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Bailey K, Lee S, de Los Reyes T, Lo L, Gorter JW, Toulany A. Quality indicators for transition from paediatric to adult care for adolescents with chronic physical and mental illness: protocol for a systematic review. BMJ Open 2021; 11:e055194. [PMID: 34725083 PMCID: PMC8562538 DOI: 10.1136/bmjopen-2021-055194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Transition from paediatric to adult care is a complex process, which poses significant challenges for adolescents with chronic physical and mental illnesses. For many, transfer to adult care is associated with poor health and psychosocial outcomes. Quality indicators to evaluate transition to adult care are needed to benchmark and compare performance across conditions and health systems. This systematic review aims to identify quality indicators for successful transition to adult care which can be applied across chronic physical and/or mental illnesses. METHODS Published literature will be searched using MEDLINE, Embase and CINHAL from earliest available date to July 2021. Grey literature will be searched using the Grey Matters tool. Using a set of inclusion/exclusion criteria, two independent reviewers will screen titles and abstracts, followed by full-text review. Disagreements will be resolved by a third reviewer. Study selection and data extraction will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Study appraisal will be completed using the Appraisal of Guidelines for Research and Evaluation for Quality Indicators instrument. Extracted quality indicators will be categorised into a conceptual framework. ETHICS AND DISSEMINATION Results from this review will offer novel insights into quality indicators that may be used to measure and evaluate transition success across conditions, which will be disseminated via a Canadian transition collaborative, workshops and peer-reviewed publication. Extracted quality indicators will be further prioritised in a Delphi study with patients, caregivers and providers. This is a critical step in developing a core set of metrics to evaluate transitions to adult care. Ethics approval is not required as this review will identify and synthesise findings from published literature. PROSPERO REGISTRATION NUMBER CRD42020198030.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Lee
- Department of Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Adolescent Medicine, Monash Children's Hospital, Clayton, New South Wales, Australia
| | - Thomas de Los Reyes
- Department of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisha Lo
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Alene Toulany
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Novais T, Mouchoux C, Kossovsky M, Winterstein L, Delphin-Combe F, Krolak-Salmon P, Dauphinot V. Neurocognitive disorders: what are the prioritized caregiver needs? A consensus obtained by the Delphi method. BMC Health Serv Res 2018; 18:1016. [PMID: 30594202 PMCID: PMC6311000 DOI: 10.1186/s12913-018-3826-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
Background The symptoms related to neurocognitive disorders (NCD) may lead to caregiver burden increase. Involving caregivers in research may be an effective way of improving the practicalities and relevance of interventions. The aim of this study was to gather opinion and gain consensus on the caregivers ‘priorities, using a Delphi method and including aspects of needs in pharmaceutical dimension. Methods Observational study using a modified Delphi method. This study was conducted in the Clinical and Research Memory Center of the University Hospital of Lyon (France), between September 2015 and January 2016. The expert panel was composed of 68 informal caregivers of people with subjective cognitive decline or NCD living at home. Results Caregivers assigned a very high importance to the dimension “information needs about their relative’s disease”, i.e. information on the disease, the treatment and the research; and to “coping skills”, i.e. skills related to emotional support, communication, relationship evolution with the relative and skills to cope with behavioural crisis, behavioural and cognitive disorders. The aspect “coping with behavioural disorders” received a high selection rate (83%). Conclusions The main needs selected can be used to design relevant interventions and give guidance to policy to support caregivers. To meet caregiver’s needs, interventions should focus on information about disease and treatment and psychoeducational interventions.
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Affiliation(s)
- Teddy Novais
- EA-7425 HESPER, Health Services and Performance Research, University Lyon, F-69003, Lyon, France. .,Pharmaceutical Unit, Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France. .,University Lyon 1, F-69000, Lyon, France.
| | - Christelle Mouchoux
- Pharmaceutical Unit, Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France.,University Lyon 1, F-69000, Lyon, France.,INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, F-69000, Lyon, France
| | - Michel Kossovsky
- Department of Internal medicine, Rehabilitation and Geriatrics, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Lucie Winterstein
- Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France
| | - Floriane Delphin-Combe
- Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France
| | - Pierre Krolak-Salmon
- University Lyon 1, F-69000, Lyon, France.,INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, F-69000, Lyon, France.,Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France
| | - V Dauphinot
- Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France
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Rose N, Toews L, Pang DSJ. A systematic review of clinical audit in companion animal veterinary medicine. BMC Vet Res 2016; 12:40. [PMID: 26920614 PMCID: PMC4769507 DOI: 10.1186/s12917-016-0661-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/18/2016] [Indexed: 11/16/2022] Open
Abstract
Background Clinical audit is a quality improvement process with the goal of continuously improving quality of patient care as assessed by explicit criteria. In human medicine clinical audit has become an integral and required component of the standard of care. In contrast, in veterinary medicine there appear to have been a limited number of clinical audits published, indicating that while clinical audit is recognised, its adoption in veterinary medicine is still in its infancy. A systematic review was designed to report and evaluate the veterinary literature on clinical audit in companion animal species (dog, cat, horse). A systematic search of English and French articles using Proquest Dissertations and Theses database (February 6, 2014), CAB Abstracts (March 21, 2014 and April 4, 2014), Scopus (March 21, 2014), Web of Science Citation index (March 21, 2014) and OVID Medline (March 21, 2014) was performed. Included articles were those either discussing clinical audit (such as review articles and editorials) or reporting parts of, or complete, audit cycles. Results The majority of articles describing clinical audit were reviews. From 89 articles identified, twenty-one articles were included and available for review. Twelve articles were reviews of clinical audit in veterinary medicine, five articles included at least one veterinary clinical audit, one thesis was identified, one report was of a veterinary clinical audit website and two articles reported incomplete clinical audits. There was no indication of an increase in the number of published clinical audits since the first report in 1998. However, there was evidence of article misclassification, with studies fulfilling the criteria of clinical audit not appropriately recognised. Quality of study design and reporting of findings varied considerably, with information missing on key components, including duration of study, changes in practice implemented between audits, development of explicit criteria and appropriate statistical analyses. Conclusions Available evidence suggests the application and reporting of clinical audit in veterinary medicine is sporadic despite the potential to improve patient care, though the true incidence of clinical audit reporting is likely to be underestimated due to incorrect indexing. Reporting standards of clinical audits are highly variable, limiting evaluation, application and repeatability of published work. Electronic supplementary material The online version of this article (doi:10.1186/s12917-016-0661-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicole Rose
- Western Veterinary Specialist and Emergency Centre, Calgary, AB, Canada.
| | - Lorraine Toews
- Health Sciences Library, University of Calgary, Calgary, AB, Canada.
| | - Daniel S J Pang
- Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada. .,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Caldarella A, Amunni G, Angiolini C, Crocetti E, Di Costanzo F, Di Leo A, Giusti F, Pegna AL, Mantellini P, Luzzatto L, Paci E. Feasibility of evaluating quality cancer care using registry data and electronic health records: a population-based study. Int J Qual Health Care 2012; 24:411-8. [DOI: 10.1093/intqhc/mzs020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Dreischulte T, Grant A, Donnan P, McCowan C, Davey P, Petrie D, Treweek S, Guthrie B. A cluster randomised stepped wedge trial to evaluate the effectiveness of a multifaceted information technology-based intervention in reducing high-risk prescribing of non-steroidal anti-inflammatory drugs and antiplatelets in primary medical care: the DQIP study protocol. Implement Sci 2012; 7:24. [PMID: 22444945 PMCID: PMC3353207 DOI: 10.1186/1748-5908-7-24] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 03/23/2012] [Indexed: 12/22/2022] Open
Abstract
Background High-risk prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelet agents accounts for a significant proportion of hospital admissions due to preventable adverse drug events. The recently completed PINCER trial has demonstrated that a one-off pharmacist-led information technology (IT)-based intervention can significantly reduce high-risk prescribing in primary care, but there is evidence that effects decrease over time and employing additional pharmacists to facilitate change may not be sustainable. Methods/design We will conduct a cluster randomised controlled with a stepped wedge design in 40 volunteer general practices in two Scottish health boards. Eligible practices are those that are using the INPS Vision clinical IT system, and have agreed to have relevant medication-related data to be automatically extracted from their electronic medical records. All practices (clusters) that agree to take part will receive the data-driven quality improvement in primary care (DQIP) intervention, but will be randomised to one of 10 start dates. The DQIP intervention has three components: a web-based informatics tool that provides weekly updated feedback of targeted prescribing at practice level, prompts the review of individual patients affected, and summarises each patient's relevant risk factors and prescribing; an outreach visit providing education on targeted prescribing and training in the use of the informatics tool; and a fixed payment of 350 GBP (560 USD; 403 EUR) up front and a small payment of 15 GBP (24 USD; 17 EUR) for each patient reviewed in the 12 months of the intervention. We hypothesise that the DQIP intervention will reduce a composite of nine previously validated measures of high-risk prescribing. Due to the nature of the intervention, it is not possible to blind practices, the core research team, or the data analyst. However, outcome assessment is entirely objective and automated. There will additionally be a process and economic evaluation alongside the main trial. Discussion The DQIP intervention is an example of a potentially sustainable safety improvement intervention that builds on the existing National Health Service IT-infrastructure to facilitate systematic management of high-risk prescribing by existing practice staff. Although the focus in this trial is on Non-steroidal anti-inflammatory drugs and antiplatelets, we anticipate that the tested intervention would be generalisable to other types of prescribing if shown to be effective. Trial registration ClinicalTrials.gov, dossier number: NCT01425502
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Affiliation(s)
- Tobias Dreischulte
- Tayside Medicines Unit, NHS Tayside, Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK.
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Battaglia TA, Burhansstipanov L, Murrell SS, Dwyer AJ, Caron SE. Assessing the impact of patient navigation: prevention and early detection metrics. Cancer 2011; 117:3553-64. [PMID: 21780090 PMCID: PMC4560256 DOI: 10.1002/cncr.26267] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The lack of comparable metrics to evaluate prevention and early detection patient navigation programs impeded the ability to identify best practices. METHODS The Prevention and Early Detection Workgroup of the Patient Navigation Leadership Summit was charged with making recommendations for common clinical metrics specific to the prevention and early detection phase of the cancer care continuum. The workgroup began with a review of existing literature to characterize variability in published navigation metrics; then developed a list of priority recommendations that would be applicable to the range of navigation settings (clinical, academic, or community-based). RESULTS Recommendations for researchers and program evaluators included the following: 1) Clearly document key program characteristics; 2) Use a set of core data elements to form the basis of your reported metrics; and 3) Prioritize data collection using methods with the least amount of bias. CONCLUSIONS If navigation programs explicitly state the context of their evaluation and choose from among the common set of data elements, meaningful comparisons among existing programs should be feasible.
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Affiliation(s)
- Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
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Sweidan M, Williamson M, Reeve JF, Harvey K, O'Neill JA, Schattner P, Snowdon T. Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process. BMC Med Inform Decis Mak 2010; 10:21. [PMID: 20398294 PMCID: PMC2881675 DOI: 10.1186/1472-6947-10-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 04/15/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electronic prescribing is increasingly being used in primary care and in hospitals. Studies on the effects of e-prescribing systems have found evidence for both benefit and harm. The aim of this study was to identify features of e-prescribing software systems that support patient safety and quality of care and that are useful to the clinician and the patient, with a focus on improving the quality use of medicines. METHODS Software features were identified by a literature review, key informants and an expert group. A modified Delphi process was used with a 12-member multidisciplinary expert group to reach consensus on the expected impact of the features in four domains: patient safety, quality of care, usefulness to the clinician and usefulness to the patient. The setting was electronic prescribing in general practice in Australia. RESULTS A list of 114 software features was developed. Most of the features relate to the recording and use of patient data, the medication selection process, prescribing decision support, monitoring drug therapy and clinical reports. The expert group rated 78 of the features (68%) as likely to have a high positive impact in at least one domain, 36 features (32%) as medium impact, and none as low or negative impact. Twenty seven features were rated as high positive impact across 3 or 4 domains including patient safety and quality of care. Ten features were considered "aspirational" because of a lack of agreed standards and/or suitable knowledge bases. CONCLUSIONS This study defines features of e-prescribing software systems that are expected to support safety and quality, especially in relation to prescribing and use of medicines in general practice. The features could be used to develop software standards, and could be adapted if necessary for use in other settings and countries.
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Affiliation(s)
- Michelle Sweidan
- National Prescribing Service Ltd, Level 7, 418A Elizabeth St, Surry Hills NSW 2010, Australia.
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