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Torri V, Ercolanoni M, Bortolan F, Leoni O, Ieva F. A NLP-based semi-automatic identification system for delays in follow-up examinations: an Italian case study on clinical referrals. BMC Med Inform Decis Mak 2024; 24:107. [PMID: 38654295 DOI: 10.1186/s12911-024-02506-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND This study aims to propose a semi-automatic method for monitoring the waiting times of follow-up examinations within the National Health System (NHS) in Italy, which is currently not possible to due the absence of the necessary structured information in the official databases. METHODS A Natural Language Processing (NLP) based pipeline has been developed to extract the waiting time information from the text of referrals for follow-up examinations in the Lombardy Region. A manually annotated dataset of 10 000 referrals has been used to develop the pipeline and another manually annotated dataset of 10 000 referrals has been used to test its performance. Subsequently, the pipeline has been used to analyze all 12 million referrals prescribed in 2021 and performed by May 2022 in the Lombardy Region. RESULTS The NLP-based pipeline exhibited high precision (0.999) and recall (0.973) in identifying waiting time information from referrals' texts, with high accuracy in normalization (0.948-0.998). The overall reporting of timing indications in referrals' texts for follow-up examinations was low (2%), showing notable variations across medical disciplines and types of prescribing physicians. Among the referrals reporting waiting times, 16% experienced delays (average delay = 19 days, standard deviation = 34 days), with significant differences observed across medical disciplines and geographical areas. CONCLUSIONS The use of NLP proved to be a valuable tool for assessing waiting times in follow-up examinations, which are particularly critical for the NHS due to the significant impact of chronic diseases, where follow-up exams are pivotal. Health authorities can exploit this tool to monitor the quality of NHS services and optimize resource allocation.
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Affiliation(s)
- Vittorio Torri
- MOX - Modelling and Scientific Computing Lab, Department of Mathematics, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan, 20133, Italy.
| | - Michele Ercolanoni
- ARIA s.p.a - Azienda Regionale per l'Innovazione e gli Acquisti, Via Taramelli 26, Milan, 20124, Italy
| | - Francesco Bortolan
- U.O. Osservatorio Epidemiologico, DG Welfare, Regione Lombardia, Piazza Città di Lombardia 1, Milan, 20124, Italy
| | - Olivia Leoni
- U.O. Osservatorio Epidemiologico, DG Welfare, Regione Lombardia, Piazza Città di Lombardia 1, Milan, 20124, Italy
| | - Francesca Ieva
- MOX - Modelling and Scientific Computing Lab, Department of Mathematics, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan, 20133, Italy
- HDS - Health Data Science Centre, Human Technopole, Viale Rita Levi-Montalcini 1, Milan, 20157, Italy
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Gebel C, Ditscheid B, Meissner F, Slotina E, Kruschel I, Marschall U, Wedding U, Freytag A. Utilization and quality of palliative care in patients with hematological and solid cancers: a population-based study. J Cancer Res Clin Oncol 2024; 150:191. [PMID: 38607376 PMCID: PMC11014814 DOI: 10.1007/s00432-024-05721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Palliative care (PC) contributes to improved end-of-life care for patients with hematologic malignancies (HM) and solid tumors (ST) by addressing physical and psychological symptoms and spiritual needs. Research on PC in HM vs. ST patients is fragmented and suggests less use. METHODS We analyzed claims data of all deceased members of a large German health insurance provider for the year before death. First, we analyzed the frequency and the beginning of different types of PC and compared patients with HM vs. ST. Second, we analyzed the adjusted impact of PC use on several end-of-life quality outcomes in patients with HM vs. ST. We performed simple and multiple (logistic) regression analysis, adjusted for relevant covariates, and standardized for age and sex. RESULTS Of the 222,493 deceased cancer patients from 2016 to 2020, we included 209,321 in the first analysis and 165,020 in the second analysis. Patients with HM vs. ST received PC less often (40.4 vs. 55.6%) and later (34 vs. 50 days before death). PC use significantly improved all six quality indicators for good end-of-life care. HM patients had worse rates in five of the six indicators compared with ST patients. Interaction terms revealed that patients with ST derived greater benefit from PC in five of six quality indicators than those with HM. CONCLUSION The data highlight the need to integrate PC more often, earlier, and more effectively into the care of patients with HM.
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Affiliation(s)
- Cordula Gebel
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany.
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland.
| | - Bianka Ditscheid
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Franziska Meissner
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Ekaterina Slotina
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Isabel Kruschel
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland
| | | | - Ullrich Wedding
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland
| | - Antje Freytag
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
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Lusendi FM, Vanherwegen AS, Doggen K, Nobels F, Matricali GA. Evidence-based interventions for identifying candidate quality indicators to assess quality of care in diabetic foot clinics: a scoping review. BMC Public Health 2024; 24:996. [PMID: 38600498 PMCID: PMC11005120 DOI: 10.1186/s12889-024-18306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 03/07/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Foot ulcers in people with diabetes are a serious complication requiring a complex management and have a high societal impact. Quality monitoring systems to optimize diabetic foot care exist, but a formal and more evidence-based approach to develop quality indicators (QIs) is lacking. We aimed to identify a set of candidate indicators for diabetic foot care by adopting an evidence-based methodology. METHODS A systematic search was conducted across four academic databases: PubMed, Embase CINAHL and Cochrane Library. Studies that reported evidence-based interventions related to organization or delivery of diabetic foot care were searched. Data from the eligible studies were summarized and used to formulate process and structure indicators. The evidence for each candidate QI was described in a methodical and transparent manner. The review process was reported according to the "Preferred Reported Items for Systematic reviews and Meta-Analysis" (PRISMA) statements and its extension for scoping reviews. RESULTS In total, 981 full-text articles were screened, and 322 clinical studies were used to formulate 42 candidate QIs. CONCLUSIONS An evidence-based approach could be used to select candidate indicators for diabetic foot ulcer care, relating to the following domains: wound healing interventions, peripheral artery disease, offloading, secondary prevention, and interventions related to organization of care. In a further step, the feasibility of the identified set of indicators will be assessed by a multidisciplinary panel of diabetic foot care stakeholders.
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Affiliation(s)
- Flora Mbela Lusendi
- Health Services Research, Sciensano, Rue Juliette Wytsmanstraat 14, Brussels, 1050, Belgium.
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
| | - An-Sofie Vanherwegen
- Health Services Research, Sciensano, Rue Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Kris Doggen
- Health Services Research, Sciensano, Rue Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Frank Nobels
- Multidisciplinary Diabetic Foot Clinic, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Giovanni Arnoldo Matricali
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Multidisciplinary Diabetic Foot Clinic, University Hospital Leuven, Leuven, Belgium
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Srinivasan M, Scott A, Soo J, Sreedhara M, Popat S, Beasley KL, Jackson TN, Abbas A, Keaton WA, Holmstedt C, Harvey J, Kruis R, McLeod S, Ahn R. The role of stroke care infrastructure on the effectiveness of a hub-and-spoke telestroke model in South Carolina. J Stroke Cerebrovasc Dis 2024; 33:107702. [PMID: 38556068 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE To examine the relationship between stroke care infrastructure and stroke quality-of-care outcomes at 29 spoke hospitals participating in the Medical University of South Carolina (MUSC) hub-and-spoke telestroke network. MATERIALS AND METHODS Encounter-level data from MUSC's telestroke patient registry were filtered to include encounters during 2015-2022 for patients aged 18 and above with a clinical diagnosis of acute ischemic stroke, and who received intravenous tissue plasminogen activator. Unadjusted and adjusted generalized estimating equations assessed associations between time-related stroke quality-of-care metrics captured during the encounter and the existence of the two components of stroke care infrastructure-stroke coordinators and stroke center certifications-across all hospitals and within hospital subgroups defined by size and rurality. RESULTS Telestroke encounters at spoke hospitals with stroke coordinators and stroke center certifications were associated with shorter door-to-needle (DTN) times (60.9 min for hospitals with both components and 57.3 min for hospitals with one, vs. 81.2 min for hospitals with neither component, p <.001). Similar patterns were observed for the percentage of encounters with DTN time of ≤60 min (63.8% and 68.9% vs. 32.0%, p <.001) and ≤45 min (34.0% and 38.4% vs. 8.42%, p <.001). Associations were similar for other metrics (e.g., door-to-registration time), and were stronger for smaller (vs. larger) hospitals and rural (vs. urban) hospitals. CONCLUSIONS Stroke coordinators or stroke center certifications may be important for stroke quality of care, especially at spoke hospitals with limited resources or in rural areas.
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Affiliation(s)
- Mithuna Srinivasan
- NORC at the University of Chicago, 4350 East-West Hwy 8th Floor, Bethesda, MD 20814, United States.
| | - Amber Scott
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Jackie Soo
- NORC at the University of Chicago, Chicago, IL, United States
| | - Meera Sreedhara
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States; Cherokee Nation Operational Solutions, Tulsa, OK, United States
| | - Shena Popat
- NORC at the University of Chicago, 4350 East-West Hwy 8th Floor, Bethesda, MD 20814, United States
| | - Kincaid Lowe Beasley
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States
| | - Tiara N Jackson
- Decision Information Resources, Inc., Houston, TX, United States
| | - Amena Abbas
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States; ASRT, Inc., Atlanta, GA, United States
| | - W Alexander Keaton
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | | | - Jillian Harvey
- Medical University of South Carolina, Charleston, SC, United States
| | - Ryan Kruis
- Medical University of South Carolina, Charleston, SC, United States
| | - Shay McLeod
- Medical University of South Carolina, Charleston, SC, United States
| | - Roy Ahn
- NORC at the University of Chicago, Chicago, IL, United States
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Fleischer S, Heinrich S, Meyer G, Mikolajczyk R, Lückmann SL. Sex differences in cardiologic medication provision for adults with coronary heart disease: an analysis of health claims data from 2018 to 2020 in Saxony-Anhalt, Germany. BMC Health Serv Res 2024; 24:288. [PMID: 38448928 PMCID: PMC10916020 DOI: 10.1186/s12913-024-10727-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/15/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Coronary heart diseases (CHDs) have experienced the largest increase worldwide as a cause of death, accounting for 16% of all deaths. In Saxony-Anhalt, a federal state in Germany, both CHD morbidity and acute myocardial infarction mortality rates are particularly high. Several risk factors associated with CHDs have been studied in Saxony-Anhalt, but sex differences in service use and medication have not been investigated. This study therefore aimed to investigate sex differences in the quality and quantity of cardiological care provided to adults with CHD. METHODS This study used health claims data from 2018 to 2020 to analyse the utilisation of healthcare services and adherence to medication-related guideline recommendations in primary and specialist care. The sample included 133,661 individuals with CHD from a major statutory health insurance company (Germany). RESULTS Almost all CHD patients (> 99%) received continuous primary care. Continuous cardiologist utilisation was lower for females than for males, with 15.0% and 22.2%, respectively, and sporadic utilisation showed greater differences, with 33.5% of females and 43.4% of males seeking sporadic cardiologist consultations. Additionally, 43.1% of the identified CHD patients participated in disease management programmes (DMPs). The study also examined the impact of DMP participation and cardiologist care on medication uptake and revealed that sex differences in medication uptake, except for statin use, were mitigated by these factors. Statins were prescribed to 42.9% of the CHD patients eligible for statin prescription in accordance with the QiSA indicator for statin prescription eligibility. However, there were significant sex differences in statin utilisation. Female CHD patients were less likely to use statins (35.2%) than male CHD patients were (50.1%). The difference in statin utilisation persisted after adjustment for DMP participation and cardiologist consultation. CONCLUSIONS This study highlights sex differences in the utilisation of cardiological healthcare services for patients with CHD in the Saxony-Anhalt cohort. These findings underscore the continuing need for interventions to reduce sex inequalities in accessing healthcare and providing health care for patients with CHD. Factors at the health care system, patient, and physician levels should be further investigated to eventually improve statin prescription in people with CHD, especially women.
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Affiliation(s)
- Steffen Fleischer
- Martin-Luther-University Halle Wittenberg, Medical Faculty, Institute of Nursing and Health Science, Magdeburger Str. 8, 06108, Halle (Saale) , Germany.
| | | | - Gabriele Meyer
- Martin-Luther-University Halle Wittenberg, Medical Faculty, Institute of Nursing and Health Science, Magdeburger Str. 8, 06108, Halle (Saale) , Germany
| | - Rafael Mikolajczyk
- Martin-Luther-University Halle Wittenberg, Medical Faculty, Institute of Medical Epidemiology Biometrics and Informatics, Halle (Saale) , Germany
| | - Sara Lena Lückmann
- Martin-Luther-University Halle Wittenberg, Medical Faculty, Institute of Medical Epidemiology Biometrics and Informatics, Halle (Saale) , Germany
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AMBROŽ M, KENDIR C, BOERMA W, KLEMENC-KETIŠ Z. Patient Reported Indicator Surveys (Paris): Methodological Considerations of a Field Trial in Slovenia. Zdr Varst 2024; 63:30-37. [PMID: 38156337 PMCID: PMC10751897 DOI: 10.2478/sjph-2024-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Healthcare systems collect little information about the experiences and outcomes of care from the perspectives of patients. Patient Reported Indicator Surveys (PaRIS) is an OECD initiative to measure the outcomes and experiences of people living with chronic conditions, who are managed in primary care. Objectives To evaluate the feasibility of the methodology employed in the Field Trial of the PaRIS survey in Slovenia and propose adjustments to enhance sampling in the Main Survey. Methods In 2022, we conducted a cross-sectional observational study in 50 family medicine practices in Slovenia with a target of recruiting 70 patients per practice. We used the Slovenian version of the PaRIS questionnaires, and evaluated sampling and data collection. Results The sample contained 21 providers (42.0% response rate) and 454 patients (50.7% response rate). The provider sample did not differ from the population characteristics, while the patient sample differed significantly from the patient population. All providers completed the survey online, in 20.9±11.1 minutes and had 1.5±1.5 restarts. Most patients (74.9%) completed the survey online and needed 36.0±22.6 minutes, and the mean number of restarts was 1.4±2.2. Conclusion Based on the results, we recommend conducting a methodology test for quality assessment studies before initiating the main survey. Legal issues should be addressed and considered early when developing the methodology. It is also necessary to be aware of the feasibility of the study in practice, to avoid a low participation rate.
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Affiliation(s)
- Matija AMBROŽ
- Community Health Centre Ljubljana, Metelkova 9, 1000Ljubljana, Slovenia
| | - Candan KENDIR
- Organisation for Economic Co-operation and Development (OECD), 2, rue André Pascal75016Paris, France
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
| | - Wienke BOERMA
- NIVEL Netherlands Institute for Health Services Research, Otterstraat 118, 3513 CRUtrecht, The Netherlands
| | - Zalika KLEMENC-KETIŠ
- Community Health Centre Ljubljana, Metelkova 9, 1000Ljubljana, Slovenia
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000Maribor, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
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Colleran M, Doherty AM. Examining assisted suicide and euthanasia through the lens of healthcare quality. Ir J Med Sci 2024; 193:353-362. [PMID: 37300598 PMCID: PMC10808165 DOI: 10.1007/s11845-023-03418-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
Many people on both sides of the debate to legalise physician-hastened death are motivated by compassion and a desire to provide better end of life care for others. Assisted dying may include euthanasia and/or assisted suicide (EAS). It is legal in some jurisdictions and under debate in others including Ireland. EAS is a complex, sensitive and can be an emotive issue; detailed and nuanced examination of the subject is needed. To enhance this discussion, we examine EAS through the lens of quality. In examining EAS from this stance, we consider the action, along with the outcomes, the impact of the outcomes from other jurisdictions with legalised EAS, alongside the risks and the balancing measures used, in addition to considering the intervention itself. Progressive expansion of eligibility for EAS has occurred over time in the Netherlands, Belgium and Canada. Given the complexity of assessing coercion, the risks to persons in vulnerable groups (including older persons, persons with mental health conditions and persons with disabilities), the progressive expansion of eligibility for EAS, the lack of safety and the undermining of suicide prevention strategies, the current law is most protective of persons in vulnerable groups in the interest of social justice. Person-centred and compassionate care needs be prioritised with greater access and equitable access to primary and specialist palliative care and mental health care for persons with incurable and terminal illnesses and support for caregivers allowing patients to die naturally with optimised symptom control.
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Affiliation(s)
- Miriam Colleran
- St Brigid's Hospice, Crotanstown, Kildare, Ireland
- Naas Hospital, Co Kildare, Naas, Ireland
| | - Anne M Doherty
- Department of Psychiatry, University College Dublin, 63 Eccles Street, Dublin 7, Ireland.
- Department of Liaison Psychiatry, Mater Misericordiae University Hospital, 63 Eccles Street, Dublin 7, Ireland.
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Osiurak S, Taylor NF, Albiston T, Williams K, Collyer TA, Snowdon DA. Interactive clinical supervision training added to self-education leads to small improvements in the effectiveness of clinical supervision of physiotherapists: a randomised trial. J Physiother 2024; 70:33-39. [PMID: 38049352 DOI: 10.1016/j.jphys.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/23/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023] Open
Abstract
QUESTION Does adding an interactive clinical supervision training program to self-education improve the effectiveness of clinical supervision of physiotherapists, reduce burnout, decrease intention to leave and increase participation in clinical supervision? DESIGN Randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS Physiotherapists (n = 58) working at a publicly funded health service. INTERVENTION Participants in both groups received a self-education clinical supervision training package. In addition, participants in the experimental group received interactive clinical supervision training consisting of three 90-minute workshops. OUTCOME MEASURES The primary outcome measure was effectiveness of clinical supervision 4 months after training measured using the Manchester Clinical Supervision Scale (MCSS-26). Secondary outcomes were the Maslach Burnout Inventory, the Intention to Leave Scale, and participation in supervision. Focus groups were also used to gauge impressions of the intervention. RESULTS The addition of interactive clinical supervision training slightly improved effectiveness of clinical supervision, with a between-group mean difference of 6.3 units (95% CI 0.3 to 12.3) on the MCSS-26. The estimate of the effect on the proportion of physiotherapists reporting effective clinical supervision (ie, MSCC-26 score ≥ 73) was unclear (OR 1.97, 95% CI 0.50 to 7.81). Physiotherapists in the experimental group reported slightly lower levels of depersonalisation (MD -3.0 units, 95% CI -4.6 to -1.3). There were negligible or uncertain effects on the other burnout domains, intention to leave and participation in clinical supervision. Qualitatively, participants reported that the workshops made them realise that supervisees could take greater ownership of where supervision focused. CONCLUSION Adding interactive clinical supervision training to self-education leads to small improvements in the effectiveness of clinical supervision of physiotherapists. REGISTRATION osf.io/yz3kx.
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Affiliation(s)
- Sarah Osiurak
- Physiotherapy Department, Eastern Health, Box Hill, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia; College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | | | | | - Taya A Collyer
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia; National Centre for Healthy Ageing, Melbourne, Australia
| | - David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia; National Centre for Healthy Ageing, Melbourne, Australia; Academic Unit, Peninsula Health, Frankston Australia.
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Scichilone N, Whittamore A, White C, Nudo E, Savella M, Lombardini M. The patient journey in Chronic Obstructive Pulmonary Disease (COPD): a human factors qualitative international study to understand the needs of people living with COPD. BMC Pulm Med 2023; 23:506. [PMID: 38093262 PMCID: PMC10720133 DOI: 10.1186/s12890-023-02796-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common condition that causes irreversible airway obstruction. Fatigue and exertional dyspnoea, for example, have a detrimental impact on the patient's daily life. Current research has revealed the need to empower the patient, which can result in not only educated and effective decision-making, but also a considerable improvement in patient satisfaction and treatment compliance. The current study aimed to investigate the perspectives and requirements of people living with COPD to possibly explore new ways to manage their disease. METHODS Adults with COPD from 8 European countries were interviewed by human factor experts to evaluate their disease journey through the gathering of information on the age, performance, length, and impact of diagnosis, symptoms progression, and family and friends' reactions. The assessment of present symptoms, services, and challenges was performed through a 90-min semi-structured interview. To identify possible unmet needs of participants, a generic thematic method was used to explore patterns, themes, linkages, and sequences within the data collected. Flow charts and diagrams were created to communicate the primary findings. Following analysis, the data was consolidated into cohesive insights and conversation themes relevant to determining the patient's unmet needs. RESULTS The 62, who voluntarily accepted to be interviewed, were patients (61% females, aged 32-70 years) with a COPD diagnosis for at least 6 months with stable symptoms of different severity. The main challenges expressed by the patients were the impact on their lifestyle, reduced physical activity, and issues with their mobility. About one-fourth had challenges with their symptoms or medication including difficulty in breathing. Beyond finding a cure for COPD was the primary goal for patients, their main needs were to receive adequate information on the disease and treatments, and to have adequate support to improve physical activity and mobility, helpful both for patients and their families. CONCLUSIONS These results could aid in the creation of new ideas and concepts to improve our patient's quality of life, encouraging a holistic approach to people living with COPD and reinforcing the commitment to understanding their needs.
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Affiliation(s)
- Nicola Scichilone
- Division of Respiratory Medicine, Department PROMISE, "Giaccone" University Hospital, University of Palermo, Palermo, Italy.
| | | | | | - Elena Nudo
- Chiesi Farmaceutici S.P.A, Via Paradigna 131/A - 43122, Parma, Italy
| | - Massimo Savella
- Chiesi Farmaceutici S.P.A, Via Paradigna 131/A - 43122, Parma, Italy
| | - Marta Lombardini
- Chiesi Farmaceutici S.P.A, Via Paradigna 131/A - 43122, Parma, Italy
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Bertoy L, Harbaugh CM, Millis MA, Zhuo L, Gutsche N, Beck G, Panzer K, Howard R, Weng W, Singh K, Englesbe M, Hendren S. Positive margin rates for colorectal cancer vary significantly by hospital in Michigan: Can we achieve a 0 % positive margin rate? Surg Open Sci 2023; 16:37-43. [PMID: 37766798 PMCID: PMC10520503 DOI: 10.1016/j.sopen.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Background High quality surgical care for colorectal cancer (CRC) includes obtaining a negative surgical margin. The Michigan Surgical Quality Collaborative (MSQC) is a statewide consortium of hospitals dedicated to quality improvement; a subset of MSQC hospitals abstract quality of care measures for CRC surgery, including positive margin rate. The purpose of this study was to determine whether positive margin rates vary significantly by hospital, and whether positive margin rates should be a target for quality improvement. Methods We performed a retrospective cohort study of patients who underwent CRC resection from 2016 to 2020. The primary outcome was the presence of a positive margin. Univariate and multivariable analyses were performed to test the association of positive margins with patient, hospital, and tumor characteristics. Results The cohort consisted of 4211 patients from 42 hospitals (85 % colon cancer and 15 % rectal cancer). The crude positive margin rate was 6.15 % (95 % CI 4.6-7.4 %); this ranged from 0 % to 22 % at individual hospitals. In multivariable analysis, factors independently associated with positive margins included male sex, underweight BMI, metastatic cancer, rectal cancer (vs. colon), T4 T-stage, N1c/N2 N-stage, and open surgical approach. After adjusting for these factors, there remained significant variation by hospital, with 8 hospitals being statistically-significant outliers. Conclusions Positive margins rates for CRC vary by hospital in Michigan, even after rigorous adjustment for case-mix. Furthermore, several hospitals achieved near-zero positive margin rates, suggesting opportunities for quality improvement through the identification of best practices among CRC surgery centers.
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Affiliation(s)
- Lauren Bertoy
- University of Michigan, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USA
| | - Calista M. Harbaugh
- Michigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - M. Andrew Millis
- Michigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Lucy Zhuo
- University of Rochester Medical Center, Department of Surgery, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Nicholas Gutsche
- University of Michigan, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USA
| | - Graham Beck
- University of Michigan, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USA
| | - Kate Panzer
- University of Michigan, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USA
| | - Ryan Howard
- Michigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Wenjing Weng
- Michigan Medicine, Michigan Surgical Quality Collaborative, 4251 Plymouth Road, Ann Arbor, MI 48105, USA
| | - Kushal Singh
- Michigan Medicine, Michigan Surgical Quality Collaborative, 4251 Plymouth Road, Ann Arbor, MI 48105, USA
| | - Michael Englesbe
- Michigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
- Michigan Medicine, Michigan Surgical Quality Collaborative, 4251 Plymouth Road, Ann Arbor, MI 48105, USA
| | - Samantha Hendren
- Michigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
- Michigan Medicine, Michigan Surgical Quality Collaborative, 4251 Plymouth Road, Ann Arbor, MI 48105, USA
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Latten BGH, Kubat B, van den Brandt PA, zur Hausen A, Schouten LJ. Cause of death and the autopsy rate in an elderly population. Virchows Arch 2023; 483:865-872. [PMID: 37269366 PMCID: PMC10238230 DOI: 10.1007/s00428-023-03571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 06/05/2023]
Abstract
Autopsy rates are declining, while major discrepancies between autopsies and clinical diagnoses remain. Still, little is known about the impact of suspected underlying diseases, for example, a diagnosis of cancer, on the autopsy rate. The aim of this study was to investigate the relation between the clinical cause of death, a history of cancer, and the medical autopsy rate using data from the Netherlands Cohort Study on Diet and Cancer (NLCS), a large prospective cohort study with a long follow-up. The NLCS is a prospective study initiated in 1986 and includes 120,852 persons (58,279 males and 62,573 females), 55-69 years of age at the time of enrollment. The NLCS was linked with the Dutch Nationwide Pathology Databank (PALGA), the Dutch Population Register (GBA), the Netherlands Cancer Registry, and the causes of death registry (Statistics Netherlands). If applicable, the 95% confidence intervals were calculated. During the follow-up of the NLCS, 59,760 deaths were recorded by linkage with the GBA from 1991 until 2009. Of these, a medical autopsy was performed on 3736 deceased according to linkage with PALGA, resulting in an overall autopsy rate of 6.3%. Major variations in the autopsy rate were observed according to the cause of death. The autopsy rate increased according to the number of contributing causes of death. Lastly, a diagnosis of cancer affected the autopsy rate. The clinical cause of death and a history of cancer both influenced the medical autopsy rate in a large national cohort. The insight this study provides may help clinicians and pathologists counteracting the further downfall of the medical autopsy.
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Affiliation(s)
- Bartholomeus G. H. Latten
- Department of Pathology, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Bela Kubat
- Department of Pathology, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Piet A. van den Brandt
- Department of Epidemiology, GROW–School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Axel zur Hausen
- Department of Pathology, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Department of Pathology, GROW–School for Oncology and Reproduction, Maastricht University, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Leo J. Schouten
- Department of Epidemiology, GROW–School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Kahles A, Goldschmid H, Volckmar AL, Ploeger C, Kazdal D, Penzel R, Budczies J, Kempny G, Kazmierczak M, Flechtenmacher C, Baretton G, Weichert W, Horst D, Klauschen F, Gassner UM, Brüggemann M, Vogeser M, Schirmacher P, Stenzinger A. Structure and content of the EU-IVDR : Current status and implications for pathology. Pathologie (Heidelb) 2023; 44:73-85. [PMID: 36735063 PMCID: PMC9896441 DOI: 10.1007/s00292-022-01176-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Regulation (EU) 2017/746 on in vitro diagnostic medical devices (IVDR) was passed by the European Parliament and the Council of the European Union on 5 April 2017 and came into force on 26 May 2017. A new amending regulation, which introduces a phased implementation of the IVDR with new transitional provisions for certain in vitro diagnostic medical devices (IVDs) and a later date of application of some requirements for in-house devices for healthcare facilities, was adopted on 15 December 2021. The combined use of CE-certified IVDs (CE-IVDs), in-house IVDs (IH-IVDs), and research use only (RUO) devices are a cornerstone of diagnostics in pathology departments and crucial for optimal patient care. The IVDR not only regulates the manufacture and placement on the market of industrially manufactured IVDs, but also imposes conditions on the manufacture and use of IH-IVDs for internal use by healthcare facilities. OBJECTIVES Our work provides an overview of the background and structure of the IVDR and identifies core areas that need to be interpreted and fleshed out in the context of the legal framework as well as expert knowledge. CONCLUSIONS The gaps and ambiguities in the IVDR crucially require the expertise of professional societies, alliances, and individual stakeholders to successfully facilitate the implementation and use of the IVDR in pathology departments and to avoid aberrant developments.
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Affiliation(s)
- Andy Kahles
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Hannah Goldschmid
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anna-Lena Volckmar
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Carolin Ploeger
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniel Kazdal
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Roland Penzel
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Budczies
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gisela Kempny
- Professional Association of German Pathologists, Bundesverband Deutscher Pathologen e. V., Berlin, Germany
| | - Marlon Kazmierczak
- Professional Association of German Pathologists, Bundesverband Deutscher Pathologen e. V., Berlin, Germany
| | | | - Gustavo Baretton
- Department of Pathology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - David Horst
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frederick Klauschen
- Institute of Pathology, Ludwig-Maximilian University of Munich, Munich, Germany
| | | | - Monika Brüggemann
- 2nd Internal Medicine Department, Hematology Lab Kiel, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Michael Vogeser
- Institute of Laboratory Medicine, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Peter Schirmacher
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.
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Tevik K, Helvik AS, Stensvik GT, Nordberg MS, Nakrem S. Nursing-sensitive quality indicators for quality improvement in Norwegian nursing homes - a modified Delphi study. BMC Health Serv Res 2023; 23:1068. [PMID: 37803376 PMCID: PMC10557356 DOI: 10.1186/s12913-023-10088-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Use of nursing-sensitive quality indicators (QIs) is one way to monitor the quality of care in nursing homes (NHs). The aim of this study was to develop a consensus list of nursing-sensitive QIs for Norwegian NHs. METHODS A narrative literature review followed by a non-in-person, two-round, six-step modified Delphi survey was conducted. A five-member project group was established to draw up a list of nursing-sensitive QIs from a preliminary list of 24 QIs selected from Minimum Data Set (2.0) (MDS) and the international Resident Assessment Instrument for Long-Term Care Facilities (interRAI LTCF). We included scientific experts (researchers), clinical experts (healthcare professionals in NHs), and experts of experience (next-of-kin of NH residents). The experts rated nursing-sensitive QIs in two rounds on a seven-point Likert scale. Consensus was based on median value and level of dispersion. Analyses were conducted for four groups: 1) all experts, 2) scientific experts, 3) clinical experts, and 4) experts of experience. RESULTS The project group drew up a list of 20 nursing-sensitive QIs. Nineteen QIs were selected from MDS/interRAI LTCF and one ('systematic medication review') from the Norwegian quality assessment system IPLOS ('Statistics linked to individual needs of care'). In the first and second Delphi round, 44 experts (13 researchers, 17 healthcare professionals, 14 next-of-kin) and 28 experts (8 researchers, 10 healthcare professionals, 10 next-of-kin) participated, respectively. The final consensus list consisted of 16 nursing-sensitive QIs, which were ranked in this order by the 'all expert group': 1) systematic medication review, 2) pressure ulcers, 3) behavioral symptoms, 4) pain, 5) dehydration, 6) oral/dental health problems, 7) urinary tract infection, 8) fecal impaction, 9) depression, 10) use of aids that inhibit freedom of movement, 11) participation in activities of interest, 12) participation in social activities, 13) decline in activities of daily living, 14) weight loss, 15) falls, and 16) hearing loss without the use of hearing aids. CONCLUSIONS Multidisciplinary experts were able to reach consensus on 16 nursing-sensitive QIs. The results from this study can be used to implement QIs in Norwegian NHs, which can improve the quality of care.
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Affiliation(s)
- Kjerstin Tevik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Anne-Sofie Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir-Tore Stensvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Marion S Nordberg
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- National Ageing Research Institute, Royal Melbourne Hospital, 34-54 Poplar Road, Victoria, 3050, Australia
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Nilsbakken IMW, Cuevas-Østrem M, Wisborg T, Sollid S, Jeppesen E. Effect of urban vs. remote settings on prehospital time and mortality in trauma patients in Norway: a national population-based study. Scand J Trauma Resusc Emerg Med 2023; 31:53. [PMID: 37798724 PMCID: PMC10557189 DOI: 10.1186/s13049-023-01121-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Norway has a diverse population pattern and often long transport distances from injury sites to hospitals. Also, previous studies have found an increased risk of trauma-related mortality in remote areas in Norway. Studies on urban vs. remote differences on trauma outcomes from other countries are sparse and they report conflicting results.The aim of the present study was to investigate differences in prehospital time intervals in urban and remote areas in Norway and assess how prehospital time and urban vs. remote settings were associated with mortality in the Norwegian trauma population. METHODS We performed a population-based study of trauma cases included in the Norwegian Trauma Registry from 2015 to 2020. 28,988 patients met the inclusion criteria. Differences in study population characteristics and prehospital time intervals (response time, on-scene time and transport time) were analyzed. The Norwegian Centrality Index score was used for urban vs. remote classification. Descriptive statistics and relevant non-parametric tests with effect size measurements were used. A binary logistic regression model, adjusted for confounding factors, was performed. RESULTS The prehospital time intervals increased significantly from urban to remote areas.Adjusted for control variables we found a significant relationship between prolonged on-scene time and higher odds of mortality. Also, suburban areas compared with remote areas were associated with higher odds of mortality. CONCLUSION In this nationwide study comparing prehospital time intervals in urban and remote areas, we found that prehospital time intervals in remote areas exceeded those in urban areas. Prolonged on-scene time was found to be associated with higher odds of mortality, but remoteness itself was not.
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Affiliation(s)
- Inger Marie Waal Nilsbakken
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Mathias Cuevas-Østrem
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Torben Wisborg
- Interprofessional rural research team – Finnmark, Faculty of Health Sciences, University of Tromsø – the Arctic University of Norway, Tromsø, Norway
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway
| | - Stephen Sollid
- Prehospital Division, Oslo University Hospital, Oslo, Norway
- Faculty of medicine, University of Oslo, Oslo, Norway
| | - Elisabeth Jeppesen
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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15
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Mužik R, Knapčoková V, Saal B, Tkáč I. Effect of a Disease Management Program on the Adherence to Guideline-Recommended HbA1c Monitoring in Patients with Diabetes in Slovakia. Diabetes Ther 2023; 14:1685-1694. [PMID: 37477855 PMCID: PMC10499705 DOI: 10.1007/s13300-023-01447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Glycated hemoglobin (HbA1c) is a crucial marker of glucose control that is widely utilized in the management of diabetes mellitus. The aim of this study was to evaluate the effect of a diabetes management program (DMP) offered by a health insurance company, together with the effects of other factors associated with patient and physician characteristics, on the frequency of HbA1c testing in outpatient diabetes clinics in Slovakia. METHODS A retrospective analysis was conducted to compare the frequency of HbA1c measurements in patients under the care of physicians participating in the DMP with those who did not, spanning the years 2015 to 2019. In 2019, a total of 74,384 patients with diabetes were included in the analysis, of which 52% were men and 48% were women, with an average age of 64.1 years. RESULTS At the end of the study period, the average annual number of HbA1c measurements was significantly higher in patients treated by physicians participating in the DMP than in patients treated by physicians who were not (2.50 vs. 1.91 per year, respectively; P < 0.001). There was a substantial increase in HbA1c testing at least twice yearly in both groups, but the growth rate was greater in the group with DMP-engaged diabetologists (14.3%) compared to the diabetes specialists who were not involved in the DMP (5.1%). In the multivariate analysis, participation in the DMP was correlated with an increase in HbA1c tests per year by 0.7. CONCLUSIONS Physician participation in a DMP was found to significantly increase the number of HbA1c tests ordered by physicians, potentially leading to improved glycemic control.
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Affiliation(s)
- Roman Mužik
- DÔVERA Health Insurance Company, Einsteinova 25, 85101, Bratislava, Slovakia.
| | - Veronika Knapčoková
- DÔVERA Health Insurance Company, Einsteinova 25, 85101, Bratislava, Slovakia
| | - Beáta Saal
- DÔVERA Health Insurance Company, Einsteinova 25, 85101, Bratislava, Slovakia
| | - Ivan Tkáč
- Department of Internal Medicine 4, Faculty of Medicine, P.J. Šafárik University-L. Pasteur University Hospital, Košice, Slovakia
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Umgelter A, Faust M, Wenske S, Umgelter K, Schmid RM, Walter G. Do patients referred to emergency departments after being assessed in primary care differ from other ED patients? Retrospective analysis of a random sample from two German metropolitan EDs. Int J Emerg Med 2023; 16:64. [PMID: 37752441 PMCID: PMC10523768 DOI: 10.1186/s12245-023-00542-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND To assess differences between patients referred to emergency departments by a primary care physician (PCP) and those presenting directly and the impact of referral on the likelihood of admission. DESIGN OF STUDY Retrospective cohort study. SETTING EDs of two nonacademic general hospitals in a German metropolitan region. PARTICIPANTS Random sample of 1500 patients out of 80,845 presentations during the year 2019. RESULTS Age was 55.8 ± 22.9 years, and 51.4% was female. A total of 34.7% presented by emergency medical services (EMS), and 47.7% were walk-ins. One-hundred seventy-four (11.9%) patients were referred by PCPs. Referrals were older (62.4 ± 20.1 vs 55.0 ± 23.1 years, p < .001) and had a higher Charlson Comorbidity Index (CCI) (3 (1-5) vs 2 (0-4); p < .001). Referrals received more ultrasound examinations independently from their admission status (27.6% vs 15.7%; p < .001) and more CT and laboratory investigations. There were no differences in sex, Manchester Triage System (MTS) category, or pain-scale values. Referrals presented by EMS less often (9.2% vs 38.5%; p < .001). Admission rates were 62.6% in referrals and 37.1% in non-referrals (p < .001). Referral (OR 3.976 95% CI: 2.595-6.091), parenteral medication in ED (OR 2.674 (1.976-3.619)), higher MTS category (1.725 (1.421-2.093)), transport by EMS (1.623 (1.212-2.172)), abnormal vital parameters (1.367 (0.953-1.960)), higher CCI (1.268 (1.196-1.344)), and trauma (1.268 (1.196-1.344)) were positively associated with admission in multivariable analysis, whereas ultrasound in ED (0.450 (0.308-0.658)) and being a nursing home resident (0.444 (0.270-0.728)) were negatively associated. CONCLUSION Referred patients were more often admitted. They received more laboratory investigations, ultrasound examinations, and computed tomographies. Difficult decisions regarding the necessity of admission requiring typical resources of EDs may be a reason for PCP referrals.
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Affiliation(s)
- Andreas Umgelter
- II. Medizinische Klinik, Klinikum Rechts Der Isar der Technischen Universität München, Munich, Germany.
- Zentrale Notfallversorgung, Vivantes Humboldt Klinikum, 13509, Berlin, Germany.
| | - Markus Faust
- II. Medizinische Klinik, Klinikum Rechts Der Isar der Technischen Universität München, Munich, Germany
- Zentrale Notfallversorgung, Vivantes Humboldt Klinikum, 13509, Berlin, Germany
| | - Slatomir Wenske
- Zentrale Notfallversorgung, Vivantes Humboldt Klinikum, 13509, Berlin, Germany
| | - Katrin Umgelter
- Klinik Für Interdisziplinäre Intensivmedizin, Vivantes Humboldt Klinikum, Berlin, Germany
| | - Roland M Schmid
- II. Medizinische Klinik, Klinikum Rechts Der Isar der Technischen Universität München, Munich, Germany
| | - Georg Walter
- Zentrale Notfallversorgung, Vivantes Klinikum Spandau, Berlin, Germany
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Chiba Y, Hayashi R, Kita Y, Takeshita M. Care provided by midwives and the unmet needs of pregnant and postpartum women: A qualitative study of Japanese mothers. Heliyon 2023; 9:e18747. [PMID: 37576280 PMCID: PMC10415878 DOI: 10.1016/j.heliyon.2023.e18747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023] Open
Abstract
Objectives We aimed to clarify the content of care provided by midwives working in hospitals and clinics in Japan and the unmet needs in midwifery care from mothers' perspectives. Design This study employed a qualitative approach through semi-structured interviews. Setting Fifteen Japanese women, whose youngest singleton children were aged 12-18 months, were asked to recall their experiences with midwives, from pregnancy through the first postpartum year. Verbatim records were analyzed using thematic analysis. Results Seven themes regarding the care provided by midwives were generated: confirmation of physical condition, maintenance and promotion of perinatal physiological process, support for better preparation for childbirth, assistance in labour and childbirth, support for a new life with a baby at home, support for the family, and care for comfort and confidence as a mother. Unmet needs were identified in all themes, except for 'confirmation of physical condition' and 'support for the family'. Ten subthemes, under the five themes of unmet needs, were integrated into three categories: midwives' responses to potential concerns, lack of continuity of care, and lack of personalised care. Key conclusions and implications for practice Midwives in hospitals and clinics in Japan mainly provided care from pregnancy to one-month postpartum, in line with global core competencies. However, they could respond more effectively to the potential concerns of women, and provide continuous, personalised care more sufficiently. Improving working environments for midwives and collaborating with postpartum public health services are key to addressing these unmet needs of women, leading to women-centred care.
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Affiliation(s)
- Yoko Chiba
- Department of Nursing, Kyoto College of Nursing, 1-21 Mibu-higashitakada-cho Nakagyo-ku Kyoto, 604-8845, Japan
| | - Risako Hayashi
- Department of Nursing, Kyoto College of Nursing, 1-21 Mibu-higashitakada-cho Nakagyo-ku Kyoto, 604-8845, Japan
| | - Yuri Kita
- Department of Nursing, Kyoto College of Nursing, 1-21 Mibu-higashitakada-cho Nakagyo-ku Kyoto, 604-8845, Japan
| | - Mai Takeshita
- Department of Nursing, Kyoto College of Nursing, 1-21 Mibu-higashitakada-cho Nakagyo-ku Kyoto, 604-8845, Japan
- Department of Health Informatics, School of Public Health, Kyoto University, Yoshida-konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
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Grammatico-Guillon L, Banaei-Bouchareb L, Solomiac A, Miliani K, Astagneau P, May-Michelangeli L. Validation of the first computerized indicator for orthopaedic surgical site infections in France: ISO-ORTHO. Antimicrob Resist Infect Control 2023; 12:44. [PMID: 37143157 PMCID: PMC10161661 DOI: 10.1186/s13756-023-01239-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 04/03/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The French national authority for health (HAS) develops in-hospital indicators for improving quality of care, safety and patient outcome. Since 2017, it has developed a measurement of surgical site infections (SSI) after total hip or knee arthroplasty (TH/KA) by using a computerized indicator, called ISO-ORTHO, based on a hospital discharge database (HDD) algorithm. The aim of the study was to assess the performance of this new indicator . METHODS The ISO-ORTHO performance was estimated via its positive predictive value (PPV) among adult patients having undergone a TH/KA between January 1st and September 30th 2018, based on the orthopaedic procedure codes. Patients at very high risk of SSI and/or with SSI not related to the in-hospital care were excluded. SSI were detected from the date of admission up to 90 days after the TH/KA using the ISO-ORTHO algorithm, based on 15 combinations of ICD-10 and procedure codes. Its PPV was estimated by a chart review in volunteer healthcare organisations (HCO). RESULTS Over the study period, 777 HCO including 143,227 TH/KA stays were selected, providing 1,279 SSI according to the ISO-ORTHO indicator. The 90-day SSI rate was 0.89 per 100 TH/KA stays (0.98% for THA and 0.80% for TKA). Among the 448 HCO with at least 1 SSI, 250 HCO participated in reviewing 725 SSI charts; 665 were confirmed, giving a PPV of 90.3% [88.2-92.5%], 89.9% [87.1-92.8%] in THA and 90.9% [87.7-94.2%] in TKA. CONCLUSIONS The PPV of ISO-ORTHO over 90% confirms its validity for any use according to the HAS method. ISO-ORTHO and detailed information were provided in 2020 to HCO and used for quality assessment and in-hospital risk management.
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Affiliation(s)
- Leslie Grammatico-Guillon
- Service of Public Health, Epidemiology and data center, Teaching hospital of Tours and Medical School of Tours, Tours, France.
- Medical School, University of tours, Tours, France.
- Center for Prevention of Healthcare Associated Infection, INSERM, Institute of Epidemiology and Public Health, Sorbonne University, Paris, F75013, France.
| | - Linda Banaei-Bouchareb
- French National Authority for Health ("Haute Autorité de Santé", HAS), Saint Denis, France
| | - Agnès Solomiac
- French National Authority for Health ("Haute Autorité de Santé", HAS), Saint Denis, France
| | - Katiuska Miliani
- Center for Prevention of Healthcare Associated Infection, INSERM, Institute of Epidemiology and Public Health, Sorbonne University, Paris, F75013, France
| | - Pascal Astagneau
- Center for Prevention of Healthcare Associated Infection, INSERM, Institute of Epidemiology and Public Health, Sorbonne University, Paris, F75013, France
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Vos JAM, El Alili M, Duineveld LAM, Wieldraaijer T, Wind J, Sert E, Donkervoort SC, Govaert MJPM, van Geloven NAW, van de Ven AWH, Heuff G, van Weert HCPM, Bosmans JE, van Asselt KM. Cost-effectiveness of general practitioner- versus surgeon-led colon cancer survivorship care: an economic evaluation alongside a randomised controlled trial. J Cancer Surviv 2023:10.1007/s11764-023-01383-4. [PMID: 37097550 DOI: 10.1007/s11764-023-01383-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/11/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE The aim of this study is to assess cost-effectiveness of general practitioner (GP) versus surgeon-led colon cancer survivorship care from a societal perspective. METHODS We performed an economic evaluation alongside the I CARE study, which included 303 cancer patients (stages I-III) who were randomised to survivorship care by a GP or surgeon. Questionnaires were administered at baseline, 3-, 6-, 12-, 24- and 36-months. Costs included healthcare costs (measured by iMTA MCQ) and lost productivity costs (SF-HLQ). Disease-specific quality of life (QoL) was measured using EORTC QLQ-C30 summary score and general QoL using EQ-5D-3L quality-adjusted life years (QALYs). Missing data were imputed. Incremental cost-effectiveness ratios (ICERs) were calculated to relate costs to effects on QoL. Statistical uncertainty was estimated using bootstrapping. RESULTS Total societal costs of GP-led care were significantly lower compared to surgeon-led care (mean difference of - €3895; 95% CI - €6113; - €1712). Lost productivity was the main contributor to the difference in societal costs (- €3305; 95% CI - €5028; - €1739). The difference in QLQ-C30 summary score over time between groups was 1.33 (95% CI - 0.049; 3.15). The ICER for QLQ-C30 was - 2073, indicating that GP-led care is dominant over surgeon-led care. The difference in QALYs was - 0.021 (95% CI - 0.083; 0.040) resulting in an ICER of 129,164. CONCLUSIONS GP-led care is likely to be cost-effective for disease-specific QoL, but not for general QoL. IMPLICATIONS FOR CANCER SURVIVORS With a growing number of cancer survivors, GP-led survivorship care could help to alleviate some of the burden on more expensive secondary healthcare services.
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Affiliation(s)
- Julien A M Vos
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Mohamed El Alili
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Van Der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Laura A M Duineveld
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Thijs Wieldraaijer
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Jan Wind
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Edanur Sert
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Sandra C Donkervoort
- Department of Surgery, OLVG Hospital, Oosterpark 9, 1091 AC, Amsterdam, the Netherlands
| | - Marc J P M Govaert
- Department of Surgery, Dijklander Hospital, Maelsonstraat 3, 1624 NP, Hoorn, the Netherlands
| | - Nanette A W van Geloven
- Department of Surgery, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | - Anthony W H van de Ven
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, the Netherlands
| | - Gijsbert Heuff
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Van Der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Kristel M van Asselt
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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20
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Lalor JG, Sheaf G, Mulligan A, Ohaja M, Clive A, Murphy-Tighe S, Ng ED, Shorey S. Parental experiences with changes in maternity care during the Covid-19 pandemic: A mixed-studies systematic review. Women Birth 2023; 36:e203-e212. [PMID: 35973917 PMCID: PMC9364727 DOI: 10.1016/j.wombi.2022.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, pregnant women were identified as a high-risk and vulnerable group. To reduce risk of transmission, maternity healthcare services were modified to limit exposure but maintain services for pregnant women. However, the change in hospital practice may have compromised quality maternal care standards. Therefore, this review aims to explore parental experiences and views with maternity care received from healthcare institutions during the COVID-19 pandemic. METHODS A mixed studies systematic review was conducted. Six electronic databases (Medline, CINAHL, Embase, PsycInfo, Web of Science, and Maternity and Infant Care) were searched for qualitative, observational, and mixed method studies from the year 2019 to February 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Quantitative findings were converted to narrative findings. Data was synthesised thematically using a convergent synthesis design. RESULTS Fifty-eight articles were included. Four themes were generated: (1) Distress associated with COVID-19 regulations (perception of hospital restrictions, confusion with ever changing policies), (2) adaptability with maternity services (prenatal: changes in birth plans, prenatal: altered antenatal appointments, education, and care, intrapartum: medicalization of birth, postpartum: varied views on care received and Breastfeeding woes, postpartum: skin-to-skin contact and mother infant bonding) (3) importance of support persons, and (4) future direction for maternity services. CONCLUSIONS Parental experiences highlighted how maternity care during the COVID-19 pandemic did not adhere to WHO standards of quality maternity care. This calls for healthcare institutions to continuously appraise the implementation of restrictive practices that deviate from evidence-based frameworks underpinning quality care.
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Affiliation(s)
- Joan Gabrielle Lalor
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier St, Dublin 2, Ireland
| | - Greg Sheaf
- The Library of Trinity College Dublin, Dublin 2, Ireland
| | - Andrea Mulligan
- School of Law, Trinity College Dublin, House 39, New Square, Dublin 2, Ireland
| | - Magdalena Ohaja
- School of Nursing and Midwifery, National University of Ireland Galway, Ireland
| | - Ashamole Clive
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier St, Dublin 2, Ireland
| | | | - Esperanza Debby Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11,10 Medical Drive, 117597, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11,10 Medical Drive, 117597, Singapore.
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21
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van de Grift TC. Masculinizing and defeminizing gender-affirming surgery. Best Pract Res Clin Obstet Gynaecol 2023:102323. [PMID: 36932000 DOI: 10.1016/j.bpobgyn.2023.102323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/24/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
Transmasculine transgender and gender-diverse individuals may request gender-affirming surgery, standalone or in addition to other interventions. The choices and preferred outcomes of surgery can be highly individual. Besides surgeons' technical skills and patient physique, professionals in this field should be able to cooperate with other disciplines and with patients. The most requested surgery is masculinizing chest surgery, aiming to create a masculine chest with minimal scarring. For genital surgery, metoidioplasty refers to the procedure where the hypertrophic clitoris is released and possibly a scrotum is created from local labia flaps, whereas phalloplasty refers to a procedure in which a neophallus is created from a flap. Possible other surgeries include hysterectomy/oophorectomy, colpectomy, and the implants of scrotal or erection prostheses. In order to guide patients and clinicians, standardized outcome measures as well as evidence-based decision aids have been developed. Such aids, in combination with collaborative medical and psychosocial care, may further leverage the long-term outcomes of these surgeries.
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Affiliation(s)
- Tim C van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam, the Netherlands; Department of Psychiatry and Medical Psychology, Zaans Medical Center, Zaandam, the Netherlands.
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22
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Gao Q, Peng L, Song S, Zhang Y, Shi Y. Assessment of healthcare quality among village clinicians in rural China: the role of internal work motivation. Hong Kong Med J 2023; 29:57-65. [PMID: 36754422 DOI: 10.12809/hkmj219871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION The quality of primary care is important for health outcomes among residents in China. There is evidence that internal work motivation improves the quality of healthcare provided by clinicians. However, few empirical studies have examined the relationship between internal work motivation and clinical performance among village clinicians in rural China. This study was performed to evaluate healthcare quality among village clinicians, then explore its relationships with internal work motivation among those clinicians. METHODS We collected survey data using a standardised patient method and a structured questionnaire. We observed 225 interactions between standardised patients and village clinicians from 21 counties in three provinces. We used logistic regression models to analyse the relationships between work motivation and healthcare quality, then conducted heterogeneity analysis. RESULTS Healthcare quality among village clinicians was generally low. There was a significantly positive correlation between internal work motivation and healthcare quality among village clinicians (P<0.1). Additionally, the positive effect of internal work motivation on healthcare quality was strongest among clinicians who received financial incentives and had a lighter workload (fewer patients per month) [P<0.1]. CONCLUSION Healthcare quality among village clinicians requires urgent improvement. We recommend implementing financial incentives to stimulate internal work motivation among village clinicians, thus improving their clinical performance.
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Affiliation(s)
- Q Gao
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - L Peng
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - S Song
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Y Zhang
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Y Shi
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
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23
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Ashinyo ME, Duti V, Dubik SD, Amegah KE, Alhassan RK. Experiences of postnatal mothers with quality of care including water, sanitation and hygiene amenities during the outbreak of COVID - 19 in Ghana: An institutional cross-sectional study. Public Health Pract (Oxf) 2023; 5:100361. [PMID: 36711002 PMCID: PMC9867557 DOI: 10.1016/j.puhip.2023.100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 01/23/2023] Open
Abstract
Objective To investigate the experiences and perceptions of postnatal mothers with quality of healthcare including WASH amenities among postnatal mothers in Ghana during the COVID-19 outbreak. Study design The study was an institutional cross-sectional. Methods The survey was conducted in six (6) regions across the northern, middle, and coastal belts of Ghana among postnatal mothers (n = 424). Eligible respondents accessed antenatal care (ANC) in 12 healthcare facilities (primary level and secondary level) during the outbreak of COVID-19 pandemic. Univariate ordered logistic regression analysis was conducted to predict determinants of overall perceived quality of healthcare and experiences with WASH amenities in healthcare facilities visited. Findings Privacy and confidentiality (mean score = 3.07) were the most highly rated quality indicator while the least rated indicator was dignity and respect of clients (mean score = 2.13). Approximately 50% of postnatal mothers reported paying out-of-pocket for essential ANC medications. Perceived quality of healthcare was positive among those who accessed care at a district/municipal hospital (Coef. = 1.29; 95%CI 0.45, 2.13, p = 0.003); co-habiting with a partner (Coef. = 1.64; 95%CI 0.64, 2.65, p = 0.001), and resident in an urban location (Coef. = 2.30; 95%CI 0.30, 3.30, p = 0.001). Mothers who accessed care at a district or municipal hospital (Coef. = 1.81; 95%CI 0.83, 2.78, p = 0.001); were co-habiting with a partner (Coef. = 1.92; 95%CI 0.76, 3.07, p = 0.001), and had a private health insurance cover (Coef. = 3.18; 95%CI 0.69, 5.67, p = 0.012) were more likely to rank WASH amenities better than their comparators. Conclusion Overall perception of postnatal mothers of healthcare quality including WASH amenities after outbreak of COVID-19 was good, but with significant concerns about dignity and respect accorded them during care and having to pay out-of-pocket for some ANC medications. Relevant managers, service providers and regulatory institutions are encouraged to initiate and sustain policy dialogues and stakeholder consultations on the healthcare quality care gaps established in this study. There is the need for more investments in WASH amenities in the health sector as a quality assurance strategy, especially for maternal and child health services.
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Affiliation(s)
- Mary Eyram Ashinyo
- Department of Quality Assurance, Institutional Care Division, Ghana Health Service Headquarters, Accra, Ghana,Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA,Corresponding author. Department of Quality Assurance, Institutional Care Division, Ghana Health Service Headquarters, Accra, Ghana.
| | - Vida Duti
- IRC Ghana, Cantonments, Accra, Ghana
| | - Stephen Dajaan Dubik
- School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Kingsley E. Amegah
- Department of Data Science and Economic Policy, University of Cape Coast, Ghana
| | - Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Godoy C, Paixão DC, Boa-Sorte NCA, Amorim T, da Silva Filho LVRF, Souza EL. Five-year performance analysis of a cystic fibrosis newborn screening program in northeastern Brazil. J Pediatr (Rio J) 2023; 99:23-30. [PMID: 35679883 DOI: 10.1016/j.jped.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To analyze the performance of the cystic fibrosis (CF) newborn screening (NBS) program over its first five years in a Brazilian northeastern state. METHOD A population-based study using a screening algorithm based on immunoreactive trypsinogen (IRT)/IRT. Data were retrieved from the state referral screening center registry. The program performance was evaluated using descriptive indicators such as the results of an active search, coverage, newborn's age at the time of blood sampling, the time between sample collection and its arrival at the laboratory, and the child's age at diagnosis of disease. RESULTS The public CF screening program covered 82.6% of the 1,017,576 births that occurred, with an accumulated five-year incidence of 1:20,767 live births. The median (25th-75th) age at diagnosis was 3.5 (2.3-7.3) months. The sampling before 7 days of life for the first IRT (IRT1) increased between 2013 and 2017 from 42.2 to 48.3%. Around 5% of IRT1 samples and 30% of the second samples were collected after 30 days of life. In the first and second stages of screening, 23.6% and 19.9% of the infants, respectively, were lost to follow-up. In both stages of screening, the samples were retained at the health units for a median (25th-75th) of 9.0 (7.0-13.0) days. CONCLUSIONS The coverage by the CF-NBS program was satisfactory as compared to other Brazilian state rates and the percentage of IRT1 samples collected within the first week of life increased progressively. However, time of samples retention at the health units, inappropriate sampling, inherent methodological problems, and loss of follow-up need to improve.
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25
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Gerlach C, Baus M, Gianicolo E, Bayer O, Haugen DF, Weber M, Mayland CR; ERANet-LAC CODE Core scientific group. What do bereaved relatives of cancer patients dying in hospital want to tell us? Analysis of free-text comments from the International Care of the Dying Evaluation (i-CODE) survey: a mixed methods approach. Support Care Cancer 2022; 31:81. [PMID: 36562882 DOI: 10.1007/s00520-022-07490-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE We conducted an international survey of bereaved relatives of cancer patients dying in hospitals in seven countries, with the aim to assess and improve the quality of care. The survey used the i-CODE (International Care of the Dying Evaluation) questionnaire. Here, we report findings from the free-text comments submitted with the questionnaires. We explored for topic areas which would potentially be important for improving the quality of care. Further, we examined who reported free-texts and in what way, to reduce bias without ignoring the function the free-texts may have for those contributing. METHODS We used a combined qualitative-quantitative approach: logistic regression analysis to study the effect of respondents' socio-demographic characteristics on the probability of free-texts contributions and thematic analysis to understand the free-text meaning. The primary survey outcomes, (1) how frequently the dying person was treated with dignity and respect and (2) support for the relative, were related to free-text content. RESULTS In total, 914 questionnaires were submitted; 457/914 (50%) contained free-text comments. We found no socio-demographic differences between the respondents providing free-texts and those who did not. We discovered different types of free-texts ("feedback," "narrative," "self-revelation") containing themes of which "continuity of care," "the one person who can make a difference," and "the importance of being a companion to the dying" represent care dimensions supplementing the questionnaire items. A free-text type of grateful feedback was associated with well perceived support for the relative. CONCLUSION Bereaved relatives used the free-texts to report details related to i-CODE items and to dimensions otherwise not represented. They highlighted the importance of the perceived support from human interaction between staff and the dying patient and themselves; and that more than professional competence alone, personal, meaningful interactions have profound importance.
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26
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Valenzano TJ, Bellicoso D, Morassaei S, Topolovec-Vranic J, Churchill K, Thomson N, Harris A, Jeffs L, Di Prospero L. Advancing Practice-Based Research among Nursing and Health Disciplines Professionals by Creating a Network of Leaders. J Med Imaging Radiat Sci 2022; 53:S71-S78. [PMID: 35232693 DOI: 10.1016/j.jmir.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/20/2022] [Accepted: 02/08/2022] [Indexed: 12/24/2022]
Abstract
Representatives from various practice-based research programs have come together to establish a Canadian Practice-Based Research Network (CP-BRN). CP-BRN is a collective of healthcare leaders focused on identifying approaches and leveraging resources to support clinician-led research to advance evidence-based practice. This paper presents an overview of the development of the CP-BRN, the proceedings from the inaugural meeting of CPBRN members, and recommendations for nursing and allied health profession leaders considering establishing their own practice-based research programs. Next steps for the network are to raise awareness of its mission, expand the network membership as to grow its influence among healthcare leaders and to further advance evidence-based practice across both healthcare and academic institutions.
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Affiliation(s)
- Teresa J Valenzano
- Interprofessional Practice Based Research, Practice, Unity Health Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Daniela Bellicoso
- Interprofessional Practice Based Research, Practice, Unity Health Toronto, Toronto, Canada
| | - Sara Morassaei
- Practice-Based Research and Innovation, Sunnybrook Health Sciences Centre, Toronto, Canada; School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Jane Topolovec-Vranic
- Interprofessional Practice Based Research, Practice, Unity Health Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Katie Churchill
- Health Professions Strategy & Practice, Alberta Health Service, Calgary, Canada; Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Nicole Thomson
- Quality, Innovation, Patient Safety & Experience, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Alexandra Harris
- Professional Practice, Trillium Health Partners, Mississauga, Canada; Institute for Better Health, Trillium Health Partners, Mississauga, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Lianne Jeffs
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Lisa Di Prospero
- Practice-Based Research and Innovation, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
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Kahles A, Goldschmid H, Volckmar AL, Plöger C, Kazdal D, Penzel R, Budczies J, Kempny G, Kazmierczak M, Flechtenmacher C, Baretton G, Weichert W, Horst D, Klauschen F, Gassner UM, Brüggemann M, Vogeser M, Schirmacher P, Stenzinger A. [Structure and content of the EU-IVDR : Current status and implications for pathology]. Pathologie (Heidelb) 2022; 43:351-364. [PMID: 35925306 PMCID: PMC9118816 DOI: 10.1007/s00292-022-01077-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Regulation (EU) 2017/746 on in vitro diagnostic medical devices (IVDR) was passed by the European Parliament and the Council of the European Union on 5 April 2017 and came into force on 26 May 2017. A new amending regulation, which introduces a phased implementation of the IVDR with new transitional provisions for certain in vitro diagnostic medical devices and a later date of application of some requirements for in-house devices for healthcare facilities, was adopted on 15 December 2021. The combined use of CE-IVDs, in-house IVDs, and RUO products are a cornerstone of diagnostics in pathology departments and crucial for optimal patient care. The IVDR not only regulates the manufacture and placement on the market of industrially manufactured IVDs, but also imposes conditions on the manufacture and use of IH-IVDs for internal use by healthcare facilities. OBJECTIVES Our work provides an overview of the background and structure of the IVDR and identifies core areas that need to be interpreted and fleshed out in the context of the legal framework as well as expert knowledge. CONCLUSIONS The gaps and ambiguities in the IVDR crucially require the expertise of professional societies, alliances, and individual stakeholders to successfully facilitate the implementation and use of the IVDR in pathology departments and to avoid aberrant developments.
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Affiliation(s)
- Andy Kahles
- Pathologisches Institut, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland.
| | - Hannah Goldschmid
- Pathologisches Institut, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland
| | - Anna-Lena Volckmar
- Pathologisches Institut, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland
| | - Carolin Plöger
- Pathologisches Institut, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland
| | - Daniel Kazdal
- Pathologisches Institut, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland
| | - Roland Penzel
- Pathologisches Institut, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland
| | - Jan Budczies
- Pathologisches Institut, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland
| | - Gisela Kempny
- Bundesverband Deutscher Pathologen e. V., Berlin, Deutschland
| | | | - Christa Flechtenmacher
- Pathologisches Institut, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland
| | - Gustavo Baretton
- Institut für Pathologie, Universitätsklinikum Dresden Carl Gustav Carus, Dresden, Deutschland
| | - Wilko Weichert
- Institut für Pathologie, Technische Universität München, München, Deutschland
| | - David Horst
- Institut für Pathologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | | | - Ulrich M Gassner
- Juristische Fakultät, Universität Augsburg, Augsburg, Deutschland
| | - Monika Brüggemann
- Klinik für Innere Medizin II, Sektion für Hämatologische Spezialdiagnostik, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Michael Vogeser
- Labormedizin, Klinische Massenspektrometrie, LMU München, München, Deutschland
| | - Peter Schirmacher
- Pathologisches Institut, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland
| | - Albrecht Stenzinger
- Pathologisches Institut, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland.
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Schenk L, Sonntag PT, Beck P, Khan Z, Peppler L, Schouler-Ocak M. Organisational and staff-related effects on cultural competence in the hospital setting: a cross-sectional online survey of nursing and medical staff. BMC Health Serv Res 2022; 22:644. [PMID: 35568939 DOI: 10.1186/s12913-022-07947-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/13/2022] [Indexed: 11/11/2022] Open
Abstract
Background Cultural competence is considered a core qualification for dealing with socio-cultural diversity and balancing disparities in health care. Objectives To explore features supporting and inhibiting cultural competence in the hospital at both organisational and staff levels. Design Cross-sectional online survey in the form of a full census from May to November 2018. Setting Two organisations that run a total of 22 hospitals in Germany. Participants Eight hundred nursing and medical professionals [nurses: n = 557; doctors: n = 243]. Methods Using the Short Form Cultural Intelligence SCALE (SFCQ), cultural competence was measured and its relation to potential influencing factors at staff level and organisational level examined, using bivariate (t-Test, one-way ANOVA, Pearson and Spearman correlations) and multivariate (multiple linear regression) approaches. Model 1 examined features at organisational level, Model 2 at individual level and Model 3 included organisational and individual features. Results The mean cultural competence measured was 3.49 [min.: 1.3; max.: 5.0]. In the bivariate and isolated multivariate models [Models 1 and 2], factors on both organisational and individual levels were significantly related to the hospital staff’s cultural competence. The multivariate overview [Model 3], however, revealed that individual features at staff level were the statistically relevant predictors. Positive influencing features included staff’s assessment of the importance of cultural competence in their professional context [B: 0.368, 95% confidence interval 0.307; 0.429], participation in competence training [B: 0.193; 95% confidence interval 0.112; 0.276] and having a migration background [B: 0.175; 95% confidence interval 0.074; 0.278], while negative features included length of medical service [B: -0.004; 95% confidence interval -0.007; -0.001]. Conclusions The development and practice of cultural competence appear to be determined less by organisational features and more on the level of individual actors. In addition to staff development, adequate organisational structures and an economic incentive system are required to promote sociocultural diversity in hospitals.
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Gupta N, Vrat P, Ojha R. Prioritizing enablers for service quality in healthcare sector - a DEMATEL approach. J Health Organ Manag 2022; ahead-of-print. [PMID: 35255202 DOI: 10.1108/jhom-06-2021-0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The Healthcare sector is one of the important sectors of the Service Industry. It is believed that in this sector, the customer server relationship is very critical, and even the slightest gap in the people quality may have a huge impact on the delivered service quality. Some of these enablers are doctors, nursing staff and support staff. Furthermore, the nonpeople quality enablers such as diagnostic services, facilities, hygiene levels and so on are also likely to impact the delivered service quality. It was also felt that the degree of impact each enabler has on the service quality could vary. Therefore there is a need for structured and deep analysis. The paper attempts to identify, analyze and prioritize the enablers that impact the delivered service quality. DESIGN/METHODOLOGY/APPROACH The enablers have been identified through literature review and inputs from experts in the healthcare fraternity. The authors have explored different decision-making tools such as analytic hierarchy process (AHP), analytic network process (ANP), stepwise weight assessment ratio analysis, Hybrid Model and DEMATEL (Decision-Making Trial and Evaluation Laboratory) for the analysis of data in this paper. Based on the strengths of the approach and careful considerations by focus group discussions, DEMATEL was chosen as the best option. It is simple, unique, sparingly used in the healthcare sector, effective in prioritizing and gives meaningful insights on importance, cause and effect factors. DEMATEL approach converts the complex problem with interrelated factors into a clear structure that makes simple interrelationships among factors in the form of cause and effects digraph, and hence, the authors chose to use it. A case study in one of the hospitals has also been conducted to demonstrate the applicability of the developed index. The case study very strongly validates the developed index. FINDINGS This research paper has found that there are people quality enablers such as the doctor, nursing staff, support staff and nonpeople quality enablers such as facilities, diagnostic services and hygiene levels maintenance, which impact the delivered service quality. It also concludes that the delivered service quality depends not only on the quality but also on the availability of these enablers. The inputs received from the experts have been run through the DEMATEL methodology and importance computed for each. The top five priority enablers are Quality of Doctor, Availability of Doctor, Quality of Support Staff, Quality of Nursing Staff and Availability of Support Staff. RESEARCH LIMITATIONS/IMPLICATIONS The weights of the enablers have been obtained using the DEMATEL tool. These weights have been calculated using the inputs from 22 experts, which meets the statistical requirement (Skulmoski, 2007). However, a larger group of experts can be reached, and based on the inputs received from them, the tool can be revalidated for repeatability and reproducibility. Using Fuzzy DEMATEL can also be explored for further analysis. PRACTICAL IMPLICATIONS The proposed framework to assess the service quality level of a healthcare organization is based on a sound approach of DEMATEL. The service index arrived, thereafter, can be used to rate the delivered service quality by any healthcare organization. It can be used to compare the similar type of healthcare organizations across locations. This Index can facilitate improvements in the healthcare organization through internal and external benchmarking. It also helps the organization to know the gaps, understand the root cause, improve upon them and become the best in class. This Index uses the inputs from the end customers to calculate the rating, which makes it more reliable and accurate. The overall scores obtained from the Index can provide the ranking to the healthcare providing organizations and options to customers to choose from best. The service quality index can be used by an organization to continuously monitor their delivered service quality scores and improve them to become the best in class. The research paper highlights the significant role played by the people quality and its strong impact/contribution on the delivered service quality. Hence, it is believed that it will encourage the healthcare organizations to prioritize the improvement and upgrade of the people quality over the nonpeople quality aspect. ORIGINALITY/VALUE Putting people and nonpeople quality enablers in one single model and assigning weights to them using the DEMATEL approach is a new application in healthcare. Developing an Index to measure the delivered service quality in the healthcare sector is also different and new.
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Affiliation(s)
- Nitin Gupta
- School of Management, The Northcap University, Gurugram, India
| | - Prem Vrat
- The Northcap University, Gurugram, India
| | - Ravindra Ojha
- Great Lakes Institute of Energy Management and Research, Gurgaon, India
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Geraedts M, de Cruppé W. [Effects of statutory quality assurance in acute inpatient care]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:285-292. [PMID: 35122107 PMCID: PMC8888375 DOI: 10.1007/s00103-022-03489-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Statutory quality assurance (QA) serves to ensure and further develop the quality of service provision. Particularly prominent in Germany's acute inpatient care are mandatory quality reports (QRs) and participation in external quality assessments (eQAs). Their effects have not yet been comprehensively evaluated. OBJECTIVES What are the effects of eQAs and QRs on the quality of care? MATERIALS AND METHODS Based on a selective literature review, international evidence on the effects of QA was compiled. This was supplemented by analyses of the quality reports of the Federal Office for Quality Assurance (BQS), the Institute for Applied Quality Improvement and Research in Health Care (AQUA), and the Institute for Quality Assurance and Transparency in Healthcare (IQTIG), which have been responsible for eQAs since 2001. RESULTS According to international literature, at most weak effects of these measures can be expected, especially on process quality. Studies from Germany mostly observe only uncontrolled temporal trends and partly show improved quality indicators. Only one controlled study each was able to show weak positive effects on outcome and process quality for eQAs and QRs, respectively. CONCLUSIONS There are no convincing evaluation results for either the QRs or the eQAs. Deficiencies in the addressee-oriented design of the QRs and the reported indicator results in terms of their validity, risk adjustment, and temporal availability can be cited as potential causes. Statutory QA should be revised by paying more attention to the prerequisites for successful performance feedback and by again creating room for an intrinsically motivated assessment of one's own quality of care.
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Affiliation(s)
- Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin, Philipps-Universität Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Deutschland.
| | - Werner de Cruppé
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin, Philipps-Universität Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Deutschland
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Riera-Vázquez NA, Gutiérrez-Alba G, Reyes-Morales H, Pavón-León P, Gogeascoechea-Trejo MC, Muños-Hernandez J. [Adverse events and essential actions for patient safety]. J Healthc Qual Res 2022; 37:239-246. [PMID: 35039248 DOI: 10.1016/j.jhqr.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The adverse events (AE) in hospitalized patients occur with increasing frequency due to the increase in complexity of medical care, which implies a greater risk of committing a human error inherent to the care, constituting a serious threat to the safety of the patient. MATERIAL AND METHODS Cross-sectional study, including patients older than 16years, with hospital stay longer than 24h and discharge from the general surgery service, patients treated in emergency observation units or other hospital services were not considered. AE were identified, classified by cause according to the essential actions for patient safety (EAPS), and compliance with the EAPS was verified. RESULTS 352 clinical records were reviewed, 61 (17%) were positive on screening. Of the positives, 66% resulted in AE (47 cases). The prevalence of AE was 13%. The AE were: 40% related to procedures; 39% with infections; 17% with medication; 4% with patient identification. The EAPS with the best rating was EAPS5 and the lowest rating was EAPS4. The night shifts with the greatest opportunity area, only with 40% and 44% correct procedures. CONCLUSIONS The study shows that the two methodologies used, one to identify AE and the other to establish its causes and classification according to the EAPS, demonstrated usefulness and synergy for patient safety, when detecting AE, as well as determining their causes and evaluate compliance with the EAPS.
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Affiliation(s)
- N A Riera-Vázquez
- Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, México.
| | - G Gutiérrez-Alba
- Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, México
| | - H Reyes-Morales
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - P Pavón-León
- Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, México
| | | | - J Muños-Hernandez
- Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, México
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Khanali J, Malekpour MR, Azangou-Khyavy M, Saeedi Moghaddam S, Rezaei N, Kolahi AA, Abbasi-Kangevari M, Mohammadi E, Rezaei N, Yoosefi M, Keykhaei M, Farzi Y, Gorgani F, Larijani B, Farzadfar F. Global, regional, and national quality of care of gallbladder and biliary tract cancer: a systematic analysis for the global burden of disease study 1990-2017. Int J Equity Health 2021; 20:259. [PMID: 34922531 PMCID: PMC8684179 DOI: 10.1186/s12939-021-01596-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To improve health outcomes to their maximum level, defining indices to measure healthcare quality and accessibility is crucial. In this study, we implemented the novel Quality of Care Index (QCI) to estimate the quality and accessibility of care for patients with gallbladder and biliary tract cancer (GBBTC) in 195 countries, 21 Global Burden of Disease (GBD) regions, Socio-demographic Index (SDI) quintiles, and sex groups. METHOD This cross-sectional study extracted estimates on GBBTC burden from the GBD 2017, which presents population-based estimates on GBBTC burden for higher than 15-year-old patients from 1990 to 2017. Four secondary indices indicating quality of care were chosen, comprising Mortality to incidence, Disability-Adjusted Life Year (DALY) to prevalence, prevalence to incidence, and years of life lost (YLL) to years lived with disability (YLD) ratios. Then, the whole dataset was analyzed using Principal Component Analysis to combine the four indices and create a single all-inclusive measure named QCI. The QCI was scaled to the 0-100 range, with 100 indicating the best quality of care among countries. Gender Disparity Ratio (GDR) was defined as the female to male QCI ratio to show gender inequity throughout the regions and countries. RESULTS Global QCI score for GBBTC was 33.5 in 2017, which has increased by 29% since 1990. There was a considerable gender disparity in favor of men (GDR = 0.74) in 2017, showing QCI has moved toward gender inequity since 1990 (GDR = 0.85). Quality of care followed a heterogeneous pattern among regions and countries and was positively correlated with the countries' developmental status reflected in SDI (r = 0.7; CI 95%: 0.61-0.76; P value< 0.001). Accordingly, High-income North America (QCI = 72.4) had the highest QCI; whereas, Eastern Sub-Saharan Africa (QCI = 3) had the lowest QCI among regions. Patients aged 45 to 80 had lower QCI scores than younger and older adults. The highest QCI score was for the older than 95 age group (QCI = 54), and the lowest was for the 50-54 age group (QCI = 26.0). CONCLUSIONS QCI improved considerably from 1990 to 2017; however, it showed heterogeneous distribution and inequity between sex and age groups. In each regional context, plans from countries with the highest QCI and best gender equity should be disseminated and implemented in order to decrease the overall burden of GBBTC.
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Affiliation(s)
- Javad Khanali
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Azangou-Khyavy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Keykhaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Gorgani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Torres Y, Rodríguez Y, Pérez E. [How to improve the quality of healthcare services and patient safety by adopting strategies from the aviation sector?]. J Healthc Qual Res 2021; 37:182-190. [PMID: 34887228 DOI: 10.1016/j.jhqr.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/26/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The World Health Organization recognizes patient safety as a priority as part of its global strategy to improve the quality of health services. However, several initiatives need to be integrated and systematized to increase the reliability of healthcare systems. This article discusses several management strategies developed in the aviation sector that have led to a drastic decrease in the accident rate. The aim is to describe each strategy and contrast them with their application in the healthcare sector. METHODS Different results and recommendations from the literature and institutions such as the World Health Organization and the International Civil Aviation Organization were consulted and compiled. A synthesis of the identified strategies was made, highlighting examples of their application and impact. RESULTS Five key strategies were identified: 1) no-blame incident reporting systems, 2) systematic use of checklists, 3) recurrent training and use of simulation, 4) management of fatigue and work schedules, and 5) management of teamwork. CONCLUSIONS The strategies from the aviation sector are presented as a valuable reference for improving patient safety and the quality of healthcare services. They should be consolidated and harmoniously integrated into the design and management of health systems.
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Affiliation(s)
- Y Torres
- Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Canadá.
| | - Y Rodríguez
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - E Pérez
- Facultad de Ingeniería Industrial, Universidad Pontificia Bolivariana, Medellín, Colombia
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Doblytė S. The vicious cycle of distrust: Access, quality, and efficiency within a post-communist mental health system. Soc Sci Med 2021; 292:114573. [PMID: 34814026 DOI: 10.1016/j.socscimed.2021.114573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/08/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Trust -a critical mechanism to manage vulnerability amidst uncertainty- may greatly influence healthcare practices, and consequently, its objectives. Building upon the work of Jürgen Habermas and the framework of trust chains, the aim of this article is to unpack how trust dynamics between the state, the provider, and the service user shape the functioning of mental healthcare in one of the former Soviet states -Lithuania. The case is of interest to medical sociology due to the region's historical and contemporary context. By drawing on in-depth interviews with healthcare providers and users, I demonstrate how the chains of reciprocal distrust underpin the workings of the mental health system and how the actors in turn employ a range of responses to such distrust. The instances of trusting relations nevertheless demonstrate how trust might facilitate the strive for mental healthcare that is more accessible, efficient, and of higher quality.
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Brouwers J, Cox B, Van Wilder A, Claessens F, Bruyneel L, De Ridder D, Eeckloo K, Vanhaecht K. The future of hospital quality of care policy: A multi-stakeholder discrete choice experiment in Flanders, Belgium. Health Policy 2021; 125:1565-1573. [PMID: 34689980 DOI: 10.1016/j.healthpol.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/04/2021] [Accepted: 10/10/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Collaboration between policymakers, patients and healthcare workers in hospital quality of care policy setting can improve the integration of new initiatives. The aim of this study was to quantify preferences for various characteristics of a future quality policy in a broad group of stakeholders. MATERIALS AND METHODS 450 policymakers, clinicians, nurses, patient representatives and hospital board members in Flanders (Belgium) participated in five discrete choice experiments (DCE) on quality control, quality improvement, inspection, patient incidents and transparency. For each DCE, various attributes and levels were defined from a literature review and interviews with 12 international quality and patient safety experts. RESULTS For the attributes with the highest relative importance, participants exhibited a strong preference for quality control by an independent national organization and coordination of quality improvement initiatives at the level of hospital networks. The individual hospital was chosen over the government for setting up an action plan following patient complaints. Respondents also strongly preferred mandatory reporting of severe patient incidents and transparency by publicly reporting quality indicators at the hospital level. CONCLUSIONS A future quality model should focus on a multicomponent approach with external quality control, improvement actions on hospital network level and public transparency. DCEs provide an opportunity to incorporate the attitudes and views for individual components of a new policy recommendation.
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Affiliation(s)
- Jonas Brouwers
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Orthopaedics, University Hospitals Leuven, Belgium.
| | - Bianca Cox
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Fien Claessens
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Quality Improvement, University Hospitals Leuven, Belgium
| | - Kristof Eeckloo
- Department of Primary Care and Public Health, Ghent University, Belgium; Strategic Policy Unit, Ghent University Hospital, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Quality Improvement, University Hospitals Leuven, Belgium
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Wilde H, Mellan T, Hawryluk I, Dennis JM, Denaxas S, Pagel C, Duncan A, Bhatt S, Flaxman S, Mateen BA, Vollmer SJ. The association between mechanical ventilator compatible bed occupancy and mortality risk in intensive care patients with COVID-19: a national retrospective cohort study. BMC Med 2021; 19:213. [PMID: 34461893 PMCID: PMC8404408 DOI: 10.1186/s12916-021-02096-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/16/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The literature paints a complex picture of the association between mortality risk and ICU strain. In this study, we sought to determine if there is an association between mortality risk in intensive care units (ICU) and occupancy of beds compatible with mechanical ventilation, as a proxy for strain. METHODS A national retrospective observational cohort study of 89 English hospital trusts (i.e. groups of hospitals functioning as single operational units). Seven thousand one hundred thirty-three adults admitted to an ICU in England between 2 April and 1 December, 2020 (inclusive), with presumed or confirmed COVID-19, for whom data was submitted to the national surveillance programme and met study inclusion criteria. A Bayesian hierarchical approach was used to model the association between hospital trust level (mechanical ventilation compatible), bed occupancy, and in-hospital all-cause mortality. Results were adjusted for unit characteristics (pre-pandemic size), individual patient-level demographic characteristics (age, sex, ethnicity, deprivation index, time-to-ICU admission), and recorded chronic comorbidities (obesity, diabetes, respiratory disease, liver disease, heart disease, hypertension, immunosuppression, neurological disease, renal disease). RESULTS One hundred thirty-five thousand six hundred patient days were observed, with a mortality rate of 19.4 per 1000 patient days. Adjusting for patient-level factors, mortality was higher for admissions during periods of high occupancy (> 85% occupancy versus the baseline of 45 to 85%) [OR 1.23 (95% posterior credible interval (PCI): 1.08 to 1.39)]. In contrast, mortality was decreased for admissions during periods of low occupancy (< 45% relative to the baseline) [OR 0.83 (95% PCI 0.75 to 0.94)]. CONCLUSION Increasing occupancy of beds compatible with mechanical ventilation, a proxy for operational strain, is associated with a higher mortality risk for individuals admitted to ICU. Further research is required to establish if this is a causal relationship or whether it reflects strain on other operational factors such as staff. If causal, the result highlights the importance of strategies to keep ICU occupancy low to mitigate the impact of this type of resource saturation.
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Affiliation(s)
- Harrison Wilde
- Department of Statistics, University of Warwick, Coventry, CV4 7AL, UK
| | - Thomas Mellan
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
| | - Iwona Hawryluk
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
| | - John M Dennis
- Institute of Biomedical & Clinical Science, RILD Building, Royal Devon & Exeter Hospital, University of Exeter Medical School, Barrack Road, Exeter, EX2 5DW, UK
| | - Spiros Denaxas
- The Alan Turing Institute, British Library, 96 Euston Road, London, NW1 2DB, UK
- Institute of Health Informatics, University College London, 222 Euston Rd, London, London, NW1 2DA, UK
- Health Data Research UK, Gibbs Building, 215 Euston Road, London, NW1 2BE, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, 222 Euston Rd, London, London, NW1 2DA, UK
| | - Andrew Duncan
- The Alan Turing Institute, British Library, 96 Euston Road, London, NW1 2DB, UK
- Department of Mathematics, Imperial College, London, London, UK
| | - Samir Bhatt
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
| | - Seth Flaxman
- Department of Mathematics, Imperial College, London, London, UK
| | - Bilal A Mateen
- The Alan Turing Institute, British Library, 96 Euston Road, London, NW1 2DB, UK.
- Institute of Health Informatics, University College London, 222 Euston Rd, London, London, NW1 2DA, UK.
- The Wellcome Trust, Gibbs Building, 215 Euston Road, London, NW1 2BE, UK.
| | - Sebastian J Vollmer
- Department of Statistics, University of Warwick, Coventry, CV4 7AL, UK
- The Alan Turing Institute, British Library, 96 Euston Road, London, NW1 2DB, UK
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Lehmann E, Hodiamont F, Landmesser M, Knobloch CS, Nauck F, Ostgathe C, Grüne B, Bausewein C. Adaptation of the Australian Palliative Care Phase concept to the German palliative care context: a mixed-methods approach using cognitive interviews and cross-sectional data. BMC Palliat Care 2021; 20:128. [PMID: 34391419 PMCID: PMC8364299 DOI: 10.1186/s12904-021-00825-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Palliative care phases (stable, unstable, deteriorating, terminal and bereavement) are routinely used in Australia and the UK to describe the clinical situation of patients and their families and to evaluate the associated care plan. In addition, it serves as a benchmark developed by the Australian Palliative Care Outcome Collaboration (PCOC) and is used nationwide for comparisons between services. In Germany, the concept is not used consistently due to various translations. Furthermore, there is no nationwide systematic approach to routinely assess clinical outcomes in palliative care. The study aims to develop a German version of the palliative care phase definitions by adapting them culturally, and to examine the inter-rater reliability of the adjusted definitions with healthcare professionals. METHODS Mixed-methods approach: Cognitive interview study using 'think aloud' and verbal probing techniques and a consecutive multi-center cross-sectional study with two clinicians independently assigning the phase definitions. Interviewees/participants were selected through convenience and purposive sampling in specialist palliative care inpatient units, advisory and community services and in three specialist palliative care units with doctors, nursing staff and allied health professionals. RESULTS Fifteen interviews were conducted. Identified difficulties were: Some translated terms were 1) not self-explanatory (e.g. 'family/carer' or 'care plan') and (2) too limited to the medical dimension neglecting the holistic approach of palliative care. (3) Problems of comprehension regarding the concept in general occurred, e.g. in differentiating between the 'unstable' and 'deteriorating' phase. Inter-rater reliability was moderate (kappa = 0.44; 95% CI = 0.39-0.52). The assignment of the phase 'deteriorating' has caused the most difficulties. CONCLUSION Overall, the adapted palliative care phases are suitable to use in the German specialist palliative care setting. However, the concept of the phases is not self-explanatory. To implement it nationwide for outcome measurement/benchmarking, it requires further education, on-the-job training and experience as well as the involvement of healthcare professionals in implementation process. For the use of international concepts in different healthcare systems, a deeper discussion and cultural adaptation is necessary besides the formal translation.
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Affiliation(s)
- Eva Lehmann
- Department, of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Farina Hodiamont
- Department, of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Mirjam Landmesser
- Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Carina S Knobloch
- Department of Palliative Medicine, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Friedemann Nauck
- Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Bettina Grüne
- Department, of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claudia Bausewein
- Department, of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Abstract
PURPOSE The purpose of this project was to determine the validity and reliability of the Healthcare Quality Perception (HQP) questionnaire tool designed to capture employees' perceptions of healthcare quality in Indian hospitals. DESIGN/METHODOLOGY/APPROACH Two hundred employees in private and public sector hospitals in India were randomly selected and given the HQP tool. It consisted of 38 Likert-scale items and six different subscales: (1) Planning and Documentation (n = 7); (2) Employee Participation in Quality Management Activities (n = 5); (3) Existence of Policies/Procedures/Guidelines (n = 5); (4) Quality and Patient Safety Management (n = 9); (5) Perceived Effect of Quality Improvement (n = 7) and (6) Training and Development Opportunities (n = 5). 156 completed questionnaires were received, demonstrating a 78% response rate. HQP tool subjected to statistical analysis to measure its reliability and validity. A p-value of less than 0.05 was considered as "significant." FINDINGS Factor analysis pulled out six factors that conjointly demonstrated 66.4 % of the variance in healthcare professionals' (HCPs') perception of healthcare service quality in selected Indian hospitals. The overall Cronbach's alpha coefficient was measured at 0.959 for internal consistency reliability. This study demonstrates that the identified six critical factors are important determinants influencing HCPs' perception of the quality of healthcare services in private and public sector hospitals in India. ORIGINALITY/VALUE This study provides evidence for the reliability and validity of the newly developed HCP Scale for the assessment of employee perception of the quality of services offered in selected hospitals in India, with potential applications in other contexts.
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Affiliation(s)
- Ajayan Kamalasanan
- Department of Business Administration, Annamalai University, Chidambaram, India.,Department of Quality Measurement and Evaluation, Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Arun Vijay Subbarayalu
- Department of Quality Measurement and Evaluation, Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Sorra J, Zebrak K, Carpenter D, Famolaro T, Rauch J, Li J, Davis T, Nguyen HQ, McIntosh M, Mitchell S, Hirschman KB, Levine C, Clouser JM, Brock J, Williams MV. Development and psychometric properties of surveys to assess patient and family caregiver experience with care transitions. BMC Health Serv Res 2021; 21:785. [PMID: 34372847 PMCID: PMC8353769 DOI: 10.1186/s12913-021-06766-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 07/15/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study was to develop and administer surveys that assess patient and family caregiver experiences with care transitions and examine the psychometric properties of the surveys. The surveys were designed to ask about 1) the transitional care services that matter most to patients and their caregivers and 2) care outcomes, including the overall quality of transitional care they received, patient self-reported health, and caregiver effort/stress. METHODS Survey items were developed based on a review of the literature, existing surveys, focus groups, site visits, stakeholder and expert input, and patient and caregiver cognitive interviews. We administered mail surveys with telephone follow up to patients recently discharged from 43 U.S. hospitals. Patients identified the caregivers who helped them during their hospital stay (Time 1 caregiver) and when they were home (Time 2 caregiver). Time 1 and Time 2 caregivers were surveyed by telephone only. The psychometric properties of the survey items and outcome composite measures were examined for each of the three surveys. Items that performed poorly across multiple analyses, including those with low variability and/or a high missing data, were dropped except when they were conceptually important. RESULTS The analysis datasets included responses from 9282 patients, 1245 Time 1 caregivers and 1749 Time 2 caregivers. The construct validity of the three proposed outcome composite measures-Overall Quality of Transitional Care (patient and caregiver surveys), Patient Overall Health (patient survey) and Caregiver Effort/Stress (caregiver surveys) -was supported by acceptable exploratory factor analysis results and acceptable internal consistency reliability. Site-level reliability was acceptable for the two patient outcome composite measures, but was low for Caregiver Effort/Stress (< 0.70). In all surveys, the Overall Quality of Transitional Care outcome composite measure was significantly correlated with other outcome composite measures and most of the single-item measures. CONCLUSIONS Overall, the final patient and caregiver surveys are psychometrically sound and can be used by health systems, hospitals, and researchers to assess the quality of care transitions and related outcomes. Results from these surveys can be used to improve care transitions, focusing on what matters most to patients and their family caregivers.
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Affiliation(s)
| | | | | | | | | | - Jing Li
- Center for Health Services Research, University of Kentucky, Lexington, Kentucky, USA
| | - Terry Davis
- Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Huong Q Nguyen
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Megan McIntosh
- Center for Health Services Research, University of Kentucky, Lexington, Kentucky, USA
| | - Suzanne Mitchell
- Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts, USA
| | - Karen B Hirschman
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | | | | | - Jane Brock
- Telligen, Greenwood Village, Colorado, USA
| | - Mark V Williams
- Center for Health Services Research, University of Kentucky, Lexington, Kentucky, USA
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Gaziel-Yablowitz M, Bates DW, Levine DM. Telehealth in US hospitals: State-level reimbursement policies no longer influence adoption rates. Int J Med Inform 2021; 153:104540. [PMID: 34332467 DOI: 10.1016/j.ijmedinf.2021.104540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/02/2021] [Accepted: 07/15/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Prior to COVID-19, levels of adoption of telehealth were low in the U.S., though they exploded during the pandemic. Following the pandemic, it will be critical to identify the characteristics that were associated with adoption of telehealth prior to the pandemic as key drivers of adoption and outside of a public health emergency. MATERIALS AND METHODS We examined three data sources: The American Telemedicine Association's 2019 state telehealth analysis, the American Hospital Association's 2018 annual survey of acute care hospitals and its Information Technology Supplement. Telehealth adoption was measured through five telehealth categories. Independent variables included seven hospital characteristics and five reimbursement policies. After bivariate comparisons, we developed a multivariable model using logistic regression to assess characteristics associated with telehealth adoption. RESULTS Among 2923 US hospitals, 73% had at least one telehealth capability. More than half of these hospitals invested in telehealth consultation services and stroke care. Non-profit hospitals, affiliated hospitals, major teaching hospitals, and hospitals located in micropolitan areas (those with 10-50,000 people) were more likely to adopt telehealth. In contrast, hospitals that lacked electronic clinical documentation, were unaffiliated with a hospital system, or were investor-owned had lower odds of adopting telehealth. None of the statewide policies were associated with adoption of telehealth. CONCLUSIONS Telehealth policy requires major revisions soon, and we suggest that these policies should be national rather than at the state level. Further steps as incentivizing rural hospitals for adopting interoperable systems and expanding RPM billing opportunities will help drive adoption, and promote equity.
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Affiliation(s)
- Michal Gaziel-Yablowitz
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Health Care Policy and Management, Harvard Chan School of Public Health, Boston, MA, USA
| | - David M Levine
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Shepherd J, Waller A, Sanson-Fisher R, Clark K. Nurses' perceptions, experiences and involvement in the provision of end-of-life care in acute hospitals: A mapping review of research output, quality and effectiveness. Int J Nurs Stud 2021; 122:104007. [PMID: 34298319 DOI: 10.1016/j.ijnurstu.2021.104007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/10/2021] [Accepted: 06/17/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Safe and high-quality end of life care is not always achieved in acute care hospitals. Nurses represent a key source of information about current practice, and active participants in interventions to improve end of life care in these settings. Examining the volume, type and quality of publications in this field can help to determine whether research is following a natural scientific progression to inform best-practice end of life care. AIMS To systematically review: (i) whether the volume and type of publications (i.e. measurement, descriptive or interventions studies) examining nurses' perceptions of, and involvement in, end-of-life care delivered in acute hospitals changed over time (i.e. since 2000); (ii) the proportion of intervention studies involving nurses that meet Risk of Bias research design criteria; and (iii) the effectiveness of intervention studies that met minimum Risk of Bias criteria. METHODS MEDLINE, Embase, CINAHL, and PsychInfo were searched for data-based papers published in English between Jan 2000 and Dec 2020. Studies were included if they focused on nurses' perceptions of, or role in, the provision of end-of-life care in hospitals. Eligible papers were classified as descriptive, measurement or intervention studies. Intervention studies were assessed against the Risk of Bias methodological criteria for research design, and their effectiveness examined. RESULTS A total of 131 papers met eligibility criteria for inclusion in the review. The number increased by 31% in each time period (p < 0.0001). Most studies were descriptive (n = 70; 53%), 11 were measurement studies (8%), and the remainder were intervention studies (n = 50; 38%). Thirteen intervention studies (26%) met eligibility criteria. Methodological quality of the eligible intervention studies was variable. Randomisation and blinding of outcome assessors were the domains of greatest concern. Results were variable, with larger, system-wide interventions that incorporated the expertise of the multidisciplinary healthcare team showing the most promise. CONCLUSION There is an increasing number of studies examining nurses' perceptions of, and involvement in, end-of-life care delivered in acute hospitals. The difficulties of conducting intervention research in this field mean that many studies are descriptive in nature. Given the importance of intervention research in establishing causal relationships, larger-scale intervention studies are essential to improving the quality of end-of-life care provided to patients dying in hospital.
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Affiliation(s)
- Jan Shepherd
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Amy Waller
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Rob Sanson-Fisher
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Katherine Clark
- Northern Sydney Local Health District, Royal North Shore Hospital Campus, Reserve Road, St Leonards, NSW 2065, Australia; Northern Clinical School, The University of Sydney, Royal North Shore Hospital Campus, Reserve Road, St Leonards, NSW 2065, Australia
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Stokstad T, Sørhaug S, Amundsen T, Grønberg BH. Associations Between Time to Treatment Start and Survival in Patients With Lung Cancer. In Vivo 2021; 35:1595-1603. [PMID: 33910841 DOI: 10.21873/invivo.12416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/11/2021] [Accepted: 03/18/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Time-to-treatment is defined as a quality indicator for cancer care but is not well documented. We investigated whether meeting Norwegian timeframes of 35/42 days from referral until start of chemotherapy or surgery/radiotherapy for lung cancer was associated with survival. PATIENTS AND METHODS The medical records of 439 lung cancer patients at a regional cancer center were reviewed and categorized according to treatment: (i) surgery; ii) radical radiotherapy; iii) stereotactic radiotherapy; iv) palliative treatment, no cancer symptoms; v) palliative treatment with severe cancer symptoms). RESULTS Proportions receiving timely treatment varied significantly at 39%, 48%, 10%, 44% and 89%, respectively (p<0.001). Overall, those starting treatment on time had the shortest median overall survival (10.6 vs. 22.6 months; p<0.001). This was also the case for palliative (5.3 vs. 11.4 months) (p<0.001) but not for curative treatment (not reached vs. 38.3 months) (p=0.038). CONCLUSION Timely treatment is not necessarily associated with improved survival.
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Affiliation(s)
- Trine Stokstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Gynecology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sveinung Sørhaug
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Thoracic Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tore Amundsen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Thoracic Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bjørn H Grønberg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; .,Department of Oncology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Aujla N, Ilori T, Irabor A, Obimakinde A, Owoaje E, Fayehun O, Ajisola MM, Bolaji SO, Watson SI, Hofer TP, Omigbodun A, Lilford RJ. Development of a video-observation method for examining doctors' clinical and interpersonal skills in a hospital outpatient clinic in Ibadan, Oyo State, Nigeria. BMC Health Serv Res 2021; 21:488. [PMID: 34022859 PMCID: PMC8141168 DOI: 10.1186/s12913-021-06491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the quality of primary healthcare provision is a key goal in low-and middle-income countries (LMICs). However, to develop effective quality improvement interventions, we first need to be able to accurately measure the quality of care. The methods most commonly used to measure the technical quality of care all have some key limitations in LMICs settings. Video-observation is appealing but has not yet been used in this context. We examine preliminary feasibility and acceptability of video-observation for assessing physician quality in a hospital outpatients' department in Nigeria. We also develop measurement procedures and examine measurement characteristics. METHODS Cross-sectional study at a large tertiary care hospital in Ibadan, Nigeria. Consecutive physician-patient consultations with adults and children under five seeking outpatient care were video-recorded. We also conducted brief interviews with participating physicians to gain feedback on our approach. Video-recordings were double-coded by two medically trained researchers, independent of the study team and each other, using an explicit checklist of key processes of care that we developed, from which we derived a process quality score. We also elicited a global quality rating from reviewers. RESULTS We analysed 142 physician-patient consultations. The median process score given by both coders was 100 %. The modal overall rating category was 'above standard' (or 4 on a scale of 1-5). Coders agreed on which rating to assign only 44 % of the time (weighted Cohen's kappa = 0.26). We found in three-level hierarchical modelling that the majority of variance in process scores was explained by coder disagreement. A very high correlation of 0.90 was found between the global quality rating and process quality score across all encounters. Participating physicians liked our approach, despite initial reservations about being observed. CONCLUSIONS Video-observation is feasible and acceptable in this setting, and the quality of consultations was high. However, we found that rater agreement is low but comparable to other modalities that involve expert clinician judgements about quality of care including in-person direct observation and case note review. We suggest ways to improve scoring consistency including careful rater selection and improved design of the measurement procedure for the process score.
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Affiliation(s)
- Navneet Aujla
- Warwick Medical School, University of Warwick, C/O Room B147a, CV4 7AL, Coventry, United Kingdom.
| | - Temitope Ilori
- University College Hospital, Ibadan, Nigeria.,University of Ibadan, Ibadan, Nigeria
| | | | - Abimbola Obimakinde
- University College Hospital, Ibadan, Nigeria.,University of Ibadan, Ibadan, Nigeria
| | | | | | | | | | - Samuel I Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Timothy P Hofer
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Negrini R, da Silva Ferreira RD, Guimarães DZ. Value-based care in obstetrics: comparison between vaginal birth and caesarean section. BMC Pregnancy Childbirth 2021; 21:333. [PMID: 33902486 DOI: 10.1186/s12884-021-03798-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare costs have substantially increased in recent years, threatening the population health. Obstetric care is a significant contributor to this scenario since it represents 20% of healthcare. The rate of cesarean sections (C-sections) has escalated worldwide. Evidence shows that cesarean delivery is not only more expensive, but it is also linked to poorer maternal and neonatal outcomes. This study assesses which type of delivery is associated with a higher healthcare value in low-risk pregnancies. Results A total of 9345 deliveries were analyzed. The C-section group had significantly worse rates of breastfeeding in the first hour after delivery (92.57% vs 88.43%, p < 0.001), a higher rate of intensive unit care (ICU) admission both for the mother and the newborn (0.8% vs 0.3%, p = 0.001; 6.7% vs 4.5%, p = 0.0078 respectively), and a higher average cost of hospitalization (BRL14,342.04 vs BRL12,230.03 considering mothers and babies). Conclusion Cesarean deliveries in low-risk pregnancies were associated with a lower value delivery because in addition to being more expensive, they had worse perinatal outcomes.
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Côté A, Abasse KS, Laberge M, Gilbert MH, Breton M, Lemaire C. Orthopedist involvement in the management of clinical activities: a case study. BMC Health Serv Res 2021; 21:299. [PMID: 33794873 PMCID: PMC8017788 DOI: 10.1186/s12913-021-06299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rapid shift in hospital governance in the past few years suggests greater orthopedist involvement in management roles, would have wide-reaching benefits for the efficiency and effectiveness of healthcare delivery. This paper analyzes the dynamics of orthopedist involvement in the management of clinical activities for three orthopedic care pathways, by examining orthopedists' level of involvement, describing the implications of such involvement, and indicating the main responses of other healthcare workers to such orthopedist involvement. METHODS We selected four contrasting cases according to their level of governance in a Canadian university hospital center. We documented the institutional dynamics of orthopedist involvement in the management of clinical activities using semi-structured interviews until data saturation was reached at the 37th interview. RESULTS Our findings show four levels (Inactive, Reactive, Contributory and Active) of orthopedist involvement in clinical activities. With the underlying nature of orthopedic surgeries, there are: (i) some activities for which decisions cannot be programmed in advance, and (ii) others for which decisions can be programmed. The management of unforeseen events requires a higher level of orthopedist involvement than the management of events that can be programmed. CONCLUSIONS Beyond simply identifying the underlying dynamics of orthopedists' involvement in clinical activities, this study analyzed how such involvement impacts management activities and the quality-of-care results for patients.
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Affiliation(s)
- André Côté
- Centre de recherche en gestion des services de santé, Université Laval, Québec City, Canada.,Faculté des sciences de l'administration (FSA), Université Laval, Québec, QC, G1V 0A6, Canada.,Centre de recherche en soins et services de première ligne- Université Laval, Québec, Canada.,Centre de recherche du centre hospitalier de l'Université Laval, Québec, Canada.,Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Québec, Canada
| | - Kassim Said Abasse
- Centre de recherche en gestion des services de santé, Université Laval, Québec City, Canada. .,Faculté des sciences de l'administration (FSA), Université Laval, Québec, QC, G1V 0A6, Canada. .,Centre de recherche en soins et services de première ligne- Université Laval, Québec, Canada. .,Centre de recherche du centre hospitalier de l'Université Laval, Québec, Canada. .,Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Québec, Canada.
| | - Maude Laberge
- Faculté des sciences de l'administration (FSA), Université Laval, Québec, QC, G1V 0A6, Canada.,Centre de recherche en soins et services de première ligne- Université Laval, Québec, Canada.,Centre de recherche du centre hospitalier de l'Université Laval, Québec, Canada.,Département d'opérations et systèmes de décision
- , Faculté des sciences de l'administration (FSA) Université Laval, Québec, QC, G1V 0A6, Canada
| | - Marie-Hélène Gilbert
- Centre de recherche en gestion des services de santé, Université Laval, Québec City, Canada.,Faculté des sciences de l'administration (FSA), Université Laval, Québec, QC, G1V 0A6, Canada
| | - Mylaine Breton
- Université de Sherbrooke, Longueuil Campus, Sherbrooke, Canada
| | - Célia Lemaire
- EM Strasbourg Business School, Université de Strasbourg, HuManiS (UR 7308), Strasbourg, France
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Boyd LAP, Waller AE, Hill D, Sanson-Fisher RW. Brain cancer patient and support persons' experiences of psychosocial care: a mapping of research outputs. Support Care Cancer 2021; 29:5559-69. [PMID: 33710411 DOI: 10.1007/s00520-021-06071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND People with brain cancer and their support persons (SPs) are critical sources of information on the components of care that contribute to psychosocial outcomes. AIMS To determine the proportion of studies that examined (1) at least one of 14 nominated components of psychosocial cancer care and (2) more than one component of care. METHODS Medline, The Cochrane Library, PsycINFO and Embase were electronically searched for publications from January 1999 to December 2019. Publications that met the inclusion criteria were coded according to the number and type of psychosocial care components assessed from 14 listed components, and whether patient and/or SPs' views about care were elicited. RESULTS Of the 113 included publications, 61 publications included patient-reported data only (54%), 27 included both patient and SP-reported data (24%) and 25 included SP-reported data only (22%). Most assessed a single component of care (77% of patient-reported and 71% of SP-reported). No publications assessed all 14 components. The "Psychosocial" component was the most frequently assessed component of care for patient-reported (n = 80/88, 91%) and SP-reported publications (n = 46/52, 88%). CONCLUSIONS Publications reporting on psychosocial care in brain cancer present a relatively narrow view of patient and support person experiences. The inclusion of both patient and support person perspectives and the assessment of multiple components of care are required in future research to optimize psychosocial outcomes in brain cancer.
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Shiner B, Westgate CL, Gui J, Cornelius S, Maguen SE, Watts BV, Schnurr PP. Measurement Strategies for Evidence-Based Psychotherapy for Posttraumatic Stress Disorder Delivery: Trends and Associations with Patient-Reported Outcomes. Adm Policy Ment Health 2021; 47:451-467. [PMID: 31853686 DOI: 10.1007/s10488-019-01004-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We sought to develop a quality standard for the delivery of psychotherapy for posttraumatic stress disorder (PTSD) that is both consistent with the underlying evidence supporting psychotherapy as a treatment for PTSD and associated with the best levels of symptom improvement. We quantified psychotherapy receipt during the initial year of PTSD treatment in a 10-year national cohort of Department of Veterans Affairs (VA) users who completed patient-reported outcome measurement as part of routine practice. We added progressively stringent measurement requirements. The most stringent requirement was associated with superior outcomes. Quality of psychotherapy for PTSD in the VA improved over time.
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Affiliation(s)
- Brian Shiner
- White River Junction VA Medical Center, 215 North Main Street, White River Junction, VT, USA.
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
- National Center for PTSD Executive Division, White River Junction, VT, USA.
| | | | - Jiang Gui
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Sarah Cornelius
- White River Junction VA Medical Center, 215 North Main Street, White River Junction, VT, USA
| | - Shira E Maguen
- San Francisco VA Medical Center, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
| | - Bradley V Watts
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- VA Office of Systems Redesign and Improvement, Washington, DC, USA
| | - Paula P Schnurr
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- National Center for PTSD Executive Division, White River Junction, VT, USA
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Deckert S, Arnold K, Becker M, Geraedts M, Brombach M, Breuing J, Bolster M, Assion C, Birkner N, Buchholz E, Carl EG, Diel F, Döbler K, Follmann M, Harfst T, Klinkhammer-Schalke M, Kopp I, Lebert B, Lühmann D, Meiling C, Niehues T, Petzold T, Schorr S, Tholen R, Wesselmann S, Voigt K, Willms G, Neugebauer E, Pieper D, Nothacker M, Schmitt J. [Methodological Standard for the Development of Quality Indicators within Clinical Practice Guidelines - Results of a structured consensus process]. Z Evid Fortbild Qual Gesundhwes 2021; 160:21-33. [PMID: 33483285 DOI: 10.1016/j.zefq.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/11/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recommendations of evidence- and formally consensus-based clinical practice guidelines (CPGs) represent a valuable source of quality indicators (QIs). Nevertheless, a standardized methodological procedure for developing QIs in the context of CPGs does not yet exist in Germany for all CPGs. For this reason, a methodological standard for the guideline-based development of QIs (QI Standard) was developed based on a structured consensus process involving multiple key stakeholders. METHODS The proposed content of the QI Standard was derived from evidence, drawing upon results of reviews and qualitative studies, and considered German manuals for guideline-based QI development of two guideline programs. A multi-perspective consensus panel, broadly representing key stakeholders from the German healthcare system with expertise in CPGs and/or quality management, was nominated to vote on recommendations for guideline-based development of QIs. The iterative, structured consensus process included a two-stage online survey based on the Delphi method ("preliminary voting") and a moderated final stakeholder conference where all those recommendations were definitely included in the QI Standard that received approval of more than 75 % (consensus criterion) of the consensus panel. RESULTS Based on the agreed QI Standard, the QI development process starts with a criteria-based selection of "potential" QIs which - in case of adoption - are published in CPGs as "preliminary" QIs and can achieve the status "final" after successful testing. The QI Standard is composed of a total of 30 recommendations, which are allocated to six areas: A) preparatory work steps for the guideline-based recommendation of QIs, B) QI development group and cooperation with the CPG group, C) development of potential QIs, D) critical appraisal of potential QIs, E) formal adoption and publication as well as F) piloting/testing of preliminary QIs and conversion into final QIs. DISCUSSION Before the QI Standard can be recommended for implementation in future CPGs, it should have been successfully tested in selected German CPG projects. In addition to methodological requirements for the QI development, it must be ensured that guideline groups have adequate resources for the implementation of the QI Standard. CONCLUSION By using the QI Standard, scientifically sound and healthcare-relevant QIs can be expected.
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Affiliation(s)
- Stefanie Deckert
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland.
| | - Katrin Arnold
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Monika Becker
- IFOM - Institut für Forschung in der Operativen Medizin, Department für Humanmedizin Universität Witten/Herdecke, Köln, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin, Philipps-Universität Marburg, Marburg, Deutschland
| | - Marie Brombach
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Jessica Breuing
- IFOM - Institut für Forschung in der Operativen Medizin, Department für Humanmedizin Universität Witten/Herdecke, Köln, Deutschland
| | - Marie Bolster
- AWMF-Institut für Medizinisches Wissensmanagement (AWMF-IMWi), c/o Philipps-Universität, Marburg, Deutschland
| | - Cornelia Assion
- Bundesministerium für Gesundheit (BMG), Referat 214 - Qualitätssicherung, Evidenzbasierte Medizin, Berlin, Deutschland
| | - Norbert Birkner
- BQS Institut für Qualität & Patientensicherheit, Hamburg, Deutschland
| | - Eva Buchholz
- Interessenvertretung Selbstbestimmt Leben in Deutschland e.V. (ISL), Berlin, Deutschland; Zentrum für Versorgungsforschung Brandenburg (ZVF-BB), Medizinische Hochschule Brandenburg Theodor Fontane, c/o Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | | | - Franziska Diel
- Kassenärztliche Bundesvereinigung (KBV), Dezernat Versorgungsqualität, Berlin, Deutschland
| | - Klaus Döbler
- Kompetenzzentrum Qualitätssicherung / Qualitätsmanagement (KCQ), MDK Baden-Württemberg, Stuttgart, Deutschland
| | - Markus Follmann
- Deutsche Krebsgesellschaft e.V., Leitlinienprogramm Onkologie, Berlin, Deutschland
| | - Timo Harfst
- Bundespsychotherapeutenkammer, Berlin, Deutschland
| | | | - Ina Kopp
- AWMF-Institut für Medizinisches Wissensmanagement (AWMF-IMWi), c/o Philipps-Universität, Marburg, Deutschland
| | - Burkhard Lebert
- Frauenselbsthilfe Krebs - Bundesverband e.V., Bonn, Deutschland
| | - Dagmar Lühmann
- Institut und Poliklinik für Allgemeinmedizin, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Claudia Meiling
- Deutscher Verband der Ergotherapeuten e.V., Referat Standards und Qualität, Karlsbad, Deutschland
| | - Tim Niehues
- Helios Klinikum Krefeld, Zentrum für Kinder- und Jugendmedizin, Krefeld, Deutschland
| | - Thomas Petzold
- Gesellschaft für Qualitätsmanagement in der Gesundheitsversorgung e.V. (GQMG), Köln, Deutschland
| | - Susanne Schorr
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin, Deutschland
| | - Reina Tholen
- Deutscher Verband für Physiotherapie (ZVK) e.V., Köln, Deutschland
| | - Simone Wesselmann
- Deutsche Krebsgesellschaft e.V., Zertifizierung, Berlin, Deutschland
| | - Karen Voigt
- Bereich Allgemeinmedizin/MK3, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland; Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM), Berlin, Deutschland
| | - Gerald Willms
- aQua - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen, Göttingen, Deutschland
| | - Edmund Neugebauer
- IFOM - Institut für Forschung in der Operativen Medizin, Department für Humanmedizin Universität Witten/Herdecke, Köln, Deutschland; Medizinische Hochschule Brandenburg - Theodor Fontane, Neuruppin, Deutschland
| | - Dawid Pieper
- IFOM - Institut für Forschung in der Operativen Medizin, Department für Humanmedizin Universität Witten/Herdecke, Köln, Deutschland
| | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement (AWMF-IMWi), c/o Philipps-Universität, Marburg, Deutschland
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
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49
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Avellaneda-Martínez S, Jiménez-Mayoral A, Humada-Calderón P, Redondo-Pérez N, Del Río-García I, Martín-Santos AB, Maté-Espeso A, Fernández-Castro M. [Management of communication between inpatients isolated due to COVID-19 and their families]. J Healthc Qual Res 2021; 36:12-8. [PMID: 33349562 DOI: 10.1016/j.jhqr.2020.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/11/2020] [Accepted: 10/02/2020] [Indexed: 12/23/2022]
Abstract
Antecedentes y objetivo La calidad asistencial se ha podido ver afectada por las dimensiones de la pandemia de COVID-19 y el estricto aislamiento hospitalario al que han sido sometidos los pacientes. Por ello, se plantea describir el proceso diseñado para facilitar la comunicación de los pacientes aislados con sus familias, detectar sus necesidades y realizar intervenciones individualizadas. Método Estudio cualitativo con metodología de investigación acción, respondiendo al siguiente algoritmo: planificar la acción, diagnóstico de la necesidad e hipótesis-acción; aplicar la acción, creación del grupo de gestores de casos y formación de los miembros; observar la acción, recoger y analizar la información. Durante el mes de abril del 2020. Resultados Se realizaron 1.754 interacciones que afectaron a 490 pacientes. Los gestores de casos realizaron 767 llamadas dirigidas principalmente a facilitar información sobre el ingreso (71,45%) y cambios de ubicación o funcionamiento de las unidades (18,84%). Recibieron un total de 1.098 llamadas de familiares solicitando: información médica (43,8%), comunicación con los pacientes (18,48%), entrega de enseres personales o gestión de objetos extraviados (12,84%) e información sobre la ubicación del paciente o gestión del alta (10,20%). En el 66% de los casos las llamadas fueron resueltas por los gestores, el 30% fueron derivadas y el 4% fallidas. Conclusiones La puesta en funcionamiento del grupo de gestores de casos ha contribuido a mejorar la comunicación de los pacientes ingresados y aislados por COVID-19 con sus familias, dando respuesta a las necesidades planteadas, mejorando la calidad asistencial y favoreciendo la humanización en los cuidados.
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50
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Seleznev I, Alibekova R, Clementi A. Patient satisfaction in Kazakhstan: Looking through the prism of patient healthcare experience. Patient Educ Couns 2020; 103:2368-2372. [PMID: 32448625 DOI: 10.1016/j.pec.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This study aimed to explore the relationship between patient satisfaction and patient experience after exposure to inpatient hospitalization. METHODS A cross-sectional self-completed survey at the bedside in the Inpatient departments of the University Medical Center hospitals (UMC) in Nur-Sultan city, Kazakhstan was submitted. A total of 153 patients completed the survey from September 2017 to June 2018. The survey used the Picker Patient Experience questionnaire validated in Russian and Kazakh languages. RESULTS The majority of patients were satisfied with their hospital stay (90.8 %). Only self-rated health status was associated with overall satisfaction (OR 1.922, 95 % CI 1.09-3.37). Patient experience assessment revealed an association of physical comfort and respect for patient preferences with overall satisfaction (OR 0.101, 95 % CI 0.01-0.91 and OR 0.317, 95 % CI 0.11-0.92). CONCLUSIONS Study findings support that patient satisfaction is an exaggerated image of healthcare performance. Groups with negative experience have shown lower overall satisfaction in the dimensions 'physical comfort' and 'respect for patient preferences'. PRACTICE IMPLICATIONS Improving patient centered communication and pain control in clinical practice may lead to the improvement in patient satisfaction.
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Affiliation(s)
- Ilya Seleznev
- Nazarbayev University School of Medicine, Nursultan, Kazakhstan
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