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Yeremin, G., Е. Тregubova, and Е. Mokhova. "Regulation of Safety and Quality of Osteopathic Healthcare." Russian Osteopathic Journal, no. 1-2 (June 30, 2016): 6–13. http://dx.doi.org/10.32885/2220-0975-2016-1-2-6-13.
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The article presents an analysis of the regulating system, an experience of the expert evaluation and control of the quality and safety of the medical care in the Russian Federation and in its constituent units. The paper considers aims, targets, ways and criteria of the expert evaluation and control of the quality and safety of the medical care with regard to the osteopathic medical care. Authors also give recommendations concerning the organization of the internal control system of safety and quality of the medical care provided by the osteopaths.
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Polyakov, Konstantin V., N. M. Gayfullin, Zh A. Akopyan, and P. G. Mal'kov. "THE LEGISLATIVE FOUNDATION OF EXPERTISE OF MEDICAL CARE QUALITY ACCORDING CASES OF LETHAL OUTCOMES." Health Care of the Russian Federation 62, no. 2 (May 24, 2019): 95–102. http://dx.doi.org/10.18821/0044-197x-2018-62-2-95-102.
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The article presents analysis of national and foreign legislative documents concerning issues of expertise of quality of medical care according cases of lethal outcomes (Universal Declaration of Human Rights, the Constitution of the Russian Federation, ICD-10, Federal laws and sectoral orders). It is established that key elements of system of medical care quality control (levels of control, authorized authority, forms of control, sources of development of criteria of quality evaluation, criteria of quality evaluation) are determined legislatively and reflect main requirements of international documents. The criteria of medical care quality evaluation are developed by groups of diseases of conditions on the basis of corresponding of medical care support Procedures, medical care Standards, Rules of implementation of laboratory, instrumental, pathologico-anatomic and other forms diagnostic analysis and Clinical Recommendations (records of treatment) related to issues of medical care support. The shortcoming of the Russian Federation legislation is an inadequate reflection of sources of development of criteria of medical care quality evaluation and relevant incompleteness of the very criteria of medical care quality evaluation. Therefore, their application by experts to issues of evaluation of medical care quality is complicated that effects formation of expert conclusion and negatively affects detection and prevention of possible violations during medical care support. The outdated normative regulation of clinical pathologic anatomic conference is noted as an important form of control of medical care support according cases of lethal outcomes. The necessity of alterations and additions in particular currently in force documents concerning issues of expertise of medical care quality, including according cases of lethal outcomes.
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Guseva, Nataliya K., and V. A. Berdutin. "Certain issues of evaluation of medical care quality in the health care system of the Russian Federation." Health Care of the Russian Federation 60, no. 5 (May 24, 2019): 228–33. http://dx.doi.org/10.18821/0044-197x-2016-60-5-228-233.
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The recent years characterized by development of normative legal base controlling issues of evaluation of quality of medical care. The legally reserved such types (levels) of quality and safety control of medical care as state, sectorial, internal, independent evaluation of medical care quality and others. The development of modern system of evaluation of quality and safety of medical activities occurred on the basis of accumulated experience offunctioning of medical organizations in this direction. The analysis of actual system of evaluation of medical care quality in Russia established that system itself is bulky, includes various and non-interrelated criteria and indices and provides no clear concept about implementation of internal control of medical care quality. All this evoke many questions in physicians of medical organizations. The major defect of actual system is absence of criterion characterizing system of medical care quality support. no attention is paid to such issues as evaluation of structure supposing establishment of potential opportunities of medical subject (organization or medical officer) to provide medical care corresponding to its functions. The demonstrative example of necessity of structural approach in analysis of medical care quality is total normalization of psychological climate, increasing professional and communicative effectiveness of medical personal within departments of medical organization after their reformatting on the basis of the results of socionic evaluation.
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Yerdavletova, Farida, and Temirkhan Mukhambetov. "Quality of medical services: problems, evaluation and regulation." Verslas: Teorija ir Praktika 16, no. 3 (October 1, 2015): 243–51. http://dx.doi.org/10.3846/btp.2015.487.
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One of the most acute problems in the healthcare industry – the problem of the quality of medical services. In this area, there is no established definition of medical services or approaches to quality management. The aim of the article is to analyze the existing definitions of “quality of medical services,” as well as development approach to managing medical organization. At the same time the management of the medical organization should be focused on ensuring the quality as the most important criterion for the organization. Methodology of the study is based on analysis and grouping of existing definitions of medical services, the factorial approach to evaluating the quality and organization of the process approach to management of the medical organization. Noting the versatility and diversity concepts of quality of care the authors suggest grouping of direct and indirect factors affecting the quality of medical services. However, it is important, according to the authors, to move from functional management to management based on the process approach, which provides better control over the processes of customer service. Is given process model of quality management of health services and highlights the main groups of processes in the medical organization.
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Lara-Esqueda, Agustin, Sergio A. Zaizar-Fregoso, Violeta M. Madrigal-Perez, Mario Ramirez-Flores, Daniel A. Montes-Galindo, Margarita L. Martinez-Fierro, Iram P. Rodriguez-Sanchez, et al. "Evaluation of Medical Care for Diabetic and Hypertensive Patients in Primary Care in Mexico: Observational Retrospective Study." Journal of Diabetes Research 2021 (August 14, 2021): 1–7. http://dx.doi.org/10.1155/2021/7365075.
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Introduction. The present study evaluated the quality of medical care for patients diagnosed with diabetes mellitus (DM), hypertension (HBP), and both pathologies (DM+HBP) within a public health system in Mexico. Methods. 45,498 patients were included from 2012 to 2015. All information was taken from the electronic medical record database. Each patient record was compared against the standard to test the quality of medical care. Results. Glycemia with hypertension goals reached 29.6% in DM+HBP, 48.6% in DM, and 53.2% in HBP. The goals of serum lipids were reached by 3% in DM+HBP, 5% in DM, and 0.2% in HBP. Glycemia, hypertension, and LDL cholesterol reached 0.04%. 15% of patients had an undiagnosed disease. Clinical follow-up examinations reached 20% for foot examination and clinical eye examination. Specialty referrals reached 1% in angiology or cardiology. Conclusion. Goals for glycemic and hypertension reached 50% in the overall population, while serum lipids, clinical follow-up examinations, and referral to a specialist were deficient. Patients who had both diseases had more consultations, better control for hypertension and lipids, but inferior glycemic control. Overall, quality care for DM and/or HBP has not been met according to the standards.
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Василькина, O. Vasilkina, Шукшин, V. Shukshin, Смирнова, O. Smirnova, Блинов, Dmitry Blinov, Качаева, and Yu Kachaeva. "The analysis of patient’s care quality in hospitals." Journal of New Medical Technologies. eJournal 9, no. 1 (April 17, 2015): 0. http://dx.doi.org/10.12737/8112.
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Based on the developed expert case record for evaluating quality and practices of medical care the most significant and common defects in medical service are identified in the paper. They include incomplete anamnesis on admission (48%), insufficient physical examination (25%), lack of staged diagnosis (16%), ab-sence of correction in the dynamics of therapeutic actions (11%), partial description of patient’s condition in journals and examination data (32%). However implementation of full and timely laboratory and instrumental examinations (93%), as well as timeliness of diagnosing in 85% of cases are revealed. The program of therapeu-tic measures was chosen rationally (79%). Effectiveness and high results of medical service were achieved in 78% of cases. Advices for the rehabilitation of a patient in accordance with diagnosis and assistance rendered were given professionally and in full volume (93%). The use of a formalized approach and a mathematic model, conversion of the function of quantitative assessment of quality from 0 to 1 to the usual five-point system of evaluation of expert activity results make it possible to level difficulties in perception of ranking and simplify understanding of the assessment criteria. Detection of defects in time, reduction of the number of errors in the process of quality control, intensification of diagnostic and therapeutic measures, as well as of diagnosing should serve as a basis for optimizing medical and organizational technologies to render medical care to patients.
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Shikina, Irina, and David Davidov. "Assessment of the quality of medical care provided to patients in a psychiatric hospital." Vestnik of Saint Petersburg University. Medicine 15, no. 4 (2020): 274–82. http://dx.doi.org/10.21638/spbu11.2020.405.
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Monitoring and evaluation of the quality of medical care provided to patients is essential in any medical specialty, but especially in relation to specialized care in mental health hospitals. The aim of our work is to assess the quality of specialized medical care provided to patients in the psychiatric hospital. We have examined 270 medical records and internal quality control cards of patients hospitalized from 2015 to 2019 in the Psychiatric Clinical Hospital No. 4 of the Moscow Healthcare Department (hereinafter referred to as “PCH No. 4” of MHD). The quality control of the provided medical care was carried out twice with the assessment of each studied section in the range from 0 to 1 point. Thus, it was possible to calculate the overall medical care quality coefficient with a description of the defects found in the provision of medical services. After the first control, quality coefficient appeared to be 0.86 (0.79; 0.91), and after the second one 0.95 (0.92; 0.96). During the second control, which was conducted in 2019, the medical care quality was significantly higher (p = 0.011) compared to the results of 2015–2018. The total share of detected defects in the medical-diagnostic process in a psychiatric hospital was 40.7 % (and was captured in 110 out of 270 cases). The results of our study demonstrate the necessity of medical care internal quality monitoring in a psychiatric hospital, since it contributes not only to the improvement of overall quality of medical treatment, but also to timely detection and reduction of the number of defects in the medical-diagnostic process.
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Jaber, Linda A., Henry Halapy, Mireille Fernet, Suresh Tummalapalli, and Hariharan Diwakaran. "Evaluation of a Pharmaceutical Care Model on Diabetes Management." Annals of Pharmacotherapy 30, no. 3 (March 1996): 238–43. http://dx.doi.org/10.1177/106002809603000305.
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OBJECTIVE: To assess the effectiveness of a pharmaceutical care model on the management of non-insulin-dependent diabetes mellitus (NIDDM) in urban African-American patients. DESIGN: Eligible patients were randomized to either a pharmacist intervention or control group and followed over a 4-month period. Patients in the intervention group received diabetes education, medication counseling, instructions on dietary regulation, exercise, and home blood glucose monitoring, and evaluation and adjustment of their hypoglycemic regimen. Patients in the control group continued to receive standard medical care provided by their physicians. SETTING: A university-affiliated internal medicine outpatient clinic. PARTICIPANTS: The study population consisted of urban African-American patients with NIDDM currently attending the clinic. MAIN OUTCOME MEASURES: Primary outcome measures included fasting plasma glucose and glycated hemoglobin concentrations. Secondary outcome endpoints included blood pressure, serum creatinine, creatinine clearance, microalbumin to creatinine ratio, total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein concentrations. Quality-of-life assessments were performed in both groups at baseline and at the end of the study. RESULTS: Thirty-nine patients (17 intervention, 22 control) completed the study. The intervention group consisted of 12 women and 5 men with a mean ± SD age of 59 ± 12 years, total body weight (TBW) of 93 ± 22 kg, body mass index (BMI) of 34 ± 7 kg/m2, and duration of NIDDM 6.8 ± 6.5 years. The control group consisted of 15 women and 7 men with a mean age of 65 ± 12 years, TBW of 88 ± 19 kg, BMI of 33 ± 7 kg/m2, and a duration of NIDDM of 6.2 ± 4.8 y. Significant improvement in glycated hemoglobin (p = 0.003) and fasting plasma glucose (p = 0.015) was achieved in the intervention group. No change in glycemia was observed in the control subjects. Statistically significant differences in the final glycated hemoglobin (p = 0.003) and fasting plasma glucose (p = 0.022) concentrations were noted between groups. No significant changes in blood pressure control, lipid profile, renal function parameters, weight, or quality-of-life measures were noted within or between groups. CONCLUSIONS: Our data demonstrate the effectiveness of pharmaceutical care in the reduction of hyperglycemia associated with NIDDM in a group of urban African-American patients.
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Crede, William B., and Walter J. Hierholzer. "Surveillance for Quality Assessment III. The Critical Assessment of Quality Indicators." Infection Control & Hospital Epidemiology 11, no. 4 (April 1990): 197–201. http://dx.doi.org/10.1017/s0195941700017963.
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The first two articles in this series reviewed the reasons for widespread acceptance of surveillence and control methods in hospital infection control programs, and discussed important factors contributing to the successes and failures in applying this approach to noninfectious nosocomial events. The quality assurance program ‘targets of surveillence” identified in these articles are referred to as “quality indicators” by other authors and have been defined as “a quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities.” This article highlights those attributes of quality indicators that should be critiqued prior to implementation in a patient care review environment and discusses methods of improving quality indicator performance with ongoing monitoring and evaluation.
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Jøldal, Bjørn. "The Evaluation and Control of Drugs in Norway." International Journal of Technology Assessment in Health Care 2, no. 4 (October 1986): 663–71. http://dx.doi.org/10.1017/s0266462300003500.
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The basic aim of a drug policy is to ensure that effective and safe drugs of good quality are available to cover the health needs of a country. A national drug policy should be considered an integral part of any comprehensive health-care policy. The formulation of national drug policies varies even between similar countries because of conflicting interests and different political, economic, and social pressures. It is influenced by such factors as:the health situation of the country;the medical care system;the education and training of health personnel;the social security and health-insurance schemes;drug research and development possibilities;the domestic production of drugs;the determination of the demand for drugs;the system of drug distribution;the possibilities for evaluation and control of drugs; andinternational policies on medicinal products.
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Lee, Sung Woo. "National evaluation program for emergency medical center." Journal of the Korean Medical Association 63, no. 4 (April 10, 2020): 184–86. http://dx.doi.org/10.5124/jkma.2020.63.4.184.
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Since 2003, the national evaluation program for emergency medical centers (EMCs) has been managed by the Central Emergency Medical center which is controlled by the Ministry of Health and Welfare. Although the evaluation system for EMC has contributed to the development of the structure of emergency centers and the expansion of emergency resources (emergency medical person and equipment), it has some limitations in terms of quality control for both EMCs and emergency medical systems. One of the purposes of the evaluation program is to assess the performance of EMC in different levels. However, both regional and local emergency centers have same role that is offering of final treatment to severe emergency patients. There is no role for local emergency rooms in the emergency care of patients. In addition, the national evaluation program does not have outcome indicators that assess the performance of the EMC in emergency care. The improvement of the national evaluation system for EMC is required for the appropriate assessment of the performance of EMCs in the future.
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Серегина, Ирина, Irina Seregina, Антон Колоколов, and Anton Kolokolov. "Medical records management in electronic format." Vestnik Roszdravnadzora 2019, no. 4 (August 22, 2019): 77–80. http://dx.doi.org/10.35576/article_5d651dbc7aa259.48167277.
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The article deals with the legal significance of medical records management in the form of electronic document flow. Proper medical records management, which is necessary for the registration of the diagnostic and treatment process at all stages and for control of the quality of medical care delivery, is basis for evaluating of the organization of medical care and quality of its delivery.
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Pannick, Samuel, Stephanie Archer, Susannah Jane Long, Fran Husson, Thanos Athanasiou, and Nick Sevdalis. "What matters to medical ward patients, and do we measure it? A qualitative comparison of patient priorities and current practice in quality measurement, on UK NHS medical wards." BMJ Open 9, no. 3 (March 2019): e024058. http://dx.doi.org/10.1136/bmjopen-2018-024058.
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ObjectivesTo compare the quality metrics selected for public display on medical wards to patients’ and carers’ expressed quality priorities.MethodsMultimodal qualitative evaluation of general medical wards and semi-structured interviews.SettingUK tertiary National Health Service (public) hospital.ParticipantsFourteen patients and carers on acute medical wards and geriatric wards.ResultsQuality metrics on public display evaluated hand hygiene, hospital-acquired infections, nurse staffing, pressure ulcers, falls and patient feedback. The intended audience for these metrics was unclear, and the displays gave no indication as to whether performance was improving or worsening. Interviews identified three perceived key components of high-quality ward care: communication, staff attitudes and hygiene. These aligned poorly with the priorities on display. Suboptimal performance reporting had the potential to reduce patients’ trust in their medical teams. More philosophically, patients’ and carers’ ongoing experiences of care would override any other evaluation, and they felt little need for measures relating to previous performance. The display of performance reports only served to emphasise patients’ and carers’ lack of control in this inpatient setting.ConclusionsThere is a gap between general medical inpatients’ care priorities and the aspects of care that are publicly reported. Patients and carers do not act as ‘informed choosers’ of healthcare in the inpatient setting, and tokenistic quality measurement may have unintended consequences.
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Ruef, Christian. "Prospective Evaluation of a Hospital Epidemiologist's Activities at a European Tertiary-Care Medical Center." Infection Control & Hospital Epidemiology 20, no. 9 (September 1999): 604–6. http://dx.doi.org/10.1086/501678.
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AbstractObjective:Assessment of the distribution of tasks and consultations provided by the hospital epidemiologist (HE) at University Hospital of Zurich (UHZ).Design:Prospective collection of data on hospital epidemiology consultations over a 3-year period (1995-1997). Time spent per consultation and activities of infection control practitioners were not recorded.Setting:A 1,040-bed tertiary-care university hospital in Zurich, Switzerland.Results:Between January 1, 1995, and December 31, 1997, the HE received 1,660 requests for consultation. Advice or action was sought in the following areas: epidemiology (27.5% of requests); quality assurance, including antibiotic utilization and technology assessment (24.8%); infection control and practice guidelines (22.5%); disinfection and sterilization (11.6%); clinical infectious diseases (13.4%). During 1997, 35% of epidemiology consults were related to methicillin-resistant Staphylococcus aureus and 5.8% to tuberculosis. Public or private hospitals not affiliated with UHZ requested 40% of all consults.Conclusions:This study shows that HEs are involved in many different activities. Only 27.5% of hospital epidemiology consultations were directly related to issues of epidemiology. Practical knowledge of the methodologies for continuous quality improvement and assessment of various new technologies is important for HEs. The results of this study may be useful in discussions between HEs and administrators about allocation of resources or issues of reimbursement.
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Et.al, Ye-Won Park. "Evaluation of Self-Produced Phantom Usafulness for image Quality Control of Radiation Generator for Diagnosis." Turkish Journal of Computer and Mathematics Education (TURCOMAT) 12, no. 6 (April 10, 2021): 828–34. http://dx.doi.org/10.17762/turcomat.v12i6.2105.
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Background/Objectives: Quality control can improve the quality of medical care along with the stability of diagnostic X-ray generator. Regular quality control provides reliable quality control of the machine and maintains consistency of general imaging using radiation for efficient diagnosis.
Methods/Statistical analysis: A phantom for quality control of diagnostic X-ray generator was produced using a 3D printer. Quantitative and qualitative evaluation of the phantom utility was conducted by modifying images acquired using S and D companies’ tools with Source to Image-Receptor Distance (SID) levels ranging between 130 cm and 180 cm. The evaluation indices were determined based on the analysis of field compliance, uniformity, low and high-contrast resolution, and linearity.
Findings: The evaluation was conducted by acquiring and changing the radiographic image to SIDs between 130 cm and 180 cm using the indigenous phantom. The field compliance of S and D companies in terms of quantitative evaluation indices was both appropriate within ± 1% according to the SID change. To ensure a uniform SID 130 cm, the internal and external means of S company were 893 and 943, respectively, while those of the D company were 228.1 and 261.4, respectively. At an SID of 180 cm, the internal and external means of the S company were 928.1 and 958.4, respectively, while those of the D company were 257.2 and 299, respectively. A characteristic of the DR system was identified to ensure linearity, altered exposure dosage according to the step wedge height, and the difference in SI values according to the characteristics of the equipment and linearity. The qualitative evaluation indices were determined by identifying the size of the hole under high-contrast resolution up to 0.8㎜ and the bar size up to 1.6 lp/㎜. The low contrast resolution was evaluated with a C-D pattern, and at SID 130 cm, the S company scored 124.6 points and the D company 116 points, and at 180 cm, the S company scored 111.4 and the D company 104.6 points.
Improvements/Applications: The utility of the homegrown phantom in quality control was confirmed for each index. The medical institutions are required to introduce quality control regulations for general image examination using radiation. It is helpful to efficiently manage old equipment and improve public health and medical care by linking with the health insurance fee.
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Iordanishvili, A. К., E. K. Barinov, and I. B. Salmanov. "ALGORITHM FOR MEDICAL EXAMINATION OF ENDODONTIC TREATMENT." Russian Journal of Forensic Medicine 5, no. 4 (January 19, 2020): 20–25. http://dx.doi.org/10.19048/2411-8729-2019-5-4-20-25.
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Evaluation (including within the framework of medico-legal examination) of the quality and efectiveness of endodontic dental treatment is a matter of current interest in the clinical dentistry.Obiectives. Te aim of the work was to develop an algorithm of medico-legal examination in case of endodontic treatment, to test this algorithm in the work of the commissions of medical care quality control in the departments of therapeutic dentistry of outpatient dental clinics.Material and methods.Te material of the study was the reports of daily activities of dental clinics of various forms of ownership (municipal, departmental, private) in 3 regions of Russia (Moscow, St. Petersburg, Rostov-on-Don), including periodic reports and reference reports, ofcial statistical reports of the activities of the examined clinics, including registration books of the work of the commissions of the quality of medical care. Tese materials were used as a source of primary statistical information. Afer grouping of the information contained in them, the main data characterizing organization, condition and quality of endodontic care were recovered taking into account nosological entities: pulpitis and periodontitis. Taking into account the medical, statistical and analytical nature of the study, the main conclusions and recommendations were formulated on the basis of a retrospective study of these materials.Results. Based on the studies carried out and recommendations of the European Endodontic Association on provision of the standard of endodontic treatment, an algorithm for medico-legal examination of endodontic treatment was proposed. Tis algorithm allows to assess the quality and efectiveness of endodontic treatment of pulpitis and periodontitis in diferent terms (immediately afer treatment, remote period)Conclusion. Te use of the developed algorithm in clinical practice in internal quality control of endodontic care has shown its efectiveness. A large number of clinical cases of insufcient quality of endodontic treatment and its low efectiveness in the remote period indicate persistence of the potential for claims from patients.
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Hydeman, Jennifer. "Improving the Integration of Palliative Care in a Comprehensive Oncology Center: Increasing Primary Care Referrals to Palliative Care." OMEGA - Journal of Death and Dying 67, no. 1-2 (August 2013): 127–34. http://dx.doi.org/10.2190/om.67.1-2.o.
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Confronted with the complexities inherent in delivering palliative care, effective collaboration with referring staff becomes vital. Based on the evaluation of the physical and psychosocial concerns of patients, the goal of palliative care is to craft interventions that maintain quality of life in the face of increasing symptoms and deteriorating functional status. The project's goal was to increase the appropriateness of referrals to palliative care by the primary services in the hospital. The aim was to achieve this by developing a process to assess patient functioning in critical psychosocial and functional areas, and providing this data to referring medical staff to educate them on the contribution of palliative care to symptom control and patient quality of life. The findings show that referrals to palliative care have increased over 100% from a broader range of services since initiating this project. Assessment data has been collected on 165 patients and outcomes are discussed.
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Peralta, Luis Mauricio Pinet. "The Prehospital Emergency Care System in Mexico City: A System's Performance Evaluation." Prehospital and Disaster Medicine 21, no. 2 (April 2006): 104–11. http://dx.doi.org/10.1017/s1049023x00003447.
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AbstractIntroduction:Mexico City has one of the highest mortality rates in Mexico, with non-intentional injuries as a leading cause of death among persons 1–44 years of age. Emergency medical services (EMS) in Mexico can achieve high levels of efficiency by offering high quality medical care at a low cost through adequate system design.Objective:The objective of this study was to determine whether the prehospital EMS system in Mexico City meets the criteria standards established by the American Ambulance Association Guide for Contracting Emergency Medical Services (AAA Guide) for highly efficient EMS systems.Methods:This retrospective, descriptive study, evaluated the structure of Mexico City's EMS system and analyzed EMS response times, clinical capacity, economic efficiency, and customer satisfaction. These results were compared with the AAA guide, according to the social, economic, and political context in Mexico. This paper describes the healthcare system structure in Mexico, followed by a description of the basic structure of EMS in Mexico City, and of each tenet described in the AAA guide. The paper includes data obtained from official documents and databases of government agencies, and operative and administrative data from public and private EMS providers.Results:The quality of the data for response times (RT) were insufficient and widely varied among providers, with a minimum RT of 6.79 minutes (min) and a maximum RT of 61 min. Providers did not define RT clearly, and measured it with averages, which can hide potentially poor performance practices. Training institutions are not required to follow a standardized curriculum. Certifications are the responsibility of the individual training centers and have no government regulation. There was no evidence of active medical control involvement in direct patient care, and providers did not report that quality assurance programs were in place. There also are limited career advancement opportunities for EMS personnel. Small economies of scale may not allow providers to be economically efficient, unit hours are difficult to calculate, and few economic data are available.There is no evidence of customer satisfaction data.Conclusions:Emergency medical services in Mexico City did not meet the AAA requirements for high-quality, prehospital, emergency care. Coordination among EMS providers is difficult to achieve, due, in part, to the lack of: (1) an authoritative structure; (2) sound system design; and (3) appropriate legislation. The government, EMS providers, stakeholders, and community members should work together to build a high quality EMS system at the lowest possible cost.
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Tohid, Hizlinda, Sheen Dee Ng, Anis Azmi, Nur Farah Adrina Nur Hamidi, Syahirah Samsuri, Amir Hazman Kamarudin, and Khairani Omar. "Quality of asthma care at a university-based primary care clinic in Malaysia." Journal of Health Research 33, no. 5 (September 9, 2019): 425–34. http://dx.doi.org/10.1108/jhr-11-2018-0148.
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Purpose The quality of asthma care may be affected if asthma management is overlooked, thus needing frequent clinical audits to identify areas for improvement. The purpose of this paper is to evaluate the quality of the process (e.g. documentation of asthma-specific information), the structure (e.g. availability of resources) and the outcome (e.g. proportion of patients prescribed with asthma medications) at a university-based primary care clinic. The associated clinical factors for non-documentation of asthma control at the last visit were also examined. Design/methodology/approach This retrospective study involved auditing medical records and the pharmacy data system of 433 adult patients with asthma to evaluate 18 quality indicators. The standard target for the indicators of process and structure was 80 percent and the standard target for the indicators of outcome was 100 percent. Findings All the indicators failed to reach the standard targets. Documentation of asthma-specific information and availability of resources were deficient. The non-documentation of asthma control was significantly associated with presence of acute complaint(s) unrelated to asthma, presence of other issues and number of the documented parameters for asthma control. Although the prescription rates of inhaled reliever and preventer were substandard, they were reasonably high compared to the targets. Research limitations/implications In this study, evaluation of the quality of care was limited by absence of asthma register, use of paper-based medical records and restricted practice capacity. Besides, the asthma-specific assessments and management were only audited at one particular time. Furthermore, the findings of this study could not be generalised to other settings that used other methods of record keeping such as patient-held cards and electronic medical records. Future studies should sample asthma patients from a register, evaluate more reliable quality indicators (e.g. over-prescription of short-acting β-2 agonist and underuse of inhaled corticosteroid) and assess asthma management over a duration of time. Practical implications This study provides quality information on all aspects of asthma care (process, structure and outcome) which can be a basis for clinical improvement. It is hoped that the study could assist the stakeholders to plan strategies for improvement of the asthma care. A more strategic and reliable system of documentation is needed, such as the use of a simple template or structured form, which should not jeopardise the provision of personalised and comprehensive care. With complete documentation, thorough investigational audits can be continuously performed to determine the quality of asthma care. Social implications This study could provide useful findings to guide healthcare providers in developing a more strategic model of asthma care that can ensure asthma patients to receive a personalised, comprehensive, holistic and continuous care. Through this approach, their physical and psychosocial well-being can be optimised. Originality/value Even though our healthcare has advanced, the quality of asthma care is still suboptimal which requires further improvement. However, it could be considered assuring due to high outcome levels of asthma care despite having limited resources and practice capacity.
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Cardiff, Karen, Geoffrey Anderson, and Samuel Sheps. "Evaluation of a Hospital-Based Utilization Management Program." Healthcare Management Forum 8, no. 1 (April 1995): 38–45. http://dx.doi.org/10.1016/s0840-4704(10)60894-0.
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The objective of this study was to evaluate the impact of a utilization management (UM) program designed to decrease inappropriate use of acute care hospital beds while maintaining quality of care. The measure used to define appropriateness was the ISD-A, a diagnosis-independent measurement tool which relies on severity of illness and intensity of service criteria. The outcome measures for the study included appropriate admission to hospital and continued days of stay in hospital, 30-day readmission rates and physician perceptions of the impact of the intervention on quality of care, access to services and patient discharge patterns. The sample frame for the study included two control and two intervention community hospitals, involving 1,800 patient charts. Readmission rates were determined by analyzing all separations from medical services (N=42,014) in the two experimental and two control hospitals. All physicians with admitting privileges (N=312) at the intervention hospitals were surveyed; obstetricians, pediatricians, and psychiatrists were excluded from the survey. The results of the study demonstrated that the proportion of inappropriate admissions did not decrease significantly in any of the hospitals, but there were significant decreases in inappropriate continued stay in the intervention hospitals (p < 0.05). Both intervention and one of the control hospitals had lower 30-day readmission rates in the “after” period than in the “before” period (p < 0.05). Eighty-six percent believed that there had been no adverse impact on access to care and, although 25% thought the program may have led to premature discharge, this was not supported by the readmission data.
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Farrell, C., S. Teed, N. Costain, M. A. Austin, A. Willmore, A. Reed, J. Maloney, and R. Dionne. "P055: EMS boot camp: a real-world, real-time educational experience for emergency medicine residents." CJEM 19, S1 (May 2017): S96—S97. http://dx.doi.org/10.1017/cem.2017.257.
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Introduction/Innovation Concept: In 2014, Eastern Ontario paramedic services, their medical director staff and area community colleges developed an EMS Boot Camp experience to orient Queen’s University and the University of Ottawa emergency medicine residents to the role of paramedics and the challenges they face in the field. Current EMS ride-alongs and didactic classroom sessions were deemed ineffective at adequately preparing residents to provide online medical control. From those early discussions came the creation of a real-world, real-time (RWRT) educational experience. Methods: Specific challenges unique to paramedicine are difficult to communicate to a medical control physician at the other end of a telephone. The goal of this one-day educational experience is for residents to gain insight into the complexity and time sensitive nature of delivering medical care in the field. Residents are immersed as responding paramedics in a day of intense RWRT simulation exercises reflecting the common paramedic logistical challenges to delivering patient care in an uncontrolled and dynamic environment. Curriculum, Tool, or Material: Scenarios, run by paramedic students, are overseen by working paramedics from participating paramedic services. Residents learn proper use of key equipment found on an Ontario ambulance while familiarize themselves with patient care standards and medical directives. Scenarios focus on prehospital-specific clinical care issues; performing dynamic CPR in a moving vehicle, extricating a bariatric patient with limited personnel, large scale multi-casualty triage as well as other time sensitive, high risk procedures requiring online medical control approval (i.e. chest needle thoracostomy). Conclusion: EMS Boot Camp dispels preconceived biases regarding “what it’s really like” to deliver high quality prehospital clinical care. When providing online medical control in the future, the residents will be primed to understand and expect certain challenges that may arise. The educational experience fosters collaboration between prehospital and hospital-based providers. The sessions provide a reproducible, standardized experience for all participants; something that cannot be guaranteed with traditional EMS ride-alongs. Future sessions will evaluate participant satisfaction and self-efficacy with the use of a standard evaluation form including pre/post self-evaluations.
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Bannon, Brittany L., Michelle Lucier, Angela Fagerlin, Jaewhan Kim, Bernadette Kiraly, Peter Weir, and Elissa M. Ozanne. "Evaluation of the intensive outpatient clinic: study protocol for a prospective study of high-cost, high-need patients in the University of Utah Health system." BMJ Open 9, no. 1 (January 2019): e024724. http://dx.doi.org/10.1136/bmjopen-2018-024724.
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IntroductionThe University of Utah (UofU) Health intensive outpatient clinic (IOC) is a primary care clinic for medically complex (high-cost, high-need) patients with Medicaid. The clinic consists of a multidisciplinary care team aimed at providing coordinated, comprehensive and patient-centred care. The protocol outlines the quantitative design of an evaluation study to determine the IOC’s effects on reducing healthcare utilisation and costs, as well as improving patient-reported health outcomes and quality of care.Methods and analysisHigh-risk patients, with high utilisation and multiple chronic illnesses, were identified in the Medicaid ACO population managed by the UofU Health plans for IOC eligibility. A prospective, case-control study design is being used to match 100 IOC patients to 200 control patients (receiving usual care within the UofU) based on demographics, health utilisation and medical complexity for evaluating the primary outcome of change in healthcare utilisation and costs. For the secondary outcomes of patient health and care quality, a prepost design will be used to examine within-person change across the 18 months of follow-up (ie, before and after IOC intervention). Logistic regression and hierarchical, longitudinal growth modelling are the two primary modelling approaches.Ethics and disseminationThis work has received ethics approval by the UofU Institutional Review Board. Results from the evaluation of primary and secondary outcomes will be disseminated in scientific research journals and presented at national conferences.
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Domańska-Glonek, Ewa, Karolina Załuska, Monika Oberc, Ewa Lewicka, Kamil Torres, Anna Torres, and Ryszard Maciejewski. "Evaluation of Patients' Satisfaction and Quality of Life in Selected Healthcare Institutions in Southern-Eastern Poland." Polish Journal of Public Health 124, no. 4 (March 1, 2015): 183–86. http://dx.doi.org/10.1515/pjph-2015-0004.
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Abstract Introduction. In recent times, patient outcome measurement has developed from being narrowly focussed upon levels of symptomatology and service use, to being a broader assessment of the impact of illness and treatment on the individual. Thus, it can be said that quality of life has become as significant as life expectance. This has brought about a transition in the assessment of treatment. Quality of life (QOL) is a multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life as it is being led. With regard to healthcare, a cross-sectional comparison of palliative care needs is crucial in understanding differences in the patients' quality of life. Hence, an analysis of programme implementation within different types of healthcare institutions is significant in evaluating current medical care standards. Our study analyzed the satisfaction level and quality of life of patients with Chronic Obstructive Pulmonary Disease (COPD), and after myocardial infarction (MI). Different types of healthcare institutions were evaluated. Aim. To evaluate patients' satisfaction and quality of life in selected healthcare institutions in southern-eastern Poland. Material and methods. The quality of life of patients with Chronic Obstructive Pulmonary Disease (COPD) was analyzed through the medical documentation obtained from different types of healthcare institutions. Among these are the pulmonary outpatient department in Moczary, as well as a GP Practice and a Nursing Home in this location. The quality of life of patients after myocardial infraction was analyzed through a survey study conducted at “Polonia” hospital spa in Rymanów Zdrój (the cardiology department). Results and conclusions. The post-myocardial infarction incident patients had began to care more about their health condition and the quality of life they led. Moreover, their satisfaction level from received treatment and medical care indicated that the cardiological services implemented in southern-eastern Poland has proceeded in a good direction. Of note, these patients were systematically under specialist control. In contrast, among patients with COPD, only those under everyday care in the Nursing Home in Moczary received a similar systematic treatment, thus, COPD patients in Moczary lead a poor quality of life. This indicates a need to re-evaluate the current programmes and services provided by health care institutions in this region.
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Wootton, Richard, Helen Gramotnev, and David Hailey. "Telephone-supported care coordination in an Australian veterans population: a randomized controlled trial." Journal of Telemedicine and Telecare 16, no. 2 (December 11, 2009): 57–62. http://dx.doi.org/10.1258/jtt.2009.090408.
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An evaluation was undertaken on the effectiveness and efficiency of care coordination in delivering health services to Australian veterans with chronic or complex medical conditions requiring multidisciplinary care and who had moderate to high care needs. The veterans participated in a randomized controlled trial (RCT) supported by the Department of Veterans' Affairs. For evaluation of the RCT, information on cost of care and quality of life (QOL) was collected before the commencement of coordinated care and at follow-up after 12 months. Of 525 veterans who were recruited, 481 were surveyed at baseline (243 in the intervention group and 238 controls). At follow-up, 421 were surveyed (213 intervention and 208 controls). There were no significant differences between the coordinated care and control groups of veterans in costs of care or in QOL measurements using the SF-12 Health Survey and the EuroQol Group EQ-5D. These findings are consistent with those reported in earlier studies which suggest that benefits from care coordination programmes may take some time to emerge.
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Stavelin, Anne, Berit Oddny Riksheim, Nina Gade Christensen, and Sverre Sandberg. "The Importance of Reagent Lot Registration in External Quality Assurance/Proficiency Testing Schemes." Clinical Chemistry 62, no. 5 (May 1, 2016): 708–15. http://dx.doi.org/10.1373/clinchem.2015.247585.
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Abstract BACKGROUND Providers of external quality assurance (EQA)/proficiency testing schemes have traditionally focused on evaluation of measurement procedures and participant performance and little attention has been given to reagent lot variation. The aim of the present study was to show the importance of reagent lot registration and evaluation in EQA schemes. METHODS Results from the Noklus (Norwegian Quality Improvement of Primary Care Laboratories) urine albumin/creatinine ratio (ACR) and prothrombin time international normalized ratio (INR) point-of-care EQA schemes from 2009–2015 were used as examples in this study. RESULTS The between-participant CV for Afinion ACR increased from 6%–7% to 11% in 3 consecutive surveys. This increase was caused by differences between albumin reagent lots that were also observed when fresh urine samples were used. For the INR scheme, the CoaguChek INR results increased with the production date of the reagent lots, with reagent lot medians increasing from 2.0 to 2.5 INR and from 2.7 to 3.3 INR (from the oldest to the newest reagent lot) for 2 control levels, respectively. These differences in lot medians were not observed when native patient samples were used. CONCLUSIONS Presenting results from different reagent lots in EQA feedback reports can give helpful information to the participants that may explain their deviant EQA results. Information regarding whether the reagent lot differences found in the schemes can affect patient samples is important and should be communicated to the participants as well as to the manufacturers. EQA providers should consider registering and evaluating results from reagent lots.
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Wylie-Rosett, Judith, Jonathan N. Tobin, and Nichola Davis. "Revised 2005 Diabetes Quality Improvement Checklist." Diabetes Educator 31, no. 5 (September 2005): 669–78. http://dx.doi.org/10.1177/0145721705280758.
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The initial 1992 Diabetes Quality Assurance (DQA) Checklist was developed as a tool to facilitate chart auditing for evaluating clinician adherence to the current quality-of-care standards. This article describes how the authors revised and updated the 1992 DQA Checklist to incorporate more recent evidence related to clinical interventions that improve outcome. The revised version is designed to address the 2005 American Diabetes Association Standards for Medical Care. Additional changes were made to facilitate the review process. The revised instrument has been named the Revised 2005 Diabetes Quality Improvement (DQI) Checklist to reflect the emphasis on its potential use in quality improvement activities. The 2005 DQI Checklist is an updated version of the original 1992 DQA Checklist, with additional modifications based on the 2005 American Diabetes Association Standards of Medical Care, the National Cholesterol Education Program Adult Treatment Panel III, the Seventh Joint National Committee on the Prevention, Detection and Treatment of High Blood Pressure Guidelines, and the Centers for Disease Control and Prevention Adult Immunizations Guidelines.
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Bikmoradi, Ali, Azam Jalalinasab, Mohsen Salvati, Mohamad Ahmadpanah, Farshid Divani, and Ghodratollah Roshanaei. "Impact of continuity of care on quality of life in patients with chronic obstructive pulmonary disease." Journal of Integrated Care 27, no. 1 (February 11, 2019): 26–36. http://dx.doi.org/10.1108/jica-04-2018-0033.
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PurposePatients with chronic obstructive pulmonary disease (COPD) suffer many physical disabilities which cause many problems in their life. These patients really need to have continuity of care based on cooperation between patient, the family and their care givers in order to achieve an integration of care. The purpose of this paper is to assess the impact of continuous care on quality of life of patients with COPD.Design/methodology/approachA before–after quasi-experimental study was carried out with 72 patients with COPD at Beheshti educational hospital of Hamadan University of Medical Sciences. The patients who met inclusion criteria were randomly allocated into an intervention group (n=36) and a control group (n=36). The patients completed the St George’s Respiratory Questionnaire before and after their care. The intervention comprised continuous care with orientation and sensitization sessions (2 weeks), control and evaluation sessions (45 days) for intervention group and with routine care in the control group. Data were analyzed with SPSS, descriptive and inferential statistics were conducted to measure differences between intervention and control group.FindingsContinuity of care improved significantly the quality of life of COPD patients in general, and in the symptoms, activity and impact domains (P=0.001). In contrast, routine care did not improve quality of life for patients in general, and in the symptoms, activity and impact domains (P=0.05).Originality/valueContinuity of care has a positive impact on quality of life for COPD patients. Health care system should utilize continuity of care models as an overall plan for patients with COPD. Moreover, managers of health care system could reduce burden of chronic diseases by employing continuity of care models in planning patient care.
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Das, Devika, Lalan Wilfong, Katherine Enright, and Gabrielle Rocque. "How Do We Align Health Services Research and Quality Improvement?" American Society of Clinical Oncology Educational Book, no. 40 (May 2020): 282–91. http://dx.doi.org/10.1200/edbk_281093.
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Quality improvement (QI) initiatives and health services research (HSR) are commonly used to target health care quality. These disciplines are increasingly important because of the movement toward value-based health care as alternative payment and care delivery models drive institutions and investigators to focus on reducing unnecessary health care use and improving care coordination. QI efforts frequently target medical error and/or efficiency of care through the Plan-Do-Study-Act methodology. Within the QI framework, strategies for data display (e.g., Pareto charts, run charts, histograms, scatter plots) are leveraged to identify opportunities for intervention and improvement. HSR is a multidisciplinary field of study that seeks to identify the most effective way to organize, deliver, and finance health care to maximize the quality and value of care at both the individual and population levels. HSR uses a diverse set of quantitative and qualitative methodologies, such as case-control studies, cohort studies, randomized control trials, and semistructured interview/focus group evaluations. This manuscript provides examples of methodologic approaches for QI and HSR, discusses potential challenges associated with concurrent quality efforts, and identifies strategies to successfully leverage the strengths of each discipline in care delivery.
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Mladenovic-Segedi, Ljiljana, Katarina Parezanovic-Ilic, Aleksandar Curcic, and Nemanja Visnjevac. "Quality of life in women with pelvic floor dysfunction." Vojnosanitetski pregled 68, no. 11 (2011): 940–47. http://dx.doi.org/10.2298/vsp1111940m.
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Background/Aim. Pelvic floor dysfunction is a frequent problem affecting more than 50% of women in peri- and postmenopause. Considering that ageing and menopause befall in the significant factors causing this issue, as well as the expected longevity of women in the world and in our country, pelvic floor dysfunction prevelence is foreseen to be even higher. The aim of the study was to evaluate impact of the symptoms of pelvic dysfunction on quality of life and examine body image satisfaction in adult women with pelvic organ prolapse presenting to tertiary care clinic for surgical treatment. Methods. This prospective case-control study included 50 patients who presented to tertiary care gynecology clinic for surgical treatment and 50 controls with normal pelvic floor support and without urinary incontinence who presented tertiary care gynecology clinic for other reasons. Both, patients and controls, completed two quastionnaires recommended for the evaluation of symptoms (Pelvic floor distress inventory - short forms) and quality of life impact (Pelvic floor impact questionnaire - short form) of pelvic organ prolapse, and Body Image Scale. Results. The patients scored significantly worse on the prolapse, urinary, colorectal scales and overall score of Pelvic floor distress inventory - 20 than controls subjects (134.91 vs 78.08; p < 0.01). The patients also measured significant decrease in condition- specific quality of life (89.23 vs 3.1; p < 0.01). They were more likely to feel self-conscious (78% vs 42%; p < 0.01), less likely to feel physically attractive (78% vs 22%; p < 0.01), more likely to have difficulty looking at themselves naked (70% vs 42%; p < 0.01), less likely to feel sexually attractive (64% vs 32%; p < 0.01), and less likely to feel feminine (56% vs 16%; p < 0.05), than controls. There were no differencies in their feeling of dissatisfaction with appearance when dressed, avoiding people because of appereance and overall dissatisfaction with their body. There was a positive correlation between decreased quality of life and body image in women with pelvic dysfunction. Conclusion. Women with pelvic floor dysfunction have decreased quality of life and body image.
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H, Erviana N., Wiryanto W, and Harahap U. "Evaluation of Pharmaceutical Care Standard Implementation in Medan City Health Center, North Sumatra." Asian Journal of Pharmaceutical Research and Development 8, no. 1 (February 14, 2020): 18–21. http://dx.doi.org/10.22270/ajprd.v8i1.649.
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Objectives: The implementation of Pharmaceutical Care Standards policies in health centers can be seen from the extent of suitability of human resources, facilities and infrastructure, management of medicines and consumable medical materials, clinical pharmacy care and quality control of pharmaceutical care. Inadequate implementation with the Pharmaceutical Care Standards policy will have a negative impact on service quality. This study aims to evaluate the implementation of Minister of Health Regulation No. 74 of 2016 concerning Pharmaceutical Care Standards in Medan City Health Center.Methods: This research is a cross sectional descriptive survey research. Data obtained from filling out questionnaire sheets and checklist sheets based on direct observation in outpatient health centers that have pharmacists and pharmacy technical staff at the pharmacy. The data obtained were analyzed using indicators and compared with literature standards. This research was conducted in July - October 2019.Results: The results showed that the total score of implementation of Pharmaceutical Care Standards in Medan City Health Center was 73-82 included in category II / moderate. Implementation has not yet fully met the standards, this is indicated by aspects of facilities and infrastructure; clinical pharmacy care have not been carried out effectively because it is related to the ratio between the number of patients with pharmacists and pharmaceutical technical personnel in the health center that is still not rational; and management of drugs and medical consumables. Assessment of the highest level of patient satisfaction is the Satisfaction category, as many as 77.89-97.87%.Conclusions: Implementation of Minister of Health Regulation No. 74 of 2016 concerning Pharmaceutical Care Standards in Medan City Health Center is included in the Medium Category. Factors affecting implementation include human resources and infrastructure. The level of patient satisfaction is Satisfied Category.
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Oh, Hyang Soon, Hae Won Cheong, Seung Eun Yi, Ho Kim, Kang Won Choe, and Sung Il Cho. "Development and Application of Evaluation Indices for Hospital Infection Surveillance and Control Programs in the Republic of Korea." Infection Control & Hospital Epidemiology 28, no. 4 (April 2007): 435–45. http://dx.doi.org/10.1086/512632.
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Objective.To develop new evaluation indices of infection control and to use them to evaluate Korean infection surveillance and control programs (ISCPs).Design.We performed a questionnaire-based survey to 164 acute care general hospitals throughout the Republic of Korea that had more than 300 beds. Study methods were based completely on those of the Study on the Efficacy of Nosocomial Infection Control (SENIC). Four SENIC indices (hospital epidemiologist index, infection control nurse index, surveillance index, and control index) and 4 newly developed indices (healthcare worker index, quality improvement index, resource index, and hand hygiene facilities index) were used to evaluate Korean ISCPs. Data were collected by questionnaire from June 17 to October 11, 2003.Setting.One hundred sixty-four general hospitals with more than 300 beds in the Republic of Korea.Results.Personnel from 85 general hospitals responded to the study questionnaire. The reliability and validity of the evaluation indices were statistically significant (P<.05). The 8 evaluation indices were categorized into 2 factor groups: personnel factors (hospital epidemiologist index and infection control nurse index) and activity factors (the remaining 6 indices). Korean ISCPs showed a major weakness in surveillance. The scores for the newly developed evaluation indices were better than those for the SENIC evaluation indices. However, most Korean hospitals were estimated to have had only slight reductions in nosocomial infection rates. The evaluation indices were influenced significantly by the number of beds in the hospital, whether the hospital was located in the Seoul-Gyonggi region, the presence of full-time infection control nurses at the hospital, the education level of the infection control nurses, and the nurses' experience in infection control (P<.05).Conclusions.The reliability and validity of the SENIC evaluation indices and the newly developed evaluation indices were satisfactory in evaluating Korean ISCPs. However, surveillance should be improved to increase the efficacy of Korean ISCPs.
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Martynova, I. N., and Irina V. Vinyarskaya. "DEVELOPMENT AND EVALUATION OF THE EFFECTIVENESS OF THE HEALTH SCHOOL FOR CHILDREN WITH OBESITY UNDER THE CONDITIONS OF THE CHILD POLYCLINIC." Russian Pediatric Journal 20, no. 5 (April 30, 2019): 276–82. http://dx.doi.org/10.18821/1560-9561-2017-20-5-276-282.
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The article is devoted to the development and evaluation of the effectiveness of the organizational model of rendering medical care to children with obesity: «Health School - Weight Control». Тhis is a modern preventive technology. The main direction in its activity is the creation and maintenance of the motivation of the family and child with excessive body weight and/or obesity to a healthy lifestyle. Its tasks include the raise the awareness of family members and children with obesity about the disease, development of practical skills for eliminating unhealthy habits, and improvement of the quality of life of patients and their relatives. To assess the effectiveness of the Health School, not only the anthropometric method was used, but also indices of the quality of life of children and adolescents according to the questionnaire «Pediatrics Quality of Life Inventory (PedsQLТМ 4.0)». The study involved 50 patients aged of from 8 to 18 years. 75% of patients showed a gradual weight reduction during the year. The analysis of the dynamics of the quality of life revealed a statistically significant increase in all the components of indices in children involved in the Health School, especially in aspects of emotional and role functioning. The developed model of rendering medical care to patients with obesity allowed optimize the organization of treatment and preventive care for this category of patients.
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Levine, David M., Michael J. Healey, Adam Wright, David W. Bates, Jeffrey A. Linder, and Lipika Samal. "Changes in the quality of care during progress from stage 1 to stage 2 of Meaningful Use." Journal of the American Medical Informatics Association 24, no. 2 (August 26, 2016): 394–97. http://dx.doi.org/10.1093/jamia/ocw127.
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Background: The Centers for Medicare and Medicaid Services (CMS) canceled Meaningful Use (MU), replacing it with Advancing Care Information, which preserves many MU elements. Therefore, transitioning from MU stage 1 to MU stage 2 has important implications for the new policy, yet the quality of care provided by physicians transitioning from MU1 to MU2 is unknown. Methods: Retrospective longitudinal evaluation of the quality of care delivered by outpatient physicians at an academic medical center in the transition between MU1 and MU2. Results: Between MU1 and MU2, 4 measures improved: hypertension control (35% vs 40%), influenza immunization (63% vs 68%), tobacco use assessment/counseling (86% vs 96%), and diabetes control (93% vs 96%; P all <.01). One worsened: senior weight screening/follow-up (54% vs 49%; P < .01). Two were unchanged: chlamydia screening and adult weight screening/follow-up. Conclusion: In this single-site study, when clinicians progressed from MU1 to MU2, 4 quality measures improved, 2 were unchanged, and 1 worsened. Analysis of national data should guide policy decisions about the content of MU’s successor.
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Wu, Xiuwen, Jie Wu, Peige Wang, Xueling Fang, Yunsong Yu, Jianguo Tang, Yonghong Xiao, et al. "Diagnosis and Management of Intraabdominal Infection: Guidelines by the Chinese Society of Surgical Infection and Intensive Care and the Chinese College of Gastrointestinal Fistula Surgeons." Clinical Infectious Diseases 71, Supplement_4 (November 15, 2020): S337—S362. http://dx.doi.org/10.1093/cid/ciaa1513.
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Abstract The Chinese guidelines for IAI presented here were developed by a panel that included experts from the fields of surgery, critical care, microbiology, infection control, pharmacology, and evidence-based medicine. All questions were structured in population, intervention, comparison, and outcomes format, and evidence profiles were generated. Recommendations were generated following the principles of the Grading of Recommendations Assessment, Development, and Evaluation system or Best Practice Statement (BPS), when applicable. The final guidelines include 45 graded recommendations and 17 BPSs, including the classification of disease severity, diagnosis, source control, antimicrobial therapy, microbiologic evaluation, nutritional therapy, other supportive therapies, diagnosis and management of specific IAIs, and recognition and management of source control failure. Recommendations on fluid resuscitation and organ support therapy could not be formulated and thus were not included. Accordingly, additional high-quality clinical studies should be performed in the future to address the clinicians’ concerns.
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Al-Saleh, Khalid A. "Is routine administration of standardized questionnaires that assess aspects of patients’ quality of life justified in medical oncology clinics?" Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e20501-e20501. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e20501.
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e20501 Background: increasing interest in the Quality of Life outcomes in cancer patients led to increase implementation of their use in routine clinical practice. The aim of this study is to review the scientific evidence behind recommending the use of quality of life (QoL) scales routinely in outpatient evaluation. Methods: systematic review for all published randomized controlled trials in English language between January 1, 1990 till December 1, 2010. Out of 479 articles (468 identified by electronic search + 11 articles identified by manual search), six trials satisfied the eligibility criteria: 1) the study was a randomized controlled trial (RCT) with randomization of patients or health care providers; 2) the findings of the administered questionnaire or scale (the intervention) were given to health care provider, and compared to standard care with no questionnaire administered (the control); 3) study was conducted in outpatient oncology clinics; and 4) an outcome was measured that related to i) QoL improvement, ii) reduction in morbidity, iii) reduction in stress for the patients, iv) improvement in communication between patients and health care provider, or v) improved patient satisfaction. Assessment for the quality of the study was done using the GRADE methodology. Results: serious methodological issues were affecting most of the trials. Overall the evaluation of the quality of the evidence from these identified trials suggests that there is a weak recommendation to use QoL scales in routine oncology practice to improve communication between physicians and patients. Conclusions: The routine use of such tools in the outpatient settings at improving the patient outcome or satisfaction cannot be recommended based on the available evidence. The potential harm with the excess use of resources needed to implement, collect, store, analyse, and present such data to health care providers should be also considered. Further research and better designed trials is required using recent methodological techniques (such as item-response theory based questionnaire and cluster randomization) might help to reach an answer to this question.
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Cadilhac, Dominique A., Tara Purvis, Monique F. Kilkenny, Mark Longworth, Katherine Mohr, Michael Pollack, and Christopher R. Levi. "Evaluation of Rural Stroke Services." Stroke 44, no. 10 (October 2013): 2848–53. http://dx.doi.org/10.1161/strokeaha.113.001258.
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Background and Purpose— The quality of hospital care for stroke varies, particularly in rural areas. In 2007, funding to improve stroke care became available as part of the Rural Stroke Project (RSP) in New South Wales (Australia). The RSP included the employment of clinical coordinators to establish stroke units or pathways and protocols, and more clinical staff. We aimed to describe the effectiveness of RSP in improving stroke care and patient outcomes. Methods— A historical control cohort design was used. Clinical practice and outcomes at 8 hospitals were compared using 2 medical record reviews of 100 consecutive ischemic or intracerebral hemorrhage patients ≥12 months before RSP and 3 to 6 months after RSP was implemented. Descriptive statistics and multivariable analyses of patient outcomes are presented. Results— Sample: pre-RSP n=750; mean age 74 (SD, 13) years; women 50% and post-RSP n=730; mean age 74 (SD, 13) years; women 46%. Many improvements in stroke care were found after RSP: access to stroke units (pre 0%; post 58%, P <0.001); use of aspirin within 24 hours of ischemic stroke (pre 59%; post 71%, P <0.001); use of care plans (pre 15%; post 63%, P <0.001); and allied health assessments within 48 hours (pre 65%; post 82% P <0.001). After implementation of the RSP, patients directly admitted to an RSP hospital were 89% more likely to be discharged home (adjusted odds ratio, 1.89; 95% confidence interval, 1.34–2.66). Conclusions— Investment in clinical coordinators who implemented organizational change, together with increased clinician resources, effectively improved stroke care in rural hospitals, resulting in more patients being discharged home.
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Molinaro, Ross J., Anne M. Winkler, Colleen S. Kraft, Corinne R. Fantz, Sean R. Stowell, James C. Ritchie, David D. Koch, et al. "Teaching Laboratory Medicine to Medical Students: Implementation and Evaluation." Archives of Pathology & Laboratory Medicine 136, no. 11 (November 1, 2012): 1423–29. http://dx.doi.org/10.5858/arpa.2011-0537-ep.
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Context.—Laboratory medicine is an integral component of patient care. Approximately 60% to 70% of medical decisions are based on laboratory results. Physicians in specialties that order the tests are teaching medical students laboratory medicine and test use with minimal input from laboratory scientists who implement and maintain the quality control for those tests. Objective.—To develop, implement, and evaluate a 1.5-day medical student clinical laboratory experience for fourth-year medical students in their last month of training. Design.—The experience was devised and directed by laboratory scientists and included a panel discussion, laboratory tours, case studies that focused on the goals and objectives recently published by the Academy of Clinical Laboratory Physicians and Scientists, and medical-student presentations highlighting salient points of the experience. The same knowledge quiz was administered at the beginning and end of the experience and 84 students took both quizzes. Results.—A score of 7 or more was obtained by 16 students (19%) on the initial quiz, whereas 34 (40%) obtained the same score on the final quiz; the improvement was found to be statistically significant (P = .002; t = 3.215), particularly in 3 out of the 10 questions administered. Conclusions.—Although the assessment can only measure a small amount of knowledge recently acquired, the improvement observed by fourth-year medical students devoting a short period to learning laboratory medicine principles was encouraging. This medical student clinical laboratory experience format allowed teaching of a select group of laboratory medicine principles in 1.5 days to an entire medical school class.
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Roberts, Jessica Caroline, Lizzie Johnston-Walker, Kim Parker, Katherine Townend, and James Bickley. "Improving communication of patient issues on transfer out of intensive care." BMJ Open Quality 7, no. 4 (October 2018): e000385. http://dx.doi.org/10.1136/bmjoq-2018-000385.
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The written medical handover document is frequently poor in quality and highly variable which raises concerns about patient safety. Intensive care unit (ICU) patients have complex medical and social issues which increases the risk of errors during ongoing hospital treatment. Our project team of four doctors and two nurses aimed to improve the documentation of patient problems as they leave the ICU.A literature review and process mapping of both medical and nursing transfer documentation helped in understanding the current process. Current problems (CP) were defined as any patient issues which require ongoing thought, management or follow-up.Our progress was tracked using a measure of the number of CPs listed in the free-text field titled ‘Current Problems’ in 50 medical transfer documents. This was graphed on a control chart showing a process in statistical control. Means and control limits were recalculated whenever a process shift occurred.There was no relationship between the number of CPs listed and length of ICU stay, age of patient, or severity of illness on presentation (Acute Physiologic Assessment and Chronic Health Evaluation II score). An inter-relationship graph identified the key drivers which were amenable to change: (1) the doctors completing the clinical summary at the time of discharge did not have all the information readily available to them and (2) the doctors were uncertain of the types of problem which should be communicated.Improvements were designed and trialled using Plan-Do-Study-Act cycles to address these two key drivers. At baseline, the average number of CPs per patient was 1.8. After implementation of a paper problem list at the patient bedside, with supporting education, the average increased to 2.7. This was further improved by the addition of a checklist of common patient problems. This increased the average to 3.85.These improvements were permanently implemented and ongoing audits have shown sustained improvement using statistical process control methods.
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Eichstädter, R., R. Haux, U. Pohl, S. Rebel, S. Ziegler, and E. Ammenwerth. "A Randomized Evaluation of a Computer-Based Nursing Documentation System." Methods of Information in Medicine 40, no. 02 (2001): 61–68. http://dx.doi.org/10.1055/s-0038-1634465.
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AbstractA two-month randomized, controlled trial based on 60 patients has been performed on a ward of the Department of Psychiatry at Heidelberg University Medical Center, Germany, to investigate the influence of computer-based nursing documentation on time investment for documentation, quality of documentation and user acceptance. Time measurements, questionnaires, documentation analysis and interviews were used to compare patients documented with the computer-based system (PIK group) with the control group (patients documented with the paper-based system). The results showed the advantages and disadvantages of computer-based nursing documentation. Time needed for nursing care planning was lower in the PIK group. Some formal aspects of quality were considerably better in the PIK group. On the other hand, time required for documentation of tasks and for report writing was greater in the PIK group. User acceptance increased significantly during the study. The interviews indicated a positive influence of PIK on the cooperation between nurses and physicians.
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Le Goff-Pronost, Myriam, Bénédicte Mourgeon, Jean-Pierre Blanchère, Luc Teot, Hervé Benateau, and Anne Dompmartin. "REAL-WORLD CLINICAL EVALUATION AND COSTS OF TELEMEDICINE FOR CHRONIC WOUND MANAGEMENT." International Journal of Technology Assessment in Health Care 34, no. 6 (2018): 567–75. http://dx.doi.org/10.1017/s0266462318000685.
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Background:Chronic wounds are frequent, affect quality of life, and increase care costs. Telemedicine provides potential for effective wound care management, especially for the monitoring of complex wounds at home.Objectives:The objective of the present study was to determine the clinical effects and costs of telemedicine for the follow-up of complex chronic wounds from the perspective of the public health insurance. The study ran over a period of 9 months.Methods:We conducted a prospective, pragmatic, open-label, observational study and carried out a cost-effectiveness analysis. A total of 116 patients with chronic wounds were assigned to their choice of two groups: telemedicine (N = 77) and traditional follow-up (control; N = 39). The primary outcome was the time to healing. Secondary outcomes included percentage of wounds reaching target objective, percentage of wounds healed completely, outpatient care costs, travel costs, and hospitalizations.Results:Time to healing was shorter in the telemedicine group than in the control group (137 versus 174 days; p < .05). The percentage of wounds completely healed was not statistically different between the telemedicine and control group (66 percent versus 61 percent; p > .05). Outpatient care and hospitalization costs were not significantly different. The main results in terms of economic savings were medical transport costs reimbursed by the French public health insurance, which were significantly lower in the telemedicine group. Telemedicine costs were found to be €4,583 less per patient compared with standard practice over 9 months.Conclusions:This trial suggests that telemedicine saves travel costs and results in a shorter healing time than traditional follow-up.
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Fang, Juemin, Xianling Guo, Zhongzheng Zhu, Hui Wang, Fei Hu, Jianhua Chen, Min Yuan, et al. "Quality control system of Watson for oncology: Artificial intelligence for supporting clinical decisions in oncology." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 6616. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.6616.
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6616 Background: Watson for Oncology (WFO) is an artificial intelligent clinical decision-support system (AI-CDSS) developed by IBM and trained by Memorial Sloan Kattering Cancer Center to assist in cancer care by providing evidence-based treatment options with priority. However, there are disagreements argue that WFO recommends “unsafe and incorrect” cancer treatments. Also, guidelines and drug availability in China are different from USA. Therefore, a quality control system of WFO is urgently needed to help oncologists better use WFO in China. Methods: Experts from medical oncology, surgical oncology, radiology, intervention, radiology and pathology etc. forming a Multiple Disciplinary Team (MDT) to score Watson recommendations in 6 aspects (shown in the table). Results: With this quality control system, the value of WFO was carefully evaluated by MDT. Recommendations with higher score(especially more than 80) were more standardized, reasonable and evidence-based thus more likely to be chosen. Localization and drug availability problem was solved by taking Chinese guidelines and drug approval into evaluation within this scoring system. Treatment options unsuitable or unavailable for patients by the system will be removed and replaced by the advices of MDT. Conclusions: Reliability and security are the top concerns of applying new technology in healthcare. With the MDT quality control system, AI-CDSS can be used safely and efficiently before it is fully mature. Also, the accuracy and advancement are assessed in this system to help oncologists better use WFO in China in the future. Indicators evaluating the WFO recommendations. [Table: see text]
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Khan, Tamkeen, Jianing Yang, Laken Barkowski, Beth Tapper, Lisa Lubomski, Donna Daniel, and Gregory Wozniak. "A hypertension control quality improvement pilot program: Experiences and blood pressure outcomes from physician practices." International Journal of Healthcare 4, no. 1 (March 28, 2018): 42. http://dx.doi.org/10.5430/ijh.v4n1p42.
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Improving Health Outcomes: Blood Pressure (IHO: BP) was a Quality Improvement (QI) pilot program developed by the American Medical Association (AMA) and Johns Hopkins Medicine aimed at helping physicians and their care teams better manage patients with uncontrolled hypertension. The pilot study was conducted at 10 ambulatory practice sites between October 2013 and November 2014 in which the initiative was to devise a framework and intervention strategies for improving hypertension control. The program included evidence-based tools and materials to support the Measure Accurately, Act Rapidly, and Partner with Patients (M.A.P.) framework, interactive components with coaching support and peer-to-peer learning opportunities, and a measurement system supported by health technology, all intended to aid blood pressure management. This paper captures the learnings from the engagement, experiences, and satisfaction of care teams from the IHO: BP pilot that were used to adjust, reassess, and refine components of the QI program. Overall, participation in the IHO: BP pilot was associated with an increase in BP control rates from a mean of 69% to 75% (p < .05) for 3 of the 10 practices. Mean systolic and diastolic blood pressure was reduced in 8 of 10 practices by a mean of 12.5 mmHg/6.5 mmHg (p < .05). Furthermore, evaluation of participant experiences indicated that 75% of the respondents were satisfied or very satisfied with the initiative. The results from this study include components of the pilot that participants indicated were most helpful and were used to generate useful information for hypertension QI efforts that were later scaled and spread to subsequent initiatives.
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Khrulev, A. E., E. S. Kudryavtseva, P. A. Egorova, A. D. Rodionova, S. N. Sorokoumova, and O. V. Suvorova. "Quality of Life of Long-Term Hemodialysis Patients." General Reanimatology 15, no. 2 (April 30, 2019): 4–12. http://dx.doi.org/10.15360/1813-9779-2019-2-4-12.
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The outcome of chronic kidney disease (CKD) is frequently development of end-stage kidney failure that requires program hemodialysis (PHD). Increase of the longevity of long-term PHD patients is associated with continuous somatic and psychic stress for the patient, which might adversely affect the quality of life (QoL) of an end-stage CKD patient.Purpose: to determine the influence of age and dialysis duration on the QoL of end-stage CKD patients receiving PHD.Materials and methods. 50 patients receiving PHD (23 men and 27 women), aged 31 to 79 years, were examined. The mean age was 56.72±11.26 years. The PHD duration ranged between 1 month to 20 years, the average figure being 5.26±4.82 years. The control group included 50 healthy subjects of comparable gender and age. The QoL evaluation data were gathered through survey using the Russian version of SF-36 Questionnaire (Short Form Medical Outcomes Study), validated by the Institute of Clinical and Pharmacological Studies (Saint Petersburg) and analysis of case records.Results. As regards the scales of physical health, a decrease of the QoL of PHD patients was found as follows: РF-physical functioning (54.1±25.6 vs. 85.0±21.4), RP-role functioning related to physical condition (38.5±35.4 vs. 74.5±29.7), Pbodily pain (64.7±32.1 vs. 70.5±24.8), GH-general health condition (51.3±15.9 vs. 65.1±21.7). A trend towards inter-group difference was also discovered as regards the scales of vitality (VT) (53.7±19.5 vs. 61.0±19.4), social functioning (SF) (72.5±18.0 vs. 79.5±23.5). Multiple regression analysis established inverse relationship between the patient’s physical health component (PH) and age (rs=-0.317, P<0.05).Conclusion. In PHD patients, the physical health component is the one that suffers most of all, namely: physical functioning, role functioning related to physical condition, pain intensity, and general health condition. The tendency to statistic differences is observed for the scales of vitality and social functioning of the mental health component. Increase of the age and dialysis duration affect adversely the physical health whereas render no influence on the mental health.
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Fønss Rasmussen, Lisa, Louise Bang Grode, Jeppe Lange, Ishay Barat, and Merete Gregersen. "Impact of transitional care interventions on hospital readmissions in older medical patients: a systematic review." BMJ Open 11, no. 1 (January 2021): e040057. http://dx.doi.org/10.1136/bmjopen-2020-040057.
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ObjectivesTo identify and synthesise available evidence on the impact of transitional care interventions with both predischarge and postdischarge elements on readmission rates in older medical patients.DesignA systematic review.MethodInclusion criteria were: medical patients ≥65 years or mean age in study population of ≥75 years; interventions were transitional care interventions between hospital and home with both predischarge and postdischarge components; outcome was hospital readmissions. Studies were excluded if they: included other patient groups than medical patients, included patients with only one diagnosis or patients with only psychiatric disorders. PubMed, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from January 2008 to August 2019. Study selection at title level was undertaken by one author; the remaining selection process, data extraction and methodological quality assessment were undertaken by two authors independently. A narrative synthesis was performed, and effect sizes were estimated.ResultWe identified 1951 records and included 11 studies: five randomised trials, four non-randomised controlled trials and two pre–post cohort studies. The 11 studies represent 15 different interventions and 29 outcome results measuring readmission rates within 7–182 days after discharge. Twenty-two of the 29 outcome results showed a drop in readmission rates in the intervention groups compared with the control groups. The most significant impact was seen when interventions were of high intensity, lasted at least 1 month and targeted patients at risk. The methodological quality of the included studies was generally poor.ConclusionTransitional care interventions reduce readmission rates among older medical patients although the impact varies at different times of outcome assessment. High-quality studies examining the impact of interventions are needed, preferably complimented by a process evaluation to refine and improve future interventions.PROSPERO registration numberCRD42019121795.
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Fønss Rasmussen, Lisa, Louise Bang Grode, Jeppe Lange, Ishay Barat, and Merete Gregersen. "Impact of transitional care interventions on hospital readmissions in older medical patients: a systematic review." BMJ Open 11, no. 1 (January 2021): e040057. http://dx.doi.org/10.1136/bmjopen-2020-040057.
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ObjectivesTo identify and synthesise available evidence on the impact of transitional care interventions with both predischarge and postdischarge elements on readmission rates in older medical patients.DesignA systematic review.MethodInclusion criteria were: medical patients ≥65 years or mean age in study population of ≥75 years; interventions were transitional care interventions between hospital and home with both predischarge and postdischarge components; outcome was hospital readmissions. Studies were excluded if they: included other patient groups than medical patients, included patients with only one diagnosis or patients with only psychiatric disorders. PubMed, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from January 2008 to August 2019. Study selection at title level was undertaken by one author; the remaining selection process, data extraction and methodological quality assessment were undertaken by two authors independently. A narrative synthesis was performed, and effect sizes were estimated.ResultWe identified 1951 records and included 11 studies: five randomised trials, four non-randomised controlled trials and two pre–post cohort studies. The 11 studies represent 15 different interventions and 29 outcome results measuring readmission rates within 7–182 days after discharge. Twenty-two of the 29 outcome results showed a drop in readmission rates in the intervention groups compared with the control groups. The most significant impact was seen when interventions were of high intensity, lasted at least 1 month and targeted patients at risk. The methodological quality of the included studies was generally poor.ConclusionTransitional care interventions reduce readmission rates among older medical patients although the impact varies at different times of outcome assessment. High-quality studies examining the impact of interventions are needed, preferably complimented by a process evaluation to refine and improve future interventions.PROSPERO registration numberCRD42019121795.
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Mangiapane, Sandra, Martin Schulz, Stephan Mühlig, Peter Ihle, Ingrid Schubert, and Hans-Christian Waldmann. "Community Pharmacy–Based Pharmaceutical Care for Asthma Patients." Annals of Pharmacotherapy 39, no. 11 (November 2005): 1817–22. http://dx.doi.org/10.1345/aph.1g180.
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BACKGROUND Despite significant progress in asthma drug therapy in recent years, there has been no major change in asthma morbidity and mortality. It is still important to determine whether pharmaceutical care (PC) influences health outcomes. OBJECTIVE To evaluate the effectiveness of PC with regard to clinical, humanistic, and economic outcomes in adults with asthma. METHODS An intervention study was conducted over 12 months. At baseline, 39 community/retail pharmacies, 84 primary care physicians (general practitioners, internal specialists, chest physicians), and 183 patients (aged 18–65 y) diagnosed with asthma were included. To evaluate economic outcomes, 2 German statutory health insurance funds provided 2 years of claims data for their insured patients (n = 55). A 1:10 matching was carried out to compare the data of this intervention subgroup with those of a control group (n = 550). RESULTS Significant improvements were found for all humanistic outcomes (eg, asthma-specific quality of life, self-efficacy, knowledge, medication adherence). In addition, asthma severity, self-reported symptoms, peak expiratory flow, and patients’ inhalation technique improved. Increases in forced expiratory volume in 1 second and vital capacity were not significant over time. Evaluation of the insurance claims data revealed a shift toward better adherence to evidence-based therapy. CONCLUSIONS The study shows that PC for people with asthma has a positive impact on humanistic and, to some extent, on clinical outcomes. To determine potential economic benefits, future research should focus on patients with more severe asthma.
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Hermann, Emilia A., Jeffrey M. Ashburner, Steven J. Atlas, Yuchiao Chang, and Sanja Percac-Lima. "Satisfaction With Health Care Among Patients Navigated for Preventive Cancer Screening." Journal of Patient Experience 5, no. 3 (January 17, 2018): 225–30. http://dx.doi.org/10.1177/2374373517750413.
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Background: Patient navigation (PN) programs can improve cancer screening in underserved populations. PN may advance quality and equity of care by supporting individuals at increased risk of not receiving recommended care. Objective: To evaluate patient satisfaction with medical care and PN for cancer screening. Methods: We conducted a telephone survey of patients enrolled in a randomized control trial evaluating the impact of PN for cancer screening to assess their satisfaction with overall medical care and the PN program. We measured patient satisfaction with medical care using the Patient Satisfaction Questionnaire-18 and evaluated patient satisfaction with PN in the navigated group using the Patient Satisfaction with Interpersonal Relationships with Navigator questionnaire. Key Results: Satisfaction surveys were completed by 114 navigated and 108 non-navigated patients (33% response rate). Patients who received PN had higher satisfaction scores with overall medical care (71.0 vs 66.8; P < .001). Conclusions: Our findings show that patients at high risk of nonadherence with comprehensive cancer screening were satisfied with PN and suggest that PN could positively influence patient satisfaction with overall medical care.
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Vafaei, Seyed Majid, Zahra Sadat Manzari, Abbas Heydari, Razieh Froutan, and Leila Amiri Farahani. "Improving Nursing Care Documentation in Emergency Department: A Participatory Action Research Study in Iran." Open Access Macedonian Journal of Medical Sciences 6, no. 8 (August 19, 2018): 1527–32. http://dx.doi.org/10.3889/oamjms.2018.303.
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BACKGROUND: Standardization of documentation has enabled the use of medical records as a primary tool for evaluating health care functions and obtaining appropriate credit points for medical centres. However, previous studies have shown that the quality of medical records in emergency departments is unsatisfactory.AIM: The aim of this study was improving the nursing care documentation in an emergency department, in Iran.MATERIAL AND METHODS: This collaborative action research study was carried out in two phases to improve nursing care documentation in cooperation with individuals involved in the process, from February 2015 to December 2017 in an affiliated academic hospital in Iran. The first phase featured virtual training, an educational workshop, and improvements to the hospital information system. The second phase involved the recruitment of human resources, the implementation of continuous codified training, the establishment of an appropriate reward and penalty system, and the review of patient education forms.RESULTS: The interventions improved nursing documentation quality score of 73.20%, which was the highest accreditation ranking provided by Iran’s Ministry of Health and Medical Education in 2017. In other words, this study caused a 32% improvement in the quality of nursing care documentation in the hospital.CONCLUSION: The appropriate practices for improving nursing care documentation are employee participation, managerial accountability, nurses’ adherence to documentation standards, improved leadership style, and continuous monitoring and control.
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Mento, Carmela, Basilia Piraino, Amelia Rizzo, Roberta Vento, Luciana Rigoli, Emanuela Moschella, Carmelo Salpietro, and Salvatore Settineri. "Affective control and life satisfaction in thalassemics." International Journal of Psychological Research 8, no. 1 (January 1, 2015): 91–98. http://dx.doi.org/10.21500/20112084.648.
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Background. Thalassemia is a chronic disease that can lead to an impact on psychological functioning and social behavior of patients. However, still little is known about the specific psychological aspects of the disease, such as the degree of tension, life satisfaction and affective control, especially in adult patients.Aim. The purpose of this study is to investigate whether patients with thalassemia have specific psychological pattern relating to the dimensions of tension, satisfaction and quality of life, management of affection.Method. We evaluated 31 patients with thalassemia major and intermedia (19 women and 12 men) aged between 18 and 50 years (M = 34 + 16), belonging to the Complex Unit of Medical Genetics. For the evaluation were used the Profile of Mood States (POMS), the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Rorschach test.Results. The findings show an inverse relationship between the levels of self-reported tension and the affective control indicators at Rorschach. Life satisfaction, instead, seems to vary according to the severity of the disease - major vs. intermediate - and the type of therapy.Conclusions. An understanding of the psychological mechanisms involved in thalassemia, both self-reported and projective, can contribute to a wider patient take-over, by considering the subjective aspects related to the psychological and socio-emotional well-being, fundamental in the care compliance.
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Firlej, Ewelina, Mariola Janiszewska, Katarzyna Sidor, Anna Sokołowska, Agnieszka Barańska, and Paweł Chruściel. "Health Evaluation in the Context of Satisfaction with Medical Services among Patients with Osteoarthritis: Descriptive Cross-Section Survey." International Journal of Environmental Research and Public Health 17, no. 1 (December 18, 2019): 9. http://dx.doi.org/10.3390/ijerph17010009.
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Osteoarthritis (OA) is one of the most common causes of rehabilitation benefits and senior disability. It generates high costs of treatment and increasing demand for medical staff and care of geriatric profile. The aim of the study was to determine the relationship between health evaluation and satisfaction with medical services among individuals with OA in rehabilitation outpatient clinics. The survey was carried out from June 2017 to May 2018, among patients being provided with services of five outpatient rehabilitation clinics in Lublin. The surveyed group comprised 328 respondents. The following tools were utilized: the List of Health Criteria (LHC), the Multidimensional Health Locus of Control Scale (version B) (MHLC), the authors’ own questionnaire compiled for the study, and the Servperf Method. According to the respondents, the most important health criterion is “not to experience any ailments” (M = 1.56). In an assessment of a clinic, the respondents rated neatness (cleanliness) of the staff highest (M = 4.38) and the appearance of a building where a clinic is located lowest (M = 3.42). The better the evaluation of medical services in an outpatient rehabilitation clinic in comparison to other settings, the better the evaluation of the quality of service (rho S = 0.593; p < 0.000). The study conducted in outpatient rehabilitation clinics showed great demand for outpatient specialist care of geriatric profile. Undoubtedly, there is need for continuation and expansion of studies on patients with OA in other rehabilitation settings.