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Chen F, Dai X, Li A, Zheng Y, Hu W. Quality assessment of the preparation and storage of leukocyte-depleted pooled platelet concentrates. Hematology 2024; 29:2293492. [PMID: 38193467 DOI: 10.1080/16078454.2023.2293492] [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: 06/06/2023] [Accepted: 11/15/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE To explore the feasibility of using a disposable platelet storage bag containing a leukocyte filter to prepare leukocyte-depleted pooled platelet concentrates with the buffy coat method. METHODS 150 bags of whole blood samples (400 mL/bag) were stored overnight at 22 ± 2°C, and buffy coats were separated on Day 2, then 5 units of ABO homotypic buffy coat and 1 unit of plasma were pooled into a disposable platelet storage bag containing a leukocyte filter to prepare leukocyte-depleted pooled platelet concentrates and stored in a Platelet Agitator. On Day 2, 4, 5 and 7 after the collection of whole blood, platelet content, pH value, pO2, pCO2, glucose (GLU), ATP, and other quality indicators were measured. RESULTS The quality indicators of leukocyte-depleted pooled platelet concentrates met the requirements for leukocyte-depleted aphaeresis platelets in the Chinese national standard Quality Requirements for Whole Blood and Blood Components (GB18469-2012). With the prolongation of storage time, MPV and PDW of platelets gradually increased, pH value, bicarbonate, and GLU gradually decreased, LA, LDH, and ATP gradually increased, pO2 slightly increased, pCO2 decreased, and HSR had no significant change. ESC decreased significantly on Day 7, CD62p decreased first and then increased, sP-selectin and GP V increased first and then decreased, but the results on Day 7 were higher than those on Day 2. CONCLUSION The quality of leukocyte-depleted pooled platelet concentrates prepared by the buffy coat method using disposable platelet storage bags containing a leukocyte filter was comparable to that of leukocyte-depleted apheresis platelets, and could be used clinically.
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Affiliation(s)
- Feng Chen
- Blood Center of Zhejiang Province, Hangzhou, People's Republic of China
| | - Xiaoqing Dai
- Blood Center of Zhejiang Province, Hangzhou, People's Republic of China
| | - Azhong Li
- Blood Center of Zhejiang Province, Hangzhou, People's Republic of China
| | - Yinhong Zheng
- Blood Center of Zhejiang Province, Hangzhou, People's Republic of China
| | - Wei Hu
- Blood Center of Zhejiang Province, Hangzhou, People's Republic of China
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Valentine JC, Gillespie E, Verspoor KM, Hall L, Worth LJ. Performance of ICD-10-AM codes for quality improvement monitoring of hospital-acquired pneumonia in a haematology-oncology casemix in Victoria, Australia. HEALTH INF MANAG J 2024; 53:112-120. [PMID: 36374542 DOI: 10.1177/18333583221131753] [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] [Indexed: 02/17/2024]
Abstract
BACKGROUND The Australian hospital-acquired complication (HAC) policy was introduced to facilitate negative funding adjustments in Australian hospitals using ICD-10-AM codes. OBJECTIVE The aim of this study was to determine the positive predictive value (PPV) of the ICD-10-AM codes in the HAC framework to detect hospital-acquired pneumonia in patients with cancer and to describe any change in PPV before and after implementation of an electronic medical record (EMR) at our centre. METHOD A retrospective case review of all coded pneumonia episodes at the Peter MacCallum Cancer Centre in Melbourne, Australia spanning two time periods (01 July 2015 to 30 June 2017 [pre-EMR period] and 01 September 2020 to 28 February 2021 [EMR period]) was performed to determine the proportion of events satisfying standardised surveillance definitions. RESULTS HAC-coded pneumonia occurred in 3.66% (n = 151) of 41,260 separations during the study period. Of the 151 coded pneumonia separations, 27 satisfied consensus surveillance criteria, corresponding to an overall PPV of 0.18 (95% CI: 0.12, 0.25). The PPV was approximately three times higher following EMR implementation (0.34 [95% CI: 0.19, 0.53] versus 0.13 [95% CI: 0.08, 0.21]; p = .013). CONCLUSION The current HAC definition is a poor-to-moderate classifier for hospital-acquired pneumonia in patients with cancer and, therefore, may not accurately reflect hospital-level quality improvement. Implementation of an EMR did enhance case detection, and future refinements to administratively coded data in support of robust monitoring frameworks should focus on EMR systems. IMPLICATIONS Although ICD-10-AM data are readily available in Australian healthcare settings, these data are not sufficient for monitoring and reporting of hospital-acquired pneumonia in haematology-oncology patients.
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Affiliation(s)
- Jake C Valentine
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Elizabeth Gillespie
- Infection Prevention Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karin M Verspoor
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- School of Computing and Information Systems, University of Melbourne, Parkville, VIC, Australia
| | - Lisa Hall
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Leon J Worth
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Infection Prevention Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Al-Dorzi HM, Arabi YM. Quality Indicators in Adult Critical Care Medicine. Glob J Qual Saf Healthc 2024; 7:75-84. [PMID: 38725886 PMCID: PMC11077517 DOI: 10.36401/jqsh-23-30] [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] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 05/12/2024]
Abstract
Quality indicators are increasingly used in the intensive care unit (ICU) to compare and improve the quality of delivered healthcare. Numerous indicators have been developed and are related to multiple domains, most importantly patient safety, care timeliness and effectiveness, staff well-being, and patient/family-centered outcomes and satisfaction. In this review, we describe pertinent ICU quality indicators that are related to organizational structure (such as the availability of an intensivist 24/7 and the nurse-to-patient ratio), processes of care (such as ventilator care bundle), and outcomes (such as ICU-acquired infections and standardized mortality rate). We also present an example of a quality improvement project in an ICU indicating the steps taken to attain the desired changes in quality measures.
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Affiliation(s)
- Hasan M. Al-Dorzi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Yaseen M. Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
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Mahomedradja RF, Tichelaar J, Mokkink LB, Sigaloff KCE, van Agtmael MA. Quality indicators for appropriate in-hospital pharmacotherapeutic stewardship: An international modified Delphi study. Br J Clin Pharmacol 2024; 90:1280-1300. [PMID: 38369619 DOI: 10.1111/bcp.16015] [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: 10/24/2023] [Revised: 12/30/2023] [Accepted: 01/08/2024] [Indexed: 02/20/2024] Open
Abstract
AIMS In-hospital prescribing errors may result in patient harm, such as prolonged hospitalisation and hospital (re)admission, and may be an emotional burden for the prescribers and healthcare professionals involved. Despite efforts, in-hospital prescribing errors and related harm still occur, necessitating an innovative approach. We therefore propose a novel approach, in-hospital pharmacotherapeutic stewardship (IPS). The aim of this study was to reach consensus on a set of quality indicators (QIs) as a basis for IPS. METHODS A three-round modified Delphi procedure was performed. Potential QIs were retrieved from two systematic searches of the literature, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. In two written questionnaires and a focus meeting (held between the written questionnaire rounds), potential QIs were appraised by an international, multidisciplinary expert panel composed of members of the European Association for Clinical Pharmacology and Therapeutics (EACPT). RESULTS The expert panel rated 59 QIs and four general statements, of which 35 QIs were accepted with consensus rates ranging between 79% and 97%. These QIs describe the activities of an IPS programme, the team delivering IPS, the patients eligible for the programme and the outcome measures that should be used to evaluate the care delivered. CONCLUSIONS A framework of 35 QIs for an IPS programme was systematically developed. These QIs can guide hospitals in setting up a pharmacotherapeutic stewardship programme to reduce in-hospital prescribing errors and improve in-hospital medication safety.
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Affiliation(s)
- Rashudy F Mahomedradja
- Department of Internal Medicine, Unit Pharmacotherapy, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine, Unit Pharmacotherapy, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, Amsterdam, The Netherlands
| | - Lidwine B Mokkink
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kim C E Sigaloff
- Department of Internal Medicine, Unit Pharmacotherapy, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Unit Pharmacotherapy, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, Amsterdam, The Netherlands
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Sluggett JK, Caughey GE, Air T, Cations M, Lang CE, Ward SA, Ahern S, Lin X, Wallis K, Crotty M, Inacio MC. National surveillance using a clinical quality indicator for prolonged antipsychotic use among older Australians with dementia who access aged care services. Int J Geriatr Psychiatry 2024; 39:e6089. [PMID: 38676658 DOI: 10.1002/gps.6089] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES Dementia guidelines recommend antipsychotics are only used for behavioral and psychological symptoms when non-drug interventions fail, and to regularly review use. Population-level clinical quality indicators (CQIs) for dementia care in permanent residential aged care (PRAC) typically monitor prevalence of antipsychotic use but not prolonged use. This study aimed to develop a CQI for antipsychotic use >90 days and examine trends, associated factors, and variation in CQI incidence; and examine duration of the first episode of use among individuals with dementia accessing home care packages (HCPs) or PRAC. METHODS Retrospective cohort study, including older individuals with dementia who accessed HCPs (n = 50,257) or PRAC (n = 250,196). Trends in annual CQI incidence (2011-12 to 2015-16) and associated factors were determined using Poisson regression. Funnel plots examined geographical and facility variation. Time to antipsychotic discontinuation was estimated among new antipsychotic users accessing HCP (n = 2367) and PRAC (n = 15,597) using the cumulative incidence function. RESULTS Between 2011-12 and 2015-16, antipsychotic use for >90 days decreased in HCP recipients from 10.7% (95% CI 10.2-11.1) to 10.1% (95% CI 9.6-10.5, adjusted incidence rate ratio (aIRR) 0.97 (95% CI 0.95-0.98)), and in PRAC residents from 24.5% (95% CI 24.2-24.7) to 21.8% (95% CI 21.5-22.0, aIRR 0.97 (95% CI 0.96-0.98)). Prior antipsychotic use (both cohorts) and being male and greater socioeconomic disadvantage (PRAC cohort) were associated with higher CQI incidence. Little geographical/facility variation was observed. Median treatment duration in HCP and PRAC was 334 (interquartile range [IQR] 108-958) and 555 (IQR 197-1239) days, respectively. CONCLUSIONS While small decreases in antipsychotic use >90 days were observed between 2011-12 and 2015-16, findings suggest antipsychotic use among aged care recipients with dementia can be further minimized.
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Affiliation(s)
- Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Gillian E Caughey
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Tracy Air
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Monica Cations
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Catherine E Lang
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, The Prince of Wales Hospital, Randwick, New South Wales, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kasey Wallis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. J Am Coll Cardiol 2024; 83:1579-1613. [PMID: 38493389 DOI: 10.1016/j.jacc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
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Zhang H, Liu S, Li S, Chen X, Xu M, Su Y, Qiao K, Chen X, Chen B, Zhong H, Lin H, Liu Z. The Effects of Four Different Thawing Methods on Quality Indicators of Amphioctopus neglectus. Foods 2024; 13:1234. [PMID: 38672906 PMCID: PMC11049476 DOI: 10.3390/foods13081234] [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: 03/11/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Amphioctopus neglectus is a species of octopus that is favored by consumers due to its rich nutrient profile. To investigate the influence of different thawing methods on the quality of octopus meat, we employed four distinct thawing methods: air thawing (AT), hydrostatic thawing (HT), flowing water thawing (FWT), and microwave thawing (MT). We then explored the differences in texture, color, water retention, pH, total volatile basic nitrogen (TVB-N), total sulfhydryl content, Ca2+-ATPase activity, and myofibrillar protein, among other quality indicators in response to these methods, and used a low-field nuclear magnetic resonance analyzer to assess the water migration that occurred during the thawing process. The results revealed that AT had the longest thawing time, leading to oxidation-induced protein denaturation, myofibrillar protein damage, and a significant decrease in water retention. Additionally, when this method was utilized, the content of TVB-N was significantly higher than in the other three groups. HT, to a certain extent, isolated the oxygen in the meat and thus alleviated protein oxidation, allowing higher levels of Ca2+-ATPase activity, sulfhydryl content, and springiness to be maintained. However, HT had a longer duration: 2.95 times that of FWT, resulting in a 9.84% higher cooking loss and a 28.21% higher TVB-N content compared to FWT. MT had the shortest thawing time, yielding the lowest content of TVB-N. However, uneven heating and in some cases overcooking occurred, severely damaging the protein structure, with a concurrent increase in thawing loss, W value, hardness, and shear force. Meanwhile, FWT improved the L*, W* and b* values of octopus meat, enhancing its color and water retention. The myofibrillar protein (MP) concentration was also the highest after FWT, with clearer subunit bands in SDS-PAGE electrophoresis, indicating that less degradation occurred and allowing greater springiness, increased Ca2+-ATPase activity, and a higher sulfhydryl content to be maintained. This suggests that FWT has an inhibitory effect on oxidation, alleviating protein oxidation degradation and preserving the quality of the meat. In conclusion, FWT outperformed the other three thawing methods, effectively minimizing adverse changes during thawing and successfully maintaining the quality of octopus meat.
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Affiliation(s)
- Huixin Zhang
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (H.Z.); (H.L.)
- Fisheries Research Institute of Fujian, Xiamen 361013, China; (M.X.); (Y.S.); (K.Q.); (B.C.)
| | - Shuji Liu
- Fisheries Research Institute of Fujian, Xiamen 361013, China; (M.X.); (Y.S.); (K.Q.); (B.C.)
| | - Shuigen Li
- Fujian Fisheries Technical Extension Station, Fuzhou 350002, China;
| | - Xiaoe Chen
- College of Food and Pharmacy, Zhejiang Ocean University, State Key Laboratory of Aquatic Products Processing of Zhejiang Province, Zhoushan 316022, China;
| | - Min Xu
- Fisheries Research Institute of Fujian, Xiamen 361013, China; (M.X.); (Y.S.); (K.Q.); (B.C.)
- Key Laboratory of Cultivation and High-Value Utilization of Marine Organisms in Fujian Province, National Research and Development Center for Marine Fish Processing (Xiamen), Xiamen 361013, China;
| | - Yongchang Su
- Fisheries Research Institute of Fujian, Xiamen 361013, China; (M.X.); (Y.S.); (K.Q.); (B.C.)
- Key Laboratory of Cultivation and High-Value Utilization of Marine Organisms in Fujian Province, National Research and Development Center for Marine Fish Processing (Xiamen), Xiamen 361013, China;
| | - Kun Qiao
- Fisheries Research Institute of Fujian, Xiamen 361013, China; (M.X.); (Y.S.); (K.Q.); (B.C.)
- Key Laboratory of Cultivation and High-Value Utilization of Marine Organisms in Fujian Province, National Research and Development Center for Marine Fish Processing (Xiamen), Xiamen 361013, China;
| | - Xiaoting Chen
- Key Laboratory of Cultivation and High-Value Utilization of Marine Organisms in Fujian Province, National Research and Development Center for Marine Fish Processing (Xiamen), Xiamen 361013, China;
| | - Bei Chen
- Fisheries Research Institute of Fujian, Xiamen 361013, China; (M.X.); (Y.S.); (K.Q.); (B.C.)
- Key Laboratory of Cultivation and High-Value Utilization of Marine Organisms in Fujian Province, National Research and Development Center for Marine Fish Processing (Xiamen), Xiamen 361013, China;
| | - Hong Zhong
- Dongshan Paul Food Co., Ltd., Zhangzhou 363400, China;
| | - Hetong Lin
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (H.Z.); (H.L.)
| | - Zhiyu Liu
- Key Laboratory of Cultivation and High-Value Utilization of Marine Organisms in Fujian Province, National Research and Development Center for Marine Fish Processing (Xiamen), Xiamen 361013, China;
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Aggarwal A, Han L, Lewis D, Costigan J, Hubbard A, Taylor J, Rigg A, Purushotham A, van der Meulen J. Association of travel time, patient characteristics, and hospital quality with patient mobility for breast cancer surgery: A national population-based study. Cancer 2024; 130:1221-1233. [PMID: 38186226 DOI: 10.1002/cncr.35153] [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: 08/08/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND This national study investigated hospital quality and patient factors associated with treatment location for breast cancer surgery. METHODS By using linked administrative data sets from the English National Health Service, the authors identified all women diagnosed between January 2, 2016, and December 31, 2018, who underwent breast-conserving surgery (BCS) or a mastectomy with or without immediate breast reconstruction. The extent to which patients bypassed their nearest hospital was investigated using a geographic information system (ArcGIS). Conditional logistic regressions were used to estimate the impact of travel time, hospital quality, and patient characteristics. RESULTS 22,622 Of 69,153 patients undergoing BCS, 22,622 (32.7%) bypassed their nearest hospital; and, of 23,536 patients undergoing mastectomy, 7179 (30.5%) bypassed their nearest hospital. Women who were younger, without comorbidities, or from rural areas were more likely to travel to more distant hospitals (p < .05). Patients undergoing BCS (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.36-2.50) or mastectomy (OR, 1.52; 95% CI, 1.14-2.02) were more likely to be treated at specialist breast reconstruction centers despite not undergoing the procedure. Patients receiving mastectomy and immediate breast reconstruction were more likely to travel to hospitals employing surgeons who had a media reputation (OR, 2.41; 95% CI, 1.28-4.52). Patients undergoing BCS were less likely to travel to hospitals with shorter surgical waiting times (OR, 0.65; 95% CI, 0.46-0.92). The authors did not observe a significant impact for research activity, hospital quality rating, breast re-excision rates, or the status as a multidisciplinary cancer center. CONCLUSIONS Patient choice policies may drive inequalities in the health care system without improving patient outcomes.
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Oncology, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Lu Han
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniel Lewis
- UK Department for Environment, Food, and Rural Affairs, Agriculture Ministry of the United Kingdom, London, UK
| | | | - Alison Hubbard
- Patient and Public Involvement Representative, Liverpool, UK
| | | | - Anne Rigg
- Department of Oncology, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Arnie Purushotham
- Department of Breast Surgery, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. Circ Cardiovasc Qual Outcomes 2024; 17:e000129. [PMID: 38484039 DOI: 10.1161/hcq.0000000000000129] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Affiliation(s)
- Hani Jneid
- ACC/AHA Joint Committee on Clinical Data Standards liaison
- Society for Cardiovascular Angiography and Interventions representative
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10
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Tholandi M, Zethof S, Kim YM, Tura AK, Ket J, Willcox M, van den Akker T, Ilozumba O. Approaches to improve and adapt maternal mortality estimations in low- and middle-income countries: A scoping review. Int J Gynaecol Obstet 2024; 165:94-106. [PMID: 37712620 DOI: 10.1002/ijgo.15103] [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] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND In the absence of robust vital registration systems, many low- and middle-income countries (LMICs) rely on national surveys or routine surveillance systems to estimate the maternal mortality ratio (MMR). Although the importance of MMR estimates in ending preventable maternal deaths is acknowledged, there is limited research on how different approaches are used and adapted, and how these adaptations function. OBJECTIVES To assess methods for estimating maternal mortality in LMICs and the rationale for these modifications. SEARCH STRATEGY A literature search with the terms "maternal death", "surveys" and "low- and middle-income countries" was performed in Medline, Embase, Web of Science, Scopus, CINAHL, APA PsycINFO, ERIC, and IBSS from January 2013 to March 17, 2023. SELECTION CRITERIA Studies were eligible if their main focus was to compare, adapt, or assess methods to estimate maternal mortality in LMICs. DATA COLLECTION AND ANALYSIS Titles and abstracts were screened using Rayyan. Relevant articles were independently reviewed by two reviewers against inclusion criteria. Data were extracted on mortality measurement methods, their context, and results. MAIN RESULTS Nineteen studies were included, focusing on data completeness, subnational estimates, and community involvement. Routinely generated MMR estimates are more complete when multiple data sources are triangulated, including data from public and private health facilities, the community, and local authorities (e.g. vital registration, police reports). For subnational estimates, existing (e.g. the sisterhood method and reproductive-age mortality surveys [RAMOS]) and adapted methods (e.g. RAMOS 4 + 2 and Pictorial Sisterhood Method) provided reliable confidence intervals. Community engagement in data collection increased community awareness of maternal deaths, provided local ownership, and was expected to reduce implementation costs. However, most studies did not include a cost-effectiveness analysis. CONCLUSION Household surveys with community involvement and RAMOS can be used to increase data validity, improve local awareness of maternal mortality estimates, and reduce costs in LMICs.
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Affiliation(s)
- Maya Tholandi
- Faculty of Science, Athena Institute, VU University, Amsterdam, The Netherlands
| | - Siem Zethof
- Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Young-Mi Kim
- Jhpiego, Johns Hopkins University, Baltimore, Maryland, USA
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Johannes Ket
- Medical Library, VU University, Amsterdam, The Netherlands
| | - Merlin Willcox
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Onaedo Ilozumba
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Donnelly C, Or M, Toh J, Thevaraja M, Janssen A, Shaw T, Pathma-Nathan N, Harnett P, Chiew KL, Vinod S, Sundaresan P. Measurement that matters: A systematic review and modified Delphi of multidisciplinary colorectal cancer quality indicators. Asia Pac J Clin Oncol 2024; 20:259-274. [PMID: 36726222 DOI: 10.1111/ajco.13917] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/19/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 02/03/2023]
Abstract
AIM To develop a priority set of quality indicators (QIs) for use by colorectal cancer (CRC) multidisciplinary teams (MDTs). METHODS The review search strategy was executed in four databases from 2009-August 2019. Two reviewers screened abstracts/manuscripts. Candidate QIs and characteristics were extracted using a tailored abstraction tool and assessed for scientific soundness. To prioritize candidate indicators, a modified Delphi consensus process was conducted. Consensus was sought over two rounds; (1) multidisciplinary expert workshops to identify relevance to Australian CRC MDTs, and (2) an online survey to prioritize QIs by clinical importance. RESULTS A total of 93 unique QIs were extracted from 118 studies and categorized into domains of care within the CRC patient pathway. Approximately half the QIs involved more than one discipline (52.7%). One-third of QIs related to surgery of primary CRC (31.2%). QIs on supportive care (6%) and neoadjuvant therapy (6%) were limited. In the Delphi Round 1, workshop participants (n = 12) assessed 93 QIs and produced consensus on retaining 49 QIs including six new QIs. In Round 2, survey participants (n = 44) rated QIs and prioritized a final 26 QIs across all domains of care and disciplines with a concordance level > 80%. Participants represented all MDT disciplines, predominantly surgical (32%), radiation (23%) and medical (20%) oncology, and nursing (18%), across six Australian states, with an even spread of experience level. CONCLUSION This study identified a large number of existing CRC QIs and prioritized the most clinically relevant QIs for use by Australian MDTs to measure and monitor their performance.
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Affiliation(s)
- Candice Donnelly
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Michelle Or
- Radiation Oncology Network, Western Sydney Local Health District, Westmead, Australia
| | - James Toh
- Department of Surgery, Westmead Hospital, Westmead, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | | | - Anna Janssen
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | | | - Paul Harnett
- Westmead Clinical School, University of Sydney, Sydney, Australia
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, Australia
| | - Kim-Lin Chiew
- Ingham Institute for Applied Medical Research, Liverpool, Australia
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia
- South Western Clinical School, University of New South Wales, Randwick, Australia
- Princess Alexandra Hospital, Division of Cancer Services, Brisbane, Australia
| | - Shalini Vinod
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia
- South Western Clinical School, University of New South Wales, Randwick, Australia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, Westmead, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
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Legros S, Vanoverschelde A, van Krieken J, Debaveye Y, Versporten A, Huis In 't Veld D, Westelinck V, Briquet C, Vercheval C, Spriet I, Denis O, Magerman K, De Schepper M, Buyle F. Development of quality indicators for antimicrobial stewardship in Belgian hospitals: a RAND - modified Delphi procedure. Acta Clin Belg 2024; 79:77-86. [PMID: 38146874 DOI: 10.1080/17843286.2023.2297123] [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: 08/17/2023] [Accepted: 12/15/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Inappropriate antibiotic use is a major cause of antibiotic resistance. Therefore, optimizing antibiotic usage is essential. In Belgium, optimization of antimicrobials for the fight against multidrug resistant organisms (MDROs) is followed up by national surveillance by public health authorities. To improve appropriate antimicrobial use in hospitals, an effective national Antimicrobial Stewardship (AMS) program should include indicators for measuring both the quantity and quality of antibiotic use. OBJECTIVES The aim of this study was to develop a set of process quality indicators (QIs) to evaluate and improve AMS in hospitals. METHODS A RAND-modified Delphi procedure was used. The procedure consisted of a structured narrative literature review to select the QIs, followed by two online questionnaires and an intermediate multidisciplinary panel discussion with experts in infectious diseases from general and teaching hospitals in Belgium. RESULTS A total of 38 QIs were selected after the RAND-modified Delphi procedure, from which 11 QIs were selected unanimously. These QIs address compliancy of antibiotic therapy and prophylaxis with local guidelines, documentation of the rationale for antibiotic treatment in the medical record, the availability of AMS Programs and Outpatient Parenteral Antibiotic Therapy, resistance patterns and antimicrobial prescribing during focused ward rounds. CONCLUSION Our study selected 38 relevant process QIs, from which 11 were unanimously selected. The QIs can contribute to the improvement of quality of antibiotic use by stimulating hospitals to present better outcomes and by providing a focus on how to intervene and to improve prescribing of antimicrobials.
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Affiliation(s)
- Sylvie Legros
- Pharmacy Department, Europe Hospitals, Brussels, Belgium
- Department of Antimicrobial Stewardship, Antimicrobial Stewardship, Europe Hospitals, Brussels, Belgium
| | - Anna Vanoverschelde
- Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ghent, Belgium
| | | | - Yves Debaveye
- Department of Intensive Care Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Ann Versporten
- Belgian Antibiotic Policy Coordination Commission (BAPCOC), Quality and Patient Safety, Direction General Healthcare, Federal Public Service Health, Food Chain Safety and Environment, Brussels, Belgium
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Diana Huis In 't Veld
- Department of Internal Medicine and Infectious Diseases, University Hospital Ghent, Ghent, Belgium
| | - Veerle Westelinck
- Department of Pharmacy, AZ Sint-Maarten, Mechelen, Belgium
- Antimicrobial Stewardship, AZ Sint-Maarten, Mechelen, Belgium
| | - Caroline Briquet
- Antimicrobial Stewardship, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
- Pharmacy Department, Cliniques Universitaires, Saint-Luc, UCLouvain, Brussels, Belgium
| | - Christelle Vercheval
- Department of Antimicrobial Stewardship, Hospital Outbreak Support Team (HOST), H.uni network, Brussels, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Olivier Denis
- Laboratory of microbiology, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Koen Magerman
- Department of Laboratory Medicine, Jessa Ziekenhuis vwz, Hasselt, Belgium
| | | | - Franky Buyle
- Pharmacy Department, Ghent University Hospital, Ghent, Belgium
- Antimicrobial Stewardship, Ghent University Hospital, Ghent, Belgium
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13
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Kim A, O'Callaghan A, Hemmaway C, Johney L, Ho J. Quality outcomes for end-of-life care among people with haematological malignancies at a New Zealand cancer centre. Intern Med J 2024; 54:588-595. [PMID: 37718574 DOI: 10.1111/imj.16235] [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: 02/06/2023] [Accepted: 08/31/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Little is known about the end-of-life (EOL) experience and specialist palliative care use patterns of patients with haematological malignancies (HMs) in New Zealand. AIMS This retrospective analysis sought to examine the quality of EOL care received by people with HMs under the care of Auckland District Health Board Cancer Centre's haematology service and compare it to international data where available. METHODS One hundred consecutive adult patients with HMs who died on or before 31 December 2019 were identified. We collected information on EOL care quality indicators, including anticancer treatment use and acute healthcare utilisation in the last 30 days of life, place of death and rate and timing of specialist palliative care input. RESULTS During the final 14 and 30 days of life, 15% and 27% of the patients received anticancer therapy respectively. Within 30 days of death, 22% had multiple hospitalisations and 25% had an intensive care unit admission. Death occurred in an acute setting for 42% of the patients. Prior contact with hospital and/or community (hospice) specialist palliative care service was noted in 80% of the patients, and 67% had a history of hospice enrolment. Among them, 15% and 28% started their enrolment in their last 3 and 7 days of life respectively. CONCLUSIONS The findings highlight the intensity of acute healthcare utilisation at the EOL and high rates of death in the acute setting in this population. The rate of specialist palliative care access was relatively high when compared with international experiences, with relatively fewer late referrals.
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Affiliation(s)
- Ann Kim
- Adult Hospital Palliative Care Service, Auckland City Hospital, Auckland, New Zealand
| | - Anne O'Callaghan
- Adult Hospital Palliative Care Service, Auckland City Hospital, Auckland, New Zealand
| | - Claire Hemmaway
- Clinical Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Leslie Johney
- Adult Hospital Palliative Care Service, Auckland City Hospital, Auckland, New Zealand
| | - Jess Ho
- School of Medicine, The University of Auckland, Auckland, New Zealand
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Arias P, Matta M, Strazzulla A, Le Mener C, Gallien S, Diamantis S. Identifying General Practitioners' Antibiotic Prescribing Profiles Based on National Health Reimbursement Data. Open Forum Infect Dis 2024; 11:ofae172. [PMID: 38595959 PMCID: PMC11002951 DOI: 10.1093/ofid/ofae172] [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: 10/06/2023] [Accepted: 03/20/2024] [Indexed: 04/11/2024] Open
Abstract
Background Antibiotic selection pressure in human medicine is a significant driver of antibiotic resistance in humans. The primary aspect of antibiotic consumption is associated with general practitioner (GP) prescriptions. We aimed to identify prescriber profiles for targeted antimicrobial stewardship programs using novel indicators. Methods A cross-sectional study was conducted in 2018 investigating GPs' antibiotic prescriptions in a French department, utilizing the reimbursement database of the national health service. Three antibiotic prescribing indicators were used. Specific targets were established for each indicator to identify the antibiotic prescribers most likely contributing to the emergence of resistance. Results Over 2018, we had 2,908,977 visits to 784 GPs, leading to 431,549 antibiotic prescriptions. Variations between GPs were shown by the 3 indicators. The median antibiotic prescription rate per visit was 13.6% (interquartile range [IQR], 9.8%-17.7%). Median ratios of the prescriptions of low-impact antibiotics to the prescriptions of high-impact antibiotics and of amoxicillin prescriptions to amoxicillin-clavulanic acid prescriptions were 2.5 (IQR, 1.7-3.7) and 2.94 (IQR, 1.7-5), respectively. We found 163 (21%) high prescribers of antibiotics with 3 distinct patterns: The first group overuses broad-spectrum antibiotics but without an overprescription rate per visit, the second group displays an overprescription rate but no excessive use of broad-spectrum antibiotics, and the third group shows both an overprescription rate and excessive use of broad-spectrum antibiotics. Conclusions Prescription-based indicators enable the identification of distinct profiles of antibiotic prescribers. This identification may allow for targeted implementation of stewardship programs focused on the specific prescribing patterns of each profile.
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Affiliation(s)
- Pauline Arias
- Infectious Diseases Department, Groupe Hospitalier Sud Ile-de-France, Melun, France
- Infectious Diseases Department, Centre hospitalier intercommunal de Villeneuve Saint Georges, Villeneuve Saint Georges, France
| | - Matta Matta
- Infectious Diseases Department, Groupe Hospitalier Sud Ile-de-France, Melun, France
| | - Alessio Strazzulla
- Infectious Diseases Department, Groupe Hospitalier Sud Ile-de-France, Melun, France
| | - Christine Le Mener
- Caisse primaire d’assurance maladie Seine-et-Marne, Ile-de-France, Melun, France
| | - Sébastien Gallien
- Infectious Diseases Department, Assistance Publique–Hôpitaux de Paris, Hôpital Henri Mondor, Université Paris Est Créteil, Créteil, France
- EA 7380 Dynamic, Université Paris Est Créteil, Créteil, France
| | - Sylvain Diamantis
- Infectious Diseases Department, Groupe Hospitalier Sud Ile-de-France, Melun, France
- EA 7380 Dynamic, Université Paris Est Créteil, Créteil, France
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15
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Duncanson E, Davies CE, Muthuramalingam S, Johns E, McColm K, Hempstalk M, Tasevski Z, Gray NA, McDonald SP. Patient Perspectives of Center-Specific Reporting in Kidney Failure Care: An Australian Qualitative Study. Kidney Int Rep 2024; 9:843-852. [PMID: 38765598 PMCID: PMC11101730 DOI: 10.1016/j.ekir.2024.01.001] [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: 08/30/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Public reporting of quality of care indicators in healthcare is intended to inform consumer decision-making; however, people may be unaware that such information exists, or it may not capture their priorities. The aim of this study was to understand the views of people with kidney disease about public reporting of dialysis and transplant center outcomes. Methods This qualitative study involved 27 patients with lived experience of kidney disease in Australia who participated in 11 online focus groups between August and December 2022. Transcripts were analyzed thematically. Results Patients from all Australian states and territories participated, with 22 (81%) having a functioning kidney transplant and 22 (81%) having current or previous experience of dialysis. Five themes were identified as follows: (i) surrendering to the health system, (ii) the complexity of quality, (iii) benefits for patient care and experience, (iv) concerned about risks and unintended consequences, and (v) optimizing the impact of data. Conclusion Patients desire choice among kidney services but perceive this as rarely possible in the Australian context. Health professionals are trusted to make decisions about appropriate centers. Public reporting of center outcomes may induce fear and a loss of balanced perspective; however, it was supported by all participants and represents an opportunity for self-advocacy and informed decision-making. Strategies to mitigate potential risks include availability of trusted clinicians and community members to aid in data interpretation, providing context about centers and patients, and framing statistics to promote positivity and hope.
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Affiliation(s)
- Emily Duncanson
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher E. Davies
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Shyamsundar Muthuramalingam
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Effie Johns
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Kate McColm
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Matty Hempstalk
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Transplant Australia, Sydney, New South Wales, Australia
| | - Zoran Tasevski
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Nicholas A. Gray
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Renal Unit, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- School of Health, University of Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Stephen P. McDonald
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Vaandering A, Lievens Y. Conducting a National RT-QI Project - Challenges and Opportunities. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00139-0. [PMID: 38616446 DOI: 10.1016/j.clon.2024.03.025] [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: 01/24/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/16/2024]
Abstract
Over the past decade, there has been an increased interest in defining and monitoring quality indicators (QI) in the field of oncology including the field of radiation oncology. The comprehensive gathering and analysis of QIs on a multicentric scale offer valuable insights into identifying gaps in clinical practice and fostering continuous improvement. This article delineates the evolution and results of the Belgian national project dedicated to radiotherapy-specific QIs while also exploring the challenges and opportunities inherent in implementing such a multi-centric initiative.
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Affiliation(s)
- A Vaandering
- UCL Cliniques Universitaires St Luc, Department of Radiation Oncology, Brussels, Belgium.
| | - Y Lievens
- Ghent University Hospital and Ghent University, Department of Radiation Oncology, Ghent, Belgium
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Ielo A, Quartarone A, Calabrò RS, De Cola MC. A hub and spoke model to supply the Sicilian neurorehabilitation demand: effects on hospitalization rates and patient mobility. Front Public Health 2024; 12:1349211. [PMID: 38572007 PMCID: PMC10987749 DOI: 10.3389/fpubh.2024.1349211] [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: 12/04/2023] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Cerebrovascular diseases in Sicily have led to high mortality and healthcare challenges, with a notable gap between healthcare demand and supply. The mobility of patients seeking care, both within and outside Sicily, has economic and organizational impacts on the healthcare system. The Hub and Spoke model implemented by the IRCCS Centro Neurolesi "Bonino-Pulejo" of Messina aims to distribute advanced neurorehabilitation services throughout Sicily, potentially reducing health mobility and improving service accessibility. Methods The evaluation was based on calculating hospitalization rates, examining patient mobility across Sicilian provinces, and assessing the financial implications of neurorehabilitation admissions. Data from 2016 to 2018, covering the period before and after the implementation of the Hub and Spoke network, were analyzed to understand the changes brought about by this model. Results The analysis revealed a significant increase in hospitalization rates for neurorehabilitation in the Sicilian provinces where spokes were established. This increase coincided with a marked decrease in interregional health mobility, indicating that patients were able to receive high-quality care closer to their residences. Furthermore, there was a decrease in both intra-regional and inter-regional escape rates in provinces within the Hub and Spoke network, demonstrating the network's efficacy in improving accessibility and quality of healthcare services. Discussion The implementation of the Hub and Spoke network substantially improved neurorehabilitation healthcare in Sicily, enhancing both accessibility and quality of care for patients. The network's establishment led to a more efficient utilization of healthcare resources and balanced distribution of services. These advancements are vital steps toward equitable and effective healthcare delivery in Sicily.
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Habbous S, Ford M, Bar-Ziv S, Donovan T, Hellsten E. The impact of the COVID-19 pandemic on longitudinal trends of surgical mortality and inpatient quality of care in Ontario, Canada. J Adv Nurs 2024. [PMID: 38491720 DOI: 10.1111/jan.16136] [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: 07/25/2023] [Revised: 11/27/2023] [Accepted: 02/18/2024] [Indexed: 03/18/2024]
Abstract
AIMS Previous studies have shown the COVID-19 pandemic was associated with reductions in volume across a spectrum of non-SARS-CoV-2 hospitalizations. In the present study, we examine the impact of the pandemic on patient safety and quality of care. DESIGN This is a retrospective population-based study of discharge abstracts. METHODS We applied a set of nationally validated indicators for measuring the quality of inpatient care to hospitalizations in Ontario, Canada between January 2010 and December 2022. We measured 90-day mortality after selected types of higher risk admissions (such as cancer surgery and cardiovascular emergency) and the rate of patient harm events (such as delirium, pressure injuries and hospital-acquired infections) occurring during the hospital stay. RESULTS A total 13,876,377 hospitalization episodes were captured. Compared with the pre-pandemic period, and independent of SARS-CoV-2 infection, the pandemic period was associated with higher rates of mortality after bladder cancer resection (adjusted risk ratio [aRR] 1.20 (1.07-1.34)) and open repair for abdominal aortic aneurysm (aRR 1.45 (1.06-1.99)). The pandemic was also associated with higher rates of delirium (adjusted odds ratio [aOR] 1.04 (1.02-1.06)), venous thromboembolism (aOR 1.10 (1.06-1.13)), pressure injuries (aOR 1.28 (1.24-1.33)), aspiration pneumonitis (aOR 1.15 (1.12-1.18)), urinary tract infections (aOR 1.02 (1.01-1.04)), Clostridiodes difficile infection (aOR 1.05 (1.02-1.09)), pneumothorax (aOR 1.08 (1.03-1.13)), and use of restraints (aOR 1.12 (1.10-1.14)), but was associated with lower rates of viral gastroenteritis (aOR 0.22 (0.18-0.28)). During the pandemic, SARS-CoV-2-positive admissions were associated with a higher likelihood of various harm events. CONCLUSION The COVID-19 pandemic was associated with higher rates of patient harm for a wide range of non-SARS-CoV-2 inpatient populations. IMPACT Understanding which quality measures are improving or deteriorating can help health systems prioritize quality improvement initiatives. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Steven Habbous
- Ontario Health (Strategic Analytics), Toronto, Ontario, Canada
- Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Maggie Ford
- Ontario Health (Clinical Institutes and Quality Programs), Toronto, Ontario, Canada
| | - Stacey Bar-Ziv
- Ontario Health (Clinical Institutes and Quality Programs), Toronto, Ontario, Canada
| | - Terri Donovan
- Ontario Health (Clinical Institutes and Quality Programs), Toronto, Ontario, Canada
| | - Erik Hellsten
- Ontario Health (Strategic Analytics), Toronto, Ontario, Canada
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Seaman K, Huang G, Wabe N, Nguyen A, Pinto S, Westbrook J. Hospitalisations before and after entry into a residential aged care facility: An interrupted time series analysis. Australas J Ageing 2024; 43:61-70. [PMID: 37861132 DOI: 10.1111/ajag.13249] [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: 02/15/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Hospitalisations are an important indicator of safety and quality of care in residential aged care facilities (RACFs). This study aimed to investigate changes in hospital use 12 months before and 12 months after RACF entry using routinely collected data from 25 Australian RACFs. METHODS This was a retrospective longitudinal cohort study using linked aged care provider and hospital record data. The sample comprised 1029 residents living in an aged care facility between July 2014 and December 2019 who had stayed a minimum of 12 months in an RACF. The outcome measures were all-cause hospitalisations and fall-related hospitalisations. We applied an interrupted time series analysis using segmented regression to examine changes in both outcome measures over time. Stratified analyses were conducted by gender and dementia status. RESULTS The rate of all-cause hospitalisations increased dramatically over the 12 months before RACF entry, from 97 per 1000 residents per month 12 months prior to RACF admission to 303 per 1000 residents at the second month prior to RACF entry. All-cause hospitalisations then decreased considerably to 55 per 1000 residents upon RACF admission and stabilised across the next 12 months. Such trajectories were also observed in fall-related hospitalisations and were consistent for gender and dementia status. CONCLUSIONS In this study, hospitalisation rates decreased significantly after RACF entry, and such reductions were maintained for residents who stayed for 12 months in RACFs. Multiple hospital admissions are likely to precipitate entry into RACF. Additional investigation of how community-based services can be successful in reducing the escalating hospitalisations is needed.
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Affiliation(s)
- Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Guogui Huang
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Amy Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sonali Pinto
- Sydney Anglican Diocese, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Cortesi PA, Fornari C, Conti S, Pollio B, Boccalandro E, Buzzi A, Carulli C, Coppola A, De Cristofaro R, Di Minno MND, Dolan G, Ferri Grazzi E, Fornari A, Gualtierotti R, Hermans C, Jiménez-Juste V, Kenet G, Lupi A, Martinoli C, Mansueto MF, Nicolò G, Tagliaferri A, Gringeri A, Molinari AC, Mantovani LG, Castaman G. The value-based healthcare approach to haemophilia: Development of outcome measures for the evaluation of care of people with haemophilia. Haemophilia 2024; 30:437-448. [PMID: 38314918 DOI: 10.1111/hae.14943] [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: 04/30/2023] [Revised: 10/16/2023] [Accepted: 11/12/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Considering the advances in haemophilia management and treatment observed in the last decades, a new set of value-based outcome indicators is needed to assess the quality of care and the impact of these medical innovations. AIM The Value-Based Healthcare in Haemophilia project aimed to define a set of clinical outcome indicators (COIs) and patient-reported outcome indicators (PROIs) to assess quality of care in haemophilia in high-income countries with a value-based approach to inform and guide the decision-making process. METHODS A Value-based healthcare approach based on the available literature, current guidelines and the involvement of a multidisciplinary group of experts was applied to generate a set of indicators to assess the quality of care of haemophilia. RESULTS A final list of three COIs and five PROIs was created and validated. The identified COIs focus on two domains: musculoskeletal health and function, and safety. The identified PROIs cover five domains: bleeding frequency, pain, mobility and physical activities, Health-Related Quality of Life and satisfaction. Finally, two composite outcomes, one based on COIs, and one based on PROIs, were proposed as synthetic outcome indicators of quality of care. CONCLUSION The presented standard set of health outcome indicators provides the basis for harmonised longitudinal and cross-sectional monitoring and comparison. The implementation of this value-based approach would enable a more robust assessment of quality of care in haemophilia, within a framework of continuous treatment improvements with potential added value for patients. Moreover, proposed COIs and PROIs should be reviewed and updated routinely.
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Affiliation(s)
- Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Carla Fornari
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Berardino Pollio
- Regional Reference Centre for Inherited Bleeding and Thrombotic Disorders, Transfusion Medicine, "Regina Margherita" Children Hospital, Turin, Italy
| | - Elena Boccalandro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | | | | | - Antonio Coppola
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | - Raimondo De Cristofaro
- Haemorrhagic and Thrombotic Disease Service, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Matteo Nicola Dario Di Minno
- Department of Clinical Medicine and Surgery, Regional Reference Center for Coagulation Disorders, Federico II University, Naples, Italy
| | | | | | - Arianna Fornari
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberta Gualtierotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
- Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Cedric Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Victor Jiménez-Juste
- Thrombosis and Haemostasis Unit - IdiPAZ, University Hospital La Paz, Madrid, Spain
| | - Gili Kenet
- National Hemophilia Center, Thrombosis Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Angelo Lupi
- Federation of Haemophilia Associations (FedEmo), Milan, Italy
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Gabriella Nicolò
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Department of Healthcare Professions, Milan, Italy
| | - Annarita Tagliaferri
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | | | - Angelo Claudio Molinari
- Regional Reference Centre for Haemorrhagic Diseases, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
- CHARTA Foundation, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giancarlo Castaman
- Department of Oncology, Centre for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
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21
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Brimelow R, Brooks D, Sriram D, Burley C, Beattie E, Byrne G, Dissanayaka N. Prototype development of the Mental Health benchmarking Industry Tool for residential aged Care (MHICare Tool): a protocol paper of a two-stage sequential and mixed methods codesign study. BMJ Open 2024; 14:e078493. [PMID: 38413151 PMCID: PMC10900333 DOI: 10.1136/bmjopen-2023-078493] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES Current mental health practices for people living in residential aged care (RAC) facilities are poor. In Australia, there are no mechanisms to monitor and promote mental health for people living in RAC, including those who experience changed behaviours and psychological symptoms. The aim of this study is to improve current practices and mental health outcomes for people living in RAC facilities by codesigning a Mental Health benchmarking Industry Tool for residential aged Care (MHICare Tool). METHODS A two-stage sequential and mixed methods codesign methodology will be used. Stage 1 will include qualitative interviews and focus groups to engage with residents, family/care partners and RAC staff to ascertain mental healthcare practices and outcomes of greatest significance to them. Adapted concept mapping methods will be used to rank identified issues of concern in order of importance and changeability, and to generate draft quality indicators. Stage 2 will comprise a Delphi procedure to gain the wider consensus of expert panel views (aged care industry, academic, clinical) on the performance indicators to be included, resulting in the codesigned MHICare Tool. ETHICS AND DISSEMINATION This study has been reviewed and approved by the University of Queensland Human Research Ethics Committee (HREC/2019002096). This project will be carried out according to the National Statement on Ethical Conduct in Human Research (2007). The study's findings will be published in peer-reviewed journals and disseminated at national and international conferences and through social media. CONCLUSION This protocol reports structured methods to codesign and develop a mental health performance indicator tool for use in Australian RAC.
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Affiliation(s)
- Rachel Brimelow
- University of Queensland Centre for Clinical Research (UQCCR), Herston, Queensland, Australia
| | - Deborah Brooks
- University of Queensland Centre for Clinical Research (UQCCR), Herston, Queensland, Australia
| | - Deepa Sriram
- University of Queensland Centre for Clinical Research (UQCCR), Herston, Queensland, Australia
| | - Claire Burley
- UNSW Medicine & Health Lifestyle Clinic, School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth Beattie
- Faculty of Health, School of Nursing, QUT, Brisbane, Queensland, Australia
| | - Gerard Byrne
- Academy of Psychiatry, UQ Faculty of Medicine, Herston, Queensland, Australia
| | - Nadeeka Dissanayaka
- Centre for Clinical Research, University of Queensland Faculty of Medicine, Herston, Queensland, Australia
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22
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D'Silva M, Cho JY, Han HS, Yoon YS, Lee HW, Lee BR, Kang MY, Park YS, Kim JJ. Achieving Textbook Outcomes after Laparoscopic Resection in Posterosuperior Segments of the Liver: The Impact of the Learning Curve. Cancers (Basel) 2024; 16:930. [PMID: 38473292 DOI: 10.3390/cancers16050930] [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: 01/10/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Achieving textbook outcomes (TOs) improves the short-term and long-term performance of a hospital. Our objective was to assess TOs in the laparoscopic liver resection (LLR) of tumors in the PS (posterosuperior) section of the liver and identify the impact of the learning curve. We conducted a retrospective cohort study analyzing patients who underwent LLR for lesions located in the PS segments. Patients were divided into a TO and no-TO group. TOs were defined as negative margins, no transfusion, no readmission, no major complications, no 30-day mortality, and a length of stay ≤ 50th percentile. Patients' outcomes were assessed in two study periods before and after 2015. TOs were achieved in 47.6% (n = 117). In multivariable analysis, obesity (p = 0.001), shorter operation time (p < 0.001), less blood loss (p < 0.001), normal albumin (p = 0.003), and minor resection (p = 0.046) were significantly associated with achieving TOs. Although the 5-year recurrence-free survival rate (p = 0.096) was not significantly different, the 5-year overall survival rate was significantly greater in the TO group (p = 0.001). Body mass index > 25 kg/m2 (p = 0.020), age > 65 years (p = 0.049), and achievement of TOs (p = 0.024) were independently associated with survival. The proportion of patients who achieved a TO was higher after 2015 than before 2015 (52.3% vs. 36.1%; p = 0.022). TOs are important markers not only for assessing hospital and surgeon performance but also as predictors of overall survival. As the number of surgeons who achieve the learning curve increases, the number of patients with TOs will gradually increase with a subsequent improvement in overall survival.
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Affiliation(s)
- Mizelle D'Silva
- Department of Surgery, Holy Family Hospital and Research Centre, Bandra, Mumbai 400050, India
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Jai-Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Hae-Won Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Bo-Ram Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Mee-Young Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Ye-Shong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Jin-Ju Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
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23
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Wang C, Garg AX, Luo B, Kim SJ, Knoll G, Yohanna S, Treleaven D, McKenzie S, Ip J, Cooper R, Elliott L, Naylor KL. Defining pre-emptive living kidney donor transplantation as a quality indicator. Am J Transplant 2024:S1600-6135(24)00159-X. [PMID: 38395149 DOI: 10.1016/j.ajt.2024.02.017] [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: 10/03/2023] [Revised: 01/31/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
Quality indicators in kidney transplants are needed to identify care gaps and improve access to transplants. We used linked administrative health care databases to examine multiple ways of defining pre-emptive living donor kidney transplants, including different patient cohorts and censoring definitions. We included adults from Ontario, Canada with advanced chronic kidney disease between January 1, 2013, to December 31, 2018. We created 4 unique incident patient cohorts, varying the eligibility by the risk of progression to kidney failure and whether individuals had a recorded contraindication to kidney transplant (eg, home oxygen use). We explored the effect of 4 censoring event definitions. Across the 4 cohorts, size varied substantially from 20 663 to 9598 patients, with the largest reduction (a 43% reduction) occurring when we excluded patients with ≥1 recorded contraindication to kidney transplantation. The incidence rate (per 100 person-years) of pre-emptive living donor kidney transplant varied across cohorts from 1.02 (95% CI: 0.91-1.14) for our most inclusive cohort to 2.21 (95% CI: 1.96-2.49) for the most restrictive cohort. Our methods can serve as a framework for developing other quality indicators in kidney transplantation and monitoring and improving access to pre-emptive living donor kidney transplants in health care systems.
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Affiliation(s)
- Carol Wang
- Division of Nephrology, Western University, London, Ontario, Canada.
| | - Amit X Garg
- Division of Nephrology, Western University, London, Ontario, Canada; ICES, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Lawson Health Research Institute and London Health Sciences Centre, London, Ontario, Canada
| | - Bin Luo
- ICES, Ontario, Canada; Lawson Health Research Institute and London Health Sciences Centre, London, Ontario, Canada
| | - S Joseph Kim
- Division of Nephrology and the Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Gregory Knoll
- University of Ottawa, Department of Medicine (Nephrology) and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Seychelle Yohanna
- Division of Nephrology, McMaster University, Hamilton, Ontario, Canada
| | - Darin Treleaven
- Division of Nephrology, McMaster University, Hamilton, Ontario, Canada
| | | | - Jane Ip
- Ontario Renal Network, Ontario Health, Ontario, Canada
| | - Rebecca Cooper
- Ontario Renal Network, Ontario Health, and Trillium Gift of Life Network, Ontario Health, Canada
| | - Lori Elliott
- Ontario Renal Network, Ontario Health, Ontario, Canada
| | - Kyla L Naylor
- ICES, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Lawson Health Research Institute and London Health Sciences Centre, London, Ontario, Canada
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24
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Almobarak F. A content analysis of YouTube videos on palliative care: understanding the quality and availability of online resources. Palliat Care Soc Pract 2024; 18:26323524241231819. [PMID: 38390558 PMCID: PMC10883131 DOI: 10.1177/26323524241231819] [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: 09/04/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Background Improvement in quality care is an important aspect of palliative care for individuals with serious illnesses. Palliative care is a multidisciplinary strategy that addresses the physical, emotional, social, and spiritual needs of patients and their families. As technology advances, digital media - especially YouTube - has come to serve as a virtual educational platform, offering resources for health-related information, including information about palliative care. Objectives In this research, the main goal was to evaluate the quality and availability of online resources related to palliative care. Design Two theoretical frameworks were used: the Health Communication Model and the Information Quality Framework. These frameworks offer a way to understand how YouTube videos contribute to palliative care information and assess the quality of that information. Methods This study utilizes a quantitative analysis approach to assess the quality and accessibility of YouTube videos on palliative care. Specifically, a random sample of 300 YouTube videos addressing palliative care was examined. Descriptive statistics were used to analyze the data, including the frequency and distribution of the different types of content, sources, and quality indicators. Chi-square tests were done to compare the quality of information provided by different sources and types of content. Results The results showed a variety of video types, with educational videos being the most common (40%), followed by personal stories (26.7%) and promotional videos (16.7%). We found that healthcare organizations (30%) and individual content creators (46.7%) were the sources for these videos. Conclusion There were varying scores in terms of accuracy, completeness, and relevance when it came to quality assessment. While many videos received excellent ratings, some received poor ratings. Additionally, this analysis revealed that the majority of these videos were in English (83.3%), which poses a limitation for non-English speakers who may have difficulty understanding them.
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Affiliation(s)
- Fhaied Almobarak
- Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
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25
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Fiore M, Bianconi A, Acuti Martellucci C, Rosso A, Zauli E, Flacco ME, Manzoli L. Impact of the Italian Healthcare Outcomes Program (PNE) on the Care Quality of the Poorest Performing Hospitals. Healthcare (Basel) 2024; 12:431. [PMID: 38391807 PMCID: PMC10887701 DOI: 10.3390/healthcare12040431] [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: 01/15/2024] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
One of the main aims of the Italian National Healthcare Outcomes Program (Programma Nazionale Esiti, PNE) is the identification of the hospitals with the lowest performance, leading them to improve their quality. In order to evaluate PNE impact for a subset of outcome indicators, we evaluated whether the performance of the hospitals with the lowest scores in 2016 had significantly improved after five years. The eight indicators measured the risk-adjusted likelihood of the death of each patient (adjusted relative risk-RR) 30 days after the admission for acute myocardial infarction, congestive heart failure, stroke, chronic obstructive pulmonary disease, chronic kidney disease, femur fracture or lung and colon cancer. In 2016, the PNE identified 288 hospitals with a very low performance in at least one of the selected indicators. Overall, 51.0% (n = 147) of these hospitals showed some degree of improvement in 2021, and 27.4% of them improved so much that the death risk of their patients fell below the national mean value. In 34.7% of the hospitals, however, the patients still carried a mean risk of death >30% higher than the average Italian patient with the same disease. Only 38.5% of the hospitals in Southern Italy improved the scores of the selected indicators, versus 68.0% in Northern and Central Italy. Multivariate analyses, adjusting for the baseline performance in 2016, confirmed univariate results and showed a significantly lower likelihood of improvement with increasing hospital volume. Despite the overall methodological validity of the PNE system, current Italian policies and actions aimed at translating hospital quality scores into effective organizational changes need to be reinforced with a special focus on larger southern regions.
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Affiliation(s)
- Matteo Fiore
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Alessandro Bianconi
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | | | - Annalisa Rosso
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Enrico Zauli
- Department of Medical Translation, University of Ferrara, 44121 Ferrara, Italy
| | - Maria Elena Flacco
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Lamberto Manzoli
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
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26
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Wright WF, Betrains A, Stelmash L, Mulders-Manders CM, Rovers CP, Vanderschueren S, Auwaerter PG. Development of a Consensus-Based List of Potential Quality Indicators for Fever and Inflammation of Unknown Origin. Open Forum Infect Dis 2024; 11:ofad671. [PMID: 38333881 PMCID: PMC10853001 DOI: 10.1093/ofid/ofad671] [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: 10/12/2023] [Accepted: 12/22/2023] [Indexed: 02/10/2024] Open
Abstract
With a growing emphasis on value-based reimbursement, developing quality indicators for infectious diseases has gained attention. Quality indicators for fever of unknown origin and inflammation of unknown origin are lacking. An assembled group of international experts developed 12 quality measures for these conditions, which could be validated with additional study.
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Affiliation(s)
- William F Wright
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Albrecht Betrains
- General Internal Medicine Department, University Hospitals Leuven, Leuven, Belgium
| | - Lauren Stelmash
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Catharina M Mulders-Manders
- Division of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Chantal P Rovers
- Division of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Steven Vanderschueren
- General Internal Medicine Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Paul G Auwaerter
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- The Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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27
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Nguyen F, Liao G, McIsaac DI, Lalu MM, Pysyk CL, Hamilton GM. Perioperative quality indicators specific to the practice of anesthesia in noncardiac surgery: an umbrella review. Can J Anaesth 2024; 71:274-291. [PMID: 38182828 DOI: 10.1007/s12630-023-02671-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE Improvement in delivery of perioperative care depends on the ability to measure outcomes that can direct meaningful changes in practice. We sought to identify and provide an overview of perioperative quality indicators specific to the practice of anesthesia in noncardiac surgery. SOURCE We conducted an umbrella review (a systematic review of systematic reviews) according to Joanna Briggs Institute methodology. We included systematic reviews examining perioperative indicators in patients ≥ 18 yr of age undergoing noncardiac surgery. Our primary outcome was any quality indicator specific to anesthesia. Indicators were classified by the Donabedian system and perioperative phase of care. The quality of systematic reviews was assessed using AMSTAR 2 criteria. Level of evidence of quality indicators was stratified by the Oxford Centre for Evidence-Based Medicine Classification. PRINCIPAL FINDINGS Our search returned 1,475 studies. After removing duplicates and screening of abstracts and full texts, 23 systematic reviews encompassing 3,164 primary studies met our inclusion criteria. There were 330 unique quality indicators. Process indicators were most common (n = 169), followed by outcome (n = 114) and structure indicators (n = 47). Few identified indicators were supported by high-level evidence (45/330, 14%). Level 1 evidence supported indicators of antibiotic prophylaxis (1a), venous thromboembolism prophylaxis (1a), postoperative nausea/vomiting prophylaxis (1b), maintenance of normothermia (1a), and goal-directed fluid therapy (1b). CONCLUSION This umbrella review highlights the scarcity of perioperative quality indicators that are supported by high quality evidence. Future development of quality indicators and recommendations for outcome measurement should focus on metrics that are supported by level 1 evidence. Potential targets for evidence-based quality-improvement programs in anesthesia are identified herein. STUDY REGISTRATION PROSPERO (CRD42020164691); first registered 28 April 2020.
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Affiliation(s)
- Frederic Nguyen
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
| | - Gary Liao
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Manoj M Lalu
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Christopher L Pysyk
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Gavin M Hamilton
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
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28
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Zhou Y, Liu L, Rong R, Guo L, Pei Y, Lu X. Constructing nursing quality indicators for intraoperative acquired pressure injury in cancer patients based on guidelines. Int J Qual Health Care 2024; 36:mzae001. [PMID: 38183267 DOI: 10.1093/intqhc/mzae001] [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: 05/05/2023] [Revised: 12/16/2023] [Accepted: 01/04/2024] [Indexed: 01/07/2024] Open
Abstract
Cancer patients have a high incidence of intraoperative acquired pressure injury (IAPI). Constructing IAPI quality indicators can reduce the incidence of pressure injury, but there are a lack of these indicators targeting cancer patients. Based on this, this study develops a system of quality indicators for IAPI. Thirty-four potential indicators were included based on the literature review. The 26 experts were asked to rate the importance and feasibility of each indicator using three rounds of email survey. The authoritative coefficient ranged from 0.92 to 0.94. After three rounds of Delphi expert consultation, nine nursing quality indicators were identified for IAPI in cancer patients. The mean importance or feasibility ratings ranged from 4.77 to 5.81 on a six-point scale, with variation coefficients ranging from 0.07 to 0.26. The percentage of full score for potential indicators ranged from 23.10% to 80.80%. Over three rounds, the Kendall's W coefficients ranged from 0.157 to 0.354 (P < .01). The absolute and relative importance and feasibility of the nine indicators were identified as potentially valid measures of nursing quality indicators for IAPI in cancer patients. This instrument is the first set of IAPI quality indicators developed specifically for cancer patients, and it should be useful for evaluating and improving the quality of IAPI in this population.
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Affiliation(s)
- Yu Zhou
- Nursing department, Chengdu Fifth People's Hospital, No. 33 Mashi Road,Wenjiang District, Chengdu 611130, China
| | - Lu Liu
- Operating Room, Operating Room, Sichuan Cancer Hospital, No. 55, Section 4, Renmin South Road, Chengdu 610041, China
| | - Rong Rong
- Operating Room, Operating Room, Sichuan Cancer Hospital, No. 55, Section 4, Renmin South Road, Chengdu 610041, China
| | - Li Guo
- Department of Development Management, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing 100191, China
| | - Yuquan Pei
- Operating Room, Beijing Cancer Hospital, No. 52 Fucheng Road, Haidian District, Beijing 100048, China
| | - Xiuying Lu
- Operating Room, Operating Room, Sichuan Cancer Hospital, No. 55, Section 4, Renmin South Road, Chengdu 610041, China
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Duan Y, Hoben M, Song Y, Chamberlain SA, Iaconi A, Choroschun K, Shrestha S, Cummings GG, Norton PG, Estabrooks CA. Organizational Context and Quality Indicators in Nursing Homes: A Microsystem Look. J Appl Gerontol 2024; 43:13-25. [PMID: 37669619 PMCID: PMC10693724 DOI: 10.1177/07334648231200110] [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: 02/02/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023] Open
Abstract
The association of organizational context with quality of care in nursing homes is not well understood at the clinical microsystem (care unit) level. This cross-sectional study examined the associations of unit-level context with 10 unit-level quality indicators derived from the Minimum Data Set 2.0. Study settings comprised 262 care units within 91 Canadian nursing homes. We assessed context using unit-aggregated care-aide-reported scores on the 10 scales of the Alberta Context Tool. Mixed-effects regression analysis showed that structural resources were negatively associated with antipsychotics use (B = -.06; p = .001) and worsened late-loss activities of daily living (B = -.03, p = .04). Organizational slack in time was negatively associated with worsened pain (B = -.04, p = .01). Social capital was positively associated with delirium symptoms (B = .12, p = .02) and worsened depressive symptoms (B = .10, p = .01). The findings suggested that targeting interventions to modifiable contextual elements and unit-level quality improvement will be promising.
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Affiliation(s)
- Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Faculty of Health, York University, Toronto, ON, Canada
| | - Yuting Song
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- School of Nursing, Qingdao University, Qingdao, China
| | | | - Alba Iaconi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | | | | | | | - Peter G. Norton
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
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30
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Iorio-Aranha F, de Freitas C, Rocha-Sousa A, Azevedo A, Barbosa-Breda J. Nationwide consensus on quality indicators to assess glaucoma care: A modified Delphi approach. Eur J Ophthalmol 2024; 34:217-225. [PMID: 37069806 PMCID: PMC10757386 DOI: 10.1177/11206721231170033] [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: 04/20/2022] [Accepted: 03/28/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Performance assessments are essential to tracking and improving quality in health care systems. Key aspects of the care process that act as indicators must be measured in order to gain an in-depth understanding of a care unit's operation. Without standardized quality indicators (QIs), it is difficult to characterize and compare the abilities of institutions to achieve excellence. The aim of this study is to reach a consensus among glaucoma specialists concerning the development of a set of QIs to assess the performance of glaucoma care units. METHODS A two-round Delphi technique was performed among glaucoma specialists in Portugal, using a 7-point Likert scale. Fifty-three initial statements (comprising process, structure, and outcome indicators) were evaluated and participants had to agree on which ones would be part of the final set of QIs. RESULTS By the end of both rounds, 28 glaucoma specialists reached consensus on 30/53 (57%) statements, including 19 (63%) process indicators (mainly relating to the proper implementation of complementary exams and the setting of follow-up intervals), 6 (20%) structure indicators, and 5 (17%) outcome indicators. Of the indicators that were part of the final list, functional and structural aspects of glaucoma progression and the availability of surgical/laser procedures were the most prevalent. CONCLUSIONS A set of 30 QIs for measuring the performance of glaucoma units was developed using a consensus methodology involving experts in the field. Their use as measurement standards would provide important information about unit operations and allow further implementation of quality improvements.
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Affiliation(s)
- Flavio Iorio-Aranha
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Ophthalmology, Faculty of Medicine, Universidade de Brasilia, Brasilia, Brasil
| | - Cláudia de Freitas
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Amândio Rocha-Sousa
- UnIC@RISE, Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Ana Azevedo
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Hospital Epidemiology Center, Centro Hospitalar Universitário São João, Porto, Portugal
| | - João Barbosa-Breda
- UnIC@RISE, Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Neurosciences, KULeuven, Research Group Ophthalmology, Leuven, Belgium
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Berta DM, Grima M, Melku M, Adane T, Chane E, Teketelew BB, Yalew A. Assessment of hematology laboratory performance in the total testing process using quality indicators and sigma metrics in the northwest of Ethiopia: A cross-sectional study. Health Sci Rep 2024; 7:e1833. [PMID: 38264158 PMCID: PMC10803892 DOI: 10.1002/hsr2.1833] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/10/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
Background and Aims Assuring laboratory quality by minimizing the magnitude of errors is essential. Therefore, this study aimed to assess hematology laboratory performance in the total testing process using quality indicators and sigma metrics. Methods A cross-sectional study was conducted from April to June 2022. The study included a total of 13,546 samples. Data on included variables were collected using a checklist. Descriptive statistics were used to present the overall distribution of errors. Binary logistic regression models were applied. Furthermore, using a Sigma scale, the percentage of errors was converted to defects per million opportunities to assess laboratory performance. Finally, the defect per million opportunities was converted to a sigma value using a sigma calculator. Results Of the 13,546 samples and corresponding requests, the overall error rate was 123,296/474,234 (26%): 93,412/47,234 (19.7%) pre-analytical, 2364/474,234 (0.5%) analytical, and 27,520/474,234 (5.8%) post-analytical. Of the overall errors, 93,412/123,296 (75.8%), 2364/123,296 (1.9%), and 27,520/123,296 (22.3%) were pre-analytical, analytical, and post-analytical errors, respectively. The overall sigma value of the laboratory was 2.2. The sigma values of the pre-analytical, analytical, and post-analytical phases were 2.4, 4.1, and 3.1, respectively. The sample from the inpatient department and collected without adherence to the standard operating procedures (SOPs) had a significantly higher (p < 0.05) rejection rate as compared to the outpatient department and collected with adherence to SOPs, respectively. In addition, an association between prolonged turnaround times and manual recording, inpatient departments, and morning work shifts was observed. Conclusion The current study found that the overall performance of the laboratory was very poor (less than three sigma). Therefore, the hospital leadership should change the manual system of ordering tests and release of results to a computerized system and give need-based training for all professionals involved in hematology laboratory sample collection and processing.
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Affiliation(s)
| | - Mekonnen Grima
- Department of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Mulugeta Melku
- Department of Hematology and ImmunohematologyUniversity of GondarGondarEthiopia
- Flinders UniversityAdelaideSouth AustraliaAustralia
| | - Tiruneh Adane
- Department of Hematology and ImmunohematologyUniversity of GondarGondarEthiopia
| | - Elias Chane
- Department of Clinical Chemistry, School of Biomedical and Laboratory SciencesUniversity of GondarGondarEthiopia
| | - Bisrat Birke Teketelew
- Department of Hematology and ImmunohematologyUniversity of GondarGondarEthiopia
- Department of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Aregawi Yalew
- Department of Hematology and ImmunohematologyUniversity of GondarGondarEthiopia
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Mahoney LB, Huang JS, Lightdale JR, Walsh CM. Pediatric endoscopy: how can we improve patient outcomes and ensure best practices? Expert Rev Gastroenterol Hepatol 2024; 18:89-102. [PMID: 38465446 DOI: 10.1080/17474124.2024.2328229] [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: 10/25/2023] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Strategies to promote high-quality endoscopy in children require consensus around pediatric-specific quality standards and indicators. Using a rigorous guideline development process, the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) was developed to support continuous quality improvement efforts within and across pediatric endoscopy services. AREAS COVERED This review presents a framework, informed by the PEnQuIN guidelines, for assessing endoscopist competence, granting procedural privileges, audit and feedback, and for skill remediation, when required. As is critical for promoting quality, PEnQuIN indicators can be benchmarked at the individual endoscopist, endoscopy facility, and endoscopy community levels. Furthermore, efforts to incorporate technologies, including electronic medical records and artificial intelligence, into endoscopic quality improvement processes can aid in creation of large-scale networks to facilitate comparison and standardization of quality indicator reporting across sites. EXPERT OPINION PEnQuIN quality standards and indicators provide a framework for continuous quality improvement in pediatric endoscopy, benefiting individual endoscopists, endoscopy facilities, and the broader endoscopy community. Routine and reliable measurement of data, facilitated by technology, is required to identify and drive improvements in care. Engaging all stakeholders in endoscopy quality improvement processes is crucial to enhancing patient outcomes and establishing best practices for safe, efficient, and effective pediatric endoscopic care.
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Affiliation(s)
- Lisa B Mahoney
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Jeannie S Huang
- Rady Children's Hospital, San Diego, CA and University of California San Diego, La Jolla, CA, USA
| | - Jenifer R Lightdale
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Kiejna A, Zięba M, Cichoń E, Paciorek S, Janus J, Gondek T. Evaluation of mental health services delivered before and after the introduction of pilot Mental Health Centers in Poland using monitoring indicators. Psychiatr Pol 2023; 57:1213-1229. [PMID: 38564523 DOI: 10.12740/pp/onlinefirst/151140] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The study assessed the performance of Mental Health Centres compared to previous non-integrated mental health facilities. METHODS The study used National Health Fund (NHF) data of individuals over 18 years treated in 27 centres (January 2017 - February 2020). Performance indicators from 19 months before (N = 124,497) and after the introduction of Mental Health Centres (N = 182,789) were compared for outpatient care, community treatment teams, inpatient wards and day wards. RESULTS The total number of patients who received mental health care increased, compared to before the establishment of those Centres; whereas the number of hospitalisations decreased by 6% and the number of patient days per person decreased by 9%. Day care saw a 14% increase in admissions following the introduction of Mental Health Centres, with a 5% decrease in patient days per person. The proportion of patients in community care increased by 86%, in outpatient care by 62% and in day care by 14%. The number of first-time patients after the introduction of Mental Health Centres increased and the number of follow-up patients decreased. For all groups of mental disorders, the priority indicator in inpatient care decreased, while increasing in outpatient and community care for most groups of disorders. CONCLUSIONS The results confirmed the effectiveness of the National Mental Health Protection Programme project in relation to the availability and reduction of inpatient treatment through Mental Health Centres. The methodology used in this study can be used for assessing the effectiveness of Mental Health Centre activities in subsequent stages of the pilot.
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Affiliation(s)
- Andrzej Kiejna
- Wyższa Szkoła Bankowa w Toruniu, Instytut Psychologii, Toruń, Polska
- Dolnośląska Szkoła Wyższa, Kolegium Studiów Psychologicznych, Wrocław, Polska
| | - Mariusz Zięba
- Ministerstwo Zdrowia, Departament Analiz i Strategii, Warszawa, Polska
| | - Ewelina Cichoń
- Wyższa Szkoła Bankowa w Toruniu, Instytut Psychologii, Toruń, Polska
- Dolnośląska Szkoła Wyższa, Kolegium Studiów Psychologicznych, Wrocław, Polska
| | - Sylwia Paciorek
- Ministerstwo Zdrowia, Departament Analiz i Strategii, Warszawa, Polska
| | - Jolanta Janus
- Ministerstwo Zdrowia, Departament Analiz i Strategii, Warszawa, Polska
| | - Tomasz Gondek
- Polskie Towarzystwo Psychiatryczne, Sekcja Kształcenia Specjalizacyjnego, Wrocław, Polska
- Europejskie Towarzystwo Psychiatryczne, Early Career Psychiatrists Committee
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Frost L, Joensen AM, Dam-Schmidt U, Qvist I, Brinck M, Brandes A, Davidsen U, Pedersen OD, Damgaard D, Mølgaard I, Bedsted R, Damgaard Møller Schlünsen A, Chousa MG, Andersen J, Pedersen AR, Johnsen SP, Vinter N. The Danish Atrial Fibrillation Registry: A Multidisciplinary National Pragmatic Initiative for Monitoring and Supporting Quality of Care Based on Data Retrieved from Administrative Registries. Clin Epidemiol 2023; 15:1259-1272. [PMID: 38149081 PMCID: PMC10750776 DOI: 10.2147/clep.s443473] [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: 10/06/2023] [Accepted: 12/09/2023] [Indexed: 12/28/2023] Open
Abstract
Aim The Danish Atrial Fibrillation (AF) Registry monitors and supports improvement of quality of care for all AF patients in Denmark. This report describes the registry's administrative and organizational structure, data sources, data flow, data analyses, annual reporting, and feedback between the registry, clinicians, and the administrative system. We also report the selection process of the quality indicators and the temporal trends in results from 2017-2021. Methods and Results The Danish AF Registry aims for complete registration and monitoring of care for all patients diagnosed with AF in Denmark. Administrative registries provide data on contacts to general practice, contacts to private cardiology practice, hospital contacts, medication prescriptions, updated vital status information, and biochemical test results. The Danish Stroke Registry provides information on stroke events. From 2017 to 2021, the proportion with a reported echocardiography among incident AF patients increased from 39.9% (95% CI: 39.3-40.6) to 82.6% (95% CI: 82.1-83.1). The initiation of oral anticoagulant therapy among patients with incident AF and a CHA2DS2-VASc score of ≥1 in men and ≥2 in women increased from 85.3% (95% CI: 84.6-85.9) to 90.4% (95% CI: 89.9-91.0). The 1-year and 2-year persistence increased from 85.2% (95% CI: 84.5-85.9) to 88.7% (95% CI: 88.0-89.3), and from 85.4% (95% CI: 84.7-86.2) to 88.2% (95% CI: 87.5-88.8), respectively. The 1-year risk of ischemic stroke among prevalent patients with AF decreased from 0.88% (95% CI: 0.83-0.93) to 0.71% (95% CI: 0.66-0.75). Variation in clinical performance between the five administrative Danish regions was reduced. Conclusion Continuous nationwide monitoring of quality indicators for AF originating from administrative registries is feasible and supportive of improvements of quality of care.
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Affiliation(s)
- Lars Frost
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Ulla Dam-Schmidt
- Department of Cardiology, Bispebjerg Hospital, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Ina Qvist
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Margit Brinck
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Axel Brandes
- Department of Cardiology, Esbjerg Hospital – University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ulla Davidsen
- Department of Cardiology, Bispebjerg Hospital, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Ole Dyg Pedersen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Dorte Damgaard
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Inge Mølgaard
- Patient Representative, Aalborg and Roskilde, Denmark
| | | | | | - Miriam Grijota Chousa
- The Danish Clinical Quality Program – National Clinical Registries (RKKP), Aarhus, Denmark
| | - Julie Andersen
- The Danish Clinical Quality Program – National Clinical Registries (RKKP), Aarhus, Denmark
| | | | - Søren Paaske Johnsen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Nicklas Vinter
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Massele A, Rogers AM, Gabriel D, Mayanda A, Magoma S, Cook A, Chigome A, Lorenzetti G, Meyer JC, Moore CE, Godman B, Minzi O. A Narrative Review of Recent Antibiotic Prescribing Practices in Ambulatory Care in Tanzania: Findings and Implications. Medicina (Kaunas) 2023; 59:2195. [PMID: 38138298 PMCID: PMC10745081 DOI: 10.3390/medicina59122195] [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] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
Background and objectives: There are concerns with the current prescribing practices of antibiotics in ambulatory care in Tanzania, including both the public and private sectors. These concerns need to be addressed as part of the national action plan (NAP) of Tanzania to reduce rising antimicrobial resistance (AMR) rates. Issues and concerns include high rates of prescribing of antibiotics for essentially self-limiting conditions. Consequently, there is a need to address this. As a result, the aims of this narrative review were to comprehensively summarize antibiotic utilization patterns particularly in ambulatory care and their rationale in Tanzania and to suggest ways forward to improve future prescribing practices. Materials and Methods: We undertook a narrative review of recently published studies and subsequently documented potential activities to improve future prescribing practices. Potential activities included instigating quality indicators and antimicrobial stewardship programs (ASPs). Results: Published studies have shown that antibiotics are being excessively prescribed in ambulatory care in Tanzania, in up to 95% to 96.3% of presenting cases depending on the sector. This is despite concerns with their appropriateness. High rates of antibiotic prescribing are not helped by variable adherence to current treatment guidelines. There have also been concerns with extensive prescribing of 'Watch' antibiotics in the private sector. Overall, the majority of antibiotics prescribed across the sectors, albeit inappropriately, were typically from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. The inappropriate prescribing of antibiotics in ambulatory care is linked to current knowledge regarding antibiotics, AMR, and ASPs among both prescribers and patients. Recommended activities for the future include improved education for all groups, the instigation of updated quality indicators, and the regular monitoring of prescribing practices against agreed-upon guidelines and indicators. Education for healthcare professionals on ASPs should start at undergraduate level and continue post qualification. Community advocacy on the rational use of antibiotics should also include social media activities to dispel misinformation. Conclusion: The quality of current prescribing practices of antibiotics in ambulatory care is sub-optimal in Tanzania. This needs to be urgently addressed.
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Affiliation(s)
- Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hubert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania
| | - Anastasia Martin Rogers
- Department of Microbiology and Parasitology, Faculty of Medicine, Hubert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania; (A.M.R.); (D.G.); (A.M.)
| | - Deogratias Gabriel
- Department of Microbiology and Parasitology, Faculty of Medicine, Hubert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania; (A.M.R.); (D.G.); (A.M.)
| | - Ashura Mayanda
- Department of Microbiology and Parasitology, Faculty of Medicine, Hubert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania; (A.M.R.); (D.G.); (A.M.)
| | - Sarah Magoma
- Department of Infectious Diseases, Faculty of Medicine, University of Dodoma, Dodoma P.O. Box 582, Tanzania;
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Audrey Chigome
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa (J.C.M.)
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa (J.C.M.)
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Catrin E. Moore
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa (J.C.M.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
| | - Omary Minzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar Es Salaam P.O. Box 65013, Tanzania;
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Duarte JL, da Silva K, Carlino FC, Souza MVDA, Vieira GDSP, Carregosa AM, Santos SCDC. Children's Hearing Health Panorama in the Unified Health System in the state of Sergipe. Codas 2023; 36:e20210197. [PMID: 38126548 PMCID: PMC10750856 DOI: 10.1590/2317-1782/20232021197pt] [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: 07/29/2021] [Accepted: 12/26/2022] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To describe the panorama of children's hearing health in the Unified Health System of the state of Sergipe. METHODS A quantitative and retrospective study consisting of four steps: 1) Search the National Registry of Health Establishments of institutions affiliated to the Health Unic System in the state of Sergipe that perform obstetric services and hearing health services; 2) Collecting Neonatal Hearing Screening (NHS) coverage data through DATASUS (from 2012 to 2020); 3) Data collection from medical records of institutions with obstetrics and that perform NHS; and 4) Interview with the guardians of children undergoing auditory rehabilitation. The results were summarized using descriptive statistics (absolute and relative frequency, measures of central tendency, and dispersion). RESULTS Only one out of the 29 establishments with obstetrics performs NHS. Two of the Hearing Health Reference Centers (HHRC) are qualified for cochlear implants and two Specialized Centers are qualified for Rehabilitation. From 2012 to 2020, NHS coverage in the state was less than 40%, and when performed in the maternity ward, there were no referrals for Brainstem Auditory Evoked Response (BERA) and audiological diagnosis. The HHRC showed considerable coverage and a lower evasion rate to perform BERA, with a diagnosis rate of 4.8%. The mean time from the NHS to rehabilitation was longer than recommended. CONCLUSION NHS coverage must be increased, adjusting the hearing health network to articulate the different levels of care, and reducing the time for identification, diagnosis, and start of rehabilitation.
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Affiliation(s)
- Josilene Luciene Duarte
- Departamento de Fonoaudiologia, Universidade Federal de Sergipe - UFS - Lagarto (SE), Brasil.
| | - Kelly da Silva
- Departamento de Fonoaudiologia, Universidade Federal de Sergipe - UFS - Lagarto (SE), Brasil.
| | | | | | | | - Ana Maria Carregosa
- Departamento de Fonoaudiologia, Universidade Federal de Sergipe - UFS - Lagarto (SE), Brasil.
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Baù MG, Borella F, Mano MP, Giordano L, Carosso M, Surace A, Mondino A, Gallio N, Benedetto C. Adherence to Quality Indicators for Breast Cancer Management in a Multidisciplinary Training Program. J Pers Med 2023; 13:1693. [PMID: 38138920 PMCID: PMC10744846 DOI: 10.3390/jpm13121693] [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: 09/30/2023] [Revised: 11/26/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Background: The management of early breast cancer (BC) needs supervision and skill maintenance, and should be performed by specialists working as a team in multidisciplinary breast units. This approach aims to improve the long-term survival and quality of life of patients with BC. Methods: This was a prospective observational study including patients newly diagnosed with operable BC. The study encompassed the pre-surgical phase, throughout the diagnostic and surgical workout, and included post-therapeutic master multidisciplinary team meetings (MTMs) sessions, between 2019 and 2022. Results: We enrolled 280 patients with BC from eight breast units. The Senonetwork indicators regarding diagnosis, waiting time, loco-regional treatment, and adjuvant therapy were collected for each patient discussed. Conclusions: Overall, the majority of quality indicators were respected among breast units. The most critical issue referred to timing indicators: more than 30 days from MTM to surgery, more than 42 days from diagnosis to surgery, and more than 60 days from the first screening mammogram to surgery for many patients. Some aspects of the histopathological diagnosis of intraductal BC also need to be improved. Furthermore, other critical issues in our study regarded some aesthetical indicators, demonstrating low interest in these essential quality indicators.
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Affiliation(s)
- Maria Grazia Baù
- Gynecology and Obstetrics Unit, Maria Vittoria Hospital, 10144 Turin, Italy;
| | - Fulvio Borella
- Gynecology and Obstetrics Unit 1, AOU Città della Salute e della Scienza di Torino, Sant’Anna Hospital, 10126 Turin, Italy; (M.C.); (C.B.)
- Department of Surgical Sciences, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy (A.M.)
| | - Maria Piera Mano
- Department of Surgical Sciences, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy (A.M.)
| | - Livia Giordano
- Unit of Epidemiology, CPO Piemonte, AOU Città della Salute e della Scienza di Torino, San Giovanni Antica Sede, 10123 Turin, Italy
| | - Marco Carosso
- Gynecology and Obstetrics Unit 1, AOU Città della Salute e della Scienza di Torino, Sant’Anna Hospital, 10126 Turin, Italy; (M.C.); (C.B.)
| | - Alessandra Surace
- Gynecology and Obstetrics Unit, Michele e Pietro Ferrero Hospital, 12060 Verduno, Italy;
| | - Aurelia Mondino
- Department of Surgical Sciences, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy (A.M.)
| | - Niccolò Gallio
- Gynecology and Obstetrics Unit 2, AOU Città della Salute e della Scienza di Torino, Sant’Anna Hospital, 10126 Turin, Italy;
| | - Chiara Benedetto
- Gynecology and Obstetrics Unit 1, AOU Città della Salute e della Scienza di Torino, Sant’Anna Hospital, 10126 Turin, Italy; (M.C.); (C.B.)
- Department of Surgical Sciences, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy (A.M.)
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Birkenmaier A, Adams M, Kleber M, Schwendener Scholl K, Rathke V, Hagmann C, Brotschi B, Grass B. Increase in Standardized Management of Neonates with Hypoxic-Ischemic Encephalopathy Since Implementation of a Patient Register. Ther Hypothermia Temp Manag 2023; 13:175-183. [PMID: 36811496 DOI: 10.1089/ther.2022.0055] [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] [Indexed: 02/24/2023] Open
Abstract
The Swiss National Asphyxia and Cooling Register was implemented in 2011. This study assessed quality indicators of the cooling process and (short-term) outcomes of neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) longitudinally over time in Switzerland. This is a multicenter national retrospective cohort study of prospectively collected register data. Quality indicators were defined for longitudinal comparison (2011-2014 vs. 2015-2018) of processes of TH and (short-term) outcomes of neonates with moderate-to-severe HIE. Five hundred seventy neonates receiving TH in 10 Swiss cooling centers were included (2011-2018). Four hundred forty-nine (449/570; 78.8%) neonates with moderate-to-severe HIE received TH according to the Swiss National Asphyxia and Cooling Register Protocol. Quality indicators of processes of TH improved in 2015-2018 (compared with 2011-2014): less passive cooling (p = 0.013), shorter time to reach target temperature (p = 0.002), and less over- or undercooling (p < 0.001). In 2015-2018, adherence to performing a cranial magnetic resonance imaging after rewarming improved (p < 0.001), whereas less cranial ultrasounds were performed on admission (p = 0.012). With regard to quality indicators of short-term outcomes, persistent pulmonary hypertension of the neonate was reduced (p = 0.003), and there was a trend toward less coagulopathy (p = 0.063) in 2015-2018. There was no statistically significant change in the remaining processes and outcomes. The Swiss National Asphyxia and Cooling Register is well implemented with good overall adherence to the treatment protocol. Management of TH improved longitudinally. Continuous reevaluation of register data is desirable for quality assessment, benchmarking, and maintaining international evidence-based quality standards.
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Affiliation(s)
- André Birkenmaier
- University of Zurich, Faculty of Medicine, Department of Neonatology and Pediatric Intensive Care, Children's Hospital St. Gallen, Neonatal and Pediatric Intensive Care Unit, St. Gallen, Switzerland
| | - Mark Adams
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Kleber
- Clinic of Neonatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Verena Rathke
- Division of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Cornelia Hagmann
- Division of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Faculty of Medicine, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Barbara Brotschi
- Division of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Faculty of Medicine, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beate Grass
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Division of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Faculty of Medicine, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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Havranek MM, Rüter F, Bilger S, Dahlem Y, Oliveira L, Ehbrecht D, Moos RM, Westerhoff C, Beck T, Le Pogam MA. Validity of 16 AHRQ Patient Safety Indicators to identify in-hospital complications: a medical record review across nine Swiss hospitals. Int J Qual Health Care 2023; 35:0. [PMID: 37949115 PMCID: PMC10656600 DOI: 10.1093/intqhc/mzad092] [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: 04/16/2023] [Revised: 08/25/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023] Open
Abstract
The validity of the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) has been established in the USA and Canada. However, these indicators are also used for hospital benchmarking and cross-country comparisons in other nations with different health-care settings and coding systems as well as missing present on admission (POA) flags in the administrative data. This study sought to comprehensively assess and compare the validity of 16 PSIs in Switzerland, where they have not been previously applied. We performed a medical record review using administrative and electronic medical record data from nine Swiss hospitals. Seven independent reviewers evaluated 1245 cases at various hospitals using retrospective data from the years 2014-18. True positives, false positives, positive predictive values (PPVs), and reasons for misclassification were compared across all investigated PSIs, and the documentation quality of the PSIs was examined. PSIs 6 (iatrogenic pneumothorax), 10 (postoperative acute kidney injury), 11 (postoperative respiratory failure), 13 (postoperative sepsis), 14 (wound dehiscence), 17 (birth trauma), and 18 and 19 (obstetric trauma with or without instrument) showed high PPVs (range: 90-99%) and were not strongly influenced by missing POA information. In contrast, PSIs 3 (pressure ulcer), 5 (retained surgical item), 7 (central venous catheter-related bloodstream infection), 8 (fall with hip fracture), and 15 (accidental puncture/laceration) showed low PPVs (range: 18-49%). In the case of PSIs 3, 8, and 12 (perioperative embolism/thrombosis), the low PPVs were largely due to the lack of POA information. Additionally, it was found that the documentation of PSI 3 in discharge letters could be improved. We found large differences in validity across the 16 PSIs in Switzerland. These results can guide policymakers in Switzerland and comparable health-care systems in selecting and prioritizing suitable PSIs for quality initiatives. Furthermore, the national introduction of a POA flag would allow for the inclusion of additional PSIs in quality monitoring.
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Affiliation(s)
- Michael M Havranek
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, Lucerne 6002, Switzerland
| | - Florian Rüter
- University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Selina Bilger
- University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Yuliya Dahlem
- University Hospital Zurich, Rämistrasse 100, Zurich 8006, Switzerland
| | - Leonel Oliveira
- University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Daniela Ehbrecht
- Zug Cantonal Hospital, Landhausstrasse 11, Zug 6340, Switzerland
| | - Rudolf M Moos
- Cantonal Hospital Winterthur, Brauerstrasse 15, Winterthur 8400, Switzerland
| | - Christian Westerhoff
- Hirslanden Private Hospital Group, Boulevard Lilienthal 2, Zurich 8152, Switzerland
| | - Thomas Beck
- University Hospital Berne (Inselspital), Freiburgstrasse, Berne 3010, Switzerland
| | - Marie-Annick Le Pogam
- Department of Epidemiology and Health Systems, Unisanté (University Center for Primary Care and Public Health), University of Lausanne, Route de la Corniche 10, Lausanne 1010, Switzerland
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Hoben M, Hogan DB, Poss JW, Gruneir A, McGrail K, Griffith LE, Chamberlain SA, Estabrooks CA, Maxwell CJ. Comparing quality of care outcomes between assisted living and nursing homes before and during the COVID-19 pandemic. J Am Geriatr Soc 2023; 71:3467-3479. [PMID: 37428008 DOI: 10.1111/jgs.18499] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/17/2023] [Revised: 05/22/2023] [Accepted: 06/25/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND While assisted living (AL) and nursing home (NHs) residents in share vulnerabilities, AL provides fewer staffing resources and services. Research has largely neglected AL, especially during the COVID-19 pandemic. Our study compared trends of practice-sensitive, risk-adjusted quality indicators between AL and NHs, and changes in these trends after the start of the pandemic. METHODS This repeated cross-sectional study used population-based resident data in Alberta, Canada. Using Resident Assessment Instrument data (01/2017-12/2021), we created quarterly cohorts, using each resident's latest assessment in each quarter. We applied validated inclusion/exclusion criteria and risk-adjustments to create nine quality indicators and their 95% confidence intervals (CIs): potentially inappropriate antipsychotic use, pain, depressive symptoms, total dependency in late-loss activities of daily living, physical restraint use, pressure ulcers, delirium, weight loss, urinary tract infections. Run charts compared quality indicators between AL and NHs over time and segmented regressions assessed whether these trends changed after the start of the pandemic. RESULTS Quarterly samples included 2015-2710 AL residents and 12,881-13,807 NH residents. Antipsychotic use (21%-26%), pain (20%-24%), and depressive symptoms (17%-25%) were most common in AL. In NHs, they were physical dependency (33%-36%), depressive symptoms (26%-32%), and antipsychotic use (17%-22%). Antipsychotic use and pain were consistently higher in AL. Depressive symptoms, physical dependency, physical restraint use, delirium, weight loss were consistently lower in AL. The most notable segmented regression findings were an increase in antipsychotic use during the pandemic in both settings (AL: change in slope = 0.6% [95% CI: 0.1%-1.0%], p = 0.0140; NHs: change in slope = 0.4% [95% CI: 0.3%-0.5%], p < 0.0001), and an increase in physical dependency in AL only (change in slope = 0.5% [95% CI: 0.1%-0.8%], p = 0.0222). CONCLUSIONS QIs differed significantly between AL and NHs before and during the pandemic. Any changes implemented to address deficiencies in either setting need to account for these differences and require monitoring to assess their impact.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrea Gruneir
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- ICES, Toronto, Ontario, Canada
| | - Kim McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie A Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
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Inacio MC, Eshetie TC, Caughey GE, Whitehead C, Westbrook J, Gray L, Hibbert P, Beattie E, Braithwaite J, Cameron ID, Crotty M, Wesselingh S. Quality and safety in residential aged care: an evaluation of a national quality indicator programme. Intern Med J 2023; 53:2073-2078. [PMID: 36878881 PMCID: PMC10946472 DOI: 10.1111/imj.16052] [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: 09/07/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND In Australia, 243 000 individuals live in approximately 2700 residential aged care facilities yearly. In 2019, a National Aged Care Mandatory Quality Indicator programme (QI programme) was implemented to monitor the quality and safety of care in facilities. AIM To examine the validity of the QI programme indicators using explicit measure review criteria. METHODS The QI programme manual and reports were reviewed. A modified American College of Physicians Measure Review Criteria was employed to examine the QI programme's eight indicators. Five authors rated each indicator on importance, appropriateness, clinical evidence, specifications and feasibility using a nine-point scale. A median score of 1-3 was considered to not meet criteria, 4-6 to meet some criteria and 7-9 to meet criteria. RESULTS All indicators, except polypharmacy, met criteria (median scores = 7-9) for importance, appropriateness and clinical evidence. Polypharmacy met some criteria for importance (median = 6, range 2-8), appropriateness (median = 5, range 2-8) and clinical evidence (median = 6, range 3-8). Pressure injury, physical restraints, significant unplanned weight loss, consecutive unplanned weight loss, falls and polypharmacy indicators met some criteria for specifications validity (all median scores = 5) and feasibility and applicability (median scores = 4 to 6). Antipsychotic use and falls resulting in major injury met some criteria for specifications (median = 6-7, range 4-8) and met criteria for feasibility and applicability (median = 7, range 4-8). CONCLUSIONS Australia's National QI programme is a major stride towards a culture of quality promotion, improvement and transparency. Measures' specifications, feasibility and applicability could be improved to ensure the programme delivers on its intended purposes.
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Affiliation(s)
- Maria C. Inacio
- Registry of Senior AustraliansSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Tesfahun C. Eshetie
- Registry of Senior AustraliansSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Clinical & Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Gillian E. Caughey
- Registry of Senior AustraliansSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Craig Whitehead
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- Southern Adelaide Local Health NetworkSA HealthAdelaideSouth AustraliaAustralia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Len Gray
- Centre for Health Services ResearchThe University of QueenslandBrisbaneQueenslandAustralia
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Elizabeth Beattie
- School of Nursing, Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Ian D. Cameron
- John Walsh Centre for Rehabilitation ResearchUniversity of SydneySydneyNew South WalesAustralia
| | - Maria Crotty
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- Southern Adelaide Local Health NetworkSA HealthAdelaideSouth AustraliaAustralia
| | - Steve Wesselingh
- Registry of Senior AustraliansSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
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Buck Sainz-Rozas P, Casal Angulo C, García Molina P. Quality assessment in initial paediatric trauma care: Systematic review from prehospital care to the paediatric intensive care unit. Nurs Crit Care 2023; 28:1143-1153. [PMID: 37621180 DOI: 10.1111/nicc.12970] [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: 11/18/2022] [Revised: 06/21/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Trauma is the most common cause of death and disability in the paediatric population. There are a huge number of variables involved in the care they receive from health care professionals. AIM The aim of this study was to review the available evidence of initial paediatric trauma care throughout the health care process with a view to create quality indicators (QIs). STUDY DESIGN A systematic review was performed from Cochrane Library, Medline, Scopus and SciELO between 2010 and 2020. Studies and guidelines that examined quality or suggested QI were included. Indicators were classified by health care setting, Donabedian's model, risk of bias and the quality of the publication with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment. RESULTS The initial search included 686 articles, which were reduced to 22, with 15 primary and 7 secondary research articles. The snowball sampling technique was used to add a further seven guidelines and two articles. From these, 534 possible indicators were extracted, summarizing them into 39 and grouping the prehospital care indicators as structure (N = 5), process (N = 12) and outcome (N = 3) indicators and the hospital care indicators as structure (N = 4), process (N = 10) and outcome (N = 6) indicators. Most of the QIs have been extracted from US studies. They are multidisciplinary and in some cases are based on an adaptation of the QIs of adult trauma care. CONCLUSIONS There was a clear gap and large variability between the indicators, as well as low-quality evidence. Future studies will validate indicators using the Delphi method. RELEVANCE TO CLINICAL PRACTICE Design a QI framework that may be used by the health system throughout the process. Indicators framework will get nurses, to assess the quality of health care, detect deficient areas and implement improvement measures.
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Affiliation(s)
- Pablo Buck Sainz-Rozas
- Facultad de Enfermería y Podología, Universidad de Valencia, Valencia, Spain
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carmen Casal Angulo
- Facultad de Enfermería y Podología, Universidad de Valencia, Valencia, Spain
- Servicio de Emergencias Sanitarias (SES) de Valencia, Valencia, Spain
| | - Pablo García Molina
- Facultad de Enfermería y Podología, Universidad de Valencia, Valencia, Spain
- Hospital Clínico Universitario de Valencia, Valencia, Spain
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Reyes-Morales H, Flores-Hernández S, Díaz-Portillo SP, Serván-Mori E, Escalante-Castañón A, Hegewisch-Taylor J, Dreser-Mansilla A. Design and validation of indicators for the comprehensive measurement of quality of care for type 2 diabetes and acute respiratory infections in ambulatory health services. Int J Qual Health Care 2023; 35:mzad087. [PMID: 37930778 DOI: 10.1093/intqhc/mzad087] [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: 05/18/2023] [Revised: 09/12/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
Developing ambulatory health services (AHS) of optimal quality is a pending issue for many health systems at a global level, especially in middle- and low-income countries. An effective health response requires indicators to measure the quality of care that are context-specific and feasible for routine monitoring. This paper aimed to design and validate indicators for assessing the technical and interpersonal quality dimensions for type 2 diabetes (T2D) and acute respiratory infections (ARI) care in AHS. The study was conducted in two stages. First, technical and user-centered-based indicators of quality of care for T2D and ARI care were designed following international recommendations, mainly from the American Diabetes Association standards and the National Institute for Health and Care Excellence guidelines. We then assessed the validity, reliability, relevance, and feasibility of the proposed indicators implementing the modified Delphi technique. A panel of 17 medical experts from five countries scored the indicators using two electronic questionnaires, one for each reason for consultation selected, sent by email in two sequential rounds of rating. We defined the levels of consensus according to the overall median for each performance category, which was established as the threshold. Selected indicators included those with scores equal to or higher than the threshold. We designed 36 T2D indicators, of which 16 were validated for measuring the detection of risks and complications, glycemic control, pharmacological treatment, and patient-centered care. Out of the 22 indicators designed for ARI, we validated 10 for diagnosis, appropriate prescription of antimicrobials, and patient-centered care. The validated indicators showed consistency for the dimensions analyzed. Hence, they proved to be a potentially reliable and valuable tool for monitoring the performance of the various T2D and ARI care processes in AHS. Further research will be needed to verify the applicability of the validated indicators in routine clinical practice.
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Affiliation(s)
- Hortensia Reyes-Morales
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 062100, Mexico
| | - Sergio Flores-Hernández
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 062100, Mexico
| | - Sandra Patricia Díaz-Portillo
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 062100, Mexico
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 062100, Mexico
| | - André Escalante-Castañón
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 062100, Mexico
| | - Jennifer Hegewisch-Taylor
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 062100, Mexico
| | - Anahí Dreser-Mansilla
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 062100, Mexico
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Fuchs B, Studer G, Bode-Lesniewska B, Heesen P. The Next Frontier in Sarcoma Care: Digital Health, AI, and the Quest for Precision Medicine. J Pers Med 2023; 13:1530. [PMID: 38003845 PMCID: PMC10672685 DOI: 10.3390/jpm13111530] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/17/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
The landscape of sarcoma care is on the cusp of a transformative era, spurred by the convergence of digital health and artificial intelligence (AI). This perspectives article explores the multifaceted opportunities and challenges in leveraging these technologies for value-based, precision sarcoma care. We delineate the current state-of-the-art methodologies and technologies in sarcoma care and outline their practical implications for healthcare providers, administrators, and policymakers. The article also addresses the limitations of AI and digital health platforms, emphasizing the need for high-quality data and ethical considerations. We delineate the promise held by the synergy of digital health platforms and AI algorithms in enhancing data-driven decision-making, outcome analytics, and personalized treatment planning. The concept of a sarcoma digital twin serves as an illustrative paradigm for this integration, offering a comprehensive, patient-centric view of the healthcare journey. The paper concludes with proposals for future research aimed at advancing the field, including the need for randomized controlled trials or target trial emulations and studies focusing on ethical and economic aspects. While the road to this transformative care is laden with ethical, regulatory, and practical challenges, we believe that the potential benefits far outweigh the obstacles. We conclude with a call to action for multidisciplinary collaboration and systemic adoption of these technologies, underscoring the urgency to act now for the future betterment of sarcoma care and healthcare at large.
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Affiliation(s)
- Bruno Fuchs
- Sarcoma Service, University Teaching Hospital LUKS, University of Lucerne, 6000 Lucerne, Switzerland
- Sarcoma Service, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
| | - Gabriela Studer
- Sarcoma Service, University Teaching Hospital LUKS, University of Lucerne, 6000 Lucerne, Switzerland
| | - Beata Bode-Lesniewska
- Patho Enge, SSN Reference Sarcoma Pathology, University of Zurich, 8000 Zurich, Switzerland
| | - Philip Heesen
- University Hospital USZ, University of Zurich, 8000 Zurich, Switzerland
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Chigome A, Ramdas N, Skosana P, Cook A, Schellack N, Campbell S, Lorenzetti G, Saleem Z, Godman B, Meyer JC. A Narrative Review of Antibiotic Prescribing Practices in Primary Care Settings in South Africa and Potential Ways Forward to Reduce Antimicrobial Resistance. Antibiotics (Basel) 2023; 12:1540. [PMID: 37887241 PMCID: PMC10604704 DOI: 10.3390/antibiotics12101540] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/01/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to current prescribing guidelines. Consequently, there is a need to comprehensively summarise current antibiotic utilization patterns from published studies as well as potential activities to improve prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the majority of antibiotics prescribed, albeit often inappropriately, were from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary care. This needs to be addressed going forward. However, studies have shown it is crucial for prescribers to use a language that patients understand when discussing key aspects to enhance appropriate antibiotic use. Recommended activities for the future include improved education for all groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators.
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Affiliation(s)
- Audrey Chigome
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
| | - Nishana Ramdas
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
| | - Phumzile Skosana
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa;
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.)
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa;
| | - Stephen Campbell
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.)
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
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Sadsad R, Ruber G, Zhou J, Nicklin S, Tsafnat G. A computable biomedical knowledge object for calculating in-hospital mortality for patients admitted with acute myocardial infarction. Learn Health Syst 2023; 7:e10388. [PMID: 37860059 PMCID: PMC10582239 DOI: 10.1002/lrh2.10388] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Quality indicators play an essential role in a learning health system. They help healthcare providers to monitor the quality and safety of care delivered and to identify areas for improvement. Clinical quality indicators, therefore, need to be based on real world data. Generating reliable and actionable data routinely is challenging. Healthcare data are often stored in different formats and use different terminologies and coding systems, making it difficult to generate and compare indicator reports from different sources. Methods The Observational Health Sciences and Informatics community maintains the Observational Medical Outcomes Partnership Common Data Model (OMOP). This is an open data standard providing a computable and interoperable format for real world data. We implemented a Computable Biomedical Knowledge Object (CBK) in the Piano Platform based on OMOP. The CBK calculates an inpatient quality indicator and was illustrated using synthetic electronic health record (EHR) data in the open OMOP standard. Results The CBK reported the in-hospital mortality of patients admitted for acute myocardial infarction (AMI) for the synthetic EHR dataset and includes interactive visualizations and the results of calculations. Value sets composed of OMOP concept codes for AMI and comorbidities used in the indicator calculation were also created. Conclusion Computable biomedical knowledge (CBK) objects that operate on OMOP data can be reused across datasets that conform to OMOP. With OMOP being a widely used interoperability standard, quality indicators embedded in CBKs can accelerate the generation of evidence for targeted quality and safety management, improving care to benefit larger populations.
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Affiliation(s)
| | | | | | | | - Guy Tsafnat
- EvidentliSydneyNew South WalesAustralia
- Centre for Health Informatics, Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
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Unger G, Benozzi SF, Girardi R, Pennacchiotti GL. Evaluation of four quality indicators of the Pre-Analytical Phase External Quality Assessment Subprogram of the Fundación Bioquímica Argentina. EJIFCC 2023; 34:203-212. [PMID: 37868086 PMCID: PMC10588077] [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: 10/24/2023]
Abstract
Pre-analytical phase external quality assessment programs contribute - through the interlaboratory comparison of quality indicators (QIs) - to the continuous improvement of the clinical laboratory total testing process. The purpose of the present work is to document the results derived from measuring four QIs within the framework of a pre-analytical phase external quality assessment subprogram in Argentina. The laboratories participating in this subprogram measured the following QIs: i) patients recalled for a new blood sample collection due to pre-analytical causes; ii) clotted samples from hemogram and coagulation tests; iii) clinical chemistry hemolyzed samples; and iv) requests with transcription errors entered into the laboratory information system. Results were expressed in percentage value and Sigma value. Databases were anonymized. A minimum acceptable quality level for the four QIs measured was recorded in the majority (75%) of the participating laboratories (Sigma > 3.0). It was nonetheless observed that the QIs of hemolyzed samples and requests with transcription errors entered into the laboratory information system deserve more attention. Through this pioneering experience in Argentina, the participating laboratories - some for the first time - could learn about their performance via interlaboratory comparison of results. This experience also proved to be motivating not only to improve the external assessment subprogram but also to continue working on the measurement of pre-analytical QIs for the continuous improvement of the clinical laboratory total testing process in Argentina.
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Affiliation(s)
- Gisela Unger
- Cátedra de Bioquímica Clínica I, Departamento de Biología, Bioquímica y Farmacia; Universidad Nacional del Sur; San Juan 670, 8000 Bahía Blanca, Argentina
- Pre-Analytical Phase External Quality Assessment Subprogram, Fundación Bioquímica Argentina, Calle 148 Nº 584, B1900BVK La Plata, Argentina
| | - Silvia Fabiana Benozzi
- Cátedra de Bioquímica Clínica I, Departamento de Biología, Bioquímica y Farmacia; Universidad Nacional del Sur; San Juan 670, 8000 Bahía Blanca, Argentina
- Pre-Analytical Phase External Quality Assessment Subprogram, Fundación Bioquímica Argentina, Calle 148 Nº 584, B1900BVK La Plata, Argentina
| | - Raúl Girardi
- External Quality Assessment Program, Fundación Bioquímica Argentina, Calle 148 Nº 584, B1900BVK La Plata, Argentina
| | - Graciela Laura Pennacchiotti
- Cátedra de Bioquímica Clínica I, Departamento de Biología, Bioquímica y Farmacia; Universidad Nacional del Sur; San Juan 670, 8000 Bahía Blanca, Argentina
- Pre-Analytical Phase External Quality Assessment Subprogram, Fundación Bioquímica Argentina, Calle 148 Nº 584, B1900BVK La Plata, Argentina
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Marsch A, Khodosh R, Porter M, Raad J, Samimi S, Schultz B, Strowd LC, Vera L, Wong E, Smith GP. Implementing patient safety and quality improvement in dermatology. Part 1: Patient safety science. J Am Acad Dermatol 2023; 89:641-654. [PMID: 35143912 DOI: 10.1016/j.jaad.2022.01.049] [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: 08/30/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/23/2022]
Abstract
Patient safety (PS) and quality improvement (QI) have gained momentum over the last decade and are becoming more integrated into medical training, physician reimbursement, maintenance of certification, and practice improvement initiatives. While PS and QI are often lumped together, they differ in that PS is focused on preventing adverse events while QI is focused on continuous improvements to improve outcomes. The pillars of health care as defined by the 1999 Institute of Medicine report "To Err is Human: Building a Safer Health System" are safety, timeliness, effectiveness, efficiency, equity, and patient-centered care. Implementing a safety culture is dependent on all levels of the health care system. Part 1 of this CME will provide dermatologists with an overview of how PS fits into our current health care system and will include a focus on basic QI/PS terminology, principles, and processes. This article also outlines systems for the reporting of medical errors and sentinel events and the steps involved in a root cause analysis.
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Affiliation(s)
- Amanda Marsch
- University of California, San Diego Medical Center, San Diego, California
| | - Rita Khodosh
- Department of Dermatology, University of Massachusetts, Boston, Massachusetts
| | - Martina Porter
- Department of Dermatology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Jason Raad
- American Academy of Dermatology, Rosemont, Illinois
| | - Sara Samimi
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Brittney Schultz
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | | | - Laura Vera
- American Academy of Dermatology, Rosemont, Illinois
| | - Emily Wong
- San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Gideon P Smith
- Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
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Veneberg B, Tijsen LMJ, Wirtz MJ, Zevenhuizen V, Buijck BI. The development of indicators to measure the quality of care in geriatric rehabilitation. Int J Qual Health Care 2023; 35:mzad044. [PMID: 37655996 PMCID: PMC10914440 DOI: 10.1093/intqhc/mzad044] [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: 01/09/2023] [Revised: 03/31/2023] [Accepted: 08/25/2023] [Indexed: 09/02/2023] Open
Abstract
Quality of care is an essential aspect of geriatric rehabilitation. Usually, there are national standards for the quality of care or indicators to measure the quality of care. However, this is not the case for geriatric rehabilitation. Therefore, the aim of this study was to develop structure, process, and outcome indicators to measure the quality of geriatric rehabilitation. To develop quality indicators for geriatric rehabilitation, a literature search was performed to identify indicators for all types of rehabilitation that can also be suitable for geriatric rehabilitation. Thereafter, in the qualitative phase, different stakeholders were inte. Indicators from the literature and indicators developed based on the interviews were merged and processed in a questionnaire. Through this questionnaire, elderly care physicians and managers of geriatric rehabilitation facilities were asked to rate the indicators on relevance and feasibility. Indicators that were considered relevant and feasible by the respondents were included in the final quality indicator set for geriatric rehabilitation. Thirty-six indicators suitable for geriatric rehabilitation were identified from the literature. Additionally, 55 quality indicators were developed based on the interviews. Merging the indicators and omitting duplicates resulted in 69 quality indicators. Analysis of the data from the questionnaires resulted in a final set of 27 quality indicators for geriatric rehabilitation that consists of 17 structure, 8 process, and 2 outcome indicators. This study contributes to the quality of geriatric rehabilitation by providing a first set of quality indicators ready to use in practice. Follow-up research is recommended and may include an assessment of the applicability, reliability, and validity of the developed indicator set.
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Affiliation(s)
- Bram Veneberg
- Department of Science and Technology, University of Twente, Drienerlolaan 5, Enschede 7522 NB, The Netherlands
| | - Lian M J Tijsen
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9500, Leiden 2300 RA, The Netherlands
- Oktober, Wielewaal 10, Bladel 5531 LJ, The Netherlands
- De Zorgboog, Postbus 16, Bakel 5760 AA, The Netherlands
| | - Maarten J Wirtz
- Geriatric Rehabilitation Centre Topaz Revitel, Bargelaan 198, Leiden 2333 CW, The Netherlands
| | - Viola Zevenhuizen
- ParView, Interim Management and Organisational Advice, Voorsterweg 124, Brummen 6971 KC, The Netherlands
| | - Bianca I Buijck
- Oktober, Wielewaal 10, Bladel 5531 LJ, The Netherlands
- De Zorgboog, Postbus 16, Bakel 5760 AA, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Postbus 2040, Rotterdam 3000 CA, The Netherlands
- Rotterdam Stroke Service, Nieuwe Binnenweg 33, Rotterdam 3014 GB, The Netherlands
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Dehmer GJ, Grines CL, Bakaeen FG, Beasley DL, Beckie TM, Boyd J, Cigarroa JE, Das SR, Diekemper RL, Frampton J, Hess CN, Ijioma N, Lawton JS, Shah B, Sutton NR. 2023 AHA/ACC Clinical Performance and Quality Measures for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures. J Am Coll Cardiol 2023; 82:1131-1174. [PMID: 37516946 DOI: 10.1016/j.jacc.2023.03.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
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