Underrepresented minority representation trends in gynecologic oncology fellowships in the United States.

OBJECTIVE: To evaluate representation trends of historically underrepresented minority (URM) groups in gynecologic oncology fellowships in the United States using a nationwide database collected by the Accreditation Council for Graduate Medical Education (ACGME). METHODS: Data on self-reported ethnicity/race of filled residency positions was collected from ACGME Database Books across three academic years from 2016 to 2019. Primary chi-square analysis compared URM representation in gynecologic oncology to obstetrics and gynecology, other surgical specialties, and other medical specialties. Secondary analysis examined representation of two URM subgroups: 1) Asian/Pacific Islander, and 2) Hispanic, Black, Native American, Other (HBNO), across specialty groups. RESULTS: A total of 528 gynecologic oncology positions, 12,559 obstetrics and gynecology positions, 52,733 other surgical positions, and 240,690 other medical positions from ACGME accredited medical specialties were included in analysis. Primary comparative analysis showed a statistically significant lower proportion (P < 0.05) of URM trainees in gynecologic oncology in comparison to each of obstetrics and gynecology, other surgical fields, and other medical fields. Secondary analysis also demonstrated a significantly lower proportion (P < 0.05) of HBNO physicians in gynecologic oncology in comparison to obstetrics and gynecology, as well as all other medical and surgical specialties. CONCLUSIONS: This study illustrates the disparities in URM representation, especially those who identify as HBNO, in gynecologic oncology fellowship training in comparison to obstetrics and gynecology as well as other medical and surgical fields. Improvements to the current recruitment and selection practices in gynecologic oncology fellowships in the United States are necessary in order to ensure a diverse and representative workforce.

Application for Public Health Accreditation Among US Local Health Departments in 2013 to 2019: Impact of Service and Activity Mix.

Objectives. To examine correlates of applying for accreditation among small local health departments (LHDs) in the United States through 2019.Methods. We used administrative data from the Public Health Accreditation Board (PHAB) and 2013, 2016, and 2019 Profile data from the National Association of County and City Health Officials to examine correlates of applying for PHAB accreditation. We fit a latent class analysis (LCA) to characterize LHDs by service mix and size. We made bivariate comparisons using the t test and Pearson χ2.Results. By the end of 2019, 126 small LHDs had applied for accreditation (8%). When we compared reasons for not pursuing accreditation, we observed a difference by size for perceptions that standards exceeded LHD capacity (47% for small vs 22% for midsized [P < .001] and 0% for large [P < .001]).Conclusions. Greater funding support, considering differing standards by LHD size, and recognition that service mix might affect practicality of accreditation are all relevant considerations in attempting to increase uptake of accreditation for small LHDs.Public Health Implications. Overall, small LHDs represented about 60% of all LHDs that had not yet applied to PHAB.

Social value of maintaining baby-friendly hospital initiative accreditation in Australia: case study.

BACKGROUND: Breastfeeding has positive impacts on the health, environment, and economic wealth of families and countries. The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative (BFHI) in 1991 as a global program to incentivize maternity services to implement the Ten Steps to Successful Breastfeeding (Ten Steps). These were developed to ensure that maternity services remove barriers for mothers and families to successfully initiate breastfeeding and to continue breastfeeding through referral to community support after hospital discharge. While more than three in four births in Australia take place in public hospitals, in 2020 only 26% of Australian hospitals were BFHI-accredited. So what is the social return to investing in BFHI accreditation in Australia, and does it incentivize BFHI accreditation? This study aimed to examine the social value of maintaining the BFHI accreditation in one public maternity unit in Australia using the Social Return on Investment (SROI) framework. This novel method was developed in 2000 and measures social, environmental and economic outcomes of change using monetary values. METHOD: The study was non-experimental and was conducted in the maternity unit of Calvary Public Hospital, Canberra, an Australian BFHI-accredited public hospital with around 1000 births annually. This facility provided an opportunity to illustrate costs for maintaining BFHI accreditation in a relatively affluent urban population. Stakeholders considered within scope of the study were the mother-baby dyad and the maternity facility. We interviewed the hospital's Director of Maternity Services and the Clinical Midwifery Educator, guided by a structured questionnaire, which examined the cost (financial, time and other resources) and benefits of each of the Ten Steps. Analysis was informed by the Social Return on Investment (SROI) framework, which consists of mapping the stakeholders, identifying and valuing outcomes, establishing impact, calculating the ratio and conducting sensitivity analysis. This information was supplemented with micro costing studies from the literature that measure the benefits of the BFHI. RESULTS: The social return from the BFHI in this facility was calculated to be AU$ 1,375,050. The total investment required was AU$ 24,433 per year. Therefore, the SROI ratio was approximately AU$ 55:1 (sensitivity analysis: AU$ 16-112), which meant that every AU$1 invested in maintaining BFHI accreditation by this maternal and newborn care facility generated approximately AU$55 of benefit. CONCLUSIONS: Scaled up nationally, the BFHI could provide important benefits to the Australian health system and national economy. In this public hospital, the BFHI produced social value greater than the cost of investment, providing new evidence of its effectiveness and economic gains as a public health intervention. Our findings using a novel tool to calculate the social rate of return, indicate that the BHFI accreditation is an investment in the health and wellbeing of families, communities and the Australian economy, as well as in health equity.

Application Factors May Not Be Predictors of Success Among General Surgery Residents as Measured by ACGME Milestones.

BACKGROUND: Can factors within the Electronic Residency Application Service application be used to predict the success of general surgery residents as measured by the Accreditation Council for Graduate Medical Education (ACGME) general surgery milestones? METHODS: This is a retrospective study of 21 residents who completed training at a single general surgery residency program. Electronic Residency Application Service applications were reviewed for objective data, such as age, US Medical Licensing Examination scores, and authorship of academic publications as well as for letters of recommendation, which were scored using a standardized grading system. These factors were correlated to resident success as measured by ACGME general surgery milestone outcomes using univariate and multivariate analyses. This study was conducted at a single academic tertiary care and level 1 trauma facility. Residents who completed general surgery residency training from the years of 2012-2018 were included in the study. RESULTS: There were few correlations between application factors and resident success determined by the ACGME milestones. CONCLUSIONS: Application factors alone do not account for ongoing growth and development throughout residency. Unlike the results presented in the literature for other surgical subspecialties, predicting general surgery resident success based on application factors is not straightforward.

Laboratory Quality Management System and Quality Indicators Implementation Status as Perceived by Laboratory Professionals in Preparation for the Accreditation Process from Selected Government Hospitals of Ethiopia.

BACKGROUND: The aim was to produce quality results that clinical laboratories need to implement and maintain continuous quality improvement systems. In recent years, health organizations have increasingly prioritized the quality of laboratory services by implementing quality management systems (QMSs) and building quality improvement activities. Efforts to strengthen laboratory systems in the African region have received increased attention in recent years. Assessing the implementation levels of laboratory quality management system components is important to identify the gaps that need further improvements. METHODS: A cross-sectional study design was used between March and May 2017 in selected government hospitals of Ethiopia, and sample size was determined using a finite population formula, and a proportional sampling technique was employed; a sample size of 184 (62%) was calculated from 295 laboratory professionals. RESULTS: All respondents were informed about the laboratory's experience in the quality management system implementation; of those, only 138 (79%) engaged in the implementation process. From the 18 selected laboratory quality management components, 5 were observed to have the list implementation status, which are: (1) Performance of internal quality control for all tests, (2) Development and communication of a quality manual for all tests, (3) Adequacy of storage space for the supplies, (4) Development of an action plan based on internal audit, and (5) monitoring of environmental conditions. Running quality controls for all types of tests became a headache in almost all laboratories. From 12 selected quality indicators studied in this research, the 5 indicators with either poor or very poor performance outcome were: control of documents 136 (77.7%), control of records 123 (70.3%), development of manuals and policies 122 (69.7%), development of process and procedures 120 (68.6%), and internal communication 114 (65.1%). CONCLUSIONS: This research indicated the top 3 LQMS components with either poor or very poor implementation status: (1) Performance of internal quality controls for all tests, (2) Development and communication of quality manuals for all tests, (3) Adequacy of storage space for the supplies. Of the quality indicators studied, control of documents was perceived to have poor performance outcome by 136 (77.7%) of study participants.

Contextual factors favouring success in the accreditation process in Colombian hospitals: a nationwide observational study.

BACKGROUND: To identify context factors associated with and predicting success in the hospital accreditation process, and to contribute to the understanding of the relative relevance of context factors and their organizational level in the success of QI initiatives. METHODS: Analytical study of cases and controls in a sample of hospitals of medium and high complexity in Colombia. Cases (n = 16) are accredited hospitals by the time of preparation of the study (2016) and controls (n = 38) are similar facilities, which have not succeeded to obtain accreditation. Eligibility criteria for both groups included complexity (medium and high), having emergency services, an official quality assurance license, and being in operation for at least 15 years. Besides eligibility criteria, geographical location, and type of ownership (public/private) are used to select controls to match cases. Context measures are assessed using a survey instrument based on the MUSIQ model ("Model for Understanding Success in Quality") adapted and tested in Colombia. Statistical analysis includes descriptive measures for twenty-three context factors, testing for significant statistical differences between accredited and non-accredited hospitals, and assessing the influence and strength of association of context factors on the probability of success in the accreditation process. A multivariate model assesses the predictive probability of achieving accreditation. RESULTS: Eighteen (78.3%) of the twenty-three context factors are significantly different when comparing cases and controls hospitals, particularly at the Microsystem level; all factors are statistically significant in favor of accredited hospitals. Five context factors are strongly associated to the achievement of accreditation but in the logistic multivariable model, only two of them remain with significant OR, one in the Macrosystem, "Availability of economic resources for QI" (OR: 22.1, p: 0,005), and the other in the Microsystem, "Involvement of physicians" (OR: 4.9, p: 0,04). CONCLUSION: This study has applied an instrument, based on the MUSIQ model, which allows assessing the relevance of different context factors and their organizational level in hospitals, to explain success in the accreditation process in Colombia. Internal macrosystem and microsystem seem to be more relevant than external environment factors.

Challenges in the Australasian neurosurgery training program: who should be trained and where should they train?

OBJECTIVE: Neurosurgical training poses particular challenges in Australia and New Zealand, given the large landmass, small population, and widely separated, often small, neurosurgical units. Such factors have necessitated a move away from autonomous, single-institution-based training to the selection of trainees by a centralized binational process. The success of this system is based on rigorous standardized evaluation of candidates' academic achievements, anatomical knowledge, references, and interview performance. Similarly, the accreditation of hospitals to train successful candidates has been standardized. The authors review the evolution of trainee selection and the accreditation of training posts in Australia and New Zealand. METHODS: The records of the Neurosurgical Society of Australasia Surgical Education and Training Board were reviewed for documents pertaining to the selection of neurosurgical trainees and the accreditation of training posts. Application records and referee scores from 2014 to the present were reviewed to encompass process changes, in particular the change from written referee reports to standardized interviews of referees. Surgical logbook case numbers for 23 trainees completing training in 2016, 2017, and 2018 were collated and presented in an aggregated, de-identified form as a measure of adherence to accreditation standards. Written evaluations of the training experience were also sought from two trainees reflecting on the selection process, the quality of training posts, and training limitations. RESULTS: While a time-consuming process, the method of obtaining referee reports by interview has resulted in a wider spread of scores, more able to separate high- and low-scoring applicants than other components of the selection process. Review of the training post accreditation records for the last 2 years showed that adherence to standards has resulted in loss of accreditation for one unit and shortened periods of review for units with more minor deficiencies. Two applications for accreditation have been denied. Examination of caseload data showed that trainees more than fulfill minimum requirements in accredited training posts, confirming the robust nature of this aspect of unit accreditation. CONCLUSIONS: A key factor determining the success of neurosurgical training in Australia and New Zealand has been a willingness to evolve selection and other processes to overcome challenges as they become apparent. According to available analyses, the revised referee process and strict accreditation standards appear effective. The benefits and challenges of the current training system are discussed in the context of a paucity of international literature.

Academic performance after neurosurgery residency training in Turkey: a national survey.

OBJECTIVE: Neurosurgery training programs aim to train specialists. In addition, they are expected to equip the residents with necessary knowledge and skills for academic development. This study aims to gain insights into academic productivity after neurosurgeons graduated from residency training in Turkey. METHODS: An electronic survey was sent to all Turkish Neurosurgical Society members (n = 1662 neurosurgeons) between September and November 2019. The number of participants was 289 (17.4%). Participants were divided into subgroups based on three main factors: training institution type (university hospital [UH] vs training and research hospital [TRH]), training institution annual case volume (low [< 1000 or inadequate cranial/spinal case numbers] vs high [> 1000 and adequate cranial/spinal case numbers]), and training program accreditation status (accredited vs nonaccredited). RESULTS: The majority of the participants (64.7%) graduated from the UHs. Those trained at UHs (vs TRHs) and high- (vs low-) volume centers had their dissertations more frequently published in Science Citation Index/Science Citation Index-Expanded journals, gave more oral presentations after residency, had higher h-indices, had higher rates of reviewership for academic journals, and had greater participation in projects with grant support. In addition, graduates of accredited programs reported more PhD degrees than those of nonaccredited programs. CONCLUSIONS: Neurosurgeons trained in higher-case-volume, accredited programs, mostly in the UHs, performed better in terms of scientific activities and productivity in Turkey. Strong research emphasis and supportive measures should be instituted to increase academic performance during and after residency training.

Adverse events in Malaysia: Associations with nurse's ethnicity and experience, hospital size, accreditation, and teaching status.

PURPOSE: In Malaysia, private healthcare sector has become a major player in delivering healthcare services alongside the government healthcare sector. However, wide disparities in health outcomes have been recorded, and adverse events in these contexts have yet to be explored. The purpose of this study was to explore associations between nurse's ethnicity and experience, hospital size, accreditation, and teaching status with adverse events in Malaysian private hospitals. METHODS: A cross-sectional survey was conducted in 12 private hospitals in Malaysia. A total of 652 (response rate = 61.8%) nurses participated in the study. Data were collected using self-administered questionnaire on nurses' characteristic, adverse events and events reporting, and perceived patient safety. RESULTS: Patient and family complaints events were the most common adverse events in Malaysian private hospitals as result of increased cost of care (3.24 ± 0.95) and verbal miscommunication (3.52 ± 0.87). CONCLUSION: Hospital size, accreditation status, teaching status, and nurse ethnicity had a mixed effect on patient safety, perceived adverse events, and events reporting. Policy makers can benefit that errors are related to several human and system related factors. Several system reforms and multidisciplinary efforts were recommended for optimizing health, healthcare and preventing patient harm.

Relationship among upgrades in academic qualifications, practice accreditations, self-efficacy, outcome expectations and nurses' career interest.

AIMS: This study examined the relationship among upgrades in academic qualifications, practice accreditations, self-efficacy, outcome expectations and nurses' career interest. BACKGROUND: Interest in the nursing career could help retain nurses in the nursing profession. A global nurse shortage warrants further research to understand what drives interest in the nursing career. METHODS: A cross-sectional design was employed. Data were collected in a medical centre in Northern Taiwan between February and March 2017, using employee records and a survey instrument. Proportionate random sampling was used to identify full-time registered nurses, of whom 524 provided useable responses. Employee records were used to measure nurses' upgrades in academic qualifications and practice accreditation. RESULTS: Upgrades in academic qualifications and upgrades in practice accreditation are positively related to outcome expectations. Both self-efficacy and outcome expectations are positively related to career interest. CONCLUSION: The pursuit of upgrades in academic qualifications and practice accreditation could enhance nurses' outcome expectations, thus enhancing their interest in a nursing career. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital managers could develop policies, procedures and programmes to encourage nurses to enhance their academic qualifications or practice accreditation, helping enhance their interest in remaining in the nursing career.

Differences Between Magnet and Non-Magnet-Designated Hospitals in Nurses' Evidence-Based Practice Knowledge, Competencies, Mentoring, and Culture.

BACKGROUND: Obtaining Magnet recognition is important to hospitals as it has been linked to positive nursing and patient outcomes. Evidence-based practice (EBP) also has been shown to positively impact these same outcomes. However, the effect that Magnet designation has on different facets of EBP when compared to non-designated institutions is less understood. AIMS: To determine the differences between Magnet-designated versus non-Magnet-designated hospitals on nurses' EBP knowledge, competency, mentoring, and culture. METHODS: A secondary analysis was performed on data obtained from the Melnyk et al. (2018) national study of U.S. nurses' EBP competencies. RESULTS: 2,344 nurses completed the survey (n = 1,622 Magnet and n = 638 non-Magnet). Magnet-designated hospital nurses had higher scores in EBP knowledge (mean ± SD: 19.9 ± 6.8 vs. 19.1 ± 7.0, Cohen's d = 0.12), mentoring (22.6 ± 11.1 vs. 18.6 ± 10.1, d = 0.38), and culture (82.9 ± 21.8 vs. 74.1 ± 21.3, d = 0.41). There was no difference between the two groups in EBP competency scores (53.8 ± 16.2 vs. 53.0 ± 15.9, d = 0.05), and average scores for the 24 EBP competency items were less than competent in both groups. LINKING EVIDENCE TO PRACTICE: Despite having higher knowledge, stronger perceived EBP cultures, and greater EBP mentoring than non-Magnet-designated nurses, Magnet nurses did not meet the EBP competencies. A tremendous need exists to provide nurses with the knowledge and skills to achieve the EBP competencies in both Magnet and non-Magnet-designated hospitals. A critical mass of EBP mentors who also meet the EBP competencies is needed to work with point-of-care nurses to ensure that EBP competency is achieved in order to ultimately ensure healthcare quality and safety. Rigorous studies are needed to determine which interventions at the academic and clinical education level result in improved EBP competency.

Addressing Health Disparities in America: Analysis of Community Health Improvement Plans.

BACKGROUND: Healthy People 2020 has made achieving health equity one of its overarching goals; another goal is increasing the number of accredited local agencies that have Community Health Improvement Plans (CHIPs). Community Health Improvement Plans are meant to serve agencies as guiding documents for multiple years. OBJECTIVES: This study investigates the prevalence with which health disparities are addressed within CHIPs and the specific health disparities targeted by these objectives. METHODS: Researchers analyzed 4,094 objectives from CHIPs of 280 local Public Health Accreditation Board (PHAB)-accredited and nonaccredited public health agencies in the United States. RESULTS: Despite the PHAB's focus on addressing health equity, not all PHAB-accredited agencies addressed health disparities (85.4% of CHIPs analyzed). However, more accredited than nonaccredited agencies (73.9%) contained at least one objective focused on health disparities. DISCUSSION: Findings indicate that if health equity is truly a goal of national initiatives, agencies' planning documents (e.g., CHIPs) can do a better job addressing commonly ignored populations.

Hospitals accreditation status in Indonesia: associated with hospital characteristics, market competition intensity, and hospital performance?

BACKGROUND: Hospital accreditation is widely adopted as a visible measure of an organisation's quality and safety management standards compliance. There is still inconsistent evidence regarding the influence of hospital accreditation on hospital performance, with limited studies in developing countries. This study aims to explore the association of hospital characteristics and market competition with hospital accreditation status and to investigate whether accreditation status differentiate hospital performance. METHODS: East Java Province, with a total 346 hospitals was selected for this study. Hospital characteristics (size, specialty, ownership) and performance indicator (bed occupancy rate, turnover interval, average length of stay, gross mortality rate, and net mortality rate) were retrieved from national hospital database while hospital accreditation status were recorded based on hospital accreditation report. Market density, Herfindahl-Hirschman index (HHI), and hospitals relative size as competition indicators were calculated based on the provincial statistical report data. Logistic regression, Mann-Whitney U-test, and one sample t-test were used to analyse the data. RESULTS: A total of 217 (62.7%) hospitals were accredited. Hospital size and ownership were significantly associated with of accreditation status. When compared to government-owned, hospital managed by ministry of defense (B = 1.705, p = 0.012) has higher probability to be accredited. Though not statistically significant, accredited hospitals had higher utility and efficiency indicators, as well as higher mortality. CONCLUSIONS: Hospital with higher size and managed by government have higher probability to be accredited independent to its specialty and the intensity of market competition. Higher utility and mortality in accredited hospitals needs further investigation.

The Relationship Between Health Department Accreditation and Workforce Satisfaction, Retention, and Training Needs.

BACKGROUND: To improve quality and consistency of health departments, a voluntary accreditation process was developed by the Public Health Accreditation Board. Understanding accreditation's role as a mediator in workforce training needs, satisfaction, and awareness is important for continued improvement for governmental public health. OBJECTIVE: To compare differences in training needs, satisfaction/intent to leave, and awareness of public health concepts for state and local health department staff with regard to their agency's accreditation status. DESIGN: This cross-sectional study considered the association between agency accreditation status and individual perceptions of training needs, satisfaction, intent to leave, and awareness of public health concepts, using 2017 Public Health Workforce Interests and Needs Survey (PH WINS) data. Respondents were categorized on the basis of whether their agencies (at the time of survey) were (1) uninvolved in accreditation, (2) formally involved in accreditation, or (3) accredited. RESULTS: Multivariate logistic regression models found several significant differences, including the following: individuals from involved state agencies were less likely to report having had their training needs assessed; staff from accredited and involved agencies identified more gaps in selected skills; and employees of accredited agencies were more aware of quality improvement. While state employees in accredited and formally involved agencies reported less job satisfaction, there were no significant differences in intent to leave or burnout. Differences were identified concerning awareness of various public health concepts, especially among respondents in state agencies. CONCLUSIONS: While some findings were consistent with past research (eg, link between accreditation and quality improvement), others were not (eg, job satisfaction). Several self-reported skill gaps were unanticipated, given accreditation's emphasis on training. Potentially, as staff are exposed to accreditation topics, they gain more appreciation of skills development needs. Findings suggest opportunities to strengthen workforce development components when revising accreditation measures.

Achievement of Accreditation by Community-Based Family Practice - Workload and Cost Analysis.

Five Alberta family practices achieved accreditation with Accreditation Canada in 2013-2015. This study conducted a workload and cost analysis of achieving accreditation. Human resources (HR) comprised 95% of the total cost. Document preparation constituted 76% of workload and 68% of total HR costs. Centralized content experts were tasked with document write-up. Clinics focused on survey preparation: 56% of staff participated, with the workload being the heaviest on managers. In CAD (2018 $ value), per capita cost was the highest for the 2-physician clinic ($65.78) and lower for the 11-physician ($19.44) clinic. Other cost determinants included culture, organizational structure, physician/staff engagement and pre-existing compliance to standards. A cost-benefit analysis shall provide insights into system-level benefits.

Health and health care in Israel: an introduction.

Starting well before Independence in 1948, and over the ensuing six decades, Israel has built a robust, relatively efficient public system of health care, resulting in good health statistics throughout the life course. Because of the initiative of people living under the British Mandate for Palestine (1922-48), the development of many of today's health services predated the state's establishment by several decades. An extensive array of high-quality services and technologies is available to all residents, largely free at point of service, via the promulgation of the 1994 National Health Insurance Law. In addition to a strong medical academic culture, well equipped (albeit crowded) hospitals, and a robust primary-care infrastructure, the country has also developed some model national projects such as a programme for community quality indicators, an annual update of the national basket of services, and a strong system of research and education. Challenges include increasing privatisation of what was once largely a public system, and the underfunding in various sectors resulting in, among other challenges, relatively few acute hospital beds. Despite substantial organisational and financial investment, disparities persist based on ethnic origin or religion, other socioeconomic factors, and, regardless of the country's small size, a geographic maldistribution of resources. The Ministry of Health continues to be involved in the ownership and administration of many general hospitals and the direct payment for some health services (eg, geriatric institutional care), activities that distract it from its main task of planning for and supervising the whole health structure. Although the health-care system itself is very well integrated in relation to the country's two main ethnic groups (Israeli Arabs and Israeli Jews), we think that health in its widest sense might help provide a bridge to peace and reconciliation between the country and its neighbours.

EANM/EARL FDG-PET/CT accreditation - summary results from the first 200 accredited imaging systems.

PURPOSE: From 2010 until July 2016, the EANM Research Ltd. (EARL) FDG-PET/CT accreditation program has collected over 2500 phantom datasets from approximately 200 systems and 150 imaging sites worldwide. The objective of this study is to report the findings and impact of the accreditation program on the participating PET/CT systems. METHODS: To obtain and maintain EARL accredited status, sites were required to complete and submit two phantom scans - calibration quality control (CalQC), using a uniform cylindrical phantom and image quality control (IQQC), using a NEMA NU2-2007 body phantom. Average volumetric SUV bias and SUV recovery coefficients (RC) were calculated and the data evaluated on the basis of quality control (QC) type, approval status, PET/CT system manufacturer and submission order. RESULTS: SUV bias in 5% (n = 96) of all CalQC submissions (n = 1816) exceeded 10%. After corrective actions following EARL feedback, sites achieved 100% compliance within EARL specifications. 30% (n = 1381) of SUVmean and 23% (n = 1095) of SUVmax sphere recoveries from IQQC submissions failed to meet EARL accreditation criteria while after accreditation, failure rate decreased to 12% (n = 360) and 9% (n = 254), respectively. Most systems demonstrated longitudinal SUV bias reproducibility within ±5%, while RC values remained stable and generally within ±10% for the four largest and ±20% for the two smallest spheres. CONCLUSIONS: Regardless of manufacturer or model, all investigated systems are able to comply with the EARL specifications. Within the EARL accreditation program, gross PET/CT calibration errors are successfully identified and longitudinal variability in PET/CT performances reduced. The program demonstrates that a harmonising accreditation procedure is feasible and achievable.

An assessment of the malaria-related knowledge and practices of Tanzania's drug retailers: exploring the impact of drug store accreditation.

BACKGROUND: Since 2003 Tanzania has upgraded its approximately 7000 drug stores to Accredited Drug Dispensing Outlets (ADDOs), involving dispenser training, introduction of record keeping and enhanced regulation. Prior to accreditation, drug stores could officially stock over-the-counter medicines only, though many stocked prescription-only antimalarials. ADDOs are permitted to stock 49 prescription-only medicines, including artemisinin combination therapies and one form of quinine injectable. Oral artemisinin monotherapies and other injectables were not permitted at any time. By late 2011 conversion was complete in 14 of 21 regions. We explored variation in malaria-related knowledge and practices of drug retailers in ADDO and non-ADDO regions. METHODS: Data were collected as part of the Independent Evaluation of the Affordable Medicines Facility - malaria (AMFm), involving a nationally representative survey of antimalarial retailers in October-December 2011. We randomly selected 49 wards and interviewed all drug stores stocking antimalarials. We compare ADDO and non-ADDO regions, excluding the largest city, Dar es Salaam, due to the unique characteristics of its market. RESULTS: Interviews were conducted in 133 drug stores in ADDO regions and 119 in non-ADDO regions. Staff qualifications were very similar in both areas. There was no significant difference in the availability of the first line antimalarial (68.9% in ADDO regions and 65.2% in non-ADDO regions); both areas had over 98% availability of non-artemisinin therapies and below 3.0% of artemisinin monotherapies. Staff in ADDO regions had better knowledge of the first line antimalarial than non-ADDO regions (99.5% and 91.5%, p = 0.001). There was weak evidence of a lower price and higher market share of the first line antimalarial in ADDO regions. Drug stores in ADDO regions were more likely to stock ADDO-certified injectables than those in non-ADDO regions (23.0% and 3.9%, p = 0.005). CONCLUSIONS: ADDO conversion is frequently cited as a model for improving retail sector drug provision. Drug stores in ADDO regions performed better on some indicators, possibly indicating some small benefits from ADDO conversion, but also weaknesses in ADDO regulation and high staff turnover. More evidence is needed on the value-added and value for money of the ADDO roll out to inform retail policy in Tanzania and elsewhere.

Patient and hospital characteristics that influence incidence of adverse events in acute public hospitals in Portugal: a retrospective cohort study.

OBJECTIVE: To analyse the variation in the rate of adverse events (AEs) between acute hospitals and explore the extent to which some patients and hospital characteristics influence the differences in the rates of AEs. DESIGN: Retrospective cohort study. Chi-square test for independence and binary logistic regression models were used to identify the potential association of some patients and hospital characteristics with AEs. SETTING: Nine acute Portuguese public hospital centres. PARTICIPANTS: A random sample of 4250 charts, representative of around 180 000 hospital admissions in 2013, was analysed. INTERVENTION: To measure adverse events based on chart review. MAIN OUTCOME MEASURE: Rate of AEs. RESULTS: Main results: (i) AE incidence was 12.5%; (ii) 66.4% of all AEs were related to Hospital-Acquired Infection and surgical procedures; (iii) patient characteristics such as sex (female 11%; male 14.4%), age (≥65 y 16.4%; <65 y 8.5%), admission coded as elective vs. urgent (8.6% vs. 14.6%) and medical vs. surgical Diagnosis Related Group code (13.4% vs. 11.7%), all with p < 0.001, were associated with a greater occurrence of AEs. (iv) hospital characteristics such as use of reporting system (13.2% vs. 7.1%), being accredited (13.7% vs. non-accredited 11.2%), university status (15.9% vs. non-university 10.9%) and hospital size (small 12.9%; medium 9.3%; large 14.3%), all with p < 0.001, seem to be associated with a higher rate of AEs. CONCLUSIONS: We identified some patient and hospital characteristics that might influence the rate of AEs. Based on these results, more adequate solutions to improve patient safety can be defined.

Accreditation Status and Geographic Location of Outpatient Echocardiographic Testing Facilities Among Medicare Beneficiaries: The VALUE-ECHO Study.

OBJECTIVES: Accreditation of echocardiographic testing facilities by the Intersocietal Accreditation Commission (IAC) is supported by the American College of Cardiology and American Society of Echocardiography. However, limited information exists on the accreditation status and geographic distribution of echocardiographic facilities in the United States. Our study aimed to identify (1) the proportion of outpatient echocardiography facilities used by Medicare beneficiaries that are IAC accredited, (2) their geographic distribution, and (3) variations in procedure type and volume by accreditation status. METHODS: As part of the VALUE-ECHO (Value of Accreditation, Location, and Utilization Evaluation-Echocardiography) study, we examined the proportion of IAC-accredited echocardiographic facilities performing outpatient echocardiography in the 2013 Centers for Medicare and Medicaid Services outpatient limited data set (100% sample) and their geographic distribution using geocoding in ArcGIS (ESRI, Redlands, CA). RESULTS: Among 4573 outpatient facilities billing Medicare for echocardiographic testing in 2013, 99.6% (n = 4554) were IAC accredited (99.7% in the 50 US states and 86.2% in Puerto Rico). The proportion IAC-accredited echocardiographic facilities varied by region, with 98.7%, 99.9%, 99.9%, 99.5%, and 86.2% of facilities accredited in the Northeast, South, Midwest, West, and Puerto Rico, respectively (P < .01, Fisher exact test). Of all echocardiographic outpatient procedures conducted (n = 1,890,156), 99.8% (n = 1,885,382) were performed in IAC-accredited echocardiographic facilities. Most procedures (90.9%) were transthoracic echocardiograms, of which 99.7% were conducted in IAC-accredited echocardiographic facilities. CONCLUSIONS: Almost all outpatient echocardiographic facilities billed by Medicare are IAC accredited. This accreditation rate is substantially higher than previously reported for US outpatient vascular testing facilities (13% IAC accredited). The uniformity of imaging and interpretation protocols from a single accrediting body is important to facilitate optimal cardiovascular care.