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1.
Headache ; 61(5): 734-739, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34021595

RESUMO

OBJECTIVE: We sought to investigate the patient experience of telemedicine for headache care during the coronavirus disease 2019 (COVID-19) pandemic. BACKGROUND: The use of telemedicine has rapidly expanded and evolved since the beginning of the COVID-19 pandemic. Telemedicine eliminates the physical and geographic barriers to health care, preserves personal protective equipment, and prevents the spread of COVID-19 by allowing encounters to happen in a socially distanced way. However, few studies have assessed the patient perspective of telemedicine for headache care. METHODS: The American Migraine Foundation (AMF) designed a standardized electronic questionnaire to assess the patient experience of telemedicine for headache care between March and September 2020 to help inform future quality improvement as part of its patient advocacy initiative. The date parameters were identified as the emergence of severe acute respiratory syndrome coronavirus 2 disease and the declaration of a national emergency in the United States. The questionnaire was distributed electronically to more than 100,000 members of the AMF community through social media platforms and the AMF email database. RESULTS: A total of 1172 patients responded to our electronic questionnaire, with 1098 complete responses. The majority, 1081/1153 (93.8%) patients, had a previous headache diagnosis prior to the telemedicine encounter. A total of 648/1127 (57.5%) patients reported that they had used telemedicine for headache care during the study period. Among those who participated in telehealth visits, 553/647 (85.5%) patients used it for follow-up visits; 94/647 (14.5%) patients used it for new patient visits. During the telemedicine encounters, 282/645 (43.7%) patients were evaluated by headache specialists, 222/645 (34.4%) patients by general neurologists, 198/645 (30.7%) patients by primary care providers, 73/645 (11.3%) patients by headache nurse practitioners, and 21/645 (3.2%) patients by headache nurses. Only 47/633 (7.4%) patients received a new headache diagnosis from telemedicine evaluation, whereas the other 586/633 (92.6%) patients did not have a change in their diagnoses. During these visits, a new treatment was prescribed for 358/636 (52.3%) patients, whereas 278/636 (43.7%) patients did not have changes made to their treatment plan. The number (%) of patients who rated the telemedicine headache care experience as "very good," "good," "fair," "poor," and "other" were 396/638 (62.1%), 132/638 (20.7%), 67/638 (10.5%), 23/638 (3.6%), and 20/638 (3.1%), respectively. Detailed reasons for "other" are listed in the manuscript. Most patients, 573/638 (89.8%), indicated that they would prefer to continue to use telemedicine for their headache care, 45/638 (7.1%) patients would not, and 20/638 (3.1%) patients were unsure. CONCLUSIONS: Our study evaluating the patient perspective demonstrated that telemedicine facilitated headache care for many patients during the COVID-19 pandemic, resulting in high patient satisfaction rates, and a desire to continue to use telemedicine for future headache care among those who completed the online survey.


Assuntos
Assistência ao Convalescente/estatística & dados numéricos , COVID-19 , Transtornos da Cefaleia/terapia , Satisfação do Paciente/estatística & dados numéricos , Avaliação de Processos em Cuidados de Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fundações , Transtornos da Cefaleia/diagnóstico , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Trials ; 22(1): 243, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794971

RESUMO

BACKGROUND: Parental mental illness is common and can lead to dependent children incurring a high risk of developing mental disorders, physical illness, and impaired educational and occupational outcomes. Family Talk is one of the better known interventions designed to prevent the intergenerational transmission of mental illness. However, its evidence base is small, with few robust independent randomised controlled trials, and no associated process or cost evaluations. The PRIMERA (Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children) research programme involves a mixed method evaluation of Family Talk which is being delivered in mental health settings in Ireland to improve child and family psychosocial functioning in families with parental mental illness. METHODS: The study comprises a multi-centre, randomised controlled trial (RCT), with nested economic and process evaluations, to assess the clinical and cost-effectiveness and implementation mechanisms of Family Talk compared to usual services. The study is being conducted in 15 adult and child mental health settings in Ireland. Families with a parent with mental illness, and children aged 5-18 years (n = 144 families) will be randomised to either the 7-session Family Talk programme (n = 96) or to standard care (n = 48) using a 2:1 allocation ratio. The primary outcomes are child psychosocial functioning and family functioning. Secondary outcomes are as follows: understanding and experience of parental mental illness, parental mental health, child and parental resilience, partner wellbeing and service utilisation. Blind assessments will take place at pre-intervention and at 6- and 12-month follow-up. DISCUSSION: Given the prevalence and burden of intergenerational mental illness, it is imperative that prevention through evidence-based interventions becomes a public health priority. The current study will provide an important contribution to the international evidence base for Family Talk whilst also helping to identify key implementation lessons in the scaling up of Family Talk, and other similar interventions, within routine mental health settings. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN13365858 . Registered 5th February 2019.


Assuntos
Filho de Pais Incapacitados , Relações Familiares , Terapia Familiar/métodos , Transtornos Mentais , Serviços de Saúde Mental , Ensaios Clínicos Controlados Aleatórios como Assunto , Adolescente , Criança , Análise Custo-Benefício , Humanos , Irlanda , Avaliação de Processos em Cuidados de Saúde , Resultado do Tratamento
4.
BMC Geriatr ; 21(1): 96, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526031

RESUMO

BACKGROUND: Process evaluations provide contextual insight into the way in which interventions are delivered. This information is essential when designing strategies to implement programs into wider clinical practice. We performed a process evaluation of the HiBalance effectiveness trial investigating the effects of a 10-week of highly challenging and progressive balance training for mild-moderate Parkinson's disease (PD). Study aims were to investigate i) the quality and quantity of intervention delivery and ii) barriers and facilitators for implementation. METHODS: Process outcomes included; Fidelity; Dose (delivered and received) Recruitment and Reach. Investigation of barriers and facilitators was guided by the Consolidated Framework for Implementation Research. Program delivery was assessed across four neurological rehabilitation sites during a two-year period. Data collection was mixed-methods in nature and quantitative and qualitative data were merged during the analysis phase. RESULTS: Thirteen program trainers delivered the intervention to 12 separate groups during 119 training sessions. Trainer fidelity to program core components was very high in 104 (87%) of the sessions. Participant responsiveness to the core components was generally high, although adherence to the home exercise program was low (50%). No significant context-specific differences were observed across sites in terms of fidelity, dose delivered/ received or participant characteristics, despite varying recruitment methods. Facilitators to program delivery were; PD-specificity, high training frequency and professional autonomy. Perceived barriers included; cognitive impairment, absent reactional balance among participants, as well a heterogeneous group in relation to balance capacity. CONCLUSION: These findings provide corroborating evidence for outcome evaluation results and valuable information for the further adaptation and implementation of this program. Important lessons can also be learned for researchers and clinicians planning to implement challenging exercise training programs for people with mild-moderate PD. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02727478 , registered 30 march, 2016 - Retrospectively registered.


Assuntos
Doença de Parkinson , Exercício Físico , Terapia por Exercício , Humanos , Avaliação de Resultados em Cuidados de Saúde , Doença de Parkinson/diagnóstico , Doença de Parkinson/terapia , Avaliação de Processos em Cuidados de Saúde
5.
Transplant Proc ; 53(2): 607-611, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33573815

RESUMO

BACKGROUND: Organ transplantation has been for years one of the best treatment options for several medical conditions, and, all over the world, thousands of people need an organ transplant. However, the process through which an organ goes from a brain-dead patient to a new recipient is a complex and delicate one. RESEARCH QUESTIONS: This study aims at identifying and assessing the main risks, their impact, and their relevance on the organ donation-transplantation (ODT) process in Brazil. DESIGN: To identify and to assess the risks of the process, we interviewed coordinators at the 10 State Transplantation Centers in Brazil, which is responsible for over 90% of donations that occurred in Brazil in 2019. We applied the Failure Mode and Effect Analysis method to calculate the risks in terms of severity, occurrence, and detection. The scores obtained from each risk were used to elaborate a ranking comparing the impact of 1 risk in relation to the others. MAIN FINDINGS: The interviewees identified 30 risks throughout the ODT process in Brazil. Most of them are related to insufficient human and material resources, lack of staff training and commitment, and poor infrastructure or logistical aspects. CONCLUSIONS: This study complements findings from previous studies and add new risks, based on the Brazilian state coordinators' point of view. It highlights the most critical weaknesses of the process and serves as a basis for future studies to delve deeper into each of those risks.


Assuntos
Transplante de Órgãos , Avaliação de Processos em Cuidados de Saúde , Obtenção de Tecidos e Órgãos , Brasil , Humanos , Masculino , Medição de Risco
6.
Neurol Sci ; 42(2): 467-473, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33409830

RESUMO

BACKGROUND AND PURPOSE: The COVID-19 pandemic has impacted the reperfusion therapy for acute ischemic stroke (AIS) patients. Huizhou City utilized its experience with the SARS and MERS breakouts to establish a reperfusion treatment program for AIS patients. METHOD: This is a retrospective study on 8 certified stroke hospitals in Huizhou City from January 2020 to May 2020. We analyzed the number of AIS patients with reperfusion therapy, stroke type (anterior/posterior circulation stroke), modes of transport to hospital, NIHSS score, onset to door time (ODT), door to needle time (DNT), and door to puncture time (DPT). The analysis was compared with baseline data from the same time period in 2019. RESULT: In 2020, the number of AIS patients receiving reperfusion therapy decreased (315 vs. 377), NIHSS score increased [8 (4, 15) vs. 7 [ (1, 2)], P = 0.024], ODT increased [126 (67.5, 210.0) vs. 120.0 (64.0, 179.0), P = 0.032], and DNT decreased [40 (32.5, 55) vs. 48 (36, 59), P = 0.003]. DPT did not change. Seventy percent of AIS patients indicated self-visit as their main mode of transport to the hospital. In both periods, mild stroke patients were more likely to self-visit than utilize emergency systems [2019: 152 (57.6%) vs. 20 (45.6%), P = 0.034; 2020: 123 (56.9%) vs. 5 (14.7%), P < 0.001]. The NIHSS score for self-visiting patients was lower for patients who utilized the ambulance system in both years [self-visit: 6.00 (3.00, 12.00), ambulance: 14.00 (9.00, 19.00), P < 0.001]. The volume of reperfusion patients was lower in 2020; however, the decrease was only significant (P = 0.028) in February 2020. CONCLUSION: During the COVID-19 pandemic in 2020, the number of AIS patients receiving reperfusion therapy significantly decreased when compared to the same period in 2019. The patients' condition increased severity, ODT increased, and the DNT decreased. DPT was not significant for self-visiting and ambulance patients. Moderate to severe stroke patients were more likely to utilize ambulance services.


Assuntos
/terapia , Avaliação de Processos em Cuidados de Saúde/estatística & dados numéricos , Reperfusão/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Transporte de Pacientes/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Ambulâncias/estatística & dados numéricos , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
7.
PLoS One ; 16(1): e0245125, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33428645

RESUMO

BACKGROUND: In combating the increasing trend of non-communicable diseases (NCDs) over the last two decades in the country, the Ministry of Health Malaysia developed the Enhanced Primary Health Care (EnPHC) initiative to improve care management across different levels of the public service delivery network. An evaluation research component was embedded to explore the implementation issues in terms of fidelity, feasibility, adaptation and benefit of the initiative's components which were triage, care coordination, screening, risk management and referral system. METHODS: A mixed methods study was conducted at 20 participating EnPHC clinics in Johor and Selangor, two months after the intervention was initiated. Data collected from self-reported forms and a structured observation checklist were descriptively analysed. In-depth interviews were also conducted with 20 participants across the clinics selected to clarify any information gaps observed in each clinic, and data were thematically analysed. RESULTS: Evaluation showed that all components of EnPHC intervention had been successfully implemented except for the primary triage counter and visit checklist. The challenges were mainly discovered in terms of human resource and physical structure. Although human resource was a common implementation challenge across all interventions, clinic-specific issues could still be identified. Among the adaptive measures taken were task sharing among staff and workflow modification to match the clinic's capacity. Despite the challenges, early benefits of implementation were highlighted especially in terms of service outcomes. CONCLUSIONS: The evaluation study disclosed issues of human resource and physical infrastructure when a supplementary intervention is implemented. To successfully achieve a scaled-up PHC service delivery model based on comprehensive management of NCDs patient-centred care, the adaptive measures in local clinic context highlight the importance of collaboration between good organisational process and good clinical practice and process.


Assuntos
Atenção à Saúde , Doenças não Transmissíveis/terapia , Atenção Primária à Saúde , Adulto , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos em Cuidados de Saúde
8.
Chemosphere ; 263: 128119, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33297111

RESUMO

Application of peracetic acid (PAA) in Advanced Oxidation Processes (AOPs) has seen an increase in the last few years. In this study, PAA/UVC-LED/transition metal was used to degrade acetaminophen (ACT) in an aqueous solution. Amongst tested transition metals (Fe, Cu, Co, Mn, Ag), Fe(II) demonstrated the highest efficiency. The effect of pH, PAA dosage, initial concentration of ACT and Fe(II) concentration was investigated on ACT removal. More than 95% removal efficiency was obtained in 30 min employing pH = 5.0, PAA 4 mM and 0.5 mM Fe(II) (kapp = 0.0993 min-1). Scavenging experiments highlighted the contribution of oxygen-centered radicals; however, the dominant mechanism is hydroxyl radical-induced, while the superoxide radicals had a negligible role. The effect of anions in water showed that carbonate, (dihydrogen) phosphate and nitrite ions had a strong inhibitory effect, while a neutral effect was observed by sulfate, nitrate and chloride ions. Seven intermediates of ACT oxidation were determined and the ACT degradation pathway by the PAA/UVC-LED/Fe(II) is presented. The efficacy of the PAA/UVC-LED/Fe(II) process was also verified for the degradation of other contaminants of emerging concern and disinfection of fecal indicator microorganisms in real matrix (secondary WW). In conclusion, the studied PAA/UVC-LED/Fe(II) process opens a new perspective as a promising application of advanced oxidation for the degradation of organic pollutants.


Assuntos
Ácido Peracético , Poluentes Químicos da Água , Acetaminofen , Estudos de Viabilidade , Compostos Ferrosos , Peróxido de Hidrogênio , Oxirredução , Avaliação de Processos em Cuidados de Saúde
9.
Esc. Anna Nery Rev. Enferm ; 25(3): e20200210, 2021.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1149299

RESUMO

RESUMO Objetivo discutir acerca da utilização das ferramentas de Análise de Modo e Efeitos de Falha e sua aplicação na assistência à saúde. Método trata-se de um artigo de reflexão visando à apresentação do formato próprio de aplicação de ambas as ferramentas seguida das suas diferenças de execução nos processos de trabalho. Resultados ambos os modelos possuem a mesma finalidade, sendo direcionados para a detecção de falhas antes mesmo da sua manifestação, auxiliando diretamente na promoção da segurança. A análise do erro, com a participação das equipes e a geração de índices de falhas, repercute no planejamento e na implementação de ações práticas voltadas à segurança do paciente. Conclusão e implicações para a prática embora semelhantes, existem, entre eles, distinções quanto à priorização das falhas para elencar ações práticas corretivas, principalmente no cálculo do Índice de Prioridade de Risco relacionado à gravidade, na probabilidade de ocorrência e na detecção das falhas. Ambas as ferramentas se mostram como importantes aliadas dos gestores de saúde para a detecção de falhas graves que colocam em risco a assistência livre de eventos adversos.


RESUMEN Objetivo discutir el uso de las herramientas de Análisis de Modos y Efectos de Falla y su aplicación en la atención médica. Método este es un artículo de reflexión, con el objetivo de presentar el formato propio de aplicación adecuado para ambas herramientas, seguido de sus diferencias de ejecución en los procesos de trabajo. Resultados ambos modelos tienen el mismo propósito, dirigidos a la detección de fallas incluso antes de su manifestación, ayudando directamente en la promoción de la seguridad. El análisis del error con la participación de los equipos y la generación de tasas de fracaso tiene repercusiones en la planificación e implementación de acciones prácticas dirigidas a la seguridad del paciente. Conclusión e implicaciones para la práctica aunque son similares, existen distinciones con respecto a la priorización de fallas para enumerar acciones correctivas prácticas, principalmente en el cálculo del Índice de Prioridad de Riesgo relacionado con la gravedad, la probabilidad de ocurrencia y la detección de fallas. Se ha demostrado que ambas herramientas son aliadas importantes para los gerentes de salud para la detección de fallas graves que ponen en riesgo la atención libre de eventos adversos.


ABSTRACT Objective to discuss the use of Failure Mode and Effects Analysis tools and their application in health care. Method this is a reflection article, aiming at presenting the proper application format for both tools, followed by their differences in execution in the work processes. Results both models have the same purpose, being directed to the detection of failures even before their manifestation, directly assisting in the promotion of safety. The analysis of the error with the participation of the teams and the generation of failure rates has repercussions on the planning and implementation of practical actions aimed at patient safety. Conclusion and implications for the practice although similar, there are distinctions regarding the prioritization of failures to list practical corrective actions, mainly in the calculation of the Risk Priority Index related to severity, probability of occurrence and failure detection. Both tools are shown to be important allies to health managers for the detection of serious failures that put care free from adverse events at risk.


Assuntos
Humanos , Avaliação de Processos em Cuidados de Saúde/métodos , Segurança do Paciente , Análise do Modo e do Efeito de Falhas na Assistência à Saúde
10.
Rev. baiana enferm ; 35: e36844, 2021. tab, graf
Artigo em Português | LILACS-Express | LILACS, BDENF - Enfermagem | ID: biblio-1149698

RESUMO

Objetivo refletir sobre o uso de indicadores na avaliação da qualidade do serviço de educação permanente. Método estudo descritivo, tipo análise reflexiva da literatura, à luz dos pilares da qualidade. Resultados a avaliação da qualidade do serviço de educação permanente remete ao monitoramento dos indicadores associados à frequência dos profissionais nas atividades propostas, abandono na sequência dos treinamentos e satisfação com as atividades. Outros indicadores são relacionados ao próprio serviço de educação permanente, mediante o monitoramento da taxa de cancelamento das ações, tempo médio de capacitações e o valor investido no planejamento das ações. Dessa forma, a avaliação dos indicadores com base nos pilares da qualidade de eficácia, efetividade, eficiência, aceitabilidade, legitimidade e equidade pode auxiliar no planejamento e na análise dos treinamentos ofertados. Conclusão o uso de indicadores na educação permanente favorece a análise retrospectiva e prospectiva das atividades por meio dos próprios profissionais e do serviço de educação permanente.


Objetivo reflexionar sobre el uso de indicadores en la evaluación de la calidad del servicio de educación permanente. Método estudio descriptivo, análisis reflexivo de la literatura, a la luz de los pilares de la calidad. Resultados la evaluación de la calidad del servicio de educación permanente se refiere al monitoreo de los indicadores asociados a la frecuentación de los profesionales en las actividades propuestas, el abandono en la secuencia de la formación y la satisfacción con las actividades. Otros indicadores se relacionan con el propio servicio de educación permanente, a través del monitoreo de la tasa de cancelación de acciones, el tiempo promedio de capacitación y el valor invertido en la planificación de acciones. Así pues, la evaluación de los indicadores basados en los pilares de la calidad de la eficacia, efectividad, eficiencia, aceptabilidad, legitimidad y equidad puede auxiliar en la planificación y el análisis de la formación ofrecida. Conclusión la utilización de indicadores en la educación permanente favorece el análisis retrospectivo y prospectivo de las actividades a través de los propios profesionales y del servicio de educación permanente.


Objective to reflect on the use of indicators in the evaluation of the quality of the continuing education service. Method descriptive study, reflective analysis of literature, in the light of the quality pillars. Results the evaluation of the quality of the permanent education service refers to the monitoring of indicators associated with the attendance of professionals in the proposed activities, abandonment in following training and satisfaction with activities. Other indicators are related to the permanent education service itself, through the monitoring of the cancellation rate of actions, average training time and the value invested in the planning of actions. Thus, the evaluation of the indicators based on the pillars of quality of efficacy, effectiveness, efficiency, acceptability, legitimacy and equity is able to assist in the planning and analysis of the training offered. Conclusion the use of indicators in permanent education favors the retrospective and prospective analysis of the activities by the professionals themselves and by the permanent education service.


Assuntos
Humanos , Avaliação de Processos em Cuidados de Saúde , Gestão em Saúde , Educação Continuada , Indicadores de Serviços , Pesquisa Qualitativa
11.
BMC Health Serv Res ; 20(1): 996, 2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33129317

RESUMO

BACKGROUND: Intimate partner violence (IPV) is highly prevalent in the United States and impacts the physical and mental health and social well-being of those who experience it. Healthcare settings are important intervention points for IPV screening and referral, yet there is a wide range of implementation of IPV protocols in healthcare settings in the U.S., and the evidence of the usefulness of IPV screening is mixed. This process evaluation investigates the facilitators and barriers to implementing Coordinated Care for IPV Survivors through the M Health Community Network ("M Health Network"), an intervention that aimed to standardize IPV screening and referral in a multi-specialty clinic and surgery center (CSC). Two validated IPV screens were introduced and mandated to be done by rooming staff at least once every 3 months with all clinic patients regardless of gender; the Humiliation Afraid Rape Kick (HARK) for presence of IPV and the shortened Danger Assessment (DA-5) for lethality of IPV. Upon a positive screen, the patient was offered immediate informational resources and, if willing, was referred to a social worker for care coordination with a community organization. METHODS: Semi-structured, individual and group process interviews with clinic managers and clinic staff at 8 CSC clinics (N = 24) were undertaken at 3,12, and 27 months after intervention start. Semi-structured interviews were undertaken with the research team (N = 3) post-implementation. A Consolidated Framework for Implementation Research (CFIR) codebook was used to code data in two rounds. After each round, thick description was used to write detailed and contextual descriptions of each code. Facilitators and barriers to implementation were identified during the second round of thick description. RESULTS: Facilitators to implementation were clinic staff support, dedication, and flexibility and research team engagement. Barriers were lack of prioritization, loss of intervention champions, lack of knowledge about intervention protocol and resources, staff and patient discomfort discussing IPV, and operational issues with screen technology. CONCLUSIONS: The IPV protocol was implemented, but faced common barriers. CFIR is a complex, but comprehensive, tool to guide process evaluation for IPV screening and referral interventions in health systems in the U.S.


Assuntos
Assistência Médica , Avaliação de Processos em Cuidados de Saúde , Instituições de Assistência Ambulatorial , Feminino , Programas Governamentais , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Masculino , Programas de Rastreamento/métodos , Encaminhamento e Consulta , Parceiros Sexuais , Sobreviventes , Estados Unidos
12.
PLoS Med ; 17(10): e1003150, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33027246

RESUMO

BACKGROUND: Evidence for the effectiveness of continuous quality improvement (CQI) in resource-poor settings is very limited. We aimed to establish the effects of CQI on quality of antenatal HIV care in primary care clinics in rural South Africa. METHODS AND FINDINGS: We conducted a stepped-wedge cluster-randomised controlled trial (RCT) comparing CQI to usual standard of antenatal care (ANC) in 7 nurse-led, public-sector primary care clinics-combined into 6 clusters-over 8 steps and 19 months. Clusters randomly switched from comparator to intervention on pre-specified dates until all had rolled over to the CQI intervention. Investigators and clusters were blinded to randomisation until 2 weeks prior to each step. The intervention was delivered by trained CQI mentors and included standard CQI tools (process maps, fishbone diagrams, run charts, Plan-Do-Study-Act [PDSA] cycles, and action learning sessions). CQI mentors worked with health workers, including nurses and HIV lay counsellors. The mentors used the standard CQI tools flexibly, tailored to local clinic needs. Health workers were the direct recipients of the intervention, whereas the ultimate beneficiaries were pregnant women attending ANC. Our 2 registered primary endpoints were viral load (VL) monitoring (which is critical for elimination of mother-to-child transmission of HIV [eMTCT] and the health of pregnant women living with HIV) and repeat HIV testing (which is necessary to identify and treat women who seroconvert during pregnancy). All pregnant women who attended their first antenatal visit at one of the 7 study clinics and were ≥18 years old at delivery were eligible for endpoint assessment. We performed intention-to-treat (ITT) analyses using modified Poisson generalised linear mixed effects models. We estimated effect sizes with time-step fixed effects and clinic random effects (Model 1). In separate models, we added a nested random clinic-time step interaction term (Model 2) or individual random effects (Model 3). Between 15 July 2015 and 30 January 2017, 2,160 participants with 13,212 ANC visits (intervention n = 6,877, control n = 6,335) were eligible for ITT analysis. No adverse events were reported. Median age at first booking was 25 years (interquartile range [IQR] 21 to 30), and median parity was 1 (IQR 0 to 2). HIV prevalence was 47% (95% CI 42% to 53%). In Model 1, CQI significantly increased VL monitoring (relative risk [RR] 1.38, 95% CI 1.21 to 1.57, p < 0.001) but did not improve repeat HIV testing (RR 1.00, 95% CI 0.88 to 1.13, p = 0.958). These results remained essentially the same in both Model 2 and Model 3. Limitations of our study include that we did not establish impact beyond the duration of the relatively short study period of 19 months, and that transition steps may have been too short to achieve the full potential impact of the CQI intervention. CONCLUSIONS: We found that CQI can be effective at increasing quality of primary care in rural Africa. Policy makers should consider CQI as a routine intervention to boost quality of primary care in rural African communities. Implementation research should accompany future CQI use to elucidate mechanisms of action and to identify factors supporting long-term success. TRIAL REGISTRATION: This trial is registered at ClinicalTrials.gov under registration number NCT02626351.


Assuntos
Infecções por HIV/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Cuidado Pré-Natal/normas , Carga Viral/estatística & dados numéricos , Adulto , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/diagnóstico , Humanos , Ciência da Implementação , Padrões de Prática em Enfermagem , Gravidez , Atenção Primária à Saúde , Avaliação de Processos em Cuidados de Saúde , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , RNA Viral/sangue , População Rural , África do Sul , Gestão da Qualidade Total , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-32872350

RESUMO

Emergency room processes are often exposed to the risk of unexpected factors, and process management based on performance measurements is required due to its connectivity to the quality of care. Regarding this, there have been several attempts to propose a method to analyze the emergency room processes. This paper proposes a framework for process performance indicators utilized in emergency rooms. Based on the devil's quadrangle, i.e., time, cost, quality, and flexibility, the paper suggests multiple process performance indicators that can be analyzed using clinical event logs and verify them with a thorough discussion with clinical experts in the emergency department. A case study is conducted with the real-life clinical data collected from a tertiary hospital in Korea tovalidate the proposed method. The case study demonstrated that the proposed indicators are well applied using the clinical data, and the framework is capable of understanding emergency room processes' performance.


Assuntos
Mineração de Dados/métodos , Serviço Hospitalar de Emergência , Avaliação de Processos em Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde , Qualidade da Assistência à Saúde , Sistemas de Informação Hospitalar , Humanos , Modelos Organizacionais , República da Coreia , Fluxo de Trabalho
14.
Emerg Med Clin North Am ; 38(4): 819-839, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981620

RESUMO

Pediatric cardiac arrest is a relatively rare but devastating presentation in infants and children. In contrast to adult patients, in whom a primary cardiac dysrhythmia is the most likely cause of cardiac arrest, pediatric patients experience cardiovascular collapse most frequently after an initial respiratory arrest. Aggressive treatment in the precardiac arrest state should be initiated to prevent deterioration and should focus on support of oxygenation, ventilation, and hemodynamics, regardless of the presumed cause. Unfortunately, outcomes for pediatric cardiac arrest, whether in hospital or out of hospital, continue to be poor.


Assuntos
Parada Cardíaca/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Glicemia/análise , Criança , Maus-Tratos Infantis/terapia , Cardioversão Elétrica , Eletroencefalografia , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/etiologia , Cardiopatias Congênitas/terapia , Frequência Cardíaca , Humanos , Hipotermia/complicações , Hipotermia/terapia , Hipotermia Induzida , Pneumopatias/terapia , Pais , Exame Físico , Envenenamento/terapia , Avaliação de Processos em Cuidados de Saúde , Valores de Referência , Insuficiência Respiratória/terapia , Taxa Respiratória , Ordens quanto à Conduta (Ética Médica) , Sepse/terapia , Choque/etiologia , Choque/terapia , Vasoconstritores/uso terapêutico , Ferimentos e Lesões/terapia
15.
Medicine (Baltimore) ; 99(38): e22254, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957373

RESUMO

The novel coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China in December 2019 and has subsequently escalated exponentially worldwide. As this virus has never been experienced previously, it poses a significant challenge to healthcare systems who are poorly equipped to handle the large number of gravely ill patients who seek medical attention. Additionally, treating providers are placing their own lives at risk due to the lack of adequate personal protective equipment. We are reporting the proactive measures that were implemented at our healthcare system in a metropolitan community in Kentucky to address COVID-19. The primary goal was to maintain a safe environment for providers, staff, and patients. Three key strategies were incorporated at our healthcare system, including.


Assuntos
Infecções por Coronavirus/prevenção & controle , Atenção à Saúde/organização & administração , Controle de Infecções/organização & administração , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Feminino , Implementação de Plano de Saúde , Número de Leitos em Hospital , Humanos , Kentucky/epidemiologia , Masculino , Saúde do Trabalhador , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Avaliação de Processos em Cuidados de Saúde
16.
Artigo em Inglês | MEDLINE | ID: mdl-32784617

RESUMO

Processes in organisations, such as hospitals, may deviate from the intended standard processes, due to unforeseeable events and the complexity of the organisation. For hospitals, the knowledge of actual patient streams for patient populations (e.g., severe or non-severe cases) is important for quality control and improvement. Process discovery from event data in electronic health records can shed light on the patient flows, but their comparison for different populations is cumbersome and time-consuming. In this paper, we present an approach for the automatic comparison of process models that were extracted from events in electronic health records. Concretely, we propose comparing processes for different patient populations by cross-log conformance checking, and standard graph similarity measures obtained from the directed graph underlying the process model. We perform a user study with 20 participants in order to obtain a ground truth for similarity of process models. We evaluate our approach on two data sets, the publicly available MIMIC database with the focus on different cancer patients in intensive care, and a database on breast cancer patients from a Dutch hospital. In our experiments, we found average fitness to be a good indicator for visual similarity in the ZGT use case, while the average precision and graph edit distance are strongly correlated with visual impression for cancer process models on MIMIC. These results are a call for further research and evaluation for determining which similarity or combination of similarities is needed in which type of process model comparison.


Assuntos
Neoplasias da Mama/terapia , Gerenciamento de Dados , Atenção à Saúde/organização & administração , Neoplasias/terapia , Avaliação de Processos em Cuidados de Saúde/métodos , Fluxo de Trabalho , Cuidados Críticos , Registros Eletrônicos de Saúde , Feminino , Hospitais , Humanos , Masculino , Melhoria de Qualidade , Qualidade da Assistência à Saúde
17.
BMJ Open ; 10(8): e039305, 2020 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-32859666

RESUMO

INTRODUCTION: The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) randomised controlled trial (RCT) is evaluating a home-based, face-to-face, individually tailored, activity and exercise programme for people living with dementia. Social distancing requirements following the COVID-19 pandemic necessitated rapid changes to intervention delivery. METHODS AND ANALYSIS: A mixed-methods process evaluation will investigate how the changes were implemented and the impact that these have on participants' experience. An implementation study will investigate how the intervention was delivered during the pandemic. A study on the mechanisms of impact and context will investigate how these changes were experienced by the PrAISED participants, their carers and the therapists delivering the intervention. The study will commence in May 2020. ETHICS AND DISSEMINATION: The PrAISED RCT and process evaluation have received ethical approval number 18/YH/0059. The PrAISED process evaluation will enable us to understand how distancing and isolation affected participants, their activity and exercise routines and whether the therapy programme could be continued with remote support. This will be valuable both in explaining trial results and also contribute to understanding and designing new ways of delivering home-based services and rehabilitation interventions for people with dementia and their carers. TRIAL REGISTRATION NUMBER: ISRCTN15320670; Pre-results.


Assuntos
Disfunção Cognitiva/terapia , Infecções por Coronavirus , Demência/terapia , Exercício Físico , Promoção da Saúde , Vida Independente , Pandemias , Pneumonia Viral , Avaliação de Processos em Cuidados de Saúde , Atividades Cotidianas , Betacoronavirus , Cuidadores , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Terapia por Exercício , Feminino , Serviços de Assistência Domiciliar , Humanos , Masculino , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Projetos de Pesquisa , Isolamento Social
18.
Public Health Res Pract ; 30(2)2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32601656

RESUMO

OBJECTIVES: This study tested the utility of the Intervention Scalability Assessment Tool (ISAT) with real-world interventions considered for scale-up in the Australian context. We explored user perceptions of the usefulness of the ISAT in making scalability decisions and conducted an analysis of completed ISATs. Type of program/service: The ISAT was designed to assist policy makers/practitioners to make structured and reflective assessments of the potential scalability of their interventions. METHODS: Participants (n = 26) were invited via email and needed to be considering a population intervention for scale-up, to be able to pilot the ISAT, and to be willing to complete an online survey to provide feedback. Survey data and completed ISATs were collated and common responses were identified, with exceptions noted. RESULTS: Thirteen participants accepted the invitation to pilot the ISAT; six completed ISATs and returned surveys and five of each were included in the final analysis. The process by which participants completed the ISAT varied, some involving up to six stakeholders in the process and others only one. The time taken to complete the ISAT ranged from 2 hours to 3 days. Interventions considered for scalability were public health interventions and all but one involved a potential statewide scale-up. In terms of outcome, scalability scores across interventions varied, however, all but one intervention was recommended for scale-up. The remaining intervention was deemed to be promising but further information was required before assessing scalability. LESSONS LEARNT: The ISAT was perceived as a useful tool to assess the scalability of real-world health programs, with participants noting only minor limitations and challenges. The ISAT can be applied to a variety of population health interventions and identifies strengths and weaknesses in the evidence base for scale-up. This study revealed that decisions to scale up are often made despite potential weaknesses highlighted through the ISAT. This is likely a reflection of the critically influential role of contextual factors in decisions to scale up, whereby decision makers may balance a variety of considerations, of which evidence of scalability is only one factor.


Assuntos
Tomada de Decisões , Avaliação de Processos em Cuidados de Saúde/métodos , Saúde Pública , Pessoal Administrativo , Austrália , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Projetos Piloto , Projetos de Pesquisa , Inquéritos e Questionários
19.
BMC Public Health ; 20(1): 1046, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32616009

RESUMO

BACKGROUND: There is an increasing interest in use of food supplements to prevent childhood stunting, however the evidence on the process indicators is scarce. We in this study explore the barriers to the effective implementation of food supplementation programs and the possible mitigation strategies which can guide the design of future programs. METHODS: We undertook a process evaluation of a stunting prevention food supplementation pilot program in rural Pakistan that distributed Wheat Soy Blend (WSB) to pregnant & lactating women, and Lipid-based Nutrient Supplement (LNS) and micronutrient powder (MNP) to < 5 years children. We used a mixed methods approach through a quantitative survey of 800 households and conducted 18 focused group discussion (FGDs) (with male and female caregivers), 4 FGDs (with Community Health Workers (CHWs)) and 22 key informant interviews (with district stakeholders) to evaluate the community side factors affecting uptake through five parameters: value, acceptability, receipt of supplement, usage and correct dosage. RESULTS: The findings show that proportionately few beneficiaries consumed the full dose of supplements, despite reasonable knowledge amongst caregivers. Sharing of supplements with other household member was common, and the full monthly stock was usually not received. Qualitative findings suggest that caregivers did not associate food supplements with stunting prevention. WSB was well accepted as an extra ration, LNS was popular due its chocolaty taste and texture, whereas MNP sprinkles were perceived to be of little value. The cultural food practices led to common sharing, whereas interaction with CHWs was minimal for nutrition counselling. Qualitative findings also indicate CHWs related programmatic constraints of low motivation, multi-tasking, inadequate counselling skills and weak supervision. CONCLUSION: We conclude that the community acceptability of food supplements does not translate into optimal consumption. Hence a greater emphasis is needed on context specific demand creation and focusing on the supply side constraints with improved logistical planning, enhanced motivation and supervision of community workers with involvement of multiple stakeholders. While, similar studies are needed in varying contexts to help frame universal guidelines. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02422953 . Registered on April 22, 2015.


Assuntos
Suplementos Nutricionais/estatística & dados numéricos , Transtornos do Crescimento/prevenção & controle , Micronutrientes/administração & dosagem , População Rural/estatística & dados numéricos , Adulto , Criança , Pré-Escolar , Agentes Comunitários de Saúde , Feminino , Humanos , Lactente , Lactação , Masculino , Paquistão , Gravidez , Avaliação de Processos em Cuidados de Saúde
20.
Scand J Trauma Resusc Emerg Med ; 28(1): 73, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32727519

RESUMO

BACKGROUND: Hospital incident command groups' (HICG) performance may have a profound impact on hospital response to major incidents. Previous research has assessed hospital incident command group capacity as opposed to performance and factors associated to performance. The objective was to assess associations between decision-making and staff procedure skills of the hospital incident command group. METHODS: This was a prospective observational study using performance indicators to assess hospital incident command groups' decision-making and performance. A total of six hospitals in Stockholm, Sweden, with their respective HICGs participated. Associations between decision-making skills and staff procedure skills during major incident simulations were assessed using measurable performance indicators. RESULTS: Decision-making skills are correlated to staff procedure skills and overall HICG performance. Proactive decision-making skills had significantly lower means than reactive decision-making skills and are significantly correlated to staff procedure skills. CONCLUSION: There is a significant correlation between decision-making skills and staff procedural skills. Hospital incident command groups' proactive decision-making abilities tended to be less developed than reactive decision-making abilities. These proactive decision-making skills may be a predictive factor for overall hospital incident command group performance. A lack of proactive decision-making ability may hamper efforts to mitigate the effects of a major incident.


Assuntos
Tomada de Decisões , Planejamento em Desastres , Administração Hospitalar , Avaliação de Processos em Cuidados de Saúde , Gestão da Segurança , Humanos , Estudos Prospectivos , Gestão de Riscos , Suécia
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