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4.
Curr Opin Ophthalmol ; 32(5): 431-438, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34231531

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to provide an overview of healthcare standards and their relevance to multiple ophthalmic workflows, with a specific emphasis on describing gaps in standards development needed for improved integration of artificial intelligence technologies into ophthalmic practice. RECENT FINDINGS: Healthcare standards are an essential component of data exchange and critical for clinical practice, research, and public health surveillance activities. Standards enable interoperability between clinical information systems, healthcare information exchange between institutions, and clinical decision support in a complex health information technology ecosystem. There are several gaps in standards in ophthalmology, including relatively low adoption of imaging standards, lack of use cases for integrating apps providing artificial intelligence -based decision support, lack of common data models to harmonize big data repositories, and no standards regarding interfaces and algorithmic outputs. SUMMARY: These gaps in standards represent opportunities for future work to develop improved data flow between various elements of the digital health ecosystem. This will enable more widespread adoption and integration of artificial intelligence-based tools into clinical practice. Engagement and support from the ophthalmology community for standards development will be important for advancing this work.


Assuntos
Inteligência Artificial , Atenção à Saúde/normas , Oftalmologia , Prática Profissional/normas , Inteligência Artificial/normas , Difusão de Inovações , Humanos , Oftalmologia/normas , Qualidade da Assistência à Saúde/normas , Fluxo de Trabalho
5.
J Healthc Manag ; 66(4): 258-270, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34228685

RESUMO

EXECUTIVE SUMMARY: Home hospital care (HHC) is a new and exciting concept that holds the promise of achieving all three components of the Triple Aim and reducing health disparities. As an innovative care delivery model, HHC substitutes traditional inpatient hospital care with hospital care at home for older patients with certain conditions. Studies have shown evidence of reduced cost of care, improved patient satisfaction, and enhanced quality and safety of care for patients treated through this model. The steady growth in Medicare Advantage enrollment and the expansion in 2020 of the Centers for Medicare & Medicaid Services (CMS) Hospitals Without Walls program to include acute hospital care at home creates an opportunity for hospitals to implement such programs and be financially rewarded for reducing costs. Capacity constraints exacerbated by the COVID-19 pandemic suggest that now is the ideal time for healthcare leaders to test and advance the concept of HHC in their communities.


Assuntos
COVID-19 , Enfermagem de Cuidados Críticos/economia , Enfermagem de Cuidados Críticos/normas , Disparidades em Assistência à Saúde/normas , Serviços de Assistência Domiciliar/economia , Serviços de Assistência Domiciliar/normas , Qualidade da Assistência à Saúde/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Satisfação do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/estatística & dados numéricos , SARS-CoV-2 , Estados Unidos
7.
Anesth Analg ; 133(1): 215-225, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34127590

RESUMO

BACKGROUND: Lack of access to safe and affordable anesthesia and surgical care is a major contributor to avoidable death and disability across the globe. Effective education initiatives are a viable mechanism to address critical skill and process gaps in perioperative teams. Vital Anaesthesia Simulation Training (VAST) aims to overcome barriers limiting widespread application of simulation-based education (SBE) in resource-limited environments, providing immersive, low-cost, multidisciplinary SBE and simulation facilitator training. There is a dearth of knowledge regarding the factors supporting effective simulation facilitation in resource-limited environments. Frameworks evaluating simulation facilitation in high-income countries (HICs) are unlikely to fully assess the range of skills required by simulation facilitators working in resource-limited environments. This study explores the qualities of effective VAST facilitators; knowledge gained will inform the design of a framework for assessing simulation facilitators working in resource-limited contexts and promote more effective simulation faculty development. METHODS: This qualitative study used in-depth interviews to explore VAST facilitators' perspectives on attributes and practices of effective simulation in resource-limited settings. Twenty VAST facilitators were purposively sampled and consented to be interviewed. They represented 6 low- and middle-income countries (LMICs) and 3 HICs. Interviews were conducted using a semistructured interview guide. Data analysis involved open coding to inductively identify themes using labels taken from the words of study participants and those from the relevant literature. RESULTS: Emergent themes centered on 4 categories: Persona, Principles, Performance and Progression. Effective VAST facilitators embody a set of traits, style, and personal attributes (Persona) and adhere to certain Principles to optimize the simulation environment, maximize learning, and enable effective VAST Course delivery. Performance describes specific practices that well-trained facilitators demonstrate while delivering VAST courses. Finally, to advance toward competency, facilitators must seek opportunities for skill Progression.Interwoven across categories was the finding that effective VAST facilitators must be cognizant of how context, culture, and language may impact delivery of SBE. The complexity of VAST Course delivery requires that facilitators have a sensitive approach and be flexible, adaptable, and open-minded. To progress toward competency, facilitators must be open to self-reflection, be mentored, and have opportunities for practice. CONCLUSIONS: The results from this study will help to develop a simulation facilitator evaluation tool that incorporates cultural sensitivity, flexibility, and a participant-focused educational model, with broad relevance across varied resource-limited environments.


Assuntos
Anestesiologia/educação , Anestesiologia/normas , Recursos em Saúde/normas , Qualidade da Assistência à Saúde/normas , Treinamento por Simulação/normas , Anestesia/normas , Humanos , Treinamento por Simulação/métodos
8.
CMAJ Open ; 9(2): E667-E672, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145049

RESUMO

BACKGROUND: Nocturnists (overnight hospitalists) are commonly implemented in US teaching hospitals to adhere to per-resident patient caps and improve care but are rare in Canada, where patient caps and duty hours are comparatively flexible. Our objective was to assess the impact of a newly implemented nocturnist program on perceived quality of care, code status documentation and patient outcomes. METHODS: Nocturnists were phased in between June 2018 and December 2019 at Toronto General Hospital, a large academic teaching hospital in Toronto, Ontario. We performed a quality-improvement study comparing rates of code status entry into the electronic health record at admission, in-hospital mortality, the 30-day readmission rate and hospital length of stay for patients with cancer admitted by nocturnists and by residents. Surveys were administered in June 2019 to general internal medicine faculty and residents to assess their perceptions of the impact of the nocturnist program. RESULTS: From July 2018 to June 2019, 30 nocturnists were on duty for 241/364 nights (66.5%), reducing the mean maximum overnight per-resident patient census from 40 (standard deviation [SD] 4) to 25 (SD 5) (p < 0.001). The rate of admission code status entry was 35.3% among patients admitted by residents (n = 133) and 54.9% among those admitted by nocturnists (n = 339) (p < 0.001). The mortality rate was 10.5% among patients admitted by residents and 5.6% among those admitted by nocturnists (p = 0.06), the 30-day readmission rate was 8.3% and 5.9%, respectively (p = 0.4), and the mean acute length of stay was 7.2 (SD 7.0) days and 6.4 (SD 7.8) days, respectively (p = 0.3). Surveys were completed by 15/24 faculty (response rate 62%), who perceived improvements in patient safety, efficiency and trainee education; however, only 30/102 residents (response rate 29.4%) completed the survey. INTERPRETATION: Although implementation of a nocturnist program did not affect patient outcomes, it reduced residents' overnight patient census, and improved faculty perceptions of quality of care and education, as well as documentation of code status. Our results support nocturnist implementation in Canadian teaching hospitals.


Assuntos
Plantão Médico , Médicos Hospitalares , Hospitais de Ensino , Internato e Residência , Neoplasias , Plantão Médico/métodos , Plantão Médico/organização & administração , Canadá/epidemiologia , Registros Eletrônicos de Saúde , Médicos Hospitalares/educação , Médicos Hospitalares/organização & administração , Hospitais de Ensino/métodos , Hospitais de Ensino/organização & administração , Humanos , Internato e Residência/métodos , Internato e Residência/normas , Neoplasias/epidemiologia , Neoplasias/patologia , Neoplasias/terapia , Avaliação de Resultados em Cuidados de Saúde , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/tendências , Qualidade da Assistência à Saúde/normas
9.
Rev Bras Enferm ; 74(suppl 5): e20200912, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34105698

RESUMO

OBJECTIVE: to know the contributions of nursing in the implementation of the quality management principle of the accreditation program in imaging diagnosis. METHODS: a single, qualitative case study carried out in an accredited radiology and imaging diagnosis service. The data collection took place through semi-structured interviews, direct observation, and documentary analysis with the support of software in organizing the data for analysis. RESULTS: a total of four thematic units emerged: the accreditation process in imaging services, the implementation of the program, the role of nursing in imaging services and patient safety and the management of non-conformities in imaging services. Of the other data sources, the word risk was highlighted and a non-conformity was evidenced in the external audit. FINAL CONSIDERATIONS: nursing contributed mainly to the management of the risks involved in the performance of imaging and patient safety tests, requirements of the quality management principle of the accreditation program.


Assuntos
Acreditação , Diagnóstico por Imagem/normas , Equipe de Enfermagem , Segurança do Paciente , Melhoria de Qualidade , Qualidade da Assistência à Saúde/normas , Humanos
10.
Pediatr Clin North Am ; 68(3): 607-619, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34044988

RESUMO

Integrated behavioral health models of care offer many benefits for patient experience and outcomes. However, multidisciplinary teams are comprised of professionals who each may have different professional norms and ethical obligations, which may at times be in conflict. This article offers a framework for negotiating potential conflicts between professional norms and expectations across disciplines involved in integrated behavioral health teams.


Assuntos
Atenção à Saúde , Serviços de Saúde Mental , Pediatria , Qualidade da Assistência à Saúde , Criança , Competência Clínica , Atenção à Saúde/ética , Atenção à Saúde/normas , Ética Médica , Humanos , Serviços de Saúde Mental/ética , Serviços de Saúde Mental/normas , Equipe de Assistência ao Paciente/ética , Equipe de Assistência ao Paciente/normas , Pediatria/ética , Pediatria/normas , Profissionalismo/ética , Profissionalismo/normas , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/normas
12.
Cochrane Database Syst Rev ; 5: CD007899, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33951190

RESUMO

BACKGROUND: There is growing interest in paying for performance (P4P) as a means to align the incentives of healthcare providers with public health goals. Rigorous evidence on the effectiveness of these strategies in improving health care and health in low- and middle-income countries (LMICs) is lacking; this is an update of the 2012 review on this topic. OBJECTIVES: To assess the effects of paying for performance on the provision of health care and health outcomes in low- and middle-income countries. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and 10 other databases between April and June 2018. We also searched two trial registries, websites, online resources of international agencies, organizations and universities, and contacted experts in the field. Studies identified from rerunning searches in 2020 are under 'Studies awaiting classification.' SELECTION CRITERIA: We included randomized or non-randomized trials, controlled before-after studies, or interrupted time series studies conducted in LMICs (as defined by the World Bank in 2018). P4P refers to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. To be included, a study had to report at least one of the following outcomes: patient health outcomes, changes in targeted measures of provider performance (such as the delivery of healthcare services), unintended effects, or changes in resource use. DATA COLLECTION AND ANALYSIS: We extracted data as per original review protocol and narratively synthesised findings. We used standard methodological procedures expected by Cochrane. Given diversity and variability in intervention types, patient populations, analyses and outcome reporting, we deemed meta-analysis inappropriate. We noted the range of effects associated with P4P against each outcome of interest. Based on intervention descriptions provided in documents, we classified design schemes and explored variation in effect by scheme design. MAIN RESULTS: We included 59 studies: controlled before-after studies (19), non-randomized (16) or cluster randomized trials (14);  and interrupted time-series studies (9). One study included both an interrupted time series and a controlled before-after study. Studies focused on a wide range of P4P interventions, including target payments and payment for outputs as modified by quality (or quality and equity assessments). Only one study assessed results-based aid. Many schemes were funded by national governments (23 studies) with the World Bank funding most externally funded schemes (11 studies). Targeted services varied; however, most interventions focused on reproductive, maternal and child health indicators. Participants were predominantly located in public or in a mix of public, non-governmental and faith-based facilities (54 studies). P4P was assessed predominantly at health facility level, though districts and other levels were also involved. Most studies assessed the effects of P4P against a status quo control (49 studies); however, some studies assessed effects against comparator interventions (predominantly enhanced financing intended to match P4P funds (17 studies)). Four studies reported intervention effects against both comparator and status quo. Controlled before-after studies were at higher risk of bias than other study designs. However, some randomised trials were also downgraded due to risk of bias. The interrupted time-series studies provided insufficient information on other concurrent changes in the study context. P4P compared to a status quo control For health services that are specifically targeted, P4P may slightly improve health outcomes (low certainty evidence), but few studies assessed this. P4P may also improve service quality overall (low certainty evidence); and probably increases the availability of health workers, medicines and well-functioning infrastructure and equipment (moderate certainty evidence). P4P may have mixed effects on the delivery and use of services (low certainty evidence) and may have few or no distorting unintended effects on outcomes that were not targeted (low-certainty evidence), but few studies assessed these. For secondary outcomes, P4P may make little or no difference to provider absenteeism, motivation or satisfaction (low certainty evidence); but may improve patient satisfaction and acceptability (low certainty evidence); and may positively affect facility managerial autonomy (low certainty evidence). P4P probably makes little to no difference to management quality or facility governance (low certainty evidence). Impacts on equity were mixed (low certainty evidence). For health services that are untargeted, P4P probably improves some health outcomes (moderate certainty evidence); may improve the delivery, use and quality of some health services but may make little or no difference to others (low certainty evidence); and may have few or no distorting unintended effects (low certainty evidence). The effects of P4P on the availability of medicines and other resources are uncertain (very low certainty evidence). P4P compared to other strategies For health outcomes and services that are specifically targeted, P4P may make little or no difference to health outcomes (low certainty evidence), but few studies assessed this. P4P may improve service quality (low certainty evidence); and may have mixed effects on the delivery and use of health services and on the availability of equipment and medicines (low certainty evidence). For health outcomes and services that are untargeted, P4P may make little or no difference to health outcomes and to the delivery and use of health services (low certainty evidence). The effects of P4P on service quality, resource availability and unintended effects are uncertain (very low certainty evidence). Findings of subgroup analyses Results-based aid, and schemes using payment per output adjusted for service quality, appeared to yield the greatest positive effects on outcomes. However, only one study evaluated results-based aid, so the effects may be spurious. Overall, schemes adjusting both for quality of service and rewarding equitable delivery of services appeared to perform best in relation to service utilization outcomes. AUTHORS' CONCLUSIONS: The evidence base on the impacts of P4P schemes has grown considerably, with study quality gradually increasing. P4P schemes may have mixed effects on outcomes of interest, and there is high heterogeneity in the types of schemes implemented and evaluations conducted. P4P is not a uniform intervention, but rather a range of approaches. Its effects depend on the interaction of several variables, including the design of the intervention (e.g., who receives payments ), the amount of additional funding,  ancillary components (such as technical support) and contextual factors (including organizational context).


Assuntos
Países em Desenvolvimento , Melhoria de Qualidade/economia , Reembolso de Incentivo , Viés , Estudos Controlados Antes e Depois , Humanos , Análise de Séries Temporais Interrompida , Ensaios Clínicos Controlados não Aleatórios como Assunto , Melhoria de Qualidade/normas , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/normas
13.
Med Educ Online ; 26(1): 1923114, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33974514

RESUMO

In Germany, two-week clinical clerkships in university-associated general practices have existed since 2002. Approximately 10,000 medical students participate in these decentral clerkships each year. Empirical information on quality management strategies in decentral learning environments is sparse. This nationwide study aims to describe the current quality management efforts of German family medicine departments in response to negative events. A nationwide three-part mixed methods study on the quality management of family medicine clerkships was conducted. First, individuals from n = 37 family medicine departments involved in the organization of family medicine clerkships were interviewed. Interview transcripts were analyzed with qualitative content analysis. Second, a questionnaire on quality management of decentralized learning environments based on the categories of the analysis was developed and sent to the departments. Three negative event cases in family medicine clerkships were included in the questionnaire. Third, interview and survey data were integrated based on respondents' process descriptions of how each department handled the cases. Of the 37 contacted departments, n = 12 (32%) performed an interview. Major categories of negative events included problems in the student-teacher interaction, didactical challenges, and problematic student behavior. Twenty departments answered at least one questionnaire (54%). Most respondents indicated that their department conducts quality management in decentralized teaching. Negative events in decentral family medicine clerkships occurred at a rate of 66.4 to 179.5 events per 10.000 Students per semester. The mixed-method analysis showed that departments are conscious about quality management issues in decentral learning environments but adhere to heterogeneous local standards. Negative events occur regularly in decentral learning environments. Local quality management processes exist but lack national harmonization. Further outcome-based research is needed to explore the effectiveness and feasibility of quality management strategies. This will become increasingly relevant with an expected upscaled family medicine content.


Assuntos
Estágio Clínico/organização & administração , Medicina de Família e Comunidade/educação , Qualidade da Assistência à Saúde/organização & administração , Alemanha , Humanos , Qualidade da Assistência à Saúde/normas , Estudantes de Medicina , Ensino
14.
CMAJ Open ; 9(2): E570-E575, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34021015

RESUMO

BACKGROUND: Factors influencing the quality of end-of-life communication are relevant to improving end-of-life care. We assessed the quality of end-of-life communication and influencing factors in 2 intensive care unit (ICU) cohorts at high risk of death: patients living in nursing homes and those on extracorporeal membrane oxygenation (ECMO). METHODS: This retrospective cohort study included admissions to 4 ICUs in Winnipeg, Manitoba, from 2000 to 2017. We identified cohorts and influencing factors from the Winnipeg ICU database and by manual chart review. We assessed quality of end-of-life communication using 18 validated, binary quality indicators to calculate a weighted, scaled, composite score (range 0-100). We used median regression to identify factors associated with the composite score. RESULTS: The ECMO cohort (n = 109) was younger than the nursing home cohort (n = 230), with longer hospital stays and higher disease severity. Mean composite scores of end-of-life communication were extremely low in both cohorts (mean 48.5 [standard error of the mean (SEM) 1.7] for the nursing home cohort, 49.1 [SEM 2.5] for the ECMO cohort). Patient characteristics associated with higher median composite scores were older age (5.0 per decade, 95% confidence interval [CI] 2.1-7.8) and lower (worse) Glasgow Coma Scale (GCS) scores (1.8 per GCS point, 95% CI 0.5-3.2). The median composite score rose significantly over time (1.7 per year, 95% CI 0.5-2.8). INTERPRETATION: The quality of end-of-life communication in ICUs is poor, and factors associated with better prognosis are also associated with worse communication. Direct and early communication should occur with all patients in the ICU and their surrogates, not just those who are believed most likely to die.


Assuntos
Barreiras de Comunicação , Estado Terminal , Morte , Relações Profissional-Paciente/ética , Qualidade de Vida , Assistência Terminal , Revelação da Verdade/ética , Planejamento Antecipado de Cuidados/ética , Idoso , Canadá/epidemiologia , Estado Terminal/mortalidade , Estado Terminal/psicologia , Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/mortalidade , Oxigenação por Membrana Extracorpórea/psicologia , Feminino , Humanos , Unidades de Terapia Intensiva/ética , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Casas de Saúde/ética , Casas de Saúde/estatística & dados numéricos , Prognóstico , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas , Medição de Risco , Índice de Gravidade de Doença , Assistência Terminal/métodos , Assistência Terminal/psicologia
15.
J Nurs Adm ; 51(5): 235-236, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33882548

RESUMO

Increasingly, nursing research is considered essential to the achievement of high-quality patient care and outcomes. In this month's Magnet® Perspectives column, we examine the origins of nursing research, its role in creating the Magnet Recognition Program®, and why a culture of clinical inquiry matters for nurses. This column explores how Magnet hospitals have built upon the foundation of seminal research to advance contemporary standards that address some of the challenges faced by healthcare organizations around the world. We offer strategies for nursing leaders to develop robust research-oriented programs in their organizations.


Assuntos
Hospitais/normas , Liderança , Pesquisa em Enfermagem/normas , Serviço Hospitalar de Enfermagem/normas , Recursos Humanos de Enfermagem no Hospital/normas , Credenciamento/normas , Humanos , Cultura Organizacional , Qualidade da Assistência à Saúde/normas , Estados Unidos
16.
Stroke ; 52(6): 2125-2133, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33896223

RESUMO

BACKGROUND AND PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has potentially caused indirect harm to patients with other conditions via reduced access to health care services. We aimed to describe the impact of the initial wave of the pandemic on admissions, care quality, and outcomes in patients with acute stroke in the United Kingdom. METHODS: Registry-based cohort study of patients with acute stroke admitted to hospital in England, Wales, and Northern Ireland between October 1, 2019, and April 30, 2020, and equivalent periods in the 3 prior years. RESULTS: One hundred fourteen hospitals provided data for a study cohort of 184 017 patients. During the lockdown period (March 23 to April 30), there was a 12% reduction (6923 versus 7902) in the number of admissions compared with the same period in the 3 previous years. Admissions fell more for ischemic than hemorrhagic stroke, for older patients, and for patients with less severe strokes. Quality of care was preserved for all measures and in some domains improved during lockdown (direct access to stroke unit care, 1-hour brain imaging, and swallow screening). Although there was no change in the proportion of patients discharged with good outcome (modified Rankin Scale score, ≤2; 48% versus 48%), 7-day inpatient case fatality increased from 6.9% to 9.4% (P<0.001) and was 22.0% in patients with confirmed or suspected COVID-19 (adjusted rate ratio, 1.41 [1.11-1.80]). CONCLUSIONS: Assuming that the true incidence of acute stroke did not change markedly during the pandemic, hospital avoidance may have created a cohort of untreated stroke patients at risk of poorer outcomes or recurrent events. Unanticipated improvements in stroke care quality should be used as an opportunity for quality improvement and to learn about how to develop resilient health care systems.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Qualidade da Assistência à Saúde/normas , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Estudos Prospectivos , Qualidade da Assistência à Saúde/tendências , Sistema de Registros , Reino Unido/epidemiologia
17.
Epidemiol Infect ; 149: e75, 2021 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-33722335

RESUMO

We investigated whether countries with higher coverage of childhood live vaccines [BCG or measles-containing-vaccine (MCV)] have reduced risk of coronavirus disease 2019 (COVID-19)-related mortality, while accounting for known systems differences between countries. In this ecological study of 140 countries using publicly available national-level data, higher vaccine coverage, representing estimated proportion of people vaccinated during the last 14 years, was associated with lower COVID-19 deaths. The associations attenuated for both vaccine variables, and MCV coverage became no longer significant once adjusted for published estimates of the Healthcare access and quality index (HAQI), a validated summary score of healthcare quality indicators. The magnitude of association between BCG coverage and COVID-19 death rate varied according to HAQI, and MCV coverage had little effect on the association between BCG and COVID-19 deaths. While there are associations between live vaccine coverage and COVID-19 outcomes, the vaccine coverage variables themselves were strongly correlated with COVID-19 testing rate, HAQI and life expectancy. This suggests that the population-level associations may be further confounded by differences in structural health systems and policies. Cluster randomised studies of booster vaccines would be ideal to evaluate the efficacy of trained immunity in preventing COVID-19 infections and mortality in vaccinated populations and on community transmission.


Assuntos
COVID-19/imunologia , COVID-19/prevenção & controle , Imunidade Inata/imunologia , SARS-CoV-2/imunologia , Cobertura Vacinal/estatística & dados numéricos , Vacina BCG/administração & dosagem , Vacina BCG/imunologia , COVID-19/mortalidade , Atenção à Saúde/normas , Atenção à Saúde/estatística & dados numéricos , Humanos , Imunização Secundária/normas , Imunização Secundária/estatística & dados numéricos , Modelos Lineares , Vacina contra Sarampo/administração & dosagem , Vacina contra Sarampo/imunologia , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos
18.
N Z Med J ; 134(1531): 77-82, 2021 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-33767479

RESUMO

The Health and Disability System Review (the 'Simpson Review') was an opportunity for health sector transformation, particularly in light of the recent damning WAI 2575 Waitangi Tribunal report released during the review process. There appears to have been a concerted effort to engage with the sector, an impressive Maori Expert Advisory Group and an extensive body of available scholarship documenting where improvements could be made. In this viewpoint, the authors, tangata whenua (Indigenous people of the land) and tangata Tiriti (people of te Tiriti) and health scholars and leaders undertook a high-level review of the Simpson Review report and analysed it against key elements of te Tiriti o Waitangi. The Simpson Review was an opportunity to share power, commit to Maori health and embed structural mechanisms, such as the proposed Maori health authority, to uphold te Tiriti o Waitangi. It was also an opportunity to recommit to health equity and eliminate institutional racism. We conclude that the Simpson Review did not take up these opportunities, but instead perpetuated further breaches of te Tiriti.


Assuntos
Competência Cultural , Equidade em Saúde/normas , Acesso aos Serviços de Saúde/normas , Serviços de Saúde do Indígena/normas , Grupo com Ancestrais Oceânicos , Qualidade da Assistência à Saúde/normas , Humanos , Nova Zelândia , Racismo/prevenção & controle
19.
Am J Public Health ; 111(5): 965-968, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33734834

RESUMO

Objectives. To examine rates of emergency department (ED) visits and hospitalizations among incarcerated people in Florida during a period when health care management in the state's prisons underwent transitions.Methods. We used Florida ED visit and hospital discharge data (2011-2018) to depict the trend in ED visit and hospital discharge rates among incarcerated people. We proxied incarcerated people using individuals admitted from and discharged or transferred to a court or law enforcement agency. We fitted a regression with year indicators to examine the significance of yearly changes.Results. Among incarcerated people in Florida, ED visit rates quadrupled, and hospitalization rates doubled, between 2015 and 2018, a period when no similar trends were evident in the nonincarcerated population.Public Health Implications. Increasing the amount and flexibility of payments to contractors overseeing prison health services may foster higher rates of hospital utilization among incarcerated people and higher costs, without addressing major quality of care problems. Hospitals and government agencies should transparently report on health care utilization and outcomes among incarcerated people to ensure better oversight of services for a highly vulnerable population.


Assuntos
Atenção à Saúde/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Prisioneiros/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Atenção à Saúde/normas , Florida , Humanos , Prisões Locais , Alta do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas
20.
Medicine (Baltimore) ; 100(12): e25211, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761706

RESUMO

ABSTRACT: Measuring patient satisfaction scores and interpreting factors that impact their variation is of importance as scores influence various aspects of health care administration. Our objective was to evaluate if Press Ganey scores differ between medical specialties.New patient visits between January 2014 and December 2016 at a single tertiary academic center were included in this study. Press Ganey scores were compared between specialties using a multivariable logistic mixed effects model. Secondary outcomes included a comparison between surgical versus non-surgical specialties, and pediatric versus adult specialties. Due to the survey's high ceiling effect, satisfaction was defined as a perfect total score.Forty four thousand four hundred ninety six patients met inclusion criteria. Compared to internal medicine, plastic surgery, general surgery, dermatology, and family medicine were more likely to achieve a perfect overall score, as, with odds ratios of 1.46 (P = .02), 1.29 (P = .002), 1.22 (P = .004), and 1.16 (P = .02) respectively. Orthopaedics, pediatric medicine, pediatric neurology, neurology, and pain management were less likely to achieve satisfaction with odds ratios of 0.85 (P = .047), 0.71 (P < .001), 0.63 (P = .005), 0.57 (P < .001), and 0.51 (P = .006), respectively. Compared to pediatric specialties, adult specialties were more likely to achieve satisfaction (OR 1.73; P < .001). There were no significant differences between surgical versus non-surgical specialties.Press Ganey scores systematically differ between specialties within the studied institution. These differences should be considered by healthcare systems that use patient satisfaction data to modify provider reimbursement.


Assuntos
Medicina , Pacientes Ambulatoriais/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Coleta de Dados , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Medicina/classificação , Medicina/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Qualidade da Assistência à Saúde/normas , Projetos de Pesquisa , Estados Unidos
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