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1.
J Surg Res ; 246: 123-130, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31569034

RESUMO

BACKGROUND: National changes in health care disparities within the setting of trauma care have not been examined within Accountable Care Organizations (ACOs) or non-ACOs. We sought to examine the impact of ACOs on post-treatment outcomes (in-hospital mortality, 90-day complications, and readmissions), as well as surgical intervention among whites and nonwhites treated for spinal fractures. MATERIALS AND METHODS: We identified all beneficiaries treated for spinal fractures between 2009 and 2014 using national Medicare fee for service claims data. Claims were used to identify sociodemographic and clinical criteria, receipt of surgery and in-hospital mortality, 90-day complications, and readmissions. Multivariable logistic regression analysis accounting for all confounders was used to determine the effect of race/ethnicity on outcomes. Nonwhites were compared with whites treated in non-ACOs between 2009 and 2011 as the referent. RESULTS: We identified 245,704 patients who were treated for spinal fractures. Two percent of the cohort received care in an ACO, whereas 7% were nonwhite. We found that disparities in the use of surgical fixation for spinal fractures were present in non-ACOs over the period 2009-2014 but did not exist in the context of care provided through ACOs (odds ratio [OR] 0.75; 95% confidence interval [CI] 0.44, 1.28). A disparity in the development of complications existed for nonwhites in non-ACOs (OR 1.09; 95% CI 1.01, 1.17) that was not encountered among nonwhites receiving care in ACOs (OR 1.32; 95% CI 0.90, 1.95). An existing disparity in readmission rates for nonwhites in ACOs over 2009-2011 (OR 1.34; 95% CI 1.01, 1.80) was eliminated in the period 2012-2014 (OR 0.85; 95% CI 0.65, 1.09). CONCLUSIONS: Our work reinforces the idea that ACOs could improve health care disparities among nonwhites. There is also the potential that as ACOs become more familiar with care integration and streamlined delivery of services, further improvements in disparities could be realized.


Assuntos
Organizações de Assistência Responsáveis/estatística & dados numéricos , Fixação de Fratura/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Fraturas da Coluna Vertebral/cirurgia , Organizações de Assistência Responsáveis/economia , Idoso , Idoso de 80 Anos ou mais , Grupos de Populações Continentais/estatística & dados numéricos , Redução de Custos/economia , Redução de Custos/estatística & dados numéricos , Grupos Étnicos , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/economia , Gastos em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/organização & administração , Mortalidade Hospitalar , Humanos , Masculino , Medicare/economia , Medicare/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade/estatística & dados numéricos , Fatores Socioeconômicos , Fraturas da Coluna Vertebral/economia , Estados Unidos/epidemiologia
2.
J Surg Res ; 246: 224-230, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31606512

RESUMO

BACKGROUND: Older patients with traumatic brain injury (TBI) have higher mortality and morbidity than their younger counterparts. Palliative care (PC) is recommended for all patients with a serious or life-limiting illness. However, its adoption for trauma patients has been variable across the nation. The goal of this study was to assess PC utilization and intensity of care in older patients with severe TBI. We hypothesized that PC is underutilized despite its positive effects. MATERIALS AND METHODS: The National Inpatient Sample database (2009-2013) was queried for patients aged ≥55 y with International Classification of Diseases, Ninth Revision codes for TBI with loss of consciousness ≥24 h. Outcome measures included PC rate, in-hospital mortality, discharge disposition, length of stay (LOS), and intensity of care represented by craniotomy and or craniectomy, ventilator use, tracheostomy, and percutaneous endoscopic gastrostomy. RESULTS: Of 5733 patients, 78% died in hospital with a median LOS of 1 d, and 85% of the survivors were discharged to facilities. The overall PC rate was 35%. Almost 40% of deaths received PC, with nearly half within 48 h of admission. PC was used in 26% who had neurosurgical procedures, compared with 35% who were nonoperatively managed (P = 0.003). PC was associated with less intensity of care in the entire population. For survivors, those with PC had significantly shorter LOS, compared with those without PC. CONCLUSIONS: Despite high mortality, only one-third of older patients with severe TBI received PC. PC was associated with decreased use of life support and lower intensity of care. Significant efforts need to be made to bridge this quality gap and improve PC in this high-risk population.


Assuntos
Cuidados de Suporte Avançado de Vida no Trauma/estatística & dados numéricos , Lesões Encefálicas Traumáticas/terapia , Cuidados Paliativos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Cuidados de Suporte Avançado de Vida no Trauma/organização & administração , Cuidados de Suporte Avançado de Vida no Trauma/tendências , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/mortalidade , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/normas , Cuidados Paliativos/tendências , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/estatística & dados numéricos , Melhoria de Qualidade/tendências , Estudos Retrospectivos , Centros de Traumatologia/organização & administração , Centros de Traumatologia/tendências , Estados Unidos
3.
Eur Radiol ; 30(1): 571-580, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31385049

RESUMO

OBJECTIVE: To clarify the relationship between entrance surface dose (ESD) and physical image quality of original and bone-suppressed chest radiographs acquired using high and low tube voltages. METHODS: An anthropomorphic chest phantom and a 12-mm diameter spherical simulated nodule with a CT value of approximately + 100 HU were used. The lung field in the chest radiograph was divided into seven areas, and the nodule was set in a total of 66 positions. A total of 264 chest radiographs were acquired using four ESD conditions: approximately 0.3 mGy at 140 and 70 kVp and approximately 0.2 and 0.1 mGy at 70 kVp. The radiographs were processed to produce bone-suppressed images. Differences in contrast and contrast-to-noise ratio (CNR) values of the nodule between each condition and between the original and bone-suppressed images were analyzed by a two-sided Wilcoxon signed-rank test. RESULTS: In the areas not overlapping with the ribs, both contrast and CNR values were significantly increased with the bone-suppression technique (p < 0.01). In the bone-suppressed images, these values of the three conditions at 70 kVp were equal to or significantly higher than those of the condition at 140 kVp. There was no apparent decrease in these values between the ESD of approximately 0.3 and 0.1 mGy at 70 kVp. CONCLUSION: By using the shortest exposure time and the lowest tube voltage possible not to increase in blurring artifact and image noise, it is possible to improve the image quality of bone-suppressed images and reduce the patient dose. KEY POINTS: • The effectiveness of bone-suppression techniques differs in areas of lung field. • Image quality of bone-suppressed chest radiographs is improved by lower tube voltage. • Applying lower tube voltage to bone-suppressed chest radiographs leads to dose reduction.


Assuntos
Melhoria de Qualidade/estatística & dados numéricos , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Artefatos , Humanos , Imagens de Fantasmas , Reprodutibilidade dos Testes
4.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(4): 486-493, Oct.-Dec. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1041358

RESUMO

ABSTRACT Objective: To describe the experience of the 25-year-old trajectory of the Baby Friendly Hospital Initiative (BFHI) in Brazil. The first unit was implemented in 1992. Methods: Information and data were collected from publications on the World Health Organization (WHO), the United Nations International Children's Emergency Fund (UNICEF) and the Ministry of Health websites and in national and international journals, about the period 1990-2017. The descriptors used were: "iniciativa hospital amigo da criança", "hospital amigo da criança", "baby friendly initiative hospital", "aleitamento materno" and "breastfeeding". The number of hospitals in the 25 years, the course of the BFHI and its repercussions on breastfeeding in Brazil were evaluated. Results: The BFHI is an intervention strategy in hospital care at birth focused on the implementation of practices that promote exclusive breastfeeding from the first hours of life and with the support, among other measures of positive impact on breastfeeding, of the International Code of Marketing of Breastmilk Substitutes. Currently, the initiative has been revised, updated and expanded to integrate care for newborns in neonatal units and care for women since prenatal care. It can be concluded that, during these 25 years, the quantity of hospitals varied greatly, with numbers still below the capacity of hospital beds. BFHI shows higher rates of breastfeeding than non-accredited hospitals. However, the number of hospitals are still few when compared to other countries. Conclusions: The BFHI has contributed to breastfeeding in Brazil in recent decades. Greater support for public policies is needed to expand the number of accredited institutions in the country.


RESUMO Objetivo: Descrever a experiência de 25 anos da Iniciativa Hospital Amigo da Criança (IHAC) no Brasil, cuja primeira unidade foi implementada em 1992. Métodos: Informações e dados foram obtidos em publicações nos sites da Organização Mundial da Saúde (OMS), do Fundo Internacional de Emergência para a Infância das Nações Unidas (UNICEF) e do Ministério da Saúde e em periódicos nacionais e internacionais, abrangendo o período de 1990 a 2017. Utilizaram-se os descritores: "iniciativa hospital amigo da criança", "hospital amigo da criança", "baby friendly initiative hospital", "aleitamento materno" e "breastfeeding". Foram avaliados o número de hospitais nos 25 anos, a trajetória da IHAC e suas repercussões sobre o aleitamento materno no Brasil. Resultados: A IHAC é uma estratégia de intervenção na assistência hospitalar ao nascimento com foco na implementação de práticas que promovem o aleitamento materno exclusivo desde as primeiras horas de vida e com o apoio, entre outras medidas de impacto positivo na amamentação, do Código Internacional de Comercialização de Substitutos do Leite Materno. Atualmente, a iniciativa foi revisada, atualizada e expandida para integrar o cuidado aos recém-nascidos nas unidades neonatais e na atenção à mulher desde o pré-natal. Pôde-se concluir que, ao longo desses 25 anos, a quantidade de hospitais variou muito, com números ainda aquém da capacidade de leitos hospitalares. Hospitais credenciados como o Hospital Amigo da Criança mostram índices de amamentação superiores ao de hospitais não credenciados, entretanto o número de hospitais credenciados no Brasil ainda é pouco se comparado com outros países. Conclusões: A IHAC contribuiu para o aleitamento materno no Brasil nessas últimas décadas. Mais apoio pelas políticas públicas é necessário para ampliar o número de instituições credenciadas no país.


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adulto , Aleitamento Materno/métodos , Aleitamento Materno/estatística & dados numéricos , Promoção da Saúde/normas , Hospitais/normas , Cuidado do Lactente/normas , Brasil , Melhoria de Qualidade/estatística & dados numéricos , Promoção da Saúde/métodos , Promoção da Saúde/estatística & dados numéricos , Cuidado do Lactente/métodos , Cuidado do Lactente/estatística & dados numéricos
5.
Clin Lab ; 65(9)2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31532088

RESUMO

BACKGROUND: The results of laboratory tests play a critical role in patient management, so the clinical laboratory is obligated to report accurate results. However, the pre-analytical phase, in which human factors are mainly involved, is clearly a vulnerable part of the laboratory process. This study was conducted to investigate and analyze pre-analytical errors. The author intended to reduce these errors by some measures in order to enhance the credibility of the laboratory. METHODS: A retrospective study was conducted to identify the rates and the types and frequencies of pre-analytical errors in the laboratory and analyze them according to the departments of patients, the sections of the laboratory, and the wards of the hospital. The reasons for these errors were persistently identified and analyzed in order to make efforts to reduce the errors. The activities for quality improvement including education and training programs on the phlebotomy teams were also accomplished to reduce these errors. RESULTS: The overall rate of pre-analytical errors was 0.40%. The rate of these errors significantly decreased from 0.44% in 2017 to 0.36% in 2018. In particular, the proportion of improper volume decreased from 46.1% in 2017 to 36.4% in 2018. The most common pre-analytical error was 'improper volume' (41.5%), followed by 'undue clotting' (32.8%). These errors were overwhelmingly more common in inpatients than in outpatients. The rate of these errors was the highest in stat section (1.95%). CONCLUSIONS: Clinical laboratory should make efforts to reduce pre-analytical errors in order to report accurate and expeditious results. Reduction of these errors can be achieved through analyzing and correcting the reasons for them and education and training on the phlebotomy teams and, as a result, the credibility of the laboratory may also be enhanced.


Assuntos
Serviços de Laboratório Clínico/normas , Técnicas de Laboratório Clínico/normas , Laboratórios Hospitalares/normas , Melhoria de Qualidade/normas , Serviços de Laboratório Clínico/tendências , Técnicas de Laboratório Clínico/métodos , Humanos , Controle de Qualidade , Melhoria de Qualidade/estatística & dados numéricos , República da Coreia , Estudos Retrospectivos
6.
Healthc Q ; 22(2): 55-62, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31556381

RESUMO

In this paper, individually reported long-term care (LTC) quality indicators have been supplemented with the composite Qindex measure and applied to 614 homes in Ontario, Canada. This study (1) describes the overall quality performance of LTC homes across five years (2012-2017) and (2) determines if organizational factors impact quality performance. The results demonstrate significant, continuous sector-wide improvement in overall quality performance (as assessed by the Qindex) over time and significant differences in quality based on home size, operator size and ownership. This paper positions the Qindex, a global metric of quality, as a valuable tool for quality measurement and management in the LTC sector.


Assuntos
Instituição de Longa Permanência para Idosos/normas , Casas de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde , Instituição de Longa Permanência para Idosos/organização & administração , Humanos , Assistência de Longa Duração/organização & administração , Assistência de Longa Duração/normas , Estudos Longitudinais , Casas de Saúde/organização & administração , Ontário , Melhoria de Qualidade/estatística & dados numéricos
7.
BMC Res Notes ; 12(1): 559, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484587

RESUMO

OBJECTIVE: The Clinical Practice Guidelines for Dementia in Australia provide evidence-based recommendations for the assessment, diagnosis, and care of people with dementia and their informal carers. The extent to which current Australian post-diagnosis care reflects these recommendations is not well understood. This brief report provides a snapshot of current practice related to three key recommendations from the Guidelines: occupational therapy, exercise, and informal carer support. RESULTS: Nursing (n = 3) and allied health clinicians (n = 29) provided data about 1114 consultations with people with dementia and/or informal carers over a 9-month study period. Results showed that delivery of evidence-based dementia care remains a significant challenge in Australia. Clinicians found it difficult to tailor exercise interventions to overcome cognitive and organisational barriers to adherence during and between consultations. Occupational therapists primarily focussed on functional assessment rather than on delivering evidence-based interventions. Clinicians also found it difficult to identify and address the array of needs reported by informal carers, especially when the person with dementia is present during the consultation. Though these results are reported by a selected sample, they emphasise the need for innovative knowledge translation strategies to facilitate widespread quality improvement in post-diagnosis dementia care. Trial registration Registered with the Australian New Zealand Clinical Trials Registry 21 February 2018 (ACTRN12618000268246).


Assuntos
Cuidadores/psicologia , Demência/terapia , Terapia Ocupacional/métodos , Modalidades de Fisioterapia/estatística & dados numéricos , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Austrália , Demência/enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos
8.
Am J Health Syst Pharm ; 76(18): 1413-1419, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31372630

RESUMO

PURPOSE: Inhaled epoprostenol and inhaled nitric oxide are pulmonary vasodilators commonly used in the management of acute respiratory distress syndrome and right ventricular failure; however, they have vastly different cost profiles. The purpose of the project was to transition from nitric oxide to epoprostenol as the inhaled pulmonary vasodilator (IPV) of choice in adult critically ill patients and evaluate the effect of the transition on associated usage and costs. METHODS: A single-center, prospective, before and after quality improvement project including adult patients receiving inhaled nitric oxide, inhaled epoprostenol, or both was conducted in 7 adult intensive care units, operating rooms, and postanesthesia care units of a tertiary care academic medical center. The total number of patients, hours of therapy, and costs for each agent were compared between stages of protocol implementation and annually. RESULTS: Seven hundred twenty-nine patients received inhaled nitric oxide, inhaled epoprostenol, or both during the study period. The monthly inhaled nitric oxide use in number of patients, hours, and cost decreased during all stages of the project (p < 0.01). The monthly inhaled epoprostenol use in number of patients, hours, and cost increased during all stages (p < 0.01). Overall, total IPV use increased during the study. However, despite this increase in usage, there was a 47% reduction in total IPV cost. CONCLUSION: Implementation of a staged protocol to introduce and expand inhaled epoprostenol use in adult critically ill patients resulted in decreased use and cost of inhaled nitric oxide. The total cost of all IPV was decreased by 47% despite increased IPV use.


Assuntos
Epoprostenol/administração & dosagem , Óxido Nítrico/administração & dosagem , Melhoria de Qualidade/organização & administração , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Vasodilatadores/administração & dosagem , Administração por Inalação , Adulto , Redução de Custos/economia , Redução de Custos/estatística & dados numéricos , Estado Terminal/terapia , Custos de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Epoprostenol/economia , Implementação de Plano de Saúde , Humanos , Pulmão/irrigação sanguínea , Pulmão/efeitos dos fármacos , Óxido Nítrico/economia , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Melhoria de Qualidade/economia , Melhoria de Qualidade/estatística & dados numéricos , Síndrome do Desconforto Respiratório do Adulto/economia
9.
Bone Joint J ; 101-B(8): 1015-1023, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362544

RESUMO

AIMS: Hip fractures are associated with high morbidity, mortality, and costs. One strategy for improving outcomes is to incentivize hospitals to provide better quality of care. We aimed to determine whether a pay-for-performance initiative affected hip fracture outcomes in England by using Scotland, which did not participate in the scheme, as a control. MATERIALS AND METHODS: We undertook an interrupted time series study with data from all patients aged more than 60 years with a hip fracture in England (2000 to 2018) using the Hospital Episode Statistics Admitted Patient Care (HES APC) data set linked to national death registrations. Difference-in-differences (DID) analysis incorporating equivalent data from the Scottish Morbidity Record was used to control for secular trends. The outcomes were 30-day and 365-day mortality, 30-day re-admission, time to operation, and acute length of stay. RESULTS: There were 1 037 860 patients with a hip fracture in England and 116 594 in Scotland. Both 30-day (DID -1.7%; 95% confidence interval (CI) -2.0 to -1.2) and 365-day (-1.9%; 95% CI -2.5 to -1.3) mortality fell in England post-intervention when compared with outcomes in Scotland. There were 7600 fewer deaths between 2010 and 2016 that could be attributed to interventions driven by pay-for-performance. A pre-existing annual trend towards increased 30-day re-admissions in England was halted post-intervention. Significant reductions were observed in the time to operation and length of stay. CONCLUSION: This study provides evidence that a pay-for-performance programme improved the outcomes after a hip fracture in England. Cite this article: Bone Joint J 2019;101-B:1015-1023.


Assuntos
Fixação de Fratura/economia , Fraturas do Quadril/economia , Melhoria de Qualidade/economia , Reembolso de Incentivo , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Feminino , Seguimentos , Fixação de Fratura/estatística & dados numéricos , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Humanos , Análise de Séries Temporais Interrompida , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Escócia , Tempo para o Tratamento/economia , Resultado do Tratamento
10.
BMC Health Serv Res ; 19(1): 475, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296211

RESUMO

BACKGROUND: Measuring and reporting outcome data is fundamental for health care systems to drive improvement. Our electronic health record built a dashboard that allows each primary care provider (PCP) to view real-time population health quality data of their patient panel and use that information to identify care gaps. We hypothesized that the number of dashboard views would be positively associated with clinical quality improvement. METHODS: We performed a retrospective analysis of change in quality scores compared to number of dashboard views for each PCP over a five-month period (2017-18). Using the manager dashboard, we recorded the number of views for each provider. The quality scores analyzed were: colorectal cancer (CRC) screening rates and diabetic patients with an A1c greater than 9% or no A1c in the past year. RESULTS: Data from 120 PCPs were included. The number of dashboard views by each PCP ranged from 0 to 222. Thirty-one PCPs (25.8%) did not view their dashboard. We found no significant correlation between views and change in quality scores (correlation coefficient = 0.06, 95% CI [- 0.13, 0.25] and - 0.05, 95% CI [- 0.25, 0.14] for CRC and diabetes, respectively). CONCLUSION: Clinical dashboards provide feedback to PCPs and are likely to become more available as healthcare systems continue to focus on improving population health. However, dashboards on their own may not be sufficient to impact clinical quality improvement. Dashboard viewership did not appear to impact clinician performance on quality metrics.


Assuntos
Neoplasias Colorretais/prevenção & controle , Diabetes Mellitus/prevenção & controle , Registros Eletrônicos de Saúde/estatística & dados numéricos , Médicos de Atenção Primária/psicologia , Melhoria de Qualidade/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Hemoglobina A Glicada/metabolismo , Humanos , Estudos Retrospectivos
11.
Am J Health Syst Pharm ; 76(15): 1127-1141, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31361871

RESUMO

PURPOSE: Results of the 2018 ASHP national survey of pharmacy practice in hospital settings pertaining to the pharmacy workforce are presented. METHODS: Pharmacy directors at 4,897 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by mail and email. Survey completion was online. IMS Health supplied data on hospital characteristics; the survey sample was drawn from the IMS hospital database. RESULTS: The survey response rate was 16.6%. The results indicate that inpatient staffing has increased for both pharmacists and pharmacy technicians. More than half of the respondents reported shortages of pharmacy managers, experienced technicians, and experienced pharmacy technicians with sterile compounding experience. More than half of the respondents reported an excess of entry-level frontline pharmacists. The perceived shortage of pharmacists is in decline, while the perceived shortage of pharmacy technicians, especially those with years of experience, is increasing. Pharmacists commonly chair multidisciplinary committees within health systems, and pharmacy leaders often report directly to the chief executive officer or chief operating officer; they are often responsible for reporting quality information associated with medication use to the health system's board. The use of a pharmacist credentialing and privileging process beyond licensure has increased over the past 4 years. Attention is being devoted to stress in the work place and addressing burnout among healthcare professionals, including pharmacists. CONCLUSION: The profession is fostering a workforce that is appropriate in composition, sufficient in number, and has the competence to improve the value and safety of medication use.


Assuntos
Serviço de Farmácia Hospitalar/organização & administração , Melhoria de Qualidade/organização & administração , Recursos Humanos/estatística & dados numéricos , Sistemas de Medicação no Hospital/organização & administração , Sistemas de Medicação no Hospital/estatística & dados numéricos , Farmacêuticos/estatística & dados numéricos , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Técnicos em Farmácia/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Sociedades Farmacêuticas , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
12.
Int J Health Policy Manag ; 8(5): 307-314, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31204447

RESUMO

BACKGROUND: A growing body of public management literature sheds light on potential shortcomings to quality improvement (QI) and performance management efforts. These challenges stem from heuristics individuals use when interpreting data. Evidence from studies of citizens suggests that individuals' evaluation of data is influenced by the linguistic framing or context of that information and may bias the way they use such information for decision-making. This study extends prospect theory into the field of public health QI by utilizing an experimental design to test for equivalency framing effects on how public health professionals interpret common QI indicators. METHODS: An experimental design utilizing randomly assigned survey vignettes is used to test for the influence of framing effects in the interpretation of QI data. The web-based survey assigned a national sample of 286 city and county health officers to a "positive frame" group or a "negative frame" group and measured perceptions of organizational performance. The majority of respondents self-report as organizational leadership. RESULTS: Public health managers are indeed susceptible to these framing effects and to a similar degree as citizens. Specifically, they tend to interpret QI information presented in a "positive frame" as indicating a higher level of performance as the same underlying data presenting in a "negative frame." These results are statistically significant and pass robustness checks when regressed against control variables and alternative sources of information. CONCLUSION: This study helps identify potential areas of reform within the reporting aspects of QI systems. Specifically, there is a need to fully contextualize data when presenting even to subject matter experts to reduce the existence of bias when making decisions and introduce training in data presentation and basic numeracy prior to fully engaging in QI initiatives.


Assuntos
Viés , Interpretação Estatística de Dados , Melhoria de Qualidade/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prática de Saúde Pública , Projetos de Pesquisa , Inquéritos e Questionários , Estados Unidos
13.
Br J Radiol ; 92(1100): 20190051, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31204842

RESUMO

OBJECTIVE: To review inferior vena cava (IVC) filter retrieval practice at our institution, the Royal London Hospital, and measure changes following a quality improvement intervention. IVC filters are a preventive treatment for pulmonary embolism when anticoagulation is ineffective/contraindicated. Unless permanent filtration is required, all filters should undergo attempted retrieval within manufacturer's recommendations with a success rate of ≥80 %. METHODS: Retrospective audit of filters inserted between 2011 and 2014, followed by a quality improvement intervention and a second audit between 2015 and 2017. Clinical-radiological data were analysed using the Picture Archiving and Communication System and electronic patient records. RESULTS: During the first audit, filter retrieval was attempted in 92% of cases, of which 82% underwent the procedure within manufacturer's recommendations and 86% were successful. During the second audit, an improvement across indicators was seen. Retrieval increased by 3% and was attempted in 95% of cases (92% of which were within manufacturer's guidelines). Rate of retrievals within manufacturer's guidelines increased by 10%. Filter retrieval success rate increased by 11% - to 97%. CONCLUSIONS: IVC filter retrieval practice at a single institution can be improved by implementing a simple audit intervention. ADVANCES IN KNOWLEDGE: Filter retrieval practice has clinical and medicolegal implications. A simple quality intervention can substantially improve overall practice.


Assuntos
Remoção de Dispositivo/métodos , Auditoria Médica/métodos , Embolia Pulmonar/prevenção & controle , Melhoria de Qualidade/estatística & dados numéricos , Filtros de Veia Cava , Adulto , Feminino , Humanos , Londres , Masculino , Estudos Retrospectivos
14.
Stroke ; 50(7): 1883-1886, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31154945

RESUMO

Background and Purpose- Endovascular therapy has been shown to be highly efficacious based on 90-day modified Rankin Scale score. We examined actual daily healthcare utilization from stroke onset to 1 year afterward from the ESCAPE trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Time) and registry data. Methods- We examined patients from Alberta, Canada, that was enrolled into the ESCAPE trial and the Quality Improvement and Clinical Research registry in the 2016/2017 fiscal year. Through data linkages to several administrative data sets, the daily location of each patient was assessed in various healthcare settings. Results- A total of 286 patients were analyzed, 52 patients were in the treatment arm, and 47 patients were in the control arm of the ESCAPE trial while 187 patients received endovascular therapy as usual care (2016/2017 fiscal year). The odds of a patient being out of a healthcare setting over 1 year was significantly higher when they received endovascular therapy: 3.46 (1.68-7.30) in ESCAPE trial patients and 2.00 (1.08-3.75) in the Quality Improvement And Clinical Research patients. Conclusions- Endovascular therapy significantly reduces healthcare utilization up to 1 year after a stroke.


Assuntos
Procedimentos Endovasculares/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Alberta , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade/estatística & dados numéricos , Sistema de Registros , Resultado do Tratamento
15.
Glob Health Action ; 12(1): 1619155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31159680

RESUMO

Background: Globally, opportunities to validate government reports through external audits are rare, notably in India. A cross-sectional maternal health study in Uttar Pradesh, India's most populous state, compares government administrative data and externally collected data on maternal health service indicators. Objectives: Our study aims to determine the level of concordance between government-reported health facility data compared to externally collected health facility data on the same maternal healthcare quality indicators. Second, our study aims to explore whether the level of agreement between government administrative data versus the externally collected data differs by level of facility or by type of maternal health service. Methods: Facility assessment surveys were administered to key health staff by government-hired enumerators from January 2017 to March 2017 at nearly 750 government health facilities across UP. The same survey was re-conducted by external data collectors from August 2017 to October 2017 at 40 of the same facilities. We conduct comparative analyses of the two datasets for agreement among the same measures of maternal healthcare quality. Results: The findings indicate concordance between most indicators across government administrative data and externally collected health facility data. However, when stratified by facility-level or service type, results suggest significant over-reporting in the government administrative data on indicators that are incentivized. This finding is consistent across all levels of facilities; however, the most significant disparities appear at higher-level facilities, namely District Hospitals. Conclusion: This study has a number of important programmatic and policy implications. Government administrative health data have the potential to be highly critical in informing large-scale quality improvements in maternal healthcare quality, but its credibility must be readily verifiable and accessible to politicians, researchers, funders, and most importantly, the public, to improve the overall health, patient experience, and well-being of women and newborns.


Assuntos
Confiabilidade dos Dados , Coleta de Dados/métodos , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
16.
J Nurs Adm ; 49(6): 315-322, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31135639

RESUMO

OBJECTIVE: This study determined whether 1 health system's frontline nursing model redesign to integrate clinical nurse leaders (CNLs) improved care quality and outcome score consistency. METHODS: Interrupted time-series design was used to measure patient satisfaction with 7 metrics before and after formally integrating CNLs into a Michigan healthcare system. Analysis generated estimates of quality outcome: a) change point; b) level change; and c) variance, pre-post implementation. RESULTS: The lowest-performing unit showed significant increases in quality scores, but there were no significant increases at the hospital level. Quality metric consistency increased significantly for every indicator at the hospital and unit level. CONCLUSIONS: To our knowledge, this is the 1st study quantifying quality outcome consistency before and after nursing care delivery redesign with CNLs. The significant improvement suggests the CNL care model is associated with production of stable clinical microsystem practices that help to reduce clinical variability, thus improving care quality.


Assuntos
Liderança , Enfermeiras Clínicas/organização & administração , Cuidados de Enfermagem/organização & administração , Cuidados de Enfermagem/normas , Melhoria de Qualidade/estatística & dados numéricos , Assistência à Saúde/organização & administração , Unidades Hospitalares/organização & administração , Humanos , Análise de Séries Temporais Interrompida , Michigan , Modelos de Enfermagem , Pesquisa em Avaliação de Enfermagem , Satisfação do Paciente/estatística & dados numéricos
18.
Artigo em Inglês | MEDLINE | ID: mdl-31052246

RESUMO

The World Trade Center Health Program (WTCHP) provides mental health services through diverse service delivery mechanisms, however there are no current benchmarks to evaluate utilization or quality. This quality improvement (QI) initiative sought to examine the delivery and effectiveness of WTCHP mental health services for World Trade Center (WTC) responders who receive care through the Northwell Health Clinical Center of Excellence (CCE), and to characterize the delivery of evidence-based treatments (EBT) for mental health (MH) difficulties in this population. Methods include an analysis of QI data from the Northwell CCE, and annual WTCHP monitoring data for all responders certified for mental health treatment. Nearly 48.9% of enrolled responders with a WTC-certified diagnosis utilized treatment. The majority of treatment delivered was focused on WTC-related conditions. There was significant disagreement between provider-reported EBT use and independently-evaluated delivery of EBT (95.6% vs. 54.8%, p ≤ 0.001). EBT delivery was associated with a small decrease in Posttraumatic Stress Disorder (PTSD) symptoms over time. Providers engaged in the process of data collection, but there were challenges with adherence to outcome monitoring and goal setting. Data from this report can inform continued QI efforts in the WTCHP, as well as the implementation and evaluation of EBT.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Socorristas/psicologia , Serviços de Saúde Mental/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Ataques Terroristas de 11 de Setembro/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Idoso , Socorristas/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia
19.
Am J Obstet Gynecol ; 221(3): 237.e1-237.e11, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31051119

RESUMO

BACKGROUND: Enhanced Recovery After Surgery Society publishes guidelines on perioperative care, but these guidelines should be validated prospectively. OBJECTIVE: To evaluate the association between compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guideline elements and postoperative outcomes in an international cohort. STUDY DESIGN: The study comprised 2101 patients undergoing elective gynecologic/oncology surgery between January 2011 and November 2017 in 10 hospitals across Canada, the United States, and Europe. Patient demographics, surgical/anesthesia details, and Enhanced Recovery After Surgery protocol compliance elements (pre-, intra-, and postoperative phases) were entered into the Enhanced Recovery After Surgery Interactive Audit System. Surgical complexity was stratified according to the Aletti scoring system (low vs medium/high). The following covariates were accounted for in the analysis: age, body mass index, smoking status, presence of diabetes, American Society of Anesthesiologists class, International Federation of Gynecology and Obstetrics stage, preoperative chemotherapy, radiotherapy, operating time, surgical approach (open vs minimally invasive), intraoperative blood loss, hospital, and Enhanced Recovery After Surgery implementation status. The primary end points were primary hospital length of stay and complications. Negative binomial regression was used to model length of stay, and logistic regression to model complications, as a function of compliance score and covariates. RESULTS: Patient demographics included a median age 56 years, 35.5% obese, 15% smokers, and 26.7% American Society of Anesthesiologists Class III-IV. Final diagnosis was malignant in 49% of patients. Laparotomy was used in 75.9% of cases, and the remainder minimally invasive surgery. The majority of cases (86%) were of low complexity (Aletti score ≤3). In patients with ovarian cancer, 69.5% had a medium/high complexity surgery (Aletti score 4-11). Median length of stay was 2 days in the low- and 5 days in the medium/high-complexity group. Every unit increase in Enhanced Recovery After Surgery guideline score was associated with 8% (IRR, 0.92; 95% confidence interval, 0.90-0.95; P<.001) decrease in days in hospital among low-complexity, and 12% (IRR, 0.88; 95% confidence interval, 0.82-0.93; P<.001) decrease among patients with medium/high-complexity scores. For every unit increase in Enhanced Recovery After Surgery guideline score, the odds of total complications were estimated to be 12% lower (P<.05) among low-complexity patients. CONCLUSION: Audit of surgical practices demonstrates that improved compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guidelines is associated with an improvement in clinical outcomes, including length of stay, highlighting the importance of Enhanced Recovery After Surgery implementation.


Assuntos
/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Procedimentos Cirúrgicos em Ginecologia , Assistência Perioperatória/normas , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Europa (Continente) , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Auditoria Médica , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Assistência Perioperatória/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Melhoria de Qualidade/estatística & dados numéricos , Estados Unidos , Adulto Jovem
20.
Plast Reconstr Surg ; 143(5): 1109e-1117e, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033841

RESUMO

BACKGROUND: This study described the prevalence of bleeding complications necessitating blood transfusion across plastic surgery procedures and identified those procedures that may be associated with higher rates of bleeding. METHODS: The authors retrospectively identified patients who suffered from postoperative bleeding complications from 2010 to 2015 using the National Surgical Quality Improvement Program database. This is defined by the National Surgical Quality Improvement Program as the need for transfusion of at least one unit of packed or whole red blood cells. Patient characteristics were described using summary statistics, and National Surgical Quality Improvement Program and univariate analysis of patient characteristics and bleeding complications was performed. RESULTS: Overall, 1955 of 95,687 patients experienced bleeding complications. Patients with bleeding complications were more likely to be diagnosed with hypertension, have a longer total operative time, and have a previously diagnosed bleeding disorder. The most common primary plastic surgery procedure associated with bleeding complications was breast reconstruction with a free flap, and breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap had the highest rate of bleeding. A return to the operating room was required in 539 patients (27.6 percent) who suffered a postoperative bleeding complication. Patients with a preexisting bleeding disorder [n = 1407 (1.5 percent)] were more likely to be diabetic, have a lower preoperative hematocrit, and have a longer operative time. In addition, these patients were more likely to suffer from other nonbleeding complications (1.29 percent versus 0.35 percent; p < 0.01). CONCLUSIONS: Complex procedures (i.e., free flap breast reconstruction) have a higher prevalence of bleeding requiring a transfusion. Furthermore, patients undergoing combined procedures-specifically, breast oncologic and reconstructive cases-may be at a higher risk for experiencing bleeding-related complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Transfusão de Eritrócitos/estatística & dados numéricos , Mamoplastia/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adulto , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Mamoplastia/métodos , Pessoa de Meia-Idade , Duração da Cirurgia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Prevalência , Melhoria de Qualidade/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos
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