Developing metrics for nursing quality of care for low- and middle-income countries: a scoping review linked to stakeholder engagement.

BACKGROUND: The use of appropriate and relevant nurse-sensitive indicators provides an opportunity to demonstrate the unique contributions of nurses to patient outcomes. The aim of this work was to develop relevant metrics to assess the quality of nursing care in low- and middle-income countries (LMICs) where they are scarce. MAIN BODY: We conducted a scoping review using EMBASE, CINAHL and MEDLINE databases of studies published in English focused on quality nursing care and with identified measurement methods. Indicators identified were reviewed by a diverse panel of nursing stakeholders in Kenya to develop a contextually appropriate set of nurse-sensitive indicators for Kenyan hospitals specific to the five major inpatient disciplines. We extracted data on study characteristics, nursing indicators reported, location and the tools used. A total of 23 articles quantifying the quality of nursing care services met the inclusion criteria. All studies identified were from high-income countries. Pooled together, 159 indicators were reported in the reviewed studies with 25 identified as the most commonly reported. Through the stakeholder consultative process, 52 nurse-sensitive indicators were recommended for Kenyan hospitals. CONCLUSIONS: Although nurse-sensitive indicators are increasingly used in high-income countries to improve quality of care, there is a wide heterogeneity in the way indicators are defined and interpreted. Whilst some indicators were regarded as useful by a Kenyan expert panel, contextual differences prompted them to recommend additional new indicators to improve the evaluations of nursing care provision in Kenyan hospitals and potentially similar LMIC settings. Taken forward through implementation, refinement and adaptation, the proposed indicators could be more standardised and may provide a common base to establish national or regional professional learning networks with the common goal of achieving high-quality care through quality improvement and learning.

Caregiver Attendance as a Quality Indicator in the Implementation of Multiple Evidence-Based Practices for Children.

OBJECTIVE: This study investigated a quality indicator for children's mental health, caregiver attendance in youth psychotherapy sessions, within a system-driven implementation of multiple evidence-based practices (EBPs) in children's community mental health services. METHOD: Administrative claims from nine fiscal years were analyzed to characterize and predict caregiver attendance. Data included characteristics of therapists (n = 8,626), youth clients (n = 134,368), sessions (e.g., individual, family), and the EBP delivered. Clients were primarily Latinx (63%), male (54%) and mean age was 11; they presented with a range of mental health problems. Three-level mixed models were conducted to examine the association between therapist, youth, service, EBP characteristics and caregiver attendance. RESULTS: Caregivers attended, on average, 46.0% of sessions per client for the full sample and 59.6% of sessions for clients who were clinically indicated, based on age and presenting problem, to receive caregiver-focused treatment. Following initial EBP implementation, the proportion of caregiver attendance in sessions increased over time. Caregivers attended a higher proportion of youth psychotherapy sessions when clients were younger, had an externalizing disorder, were non-Hispanic White, and were male. Further, higher proportions of caregiver attendance occurred when services were delivered in a clinic setting (compared with school and other settings), by bilingual therapists, and the EBP prescribed caregiver attendance in all sessions. CONCLUSIONS: Overall, the patterns of caregiver attendance appear consistent with evidence-informed practice parameters of client presenting problem and age. Yet, several improvement targets emerged such as client racial/ethnic background and service setting. Potential reasons for these disparities are discussed.

American College of Surgeons Children's Surgery Verification Quality Improvement Program: What Anesthesiologists Need to Know Now.

A task force of pediatric surgical specialists with the support of The American College of Surgeons recently launched a verification program for pediatric surgery, the Children's Surgery Verification quality improvement program, with the goal of improving pediatric surgical, procedural, and perioperative care. Included in this program are specific standards for the delivery of pediatric anesthesia care across a variety of practice settings. We review the background, available evidence, requirements for verification, and verification process and its implications for the practice of pediatric anesthesia across the country. In addition, we have included a special roundtable interview of 3 recently Children's Surgery Verification-verified program directors to provide an up-to-date real-world perspective of this children's surgery quality improvement program.

[Quality improvement in primary care. Financial incentives related to quality indicators in Europe]. / A minoség javításának lehetséges eszközei az alapellátásban. Minoségi indikátorokhoz kapcsolt anyagi ösztönzok Európában.

Quality improvement in primary care has been an important issue worldwide for decades. Quality indicators are increasingly used quantitative tools for quality measurement. One of the possible motivational methods for doctors to provide better medical care is the implementation of financial incentives, however, there is no sufficient evidence to support or contradict their effect in quality improvement. Quality indicators and financial incentives are used in the primary care in more and more European countries. The authors provide a brief update on the primary care quality indicator systems of the United Kingdom, Hungary and other European countries, where financial incentives and quality indicators were introduced. There are eight countries where quality indicators linked to financial incentives are used which can influence the finances/salary of family physicians with a bonus of 1-25%. Reliable data are essential for quality indicators, although such data are lacking in primary care of most countries. Further, improvement of indicator systems should be based on broad professional consensus.

Measuring performance to drive improvement: development of a clinical indicator set for general medicine.

BACKGROUND: There are delays in implementing evidence about effective therapy into clinical practice. Clinical indicators may support implementation of guideline recommendations. AIM: To develop and evaluate the short-term impact of a clinical indicator set for general medicine. METHODS: A set of clinical process indicators was developed using a structured process. The indicator set was implemented between January 2006 and December 2006, using strategies based on evidence about effectiveness and local contextual factors. Evaluation included a structured survey of general medical staff to assess awareness and attitudes towards the programme and qualitative assessment of barriers to implementation. Impact on documentation of adherence to clinical indicators was assessed by auditing a random sample of medical records before (2003-2005) and after (2006) implementation. RESULTS: Clinical indicators were developed for the following areas: venous thromboembolism, cognition, chronic heart failure, chronic obstructive pulmonary disease, diabetes, low trauma fracture, patient written care plans. The programme was well supported and incurred little burden to staff. Implementation occurred largely as planned; however, documentation of adherence to clinical indicators was variable. There was a generally positive trend over time, but for most indicators this was independent of the implementation process and may have been influenced by other system improvement activities. Failure to demonstrate a significant impact during the pilot phase is likely to have been influenced by administrative factors, especially lack of an integrative data documentation and collection process. CONCLUSION: Successful implementation in phase two is likely to depend upon an effective data collection system integrated into usual care.

The physician quality reporting initiative--a gateway to pay for performance: what every health care professional should know.

The Physician Quality Reporting Initiative (PQRI) is a pay-for-reporting (P4R) program sponsored by the Centers for Medicare & Medicaid Services open to all health care providers that treat Medicare patients. This P4R initiative provides financial incentives for participation and unlike most pay-for-performance (P4P) programs, there are no penalties for poor performance. PQRI therefore offers Medicare providers nationwide a low-risk opportunity to gain experience with reporting procedures likely to be incorporated into P4P reimbursement schemes. The 74 measures used during the first reporting period are applicable to both generalist and specialist providers and open participation in PQRI to a much broader audience compared with previous federal initiatives. Also in contrast to programs that measure hospital or group quality and reimburse for services at the health system level, measurement and reimbursement in PQRI directly affects individual Medicare providers. The combination of provider-level measurement and reimbursement and efforts to assess care delivered by both generalist and specialist Medicare providers highlights how this P4R initiative is truly a gateway to a P4P reimbursement system. Participation in the PQRI program provides useful experience to Medicare providers and their staff in preparing for future initiatives that try to tie quality to reimbursement.

Medicare's Physician Quality Reporting System (PQRS): quality measurement and beneficiary attribution.

PURPOSE: To explore two issues that are relevant to inclusion of PQRS reporting in a value-based payment system: (1) what are the characteristics of PQRS reports and the providers who file them; and (2) could PQRS provide active attribution information to supplement existing attribution algorithms? DESIGN AND METHODS: Using data from five states for the years 2008 (the first full year of the program) and 2009, we examined the number and type of providers who reported PQRS measures and the types of measures that were reported. We then compared the PQRS reporting provider to the provider who supplied the plurality of the beneficiary's non-hospital evaluation and management (NH-E&M) visits. RESULTS: Although PQRS-reporting providers provide only 17 percent of the beneficiary's NH-E&M visits on average in 2009, the provider who provided the plurality of visits supplied only 50 percent of such visits, on average. IMPLICATIONS: PQRS reporting alone cannot solve the attribution problem that is inherent in traditional fee-for-service Medicare, but as PQRS participation increases, it could help improve both attribution and information regarding the quality of health care services delivered to Medicare beneficiaries.

Measures of availability of health care services for children.

OBJECTIVE: The Children's Health Insurance Program Reauthorization Act (CHIPRA) mandates that measures of availability of child health services be included in the recommended core measurement set. The objective of this work was to review and evaluate measures of availability of child health services for potential inclusion in the initial core set of health care quality measures as mandated by CHIPRA. METHODS: To find measures, I searched the published literature, measurement sets, and recommended articles to identify existing measures of availability. I comment on the use of these measures as well as their reliability and validity (where available). RESULTS: I identified measures of geographic availability (n = 11), timeliness (n = 7), and barriers (n = 4). Geographic measures range from counts of the number of providers in a specific area to measures that account for whether providers are open to caring for patients with public insurance and distance. Measures of timeliness address whether patients can see a provider quickly. Barriers measure the ease with which providers can be seen. CONCLUSIONS: Of potential use to the CHIPRA measurement initiative are objective measures of provider density and some existing parent survey questions about timeliness and ease of use. Other measures include more refined measures of density or distance, perhaps looking at providers who are taking new Medicaid and State Children's Health Insurance Program patients and more detailed questions about the timeliness and ease with which patients can get care. However, more work is needed on the validity and reliability of existing measures; more work is also needed to expand measures of availability beyond existing domains of providers and conditions.

Measuring the quality of evidence-based nursing care: NQuIRE - nursing quality indicators for reporting and evaluation data-system / Midiendo la calidad del cuidado de enfermería basado en la evidencia: NQuIRE: sistema de indicadores de calidad en enfermería para reportar y evaluar / Avaliando a qualidade dos cuidados de enfermagem baseada em evidências: NQuIRE: sistema de indicadores de qualidade na enfermagem para referenciar e avaliar

Nursing Quality Indicators for Reporting and Evaluation (NQuIRE) is an international quality improvement initiative to develop and sustain a data-system of nursing-sensitive quality indicators derived from recommendations within the Registered Nurses’ Association of Ontario’s evidence-based best practice guidelines. Objective: The purpose of this article is to provide an overview of the indicator database within the context of the Registered Nurses’ Association of Ontario’s best practice guideline program and Best Practice Spotlight Organization® Designation. Future directions for technical enhancements, quality indicator development and research within the database will also be discussed. Topic: Nursing Quality Indicators for Reporting and Evaluation consists of a database, a data dictionary, including a set of organization-level structural indicators, as well as a set of process and outcome indicators for each best practice guideline, and data collection and reporting processes. Conclusions: The data-system collects, analyzes and reports quality indicator data submitted by health-care service and academic organizations participating in the Registered Nurses’ Association of Ontario’s Best Practice Spotlight Organization® Designation.

El sistema de indicadores de calidad en enfermería para reportar y evaluar (NQuIRE) es una iniciativa internacional de mejoramiento de la calidad para desarrollar y sostener un sistema de datos de indicadores de calidad de enfermería derivados de las recomendaciones de guías de buenas prácticas basadas en la evidencia de la Asociación de Enfermeras Profesionales de Ontario. Objetivo: El propósito de este artículo es ofrecer un panorama de la base de datos de indicadores dentro del contexto del programa de guías de buenas prácticas de enfermería de la Asociación de Enfermeras Profesionales de Ontario y el programa de centros comprometidos con la Excelencia en Cuidados. Futuras directrices para el mejoramiento técnico, desarrollo e investigación de los indicadores de calidad en la base de datos también serán discutidos. Desarrollo del tema: El Sistema de Indicadores de Calidad en Enfermería para Reportar y Evaluar consta de una base de datos, un diccionario de datos que incluye un conjunto de indicadores estructurales a nivel de la organización, además de un conjunto de indicadores de procesos y resultados para cada guía de mejores prácticas, y procesos de recopilación y reporte de datos. Conclusiones: El sistema de datos recopila, analiza e informa los datos sobre indicadores de calidad presentados por las organizaciones académicas y de servicio de atención médica que participan en el programa de designación como Centro Comprometido con la Excelencia en Cuidados de la Organización de Enfermeras Profesionales de Ontario.

O Sistema de Indicadores da Avaliação de Qualidade na Enfermagem é uma iniciativa internacional de melhoria na qualidade para promover e manter um sistema de dados de indicadores de qualidade na enfermagem decorrentes das recomendações de diretrizes de melhores práticas baseadas em evidências da Associação das Enfermeiras Profissionais de Ontario, no Canadá*. Objetivo: O objetivo deste artigo é fornecer uma visão geral do banco de dados de indicadores no contexto do Programa das Guias* de Boas Práticas na Enfermagem da Associação de Enfermeiras Profissionais de Ontario e o Programa dos Centros Comprometidos com a Excelência nos Cuidados. Orientações futuras para o aprimoramento técnico, pesquisa e desenvolvimento de indicadores de qualidade no banco de dados, também serão discutidos. Temas: O sistema de indicadores de Qualidade na Enfermagem para o Relatório e Avaliação conta com um banco de dados, um dicionário de dados que inclui um conjunto de indicadores estruturais próprio da organização, juntamente com um conjunto de indicadores de processos e resultados para cada guia de melhores práticas, e processos recopilados e dados relatados. Conclusões: O sistema de dados recolhe, analisa e informa os indicadores de qualidade apresentados pelas organizações acadêmicas e os serviços médicos escolhidos como Centros Comprometidos com a Excelência nos Cuidados da Organização de Enfermeiras Profissionais de Ontario.

Baseline Indicators - 20 Goals for a Decade in HRH - Barbados 2011. Tracking Regional Goals for Human Resources for Health: A Shared Commitment

The signatory countries of Resolution CSP27/10 of the 27th Pan American Sanitary Conference "Regional Goals for Human Resources for Health (HRH) 20072015," have agreed that the 20 goals of the Resolution will signify the achievement of meeting the Five Challenges of the Toronto Call to Action to provide a well-trained, well-distributed, and motivated workforce to deliver quality and equitable services based on primary care to all persons of the Region. To achieve these 20 goals evidence-based policies are required to address the real areas of need in workforce planning. The ability to measure and monitor the status of the country's workforce with respect to each of the 20 goals is essential to the development of the country's policies and strategies to improve their human resources. In Barbados some data pertaining to the goals have already been collected as part of the Core Data Set. The Core Data Set was defined during an orientation seminar that was held in Barbados (28-29 September de 2007) and was attended by teams from Jamaica, Belize, Trinidad and Tobago and Barbados/EC, along with relevant PAHO country programme officers. The aim of the baseline measurement project is to build on this core data set and collect additional information to measure the baseline indicators for the 20 goals.(AU)

La perspectiva de la Sociedad Española de Calidad Asistencial / The perspective of the Spanish Society of Care Quality

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Opinión del personal de enfermería, y usuarios internados en el servicio de Clínica Médica del Hospital Central-IPS, sobre la calidad de atención brindada

Estudio descriptivo exploratorio de la opinión del personal de enfermería y usuarios internados en el sevicio de Clínica Médica del Hospital Central del IPSsobre la calidad de atención brindada. Presenta conceptos relacionados a la calidad en la atención brindada, de los servicios y el papel de la enfermera dentro de su perfil profesional