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1.
Washington, D.C.; PAHO; 2021-04-06. (PAHO/EGC/COVID-19/21-0002).
en Inglés | PAHO-IRIS | ID: phr-53525

RESUMEN

This report summarizes the main demands and expectations presented by Afro-descendant leaders during the high-level meeting “The Impact of COVID-19 on Afro-Descendant Populations in the Region: Perspectives and Opportunities” held on 17 November 2020. The issues identified in this document correspond to the general considerations of the debate, which had also been raised in the three previous subregional technical consultations. These issues are presented broadly and are not intended to represent the priorities of all of the Afro-descendant communities in the Region. The problems identified and measures suggested to countries should consider the specific cultural characteristics and particular situations of Afro-descendant populations.


Asunto(s)
Infecciones por Coronavirus , Infecciones por Coronavirus , Betacoronavirus , Coronavirus , Servicios de Salud , Grupo de Ascendencia Continental Africana , Américas , Calidad de la Atención de Salud
2.
Washington, D.C.; PAHO; 2021-04-01. (PAHO/EGC/COVID-19/21-0001).
No convencional en Inglés | PAHO-IRIS | ID: phr-53428

RESUMEN

In order to continue creating opportunities for dialogue and implementing the universal health agenda in the COVID-19 response in indigenous populations, PAHO organized a high-level meeting on 30 October 2020 to move forward in drafting a road map to strengthen the COVID-19 response, highlighting the priorities, needs, and proposals raised by the indigenous populations, with an intercultural approach and in coordination with the indigenous peoples of the Region. This report summarizes the main perspectives and opportunities recognized during the high-level meeting, both by the indigenous leaders themselves and by representatives of some ministries of health of the Region. The issues identified are widely applicable to all of the indigenous populations; however, due to their important contextual and cultural differences, they should be considered using differentiated approaches, based on the special economic, social, political, and environmental features of each population.


Asunto(s)
Infecciones por Coronavirus , Coronavirus , Betacoronavirus , Infecciones por Coronavirus , Pueblos Indígenas , Salud de Poblaciones Indígenas , Grupos de Población , Servicios de Salud , Calidad de la Atención de Salud
3.
BMC Surg ; 21(1): 163, 2021 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-33765978

RESUMEN

BACKGROUND: This study aimed to identify socioeconomic predictors of permanent stoma in rectal cancer treatment and examine its association with length of stay at the treatment facility. METHODS: Rectal cancer patients who underwent elective surgery between January 2015 and December 2018 were identified from the Agency for Health Care Administration Florida Hospital Inpatient Discharge Dataset. Multivariate regression models were utilized to identify demographic and socioeconomic factors associated with receiving a permanent stoma as well as the associated length of stay of these patients. RESULTS: Of 2630 rectal cancer patients who underwent surgery for rectal cancer, 21% had a permanent stoma. The odds of receiving permanent stoma increased with higher Elixhauser score, metastatic disease, advanced age, having open surgery, residence in Southwest Florida, and having Medicaid insurance or no insurance/self-payers (p < 0.05). Patients with a permanent stoma had a significantly extended stay after surgery (p < 0.001). CONCLUSIONS: Patients with a permanent stoma following cancer resection were more likely to have open surgery, had more comorbidities, and had a longer length of stay. Having permanent stoma was higher in patients living in South West Florida, patients with Medicaid insurance, and in the uninsured. Additionally, the payer type significantly affected the length of stay.


Asunto(s)
Neoplasias del Recto , Estomas Quirúrgicos , Humanos , Tiempo de Internación/estadística & datos numéricos , Calidad de la Atención de Salud , Neoplasias del Recto/cirugía , Factores Socioeconómicos , Resultado del Tratamiento
4.
Soins ; 66(853): 10-14, 2021 Mar.
Artículo en Francés | MEDLINE | ID: mdl-33775293

RESUMEN

In a healthcare facility, the way in which health professionals envisage quality can explain the different levels of investment observed. Documentary research into the representations of quality among caregivers identified the human and regulatory dimensions which influence their engagement. It opens up prospects for the involvement of lead nurses for quality, trained in encouraging a change of perspectives and the appropriation of a quality culture.


Asunto(s)
Enfermeras y Enfermeros , Calidad de la Atención de Salud , Humanos , Enfermeras y Enfermeros/psicología , Calidad de la Atención de Salud/organización & administración
5.
Medicine (Baltimore) ; 100(11): e25133, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725994

RESUMEN

ABSTRACT: The purpose of this research was to identify whether a certain set of drivers of satisfaction/perceived quality of healthcare (PQHC) could indirectly affect patients' confidence/trust in the emergency department (ED).Patients were seen at an ED in the public hospital in Lisbon, Portugal between January and December 2016. Data were collected between May and November 2017, using a questionnaire, by mail or e-mail. The total sample size comprised 382 patients. The data analysis included structural equation modeling to test the conceptual model with specific drivers of satisfaction/PQHC (privacy; accessibility and availability; doctors; meeting expectations; waiting time for triage [perception]; waiting time to be called back by the doctor following examinations and/or tests [perception]; information about possible delays in receiving treatment/waiting times) and with the main outcome (confidence/trust in the ED) using path analysis.The analysis of the coefficients revealed that all the mediated paths are statistically significant (P ≤ .05). Although, altogether, the direct paths did not prove statistically significant (P > .05), the overall satisfaction with doctors (P ≤ .01) and meeting expectations (P = .01) can still directly explain the confidence/trust in the ED without the mediating role of satisfaction and PQHC. Hence, overall satisfaction with doctors and meeting expectations can influence, both directly and indirectly, confidence/trust in the ED. All other variables can only indirectly affect confidence/trust in the ED, either through PQHC or through satisfaction.Even though there are more variables that influence confidence/trust in the ED through PQHC (1)waiting time to be called back by the doctor following examinations and/or tests [perception]; 2) privacy; 3) accessibility and availability; 4) doctors; 5) meeting expectations than through satisfaction (1)waiting time for triage [perception]; 2) information about possible delays in receiving treatment/waiting times; 3) doctors; 4) meeting expectations), we observe the strongest contribution in the mediation model through satisfaction, which reveals its dominant role over PQHC.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicio de Urgencia en Hospital/normas , Aceptación de la Atención de Salud/psicología , Satisfacción del Paciente/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Encuestas de Atención de la Salud , Hospitales Públicos , Humanos , Masculino , Persona de Mediana Edad , Percepción , Portugal , Factores de Tiempo , Triaje/normas , Triaje/estadística & datos numéricos , Listas de Espera , Adulto Joven
6.
Laryngoscope ; 131 Suppl 4: S1-S42, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33729584

RESUMEN

OBJECTIVES/HYPOTHESIS: Facial nerve monitoring (FNM) has evolved into a widely used adjunct for many surgical procedures along the course of the facial nerve. Even though majority opinion holds that FNM reduces the incidence of iatrogenic nerve injury, there are few if any studies yielding high-level evidence and no practice guidelines on which clinicians can rely. Instead, a review of the literature and medicolegal cases reveals significant variations in methodology, training, and clinical indications. STUDY DESIGN: Literature review and expert opinion. METHODS: Given the lack of standard references to serve as a resource for FNM, we assembled a multidisciplinary group of experts representing more than a century of combined monitoring experience to synthesize the literature and provide a rational basis to improve the quality of patient care during FNM. RESULTS: Over the years, two models of monitoring have become well-established: 1) monitoring by the surgeon using a stand-alone device that provides auditory feedback of facial electromyography directly to the surgeon, and 2) a team, typically consisting of surgeon, technologist, and interpreting neurophysiologist. Regardless of the setting and the number of people involved, the reliability of monitoring depends on the integration of proper technical performance, accurate interpretation of responses, and their timely application to the surgical procedure. We describe critical steps in the technical set-up and provide a basis for context-appropriate interpretation and troubleshooting of recorded signals. CONCLUSIONS: We trust this initial attempt to describe best practices will serve as a basis for improving the quality of patient care while reducing inappropriate variations. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:S1-S42, 2021.


Asunto(s)
Electromiografía/métodos , Nervio Facial/fisiología , Nervio Facial/cirugía , Monitoreo Intraoperatorio/instrumentación , Guías de Práctica Clínica como Asunto/normas , Anciano , Lista de Verificación , Análisis Costo-Beneficio , Traumatismos del Nervio Facial/epidemiología , Traumatismos del Nervio Facial/prevención & control , Femenino , Humanos , Enfermedad Iatrogénica/epidemiología , Enfermedad Iatrogénica/prevención & control , Incidencia , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio/métodos , Neurofisiología/métodos , Neurofisiología/estadística & datos numéricos , Preceptoría/normas , Calidad de la Atención de Salud , Reproducibilidad de los Resultados
9.
N Z Med J ; 134(1531): 77-82, 2021 03 26.
Artículo en Inglés | MEDLINE | ID: mdl-33767479

RESUMEN

The Health and Disability System Review (the 'Simpson Review') was an opportunity for health sector transformation, particularly in light of the recent damning WAI 2575 Waitangi Tribunal report released during the review process. There appears to have been a concerted effort to engage with the sector, an impressive Maori Expert Advisory Group and an extensive body of available scholarship documenting where improvements could be made. In this viewpoint, the authors, tangata whenua (Indigenous people of the land) and tangata Tiriti (people of te Tiriti) and health scholars and leaders undertook a high-level review of the Simpson Review report and analysed it against key elements of te Tiriti o Waitangi. The Simpson Review was an opportunity to share power, commit to Maori health and embed structural mechanisms, such as the proposed Maori health authority, to uphold te Tiriti o Waitangi. It was also an opportunity to recommit to health equity and eliminate institutional racism. We conclude that the Simpson Review did not take up these opportunities, but instead perpetuated further breaches of te Tiriti.


Asunto(s)
Competencia Cultural , Equidad en Salud/normas , Accesibilidad a los Servicios de Salud/normas , Servicios de Salud del Indígena/normas , Grupo de Ascendencia Oceánica , Calidad de la Atención de Salud/normas , Humanos , Nueva Zelanda , Racismo/prevención & control
11.
Am J Med Qual ; 36(1): 5-16, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33764917

RESUMEN

Routine outpatient epilepsy care has shifted from in-person to telemedicine visits in response to safety concerns posed by the coronavirus disease 2019 (COVID-19) pandemic. But whether telemedicine can support and maintain standardized documentation of high-quality epilepsy care remains unknown. In response, the authors conducted a quality improvement study at a level 4 epilepsy center between January 20, 2019, and May 31, 2020. Weekly average completion proportion of standardized documentation used by a team of neurologists for adult patients for the diagnosis of epilepsy, seizure classification, and frequency were analyzed. By December 15, 2019, a 94% average weekly completion proportion of standardized epilepsy care documentation was achieved that was maintained through May 31, 2020. Moreover, during the period of predominately telemedicine encounters in response to the pandemic, the completion proportion was 90%. This study indicates that high completion of standardized documentation of seizure-related information can be sustained during telemedicine appointments for routine outpatient epilepsy care at a level 4 epilepsy center.


Asunto(s)
/epidemiología , Epilepsia/terapia , Telemedicina , Adulto , Femenino , Humanos , Masculino , Massachusetts/epidemiología , Persona de Mediana Edad , Calidad de la Atención de Salud , Telemedicina/métodos , Telemedicina/normas
12.
Soins ; 66(852): 53-54, 2021.
Artículo en Francés | MEDLINE | ID: mdl-33750562

RESUMEN

Nurses in the fire and rescue service have been providing emergency care to people for more than twenty years. Their practice is regulated by national emergency nursing care protocols drawn up by the relevant learned societies. Numerous training programmes and more recently, the possible use of telemedicine, help to ensure the quality of the emergency care provided to patients or victims.


Asunto(s)
Enfermería de Urgencia , Pautas de la Práctica en Enfermería , Enfermería de Urgencia/legislación & jurisprudencia , Francia , Humanos , Pautas de la Práctica en Enfermería/legislación & jurisprudencia , Calidad de la Atención de Salud , Telemedicina
13.
J Nurs Adm ; 51(4): 175-176, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33734173

RESUMEN

This month's Magnet® Perspectives column examines American Nurses Credentialing Center's Magnet Recognition Program® and Pathway to Excellence® Program as partners for nursing excellence. We explore the differences between the programs, how they complement one another, and how they can be combined to impact a host of key measures, including nurse engagement, interprofessional collaboration, and patient safety. Nursing leaders at 2 dual-designated hospitals share their decision to pursue both credentials and ways in which the combined designation adds value for nurses and the patient care environment. They discuss how the essential elements of a Magnet and Pathway culture contributed to a nimble, innovative response to the COVID-19 pandemic and strategies nursing leaders can employ to create and sustain an environment where change flourishes and nurses thrive.


Asunto(s)
Habilitación Profesional , Liderazgo , Personal de Enfermería en Hospital/normas , Humanos , Investigación en Evaluación de Enfermería , Cultura Organizacional , Calidad de la Atención de Salud
15.
J Nurs Adm ; 51(4): 179-181, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33734175

RESUMEN

This month's column highlights organizational, practice, and patient care advantages to adding advanced practice leaders to health systems' leadership teams and ideal characteristics of effective, executive advanced practice leaders.


Asunto(s)
Liderazgo , Atención al Paciente/normas , Calidad de la Atención de Salud , Gestión de la Calidad Total/organización & administración , Humanos , Relaciones Interprofesionales , Cultura Organizacional , Innovación Organizacional
16.
J Nurs Adm ; 51(4): 200-205, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33734179

RESUMEN

OBJECTIVE: The aim of this study was to examine the factors influencing job satisfaction of nurses, physicians, and advanced practice providers in ambulatory oncology settings. BACKGROUND: Job satisfaction is essential to clinician well-being and quality of care. METHODS: In 2017, clinicians from 29 ambulatory medical oncology practices completed anonymous paper questionnaires that examined job satisfaction, clinician-to-clinician communication, and perceptions of patient safety. Linear regression, adjusted for clustered observations, examined the relationship between job satisfaction, clinician communication, and patient safety perceptions. RESULTS: Of 280 respondents (response rate of 68%), 85% reported that they were satisfied or very satisfied with their current position. Patient safety and accuracy of clinician communication were positively and significantly associated with job satisfaction. CONCLUSIONS: Although most surveyed clinicians were satisfied, 15% were dissatisfied and reported communication and safety concerns. Leadership efforts to strengthen clinician communication actions and develop positive safety cultures are promising strategies to promote clinician well-being and high-quality cancer care.


Asunto(s)
Satisfacción en el Trabajo , Oncología Médica/organización & administración , Cuerpo Médico de Hospitales/psicología , Personal de Enfermería en Hospital/psicología , Grupo de Atención al Paciente/organización & administración , Adulto , Actitud del Personal de Salud , Femenino , Humanos , Relaciones Interprofesionales , Masculino , Persona de Mediana Edad , Seguridad del Paciente/estadística & datos numéricos , Calidad de la Atención de Salud
17.
Medicine (Baltimore) ; 100(12): e25211, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761706

RESUMEN

ABSTRACT: Measuring patient satisfaction scores and interpreting factors that impact their variation is of importance as scores influence various aspects of health care administration. Our objective was to evaluate if Press Ganey scores differ between medical specialties.New patient visits between January 2014 and December 2016 at a single tertiary academic center were included in this study. Press Ganey scores were compared between specialties using a multivariable logistic mixed effects model. Secondary outcomes included a comparison between surgical versus non-surgical specialties, and pediatric versus adult specialties. Due to the survey's high ceiling effect, satisfaction was defined as a perfect total score.Forty four thousand four hundred ninety six patients met inclusion criteria. Compared to internal medicine, plastic surgery, general surgery, dermatology, and family medicine were more likely to achieve a perfect overall score, as, with odds ratios of 1.46 (P = .02), 1.29 (P = .002), 1.22 (P = .004), and 1.16 (P = .02) respectively. Orthopaedics, pediatric medicine, pediatric neurology, neurology, and pain management were less likely to achieve satisfaction with odds ratios of 0.85 (P = .047), 0.71 (P < .001), 0.63 (P = .005), 0.57 (P < .001), and 0.51 (P = .006), respectively. Compared to pediatric specialties, adult specialties were more likely to achieve satisfaction (OR 1.73; P < .001). There were no significant differences between surgical versus non-surgical specialties.Press Ganey scores systematically differ between specialties within the studied institution. These differences should be considered by healthcare systems that use patient satisfaction data to modify provider reimbursement.


Asunto(s)
Medicina , Pacientes Ambulatorios/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Recolección de Datos , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Medicina/clasificación , Medicina/estadística & datos numéricos , Medición de Resultados Informados por el Paciente , Calidad de la Atención de Salud/normas , Proyectos de Investigación , Estados Unidos
18.
BMC Med ; 19(1): 71, 2021 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-33663498

RESUMEN

BACKGROUND: To estimate excess mortality for care home residents during the COVID-19 pandemic in England, exploring associations with care home characteristics. METHODS: Daily number of deaths in all residential and nursing homes in England notified to the Care Quality Commission (CQC) from 1 January 2017 to 7 August 2020. Care home-level data linked with CQC care home register to identify home characteristics: client type (over 65s/children and adults), ownership status (for-profit/not-for-profit; branded/independent) and size (small/medium/large). Excess deaths computed as the difference between observed and predicted deaths using local authority fixed-effect Poisson regressions on pre-pandemic data. Fixed-effect logistic regressions were used to model odds of experiencing COVID-19 suspected/confirmed deaths. RESULTS: Up to 7 August 2020, there were 29,542 (95% CI 25,176 to 33,908) excess deaths in all care homes. Excess deaths represented 6.5% (95% CI 5.5 to 7.4%) of all care home beds, higher in nursing (8.4%) than residential (4.6%) homes. 64.7% (95% CI 56.4 to 76.0%) of the excess deaths were confirmed/suspected COVID-19. Almost all excess deaths were recorded in the quarter (27.4%) of homes with any COVID-19 fatalities. The odds of experiencing COVID-19 attributable deaths were higher in homes providing nursing services (OR 1.8, 95% CI 1.6 to 2.0), to older people and/or with dementia (OR 5.5, 95% CI 4.4 to 6.8), amongst larger (vs. small) homes (OR 13.3, 95% CI 11.5 to 15.4) and belonging to a large provider/brand (OR 1.2, 95% CI 1.1 to 1.3). There was no significant association with for-profit status of providers. CONCLUSIONS: To limit excess mortality, policy should be targeted at care homes to minimise the risk of ingress of disease and limit subsequent transmission. Our findings provide specific characteristic targets for further research on mechanisms and policy priority.


Asunto(s)
Servicios de Salud para Ancianos , Hogares para Ancianos/estadística & datos numéricos , Casas de Salud/estadística & datos numéricos , Calidad de la Atención de Salud , Instituciones Residenciales/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , /prevención & control , Estudios de Cohortes , Inglaterra/epidemiología , Femenino , Necesidades y Demandas de Servicios de Salud , Servicios de Salud para Ancianos/organización & administración , Servicios de Salud para Ancianos/normas , Humanos , Masculino , Mortalidad
19.
J Health Care Poor Underserved ; 32(1): 137-144, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33678686

RESUMEN

The COVID-19 pandemic has brought about a precipitous transformation in health care delivery in the nation's safety-net, primary care system of federally qualified health centers (FQHCs). This study uses electronic health record data to quantify the extent of changes to visit volume in 36 FQHCs across 19 states as well as changes in quality metrics. We found a steep decline in in-person visits in March 2020 accompanied by a sharp increase in telehealth visits; however, combined volume remained 23% below pre-pandemic levels. The implications for public health are significant, as preventive and chronic care deferral could lead to exacerbations of health disparities. Our examination of the impact on quality measures suggests that gaps in care are already emerging. Services that cannot be readily performed virtually are most affected. As FQHC visit numbers recover, concerted efforts are needed to encourage access and re-engage at-risk groups that fell out of care.


Asunto(s)
Registros Electrónicos de Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Calidad de la Atención de Salud , Proveedores de Redes de Seguridad/estadística & datos numéricos , Atención Odontológica/tendencias , Gobierno Federal , Humanos , Proveedores de Redes de Seguridad/normas , Telemedicina/tendencias , Estados Unidos
20.
Front Public Health ; 9: 640598, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33681137

RESUMEN

Developing countries struggle to provide high-quality, equitable care to all. Challenges of resource allocation frequently lead to ethical concerns of healthcare inequity. To tackle this, such developing nations continually need to implement healthcare innovation, coupled with capacity building to ensure new strategies continue to be developed and executed. The COVID-19 pandemic has made significant demands of healthcare systems across the world-to provide equitable healthcare to all, to ensure public health principles are followed, to find novel solutions for previously unencountered healthcare challenges, and to rapidly develop new therapeutics and vaccines for COVID-19. Countries worldwide have struggled to accomplish these demands, especially the latter two, considering that few nations had long-standing systems in place to ensure processes for innovation were on-going before the pandemic struck. The crisis represents a critical juncture to plan for a future. This future needs to incorporate a vision for the implementation of healthcare innovation, coupled with capacity building to ensure new strategies continue to be developed and executed. In this paper, the case of the massive Indian healthcare system is utilized to describe how it could implement this vision. An inclusive, ethically-resilient framework has been broadly laid out for healthcare innovation in the future, thereby ensuring success in both the short- and the long-term.


Asunto(s)
Prestación de Atención de Salud , Planificación en Salud , Innovación Organizacional , Creación de Capacidad , Difusión de Innovaciones , Política de Salud , Humanos , India , Aprendizaje Automático , Salud Pública , Calidad de la Atención de Salud
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