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1.
Medicine (Baltimore) ; 99(5): e18977, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000429

RESUMO

To address the remaining medical misconducts after the zero-makeup drug policy (ZMDP), e.g., over-examinations, China has given the priority to government supervision on medical institutions. This study evaluated the effect of government supervision on medical costs among inpatients with chronic obstructive pulmonary disease (COPD) in Sichuan province, the first province in China where the medical supervision was conducted.A linear interrupted time series (ITS) model was employed to analyze data about 72,113 inpatients from 32 hospitals. Monthly average medicine costs, diagnostic costs, and medical services costs, nursing costs from January 2015 to June 2018 were analyzed, respectively.The average hospitalization costs fell with a monthly trend of 42.90Yuan before the implementation of supervision (P < .001), and the declining trend remained with the more dramatic rate (-158.70Yuan, P < .001) after the government audit carried out. For western medicine costs, the monthly decreasing trend remained after the implementation of supervision (-66.44Yuan, P < .001); meanwhile, the monthly upward trend was changed into a downtrend trend for traditional Chinese medicine costs (-11.80Yuan, P = .009). Additionally, the increasing monthly trend in average diagnostics costs disappeared after government supervision, and was inversed to an insignificant decreasing trend at the rate of 26.18Yuan per month. Moreover, the previous upward trends were changed into downward trends for both medical service costs and nursing costs (P = .056, -44.71Yuan; P = .007, -11.17Yuan, respectively) after the supervision carried out.Our findings reveal that government supervision in Sichuan province was applicable to curb the growth of medical costs for inpatients with COPD, which may reflect its role in restraining physicians' compensating behaviors after the ZMDP. The government medical supervision holds promise to dismiss medical misconducts in Sichuan province, the experience of which may offer implications for other regions of China as well as other low- and middle-income countries.


Assuntos
Regulamentação Governamental , Hospitalização/economia , Pacientes Internados/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/economia , Garantia da Qualidade dos Cuidados de Saúde , Idoso , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
2.
Plast Reconstr Surg ; 145(2): 284e-294e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985618

RESUMO

The American Society of Plastic Surgeons commissioned the Autologous Breast Reconstruction Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing autologous breast reconstruction and other breast reconstruction surgery. Four outcome measures and one process measure were identified. Outcomes include patient satisfaction with information for all breast reconstruction, a subscale of the BREAST-Q, and the length of stay, operative time, and rate of blood transfusion for autologous blood transfusion. The process measure looks at coordination of care around managing the breast reconstruction patient's care, with the physician coordinating the ongoing care, be it an oncologist, radiologist, other specialist, or primary care physician. All measures in this report were approved by the American Society of Plastic Surgeons Quality and Performance Measures Work Group and the American Society of Plastic Surgeons Executive Committee. The Work Group recommends the use of these measures for quality initiatives, continuing medical education, maintenance of certification, American Society of Plastic Surgeons' Qualified Clinical Data Registry reporting, and national quality-reporting programs.


Assuntos
Mamoplastia/métodos , Mastectomia/métodos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Medicina Baseada em Evidências , Feminino , Humanos , Mamoplastia/normas , Satisfação do Paciente
3.
Hu Li Za Zhi ; 67(1): 98-105, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960401

RESUMO

Alzheimer's disease (AD) is one of the most common diseases in older populations. Its main clinical features include cognitive dysfunction, affective disorder, and abnormal mental behavior. Due to the lack of therapeutic drugs, professional care has become an important diagnostic and therapeutic strategy for Alzheimer's disease patients. At present, most Alzheimer's disease patients are cared for at home by relatives or caregivers, and less than l0% of city-based patients receive care in old-age institutions. Due to mixed treatment regimens in the hospital, care services do not necessarily match patient care needs and thus Alzheimer's disease patients do not receive adequate treatment. Developed countries have a mature care system for the elderly, but no graded care model for the elderly with Alzheimer's disease currently exists in China. In this paper, the author draws on the experience of developed countries to construct an index system for the graded care of Alzheimer's disease patients that is suited to conditions in China. This article addresses the burden faced by the elderly with Alzheimer's disease and the current standard of care for the elderly at home and abroad. After explaining the necessity of constructing a care model for the elderly with Alzheimer's disease, the author then explains the practicability of the care system proposed in this study in order to provide a whole-course care model for the mentally impaired elderly in China.


Assuntos
Doença de Alzheimer/enfermagem , Modelos de Enfermagem , Garantia da Qualidade dos Cuidados de Saúde/métodos , Idoso , China , Humanos , Pesquisa em Avaliação de Enfermagem
4.
Int J Radiat Oncol Biol Phys ; 106(3): 639-647, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31983560

RESUMO

PURPOSE: We sought to develop a quality surveillance program for approximately 15,000 US veterans treated at the 40 radiation oncology facilities at the Veterans Affairs (VA) hospitals each year. METHODS AND MATERIALS: State-of-the-art technologies were used with the goal to improve clinical outcomes while providing the best possible care to veterans. To measure quality of care and service rendered to veterans, the Veterans Health Administration established the VA Radiation Oncology Quality Surveillance program. The program carries forward the American College of Radiology Quality Research in Radiation Oncology project methodology of assessing the wide variation in practice pattern and quality of care in radiation therapy by developing clinical quality measures (QM) used as quality indices. These QM data provide feedback to physicians by identifying areas for improvement in the process of care and identifying the adoption of evidence-based recommendations for radiation therapy. RESULTS: Disease-site expert panels organized by the American Society for Radiation Oncology (ASTRO) defined quality measures and established scoring criteria for prostate cancer (intermediate and high risk), non-small cell lung cancer (IIIA/B stage), and small cell lung cancer (limited stage) case presentations. Data elements for 1567 patients from the 40 VA radiation oncology practices were abstracted from the electronic medical records and treatment management and planning systems. Overall, the 1567 assessed cases passed 82.4% of all QM. Pass rates for QM for the 773 lung and 794 prostate cases were 78.0% and 87.2%, respectively. Marked variations, however, were noted in the pass rates for QM when tumor site, clinical pathway, or performing centers were separately examined. CONCLUSIONS: The peer-review protected VA-Radiation Oncology Surveillance program based on clinical quality measures allows providers to compare their clinical practice to peers and to make meaningful adjustments in their personal patterns of care unobtrusively.


Assuntos
Institutos de Câncer/normas , Hospitais de Veteranos/normas , Desenvolvimento de Programas , Garantia da Qualidade dos Cuidados de Saúde/normas , Radioterapia (Especialidade)/normas , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Medicina Baseada em Evidências/normas , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Revisão por Pares , Avaliação de Programas e Projetos de Saúde/normas , Neoplasias da Próstata/radioterapia , Garantia da Qualidade dos Cuidados de Saúde/métodos , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Carcinoma de Pequenas Células do Pulmão/radioterapia , Sociedades Médicas/normas , Estados Unidos , Veteranos
5.
Gesundheitswesen ; 82(1): 63-71, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-29801188

RESUMO

AIMS: Indicators of process quality were developed for outpatient oncology care in Germany with the aim to advance quality monitoring and assurance. In this pilot study, data to assess these quality indicators (QI) were gathered and analyzed for the first time. METHODS: Data were retrieved from patient records in oncology practices using an online data tool. Data were collected by practice-internal and in 7 (wave 1), 9 (wave 2) and 7 (wave 3) practices, respectively, by an external documentalist. RESULTS: Altogether, 5,160 patient records from 37 oncology practices were analyzed. The adherence rates varied considerably between QI as well as between practices (0-100%). In summary, adherence rates were higher for QI of basis documentation (81%) than for therapy planning and implementation (72%), holistic care and psychosocial wellbeing (71%) or pain management (63%). CONCLUSION: The ranges and high standard deviations show a high spread of adherence rates of QI. However, except for pain management, 100% fulfilment of QI requirements in some practices suggests that adherence to QI is generally feasible. Data collection for QI is resource intensive (time and personnel). Yet, collecting and examining data for QI provides useful information about areas with potential for improvement. QI can help improve the quality of care in oncology.


Assuntos
Assistência Ambulatorial , Pacientes Ambulatoriais , Garantia da Qualidade dos Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde , Assistência Ambulatorial/normas , Alemanha , Humanos , Projetos Piloto , Melhoria de Qualidade
6.
Biochem Med (Zagreb) ; 30(1): 010502, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31839720

RESUMO

Extravascular body fluids (EBF) analysis can provide useful information in the differential diagnosis of conditions that caused their accumulation. Their unique nature and particular requirements accompanying EBF analysis need to be recognized in order to minimize possible negative implications on patient safety. This recommendation was prepared by the members of the Working group for extravascular body fluid samples (WG EBFS). It is designed to address the total testing process and clinical significance of tests used in EBF analysis. The recommendation begins with a chapter addressing validation of methods used in EBF analysis, and continues with specific recommendations for serous fluids analysis. It is organized in sections referring to the preanalytical, analytical and postanalytical phase with specific recommendations presented in boxes. Its main goal is to assist in the attainment of national harmonization of serous fluid analysis and ultimately improve patient safety and healthcare outcomes. This recommendation is intended to all laboratory professionals performing EBF analysis and healthcare professionals involved in EBF collection and processing. Cytological and microbiological evaluations of EBF are beyond the scope of this document.


Assuntos
Líquidos Corporais/química , Técnicas de Laboratório Clínico/normas , Líquidos Corporais/metabolismo , Exsudatos e Transudatos/química , Exsudatos e Transudatos/metabolismo , Guias como Assunto , Humanos , Segurança do Paciente , Derrame Pleural/diagnóstico , Garantia da Qualidade dos Cuidados de Saúde , Sociedades Médicas , Manejo de Espécimes/normas
9.
Rev Saude Publica ; 53: 98, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31778397

RESUMO

OBJECTIVES: To analyze the health care network for at-risk infants in the western region of the city of São Paulo, with the primary health care as coordinator, and to compare the presence and extension of attributes of primary health care in the services provided, according to the service management model (Family Health Strategy and traditional basic health units). METHODS: A survey was conducted with all at-risk infants born in the western region of São Paulo between 2013 and 2014. The children were then actively searched for a later application of the PCATool - child version. The total of 233 children were located in the territory; 113 guardians agreed to participate, and 81 composed the final sample. RESULTS: Regarding the results of PCATool for overall and essential scores, the units with Family Health Strategy were better evaluated by users, when compared with traditional basic health units, showing a statistically significant difference. However, these scores were low for both management models. Regarding attributes, the Family Health Strategy presented better performance compared with traditional basic health units for most of them, except for coordination of information systems. Of ten assessed attributes, seven reached values ≥6.6 for Family Health Strategy and two for the traditional basic health unit. CONCLUSIONS: Regardless of the type of management model, low overall and essential scores were found, indicating that guardians of at-risk infants rated some attributes as unsatisfactory, with emphasis on accessibility, integrality and family guidance. Such a performance may have negative consequences for the quality and integrality of these infants' health care.


Assuntos
Serviços de Saúde da Criança/provisão & distribução , Serviços de Saúde da Criança/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Brasil , Estudos Transversais , Saúde da Família , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
12.
Br J Nurs ; 28(17): 1152-1153, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31556735

RESUMO

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses the Annual Report and Accounts 2018-2019 of the health and social care regulator.


Assuntos
Comitês Consultivos , Relatórios Anuais como Assunto , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Inglaterra , Humanos , Medicina Estatal/normas
14.
Artigo em Japonês | MEDLINE | ID: mdl-31548467

RESUMO

PURPOSE: Intensity modulated radiation therapy (IMRT) has become a widely accepted and efficient treatment technique for many types of cancers. Patient's specific quality assurance (QA) should be performed with QA devices. Stability and sensitivity tests conducted on the ArcCHECK (AC) 3D diode array were performed. METHODS: Set-up error test with AC was performed. The set-up position moved to lateral (mm), longitudinal (mm) and rotational (°) were 0.5, 1.0, 2.0 and 3.0, respectively. Sensitivity change test of diode array with AC through 230 days was also performed. Same array calibration data was applied to all measurements of volumetric-modulated arc therapy benchmark test through 230 days. Gamma method (2 mm/2% criteria) was performed to analyze the result of all measurements. RESULTS: In the results of positional error, gamma pass rate become degenerate according to positional error became larger. With 0.5 mm or 0.5° positional error, decreasing rate of the pass rate of lateral, longitudinal and rotational were 1.0%, 2.5% and 4.2%, respectively. In the sensitivity change test, the gamma pass rate decreased 2.2%/100 days with same calibration data. CONCLUSION: AC has highly sensitivity against positional error. Sensitivity of AC has been changed and pass rate was decreased 2.2%/100 days through 230 days. Array calibration should be performed in consideration of change of sensitivity.


Assuntos
Planejamento da Radioterapia Assistida por Computador , Radioterapia de Intensidade Modulada , Calibragem , Humanos , Garantia da Qualidade dos Cuidados de Saúde , Radiometria , Dosagem Radioterapêutica
18.
Hu Li Za Zhi ; 66(5): 54-64, 2019 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-31549381

RESUMO

BACKGROUND: Many hospitals in Taiwan currently use the nurse practitioner (NP) care model to ameliorate the chronic shortage of resident physicians. However, no healthcare service quality scale is presently available that allows the evaluation of the healthcare quality provided by NPs from the perspective of patients. A scale of this type is necessary in order to effectively monitor and improve care outcomes. PURPOSE: This project was designed to develop the Nurse Practitioner Healthcare Service Quality Scale (NPHSQS) and then to test its validity and reliability. METHODS: A cross-sectional design combined with Parasuraman, Zeithaml, and Berry's Service Quality Model was adopted to construct the NPHSQS. After expert evaluation and confirmation of the model's content validity, 200 valid questionnaires were collected from a convenience sample of patients from medical center wards in northern Taiwan that regularly used the NP care model. The data were analyzed by group using item analysis, construct validity, internal consistency, and discriminant validity. RESULTS: The 25-item NPHSQS developed in this study earned a CVI (content validity index) of .91 and a good CR (critical ratio). Exploratory factor analysis revealed that four factors extracted in the expectation level, including reliable responsiveness, assurance, empathy, and tangibility, explained 62.47% of the total variance. Furthermore, three factors extracted in the perception level, including reliable responsiveness, trust, and tangibility, explained 67.71% of the total variance. The NPHSQS has a good overall internal consistency coefficient and may also significantly distinguish differences in patient satisfaction between good and bad healthcare service quality groups (p < .001). CONCLUSIONS: The developed NPHSQS has good reliability and validity and is a reliable instrument for assessing the quality of NP-provided healthcare services from the perspective of healthcare recipients.


Assuntos
Profissionais de Enfermagem , Garantia da Qualidade dos Cuidados de Saúde , Inquéritos e Questionários , Estudos Transversais , Humanos , Psicometria , Reprodutibilidade dos Testes , Taiwan
19.
Urologe A ; 58(10): 1156-1164, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31501984

RESUMO

The aim of quality management in medicine must be to increase the safety of treatment, to optimize the treatment results, but also to confirm economic justifiability. Participation in multiagency quality assurance measures should create the possibility to assess the quality of the services offered compared with other service providers and to recognize and correct corresponding deficits. Comparative examinations and assessments should serve to improve the quality of the results. The benefits of quality management as an important approach to promoting patient safety should be made known to all stakeholders. Patient-oriented process optimization and patient satisfaction are the focus. Furthermore, quality management should help increase the satisfaction of everyone involved in the process.


Assuntos
Assistência à Saúde/normas , Legislação Médica , Médicos/normas , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Humanos , Responsabilidade Legal
20.
Cancer Radiother ; 23(6-7): 581-591, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31473088

RESUMO

Intensity modulated radiotherapy combined with image guided radiotherapy has led to increase the precision of external beam radiotherapy. However, intra or inter-fraction anatomical variations are frequent during the treatment course and can cause under-dosing of the target volume and/or over-dosing of the organs at risk. Several adaptive radiotherapy (ART) strategies can be defined to compensate these anatomical variations. The purpose of this article is to provide an overview of available ART strategies: offline, online, hybrid (library of treatment plans) or in real-time, while considering the arrival of MR-Linac devices in radiotherapy departments. The tools required to these ART strategies such as auto-segmentation, deformable image registration, calculation of the daily dose or dose accumulation, are also described. Implementing an ART strategy requires a rigorous quality assurance process, at each stage and on the entire workflow, as well as prior organization and training from of all the trades. A strong multidisciplinary involvement is finally required in order to ensure ART treatments.


Assuntos
Órgãos em Risco/efeitos da radiação , Garantia da Qualidade dos Cuidados de Saúde , Lesões por Radiação/prevenção & controle , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Radioterapia de Intensidade Modulada/métodos , Tomografia Computadorizada de Feixe Cônico/métodos , Humanos , Neoplasias/diagnóstico por imagem , Neoplasias/patologia , Neoplasias/radioterapia , Dosagem Radioterapêutica , Radioterapia de Alta Energia , Radioterapia Guiada por Imagem/instrumentação , Radioterapia de Intensidade Modulada/instrumentação
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