RESUMEN
This is the fifth article in a new series about evidence-based practice (EBP) that builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step-published between 2009 and 2011 (to access the series, go to http://links.lww.com/AJN/A133). This follow-up series features exemplars illustrating the various strategies that can be used to implement EBP changes-one of the most challenging steps in the EBP process.
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Desnutrición/prevención & control , Evaluación de Procesos y Resultados en Atención de Salud/normas , Readmisión del Paciente/estadística & datos numéricos , Mejoramiento de la Calidad , Benchmarking , Prestación Integrada de Atención de Salud/organización & administración , Práctica Clínica Basada en la Evidencia/métodos , Humanos , Desnutrición/diagnóstico , Medición de RiesgoRESUMEN
BACKGROUND: We aimed to develop quality indicators (QIs) related to primary and comprehensive stroke care and examine the feasibility of their measurement using the existing Diagnosis Procedure Combination (DPC) database. METHODSâANDâRESULTS: We conducted a systematic review of domestic and international studies using the modified Delphi method. Feasibility of measuring the QI adherence rates was examined using a DPC-based nationwide stroke database (396,350 patients admitted during 2013-2015 to 558 hospitals participating in the J-ASPECT study). Associations between adherence rates of these QIs and hospital characteristics were analyzed using hierarchical logistic regression analysis. We developed 17 and 12 measures as QIs for primary and comprehensive stroke care, respectively. We found that measurement of the adherence rates of the developed QIs using the existing DPC database was feasible for the 6 QIs (primary stroke care: early and discharge antithrombotic drugs, mean 54.6% and 58.7%; discharge anticoagulation for atrial fibrillation, 64.4%; discharge antihypertensive agents, 51.7%; comprehensive stroke care: fasudil hydrochloride or ozagrel sodium for vasospasm prevention, 86.9%; death complications of diagnostic neuroangiography, 0.4%). We found wide inter-hospital variation in QI adherence rates based on hospital characteristics. CONCLUSIONS: We developed QIs for primary and comprehensive stroke care. The DPC database may allow efficient data collection at low cost and decreased burden to evaluate the developed QIs.
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Reclamos Administrativos en el Cuidado de la Salud , Atención Integral de Salud/normas , Prestación Integrada de Atención de Salud/normas , Evaluación de Procesos y Resultados en Atención de Salud/normas , Pautas de la Práctica en Medicina/normas , Indicadores de Calidad de la Atención de Salud/normas , Accidente Cerebrovascular/terapia , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Técnica Delphi , Estudios de Factibilidad , Femenino , Adhesión a Directriz/normas , Disparidades en Atención de Salud/normas , Humanos , Japón , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto/normas , Mejoramiento de la Calidad/normas , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCTION: Telestroke has increased access to acute management of ischemic stroke in areas that lack stroke care expertise, yet delays persist in evaluation and treatment. We describe variation in time to alert a telestroke physician of suspected acute ischemic stroke patients potentially eligible for acute stroke therapies among community hospitals in our telestroke network, and explore demographic and spoke-related characteristics associated with delays. METHODS: From our telestroke registry, we identified suspected acute ischemic stroke patients who arrived within 6 hours of symptom onset and underwent video consultation at 1 of 17 community hospitals in our hub-and-spoke network. We compared time between patient arrival to telestroke alert (door-to-page-time) and to tissue plasminogen activator (tPA) administration for eligible patients (door-to-needle-time). We identified factors associated with prolonged metrics. RESULTS: Of 1020 cases between 9/2015 and 3/2017, 47% received tPA. Sixty percent had door-to-page-time more than 15 minutes (median 19.5; IQR, 11-34). Door-to-page-time more than 15 minutes was associated with an 8-fold increase in likelihood of door-to-needle-time more than 60 minutes. Patients with severe stroke experienced faster door-to-page-times. Hospitals with more beds had prolonged door-to-page-time. Full time in-house neurology presence, even when not covering emergent consultations, was associated with faster door-to-page-time over telestroke. Seventy-one percent of patients underwent CT brain prior to the telestroke physician alert; this scenario delayed door-to-page and door-to-needle times. CONCLUSIONS: Door-to-page-time varied considerably among spokes. Awaiting CT scan prior to alerting the telestroke consultant of a stroke code delayed metrics. Telestroke physician alert standards are needed, as are educational initiatives on acute ischemic stroke management and workflow.
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Benchmarking/normas , Isquemia Encefálica/terapia , Prestación Integrada de Atención de Salud/normas , Evaluación de Procesos y Resultados en Atención de Salud/normas , Grupo de Atención al Paciente/normas , Pautas de la Práctica en Medicina/normas , Consulta Remota/normas , Accidente Cerebrovascular/terapia , Terapia Trombolítica/normas , Tiempo de Tratamiento/normas , Administración Intravenosa , Anciano , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatología , Femenino , Fibrinolíticos/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Activador de Tejido Plasminógeno/administración & dosificación , Tomografía Computarizada por Rayos X/normas , Resultado del Tratamiento , Comunicación por Videoconferencia/normas , Flujo de TrabajoRESUMEN
Emergent implantation of temporary mechanical circulatory support using venoarterial ECMO (ECLS for extracorporeal Life Support) is increasingly adopted in various indications of acute circulatory failure refractory to optimal medical treatment. To implant such devices, but also to provide appropriate daily management, expertise and adapted technical platform are required. Organization, coordination and regulation of such program are not clearly established in our country. We propose a dedicated territorial organization to improve and facilitate management of these specific and most severe patients.
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Prestación Integrada de Atención de Salud/normas , Oxigenación por Membrana Extracorpórea/normas , Evaluación de Procesos y Resultados en Atención de Salud/normas , Choque/terapia , Enfermedad Aguda , Consenso , Prestación Integrada de Atención de Salud/organización & administración , Oxigenación por Membrana Extracorpórea/efectos adversos , Oxigenación por Membrana Extracorpórea/instrumentación , Oxigenación por Membrana Extracorpórea/mortalidad , Francia , Humanos , Modelos Organizacionales , Evaluación de Procesos y Resultados en Atención de Salud/organización & administración , Grupo de Atención al Paciente/normas , Choque/diagnóstico , Choque/mortalidad , Choque/fisiopatología , Resultado del TratamientoRESUMEN
AIM: The aims of this study were to: (a) measure the proportion of CARTaGENE rheumatoid arthritis (RA) patients fulfilling pre-specified quality indicators (ie disease-modifying antirheumatic drug [DMARD] use, regular follow up, use of folate supplementation, use of vitamin D and calcium, exercise and smoking status); and (b) examine variation in DMARD use with respect to patient age, sex, education and income. METHODS: A cohort of RA patients was constructed based on the CARTaGENE survey and health administrative database. CARTaGENE is a large, established, population-based study which recruited 19 995 participants from four metropolitan regions in Quebec. Six quality indicators (QI) were assessed; four pertained to RA management and treatment received (use of DMARD therapy, annual medical visits, use of folate supplementation with methotrexate therapy, and use of calcium and vitamin D in steroid-exposed patients) and two pertained to lifestyle factors (physical activity and smoking cessation). QI were reported in terms of proportion of patients fulfilling them. Bayesian logistic regression analyses were preformed to investigate potential variation with DMARD use. RESULTS: Our cohort included 142 RA patients. The QI that pertain to RA pharmacotherapy and medical management ranged 60-80%. Regarding the QI focusing on lifestyle factors, 55% of patients reported performing moderate physical activity and only 16.6% reported current smoking. Results from the Bayesian logistic regression showed no definite associations between DMARD use and patient characteristics (age, education, income and sex). CONCLUSION: Our findings suggest a seemingly modest performance of Quebec's health-care system for RA patients, with respect to these QI.
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Antirreumáticos/uso terapéutico , Artritis Reumatoide/terapia , Suplementos Dietéticos , Evaluación de Procesos y Resultados en Atención de Salud/normas , Pautas de la Práctica en Medicina/normas , Indicadores de Calidad de la Atención de Salud/normas , Reumatología/normas , Conducta de Reducción del Riesgo , Adulto , Factores de Edad , Anciano , Artritis Reumatoide/diagnóstico , Bases de Datos Factuales , Escolaridad , Ejercicio Físico , Femenino , Encuestas de Atención de la Salud , Humanos , Renta , Masculino , Persona de Mediana Edad , Quebec , Factores Sexuales , Cese del Hábito de Fumar , Resultado del TratamientoRESUMEN
Background The attitudes of Department of Veterans Affairs ( VA ) cardiovascular clinicians toward the VA 's quality-of-care processes, clinical outcomes measures, and healthcare value are not well understood. Methods and Results Semistructured telephone interviews were conducted with cardiovascular healthcare providers (n=31) at VA hospitals that were previously identified as high or low performers in terms of healthcare value. The interviews focused on VA providers' experiences with measures of processes, outcomes, and value (ie, costs relative to outcomes) of cardiovascular care. Most providers were aware of process-of-care measurements, received regular feedback generated from those data, and used that feedback to change their practices. Fewer respondents reported clinical outcomes measures influencing their practice, and virtually no participants used value data to inform their practice, although several described administrative barriers limiting high-cost care. Providers also expressed general enthusiasm for the VA 's quality measurement/improvement efforts, with relatively few criticisms about the workload or opportunity costs inherent in clinical performance data collection. There were no material differences in the responses of employees of low-performing versus high-performing VA medical centers. Conclusions Regardless of their medical center's healthcare value performance, most VA cardiovascular providers used feedback from process-of-care data to inform their practice. However, clinical outcomes data were used more rarely, and value-of-care data were almost never used. The limited use of outcomes data to inform healthcare practice raises concern that healthcare outcomes may have insufficient influence, whereas the lack of value data influencing cardiovascular care practices may perpetuate inefficiencies in resource use.
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Prestación Integrada de Atención de Salud/economía , Costos de la Atención en Salud , Evaluación de Procesos y Resultados en Atención de Salud/economía , Pautas de la Práctica en Medicina/economía , Indicadores de Calidad de la Atención de Salud/economía , Servicios de Salud para Veteranos/economía , Actitud del Personal de Salud , Análisis Costo-Beneficio , Prestación Integrada de Atención de Salud/normas , Costos de la Atención en Salud/normas , Encuestas de Atención de la Salud , Conocimientos, Actitudes y Práctica en Salud , Investigación sobre Servicios de Salud , Humanos , Evaluación de Procesos y Resultados en Atención de Salud/normas , Pautas de la Práctica en Medicina/normas , Investigación Cualitativa , Mejoramiento de la Calidad/economía , Indicadores de Calidad de la Atención de Salud/normas , Estados Unidos , Servicios de Salud para Veteranos/normasRESUMEN
OBJECTIVE: To compare the quality of care received by patients with systemic lupus erythematosus (SLE) in 2 settings within the academic institution (a dedicated lupus clinic and a general rheumatology clinic) using validated SLE quality measures. METHODS: One hundred fifty consenting, consecutive SLE patients receiving longitudinal care at the Rush University general rheumatology clinic (n = 73) or the subspecialty lupus clinic (n = 77) were recruited. An updated quality measure survey and retrospective medical chart review were used to evaluate each quality measure (n = 20). The overall and individual quality measure performance was calculated and compared between the 2 groups. Data on the number of SLE patients seen by each rheumatologist were collected to assess the relationship between SLE patient volume and quality measures. RESULTS: Overall quality measure performance was significantly better in SLE patients receiving care at the lupus clinic (85.8% versus 70.2% of patients receiving care at the general rheumatology clinic; P = 0.001). Differences between the 2 groups were observed for sunscreen counseling (98.7% and 83.6%, respectively; P = 0.001), antiphospholipid antibody testing (71.4% and 37%, respectively; P < 0.001), pneumococcal vaccination (84.8% and 48.8%, respectively; P < 0.001), bone mineral density testing (94.2% and 54.5%, respectively; P < 0.001), drug counseling (92.2% and 80.8%, respectively; P = 0.04), use of a steroid-sparing agent (100% and 82%, respectively; P < 0.007), use of an angiotensin-converting enzyme inhibitor (94.4% and 58.3%, respectively; P = 0.03), and cardiovascular disease risk assessment (40.3% and 15.1%, respectively; P = 0.01). There was a moderate correlation between physician volume and quality measure performance (ρ = 0.48, P < 0.001). CONCLUSION: Compared with the general rheumatology clinic, the dedicated lupus clinic had better quality measure performance in this cross-sectional single-center study. In our health care system, we also observed indicators suggesting that rheumatologists with a higher volume of SLE patients provide higher quality of care.
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Prestación Integrada de Atención de Salud/normas , Lupus Eritematoso Sistémico/terapia , Evaluación de Procesos y Resultados en Atención de Salud/normas , Servicio Ambulatorio en Hospital/normas , Indicadores de Calidad de la Atención de Salud/normas , Reumatólogos/normas , Reumatología/normas , Adulto , Citas y Horarios , Chicago , Estudios Transversales , Femenino , Humanos , Lupus Eritematoso Sistémico/diagnóstico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Carga de Trabajo/normasAsunto(s)
Prestación Integrada de Atención de Salud/normas , Disparidades en Atención de Salud/normas , Reperfusión Miocárdica/normas , Evaluación de Procesos y Resultados en Atención de Salud/normas , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Infarto del Miocardio con Elevación del ST/terapia , Servicios Médicos de Urgencia/normas , Florida , Humanos , Reperfusión Miocárdica/efectos adversos , Reperfusión Miocárdica/mortalidad , Grupo de Atención al Paciente/normas , Evaluación de Programas y Proyectos de Salud , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/fisiopatología , Factores de Tiempo , Tiempo de Tratamiento , Resultado del TratamientoRESUMEN
Few group psychotherapy studies focus on therapists' interventions, and instruments that can measure group psychotherapy treatment fidelity are scarce. The aim of the present study was to evaluate the reliability of the Mentalization-based Group Therapy Adherence and Quality Scale (MBT-G-AQS), which is a 19-item scale developed to measure adherence and quality in mentalization-based group therapy (MBT-G). Eight MBT groups and eight psychodynamic groups (a total of 16 videotaped therapy sessions) were rated independently by five raters. All groups were long-term, outpatient psychotherapy groups with 1.5 hours weekly sessions. Data were analysed by a Generalizability Study (G-study and D-study). The generalizability models included analyses of reliability for different numbers of raters. The global (overall) ratings for adherence and quality showed high to excellent reliability for all numbers of raters (the reliability by use of five raters was 0.97 for adherence and 0.96 for quality). The mean reliability for all 19 items for a single rater was 0.57 (item range 0.26-0.86) for adherence, and 0.62 (item range 0.26-0.83) for quality. The reliability for two raters obtained mean absolute G-coefficients on 0.71 (item range 0.41-0.92 for the different items) for adherence and 0.76 (item range 0.42-0.91) for quality. With all five raters the mean absolute G-coefficient for adherence was 0.86 (item range 0.63-0.97) and 0.88 for quality (item range 0.64-0.96). The study demonstrates high reliability of ratings of MBT-G-AQS. In models differentiating between different numbers of raters, reliability was particularly high when including several raters, but was also acceptable for two raters. For practical purposes, the MBT-G-AQS can be used for training, supervision and psychotherapy research.
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Adhesión a Directriz/normas , Evaluación de Procesos y Resultados en Atención de Salud/normas , Psicometría/normas , Psicoterapia de Grupo/normas , Psicoterapia Psicodinámica/normas , Teoría de la Mente , Adulto , Humanos , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Little evidence exists about processes in massage therapy practice. Investigating current frameworks is warranted. This qualitative study is a secondary data analysis using grounded theory to understand how massage therapy experts describe massage therapy practice. METHODS: 31 massage therapy experts were invited to a 2-day symposium to discuss best practices for the profession. Through qualitative analysis, memoing, and discussion, the data were summarized into themes. RESULTS: Three themes were identified around massage therapy practice: 1) client centered, 2) structure for practice, and 3) influencing factors. Each theme is clarified and expanded. DISCUSSION: Conceptual models were developed for research and clinical practice and a definition for massage therapy practice was identified. Challenges and limitations are discussed. CONCLUSION: The goal of providing these models is to give massage therapists tools to deliver the best possible care. The models need testing to see if they help advance the profession.
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Masaje/organización & administración , Evaluación de Procesos y Resultados en Atención de Salud/organización & administración , Documentación , Humanos , Masaje/métodos , Masaje/normas , Evaluación de Procesos y Resultados en Atención de Salud/normas , Planificación de Atención al Paciente , Atención Dirigida al Paciente/organización & administración , Guías de Práctica Clínica como Asunto , Investigación CualitativaRESUMEN
BACKGROUND: Quality profiling is practiced at the TCM hospital Bad Kötzting since its establishment 25 years ago. The profiling comprises assessment of treatment effectiveness andsafety, structural features, staff qualification as well as diagnostic and therapeutic processes. Findings regarding patients, intervention and outcome profiles are presented by appropriate examples. METHODS: Data of each in-patient were systematically collected by physicians and via self-reports at admission, discharge and follow-up. Over the years the system was adjusted several times resulting in a data pool of about 19,000 in-patients by end of 2014. RESULTS: Patients are 52 years old on average, 70% are female, and suffering from the main complaint since 7 years (median). The diagnostic spectrum changed over the years according to the development towards a psychosomatic focus. For TCM acupuncture therapy 222 different acupoints were used in 7.7 different localisations on average per individual treatment. The mean intensity of the main complaint decreased clinically relevant (Cohen's d = 1.11 at discharge and 0.93 at follow-up). After the hospital stay the number of days of sick leave declined from 51.3 days by 40% per patient and year. Depressive disorders as most common mental illness decreased significantly decreased significantly at discharge (ICD symptom rating; Cohen's d = -1.01). 29.8% of patients met the criteria for a metabolic syndrome diagnosis according to the International Diabetes Federation (IDF). In this group of cases, triglycerides, cholesterol and blood glucose improved markedly at discharge. DISCUSSION: The presented quality control measures clearly contribute to an enhanced transparency in terms of a comprehensive quality profile. The findings from various outcome parameters indicate that patients benefit from the treatment.
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Enfermedad Crónica/terapia , Hospitales/normas , Medicina Tradicional China/normas , Garantía de la Calidad de Atención de Salud/normas , Terapia Combinada/normas , Trastorno Depresivo/terapia , Femenino , Alemania , Humanos , Masculino , Síndrome Metabólico/terapia , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud/normas , Medicina Psicosomática/normasAsunto(s)
Benchmarking/normas , Atención a la Salud/normas , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Psicoterapia/normas , Mejoramiento de la Calidad/normas , Benchmarking/economía , Análisis Costo-Beneficio/economía , Análisis Costo-Beneficio/normas , Atención a la Salud/economía , Medicina Basada en la Evidencia/economía , Medicina Basada en la Evidencia/normas , Alemania , Asignación de Recursos para la Atención de Salud/economía , Humanos , Trastornos Mentales/economía , Trastornos Mentales/psicología , Programas Nacionales de Salud/economía , Evaluación de Procesos y Resultados en Atención de Salud/normas , Psicoterapia/economía , Mejoramiento de la Calidad/economía , Indicadores de Calidad de la Atención de Salud/economía , Indicadores de Calidad de la Atención de Salud/normasAsunto(s)
Benchmarking/normas , Atención a la Salud/normas , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Psicoterapia/normas , Mejoramiento de la Calidad/normas , Benchmarking/economía , Sesgo , Análisis Costo-Beneficio/economía , Análisis Costo-Beneficio/normas , Atención a la Salud/economía , Medicina Basada en la Evidencia/economía , Medicina Basada en la Evidencia/normas , Asignación de Recursos para la Atención de Salud/economía , Humanos , Trastornos Mentales/economía , Trastornos Mentales/psicología , Programas Nacionales de Salud/economía , Evaluación de Resultado en la Atención de Salud/normas , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud/normas , Psicoterapia/economía , Mejoramiento de la Calidad/economía , Indicadores de Calidad de la Atención de Salud/economía , Indicadores de Calidad de la Atención de Salud/normasRESUMEN
INTRODUCTION: Cardiovascular disease is the leading cause of death in the United States, and mortality rates are higher among African Americans than among people of other races/ethnicities. We aimed to understand how African American adults and adolescents conceptualize cardiovascular health and perceive related barriers and facilitators. METHODS: This qualitative study was conducted as formative research for a larger study, Heart Healthy Lenoir, which aimed to reduce cardiovascular disease disparities among African Americans in eastern North Carolina, part of the widely-known "stroke belt" that runs through the southeastern United States. Using photovoice, a community-based participatory research method, we conducted eight 90-minute photovoice sessions with 6 adults and 9 adolescents in Lenoir County, North Carolina. Topics for each discussion were selected by participants and reflected themes related to cardiovascular health promotion. All sessions were transcribed and coded using a data-driven, inductive approach. RESULTS: Participants conceptualized cardiovascular health to have mental, spiritual, and social health dimensions. Given these broad domains, participants acknowledged many ecological barriers to cardiovascular health; however, they also emphasized the importance of personal responsibility. Facilitators for cardiovascular health included using social health (eg, family/community relationships) and spiritual health dimensions (eg, understanding one's body and purpose) to improve health behaviors. CONCLUSION: The perspectives of African American adults and adolescents elicited through this formative research provided a strong foundation for Heart Healthy Lenoir's ongoing engagement of community members in Lenoir County and development and implementation of its intervention to prevent cardiovascular disease.
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Negro o Afroamericano/psicología , Enfermedades Cardiovasculares/etnología , Enfermedades Cardiovasculares/psicología , Investigación Participativa Basada en la Comunidad/estadística & datos numéricos , Disparidades en el Estado de Salud , Adolescente , Conducta del Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Enfermedades Cardiovasculares/prevención & control , Relaciones Comunidad-Institución , Toma de Decisiones , Planificación Ambiental , Salud de la Familia , Femenino , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/economía , Promoción de la Salud/métodos , Humanos , Masculino , Relaciones Metafisicas Mente-Cuerpo , North Carolina/epidemiología , Evaluación de Procesos y Resultados en Atención de Salud/normas , Percepción , Fotograbar , Prejuicio , Investigación Cualitativa , Espiritualidad , Estrés PsicológicoRESUMEN
INTRODUCTION: Although deemed a globally accepted framework, there remains scare evidence on the process and outcome of implementing the International Classification of Functioning, Disability and Health (ICF) within neurorehabilitation. OBJECTIVES: This review briefly explores the existing, broader literature and then reports on two action research projects, undertaken in England, specifically within stroke and neurorehabilitation. Working with participants, including clinicians from in-patient and community settings, there are now 35 different ways identified for the use of the ICF. CONCLUSION: The outcome of the first project highlights that using the ICF enhances communication within and beyond the acute stroke service, fosters holistic thinking and clarifies team roles. To adopt it into clinical practice, the ICF must be adapted to meet local service needs. The use of action research has facilitated the knowledge translation process which has enabled the ICF to become a clinical reality in neurorehabilitation, with clinicians identifying a range of potential uses.
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Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud , Evaluación de Procesos y Resultados en Atención de Salud , Rehabilitación de Accidente Cerebrovascular , Humanos , Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud/normas , Evaluación de Procesos y Resultados en Atención de Salud/normasRESUMEN
Intermediate care services have developed internationally to expedite discharge from hospital and to provide an alternative to an emergency hospital admission. Inconsistencies in the evidence base and under-developed governance structures led to concerns about the care quality, outcomes and provision of intermediate care in the NHS. The National Audit of Intermediate Care was therefore established by an interdisciplinary group. The second national audit reported in 2013 and included crisis response teams, home-based and bed-based services in approximately a half of the NHS. The main findings were evidence of weak local strategic planning, considerable under-provision, delays in accessing the services and lack of mental health involvement in care. There was a very high level of positive patient experience reported across all types of intermediate care, though reported involvement with care decisions was less satisfactory.
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Prestación Integrada de Atención de Salud/normas , Servicios de Salud para Ancianos/normas , Instituciones de Cuidados Intermedios/normas , Auditoría Médica , Evaluación de Procesos y Resultados en Atención de Salud/normas , Medicina Estatal/normas , Prestación Integrada de Atención de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/normas , Servicios de Salud para Ancianos/organización & administración , Humanos , Instituciones de Cuidados Intermedios/organización & administración , Modelos Organizacionales , Evaluación de Necesidades , Evaluación de Procesos y Resultados en Atención de Salud/organización & administración , Satisfacción del Paciente , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud , Medicina Estatal/organización & administración , Reino UnidoAsunto(s)
Gastroenterología/normas , Enfermedades Inflamatorias del Intestino/terapia , Evaluación de Procesos y Resultados en Atención de Salud/normas , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Prestación Integrada de Atención de Salud/normas , Adhesión a Directriz/normas , Disparidades en Atención de Salud , Humanos , Enfermedades Inflamatorias del Intestino/diagnóstico , Pautas de la Práctica en Medicina/normas , Rumanía , Resultado del TratamientoRESUMEN
The National Institute of Diabetes and Digestive and Kidney Diseases-supported Kidney Research National Dialogue asked the scientific community to formulate and prioritize research objectives that would enhance understanding of kidney function and disease and improve clinical outcomes. An engaged and growing group of investigators working in type 2 translation (from clinical evidence to implementation in the community) identified barriers to improving patient care in CKD and suggested research priorities to test translational strategies that have been effective for other chronic diseases.
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Nefrología/tendencias , Evaluación de Procesos y Resultados en Atención de Salud/tendencias , Insuficiencia Renal Crónica/terapia , Investigación Biomédica Traslacional/tendencias , Animales , Prestación Integrada de Atención de Salud/tendencias , Difusión de Innovaciones , Conocimientos, Actitudes y Práctica en Salud , Alfabetización en Salud , Prioridades en Salud/tendencias , Humanos , Nefrología/normas , Evaluación de Procesos y Resultados en Atención de Salud/normas , Grupo de Atención al Paciente/tendencias , Educación del Paciente como Asunto , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud/tendencias , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiología , Factores de Riesgo , Autocuidado , Investigación Biomédica Traslacional/normas , Resultado del TratamientoRESUMEN
UNLABELLED: This article looks at the background to the current changes in primary care dentistry being piloted in England. It looks at the structure of the different elements being piloted, such as the oral health assessment, interim care appointments and care pathways. It also examines advanced care pathways and how complex care will be provided when clinically feasible and beneficial to the patient. The authors have worked in a type 1 pilot practice since September 2010. CLINICAL RELEVANCE: The NHS contract currently being piloted in England delivers care through care pathways and clinical risk assessments with prevention as an important building block for the delivery of services. There are new measures planned for measuring quality outcomes in primary care. This has implications for how services are delivered, who delivers them and how dentists will be remunerated in the future.
Asunto(s)
Atención a la Salud/organización & administración , Atención Odontológica/organización & administración , Atención Primaria de Salud/organización & administración , Odontología Estatal/organización & administración , Citas y Horarios , Atención Odontológica Integral/organización & administración , Servicios Contratados/economía , Servicios Contratados/organización & administración , Vías Clínicas , Atención Odontológica/economía , Atención Odontológica/normas , Predicción , Reforma de la Atención de Salud , Humanos , Salud Bucal , Evaluación de Procesos y Resultados en Atención de Salud/normas , Grupo de Atención al Paciente , Proyectos Piloto , Odontología Preventiva/economía , Odontología Preventiva/organización & administración , Atención Primaria de Salud/economía , Atención Primaria de Salud/normas , Mecanismo de Reembolso , Medición de Riesgo , Odontología Estatal/tendencias , Reino UnidoRESUMEN
BACKGROUND: The Institute of Medicine (IOM) has endorsed six dimensions of patient-centredness as crucial to providing quality healthcare. These dimensions outline that care must be: 1) respectful to patients' values, preferences, and expressed needs; 2) coordinated and integrated; 3) provide information, communication, and education; 4) ensure physical comfort; 5) provide emotional support-relieving fear and anxiety; and 6) involve family and friends. However, whether patient-reported outcome measures (PROMs) comprehensively cover these dimensions remains unexplored. This systematic review examined whether PROMs designed to assess the quality of patient-centred cancer care addressed all six IOM dimensions of patient-centred care and the psychometric properties of these measures. METHODS: Medline, PsycINFO, Current Contents, Embase, CINAHL and Scopus were searched to retrieve published studies describing the development and psychometric properties of PROMs assessing the quality of patient-centred cancer care. Two authors determined if eligible PROMs included the six IOM dimensions of patient-centred care and evaluated the adequacy of psychometric properties based on recommended criteria for internal consistency, test-retest reliability, face/content validity, construct validity and cross-cultural adaptation. RESULTS: Across all 21 PROMs, the most commonly included IOM dimension of patient-centred care was "information, communication and education" (19 measures). In contrast, only five measures assessed the "involvement of family and friends." Two measures included one IOM-endorsed patient-centred care dimension, two measures had two dimensions, seven measures had three dimensions, five measures had four dimensions, and four measures had five dimensions. One measure, the Indicators (Non-small Cell Lung Cancer), covered all six IOM dimensions of patient-centred care, but had adequate face/content validity only. Eighteen measures met the recommended adequacy criteria for construct validity, 15 for face/content validity, seven for internal consistency, three for cross-cultural adaptation and no measure for test-retest reliability. CONCLUSIONS: There are no psychometrically rigorous PROMs developed with cancer patients that capture all six IOM dimensions of patient-centred care. Using more than one measure or expanding existing measures to cover all six patient-centred care dimensions could improve assessment and delivery of patient-centred care. Construction of new comprehensive measures with acceptable psychometric properties that can be used with the general cancer population may also be warranted.