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2.
CMAJ ; 192(4): E81-E91, 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-31988152

RESUMO

BACKGROUND: Preterm birth is the leading cause of morbidity and mortality in children younger than 5 years. We report the changes in neonatal outcomes and care practices among very preterm infants in Canada over 14 years within a national, collaborative, continuous quality-improvement program. METHODS: We retrospectively studied infants born at 23-32 weeks' gestation who were admitted to tertiary neonatal intensive care units that participated in the Evidence-based Practice for Improving Quality program in the Canadian Neonatal Network from 2004 to 2017. The primary outcome was survival without major morbidity during the initial hospital admission. We quantified changes using process-control charts in 6-month intervals to identify special-cause variations, adjusted regression models for yearly changes, and interrupted time series analyses. RESULTS: The final study population included 50 831 infants. As a result of practice changes, survival without major morbidity increased significantly (56.6% [669/1183] to 70.9% [1424/2009]; adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06-1.10, per year) across all gestational ages. Survival of infants born at 23-25 weeks' gestation increased (70.8% [97/137] to 74.5% [219/294]; adjusted OR 1.03, 95% CI 1.02-1.05, per year). Changes in care practices included increased use of antenatal steroids (83.6% [904/1081] to 88.1% [1747/1983]), increased rates of normothermia at admission (44.8% [520/1160] to 67.5% [1316/1951]) and reduced use of pulmonary surfactant (52.8% [625/1183] to 42.7% [857/2009]). INTERPRETATION: Network-wide quality-improvement activities that include better implementation of optimal care practices can yield sustained improvement in survival without morbidity in very preterm infants.


Assuntos
Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/normas , Melhoria de Qualidade , Canadá , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Avaliação de Programas e Projetos de Saúde , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Análise de Sobrevida
3.
Int J Radiat Oncol Biol Phys ; 106(3): 639-647, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31983560

RESUMO

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


Assuntos
Institutos de Câncer/normas , Hospitais de Veteranos/normas , Desenvolvimento de Programas , Garantia da Qualidade dos Cuidados de Saúde/normas , Radioterapia (Especialidade)/normas , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Medicina Baseada em Evidências/normas , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Revisão por Pares , Avaliação de Programas e Projetos de Saúde/normas , Neoplasias da Próstata/radioterapia , Garantia da Qualidade dos Cuidados de Saúde/métodos , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Carcinoma de Pequenas Células do Pulmão/radioterapia , Sociedades Médicas/normas , Estados Unidos , Veteranos
4.
N Engl J Med ; 382(1): 51-59, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-31893515

RESUMO

BACKGROUND: The hospital industry has consolidated substantially during the past two decades and at an accelerated pace since 2010. Multiple studies have shown that hospital mergers have led to higher prices for commercially insured patients, but research about effects on quality of care is limited. METHODS: Using Medicare claims and Hospital Compare data from 2007 through 2016 on performance on four measures of quality of care (a composite of clinical-process measures, a composite of patient-experience measures, mortality, and the rate of readmission after discharge) and data on hospital mergers and acquisitions occurring from 2009 through 2013, we conducted difference-in-differences analyses comparing changes in the performance of acquired hospitals from the time before acquisition to the time after acquisition with concurrent changes for control hospitals that did not have a change in ownership. RESULTS: The study sample included 246 acquired hospitals and 1986 control hospitals. Being acquired was associated with a modest differential decline in performance on the patient-experience measure (adjusted differential change, -0.17 SD; 95% confidence interval [CI], -0.26 to -0.07; P = 0.002; the change was analogous to a fall from the 50th to the 41st percentile) and no significant differential change in 30-day readmission rates (-0.10 percentage points; 95% CI, -0.53 to 0.34; P = 0.72) or in 30-day mortality (-0.03 percentage points; 95% CI, -0.20 to 0.14; P = 0.72). Acquired hospitals had a significant differential improvement in performance on the clinical-process measure (0.22 SD; 95% CI, 0.05 to 0.38; P = 0.03), but this could not be attributed conclusively to a change in ownership because differential improvement occurred before acquisition. CONCLUSIONS: Hospital acquisition by another hospital or hospital system was associated with modestly worse patient experiences and no significant changes in readmission or mortality rates. Effects on process measures of quality were inconclusive. (Funded by the Agency for Healthcare Research and Quality.).


Assuntos
Instituições Associadas de Saúde , Hospitais , Qualidade da Assistência à Saúde , Idoso , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Medicare , Readmissão do Paciente/estatística & dados numéricos , Readmissão do Paciente/tendências , Medidas de Resultados Relatados pelo Paciente , Indicadores de Qualidade em Assistência à Saúde , Estados Unidos
5.
Gesundheitswesen ; 82(1): 63-71, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-29801188

RESUMO

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


Assuntos
Assistência Ambulatorial , Pacientes Ambulatoriais , Garantia da Qualidade dos Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde , Assistência Ambulatorial/normas , Alemanha , Humanos , Projetos Piloto , Melhoria de Qualidade
7.
Aten. prim. (Barc., Ed. impr.) ; 51(10): 610-616, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185943

RESUMO

Objetivo: Comparar los resultados de los equipos de atención primaria en Cataluña en función de su modelo de gestión y evaluar el impacto de un modelo de gestión conocido como gestión por entidades de base asociativa (EBA). Diseño: Llevamos a cabo un análisis comparado multidimensional siguiendo una lógica cuasi-experimental a partir de comparar los centros gestionados a través del modelo EBA con otros centros gestionados por el sector público a través del Instituto Catalán de la Salud (ICS) o por el tercer sector a través de consorcios hospitalarios. Localización: Barcelona, Cataluña, España. Participantes: Tenemos en cuenta 368 observaciones (centros de atención primaria) y 18 parámetros medidos en 2015. Intervenciones: Distintos métodos de gestión. Mediciones principales: Comparación de indicadores de actividad, efectividad en el proceso asistencial y eficiencia antes y después de controlar por el indicador socioeconómico del área básica de salud y las características de la región sanitaria. Test de diferencias significativas en las medias de los indicadores según modelo de gestión una vez realizado el emparejamiento conforme a variables clave mediante la técnica Propensity Score Matching. Resultados: Diferencias significativas en el indicador de carga de trabajo por profesional médico de familia, en cinco indicadores de efectividad en el proceso asistencial y en el coste por usuario. Conclusiones: La diversificación del modelo de gestión a través del modelo EBA muestra resultados que se pueden interpretar a favor del mantenimiento o de la ampliación de la aplicación de este modelo de gestión. Si bien los centros gestionados a través del modelo EBA se han implantado en áreas de nivel socioeconómico medio o alto, sus resultados continúan siendo significativamente positivos una vez se controla por el nivel socioeconómico de su área


Goal: Compare the performance of primary health centers managed by the public sector (ICS), the third sector (Hospitals) or by small private organizations known as EBAs. Design: Multidimensional comparative analysis. We follow a quasi-experimental logic comparing primary health centers managed by EBAs with other centers managed by the public sector (ICS) o by the third sector (hospitals). Localization: Barcelona, Catalonia, Spain. Participants: We have 368 observations (primary health centers) and 18 indicators measured in 2015. Intervention: Different management models (public, third sector, private). Main measures: We compare activity measures, measures of effectiveness in the process of medical assistance, and efficiency. We compare before and after controlling for the socio-economic level corresponding to the basic health area and the characteristics of the population and health region. We conduct a test of significant differences between the indicators corresponding to centers managed differently, after a process of matching using key variables and Propensity Score Matching. Results: Significant differences in the measure of work load for family doctors, in five measures of effectiveness in the process of assistance and in the cost per user. Conclusions: The diversity in the management model through EBAs shows results that can be interpreted in favor of the maintenance or the expansion of this model of management. The majority of EBAs have been implanted in areas of a medium or high level, but their results are still significantly positive once the socio economic level of the area is controlled


Assuntos
Humanos , Pessoa de Meia-Idade , Administração Pública , Atenção Primária à Saúde/organização & administração , Modelos de Assistência à Saúde/organização & administração , Modernização do Setor Público , Espanha , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde/normas
8.
Z Evid Fortbild Qual Gesundhwes ; 147-148: 45-57, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31718988

RESUMO

BACKGROUND: Evidence-based and formally consensus-based clinical practice guidelines (CPGs) offer potential for the development of quality indicators (QIs). Although QIs are recommended as part of some CPGs, there is no accepted gold standard for the specific development process of guideline-based QIs. The purpose of this review, which is embedded in a mixed-methods research project, was to analyze the current state of methodological approaches for QI development in German CPGs to derive insights for the development of a national evidence-guided and consensus-based standard for guideline-based development of QIs. METHODS: In order to identify valid CPGs containing recommendations for QIs, a search was carried out (July 31, 2016) via the guideline database of the German Association of the Scientific Medical Societies (AWMF). Based on a stratified random sample per guideline program (guidelines published by medical societies, National Program for Disease Management Guidelines (DMG), and the German Guideline Program in Oncology [GGPO]), 11 CPGs were selected. With regard to QIs, the specific development methodology, indications on their psychometric properties and how the quality of care should be examined by recommended QIs were extracted and compared by using the guideline documents. RESULTS: In 35 of the 109 (16/85 medical societies, 4/8 DMG, 15/16 GGPO) (32 %) valid CPGs, a total of 372 QIs were recommended. Based on 11 randomly selected guidelines (5 published by medical societies, 1 DMG, 5 GGPO; a total of 109 QIs), the QI development methodology was inconsistent in all five medical societies guidelines (including QI presentation, usage and selection of guideline recommendations for QI derivation) compared to DMG and GGPO. Based on all 109 QIs, 2 (2 %) were presented as a quantitative measure with a reference range, and quality objectives were formulated for 17 (16 %). There was no guideline explicitly reporting about the results of a pilot study or data-based analysis of the psychometric properties of the recommended QIs. The GGPO guideline documents were the only ones providing information on the assessment of the quality of care based on recommended QIs. DISCUSSION: The usage of the QI manuals of the DMG and GGPO leads to a largely standardized development of guideline-based QIs. In the CPGs of the medical societies - if at all - QIs are developed inconsistently and mostly unsystematically. Due to largely missing reference ranges and quality objectives, the identified QIs cannot yet be used to transparently identify potential quality deficits in health care. This requires results of pilot studies and further development of guideline-based QI. CONCLUSIONS: A standard for QI development is needed for German guideline authors to seize the opportunity and develop clinically relevant, widely accepted and evidence-based QIs in the guideline development process. In addition, it must be ensured that appropriate structures are used or set up in order to be able to apply the recommended QIs in the German healthcare system.


Assuntos
Assistência à Saúde , Guias de Prática Clínica como Assunto , Indicadores de Qualidade em Assistência à Saúde , Qualidade da Assistência à Saúde , Prática Clínica Baseada em Evidências , Alemanha , Humanos , Projetos Piloto
9.
Nurs Res ; 68(6): 439-444, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693549

RESUMO

BACKGROUND: Nursing presence has been developed as a distinct concept with identifiable behaviors but remains only partially defined as a quantifiable construct. OBJECTIVES: This study asked if the Presence of Nursing Scale (PONS) is a reliable and valid instrument to measure nursing presence from the patient's perspective. METHODS: A convenience sample of 75 adult acute care inpatients were verbally administered the 25-item PONS considering the registered nurse taking care of them on the day of data collection. Open-ended questions elicited the patients' explanations of their ratings. They also rated their overall satisfaction with the nursing care provided by the subject nurse using a 5-point scale. RESULTS: The mean PONS score was 104.5 (SD = 17.26) on the 25-125 scale. Instrument reliability reported as a Cronbach's alpha coefficient of .95 was .94 in this study. Instrument validity was tested correlating PONS scores to the satisfaction rating. The Spearman's rho correlation was large and statistically significant, r (73) = .708. The higher the PONS score, the more satisfied the patient was with care from that nurse. Nineteen narratives selected from the lower quartile PONS scores (PONS < 99) and 11 from the upper quartile (PONS > 116) were thematically analyzed. Lower PONS scores corresponded with themes of patients being objectified as the work of the nurse without a respectful and caring nurse-patient relationship. Higher PONS scores coincided with patients' perceptions of enhanced nurse-patient rapport, feelings of better coping, and decreased anxiety. DISCUSSION: These results demonstrate reliability and validity of the PONS and add to the body of evidence about nurse behaviors exhibited in the nurse-patient relationship, which influence patients' feelings of being cared for and satisfied with nursing care. These findings may be useful in the development of educational materials aimed at the advancement of nursing presence competency.


Assuntos
Relações Enfermeiro-Paciente , Satisfação do Paciente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Indicadores de Qualidade em Assistência à Saúde , Reprodutibilidade dos Testes , Inquéritos e Questionários
10.
Z Evid Fortbild Qual Gesundhwes ; 147-148: 34-44, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31732386

RESUMO

BACKGROUND: Evidence-based and formally consensus-based clinical practice guidelines (S3-CPGs) are a valuable source for the development of quality indicators (QIs) in Germany. While deriving QIs from guideline recommendations is a mandatory part of the development of S3-CPGs within the National Program for Disease Management Guidelines (DMGP) and the German Guideline Program in Oncology (GGPO), there is no such obligation in the guideline program of the Association of the Scientific Medical Societies in Germany (AWMF) (MS program). Despite that, several S3-CPGs in the MS program have been published with QIs in the last years while some DMGP and one GGPO S3 guidelines have failed to meet this requirement. From the perspective of the guideline authors of all three mentioned programs, the present qualitative study examined why S3-CPGs do or do not contain QIs and explored the factors perceived by authors as either facilitating or hampering in the QI development process. METHODS: Semi-structured interviews were conducted with authors of 22 S3-CPGs, 11 of which represented guidelines containing QIs and 11 of which represented guidelines without QIs. Authors of guidelines containing QIs (n=11) were asked about the perceived decisive reasons for formulating QIs and about facilitators and barriers during the QI development process. Authors of guidelines without QIs (n=11) gave reasons for not formulating QIs. Interviews were analyzed using structuring qualitative content analysis. RESULTS: Within the MS program, not formulating QIs was mainly attributed to the lack of a mandatory requirement and to insufficient funding of guideline projects. Amongst DMGP authors, a low priority of QI development prevailed, which was, for example, due to already existing QIs or to their lacking implementation. In the GGPO guideline examined, not formulating QIs was due to the guideline topic (prevention) - for this topic, there was a lack of suitable evidence and data sources. If QIs were developed, the most important facilitating factor in the development process, across all programs, was the methodological support provided by the guideline program. Important hampering factors included the additional time required for QI development and concerns regarding the implementation of many potential QIs, especially due to a lack of data availability. DISCUSSION: For regular development of QIs within S3-CPG projects, the incorporation of such a requirement in the guideline program is a necessary, but not a sufficient, condition. Other pivotal factors include systematic methodological support, adequate financial and staff resources and the perceived meaningfulness and relevance of guideline-based QI development, measured in terms of the actual implementation of already existing QIs. CONCLUSION: The study reveals starting points for measures to strengthen the consideration of QI development in German S3-CPG projects, especially within the MS program. Without substantial structural changes, especially of the resources of guideline groups, and without an overall concept covering the entire process from QI development to QI implementation, guideline-based QI development will remain heavily dependent on the (self-)motivation of guideline groups.


Assuntos
Recursos em Saúde , Guias de Prática Clínica como Assunto/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Sociedades Médicas , Protocolos Clínicos/normas , Assistência à Saúde/normas , Alemanha , Humanos , Oncologia , Pesquisa Qualitativa
12.
Lancet ; 394(10211): 1827-1835, 2019 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-31668728

RESUMO

BACKGROUND: Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder. METHODS: In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death. FINDINGS: 7 369 926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57-28·82] vs 12·95 deaths [12·93-12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91-1·94) for mood disorders to 3·91 (3·87-3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36-5·48) for organic disorders in females to 14·84 years (14·70-14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher. INTERPRETATION: Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death. FUNDING: Danish National Research Foundation.


Assuntos
Transtornos Mentais/mortalidade , Indicadores de Qualidade em Assistência à Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/mortalidade , Mortalidade Prematura , Sistema de Registros , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Suicídio/estatística & dados numéricos , Adulto Jovem
13.
Yonsei Med J ; 60(11): 1054-1060, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31637887

RESUMO

PURPOSE: Quality indicators of the National Endoscopy Quality Improvement Program (NEQIP) and outcome measures of endoscopy in the National Cancer Screening Program (NCSP) in Korea are not clear. We evaluated the quality indicators of the revised NEQIP and outcome measures of endoscopy at different types of healthcare facilities participating in the NCSP. MATERIALS AND METHODS: This study was conducted between March and August 2018 in primary, secondary, and tertiary healthcare facilities that perform endoscopy as a part of the NCSP. Representative endoscopists completed a questionnaire for quality indicators of the NEQIP and provided data on outcome measures for endoscopy. RESULTS: Quality indicators of the NEQIP were mostly acceptable. However, the quality indicators for annual volume of esophagogastroduodenoscopy (EGD) and colonoscopy, training for endoscopy quality improvement by endoscopy nursing staff, colonoscopy reports, documentation of pathologic lesions, quality of endoscopy reprocessing areas, and completion of endoscopy reprocessing education programs were suboptimal. For outcome measures of EGD, the number of photo-documentations and total procedure time were higher at tertiary healthcare facilities than at other facilities (p<0.001 and p=0.023, respectively). For the outcome measures of colonoscopy, colonoscopy completion rate and waiting times for colonoscopy were significantly higher at tertiary healthcare facilities than at other facilities (both p<0.001). CONCLUSION: Outcome measures of endoscopy should be included as quality indicators of NCSP. However, universal outcome measures for all types of healthcare facilities should be established because performance levels of some outcome measures differ among individual healthcare facility types.


Assuntos
Detecção Precoce de Câncer , Endoscopia do Sistema Digestório , Neoplasias/diagnóstico , Indicadores de Qualidade em Assistência à Saúde , Adulto , Colonoscopia , Feminino , Humanos , Masculino , Melhoria de Qualidade , República da Coreia , Inquéritos e Questionários
14.
Medicine (Baltimore) ; 98(43): e17690, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651898

RESUMO

The accumulated healthcare performance data related to unwarranted practice variations are not necessarily disseminated to patients and citizens. To clarify the needs for public disclosure, we explored Japanese and Dutch citizens' preferences and values towards information disclosure and healthcare disparity.Online opt-in survey was conducted and we asked citizens their preference to know about the healthcare performance indicators of regions and hospitals, and their attitudes towards healthcare equity. After a descriptive statistical analysis, Chi-squared automatic interaction detection tree analysis was performed to explore the socio-demographic determinants which were associated with positive value for information disclosure and healthcare equity. Then, we compared the combination of attributes of the highest and the lowest subgroups of each country and compared within and between countries. Last, logistic regression analysis was performed to further evaluate the impact of each determinant.Significant differences were observed between the 2 countries (Japan [JPN] 1038; Netherlands [NL] 1040). The crucial attributes identified were age, sex, educational background, and living area (JPN), along with age and sex (NL). Japanese comprised multiple subgroups with heterogeneous values, showed relatively low interest in knowing the information, and seemed to accept healthcare inequality, especially among urban males aged 20 to 59 years. Contrarily, Dutch people mostly showed high interest in both items. Female and older respondents valued information disclosure highly across countries.To share healthcare performance knowledge and empowering the public, historical, cultural, and socio-demographic context including health literacy of citizens' subgroups should be considered in making comprehensive public reports.


Assuntos
Revelação , Disparidades em Assistência à Saúde , Indicadores de Qualidade em Assistência à Saúde , Humanos , Japão , Países Baixos , Inquéritos e Questionários
15.
Scand J Trauma Resusc Emerg Med ; 27(1): 94, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31661006

RESUMO

BACKGROUND: Access to an Emergency Medical Communication Centre is essential for the population in emergency situations. Handling inbound calls without delay requires managing activity, process and outcome measures of the Emergency Medical Communication Centre to improve the workforce management and the level of service. France is facing political decisions on the evolution of the organisation of Emergency Medical Communication Centres to improve accessibility for the population. First, we aim to describe the variation in activity between Emergency Medical Communication Centres, and second, to explore the correlation between process measures and outcome measures. METHODS: Using telephone activity data extraction, we conducted an observational multicentre study of six French Emergency Medical Communication Centres from 1 July 2016 to 30 June 2017. We described the activity (number of incoming calls, call rate per 1000 inhabitants), process measure (agent occupation rate), and outcome measure (number of calls answered within 20 s) by hourly range and estimated the correlation between them according to the structural equation methods. RESULTS: A total of 52,542 h of activity were analysed, during which 2,544,254 calls were received. The annual Emergency Medical Communication Centre call rate was 285.5 [95% CI: 285.2-285.8] per 1000 inhabitants. The average hourly number of calls ranged from 29 to 61 and the call-handled rate from 75 to 98%. There are variations in activity between Emergency Medical Communication Centres. The mean agent occupation rate was correlated with the quality of service at 20 s (coefficient at - 0.54). The number of incoming calls per agent was correlated with the mean occupation rate (coefficient at 0.67). Correlation coefficients varied according to the centres and existed between different process measures. CONCLUSIONS: The activity dynamics of the six Emergency Medical Communication Centres are not identical. This variability, illustrating the particularity of each centre, must be accurately assessed and should be taken into account in managerial considerations. The call taker occupation rate is the leverage in the workforce management to improve the population accessibility.


Assuntos
Call Centers/estatística & dados numéricos , Sistemas de Comunicação entre Serviços de Emergência , França , Humanos , Indicadores de Qualidade em Assistência à Saúde
17.
BMJ ; 367: l5205, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31578187

RESUMO

OBJECTIVES: To determine how clinicians vary in their response to new guidance on existing or new interventions, by measuring the timing and magnitude of change at healthcare institutions. DESIGN: Automated change detection in longitudinal prescribing data. SETTING: Prescribing data in English primary care. PARTICIPANTS: English general practices. MAIN OUTCOME MEASURES: In each practice the following were measured: the timing of the largest changes, steepness of the change slope (change in proportion per month), and magnitude of the change for two example time series (expiry of the Cerazette patent in 2012, leading to cheaper generic desogestrel alternatives becoming available; and a change in antibiotic prescribing guidelines after 2014, favouring nitrofurantoin over trimethoprim for uncomplicated urinary tract infection (UTI)). RESULTS: Substantial heterogeneity was found between institutions in both timing and steepness of change. The range of time delay before a change was implemented was large (interquartile range 2-14 months (median 8) for Cerazette, and 5-29 months (18) for UTI). Substantial heterogeneity was also seen in slope following a detected change (interquartile range 2-28% absolute reduction per month (median 9%) for Cerazette, and 1-8% (2%) for UTI). When changes were implemented, the magnitude of change showed substantially less heterogeneity (interquartile range 44-85% (median 66%) for Cerazette and 28-47% (38%) for UTI). CONCLUSIONS: Substantial variation was observed in the speed with which individual NHS general practices responded to warranted changes in clinical practice. Changes in prescribing behaviour were detected automatically and robustly. Detection of structural breaks using indicator saturation methods opens up new opportunities to improve patient care through audit and feedback by moving away from cross sectional analyses, and automatically identifying institutions that respond rapidly, or slowly, to warranted changes in clinical practice.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Anti-Infecciosos/uso terapêutico , Conjuntos de Dados como Assunto , Substituição de Medicamentos/estatística & dados numéricos , Medicamentos Genéricos/uso terapêutico , Inglaterra , Medicina Geral/organização & administração , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Humanos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Medicina Estatal/normas , Fatores de Tempo , Infecções Urinárias/tratamento farmacológico
19.
BMC Med ; 17(1): 184, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31570106

RESUMO

BACKGROUND: The healthcare system can be understood as the dynamic result of the interaction of hospitals, patients, providers, and government configuring a complex network of reciprocal influences. In order to better understand such a complex system, the analysis must include characteristics that are feasible to be studied in order to redesign its functioning. The analysis of the emergent patterns of pregnant women flows crossing municipal borders for birth-related hospitalizations in a region of São Paulo, Brazil, allowed to examine the functionality of the regional division in the state using a complex systems approach and to propose answers to the dilemma of concentration vs. distribution of maternal care regional services in the context of the Brazilian Unified Health System (SUS). METHODS: Cross-sectional research of the areas of influence of hospitals using spatial interaction methods, recording the points of origin and destination of the patients and exploring the emergent patterns of displacement. RESULTS: The resulting functional region is broader than the limits established in the legal provisions, verifying that 85% of patients move to hospitals with high technology to perform normal deliveries and cesarean sections. The region has high independence rates and behaves as a "service exporter." Patients going to centrally located hospitals travel twice as long as patients who receive care in other municipalities even when the patients' conditions do not demand technologically sophisticated services. The effects of regulation and the agents' preferences reinforce the tendency to refer patients to centrally located hospitals. CONCLUSIONS: Displacement of patients during delivery may affect indicators of maternal and perinatal health. The emergent pattern of movements allowed examining the contradiction between wider deployments of services versus concentration of highly specialized resources in a few places. The study shows the potential of this type of analysis applied to other type of patients' flows, such as cancer or specialized surgery, as tools to guide the regionalization of the Brazilian Health System.


Assuntos
Procedimentos Clínicos/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Cesárea/estatística & dados numéricos , Cidades/epidemiologia , Cidades/estatística & dados numéricos , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/normas , Estudos Transversais , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Parto Obstétrico/métodos , Parto Obstétrico/normas , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Materna/normas , Transferência de Pacientes/organização & administração , Gravidez , Indicadores de Qualidade em Assistência à Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Análise de Sistemas , Transporte de Pacientes/estatística & dados numéricos
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