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1.
Am J Manag Care ; 26(10): 421-422, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33094935

RESUMO

To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a health care thought leader. The October issue features a conversation with Kavita K. Patel, MD, MS, nonresident fellow at The Brookings Institution and editorial board member of AJMC®.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Política de Saúde , Controle de Infecções/organização & administração , Pneumonia Viral/terapia , Programas Governamentais/organização & administração , Humanos , Controle de Infecções/legislação & jurisprudência , Pandemias/legislação & jurisprudência , Qualidade da Assistência à Saúde/organização & administração
2.
Artigo em Inglês | MEDLINE | ID: mdl-32806697

RESUMO

The COVID-19 pandemic has changed the orders and structures of societies, particularly in the fields of medical and nursing professions. The researcher aims to understand the experiences, sense of belonging, and decision-making processes about Japanese pre-service nursing students and how the COVID-19 pandemic, social distancing, and lockdown has influenced their understanding as pre-service nursing professionals in Japan. As this study focuses on the issues of pre-service nursing students, the researcher invited forty-nine pre-service nursing students for a virtual interview due to the recommendation of social distancing. To increase the coverage of the population, the researcher employed snowball sampling to recruit participants from all over Japan. Although the COVID-19 pandemic influenced the overall performance of the medical and nursing professions, all participants showed a sense of belonging as Japanese citizens and nursing professionals due to the natural disaster of their country. More importantly, all expressed their desires and missions to upgrade and improve the overall performance of the public health system due to the influence of the COVID-19 pandemic. The results discovered that many Japanese nursing students advocated that Japan's national development, the benefits and advantages of their country, were of a greater importance than their own personal development and goals.


Assuntos
Infecções por Coronavirus/epidemiologia , Educação em Enfermagem/organização & administração , Pneumonia Viral/epidemiologia , Estudantes de Enfermagem/psicologia , Betacoronavirus , Escolha da Profissão , Tomada de Decisões , Humanos , Entrevistas como Assunto , Japão/epidemiologia , Desastres Naturais , Pandemias , Administração em Saúde Pública/normas , Qualidade da Assistência à Saúde/organização & administração
3.
Value Health ; 23(8): 1012-1019, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828212

RESUMO

OBJECTIVE: Patient-centered care (PCC) could reduce gender inequities in quality of care. Little is known about how to implement patient-centered care for women (PCCW). We aimed to generate consensus recommendations for achieving PCCW. METHODS: We used a 2-round Delphi technique. Panelists included 21 women of varied age, ethnicity, education, and urban/rural residence; and 21 health professionals with PCC or women's health expertise. Panelists rated recommendations, derived from prior research and organized by a 6-domain PCC framework, on a 7-point Likert scale in an online survey. We used summary statistics to report response frequencies and defined consensus as when ≥85% panelists chose 5 to 7. RESULTS: The response rate was 100%. In round 1, women and professionals retained 46 (97.9%) and 42 (89.4%) of 47 initial recommendations, respectively. The round 2 survey included 6 recommendations for women and 5 recommendations for professionals (did not achieve consensus in round 1 or were newly suggested). In round 2, women retained 2 of 6 recommendations and professionals retained 3 of 5 recommendations. Overall, 49 recommendations were generated. Both groups agreed on 44 (94.0%) recommendations (13 retained by 100% of both women and clinicians): fostering patient-physician relationship (n = 11), exchanging information (n = 10), responding to emotions (n = 4), managing uncertainty (n = 5), making decisions (n = 8), and enabling patient self-management (n = 6). CONCLUSION: The recommendations represent the range of PCC domains, are based on evidence from primary research, and reflect high concordance between women and professional panelists. They can inform the development of policies, guidelines, programs, and performance measures that foster PCCW.


Assuntos
Assistência Centrada no Paciente/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Saúde da Mulher , Adulto , Fatores Etários , Comunicação , Técnica Delfos , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/métodos , Relações Médico-Paciente , Autogestão/métodos , Fatores Socioeconômicos
5.
Emerg Med Clin North Am ; 38(3): 715-727, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616290

RESUMO

Academic emergency departments (EDs) play a vital role in provision of emergency care and contribute to training of resident physicians. Academic EDs also generate innovations and discoveries through clinical research within academic medical centers. However, academic EDs face challenges when initiating operational process improvement efforts because of the medical complexity of patients, academic culture within academic medical centers, and variability in productivity and specialty training of trainees. To optimize operations within academic EDs, it is critical to understand characteristics shared by academic EDs, how to implement process improvement initiatives, trainee impact on ED operations, and how to promote operational research.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Eficiência Organizacional , Humanos , Melhoria de Qualidade/organização & administração , Qualidade da Assistência à Saúde/organização & administração
6.
PLoS One ; 15(6): e0233635, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32542043

RESUMO

INTRODUCTION: Accompanying rapid urbanization in Bangladesh are inequities in health and healthcare which are most visibly manifested in slums or low-income settlements. This study examines socioeconomic, demographic and geographic patterns of self-reported chronic illness and healthcare seeking among adult slum dwellers in Bangladesh. Understanding these patterns is critical in designing more equitable urban health systems and in enabling the country's goal of Universal Health Coverage by 2030. METHODS: This descriptive cross-sectional study compares survey data from slum settlements located in two urban sites in Bangladesh, Tongi and Sylhet. Reported chronic illness symptoms and associated healthcare-seeking strategies are compared, and the catastrophic impact of household healthcare expenditures are assessed. RESULTS: Significant differences in healthcare-seeking for chronic illness were apparent both within and between slum settlements related to sex, wealth score (PPI), and location. Women were more likely to use private clinics than men. Compared to poorer residents, those from wealthier households sought care to a greater extent in private clinics, while poorer households relied more on drug shops and public hospitals. Chronic symptoms also differed. A greater prevalence of musculoskeletal, respiratory, digestive and neurological symptoms was reported among those with lower PPIs. In both slum sites, reliance on the private healthcare market was widespread, but greater in industrialized Tongi. Tongi also experienced a higher probability of catastrophic expenditure than Sylhet. CONCLUSIONS: Study results point to the value of understanding context-specific health-seeking patterns for chronic illness when designing delivery strategies to address the growing burden of NCDs in slum environments. Slums are complex social and geographic entities and cannot be generalized. Priority attention should be focused on developing chronic care services that meet the needs of the working poor in terms of proximity, opening hours, quality, and cost.


Assuntos
Doença Crônica/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Serviços Urbanos de Saúde/organização & administração , População Urbana/estatística & dados numéricos , Adulto , Bangladesh , Estudos Transversais , Feminino , Geografia , Gastos em Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/organização & administração , Serviços Urbanos de Saúde/economia , Serviços Urbanos de Saúde/estatística & dados numéricos , Urbanização
7.
Am J Trop Med Hyg ; 103(3): 986-992, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32588806

RESUMO

Quality of care is essential for improving health outcomes, but heterogeneity in theoretical frameworks and metrics can limit studies' generalizability and comparability. This research aimed to compare definitions of care quality across research articles that incorporate data from Service Provision Assessment (SPA) surveys. Following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, we used a keyword search in PubMed. Each author reviewed abstracts, then full texts, for inclusion criteria, and peer-reviewed publications of empirical analysis using SPA data. The search yielded 3,250 unique abstracts, and 34 publications were included in the final analysis. We extracted details on the SPA dataset(s) used, theoretical framework applied, and how care quality was operationalized. The 34 included articles used SPA data from 14 surveys in nine countries (all in sub-Saharan Africa plus Haiti). One-third of these articles (n = 13) included no theoretical or conceptual framework for care quality. Among those articles referencing a framework, the most common was the Donabedian model (n = 7). Studies operationalized quality constructs in extremely different ways. Few articles included outcomes as a quality construct, and the operationalization of structure varied widely. A key asset of SPA surveys, owing to the standardized structure and use of harmonized data collection instruments, is the potential for cross-survey comparisons. However, this is limited by the lack of a common framework for measuring and reporting quality in the existing literature using SPA data. Service Provision Assessment surveys offer unique and valuable insights, and a common framework and approach would substantially strengthen the body of knowledge on quality of care in low-resource settings.


Assuntos
Atitude do Pessoal de Saúde , Assistência à Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Qualidade da Assistência à Saúde/estatística & dados numéricos , Análise de Variância , Assistência à Saúde/economia , Assistência à Saúde/organização & administração , Países em Desenvolvimento/economia , Humanos , Renda/estatística & dados numéricos , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/organização & administração , Projetos de Pesquisa , Inquéritos e Questionários/estatística & dados numéricos
9.
Med Clin North Am ; 104(4): 727-737, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505263

RESUMO

Teamwork is essential to providing high-quality patient care. Hospital settings pose important challenges to teamwork. Measurement is key to understanding baseline performance and assessing whether teamwork is improving. The authors recommend a multifaceted approach, using a combination of complementary interventions with an ultimate goal that improved teamwork translates into improved patient outcomes.


Assuntos
Comportamento Cooperativo , Médicos Hospitalares , Liderança , Equipe de Assistência ao Paciente/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Humanos , Relações Interprofissionais , Segurança do Paciente
11.
J Aging Soc Policy ; 32(4-5): 323-333, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32476614

RESUMO

What services are available and where racial and ethnic minorities receive long-term services and supports (LTSS) have resulted in a lower quality of care and life for racial/ethnic minority users. These disparities are only likely to worsen during the COVID-19 pandemic, as the pandemic has disproportionately affected racial and ethnic minority communities both in the rate of infection and virus-related mortality. By examining these disparities in the context of the pandemic, we bring to light the challenges and issues faced in LTSS by minority communities with regard to this virus as well as the disparities in LTSS that have always existed.


Assuntos
Grupos de Populações Continentais , Infecções por Coronavirus/etnologia , Grupos Étnicos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Assistência de Longa Duração/organização & administração , Pneumonia Viral/etnologia , Grupo com Ancestrais do Continente Africano , Betacoronavirus , Comorbidade , Acesso aos Serviços de Saúde , Hispano-Americanos , Instituição de Longa Permanência para Idosos/organização & administração , Humanos , Idioma , Assistência de Longa Duração/normas , Grupos Minoritários , Casas de Saúde/organização & administração , Pandemias , Qualidade da Assistência à Saúde/organização & administração , Qualidade de Vida , Estados Unidos/epidemiologia
12.
J Aging Soc Policy ; 32(4-5): 316-322, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497467

RESUMO

As of May 2020, nursing home residents account for a staggering one-third of the more than 80,000 deaths due to COVID-19 in the U.S. This pandemic has resulted in unprecedented threats to achieving and sustaining care quality even in the best nursing homes, requiring active engagement of nursing home leaders in developing solutions responsive to the unprecedented threats to quality standards of care delivery during the pandemic. This perspective offers a framework, designed with the input of nursing home leaders, to facilitate internal and external decision-making and collective action to address these threats. Policy options focus on assuring a shared understanding among nursing home leaders and government agencies of changes in the operational status of nursing homes throughout the crisis, improving access to additional essential resources needed to mitigate the crisis' impact, and promoting shared accountability for consistently achieving accepted standards in core quality domains.


Assuntos
Infecções por Coronavirus/epidemiologia , Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Qualidade da Assistência à Saúde/organização & administração , Betacoronavirus , Planejamento em Desastres/organização & administração , Instituição de Longa Permanência para Idosos/normas , Humanos , Liderança , Casas de Saúde/normas , Políticas , Roupa de Proteção/provisão & distribução , Garantia da Qualidade dos Cuidados de Saúde/normas , Qualidade da Assistência à Saúde/normas
14.
Artigo em Inglês | MEDLINE | ID: covidwho-381788

RESUMO

The Coronavirus Disease (Covid-19) pandemic is rapidly spreading across the world, representing an unparalleled challenge for health care systems. There are differences in the estimated fatality rates, which cannot be explained easily. In Italy, the estimated case fatality rate was 12.7% in mid-April, while Germany remained at 1.8%. Moreover, it is to be noted that different areas of Italy have very different lethality rates. Due to the complexity of Covid-19 patient management, it is of paramount importance to develop a well-defined clinical workflow in order to avoid the inconsistent management of patients. The Integrated Care Pathway (ICP) represents a multidisciplinary outline of anticipated care to support patient management in the Sant'Andrea Hospital, Rome. The main objective of this pilot study was to develop a new ICP evaluated by care indicators, in order to improve the COVID-19 patient management. The suggested ICP was developed by a multi-professional team composed of different specialists and administrators already involved in clinical and management processes. After a review of current internal practices and published evidences, we identified (1) the activities performed during care delivery, (2) the responsibilities for these activities, (3) hospital structural adaptation needs and potential improvements, and (4) ICP indicators. The process map formed the basis of the final ICP document; 160 COVID-19 inpatients were considered, and the effect of the ICP implementation was evaluated over time during the exponential phase of the COVID-19 pandemic. In conclusion, a rapid adoption of ICP and regular audits of quality indicators for the management of COVID-19 patients might be important tools to improve the quality of care and outcomes.


Assuntos
Protocolos Clínicos/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Administração Hospitalar , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Betacoronavirus , Humanos , Itália/epidemiologia , Equipe de Assistência ao Paciente/organização & administração , Projetos Piloto , Qualidade da Assistência à Saúde/organização & administração , Fluxo de Trabalho
16.
Ceska Gynekol ; 85(1): 59-66, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32414286

RESUMO

OBJECTIVE: Evaluation of the quality of the hospital care at individual departments of the clinic from the patient's perspective using a standard questionnaire. DESIGN: Retrospective observational studies. SETTING: 2nd Department of Obstetrics and Gynecology, University hospital Bratislava, Faculty of Medicine, Comenius University Bratislava, Slovakia. MATERIAL AND METHODS: In the study we included all patients who were hospitalized in II. GPK from 1. 1. 2019 to 1. 3. 2019. When the patient was released, they received a HCAHPS questionnaire. Obtained results were statistically processed and compared with publicly available data from all USA hospitals. RESULTS: We received 481 questionnaires suitable for processing. 53.2% of patients evaluated the clinic as the best possible. 57.4% of patients would definitely recommend the clinic to their family and friends. The biggest difference between patients who rated the clinic as the best and those who rated it low were in nurse communication (OR: 6.19, CI: 4.46-8.63). At maternity ward we haven't found any statistical effect in impact of age, but in nurses communication, pain management, communiation about medicines we found significant statistical differences in impact of different education between women. CONCLUSION: The quality of nurses and doctors communication and instructing patients about medication has a significant impact on the clinic's evaluation. Women with university education at maternity ward evaluate quality of hospital care stricter, regardles of age.


Assuntos
Hospitalização/estatística & dados numéricos , Pacientes Internados/psicologia , Unidade Hospitalar de Ginecologia e Obstetrícia/normas , Satisfação do Paciente , Qualidade da Assistência à Saúde/organização & administração , Feminino , Humanos , Obstetrícia , Gravidez , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Eslováquia , Inquéritos e Questionários
17.
West J Emerg Med ; 21(3): 555-565, 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32421501

RESUMO

Medicine recognizes burnout as a threat to quality patient care and physician quality of life. This issue exists throughout medicine but is notably prevalent in emergency medicine (EM). Because the concept of "wellness" lacks a clear definition, attempts at ameliorating burnout that focus on achieving wellness make success difficult to achieve and measure. Recent work within the wellness literature suggests that the end goal should be to achieve a culture of wellness by addressing all aspects of the physician's environment. A review of the available literature on burnout and wellness interventions in all medical specialties reveals that interventions focusing on individual physicians have varying levels of success. Efforts to compare these interventions are hampered by a lack of consistent endpoints. Studies with consistent endpoints do not demonstrate clear benefits of achieving them because improving scores on various scales may not equate to improvement in quality of care or physician quality of life. Successful interventions have uncertain, long-term effects. Outside of EM, the most successful interventions focus on changes to systems rather than to individual physicians. Within EM, the number of well-structured interventions that have been studied is limited. Future work to achieve the desired culture of wellness within EM requires establishment of a consistent endpoint that serves as a surrogate for clinical significance, addressing contributors to burnout at all levels, and integrating successful interventions into the fabric of EM.


Assuntos
Esgotamento Profissional , Medicina de Emergência , Médicos/psicologia , Qualidade da Assistência à Saúde/organização & administração , Qualidade de Vida , Esgotamento Profissional/etiologia , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , Medicina de Emergência/métodos , Medicina de Emergência/normas , Humanos , Cultura Organizacional , Objetivos Organizacionais , Psicologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-32471066

RESUMO

The Coronavirus Disease (Covid-19) pandemic is rapidly spreading across the world, representing an unparalleled challenge for health care systems. There are differences in the estimated fatality rates, which cannot be explained easily. In Italy, the estimated case fatality rate was 12.7% in mid-April, while Germany remained at 1.8%. Moreover, it is to be noted that different areas of Italy have very different lethality rates. Due to the complexity of Covid-19 patient management, it is of paramount importance to develop a well-defined clinical workflow in order to avoid the inconsistent management of patients. The Integrated Care Pathway (ICP) represents a multidisciplinary outline of anticipated care to support patient management in the Sant'Andrea Hospital, Rome. The main objective of this pilot study was to develop a new ICP evaluated by care indicators, in order to improve the COVID-19 patient management. The suggested ICP was developed by a multi-professional team composed of different specialists and administrators already involved in clinical and management processes. After a review of current internal practices and published evidences, we identified (1) the activities performed during care delivery, (2) the responsibilities for these activities, (3) hospital structural adaptation needs and potential improvements, and (4) ICP indicators. The process map formed the basis of the final ICP document; 160 COVID-19 inpatients were considered, and the effect of the ICP implementation was evaluated over time during the exponential phase of the COVID-19 pandemic. In conclusion, a rapid adoption of ICP and regular audits of quality indicators for the management of COVID-19 patients might be important tools to improve the quality of care and outcomes.


Assuntos
Protocolos Clínicos/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Administração Hospitalar , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Betacoronavirus , Humanos , Itália/epidemiologia , Equipe de Assistência ao Paciente/organização & administração , Projetos Piloto , Qualidade da Assistência à Saúde/organização & administração , Fluxo de Trabalho
19.
Otolaryngol Head Neck Surg ; 163(1): 54-59, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32369430

RESUMO

Academic otolaryngology has historically comprised a tripartite mission of research, education, and clinical care. This mission is greatly strained by the COVID-19 pandemic. Research laboratories are fallow, surgical cases are deferred, and clerkships are canceled. Otolaryngologists are adapting to new circumstances ranging from virtual patient care to urgent procedures in protective gear to deployment to provisional field hospitals. Amid these operational challenges, the specialty is demonstrating extraordinary resilience and grit, discovering new ways to serve learners, colleagues, and communities. Statements from leaders in otolaryngology reveal selfless acts and purposefulness. Necessity has spurred innovation in education, science, and novel models of care. Paragons strike notes of hope, inspiring us to persevere and serve. This commentary explores the present challenges and offers a vision for upholding the academic mission.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Modelos Organizacionais , Otolaringologia/organização & administração , Otorrinolaringopatias/terapia , Assistência ao Paciente/normas , Pneumonia Viral/complicações , Qualidade da Assistência à Saúde/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Otorrinolaringopatias/complicações , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
20.
Cancer ; 126(17): 3896-3899, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32463478

RESUMO

The treatment of patients with cancer who test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses unique challenges. In this commentary, the authors describe the ethical rationale and implementation details for the creation of a novel, multidisciplinary treatment prioritization committee, including physicians, frontline staff, an ethicist, and an infectious disease expert. Organizational obligations to health care workers also are discussed. The treatment prioritization committee sets a threshold of acceptable harm to patients from decreased cancer control that is justified to reduce risk to staff. The creation of an ethical, consistent, and transparent decision-making process involving such frontline stakeholders is essential as departments across the country are faced with decisions regarding the treatment of SARS-CoV-2-positive patients with cancer.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Assistência à Saúde/ética , Pessoal de Saúde/ética , Neoplasias/complicações , Pandemias/ética , Pneumonia Viral/complicações , Qualidade da Assistência à Saúde/ética , Assistência Ambulatorial/ética , Assistência Ambulatorial/organização & administração , Tomada de Decisão Clínica , Infecções por Coronavirus/virologia , Assistência à Saúde/organização & administração , Pessoal de Saúde/organização & administração , Humanos , Neoplasias/radioterapia , Segurança do Paciente , Pneumonia Viral/virologia , Qualidade da Assistência à Saúde/organização & administração
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