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Showing 1 - 200 of 370 Journals sorted alphabetically
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 6, SJR: 0.881, h-index: 38)
Adaptation     Hybrid Journal   (Followers: 9, SJR: 0.111, h-index: 4)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.538, h-index: 35)
African Affairs     Hybrid Journal   (Followers: 59, SJR: 1.512, h-index: 46)
Age and Ageing     Hybrid Journal   (Followers: 85, SJR: 1.611, h-index: 107)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 17, SJR: 0.935, h-index: 80)
American Entomologist     Full-text available via subscription   (Followers: 6)
American Historical Review     Hybrid Journal   (Followers: 149, SJR: 0.652, h-index: 43)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 39, SJR: 1.441, h-index: 77)
American J. of Epidemiology     Hybrid Journal   (Followers: 176, SJR: 3.047, h-index: 201)
American J. of Hypertension     Hybrid Journal   (Followers: 25, SJR: 1.397, h-index: 111)
American J. of Jurisprudence     Hybrid Journal   (Followers: 18)
American J. of Legal History     Full-text available via subscription   (Followers: 6, SJR: 0.151, h-index: 7)
American Law and Economics Review     Hybrid Journal   (Followers: 27, SJR: 0.824, h-index: 23)
American Literary History     Hybrid Journal   (Followers: 12, SJR: 0.185, h-index: 22)
Analysis     Hybrid Journal   (Followers: 23)
Annals of Botany     Hybrid Journal   (Followers: 35, SJR: 1.912, h-index: 124)
Annals of Occupational Hygiene     Hybrid Journal   (Followers: 28, SJR: 0.837, h-index: 57)
Annals of Oncology     Hybrid Journal   (Followers: 48, SJR: 4.362, h-index: 173)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 8, SJR: 0.642, h-index: 53)
Annals of Work Exposures and Health     Hybrid Journal  
AoB Plants     Open Access   (Followers: 4, SJR: 0.78, h-index: 10)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 19, SJR: 0.884, h-index: 31)
Applied Linguistics     Hybrid Journal   (Followers: 52, SJR: 1.749, h-index: 63)
Applied Mathematics Research eXpress     Hybrid Journal   (Followers: 1, SJR: 0.779, h-index: 11)
Arbitration Intl.     Full-text available via subscription   (Followers: 20)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 13)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 27, SJR: 0.96, h-index: 71)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 20)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 45, SJR: 0.144, h-index: 15)
Behavioral Ecology     Hybrid Journal   (Followers: 51, SJR: 1.698, h-index: 92)
Bioinformatics     Hybrid Journal   (Followers: 270, SJR: 4.643, h-index: 271)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 9, SJR: 1.646, h-index: 149)
Biometrika     Hybrid Journal   (Followers: 19, SJR: 2.801, h-index: 90)
BioScience     Hybrid Journal   (Followers: 30, SJR: 2.374, h-index: 154)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 1, SJR: 0.213, h-index: 9)
Biostatistics     Hybrid Journal   (Followers: 16, SJR: 1.955, h-index: 55)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 159, SJR: 2.314, h-index: 133)
BJA Education     Hybrid Journal   (Followers: 65, SJR: 0.272, h-index: 20)
Brain     Hybrid Journal   (Followers: 63, SJR: 6.097, h-index: 264)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 45, SJR: 4.086, h-index: 73)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 50)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 35, SJR: 1.267, h-index: 38)
British J. of Aesthetics     Hybrid Journal   (Followers: 27, SJR: 0.217, h-index: 18)
British J. of Criminology     Hybrid Journal   (Followers: 549, SJR: 1.373, h-index: 62)
British J. of Social Work     Hybrid Journal   (Followers: 85, SJR: 0.771, h-index: 53)
British Medical Bulletin     Hybrid Journal   (Followers: 7, SJR: 1.391, h-index: 84)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 27)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 3, SJR: 1.474, h-index: 31)
Cambridge J. of Economics     Hybrid Journal   (Followers: 59, SJR: 0.957, h-index: 59)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 10, SJR: 1.067, h-index: 22)
Cambridge Quarterly     Hybrid Journal   (Followers: 11, SJR: 0.1, h-index: 7)
Capital Markets Law J.     Hybrid Journal   (Followers: 1)
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.439, h-index: 167)
Cardiovascular Research     Hybrid Journal   (Followers: 12, SJR: 2.897, h-index: 175)
Cerebral Cortex     Hybrid Journal   (Followers: 43, SJR: 4.827, h-index: 192)
CESifo Economic Studies     Hybrid Journal   (Followers: 17, SJR: 0.501, h-index: 19)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.436, h-index: 76)
Children and Schools     Hybrid Journal   (Followers: 6, SJR: 0.211, h-index: 18)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 3)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 21, SJR: 0.737, h-index: 11)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 9, SJR: 1.238, h-index: 15)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 11, SJR: 0.191, h-index: 8)
Classical Receptions J.     Hybrid Journal   (Followers: 24, SJR: 0.1, h-index: 3)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 60, SJR: 4.742, h-index: 261)
Clinical Kidney J.     Open Access   (Followers: 4, SJR: 0.338, h-index: 19)
Community Development J.     Hybrid Journal   (Followers: 24, SJR: 0.47, h-index: 28)
Computer J.     Hybrid Journal   (Followers: 8, SJR: 0.371, h-index: 47)
Conservation Physiology     Open Access   (Followers: 2)
Contemporary Women's Writing     Hybrid Journal   (Followers: 11, SJR: 0.111, h-index: 3)
Contributions to Political Economy     Hybrid Journal   (Followers: 5, SJR: 0.313, h-index: 10)
Critical Values     Full-text available via subscription  
Current Legal Problems     Hybrid Journal   (Followers: 26)
Current Zoology     Full-text available via subscription   (Followers: 1, SJR: 0.999, h-index: 20)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 11, SJR: 1.068, h-index: 24)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 13)
Diplomatic History     Hybrid Journal   (Followers: 20, SJR: 0.296, h-index: 22)
DNA Research     Open Access   (Followers: 4, SJR: 2.42, h-index: 77)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 3)
Early Music     Hybrid Journal   (Followers: 15, SJR: 0.124, h-index: 11)
Economic Policy     Hybrid Journal   (Followers: 37, SJR: 2.052, h-index: 52)
ELT J.     Hybrid Journal   (Followers: 25, SJR: 1.26, h-index: 23)
English Historical Review     Hybrid Journal   (Followers: 52, SJR: 0.311, h-index: 10)
English: J. of the English Association     Hybrid Journal   (Followers: 13, SJR: 0.144, h-index: 3)
Environmental Entomology     Full-text available via subscription   (Followers: 11, SJR: 0.791, h-index: 66)
Environmental Epigenetics     Open Access   (Followers: 1)
Environmental History     Hybrid Journal   (Followers: 28, SJR: 0.197, h-index: 25)
EP-Europace     Hybrid Journal   (Followers: 2, SJR: 2.201, h-index: 71)
Epidemiologic Reviews     Hybrid Journal   (Followers: 10, SJR: 3.917, h-index: 81)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 16, SJR: 0.1, h-index: 6)
European Heart J.     Hybrid Journal   (Followers: 50, SJR: 6.997, h-index: 227)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 8, SJR: 2.044, h-index: 58)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 1)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. Supplements     Hybrid Journal   (Followers: 7, SJR: 0.152, h-index: 31)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 8, SJR: 1.568, h-index: 104)
European J. of Intl. Law     Hybrid Journal   (Followers: 168, SJR: 0.722, h-index: 38)
European J. of Orthodontics     Hybrid Journal   (Followers: 4, SJR: 1.09, h-index: 60)
European J. of Public Health     Hybrid Journal   (Followers: 23, SJR: 1.284, h-index: 64)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 11, SJR: 1.549, h-index: 42)
European Review of Economic History     Hybrid Journal   (Followers: 28, SJR: 0.628, h-index: 24)
European Sociological Review     Hybrid Journal   (Followers: 41, SJR: 2.061, h-index: 53)
Evolution, Medicine, and Public Health     Open Access   (Followers: 11)
Family Practice     Hybrid Journal   (Followers: 12, SJR: 1.048, h-index: 77)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 9, SJR: 1.687, h-index: 115)
Fems Microbiology Letters     Hybrid Journal   (Followers: 21, SJR: 1.126, h-index: 118)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 26, SJR: 7.587, h-index: 150)
Fems Yeast Research     Hybrid Journal   (Followers: 13, SJR: 1.213, h-index: 66)
Foreign Policy Analysis     Hybrid Journal   (Followers: 22, SJR: 0.859, h-index: 10)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 16, SJR: 0.903, h-index: 44)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.108, h-index: 6)
French History     Hybrid Journal   (Followers: 32, SJR: 0.123, h-index: 10)
French Studies     Hybrid Journal   (Followers: 20, SJR: 0.119, h-index: 7)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.102, h-index: 3)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 12, SJR: 3.22, h-index: 39)
Geophysical J. Intl.     Hybrid Journal   (Followers: 34, SJR: 1.839, h-index: 119)
German History     Hybrid Journal   (Followers: 26, SJR: 0.437, h-index: 13)
GigaScience     Open Access   (Followers: 3)
Global Summitry     Hybrid Journal  
Glycobiology     Hybrid Journal   (Followers: 14, SJR: 1.692, h-index: 101)
Health and Social Work     Hybrid Journal   (Followers: 51, SJR: 0.505, h-index: 40)
Health Education Research     Hybrid Journal   (Followers: 13, SJR: 0.814, h-index: 80)
Health Policy and Planning     Hybrid Journal   (Followers: 21, SJR: 1.628, h-index: 66)
Health Promotion Intl.     Hybrid Journal   (Followers: 21, SJR: 0.664, h-index: 60)
History Workshop J.     Hybrid Journal   (Followers: 27, SJR: 0.313, h-index: 20)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 26, SJR: 0.115, h-index: 13)
Human Molecular Genetics     Hybrid Journal   (Followers: 9, SJR: 4.288, h-index: 233)
Human Reproduction     Hybrid Journal   (Followers: 79, SJR: 2.271, h-index: 179)
Human Reproduction Update     Hybrid Journal   (Followers: 17, SJR: 4.678, h-index: 128)
Human Rights Law Review     Hybrid Journal   (Followers: 61, SJR: 0.7, h-index: 21)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 54, SJR: 1.233, h-index: 88)
ICSID Review     Hybrid Journal   (Followers: 11)
ILAR J.     Hybrid Journal   (Followers: 1, SJR: 1.099, h-index: 51)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.329, h-index: 26)
IMA J. of Management Mathematics     Hybrid Journal   (Followers: 1, SJR: 0.351, h-index: 20)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.661, h-index: 28)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 2.032, h-index: 44)
Industrial and Corporate Change     Hybrid Journal   (Followers: 7, SJR: 1.37, h-index: 81)
Industrial Law J.     Hybrid Journal   (Followers: 32, SJR: 0.184, h-index: 15)
Information and Inference     Free  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 8, SJR: 1.911, h-index: 90)
Interacting with Computers     Hybrid Journal   (Followers: 10, SJR: 0.529, h-index: 59)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 5, SJR: 0.743, h-index: 35)
Intl. Affairs     Hybrid Journal   (Followers: 52, SJR: 1.264, h-index: 53)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 30)
Intl. Health     Hybrid Journal   (Followers: 5, SJR: 0.835, h-index: 15)
Intl. Immunology     Hybrid Journal   (Followers: 3, SJR: 1.613, h-index: 111)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 34, SJR: 1.593, h-index: 69)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 60, SJR: 0.613, h-index: 19)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 149, SJR: 4.381, h-index: 145)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 4, SJR: 0.247, h-index: 8)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 29, SJR: 0.307, h-index: 15)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 8, SJR: 0.404, h-index: 18)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.457, h-index: 12)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 3, SJR: 1.69, h-index: 79)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 9, SJR: 0.906, h-index: 33)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 34, SJR: 0.231, h-index: 21)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 13, SJR: 0.833, h-index: 12)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.052, h-index: 42)
Intl. Political Sociology     Hybrid Journal   (Followers: 32, SJR: 1.339, h-index: 19)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 18, SJR: 0.539, h-index: 17)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 7, SJR: 0.998, h-index: 28)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 40, SJR: 2.184, h-index: 68)
Intl. Studies Review     Hybrid Journal   (Followers: 18, SJR: 0.783, h-index: 38)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 1, SJR: 0.155, h-index: 4)
ITNOW     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 4)
J. of African Economies     Hybrid Journal   (Followers: 15, SJR: 0.647, h-index: 30)
J. of American History     Hybrid Journal   (Followers: 44, SJR: 0.286, h-index: 34)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 13, SJR: 1.038, h-index: 60)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 13, SJR: 2.157, h-index: 149)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 3, SJR: 0.563, h-index: 43)
J. of Biochemistry     Hybrid Journal   (Followers: 42, SJR: 1.341, h-index: 96)
J. of Chromatographic Science     Hybrid Journal   (Followers: 18, SJR: 0.448, h-index: 42)
J. of Church and State     Hybrid Journal   (Followers: 11, SJR: 0.167, h-index: 11)
J. of Competition Law and Economics     Hybrid Journal   (Followers: 36, SJR: 0.442, h-index: 16)
J. of Complex Networks     Hybrid Journal   (Followers: 1, SJR: 1.165, h-index: 5)
J. of Conflict and Security Law     Hybrid Journal   (Followers: 13, SJR: 0.196, h-index: 15)
J. of Consumer Research     Full-text available via subscription   (Followers: 43, SJR: 4.896, h-index: 121)
J. of Crohn's and Colitis     Hybrid Journal   (Followers: 10, SJR: 1.543, h-index: 37)
J. of Cybersecurity     Hybrid Journal   (Followers: 3)
J. of Deaf Studies and Deaf Education     Hybrid Journal   (Followers: 9, SJR: 0.69, h-index: 36)
J. of Design History     Hybrid Journal   (Followers: 16, SJR: 0.166, h-index: 14)
J. of Economic Entomology     Full-text available via subscription   (Followers: 6, SJR: 0.894, h-index: 76)
J. of Economic Geography     Hybrid Journal   (Followers: 24, SJR: 2.909, h-index: 69)
J. of Environmental Law     Hybrid Journal   (Followers: 24, SJR: 0.457, h-index: 20)
J. of European Competition Law & Practice     Hybrid Journal   (Followers: 20)
J. of Experimental Botany     Hybrid Journal   (Followers: 14, SJR: 2.798, h-index: 163)
J. of Financial Econometrics     Hybrid Journal   (Followers: 22, SJR: 1.314, h-index: 27)
J. of Global Security Studies     Hybrid Journal   (Followers: 4)
J. of Heredity     Hybrid Journal   (Followers: 4, SJR: 1.024, h-index: 76)
J. of Hindu Studies     Hybrid Journal   (Followers: 7, SJR: 0.186, h-index: 3)
J. of Hip Preservation Surgery     Open Access  
J. of Human Rights Practice     Hybrid Journal   (Followers: 20, SJR: 0.399, h-index: 10)
J. of Infectious Diseases     Hybrid Journal   (Followers: 39, SJR: 4, h-index: 209)
J. of Insect Science     Open Access   (Followers: 9, SJR: 0.388, h-index: 31)

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Journal Cover International Journal for Quality in Health Care
  [SJR: 1.593]   [H-I: 69]   [34 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1353-4505 - ISSN (Online) 1464-3677
   Published by Oxford University Press Homepage  [370 journals]
  • Healthcare quality improvements through hospital accreditation compliance
           and effective procedure use
    • Authors: Chen W; Iqbal U, Li Y.
      Pages: 603 - 603
      PubDate: 2017-10-05
      DOI: 10.1093/intqhc/mzx103
      Issue No: Vol. 29, No. 5 (2017)
  • Conceptualizing and assessing improvement capability: a review
    • Authors: Furnival J; Boaden R, Walshe K.
      Pages: 604 - 611
      Abstract: PurposeThe literature is reviewed to examine how ‘improvement capability’ is conceptualized and assessed and to identify future areas for research.Data sourcesAn iterative and systematic search of the literature was carried out across all sectors including healthcare. The search was limited to literature written in English.Data extractionThe study identifies and analyses 70 instruments and frameworks for assessing or measuring improvement capability. Information about the source of the instruments, the sectors in which they were developed or used, the measurement constructs or domains they employ, and how they were tested was extracted.Results of data synthesisThe instruments and framework constructs are very heterogeneous, demonstrating the ambiguity of improvement capability as a concept, and the difficulties involved in its operationalisation. Two-thirds of the instruments and frameworks have been subject to tests of reliability and half to tests of validity. Many instruments have little apparent theoretical basis and do not seem to have been used widely.ConclusionThe assessment and development of improvement capability needs clearer and more consistent conceptual and terminological definition, used consistently across disciplines and sectors. There is scope to learn from existing instruments and frameworks, and this study proposes a synthetic framework of eight dimensions of improvement capability. Future instruments need robust testing for reliability and validity. This study contributes to practice and research by presenting the first review of the literature on improvement capability across all sectors including healthcare.
      PubDate: 2017-07-18
      DOI: 10.1093/intqhc/mzx088
      Issue No: Vol. 29, No. 5 (2017)
  • What works in implementation of integrated care programs for older adults
           with complex needs' A realist review
    • Authors: Kirst M; Im J, Burns T, et al.
      Pages: 612 - 624
      Abstract: PurposeA realist review of the evaluative evidence was conducted on integrated care (IC) programs for older adults to identify key processes that lead to the success or failure of these programs in achieving outcomes such as reduced healthcare utilization, improved patient health, and improved patient and caregiver experience.Data sourcesInternational academic literature was searched in 12 indexed, electronic databases and gray literature through internet searches, to identify evaluative studies.Study selectionInclusion criteria included evaluative literature on integrated, long-stay health and social care programs, published between January 1980 and July 2015, in English.Data extractionData were extracted on the study purpose, period, setting, design, population, sample size, outcomes, and study results, as well as explanations of mechanisms and contextual factors influencing outcomes.Results of data synthesisA total of 65 articles, representing 28 IC programs, were included in the review. Two context-mechanism-outcome configurations (CMOcs) were identified: (i) trusting multidisciplinary team relationships and (ii) provider commitment to and understanding of the model. Contextual factors such as strong leadership that sets clear goals and establishes an organizational culture in support of the program, along with joint governance structures, supported team collaboration and subsequent successful implementation. Furthermore, time to build an infrastructure to implement and flexibility in implementation, emerged as key processes instrumental to success of these programs.ConclusionsThis review included a wide range of international evidence, and identified key processes for successful implementation of IC programs that should be considered by program planners, leaders and evaluators.
      PubDate: 2017-08-09
      DOI: 10.1093/intqhc/mzx095
      Issue No: Vol. 29, No. 5 (2017)
  • Compliance with accreditation and recommended hospital care—a Danish
           nationwide population-based study
    • Authors: Falstie-Jensen A; Bogh S, Hollnagel E, et al.
      Pages: 625 - 633
      Abstract: ObjectiveTo examine the association between compliance with accreditation and recommended hospital care.DesignA Danish nationwide population-based follow-up study based on data from six national, clinical quality registries between November 2009 and December 2012.SettingPublic, non-psychiatric Danish hospitals.ParticipantsPatients with acute stroke, chronic obstructive pulmonary disease, diabetes, heart failure, hip fracture and bleeding/perforated ulcers.InterventionsAll hospitals were accredited by the first version of The Danish Healthcare Quality Programme. Compliance with accreditation was defined by level of accreditation awarded the hospital after an announced onsite survey; hence, hospitals were either fully (n = 11) or partially accredited (n = 20).Main Outcome MeasuresRecommended hospital care included 48 process performance measures reflecting recommendations from clinical guidelines. We assessed recommended hospital care as fulfilment of the measures individually and as an all-or-none composite score.ResultsIn total 449 248 processes of care were included corresponding to 68 780 patient pathways. Patients at fully accredited hospitals had a significantly higher probability of receiving care according to clinical guideline recommendations than patients at partially accredited hospitals across conditions (individual measure: adjusted odds ratio (OR) = 1.20, 95% CI: 1.01–1.43, all-or-none: adjusted OR = 1.27, 95% CI: 1.02–1.58). For five of the six included conditions there were an association; the pattern appeared particular strong among patients with acute stroke and hip fracture (all-or-none; acute stroke: adjusted OR = 1.39, 95% CI: 1.05–1.83, hip fracture: adjusted OR = 1.57, 95% CI: 1.00–2.49).ConclusionHigh compliance with accreditation standards was associated with a higher level of evidence-based hospital care in Danish hospitals.
      PubDate: 2017-08-22
      DOI: 10.1093/intqhc/mzx104
      Issue No: Vol. 29, No. 5 (2017)
  • Physicians’ and pharmacists’ perceptions on real-time drug utilization
           review system: a nationwide survey
    • Authors: Lee S; Lee S, Kim D.
      Pages: 634 - 641
      Abstract: ObjectiveTo identify healthcare providers’ experience and satisfaction for the drug utilization review (DUR) system, their impact on prescription changes following alerts, and difficulties experienced in the system by surveying primary healthcare centers and pharmacies.DesignA cross-sectional nationwide survey.Setting and participantsApproximately 2000 institutions were selected for the survey by a simple random sampling of nationwide primary healthcare centers and community pharmacy approximately practices, and 358 replied.Main outcomes measuresThe questionnaire included questions on experience and recognition of DUR alerts, personal attitude and respondents’ biographical information. Space was included for respondents to suggest improvements of the DUR system.ResultsThe DUR system scored 71.5 out of 100 points for satisfaction by physicians and pharmacists, who reported that the alerts prevent medication-related errors; most respondents (96.6%) received the alerts. Several respondents (10.9%) replied that they prescribe or dispense prescriptions as they are without following the alerts. Physicians (adjusted odds ratio, 8.334; 95% confidence interval, 3.449–20.139) are more likely to change the prescription than pharmacists and persons with alert experience (4.605; 1.080–19.638). However, current practice in metropolitan areas (0.478; 0.228–1.000) and frequent alerts regarding co-administration incompatibilities within prescriptions (0.135; 0.031–0.589) negatively influence adherence to DUR alerts.ConclusionsAlthough most surveyed physicians and pharmacists receive the alerts, some do not or reported that they would not follow the alerts. To increase adherence, the DUR system should be improved to ensure a preferential and intensive approach to detecting potentially high-risk drug combinations.
      PubDate: 2017-10-05
      DOI: 10.1093/intqhc/mzx085
      Issue No: Vol. 29, No. 5 (2017)
  • Avoidable emergency department visits: a starting point
    • Authors: Hsia R; Niedzwiecki M.
      Pages: 642 - 645
      Abstract: ObjectiveTo better characterize and understand the nature of a very conservative definition of ‘avoidable’ emergency department (ED) visits in the United States to provide policymakers insight into what interventions can target non-urgent ED visits.Design/settingWe performed a retrospective analysis of a very conservative definition of ‘avoidable’ ED visits using data from the National Hospital Ambulatory Medical Care Survey from 2005 to 2011.ParticipantsWe examined a total of 115 081 records, representing 424 million ED visits made by patients aged 18–64 years who were seen in the ED and discharged home.Main outcome measuresWe defined ‘avoidable’ as ED visits that did not require any diagnostic or screening services, procedures or medications, and were discharged home.ResultsIn total, 3.3% (95% CI: 3.0–3.7) of all ED visits were ‘avoidable.’ The top five chief complaints included toothache, back pain, headache, other symptoms/problems related to psychosis and throat soreness. Alcohol abuse, dental disorders and depressive disorders were among the top three ICD-9 discharge diagnoses. Alcohol-related disorders and mood disorders accounted for 6.8% (95% CI: 5.7–8.0) of avoidable visits, and dental disorders accounted for 3.9% (95% CI: 3.0–4.8) of CCS-grouped discharge diagnoses.ConclusionsA significant number of ‘avoidable’ ED visits were for mental health and dental conditions, which the ED is not fully equipped to treat. Our findings provide a better understanding of what policy initiatives could potentially reduce these ‘avoidable’ ED visits to address the gaps in our healthcare system, such as increased access to mental health and dental care.
      PubDate: 2017-08-31
      DOI: 10.1093/intqhc/mzx081
      Issue No: Vol. 29, No. 5 (2017)
  • A qualitative study of sign-out processes between primary and on-call
           residents: relationships in information exchange, responsibility and
    • Authors: LEE S; FISHER D, MAH H, et al.
      Pages: 646 - 653
      Abstract: ObjectiveTo review a quality improvement event on the process of sign-outs between the primary and on-call residents.DesignA retrospective qualitative study using semi-structured interviews.SettingA tertiary academic medical center in Singapore with 283 inpatient Medicine beds served by 28 consultants, 29 registrars, 45 residents and 30 interns during the day but 5 residents and 3 interns at night.ParticipantsResidents, registrars and consultants.InterventionQuality improvement event on sign-out.Main outcomeEffectiveness of sign-out comprises exchange of patient information, professional responsibility and task accountability.ResultsThe following process of sign-outs was noted. Primary teams were accountable to the on-call resident by selecting at-risk patients and preparing contingency plans for sign-out. Structured information exchanged included patient history, active problems and plans of care. On-call residents took ownership of at-risk patients by actively asking questions during sign-out and reporting back the agreed care plan. On-call residents were accountable to the primary team by reporting back at-risk patients the next day.ConclusionA structured information exchange at sign-out increased the on-call resident's ability to care for at-risk patients when it was supported by two-way transfers of responsibility and accountability.
      PubDate: 2017-07-18
      DOI: 10.1093/intqhc/mzx082
      Issue No: Vol. 29, No. 5 (2017)
  • The patient-centered medical home: a reality for HIV care in Nigeria
    • Authors: Ahonkhai A; Onwuatuelo I, Regan S, et al.
      Pages: 654 - 661
      Abstract: ObjectiveHIV care delivery in resource-limited settings (RLS) may serve as a paradigm for chronic disease care, but comprehensive measurement frameworks are lacking. Our objective was to adapt the patient-centered medical home (PCMH) framework for use in RLS, and evaluate the performance of HIV treatment programs within this framework.Design and settingCross-sectional survey administered within the AIDS Prevention Initiative in Nigeria (APIN) network.ParticipantsMedical directors at APIN clinics.Main outcome measuresWe adapted the 2011 US National Committee on Quality Assurance's PCMH standard to develop a survey measuring five domains of HIV care: (i) enhancing access and continuity, (ii) identifying and managing patient populations, (iii) planning and managing care, (iv) promoting self-care and support and (v) measuring and improving performance.ResultsThirty-three of 36 clinics completed the survey. Most were public (73%) and urban/semi-urban (64%); 52% had >500 patients in care. On a 0–100 scale, clinics scored highest in self-care and support, 91% (63–100%); managing patient populations, 80% (72–81%) and improving performance, 72% (44–78%). Clinics scored lowest with the most variability in planning/managing care, 65% (22–89%), and access and continuity, 61% (33–80%). Average score across all domains was 72% (58–81%).ConclusionsOur findings suggest that the modified PCMH tool is feasible, and likely has sufficient performance variation to discriminate among clinics. Consistent with extant literature, clinics showed greatest room for improvement on access and continuity, supporting the tool's face validity. The modified PCMH tool may provide a powerful framework for evaluating chronic HIV care in RLS.
      PubDate: 2017-08-09
      DOI: 10.1093/intqhc/mzx083
      Issue No: Vol. 29, No. 5 (2017)
  • Are children presenting with non-IMCI complaints at greater risk for
    • Authors: Venkataramani M; Edward A, Ickx P, et al.
      Pages: 662 - 668
      Abstract: ObjectiveTo determine if children presenting without complaints related to the Integrated Management of Childhood Illness (IMCI) are at greater risk for suboptimal screening for IMCI conditionsDesignCross-sectional study.SettingThirty-three provinces in Afghanistan.ParticipantsObservation of 3072 sick child visits selected by systematic random sampling.Main outcome measure(s)A 10 point IMCI assessment index.ResultsOne hundred and thirty-one (4.3%) of the 3072 sick child visits involved no IMCI-related complaints. The mean assessment index for all sick child visits was 4.81 (SD 2.41). Visits involving any IMCI-related complaint were associated with a 1.02 point higher mean assessment index than those without IMCI-related complaints (95% CI, 0.52–1.53; P < 0.001). After adjusting for relevant covariates including patient age, caretaker gender, provider type, provider gender, provider IMCI training status and IMCI guideline availability, we found that children with IMCI-related presenting complaints had a significantly better quality of IMCI screening, than those without IMCI presenting complaints (by 0.75 points; 95% CI, 0.25–1.26; P = 0.003)ConclusionsOur study indicates that children with non-IMCI presenting complaints are at greater risk of suboptimal screening compared to children with IMCI-related presenting complaints. The premise of IMCI is to routinely screen all children for conditions responsible for the major burden of childhood disease in countries like Afghanistan. The study illustrates an important finding that facility and provider capacity needs to be improved, particularly during training, supervision and guideline dissemination to ensure that all children receive routine screening for common IMCI conditions.
      PubDate: 2017-07-28
      DOI: 10.1093/intqhc/mzx084
      Issue No: Vol. 29, No. 5 (2017)
  • A comparison of in-hospital acute myocardial infarction management between
           Portugal and the United States: 2000–2010
    • Authors: Lobo M; Azzone V, Azevedo L, et al.
      Pages: 669 - 678
      Abstract: ObjectiveTo compare healthcare in acute myocardial infarction (AMI) treatment between contrasting health systems using comparable representative data from Europe and USA.DesignRepeated cross-sectional retrospective cohort study.SettingAcute care hospitals in Portugal and USA during 2000–2010.ParticipantsAdults discharged with AMI.InterventionsCoronary revascularizations procedures (percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery).Main Outcome MeasuresIn-hospital mortality and length of stay.ResultsWe identified 1 566 601 AMI hospitalizations. Relative to the USA, more hospitalizations in Portugal presented with elevated ST-segment, and fewer had documented comorbidities. Age-sex-adjusted AMI hospitalization rates decreased in USA but increased in Portugal. Crude procedure rates were generally lower in Portugal (PCI: 44% vs. 47%; CABG: 2% vs. 9%, 2010) but only CABG rates differed significantly after standardization. PCI use increased annually in both countries but CABG decreased only in the USA (USA: 0.95 [0.94, 0.95], Portugal: 1.04 [1.02, 1.07], odds ratios). Both countries observed annual decreases in risk-adjusted mortality (USA: 0.97 [0.965, 0.969]; Portugal: 0.99 [0.979, 0.991], hazard ratios). While between-hospital variability in procedure use was larger in USA, the risk of dying in a high relative to a low mortality hospital (hospitals in percentiles 95 and 5) was 2.65 in Portugal when in USA was only 1.03.ConclusionsAlthough in-hospital mortality due to an AMI improved in both countries, patient management in USA seems more effective and alarming disparities in quality of care across hospitals are more likely to exist in Portugal.
      PubDate: 2017-07-28
      DOI: 10.1093/intqhc/mzx092
      Issue No: Vol. 29, No. 5 (2017)
  • Burnout syndrome among non-consultant hospital doctors in Ireland:
           relationship with self-reported patient care
    • Authors: Sulaiman C; Henn P, Smith S, et al.
      Pages: 679 - 684
      Abstract: ObjectiveIntensive workload and limited training opportunities for Irish non-consultant hospital doctors (NCHDs) has a negative effect on their health and well-being, and can result in burnout. Burnout affects physician performance and can lead to medical errors. This study examined the prevalence of burnout syndrome among Irish NCHDs and its association with self-reported medical error and poor quality of patient care.MethodsA cross-sectional quantitative survey-based design.SettingAll teaching hospitals affiliated with University College Cork.ParticipantsNCHDs of all grades and specialties.Intervention(s)The following instruments were completed by all participants: Maslach Burnout Inventory-Human Service Survey (MBI-HSS), assessing three categories of burnout syndrome: Emotional exhaustion (EE), Personal Achievement (PA) and Depersonalization (DP); questions related to self-reported medical errors/poor patient care quality and socio-demographic information.Main outcome measure(s)Self-reported measures of burnout and poor quality of patient care.ResultsPrevalence of burnout among physicians (n = 265) was 26.4%. There was a significant gender difference for EE and DP, but none for PA. A positive weak correlation was observed between EE and DP with medical error or poor patient care. A negative association was reported between PA and medical error and reduced quality of patient care.ConclusionsBurnout is prevalent among NCHDs in Ireland. Burnout syndrome is associated with self-reported medical error and quality of care in this sample population. Measures need to be taken to address this issue, with a view to protecting health of NCHDs and maintaining quality of patient care.
      PubDate: 2017-07-18
      DOI: 10.1093/intqhc/mzx087
      Issue No: Vol. 29, No. 5 (2017)
  • Hospital survey on patient safety culture (HSOPS): variability of scoring
    • Authors: Giai J; Boussat B, Occelli P, et al.
      Pages: 685 - 692
      Abstract: ObjectiveTo assess the variability of safety culture dimension scores and their associated rankings depending on three different scoring strategies using the Hospital Survey On Patient Safety Culture (HSOPS).DesignCross-sectional study using a self-administered questionnaire.SettingThe study was conducted in an 1836-bed acute-care French university hospital with an annual volume of 135 999 stays, between April 2013 and November 2014.ParticipantsAll caregivers and technical-administrative staff with at least 6 months of employment, spending at least half of their working time in the hospital, were asked to participate.InterventionNone.Main outcome measureThe variability of the HSOPS results using three different scoring methods: the percentage of positive responses recommended by the Agency for Healthcare Research and Quality, the averaged individual means and the averaged individual sums.ResultsThe response rate was 78.6% (n = 3978). The percentage of positive responses resulted in lower scores compared to averaged individual means and averaged individual sums in the six least developed dimensions, and gave more widely spread scores and greater 95CIs in the six most developed dimensions. Department rankings also varied greatly depending on the scoring methods.ConclusionThe values of the HSOPS scores and their corresponding rankings greatly depended on the computation method. This finding shows how important it is to agree on the use of the same scoring strategies, before broadly comparing results within and across organizations.
      PubDate: 2017-07-18
      DOI: 10.1093/intqhc/mzx086
      Issue No: Vol. 29, No. 5 (2017)
  • Attitudes towards accreditation among hospital employees in Denmark: a
           cross-sectional survey
    • Authors: Ehlers L; Jensen M, Simonsen K, et al.
      Pages: 693 - 698
      Abstract: ObjectiveTo evaluate attitudes towards accreditation and the Danish Quality Model (DDKM) among hospital employees in Denmark. Negative attitudes led the Danish Government to abolish accreditation in 2015.DesignA cross-sectional survey was carried out via web-based questionnaire.SettingAll hospital managers, quality improvement staff (quality managers and employees), and hospital surveyors in Denmark; and clinicians (doctors and nurses) within nine selected specialties.ParticipantsOverall response rate was 29% with 5055 of 17 646 valid responses included in the data analysis. The response rate was 82% (5055/6188) among respondents who clicked on the link in the mail containing the questionnaire.MethodsA short questionnaire was designed using a 7-point Likert scale ranging from 1 ‘strongly disagree’ to 7 ‘strongly agree’. To compare mean values between respondent groups, regression analysis using dummy coding of respondent groups and calculation of standardized mean difference effect sizes were performed.ResultsOverall attitudes were supportive, with physicians more skeptical. There were different patterns of attitudes in the five Danish regions and between medical professions. A small group of physicians was extremely negative.ConclusionClinical attitudes are important, and can affect Government decisions. On the basis of our study, future attention should be paid to attitudes towards accreditation (and attitudes towards other means of quality improvement). Attitudes may reflect political agendas and impede the take-up of improvement programs, cause their demise, or reduce their effectiveness.
      PubDate: 2017-08-09
      DOI: 10.1093/intqhc/mzx090
      Issue No: Vol. 29, No. 5 (2017)
  • Inappropriate hospital days of a tertiary hospital in Shanghai, China
    • Authors: Liu W; Yuan S, Wei F, et al.
      Pages: 699 - 704
      Abstract: ObjectiveThis study aims to evaluate the prevalence of inappropriate hospital stays in a tertiary hospital in Shanghai, identify the causes for the inappropriateness and analyze the predictors.DesignA retrospective review of medical records.SettingThe cardiology and the orthopedics departments of a tertiary hospital in Shanghai, China.ParticipantsAbout 806 patients discharged from the cardiology or the orthopedics department of a tertiary hospital from March 2013 to February 2014.InterventionsTwo reviewers audited 8396 hospital days of the cardiology department (n = 3606) and the orthopedics department (n = 4790) by adopting the Chinese Version of the Appropriateness Evaluation Protocol. Univariate and multivariate analysis were adopted to identify the predictors of higher levels of inappropriateness produced by internal causes.Main outcome measureThe prevalence of inappropriate hospital days.ResultsIt was found that 910 (25.2%) and 1940 (40.5%) hospital days were judged to be inappropriate in the cardiology and the orthopedics departments, respectively; and 753 (20.9%) and 1585 (33.1%) of these inappropriate hospital days were due to internal reasons, respectively. Awaiting tests, surgery or discharge were determined to constitute the main causes of inappropriateness for both departments. The predictors of higher levels of inappropriateness in the cardiology department were younger age, self-pay, outpatient admission and inappropriate admission. Self-pay, surgical and/or first-time admission patients exhibited the highest levels of inappropriateness in the orthopedics department.ConclusionsThe rates of inappropriateness in the involved departments were relatively high. Further interventions should be designed and implemented, accordingly.
      PubDate: 2017-07-18
      DOI: 10.1093/intqhc/mzx091
      Issue No: Vol. 29, No. 5 (2017)
  • The degree of severity and trends in hospital standardized mortality
           ratios in Japan between 2008 and 2012: a retrospective observational study
    • Authors: Shinjo D; Fushimi K.
      Pages: 705 - 712
      Abstract: ObjectivesHospital standardized mortality ratio (HSMR), an indicator that adjusts hospital mortality for case-mix differences, is used as a hospital performance measure. The aim of this study is to build a new HSMR model in Japan and examine HSMR trends according to the degree of severity.DesignObservational retrospective study.SettingsData from the Japanese Administrative Database.ParticipantsA total of 3 813 492 admissions from 278 Japanese acute-care hospitals were extracted from the database (patients between 2008 and 2012, from July to December in each year).Main Outcome MeasuresWe estimated the probability of in-hospital death by fitting a logistic regression model, and assessed the performance of the models with the c-index. In each year, HSMRs were obtained by calculating the ratio of the number of observed deaths to the number of expected deaths. The HSMR trends, including trends in comorbidity subgroups defined by the Charlson comorbidity index, were analysed.ResultsThe c-index value was 0.871 for the HSMR model. The HSMR followed a constant decreasing trend over time; it fell by 18.8% from 110.3 in 2008 to 91.5 in 2012. The reduction in HSMR was not present in the severe comorbidity group, while the reduction trend was observed in the mild comorbidity group.ConclusionsOur model demonstrated excellent discrimination without detailed clinical data. The Japanese HSMR followed a constant decreased trend, while the reduction trend was not present in the severe patients. Our study implies the need to consider severe patients for assessing hospital quality by HSMR.
      PubDate: 2017-07-18
      DOI: 10.1093/intqhc/mzx089
      Issue No: Vol. 29, No. 5 (2017)
  • Evaluating the impact of accreditation on Brazilian healthcare
           organizations: A quantitative study
    • Authors: Saut A; Berssaneti F, Moreno M.
      Pages: 713 - 721
      Abstract: ObjectiveThe aim of this study was to evaluate the impact of accreditation programs on Brazilian healthcare organizations.DesignA web-based questionnaire survey was undertaken between February and May 2016.SettingHealthcare organizations from the Federal District and from 18 Brazilian states.ParticipantsThe quality managers of 141 Brazilian healthcare organizations were the main respondents of the study.InterventionThe questionnaire was applied to not accredited and accredited organizations.Main Outcome MeasuresThe main outcome measures were patient safety activities, quality management activities, planning activities—policies and strategies, patient involvement, involvement of professionals in the quality programs, monitoring of patient safety goals, organizational impact and financial impacts.ResultsThe study identified 13 organizational impacts of accreditation. There was evidence of a significant and moderate correlation between the status of accreditation and patient safety activities, quality management activities, planning activities—policies and strategies, and involvement of professionals in the quality programs. The correlation between accreditation status and patient involvement was significant but weak, suggesting that this issue should be treated with a specific policy. The impact of accreditation on the financial results was not confirmed as relevant; however, the need for investment in the planning stage was validated.ConclusionsThe impact of accreditation is mainly related to internal processes, culture, training, institutional image and competitive differentiation.
      PubDate: 2017-07-28
      DOI: 10.1093/intqhc/mzx094
      Issue No: Vol. 29, No. 5 (2017)
  • The role of patient perception of crowding in the determination of
           real-time patient satisfaction at Emergency Department
    • Authors: Wang H; Kline J, Jackson B, et al.
      Pages: 722 - 727
      Abstract: ObjectiveTo evaluate the associations between real-time overall patient satisfaction and Emergency Department (ED) crowding as determined by patient percepton and crowding estimation tool score in a high-volume ED.DesignA prospective observational study.SettingA tertiary acute hospital ED and a Level 1 trauma center.ParticipantsED patients.Intervention(s)Crowding status was measured by two crowding tools [National Emergency Department Overcrowding Scale (NEDOCS) and Severely overcrowded–Overcrowded–Not overcrowded Estimation Tool (SONET)] and patient perception of crowding surveys administered at discharge.Main outcome measure(s)ED crowding and patient real-time satisfaction.ResultsFrom 29 November 2015 through 11 January 2016, we enrolled 1345 participants. We observed considerable agreement between the NEDOCS and SONET assessment of ED crowding (bias = 0.22; 95% limits of agreement (LOAs): −1.67, 2.12). However, agreement was more variable between patient perceptions of ED crowding with NEDOCS (bias = 0.62; 95% LOA: −5.85, 7.09) and SONET (bias = 0.40; 95% LOA: −5.81, 6.61). Compared to not overcrowded, there were overall inverse associations between ED overcrowding and patient satisfaction (Patient perception OR = 0.49, 95% confidence limit (CL): 0.38, 0.63; NEDOCS OR = 0.78, 95% CL: 0.65, 0.95; SONET OR = 0.82, 95% CL: 0.69, 0.98).ConclusionsWhile heterogeneity exists in the degree of agreement between objective and patient perceived assessments of ED crowding, in our study we observed that higher degrees of ED crowding at admission might be associated with lower real-time patient satisfaction.
      PubDate: 2017-10-05
      DOI: 10.1093/intqhc/mzx097
      Issue No: Vol. 29, No. 5 (2017)
  • Reporting of medication administration errors by nurses in South Korean
    • Authors: Lee E.
      Pages: 728 - 734
      Abstract: ObjectiveTo identify differences in what nurses consider as medication administration errors, to examine their willingness to report these errors and to identify barriers to reporting medication errors by hospital type.DesignCross-sectional, descriptive design. The questionnaire comprised six medication administration error scenarios and items related to the reasons for not reporting medication errors.SettingTwo tertiary and three general hospitals in a metropolitan area, and five general hospitals in K province, in South Korea.ParticipantsRegistered nurses working at tertiary and general hospitals in South Korea (n = 467).Main outcome measuresConsideration of medication administration errors, intention to report medication errors and reasoning for not file an incident report.ResultsThere were no significant differences in what nurses considered as medication administration errors between nurses working different in hospital types. The rate of incident reporting was very low; it ranged from 6.3% to 29.9%, regardless of hospital type. Korean nurses were more likely to report an error to a physician than file an incident report. The primary reason for not reporting medication errors was fear of the negative consequences of reporting the error and subsequent legal action.ConclusionsThe rate of filing an incident report among nurses was very low, regardless of hospital type or whether nurses perceived the incident as a medication administration error. These results may have significant implications for improving medication safety in hospitals, and more efforts are needed at the organizational level to improve incident reporting by nurses.
      PubDate: 2017-07-28
      DOI: 10.1093/intqhc/mzx096
      Issue No: Vol. 29, No. 5 (2017)
  • Using an online quiz-based reinforcement system to teach healthcare
           quality and patient safety and care transitions at the University of
    • Authors: Shaikh U; Afsar-manesh N, Amin A, et al.
      Pages: 735 - 739
      Abstract: Quality issueImplementing quality improvement (QI) education during clinical training is challenging due to time constraints and inadequate faculty development in these areas.Initial assessmentQuiz-based reinforcement systems show promise in fostering active engagement, collaboration, healthy competition and real-time formative feedback, although further research on their effectiveness is required.Choice of solutionAn online quiz-based reinforcement system to increase resident and faculty knowledge in QI, patient safety and care transitions.ImplementationExperts in QI and educational assessment at the 5 University of California medical campuses developed a course comprised of 3 quizzes on Introduction to QI, Patient Safety and Care Transitions. Each quiz contained 20 questions and utilized an online educational quiz-based reinforcement system that leveraged spaced learning.EvaluationApproximately 500 learners completed the course (completion rate 66–86%). Knowledge acquisition scores for all quizzes increased after completion: Introduction to QI (35–73%), Patient Safety (58–95%), and Care Transitions (66–90%). Learners reported that the quiz-based system was an effective teaching modality and preferred this type of education to classroom-based lectures. Suggestions for improvement included reducing frequency of presentation of questions and utilizing more questions that test learners on application of knowledge instead of knowledge acquisition.Lessons learnedA multi-campus online quiz-based reinforcement system to train residents in QI, patient safety and care transitions was feasible, acceptable, and increased knowledge. The course may be best utilized to supplement classroom-based and experiential curricula, along with increased attention to optimizing frequency of presentation of questions and enhancing application skills.
      PubDate: 2017-07-18
      DOI: 10.1093/intqhc/mzx093
      Issue No: Vol. 29, No. 5 (2017)
  • A multi-state, multi-site, multi-sector healthcare improvement model:
           implementing evidence for practice
    • Authors: Edward K; Walker K, Duff J.
      Pages: 740 - 744
      Abstract: Quality problem or issueHealthcare is complex and we know that evidence takes nearly 20 years to find its way into clinical practice.Initial assessmentThe slow process of translating research points to the need for effective translational research models to ensure patient care quality and safety are not compromised by such an epistemic failure.Choice of solutionOur model to achieve reasonably rapid and enduring improvements to clinical care draws on that developed and promulgated by the Institute for Healthcare Improvement in the United States of America model as well as that developed by the Johns Hopkins Quality and Safety Group known as the Translating Research into Practice implementation model.ImplementationThe core principle of our hybrid model was to engage those most likely to be affected by the changes being introduced through a series of face-to-face and web-enabled meetings that act both as drivers of information but also as a means of engaging all stakeholders across the healthcare system involved in the change towards their pre-established goals.EvaluationThe model was piloted on the focused topic of the management of inadvertent perioperative hypothermia across nine hospitals within Australia (four sites in Victoria, three sites in New South Wales and two sites in Queensland). Improvement in management of hypothermia in these patients was achieved and sustained over time.Lessons learnedOur model aims to engage the hearts and minds of healthcare clinicians, and others in order to empower them to make the necessary improvements to enhance patient care quality and safety.
      PubDate: 2017-08-14
      DOI: 10.1093/intqhc/mzx099
      Issue No: Vol. 29, No. 5 (2017)
  • Researching safety culture: deliberative dialogue with a restorative lens
    • Authors: Lorenzini E; Oelke N, Marck P, et al.
      Pages: 745 - 749
      Abstract: Safety culture is a key component of patient safety. Many patient safety strategies in health care have been adapted from high-reliability organizations (HRO) such as aviation. However, to date, attempts to transform the cultures of health care settings through HRO approaches have had mixed results. We propose a methodological approach for safety culture research, which integrates the theory and practice of restoration science with the principles and methods of deliberative dialogue to support active engagement in critical reflection and collective debate. Our aim is to describe how these two innovative approaches in health services research can be used together to provide a comprehensive effective method to study and implement change in safety culture. Restorative research in health care integrates socio-ecological theory of complex adaptive systems concepts with collaborative, place-sensitive study of local practice contexts. Deliberative dialogue brings together all stakeholders to collectively develop solutions on an issue to facilitate change. Together these approaches can be used to actively engage people in the study of safety culture to gain a better understanding of its elements. More importantly, we argue that the synergistic use of these approaches offers enhanced potential to move health care professionals towards actionable strategies to improve patient safety within today's complex health care systems.
      PubDate: 2017-07-18
      DOI: 10.1093/intqhc/mzx080
      Issue No: Vol. 29, No. 5 (2017)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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