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1.
Urol Clin North Am ; 48(2): 259-268, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33795060

RESUMEN

The Quality Payment Program was established by the Medicare Access and CHIP Reauthorization Act (MACRA) legislation in response to repeated efforts to create a permanent so-called doc fix in response to the failures of the sustainable growth formula. This article examines the history leading up to MACRA, the current pathways associated with the Quality Payment Program, and future expectation both from the Centers for Medicare and Medicaid Services, stakeholders, and patients.


Asunto(s)
Medicare/economía , Planes de Incentivos para los Médicos/economía , Reembolso de Incentivo/economía , Urólogos/economía , Centers for Medicare and Medicaid Services, U.S. , Predicción , Humanos , Indicadores de Calidad de la Atención de Salud , Estados Unidos
2.
Rev Col Bras Cir ; 48: e20202769, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33656134

RESUMEN

PURPOSE: to analyze the relation between Trauma Quality Indicators (QI) and death, as well as clinical adverse events in severe trauma patients. METHODS: analysis of data collected in the Trauma Register between 2014-2015, including patients with Injury Severity Score (ISS) > 16, reviewing the QI: (F1) Acute subdural hematoma drainage > 4 hours with Glasgow Coma Scale (GCS) <9; (F2) emergency room transference without definitive airway and GCS <9; (F3) Re-intubation within 48 hours; (F4) Admission-laparotomy time greater than 60 min in hemodynamically instable patients with abdominal bleeding; (F5) Unprogrammed reoperation; (F6) Laparotomy after 4 hours; (F7) Unfixed femur diaphyseal fracture; (F8) Non-operative treatment for abdominal gunshot; (F9) Admission-tibial exposure fracture treatment time > 6 hours; (F10) Surgery > 24 hours. T the chi-squared and Fisher tests were used to calculate statistical relevance, considering p<0.05 as relevant. RESULTS: 127 patients were included, whose ISS ranged from 17 to 75 (28.8 + 11.5). There were adverse events in 80 cases (63%) and 29 died (22.8%). Twenty-six patients had some QI compromised (20.6%). From the 101 patients with no QI, 22% died, and 7 of 26 patients with compromised QI (26.9%) (p=0.595). From the patients with no compromised QI, 62% presented some adverse event. From the patients with any compromised QI, 18 (65.4%) had some adverse event on clinical evolution (p=0.751). CONCLUSION: the QI should not be used as death or adverse events predictors in severe trauma patients.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Hemorragia , Indicadores de Calidad de la Atención de Salud , Adolescente , Adulto , Anciano , Escala de Coma de Glasgow , Humanos , Puntaje de Gravedad del Traumatismo , Persona de Mediana Edad , Estudios Retrospectivos , Índices de Gravedad del Trauma , Adulto Joven
3.
Orv Hetil ; 162(11): 413-418, 2021 03 14.
Artículo en Húngaro | MEDLINE | ID: mdl-33714939

RESUMEN

Összefoglaló. Bevezetés: Az akut pancreatitis az egyik leggyakoribb kórházi felvételt igénylo gastrointestinalis kórkép. A korai visszavételi arány egyrészt az ellátást jellemzo minoségi mutató, másrészt az akut pancreatitis 1 éves mortalitásának legerosebb prognosztikai faktora. Célkituzés: A korai visszavétel arányának, illetve okainak vizsgálata klinikánkon akut pancreatitis diagnózisával kezelt betegek körében. Módszerek: Retrospektív vizsgálatunkat azon 18 év feletti betegek körében végeztük, akiket a 2010. január és 2018. december közötti idoszakban akut pancreatitis diagnózisával kezeltünk klinikánkon, és az elso emissziótól számítva 30 napon belül újból felvételre kerültek. A betegek adatait az Akut Pancreatitis Regiszter és a betegnyilvántartó rendszer (MedSol ) segítségével gyujtöttük össze. A biliaris, illetve nem biliaris akut pancreatitises eseteket hasonlítottuk össze az epidemiológiai adatok, a visszavétel oka, a visszavételig eltelt átlagos idotartam, és a visszavétel idotartama, valamint kimenetele vonatkozásában. Eredmények: Akut pancreatitis diagnózisával 647 beteg került felvételre. Közülük 28 beteg került újrafelvételre. A leggyakoribb okok között 1) peripancreaticus szövodmények, 2) epés panaszok és 3) az akut pancreatitis kiújulása szerepel. A biliaris és a nem biliaris pancreatitises eseteket összehasonlítva, a visszavétel oka epés panasz volt az elobbi csoport 65,5%-ában és az utóbbi 15%-ában. A középsúlyos pancreatitises esetek száma szignifikánsan magasabbnak adódott a nem biliaris csoportban. Következtetés: A középsúlyos/súlyos pancreatitises esetek aránya magasabb volt a nem biliaris pancreatitises csoportban. Biliaris pancreatitis esetén javasolt index-cholecystectomia végzése. Orv Hetil. 2021; 162(11): 413-418. INTRODUCTION: Acute pancreatitis is the leading cause of hospitalization among gastrointestinal diseases. The early readmission rate is a quality marker and the strongest prognostical factor of 1-year mortality of acute pancreatitis. OBJECTIVE: To investigate the rate and cause of early readmission among patients treated with acute pancreatitis at our clinic. METHODS: Our retrospective study was conducted among patients (>18 years) treated with acute pancreatitis between January 2010 and December 2018 at our clinic, by whom unplanned readmission happened <30 days from emission. Personal data were collected from the Hungarian Pancreas Registry. Data of biliary and non-biliary acute pancreatitis cases were compared concerning epidemiological data, cause of readmission, mean time elapsed until readmission, its duration and outcome. RESULTS: 647 patients were diagnosed with acute pancreatitis. Of them, 28 patients had early readmission. The most common causes were 1) local pancreatic complications, 2) biliary and 3) recurrence of acute pancreatitis. By investigating the biliary and non-biliary pancreatitis cases separately, the cause of readmission was biliary in 65.5% and 15%, respectively. The number of moderately severe pancreatitis cases was significantly higher in the non-biliary group. CONCLUSION: The proportion of moderate/severe diseases was higher in the non-biliary pancreatitis group. In the case of biliary pancreatitis, it is suggested to perform index cholecystectomy. Orv Hetil. 2021; 162(11): 413-418.


Asunto(s)
Pancreatitis , Readmisión del Paciente , Indicadores de Calidad de la Atención de Salud , Enfermedad Aguda , Adulto , Humanos , Hungría , Pancreatitis/terapia , Readmisión del Paciente/estadística & datos numéricos , Estudios Retrospectivos
4.
Medicine (Baltimore) ; 100(8): e24755, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663091

RESUMEN

ABSTRACT: Health information technology (IT) is often proposed as a solution to fragmentation of care, and has been hypothesized to reduce readmission risk through better information flow. However, there are numerous distinct health IT capabilities, and it is unclear which, if any, are associated with lower readmission risk.To identify the specific health IT capabilities adopted by hospitals that are associated with hospital-level risk-standardized readmission rates (RSRRs) through path analyses using structural equation modeling.This STROBE-compliant retrospective cross-sectional study included non-federal U.S. acute care hospitals, based on their adoption of specific types of health IT capabilities self-reported in a 2013 American Hospital Association IT survey as independent variables. The outcome measure included the 2014 RSRRs reported on Hospital Compare website.A 54-indicator 7-factor structure of hospital health IT capabilities was identified by exploratory factor analysis, and corroborated by confirmatory factor analysis. Subsequent path analysis using Structural equation modeling revealed that a one-point increase in the hospital adoption of patient engagement capability latent scores (median path coefficient ß = -0.086; 95% Confidence Interval, -0.162 to -0.008), including functionalities like direct access to the electronic health records, would generally lead to a decrease in RSRRs by 0.086%. However, computerized hospital discharge and information exchange capabilities with other inpatient and outpatient providers were not associated with readmission rates.These findings suggest that improving patient access to and use of their electronic health records may be helpful in improving hospital performance on readmission; however, computerized hospital discharge and information exchange among clinicians did not seem as beneficial - perhaps because of the quality or timeliness of information transmitted. Future research should use more recent data to study, not just adoption of health IT capabilities, but also whether their usage is associated with lower readmission risk. Understanding which capabilities impact readmission risk can help policymakers and clinical stakeholders better focus their scarce resources as they invest in health IT to improve care delivery.


Asunto(s)
Hospitales/estadística & datos numéricos , Informática Médica/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Estudios Transversales , Registros Electrónicos de Salud/estadística & datos numéricos , Capacidad de Camas en Hospitales , Humanos , Acceso de los Pacientes a los Registros/estadística & datos numéricos , Participación del Paciente/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Características de la Residencia , Estudios Retrospectivos , Estados Unidos
6.
Int J Qual Health Care ; 33(1)2021 Mar 09.
Artículo en Inglés | MEDLINE | ID: mdl-33644795

RESUMEN

OBJECTIVE: To identify how features of the community in which a hospital serves differentially relate to its patients' experiences based on the quality of that hospital. DESIGN: A Finite Mixture Model (FMM) is used to uncover a mix of two latent groups of hospitals that differ in quality. In the FMM, a multinomial logistic equation relates hospital-level factors to the odds of being in either group. And a multiple linear regression relates the characteristics of communities served by hospitals to the patients' expected ratings of their experiences at hospitals in each group. Thus, this association potentially varies with hospital quality. The analysis was conducted via Stata. SETTING: Hospital Ratings are measured by Hospital Compare using the HCAHPS survey, a patient satisfaction survey required by the Centers for Medicare and Medicaid Services (CMS) for hospitals in the United States. Participants: 2,816 Medicare-certified acute care hospitals across all US states.


Asunto(s)
/epidemiología , Centers for Medicare and Medicaid Services, U.S./normas , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Factores Socioeconómicos , Factores de Edad , Femenino , Humanos , Modelos Lineales , Masculino , Satisfacción del Paciente/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores Sexuales , Estados Unidos/epidemiología
7.
Mar Pollut Bull ; 164: 112081, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33524833

RESUMEN

Short term stress experiments with dissolved inorganic phosphorus (DIP) and tripolyphosphate (TPP) have been carried out on the staghorn coral Acropora intermedia, collected from Heron Island in the southern Great Barrier Reef, at low and elevated seawater temperatures. Zooxanthellae, chlorophyll a, intracellular and tissue dimethylsulfoniopropionate (DMSP), and extracellular DMSP production were measured to assess the level of stress on A. intermedia at different winter and summer seasons from 2001 to 2003. Whilst no significant changes were measured in these stress indicators in 2001 and 2003, significant changes occurred in winter 2002, reflecting natural stresses on A. intermedia in the field, and stress from added DIP and TPP at high seawater temperatures. These stresses caused corals to bleach, whilst extracellular DMSP, intracellular and tissue DMSP concentrations increased, reflecting the antioxidant role of DMSP in the coral zooxanthellae and coral host to combat stress. These results have important implications for future research in the GBR.


Asunto(s)
Antozoos , Animales , Clorofila A , Arrecifes de Coral , Indicadores de Calidad de la Atención de Salud , Compuestos de Sulfonio
8.
J Surg Oncol ; 123(4): 986-996, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33577718

RESUMEN

BACKGROUND: There has been a growing trend toward minimally invasive surgery (MIS) for colon cancer. Pathological analysis of a minimum of 12 lymph nodes (LNs) is a benchmark for adequate resection. Here, we present a comparison of surgical techniques in achieving a full oncologic resection. METHODS: Patients undergoing surgery for Stage I-III colon cancer (2010-2016) were identified from the National Cancer Database. Cases were stratified by surgical approach. Trends in approach were assessed, including whether the 12-LN benchmark was met. Uni- and multivariate regression was used to assess overall survival (OS). RESULTS: A total of 290,776 colectomies were analyzed. MIS increased from 32.8% to 57.2% from 2010 to 2016 (p < .001). An overall median of 18 LNs were harvested and compliance with the 12-LN benchmark increased (84.6%-91.6%, p < .001); there were no difference between open and MIS. A subset analysis comparing hospital type revealed that regardless of approach, compliance was lower at community hospitals (p < .001). OS was better for patients treated at academic or National Cancer Institute centers, underwent MIS, and in those meeting the 12-LN benchmark (all p ≤ .002). CONCLUSION: As MIS colon resections continue to increase, we demonstrate that there is no difference in the ability to achieve the 12-LN benchmark with open and MIS approaches.


Asunto(s)
Colectomía/mortalidad , Neoplasias del Colon/cirugía , Laparoscopía/mortalidad , Escisión del Ganglio Linfático/mortalidad , Ganglios Linfáticos/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/mortalidad , Indicadores de Calidad de la Atención de Salud , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias del Colon/patología , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Hospitales Comunitarios , Humanos , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Adulto Joven
9.
Lancet Glob Health ; 9(3): e331-e339, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33607031

RESUMEN

BACKGROUND: Many governments have introduced pay-for-performance programmes to incentivise health providers to improve quality of care. Evidence on whether these programmes reduce or exacerbate disparities in health care is scarce. In this study, we aimed to assess socioeconomic inequalities in the performance of family health teams under Brazil's National Programme for Improving Primary Care Access and Quality (PMAQ). METHODS: For this longitudinal study, we analysed data on the quality of care delivered by family health teams participating in PMAQ over three rounds of implementation: round 1 (November, 2011, to March, 2013), round 2 (April, 2013, to September, 2015), and round 3 (October, 2015, to December, 2019). The primary outcome was the percentage of the maximum performance score obtainable by family health teams (the PMAQ score), based on several hundred (ranging from 598 to 914) indicators of health-care delivery. Using census data on household income of local areas, we examined the PMAQ score by income ventile. We used ordinary least squares regressions to examine the association between PMAQ scores and the income of each local area across implementation rounds, and we did an analysis of variance to assess geographical variation in PMAQ score. FINDINGS: Of the 40 361 family health teams that were registered as ever participating in PMAQ, we included 13 934 teams that participated in the three rounds of PMAQ in our analysis. These teams were located in 11 472 census areas and served approximately 48 million people. The mean PMAQ score was 61·0% (median 61·8, IQR 55·3-67·9) in round 1, 55·3% (median 56·0, IQR 47·6-63·4) in round 2, and 61·6% (median 62·7, IQR 54·4-69·9) in round 3. In round 1, we observed a positive socioeconomic gradient, with the mean PMAQ score ranging from 56·6% in the poorest group to 64·1% in the richest group. Between rounds 1 and 3, mean PMAQ performance increased by 7·1 percentage points for the poorest group and decreased by 0·8 percentage points for the richest group (p<0·0001), with the gap between richest and poorest narrowing from 7·5 percentage points (95% CI 6·5 to 8·5) to -0·4 percentage points over the same period (-1·6 to 0·8). INTERPRETATION: Existing income inequalities in the delivery of primary health care were eliminated during the three rounds of PMAQ, plausibly due to a design feature of PMAQ that adjusted financial payments for socioeconomic inequalities. However, there remains an important policy agenda in Brazil to address the large inequities in health. FUNDING: UK Medical Research Council, Newton Fund, and CONFAP (Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa).


Asunto(s)
Salud de la Familia/normas , Atención Primaria de Salud/organización & administración , Calidad de la Atención de Salud/organización & administración , Reembolso de Incentivo/estadística & datos numéricos , Brasil , Disparidades en Atención de Salud/economía , Disparidades en Atención de Salud/normas , Humanos , Estudios Longitudinales , Grupo de Atención al Paciente/organización & administración , Atención Primaria de Salud/economía , Atención Primaria de Salud/normas , Indicadores de Calidad de la Atención de Salud , Calidad de la Atención de Salud/economía , Calidad de la Atención de Salud/normas , Factores Socioeconómicos
10.
BMC Neurol ; 21(1): 76, 2021 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-33596841

RESUMEN

BACKGROUND: In contrast to the hospital setting, today little work has been directed to the definition, measurement, and improvement of the quality of out-patient medical and therapeutic care. We developed a set of indicators to measure the quality of out-patient neuropsychological therapy after stroke. METHODS: The indicators cover core and interdisciplinary aspects of out-patient neuropsychological work such as mediation of patients into social care in case of need. Selection of the quality-indicators was done together with a consensus group of out-patient therapists and supported by evidence, validity, reliability as well as estimated relevance and variability with the quality of care. The set of indicators was further tested in a retrospective cohort study. Anonymous data of 104 patients were collected from out-patient clinical records of five clinics between November 2017 and April 2018. Associations between process and outcome quality were estimated exploitatively. RESULTS: Results allowed for the identification of areas with greater variability in the quality of process care and indicated that attention training as recommended by current guidelines had the lowest overall rate for meeting the quality-aim (met in 44% of the cases). This was followed by time < 1 month until the start of therapy (63% met) and mediation into social care in case of need (65% met). We further observed that overall quality and involving relatives in the therapy was associated with higher rates of professional reintegration (p-value = 0.03). However, the need for mediation into social care was associated with a reduced chance for successful professional reintegration (p-value = 0.009). CONCLUSION: In conclusion, we describe a first set of quality indicators which cover different aspects of out-patient neuropsychological therapy and sufficient variability with care. First data further suggests that meeting the specified quality aims may indeed have relevant effects on outcomes.


Asunto(s)
Atención Ambulatoria/normas , Psicoterapia/normas , Rehabilitación de Accidente Cerebrovascular/normas , Accidente Cerebrovascular/terapia , Adulto , Anciano , Anciano de 80 o más Años , Consenso , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Neuropsicología , Evaluación de Procesos y Resultados en Atención de Salud , Proyectos Piloto , Indicadores de Calidad de la Atención de Salud , Reproducibilidad de los Resultados , Estudios Retrospectivos , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/psicología
12.
Int J Qual Health Care ; 33(1)2021 Mar 03.
Artículo en Inglés | MEDLINE | ID: mdl-33620065

RESUMEN

BACKGROUND: The effects of an early and prolonged lockdown during the coronavirus disease 2019 (COVID-19) pandemic on cardiovascular intensive care units (CICUs) are not well established. OBJECTIVES: This study analyses patterns of admission, mortality and performance indicators in a CICU before and during the Argentine lockdown in the COVID-19 pandemic. METHODS: This is a retrospective observational cross-sectional study of all consecutive patients aged 18 years or more admitted to the cardiac intensive care unit at a high-volume reference hospital in Buenos Aires, Argentina, comparing hospitalization rates, primary causes of admission, inpatient utilization indicators, pharmacy supplies' expenditures and in-hospital mortality between 5 March and 31 July 2020, with two corresponding control periods in 2019 and 2018. RESULTS: We included 722 female patients [mean age of 61.6 (SD 15.5) years; 237 (32.8%)]. Overall hospitalizations dropped 53.2% (95%CI: 45.3, 61.0%), from 295.5 patients/year over the periods 2018/2019 to 137 patients in 2020. Cardiovascular disease-related admissions dropped 59.9%, while admission for non-cardiac causes doubled its prevalence from 9.6% over the periods 2018/2019 to 22.6% in the study period (P < 0.001).In the period 2020, the bed occupancy rate fell from 82.2% to 77.4%, and the bed turnover rate dropped 50% from 7.88 to 3.91 monthly discharges/bed. The average length of stay doubled from 3.26 to 6.75 days, and the turnover interval increased from 3.8 to 8.39 days in 2020.Pharmacy supplies' expenditures per discharge increased 134% along with a rise in antibiotics usage from 6.5 to 11.4 vials/ampoules per discharge (P < 0.02).Overall mortality increased from 7% (n = 41) to 13.9% (n = 19) (P = 0.008) at the expense of non-cardiac-related admissions (3.6-19.4%, P = 0.01). CONCLUSIONS: This study found a significant reduction in overall and cardiovascular disease-related causes of admission to the cardiac intensive care unit, worse performance indicators and increased in-hospital mortality along the first 5 months of the early and long-lasting COVID-19 lockdown in Argentina. These results highlight the need to foster public awareness concerning the risks of avoiding hospital attendance. Moreover, health systems should follow strict screening protocols to prevent potential biases in the admission of patients with critical conditions unrelated to the COVID-19 pandemic.


Asunto(s)
/epidemiología , Enfermedades Cardiovasculares/epidemiología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Adulto , Anciano , Argentina/epidemiología , Ocupación de Camas/estadística & datos numéricos , Estudios Transversales , Femenino , Política de Salud , Mortalidad Hospitalaria/tendencias , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pandemias , Servicio de Farmacia en Hospital/economía , Servicio de Farmacia en Hospital/estadística & datos numéricos , Estudios Retrospectivos
13.
Z Evid Fortbild Qual Gesundhwes ; 160: 21-33, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33483285

RESUMEN

BACKGROUND: Recommendations of evidence- and formally consensus-based clinical practice guidelines (CPGs) represent a valuable source of quality indicators (QIs). Nevertheless, a standardized methodological procedure for developing QIs in the context of CPGs does not yet exist in Germany for all CPGs. For this reason, a methodological standard for the guideline-based development of QIs (QI Standard) was developed based on a structured consensus process involving multiple key stakeholders. METHODS: The proposed content of the QI Standard was derived from evidence, drawing upon results of reviews and qualitative studies, and considered German manuals for guideline-based QI development of two guideline programs. A multi-perspective consensus panel, broadly representing key stakeholders from the German healthcare system with expertise in CPGs and/or quality management, was nominated to vote on recommendations for guideline-based development of QIs. The iterative, structured consensus process included a two-stage online survey based on the Delphi method ("preliminary voting") and a moderated final stakeholder conference where all those recommendations were definitely included in the QI Standard that received approval of more than 75 % (consensus criterion) of the consensus panel. RESULTS: Based on the agreed QI Standard, the QI development process starts with a criteria-based selection of "potential" QIs which - in case of adoption - are published in CPGs as "preliminary" QIs and can achieve the status "final" after successful testing. The QI Standard is composed of a total of 30 recommendations, which are allocated to six areas: A) preparatory work steps for the guideline-based recommendation of QIs, B) QI development group and cooperation with the CPG group, C) development of potential QIs, D) critical appraisal of potential QIs, E) formal adoption and publication as well as F) piloting/testing of preliminary QIs and conversion into final QIs. DISCUSSION: Before the QI Standard can be recommended for implementation in future CPGs, it should have been successfully tested in selected German CPG projects. In addition to methodological requirements for the QI development, it must be ensured that guideline groups have adequate resources for the implementation of the QI Standard. CONCLUSION: By using the QI Standard, scientifically sound and healthcare-relevant QIs can be expected.


Asunto(s)
Prestación de Atención de Salud , Guías de Práctica Clínica como Asunto , Indicadores de Calidad de la Atención de Salud , Consenso , Alemania , Estándares de Referencia
14.
Am J Nurs ; 121(2): 46-52, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33497127

RESUMEN

PURPOSE: The purpose of this project was to examine whether initiating a standardized pressure injury (PI) assessment and prevention protocol early in adult patients' ED stay reduces hospital-acquired PIs (HAPIs) in those patients admitted from the ED to acute care inpatient medical units. METHODS: A nurse-led evidence-based practice team studied the problem of increasing HAPIs on four acute care inpatient units and found that, among patients who had been admitted to inpatient care from the ED, longer ED boarding times correlated with a higher rate of HAPIs. ED staff and acute care unit nurses collaborated to develop new protocols to prevent HAPIs in the ED, including staff education and standardized assessments and prevention care for at-risk patients. Data collection was performed at three time periods over approximately two and a half years: baseline, intervention, and postintervention. RESULTS: The incidence rate for HAPIs decreased from 3.56 per 1,000 patient-days at baseline to 1.31 per 1,000 patient-days during the intervention period. This reduction was sustained over the next five months, during which the HAPI incidence rate was 1.53 per 1,000 patient-days. IMPLICATIONS: At a time when ED length of stay is difficult to manage and continues to increase, the use of evidence-based interventions and protocols can reduce the rate of PIs in high-risk patients waiting for hospital admission, leading to a reduction in PI rates and overall hospital costs.


Asunto(s)
Admisión del Paciente/normas , Úlcera por Presión/prevención & control , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , California , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/normas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Enfermedad Iatrogénica/prevención & control , Tiempo de Internación/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos
15.
Artículo en Alemán | MEDLINE | ID: mdl-33412600

RESUMEN

Goal-oriented quality management in health care is an essential tool to provide good medical practice and treatment. It aims at a patient-centred case management with high transparency of structural and clinical process aspects, as well as patient outcome. An objective and comprehensive description of clinical care includes the use of quality indicators. However, the appliance of those indicators falls short, when the evaluation of quality is not followed by recommendations for improvement.As a highly specified area in health care provided in hospitals, intensive care medicine is characterized by complex interprofessional and multidisciplinary approaches. In addition, critical care units are an expensive resource. In order to provide an economic and yet high quality patient care, treatments should be evidence-based, and cost-drivers must be analysed for their effectiveness on patient-outcome.Various methods of quality assurance allow for a formative evaluation of intensive care units by peer reviews, including the use of quality indicators. This article focuses on peer review systems currently applied in German hospitals, and particularly describes quality indicators that have been established by DIVI (German Interdisciplinary Society of Intensive Care and Emergency Medicine). It also addresses the need for a professional dialogue between equal partners. This has to accompany each peer review that aims at an improvement in quality of critical patient care.


Asunto(s)
Medicina , Indicadores de Calidad de la Atención de Salud , Cuidados Críticos , Humanos , Unidades de Cuidados Intensivos , Revisión por Pares
17.
J Thorac Cardiovasc Surg ; 161(3): 1155-1166.e9, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33419533

RESUMEN

OBJECTIVE: Unplanned reintervention (uRE) is used as an indicator of patient morbidity and quality of care in pediatric cardiac surgery. We investigated associated factors and early mortality after uREs. METHODS: Morbidity data were prospectively collected in 5 UK centers between 2015 and 2017; uRE included surgical cardiac, interventional transcatheter cardiac, permanent pacemaker, and diaphragm plication procedures. Mortality (30-day and 6-month) in uRE/no-uRE patients was reported before and after matching. Predicted 30-day mortality was calculated using the Partial Risk Adjustment in Surgery score. RESULTS: A total of 3090 procedures (2861 patients) were included (median age, 228 days). There were 146 uREs, resulting in an uRE rate of 4.7%. Partial Risk Adjustment in Surgery score, 30-day mortality and 6-month mortality in uRE and no-uRE groups were 2.4% versus 1.3%, 8.9% versus 1%, and 17.1% versus 2.4%, respectively. After matching, mortality at 6 months remained higher in uRE compared with no-uRE (12.2% vs 1.4%; P = .02; 74 pairs). In the uRE group, 21 out of 25 deaths at 6 months occurred when at least 1 additional postoperative complication was present. In multivariable analysis, neonatal age (P = .002), low weight (P = .009), univentricular heart (P < .001), and arterial shunt (P < .001) were associated with increased risk of uRE, but Partial Risk Adjustment in Surgery score was not (only in univariable analysis). CONCLUSIONS: uREs are a relatively frequent complication after pediatric cardiac surgery and are associated with some patient characteristics, but not the Partial Risk Adjustment in Surgery risk score. Early mortality was higher after uRE, independent of preoperative factors, but linked to other postoperative complications.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/mortalidad , Cardiopatías Congénitas/cirugía , Complicaciones Posoperatorias/cirugía , Reoperación/mortalidad , Adolescente , Factores de Edad , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Niño , Preescolar , Femenino , Cardiopatías Congénitas/mortalidad , Humanos , Lactante , Recién Nacido , Masculino , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Indicadores de Calidad de la Atención de Salud , Reoperación/efectos adversos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Reino Unido
18.
Artículo en Inglés | MEDLINE | ID: mdl-33478066

RESUMEN

An increasingly frail population in nursing homes accentuates the need for high quality care at the end of life and better access to palliative care in this context. Implementation of palliative care and its outcomes can be monitored by using quality indicators. Therefore, we developed a quality indicator set for palliative care in nursing homes and a tailored measurement procedure while using a mixed-methods design. We developed the instrument in three phases: (1) literature search, (2) interviews with experts, and (3) indicator and measurement selection by expert consensus (RAND/UCLA). Second, we pilot tested and evaluated the instrument in nine nursing homes in Flanders, Belgium. After identifying 26 indicators in the literature and expert interviews, 19 of them were selected through expert consensus. Setting-specific themes were advance care planning, autonomy, and communication with family. The quantitative and qualitative analyses showed that the indicators were measurable, had good preliminary face validity and discriminative power, and were considered to be useful in terms of quality monitoring according to the caregivers. The quality indicators can be used in a large implementation study and process evaluation in order to achieve continuous monitoring of the access to palliative care for all of the residents in nursing homes.


Asunto(s)
Cuidados Paliativos , Indicadores de Calidad de la Atención de Salud , Bélgica , Humanos , Casas de Salud , Proyectos Piloto
19.
J Stroke Cerebrovasc Dis ; 30(3): 105586, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33412397

RESUMEN

OBJECTIVES: How race/ethnic disparities in acute stroke care contribute to disparities in outcomes is not well-understood. We examined the relationship between acute stroke care measures with mortality within the first year and 30-day hospital readmission by race/ethnicity. MATERIALS AND METHODS: The study included fee-for-service Medicare beneficiaries age ≥65 with ischemic stroke in 2010-2013 treated at 66 hospitals in the Florida Stroke Registry. Stroke care metrics included intravenous Alteplase treatment, in-hospital antithrombotic therapy, DVT prophylaxis, discharge antithrombotic therapy, anticoagulation therapy, statin use, and smoking cessation counseling. We used mixed logistic models to assess the associations between stroke care and mortality (in-hospital, 30-day, 6-month, 1-year post-stroke) and hospital readmission by race/ethnicity, adjusting for demographics, stroke severity, and vascular risk factors. RESULTS: Among 14,100 ischemic stroke patients in the full study population (73% white, 11% Black, 15% Hispanic), mortality was 3% in-hospital, 12% at 30d, 21% at 6m, 26% at 1y, and 15% had a hospital readmission within 30 days. Patients who received antithrombotics early and at discharge had lower mortality at all time points, and the protective association for early antithrombotic use was strongest among whites. Eligible patients who received statin therapy at discharge had decreased 6m and 1y mortality, but specifically among minority groups. Statin therapy was associated with lower 30-day hospital readmission. CONCLUSIONS: Acute stroke care measures, particularly antithrombotic use and statin therapy, were associated with reduced odds of long-term mortality. The benefits of these acute care measures were less likely among Hispanic patients. Results underscore the importance of optimizing acute stroke care for all patients.


Asunto(s)
Adhesión a Directriz , Disparidades en Atención de Salud/etnología , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Indicadores de Calidad de la Atención de Salud , Anciano , Anciano de 80 o más Años , Femenino , Fibrinolíticos/uso terapéutico , Florida/epidemiología , Mortalidad Hospitalaria , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , /etnología , Masculino , Medicare , Readmisión del Paciente , Mejoramiento de la Calidad , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Conducta de Reducción del Riesgo , Cese del Hábito de Fumar , Terapia Trombolítica , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos/epidemiología
20.
Anaesthesia ; 76 Suppl 1: 89-99, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33426666

RESUMEN

Improvement in healthcare delivery depends on the ability to measure outcomes that can direct changes in the system. An overview of quality indicators within the field of regional anaesthesia is lacking. This systematic review aims to synthesise available quality indicators, as per the Donabedian framework, and provide a concise overview of evidence-based quality indicators within regional anaesthesia. A systematic literature search was conducted using the databases MEDLINE, Embase, CINAHL and Cochrane from 2003 to present, and a prespecified search of regional anaesthesia society websites and healthcare quality agencies. The quality indicators relevant to regional anaesthesia were subdivided into peri-operative structure, process and outcome indicators as per the Donabedian framework. The methodological quality of the indicators was determined as per the Oxford Centre for Evidence-Based Medicine's framework. Twenty manuscripts met our inclusion criteria and, in total, 68 unique quality indicators were identified. There were 4 (6%) structure, 12 (18%) process and 52 (76%) outcome indicators. Most of the indicators were related to the safety (57%) and effectiveness (19%) of regional anaesthesia and were general in nature (60%). In addition, most indicators (84%) were based on low levels of evidence. Our study is an important first step towards describing quality indicators for the provision of regional anaesthesia. Future research should focus on the development of structure and process quality indicators and improving the methodological quality and usability of these indicators.


Asunto(s)
Anestesia de Conducción/normas , Indicadores de Calidad de la Atención de Salud , Procedimientos Quirúrgicos Operativos/normas , Humanos , Mejoramiento de la Calidad , Procedimientos Quirúrgicos Operativos/efectos adversos
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