Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.321
Filtrar
1.
BMC Med ; 17(1): 92, 2019 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-31084606

RESUMO

BACKGROUND: Understanding where adults with diabetes in India are lost in the diabetes care cascade is essential for the design of targeted health interventions and to monitor progress in health system performance for managing diabetes over time. This study aimed to determine (i) the proportion of adults with diabetes in India who have reached each step of the care cascade and (ii) the variation of these cascade indicators among states and socio-demographic groups. METHODS: We used data from a population-based household survey carried out in 2015 and 2016 among women and men aged 15-49 years in all states of India. Diabetes was defined as a random blood glucose (RBG) ≥ 200 mg/dL or reporting to have diabetes. The care cascade-constructed among those with diabetes-consisted of the proportion who (i) reported having diabetes ("aware"), (ii) had sought treatment ("treated"), and (iii) had sought treatment and had a RBG < 200 mg/dL ("controlled"). The care cascade was disaggregated by state, rural-urban location, age, sex, household wealth quintile, education, and marital status. RESULTS: This analysis included 729,829 participants. Among those with diabetes (19,453 participants), 52.5% (95% CI, 50.6-54.4%) were "aware", 40.5% (95% CI, 38.6-42.3%) "treated", and 24.8% (95% CI, 23.1-26.4%) "controlled". Living in a rural area, male sex, less household wealth, and lower education were associated with worse care cascade indicators. Adults with untreated diabetes constituted the highest percentage of the adult population (irrespective of diabetes status) aged 15 to 49 years in Goa (4.2%; 95% CI, 3.2-5.2%) and Tamil Nadu (3.8%; 95% CI, 3.4-4.1%). The highest absolute number of adults with untreated diabetes lived in Tamil Nadu (1,670,035; 95% CI, 1,519,130-1,812,278) and Uttar Pradesh (1,506,638; 95% CI, 1,419,466-1,589,832). CONCLUSIONS: There are large losses to diabetes care at each step of the care cascade in India, with the greatest loss occurring at the awareness stage. While health system performance for managing diabetes varies greatly among India's states, improvements are particularly needed for rural areas, those with less household wealth and education, and men. Although such improvements will likely have the greatest benefits for population health in Goa and Tamil Nadu, large states with a low diabetes prevalence but a high absolute number of adults with untreated diabetes, such as Uttar Pradesh, should not be neglected.


Assuntos
Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Garantia da Qualidade dos Cuidados de Saúde , Adolescente , Adulto , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Planos de Sistemas de Saúde/normas , Planos de Sistemas de Saúde/estatística & dados numéricos , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Prevalência , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto Jovem
2.
J Wound Ostomy Continence Nurs ; 46(3): 207-213, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083063

RESUMO

PURPOSE: We examined the usability, user perceptions, and nursing occupational subculture associated with introduction of a patient monitoring system to facilitate nursing staff implementation of standard care for pressure ulcer/injury prevention in the nursing home setting. DESIGN: Mixed methods, pre-/posttest design. SUBJECTS AND SETTING: Resident (n = 44) and staff (n = 38) participants were recruited from a 120-bed nursing home in the Southeast United States. METHODS: Digital data on frequency and position of residents were transmitted wirelessly from sensors worn on each resident's anterior chest to estimate nursing staff compliance with repositioning standard of care before and after visual monitors were activated to cue staff. The validated Nursing Culture Assessment Tool was used to determine changes in nursing culture. Benefits and challenges of implementation were assessed by 2 focus groups composed of 8 and 5 female members of the nursing staff (RN, LPN, CNA), respectively, and led by the three authors. Descriptive statistics were used for all quantitative variables, and inferential statistics were applied to categorical variables (χ test or Fisher exact test) and continuous variables (analyses of variance or equivalent nonparametric tests), respectively, where a 2-sided P value of <.05 was considered statistically significant. RESULTS: System use significantly (P = .0003) improved compliance with every 2-hour repositioning standards. The nursing culture normative ranking percentage increased from 30.9% to 58.2%; this difference was not statistically significant. Focus groups expressed satisfaction with the monitoring system and recommended improvements to support adaptation and use of technology. CONCLUSIONS: Study findings support the usability of the patient monitoring system to facilitate repositioning. Implementation of multiple strategies for training, supplies, and communication may enhance uptake and effectiveness.


Assuntos
Monitorização Fisiológica/métodos , Casas de Saúde/estatística & dados numéricos , Lesão por Pressão/complicações , Lesão por Pressão/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas , Casas de Saúde/organização & administração , Postura , Lesão por Pressão/epidemiologia , Pesquisa Qualitativa , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Sudeste dos Estados Unidos/epidemiologia
3.
Heart Lung Circ ; 28(10): 1459-1462, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30962063

RESUMO

Over two decades, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) cardiac surgery database program has evolved from a single state-based database to a national clinical quality registry program and is now the most comprehensive cardiac surgical registry in Australia. We report the current structure and governance of the program and its key activities.


Assuntos
/normas , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Sistema de Registros , Sociedades Médicas , Cirurgia Torácica/estatística & dados numéricos , Procedimentos Cirúrgicos Torácicos/normas , Austrália , Humanos , Nova Zelândia
4.
Early Interv Psychiatry ; 13(3): 568-573, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-29193743

RESUMO

BACKGROUND: The efficacy of the Specialized Early Intervention (SEI) treatment in Denmark, the OPUS treatment, has in a randomized clinical trial proved to be very effective compared to treatment as usual, and the dissemination of SEI services is increasing in Denmark. A prerequisite for upholding positive effects along with creating new teams and preserving critical components is to ensure fidelity to the model. Currently there is no Danish fidelity scale for SEI services. AIM: To establish a fidelity scale for SEI teams, in a brief and easily manageable form, for the use of evaluating and assessing the critical components in Danish SEI services. METHOD: We identified essential evidence-based components of SEI services internationally and interviewed experts from five Danish SEI teams, using an adapted version of the Delphi Consensus method. RESULTS: An 18-point fidelity scale was constructed. The scale was divided into two dimensions: one relating to the structure of the SEI team and one relating to the character and content of the SEI treatment. Each component can be rated either 1 or 0 (1 point = fulfilling the requirements for the components; and 0 point = the requirements were not met). The maximum score was a total of 18 points with 5 of the components being mandatory. CONCLUSION: The development of the fidelity scale is an important tool for securing the quality of SEI treatment in Denmark.


Assuntos
Intervenção Médica Precoce/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Esquizofrenia/terapia , Psicologia do Esquizofrênico , Adulto , Administração de Caso , Dinamarca , Estudos de Avaliação como Assunto , Medicina Baseada em Evidências , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Masculino , Determinação de Necessidades de Cuidados de Saúde , Equipe de Assistência ao Paciente/normas , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Psicometria , Esquizofrenia/diagnóstico , Resultado do Tratamento
5.
Neurosurgery ; 84(2): 537-543, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29566181

RESUMO

Recent legislation has changed quality reporting in neurological surgery. The present study summarizes the reporting of objectives and measures outlined by the Quality Payment Program (QPP) and assesses how practices are preparing to comply. In February 2017, 220 neurosurgical practices were surveyed regarding their adherence to quality reporting objectives and measures. Survey responders were asked to report infrastructure-level data including practice type and number of providers. Furthermore, we evaluated the reporting of quality and advancing care measures outlined by the QPP. Assessment of quality measures was focused on those related to neurosurgical patient management. A total of 27 responses were obtained. Practices consisted of 8 academic (30%), 16 physician-owned (59%), and 3 hospital-owned (11%) neurosurgical practices. Of the 27 total responders, 18 indicated their adherence to a host of quality and advancing care measures. Practice type was strongly associated with the number of quality measures performed (P = .020, Wilcoxon rank-sum test). Physician-owned practices reported performing a median of 5 quality measures (interquartile range, 4.5-9.5), while practices in academic and hospital-owned groups reported performing 12 quality measures (interquartile range, 9.5-13.5). Forty-five percent of physician-owned practices reported performing at least 6 quality measures, whereas 100% of academic and hospital-owned practices reported the same benchmark (P = .038, Fisher's exact test). Performance of advancing care measures was not associated with practice type. Compared to other practice types, the rate of quality reporting among physician-owned neurosurgical practices appears to be modest thus far, which may influence future reimbursement adjustments.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Neurocirurgia/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Humanos , Neurocirurgiões/normas , Neurocirurgiões/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Inquéritos e Questionários
6.
Clin Microbiol Infect ; 25(3): 380.e9-380.e16, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29906596

RESUMO

OBJECTIVES: Hospital-based surveillance of influenza and acute respiratory infections relies on International Classification of Diseases (ICD) codes and hospital laboratory reports (Standard-of-Care). It is unclear how many cases are missed with either method, i.e. remain undiagnosed/coded as influenza and other respiratory virus infections. Various influenza-like illness (ILI) definitions co-exist with little guidance on how to use them. We compared the diagnostic accuracy of standard surveillance methods with a prospective quality management (QM) programme at a Berlin children's hospital with the Robert Koch Institute. METHODS: Independent from routine care, all patients fulfilling pre-defined ILI-criteria (QM-ILI) participated in the QM programme. A separate QM team conducted standardized clinical assessments and collected nasopharyngeal specimens for blinded real-time quantitative PCR for influenza A/B viruses, respiratory syncytial virus, adenovirus, rhinovirus and human metapneumovirus. RESULTS: Among 6073 individuals with ILI qualifying for the QM programme, only 8.7% (528/6073) would have undergone virus diagnostics during Standard-of-Care. Surveillance based on ICD codes would have missed 61% (359/587) of influenza diagnoses. Of baseline ICD codes, 53.2% (2811/5282) were non-specific, most commonly J06 ('acute upper respiratory infection'). Comparison of stakeholder case definitions revealed that QM-ILI and the WHO ILI case definition showed the highest overall sensitivities (84%-97% and 45%-68%, respectively) and the CDC ILI definition had the highest sensitivity for influenza infections (36%, 95% CI 31.4-40.8 for influenza A and 48%, 95% CI 40.5-54.7 for influenza B). CONCLUSIONS: Disease-burden estimates and surveillance should account for the underreporting of cases in routine care. Future studies should explore the effect of ILI screening and surveillance in various age groups and settings. Diagnostic algorithms should be based on the WHO ILI case definition combined with targeted testing.


Assuntos
Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Infecções Respiratórias/diagnóstico , Padrão de Cuidado/estatística & dados numéricos , Viroses/diagnóstico , Vírus/isolamento & purificação , Adolescente , Criança , Pré-Escolar , Feminino , Hospitais , Humanos , Lactente , Recém-Nascido , Influenza Humana/classificação , Influenza Humana/diagnóstico , Classificação Internacional de Doenças/normas , Masculino , Nasofaringe/virologia , Vigilância da População , Estudos Prospectivos , Garantia da Qualidade dos Cuidados de Saúde/normas , Reação em Cadeia da Polimerase em Tempo Real , Infecções Respiratórias/classificação , Infecções Respiratórias/virologia , Padrão de Cuidado/normas , Viroses/classificação
7.
J Am Coll Surg ; 228(2): 180-187, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30359838

RESUMO

BACKGROUND: Public reporting of cardiac surgery ratings has been advocated to inform patient selection of hospitals. Although Society of Thoracic Surgeons (STS) ratings are based on audited risk-adjusted patient outcomes, other rating systems rely on administrative databases. In this study, we evaluate correlation among 4 widely used hospital rating systems for coronary artery bypass grafting (CABG) and aortic valve replacement (AVR). STUDY DESIGN: We identified an initial cohort of 602 hospitals from US News & World Report's (USN) listing of the 2016-2017 "Best Hospitals for Cardiology & Heart Surgery." From this cohort, current publicly available CABG and AVR ratings were collected from the STS, USN, Centers for Medicare & Medicaid Services, and Healthgrades. All 4 rating systems rated hospitals as high, average, or below average performers for each procedure. We then determined the match rate between rating systems for individual hospitals and assessed interrater reliability with Cohen's κ. RESULTS: Rating systems had different distributions of high and low performing ratings assigned. USN rated hospitals as high performing for both CABG and AVR more frequently compared with STS, Healthgrades, and Centers for Medicare & Medicaid Services. For CABG, the match rate between systems varied from 50% to 85%, with the best match between STS and Centers for Medicare & Medicaid Services. Similarly for AVR, the match rate varied from 50% to 73%, with the best match between STS and Healthgrades. Interrater reliability was poor among the 4 rating systems (κ < 0.2) and consistent with no agreement for CABG and AVR ratings. CONCLUSIONS: Publicly reported cardiac surgery ratings have significant discrepancy and poor correlation. This might confuse instead of clarify public perception of hospital quality for cardiac surgery.


Assuntos
Valva Aórtica , Informação de Saúde ao Consumidor/normas , Ponte de Artéria Coronária/normas , Implante de Prótese de Valva Cardíaca/normas , Hospitais/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Acesso à Informação , Informação de Saúde ao Consumidor/estatística & dados numéricos , Ponte de Artéria Coronária/estatística & dados numéricos , Comunicação em Saúde/normas , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Variações Dependentes do Observador , Percepção , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Estados Unidos
8.
Korean J Intern Med ; 34(1): 125-136, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28286936

RESUMO

BACKGROUND/AIMS: Due to recent increases in the disease burden of diabetes mellitus, the Health Insurance Review and Assessment Service (HIRA) of Korea implemented a quality assessment of the treatment of diabetes to improve patient care. The present study was conducted to identify any changes after the implementation of the diabetes quality assessment (DQA). METHODS: The present study evaluated eight quality assessment indicators that were proposed by the HIRA in all patients with diabetes who visited a university hospital in Korea between 2009 and 2014. The indicators were statistically compared according to the characteristics of the subjects. RESULTS: There were several significant differences in the indicators among the subjects according to their demographic characteristics. Female patients had a higher continuity of treatment (COT) than that of male patients, and the insulin-treated group had a higher COT than that of the non-treated group, as well as a higher rate of undergoing the diabetes complication tests (DCTs). Patients between 40 and 80 years of age had the highest COT, while patients under 40 years of age had the lowest COT but the highest rate of taking the DCTs. Patients receiving treatment from an endocrinologist exhibited higher numbers of DCTs performed but displayed lower proportions for the prescription indicators. CONCLUSION: The present analysis of the DQA findings revealed that endocrinologists combine prevention and management of diabetes complications with measures for glycemic control. Thus, the effective management of diabetes likely entails systematic joint treatment regimens that involve an endocrinologist.


Assuntos
Diabetes Mellitus/terapia , Garantia da Qualidade dos Cuidados de Saúde/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/metabolismo , Continuidade da Assistência ao Paciente , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/prevenção & controle , Diabetes Mellitus/sangue , Endocrinologistas , Feminino , Hospitais Universitários , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , República da Coreia
10.
Health Policy ; 122(11): 1177-1182, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30270032

RESUMO

OBJECTIVE: To identify ambulatory care physicians' priorities for hospital quality criteria to support them in counselling patients what hospital to choose. METHODS: Three hundred non-hospital-based stratified randomly sampled physicians, representing the five main referring specialties in Germany participated in a cross-sectional survey. Physicians rated the importance of 80 hospital quality criteria to be used in their counselling of patients in need of hospital care. Criteria selection was based on a literature analysis and the content of Germany's mandatory hospital quality reports. We calculated the most important criteria and performed an ordinal regression analysis to examine whether the physicians' characteristics 'age', 'sex', 'specialty', 'practice type' and 'region' affected physicians' importance ratings. RESULTS: To counsel patients in need of a hospital referral, physicians preferred hospital quality criteria that reflect their own and their patients' experiences with a hospital. Additionally, hospitals' expertise and results of treatment were rated highly important. In contrast, hospitals' structural characteristics and compliance with external requirements were rated less important. Physicians' characteristics affected importance ratings only negligibly. CONCLUSIONS: To support referring physicians' counselling of patients regarding what hospital to choose in order to achieve optimal patient outcomes eventually, hospital report cards must be enriched by information on physicians' and their patients' experiences with hospitals. Hospitals' structural characteristics play a minor role in counselling of patients needing hospital care.


Assuntos
Hospitais/normas , Notificação de Abuso , Médicos de Atenção Primária , Garantia da Qualidade dos Cuidados de Saúde/normas , Encaminhamento e Consulta , Estudos Transversais , Feminino , Alemanha , Humanos , Masculino , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Inquéritos e Questionários
11.
J Med Libr Assoc ; 106(4): 420-431, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30271283

RESUMO

Objective: This review aimed to determine if the use of the patient, intervention, comparison, outcome (PICO) model as a search strategy tool affects the quality of a literature search. Methods: A comprehensive literature search was conducted in PubMed, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, Library and Information Science Abstracts (LISA), Scopus, and the National Library of Medicine (NLM) catalog up until January 9, 2017. Reference lists were scrutinized, and citation searches were performed on the included studies. The primary outcome was the quality of literature searches and the secondary outcome was time spent on the literature search when the PICO model was used as a search strategy tool, compared to the use of another conceptualizing tool or unguided searching. Results: A total of 2,163 records were identified, and after removal of duplicates and initial screening, 22 full-text articles were assessed. Of these, 19 studies were excluded and 3 studies were included, data were extracted, risk of bias was assessed, and a qualitative analysis was conducted. The included studies compared PICO to the PIC truncation or links to related articles in PubMed, PICOS, and sample, phenomenon of interest, design, evaluation, research type (SPIDER). One study compared PICO to unguided searching. Due to differences in intervention, no quantitative analysis was performed. Conclusions: Only few studies exist that assess the effect of the PICO model vis-a-vis other available models or even vis-a-vis the use of no model. Before implications for current practice can be drawn, well-designed studies are needed to evaluate the role of the tool used to devise a search strategy.


Assuntos
Medicina Baseada em Evidências/normas , Armazenamento e Recuperação da Informação/métodos , Publicações Periódicas como Assunto/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Humanos , Estados Unidos
13.
Unfallchirurg ; 121(10): 794-801, 2018 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-30225633

RESUMO

BACKGROUND: Since the publication in 1993, the dataset and documentation form of the TraumaRegister DGU® (TR-DGU) have continuously evolved. On the occasion of the 25th anniversary the authors have analyzed this evolution in order to reflect it in the light of medical progress in the treatment of the severely injured. MATERIAL AND METHODS: Enrolled in the study were 5 reference data entry sheets from the years 1993, 1996, 2002, 2009 and 2016. Every piece of information (item) queried therein was entered into the study database, was categorized by topic and counted for further analysis. RESULTS: The arrangement of the 4­page data entry form has remained practically unchanged since 1993 and includes an average of 212 items. A total of 491 items were identified of which 64 were present throughout every dataset. Based on the average extent of the form this equals a proportion of approximately 30%. The dataset actually shows much more consistency than this number suggests because many changes can be traced back to a smarter design of the data entry form. Most items fell into the categories "results/diagnosis" (143 items/29.1%), "coagulation" (104/21.2%) and "surgical approach" (40/8.1%). Many items serve as raw data for the calculation of prognostic risk scores, such as the trauma and injury severity score (TRISS), the revised injury severity classification II (RISC II) and the trauma associated severe hemorrhage (TASH) score. Currently, nine scores can be calculated from the dataset. CONCLUSION: The members of the working group TraumaRegister all actively participate in the treatment of severely injured patients. For 25 years this group has managed to unify the latest medical developments and well-established parameters within the TR-DGU dataset at a relatively constant degree of effort for documentation. Practice in place of theory is the driving force behind this development that serves quality assurance and research in the treatment of severely injured patients.


Assuntos
Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/terapia , Bases de Dados Factuais/normas , Bases de Dados Factuais/estatística & dados numéricos , Bases de Dados Factuais/tendências , Documentação/normas , Documentação/estatística & dados numéricos , Alemanha/epidemiologia , Humanos , Garantia da Qualidade dos Cuidados de Saúde/normas , Sistema de Registros/normas , Fatores de Risco , Traumatologia/normas , Ferimentos e Lesões/epidemiologia
14.
Laryngoscope ; 128(12): 2697-2701, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30229937

RESUMO

OBJECTIVES/HYPOTHESIS: Children presenting to the emergency department with coin-shaped foreign body (FB) ingestion must be evaluated urgently to rule out a button battery. As many of these ingestions are well-appearing on presentation, delays in triage put patients at risk for further injury. STUDY DESIGN: Quality initiative. METHODS: A quality initiative, utilizing electronic medical record (EMR)-based tools, was implemented at our academic children's hospital. A chief complaint pertaining to coin-shaped FB ingestion was created and was linked to a best practice advisory, instructing assignment of acuity level 2 and the order of a Stat x-ray. A link to the hospital's relevant algorithm was provided. A review was conducted comparing children who underwent FB removal preinitiative (January 1, 2016-January 28, 2017) and postinitiative (January 31, 2017-August 30, 2017). Primary outcomes were frequency of assignment of acuity level 2 and time from patient arrival to x-ray order placement and x-ray completion. RESULTS: Thirty-six patients in the baseline group and 30 in the postintervention group underwent FB removal. The rate of appropriate acuity assignment increased from 63.8% (23/36) pre implementation to 100% (30/30) postimplementation (P = .0003). Median time from arrival to imaging ordered and completed decreased from 36.5 to 4 minutes (95% confidence interval [CI]: -44 to -17) and 59 to 41 minutes (95% CI: -39 to -1), respectively. CONCLUSIONS: Utilization of EMR-based tools was associated with improved timeliness in initiation of care in metallic FB ingestion patients. Further initiatives will be aimed at downstream events in the diagnosis and treatment of these patients. LEVEL OF EVIDENCE: NA Laryngoscope, 128:2697-2701, 2018.


Assuntos
Algoritmos , Registros Eletrônicos de Saúde , Corpos Estranhos/diagnóstico , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Triagem/normas , Pré-Escolar , Fontes de Energia Elétrica , Serviço Hospitalar de Emergência , Feminino , Corpos Estranhos/cirurgia , Implementação de Plano de Saúde , Hospitais Pediátricos , Humanos , Masculino , Radiografia/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Triagem/métodos
15.
J Am Pharm Assoc (2003) ; 58(6): 622-629, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30190200

RESUMO

OBJECTIVES: To evaluate community pharmacists' reimbursed prescribing interventions (called pharmaceutical opinions/POs in Canada) by determining the types of drug-related problems (DRPs) identified; the type, quality, and clinical impact of recommendations made; and variation in recommendation quality across regions, pharmacy ownership type, and pharmacy size. DESIGN: Retrospective audit of randomly sampled service documentation records. SETTING: Community pharmacies in Ontario, Canada, 3 years after implementation of a government program that reimburses pharmacies for providing DRP-based POs to physicians. PARTICIPANTS: Thirty-six community pharmacies in 4 regions of Ontario. MAIN OUTCOME MEASURES: For each PO, 2 experienced clinical pharmacists independently, and then by consensus, determined the primary drug implicated and its therapeutic category, the type of DRP, and the type of prescriber recommendation. Each PO recommendation was assessed for clinical impact, evidence base, and overall quality. Chi-square analyses assessed the relationship between PO quality and pharmacy characteristics. RESULTS: Of 563 POs, 261 (46%) met reimbursement criteria for stating a DRP and prescriber recommendation. Among these eligible POs, systemic antiinfective (22%), alimentary tract and metabolism (19%), nervous system (15%), and cardiovascular (15%) drugs were most commonly identified in the DRP. Adverse drug reactions (which included drug interactions) were the most common type of DRP (42.5%), followed by "dose too high" (16%) and "needs additional therapy" (14%). Top recommendations were to change the drug (41%) and to decrease the dose (20%). The quality of the pharmacist's recommendation was judged to be good to excellent in 70% of the 261 eligible POs; quality was associated with region and ownership type. CONCLUSION: PO quality was suboptimal: the primary issue was failure to state a prescriber recommendation. Collaborative efforts are needed from community pharmacy stakeholders (schools of pharmacy, regulatory colleges, and continuing education providers) to help pharmacists enhance the quality of their POs, beginning with their clinical documentation skills.


Assuntos
Serviços Comunitários de Farmácia/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Farmacêuticos/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Canadá , Competência Clínica/estatística & dados numéricos , Interações de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Feminino , Humanos , Masculino , Farmácias/estatística & dados numéricos , Papel Profissional , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Estudos Retrospectivos
16.
Vet Radiol Ultrasound ; 59(6): 786-795, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30062728

RESUMO

Radiotherapy plays an important role in curative and palliative cancer treatment. As a novel radiation delivery technique, stereotactic radiotherapy utilizes three-dimensional-conformal treatment planning, high-precision beam delivery technology, and patient specific position verification to target tumors, often in one to five high-dose fractions. Currently, there is no consensus about best stereotactic radiotherapy practices in veterinary radiotherapy. The objective of this study was to document the breadth of perspectives, techniques, and applications of stereotactic radiotherapy in veterinary medicine. We conducted an online survey of American College of Veterinary Radiology members specializing in radiation oncology to assess how, when, and why stereotactic radiotherapy is being used. Both stereotactic radiotherapy users and nonusers completed the survey. The overall response and survey completion rates were 54% (67/123) and 87% (58/67), respectively. Overall, 55% of respondents reported providing stereotactic radiotherapy at their facility, with a median of 4.5 canine cases and one feline case per month. Delivery methods included C-arm linear accelerator with multi-leaf collimator, helical tomotherapy, and CyberKnife. Nonpituitary intracranial tumors, pituitary tumors, and sinonasal tumors were the most common cancers treated using stereotactic radiotherapy in both species. The most common fractionation scheme was three fractions of 10 Gy/fraction. The results of this survey suggest common availability of stereotactic radiotherapy in veterinary radiation facilities. These results provide valuable information regarding current stereotactic radiotherapy practices in veterinary medicine, and may provide an initial step toward standardizing methods and establishing consensus guidelines.


Assuntos
Radiocirurgia/estatística & dados numéricos , Medicina Veterinária/métodos , Animais , Gatos , Cães , Fracionamento da Dose de Radiação , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Radiocirurgia/instrumentação , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador/estatística & dados numéricos , Planejamento da Radioterapia Assistida por Computador/veterinária , Estados Unidos , Medicina Veterinária/instrumentação , Medicina Veterinária/estatística & dados numéricos
17.
Eur J Public Health ; 28(5): 885-890, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30084999

RESUMO

Background: In the region of Central and Eastern Europe, long-term departments at psychiatric hospitals provide a large proportion of the care for people with complex mental health needs. The System of United Psychiatric Rehabilitation (S.U.P.R.) project focussed on the implementation of a complex set of interventions of psychosocial rehabilitation to increase the quality of care. The aim of this study was to assess the effect of the S.U.P.R. psychosocial rehabilitation programme on the quality of care at the longer-term inpatient psychiatric departments. Methods: All 12 psychiatric hospitals in the Czech Republic were asked to participate in the study. A 'before and after' design was adopted to evaluate the impact of the S.U.P.R. programme. Quality of care was assessed using the internationally validated, web-based tool, QuIRC (Quality Indicator for Rehabilitative Care), which provides percentage scores (0-100%) on seven domains of care and an overall mean quality score. Results: Fourteen long-term wards of 12 psychiatric hospitals for adults in the Czech Republic participated in the S.U.P.R. project. The mean total QuIRC scores were relatively low at the start of the project (range 33% to 53%) but all domain scores increased two years after the S.U.P.R. programme was implemented (range 44% to 62%). Staff feedback was generally positive about the programme, but inadequate staffing was an impediment to its success. Conclusion: Implementing a modern concept for psychosocial rehabilitation aimed at progressing the recovery of people with complex mental health problems can improve the quality of care in longer term inpatient settings.


Assuntos
Hospitais Psiquiátricos/organização & administração , Assistência de Longa Duração/organização & administração , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , República Tcheca , Feminino , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos
18.
Disabil Health J ; 11(4): 545-554, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29983376

RESUMO

BACKGROUND: Persons leading their own evaluations of care quality offers the promise of generating maximally meaningful information to ensure person-centered care. OBJECTIVES: To describe an intervention where persons with disability engage other persons with disability, develop their own metrics to assess their care, and provide these care evaluations directly to primary care practitioners, with the goal of improving care. The context was a research study involving One Care, a Massachusetts demonstration program with capitated reimbursement for individuals ages 18-64 dually eligible for Medicare and Medicaid. METHODS: Individuals with serious mental illness or significant physical disability designed and implemented "YESHealth: Your Experience, Speak up for better health care." To solicit and communicate with YESHealth members, they mailed postcards announcing YESHealth to potential participants, created a website, sponsored a Facebook group, and staffed telephones in English and Spanish. YESHealth also involved reaching out to numerous disability advocacy organizations, developing and conducting short quarterly surveys about quality concerns they identified, and reporting survey results to YESHealth members and their primary care practitioners. RESULTS: Over 12 months, YESHealth staff visited 60 community organizations to recruit participants. Recruiting participants was challenging and ultimately required offering monetary compensation. Participants preferred telephone to online communication. Efforts to engage targeted primary care practitioners had very limited success. CONCLUSIONS: Despite these challenges, YESHealth represents a unique model for consumers' voices to try to affect change in care delivery. A randomized trial has evaluated whether the YESHealth intervention affected care quality for One Care members with disability.


Assuntos
Redes Comunitárias/organização & administração , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/estatística & dados numéricos , Distribuição Aleatória , Inquéritos e Questionários , Estados Unidos
19.
Disabil Health J ; 11(4): 537-544, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30054227

RESUMO

BACKGROUND: In October 2013, Massachusetts initiated the One Care demonstration, which enrolls beneficiaries ages 21 to 64 dually-eligible for Medicare and Medicaid. Local disability advocates argued that persons with disability should assess their own One Care quality. OBJECTIVES: To test the comparative effectiveness for improving patient-reported health care experiences of two informational interventions in a 12-month period: (1) "YESHealth: Your Experience, Speak up for better health care," in which disability advocates developed brief topical surveys and gathered information from One Care enrollees with significant physical disability or serious mental illness; and (2) the Persons with Disability Quality Survey (PDQ-S), developed collaboratively with persons with disability. METHODS: This cluster randomized controlled trial randomly assigned 27 primary care practices with ≥50 One Care members to three study arms differing by information provided to practice directors and primary care providers (PCPs): (1) quarterly YESHealth reports plus results from baseline administration of PDQ-S to 720 enrollees before YESHealth implementation; (2) PDQ-S results only; and (3) no study information. We administered PDQ-S again one year later and used difference-in-differences analyses of results across the two years to assess intervention outcomes. RESULTS: Disability advocates conducting YESHealth reported substantial difficulties contacting practices and engaging PCPs. With few exceptions, no differences were found across the three study arms in enrollee-reported outcomes. CONCLUSIONS: Providing consumer-designed and generated quality information to PCPs had no measurable effect on enrollees' perceptions of One Care quality. Barriers to PCPs engaging with disability advocates could have contributed to YESHealth's failure to improve care.


Assuntos
Redes Comunitárias/organização & administração , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Massachusetts , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Participação do Paciente/estatística & dados numéricos , Distribuição Aleatória , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
20.
BMC Med Res Methodol ; 18(1): 54, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29902975

RESUMO

BACKGROUND: When profiling multiple health care providers, adjustment for case-mix is essential to accurately classify the quality of providers. Unfortunately, misclassification of provider performance is not uncommon and can have grave implications. Propensity score (PS) methods have been proposed as viable alternatives to conventional multivariable regression. The objective was to assess the outlier classification performance of risk adjustment methods when profiling multiple providers. METHODS: In a simulation study based on empirical data, the classification performance of logistic regression (fixed and random effects), PS adjustment, and three PS weighting methods was evaluated when varying parameters such as the number of providers, the average incidence of the outcome, and the percentage of outliers. Traditional classification accuracy measures were considered, including sensitivity and specificity. RESULTS: Fixed effects logistic regression consistently had the highest sensitivity and negative predictive value, yet a low specificity and positive predictive value. Of the random effects methods, PS adjustment and random effects logistic regression performed equally well or better than all the remaining PS methods for all classification accuracy measures across the studied scenarios. CONCLUSIONS: Of the evaluated PS methods, only PS adjustment can be considered a viable alternative to random effects logistic regression when profiling multiple providers in different scenarios.


Assuntos
Algoritmos , Pessoal de Saúde/estatística & dados numéricos , Modelos Logísticos , Risco Ajustado/estatística & dados numéricos , Pessoal de Saúde/classificação , Humanos , Pontuação de Propensão , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Risco Ajustado/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA