Key components of international and European governance for quality of care

The legal status and binding nature of various international governance and guidance instruments to foster and support quality strategies in European countries differs substantially. This presentation introduces and discusses the four main elements of an integrated international governance framework for quality in health care: i) raising political awareness of the relevance of health care quality and creating a common vision on how to improve it; ii) implementing this vision into actual policy frameworks by sharing experience and practice between countries; iii) developing and providing standards and models (voluntary or mandatory) that can be transposed into national policy; iv) measuring, assessing and comparing quality by developing better information, better indicators and methodologies as well as dissemination strategies.

The presentation will also focus on how quality in health care is addressed through EU policy, first through EU provisions and policies that are meant to ensure free movement of citizens and goods and establish an internal market, and by means of more horizontal and generic EU policies on quality and safety that stem from the mandate to support, coordinate or supplement national policies. It will further highlight how EU integration and policy touch upon quality in health care and how the approach has evolved over time.

Cognitive Vulnerability to Depression in Adolescents with Depression, their Healthy Siblings and a Control Group: A Cross-sectional Study

Introduction

At least half of first depressive episode appear before adulthood. A negative cognitive bias is present among individuals who suffer from major depression. This bias is also reported among individuals at high risk of major depression (e.g. child of depressed mother). When present, cognitive vulnerability may predispose to major depression. No study to date aimed to evaluate the cognitive vulnerability of siblings of depressed individuals.

Objectives and aims

To review the principles behind cognitive vulnerability. To assess cognitive vulnerability in depressed adolescents, in healthy siblings and in a control group.

Methods

Eighty adolescents (27 adolescents treated for depression, 24 healthy siblings and 29 controls), aged between 12 and 20 years old, were recruited and assessed using validated measures of bio-psycho-social vulnerabilities. All diagnoses were confirmed using a K-SADS interview. Cortisol level samples were obtained through morning saliva. Cognitive vulnerability was assessed using self-report questionnaires (CES-D, LEIDS-R, EPQ) as well as computer-based tasks (Ekman's tasks of facial recognition and the movie for assessment of social cognition [MASC]). We translated the MASC from German to French. The parents of the adolescents also filled the LEIDSR and the CESD.

Results

The LEIDS-R presented a significant increase in certain subscales (hopelessness, aggression and rumination) compared to the healthy siblings and the controls. Interestingly, there was also a correlation between the LEIDS R results of the parents and of the depressed adolescent (r = 0.43, P = 0.04).

Conclusions

The LEIDSR appears to be the most sensitive task to detect cognitive vulnerability. A relation between the parent response and the depressed adolescent response could be found.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Cross-border care and healthcare quality improvement in Europe: the MARQuIS research project

Citizens are increasingly crossing borders within the European Union (EU). Europeans have always been free to travel to receive care abroad, but if they wished to benefit from their statutory social protection scheme, they were subject to their local or national legislation on social protection. This changed in 1991 with the European Court of Justice defining healthcare as a service, starting a debate on the right balance between different principles in European treaties: movement of persons, goods and services, versus the responsibility of member states to organise their healthcare systems. Simultaneously, cross-border cooperation has developed between member states.

In this context, patient mobility has become a relevant issue on the EU’s agenda. The EU funded a number of Scientific Support to Policies (SSP) activities within the Sixth Framework Programme, to provide the evidence needed by EU policy makers to deal with issues that European citizens face due to enhanced mobility in Europe. One SSP project “Methods of Assessing Response to Quality Improvement Strategies” (MARQuIS), focused on cross-border care. It aimed to assess the value of different quality strategies, and to provide information needed when: (1) countries contract care for patients moving across borders; and (2) individual hospitals review the design of their quality strategies. This article describes the European context related to healthcare, and its implications for cross-border healthcare in Europe. The background information demonstrates a need for further research and development in this area.

Implementation of patient safety strategies in European hospitals

CONTEXT

This study is part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project on cross-border care, investigating quality improvement strategies in healthcare systems across the European Union (EU).

AIM

To explore to what extent a sample of acute care European hospitals have implemented patient safety strategies and mechanisms and whether the implementation is related to the type of hospital.

METHODS

Data were collected on patient safety structures and mechanisms in 389 acute care hospitals in eight EU countries using a web-based questionnaire. Subsequently, an on-site audit was carried out by independent surveyors in 89 of these hospitals to assess patient safety outputs. This paper presents univariate and bivariate statistics on the implementation and explores the associations between implementation of patient safety strategies and hospital type using the chi(2) test and Fisher exact test.

RESULTS

Structures and plans for safety (including responsibilities regarding patient safety management) are well developed in most of the hospitals that participated in this study. The study found greater variation regarding the implementation of mechanisms or activities to promote patient safety, such as electronic drug prescription systems, guidelines for prevention of wrong patient, wrong site and wrong surgical procedure, and adverse events reporting systems. In the sample of hospitals that underwent audit, a considerable proportion do not comply with basic patient safety strategies--for example, using bracelets for adult patient identification and correct labelling of medication.