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1.
Res Nurs Health ; 35(4): 397-408, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22511461

RESUMEN

Accurately measuring trust between patients and health care providers is important because low patient-provider trust can lead to poor treatment adherence and negative health outcomes. To measure patient-provider trust, we developed the Health Care Relationship (HCR) Trust scale. Findings from our initial use of the scale suggested the need to examine the scale's psychometric performance in a larger sample of adults with various chronic health conditions. We therefore examined the psychometric properties of the HCR Trust Scale in a random sample of adult primary care patients. Thirteen of the original 15 items fit the data best; a single-factor structure explained 67% of the variance in patient-provider trust. The Cronbach's alpha for the 13-item HCR Trust Scale-Revised was .96.


Asunto(s)
Relaciones Médico-Paciente , Encuestas y Cuestionarios/normas , Confianza/psicología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Grupos de Población Continentales/psicología , Grupos de Población Continentales/estadística & datos numéricos , Análisis Factorial , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/estadística & datos numéricos , Pruebas Psicológicas/normas , Psicometría , Reproducibilidad de los Resultados , Factores Sexuales , Adulto Joven
5.
Am J Med Qual ; 25(3): 197-201, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20093713

RESUMEN

The objective of this study was to demonstrate the impact of a single ICD-9 (International Statistical Classification of Diseases and Related Health Problems, Version 9) code on the observed-to-expected mortality ratios for acute care hospitals, calculated using administrative data. The study was a retrospective analysis of mortality data and prospective measurement of the impact of a change in coding on expected mortality rates. Measurement included overall mortality observed-to-expected mortality index for 2 hospitals and rate of use of the palliative care ICD-9 code. The main result was that both retrospective and prospective applications of this single ICD-9 code significantly reduced observed-to-expected mortality ratios. Both regulators and hospitals need to be aware of the impact of the quality of coding on publicly reported quality and patient safety data.


Asunto(s)
Bases de Datos Factuales/estadística & datos numéricos , Control de Formularios y Registros/estadística & datos numéricos , Mortalidad Hospitalaria , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Departamentos de Hospitales/organización & administración , Humanos , Clasificación Internacional de Enfermedades , Cuidados Paliativos/organización & administración , Grupo de Atención al Paciente/organización & administración , Estudios Retrospectivos , Medición de Riesgo/estadística & datos numéricos , Administración de la Seguridad/estadística & datos numéricos , Tasa de Supervivencia , Estados Unidos
6.
Am J Med Qual ; 24(4): 295-301, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19487577

RESUMEN

The slow progress in health care quality improvement and patient safety in America can be attributed, in part, to the challenge of physician engagement. As multidisciplinary patient-centered care becomes the standard, it is essential to integrate physicians into this process. To this end, the UMass Memorial Medical Center redesigned its Physician Quality Officer (PQO) program in 2007. The PQOs of the UMass Memorial Medical Center, who are all practicing clinicians, are fully compensated for their time and effort, trained in safety science, and teamed with other members of the department of quality and patient safety. Over the first year of the new program, the PQOs have successfully led major hospital initiatives in areas such as surgical care improvement, critical values reporting, and medication reconciliation. In this article, the authors describe the challenges and insights in the development and implementation of this new program.


Asunto(s)
Centros Médicos Académicos/organización & administración , Médicos , Garantía de la Calidad de Atención de Salud/organización & administración , Humanos , Capacitación en Servicio/organización & administración , Administración de la Seguridad/organización & administración
7.
Am J Med Qual ; 23(2): 90-5, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18245577

RESUMEN

The public reporting of hospital quality and safety data is a growing phenomenon. Yet there are few reports of the effects of publicly reported data on individual organizations, particularly when the data show worse than expected performance. In this article, our hospital's response to having a mortality rate from coronary artery bypass graft surgery that was significantly higher than other programs in the Commonwealth of Massachusetts is reported. The data caused suspension of elective cardiac surgery at the institution, and an independent review of the program was undertaken. The effects of the suspension and publication of mortality data on quality and patient safety, the residency training program in cardiothoracic surgery, and the financial performance of the hospital are described. Several lessons were learned that may be of value to other health care organizations that experience a public crisis in clinical quality.


Asunto(s)
Puente de Arteria Coronaria/mortalidad , Acampadores DRG , Garantía de la Calidad de Atención de Salud/organización & administración , Calidad de la Atención de Salud/organización & administración , Centros Médicos Académicos/organización & administración , Centros Médicos Académicos/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/mortalidad , Humanos , Indicadores de Calidad de la Atención de Salud/organización & administración , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos
8.
Arthritis Rheum ; 50(5): 1501-10, 2004 May.
Artículo en Inglés | MEDLINE | ID: mdl-15146420

RESUMEN

OBJECTIVE: The Arthritis, Diet, and Activity Promotion Trial (ADAPT) was a randomized, single-blind clinical trial lasting 18 months that was designed to determine whether long-term exercise and dietary weight loss are more effective, either separately or in combination, than usual care in improving physical function, pain, and mobility in older overweight and obese adults with knee osteoarthritis (OA). METHODS: Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older, with a body mass index of > or =28 kg/m(2), knee pain, radiographic evidence of knee OA, and self-reported physical disability, were randomized into healthy lifestyle (control), diet only, exercise only, and diet plus exercise groups. The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included weight loss, 6-minute walk distance, stair-climb time, WOMAC pain and stiffness scores, and joint space width. RESULTS: Of the 316 randomized participants, 252 (80%) completed the study. Adherence was as follows: for healthy lifestyle, 73%; for diet only, 72%; for exercise only, 60%; and for diet plus exercise, 64%. In the diet plus exercise group, significant improvements in self-reported physical function (P < 0.05), 6-minute walk distance (P < 0.05), stair-climb time (P < 0.05), and knee pain (P < 0.05) relative to the healthy lifestyle group were observed. In the exercise group, a significant improvement in the 6-minute walk distance (P < 0.05) was observed. The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures. The weight-loss groups lost significantly (P < 0.05) more body weight (for diet, 4.9%; for diet plus exercise, 5.7%) than did the healthy lifestyle group (1.2%). Finally, changes in joint space width were not different between the groups. CONCLUSION: The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone.


Asunto(s)
Ejercicio , Obesidad/dietoterapia , Osteoartritis de la Rodilla/dietoterapia , Pérdida de Peso , Anciano , Dieta Reductora , Evaluación de la Discapacidad , Femenino , Humanos , Estilo de Vida , Masculino , Obesidad/complicaciones , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/diagnóstico por imagen , Cooperación del Paciente , Radiografía , Resultado del Tratamiento
9.
Physician Exec ; 29(5): 34-8, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-14531183

RESUMEN

Active physician participation and acceptance of Six Sigma is critical to successful implementation. Take a look at strategies and techniques that can help secure physician support for Six Sigma.


Asunto(s)
Actitud del Personal de Salud , Cuerpo Médico de Hospitales/psicología , Comunicación Persuasiva , Gestión de la Calidad Total , Humanos , Relaciones Interprofesionales , Innovación Organizacional , Ejecutivos Médicos , Estados Unidos
10.
J Cardiopulm Rehabil ; 23(1): 60-8, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12576914

RESUMEN

PURPOSE: To compare the effects of short-term (3 months) and long-term (18 months) involvement in an exercise program on self-reported disability and physical function in patients with chronic obstructive pulmonary disease (COPD). METHODS: A total of 140 patients with COPD were studied in a randomized, single-blinded clinical trial. Self-reported disability and physical function were assessed using a 21-item questionnaire, a 6-minute walk, timed stair climb, and an overhead task. RESULTS: At the completion of the trial, participants in the long-term intervention reported 12% less disability than those in the short-term intervention (adjusted mean with 95% confidence interval, 1.53 (1.43-1.63) versus 1.71 (1.61 to 1.81) units, respectively; P=.016), walked 6% farther during 6-minutes (1,815.0 [1,750.4-1,879.6] vs 1,711.5 [1,640.7-1,782.3] feet, respectively), climbed steps 11% faster (11.6 [11.0-12.2] vs 12.9 [12.3-13.5] seconds, respectively), and completed an overhead task 8% faster (46.8 [44.4-49.2] vs 50.4 [47.8-53.0] seconds, respectively) than those in the short-term intervention. CONCLUSION: An 18 month exercise program results in greater improvements in self-reported disability and physical function in patients with COPD when compared with a 3-month exercise program. As such, long-term exercise should be recommended for all patients with COPD.


Asunto(s)
Ejercicio , Aptitud Física/fisiología , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Factores de Edad , Anciano , Intervalos de Confianza , Femenino , Humanos , Masculino , Persona de Mediana Edad , Consumo de Oxígeno/fisiología , Cooperación del Paciente , Satisfacción del Paciente , Probabilidad , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Pruebas de Función Respiratoria , Índice de Severidad de la Enfermedad , Factores Sexuales , Método Simple Ciego , Factores de Tiempo , Resultado del Tratamiento
12.
Arthritis Rheum ; 47(2): 141-8, 2002 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-11954007

RESUMEN

OBJECTIVES: To document changes in lower extremity strength and balance over a 30-month period in older adults with chronic knee pain, and to identify relationships among these variables that may prove useful in designing a subsequent clinical intervention trial. METHODS: This longitudinal, 30-month, observational study was designed to examine the association of physical, psychological, social, and environmental factors with severity and progression of physical disability caused by chronic knee pain. This article will focus on 2 physical measures: strength and dynamic balance. The participants were a cohort of 480 adults 65 years of age or older with chronic knee pain. Measurements included: 1) force platform dynamic balance measure of the center of pressure excursion during a forward and subsequent backward lean, 2) isokinetic strength measures of concentric and eccentric knee flexion and extension, and concentric ankle plantar flexion and dorsiflexion, and 3) body mass index and a knee pain scale to measure obesity and knee pain, respectively. RESULTS: A maximum-likelihood analysis revealed an overall significant decline in knee (P < 0.001) and ankle (P = 0.012) strength, and balance (P < 0.001) after a 30-month followup period. Participants with greater knee strength at baseline had less expected decline in balance at followup than their weaker counterparts (4.2% versus 7.7% for the 75th versus 25th percentiles of strength; P = 0.023). However, the absolute decline in balance over 30 months was similar regardless of baseline ankle strength. CONCLUSIONS: Adults age >or=65 years with chronic knee pain experience significant declines in balance and lower extremity strength over a 30-month period. Moreover, greater knee and ankle muscular strength is associated with better balance. Previous studies have shown that weight training is effective in improving balance in older adults with knee osteoarthritis. Taken together, these studies present a strong rationale for incorporating weight training into an exercise prescription for older adults with chronic knee pain.


Asunto(s)
Tobillo/fisiopatología , Rodilla/fisiopatología , Músculo Esquelético/fisiopatología , Dolor/fisiopatología , Balance Postural/fisiología , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Progresión de la Enfermedad , Femenino , Humanos , Funciones de Verosimilitud , Estudios Longitudinales , Masculino , Osteoartritis de la Rodilla/fisiopatología
13.
Am J Geriatr Cardiol ; 4(4): 16-36, 1995 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-11416341

RESUMEN

Of all the risk factors to cardiovascular disease (CVD), age is the most powerful: CVD incidence and prevalence rise progressively at all ages beyond young adulthood. This reflects the central role of time, and hence duration, in the atherogenic process. It also reflects age-related changes in physiology - notably alterations in body mass and composition favoring increased adiposity and in sex hormone secretion (combining adverse effects of androgens on lipoprotein lipid levels in males, lowering HDL, and of the decline in estrogens in postmenopausal females, raising LDL). The interactions among the passage of time, these physiological changes and perhaps aging per se, and pathological forces such as cigarette smoking, hypertension, and genetically determined dyslipoproteinemia conspire to accelerate the rate of atherogenesis. Thus clinical atherosclerosis and its complications rise exponentially with increasing age in the population at large. However, the relationship between dyslipoproteinemia and CVD risk in the individual patient actually declines with advancing age. This apparent paradox reflects confounding introduced by the advent of disease processes that cause wasting and inflammation such as cancer, infection, diabetes, trauma, and even CVD that actually lower lipid levels, frequently to the level of hypocholesterolemia. Thus, while with age the population-attributable risk of hypercholesterolemia (and/or low HDL) rises, the cholesterol-attributable risk in the individual falls. As a result the prescription of lipid-lowering therapy in elderly patients requires exquisite individualization: patients most likely to benefit are those with existing CVD (i.e., in secondary prevention) who nevertheless enjoy robust health and are highly motivated to comply with demanding regimens of diet and exercise plus drugs where needed to reach target LDL levels (less than 100 mg/dl). At the other extreme are those least likely to benefit: patients who are frail and failing from CVD or other wasting diseases of old age that present a more immediate threat to survival.

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