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1.
Rev. Esc. Enferm. USP ; 53: e03509, Jan.-Dez. 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1020390

RESUMO

RESUMO Objetivo Analisar o resultado do desempenho dos Núcleos Ampliados de Saúde da Família do estado de São Paulo, na dimensão Organização do Processo de Trabalho, na Avaliação do PMAQ-AB, segundo o Índice Paulista de Responsabilidade Social. Método Estudo transversal, descritivo, exploratório, com abordagem quantitativa, baseado nos dados do 2º ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Foram analisadas por frequência simples 149 equipes, de 47 municípios, distribuídas em cinco agrupamentos, de acordo com o Índice Paulista de Responsabilidade Social. Resultados As equipes do agrupamento quatro (municípios com baixa riqueza e indicadores sociais intermediários) alcançaram desempenho satisfatório e muito satisfatório (90,9%). As equipes dos municípios do agrupamento dois (alto índice de riqueza e indicadores sociais insatisfatórios) tiveram pior desempenho; as equipes do município de São Paulo obtiveram o maior percentual de desempenho satisfatório e muito satisfatório (95,8%). Conclusão As equipes do município de São Paulo (alto índice de riqueza e indicadores sociais insatisfatórios) e as equipes dos municípios do agrupamento quatro (baixa riqueza e indicadores sociais intermediários) foram as que alcançaram melhor desempenho.


RESUMEN Objetivo Analizar el resultado del desempeño de los Núcleos Ampliados de Salud de la Familia del Estado de São Paulo, en la dimensión Organización del Proceso de Trabajo, en la Evaluación del PMAQ-AB, según el Índice Paulista de Responsabilidad Social. Método Estudio transversal, descriptivo, exploratorio, con abordaje cuantitativo, basado en los datos del 2º ciclo del Programa Nacional de Mejoría del Acceso y la Calidad de la Atención Básica. Fueron analizadas por frecuencia simple 149 equipos, de 47 municipios, distribuidas en cinco agrupaciones, según el Índice Paulista de Responsabilidad Social. Resultados Los equipos de la agrupación cuatro (municipios con baja riqueza e indicadores sociales intermedios) alcanzaron desempeño satisfactorio y muy satisfactorio (90,9%). Los equipos de los municipios de la agrupación dos (alto índice de riqueza e indicadores sociales insatisfactorios) tuvieron peor desempeño; los equipos del municipio de São Paulo obtuvieron el mayor porcentual de desempeño satisfactorio y muy satisfactorio (95,8%). Conclusión Los equipos del municipio de São Paulo (alto índice de riqueza e indicadores sociales insatisfactorios) y los equipos de los municipios de la agrupación cuatro (baja riqueza e indicadores sociales intermedios) fueron las que alcanzaron mejor desempeño.


ABSTRACT Objective To analyze the performance of the Expanded Family Health Centers in the state of São Paulo in the Work Process Organization dimension in evaluating the PMAQ-AB , according to the Paulista Social Responsibility Index. A cross-sectional, descriptive, exploratory study with a quantitative approach based on data from the 2ndcycle of the National Program for Improving Access and Quality in Primary Care ( PMAQ-AB ). There were 149 teams from 47 municipalities distributed in five groups analyzed by simple frequency, according to the Paulista Social Responsibility Index. The teams from group four (municipalities of low wealth and intermediate social indicators) achieved satisfactory and very satisfactory performance (90.9%). The teams from the group two municipalities (high wealth index and unsatisfactory social indicators) had worse performance; the teams from the municipality of São Paulo obtained the highest percentage of satisfactory and very satisfactory performance (95.8%). Conclusion The teams from the municipality of São Paulo (high wealth index and unsatisfactory social indicators) and the teams from the municipalities of group four (low wealth and intermediate social indicators) were those that achieved better performance.


Assuntos
Qualidade da Assistência à Saúde , Enfermagem de Atenção Primária , Planejamento em Saúde , Equipe de Assistência ao Paciente , Avaliação em Saúde , Estudos Transversais , Administração em Saúde
2.
N C Med J ; 80(5): 280-284, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471509

RESUMO

North Carolina's upcoming shift to Medicaid managed care will present the opportunity to build on the current quality of services in a system that is focused on whole-person treatment. WellCare of North Carolina, Inc. intends to use innovative approaches that combine aspects of successful programs in other states, tailored to fit North Carolina and improve the quality of care.


Assuntos
Programas de Assistência Gerenciada/organização & administração , Medicaid/organização & administração , Qualidade da Assistência à Saúde , Humanos , North Carolina , Estados Unidos
3.
N C Med J ; 80(5): 301-305, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471515

RESUMO

Federal managed care rules require that the services delivered through Medicaid prepaid health plans are available, accessible, and continually being evaluated for improvement. Working with stakeholders, NC Medicaid created a Quality Strategy that serves as a roadmap to measure and oversee performance. NC Medicaid will make a variety of quality reports available including network access, annual quality measures, and provider survey results.


Assuntos
Programas de Assistência Gerenciada/organização & administração , Medicaid/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Humanos , North Carolina , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Estados Unidos
4.
Artigo em Japonês | MEDLINE | ID: mdl-31527355

RESUMO

OBJECTIVE: The Organisation for Economic Co-operation and Development (OECD) pointed out the deterioration of the performance of health systems (performance) in Japan. To correct this, we evaluated the performances in different prefectures. METHODS: By the OECD method, we set 27 indicators concerning "health status (HS)", " risk factors (RFs)", " access to care (AC)", " quality of care (QC)", and " health care resources (HRs)". Next, the relative value (RV, ±4 standard deviation) from the average value of each indicator in each prefecture was obtained. On the basis of this RV, the prefectures were divided into A, B, and C by cluster analysis. Then, the 27 indicators of the three groups were subjected to multiple comparison tests and the performances were evaluated. RESULTS: A included Hokkaido, Ishikawa, Kyoto, Shimane, Okayama, Hiroshima, Yamaguchi, Tokushima, Kagawa, Ehime, Kochi, Fukuoka, Saga, Nagasaki, Kumamoto, Oita, Miyazaki, Kagoshima, and Okinawa, B included Aomori, Iwate, Akita, Fukushima, Ibaraki, Tochigi, Saitama, Tokyo, Osaka, and Wakayama, C included Miyagi, Yamagata, Gunma, Chiba, Kanagawa, Niigata, Toyama, Fukui, Yamanashi, Nagano, Gifu, Shizuoka, Aichi, Mie, Shiga, Hyogo, Nara, and Tottori. The multiple comparison test results showed that HS and RFs were not significantly different between A and C. In A, AC and QC were poor, but HRs were excessive, and the local allocation tax was high. RFs, AC, QC, HRs, and the local allocation taxes were not significantly different between B and C, but HS was poor in B. CONCLUSIONS: The performance of health systems was deteriorating in the 19 prefectures included in A, and correction is necessary in these prefectures.


Assuntos
Análise por Conglomerados , Planejamento em Saúde Comunitária/estatística & dados numéricos , Organização para a Cooperação e Desenvolvimento Econômico/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Japão , Qualidade da Assistência à Saúde/estatística & dados numéricos , Fatores de Risco
5.
Am Surg ; 85(8): 789-793, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560298

RESUMO

Current quality measures intended to drive improved clinical performance are perceived as an inappropriate administrative burden. Surgeon-constructed quality measures, including the NSQIP, are more closely aligned with provider performance and relevant outcome. We hypothesized that NSQIP participation would be associated with measurable improvement in surgical outcomes. Elective general surgical cases were compared by case volume and incidence of postoperative adverse events (AEs) from 2014 to 2017. Using the Clavien-Dindo severity scaling system, we summed the grades for each AE and defined the patient population burden of these AEs as this sum divided by case volume. Case volume samples increased 67 per cent from 2014 (n = 526, 30 day complete) to 2017 (n = 878). Ratio of patient burden to case volume improved from 0.92 (2014) to 0.73 (2017). Comparison of AE incidence was not significantly different; however, the majority decreased over time. Analysis of individual AE interval change identified sepsis-related respiratory care as the top priority performance improvement target. These data reflect improved performance for a growing volume of surgical procedures. The impact of perioperative morbidity and their associated burden on affected patients has decreased, demonstrating the value of combining NSQIP with Clavien-Dindo to measure the quality of surgical care in objective and patient-specific terms.


Assuntos
Procedimentos Cirúrgicos Eletivos/normas , Complicações Pós-Operatórias/epidemiologia , Qualidade da Assistência à Saúde , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Humanos , Medição de Risco , Estados Unidos/epidemiologia
6.
Rev Col Bras Cir ; 46(4): e2146, 2019 Sep 09.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31508733

RESUMO

OBJECTIVE: to evaluate the perception of surgeons, members of the Brazilian College of Surgeons (CBC), on safety and quality issues in surgery, based on projects of Brazilian Ministry of Health (MS), CBC, World Health Organization (WHO), and American College of Surgeons (ACS). METHODS: a questionnaire based on WHO, CBC, and ACS initiatives was sent to all active and non-active CBC members, using Survey Monkey, in March 2018. RESULTS: out of 7,100 members, 171 professionals answered the questionnaire. Out of these, the majority (63.2%) declared to perform general surgery, 88.9% indicated knowing the project called Safe Surgery developed by MS, 73.1%, the CBC manual, and 14.6%, the ACS Strong for Surgery. Among those who indicated knowing the MS project, 73.1% said that they were accustomed to use it as a routine, and, among those who indicated knowing the CBC manual, 46.2% said that they were accustomed to use it. Most of the surgeons (81.3%) indicated that they had experienced severe surgical failures, being failures related to surgical material (49.7%) and presence of foreign bodies (8.2%) the most common ones. There were distinct opinions on who was responsible for checking over the checklist. CONCLUSION: the importance of safety and quality in surgery is well known by surgeons, but the practice is varied. Serious adverse events had been experienced by many surgeons, mainly related to surgical material and foreign bodies. The concept of interdisciplinarity did not seem to be common practice. Data indicated the need to develop education projects and the obligation of audits.


Assuntos
Competência Clínica , Cirurgia Geral , Cirurgiões , Atitude do Pessoal de Saúde , Brasil , Competência Clínica/estatística & dados numéricos , Cirurgia Geral/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Near Miss , Qualidade da Assistência à Saúde , Sociedades Médicas , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários
7.
Rev Saude Publica ; 53: 76, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31553379

RESUMO

OBJECTIVE: To evaluate the factors associated with HIV and syphilis testing during pregnancy in Brazil. METHODS: This was an ecological study covering all Brazilian municipalities evaluated by the second cycle of the National Program for Access and Quality Improvement in Primary Care, 2013-2014. The dependent variables were based on prenatal care access: prenatal care appointments, and HIV and syphilis tests during prenatal care. The independent variables were compared with demographic and social characteristics. Bivariate analysis was performed assessing the three outcomes with the independent variables. Variables with significant associations in this bivariate analysis were fit in a Poisson multiple regression analysis with robust variance to obtain adjusted estimates. RESULT: Poisson regression analysis showed a statistically significant association with the variables "less than eight years of study" [prevalence ratio (PR) = 1.31; 95%CI 1.19-1.45; p < 0.001] and "participants of the cash transfer program" (PR = 0.80; 95%CI 0.72-0.88; p < 0.001) for the outcome of "having less than six prenatal care appointments" and individual variables. A statistically significant association was found for "participants of the cash transfer program" (PR = 1.43; 95%CI 1.19-1.72; p < 0.001) regarding the outcome from the comparison between HIV testing absence during prenatal care and demographic and social characteristics. The absence of syphilis testing during prenatal care, and demographic and social characteristics presented a statistically significant association for the education level variable "less than eight years of study" (PR =1.75; 95%CI 1.56-1.96; p < 0.001) and "participants of the cash transfer program" (PR = 1.21, 95%CI 1.07-1.36; p < 0.001). CONCLUSIONS: The individual factors were associated with prenatal care appointments and HIV and syphilis tests in Brazilian pregnant women. They show missed opportunities for diagnosing HIV and syphilis infection during prenatal care and indicate weaknesses in the quality of maternal health care services to eliminate mother-to-child transmission.


Assuntos
Infecções por HIV/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Cuidado Pré-Natal/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Sífilis Congênita/diagnóstico , Distribuição por Idade , Brasil/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Distribuição de Poisson , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Prevalência , Atenção Primária à Saúde/métodos , Qualidade da Assistência à Saúde , Análise de Regressão , Fatores Socioeconômicos , Sífilis Congênita/epidemiologia
8.
9.
Medicine (Baltimore) ; 98(37): e17131, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517851

RESUMO

Unexplained fever is one of the most common and difficult diagnostic problems faced daily by clinicians. This study evaluated the differences in health service utilization, health care expenditures, and quality of care provided to patients with unexplained fever before and after global budget (GB) implementation in Taiwan.The National Health Insurance Research Database was used for analyzing the health care expenditures and quality of care before and after implementation of the GB system. Patients diagnosed as having unexplained fever during 2000-2001 were recruited; their 2000-2001 and 2004-2005 data were considered baseline and postintervention data, respectively.Data of 259 patients with unexplained fever were analyzed. The mean lengths of stay (LOSs) before and after GB system implementation were 4.22 ±â€Š0.35 days and 5.29 ±â€Š0.70 days, respectively. The mean costs of different health care expenditures before and after implementation of the GB system were as follows: the mean diagnostic, drug, therapy, and total costs increased respectively from New Taiwan Dollar (NT$) 1440.05 ±â€ŠNT$97.43, NT$3249.90 ±â€ŠNT$1108.27, NT$421.03 ±â€ŠNT$100.03, and NT$13,866.77 ±â€ŠNT$2,114.95 before GB system implementation to NT$2224.34 ±â€ŠNT$238.36, NT$4272.31 ±â€ŠNT$1466.90, NT$2217.03 ±â€ŠNT$672.20, and NT$22,856.41 ±â€ŠNT$4,196.28 after implementation. The mean rates of revisiting the emergency department within 3 days and readmission within 14 days increased respectively from 10.5% ±â€Š2.7% and 8.3% ±â€Š2.4% before implementation to 6.3% ±â€Š2.2% and 4.0% ±â€Š1.7% after implementation.GB significantly increased LOS and incremental total costs for patients with unexplained fever; but improved the quality of care.


Assuntos
Orçamentos , Febre/economia , Febre/terapia , Hospitalização/economia , Medicina Estatal/economia , Adolescente , Feminino , Febre/epidemiologia , Febre/etiologia , Custos de Cuidados de Saúde , Humanos , Pacientes Internados , Masculino , Qualidade da Assistência à Saúde/economia , Fatores de Risco , Taiwan , Adulto Jovem
10.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(8): 796-800, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31422622

RESUMO

The insufficiency of the examined number of lymph nodes after surgery for gastric cancer may undermine the stage of lymph node metastasis, which would have a significant impact on prognostic evaluation and strategy formulation of adjuvant therapy. Under the premise of standard D2 lymphadenectomy, the number of harvested lymph nodes is mainly dependent on the procedures of lymph node examination. Since 2013, our center has set up a special lymph node examination team. In the same year, the average number of harvested lymph nodes in each sample was 46, which was significantly higher than before (average 18 nodes/case in 2004-2012). After continuous quality improvement and regular quality control in 2014, average number of retrieved lymph nodes was 64 per specimen. Therefore, this paper summarizes the methods and experience of lymph node examination in gastric cancer specimens of general surgery in Southern Hospital. The overall construction of the lymph node examination team of gastric cancer in our center mainly includes three parts: establishment of a specialized lymph node examination team, effective standard operating procedures (SOP), and long-term and sustained quality control. The specialized lymph node examination team consists of postgraduate students who are not involved in surgery but have been trained by surgeons. Standard procedures include theoretical reserve of gastric anatomy, surgical observation to correspond to specimens in vitro and in vivo, and standardized specimen processing procedures. Long-term and sustained quality control requires periodic report of lymph node examination data and continuous feedback optimization of the process. Intraoperative lymph node tracing navigation and specimen lymph node intensification are carried out with nanocarbon and indocyanine green dye staining, and then lymph nodes are harvested based on the traditional methods, which can improve the examination rate of lymph nodes, especially for small lymph nodes. Research on lymph node tracing methods, requires multidisciplinary cooperation in particular, will become a hot topic.


Assuntos
Gastrectomia/métodos , Técnicas Histológicas/normas , Excisão de Linfonodo/normas , Linfonodos/patologia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Gastrectomia/normas , Técnicas Histológicas/métodos , Humanos , Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Metástase Linfática , Estadiamento de Neoplasias , Prognóstico , Qualidade da Assistência à Saúde
11.
Am Surg ; 85(7): 747-751, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405421

RESUMO

The ACGME work hour restrictions facilitated increased utilization of service-based advanced practice providers (APPs) to offset reduced general surgery resident work hours. Information regarding attending surgeon perceptions of APP impact is limited. The aim of this survey was to gauge these perceptions with respect to workload, length of stay (LOS), safety, best practice, level of function, and clinical judgment. Attending surgeons on surgical teams that employ service-based APPs at an urban tertiary referral center responded to a survey at the completion of academic year 2016. Perceptions regarding APP impact on workload, LOS, safety, best practice, level of function, and clinical judgment were examined. Twenty-two attending surgeons (40%) responded. Respondents agreed that APPs always/usually decrease their workload (77%), decrease LOS (64%), improve safety (68%), contribute to best practice (82%), and decrease near misses (71%). They also agreed that APPs decrease resident workload (87%), but fewer agreed that APPs contribute to resident education (68%). The majority perceived APPs function at the PGY1/2 (43%) or PGY3 (39%) level and always/usually trust their clinical judgment (72%), and felt there was variability in level of function among APPs (56%). This single-center study illustrates that attending surgeons perceive a positive impact on patient care by service-based APPs.


Assuntos
Atitude do Pessoal de Saúde , Internato e Residência , Admissão e Escalonamento de Pessoal/organização & administração , Adulto , Feminino , Cirurgia Geral/educação , Pesquisas sobre Serviços de Saúde , Humanos , Tempo de Internação , Masculino , Profissionais de Enfermagem , Segurança do Paciente/normas , Qualidade da Assistência à Saúde , Carga de Trabalho
12.
Stud Health Technol Inform ; 265: 12-21, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431571

RESUMO

In this paper we elaborate a preliminary framework to fill this gap and describe the potential contributions of HFE to improve digital health interventions, at the macro, meso and micro level of a health system. Researchers present a practical approach, integrated with some limited reflections on methodological aspects, recently covered in a position paper [8], while previously in conference series and handbooks. This paper presents a HFES perspective on digital health - from the macro, meso and micro level to improve patient safety and delivery of quality care. Experts in HFE can play a key role in creating evidence for an ethical and effective design of digital health intervention and providing support to their implementation and evaluation at the macro, meso and micro level. This framework may help to integrate HFE at the different levels of the system and following the tracks of organization, technology and human factors.


Assuntos
Ergonomia , Segurança do Paciente , Humanos , Qualidade da Assistência à Saúde , Tecnologia
14.
BMC Ophthalmol ; 19(1): 192, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438884

RESUMO

BACKGROUND: A patient's perception of how their glaucoma is managed will influence both adherence to their medication and outcome measures such as quality of life. METHODS: Prospective consecutive study using a Glaucoma Patient-reported Outcome and Experience Measure (POEM) modified for an Australian ophthalmic private clinical practice setting. The Australian Glaucoma POEM consists of eight items related to the patient's understanding of the diagnosis and management, acceptability of the treatment, whether they feel their glaucoma is getting worse, interfering with their daily life and concerns regarding loss of vision as well as addressing whether they feel safe under the care of their glaucoma team and how well their care is organised. RESULTS: Two hundred and two patients (M:F 91:111) participated in the study. Mean ± standard deviation for subject age was 69 ± 13 years. Patient's overall perception of their treatment and outcome was favourable. Younger patients felt their glaucoma interfered more with their daily lives and were more worried about losing vision from glaucoma. The greater the number of medications in use, the more they felt their glaucoma was getting worse and that glaucoma interfered with their daily lives. With all other variables accounted for by the multivariate linear model, female patients more strongly agreed that they understood their glaucoma diagnosis and glaucoma management. The patients with a severe visual defect in their worse eye, reported a greater perceived understanding of their glaucoma diagnosis and management and that they felt that glaucoma had a greater interference on their daily life. They were also more concerned about losing vision from glaucoma than their fellow glaucoma patients with less severe or no visual field deficit in the worse eye. CONCLUSIONS: The modified POEM demonstrates potential to capture the concerns of a practice's glaucoma cohort with a view to enhancing the quality of glaucoma care delivered.


Assuntos
Glaucoma/terapia , Pressão Intraocular/fisiologia , Medidas de Resultados Relatados pelo Paciente , Qualidade da Assistência à Saúde , Acuidade Visual , Campos Visuais/fisiologia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Glaucoma/epidemiologia , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Estudos Prospectivos , Qualidade de Vida , Queensland/epidemiologia , Inquéritos e Questionários , Adulto Jovem
15.
Medicine (Baltimore) ; 98(33): e16874, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415427

RESUMO

To expand our prior statewide analysis of care distribution for locally advanced cervical cancer in Virginia to include 2 more states and to develop a tool for predicting quality of care. Complete treatment was defined as receiving chemotherapy (CT), brachytherapy (BT), and external beam radiotherapy.State cancer registry databases yielded a three-state cohort of 3197 women diagnosed with locally advanced cervical cancer from 2000 to 2013. A logistic regression evaluated predictors for receipt of BT, CT, and high (2-3 modalities received) versus low (0-1 modalities received) quality care. A Cox proportional hazards models determined predictors of survival. Finally, a predictive model was developed and preliminarily validated using our cohort.Only 35.3% of the cohort received complete treatment and only 57.3% received BT. Significant predictors of lower odds of receiving high quality care varied by state but included: 66+ age at diagnosis as compared to 18 to 42, 42 to 53, or 53 to 66; cancer stage IVA as compared to IIIx, IIx, or IB2; public insurance with supplement as compared to private; treatment at a low volume facility; and closer distance quintiles to a high volume treatment center as compared to the furthest quintile. Significant predictors of worse survival varied by state but included: low quality score (0-1 modalities received); 2000 to 2004 or 2005 to 2009 year of diagnosis as compared to 2010 to 2013; 66+ age at diagnosis as compared to 18 to 42, 42 to 53, or 53 to 66; cancer stage IVA as compared to IIIx, IIx, or IB2; treatment at a low volume facility; and unmarried/unknown marital status as compared to married. Our treatment quality prediction tool included age, age, treatment at high volume facility, and cancer stage and demonstrated 78.2% sensitivity and a 62.9% specificity.Only 35.3% of patients received complete guidelines-concordant treatment. Additionally, in 2/3 states it appeared that BT usage may have decreased during the study period. Our predictive model may help identify patients/regions at risk of receiving low quality care to target interventions aimed at improving cervical cancer treatment quality and survival.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Segunda Neoplasia Primária/terapia , Qualidade da Assistência à Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Braquiterapia/estatística & dados numéricos , Feminino , Humanos , Kentucky , Pessoa de Meia-Idade , Estadiamento de Neoplasias , North Carolina , Guias de Prática Clínica como Assunto , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Virginia , Adulto Jovem
16.
Rev Lat Am Enfermagem ; 27: e3167, 2019 Aug 19.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31432920

RESUMO

OBJECTIVE: analyze the safety culture of multidisciplinary teams from three neonatal intensive care units of public hospitals in Minas Gerais, Brazil. METHOD: a cross-sectional survey conducted with 514 health professionals, using the Hospital Survey on Patient Safety Culture; data were subjected to a descriptive statistical analysis in software R-3.3.2. RESULTS: the findings showed that none of the dimensions had a positive response score above 75% to be considered as a strength area. The dimension 'Nonpunitive response to error' was classified as a critical area of the patient safety culture, present in 55.45% of the responses. However, areas with potential for improvements were identified, such as 'Teamwork within units' (59.44%) and 'Supervisor/manager's expectations and actions to promote patient safety' (49.90%). CONCLUSION: none of the dimensions was considered as a strength area, which indicates safety culture has not been fully implemented in the evaluated units. A critical look at the weaknesses of the patient safety process is recommended in order to seek strategies for the adoption of a positive safety culture to benefit patients, family members and health professionals.


Assuntos
Hospitais Públicos/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Gestão da Segurança/estatística & dados numéricos , Adulto , Brasil , Estudos Transversais , Feminino , Hospitais Públicos/normas , Humanos , Unidades de Terapia Intensiva Neonatal/normas , Masculino , Cultura Organizacional , Equipe de Assistência ao Paciente/normas , Segurança do Paciente/normas , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Gestão da Segurança/normas , Estatísticas não Paramétricas , Inquéritos e Questionários , Fatores de Tempo , Carga de Trabalho/estatística & dados numéricos , Adulto Jovem
17.
Presse Med ; 48(7-8 Pt 1): e209-e215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31421945

RESUMO

AIM: Identified Palliative Care Beds (Lits Identifiés Soins Palliatifs - LISPs) is a French specificity. Primarily created to integrate palliative care culture into conventional hospital units, the relevance of this measure became a controversial issue. Nowadays, hospital teams continue to frequently encounter complex situations regarding medical care for palliative patients. To the best of our knowledge, there is only one study, a quantitative one, bridging the gap about that subject. It showed failure in practicing palliative care work around LISP. Our study is based on a qualitative method that complements the quantitative study. It aimed to describe difficulties that limit palliative care practices in managing adult patients in LISP. METHOD: This qualitative exploratory survey was conducted with a sample of health service professionals (n=20), from senior physicians to caregivers. Each semi-structured interview included open questions regarding their experiences, feelings and difficulties with palliative care practices on LISP. It also included closed questions concerning interviewee's demographics and career course. The data for this research were submitted to a two-stage analysis: first, a global review of each interview was performed to identify trends. Then, a detailed breakdown, question by question, was implemented. RESULTS: From a quantitative perspective, the interviews revealed 305 difficulties, indicating the gaps and barriers limiting the implementation of a palliative approach in these services. From a qualitative perspective, five topics raised our attention by their recurrence in discourses: (1) partial knowledge about palliative care definition and legislation mostly due to a lack of training; (2) need for time; (3) need for human resources; (4) need for communication; (5) hard time in transitioning from curative to palliative care. PERSPECTIVE: This survey gives the opportunity to understand health service professionals' difficulties in practicing palliative care in conventional medical services. It raises the central issue of the pricing reform on the health institutes activity. It also provides angles of inquiry to improve LISP effectiveness. This qualitative and descriptive study was designed to explore difficulties in practicing palliative care around LISP. Nevertheless, according to the size of the sample, results will need to be confirmed by a more extensive qualitative survey.


Assuntos
Continuidade da Assistência ao Paciente , Unidades Hospitalares/organização & administração , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Padrões de Prática Médica , Qualidade da Assistência à Saúde/organização & administração , Adulto , Atitude do Pessoal de Saúde , Cuidadores/organização & administração , Cuidadores/normas , Barreiras de Comunicação , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Arquitetura de Instituições de Saúde/normas , França , Conhecimentos, Atitudes e Prática em Saúde , Número de Leitos em Hospital , Unidades Hospitalares/normas , Humanos , Entrevistas como Assunto , Satisfação no Emprego , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Equipe de Assistência ao Paciente/normas , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas , Estudos Retrospectivos , Inquéritos e Questionários
19.
Psychiatr Prax ; 46(6): 317-323, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31408892

RESUMO

OBJECTIVE: Data on the quality and structure of outpatient care for adults with ADHD in Germany are scarce. The study describes the reality of care and identifies possible measures for improvement. METHOD: A complete survey of adults ≥ 18 years of age with a diagnosis of ADHD (ICD-Code F90.0) covered by statutory health insurance was carried out in the outpatient setting in the German Free State of Bavaria in 2012. RESULTS: The analysis revealed a diagnostic prevalence of ADHD in adults in Bavaria of 0.1 %, which was lower than expected based on ADHD prevalence estimates in the general population (about 3 %). Patients were diagnosed by specialists for CNS disorders and by general practitioners. About 30 % of patients received a medication approved for the treatment of ADHD, and these were in approx. 75 % of cases prescribed by specialists for CNS disorders. About 50 % of the patients received psychotherapy. CONCLUSION: General practitioners play an important role for medical care of adult patients with ADHD. Continuous medical education programmes and collaboration between general practitioners and specialists is an urgent imperative for improving outpatient care of ADHD in adults.


Assuntos
Assistência Ambulatorial/normas , Transtorno do Deficit de Atenção com Hiperatividade , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Análise de Dados , Alemanha , Humanos , Qualidade da Assistência à Saúde , Estudos Retrospectivos
20.
Stud Health Technol Inform ; 264: 669-673, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438008

RESUMO

Continuity of patient care (COC) is considered an essential feature of good quality care, but the ambiguity of the concept has given rise to methodological challenges in scientific studies. This study has a strong link to the functional definitions of electronic health records (EHR). In order to evaluate how COC is achieved, through a discharge summary, for example, the contents of COC should be defined. Conceptual consensus on COC as a multidimensional concept has increased. This study was conducted to provide an overview of the dimensions and descriptions of informational and management continuity of care. A scoping review was conducted. We found that informational continuity of care refers to data tool, data content, data structures or information quality related processes. Management continuity of care refers to information flow, co-operation, co-ordination, multiprofessionality or management processes. We identified the need to define next the contents of relational and cross-border continuities.


Assuntos
Continuidade da Assistência ao Paciente , Assistência à Saúde , Registros Eletrônicos de Saúde , Humanos , Qualidade da Assistência à Saúde
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