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1.
Medicine (Baltimore) ; 100(8): e24755, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663091

RESUMO

ABSTRACT: Health information technology (IT) is often proposed as a solution to fragmentation of care, and has been hypothesized to reduce readmission risk through better information flow. However, there are numerous distinct health IT capabilities, and it is unclear which, if any, are associated with lower readmission risk.To identify the specific health IT capabilities adopted by hospitals that are associated with hospital-level risk-standardized readmission rates (RSRRs) through path analyses using structural equation modeling.This STROBE-compliant retrospective cross-sectional study included non-federal U.S. acute care hospitals, based on their adoption of specific types of health IT capabilities self-reported in a 2013 American Hospital Association IT survey as independent variables. The outcome measure included the 2014 RSRRs reported on Hospital Compare website.A 54-indicator 7-factor structure of hospital health IT capabilities was identified by exploratory factor analysis, and corroborated by confirmatory factor analysis. Subsequent path analysis using Structural equation modeling revealed that a one-point increase in the hospital adoption of patient engagement capability latent scores (median path coefficient ß = -0.086; 95% Confidence Interval, -0.162 to -0.008), including functionalities like direct access to the electronic health records, would generally lead to a decrease in RSRRs by 0.086%. However, computerized hospital discharge and information exchange capabilities with other inpatient and outpatient providers were not associated with readmission rates.These findings suggest that improving patient access to and use of their electronic health records may be helpful in improving hospital performance on readmission; however, computerized hospital discharge and information exchange among clinicians did not seem as beneficial - perhaps because of the quality or timeliness of information transmitted. Future research should use more recent data to study, not just adoption of health IT capabilities, but also whether their usage is associated with lower readmission risk. Understanding which capabilities impact readmission risk can help policymakers and clinical stakeholders better focus their scarce resources as they invest in health IT to improve care delivery.


Assuntos
Hospitais/estatística & dados numéricos , Informática Médica/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Estudos Transversais , Registros Eletrônicos de Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Humanos , Acesso dos Pacientes aos Registros/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Características de Residência , Estudos Retrospectivos , Estados Unidos
2.
Int J Qual Health Care ; 33(1)2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33644795

RESUMO

OBJECTIVE: To identify how features of the community in which a hospital serves differentially relate to its patients' experiences based on the quality of that hospital. DESIGN: A Finite Mixture Model (FMM) is used to uncover a mix of two latent groups of hospitals that differ in quality. In the FMM, a multinomial logistic equation relates hospital-level factors to the odds of being in either group. And a multiple linear regression relates the characteristics of communities served by hospitals to the patients' expected ratings of their experiences at hospitals in each group. Thus, this association potentially varies with hospital quality. The analysis was conducted via Stata. SETTING: Hospital Ratings are measured by Hospital Compare using the HCAHPS survey, a patient satisfaction survey required by the Centers for Medicare and Medicaid Services (CMS) for hospitals in the United States. Participants: 2,816 Medicare-certified acute care hospitals across all US states.


Assuntos
/epidemiologia , Centers for Medicare and Medicaid Services, U.S./normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Fatores Etários , Feminino , Humanos , Modelos Lineares , Masculino , Satisfação do Paciente/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Fatores Sexuais , Estados Unidos/epidemiologia
4.
Int J Qual Health Care ; 33(1)2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33620065

RESUMO

BACKGROUND: The effects of an early and prolonged lockdown during the coronavirus disease 2019 (COVID-19) pandemic on cardiovascular intensive care units (CICUs) are not well established. OBJECTIVES: This study analyses patterns of admission, mortality and performance indicators in a CICU before and during the Argentine lockdown in the COVID-19 pandemic. METHODS: This is a retrospective observational cross-sectional study of all consecutive patients aged 18 years or more admitted to the cardiac intensive care unit at a high-volume reference hospital in Buenos Aires, Argentina, comparing hospitalization rates, primary causes of admission, inpatient utilization indicators, pharmacy supplies' expenditures and in-hospital mortality between 5 March and 31 July 2020, with two corresponding control periods in 2019 and 2018. RESULTS: We included 722 female patients [mean age of 61.6 (SD 15.5) years; 237 (32.8%)]. Overall hospitalizations dropped 53.2% (95%CI: 45.3, 61.0%), from 295.5 patients/year over the periods 2018/2019 to 137 patients in 2020. Cardiovascular disease-related admissions dropped 59.9%, while admission for non-cardiac causes doubled its prevalence from 9.6% over the periods 2018/2019 to 22.6% in the study period (P < 0.001).In the period 2020, the bed occupancy rate fell from 82.2% to 77.4%, and the bed turnover rate dropped 50% from 7.88 to 3.91 monthly discharges/bed. The average length of stay doubled from 3.26 to 6.75 days, and the turnover interval increased from 3.8 to 8.39 days in 2020.Pharmacy supplies' expenditures per discharge increased 134% along with a rise in antibiotics usage from 6.5 to 11.4 vials/ampoules per discharge (P < 0.02).Overall mortality increased from 7% (n = 41) to 13.9% (n = 19) (P = 0.008) at the expense of non-cardiac-related admissions (3.6-19.4%, P = 0.01). CONCLUSIONS: This study found a significant reduction in overall and cardiovascular disease-related causes of admission to the cardiac intensive care unit, worse performance indicators and increased in-hospital mortality along the first 5 months of the early and long-lasting COVID-19 lockdown in Argentina. These results highlight the need to foster public awareness concerning the risks of avoiding hospital attendance. Moreover, health systems should follow strict screening protocols to prevent potential biases in the admission of patients with critical conditions unrelated to the COVID-19 pandemic.


Assuntos
/epidemiologia , Doenças Cardiovasculares/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Argentina/epidemiologia , Ocupação de Leitos/estatística & dados numéricos , Estudos Transversais , Feminino , Política de Saúde , Mortalidade Hospitalar/tendências , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Estudos Retrospectivos
5.
Am J Nurs ; 121(2): 46-52, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33497127

RESUMO

PURPOSE: The purpose of this project was to examine whether initiating a standardized pressure injury (PI) assessment and prevention protocol early in adult patients' ED stay reduces hospital-acquired PIs (HAPIs) in those patients admitted from the ED to acute care inpatient medical units. METHODS: A nurse-led evidence-based practice team studied the problem of increasing HAPIs on four acute care inpatient units and found that, among patients who had been admitted to inpatient care from the ED, longer ED boarding times correlated with a higher rate of HAPIs. ED staff and acute care unit nurses collaborated to develop new protocols to prevent HAPIs in the ED, including staff education and standardized assessments and prevention care for at-risk patients. Data collection was performed at three time periods over approximately two and a half years: baseline, intervention, and postintervention. RESULTS: The incidence rate for HAPIs decreased from 3.56 per 1,000 patient-days at baseline to 1.31 per 1,000 patient-days during the intervention period. This reduction was sustained over the next five months, during which the HAPI incidence rate was 1.53 per 1,000 patient-days. IMPLICATIONS: At a time when ED length of stay is difficult to manage and continues to increase, the use of evidence-based interventions and protocols can reduce the rate of PIs in high-risk patients waiting for hospital admission, leading to a reduction in PI rates and overall hospital costs.


Assuntos
Admissão do Paciente/normas , Lesão por Pressão/prevenção & controle , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , California , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Doença Iatrogênica/prevenção & controle , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos
6.
Artigo em Inglês | MEDLINE | ID: mdl-33321952

RESUMO

Nursing home quality indicators are often used to publicly report the quality of nursing home care. In Switzerland, six national nursing home quality indicators covering four clinical domains (polypharmacy, pain, use of physical restraints and weight loss) were recently developed. To allow for meaningful comparisons, these indicators must reliably show differences in quality of care levels between nursing homes. This study's objectives were to assess nursing home quality indicators' between-provider variability and reliability using intraclass correlations and rankability. This approach has not yet been used in long-term care contexts but presents methodological advantages. This cross-sectional multicenter study uses data of 11,412 residents from a convenience sample of 152 Swiss nursing homes. After calculating intraclass correlation 1 (ICC1) and rankability, we describe between-provider variability for each quality indicator using empirical Bayes estimate-based caterpillar plots. To assess reliability, we used intraclass correlation 2 (ICC2). Overall, ICC1 values were high, ranging from 0.068 (95% confidence interval (CI) 0.047-0.086) for polypharmacy to 0.396 (95% CI 0.297-0.474) for physical restraints, with quality indicator caterpillar plots showing sufficient between-provider variability. However, testing for rankability produced mixed results, with low figures for two indicators (0.144 for polypharmacy; 0.471 for self-reported pain) and moderate to high figures for the four others (from 0.692 for observed pain to 0.976 for physical restraints). High ICC2 figures, ranging from 0.896 (95% CI 0.852-0.917) (self-reported pain) to 0.990 (95% CI 0.985-0.993) (physical restraints), indicated good reliability for all six quality indicators. Intraclass correlations and rankability can be used to assess nursing home quality indicators' between-provider variability and reliability. The six selected quality indicators reliably distinguish care differences between nursing homes and can be recommended for use, although the variability of two-polypharmacy and self-reported pain-is substantially chance-driven, limiting their utility.


Assuntos
Casas de Saúde , Indicadores de Qualidade em Assistência à Saúde , Teorema de Bayes , Estudos Transversais , Pessoal de Saúde/normas , Humanos , Casas de Saúde/normas , Casas de Saúde/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Reprodutibilidade dos Testes , Suíça
7.
Obstet Gynecol ; 136(5): 912-921, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030878

RESUMO

OBJECTIVE: To define and assess the prevalence of potentially life-threatening gynecologic emergencies among women presenting for acute pelvic pain for the purpose of developing measures to audit quality of care in emergency departments. METHODS: We conducted a mixed-methods multicenter study at gynecologic emergency departments in France and Belgium. A modified Delphi procedure was first conducted in 2014 among health care professionals to define relevant combinations of potentially life-threatening conditions and near misses in the field of gynecologic emergency care. A prospective case-cohort study in the spring of 2015 then assessed the prevalence of these potentially life-threatening emergencies and near misses among women of reproductive age presenting for acute pelvic pain. Women in the case group were identified at 21 participating centers. The control group consisted of a sample of women hospitalized for acute pelvic pain not caused by a potentially life-threatening condition and a 10% random sample of outpatients. RESULTS: Eight gynecologic emergencies and 17 criteria for near misses were identified using the Delphi procedure. Among the 3,825 women who presented for acute pelvic pain, 130 (3%) were considered to have a potentially life-threatening condition. The most common diagnoses were ectopic pregnancies with severe bleeding (n=54; 42%), complex pelvic inflammatory disease (n=30; 23%), adnexal torsion (n=20; 15%), hemorrhagic miscarriage (n=15; 12%), and severe appendicitis (n=6; 5%). The control group comprised 225 hospitalized women and 381 outpatients. Diagnostic errors occurred more frequently among women with potentially life-threatening emergencies than among either hospitalized (odds ratio [OR] 1.7, 95% CI 1.1-2.7) or outpatient (OR 14.7, 95% CI 8.1-26.8) women in the control group. Of the women with potentially life-threatening conditions, 26 met near-miss criteria compared with six with not potentially life-threatening conditions (OR 25.6, 95% CI 10.9-70.7). CONCLUSIONS: Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Ginecologia/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Dor Pélvica/terapia , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adulto , Bélgica/epidemiologia , Estudos de Casos e Controles , Técnica Delfos , Emergências , Serviço Hospitalar de Emergência/normas , Feminino , França/epidemiologia , Ginecologia/normas , Humanos , Near Miss/normas , Dor Pélvica/epidemiologia , Estudos Prospectivos , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde/normas
8.
Medicine (Baltimore) ; 99(40): e22447, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019430

RESUMO

The aim of this study was to investigate the relationship between textbook outcome and survival in patients with surgically treated colon cancer. A total of 804 surgical cases were enrolled between June 1, 2010 and December 31, 2014. Textbook outcome was defined as patients who had colon cancer surgery and met the six healthcare parameters of surgery within 6 weeks, radical resection, lymph node (LN) yield ≥12, no ostomy, no adverse outcome and colonoscopy before/after surgery within 6 months. The effect of textbook outcome on 5-year disease-specific survival (DSS) was calculated using the Kaplan-Meier method. A Cox regression model was used to find significant independent variables and stratified analysis used to determine whether text-book outcome had a survival benefit. A textbook outcome was achieved in 59.5% of patients undergoing colon cancer surgery. Important obstacles to achieving textbook outcome were no stomy, no adverse outcome and LN yield ≥12. Patients with text-book outcome had statistically significant better 5-year DSS compared to those with-out (80.1% vs. 58.3%). Multivariate analyses indicated that colon cancer patients with textbook outcome had better 5-year DSS after adjusting for various confounders ([aHR], 0.44; 95% CI, 0.34-0.57). Thus, besides being an index of short-term quality of care, textbook outcomes could be used as a prognosticator of long-term outcomes, such as 5-year survival rates.


Assuntos
Neoplasias do Colo/cirurgia , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Idoso , Neoplasias do Colo/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Taxa de Sobrevida
9.
Can J Surg ; 63(5): E468-E474, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107816

RESUMO

BACKGROUND: The implementation of quality-of-care indicators aiming to improve colorectal cancer (CRC) outcomes has been previously described by Cancer Care Ontario. The aim of this study was to assess the quality-of-care indicators in CRC at a referral centre in a developing country and to determine whether improvement occurred over time. METHODS: We performed a retrospective study of our prospectively collected database of patients after CRC surgery from 2001 to 2016. We excluded patients who underwent local transanal excision, pelvic exenteration or palliative procedures. We evaluated trends over time using the Cochran-Armitage test for trend. RESULTS: A total of 343 patients underwent surgical resection of CRC over the study period. There was improvement of the following indicators over time: the proportion of patients detected by screening (p = 0.03), the proportion of patients with preoperative liver imaging (p = 0.001), the proportion of patients with stage II or III rectal cancer who received neoadjuvant chemotherapy (p = 0.03), the proportion of patients with pathology reports that indicated the number of lymph nodes examined and the number of positive nodes (p = 0.001), and the proportion of patients with pathology reports describing the details on margin status (p = 0.001). CONCLUSION: This study showed the feasibility of applying the Cancer Care Ontario indicators for evaluating outcomes in CRC treatment at a single centre in a developing country. Although there was an improvement of some of the quality-of-care indicators over time, policies and interventions must be implemented to improve the fulfillment of all indicators.


Assuntos
Neoplasias Colorretais/cirurgia , Países em Desenvolvimento , Recidiva Local de Neoplasia/epidemiologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/mortalidade , Estudos de Viabilidade , Feminino , Seguimentos , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Masculino , México , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
10.
Gac. sanit. (Barc., Ed. impr.) ; 34(5): 500-513, sept.-oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198874

RESUMO

OBJETIVO: 1) Determinar la percepción de seguridad que tienen los/las profesionales sanitarios/as y no sanitarios/as en un hospital universitario; 2) describir el clima de seguridad con sus fortalezas y debilidades; y 3) evaluar las dimensiones valoradas negativamente y establecer áreas de mejoras. MÉTODO: Estudio transversal y descriptivo realizado en el Hospital Universitario San Juan de Alicante en el que se recogen los resultados de la valoración del nivel de cultura de seguridad utilizando como instrumento de medición la encuesta Hospital Survey on Patient Safety Culture de la Agency for Healthcare Research and Quality adaptada al español. RESULTADOS: La tasa de respuesta fue del 35,36%. El colectivo con mayor participación fue el médico (32,3%), y el servicio más implicado, el de urgencias (9%). El 86,4% tuvo contacto con el paciente. El 50% de los/las trabajadores/as calificó el clima de seguridad entre 6 y 8 puntos. El 82,8% no notificó ningún evento adverso en el último año. Los profesionales con mayor cultura de seguridad fueron los farmacéuticos, y los que tuvieron peor cultura, los celadores. No se identificó ninguna fortaleza de manera global. Hubo dos dimensiones que se comportaron como una debilidad: la 9 (dotación de personal) y la 10 (apoyo de la gerencia a la seguridad del paciente). CONCLUSIONES: La percepción sobre seguridad del paciente es buena, aunque mejorable. No se han identificado fortalezas. Las debilidades identificadas son dotación de personal, apoyo de la gerencia a la seguridad del paciente, cambios de turno y transición entre servicios, y percepción de seguridad


OBJECTIVE: 1) To determine the perception of safety of health professionals and non-health professionals in a university hospital; 2) describe the climate of safety with its strengths and weaknesses; 3) evaluate the negatively valued dimensions and establish areas of improvement. METHOD: A cross-sectional and descriptive study carried out at the San Juan University Hospital in Alicante, where the results of the assessment of the safety culture level are collected using Hospital Survey On Patient Safety survey of the Agency for Healthcare Research and Quality adapted to Spanish language. RESULTS: The response rate was 35.36%. The group with the greatest participation was the physician (32.3%) and the service most involved, urgencies (9%). 86.4% had contact with the patient. 50% of workers rated the safety climate between 6 and 8 points. 82.8% did not report any adverse events in the last year. The professionals with the greatest security culture were the pharmacists and with the worst culture, the guards. No strength was identified globally. There were two dimensions that behaved like a weakness: 9 (staffing) and 10 (management support for patient safety). CONCLUSIONS: The patient's perception of safety is good, although it can be improved. No strengths have been identified. The weaknesses identified are staffing, management support for patient safety, handoffs and transitions, and safety perception


Assuntos
Humanos , Gestão da Segurança/organização & administração , Segurança do Paciente/estatística & dados numéricos , Ameaças/prevenção & controle , Dano ao Paciente/prevenção & controle , Cultura Organizacional , Hospitais Universitários/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Estudos Transversais , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Melhoria de Qualidade/tendências , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos
12.
Eur J Vasc Endovasc Surg ; 60(4): 509-517, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32807679

RESUMO

OBJECTIVE: To investigate whether a volume-outcome relationship exists for elective abdominal aortic aneurysm (AAA) surgery conducted within the National Health Service (NHS) in England. METHODS: This was an analysis of administrative data. Data were extracted from the Hospital Episodes Statistics database for England from April 2011 to March 2019 for all adult admissions for elective infrarenal AAA surgery. Data were extracted for the NHS trust and surgeon undertaking the procedure, the surgical technique used (open or endovascular), the financial year of admission, length of hospital and critical care stay during the procedure and subsequent emergency re-admissions (primary outcome) and deaths within 30 days. Multilevel modelling was used to adjust for hierarchy and confounding. RESULTS: A dataset of 31 829 procedures (8867 open, 22 962 endovascular) was extracted. For open surgery, lower trust annual volume was associated with higher 30 day emergency re-admission rates and higher 30 day mortality. For open surgery, lower surgeon annual volume was associated with higher 30 day mortality and length of hospital stay greater than the median. For endovascular surgery, lower surgeon annual volume was associated with not having an overnight stay in critical care. None of the other volume-outcome relationships investigated was significant. CONCLUSION: For elective infrarenal AAA surgery in the UK NHS, there was strong evidence of a volume-outcome relationship for open surgery. However, evidence for a volume-outcome relationship is dependent on the specific procedure undertaken and the outcome of interest.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/mortalidade , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos , Inglaterra/epidemiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
13.
Med Care ; 58(10): 927-933, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32833937

RESUMO

BACKGROUND: Hypoglycemia related to antidiabetic drugs (ADDs) is important iatrogenic harm in hospitalized patients. Electronic identification of ADD-related hypoglycemia may be an efficient, reliable method to inform quality improvement. OBJECTIVE: Develop electronic queries of electronic health records for facility-wide and unit-specific inpatient hypoglycemia event rates and validate query findings with manual chart review. METHODS: Electronic queries were created to associate blood glucose (BG) values with ADD administration and inpatient location in 3 tertiary care hospitals with Patient-Centered Outcomes Research Network (PCORnet) databases. Queries were based on National Quality Forum criteria with hypoglycemia thresholds <40 and <54 mg/dL, and validated using a stratified random sample of 321 BG events. Sensitivity and specificity were calculated with manual chart review as the reference standard. RESULTS: The sensitivity and specificity of queries for hypoglycemia events were 97.3% [95% confidence interval (CI), 90.5%-99.7%] and 100.0% (95% CI, 92.6%-100.0%), respectively for BG <40 mg/dL, and 97.7% (95% CI, 93.3%-99.5%) and 100.0% (95% CI, 95.3%-100.0%), respectively for <54 mg/dL. The sensitivity and specificity of the query for identifying ADD days were 91.8% (95% CI, 89.2%-94.0%) and 99.0% (95% CI, 97.5%-99.7%). Of 48 events missed by the queries, 37 (77.1%) were due to incomplete identification of insulin administered by infusion. Facility-wide hypoglycemia rates were 0.4%-0.8% (BG <40 mg/dL) and 1.9%-3.0% (BG <54 mg/dL); rates varied by patient care unit. CONCLUSIONS: Electronic queries can accurately identify inpatient hypoglycemia. Implementation in non-PCORnet-participating facilities should be assessed, with particular attention to patient location and insulin infusions.


Assuntos
Registros Eletrônicos de Saúde , Hipoglicemia/epidemiologia , Hipoglicemiantes/efeitos adversos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Pacientes Internados , Insulina/administração & dosagem , Insulina/efeitos adversos , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Centros de Atenção Terciária/normas
14.
Surgery ; 168(3): 411-418, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32600884

RESUMO

BACKGROUND: The development of laparoscopic liver resection has led to the hypothesis that intraoperative blood loss may be a key indicator of surgical care quality. This study assessed short- and long-term results of patients according to three levels of intraoperative blood loss during laparoscopic liver resection for colorectal liver metastasis. METHODS: All patients who underwent laparoscopic liver resection for colorectal liver metastasis between 2000 and 2018 were included. Difficulty of laparoscopic liver resection was defined according to the Institut Mutualiste Montsouris classification. Three levels of the extent of intraoperative blood loss were defined: massive (≥1,000 mL), substantial (≥75th percentile of intraoperative blood loss within each grade of difficulty), and normal intraoperative blood loss. RESULTS: During study period, 317 patients underwent laparoscopic liver resection for colorectal liver metastasis. Among them, 213 (67.2%), 80 (25.2%), and 24 (7.6%) patients had normal, substantial, and massive intraoperative blood loss, respectively. Twenty-six patients (8.2%) required transfusion. Massive intraoperative blood loss came from a major hepatic vein in 54% of cases and were managed by laparoscopy in 83% of the cases. Laparoscopic liver resection difficulty grade (odds ratio = 3.15; P = .053) and number of colorectal liver metastasis (odds ratio = 1.24; P = .020) were independently associated with massive intraoperative blood loss. Risks factors for substantial intraoperative blood loss were bi-lobar colorectal liver metastasis (odds ratio = 3.12; P = .033) and sinusoidal obstruction syndrome (odds ratio = 3.27; P = .004). The level of intraoperative blood loss was not associated with severe complications nor overall and disease-free survival. Requirement of transfusion was associated with severe complications (odds ratio = 7.27; P = .002) and decreased 1-, 3-, and 5-year overall survival (87%, 68%, and 61% vs 95%, 88%, and 79%; P = .042). CONCLUSION: The extent of intraoperative blood loss did not affect short- and long-term results of laparoscopic liver resection for colorectal liver metastasis. Massive intraoperative blood loss was often incidental and, 83% of the time, manageable by laparoscopy. Rather than intraoperative blood loss, transfusion is a better relevant indicator of laparoscopic liver resection surgical quality.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Neoplasias Colorretais/patologia , Hepatectomia/efeitos adversos , Laparoscopia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Idoso , Transfusão de Sangue/estatística & dados numéricos , Intervalo Livre de Doença , Feminino , Seguimentos , Hemostasia Cirúrgica/estatística & dados numéricos , Hepatectomia/métodos , Hepatectomia/normas , Hepatectomia/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Laparoscopia/métodos , Laparoscopia/normas , Laparoscopia/estatística & dados numéricos , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Complicações Cognitivas Pós-Operatórias/epidemiologia , Complicações Cognitivas Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
15.
BMC Public Health ; 20(1): 938, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32539691

RESUMO

BACKGROUND: Measles is a vaccine preventable, highly transmissible viral infection that affects mostly children under five years. It has been ear marked for elimination and Nigeria adopted the measles elimination strategies of the World Health Organization (WHO) African region to reduce cases and deaths. This study was done to determine trends in measles cases in Bayelsa state, to describe cases in terms of person and place, identify gaps in the case-based surveillance data collection system and identify risk factors for measles infection. METHODS: We carried out a secondary data analysis of measles case-based surveillance data for the period of January 2014 to December 2018 obtained in Microsoft Excel from the State Ministry of Health. Cases were defined according to WHO standard case definitions. We calculated frequencies, proportions, estimated odds ratios (OR), 95% confidence intervals (CI) and multivariate analysis. RESULTS: A total of 449 cases of measles were reported. There were 245(54.6%) males and the most affected age group was 1-4 years with 288(64.1%) cases. Of all cases, 289(9.35%) were confirmed and 70 (48.27%) had received at least one dose of measles vaccine. There was an all-year transmission with increased cases in the 4th quarter of the year. Yenegoa local government area had the highest number of cases. Timeliness of specimen reaching the laboratory and the proportion of specimens received at the laboratory with results sent to the national level timely were below WHO recommended 80% respectively. Predictors of measles infection were, age less than 5 years (AOR: 0.57, 95% CI: 0.36-0.91) and residing in an urban area (AOR: 1.55, 95% CI:1.02-2.34). CONCLUSIONS: Measles infection occurred all-year round, with children less than 5 years being more affected. Measles case-based surveillance system showed high levels of case investigation with poor data quality and poor but improving indicators. Being less than 5 years was protective of measles while living in urban areas increased risk for infection. We recommended to the state government to prioritize immunization activities in the urban centers, start campaigns by the 4th quarter and continue to support measles surveillance activities and the federal government to strengthen regional laboratory capacities.


Assuntos
Assistência à Saúde/tendências , Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Vigilância da População/métodos , Indicadores de Qualidade em Assistência à Saúde/tendências , Vacinação/estatística & dados numéricos , Vacinação/tendências , Adolescente , Criança , Pré-Escolar , Assistência à Saúde/estatística & dados numéricos , Feminino , Previsões , Humanos , Incidência , Lactente , Masculino , Nigéria/epidemiologia , Prevalência , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Fatores de Risco , Organização Mundial da Saúde
16.
BMC Health Serv Res ; 20(1): 372, 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32366235

RESUMO

BACKGROUND: Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. METHOD: We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. FINDINGS: Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR = 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR = 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR = 2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR = 1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII = 7.45 vs 1.64). CONCLUSION: Our findings suggest that urban areas have achieved better prevention and management of non-communicable disease than rural areas, but access to healthcare was equivalent. A better understanding of the causes of the observed variations is needed to develop appropriate policy interventions which address these disparities.


Assuntos
Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Serviços de Saúde Rural/normas , Serviços Urbanos de Saúde/normas , Idoso , China , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos
17.
J Surg Res ; 253: 79-85, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32335394

RESUMO

BACKGROUND: The American College of Surgeons Commission on Cancer has incorporated documentation of critical elements outlined in Operative Standards for Cancer Surgery into revised standards for cancer center accreditation. This study assessed the current documentation of critical elements in partial mastectomy (PM) and sentinel lymph node biopsy (SLNB) operative reports. MATERIALS AND METHODS: Operative reports for PM + SLNB at a single academic institution from 2013 to 2018 were reviewed for compliance and surveyor interobserver reliability with the Oncologic Elements of Operative Record defined in Operative Standards and compared with a nonredundant American Society of Breast Surgeons Mastery of Breast Surgery (MBS) quality measure for specimen orientation. RESULTS: Ten reviewers each evaluated 66 PM + SLNB operative reports for 13 Oncologic Elements and one MBS measure. No operative records reported all critical elements for PM + SLNB or PM alone. Residents completed 36.4% of operative reports: Element documentation was similar for PM but varied significantly for SLNB between resident and attending authorship. Combined reporting performance and interrater reliability varied across all elements and was highest for the use of SLNB tracer (97.1% and κ = 0.95, respectively) and lowest for intraoperative assessment of SLNB (30.6%, κ = 0.43). MBS specimen orientation had both high proportion reported (87.0%) and interrater reliability (κ = 0.84). CONCLUSIONS: Adherence to reporting critical elements for PM and SLNB varied. Whether differential compliance was tied to discrepancies in documentation or reviewer abstraction, clarification of synoptic choices may improve reporting consistency. Evolving techniques or technologies will require continuous appraisal of mandated reporting for breast surgery.


Assuntos
Acreditação/normas , Neoplasias da Mama/cirurgia , Documentação/normas , Excisão de Linfonodo/estatística & dados numéricos , Mastectomia Segmentar/estatística & dados numéricos , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/normas , Centros Médicos Acadêmicos/estatística & dados numéricos , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/patologia , Institutos de Câncer/organização & administração , Institutos de Câncer/normas , Institutos de Câncer/estatística & dados numéricos , Documentação/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Excisão de Linfonodo/instrumentação , Excisão de Linfonodo/métodos , Excisão de Linfonodo/normas , Mastectomia Segmentar/instrumentação , Mastectomia Segmentar/métodos , Mastectomia Segmentar/normas , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Reprodutibilidade dos Testes , Biópsia de Linfonodo Sentinela/normas , Biópsia de Linfonodo Sentinela/estatística & dados numéricos
18.
Int J Public Health ; 65(3): 267-272, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32313968

RESUMO

OBJECTIVES: The More Doctors Program (MDP) is an ongoing Brazilian policy that aims to improve healthcare by providing physicians to the most vulnerable municipalities. We aimed to measure the impact of MDP in mortality and infant mortality rate, the proportion of live births with low weight, prenatal appointments, childbirths at first and fifth min Apgar, public health investment and immunization in Brazil. METHODS: Municipal health indicators were collected before and after the intervention (2012 and 2015). Effects were measured by applying propensity score matching with difference-in-differences. RESULTS: Our findings show that infant mortality presented the highest improvement during the period (a decrease in 11 infant deaths per 1000 live births, p < 0.01). A significant effect, albeit smaller, was also found for the age-standardized total mortality (a decrease in five deaths per 10,000 residents), proportion of children with Apgar score lower than 8 in the fifth min and children with low birth weight. CONCLUSIONS: MDP contributed to improve important health indicators, highlighting the importance of a doctor in remote areas of Brazil.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Mortalidade Infantil , Médicos/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Criança , Pré-Escolar , Cidades/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mortalidade , Gravidez , Pontuação de Propensão , Adulto Jovem
19.
Gynecol Obstet Invest ; 85(3): 222-228, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32224609

RESUMO

INTRODUCTION: Quality of care is an emerging concern, notably in oncology. The aim of the present study was to identify the sociodemographic factors influencing the quality of care in the USA concerning the surgical management of endometrial cancer (EC) through the Surveillance Epidemiology and End Results (SEER) database using already published Belgian quality indicators (QI). METHODS: Using the SEER database 1988-2013, we identified 151,752 patients treated for EC. Six QI were extracted from a Belgian study on quality of care in EC because of their applicability to the SEER. These QI evaluated only the surgical management. We examined the association between sociodemographic characteristics and quality of care with a logistic regression model. We compared our results with those defined as theoretical target by the Belgian initiative and considered a QI to be accurately met if >80% of the population met the indicator, moderately met between 50 and 80%, and poorly met under 50%. RESULTS: Concerning the 6 surgical QIs, one was accurately met, 3 were moderately met, and 2 were poorly met. For example, 73% of the patients with a high-risk EC underwent a pelvic lymphadenectomy. Age over 75 years old, black ethnicity, lower-income group, without partner, and uninsured had a negative impact on adherence to QIs. CONCLUSION: Demographic discrepancies persist in the surgical management of EC, impacting evidence-based care.


Assuntos
Neoplasias do Endométrio/cirurgia , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Oncologia/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Adulto , Idoso , Grupos Étnicos/estatística & dados numéricos , Feminino , Procedimentos Cirúrgicos em Ginecologia/normas , Humanos , Excisão de Linfonodo/normas , Excisão de Linfonodo/estatística & dados numéricos , Oncologia/normas , Pessoa de Meia-Idade , Programa de SEER , Estados Unidos
20.
BJOG ; 127(9): 1074-1080, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32180311

RESUMO

OBJECTIVE: To assess the impact of increasing obstetric intervention on birthweight centiles. DESIGN: Retrospective cohort study of births in five 2-year epochs: 1983-84, 1993-94, 2003-2004, 2013-2014 and 2016-2017. POPULATION: 665 205 singleton births at ≥32 weeks' gestation. SETTING: All maternity services in Victoria, Australia. METHODS: For each epoch, we calculated the birthweight cutoffs defining each birthweight centile at 34, 37 and 40 weeks' gestation. We calculated rates of iatrogenic delivery over time. We then calculated the number of babies whose birthweight would have classified them as ≥3rd centile based on 1983-84 centile definitions but as <3rd centile based on 2016-2017 centile definitions. MAIN OUTCOME MEASURES: Birthweight centile, and gestation at delivery. RESULTS: From 1983-84 to 2016-2017, the rate of iatrogenic delivery for singleton pregnancies increased at all term gestations: 1.6-6.4% at 37 weeks', 4.5-18.3% at 38 weeks', 7.6-23.9% at 39 weeks' and 18.4-25.1% at 40 weeks' (all P < 0.001). Over the same period, the birthweight cutoffs defining the 3rd, 5th and 10th centiles increased significantly at term, but not preterm, gestations. This led to increasing numbers of term births being classified as small for gestational age (SGA). Of the 2748 babies born in 2016-2017 at 37-39 weeks' gestation with a birthweight <3rd centile in that period, 1478 (53.8%) would have been classified as ≥3rd centile based on 1983-84 centile definitions. CONCLUSION: Increasing intervention is shifting the birthweight cutoffs that define birthweight centiles and thereby redefining what constitutes SGA. This undermines the use of population-derived birthweight centiles to audit clinical care. TWEETABLE ABSTRACT: Increasing obstetric intervention is shifting birthweight centiles and therefore definitions of normality.


Assuntos
Peso ao Nascer , Retardo do Crescimento Fetal/diagnóstico , Idade Gestacional , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Feminino , Retardo do Crescimento Fetal/terapia , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Auditoria Médica/métodos , Gravidez , Estudos Retrospectivos , Nascimento a Termo
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