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Wang W, Li M, Loban K, Zhang J, Wei X, Mitchel R. Electronic health record and primary care physician self-reported quality of care: a multilevel study in China. Glob Health Action 2024; 17:2301195. [PMID: 38205626 PMCID: PMC10786430 DOI: 10.1080/16549716.2023.2301195] [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: 04/23/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Health information technology is one of the building blocks of a high-performing health system. However, the evidence regarding the influence of an electronic health record (EHR) on the quality of care remains mixed, especially in low- and middle-income countries. OBJECTIVE This study examines the association between greater EHR functionality and primary care physician self-reported quality of care. METHODS A total of 224 primary care physicians from 38 community health centres (CHCs) in four large Chinese cities participated in a cross-sectional survey to assess CHC care quality. Each CHC director scored their CHC's EHR functionality on the availability of ten typical features covering health information, data, results management, patient access, and clinical decision support. Data analysis utilised hierarchical linear modelling. RESULTS The availability of five EHR features was positively associated with physician self-reported clinical quality: share records online with providers outside the practice (β = 0.276, p = 0.04), access records online by the patient (β = 0.325, p = 0.04), alert provider of potential prescription problems (β = 0.353, p = 0.04), send the patient reminders for care (β = 0.419, p = 0.003), and list patients by diagnosis or health risk (β = 0.282, p = 0.04). However, no association was found between specific features availability or total features score and physician self-reported preventive quality. CONCLUSIONS This study provides evidence that the availability of EHR systems, and specific features of these systems, was positively associated with physician self-reported quality of care in these 38 CHCs. Future longitudinal studies focused on standardised quality metrics, and designed to control known confounding variables, will further inform quality improvement efforts in primary care.
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Affiliation(s)
- Wenhua Wang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, PR China
| | - Mengyao Li
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, PR China
| | - Katya Loban
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada
| | - Jinnan Zhang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, PR China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Rebecca Mitchel
- Health and Wellbeing Research Unit (HoWRU), Macquarie Business School, Macquarie University, Sydney, Australia
- Newcastle Business School, University of Newcastle, Newcastle, Australia
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Abdalla R, Pavlova M, Groot W. Association of patient experience and the quality of hospital care. Int J Qual Health Care 2023; 35:mzad047. [PMID: 37405854 PMCID: PMC10321378 DOI: 10.1093/intqhc/mzad047] [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: 02/26/2023] [Revised: 05/26/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
The association between patient experience and the quality of hospital care is controversial. We assess the association between clinical outcomes and patient-reported experience measures (PREMs) in hospitals in Saudi Arabia. Knowledge on this issue informs value-based health-care reforms. A retrospective observational study was conducted in 17 hospitals in Saudi Arabia during the period of 2019-22. Hospital data were collected on PREMs, mortality, readmission, length of stay (LOS), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and surgical site infection. Descriptive analysis was used to describe hospital characteristics. Spearman's rho correlation tests were used to assess the correlation between these measures, and multivariate generalized linear mixed model regression analysis was used to study associations while controlling for hospital characteristics and year. Our analysis showed that PREMs were negatively correlated with hospital readmission rate (r = -0.332, P ≤ .01), LOS (r = -0.299, P ≤ .01), CLABSI (r = -0.297, P ≤ .01), CAUTI (r = -0.393, P ≤ .01), and surgical site infection (r = -0.298, P ≤ .01). The results indicated that CAUTI and LOS converged negatively with PREMs (β = -0.548, P = .005; β = -0.873, P = .008, respectively) and that larger hospitals tended to have better patient experience scores (β =0.009, P = .003). Our findings suggest that better performance in clinical outcomes is associated with higher PREM scores. PREMs are not a substitute or surrogate for clinical quality. Yet, PREMs are complementary to other objective measures of patient-reported outcomes, the process of care, and clinical outcomes.
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Affiliation(s)
- Rawia Abdalla
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, Limburg 6200 MD, The Netherlands
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, Limburg 6200 MD, The Netherlands
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, Limburg 6200 MD, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, P.O. Box 616, Maastricht, Limburg 6200 MD, The Netherlands
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Isola G, Nucera R, Damonte S, Ugolini A, De Mari A, Migliorati M. Implant Site Changes in Three Different Clinical Approaches: Orthodontic Extrusion, Regenerative Surgery and Spontaneous Healing after Extraction: A Systematic Review. J Clin Med 2022; 11:6347. [PMID: 36362575 PMCID: PMC9655824 DOI: 10.3390/jcm11216347] [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: 09/19/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 09/16/2023] Open
Abstract
Both surgical and non-surgical techniques are employed for implant site development. However, the efficacy of these methods has not been thoroughly evaluated and compared. This systematic review aims to compare the biologic, functional and esthetic outcomes of three different approaches before implant placement in both the maxillary and mandibular arches: orthodontic extrusion, regenerative surgery and spontaneous healing after extraction. The systematic research of articles was conducted up to January 2020 in Medline, Scopus and the Cochrane Library databases. Studies were selected in a three-stage process according to the title, the abstract and the inclusion criteria. The methodological quality and the risk of bias of the included studies were evaluated using ROBINS-I tools for non-randomized studies, Rob 2.0 for RCT. Quality evaluation of case reports was performed using CARE guidelines. Through the digital search, 1607 articles were identified, and 25 of them were included in the systematic review. The qualitative evaluation showed a good methodological quality for RCT, sufficient for non-randomized studies and poor for case reports. Based on the available results, both orthodontic extrusion and regenerative surgery allowed the development of the implant site with satisfying esthetic and functional outcomes. Studies about the spontaneous healing of the extraction socket showed resorption of the edentulous ridge, which complicated the implant insertion. No study referred to failures or severe complications. Most of the studies reported only qualitative results. The present systematic review demonstrated that there is a substantial lack of data and evidence to determine which of the presented methods is better for developing a future implant site. Both surgical and non-surgical procedures appear effective in the regeneration of hard tissue, whereas not all the techniques can improve soft tissue volume, too. The orthodontic technique simultaneously enhances both hard and soft tissue.
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Affiliation(s)
- Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95123 Catania, Italy
| | - Riccardo Nucera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, University of Messina, 98100 Messina, Italy
| | - Silvia Damonte
- Department of Orthodontics, Genova University, 16100 Genova, Italy
| | | | - Anna De Mari
- Department of Orthodontics, Genova University, 16100 Genova, Italy
| | - Marco Migliorati
- Department of Orthodontics, Genova University, 16100 Genova, Italy
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Pronovost PJ, Ata GJ, Carson B, Gordon Z, Smith GA, Khaitan L, Kraay MJ. What Is a Center of Excellence? Popul Health Manag 2022; 25:561-567. [PMID: 35231195 DOI: 10.1089/pop.2021.0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter J Pronovost
- Department of Anesthesia and Critical Care Medicine, School of Medicine, Case Western Reserve University, University Hospitals, Shaker Heights, Ohio, USA
| | - George J Ata
- Adult Specialty Care, University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - Brent Carson
- Adult Specialty Care, University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - Zachary Gordon
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, University Hospitals Spine Institute, Cleveland, Ohio, USA
| | - Gabriel A Smith
- Department of Neurosurgery, University Hospitals, St. John and Southwest General Medical Centers, University Hospitals Spine Institute, Cleveland, Ohio, USA
| | - Leena Khaitan
- Department of Surgery, Metabolic and Bariatric Nutrition Center, University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - Matthew J Kraay
- Department of Orthopaedic Surgery, Center for Joint Replacement and Preservation, University Hospitals Cleveland Medical Center
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Han A, Park J. Disparate Impacts of Two Public Reporting Initiatives on Clinical and Perceived Quality in Healthcare. Risk Manag Healthc Policy 2021; 14:5015-5025. [PMID: 34938137 PMCID: PMC8685764 DOI: 10.2147/rmhp.s337596] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Transparency is increasingly viewed as a prerequisite for value-based health care that invites quality in the assessment of achieved value. However, nowadays the ability of transparency initiatives to enhance quality of care remains obscure, if not rejected. Thus, this study aims to investigate how transparency initiatives influence two types of quality of care: clinical and perceived quality. Methods First, factor analyses were conducted to construct three dependent variables: healthcare-associated infections (HAIs), 30-day readmission rates, and patient satisfaction. Then, the three quality models were compared by running ordinary least squares multiple regressions using STATA 14.1. The existence of heteroskedasticity was remedied by using robust standard errors. Results Examining general acute care hospitals in the US, the present study noted that the ability of public reporting to improve quality of care remains inconclusive and that the pursuit of transparency may lead to inadvertent results. The disclosure of all-payer claims data (APCD) was found to have the power to differentiate hospitals’ clinical and perceived quality, but it failed to reach the desired outcomes without market pressure. The impact of transparency on quality of care diverges depending on the unique characteristics of each transparency policy, even though they pursue the same ends through information dissemination. Furthermore, the same public policy showed starkly disparate impacts on clinical quality (eg, healthcare-associated infections (HAIs) and 30-day readmission rates) and perceived quality (eg, patient satisfaction). Conclusion Despite the theoretically acknowledged merits of transparency, the present study noted that its ability to enhance quality of care remains inconclusive, and the pursuit of transparency may even inadvertently harm quality of care. While hospitals may need to finetune their strategies for each quality measurement in order to cope with the new environmental pressure, it is health policymakers’ role to coordinate those quality metrics and improve the validity of patient experience measures and surveys.
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Affiliation(s)
- Ahreum Han
- Department of Health Care Administration, Trinity University, San Antonio, TX, USA
| | - Jongsun Park
- Department of Public Administration, Gachon University, Seongnam-si, Gyeonggi-do, South Korea
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Feng Y, Gravelle H. Patient Self-Reported Health, Clinical Quality, and Patient Satisfaction in English Primary Care: Practice-Level Longitudinal Observational Study. Value Health 2021; 24:1660-1666. [PMID: 34711367 DOI: 10.1016/j.jval.2021.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/22/2021] [Revised: 04/20/2021] [Accepted: 05/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To examine the association of self-reported health of patients in general practices, as measured by the EQ-5D-5L, with practice clinical quality and patient-reported satisfaction with accessibility and consultations. METHODS We used data from the General Practitioner (GP) Patient Survey to construct a practice-level EQ-5D-5L index as the health outcome. Key explanatories were patient-reported measures of satisfaction with access and consultations (also derived from the GP Patient Survey) and clinical quality measured by the achievement of clinical quality indicators reported in the Quality and Outcomes Framework. We estimated practice-level linear panel data models with random and fixed practice effects and practice and patient covariates using 2012/13 to 2016/17 data on more than 7500 English general practices. RESULTS Bivariate correlations of the EQ-5D-5L index with quality measures were 0.048 for clinical quality, 0.071 for satisfaction with access, and 0.107 for satisfaction with GP consultations (all with P<.001). In both fixed effects regressions, which allow for unobserved time invariant practice characteristics, and random effects regressions which do not, the EQ-5D-5L index was positively associated with 1-year lags of patient satisfaction with access and GP consultations. Patient-reported health was positively associated with clinical quality in the fixed effects regressions. The implied effects were small in all cases. CONCLUSION Practice-level EQ-5D-5L is positively associated with clinical quality and with 1-year lags of patient-reported satisfaction with access and GP consultations.
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Affiliation(s)
- Yan Feng
- Institute of Population Health Sciences, Queen Mary University of London, England, UK.
| | - Hugh Gravelle
- Centre for Health Economics, University of York, England, UK
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7
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Jin B, Nembhard IM. Effects of affiliation network membership on hospital quality and financial performance. Health Serv Res 2021; 57:248-258. [PMID: 34490641 DOI: 10.1111/1475-6773.13876] [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: 01/11/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the effects of hospital membership in affiliation networks-franchise-like networks sponsored by high-quality health systems in which affiliate hospitals pay an annual fee for access to sponsor's operational and clinical resources-on clinical quality, patient experience ratings, and financial performance of affiliates and their competitors. DATA SOURCES Network membership data from press releases and websites of four sponsors (Mayo Clinic, Cleveland Clinic, MD Anderson, Memorial Sloan Kettering), American Hospital Association's Annual Survey, Centers for Medicare & Medicaid Services' Hospital Compare, and Healthcare Cost Report Information System, all for 2005-2016. STUDY DESIGN We used a quasi-experimental design and estimated hospital-level regressions with hospital-fixed effects. Dependent variables were measures of clinical quality, patient experience, and financial performance. Independent variables included an indicator for affiliate versus nonaffiliate and fixed effects for hospital characteristics and year. To analyze effects on competitors, we repeated analyses by comparing hospitals in the same county as an affiliate to nonaffiliated, noncompetitor hospitals. DATA COLLECTION Membership was obtained through press releases and network websites then linked across datasets by name and Medicare's identification number. PRINCIPAL FINDINGS Across networks, affiliates (N = 199) experienced insignificant clinical quality changes but increased net income by $38,500 and operating margin by 6.6% (p values = 0.01-0.08) compared to nonaffiliates. Multispecialty affiliates improved on no measures. Cancer-specific affiliates improved their net income ($96,900) and operating margin (3.6%; p-values < 0.05). Affiliates' competitors experienced mixed changes in clinical measures relative to hospitals without affiliates in market (p-value < 0.05) but no financial effects. Affiliation was not associated with patient experience ratings for affiliates nor competitors. CONCLUSIONS Despite quality-focused missions, affiliation networks are not guaranteed to improve public measures of quality in affiliated hospitals, although hospitals in these communities improve financially. Future research should assess the conditions and mechanisms by which affiliation improves quality consistently and which forms of quality.
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Affiliation(s)
- Bonnie Jin
- Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Ingrid M Nembhard
- Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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A. Rahim AI, Ibrahim MI, Musa KI, Chua SL. Facebook Reviews as a Supplemental Tool for Hospital Patient Satisfaction and Its Relationship with Hospital Accreditation in Malaysia. Int J Environ Res Public Health 2021; 18:ijerph18147454. [PMID: 34299905 PMCID: PMC8306730 DOI: 10.3390/ijerph18147454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 02/05/2023]
Abstract
Patient satisfaction is one indicator used to assess the impact of accreditation on patient care. However, traditional patient satisfaction surveys have a few disadvantages, and some researchers have suggested that social media be used in their place. Social media usage is gaining popularity in healthcare organizations, but there is still a paucity of data to support it. The purpose of this study was to determine the association between online reviews and hospital patient satisfaction and the relationship between online reviews and hospital accreditation. We used a cross-sectional design with data acquired from the official Facebook pages of 48 Malaysian public hospitals, 25 of which are accredited. We collected all patient comments from Facebook reviews of those hospitals between 2018 and 2019. Spearman’s correlation and logistic regression were used to evaluate the data. There was a significant and moderate correlation between hospital patient satisfaction and online reviews. Patient satisfaction was closely connected to urban location, tertiary hospital, and previous Facebook ratings. However, hospital accreditation was not found to be significantly associated with online reports of patient satisfaction. This groundbreaking study demonstrates how Facebook reviews can assist hospital administrators in monitoring their institutions’ quality of care in real time.
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Affiliation(s)
- Afiq Izzudin A. Rahim
- Department of Community Medicine, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; (A.I.A.R.); (K.I.M.)
| | - Mohd Ismail Ibrahim
- Department of Community Medicine, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; (A.I.A.R.); (K.I.M.)
- Correspondence: ; Tel.: +60-97676621; Fax: +60-97653370
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; (A.I.A.R.); (K.I.M.)
| | - Sook-Ling Chua
- Faculty of Computing and Informatics, Persiaran Multimedia, Multimedia University, Cyberjaya 63100, Selangor, Malaysia;
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Marcinek JP, Sripipatana A, Lin S. Preventive Care and Chronic Disease Management Comparison of Appalachian and Non-Appalachian Community Health Centers in the United States. J Appalach Health 2020; 2:41-52. [PMID: 35770206 PMCID: PMC9138755 DOI: 10.13023/jah.0203.06] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Introduction The Appalachian region is often characterized by poor health outcomes and economic depression. Health centers (HCs) are community-based and patient-directed organizations that deliver comprehensive, culturally competent, high-quality primary healthcare services in high need areas, including Appalachia, where economic, geographic, or cultural factors can hinder access to healthcare services. Purpose The study compares the clinical quality performance in preventive care and chronic disease management between Appalachian HCs and their non-Appalachian counterparts. Methods Using 2015 Uniform Data System (UDS) health center data, bivariate and multivariate linear regression analyses examine the association of Appalachian HC with performance on preventive and chronic care clinical quality measures (CQMs). Results In the multivariate analysis, patients served at Appalachian HCs are more likely to receive colorectal cancer screening and pediatric weight assessment and counseling than at non-Appalachian HCs. No statistically significant differences in performance observed among other CQMs. The percentage of Medicaid patients and total physician FTEs have positive associations with preventive care in colorectal and cervical cancer screening, pediatric weight assessment and counseling, and tobacco screening and cessation intervention as well as chronic disease management of aspirin therapy for ischemic vascular disease and hypertension control in the multivariate model. Implications Overall Appalachian HCs perform as well as or better than non-Appalachian HCs in delivering preventive and chronic care services. Further examination of clinical quality improvement programs, insurance payer mix, and practice size among Appalachian HCs could advance the replication of clinical quality success for clinics in similar underserved communities.
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Affiliation(s)
- Julie P Marcinek
- Robert Graham Center for Policy Studies in Primary Care, Washington DC
| | - Alek Sripipatana
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care
| | - Sue Lin
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care
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Rios-Zertuche D, Zúñiga-Brenes P, Palmisano E, Hernández B, Schaefer A, Johanns CK, Gonzalez-Marmol A, Mokdad AH, Iriarte E. Methods to measure quality of care and quality indicators through health facility surveys in low- and middle-income countries. Int J Qual Health Care 2019; 31:183-190. [PMID: 29917087 PMCID: PMC6464097 DOI: 10.1093/intqhc/mzy136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 09/13/2017] [Revised: 05/02/2018] [Accepted: 05/31/2018] [Indexed: 12/28/2022] Open
Abstract
Objective Present methods to measure standardized, replicable and comparable metrics to measure quality of medical care in low- and middle-income countries. Design We constructed quality indicators for maternal, neonatal and child care. To minimize reviewer judgment, we transformed criteria from check-lists into data points and decisions into conditional algorithms. Distinct criteria were established for each facility level and type of care. Indicators were linked to discharge diagnoses. We designed electronic abstraction tools using computer-assisted personal interviewing software. Setting We present results for data collected in the poorest areas of Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and the state of Chiapas in Mexico (January—October 2014). Results We collected data from 12 662 medical records. Indicators show variations of quality of care between and within countries. Routine interventions, such as quality antenatal care (ANC), immediate neonatal care and postpartum contraception, had low levels of compliance. Records that complied with quality ANC ranged from 68.8% [confidence interval (CI):64.5–72.9] in Costa Rica to 5.7% [CI:4.0–8.0] in Guatemala. Less than 25% of obstetric and neonatal complications were managed according to standards in all countries. Conclusions Our study underscores that, with adequate resources and technical expertise, collecting data for quality indicators at scale in low- and middle-income countries is possible. Our indicators offer a comparable, replicable and standardized framework to identify variations on quality of care. The indicators and methods described are highly transferable and could be used to measure quality of care in other countries.
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Affiliation(s)
- Diego Rios-Zertuche
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Apartado postal: 0816-02900 zona 5, Panamá, Panamá
| | - Paola Zúñiga-Brenes
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Apartado postal: 0816-02900 zona 5, Panamá, Panamá
| | - Erin Palmisano
- Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, USA
| | - Bernardo Hernández
- Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, USA
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, USA
| | - Casey K Johanns
- Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, USA
| | - Alvaro Gonzalez-Marmol
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Apartado postal: 0816-02900 zona 5, Panamá, Panamá
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, USA
| | - Emma Iriarte
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Apartado postal: 0816-02900 zona 5, Panamá, Panamá
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Abstract
Background Monitoring hospital outcomes and clinical processes as a measure of clinical performance is an integral part of modern health care. The risk-adjusted cumulative sum (CUSUM) chart is a frequently used sequential analysis technique that can be implemented to monitor a wide range of different types of outcomes. Objective The aim of this study was to describe how risk-adjusted CUSUM charts based on population-based nationwide medical registers were used to monitor 30-day mortality in Danish hospitals and to give an example on how alarms of increased hospital mortality from the charts can guide further in-depth analyses. Materials and methods We used routinely collected administrative data from the Danish National Patient Registry and the Danish Civil Registration System to create risk-adjusted CUSUM charts. We monitored 30-day mortality after hospital admission with one of 77 selected diagnoses in 24 hospital units in Denmark in 2015. The charts were set to detect a 50% increase in 30-day mortality, and control limits were determined by simulations. Results Among 1,085,576 hospital admissions, 441,352 admissions had one of the 77 selected diagnoses as their primary diagnosis and were included in the risk-adjusted CUSUM charts. The charts yielded a total of eight alarms of increased mortality. The median of the hospitals’ estimated average time to detect a 50% increase in 30-day mortality was 50 days (interquartile interval, 43;54). In the selected example of an alarm, descriptive analyses indicated performance problems with 30-day mortality following hip fracture surgery and diagnosis of chronic obstructive pulmonary disease. Conclusion The presented implementation of risk-adjusted CUSUM charts can detect significant increases in 30-day mortality within 2 months, on average, in most Danish hospitals. Together with descriptive analyses, it was possible to use an alarm from a risk-adjusted CUSUM chart to identify potential performance problems.
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Affiliation(s)
| | | | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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Mühlemann S, Benic GI, Fehmer V, Hämmerle CHF, Sailer I. Clinical quality and efficiency of monolithic glass ceramic crowns in the posterior area: digital compared with conventional workflows. Int J Comput Dent 2018; 21:215-223. [PMID: 30264050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this clinical study was to test whether or not digital workflows for the fabrication of crowns render different clinical outcomes from the conventional pathway with respect to (1) crown quality, and (2) time efficiency. MATERIAL AND METHODS For each of the 10 patients in need of one tooth-supported crown, five monolithic crowns were produced out of lithium disilicate reinforced glass ceramic. Four different optical impression and associated computer-aided design/computer-aided manufacturing (CAD/CAM) systems were used for crown fabrication (digital workflows): (1) Lava C.O.S. scanner and Lava C.O.S. and CARES CAD software, centralized CAM (group L); (2) Cadent iTero scanner, CARES CAD software and centralized CAM (group iT); (3) Cerec Bluecam, Cerec Connect CAD software, followed by laboratory-based CAM (group CiL); and (4) centralized CAM (group CiD). The conventional crown (group K) was fabricated based on a conventional silicone impression followed by a conventional wax-up and heat press technique. The examiners were blinded and evaluated the crowns clinically at the bisque-bake stage (initial try-in), and subsequently after finalization by a dental technician (final try-in). For the assessment of crown quality, modified United States Public Health Service (USPHS) criteria were used. Treatment times were recorded for clinical evaluation and adjustment. The quality ratings were analyzed descriptively. For both the continuous and ordinal outcomes, the non-parametric paired Wilcoxon test was applied, together with an appropriate Bonferroni correction to evaluate the differences between treatment groups. The results of the statistical analysis were interpreted globally at the significance level P = 0.05. RESULTS The clinical evaluation during the initial and final try-ins demonstrated similar clinical outcome measures for crowns generated with the four digital workflows and the conventional workflow. No statistically significant differences of crown quality in any state were found between groups (P > 0.005). The total clinical treatment times measured were: 456 ± 240 s for L; 655 ± 374 s for iT; 783 ± 403 s for CiL; 556 ± 285 s for CiD; and 833 ± 451 s for K. No statistically significant differences in treatment times were found between the groups (P > 0.05). CONCLUSIONS Within the limitations of the present study, the monolithic ceramic crowns resulting from the four different CAD/CAM systems did not differ from the conventionally produced crowns with respect to the clinical quality rating and the treatment time efficiency.
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Ricci-Cabello I, Stevens S, Dalton ARH, Griffiths RI, Campbell JL, Valderas JM. Identifying Primary Care Pathways from Quality of Care to Outcomes and Satisfaction Using Structural Equation Modeling. Health Serv Res 2017; 53:430-449. [PMID: 28217876 DOI: 10.1111/1475-6773.12666] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To study the relationships between the different domains of quality of primary health care for the evaluation of health system performance and for informing policy decision making. DATA SOURCES A total of 137 quality indicators collected from 7,607 English practices between 2011 and 2012. STUDY DESIGN Cross-sectional study at the practice level. Indicators were allocated to subdomains of processes of care ("quality assurance," "education and training," "medicine management," "access," "clinical management," and "patient-centered care"), health outcomes ("intermediate outcomes" and "patient-reported health status"), and patient satisfaction. The relationships between the subdomains were hypothesized in a conceptual model and subsequently tested using structural equation modeling. PRINCIPAL FINDINGS The model supported two independent paths. In the first path, "access" was associated with "patient-centered care" (β = 0.63), which in turn was strongly associated with "patient satisfaction" (β = 0.88). In the second path, "education and training" was associated with "clinical management" (β = 0.32), which in turn was associated with "intermediate outcomes" (β = 0.69). "Patient-reported health status" was weakly associated with "patient-centered care" (β = -0.05) and "patient satisfaction" (β = 0.09), and not associated with "clinical management" or "intermediate outcomes." CONCLUSIONS This is the first empirical model to simultaneously provide evidence on the independence of intermediate health care outcomes, patient satisfaction, and health status. The explanatory paths via technical quality clinical management and patient centeredness offer specific opportunities for the development of quality improvement initiatives.
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Affiliation(s)
- Ignacio Ricci-Cabello
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Robert I Griffiths
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John L Campbell
- APEx Collaboration for Academic Primary Care, Institute for Health Services Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jose M Valderas
- APEx Collaboration for Academic Primary Care, Institute for Health Services Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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Salzano KA, Maurer CA, Wyvratt JM, Stewart T, Peck J, Rygiel B, Petree T. A Knowledge Management Framework and Approach for Clinical Development. Ther Innov Regul Sci 2016; 50:536-545. [PMID: 30231759 DOI: 10.1177/2168479016664773] [Citation(s) in RCA: 8] [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] [Indexed: 11/16/2022]
Abstract
A knowledge management (KM) framework enhances knowledge gathering, sharing, application, and retention within clinical development and enables the effective and successful implementation of a clinical quality management system (QMS). The goal of managing knowledge is to improve organizational performance by getting the right information to the right people at the right time. The concepts of KM have been around for decades but, to date, have not been widely adopted within the clinical development arena. Implementing a structured approach and strategy to managing knowledge can enable more timely and informed decision making, enhance quality and productivity, and ultimately support the delivery of new products to patients. This paper outlines in general terms key elements of a clinical knowledge management (CKM) framework to assist clinical development organizations in understanding its benefits and basic components. Ideas are provided at a high level for flexible approaches and solutions aimed to enhance knowledge gathering, sharing, application, and retention within clinical development.
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Affiliation(s)
- Kathy A Salzano
- 1 Global Clinical Trial Operations: Quality & Continuous Improvement, Merck & Co Inc, Rahway, NJ, USA
| | - Christa A Maurer
- 2 Global Quality & Regulatory Compliance, Bristol-Myers Squibb, Princeton, NJ, USA
| | | | - Terry Stewart
- 4 Product Development Global Operations, Roche Products Ltd, Welwyn Garden City, UK
| | - Jennifer Peck
- 5 Clinical Systems, Information Management, Global Product Development, Pfizer Inc, New York, NY, USA
| | - Beata Rygiel
- 6 Clinical Operations, AstraZeneca, Warsaw, Poland
| | - Teresa Petree
- 7 R&D, Quality and Risk Management, GlaxoSmithKline, Research Triangle Park, NC, USA
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Meeker-O'Connell A, Sam LM, Bergamo N, Little JA. TransCelerate's Clinical Quality Management System: From a Vision to a Conceptual Framework. Ther Innov Regul Sci 2016; 50:397-413. [PMID: 30227025 DOI: 10.1177/2168479016651300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/16/2022]
Abstract
The Quality Management System (QMS) initiative of TransCelerate BioPharma Inc has identified potential benefits that could be captured from the development of a flexible, proactive clinical QMS conceptual framework for clinical research. Such a framework would aid organizations in seamlessly managing the complex clinical trial environment and, ultimately, in expediting delivery of needed treatments to patients. This article chronicles the evolution of a TransCelerate concept paper describing a proposed clinical QMS framework and reviews feedback from varied global clinical trial stakeholders during socialization of the concept paper. Many stakeholders recognized the potential for the concept paper to inform development of a harmonized International Council for Harmonisation (ICH) guideline, providing needed clarity from regulators on their expectations for QMS in the clinical realm. Accordingly, the article also describes TransCelerate's efforts to work with regulators to facilitate harmonization on this important topic and reviews ongoing work to develop additional tools and resources that may support organizations in evaluating whether and how they might translate the conceptual framework principles into practice.
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Affiliation(s)
- Ann Meeker-O'Connell
- 1 BioResearch Quality and Compliance, Johnson & Johnson, 1 Johnson and Johnson Plaza, New Brunswick, NJ, USA
| | - Leslie M Sam
- 2 Global Quality Systems, Eli Lilly and Company, Indianapolis, IN, USA
| | - Nanci Bergamo
- 3 Clinical and Medical Quality Operations, Sanofi, Bridgewater, NJ, USA
| | - Janis A Little
- 4 Global R&D Quality, Allergan-Actavis, Bridgewater, NJ, USA
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Abstract
Aim of the database The main purpose of the database of the Danish Renal Cancer Group (DaRenCaData) is to improve the quality of renal cancer treatment in Denmark and secondarily to conduct observational research. Study population DaRenCaData includes all Danish patients with a first-time diagnosis of renal cancer in the Danish National Pathology Registry since August 1, 2010. Main variables DaRenCaData holds data on demographic characteristics, treatments, and pathology collected through linkage to central registries and online registration of a few clinical key variables. Eight quality indicators have been selected for monitoring treatment quality and outcome after renal cancer. Descriptive data The incidence of renal cancer in Denmark has increased from 12.7 per 100,000 population-years in 2010–2011 to 15.9 per 100,000 population-years in 2014–2015. A total of 3,977 Danish patients with renal cancer have been enrolled in the database in the period August 1, 2010–July 31, 2015. The completeness of data registration has increased substantially since the first years of the database. A tendency toward smaller and less advanced tumors, less invasive surgery, and a shorter hospital stay was observed, while the postoperative morbidity and mortality remained stable. Concurrently, the 1-year survival has improved and was 84.1% in 2014–2015. Conclusion DaRenCaData provides valuable information on quality of and outcome after renal cancer treatment. Efforts to improve collection and registration of data are ongoing.
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Affiliation(s)
| | - Mette Søgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus
| | - Frank Mehnert
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus
| | | | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus
| | - Nessn H Azawi
- Department of Urology, Zealand University Hospital, Roskilde
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Abstract
AIM OF DATABASE The Danish National Penile Cancer Quality database (DaPeCa-data) aims to improve the quality of cancer care and monitor the diagnosis, staging, and treatment of all incident penile cancer cases in Denmark. The aim is to assure referral practice, guideline adherence, and treatment and development of the database in order to enhance research opportunities and increase knowledge and survival outcomes of penile cancer. STUDY POPULATION The DaPeCa-data registers all patients with newly diagnosed invasive squamous cell carcinoma of the penis in Denmark since June 2011. MAIN VARIABLES Data are systematically registered at the time of diagnosis by a combination of automated data-linkage to the central registries as well as online registration by treating clinicians. The main variables registered relate to disease prognosis and treatment morbidity and include the presence of risk factors (phimosis, lichen sclerosus, and human papillomavirus), date of diagnosis, date of treatment decision, date of beginning of treatment, type of treatment, treating hospital, type and time of complications, date of recurrence, date of death, and cause of death. DESCRIPTIVE DATA Registration of these variables correlated to the unique Danish ten-digit civil registration number enables characterization of the cohort, individual patients, and patient groups with respect to age; 1-, 3-, and 5-year disease-specific and overall survival; recurrence patterns; and morbidity profile related to treatment modality. As of August 2015, more than 200 patients are registered with ∼65 new entries per year. CONCLUSION The DaPeCa-data has potential to provide meaningful, timely, and clinically relevant quality data for quality maintenance, development, and research purposes.
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Affiliation(s)
| | - Buket Öztürk
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus Nord, Denmark
| | - Mette Søgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus Nord, Denmark
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Thomsen RW, Baggesen LM, Svensson E, Pedersen L, Nørrelund H, Buhl ES, Haase CL, Johnsen SP. Early glycaemic control among patients with type 2 diabetes and initial glucose-lowering treatment: a 13-year population-based cohort study. Diabetes Obes Metab 2015; 17:771-80. [PMID: 25929277 DOI: 10.1111/dom.12484] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 01/24/2015] [Revised: 04/14/2015] [Accepted: 04/28/2015] [Indexed: 11/29/2022]
Abstract
AIM To examine real-life time trends in early glycaemic control in patients with type 2 diabetes between 2000 and 2012. METHODS We used population-based medical databases to ascertain the association between achievement of glycaemic control with initial glucose-lowering treatment in patients with incident type 2 diabetes in Northern Denmark. Success in reaching glycated haemoglobin (HbA1c) goals within 3-6 months was examined using regression analysis. RESULTS Of 38 418 patients, 91% started with oral glucose-lowering drugs in monotherapy. Metformin initiation increased from 32% in 2000-2003 to 90% of all patients in 2010-2012. Pretreatment (interquartile range) HbA1c levels decreased from 8.9 (7.6-10.7)% in 2000-2003 to 7.0 (6.5-8.1)% in 2010-2012. More patients achieved an HbA1c target of <7% (<53 mmol/mol) in 2010-2012 than in 2000-2003 [80 vs 60%, adjusted relative risk (aRR) 1.10, 95% confidence interval (CI) 1.08-1.13], and more achieved an HbA1c target of <6.5% [(<48 mmol/mol) 53 vs 37%, aRR 1.07 95% CI 1.03-1.11)], with similar success rates observed among patients aged <65 years without comorbidities. Achieved HbA1c levels were similar for different initiation therapies, with reductions of 0.8% (from 7.3 to 6.5%) on metformin, 1.5% (from 8.1 to 6.6%) on sulphonylurea, 4.0% (from 10.4 to 6.4%) on non-insulin combination therapies, and 3.8% (from 10.3 to 6.5%) on insulin monotherapy. CONCLUSIONS Pretreatment HbA1c levels in patients with incident type 2 diabetes have decreased substantially, which is probably related to earlier detection and treatment in accordance with changing guidelines. Achievement of glycaemic control has improved, but 20% of patients still do not attain an HbA1c level of <7% within the first 6 months of initial treatment.
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Affiliation(s)
- R W Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - L M Baggesen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - E Svensson
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - L Pedersen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - H Nørrelund
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - E S Buhl
- Novo Nordisk Scandinavia AB, Ørestad, Copenhagen, Denmark
| | - C L Haase
- Novo Nordisk Scandinavia AB, Ørestad, Copenhagen, Denmark
| | - S P Johnsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Guth RM, Storey PE, Vitale M, Markan-Aurora S, Gordon R, Prevost TQ, Dunagan WC, Woeltje KF. Decision Analysis for Metric Selection on a Clinical Quality Scorecard. Am J Med Qual 2015; 31:400-7. [PMID: 26038608 DOI: 10.1177/1062860615589117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/16/2022]
Abstract
Clinical quality scorecards are used by health care institutions to monitor clinical performance and drive quality improvement. Because of the rapid proliferation of quality metrics in health care, BJC HealthCare found it increasingly difficult to select the most impactful scorecard metrics while still monitoring metrics for regulatory purposes. A 7-step measure selection process was implemented incorporating Kepner-Tregoe Decision Analysis, which is a systematic process that considers key criteria that must be satisfied in order to make the best decision. The decision analysis process evaluates what metrics will most appropriately fulfill these criteria, as well as identifies potential risks associated with a particular metric in order to identify threats to its implementation. Using this process, a list of 750 potential metrics was narrowed to 25 that were selected for scorecard inclusion. This decision analysis process created a more transparent, reproducible approach for selecting quality metrics for clinical quality scorecards.
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Affiliation(s)
- Rebecca M Guth
- Center for Clinical Excellence, BJC HealthCare, St Louis, MO
| | | | - Michael Vitale
- Center for Clinical Excellence, BJC HealthCare, St Louis, MO
| | | | | | | | - Wm Claiborne Dunagan
- Center for Clinical Excellence, BJC HealthCare, St Louis, MO Washington University School of Medicine, St Louis, MO
| | - Keith F Woeltje
- Center for Clinical Excellence, BJC HealthCare, St Louis, MO Washington University School of Medicine, St Louis, MO
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Greaves F, Laverty AA, Pape U, Ratneswaren A, Majeed A, Millett C. Performance of new alternative providers of primary care services in England: an observational study. J R Soc Med 2015; 108:171-83. [PMID: 25908312 DOI: 10.1177/0141076815583303] [Citation(s) in RCA: 9] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Health system reforms in England are opening broad areas of clinical practice to new providers of care. As part of these reforms, new entrants--including private companies--have been allowed into the primary care market under 'alternative provider of medical services' contracting mechanisms since 2004. The characteristics and performance of general practices working under new alternative provider contracts are not well described. We sought to compare the quality of care provided by new entrant providers to that provided by the traditional model of general practice. DESIGN Open cohort study of English general practices. We used linear regression in cross-sectional and time series analyses, adjusting for practice and population characteristics, to compare quality in practices using alternative provider contracts to traditional practices. We created regression models using practice fixed effects to estimate the impact of practices changing to the new contract type. SETTING The English National Health Service. PARTICIPANTS All general practices open from 2008/2009 to 2012/2013. MAIN OUTCOME MEASURES Seventeen established quality indicators--covering clinical effectiveness, efficiency, access and patient experience. RESULTS In total, 4.1% (347 of 8300) of general practices in England were run by alternative contract providers. These practices tended to be smaller, and serve younger, more diverse and more deprived populations than traditional providers. Practices run by alternative providers performed worse than traditional providers on 15 of 17 indicators after adjusting for practice and population characteristics (p < 0.01 for all). Switching to a new alternative provider contract did not result in improved performance. CONCLUSIONS The introduction of new alternative providers to deliver primary care services in England has not led to improvements in quality and may have resulted in worse care. Regulators should ensure that new entrants to clinical provider markets are performing to adequate standards and at least as well as traditional providers.
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Affiliation(s)
- Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Anthony A Laverty
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Utz Pape
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Anenta Ratneswaren
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Christopher Millett
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
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Burke HB, Sessums LL, Hoang A, Becher DA, Fontelo P, Liu F, Stephens M, Pangaro LN, O'Malley PG, Baxi NS, Bunt CW, Capaldi VF, Chen JM, Cooper BA, Djuric DA, Hodge JA, Kane S, Magee C, Makary ZR, Mallory RM, Miller T, Saperstein A, Servey J, Gimbel RW. Electronic health records improve clinical note quality. J Am Med Inform Assoc 2014; 22:199-205. [PMID: 25342178 PMCID: PMC4433367 DOI: 10.1136/amiajnl-2014-002726] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The clinical note documents the clinician's information collection, problem assessment, clinical management, and its used for administrative purposes. Electronic health records (EHRs) are being implemented in clinical practices throughout the USA yet it is not known whether they improve the quality of clinical notes. The goal in this study was to determine if EHRs improve the quality of outpatient clinical notes. MATERIALS AND METHODS A five and a half year longitudinal retrospective multicenter quantitative study comparing the quality of handwritten and electronic outpatient clinical visit notes for 100 patients with type 2 diabetes at three time points: 6 months prior to the introduction of the EHR (before-EHR), 6 months after the introduction of the EHR (after-EHR), and 5 years after the introduction of the EHR (5-year-EHR). QNOTE, a validated quantitative instrument, was used to assess the quality of outpatient clinical notes. Its scores can range from a low of 0 to a high of 100. Sixteen primary care physicians with active practices used QNOTE to determine the quality of the 300 patient notes. RESULTS The before-EHR, after-EHR, and 5-year-EHR grand mean scores (SD) were 52.0 (18.4), 61.2 (16.3), and 80.4 (8.9), respectively, and the change in scores for before-EHR to after-EHR and before-EHR to 5-year-EHR were 18% (p<0.0001) and 55% (p<0.0001), respectively. All the element and grand mean quality scores significantly improved over the 5-year time interval. CONCLUSIONS The EHR significantly improved the overall quality of the outpatient clinical note and the quality of all its elements, including the core and non-core elements. To our knowledge, this is the first study to demonstrate that the EHR significantly improves the quality of clinical notes.
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Affiliation(s)
- Harry B Burke
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Laura L Sessums
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Albert Hoang
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Dorothy A Becher
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Paul Fontelo
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Fang Liu
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark Stephens
- Department of Family, Medicine, Uniformed Services, University of the Health Sciences, Bethesda, Maryland, USA
| | - Louis N Pangaro
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Patrick G O'Malley
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nancy S Baxi
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Christopher W Bunt
- Department of Family, Medicine, Uniformed Services, University of the Health Sciences, Bethesda, Maryland, USA
| | - Vincent F Capaldi
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Julie M Chen
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Barbara A Cooper
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | | | | - Shawn Kane
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Charles Magee
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Zizette R Makary
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Renee M Mallory
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Thomas Miller
- Department of Family, Medicine, Uniformed Services, University of the Health Sciences, Bethesda, Maryland, USA
| | - Adam Saperstein
- Department of Family, Medicine, Uniformed Services, University of the Health Sciences, Bethesda, Maryland, USA
| | - Jessica Servey
- Department of Family, Medicine, Uniformed Services, University of the Health Sciences, Bethesda, Maryland, USA
| | - Ronald W Gimbel
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
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Sharma R, Lebrun-Harris LA, Ngo-Metzger Q. Costs and clinical quality among Medicare beneficiaries: associations with health center penetration of low-income residents. Medicare Medicaid Res Rev 2014; 4:mmrr2014-004-03-a05. [PMID: 25243096 DOI: 10.5600/mmrr.004.03.a05] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Determine the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). DATA SOURCES Data on elderly fee-for-service beneficiaries across 306 HRRs came from CMS' Geographic Variation in Medicare Spending and Utilization database (2010). We merged data on number of health center patients (HRSA's Uniform Data System) and number of low-income residents (American Community Survey). STUDY DESIGN We estimated access to primary care in each HRR by "health center penetration" (health center patients as a proportion of low-income residents). We calculated total Medicare spending (adjusted for population size, local input prices, and health risk). We assessed clinical quality by preventable hospital admissions, hospital readmissions, and emergency department visits. We sorted HRRs by health center penetration rate and compared spending and quality measures between the high- and low-penetration deciles. We also employed linear regressions to estimate spending and quality measures as a function of health center penetration. PRINCIPAL FINDINGS The high-penetration decile had 9.7% lower Medicare spending ($926 per capita, p=0.01) than the low-penetration decile, and no different clinical quality outcomes. CONCLUSIONS Compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings. Limited evidence suggests that these savings do not compromise clinical quality.
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Affiliation(s)
- Ravi Sharma
- Health Resources and Services Administration-Bureau of Primary Health Care
| | - Lydie A Lebrun-Harris
- Health Resources and Services Administration-Office of Planning, Analysis and Evaluation
| | - Quyen Ngo-Metzger
- Agency for Healthcare Research and Quality-Center for Primary Care, Prevention, and Clinical Partnerships
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Abstract
Study Design Systematic review. Objective We assessed the current state of spine registries by collecting spine trauma data and assessing their compliance to defined registry standards of being clinical quality. We ascertained if these registries collected spinal cord injury data alone or with spine column trauma data. Methods A systematic review was performed using MEDLINE and Embase databases for articles describing dedicated spinal cord and spine column databases published between January 1990 and April 2011. Correspondence with these registries was performed via e-mail or post. When no correspondence was possible, the registries were analyzed with best information available. Results Three hundred eight full-text articles were reviewed. Of 41 registries identified, 20 registries fulfilled the criteria of being clinical quality. The main reason for failure to attain clinical quality designation was due to the unavailability of patient outcomes. Eight registries collected both spine column and spinal cord injury data with 33 collecting only traumatic spinal cord injury data. Conclusion There is currently a paucity of clinical quality spine trauma registries. Clinical quality registries are important tools for demonstrating trends and outcomes, monitoring care quality, and resolving controversies in the management of spine trauma. An international spine trauma data set (containing both spinal cord and spine column injury data) and standardized approach to recording and analysis are needed to allow international multicenter collaboration and benchmarking.
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Affiliation(s)
- Jin W. Tee
- Department of Neurosurgery, The Alfred, Melbourne, Australia,The Alfred Trauma Service, Melbourne, Australia,Department of Surgery, Monash University, Melbourne, Australia,Address for correspondence Dr. Jin Wee Tee, MBBS Level 1, Old Baker Building, The Alfred, Commercial RoadMelbourne, 3004 VictoriaAustralia
| | - Patrick C. H. Chan
- Department of Neurosurgery, The Alfred, Melbourne, Australia,Department of Surgery, Monash University, Melbourne, Australia
| | - Jeffrey V. Rosenfeld
- Department of Neurosurgery, The Alfred, Melbourne, Australia,Department of Surgery, Monash University, Melbourne, Australia,National Trauma Research Institute, Melbourne, Australia
| | - Russell L. Gruen
- The Alfred Trauma Service, Melbourne, Australia,Department of Surgery, Monash University, Melbourne, Australia,National Trauma Research Institute, Melbourne, Australia
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Llanwarne NR, Abel GA, Elliott MN, Paddison CAM, Lyratzopoulos G, Campbell JL, Roland M. Relationship between clinical quality and patient experience: analysis of data from the english quality and outcomes framework and the National GP Patient Survey. Ann Fam Med 2013; 11:467-72. [PMID: 24019279 PMCID: PMC3767716 DOI: 10.1370/afm.1514] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [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] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Clinical quality and patient experience are both widely used to evaluate the quality of health care, but the relationship between these 2 domains remains uncertain. The aim of this study was to examine this relationship using data from 2 established measures of quality in primary care in England. METHODS Practice-level analyses (N = 7,759 practices in England) were conducted on measures of patient experience from the national General Practice Patient Survey (GPPS), and measures of clinical quality from the national pay-for-performance scheme (Quality and Outcomes Framework). Spearman's rank correlation and multiple linear regression were used on practice-level estimates. RESULTS Although all the correlations between clinical quality summary scores and patient survey scores are positive, and most are statistically significant, the strength of the associations was weak, with the highest correlation coefficient reaching 0.18, and more than one-half were 0.11 or less. Correlations with clinical quality were highest for patient-reported access scores (telephone access 0.16, availability of urgent appointments 0.15, ability to book ahead 0.18, ability to see preferred doctor 0.17) and overall satisfaction (0.15). CONCLUSION Although there are associations between clinical quality and measures of patient experience, the 2 domains of care quality remain predominantly distinct. The strongest correlations are observed between practice clinical quality and practice access, with very low correlations between clinical quality and interpersonal aspects of care. The quality of clinical care and the quality of interpersonal care should be considered separately to give an overall assessment of medical care.
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