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1.
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
2.
BMC Health Serv Res ; 19(1): 556, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399089

RESUMO

BACKGROUND: Employees insured in pension insurance, who are incapable of working due to ill health, are entitled to a disability pension. To assess whether an individual meets the medical requirements to be considered as disabled, a work capacity evaluation is conducted. However, there are no official guidelines on how to perform an external quality assurance for this evaluation process. Furthermore, the quality of medical reports in the field of insurance medicine can vary substantially, and systematic evaluations are scarce. Reliability studies using peer review have repeatedly shown insufficient ability to distinguish between high, moderate and low quality. Considering literature recommendations, we developed an instrument to examine the quality of medical experts' reports. METHODS: The peer review manual developed contains six quality domains (formal structure, clarity, transparency, completeness, medical-scientific principles, and efficiency) comprising 22 items. In addition, a superordinate criterion (survey confirmability) rank the overall quality and usefulness of a report. This criterion evaluates problems of inner logic and reasoning. Development of the manual was assisted by experienced physicians in a pre-test. We examined the observable variance in peer judgements and reliability as the most important outcome criteria. To evaluate inter-rater reliability, 20 anonymous experts' reports detailing the work capacity evaluation were reviewed by 19 trained raters (peers). Percentage agreement and Kendall's W, a reliability measure of concordance between two or more peers, were calculated. A total of 325 reviews were conducted. RESULTS: Agreement of peer judgements with respect to the superordinate criterion ranged from 29.2 to 87.5%. Kendall's W for the quality domain items varied greatly, ranging from 0.09 to 0.88. With respect to the superordinate criterion, Kendall's W was 0.39, which indicates fair agreement. The results of the percentage agreement revealed systemic peer preferences for certain deficit scale categories. CONCLUSION: The superordinate criterion was not sufficiently reliable. However, in comparison to other reliability studies, this criterion showed an equivalent reliability value. This report aims to encourage further efforts to improve evaluation instruments. To reduce disagreement between peer judgments, we propose the revision of the peer review instrument and the development and implementation of a standardized rater training to improve reliability.


Assuntos
Revisão por Pares/normas , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Avaliação da Capacidade de Trabalho , Avaliação da Deficiência , Humanos , Pensões , Reprodutibilidade dos Testes
3.
BMC Public Health ; 19(1): 911, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288783

RESUMO

BACKGROUND: Providing comprehensive and high-quality services is one of the most important goals of the health systems and a basic principle for Universal Health Coverage (UHC). Fulfilling this important task would be feasible through continuous evaluation and improvement of the health services quality. The aim of this study was to develop a framework for quality assessment of Primary Health Care (PHC) in Iran's health system. METHODS: This study is a literature review which continued by a qualitative research. The extracted quality dimensions and indicators for initial screening were reviewed and discussed in two panel meetings attended by the experts with regard to the current package of health system in Iran. Using Delphi method, the dimensions and Quality Indicators(QIs) were evaluated and approved by 39 national health professionals in two rounds. Finally, after 4 panel sessions at ministerial level, the selected QIs were categorized in form of the final dimensions of the quality of care. RESULTS: The literature review emerged 13 Primary Health Care Quality Assessment Frameworks (PHCQAF) including 20 and 698 QIs. Delphi study resulted in developing Iranian PHCQAF comprising 7 dimensions and 40 QIs. Among these, 8 QIs of the dimension of access and equity, 5 QIs of safety dimension, 2 QIs of efficiency dimension, 13 QIs of effectiveness dimension, 2 QIs of patient-centeredness dimension, 3 QIs of governance dimension and 7 QIs of appropriateness dimension were presented. CONCLUSIONS: The presented PHCQAF can be used as a comprehensive and practical tool for continuous improvement of the quality of PHC services at local, national and regional levels. Moreover, it can give some useful information to the health managers and policy makers on how the services are provided.


Assuntos
Atenção Primária à Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Técnica Delfos , Humanos , Irã (Geográfico)
4.
N Z Med J ; 132(1499): 56-63, 2019 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-31352475

RESUMO

Point-of-care testing (POCT) devices are in vitro diagnostic devices used in hospitals, primary care and at home to provide rapid medical test results to support decision making. Most POCT devices are not regulated in New Zealand and there is no requirement for public or private hospital providers who use POCT devices to meet minimum accreditation standards for POCT. This article describes a regulatory framework for POCT devices, which is consistent with the principles of the draft Therapeutic Products Bill 2018. The proposed framework includes thorough evaluation, laboratory validation and approval processes for devices, improved traceability, accreditation for POCT and an adverse event management system; in the interests of patient safety.


Assuntos
Testes Imediatos , Garantia da Qualidade dos Cuidados de Saúde , Humanos , Modelos Organizacionais , Nova Zelândia , Testes Imediatos/organização & administração , Testes Imediatos/normas , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/normas
5.
G Ital Nefrol ; 36(3)2019 Jun 11.
Artigo em Italiano | MEDLINE | ID: mdl-31250993

RESUMO

The so-called Gelli-Bianco Law (L 24/2017) recognizes the central role of Guidelines as far as decision-making in the health sector is concerned and establishes the Italian National Guidelines System (SNLG) as a "safe harbor", notwithstanding the specificities of each real-world case. The Italian National Center for Clinical Excellence, Quality and Security (CNEC) is responsible for the creation and the development of the SNLG. After considering the many issues revolving around the creation of shared Guidelines, both on the national and international level, we present here the activities of the SNLG to date, together with an evaluation of how the new rules and practices around the creation of National Guidelines have been received. We also provide a series of recommendations for scientific societies on how best to produce Guidelines in their own field and how to submit them to the SNLG.


Assuntos
Guias de Prática Clínica como Assunto/normas , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Humanos , Itália , Garantia da Qualidade dos Cuidados de Saúde/organização & administração
6.
Z Evid Fortbild Qual Gesundhwes ; 143: 8-14, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31153810

RESUMO

RATIONALE, AIMS AND OBJECTIVES: The hospital sector is under considerable pressure to change. On the one hand, demographic change plays an important role and, on the other hand, the rapid development of medicine and nursing care can be attributed to the pressure to change. The Lean Management concept, which originated in the automotive sector, represents a successful management method for meeting these growing challenges. The aim of this work therefore was to use interviews with experts from the healthcare sector to find out which leadership philosophy hospitals need in order to successfully implement the lean management approach in their organisational culture. METHODS: A semi-qualitative approach was chosen as a survey instrument for the present study of the expert interviews. The interview guideline was divided into four categories: hospital management, knowledge, practice and implementation. Four experts were interviewed for approx. 45minutes each. All four interviewees are male and hold intermediate- or top-level management positions in a hospital. The evaluation method used is based on the content analysis according to Mayring. RESULTS: In category 1, a high pressure for change was indicated. The reasons cited were different financing arrangements, changes in the framework and the unregulated flow of patients into the hospital. Managers in hospitals are not recruited for their management skills, but exclusively for their medical knowledge. Category 2 shows that managers in hospitals have never learned to lead or manage. The term 'Lean Management' is sometimes interpreted differently. In category 3, the interviewees cited different reasons for implementing the lean management approach. Among other things, they see the possibility of increasing quality for the patient, employee satisfaction and safety. In category 4, it was confirmed that employees and management play a key role in implementation. In a hospital, the 'patient-first' approach should be prioritised. CONCLUSION: A critical analysis of the results shows that implementing the lean management approach in a hospital will pose a major challenge. The functional, hierarchical structure as well as the understanding of leadership and the organizational culture are critical success factors.


Assuntos
Assistência à Saúde , Eficiência Organizacional , Administração Hospitalar , Áustria , Assistência à Saúde/métodos , Assistência à Saúde/normas , Alemanha , Administração de Serviços de Saúde , Humanos , Masculino , Garantia da Qualidade dos Cuidados de Saúde/organização & administração
7.
Int Nurs Rev ; 66(2): 147-150, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31124127

RESUMO

We all know great leadership when we see it. Outstanding nurse leaders, guided by a moral compass, simultaneously see the big picture and the consequences at micro level. While policy and politics determine health and nursing practice, most nurses just want to get on with their day job. They carry out decisions made by others but have little say in them, and weak influence or status, although they are increasingly knowledgeable and skilled. In settings where policy decisions are made - parliaments, governments, and boardrooms - nurse leaders are often neither heard nor heeded. This is starting to change. The global Nursing Now campaign is working with the International Council of Nurses, and the World Health Organization, to create and strengthen strategic nursing leadership, as modelled by the International Council of Nurses' Global Nursing Leadership Institute. A new window of opportunity is opening, with the bicentennial of Florence Nightingale's birth in 2020. Now is the moment!


Assuntos
Política de Saúde , Liderança , Enfermeiras Administradoras/organização & administração , Papel do Profissional de Enfermagem , Supervisão de Enfermagem/organização & administração , Competência Clínica/normas , Humanos , Recursos Humanos de Enfermagem/organização & administração , Enfermagem em Saúde Pública/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração
8.
BMC Health Serv Res ; 19(1): 293, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068161

RESUMO

BACKGROUND: A number of challenges impede our ability to consistently provide high quality care to patients hospitalized with medical conditions. Teams are large, team membership continually evolves, and physicians are often spread across multiple units and floors. Moreover, patients and family members are generally poorly informed and lack opportunities to partner in decision making. Prior studies have tested interventions to redesign aspects of the care delivery system for hospitalized medical patients, but the majority have evaluated the effect of a single intervention. We believe these interventions represent complementary and mutually reinforcing components of a redesigned clinical microsystem. Our specific objective for this study is to implement a set of evidence-based complementary interventions across a range of clinical microsystems, identify factors and strategies associated with successful implementation, and evaluate the impact on quality. METHODS: The RESET project uses the Advanced and Integrated MicroSystems (AIMS) interventions. The AIMS interventions consist of 1) Unit-based Physician Teams, 2) Unit Nurse-Physician Co-leadership, 3) Enhanced Interprofessional Rounds, 4) Unit-level Performance Reports, and 5) Patient Engagement Activities. Four hospital sites were chosen to receive guidance and resources as they implement the AIMS interventions. Each study site has assembled a local leadership team, consisting of a physician and nurse, and receives mentorship from a physician and nurse with experience in leading similar interventions. Primary outcomes include teamwork climate, assessed using the Safety Attitudes Questionnaire, and adverse events using the Medicare Patient Safety Monitoring System (MPSMS). RESET uses a parallel group study design and two group pretest-posttest analyses for primary outcomes. We use a multi-method approach to collect and triangulate qualitative data collected during 3 visits to study sites. We will use cross-case comparisons to consider how site-specific contextual factors interact with the variation in the intensity and fidelity of implementation to affect teamwork and patient outcomes. DISCUSSION: The RESET study provides mentorship and resources to assist hospitals as they implement complementary and mutually reinforcing components to redesign the clinical microsystems caring for medical patients. Our findings will be of interest and directly applicable to all hospitals providing care to patients with medical conditions. TRIAL REGISTRATION: NCT03745677 . Retrospectively registered on November 19, 2018.


Assuntos
Assistência à Saúde/organização & administração , Liderança , Equipe de Assistência ao Paciente/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Humanos , Mentores , Modelos Organizacionais , Cultura Organizacional , Inovação Organizacional , Equipe de Assistência ao Paciente/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Inquéritos e Questionários
9.
Strahlenther Onkol ; 195(9): 843-850, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31025053

RESUMO

PURPOSE: Pediatric radiotherapy (RT) is a highly specialized field, requiring great experience to delineate correctly tumor targets and organs at risk. To reduce treatment failures related to planning inaccuracies and to obtain robust clinical results despite the limited numbers of enrolled pediatric patients, the SIOP PNET5MB clinical trial on medulloblastoma requires a real-time, pre-radiation review of the RT treatment (craniospinal irradiation and boost plan) under the direct responsibility of the national coordinator center. Here we describe the centralized radiotherapy quality assurance (QA) program developed in Italy for this purpose. METHODS: Using the software package VODCA (MSS, Hagendorn, Switzerland, www.vodca.ch ), we developed a cloud platform able to handle computed tomography (CT) images and RT objects and to support the complete workflow required by the review process in the context of the SIOP PNET5 trial. RESULTS: All Italian centers participating in the PNET5 trial adopted the proposed QA system. 24 patients were successfully enrolled and reviewed. For 15 patients (62.5%), one or more plan revisions were requested for the craniospinal irradiation plan and for 11 patients (45.8%) plan revisions were requested for the boost. RT was delivered after the plan was centrally approved for all enrolled patients. So far, in Italy, no patients have been excluded from PNET5 due to dosimetric incompliance to the protocol or for exceeding the RT starting time limit. CONCLUSION: The cloud platform successfully supported the trial workflow, producing official review documents. This efficient QA was crucial to guarantee optimized treatments and protocol compliance for all pediatric patients enrolled in the SIOP protocol.


Assuntos
Neoplasias Cerebelares/radioterapia , Computação em Nuvem , Meduloblastoma/radioterapia , Tumores Neuroectodérmicos Primitivos/radioterapia , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Especialização , Criança , Humanos , Órgãos em Risco/efeitos da radiação , Radiometria , Planejamento da Radioterapia Assistida por Computador/métodos , Desenho de Programas de Computador , Fluxo de Trabalho
10.
Int J Health Care Qual Assur ; 32(2): 321-331, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-31017063

RESUMO

PURPOSE: The purpose of this paper is to determine the experience participating in a health promotion program for refugee and asylum seekers and torture survivors in a safety net clinical setting. DESIGN/METHODOLOGY/APPROACH: Refugee and asylum seeker torture survivors participated in a seven-week health promotion program at a safety-net clinic. Participants interviewed before, during and after the program was designed to improve and maintain health promotion program quality. FINDINGS: Six major themes emerged: social networks; tools/techniques/skills; wellness planning; spiritualism; health maintenance; and social/group interaction. Preliminary results suggest that this multi-pronged approach is feasible and acceptable to foreign-born torture survivors. RESEARCH LIMITATIONS/IMPLICATIONS: Torture impacts many facets of one's life. A program which addresses health from a multidisciplinary perspective has promise to facilitate healing. PRACTICAL IMPLICATIONS: The impact of torture and human rights violations significantly affects many facets of peoples' lives including emotional, social, physical and spiritual dimensions. Therefore a program which utilizes a multidisciplinary integrated bio-psychosocial and spiritual approach has the potential to simultaneously address many domains facilitating healing. ORIGINALITY/VALUE: BeWell, a bio-psychosocio-spiritual health promotion strategy aimed at improving health service quality and increasing patient satisfaction to support positive health outcomes by implementing in-classroom/person modules for patients, to the authors' knowledge is unique in its efforts to encompass multiple domains simultaneously and fully integrate an approach to wellbeing.


Assuntos
Promoção da Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Refugiados/educação , Refugiados/psicologia , Provedores de Redes de Segurança/organização & administração , Feminino , Direitos Humanos , Humanos , Relações Interpessoais , Masculino , Projetos Piloto , Rede Social , Espiritualismo , Tortura/psicologia
11.
Healthc Q ; 21(4): 37-42, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30946653

RESUMO

Alberta is undertaking a bold and somewhat risky step overhauling its health system governance to build higher performance in quality, safety and improved health outcomes for Albertans. On the heels of having re-established a single province-wide health authority (Alberta Health Services [AHS]), provincial health system decision makers have moved to establish province-wide Strategic Clinical Networks™ (SCNs). Sixteen SCNs have been implemented, and all are constituted as teams of healthcare professionals, researchers, government stakeholders, patients and families seeking to improve delivery of healthcare across the province. SCNs were developed in part as a strategy for strengthening clinical engagement to achieve a broad range of healthcare delivery benefits including improvement of clinical care processes and reduced variations in practice, better access to care and improved patient outcomes across the province. Here, we examine the rationale and potential of this governance intervention, while also considering some of the fundamental questions around their potential impact and the ultimate need for multidimensional assessment.


Assuntos
Assistência à Saúde/organização & administração , Melhoria de Qualidade/organização & administração , Alberta , Programas Governamentais/organização & administração , Humanos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração
13.
Plast Reconstr Surg ; 143(4): 1165-1178, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30921141

RESUMO

BACKGROUND: Cleft deformities of the lip and palate affect nearly one in 500 to 700 births, and lead to increased morbidity and mortality if untreated. Nevertheless, significant global disparities in access to timely and appropriate care still exist. The relatively basic infrastructure required to surgically correct these deformities and large unmet disease burden have resulted in a significant number of foundation-based cleft care initiatives focused on developing countries. In this study, the authors evaluate the peer-reviewed literature generated by these foundations in an attempt to assess their clinical, scientific, educational, and economic impact. METHODS: A comprehensive review of the literature was performed using key search terms, and the level of evidence of identified articles was determined. Data were then analyzed to determine the different models of foundation-based cleft care in developing countries, and their clinical, scientific, educational, and economic impact. RESULTS: A total of 244 articles were identified through the authors' search and reviewed. Foundation-based cleft care initiatives in developing countries have significantly contributed to a better understanding of disease epidemiology, barriers to care, safety considerations, complications and outcomes, and international and local cleft surgery education. The cleft care center model is more cost-effective than the surgical mission model and provides more sustainable care. CONCLUSIONS: Foundation-based cleft care prevents significant morbidity in developing countries and has provided valuable resources for capacity building. The surgical mission model should be considered as a transitory conduit for establishing the more effective and sustainable cleft care center model of care.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Fundações/organização & administração , Missões Médicas/organização & administração , Procedimentos Cirúrgicos Reconstrutivos , Países em Desenvolvimento , Acesso aos Serviços de Saúde/organização & administração , Humanos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração
14.
Qual Manag Health Care ; 28(2): 103-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30921283

RESUMO

BACKGROUND AND OBJECTIVES: This study aims to validate an instrument designed to measure care quality in the operating room. METHODS: We conducted a transversal exploratory descriptive study with the objective of analyzing the psychometric properties of the scale. The 13 items included in the scale result from 2 previously conducted studies, a literature review study and a Delphi study. The instrument was administered to health professionals with at least 2 years of experience in the operating room in 71 Portuguese hospitals. RESULTS: The sample consisted of 1019 professionals who worked in an operating room; among them were nurses and doctors. The results show that the scale is a reliable and valid instrument composed of 3 dimensions: assessment of the quality of care; evaluation of processes; and control systems. CONCLUSION: The final version of the scale meets the validity requirements, revealing high potential to be used in research and clinical practice. The use of this scale will allow evaluation and comparison of the results among the different operating rooms.


Assuntos
Salas Cirúrgicas/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Inquéritos e Questionários/normas , Adulto , Idoso , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/organização & administração , Salas Cirúrgicas/normas , Satisfação do Paciente/estatística & dados numéricos , Médicos/organização & administração , Portugal , Complicações Pós-Operatórias/epidemiologia , Psicometria , Garantia da Qualidade dos Cuidados de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde , Reprodutibilidade dos Testes
15.
Int J Health Care Qual Assur ; 32(1): 84-86, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30859881

RESUMO

PURPOSE: With recent advances in laboratory hematology automation, emphasis is now on quality assurance processes as they are indispensable for generating reliable and accurate test results. It is therefore imperative to acquire efficient measures for recognizing laboratory malfunctions and errors to improve patient safety. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: Moving algorithm is a quality control process that monitors analyzer performance from historical records through a continuous process, which does not require additional expenditure, and can serve as an additional support to the laboratory quality control program. FINDINGS: The authors describe an important quality assurance tool, which can be easily applied in any laboratory setting, especially in cost-constrained areas where running commercial controls throughout every shift may not be a feasible option. ORIGINALITY/VALUE: The authors focus on clinical laboratory quality control measures for providing reliable test results. The moving average appears to be a reasonable and applicable choice for vigilantly monitoring each result.


Assuntos
Algoritmos , Serviços de Laboratório Clínico/organização & administração , Erros Médicos/prevenção & controle , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Países em Desenvolvimento , Feminino , Humanos , Laboratórios/normas , Masculino , Determinação de Necessidades de Cuidados de Saúde , Paquistão , Segurança do Paciente , Controle de Qualidade
16.
Arch. prev. riesgos labor. (Ed. impr.) ; 22(1): 11-17, ene.-mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-180700

RESUMO

Objetivo: Evaluar diferencias en el grado de satisfacción de los profesionales que participan en la asistencia sanitaria y en la gestión de las organizaciones de salud en relación a la historia clínica electrónica (HCE) implantada en sus organizaciones. Métodos: Se incluyen profesionales asistenciales, gestores y profesionales de Sistemas de Información que trabajan con la HCE de cualquier organización sanitaria o social en Cataluña. De 312 usuarios contactados, se obtuvo una tasa de participación del 60,25%. Las variables explicativas fueron el sexo, la edad, nivel de estudios, tipo de organización y categoría profesional. Como variables dependientes se incluyeron: el grado de satisfacción global con el sistema actual, la valoración de la posibilidad de cambio de la aplicación de la HCE y la valoración de su uso para mejorar la atención sanitaria. Resultados: Se observa un menor grado de satisfacción en los centros analizados respecto a atención primaria (ORa=0,11; IC 95% = (0,02-0,52)), en los profesionales con Grado/Licenciatura (ORa=0,12; IC 95%=(0,01-1,26)) y de Máster/Doctorado (ORa=0,10; IC 95%=(0,01-1,17) respecto a estudios secundarios, y en los profesionales considerados respecto a los de gerencia/dirección (Médica/o: ORa=0,18; IC 95%=(0,06-0,54) y Enfermera/o: ORa=0,36; IC 95%=(0,13 - 1,03)). Conclusiones: Las diferencias observadas entre los profesionales en su percepción del uso de la HCE deberían conllevar una mejora de estas herramientas para la asistencia de los pacientes


Objective: To evaluate differences in the degree of satisfaction among professionals who participate in health care and in the management of health organizations in relation to the electronic medical record (EMR) used in their organizations. Methods: We surveyed healthcare professionals, managers and information technology professionals who work with an EMR in any health or social organization in Catalonia. Among 312 contacted professionals, the participation rate was 60.25%. Explanatory (independent) variables were sex, age, education, type of organization and professional category. Dependent variables included the degree of overall satisfaction with the current system, an assessment of possibly changing the EMR system s and an assessment of the use of an EMR to improve health care. Results: There was a lower degree of satisfaction in primary care centers (sociosanitary, assisted residence and other work centers: ORa = 0.11, 95% CI = (0.02-0.52)), among those with a professional or bachelor’s degree (ORa = 0.12, 95% CI = (0.01-1.26)) and those with graduate studies (ORa = 0.10, 95% CI = (0.01-1.17) as compared to respondents with secondary studies, and among healthcare professionals as compared to managers (physicians: ORa = 0.18, 95% CI = (0.06-0.54) and nurses: ORa = 0, 36; 95% CI = (0.13 - 1.03)). Conclusions: The differences observed among the professionals with respect to their perception of the use of the EMR should lead to improvements in the use of these tools for patient care


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Registros Eletrônicos de Saúde/normas , Avaliação da Capacidade de Trabalho , Atenção Primária à Saúde , Registros Eletrônicos de Saúde/instrumentação , Registros Eletrônicos de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Medição de Risco/métodos , Estudos Transversais
17.
J Nepal Health Res Counc ; 16(41): 372-377, 2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30739917

RESUMO

BACKGROUND: Access to high quality medicines is often considered as one of the main obstacle in achieving health for all. With the objective of increasing access to health services of poor segment of population, government of Nepal has implemented free health care program. However, there is strong need for evaluating the performance and coverage of free health Care scheme. In this context, this study aims to provide better understanding on the implementation status of free health care scheme in context of Nepal. METHODS: It is a qualitative study conducted in 7 districts of Nepal. Total of 14 focused group discussion were conducted among service providers and service users. All the discussions were carried in neutral and natural setting making sure that each of participants feels free to express their opinion. Focused group discussions were transcribed, translated into English, coded and analyzed manually. RESULTS: Participants shared that free health care has contributed positively in making essential health services reachable, affordable and accessible to all specially benefiting poor segment of population. However, multitude of factors like geographical access, perception of community people towards health services, availability of medicines, laboratory services and human resources come into play determining the utilization of health services. Service providers recommended that there need to be improvements in procurement and supply system for uninterrupted supply of services. CONCLUSIONS: Despite having some problems in availability of medicines, human resource and diagnostic services, free health care has improved access to health services specially for poor population. Decentralizing the procurement process can be one promising option to overcome the inappropriate supply of medicines.


Assuntos
Programas Nacionais de Saúde , Estudos de Avaliação como Assunto , Grupos Focais , Acesso aos Serviços de Saúde/organização & administração , Financiamento da Assistência à Saúde , Humanos , Programas Nacionais de Saúde/organização & administração , Nepal , Satisfação do Paciente , Avaliação de Programas e Projetos de Saúde , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração
18.
Healthc Manage Forum ; 32(2): 105-112, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30739488

RESUMO

To inform the future development of a pan-Canadian Mental Health and Addictions (MHA) performance measurement framework, we undertook a review and comparison of current provincial/territorial MHA policies and performance measurement frameworks. Most did not have performance measurement approaches that were explicitly linked to policy actions but eleven acknowledged the importance of performance measurement. Among the provinces with a framework, there were few performance domains in common. The common policy priorities and areas of convergence in current performance measurement practices may provide a useful starting point for the development of a pan-Canadian MHA performance measurement framework.


Assuntos
Política de Saúde , Prioridades em Saúde , Serviços de Saúde Mental/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Canadá , Prioridades em Saúde/normas , Humanos , Transtornos Mentais/terapia , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Transtornos Relacionados ao Uso de Substâncias/terapia
19.
Healthc Manage Forum ; 32(2): 97-104, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30739489

RESUMO

To inform the development of a pan-Canadian Mental Health and Addictions (MHA) performance measurement framework, we undertook a rapid review of the recent Performance Measurement (PM) literature and solicited input from 20 MHA policy and measurement experts. Six key steps for framework development were identified: recognizing and acknowledging key issues, developing shared language and understanding of key concepts, defining overall scope, defining framework dimension/domains, selecting indicators and using systematic engagement and consultation processes with stakeholders. Subject matter experts underscored the need for a comprehensive engagement process which would honour multiple stakeholder viewpoints and attend to key issues in the codesign of features of the PM framework. Findings from this analysis may be used to inform a comprehensive stakeholder consultation process for the development of a pan-Canadian PM framework for MHA.


Assuntos
Serviços de Saúde Mental/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Canadá , Humanos , Transtornos Mentais/terapia , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Transtornos Relacionados ao Uso de Substâncias/terapia
20.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 38(1): 38-45, ene.-feb. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182354

RESUMO

La seguridad del paciente es un componente esencial de la calidad asistencial, especialmente cuando la complejidad de la asistencia ha alcanzado niveles extremos. En la actualidad, conseguir esta seguridad se considera una estrategia básica del sistema nacional de salud. Los servicios de Medicina Nuclear muestran unas particularidades que los hacen especiales en materia de seguridad del paciente, con situaciones que se salen de la práctica asistencial común de los servicios del resto del marco hospitalario. Estas particularidades vienen definidas por el hecho de utilizar en la actividad diaria radiaciones ionizantes, tanto encapsuladas como no encapsuladas. Además, y concretamente en el caso de la tomografía por emisión de positrones (PET), el hecho de realizar la exploración implica de modo indispensable la coordinación de numerosos grupos de profesionales, tanto de la propia unidad de gestión clínica como de otros servicios del hospital (incluso de empresas ajenas al propio hospital y al propio sistema sanitario público). El objetivo del presente trabajo ha sido identificar los riesgos a los que puede exponerse un paciente que va a ser explorado mediante PET en un servicio de Medicina Nuclear y elaborar el mapa de riesgos para el proceso PET. La metodología empleada se enmarca genéricamente en la propuesta por el Ministerio de Sanidad (2007) y su concreción práctica (dada la escasa literatura disponible en Medicina Nuclear) sigue en lo posible lo desarrollado en áreas asistenciales afines (radiodiagnóstico y radioterapia). Para ello, se constituyó un equipo multidisciplinar de profesionales directamente relacionados con el proceso PET, se utilizó la metodología análisis modal de fallos y efectos con la intención de identificar los posibles fallos, sus causas y los potenciales eventos adversos que provocan cada uno de los fallos. Como paso final, se creó el mapa de riesgos, ubicando en cada etapa del proceso los fallos previamente identificados. El presente trabajo expone el proceso PET, el cual ha permitido describir los riesgos que puede correr un paciente cuando es requerido para realizarse una exploración PET, así como los eventos adversos derivados de ellos. Todo ello ha quedado plasmado en un mapa de riesgos del proceso PET


Patient safety is an essential component of quality of care, especially when the complexity of care has reached extreme levels. Currently achieving this safety is considered a basic strategy of the National Health System. Nuclear Medicine departments have certain peculiarities that make them special in terms of patient safety, with situations that go beyond the common healthcare practice of other departments. Namely, that both encapsulated and non-encapsulated ionizing radiation is used in daily practice, and numerous groups of professionals must be coordinated to undertake positron emission tomography (PET) specifically, from the clinical management unit itself, and from other departments of the hospital (as well as companies outside the hospital itself and the Public Health System). The objective of this paper was to identify the risks to which a patient who is to be explored through PET can be exposed in a Nuclear Medicine department and draw up a risk map for the PET process. The methodology used is part of the proposal of the Ministry of Health (2007), and its practical implementation (given the limited literature available on Nuclear Medicine), follows as far as possible that of related care areas (radiodiagnosis and radiotherapy). For this purpose, a multidisciplinary team of professionals directly related to the PET process was created, using the modal analysis of faults and effects methodology to identify possible failures, their causes and the potential adverse events causing each. As a final step, a risk map was created, locating the previously identified faults at each stage of the process. This paper exposes the PET process, and describes the risks that patients might run when a PET scan is required, as well as the adverse events deriving from it. All this is shown in a risk map of the PET process


Assuntos
Humanos , Tomografia por Emissão de Pósitrons/efeitos adversos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Segurança do Paciente/normas , Mapa de Risco , Exposição Ocupacional/efeitos adversos , Precauções Universais/tendências , Proteção Radiológica/normas
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