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Ssengooba F, Tuhebwe D, Ssendagire S, Babirye S, Akulume M, Ssennyonjo A, Rutaroh A, Mutesa L, Nangami M. Experiences of seeking healthcare across the border: lessons to inform upstream policies and system developments on cross-border health in East Africa. BMJ Open 2021; 11:e045575. [PMID: 34857547 PMCID: PMC8640642 DOI: 10.1136/bmjopen-2020-045575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 10/24/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study explored the experiences of accessing care across the border in East Africa. PARTICIPANTS From February to June 2018, a cross-sectional study using qualitative and quantitative methods was conducted among 279 household adults residing along selected national border sites of Uganda, Kenya and Rwanda and had accessed care from the opposite side of the border 5 years prior to this study. SETTING Access to HIV treatment, maternal delivery and childhood immunisation services was explored. We applied the health access framework and an appreciative inquiry approach to identify factors that enabled access to the services. MEASURES Exploratory factor analysis and linear regression were used for quantitative data, while deductive content analysis was done for the qualitative data on respondent's experiences navigating health access barriers. RESULTS The majority of respondents (83.9%; 234/279) had accessed care from public health facilities. Nearly one-third (77/279) had sought care across the border more than a year ago and 22.9% (64/279) less than a month ago. From the linear regression, the main predictor for ease of access for healthcare were ''ease of border crossing' (regression coefficient (RegCoef) 0.381); 'services being free' (RegCoef 0.478); 'services and medicines availability' (RegCoef 0.274) and 'acceptable quality of services' (RegCoef 0.364). The key facilitators for successful navigation of access barriers were related to the presence of informal routes, speaking a similar language and the ability to pay for the services. CONCLUSION Communities resident near national borders were able to cross borders to seek healthcare. There is need for a policy environment to enable East Africa invest better and realise synergies for these communities. This will advance Universal Health Coverage goals for communities along the border who represent the far fang areas of the health system with multiple barriers to healthcare access.
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Affiliation(s)
- Freddie Ssengooba
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
- Makerere University School of Public Health, SPEED Project, Kampala, Uganda
| | - Doreen Tuhebwe
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Steven Ssendagire
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Susan Babirye
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Martha Akulume
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Aloysius Ssennyonjo
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
- Makerere University School of Public Health, SPEED Project, Kampala, Uganda
| | - Arthur Rutaroh
- Health Economics and Policy, African Health Economics and Policy Association, Kampala, Uganda
| | - Leon Mutesa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Mabel Nangami
- Department of Health Policy and Management, College of Health Sciences, Moi University, Eldoret, Uasin Gishu, Kenya
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Lalova T, Padeanu C, Negrouk A, Lacombe D, Geissler J, Klingmann I, Huys I. Cross-Border Access to Clinical Trials in the EU: Exploratory Study on Needs and Reality. Front Med (Lausanne) 2020; 7:585722. [PMID: 33195343 PMCID: PMC7642582 DOI: 10.3389/fmed.2020.585722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/14/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives: To analyze the current situation of cross-border access to clinical trials in the EU with an overview of stakeholders' real-life experience, and to identify the needs, challenges, and potential for facilitation of cross-border access. Methods: We employed a mixed methods design. Semi-structured interviews and an online survey were conducted with a wide range of stakeholders: patient representatives, investigators/physicians, policy and regulatory experts, academic and commercial sponsor representatives, ethics committee members. Interviews underwent a framework analysis. The survey was analyzed descriptively. Results: Three hundred ninety six individuals responded to the survey. The majority were investigators/physicians (46%) and patient representatives (33%). Thirty eight individuals were interviewed. The majority were investigators/physicians (29%) and patient representatives (29%). All European regions were represented in the study. The highest response rate was received from residents of Western European countries (38% of survey respondents, 45% of interviewees), the lowest from Eastern Europe (9% of survey respondents, 5% of interviewees). The study suggested that cross-border participation in clinical trials occurs in practice, however very rarely. Ninety two percentage of survey respondents and the majority of interviewees perceived as needed the possibility to access clinical trials abroad. However, most interviewees also opined that patients ideally should not have to travel in order to access experimental treatment. The lack of access to treatment in the home country of the patient was described as the main motivation to participate in a clinical trial in another country. The logistical and financial burden for patients was perceived as the biggest challenge. Different stakeholders expressed diverging opinions regarding the allocation of financial and organizational responsibility for enabling cross-border access to clinical trials. Participants provided a number of proposals for improving the current system, which were carefully evaluated by the research team and informed future recommendations. Conclusions: Participation in clinical trials abroad is happening rarely but should be facilitated. There was a consensus on the need for reliable and accessible information regarding practical aspects, as well as multi-stakeholder, multi-national recommendations on existing options and best practice on cross-border access to clinical trials. Broader interdisciplinary research is recommended before discussing options in the EU legislative framework to enable clearly defined conditions for cross-border access to clinical trials.
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Affiliation(s)
- Teodora Lalova
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium.,Center for IT & IP law (CiTiP), KU Leuven, Leuven, Belgium
| | | | - Anastassia Negrouk
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Denis Lacombe
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | | | | | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
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Blaakilde AL, Jervelund SS, Yazici S, Petersen SG, Krasnik A. Use of Cross-Border Healthcare Services by Elderly Turkish Migrants in Denmark: A Qualitative Study and Some Critical Reflections about Public Health ‘Concerns’. NORDIC JOURNAL OF MIGRATION RESEARCH 2020. [DOI: 10.33134/njmr.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Arnolda G, Winata T, Ting HP, Clay-Williams R, Taylor N, Tran Y, Braithwaite J. Implementation and data-related challenges in the Deepening our Understanding of Quality in Australia (DUQuA) study: implications for large-scale cross-sectional research. Int J Qual Health Care 2020; 32:75-83. [PMID: 32026937 DOI: 10.1093/intqhc/mzz108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/07/2019] [Accepted: 09/12/2019] [Indexed: 12/31/2022] Open
Abstract
Healthcare organisations vary in the degree to which they implement quality and safety systems and strategies. Large-scale cross-sectional studies have been implemented to explore whether this variation is associated with outcomes relevant at the patient level. The Deepening our Understanding of Quality in Australia (DUQuA) study draws from earlier research of this type, to examine these issues in 32 Australian hospitals. This paper outlines the key implementation and analysis challenges faced by DUQuA. Many of the logistical difficulties of implementing DUQuA derived from compliance with the administratively complex and time-consuming Australian ethics and governance system designed principally to protect patients involved in clinical trials, rather than for low-risk health services research. The complexity of these processes is compounded by a lack of organizational capacity for multi-site health services research; research is expected to be undertaken in addition to usual work, not as part of it. These issues likely contributed to a relatively low recruitment rate for hospitals (41% of eligible hospitals). Both sets of issues need to be addressed by health services researchers, policymakers and healthcare administrators, if health services research is to flourish. Large-scale research also inevitably involves multiple measurements. The timing for applying these measures needs to be coherent, to maximise the likelihood of finding real relationships between quality and safety systems and strategies, and patient outcomes; this timing was less than ideal in DUQuA, in part due to administrative delays. Other issues that affected our study include low response rates for measures requiring recruitment of clinicians and patients, missing data and a design that necessarily included multiple statistical comparisons. We discuss how these were addressed. Successful completion of these projects relies on mutual and ongoing commitment, and two-way communication between the research team and hospital staff at all levels. This will help to ensure that enthusiasm and engagement are established and maintained.
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Affiliation(s)
- Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, North Ryde, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, North Ryde, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, North Ryde, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, North Ryde, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Woolloomooloo, Australia.,Faculty of Health Sciences, University of Sydney, Camperdown, Sydney, NSW 2006, Sydney, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, North Ryde, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, North Ryde, Australia
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Harrison R, Walton M, Chitkara U, Manias E, Chauhan A, Latanik M, Leone D. Beyond translation: Engaging with culturally and linguistically diverse consumers. Health Expect 2019; 23:159-168. [PMID: 31625264 PMCID: PMC6978859 DOI: 10.1111/hex.12984] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/28/2019] [Accepted: 09/20/2019] [Indexed: 12/02/2022] Open
Abstract
Background In the context of an effective consumer engagement framework, there is potential for health‐care delivery to be safer. Consumers from culturally and linguistically diverse (CALD) backgrounds may experience several barriers when trying to engage about their health care, and they are not acknowledged sufficiently in contemporary strategies to facilitate patient engagement. Methods Four focus group discussions were facilitated by bilingual fieldworkers in Arabic, Mandarin, Turkish and Dari in a district of Sydney, Australia that has a high proportion of CALD consumers. Each group included 5‐7 health‐care consumers who, using a topic guide, discussed their experiences of barriers and facilitators when engaging with health‐care services in Australia. Thematic analysis was undertaken to identify, analyse and report patterns in the data. Results In all, 24 consumers participated. Six inter‐related themes emerged: navigating the health system; seeking meaningful interpretation; understanding and managing expectations; respectful professional care; accessing services; and feeling unsafe. Conclusions The incorporation of strategies such as professional interpreters and migrant health workers may go some way to addressing the needs of culturally or linguistically diverse consumers and facilitate communication, but do not sufficiently address the range of barriers to consumer engagement identified in this work. Understanding consumer experience in the context of the complex factors that may be associated with poor engagement and poor outcomes such as health literacy, cultural, educational and linguistic background, and health‐care setting or condition, may contribute to better understanding about how to deliver quality health care to these patients.
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Affiliation(s)
- Reema Harrison
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Merrilyn Walton
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Upma Chitkara
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia.,Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Ashfaq Chauhan
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Monika Latanik
- Multicultural Health, Western Sydney Local Health District, Penrith, NSW, Australia
| | - Desiree Leone
- Multicultural Health, Western Sydney Local Health District, Penrith, NSW, Australia
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Charoenmukayananta S, Sriratanaban J, Hengpraprom S, Trarathep C. Factors influencing decisions of Laotian patients to use health care services in Thailand. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0805.342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Thailand has been facing a gradual increase in use of cross-border health care. Nevertheless, no evidence regarding factors influencing cross-border use of health care by Laotian patients in public Thai hospitals among this group has been established.
Objectives: To assess the use of cross-border health care by Laotian patients, and factors that may influence health services in public Thai hospitals along the border.
Methods: This study consisted of two parts. (1) Site-visits to 53 Thai public hospitals along the Thai-Laos border during May to July 2011 and collection of data regarding the use of health care services by Laotian patients. (2) A structured questionnaire survey was conducted via face interviews by trained researchers. Findings were analyzed using descriptive statistics and multiple logistic regression.
Results: The most common conditions for which treatment was sought were common diseases and basic operative procedures. All hospitals had been facing substantial financial burden, particularly for inpatient care. The analysis of use indicated that a perception of differences in the quality of health services, ability to pay for treatment anywhere, and distance to health services were three major factors affecting the decision of Laotian patients to cross the border to obtain health care in Thailand. Interviews with hospital directors and staff revealed that more financial support and a clear policy for care of Laotian patients was needed.
Conclusions: The perception of better quality of health care in Thailand by Laotian patients was the major factor affecting cross-border use of health care services. Assistance to improve healthcare in Laos and financial support for subsidizing care for the indigent Laotian patients is needed.
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Affiliation(s)
- Suwaree Charoenmukayananta
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Jiruth Sriratanaban
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Sarunya Hengpraprom
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Chanvit Trarathep
- Bureau of Health Administration, Office of Permanent Secretary, Ministry of Public Health, Nonthaburi, Thailand
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Granlund D, Wikström M. Public Provision and Cross-Border Health Care. Forum Health Econ Policy 2016; 19:157-177. [PMID: 31419898 DOI: 10.1515/fhep-2014-0024] [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: 06/10/2023]
Abstract
We study how the optimal public provision of health care depends on whether or not individuals have an option to seek publicly financed treatment in other regions. We find that, relative to the first-best solution, the government has an incentive to over-provide health care to low-income individuals. When cross-border health care takes place, this incentive is solely explained by that over-provision facilitates redistribution. The reason why more health care facilitates redistribution is that high-ability individuals mimicking low-ability individuals benefit the least from health care when health and labor supply are complements. Without cross-border health care, higher demand for health care among high-income individuals also contributes to the over-provision given that high-income individuals do not work considerably less than low-income individuals and that the government cannot discriminate between the income groups by giving them different access to health care.
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Affiliation(s)
- David Granlund
- Department of Economics, Umeå University, SE-901 87 Umeå,Sweden
| | - Magnus Wikström
- Department of Economics, Umeå University, SE-901 87 Umeå,Sweden
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Aghaei Hashjin A, Delgoshaei B, Kringos DS, Tabibi SJ, Manouchehri J, Klazinga NS. Implementing hospital quality assurance policies in Iran. Int J Health Care Qual Assur 2015; 28:343-55. [DOI: 10.1108/ijhcqa-03-2014-0034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to provide an overview of applied hospital quality assurance (QA) policies in Iran.
Design/methodology/approach
– A mixed method (quantitative data and qualitative document analysis) study was carried out between 1996 and 2010.
Findings
– The QA policy cycle forms a tight monitoring system to assure hospital quality by combining mandatory and voluntary methods in Iran. The licensing, annual evaluation and grading, and regulatory inspections statutorily implemented by the government as a national package to assure and improve hospital care quality, while implementing quality management systems (QMS) was voluntary for hospitals. The government’s strong QA policy legislation role and support has been an important factor for successful QA implementation in Iran, though it may affected QA assessment independency and validity. Increased hospital evaluation independency and repositioning, updating standards, professional involvement and effectiveness studies could increase QA policy impact and maturity.
Practical implications
– The study highlights the current QA policy implementation cycle in Iranian hospitals. It provides a basis for further quality strategy development in Iranian hospitals and elsewhere. It also raises attention about finding the optimal balance between different QA policies, which is topical for many countries.
Originality/value
– This paper describes experiences when implementing a unique approach, combining mandatory and voluntary QA policies simultaneously in a developing country, which has invested considerably over time to improve hospital quality. The experiences with a mixed obligatory/voluntary approach and comprehensive policies in Iran may contain lessons for policy makers in developing and developed countries.
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Secanell M, Groene O, Arah OA, Lopez MA, Kutryba B, Pfaff H, Klazinga N, Wagner C, Kristensen S, Bartels PD, Garel P, Bruneau C, Escoval A, França M, Mora N, Suñol R. Deepening our understanding of quality improvement in Europe (DUQuE): overview of a study of hospital quality management in seven countries. Int J Qual Health Care 2014; 26 Suppl 1:5-15. [PMID: 24671120 PMCID: PMC4001699 DOI: 10.1093/intqhc/mzu025] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction and Objective This paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework and methods applied, highlighting the novel features of this study. Design DUQuE was designed as a multi-level cross-sectional study with data collection at hospital, pathway, professional and patient level in eight countries. Setting and Participants We aimed to collect data for the assessment of hospital-wide constructs from up to 30 randomly selected hospitals in each country, and additional data at pathway and patient level in 12 of these 30. Main outcome measures A comprehensive conceptual framework was developed to account for the multiple levels that influence hospital performance and patient outcomes. We assessed hospital-specific constructs (organizational culture and professional involvement), clinical pathway constructs (the organization of care processes for acute myocardial infarction, stroke, hip fracture and deliveries), patient-specific processes and outcomes (clinical effectiveness, patient safety and patient experience) and external constructs that could modify hospital quality (external assessment and perceived external pressure). Results Data was gathered from 188 hospitals in 7 participating countries. The overall participation and response rate were between 75% and 100% for the assessed measures. Conclusions This is the first study assessing relation between quality management and patient outcomes at EU level. The study involved a large number of respondents and achieved high response rates. This work will serve to develop guidance in how to assess quality management and makes recommendations on the best ways to improve quality in healthcare for hospital stakeholders, payers, researchers, and policy makers throughout the EU.
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Affiliation(s)
- Mariona Secanell
- Avedis Donabedian Reseach Institute, University Autonomous of Barcelona, C/Provenza 293, Pral. 08037 Barcelona, Spain.
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Messina G, Forni S, Collini F, Quercioli C, Nante N. Patient mobility for cardiac problems: a risk-adjusted analysis in Italy. BMC Health Serv Res 2013; 13:56. [PMID: 23399540 PMCID: PMC3606354 DOI: 10.1186/1472-6963-13-56] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 02/08/2013] [Indexed: 11/10/2022] Open
Abstract
Background The Italian National Health System was revised in the last 20 years, introducing new elements such as efficacy, efficiency and competitiveness. Devolution to regional authorities has created a quasi-market system where patients can choose the hospital in which to be treated. Patient mobility therefore becomes an indicator of perceived hospital quality and of financial flows between the regions of Italy. Previous studies analyzed patient mobility in general or by specific disease/diagnosis-related groups but there is a lack of research on the influence of severity of patient condition. The aim of the study was to describe patient mobility, crude and stratified by disease severity, in cardiac surgery units of three health areas (HAs) in Tuscany (Italy). Methods In this retrospective observational study, data was gathered from hospital discharge records obtained from the Tuscan Regional Health Agency, Italy. The three HAs (HA1, HA2, HA3) recorded 25,017 planned hospitalizations in cardiac surgery units in the period 2001–2007. Patients were stratified in four All Patient Refined Diagnosis Related Group (APR-DRG) severity levels. Gandy’s nomogram was used to describe how HAs met health care demand and their capacity to attract patients. Cuzick’s test was used to identify significant differences in time trends. Results Raw data showed that the HAs met their own local health care demand. Stratifying by APR-DRG severity, it emerged that capacity to meet local demand remained unchanged for zero-to-minor severity levels, but one HA was less able to meet demand for moderate severity levels or to attract patients from other HAs and Regions of Italy. In fact, HA3 showed a decrease in admissions of local residents. Conclusions The study highlights important differences between the three HAs that were only revealed by severity stratification: unlike HA3, HA1 and HA2 seemed able to deal with local demand, even after severity stratification. Planners and researchers can benefit from risk stratification data, which provides more elements for correct comparisons and interventions. In the context of patient mobility, the present study is a step in that direction.
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Affiliation(s)
- Gabriele Messina
- Department of Public Health, Health Services Research Laboratory, University of Siena, Via Aldo Moro, 2 Siena, 53100, Italy.
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Groene O, Mora N, Thompson A, Saez M, Casas M, Suñol R. Is the maturity of hospitals' quality improvement systems associated with measures of quality and patient safety? BMC Health Serv Res 2011; 11:344. [PMID: 22185479 PMCID: PMC3267703 DOI: 10.1186/1472-6963-11-344] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 12/20/2011] [Indexed: 11/17/2022] Open
Abstract
Background Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. Methods The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. Results Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. Conclusions We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement system is associated with lower rates of adjusted hospital complications. A number of methodological and logistic hurdles remain to link hospital quality improvement systems to outcomes. Further research should aim at identifying the latent dimensions of quality improvement systems that predict quality and safety outcomes. Such research would add pertinent knowledge regarding the implementation of organizational strategies related with quality of care outcomes.
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Affiliation(s)
- Oliver Groene
- Avedis Donabedian University Institute, Autonomous University of Barcelona, Barcelona, Spain.
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12
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Klazinga N, Fischer C, Ten Asbroek A. Health services research related to performance indicators and benchmarking in Europe. J Health Serv Res Policy 2011; 16 Suppl 2:38-47. [DOI: 10.1258/jhsrp.2011.011042] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: Measuring quality of care through performance indicators and subsequently using these to compare, learn, and improve (benchmarking) has become a central component of health care policy. This paper aims to identify the main themes of health services research in this area and focuses on opportunities for improving the evidence underpinning performance indicators. Methods: A literature survey was carried out to identify research activities and main research themes in Europe in the years 2000-09. Identified literature was categorized into sub-topics and for each topic the main methodological issues were identified and discussed. Experts validated the findings and explored the potential for related further European research. Results: The distribution of research on performance and benchmarking across EU member states varies in time, scope and settings with a large amount of studies focusing on hospitals. Eight specific fields of research were identified (research on concepts and performance frameworks; performance indicators and benchmarking using mortality data; performance indicators and benchmarking related to cancer care; performance indicators and benchmarking on care delivered in hospitals; patient safety indicators; performance indicators in primary care; patient experience; research on the practice of benchmarking and performance improvement). Expert discussions confirmed that research on performance indicators and benchmarking should focus on the development of indicators, as well as their use. The research should involve the potential users and incorporate scientific approaches from biomedicine and epidemiology as well as the social sciences. Further progress is hampered by data availability. Issues which need to be addressed include the use of unique patient identifiers (UPIs) to facilitate linkages between separate databases; standardized measurement of the experiences of patients and others; and deepening collaboration between Eurostat, the World Health Organization (WHO), and the Organization for Economic Co-operation and Development (OECD) to facilitate the availability of internationally comparable performance information. Conclusions: This study suggests a number of themes for future research. These include testing and improving: the validity and reliability of performance indicators, especially related to avoidable mortality and other outcome indicators; the effectiveness and efficiency of embedding performance indicators in the various governance, monitoring and management models, and their effect on health systems, services and professionals; and the effectiveness and efficiency of linking performance indicators to other national and international strategies and policies such as accreditation and certification, practice guidelines, audits, quality systems, patient safety strategies, national standards on volume and/or quality, public reporting, pay-for-performance and patient/consumer involvement. The field would benefit from strengthening the clearinghouse function for research findings, training of researchers and appropriate scientific publication media. Results should be systematically shared with policy-makers and managers, and networking stimulated between the growing number of regional and national institutes involved in quality measurement and reporting.
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Affiliation(s)
- Niek Klazinga
- Academic Medical Center, University of Amsterdam, Amsterdam
| | - Claudia Fischer
- Academic Medical Center, University of Amsterdam, Amsterdam
- Erasmus MC, Department of Public Health, Rotterdam, Netherlands
| | - Augustinus Ten Asbroek
- Academic Medical Center, University of Amsterdam, Amsterdam
- London School of Hygiene and Tropical Medicine, London, UK
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Groene O, Suñol R. Factors associated with the implementation of quality and safety requirements for cross-border care in acute myocardial infarction: Results from 315 hospitals in four countries. Health Policy 2010; 98:107-13. [PMID: 21075263 DOI: 10.1016/j.healthpol.2010.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 05/12/2010] [Accepted: 05/12/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cross-border patients have specific quality and safety requirements for hospital care. Little is known to what extent hospitals meet these requirements. We aim to assess their current level, and the factors associated with their implementation. METHODS A cross-sectional survey of 315 hospitals and cardiology departments in the Czech Republic, France, Poland and Spain. Employing bi-variate statistics and logistic regression analysis, we assess quality and safety requirements for cross-border patients and their association with hospital characteristics, cross-border care arrangements, proximity to EU borders, the hospital's quality improvement system, and country. RESULTS Certain quality and safety requirements are frequently met (administrative support or informed consent using forms in various EU languages) while others are widely absent (case-managers, contacts to patients' general practitioners). Due to communication problems, it is often not possible to inform patients about their condition and treatment. Discharge summaries are rarely available in other than the vernacular languages, and medication upon discharge and arranging back-transfer occur occasionally only. Logistic regression analysis suggests a strong effect of country-level covariates (followed by type of hospital, hospital size and hospital's quality improvement system), but covariates are not consistently associated with higher rates of implementation. Hospitals with existing cross-border care collaboration do not differ substantially from hospitals without such arrangements. CONCLUSION Cross-border patients have specific quality and safety requirements that are not always met. Various factors are associated with these requirements; however, the trend is not systematic and the underlying mechanisms need to be studied further to inform policy decisions.
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Affiliation(s)
- Oliver Groene
- Avedis Donabedian Research Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health, C/ Provenza, 293, pral., 08037 Barcelona, Spain.
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Shaw C, Groene O, Mora N, Sunol R. Accreditation and ISO certification: do they explain differences in quality management in European hospitals? Int J Qual Health Care 2010; 22:445-51. [PMID: 20935006 DOI: 10.1093/intqhc/mzq054] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hospital accreditation and International Standardisation Organisation (ISO) certification offer alternative mechanisms for improving safety and quality, or as a mark of achievement. There is little published evidence on their relative merits. OBJECTIVE To identify systematic differences in quality management between hospitals that were accredited, or certificated, or neither. Research design ANALYSIS of compliance with measures of quality in 89 hospitals in six countries, as assessed by external auditors using a standardized tool, as part of the EC-funded METHODS of Assessing Response to Quality Improvement Strategies project. MAIN OUTCOME MEASURES Compliance scores in six dimensions of each hospital-grouped according to the achievement of accreditation, certification or neither. RESULTS Of the 89 hospitals selected for external audit, 34 were accredited (without ISO certification), 10 were certificated under ISO 9001 (without accreditation) and 27 had neither accreditation nor certification. Overall percentage scores for 229 criteria of quality and safety were 66.9, 60.0 and 51.2, respectively. Analysis confirmed statistically significant differences comparing mean scores by the type of external assessment (accreditation, certification or neither); however, it did not substantially differentiate between accreditation and certification only. Some of these associations with external assessments were confounded by the country in which the sample hospitals were located. CONCLUSIONS It appears that quality and safety structures and procedures are more evident in hospitals with either the type of external assessment and suggest that some differences exist between accredited versus certified hospitals. Interpretation of these results, however, is limited by the sample size and confounded by variations in the application of accreditation and certification within and between countries.
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Affiliation(s)
- Charles Shaw
- European Society for Quality in Healthcare, Limerick, Ireland.
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Laugesen MJ, Vargas-Bustamante A. A patient mobility framework that travels: European and United States–Mexican comparisons. Health Policy 2010; 97:225-31. [DOI: 10.1016/j.healthpol.2010.05.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 05/07/2010] [Accepted: 05/09/2010] [Indexed: 11/29/2022]
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Groene O, Klazinga N, Wagner C, Arah OA, Thompson A, Bruneau C, Suñol R. Investigating organizational quality improvement systems, patient empowerment, organizational culture, professional involvement and the quality of care in European hospitals: the 'Deepening our Understanding of Quality Improvement in Europe (DUQuE)' project. BMC Health Serv Res 2010; 10:281. [PMID: 20868470 PMCID: PMC2949856 DOI: 10.1186/1472-6963-10-281] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/24/2010] [Indexed: 11/16/2022] Open
Abstract
Background Hospitals in European countries apply a wide range of quality improvement strategies. Knowledge of the effectiveness of these strategies, implemented as part of an overall hospital quality improvement system, is limited. Methods/Design We propose to study the relationships among organisational quality improvement systems, patient empowerment, organisational culture, professionals' involvement with the quality of hospital care, including clinical effectiveness, patient safety and patient involvement. We will employ a cross-sectional, multi-level study design in which patient-level measurements are nested in hospital departments, which are in turn nested in hospitals in different EU countries. Mixed methods will be used for data collection, measurement and analysis. Hospital/care pathway level constructs that will be assessed include external pressure, hospital governance, quality improvement system, patient empowerment in quality improvement, organisational culture and professional involvement. These constructs will be assessed using questionnaires. Patient-level constructs include clinical effectiveness, patient safety and patient involvement, and will be assessed using audit of patient records, routine data and patient surveys. For the assessment of hospital and pathway level constructs we will collect data from randomly selected hospitals in eight countries. For a sample of hospitals in each country we will carry out additional data collection at patient-level related to four conditions (stroke, acute myocardial infarction, hip fracture and delivery). In addition, structural components of quality improvement systems will be assessed using visits by experienced external assessors. Data analysis will include descriptive statistics and graphical representations and methods for data reduction, classification techniques and psychometric analysis, before moving to bi-variate and multivariate analysis. The latter will be conducted at hospital and multilevel. In addition, we will apply sophisticated methodological elements such as the use of causal diagrams, outcome modelling, double robust estimation and detailed sensitivity analysis or multiple bias analyses to assess the impact of the various sources of bias. Discussion Products of the project will include a catalogue of instruments and tools that can be used to build departmental or hospital quality and safety programme and an appraisal scheme to assess the maturity of the quality improvement system for use by hospitals and by purchasers to contract hospitals.
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Affiliation(s)
- Oliver Groene
- Avedis Donabedian University Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health, Barcelona, Spain.
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Vallejo P, Suñol R, Escaramis G, Torrontegui M, Lombarts K, Bañeres J. [Clinical safety and patient oriented care: descriptive study of 113 Spanish hospitals and similarities in other European countries]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2009; 24:139-148. [PMID: 19647675 DOI: 10.1016/s1134-282x(09)71797-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 02/23/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVES This study describes the stage of development of the Spanish acute care hospitals quality improvement systems. It also presents data on their achievement of some specific requirements related to clinical safety and patient oriented care. Additional data from seven other European countries are included, in order to provide a comparative reference for the analysis of results. MATERIAL AND METHODS Cross-sectional descriptive study developed in acute care hospitals with more than 100 beds from 8 European countries. Data was gathered using an on-line questionnaire that had more than 500 close questions. In order to validate the responses, a sample of the hospitals that had answered the questionnaire received an evaluation by external assessors. RESULTS A total of 113 public and private Spanish hospitals participated in the study, which represented 34% of the total group that met the inclusion criteria. Another 276 hospitals from 7 other countries also answered the questionnaire. The results associated with quality management, clinical safety and patient oriented care from both groups are presented. CONCLUSIONS Improvements must be made in those areas where Spanish hospitals have a lower developmental level than the rest of the participating countries: public dissemination of results from external quality assessments, development of some key mechanisms to promote clinical safety and patient involvement in organisational management.
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Affiliation(s)
- Paula Vallejo
- Instituto Universitario Avedis Donabedian, Universidad Autónoma de Barcelona, Barcelona, CIBER Epidemiología y Salud Pública (CIBERESP), España.
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Suñol R, Vallejo P, Thompson A, Lombarts MJMH, Shaw CD, Klazinga N. Impact of quality strategies on hospital outputs. Qual Saf Health Care 2009; 18 Suppl 1:i62-8. [PMID: 19188464 PMCID: PMC2629927 DOI: 10.1136/qshc.2008.029439] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT This study was part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project on patients crossing borders, a study to investigate quality improvement strategies in healthcare systems across the European Union (EU). AIM To explore the association between the implementation of quality improvement strategies in hospitals and hospitals' success in meeting defined quality requirements that are considered intermediate outputs of the care process. METHODS Data regarding the implementation of seven quality improvement strategies (accreditation, organisational quality management programmes, audit and internal assessment of clinical standards, patient safety systems, clinical practice guidelines, performance indicators and systems for obtaining patients' views) and four dimensions of outputs (clinical, safety, patient-centredness and cross-border patient-centredness) were collected from 389 acute care hospitals in eight EU countries using a web-based questionnaire. In a second phase, 89 of these hospitals participated in an on-site audit by independent surveyors. Pearson correlation and linear regression models were used to explore associations and relations between quality improvement strategies and achievement of outputs. RESULTS Positive associations were found between six internal quality improvement strategies and hospital outputs. The quality improvement strategies could be reasonably subsumed under one latent index which explained about half of their variation. The analysis of outputs concluded that the outputs can also be considered part of a single construct. The findings indicate that the implementation of internal as well as external quality improvement strategies in hospitals has beneficial effects on the hospital outputs studied here. CONCLUSION The implementation of internal quality improvement strategies as well as external assessment systems should be promoted.
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Affiliation(s)
- R Suñol
- Avedis Donabedian Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona 08037, Spain.
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Spencer E, Walshe K. National quality improvement policies and strategies in European healthcare systems. Qual Saf Health Care 2009; 18 Suppl 1:i22-7. [PMID: 19188457 PMCID: PMC2629881 DOI: 10.1136/qshc.2008.029355] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This survey provides an overview of the development of policies and strategies for quality improvement in European healthcare systems, by mapping quality improvement policies and strategies, progress in their implementation, and early indications of their impact. STUDY DESIGN A survey of quality improvement policies and strategies in healthcare systems of the European Union was conducted in 2005 for the first phase of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project. PARTICIPANTS The survey, completed by 68 key experts in quality improvement from 24 European Union member states, represents their views and accounts of quality improvement policies and strategies in their healthcare systems. PRINCIPAL FINDINGS There are substantial international and intra-national variations in the development of healthcare quality improvement. Legal requirements for quality improvement strategies are an important driver of progress, along with the activities of national governments and professional associations and societies. Patient and service user organisations appear to have less influence on quality improvement. Wide variation in voluntary and mandatory coverage of quality improvement policies and strategies across sectors can potentially lead to varying levels of progress in implementation. Many healthcare organisations lack basic infrastructure for quality improvement. CONCLUSIONS Some convergence can be observed in policies on quality improvement in healthcare. Nevertheless, the growth of patient mobility across borders, along with the implications of free market provisions for the organisation and funding of healthcare systems in European Union member states, require policies for cooperation and learning transfer.
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Affiliation(s)
- E Spencer
- Herbert Simon Institute for Public Policy and Management, Manchester Business School, Manchester, UK
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Vallejo P, Suñol R. MARQulS: quality improvement strategies for European cross-border healthcare. Qual Saf Health Care 2009; 18 Suppl 1:i1-2. [PMID: 19188455 PMCID: PMC2629852 DOI: 10.1136/qshc.2008.032110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- P Vallejo
- Avedis Donabedian University Institute-Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Provença 2963, Barcelona, Spain.
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Vallejo P, Suñol R, Van Beek B, Lombarts MJMH, Bruneau C, Vlcek F. Volume and diagnosis: an approach to cross-border care in eight European countries. Qual Saf Health Care 2009; 18 Suppl 1:i8-14. [PMID: 19188467 PMCID: PMC2629880 DOI: 10.1136/qshc.2008.029553] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Mobility of patients is a pertinent issue on the European Union's agenda. This study aimed to estimate the volume and main diagnoses of cross-border care in eight European countries, in order to provide policy makers with background information about the nature of patient mobility in Europe. METHODS This article reports the combined findings from three independent studies that compiled self-reported information on admissions data and main diagnoses from more than 200 hospitals in eight European countries. RESULTS The average volume of cross-border patients accounted for less than 1% of total admissions in the hospitals studied here. Diseases of the circulatory system (mainly acute myocardial infarction) and fractures were the most common reasons for hospitalisation of European patients abroad. Deliveries and other diagnoses related to pregnancy, pneumonia, appendicitis and other diseases of the digestive system, aftercare procedures, and disorders of the eye and adnexa were also common diagnoses for this population. CONCLUSIONS Hospitals should reinforce their efforts to adapt the care provided to the needs of foreign patients in treatment areas that cover the most frequent pathologies identified in this population.
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Affiliation(s)
- P Vallejo
- Avedis Donabedian Institute, Autonomous University of Barcelona, and CIBER Epidemiology and Public Health (CIBERESP), Provenza 293 Pral, Barcelona 08037, Spain.
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Groene O, Lombarts MJMH, Klazinga N, Alonso J, Thompson A, Suñol R. Is patient-centredness in European hospitals related to existing quality improvement strategies? Analysis of a cross-sectional survey (MARQuIS study). Qual Saf Health Care 2009; 18 Suppl 1:i44-50. [PMID: 19188461 PMCID: PMC2629879 DOI: 10.1136/qshc.2008.029397] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2008] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is growing recognition of patients' contributions to setting objectives for their own care, improving health outcomes and evaluating care. OBJECTIVE To quantify the extent to which European hospitals have implemented strategies to promote a patient-centred approach, and to assess whether these strategies are associated with hospital characteristics and the development of the hospital's quality improvement system. DESIGN Cross-sectional survey of 351 European hospital managers and professionals. MAIN OUTCOME MEASURES Patients' rights, patient information and empowerment, patient involvement in quality management, learning from patients, and patient hotel services at the hospital and ward level were assessed. The hypothesis that the implementation of strategies to improve patient-centredness is associated with hospital characteristics, including maturity of the hospital's quality management system, was tested using binary logistic regression. RESULTS In general, hospitals reported high implementation of policies for patients' rights (85.5%) and informed consent (93%), whereas strategies to involve patients (71%) and learn from their experience (66%) were less frequently implemented. For 13 out of 18 hospital strategies, institutions with a more developed quality improvement system consistently reported better results (percentage differences within maturity classification ranged from 12.4% to 46.6%). The strength of association between implementation of patient-centredness strategies and the quality improvement system, however, seemed lower at the ward than at the hospital level. Some associations (OR 2.1 to 5.1) disappeared or were weaker after adjustment for potential confounding variables (OR 2.2 to 3.7). CONCLUSIONS Although quality improvement systems seem to be effective with regard to the implementation of selected patient-centredness strategies, they seem to be insufficient to ensure widespread implementation of patient-centredness throughout the organisation.
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Affiliation(s)
- O Groene
- Avedis Donabedian University Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
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Groene O, Klazinga N, Walshe K, Cucic C, Shaw CD, Suñol R. Learning from MARQuIS: future direction of quality and safety in hospital care in the European Union. Qual Saf Health Care 2009; 18 Suppl 1:i69-74. [PMID: 19188465 PMCID: PMC2629925 DOI: 10.1136/qshc.2008.029447] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
This article summarises the significant lessons to be drawn from, and the policy implications of, the findings of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project--a part of the suite of research projects intended to support policy established by the European Commission through its Sixth Framework Programme. The article first reviews the findings of MARQuIS and their implications for healthcare providers (and particularly for hospitals), and then addresses the broader policy implications for member states of the European Union (EU) and for the commission itself. Against the background of the European Commission's Seventh Framework Programme, it then outlines a number of future areas for research to inform policy and practice in quality and safety in Europe. The article concludes that at this stage, a unique EU-wide quality improvement system for hospitals does not seem to be feasible or effective. Because of possible future community action in this field, attention should focus on the use of existing research on quality and safety strategies in healthcare, with the aim of combining soft measures to accelerate mutual learning. Concrete measures should be considered only in areas for which there is substantial evidence and effective implementation can be ensured.
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Affiliation(s)
- O Groene
- Avedis Donabedian University Institute, UAB, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
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Lombarts MJMH, Rupp I, Vallejo P, Suñol R, Klazinga NS. Application of quality improvement strategies in 389 European hospitals: results of the MARQuIS project. Qual Saf Health Care 2009; 18 Suppl 1:i28-37. [PMID: 19188458 PMCID: PMC3269892 DOI: 10.1136/qshc.2008.029363] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2008] [Indexed: 11/03/2022]
Abstract
CONTEXT This study was part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project investigating the impact of quality improvement strategies on hospital care in various countries of the European Union (EU), in relation to specific needs of cross-border patients. AIM This paper describes how EU hospitals have applied seven quality improvement strategies previously defined by the MARQuIS study: organisational quality management programmes; systems for obtaining patients' views; patient safety systems; audit and internal assessment of clinical standards; clinical and practice guidelines; performance indicators; and external assessment. METHODS A web-based questionnaire was used to survey acute care hospitals in eight EU countries. The reported findings were later validated via on-site survey and site visits in a sample of the participating hospitals. Data collection took place from April to August 2006. RESULTS 389 hospitals participated in the survey; response rates varied per country. All seven quality improvement strategies were widely used in European countries. Activities related to external assessment were the most broadly applied across Europe, and activities related to patient involvement were the least widely implemented. No one country implemented all quality strategies at all hospitals. There were no differences between participating hospitals in western and eastern European countries regarding the application of quality improvement strategies. CONCLUSIONS Implementation varied per country and per quality improvement strategy, leaving considerable scope for progress in quality improvements. The results may contribute to benchmarking activities in European countries, and point to further areas of research to explore the relationship between the application of quality improvement strategies and actual hospital performance.
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Affiliation(s)
- M J M H Lombarts
- Academic Medical Center, Department of Social Medicine, University of Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, the Netherlands.
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