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1.
Arch. Soc. Esp. Oftalmol ; 95(12): 586-590, dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-194908

RESUMO

OBJETIVO: Reportar una experiencia piloto de atención por telemedicina en la especialidad de oftalmología, en el periodo de confinamiento por la pandemia por COVID-19. MÉTODOS: Estudio descriptivo. Se describen características demográficas y clínicas de pacientes atendidos en periodo de confinamiento de 10 semanas. Se evalúa la satisfacción de los pacientes y médicos participantes mediante una encuesta en línea. RESULTADOS: En las primeras 10 semanas, se realizaron 291 atenciones de telemedicina oftalmológica. Los principales motivos de consulta fueron afecciones inflamatorias de la superficie ocular y párpados (79,4%), seguido de requerimientos administrativos (6,5%), afecciones no inflamatorias de la superficie ocular (5,2%), sospecha de estrabismo (3,4%) y síntomas vitreorretinales (3,1%); 22 pacientes (7,5%) fueron derivados a atención presencial inmediata. El nivel de satisfacción con la prestación fue alto, tanto en médicos (100%), como en pacientes (93,4%). CONCLUSIONES: La atención oftalmológica por telemedicina en periodo de pandemia es un instrumento de utilidad para realizar un filtro de potenciales consultas presenciales, ya sea electivas o de urgencia, y para reducir potencialmente el riesgo de contagio por COVID-1


BACKGROUND: To report a pilot experience of telemedicine in ophthalmology in open-care modality (i.e. direct video call), in a confinement period due to the COVID-19 pandemic. METHODS: Descriptive study of the demographic and clinical characteristics of patients attended in a 10-week confinement period. Reported satisfaction of the participating patients and doctors was evaluated through an online survey. RESULTS: In the 10-week period, 291 ophthalmologic telemedicine consultations were performed. The main reasons for consultation were inflammatory conditions of the ocular surface and eyelids (79.4%), followed by administrative requirements (6.5%), non-inflammatory conditions of the ocular surface (5.2%), strabismus suspicion (3.4%) and vitreo-retinal symptoms (3.1%). According to previously defined criteria, 22 patients (7.5%) were referred to immediate face-to-face consultation. The level of satisfaction was high, both in doctors (100%) and in patients (93.4%). CONCLUSIONS: Open-care modality of telemedicine in ophthalmology during the pandemic period is a useful instrument to filter potential face-to-face consultations, either elective or emergency, and potentially reduce the risk of COVID-19 infection


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Telemedicina/instrumentação , Projetos Piloto , Pandemias/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Teleoftalmologia , Betacoronavirus , Satisfação do Paciente , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos
2.
Ann Biol Clin (Paris) ; 78(5): 574-580, 2020 10 01.
Artigo em Francês | MEDLINE | ID: mdl-32716002

RESUMO

Laboratories need to set up effective overall management of their internal quality control (IQC) and external quality assessment (EQA) results as key elements in statistical process control. Quality targets need to be defined, with methods to ensure durable control with respect to the relevant specifications. The hemostasis laboratory of the Lyon Hospitals Board (HCL, Lyon, France) uses model 3 from the Milan consensus conference, which is the state of the art in terms of quality targets, and uses a common EQA provider supplying as many real patient samples as possible. Giving priority to adopted methods, the lab optimizes the use of manufacturers' prior data: maximum acceptable inter assay coefficient of variation (CV) and prior IQC target values. Bayesian inference brings the method under control with respect to the manufacturers' prior data without the need for a preliminary phase. It links the IQC and EQA plans by the maximum acceptable CVs defined by the manufacturer.


Assuntos
Testes Hematológicos/estatística & dados numéricos , Testes Hematológicos/normas , Laboratórios Hospitalares/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde , Teorema de Bayes , Testes de Coagulação Sanguínea/instrumentação , Testes de Coagulação Sanguínea/métodos , Testes de Coagulação Sanguínea/normas , Testes de Coagulação Sanguínea/estatística & dados numéricos , Serviços de Laboratório Clínico/organização & administração , Serviços de Laboratório Clínico/normas , Serviços de Laboratório Clínico/estatística & dados numéricos , França/epidemiologia , Testes Hematológicos/instrumentação , Testes Hematológicos/métodos , Hemostasia/fisiologia , Humanos , Laboratórios Hospitalares/organização & administração , Laboratórios Hospitalares/normas , Ensaio de Proficiência Laboratorial/organização & administração , Ensaio de Proficiência Laboratorial/normas , Ensaio de Proficiência Laboratorial/estatística & dados numéricos , Prática Profissional/organização & administração , Prática Profissional/normas , Prática Profissional/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Controle de Qualidade , Estudos Retrospectivos
3.
JAMA Netw Open ; 3(7): e2010383, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32662845

RESUMO

Importance: The Centers for Medicare and Medicaid Services's (CMS's) 30-day risk-standardized mortality rate (RSMR) and risk-standardized readmission rate (RSRR) models do not adjust for do-not-resuscitate (DNR) status of hospitalized patients and may bias Hospital Readmissions Reduction Program (HRRP) financial penalties and Overall Hospital Quality Star Ratings. Objective: To identify the association between hospital-level DNR prevalence and condition-specific 30-day RSMR and RSRR and the implications of this association for HRRP financial penalty. Design, Setting, and Participants: This cross-sectional study obtained patient-level data from the Medicare Limited Data Set Inpatient Standard Analytical File and hospital-level data from the CMS Hospital Compare website for all consecutive Medicare inpatient encounters from July 1, 2015, to June 30, 2018, in 4484 US hospitals. Hospitalized patients had a principal diagnosis of acute myocardial infarction (AMI), heart failure (HF), stroke, pneumonia, or chronic obstructive pulmonary disease (COPD). Incoming acute care transfers, discharges against medical advice, and patients coming from or discharged to hospice were among those excluded from the analysis. Exposures: Present-on-admission (POA) DNR status was defined as an International Classification of Diseases, Ninth Revision diagnosis code of V49.86 (before October 1, 2015) or as an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis code of Z66 (beginning October 1, 2015). Hospital-level prevalence of POA DNR status was calculated for each of the 5 conditions. Main Outcomes and Measures: Hospital-level 30-day RSMRs and RSRRs for 5 condition-specific cohorts (mortality cohorts: AMI, HF, stroke, pneumonia, and COPD; readmission cohorts: AMI, HF, pneumonia, and COPD) and HRRP financial penalty status (yes or no). Results: Included in the study were 4 884 237 inpatient encounters across condition-specific 30-day mortality cohorts (patient mean [SD] age, 78.8 [8.5] years; 2 608 182 women [53.4%]) and 4 450 378 inpatient encounters across condition-specific 30-day readmission cohorts (patient mean [SD] age, 78.6 [8.5] years; 2 349 799 women [52.8%]). Hospital-level median (interquartile range [IQR]) prevalence of POA DNR status in the mortality cohorts varied: 11% (7%-16%) for AMI, 13% (7%-23%) for HF, 14% (9%-22%) for stroke, 17% (9%-26%) for pneumonia, and 10% (5%-18%) for COPD. For the readmission cohorts, the hospital-level median (IQR) POA DNR prevalence was 9% (6%-15%) for AMI, 12% (6%-22%) for HF, 16% (8%-24%) for pneumonia, and 9% (4%-17%) for COPD. The 30-day RSMRs were significantly higher for hospitals in the highest quintiles vs the lowest quintiles of DNR prevalence (eg, AMI: 12.9 [95% CI, 12.8-13.1] vs 12.5 [95% CI, 12.4-12.7]; P < .001). The inverse was true among the readmission cohorts, with the highest quintiles of DNR prevalence exhibiting the lowest RSRRs (eg, AMI: 15.3 [95% CI, 15.1-15.5] vs 15.9 [95% CI, 15.7-16.0]; P < .001). A 1% absolute increase in risk-adjusted hospital-level DNR prevalence was associated with greater odds of avoiding HRRP financial penalty (odds ratio, 1.06; 95% CI, 1.04-1.08; P < .001). Conclusions and Relevance: This cross-sectional study found that the lack of adjustment in CMS 30-day RSMR and RSRR models for POA DNR status of hospitalized patients may be associated with biased readmission penalization and hospital-level performance.


Assuntos
Mortalidade Hospitalar , Readmissão do Paciente/estatística & dados numéricos , Ordens quanto à Conduta (Ética Médica) , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Feminino , Humanos , Masculino , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Fatores de Risco , Estados Unidos/epidemiologia
4.
Pan Afr Med J ; 35: 35, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32499851

RESUMO

Introduction: The sterilization of surgical drapes plays an important role in preventing infections associated with treatments. At the CNHU-HKM, sterilization procedure for drapes encounters problems. The purpose of this study was to examine the factors associated with the quality of sterilization of surgical drapes at the CNHU-HKM. Methods: We conducted a cross-sectional, descriptive and analytical study focusing on 20 sterile surgical drapes, 41 agents were involved in the management of drapes and 55 members of the surgical team. The probabilistic method was used for sterile surgical drapes, the non-probabilistic method for the others. Pearson's Chi-square Test and logistic regression were used to find the association, with a significant threshold and a p<0.05. Results: Eighty six point forty six percent of subjects were males with an average age of 42 years. The quality of the process of sterilization of the operative drapes was not good in the two departments responsible for processing the drapes. Bacteriological analysis showed that, out of 20 sterile surgical drapes, 9 had Acinetobacter spp. a multidrug-resistant germ causing nosocomial infections. Multivariate analysis showed that professional experience (p=0.015) and quality control of the procedure (p=0.034) were statistically associated with the quality of sterilization. Conclusion: The presence of Acinetobacter spp. on the sterilized drapes demonstrates that sterilization of drapes at the CNHU-HKM is of poor quality. Measures strengthening the skills of providers are necessary to improve the quality of sterilization procedures.


Assuntos
Garantia da Qualidade dos Cuidados de Saúde , Esterilização/normas , Campos Cirúrgicos/microbiologia , Adulto , Benin/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Feminino , Higiene das Mãos/normas , Higiene das Mãos/estatística & dados numéricos , Hospitais Universitários , Humanos , Masculino , Técnicas Microbiológicas , Salas Cirúrgicas/normas , Salas Cirúrgicas/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde , Medição de Risco , Fatores de Risco , Esterilização/estatística & dados numéricos , Campos Cirúrgicos/normas , Campos Cirúrgicos/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle
5.
Malar J ; 19(1): 129, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228615

RESUMO

BACKGROUND: The World Health Organization (WHO) recommends parasite-based diagnosis of malaria. In recent years, there has been surge in the use of various kinds of nucleic-acid amplification based tests (NAATs) for detection and identification of Plasmodium spp. to support clinical care in high-resource settings and clinical and epidemiological research worldwide. However, these tests are not without challenges, including lack (or limited use) of standards and lack of reproducibility, due in part to variation in protocols amongst laboratories. Therefore, there is a need for rigorous quality control, including a robust external quality assessment (EQA) scheme targeted towards malaria NAATs. To this effect, the WHO Global Malaria Programme worked with the UK National External Quality Assessment Scheme (UK NEQAS) Parasitology and with technical experts to launch a global NAAT EQA scheme in January 2017. METHODS: Panels of NAAT EQA specimens containing five major species of human-infecting Plasmodium at various parasite concentrations and negative samples were created in lyophilized blood (LB) and dried blood spot (DBS) formats. Two distributions per year were sent, containing five LB and five DBS specimens. Samples were tested and validated by six expert referee laboratories prior to distribution. Between 37 and 45 laboratories participated in each distribution and submitted results using the online submission portal of UK NEQAS. Participants were scored based on their laboratory's stated capacity to identify Plasmodium species, and individual laboratory reports were sent which included performance comparison with anonymized peers. RESULTS: Analysis of the first three distributions revealed that the factors that most significantly affected performance were sample format (DBS vs LB), species and parasite density, while laboratory location and the reported methodology used (type of nucleic acid extraction, amplification, or DNA vs RNA target) did not significantly affect performance. Referee laboratories performed better than non-referee laboratories. CONCLUSIONS: Globally, malaria NAAT assays now inform a range of clinical, epidemiological and research investigations. EQA schemes offer a way for laboratories to assess and improve their performance, which is critical to safeguarding the reliability of data and diagnoses especially in situations where various NAAT methodologies and protocols are in use.


Assuntos
Testes Diagnósticos de Rotina/estatística & dados numéricos , Malária/diagnóstico , Técnicas de Amplificação de Ácido Nucleico/estatística & dados numéricos , Plasmodium/isolamento & purificação , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Humanos , Controle de Qualidade , Reprodutibilidade dos Testes , Organização Mundial da Saúde
6.
Healthc Q ; 23(1): 53-59, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32249740

RESUMO

Over the past 15 years, Cancer Care Ontario has used a robust performance management approach to drive improvements in care. Each year, priority indicators and targets are selected or retained, and performance is reviewed quarterly with each of Ontario's Regional Cancer Programs. Improvement support and encouragement are provided, such as data analysis, program ranking, communities of practice, consultations, action plan requests and certificates. This article analyzes data on 28 indicators prioritized over these years and demonstrates that 25 have shown sustained improvement over time. The performance management approach, lessons learned and gaps in knowledge are described to inform future research and practice.


Assuntos
Neoplasias/diagnóstico , Neoplasias/terapia , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Humanos , Ontário , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/normas
7.
BMJ Open Qual ; 9(1)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32169862

RESUMO

BACKGROUND: In recent years, Rutgers New Jersey Medical School Department of Family Medicine has integrated a quality assurance (QA) project as a required component of their 5-week medical student clerkship. This project requires each student to conduct a QA study at an assigned family practice and discuss the results with their preceptor. The aim of this study was to determine if sequential medical student QA projects impact physician readiness to improve guideline adherence over time. METHODS: A retrospective analysis of student reports was conducted to determine if physician readiness to improve compliance improved post implementation of the QA project using James Prochaska's Transtheoretical Model of Behavioral Change. Fisher's exact test or the χ2 test were used as applicable to compare the change in results. RESULTS: In academic year 2015-2016, there were 11 (6%) instances where physicians were precontemplating on change, 43 (24%) instances where physicians were contemplating, 101 (57%) instances where physicians were preparing to make change, 18 (10%) instances where physicians were acting, and 4 (2%) of instances where a physician were maintaining previous changes. The following year, the numbers were: 15 (8%), 38 (21%), 82 (46%), 34 (19%) and 11 (6%), respectively. There were increases of physicians in stages of precontemplation (p=0.047), action (p=0.02) and maintenance (p=0.047), a decrease in physicians that were in the stage of preparation (p=0.05) and no significant change in the instances they were in a stage of contemplation (p=0.60). CONCLUSION: Student QA projects appear to leverage physician readiness to improve guideline adherence. Future studies will determine if raising awareness through these clerkship projects results in practice behavioural change.


Assuntos
Medicina de Família e Comunidade/educação , Garantia da Qualidade dos Cuidados de Saúde/métodos , Estudantes de Medicina/psicologia , Estágio Clínico/métodos , Estágio Clínico/estatística & dados numéricos , Educação de Graduação em Medicina/métodos , Medicina de Família e Comunidade/métodos , Humanos , New Jersey , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Melhoria de Qualidade , Estudos Retrospectivos , Estudantes de Medicina/estatística & dados numéricos
8.
Phys Med ; 70: 139-144, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32018090

RESUMO

PURPOSE: The objective of this work is to determine mechanical, radiation, and imaging isocentres in three-dimensional (3D) coordinates and verifying coincidence of isocentres of passively scattered proton beam using a visual tracking system (VTS) and an in-house developed phantom named the Eagle. METHODS: The Eagle phantom consists of two modules: The first, named Eagle-head, is used for determining 3D mechanical isocentre of gantry rotation. The second, named Eagle-body, is used for determining 3D radiation and imaging isocentres. The Eagle-body has four slots wherein radiochromic films were inserted for measuring the 3D radiation isocentre and a metal bead was embedded in the centre of one cube to determine the imaging isocentre; this was determined by analysing cone-beam computed tomography images of the cube. Infrared reflective markers that can be tracked by VTS were attached to the Eagle at predetermined locations. The tracked data were converted into 3D treatment room coordinates. The developed method was compared with other methods to assess accuracy. RESULTS: The isocentres were determined in mm with respect to the laser isocentre. The mechanical, radiation, and imaging isocentres were (-0.289, 0.189, 0.096), (-0.436, -0.217, 0.009), and (0.134, 0.142, 0.103), respectively. When compared with other methods, the difference in coordinates was (-0.033, -0.107, 0.014) and (0.003, 0.067, 0.039) for radiation and imaging isocentres, respectively. CONCLUSION: The developed system was found to be useful in providing fast and accurate measurements of the three isocentres in the 3D treatment room coordinate system.


Assuntos
Tomografia Computadorizada de Feixe Cônico/instrumentação , Terapia com Prótons/métodos , Prótons , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Algoritmos , Desenho de Equipamento , Humanos , Movimento (Física) , Imagens de Fantasmas , Traçadores Radioativos
9.
Indian Pediatr ; 56(8): 663-668, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31477647

RESUMO

OBJECTIVES: To evaluate the existing status of human milk banks in India with reference to infrastructure, human resources, funding mechanisms, operating procedures and quality assurance. METHODS: A pretested questionnaire was administered to 16 out of 22 human milk banks across India, operational for more than one year prior to commencing the study. RESULTS: 11 (69%) milk banks were in government or charitable hospitals; only 2 (12.5%) were established with government funding. 8 (50%) had a dedicated technician and only 1(6%) had more than five lactation counsellors. Milk was collected predominantly from mothers of sick babies and in postnatal care wards followed by pediatric outpatient departments, camps, satellite centers, and homes. 10 (63%) reported gaps between donor milk demand and supply. 12 (75%) used shaker water bath pasteurizer and cooled the milk manually without monitoring temperature, and 4 (25%) pooled milk under the laminar airflow. 10 (63%) tracked donor to recipient and almost all did not collect data on early initiation, exclusive breastfeeding or human milk feeding. CONCLUSIONS: Our study reports the gaps of milk banking practices in India, which need to be addressed for strengthening them. Gaps include suboptimal financial support from the government, shortage of key human resources, processes and data gaps, and demand supply gap of donor human milk.


Assuntos
Bancos de Leite/organização & administração , Estudos Transversais , Financiamento Governamental/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Índia , Bancos de Leite/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos
10.
Hosp Top ; 97(4): 148-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464174

RESUMO

This study investigated the association between community diversity within hospitals' referral region (HRR) and hospital-acquired conditions (HACs) incident rate among adults ages ≥ 65 years. HRR level (n = 274) HACs were examined and the analysis showed that high diverse communities (OR 1.48, 95% CI [1.15,1.91]) had higher adjusted odds than low diverse communities to score poorly on Domain 2, and increased odds of scoring poor on overall total HAC score. Although hospital quality of care is not intentionally segregated, its surrounding community is impacting its performance, thus policymakers need to accommodate the diversity of communities when developing pay-for-performance or merit-based initiatives.


Assuntos
Doença Iatrogênica/prevenção & controle , Reembolso de Incentivo/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Diversidade Cultural , Feminino , Humanos , Doença Iatrogênica/epidemiologia , Masculino , Medicare/organização & administração , Medicare/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Segregação Social/tendências , Estados Unidos
12.
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
13.
BMJ Open ; 9(5): e028202, 2019 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-31110108

RESUMO

OBJECTIVE: To quantify which publicly reported hospital quality metrics have the greatest impact on a patient's simulated hospital selection for hip or knee arthroplasty. DESIGN: Discrete choice experiment. SETTING: Two university-affiliated orthopaedic clinics in the greater Baltimore area, Maryland, USA. PARTICIPANTS: One hundred and twenty-eight patients who were candidates for total hip or knee arthroplasty. PRIMARY AND SECONDARY OUTCOME MEASURES: The effect and magnitude of acceptable trade-offs between publicly reported hospital quality parameters on patients' decision-making strategies using a Hierarchical Bayes model. RESULTS: Publicly reported information on patient perceptions of attention to alleviation of postoperative pain had the most influence on simulated hospital choice (20.7%), followed by methicillin-resistant Staphylococcus aureus (MRSA) rates (18.8%). The understandability of the discharge instructions was deemed the least important attribute with a relative importance of 6.9%. Stratification of these results by insurance status and duration of pain prior to surgery revealed that patient demographics and clinical presentation affect the decision-making paradigm. CONCLUSIONS: Publicly available information regarding hospital performance is of interest to hip and knee arthroplasty patients. Patients are willing to accept suboptimal understanding of discharge instructions, lower hospital ratings and suboptimal cleanliness in exchange for better postoperative pain management, lower MRSA rates, and lower complication rates.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Idoso , Teorema de Bayes , Tomada de Decisões , Feminino , Grupos Focais , Humanos , Masculino , Maryland , Pessoa de Meia-Idade
14.
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
15.
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
Gerenciamento de Dados/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
16.
Rofo ; 191(8): 725-731, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30703823

RESUMO

GOAL: In order to ensure high-quality cooperation between referring physicians and imaging services, it is important to assess the quality of imaging services as perceived by referring physicians. The present study aimed to develop and validate a questionnaire for referring physicians to assess the quality of outpatient diagnostic imaging services. MATERIALS & METHODS: The questionnaire was developed by discussing and modifying an existing instrument by the German Association of Surgeons. After qualitative pretesting, the instrument was tested with physicians referring to four outpatient diagnostic imaging services in Switzerland. The results were first assessed using descriptive statistics. The final instrument was tested for validity using the concept of known-groups validity. The hypothesis underlying this procedure was that physicians referring frequently to services estimated the quality of these services to be higher than physicians who referred less often to services. The differences in ratings were assessed using a one-sided two-sample Wilcoxon test. The final questionnaire was tested for internal consistency and reliability using Cronbach's Alpha. RESULTS: Results show a high level of satisfaction of referring physicians with the relevant services but also potential for quality improvement initiatives. The psychometric evaluation of the final questionnaire shows that it is a valid instrument, showing significant differences between the ratings of physicians referring with high and low frequency. Furthermore, the instrument proves to be consistent and reliable. CONCLUSION: The final instrument presents a valid, consistent and reliable option for assess the quality of outpatient diagnostic imaging services as perceived by referring physicians. Results can be used as a basis for quality improvement. KEY POINTS: · A newly developed questionnaire assesses the quality of outpatient diagnostic imaging services as perceived by referring physicians. The questionnaire was developed and tested in Switzerland.. · Psychometric evaluation showed the questionnaire to be a valid, consistent and reliable instrument.. · Results are of interest for imaging services as well as for initiatives encompassing several services.. CITATION FORMAT: · Jossen M, Valeri F, Heilmaier C et al. Referring Physicians Assess the Quality of Outpatient Diagnostic Imaging Services: Development and Psychometric Evaluation of a Questionnaire. Fortschr Röntgenstr 2019; 191: 725 - 731.


Assuntos
Imagem de Perfusão/estatística & dados numéricos , Imagem de Perfusão/normas , Psicometria/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/normas , Inquéritos e Questionários/estatística & dados numéricos , Inquéritos e Questionários/normas , Assistência Ambulatorial/normas , Assistência Ambulatorial/estatística & dados numéricos , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico/normas , Tomografia Computadorizada de Feixe Cônico/estatística & dados numéricos , Diagnóstico Diferencial , Humanos , Aumento da Imagem/métodos , Aumento da Imagem/normas , Cirrose Hepática/diagnóstico por imagem , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Lesões Pré-Cancerosas/diagnóstico por imagem , Lesões Pré-Cancerosas/fisiopatologia , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Fluxo Sanguíneo Regional/fisiologia
17.
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
18.
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
19.
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
20.
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
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