Evaluación de la gestión de calidad de los servicios de Enfermería en un Centro de Restauración Neurológica / Evaluation of quality management of Nursing services at the International Center for Neurological Restoration

Introducción: La evaluación de la gestión de calidad de los servicios de Enfermería se perfila como una herramienta útil para trazar estrategias de mejora de los procesos organizacionales y satisfacer las necesidades del cliente. Objetivo: Evaluar la gestión de calidad de los servicios de Enfermería. Métodos: Estudio cuantitativo, descriptivo, de corte transversal, en el Centro Internacional de Restauración Neurológica, La Habana, en el año 2022. Participaron 60 enfermeras con 5 o más años de servicio, pertenecientes a los servicios lesiones estáticas, restauración biológica cerebral, atención a cubanos, lesiones raquimedulares, trastornos del movimiento y neurocirugía. Se aplicó una encuesta adaptada al contexto hospitalario basada en el Modelo Europeo de excelencia European Foundation for Quality Management. Se utilizó la media como medida de resumen. Se consideró la evaluación punto fuerte (aceptable) cuando el valor real alcanzado fue igual o superior al deseado y área de mejora (no aceptable) cuando el valor real no alcanzó el deseado. Resultados: La puntuación global fue de 977,88 de 1000 puntos que exige el Modelo. Se detectaron dos áreas de mejora a expensas de los criterios 3 (implicar los grupos de interés) y 5 (gestionar el funcionamiento y la transformación). Se evidenciaron puntos fuertes con énfasis en una cultura de calidad y elevada capacitación en los profesionales. Conclusión: La evaluación de gestión de la calidad en los servicios de Enfermería se considera aceptable. Los hallazgos obtenidos permiten plantearse acciones de mejora para fortalecer la calidad de la atención que se brinda a los clientes. La evaluación de la gestión de calidad en los servicios de enfermería es una estrategia metodológica útil para identificar errores y ayudar a identificar el camino hacia la excelencia(AU)

Introduction: The evaluation of quality management of Nursing services is emerging as a useful tool to outline strategies to improve organizational processes and meet customer needs, Objective: To evaluate the quality management of nursing services. Methods: Quantitative, descriptive, cross-sectional, cross-sectional study at the International Center for Neurological Restoration, Havana, Cuba, in the year 2022. Sixty nurses with 5 or more years of service, belonging to the services Static Injuries, Biological Brain Restoration, Care for Cubans, Rachimedullary Injuries, Movement Disorders and Neurosurgery participated. A survey was applied, adapted to the hospital context based on the European Model of Excellence EFQM. The mean was used as a summary measure. The evaluation was considered a strong point (acceptable) when the actual value achieved was equal to or higher than the desired value, and an area for improvement (not acceptable) when the actual value did not reach the desired value. Results: The overall score was 977.88 out of 1000 points required by the Model. Two areas for improvement were detected at the expense of criteria 3 (involve stakeholders) and 5 (manage operation and transformation). Strengths were evidenced with emphasis on a culture of quality and high qualification of professionals. Conclusion: The evaluation of quality management in nursing services is considered acceptable(AU)

Interoperability in a Post-Roe Era: Sustaining Progress While Protecting Reproductive Health Information.

This Viewpoint proposes a solution to better safeguard reproductive health information in patient records that are now more complete owing to the interoperability of health information exchange networks.

Las normas técnicas para la formación en ingeniería biomédica, tecnología y administración en salud / Technical standards for the training in biomedical engineering, health technology and health management

Introducción: Los documentos normativos establecen el estado del arte relacionado con determinado campo del conocimiento. Existe una gran cantidad de normas relacionadas con los servicios de salud y su gestión, cuya aplicación es relevante en este sector. Objetivo: Exponer la importancia de las normas técnicas en la formación de los profesionales en ingeniería biomédica, tecnología y administración en salud. Desarrollo: Diferentes aspectos relacionados con el desempeño y las funciones de los profesionales en ingeniería biomédica, tecnología de la salud y administración en salud están recogidos en normas técnicas internacionales y en otras de carácter nacional, que resultan pertinentes y de gran utilidad para su formación en el nivel de grado y el posgrado. Conclusiones: Las profesiones abordadas requieren emplear los documentos normativos relacionados con sus funciones para contribuir con la calidad de los servicios de salud; de ahí la pertinencia de su incorporación en los planes de estudio de estas carreras(AU)

Introduction: Normative documents establish the state of the art related to a certain field of knowledge. There is a large number of standards related to health services and their management, whose application is relevant in this sector. Objective: To show the importance of technical standards in the training of professionals from the fields of biomedical engineering, health technology and health management. Development: Different aspects related to the performance and functions of professionals from the fields of biomedical engineering, health technology and health management are gathered in international and other national technical standards, relevant and useful for their training at the undergraduate and postgraduate levels. Conclusions: The addressed professions require the use of normative documents related to their functions in order to contribute to the quality of health services, hence the relevance of their incorporation into the curriculums of these major(AU)

Trends in quality of primary care in the United States, 2007-2016.

During the past decade, many reforms were proposed and implemented for improving primary care in the US. This study assessed improvements in quality of primary care, using a nationally representative database. We conducted a retrospective trend analysis of National Inpatient Sample data (2007-2016). The quality of primary care was assessed using Prevention Quality Indicators (PQIs), which consist of 13 sets of preventable hospitalization conditions. PQI hospitalization decreased from 154,565 to 151,168 per million hospitalizations during the study period (relative decrease, 2.2%; P = 0.041). Age-adjusted hospitalization rate increased for diabetes short-term complications (relative increase, 46.9%; P < 0.001) and lower-extremity amputations (relative increase, 15.1%; P = 0.035). Age stratified trends showed that hospitalization rates decreased significantly in all age-groups for diabetes short-term complications. For lower-extremity amputations, hospitalization rates increased significantly in younger age groups and decreased significantly in the older age groups. All other PQIs showed either decreasing or no change in trends. Adults aged 18-64 years should be the focus for future prevention attempts for diabetes complications. Identifying and acting on the factors responsible for these changes could help in reversing the concerning trends observed in this study. Existing strategies should focus on improving access to diabetes care and self-management.

Patient and family experience of telehealth care delivery as part of the CF chronic care model early in the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, CF centers shifted to a telehealth delivery model. Our study aimed to determine how people with CF (PwCF) and their families experienced telehealth and assessed its quality and acceptability for future CF care. METHODS: The CF Patient and Family State of Care Survey (PFSoC) was fielded from August 31-October 30, 2020. The PFSoC explored themes of overall telehealth quality, ease of use, desirability, and preference for a future mix of in-person and telehealth care. Demographic covariates considered included: gender, age, CFTR modulator status, and region of residence. RESULTS: 424 PwCF and parents of PwCF responded (47% parents). Most (81%) reported a telehealth visit which included a MD/APP and nurse team members. 91% found telehealth easy to use, and 66% reported similar/higher quality than in-person care. One-third (34%) reported the highest desire for future telehealth care, with 45% (n =212) desiring 50% or more of visits conducted via telehealth. Adults were more likely than parents to report highest desire for future telehealth (64% vs. 36%). Respondents who perceived telehealth as similar/higher quality were more likely to desire future telehealth compared to those who perceived telehealth as lower quality (96% vs. 50%). Mixed methods analysis revealed themes affecting perceptions of telehealth. CONCLUSIONS: PwCF desire for future telehealth was influenced by perception of quality and age. Several themes emerged that need to be explored as telehealth is adapted into the CF chronic care model, especially when thinking about integration into pediatric care.

The interaction of healthcare service quality and community-based health insurance in Ethiopia.

Community-based health insurance (CBHI) as a demand-side intervention is presumed to drive improvements in health services quality, and the quality of health services is an important supple-side factor in motivating CBHI enrollment and retention. There is, however, limited evidence on this interaction. This study examined the interaction between quality of health services and CBHI enrollment and renewal. A mixed-method comparative study was conducted in four agrarian regions of Ethiopia. The study followed the Donabedian model to compare quality of health services in health centers located in woredas/districts that implemented CBHI with those that did not. Data was collected through facility assessments, client-exit interviews, and key informant interviews. In addition to manual thematic analysis of qualitative data, quantitative descriptive and inferential analyses were done using SPSS vs 25. The process related (composite index including provider-client interpersonal communication) and outcome related (client satisfaction) measures of service quality in CBHI woreda/districts differed significantly from non-CBHI woredas/districts, but there were no significant differences in overall measures of structural quality between the two. The study found better diagnostic test capacity, availability of tracer drugs, provider interpersonal communication, and service quality standards in CBHI woredas. A higher proportion of clients at CBHI health centers gave high ratings of overall satisfaction with services. Individual and household factors including family size, age, household health care-related expenditures, and educational status, played a more significant role in CBHI enrollment and renewal decisions than health service quality. Key-informants reported in interviews that participation in the scheme increased accountability of health facilities in CBHI woredas/districts, because they promised to provide quality services using the CBHI premium collected at the beginning of the year from all enrolled households. This study indicates a need for follow-up research to understand the nuanced linkages between quality of care and CBHI enrollment.

Nursing home care under Medicaid managed long-term services and supports.

OBJECTIVE: To measure the impact of Medicaid managed long-term services and supports (MLTSS) on nursing home (NH) quality and rebalancing. DATA SOURCES/STUDY SETTING: This study analyzes secondary data from annual NH recertification surveys and the minimum dataset (MDS) in three states that implemented MLTSS: Massachusetts (2001-2007), Kansas and Ohio (2011-2017). STUDY DESIGN: We utilized a difference-in-difference approach comparing NHs in border counties of states that implemented MLTSS with a control group of NHs in neighboring border counties in states that did not implement MLTSS. Sensitivity analyses included a triple-difference model (stratified by Medicaid payer mix) and a within-state comparison. We examined changes in six NH-level outcomes (percentage of low-care NH residents, facility occupancy, and four NH quality measures) after MLTSS implementation. DATA COLLECTION/EXTRACTION METHODS: For each state, all freestanding NHs in border counties were included, as were NHs in neighboring counties located in other states. Information on low-care residents was aggregated to the NH level from MDS data, then combined with Online Survey Certification and Reporting (OSCAR) and Certification and Survey Provider Enhanced Reporting (CASPER) data. PRINCIPAL FINDINGS: MLTSS had no statistically significant effects on NH quality outcomes in Massachusetts or Kansas. In Ohio, MLTSS led to an increase of 0.21 nursing hours per resident day [95% CI: 0.03, 0.40], and a decrease of 1.47 deficiencies [95% CI: -2.52, -0.42] and 9.38 deficiency points [95% CI: -18.53, -0.24] per certification survey. After MLTSS, occupancy decreased by 1.52 percentage points [95% CI: -2.92, -0.12] in Massachusetts, but increased by 3.17 percentage points [95% CI: 0.36, 5.99] in Ohio. We found no effect on low-care residents in any state. Findings were moderately sensitive to the choice of comparator group. CONCLUSION: The study provides little evidence that MLTSS reduces quality of care, occupancy, or the percentage of low-care residents in NHs.

Changes in proportion of bachelor's nurses associated with improvements in patient outcomes.

This study uses data from two cross-sections in time (2006, 2016) to determine whether changes over time in hospital employment of bachelor's of science in nursing (BSN) nurses is associated with changes in patient outcomes. Data sources include nurse survey data, American Hospital Association Annual Survey data, and patient administrative claims data from state agencies in California, Florida, New Jersey, and Pennsylvania. The study sample included general surgical patients aged 18-99 years admitted to one of the 519 study hospitals. Multilevel logistic regression and truncated negative binomial models were used to estimate the cross-sectional and longitudinal effects of the proportion of hospital BSN nurses on patient outcomes (i.e., in-hospital mortality, 7- and 30-day readmissions, length of stay). Between 2006 and 2016, the average proportion of BSN nurses in hospitals increased from 41% to 56%. Patients in hospitals that increased their proportion of BSN nurses over time had significantly reduced odds of risk-adjusted mortality (odds ratio [OR]: 0.95, 95% confidence interval [CI]: 0.92-0.98), 7-day readmission (OR: 0.96, 95% CI: 0.94-0.99) and 30-day readmission (OR: 0.98, 95% CI: 0.95-1.00), and shorter lengths of stay (incident rate ratio [IRR]: 0.98, 95% CI: 0.97-0.99). Longitudinal findings of an association between increased proportions of BSN nurses and improvements in patient outcomes corroborate previous cross-sectional research, suggesting that a better educated nurse workforce may add value to hospitals and patients.

Stroke Care in the United Kingdom During the COVID-19 Pandemic.

BACKGROUND AND PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has potentially caused indirect harm to patients with other conditions via reduced access to health care services. We aimed to describe the impact of the initial wave of the pandemic on admissions, care quality, and outcomes in patients with acute stroke in the United Kingdom. METHODS: Registry-based cohort study of patients with acute stroke admitted to hospital in England, Wales, and Northern Ireland between October 1, 2019, and April 30, 2020, and equivalent periods in the 3 prior years. RESULTS: One hundred fourteen hospitals provided data for a study cohort of 184 017 patients. During the lockdown period (March 23 to April 30), there was a 12% reduction (6923 versus 7902) in the number of admissions compared with the same period in the 3 previous years. Admissions fell more for ischemic than hemorrhagic stroke, for older patients, and for patients with less severe strokes. Quality of care was preserved for all measures and in some domains improved during lockdown (direct access to stroke unit care, 1-hour brain imaging, and swallow screening). Although there was no change in the proportion of patients discharged with good outcome (modified Rankin Scale score, ≤2; 48% versus 48%), 7-day inpatient case fatality increased from 6.9% to 9.4% (P<0.001) and was 22.0% in patients with confirmed or suspected COVID-19 (adjusted rate ratio, 1.41 [1.11-1.80]). CONCLUSIONS: Assuming that the true incidence of acute stroke did not change markedly during the pandemic, hospital avoidance may have created a cohort of untreated stroke patients at risk of poorer outcomes or recurrent events. Unanticipated improvements in stroke care quality should be used as an opportunity for quality improvement and to learn about how to develop resilient health care systems.

The Italian Obstetric Surveillance System: Implementation of a bundle of population-based initiatives to reduce haemorrhagic maternal deaths.

In this before and after cross-sectional analysis, the authors aim to assess the impact of the bundle of research and training initiatives implemented between 2013 and 2018, and coordinated by the Italian Obstetric Surveillance System (ItOSS) to reduce obstetric haemorrhagic emergencies in five selected Italian Regions. To this purpose, the haemorrhagic Maternal Mortality Ratios (MMR) per 100,000 live births were estimated before and after implementing the bundle, through the ItOSS's vital statistic linkage procedures and incident reporting and Confidential Enquiries. The research and training bundle was offered to all health professionals involved in pregnancy and birth care in the selected regions, representing 40% of national live births, and participating in the ItOSS audit cycle since its institution. The haemorrhagic MMR significantly decreased from 2.49/100,000 live births [95% CI 1.75 to 3.43] in the years 2007-2013 prior to the bundle implementation, to 0.77/100,000 live births [95% CI 0.31 to 1.58] in the years 2014-2018 after its implementation. According to the study results, the bundle of population-based initiatives might have contributed to reducing the haemorrhagic MMR in the participating regions, thus improving the quality of care of the major obstetric haemorrhage.

Nivel de adherencia al protocolo asistencial para la prevención de lesiones por presión en servicios de atención al grave / Level of Adherence to the Care Protocol for the Prevention of Pressure Injuries in Services of Care for Seriously Ill Patients

Introducción: La implementación de protocolos asistenciales como proyección estratégica en la prestación de servicios de salud permite contribuir a mejorar la calidad de la atención. Objetivo: Identificar el nivel de adherencia al protocolo asistencial para la prevención de lesiones por presión en servicios de atención al grave. Métodos: Estudio descriptivo y transversal en cinco servicios de atención al grave del Hospital Hermanos Ameijeiras, desde octubre a diciembre de 2019. Según criterios, la muestra quedó constituida por 31 personal de enfermería, de ellos, 16 licenciados en enfermería (51,61 por ciento) y 15 enfermeros técnicos (48,39 por ciento). Fueron evaluadas 21 historias clínicas. La recolección de la información se realizó mediante un test de conocimientos y una lista de chequeo, validados a través de criterios de expertos. Se realizó prueba piloto con el test, que permitió evaluar su validez y confiabilidad. Resultados: El 92,09 por ciento del total de los evaluados presentaron conocimientos medianamente suficientes (64,51 por ciento) y suficientes (27,58 por ciento). En cuatro servicios evaluados (80 por ciento) tenían disponible los recursos materiales. En 21 historias clínicas (100 por ciento) se valoraron los factores de riesgo. La identificación del riesgo, así como la planificación y ejecución de intervenciones de enfermería, solamente se reflejaron en 10 historias (47,61 por ciento). Se obtuvieron 4,33 puntos en la sumatoria total. Conclusiones: Se determinó como de nivel medio la adherencia al protocolo asistencial para la prevención de lesiones por presión en servicios de atención al grave(AU)

Introduction: The implementation of care protocols as a strategic projection in the provision of health services allows to contribute to improving the quality of care. Objective: To identify the level of adherence to the care protocol for the prevention of pressure injuries in care services for severely ill patients. Methods: Descriptive and cross-sectional study carried out in five care services for severely ill patients at Hermanos Ameijeiras Hospital, from October to December 2019. Based on to criteria, the sample consisted of 31 nursing staff members, of which sixteen were diploma nurses (51.61 percent) and fifteen were associate nurses (48.39 percent). Twenty-one medical records were assessed. The information was collected using a knowledge test and a checklist, validated through expert criteria. A pilot test was carried out with the test, which made it possible to evaluate its validity and reliability. Results: 92.09 percent of those evaluated had moderately sufficient (64.51 percent) and sufficient (27.58 percent) knowledge. In four assessed services (80 percent), the material resources were available. Risk factors were assessed in 21 medical records (100 percent). The identification of risk, as well as the planning and execution of nursing interventions, were only reflected in ten medical records (47.61 percent). In the total sum, 4.33 points were obtained. Conclusions: Adherence to the care protocol for the prevention of pressure injuries in serious care services was determined as medium level(AU)

Clinical applications of artificial intelligence and machine learning-based methods in inflammatory bowel disease.

Our objective was to review and exemplify how selected applications of artificial intelligence (AI) might facilitate and improve inflammatory bowel disease (IBD) care and to identify gaps for future work in this field. IBD is highly complex and associated with significant variation in care and outcomes. The application of AI to IBD has the potential to reduce variation in healthcare delivery and improve quality of care. AI refers to the ability of machines to mimic human intelligence. The range of AI's ability to perform tasks that would normally require human intelligence varies from prediction to complex decision-making that more closely resembles human thought. Clinical applications of AI have been applied to study pathogenesis, diagnosis, and patient prognosis in IBD. Despite these advancements, AI in IBD is in its early development and has tremendous potential to transform future care.

Applications of the High Impact Practices in Family Planning during COVID-19.

The COVID-19 pandemic has substantially strained health systems across the globe. In particular, documented disruptions to voluntary family planning and reproductive health care due to competing health priorities, service disruptions, stockouts, and lockdowns are significantly impacting reproductive, maternal, newborn, and child health. As governments and family planning programmes grapple with how best to respond to the direct and indirect effects of the pandemic on family planning and reproductive health (FP/RH), the implementation and adaptation of evidence-based practices is crucial. In this commentary, we outline applications of the High Impact Practices in Family Planning (HIPs) towards COVID-19 response efforts. The HIPs are a set of evidence-based family planning practices which reflect global expert consensus on what works in family planning programming. Drawing upon preliminary COVID-19 data, documented experiences from prior health emergencies, and recommended programme adaptations from a variety of global health partners, we outline situations where specific HIPs may assist family planning programme managers in developing context-specific and evidence-based responses to COVID-19-related impacts on FP/RH, with the ultimate goal of ensuring the accessibility, availability, and continuity of voluntary family planning services across the world.

Aproximación a las experiencias de las personas usuarias en una Unidad de Identidad de Género / Approach to the experiences of the users of a Gender Identity Unit

OBJETIVO: Conocer en profundidad las experiencias de las personas usuarias atendidas en la Unidad de Identidad de Género (UIG) del Hospital Clínic de Barcelona. MÉTODOS: Investigación cualitativa socioconstructivista que incluye el papel de las transformaciones de la Unidad y los cambios sociopolíticos en la transidentidad sobre la vivencia de las personas usuarias. Se han realizado ocho entrevistas semiestructuradas y posteriormente un análisis de contenido. RESULTADOS: Del análisis de las entrevistas se definieron cuatro categorías temáticas principales: aspectos sociales, la espera, fuentes de información y UIG frente a Trànsit (actual unidad de referencia). El entorno y el contexto social son fundamentales en la aceptación propia y en las expectativas de cómo debe ser la atención. Muchos de los momentos de espera escapan del control de las personas usuarias generando incertidumbre. Coinciden en la falta de formación de profesionales ajenos a las unidades especializadas y al uso de canales no sanitarios para obtener información. Apuntan a un antagonismo entre la UIG y Trànsit y a la necesidad de colaboración y de cambio en el sistema sanitario para aumentar la autonomía de las personas usuarias. DISCUSIÓN: Los resultados sugieren que para mejorar la experiencia del colectivo trans es fundamental un cambio en los planes de formación sanitaria con perspectiva de género, incluyendo temática trans, un compromiso institucional en favor de la educación, formación e información en este sentido, y que exista colaboración entre la UIG, Trànsit y los centros de Atención Primaria para que todas las entidades avancen

OBJECTIVES: To ascertain the experiences of the users of the Gender Identity Services at Hospital Clínic Barcelona. METHODS: Qualitative research analysed by means of social constructionism which takes into account the role of the transformations in the unit and socio-political changes in the concept of trans identity for users and their experiences. A total of eight semi-structured interviews were held followed by a content analysis. RESULTS: From the analysis of the interviews four main categories were defined. Social aspects, waiting, sources of information and Hospital Services versus Trànsit (the current reference unit). Setting and social context are fundamental for self-acceptance and for expectations about how healthcare should be configured. Most of the waiting time is beyond users' control, which generates uncertainty. They agree on lack of training among healthcare professionals outside specialised services, and on using alternative sources of information other than healthcare providers. They expose the antagonism between hospital services and Trànsit and acknowledge the need for collaboration and change within the health system to ensure the autonomy of users. DISCUSSION: The results suggest that to improve the experience of trans people a change in medical training that includes a gender perspective is required. This must take into account trans issues, an institutional undertaking in favour of education, training and information in this regard, and collaboration with Trànsit and primary care so that all entities can move forward