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1.
Am J Public Health ; 110(4): 567-573, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32078348

RESUMO

Objectives. To describe the types of social services provided at community health centers (CHCs), characteristics of CHCs providing these services, and the association between on-site provision and health care quality.Methods. We surveyed CHCs in 12 US states and the District of Columbia during summer 2017 (n = 208) to identify referral to and provision of services to address 8 social needs. Regression models estimated factors associated with the provision of social services by CHCs and the association between providing services and health care quality (an 8-item composite).Results. CHCs most often offered on-site assistance for needs related to food or nutrition (43%), interpersonal violence (32%), and housing (30%). Participation in projects with community-based organizations was associated with providing services on-site (odds ratio = 2.48; P = .018). On-site provision was associated with better performance on measures of health care quality (e.g., each additional social service was associated with a 4.3 percentage point increase in colorectal cancer screenings).Conclusions. Some CHCs provide social services on-site, and this was associated with better performance on measures of health care quality.Public Health Implications. Health care providers are increasingly seeking to identify and address patients' unmet social needs, and on-site provision of services is 1 strategy to consider.


Assuntos
Centros Comunitários de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Centros Comunitários de Saúde/organização & administração , Violência Doméstica , Abastecimento de Alimentos , Habitação , Humanos , Inquéritos e Questionários , Estados Unidos
2.
PLoS One ; 15(2): e0229229, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32084203

RESUMO

OBJECTIVE: To analyze the pattern and appropriateness of pain medications in older adults receiving home care. METHODS: We performed a prospective cross-sectional study in patients ≥65 years old having chronic pain and receiving home care in Berlin, Germany. Data on prescribed pain medications were collected using self-reported information, nursing documents, and medication plans during interviews at home. Pain intensity was determined with the numeric rating scale (NRS) and the Pain Assessment In Advanced dementia (PAINAD) scale. The Pain Medication Appropriateness Scale score (SPMAS) was applied to evaluate inappropriateness (i.e. a score ≤67) of pain medication. RESULTS: Overall 322 patients with a mean age of 82.1 ± 7.4 years (71.4% females) were evaluated. The average pain intensity scores during the last 24 hours were 5.3 ± 2.1 and 2.3 ± 2.3 on NRS and PAINAD scale (range 0-10, respectively). Sixty (18.6%) patients did not receive any pain medication. Among the treated patients, dipyrone was the most frequently prescribed analgesic (71.4%), while 50.8% and 19.1% received systemic treatment with opioids and non-steroidal anti-inflammatory drugs, respectively. The observed median SPMAS was 47.6 (range 0-100) with 58 (18.0%) of patients achieving appropriate values. Half of the patients were treated with scheduled, while 29.9% were only treated with on-demand medications. Cognitive status had no effect on appropriateness of pain treatment. CONCLUSIONS: We observed substantial deficits in dosing patterns and appropriateness of pain medication in older adults with pain receiving home care. This applied to both patients with and without severe cognitive impairment.


Assuntos
Dor Crônica/tratamento farmacológico , Serviços de Assistência Domiciliar/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Alemanha , Humanos , Masculino
3.
Nurs Clin North Am ; 55(1): 97-107, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32005369

RESUMO

The release of a quality study by the Institute of Medicine in 2001 challenged health care providers to deliver safe, quality care. Research has focused on 2 primary categories of nursing characteristics: demographic data and emotional intelligence and personality traits. The research has shown a correlation between nursing characteristics and quality care and patient outcomes. Factors not considered in this article include hospital teaching status, type of unit, unit skill mix, hospital safety culture, and total nursing hours per patient day. These factors may contribute to quality of care and patient outcomes.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Cuidados de Enfermagem/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Determinação da Personalidade , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos
4.
Medicine (Baltimore) ; 99(3): e18770, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011467

RESUMO

Discrepancies between clinical and autopsy diagnoses range from 30% to 37%. The significance of deontological examinations remains high. In the pursuit of proper evaluation of diagnostic discrepancies, the establishment of pathogenesis, the mechanism of death, and a correct diagnosis are of particular importance.A retrospective study of deontological examinations, aimed at the detection of medical errors and carried out by the State Forensic Medicine Service during the period 1989 to 2016, was performed. The clinical and autopsy data from 1007 cases were collected in compliance with the research protocol.The number of deontological examinations tends to increase. In 60% of cases, the deceased were men. Most cases were in the age group of 50 to 59 years. Most examinations were carried out in relation to improperly provided healthcare services and the patient's death in surgery, admission, intensive care and obstetrics-gynecology departments. In 13% of cases, the diagnosis did not coincide and, in 79% of cases, the diagnoses fully coincided. In 68% of cases, the medical error was disproved.The number of deontological examinations is increasing. In most cases, clinical and autopsy diagnoses fully matched. Incorrectly clinically diagnosed intracranial injuries were the most common diagnostic mistakes. The data are similar to the results of research in other countries and would be relevant to ensuring the prevention of medical mistakes and the improvement of healthcare quality.


Assuntos
Causas de Morte , Erros de Diagnóstico/estatística & dados numéricos , Medicina Legal/métodos , Erros Médicos/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Autopsia , Feminino , Humanos , Lituânia , Masculino , Estudos Retrospectivos
5.
JAMA Netw Open ; 3(1): e1920053, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995216

RESUMO

Importance: Access to reproductive health services is a public health goal. It is unknown how geographic and health plan network availability of Catholic and non-Catholic hospitals may be associated with access to reproductive health services in the United States. Objective: To characterize the market share of Catholic hospitals in the United States, both overall and within Marketplace health insurance plans' hospital networks. Design, Setting, and Participants: This cross-sectional study of US counties used data on hospitals' Catholic affiliation and discharges, hospital networks in Marketplace health insurance plans, and US Census population data to construct a national, county-level data set. The Catholic hospital market share overall in each county and in Marketplace plans' hospital networks in each county were calculated. The study examined whether the Catholic hospital market share was different within Marketplace networks compared with the counties they served. Data analysis was conducted in May and June 2018. Main Outcomes and Measures: The overall Catholic hospital market share was calculated on the basis of the share of discharges in Catholic hospitals in a county compared with all hospital discharges. Overall market share was categorized as minimal (≤2%), low (>2% to ≤20%), high (>20% to ≤70%), or dominant (>70%). The Catholic hospital market share in Marketplace networks was calculated as the share of Catholic hospital discharges in each Marketplace network. Results: The sample included 4450 hospitals in 3101 counties. Overall, 26.1% of US counties had minimal Catholic hospital market share, 38.6% had low Catholic hospital market share, and 35.3% had high or dominant Catholic hospital market share; 38.7% of US reproductive-aged women resided in counties with high or dominant Catholic hospital market share. Among counties with Catholic hospital market share greater than 2%, the distribution of the median Marketplace network's Catholic hospital market share (median [interquartile range], 4.6% [0%-24.3%]) was lower than overall Catholic hospital market share (median [interquartile range], 18.5% [8.1%-36.5%]). The median Marketplace hospital network had a lower Catholic hospital market share than the county overall in 68.0% of US counties with Catholic hospital market share greater than 2%. Conclusions and Relevance: In this national study, 35.3% of counties had high or dominant Catholic hospital market share serving an estimated 38.7% of US women of reproductive age. Marketplace health insurance plans' hospital networks included a lower share of Catholic hospitals than the counties they serve.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Religiosos/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/provisão & distribução , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Catolicismo , Feminino , Humanos , Gravidez , Complicações na Gravidez/prevenção & controle , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estados Unidos
8.
J Nurs Adm ; 50(2): 72-77, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31929345

RESUMO

OBJECTIVE: To examine whether end-of-life care quality is superior in Magnet hospitals, a recognition designating nursing excellence. BACKGROUND: Considerable research shows better patient outcomes in hospitals with excellent nurse work environments, but end-of-life care quality has not been studied in Magnet hospitals. METHODS: An analysis of cross-sectional data was completed using surveys of nurses and hospitals. Multivariate logistic regression models were used to determine the association between Magnet hospitals and measures of end-of-life care quality. RESULTS: Overall, nurses report poor quality of end-of-life care in US hospitals. In Magnet hospitals, nurses were significantly less likely to give their hospital an unfavorable rating on end-of-life care. CONCLUSIONS: Hospital Magnet status may signal better quality in end-of-life care. Administrators looking to improve the quality of end-of-life care may consider improving aspects of nursing that distinguish Magnet hospitals.


Assuntos
Hospitais/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/psicologia , Recursos Humanos de Enfermagem no Hospital/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Assistência Terminal/psicologia , Assistência Terminal/normas , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Assistência Terminal/estatística & dados numéricos , Estados Unidos
9.
J Nurs Care Qual ; 35(1): E1-E5, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30817408

RESUMO

BACKGROUND: Certification of nurses has been identified as a strategy to improve health care quality. However, the impact nursing certification has on clinical patient outcomes remains unclear. PURPOSE: The purpose was to examine the relationship between nursing certification and clinical outcomes. METHODS: A systematic review of the literature was conducted through the search of relevant bibliographic databases (CINAHL Plus, PubMed, Medline, and Cochrane Collaboration). RESULTS: Nursing certification was found to have a significant inverse relationship to patient falls and health care-associated infections. Significant correlations were not established in outcomes such as pressure injuries and mortality. CONCLUSIONS: The validation of knowledge through nursing certification has an impact on specific outcomes such as patients falls and health care-associated infections.


Assuntos
Certificação/estatística & dados numéricos , Enfermeiras e Enfermeiros/classificação , Avaliação de Resultados em Cuidados de Saúde/normas , Qualidade da Assistência à Saúde/normas , Certificação/métodos , Escolaridade , Humanos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos
10.
Eur Radiol ; 30(1): 523-536, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31350588

RESUMO

OBJECTIVES: To evaluate radiomics studies according to radiomics quality score (RQS) and Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) to provide objective measurement of radiomics research. MATERIALS AND METHODS: PubMed and Embase were searched for studies published in high clinical imaging journals until December 2018 using the terms "radiomics" and "radiogenomics." Studies were scored against the items in the RQS and TRIPOD guidelines. Subgroup analyses were performed for journal type (clinical vs. imaging), intended use (diagnostic vs. prognostic), and imaging modality (CT vs. MRI), and articles were compared using Fisher's exact test and Mann-Whitney analysis. RESULTS: Seventy-seven articles were included. The mean RQS score was 26.1% of the maximum (9.4 out of 36). The RQS was low in demonstration of clinical utility (19.5%), test-retest analysis (6.5%), prospective study (3.9%), and open science (3.9%). None of the studies conducted a phantom or cost-effectiveness analysis. The adherence rate for TRIPOD was 57.8% (mean) and was particularly low in reporting title (2.6%), stating study objective in abstract and introduction (7.8% and 16.9%), blind assessment of outcome (14.3%), sample size (6.5%), and missing data (11.7%) categories. Studies in clinical journals scored higher and more frequently adopted external validation than imaging journals. CONCLUSIONS: The overall scientific quality and reporting of radiomics studies is insufficient. Scientific improvements need to be made to feature reproducibility, analysis of clinical utility, and open science categories. Reporting of study objectives, blind assessment, sample size, and missing data is deemed to be necessary. KEY POINTS: • The overall scientific quality and reporting of radiomics studies is insufficient. • The RQS was low in demonstration of clinical utility, test-retest analysis, prospective study, and open science. • Room for improvement was shown in TRIPOD in stating study objective in abstract and introduction, blind assessment of outcome, sample size, and missing data categories.


Assuntos
Imagem por Ressonância Magnética/métodos , Neoplasias/diagnóstico por imagem , Qualidade da Assistência à Saúde/estatística & dados numéricos , Projetos de Pesquisa/normas , Tomografia Computadorizada por Raios X/métodos , Humanos , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes
11.
Artigo em Inglês | MEDLINE | ID: mdl-31878246

RESUMO

Introduction: Patients' satisfaction was extensively researched over the last decades, given its role in building loyalty, compliance to treatment, prevention, and eventually higher levels of wellbeing and improved health status. Patients' feedback on the perceived quality of health services can be incorporated into practice; therefore, understanding factors and mechanisms responsible for patients' satisfaction allows providers to tailor targeted interventions. Method: A questionnaire assessing patients' perception of the quality of health services was administered to a country-representative sample of 1500 Romanian patients. Using a partial least squares-path modeling approach (PLS-PM), with cross-sectional data, we developed a variance-based structural model, emphasizing the mediating role of trust and satisfaction with various categories of health services. Results: We confirmed the mediating role of trust in shaping the relationship between the procedural accuracy of health professionals, along with the perceived intensity of their interaction with patients, and patients' experienced quality of the health services. We confirmed the mediating role of satisfaction by the categories of services in the relationship between waiting time on the premises, attention received, and the perceived reliability of the information received, as predictors, and the experienced quality of the health services. In addition, indirect assessment of patients' satisfaction is a good predictor for direct assessment, thereby affirming the idea that the results of the two types of evaluations converge. Discussions: One of the most efficient solutions to increase both patients' satisfaction and their compliance is to empower the communication dimension between patients and health practitioners. Given the non-linear relationships among variables, we advocate that, unless the nature of the relationships between satisfaction and its predictors is understood, practical interventions could fail. The most relevant variable for intervention is the degree of attention patients perceive they received. We suggest three methods to turn waiting time into attention given to patients.


Assuntos
Satisfação do Paciente/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , Saúde Pública/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Romênia , Inquéritos e Questionários
12.
PLoS One ; 14(12): e0226230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31856219

RESUMO

BACKGROUND: The Emergency Medical Services (EMS) have been developed in the Arabian Gulf States (AGS) in the last three decades. The EMS needs continuous quality assessment of their performance to improve and provide the best out-of-hospital care. This study aims to assess the quality of EMS in the AGS according to the six quality domains of the Institute of Medicine. METHODS: We searched four databases (i.e., PubMed, EMBASE, Web of Science, and CINAHL) for studies that reported on the quality of EMS in any of the AGS using clinical or non-clinical performance indicators. To quantify study quality and risk of bias, the adapted Newcastle Ottawa Scale was used. We focused on structural and functional indicators, clinical and non-clinical. RESULTS: Twenty-five studies were eligible for inclusion. One study contained result of safety, fifteen time-centeredness, twenty effectiveness, five patient-centeredness, and thirteen studies reported on equity of EMS. None of the studies reported on efficiency of EMS. A significant proportion of studies showed high scores on the Newcastle-Ottawa scale. Limited studies on EMS quality were available, not covering all relevant quality domains and not covering the whole AGS region. The equity domain showed the best outcome performance finding, whereas finding of the patient-centeredness domain showed room for improvement in the foreseeable future. CONCLUSION: This review highlights the need for more and better studies of sufficient quality about all domains of quality in EMS in all the AGS. EMS research in Kuwait and Bahrain is warranted, as currently studies of EMS quality are unavailable for these States. Moreover, efficiency researches exploring this discipline should be conducted specially no studies were found has been searching this domain. TRIAL REGISTRATION: PROSPERO registration number: CRD42019123896.


Assuntos
Serviços Médicos de Emergência/normas , Oceano Índico , Qualidade da Assistência à Saúde/estatística & dados numéricos , Humanos
13.
BMC Health Serv Res ; 19(1): 987, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31870361

RESUMO

BACKGROUND: Social disparities in healthcare persist in the US despite the expansion of Medicaid under the Affordable Care Act. We investigated the causal impact of socioeconomic status on the quality of care in a setting with minimal confounding bias from race, insurance type, and access to care. METHODS: We designed a retrospective population-based study with a random 25% sample of adult Taiwan population enrolled in Taiwan's National Health Insurance system from 2000 to 2016. Patient's income levels were categorized into low-income group (<25th percentile) and high-income group (≥25th percentile). We used marginal structural modeling analysis to calculate the odds of hospital admissions for 11 ambulatory care sensitive conditions identified by the Agency for Healthcare Research and Quality and the odds of having an Elixhauser comorbidity index greater than zero for low-income patients. RESULTS: Among 2,844,334 patients, those in lower-income group had 1.28 greater odds (95% CI 1.24-1.33) of experiencing preventable hospitalizations, and 1.04 greater odds (95% CI 1.03-1.05) of having a comorbid condition in comparison to high-income group. CONCLUSIONS: Income was shown to be a causal factor in a patient's health and a determinant of the quality of care received even with equitable access to care under a universal health insurance system. Policies focusing on addressing income as an important upstream causal determinant of health to provide support to patients in lower socioeconomic status will be effective in improving health outcomes for this vulnerable social stratum.


Assuntos
Disparidades em Assistência à Saúde/economia , Renda/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Classe Social , Cobertura Universal do Seguro de Saúde , Adulto , Assistência Ambulatorial , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Programas Nacionais de Saúde , Estudos Retrospectivos , Taiwan/epidemiologia
14.
Healthc Q ; 22(3): 47-53, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31845858

RESUMO

This article examines three family health teams (FHTs) in different Ontario communities that exemplify the features of a Patient's Medical Home (PMH), a vision developed by the College of Family Physicians of Canada. With PMH supports and foundations in place, these FHTs deliver high-quality care enabled by strong PMH functions: accessible, comprehensive, patient- and family-centred continuous care that is responsive to a community's unique needs. Adhering to PMH principles not only improves patient experience, health outcomes and provider satisfaction but also leads to fewer unnecessary hospital admissions and emergency room visits - system savings and better use of public resources.


Assuntos
Assistência à Saúde/organização & administração , Medicina de Família e Comunidade/organização & administração , Assistência Centrada no Paciente/organização & administração , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Acesso aos Serviços de Saúde/organização & administração , Humanos , Ontário , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Qualidade da Assistência à Saúde/estatística & dados numéricos
15.
PLoS Med ; 16(12): e1002990, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31851685

RESUMO

BACKGROUND: In low-resource settings where disease burdens remain high and many health facilities lack essentials such as drugs or commodities, functional equipment, and trained personnel, poor quality of care often results and the impact can be profound. In this paper, we systematically quantify the potential gain of addressing quality of care globally using country-level data about antenatal, childbirth, and postnatal care interventions. METHODS AND FINDINGS: In this study, we created deterministic models to project health outcomes if quality of care was addressed in a representative sample of 81 low- and middle-income countries (LMICs). First, available data from health facility surveys (e.g., Service Provision Assessment [SPA] and Service Availability and Readiness Assessment [SARA]) conducted 2007-2016 were linked to household surveys (e.g., Demographic and Health Surveys [DHS] and Multiple Indicator Cluster Surveys [MICS]) to estimate baseline coverage for a core subset of 19 maternal and newborn health interventions. Next, models were constructed with the Lives Saved Tool (LiST) using country-specific baseline levels in countries with a linked dataset (n = 17) and sample medians applied as a proxy in countries without linked data. Lastly, these 2016 starting baseline levels were raised to reach targets in 2020 as endline based upon country-specific utilization (e.g., proportion of women who attended 4+ antenatal visits, percentage of births delivered in a health facility) from the latest DHS or MICS population-based reports. Our findings indicate that if high-quality health systems could effectively deliver this subset of evidence-based interventions to mothers and their newborns who are already seeking care, there would be an estimated 28% decrease in maternal deaths, 28% decrease in neonatal deaths, and 22% fewer stillbirths compared to a scenario without any change or improvement in quality of care. Totals of 86,000 (range, 77,800-92,400) maternal and 0.67 million (range, 0.59 million-0.75 million) neonatal lives could be saved, and 0.52 million (range, 0.48 million-0.55 million) stillbirths could be prevented across the 81 countries in the calendar year 2020 when adequate quality care is provided at current levels of utilization. Limitations include the paucity of data to individually assess quality of care for each intervention in all LMICs and the necessary assumption that quality of care being provided among the subset of countries with linked datasets is comparable or representative of LMICs overall. CONCLUSIONS: Our findings suggest that efforts to close the quality gap would still produce substantial benefits at current levels of access or utilization. With estimated mortality rate declines of 21%-32% on average, gains from this first step would be significant if quality was improved for selected antenatal, intrapartum, and postnatal interventions to benefit pregnant women and newborns seeking care. Interventions provided at or around the time of childbirth are most critical and accounted for 64% of the impact overall estimated in this quality improvement analysis.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Natimorto/epidemiologia
16.
BMC Health Serv Res ; 19(1): 776, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666066

RESUMO

BACKGROUND: In 2002, a voluntary diagnosis-related groups (DRGs) payment system was introduced in South Korea for seven disease groups, and participation in the DRGs was mandated for all hospitals beginning in 2013. The primary aim of this study was to compare results reflective of patient care between voluntary participation hospitals (VPHs) and mandatory participation hospitals (MPHs) governed by either the DRGs or fee-for-service (FFS) payment system. METHODS: We collected DRGs and FFS inpatient records (n=3,038,006) from the Health Insurance Review and Assessment for the period of July 2011 to July 2014 and compared length-of-stay, total medical costs, shifting services to an outpatient setting, and readmission rates according to payment system, time of DRGs implementation, and hospital type. We analyzed the effects of mandatory introduction in DRGs payment system on results for patient care and used generalized estimating equations with difference-in-difference methodology. RESULTS: Most notably, patients at MPHs had significantly shorter LOS and lower readmission rates than VPH patients after mandatory introduction of the DRGs. Shifting services to an outpatient setting was similar between the groups. CONCLUSIONS: Our findings suggest that the DRGs payment policy in Korea has decreased LOS and readmission rates. These findings support the continued implementation and enlargement of the DRGs payment system for other diseases in South Korea, given its potential for curbing unnecessary resource usage encouraged by FFS. If the Korean government deliberates on expansion of the DRGs to include other diseases with higher rates of complications, policymakers need to monitor deterioration of health care quality caused by fixed pricing.


Assuntos
Grupos Diagnósticos Relacionados/economia , Hospitais , Programas Obrigatórios , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Planos de Pagamento por Serviço Prestado/economia , Feminino , Humanos , Revisão da Utilização de Seguros , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , República da Coreia , Adulto Jovem
17.
Rev Saude Publica ; 53: 87, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31576946

RESUMO

OBJECTIVE: To analyze the trend of opinion and satisfaction indicators of the Spanish national health system from 2005 to 2017. METHODS: Ecological study of time series analyzing the trend of eight indicators of opinion and satisfaction on the Spanish national health system and its autonomous communities from 2005 to 2017. The data was obtained from the Ministry of Health, Social Services and Equality and from the Health Barometer. The Prais-Winsten regression method was used. RESULTS: A static tendency was observed in the perception of users on how the health system works (APC = 1.898, 95%CI -0.954 - 4.751) and decreasing opinion on the improvement of primary care (APC = -0.283; 95%CI -0.335 - -0.121), specialized (APC = -0.241, 95%CI -0.74 - -0.109) and hospitalization (APC = -0.171, 95%CI -0.307 - -0.036). Satisfaction with knowledge and follow-up by the family doctor and pediatrician showed an increasing trend (APC = 7.939, 95%CI 3.965 - 11.914). Satisfaction with medical and nursing professionals was static. No large differences were observed in the trends of the indicators studied in the autonomous communities. CONCLUSIONS: A negative trend was observed in the opinion of the Spanish national health system users. Financing, human resources, quality management systems and differences in the autonomous communities may be some of the causes.


Assuntos
Programas Nacionais de Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/tendências , Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/tendências , Pesquisa sobre Serviços de Saúde , Humanos , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências , Valores de Referência , Análise de Regressão , Espanha , Fatores de Tempo
18.
Artigo em Inglês | MEDLINE | ID: mdl-31581643

RESUMO

Patient satisfaction is a core tool for measuring the performance of the hospitals as well as the service provider and the services that they are providing to the patients. The aim of this research is to evaluate how information received, medical equipment, distance from the hospital, and physical infrastructure influenced patient satisfaction at public hospitals in Southern Punjab, Pakistan. An exploratory research technique was used. We distributed 700 questionnaires through a random method, and 579 provided proper responses. A confirmatory factor analysis (CFA) and a regression analysis were used for the data analysis. The study results illustrated that medical equipment, information received, distance from the hospital, and physical infrastructure had significantly positive impacts (p = 0.001) on patient satisfaction. To promote higher level of satisfaction, there is a need to take appropriate steps for improvement.


Assuntos
Serviços de Saúde/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão , Inquéritos e Questionários , Adulto Jovem
19.
Codas ; 31(5): e20180102, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31664367

RESUMO

PURPOSE: verify the perception of Care Network users for People with Disabilities in Minas Gerais regarding the quality of care. METHODS: This is an observational, descriptive and cross-sectional study of 871 informants, users and caregivers of Care Network for People with Disabilities in Minas Gerais. Interviews were carried out based on three instruments, the User Interview Roadmap and Brazil's Economic Classification Criteria for sociodemographic, clinical and care characterization, as well as the Quality of Care Scale to assess the quality of care for the interviewees. RESULTS: the majority of users were male, single, unworked and had income of a minimum wage. A higher proportion of elementary school is incomplete, white in color, with household income greater than one and up to two minimum wages. The average age of 98.9% of the users was 28.6 years, of which 50.0% was up to 14 years. The majority reported having a type of disability with no associated comorbidity. Regarding the quality of care referred to, at least a quarter of the interviewees evaluated negatively the Access, Social Needs and Received Information axes. CONCLUSION: It will be necessary to improve the waiting time to receive care and also the services offer where the user resides, to facilitate access to consultations, to contribute intersectorally in leisure and social activities and to improve communication with users to increase the quality of care.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Brasil , Cuidadores , Estudos Transversais , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Características de Residência , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
20.
Prim Health Care Res Dev ; 20: e132, 2019 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-31524124

RESUMO

AIM: To identify discrete approaches to specialist healthcare support for older care home residents in the UK and to estimate their prevalence. BACKGROUND: Internationally, a range of new initiatives are emerging to meet the multiple and complex healthcare needs of care home residents. However, little is known about their relative effectiveness and, given their heterogeneity, a classification scheme is required to enable research staff to explore this. METHOD: A UK survey collected information on the funding, age, coverage, aims, staffing and activities of 64 specialist care home support services. Latent class analysis (LCA) was used to allocate the sample into subgroups with similar characteristics. FINDINGS: Three classes were identified. Class 1 (55% of sample) contained services with a high probability of providing scheduled input (regular preplanned visits) and support for all residents and a moderate probability of undertaking medication management, but a low probability of training care home staff ('predominantly direct care'). Class 2 (23% of sample) had a moderate/high probability of providing scheduled input, support for all residents, medication management and training ('direct and indirect care'). Class 3 (22% of sample) had a low probability of providing scheduled input, support for all residents and medication management, but a high probability of providing training for care home staff ('predominantly indirect care'). Consultants were more likely to be members of services in Class 1 than Class 2, and Class 2 than Class 3. CONCLUSIONS: LCA offers a promising approach to the creation of a taxonomy of specialist care home support services. The skills and knowledge required by healthcare staff vary between classes, raising important issues for service design. The proposed classification can be used to explore the extent to which different organisational forms are associated with better resident, process and service outcomes.


Assuntos
Serviços de Saúde para Idosos/organização & administração , Serviços de Saúde para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/estatística & dados numéricos , Especialização , Medicina Estatal/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Reino Unido
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