s)
- Modi Al-Moteri
- Nursing Department, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Amer A. Alzahrani
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Ensherah Saeed Althobiti
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Virginia Plummer
- Institute of Health and Wellbeing, Federation University, Berwick, VIC 3806, Australia;
| | - Afnan Z. Sahrah
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Maha Jabar Alkhaldi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Eishah Fahad Rajab
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Amani R. Alsalmi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Merhamah E. Abdullah
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | | | - Mari-zel M. Caslangen
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Mariam G. Ismail
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Talal Awadh Alqurashi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
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Jukic Peladic N, Orlandoni P. Development of Quality Indicators for Geriatric Home Enteral Nutrition (HEN) Services. Nutrients 2023; 15:3119. [PMID: 37513537 PMCID: PMC10384251 DOI: 10.3390/nu15143119] [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: 06/08/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
The evidence on the safety, efficacy and patient centeredness of Home Enteral Nutrition (HEN) services is scarce. In 2015, we carried out a search of the literature to identify specific indicators for HEN services as tools to be used to assess the quality of INRCA HEN services. No specific indicators for HEN services were found. Through a subsequent search of the literature, we have identified the appropriate methodology to define quality indicators and developed eight (8) specific indicators to track the quality of our HEN service for geriatric patients. Following Donabiedan's classification, we have defined two structure indicators, two process indicators and four outcome indicators that are presented in this manuscript. Though they may be used to make a comparison of HEN services for geriatric patients and to monitor the quality of therapy provided at patients' homes, the definition of quality system indicators for HEN services requires the additional joint efforts of experts in the field of nutrition and the scientific community for their validation.
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Affiliation(s)
- Nikolina Jukic Peladic
- Vivisol Srl., Clinical Nutrition Unit, National Institute of Health and Science on Aging, IRCCS INRCA Ancona, Via della Montagnola 81, 60127 Ancona, Italy
| | - Paolo Orlandoni
- Clinical Nutrition Unit, National Institute of Health and Science on Aging, IRCCS INRCA Ancona, Via della Montagnola 81, 60127 Ancona, Italy
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11
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Sesler A, Stambough JB, Mears SC, Barnes CL, Stronach BM. Socioeconomic Challenges in the Rural Patient Population in Need of Total Joint Arthroplasty. Orthop Clin North Am 2023; 54:269-275. [PMID: 37271555 DOI: 10.1016/j.ocl.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Many challenges exist for the rural patient in need of joint arthroplasty. Optimization for surgery is more difficult due to factors such as deprivation, education, employment, household income, and access to proper surgical institutions. Rural individuals have less access to primary care and even less access to surgical specialists, creating a distinct subset of patients who endure higher costs, poorer outcomes, and lack of care. Reducing socioeconomic disparities in rural communities will require policy initiatives addressing the components of socioeconomic status (income, education, and occupation). Hopefully remote patient technologies can help with access and timely addressing of modifiable risk factors.
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Affiliation(s)
- Aaron Sesler
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street Mail, Little Rock, AR 72205, USA
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street Mail, Little Rock, AR 72205, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street Mail, Little Rock, AR 72205, USA
| | - Charles Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street Mail, Little Rock, AR 72205, USA
| | - Benjamin M Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street Mail, Little Rock, AR 72205, USA.
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12
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El-Amin A, Koehlmoos T, Yue D, Chen J, Benharash P, Franzini L. Does universal insurance influence disparities in high-quality hospital use for inpatient pediatric congenital heart defect care within the first year of diagnosis? BMC Health Serv Res 2023; 23:702. [PMID: 37381049 DOI: 10.1186/s12913-023-09668-1] [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: 01/20/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Healthcare disparities are an issue in the management of Congenital Heart Defects (CHD) in children. Although universal insurance may mitigate racial or socioeconomic status (SES) disparities in CHD care, prior studies have not examined these effects in the use of High-Quality Hospitals (HQH) for inpatient pediatric CHD care in the Military Healthcare System (MHS). To assess for racial and SES disparities in inpatient pediatric CHD care that may persist despite universal insurance coverage, we performed a cross-sectional study of the HQH use for children treated for CHD in the TRICARE system, a universal healthcare system for the U.S. Department of Defense. In the present work we evaluated for the presence of disparities, like those seen in the civilian U.S. healthcare system, among military ranks (SES surrogate) and races and ethnicities in HQH use for pediatric inpatient admissions for CHD care within a universal healthcare system (MHS). METHODS We conducted a cross-sectional study using claims data from the U.S. MHS Data Repository from 2016 to 2020. We identified 11,748 beneficiaries aged 0 to 17 years who had an inpatient admission for CHD care from 2016 to 2020. The outcome variable was a dichotomous indicator for HQH utilization. In the sample, 42 hospitals were designated as HQH. Of the population, 82.9% did not use an HQH at any point for CHD care and 17.1% used an HQH at some point for CHD care. The primary predictor variables were race and sponsor rank. Military rank has been used as an indicator of SES status. Patient demographic information at the time of index admission post initial CHD diagnosis (age, gender, sponsor marital status, insurance type, sponsor service branch, proximity to HQH based on patient zip code centroid, and provider region) and clinical information (complexity of CHD, common comorbid conditions, genetic syndromes, and prematurity) were used as covariates in multivariable logistic regression analysis. RESULTS After controlling for demographic and clinical factors including age, gender, sponsor marital status, insurance type, sponsor service branch, proximity to HQH based on patient zip code centroid, provider region, complexity of CHD, common comorbid conditions, genetic syndromes, and prematurity, we did not find disparities in HQH use for inpatient pediatric CHD care based upon military rank. After controlling for demographic and clinical factors, lower SES (Other rank) was less likely to use an HQH for inpatient pediatric CHD care; OR of 0.47 (95% CI of 0.31 to 0.73). CONCLUSIONS We found that for inpatient pediatric CHD care in the universally insured TRICARE system, historically reported racial disparities in care were mitigated, suggesting that this population benefitted from expanded access to care. Despite universal coverage, SES disparities persisted in the civilian care setting, suggesting that universal insurance alone cannot sufficiently address differences in SES disparities in CHD care. Future studies are needed to address the pervasiveness of SES disparities and potential interventions to mitigate these disparities such as a more comprehensive patient travel program.
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Affiliation(s)
- Amber El-Amin
- Center for Health Services Research, Uniformed Services University of Health Sciences, Bethesda, MD, US.
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, US.
| | - Tracey Koehlmoos
- Center for Health Services Research, Uniformed Services University of Health Sciences, Bethesda, MD, US
| | - Dahai Yue
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, US
| | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, US
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, US
- Department of Surgery, University of California, Los Angeles, CA, US
| | - Luisa Franzini
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, US
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13
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Montesinos L, Salinas-Navarro DE, Santos-Diaz A. Transdisciplinary experiential learning in biomedical engineering education for healthcare systems improvement. BMC MEDICAL EDUCATION 2023; 23:207. [PMID: 37013525 PMCID: PMC10069080 DOI: 10.1186/s12909-023-04171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The growing demand for more efficient, timely, and safer health services, together with insufficient resources, put unprecedented pressure on health systems worldwide. This challenge has motivated the application of principles and tools of operations management and lean systems to healthcare processes to maximize value while reducing waste. Consequently, there is an increasing need for professionals with the appropriate clinical experience and skills in systems and process engineering. Given their multidisciplinary education and training, biomedical engineering professionals are likely among the most suitable to assume this role. In this context, biomedical engineering education must prepare students for a transdisciplinary professional role by including concepts, methods, and tools that commonly belong to industrial engineering. This work aims to create relevant learning experiences for biomedical engineering education to expand transdisciplinary knowledge and skills in students to improve and optimize hospital and healthcare care processes. METHODS Healthcare processes were translated into specific learning experiences using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model. This model allowed us to systematically identify the context where learning experiences were expected to occur, the new concepts and skills to be developed through these experiences, the stages of the student's learning journey, the resources required to implement the learning experiences, and the assessment and evaluation methods. The learning journey was structured around Kolb's experiential learning cycle, which considers four stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation. Data on the student's learning and experience were collected through formative and summative assessments and a student opinion survey. RESULTS The proposed learning experiences were implemented in a 16-week elective course on hospital management for last-year biomedical engineering undergraduate students. Students engaged in analyzing and redesigning healthcare operations for improvement and optimization. Namely, students observed a relevant healthcare process, identified a problem, and defined an improvement and deployment plan. These activities were carried out using tools drawn from industrial engineering, which expanded their traditional professional role. The fieldwork occurred in two large hospitals and a university medical service in Mexico. A transdisciplinary teaching team designed and implemented these learning experiences. CONCLUSIONS This teaching-learning experience benefited students and faculty concerning public participation, transdisciplinarity, and situated learning. However, the time devoted to the proposed learning experience represented a challenge.
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Affiliation(s)
- Luis Montesinos
- Institute of Advanced Materials for Sustainable Manufacturing, Tecnologico de Monterrey, Mexico City, 14380, Mexico.
- School of Engineering and Sciences, Tecnologico de Monterrey, Mexico City, 14380, Mexico.
| | | | - Alejandro Santos-Diaz
- School of Engineering and Sciences, Tecnologico de Monterrey, Mexico City, 14380, Mexico
- School of Medicine and Health Sciences, Tecnologico de Monterrey, Monterrey, 64710, Mexico
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14
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Kalt F, Mayr H, Gero D. Classification of Adverse Events in Adult Surgery. Eur J Pediatr Surg 2023; 33:120-128. [PMID: 36720250 DOI: 10.1055/s-0043-1760821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Successful surgery combines quality (achievement of a positive outcome) with safety (avoidance of a negative outcome). Outcome assessment serves the purpose of quality improvement in health care by establishing performance indicators and allowing the identification of performance gaps. Novel surgical quality metric tools (benchmark cutoffs and textbook outcomes) provide procedure-specific ideal surgical outcomes in a subgroup of well-defined low-risk patients, with the aim of setting realistic and best achievable goals for surgeons and centers, as well as supporting unbiased comparison of surgical quality between centers and periods of time. Validated classification systems have been deployed to grade adverse events during the surgical journey: (1) the ClassIntra classification for the intraoperative period; (2) the Clavien-Dindo classification for the gravity of single adverse events; and the (3) Comprehensive Complication Index (CCI) for the sum of adverse events over a defined postoperative period. The failure to rescue rate refers to the death of a patient following one or more potentially treatable postoperative adverse event(s) and is a reliable proxy of the institutional safety culture and infrastructure. Complication assessment is undergoing digital transformation to decrease resource-intensity and provide surgeons with real-time pre- or intraoperative decision support. Standardized reporting of complications informs patients on their chances to realize favorable postoperative outcomes and assists surgical centers in the prioritization of quality improvement initiatives, multidisciplinary teamwork, surgical education, and ultimately, in the enhancement of clinical standards.
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Affiliation(s)
- Fabian Kalt
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Switzerland
| | - Hemma Mayr
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Switzerland
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Switzerland
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15
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Detection of Adverse Drug Reactions in COVID-19 Hospitalized Patients in Saudi Arabia: A Retrospective Study by ADR Prompt Indicators. Healthcare (Basel) 2023; 11:healthcare11050660. [PMID: 36900665 PMCID: PMC10001386 DOI: 10.3390/healthcare11050660] [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: 01/08/2023] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023] Open
Abstract
Seeking an alternative approach for detecting adverse drug reactions (ADRs) in coronavirus patients (COVID-19) and enhancing drug safety, a retrospective study of six months was conducted utilizing an electronic medical record (EMR) database to detect ADRs in hospitalized patients for COVID-19, using "ADR prompt indicators" (APIs). Consequently, confirmed ADRs were subjected to multifaceted analyses, such as demographic attribution, relationship with specific drugs and implication for organs and systems of the body, incidence rate, type, severity, and preventability of ADR. The incidence rate of ADRs is 37%, the predisposition of organs and systems to ADR is observed remarkably in the hepatobiliary and gastrointestinal systems at 41.8% vs. 36.2%, p < 0.0001, and the classes of drugs implicated in the ADRs are lopinavir-ritonavir 16.3%, antibiotics 24.1%, and hydroxychloroquine12.8%. Furthermore, the duration of hospitalization and polypharmacy are significantly higher in patients with ADRs at 14.13 ± 7.87 versus 9.55 ± 7.90, p < 0.001, and 9.74 ± 5.51 versus 6.98 ± 4.36, p < 0.0001, respectively. Comorbidities are detected in 42.5% of patients and 75.2%, of patients with DM, and HTN, displaying significant ADRs, p-value < 0.05. This is a symbolic study providing a comprehensive acquaintance of the importance of APIs in detecting hospitalized ADRs, revealing increased detection rates and robust assertive values with insignificant costs, incorporating the hospital EMR database, and enhancing transparency and time effectiveness.
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Effects of Inclusive Leadership on Quality of Care: The Mediating Role of Psychological Safety Climate and Perceived Workgroup Inclusion. Healthcare (Basel) 2022; 10:healthcare10112258. [DOI: 10.3390/healthcare10112258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim of the study is to investigate the multilevel effects of the inclusiveness of workgroup leaders on quality of care by intervening through a “psychological safety climate” at the group level and “perceived workgroup inclusion” at the individual level within professionally diverse workgroups of healthcare professionals. Material and Methods: Data are collected from 305 healthcare professionals nested in 61 workgroups and 305 patients treated by the same workgroups working in public-sector hospitals in Pakistan. Hypothesized relationships are tested through multilevel analyses using Mplus 7. Results: The results of the study show that inclusive leadership can enhance the quality of care delivered by multiprofessional workgroups of healthcare professionals through perceived workgroup inclusion. Further, the psychological safety climate does not mediate the relationship between inclusive leadership and quality of care individually, but it transmits the effects of inclusive leadership through perceived workgroup inclusion on quality of care. Conclusion: The results of the study suggest that the inclusiveness of workgroup leaders, the psychological safety climate, and perceived workgroup inclusion can create safe and inclusive interpersonal mechanisms that play a key role in transmitting the positive effects of inclusive leadership on quality of care.
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Pogue CA, Li P, Swiger P, Gillespie G, Ivankova N, Patrician PA. Associations among the nursing work environment, nurse-reported workplace bullying, and patient outcomes. Nurs Forum 2022; 57:1059-1068. [PMID: 35908259 PMCID: PMC9771862 DOI: 10.1111/nuf.12781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/15/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Bullying may undermine patient safety in healthcare organizations threatening quality improvement and patient outcomes. PURPOSE To explore the associations between the nursing work environment, nurse-reported workplace bullying, and patient outcomes. METHOD Cross-sectional analysis of nurse survey data (N = 943). The Practice Environment Scale of the nursing work index was used to measure the work environment, nurse-reported bullying was measured with the short negative acts questionnaire, and single items measured care quality and patient safety grade. Random effects logistic regressions were used to determine associations controlling for individual, employment, and organizational factors. FINDINGS Fourty percent of nurses reported experiencing bullying. A higher work environment composite score was significantly associated with a lower risk of bullying (OR = 0.16 [0.12, 0.22], p < .0001). Nurses experiencing bullying were less likely to report good/excellent quality of care (OR = 0.28 [0.18, 0.44], p < .0001) or a favorable patient safety grade (OR = 0.36 [0.25, 0.51], p < .0001). DISCUSSION The nursing work environment influences the presence of bullying, which can negatively impact patient outcomes. Improving nurse work environments is one mechanism to better address nurse bullying.
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Affiliation(s)
- Colleen A. Pogue
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Peng Li
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Pauline Swiger
- Center for Nursing Science & Clinical Inquiry, Manson, Washington, USA
| | - Gordon Gillespie
- University of Cincinnati College of Nursing, Cincinnati, Ohio, USA
| | - Nataliya Ivankova
- University of Alabama at Birmingham School of Health Professions, Birmingham, Alabama, USA
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18
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Sonneville SA. Spiritual support of transgender individuals: a literature review. J Health Care Chaplain 2022; 29:196-210. [PMID: 35776733 DOI: 10.1080/08854726.2022.2080965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Spiritual support has been a staple of healthcare before hospitals in western civilizations were established by communities of faith. Research has demonstrated that wellbeing is associated with balanced care for the body, mind, and spirit. Healthcare disparities are being identified as disproportionally impacting transgender and gender nonconforming (TGNC) individuals. The root cause of this disparity is being studied as are medical and wellbeing interventions, including the benefit of spiritual support. This author's objective was two-fold. First, to identify opportunities for extending spiritual support to TGNC individuals in healthcare by chaplains. Secondly, to identify evidence of current spiritual support advocacy initiatives and interventions for TGNC patients in healthcare by chaplains.
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Affiliation(s)
- Seth A Sonneville
- Program Director, , Wellbeing & Inclusion, Center for Wellbeing, Children's Mercy, Kansas City, MO, USA
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Stavropoulou A, Rovithis M, Kelesi M, Vasilopoulos G, Sigala E, Papageorgiou D, Moudatsou M, Koukouli S. What Quality of Care Means? Exploring Clinical Nurses’ Perceptions on the Concept of Quality Care: A Qualitative Study. Clin Pract 2022; 12:468-481. [PMID: 35892437 PMCID: PMC9326653 DOI: 10.3390/clinpract12040051] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Quality is a multidimensional issue involving various features that depend on service performance and personal assessment. Clarifying the concept of quality is essential in order to further facilitate the understanding and improvement of quality in healthcare. The purpose of this study was to investigate how clinical nurses, providing care to adult medical patients, perceive and define the concept of quality nursing care. A descriptive qualitative research design was applied. A purposive sampling strategy was used to recruit nurses from the clinical sector of a general public hospital in Athens, Greece. Ten female nurses from the medical sector participated the study. Data collection was conducted through in-depth, semi-structured interviews. Conventional content analysis was used to analyze the verbatim data. Four categories were revealed from the data analysis, namely: (a) “Quality care is holistic care”, (b) “Good care is an interpersonal issue”, (c) “Leadership is crucial”, and (d) “Best care is our responsibility”. Quality care was defined as holistic care, addressing all patient needs with competency and aiming for the best patient outcomes. It was associated with communication, teamwork, good leadership, and personal commitment. By developing an in-depth and mutual understanding about what quality means, nurse leaders and practitioners may collaborate in finding common paths to support quality interventions and enhance quality nursing care in clinical practice.
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Affiliation(s)
- Areti Stavropoulou
- Department of Nursing, Faculty of Health and Care Sciences, University of West Attica, Ag. Spyridonos Str., 122 43 Athens, Greece; (M.K.); (G.V.); (E.S.); (D.P.)
- Correspondence:
| | - Michael Rovithis
- Department of Nursing, Faculty of Health Sciences, Hellenic Mediterranean University, Gianni Kornarou, Estavromenos 1, 714 10 Heraklion, Greece;
| | - Martha Kelesi
- Department of Nursing, Faculty of Health and Care Sciences, University of West Attica, Ag. Spyridonos Str., 122 43 Athens, Greece; (M.K.); (G.V.); (E.S.); (D.P.)
| | - George Vasilopoulos
- Department of Nursing, Faculty of Health and Care Sciences, University of West Attica, Ag. Spyridonos Str., 122 43 Athens, Greece; (M.K.); (G.V.); (E.S.); (D.P.)
| | - Evangelia Sigala
- Department of Nursing, Faculty of Health and Care Sciences, University of West Attica, Ag. Spyridonos Str., 122 43 Athens, Greece; (M.K.); (G.V.); (E.S.); (D.P.)
| | - Dimitrios Papageorgiou
- Department of Nursing, Faculty of Health and Care Sciences, University of West Attica, Ag. Spyridonos Str., 122 43 Athens, Greece; (M.K.); (G.V.); (E.S.); (D.P.)
| | - Maria Moudatsou
- Department of Social Work, Faculty of Health Sciences, Hellenic Mediterranean University, Gianni Kornarou, Estavromenos 1, 714 10 Heraklion, Greece; (M.M.); (S.K.)
| | - Sofia Koukouli
- Department of Social Work, Faculty of Health Sciences, Hellenic Mediterranean University, Gianni Kornarou, Estavromenos 1, 714 10 Heraklion, Greece; (M.M.); (S.K.)
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20
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Ortega-Galán ÁM, Ruiz-Fernández MD, Roldán-Rodríguez L, Ramos-Pichardo JD, Cabrera-Troya J, Gómez-Beltrán PA, Ortiz-Amo R. Unbearable Suffering: A Concept Analysis. J Hosp Palliat Nurs 2022; 24:159-166. [PMID: 35135981 DOI: 10.1097/njh.0000000000000844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To understand and analyze the concept of "unbearable suffering" using a concept analysis method and to propose a new nursing diagnosis, the Walker and Avant method of concept analysis was used. Following the concept analysis method in 8 steps, a literature search was carried out in the MEDLINE, Dialnet, WOS, and PsycINFO databases between 2016 and 2020. Articles of theoretical or empirical nature, written in English, with the abstract available were included. As a result, 11 articles (4 theoretical and 7 empirical) were included. In addition, 2 cases were developed. The proposed new diagnosis, "unbearable suffering," refers to the situation of an individual who, because of a variety of factors, regardless of the cause, feels that he/she is unable to bear the suffering he/she is experiencing. The diagnosis is proposed for inclusion in "Domain 9: Coping/Stress Tolerance" and "Class 2: Coping Responses" of the North American Nursing Diagnosis Association taxonomy. Recognition of a nursing diagnosis for unbearable suffering could be key in identifying this type of suffering and facilitating interventions to reduce or mitigate it. Nurses play a fundamental role in situations of high levels of end-of-life suffering.
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21
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WBMT Special Article on Key Elements in Quality and Accreditation in Hematopoietic Stem Cell Transplantation and Cellular Therapy. Transplant Cell Ther 2022; 28:455-462. [PMID: 35413459 DOI: 10.1016/j.jtct.2022.04.003] [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: 12/01/2021] [Revised: 02/23/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) represents an example of a highly complex and costly medical procedure with major applications in hematology and oncology. It is associated with life threatening complications and, consequently, increases demands on healthcare resources. While improving quality is an integral component of the healthcare strategic planning, drivers of quality may be variable and there is logical debate as to what drives quality in HSCT. Also, HSCT programs differ in their structures and availability of resources which drive the type of transplant and determine what is affordable and/or economically feasible. The complexity of HSCT procedure with involvement of different stakeholders necessitates not only regulatory frameworks but also robust quality systems to ensure consistent standards, demonstrate transparency for regulators, and define what quality means within the HSCT program. In an era of escalating healthcare complexity and heightened fiscal responsibility, transparency and accountability, accreditation contributes to ensuring that care meets the highest standards, and can serve as a risk mitigation strategy. Quality management has become an indispensable tool for the management of a complex medical intervention such as HSCT. It allows the transplant team to monitor its activities and identify areas for continuous improvement. The Worldwide Network for Blood and Marrow Transplantation (WBMT) had invited a group of international experts in HSCT and quality management to work on providing a summary document about the key elements in quality and accreditation in HSCT and highlight the foremost challenges of implementing them with special focus on low- and middle-income economies (LMIEs).
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22
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Khurshid Z, De Brún A, McAuliffe E. Protocol for an integrated evaluation framework to study training, curricular and contextual factors impacting the success of a measurement for improvement training programme for healthcare staff in Ireland. BMJ Open 2022; 12:e047639. [PMID: 35149560 PMCID: PMC8845174 DOI: 10.1136/bmjopen-2020-047639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Measurement for improvement is the process of collecting, analysing and presenting data to demonstrate whether a change has resulted in an improvement. It is also important in demonstrating sustainability of improvements through continuous measurement. This makes measurement for improvement a core element in quality improvement (QI) efforts. However, there is little to no research investigating factors that influence measurement for improvement skills in healthcare staff. This protocol paper presents an integrated evaluation framework to understand the training, curricular and contextual factors that influence the success of measurement for improvement training by using the experiences of trainees, trainers, programme and site coordinators. METHODS AND ANALYSIS This research will adopt a qualitative retrospective case study design based on constructivist-pragmatic philosophy. The Pressure Ulcers to Zero collaborative and the Clinical Microsystems collaborative from the Irish health system which included a measurement for improvement component have been selected for this study. This paper presents an integrated approach proposing a novel application of two pre-existing frameworks: the Model for Understanding Success in Quality framework and the Kirkpatrick Evaluation Model to evaluate an unexplored QI context and programme. A thematic analysis of the qualitative interview data and the documents collected will be conducted. The thematic analysis is based on a four-step coding framework adapted for this research study. The coding process will be conducted using NVivo V.12 software and Microsoft Excel. A cross-case comparison between the two cases will be performed. ETHICS AND DISSEMINATION The study has received an exemption from full ethical review from the Human Research Ethics Committee of University College Dublin, Ireland (LS-E-19-108). Informed consent will be obtained from all participants and the data will be anonymised and stored securely. The results of the study will be disseminated in peer-reviewed journals.
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Affiliation(s)
- Zuneera Khurshid
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Mahmoudi G, Asadi Abu Kheili M, Yazdani Charati J. Exploring health-care providers understanding and experiences of providing patient-centered care in hospitalized patients based on patient's bill of rights: A qualitative study. JOURNAL OF NURSING AND MIDWIFERY SCIENCES 2022. [DOI: 10.4103/jnms.jnms_38_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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Ramos-Vera C, Saintila J, Calizaya-Milla YE, Acosta Enríquez ME, Serpa Barrientos A. Relationship Between Satisfaction With Medical Care, Physical Health, and Emotional Well-Being in Adult Men: Mediating Role of Communication. J Prim Care Community Health 2022; 13:21501319221114850. [PMID: 35880499 PMCID: PMC9340312 DOI: 10.1177/21501319221114850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Non-communicable diseases and psychiatric pathologies are the health problems
that most affect the population in the United States. Objective: This study aimed to examine the mediating role of patient-centered
communication (PCC) in the relationship between satisfaction with medical
care, physical health, and emotional well-being in American men. Methods: A cross-sectional - predictive study was carried out. The variables analyzed
were satisfaction with medical care, physical health, and emotional
well-being. Information from the Health Information National Trends Survey
Data (HINTS) was used; HINTS 5, cycle 3 (collected between January and June
2019) and 4 (2020). Data from 3338 men were considered (mean age:
M = 55.40, SD = 19.53). Data analyses were carried out
using structural equation modeling (SEM) to represent the statistical
mediation model with latent and observable variables. Results: Analyses showed that the variables were significantly related
(P < .01). In the mediation model, there is evidence
that satisfaction predicts communication (β = .764,
P < .001) and this, in turn, is related to physical
health (β = .079, P = .007) and emotional well-being
(β = .145, P < .001). In addition, the standardized
estimates of the structural multiple mediation model presented acceptable
goodness-of-fit indices: χ2/gl = 2.24, CFI = 0.999, TLI = 0.999,
RMSEA = 0.019 [90% CI: 0.013-0.022], SRMR = 0.018. Conclusion: Patient-centered communication plays a significant dual mediating role in the
relationship between satisfaction with medical care, physical health, and
emotional well-being, respectively. Therefore, PCC is essential in
healthcare for American men.
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Marks BE, Mungmode A, Neyman A, Levin L, Rioles N, Eng D, Lee JM, Basina M, Hawah-Jones N, Mann E, O’Malley G, Wilkes M, Steenkamp D, Aleppo G, Accacha S, Ebekozien O. Baseline Quality Improvement Capacity of 33 Endocrinology Centers Participating in the T1D Exchange Quality Improvement Collaborative. Clin Diabetes 2022; 41:35-44. [PMID: 36714248 PMCID: PMC9845085 DOI: 10.2337/cd22-0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article describes the evolution of the Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) and provides insight into the development and growth of a successful type 1 diabetes quality improvement (QI) program. Since its inception 8 years ago, the collaborative has expanded to include centers across the United States with varying levels of QI experience, while simultaneously achieving many tangible improvements in type 1 diabetes care. These successes underscore the importance of learning health systems, data-sharing, benchmarking, and peer collaboration as drivers for continuous QI. Future efforts will include recruiting additional small- to medium-sized centers focused on adult care and underserved communities to further the goal of improving care and outcomes for all people living with type 1 diabetes.
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Affiliation(s)
- Brynn E. Marks
- Children’s National Hospital, Washington, DC
- Children’s Hospital of Philadelphia, Philadelphia, PA
- Corresponding author: Brynn E. Marks,
| | | | - Anna Neyman
- Riley Children’s Hospital, Indiana University School of Medicine, Indianapolis, IN
| | - Laura Levin
- Ann and Robert H. Lurie Children Hospital, Chicago, IL
| | | | - Donna Eng
- Helen DeVos Children’s Hospital, Grand Rapids, MI
| | - Joyce M. Lee
- C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
| | | | | | - Elizabeth Mann
- UW Health Kids, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | | | | | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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26
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MacVane Phipps FE. Strengthening healthcare quality through identification of risk, improving quality standards and an outlier considering the integration between environmental status and human health. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2021. [DOI: 10.1108/ijhg-09-2021-139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Häussl A, Ehmann E, Pacher A, Knödl K, Huber T, Neundlinger L, Osmanovic A, Plank-Straner A, Walter P, Schüssler S, Schoberer D. Psychological, physical, and social effects of the COVID-19 pandemic on hospital nurses. Int Nurs Rev 2021; 68:482-492. [PMID: 34582576 PMCID: PMC8653222 DOI: 10.1111/inr.12716] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Abstract
Aim The study aim was to explore the physical, mental, and social effects of the COVID‐19 pandemic on Austrian nurses working in hospitals. Background The COVID‐19 pandemic required nurses to work extremely hard and over long periods, which can have physical, psychological, and social consequences. Methods This study was carried out using a qualitative descriptive design and data was collected through individual interviews using an interview guide. A qualitative content analysis was conducted taking both deductive and inductive approaches. Findings Eighteen nurses (average age of 34.7 years) participated in the study. Their general attitude and feelings regarding working during the COVID‐19 pandemic in the hospital setting were positive. Several behavioral changes in the nurses’ daily working and private daily lives were reported. Psychological impacts included the fear of infecting someone at home, insomnia, and sadness. Headaches, diarrhea, muscle tension, skin redness, and increased sweating were identified as the most common physical impacts. In terms of social impact, all nurses mentioned social isolation and the increased use of (new) media. Conclusions Working with people suffering from COVID‐19 had psychological and physical effects on caregivers. Caregivers felt socially isolated in their private environments; however, they often compensated for this isolation by using social media. Implications for nursing and implications for nursing policy Staff perceived the provision of sufficient information, regular team meetings, and the employer's positive reinforcement as supportive, enhancing their feelings of security. We recommend providing more psychological support and making structural adjustments in daily clinical practice to counteract the negative effects of working during a pandemic.
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Affiliation(s)
- Alfred Häussl
- Institute of Nursing Science Medical University of Graz, Graz, Austria
| | - Eva Ehmann
- Institute of Nursing Science Medical University of Graz, Graz, Austria
| | - Angelika Pacher
- Institute of Nursing Science Medical University of Graz, Graz, Austria
| | - Katrin Knödl
- Institute of Nursing Science Medical University of Graz, Graz, Austria
| | - Teresa Huber
- Institute of Nursing Science Medical University of Graz, Graz, Austria
| | - Lydia Neundlinger
- Institute of Nursing Science Medical University of Graz, Graz, Austria
| | - Asmir Osmanovic
- Institute of Nursing Science Medical University of Graz, Graz, Austria
| | | | - Petra Walter
- Institute of Nursing Science Medical University of Graz, Graz, Austria
| | - Sandra Schüssler
- Institute of Nursing Science Medical University of Graz, Graz, Austria
| | - Daniela Schoberer
- Institute of Nursing Science Medical University of Graz, Graz, Austria
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Slone H, Gutierrez A, Lutzky C, Zhu D, Hedriana H, Barrera JF, Paige SR, Bunnell BE. Assessing the impact of COVID-19 on mental health providers in the southeastern United States. Psychiatry Res 2021; 302:114055. [PMID: 34144509 PMCID: PMC8362842 DOI: 10.1016/j.psychres.2021.114055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic has increased the need for mental health care despite novel barriers to services. Little is known about how the pandemic has affected mental health providers and their practice. In July 2020, we conducted a web-based survey of 500 licensed mental health providers to assess their employment and caseloads, logistics of care, quality of care, and patient-provider relationships and communication during the pandemic. Over 90% of providers reported changes to their employment (e.g., furloughs), with 64% no longer practicing. Providers who reported no longer practicing were older in age, racial minorities, served rural communities, worked in small clinics/provider networks, were social workers and marriage and family therapists, and relied on private insurance or out-of-pocket payment. Most practicing providers reported similar-to-increased caseloads (62%), new patients seeking services (67%), and appointment frequency (70%). Approximately 97% of providers used telemedicine, with 54% providing services mostly-to-exclusively via telemedicine. Most providers reported losing contact with patients deemed unstable (76%) or a danger to themselves/others (71%). Most providers reported maintained-to-improved quality of care (83%), patient-provider relationships (80%), and communication (80%). Results highlight concerns relating to mental health services during the pandemic, however practicing providers have demonstrated resilience to coordinate and provide high quality care.
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Affiliation(s)
- Henry Slone
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Arianna Gutierrez
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Caroline Lutzky
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Demi Zhu
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Hannah Hedriana
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Janelle F Barrera
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; Doxy.me Research, Doxy.me LLC, Rochester, NY, USA
| | | | - Brian E Bunnell
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; Doxy.me Research, Doxy.me LLC, Rochester, NY, USA
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Cook K, Foster B, Perry I, Hoke C, Smith D, Peterson L, Martin J, Korvink M, Gunn LH. Associations between Hospital Quality Outcomes and Medicare Spending per Beneficiary in the USA. Healthcare (Basel) 2021; 9:healthcare9070831. [PMID: 34356209 PMCID: PMC8304565 DOI: 10.3390/healthcare9070831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 12/19/2022] Open
Abstract
The cost of healthcare in the United States has increased over time. However, patient health outcomes have not trended with spending. There is a need to better comprehend the association between healthcare costs in the United States and hospital quality outcomes. Medicare spending per beneficiary (MSPB), a homogeneous metric across providers, can be used to evaluate the association between episodic Medicare spending and quality of care. Fifteen inpatient outcome measures were selected from Hospital Compare data among all (n = 4758) facilities and transformed to quintiles to ensure comparability across measures and to reduce the influence of outliers on the analysis. Both univariate and multiresponse multinomial ordered probit regression models were utilized across outcome domains to quantify associations between outcomes and spending. We found that MSPB was not associated with quality of care in most cases, adding evidence of a lack of outcome accountability among Medicare-funded facilities. Furthermore, worse outcomes were found to be associated with increased spending for some metrics. Policies are needed to align quality of care outcomes with the increasing costs of U.S. healthcare.
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Affiliation(s)
- Karyn Cook
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (K.C.); (B.F.); (I.P.); (C.H.); (D.S.); (L.P.)
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | - Brent Foster
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (K.C.); (B.F.); (I.P.); (C.H.); (D.S.); (L.P.)
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | - I’sis Perry
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (K.C.); (B.F.); (I.P.); (C.H.); (D.S.); (L.P.)
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | - Christy Hoke
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (K.C.); (B.F.); (I.P.); (C.H.); (D.S.); (L.P.)
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | - Dana Smith
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (K.C.); (B.F.); (I.P.); (C.H.); (D.S.); (L.P.)
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | - Leanne Peterson
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (K.C.); (B.F.); (I.P.); (C.H.); (D.S.); (L.P.)
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | - John Martin
- ITS Data Science, Premier, Inc., Charlotte, NC 28277, USA; (J.M.); (M.K.)
| | - Michael Korvink
- ITS Data Science, Premier, Inc., Charlotte, NC 28277, USA; (J.M.); (M.K.)
| | - Laura H. Gunn
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (K.C.); (B.F.); (I.P.); (C.H.); (D.S.); (L.P.)
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
- Faculty of Medicine, School of Public Health, Imperial College London, London W6 8RP, UK
- Correspondence:
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30
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Wei L, Hong Q, Lin X, Chen Y, Yang F, Li F, Chen Y. Effect of comprehensive high-quality nursing care on postoperative complications, degree of pain, and nursing satisfaction in gallstone patients during perioperative period. Am J Transl Res 2021; 13:2678-2685. [PMID: 34017428 PMCID: PMC8129269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the influence of comprehensive high-quality nursing care on postoperative complications, degree of pain, and nursing satisfaction in gallstone patients during the perioperative period. METHODS A total of 77 gallstone patients admitted to our hospital were selected as the study subjects, and divided into a control group (n=38) and an experimental group (n=39) in accordance with the random number table method. During the perioperative period, the control group received conventional nursing, while the experimental group received comprehensive high-quality nursing and conventional nursing. The visual analogue scale (VAS) was adopted to score degree of pain in both groups at 6 h, 24 h, and 48 h after surgery. Nursing satisfaction questionnaires were used to evaluate the satisfaction of the two groups of patients. The changes of postoperative complications, pain degrees, and nursing satisfaction were observed in the two groups after nursing interventions during the perioperative period. RESULTS After comprehensive high-quality nursing intervention, the time to first flatus, time to first defecation, time to first off-bed activity and hospital stay in the experimental group were significantly shorter than those in the control group after surgery (P < 0.05). The number of postoperative complications in the experimental group was remarkably lower than that in the control group (P < 0.05). After intervention, degree of pain scores in the experimental group were lower than those of the control group (P < 0.05). After intervention, the scores of nursing satisfaction in the experimental group were higher than those of the control group (P < 0.05). CONCLUSION Comprehensive high-quality nursing can improve the incidence of postoperative complications, degree of pain, nursing satisfaction, and the quality of life of gallstone patients during the perioperative period.
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Affiliation(s)
- Liuyuan Wei
- Department of Blood Purification, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan Province, China
| | - Qiao Hong
- Department of Emergency, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan Province, China
| | - Xiaomei Lin
- Department of Emergency, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan Province, China
| | - Yuyan Chen
- Department of Obstetrics and Gynecology, Haikou Fourth People’s HospitalHaikou 570311, Hainan Province, China
| | - Fan Yang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan Province, China
| | - Fen Li
- Department of Emergency, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan Province, China
| | - Yulin Chen
- Department of Emergency, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan Province, China
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Abstract
SUMMARY The ambiguity of medical finances, both to the patient and to the provider, has direct effects on the quality of care that is delivered to the patient. To encourage transparency in health care, physician reimbursement is a process that must be understood to ensure patient satisfaction, a physician's willingness to deliver care, and the success of health care facilities. Furthermore, physicians should be aware of the effects that legislative action, such as the Patient Protection and Affordable Care Act, has on their income. As a field that encompasses both cosmetic and reconstructive surgery, plastic surgeons must know this process intimately to ensure efficient services and appropriate reimbursement. In particular, plastic surgeons should be familiar with how the Affordable Care Act affects their income, practice, and the patient's access to care. As Medicare and Medicaid continue to increase health care access for many Americans, specialists such as plastic surgeons will need to reinforce the value of the specialty in the continuum of care. As the health care industry moves away from a fee-for-service system to one of value-based care, plastic surgeons need to be at the forefront of this transition to ensure that they are delivering quality care, and receiving appropriate reimbursement. The authors have provided data from the University of Michigan to demonstrate the reimbursement patterns seen in plastic surgery. This Special Topic article provides insight into the reimbursement process in the era of the Affordable Care Act and the various challenges that may be encountered within this field.
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Yarimoglu E, Ataman G. How service quality in hospitals varies based on hospital ownership and demographics: a study on Turkish patients living urban areas. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2021. [DOI: 10.1080/14783363.2021.1890576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Emel Yarimoglu
- Faculty of Business, Department of Business Administration, Yasar University, Izmir, Turkey
| | - Gorkem Ataman
- Faculty of Business, Department of Business Administration, Yasar University, Izmir, Turkey
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33
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Koning C, Lock A, Bushe J, Guo C. Patient Satisfaction With Heart Health Clinics in Fraser Health, Canada. J Patient Exp 2021; 8:2374373520981475. [PMID: 34179354 PMCID: PMC8205352 DOI: 10.1177/2374373520981475] [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] [Indexed: 11/25/2022] Open
Abstract
The Fraser Health heart function clinics explored patient satisfaction using a survey with the goal of understanding and improving care and service delivery. Data were collected from 124 respondents at 3 ambulatory care sites in the region. Patient satisfaction scores were high, with an average score of 8.85 out of 10 and 95% of respondents rating the service higher than 6 out of 10. The results highlighted the importance of multidisciplinary teams, good communication, adequate information, and emphasis on how a patient is treated. The patient's understanding of the information provided and of their heart health treatment plan were identified as two areas that require greater awareness.
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Affiliation(s)
- Clare Koning
- Fraser Health Authority, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | | | - Judy Bushe
- Fraser Health Authority, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Charles Guo
- Fraser Health Authority, Royal Columbian Hospital, New Westminster, British Columbia, Canada
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Shah R, Diaz A, Tripepi M, Bagante F, Tsilimigras DI, Machairas N, Sigala F, Moris D, Barreto SG, Pawlik TM. Quality Versus Costs Related to Gastrointestinal Surgery: Disentangling the Value Proposition. J Gastrointest Surg 2020; 24:2874-2883. [PMID: 32705613 DOI: 10.1007/s11605-020-04748-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND There has been a dramatic increase in worldwide health care spending over the last several decades. Operative procedures and perioperative care in the USA represent some of the most expensive episodes per patient. In view of both the rising cost of health care in general and the rising cost of surgical care specifically, policymakers and stakeholders have sought to identify ways to increase the value-improving quality of care while controlling (or diminishing) costs. In this context, we reviewed data relative to achieving the "value proposition" in the delivery of gastrointestinal surgical care. METHODS The National Library of Medicine online repository (PubMed) was text searched for human studies including "cost," "quality," "outcomes," "health care," "surgery," and "value." Results from this literature framed by the Donabedian conceptual model (identifying structures, processes, and outcomes), and the resulting impact of efforts to improve quality on costs. RESULTS The relationship between quality and costs was nuanced. Better quality care, though associated with better outcomes, was not always reported as concomitant with low costs. Moreover, some centers reported higher costs of surgical care commensurate with higher quality. Conversely, higher costs in health care delivery were not always linked to improved outcomes. While higher quality surgical care can lead to lower costs, higher costs of care were not necessarily associated with better outcomes. Strategies to improve quality, reduce cost, or achieve both simultaneously included regionalization of complex operations to high-volume centers of excellence, overall reduction in complications, introducing evidence-based improvements in perioperative care pathways including as enhanced recovery after surgery (ERAS), and elimination of inefficient or low-value care. CONCLUSIONS The relationship between quality and cost following gastrointestinal surgical procedure is complex. Data from the current study should serve to highlight the various means available to improve the value proposition related to surgery, as well as encourage surgeons to become more engaged in the national conversation around the Triple Aim of better health care quality, lower costs, and improved health care outcomes.
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Affiliation(s)
- Rohan Shah
- College of Medicine, Ohio State University, Columbus, OH, USA
| | - Adrian Diaz
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.,Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Marzia Tripepi
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.,Department of Surgery, University of Verona, Verona, Italy
| | - Fabio Bagante
- Department of Surgery, University of Verona, Verona, Italy
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Nikolaos Machairas
- Department of HPB Surgery and Liver Transplantation, Royal Free London, London, UK
| | - Fragiska Sigala
- Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Moris
- Department of HPB Surgery and Liver Transplantation, Royal Free London, London, UK
| | - Savio George Barreto
- Hepatobiliary and Oesophagogastric Unit, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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35
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Gerdesköld C, Toth-Pal E, Wårdh I, Nilsson GH, Nager A. Use of online knowledge base in primary health care and correlation to health care quality: an observational study. BMC Med Inform Decis Mak 2020; 20:294. [PMID: 33198720 PMCID: PMC7670813 DOI: 10.1186/s12911-020-01313-9] [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] [Received: 02/09/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Evidence-based information available at the point of care improves patient care outcomes. Online knowledge bases can increase the application of evidence-based medicine and influence patient outcome data which may be captured in quality registries. The aim of this study was to explore the effect of use of an online knowledge base on patient experiences and health care quality. Methods The study was conducted as a retrospective, observational study of 24 primary health care centers in Sweden exploring their use of an online knowledge base. Frequency of use was compared to patient outcomes in two national quality registries. A socio-economic Care Need Index was applied to assess whether the burden of care influenced the results from those quality registries. Non-parametric statistical methods and linear regression were used. Results Frequency of knowledge base use showed two groups: frequent and non-frequent users, with a significant use difference between the groups (p < 0.001). Outcome data showed significant higher values for all seven National Primary Care Patient Survey dimensions in the frequent compared to the non-frequent knowledge base users (p < 0.001), whereas 10 out of 11 parameters in the National Diabetes Register showed no differences between the groups (p > 0.05). Adjusting for Care Need Index had almost no effect on the outcomes for the groups. Conclusions Frequent users of a national online knowledge base received higher ratings on patient experiences, but figures on health care quality in diabetes showed near to no correlation. The findings indicate that some effects may be attributed to the use of knowledge bases and requires a controlled evaluation.
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Affiliation(s)
- Christian Gerdesköld
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23 D2, 141 83, Stockholm, Sweden.
| | - Eva Toth-Pal
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23 D2, 141 83, Stockholm, Sweden.,Academic Primary Health Care Centre, Region Stockholm, Sweden
| | - Inger Wårdh
- Department of Dental Medicine, Academic Centre of Geriatric Dentistry, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar H Nilsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23 D2, 141 83, Stockholm, Sweden.,Academic Primary Health Care Centre, Region Stockholm, Sweden
| | - Anna Nager
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23 D2, 141 83, Stockholm, Sweden.,Medibas, Bonnier Healthcare Sweden, Stockholm, Sweden
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36
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Zhang LM, Ma M, Russell MM, Ko CY. Surgical quality— what have we done and where are we going? SEMINARS IN COLON AND RECTAL SURGERY 2020. [DOI: 10.1016/j.scrs.2020.100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ernst J. The curse of bureaucratisation or the blessings of professionalisation? Nurses’ engaged adoption of quality management in hybrid managerial positions. SCANDINAVIAN JOURNAL OF MANAGEMENT 2019. [DOI: 10.1016/j.scaman.2019.101050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Alhajj MN, Halboub E, Amran AG, Alkheraif AA, Al-Sanabani FA, Al-Makramani BM, Al-Basmi AA, Al-Ghabri FA. Link between perceived oral and general health status among Yemeni adult dental patients. BMC Oral Health 2019; 19:93. [PMID: 31138198 PMCID: PMC6540451 DOI: 10.1186/s12903-019-0793-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/20/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Self-perceived health is an essential measure of health status and even a paramount predictor of mortality. So long as it is said that oral health (OH) and general health (GH) are mirrors to each other. This study sought to determine how Yemeni adults rate their OH and GH, whether such a self-rating influenced by some potential risk factors, and whether both ratings (OH and GH) are correlated. METHODS A sample of 587 Yemeni dental patients aged 20 years and over were consecutively recruited. A structured interview form was used covering the following variables: age, gender, marital status, educational level, presence of dental prosthesis (DP), smoking and Qat chewing habits as independent variables, along with questions on "perceived oral health (POH)" and "perceived general health (PGH)" as dependent variables. The bivariate and multiple ordinal regression analyses were applied at P-value < 0.05. RESULTS Most of participants were women (73.6%), and married (71.4%), and more than half of them were young adults (58.2%), with high educational levels (53.3%), and not having DP. Only 310 participants responded to the questions on smoking and Qat chewing habits. Of these, 88.5% were non-smokers and 62.1% were Qat non-chewers. Up to 50% of the participants reported their POH as poor or fair, while lower proportions of participants (17%) reported their PGH as such. Younger age (compared to elders), high education levels (compared to primary education) and being single (compared to married) significantly revealed better levels of POH, while high education levels and being females significantly revealed better levels of PGH. Smoking and Qat chewing habits were found to have no effect on the perception of POH or PGH. POH and PGH were found to be significantly correlated (r = 0.486; P < 0.001). CONCLUSION Higher levels of oral health problems can be anticipated among patients who perceive poor general health, and vice versa. The age, marital status and education were independent determinants of POH, while the gender and education were independent determinants of PGH.
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Affiliation(s)
| | - Esam Halboub
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Abdullah G Amran
- Department of Periodontics, Faculty of Dentistry, Thamar University, Dhamar, Yemen
| | - Abdulaziz A Alkheraif
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Fuad A Al-Sanabani
- Department of Prosthetic Dental Science, College of Dentistry, Jazan university, Jazan, Kingdom of Saudi Arabia
| | - Bandar M Al-Makramani
- Department of Prosthetic Dental Science, College of Dentistry, Jazan university, Jazan, Kingdom of Saudi Arabia
| | | | - Fawaz A Al-Ghabri
- Department of Periodontics, Faculty of Dentistry, Thamar University, Dhamar, Yemen
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Puchi-Gómez C, Paravic-Klijn T, Salazar A. Indicadores de calidad de la atención en salud en hospitalización domiciliaria: revisión integradora. AQUICHAN 2018. [DOI: 10.5294/aqui.2018.18.2.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: describir la producción empírica sobre indicadores para evaluar la calidad de la atención en salud otorgada a usuarios de unidades de hospitalización domiciliaria (HD). Materiales y métodos: se realizó una revisión integradora en las bases Pubmed, Web of Science, IBECS, SciELO y Biblioteca Cochrane. El periodo de búsqueda se extendió del año 1990 hasta el 2017. Resultados: se hallaron 10 documentos, de los cuales 6 correspondieron a artículos originales y 4 a revisiones sistemáticas. Sólo en 3 de los 6 artículos originales hallados se mencionaron indicadores relacionados con reingresos hospitalarios no planificados, llamadas telefónicas no planificadas realizadas por los pacientes y/o el equipo de salud de HD, negativa de los pacientes a ser ingresados a HD y errores en la administración de medicamentos. Conclusión: la investigación de la evaluación de la calidad de la atención en salud en HD mediante indicadores ha tenido un escaso desarrollo, especialmente en enfermería. Los indicadores pesquisados han sido desarrollados sólo en algunos países europeos pero sin reportar bases conceptuales claras y sin asegurar la solidez científica y factibilidad de las medidas.
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