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Publisher: Oxford University Press   (Total: 370 journals)

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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: 8, SJR: 0.111, h-index: 4)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.538, h-index: 35)
African Affairs     Hybrid Journal   (Followers: 57, SJR: 1.512, h-index: 46)
Age and Ageing     Hybrid Journal   (Followers: 81, SJR: 1.611, h-index: 107)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 14, SJR: 0.935, h-index: 80)
American Entomologist     Full-text available via subscription   (Followers: 6)
American Historical Review     Hybrid Journal   (Followers: 125, SJR: 0.652, h-index: 43)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 41, SJR: 1.441, h-index: 77)
American J. of Epidemiology     Hybrid Journal   (Followers: 151, SJR: 3.047, h-index: 201)
American J. of Hypertension     Hybrid Journal   (Followers: 18, SJR: 1.397, h-index: 111)
American J. of Jurisprudence     Hybrid Journal   (Followers: 15)
American journal of legal history     Full-text available via subscription   (Followers: 4, SJR: 0.151, h-index: 7)
American Law and Economics Review     Hybrid Journal   (Followers: 26, SJR: 0.824, h-index: 23)
American Literary History     Hybrid Journal   (Followers: 12, SJR: 0.185, h-index: 22)
Analysis     Hybrid Journal   (Followers: 24)
Annals of Botany     Hybrid Journal   (Followers: 35, SJR: 1.912, h-index: 124)
Annals of Occupational Hygiene     Hybrid Journal   (Followers: 26, 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: 51, 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: 19)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 12)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 26, 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: 47, SJR: 0.144, h-index: 15)
Behavioral Ecology     Hybrid Journal   (Followers: 46, SJR: 1.698, h-index: 92)
Bioinformatics     Hybrid Journal   (Followers: 231, 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: 28, 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: 134, SJR: 2.314, h-index: 133)
BJA Education     Hybrid Journal   (Followers: 65, SJR: 0.272, h-index: 20)
Brain     Hybrid Journal   (Followers: 61, 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: 33, SJR: 1.267, h-index: 38)
British J. of Aesthetics     Hybrid Journal   (Followers: 25, SJR: 0.217, h-index: 18)
British J. of Criminology     Hybrid Journal   (Followers: 502, SJR: 1.373, h-index: 62)
British J. of Social Work     Hybrid Journal   (Followers: 80, 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: 26)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 3, SJR: 1.474, h-index: 31)
Cambridge J. of Economics     Hybrid Journal   (Followers: 54, SJR: 0.957, h-index: 59)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 9, SJR: 1.067, h-index: 22)
Cambridge Quarterly     Hybrid Journal   (Followers: 10, SJR: 0.1, h-index: 7)
Capital Markets Law J.     Hybrid Journal  
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.439, h-index: 167)
Cardiovascular Research     Hybrid Journal   (Followers: 11, SJR: 2.897, h-index: 175)
Cerebral Cortex     Hybrid Journal   (Followers: 39, SJR: 4.827, h-index: 192)
CESifo Economic Studies     Hybrid Journal   (Followers: 16, 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: 19, SJR: 0.737, h-index: 11)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 8, 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: 17, SJR: 0.1, h-index: 3)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 59, 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: 6, SJR: 0.313, h-index: 10)
Critical Values     Full-text available via subscription  
Current Legal Problems     Hybrid Journal   (Followers: 25)
Current Zoology     Full-text available via subscription   (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: 12)
Diplomatic History     Hybrid Journal   (Followers: 18, 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: 13, SJR: 0.124, h-index: 11)
Economic Policy     Hybrid Journal   (Followers: 52, SJR: 2.052, h-index: 52)
ELT J.     Hybrid Journal   (Followers: 25, SJR: 1.26, h-index: 23)
English Historical Review     Hybrid Journal   (Followers: 46, SJR: 0.311, h-index: 10)
English: J. of the English Association     Hybrid Journal   (Followers: 12, 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: 25, SJR: 0.197, h-index: 25)
EP-Europace     Hybrid Journal   (Followers: 2, SJR: 2.201, h-index: 71)
Epidemiologic Reviews     Hybrid Journal   (Followers: 9, SJR: 3.917, h-index: 81)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 15, SJR: 0.1, h-index: 6)
European Heart J.     Hybrid Journal   (Followers: 47, SJR: 6.997, h-index: 227)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 9, 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: 8, SJR: 0.152, h-index: 31)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 7, SJR: 1.568, h-index: 104)
European J. of Intl. Law     Hybrid Journal   (Followers: 147, 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: 22, SJR: 1.284, h-index: 64)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 12, SJR: 1.549, h-index: 42)
European Review of Economic History     Hybrid Journal   (Followers: 26, SJR: 0.628, h-index: 24)
European Sociological Review     Hybrid Journal   (Followers: 37, SJR: 2.061, h-index: 53)
Evolution, Medicine, and Public Health     Open Access   (Followers: 11)
Family Practice     Hybrid Journal   (Followers: 13, SJR: 1.048, h-index: 77)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 8, SJR: 1.687, h-index: 115)
Fems Microbiology Letters     Hybrid Journal   (Followers: 20, SJR: 1.126, h-index: 118)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 25, 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: 21, 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: 30, SJR: 0.123, h-index: 10)
French Studies     Hybrid Journal   (Followers: 19, 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: 10, SJR: 3.22, h-index: 39)
Geophysical J. Intl.     Hybrid Journal   (Followers: 31, SJR: 1.839, h-index: 119)
German History     Hybrid Journal   (Followers: 25, 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: 45, SJR: 0.505, h-index: 40)
Health Education Research     Hybrid Journal   (Followers: 12, 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: 20, 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: 23, SJR: 0.115, h-index: 13)
Human Molecular Genetics     Hybrid Journal   (Followers: 9, SJR: 4.288, h-index: 233)
Human Reproduction     Hybrid Journal   (Followers: 76, SJR: 2.271, h-index: 179)
Human Reproduction Update     Hybrid Journal   (Followers: 16, SJR: 4.678, h-index: 128)
Human Rights Law Review     Hybrid Journal   (Followers: 58, 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: 9)
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: 2, 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: 8, SJR: 1.37, h-index: 81)
Industrial Law J.     Hybrid Journal   (Followers: 29, 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: 4, SJR: 0.743, h-index: 35)
Intl. Affairs     Hybrid Journal   (Followers: 51, SJR: 1.264, h-index: 53)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 26)
Intl. Health     Hybrid Journal   (Followers: 4, 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: 32, SJR: 1.593, h-index: 69)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 59, SJR: 0.613, h-index: 19)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 121, SJR: 4.381, h-index: 145)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 3, SJR: 0.247, h-index: 8)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 28, 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: 8, SJR: 0.906, h-index: 33)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 32, 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: 26, SJR: 1.339, h-index: 19)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 17, 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: 36, SJR: 2.184, h-index: 68)
Intl. Studies Review     Hybrid Journal   (Followers: 17, 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: 39, 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: 19, 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: 44, SJR: 1.341, h-index: 96)
J. of Chromatographic Science     Hybrid Journal   (Followers: 16, 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: 34, 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: 11, SJR: 0.196, h-index: 15)
J. of Consumer Research     Full-text available via subscription   (Followers: 40, SJR: 4.896, h-index: 121)
J. of Crohn's and Colitis     Hybrid Journal   (Followers: 9, SJR: 1.543, h-index: 37)
J. of Cybersecurity     Hybrid Journal   (Followers: 3)
J. of Deaf Studies and Deaf Education     Hybrid Journal   (Followers: 8, SJR: 0.69, h-index: 36)
J. of Design History     Hybrid Journal   (Followers: 15, 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: 34, SJR: 2.909, h-index: 69)
J. of Environmental Law     Hybrid Journal   (Followers: 23, SJR: 0.457, h-index: 20)
J. of European Competition Law & Practice     Hybrid Journal   (Followers: 19)
J. of Experimental Botany     Hybrid Journal   (Followers: 14, SJR: 2.798, h-index: 163)
J. of Financial Econometrics     Hybrid Journal   (Followers: 21, SJR: 1.314, h-index: 27)
J. of Global Security Studies     Hybrid Journal   (Followers: 2)
J. of Heredity     Hybrid Journal   (Followers: 3, 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: 40, 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]   [32 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]
  • Simplified Chinese Abstracts *
    • PubDate: 2017-04-26
  • Spanish Abstracts *
    • PubDate: 2017-04-26
  • Traditional Chinese Abstracts *
    • PubDate: 2017-04-26
  • Portuguese Abstracts *
    • PubDate: 2017-04-26
  • Japanese Abstracts *
    • PubDate: 2017-04-26
  • Patient's satisfaction and incentive programs for physicians
    • Authors: Iqbal U Li Y.
      PubDate: 2017-04-26
  • Pay-for-performance reduces healthcare spending and improves quality of
           care: Analysis of target and non-target obstetrics and gynecology
    • Authors: Ju Kim S; Han K, Kim S, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>In Korea, the Value Incentive Program (VIP) was first applied to selected clinical conditions in 2007 to evaluate the performance of medical institutes. We examined whether the condition-specific performance of the VIP resulted in measurable improvement in quality of care and in reduced medical costs.<div class="boxTitle">Design</div>Population-based retrospective observational study.<div class="boxTitle">Setting</div>We used two data set including the results of quality assessment and hospitalization data from National Health Claim data from 2011 to 2014.<div class="boxTitle">Participants</div>Participants who were admitted to the hospital for obstetrics and gynecology were included. A total of 535 289 hospitalizations were included in our analysis.<div class="boxTitle">Methods</div>We used a generalized estimating equation (GEE) model to identify associations between the quality assessment and length of stay (LOS). A GEE model based on a gamma distribution was used to evaluate medical cost. The Poisson regression analysis was used to evaluate readmission.<div class="boxTitle">Main Outcome Measures</div>The outcome variables included LOS, medical costs and readmission within 30 days.<div class="boxTitle">Results</div>Higher condition-specific performance by VIP participants was associated with shorter LOSs, decreases in medical cost, and lower within 30-day readmission rates for target and non-target surgeries. LOS and readmission within 30 days were different by change in quality assessment at each medical institute.<div class="boxTitle">Conclusions</div>Our findings contribute to the body of evidence used by policy-makers for expansion and development of the VIP. The study revealed the positive effects of quality assessment on quality of care. To reduce the between-institute quality gap, alternative strategies are needed for medical institutes that had low performance.</span>
      PubDate: 2017-04-12
  • Association between the application of ISO 9001:2008 alone or in
           combination with health-specific standards and quality-related activities
           in Hungarian hospitals
    • Authors: Dombrádi V; Csenteri O, Sándor J, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>To investigate how International Organization for Standardization (ISO) 9001 and the Hungarian Health Care Standards (HHCS) certifications are associated with quality management, patient safety, patient rights and human resource management activities.<div class="boxTitle">Design</div>A cross-sectional study was implemented using the 2009 Hungarian hospital survey's database.<div class="boxTitle">Setting</div>Hungary.<div class="boxTitle">Participants</div>Fifty-three general hospitals were included in the statistical analysis.<div class="boxTitle">Intervention</div>No intervention was carried out in the study.<div class="boxTitle">Main Outcome Measures</div>The outcomes included the percentage of compliance in the dimensions of quality management, patient safety, patient rights, human resource management and the overall score for each hospital, and they were grouped according to the hospitals’ certifications.<div class="boxTitle">Results</div>Sixteen hospitals did not have either ISO 9001 or HHCS certifications, 19 had ISO 9001 certification only and 18 had both. Hospitals with ISO 9001 alone or in combination with the HHCS significantly outperformed hospitals with no certifications in terms of quality management and human resource management activities but not in terms of patient safety or patient rights activities. Combined, the two models provided the highest median levels in all cases. Nevertheless, no significant differences were observed when the hospitals with both certifications were compared with hospitals with ISO 9001 only.<div class="boxTitle">Conclusions</div>Although the combination of ISO 9001 and the HHCS showed the best results, the benefits were not decisive. Furthermore, although the HHCS include standards addressing patient safety, no direct association was found with regard to compliance. Thus, further investigation is required to understand this enigma.</span>
      PubDate: 2017-03-07
  • Incidence and potential risk factors for hospital-acquired pneumonia in an
           emergency department of surgery
    • Authors: Stenlund M; Sjödahl R, Pia Yngman-Uhlin R.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>Hospital-acquired pneumonia (HAP) is associated with high mortality and is the second most common nosocomial infection. The aim of this study was to calculate the incidence and to identify potential risk factors for HAP in an emergency ward for surgical patients admitted because of acute abdomen or trauma.<div class="boxTitle">Design</div>A structured review of medical records was conducted. Patients diagnosed with pneumonia >48 h after admittance, were compared with a randomly chosen age-matched reference group. Ten variables judged as potential risk factors for HAP were studied in 90 patients.<div class="boxTitle">Setting</div>An emergency ward for surgical patients with acute abdomen or trauma at an Univerity hospital in Sweden.<div class="boxTitle">Participants</div>A total of 90 patients with HAP and 120 age-matched controls were included.<div class="boxTitle">Main Outcome Measures</div>Risk factors for HAP in patients at a surgical clinic.<div class="boxTitle">Results</div>Of a total of 10 335 admitted patients, during 4.5 years the hospital stay was longer than 48 h in 4961 patients. Of these 90 (1.8%) fulfilled the strict criteria for HAP.Potential risk factors were suspected or verified aspiration (odds ratio (OR): 23.9) that was 2-fold higher than immobilization (OR: 11.2). Further, chronic pulmonary obstructive disease (COPD)/asthma, abdominal surgery and gastric retention/vomiting were risk factors for HAP.<div class="boxTitle">Conclusion</div>Verified or suspected aspiration was the dominating risk factor for HAP but also immobilization was frequently associated with HAP. Various established preventive measures should be implemented in the nursing care to reduce the frequency of HAP.</span>
      PubDate: 2017-02-23
  • Triage quality control is missing tools—a new observation technique
           for ED quality improvement
    • Authors: Malmström T; Harjola V, Torkki P, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>Correct assessment of patient urgency is critical to ensuring patient safety in emergency departments (EDs). Although significant time and effort have been devoted to developing triage systems, less attention has been paid to the development of quality control. The aim of this study is to introduce and test observation technique, which enables identifying of patient groups at risk of erroneous assessment in triage. The introduced technique is aimed to be less laborious to use than existing triage quality control methods.<div class="boxTitle">Design</div>The study developed an observation technique for identifying patients with possible erroneous assessments in triage. Data sample for the observation technique is carried out with survey form filled in by nurse.<div class="boxTitle">Setting</div>Hospital ED with ~74 000 patient visits annually.<div class="boxTitle">Participants</div>Consecutive adult patients in an ED for baseline study period of 14 days (1774 patients) in 2010 and control study period of 4 days (541 patients) in 2012.<div class="boxTitle">Intervention</div>Triage observation technique for continuous improvement of triage performance.<div class="boxTitle">Main Outcome Measures</div>Primary measures of triage improvement were triage accuracy and nurses’ ability to predict patient admissions.<div class="boxTitle">Results</div>With the observation technique the ED staff was able to identify patient groups at risk for erroneous triage. Under-triage related mostly to patients with chest pain, shortness of breath, collapse, stomach pain and infections. Instead injures and muscular skeletal symptoms were seldom undertriaged even though they are common.<div class="boxTitle">Conclusions</div>EDs can control triage quality with simple observation technique. The usability of observation technique and triage quality improvement process were good.</span>
      PubDate: 2017-02-23
  • A before–after study of multidisciplinary Out-of-Hours handover:
           combining management and frontline efforts to create sustainable
    • Authors: Pennell C; Flynn L, Boulton B, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>The importance of implementation strategy in systems improvement is increasingly recognized and both ‘bottom-up’ and ‘top-down’ approaches have significant barriers. A trial of a combined approach involving frontline and managerial staff therefore seems merited. We attempted to improve handover using a Human Factors-based approach integrated with a combined ‘top and bottom’ implementation strategy.<div class="boxTitle">Design</div>A before–after study was conducted across 9 months.<div class="boxTitle">Setting</div>The study was set in a 236 bed district general hospital.<div class="boxTitle">Participants</div>Participants included any member of staff involved in Out of Hours handover.<div class="boxTitle">Intervention</div>Existing processes were analysed using Human Factors methods. Changes made were based on this analysis and developed via facilitation between management and frontline staff. These included creating a single multidisciplinary handover, changing the venue, standardizing the meeting structure, developing an standard operating procedure for identifying unwell patients for handover and creating a clinical coordinator role.<div class="boxTitle">Main outcome measures</div>Meeting attendance, duration, start time efficiency, the type of patients handed over and the transfer of important information were measured pre- and post-intervention.<div class="boxTitle">Results</div>We found improvement in handover start time (<span style="font-style:italic;">P</span> = 0.002, <span style="font-style:italic;">r</span> = 0) and multidisciplinary participation (<span style="font-style:italic;">P</span> = 0.002, <span style="font-style:italic;">r</span> = −0.534). Handover of unwell patients improved, but not significantly. Communication of plan (<span style="font-style:italic;">P</span> < 0.001, <span style="font-style:italic;">r</span> = 0.14) and pending tasks (<span style="font-style:italic;">P</span> < 0.001, <span style="font-style:italic;">r</span> = 0.30) improved, but diagnosis (<span style="font-style:italic;">P</span> = 0.233, <span style="font-style:italic;">r</span> = −0.05), history (<span style="font-style:italic;">P</span> = 0.482, <span style="font-style:italic;">r</span> = −0.03) and comorbidities (<span style="font-style:italic;">P</span> = 0.19, <span style="font-style:italic;">r</span> = −0.05) did not.<div class="boxTitle">Conclusions</div>The changes produced greater multidisciplinary participation, a broader focus and improved communication of plans and tasks outstanding. The ‘top and bottom’ implementation approach appeared valuable. Management involvement was essential for significant changes, while frontline staff involvement facilitated the design of context-specific practical solutions with staff buy-in.</span>
      PubDate: 2017-02-17
  • Measuring job satisfaction among healthcare staff in the United States: a
           confirmatory factor analysis of the Satisfaction of Employees in Health
           Care (SEHC) survey
    • Authors: Chang E; Cohen J, Koethe B, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>To validate the Satisfaction of Employees in Health Care (SEHC) survey with multidisciplinary, healthcare staff in the United States (U.S.).<div class="boxTitle">Design</div>A cross-sectional psychometric study using confirmatory factor analysis. The original three-factor model was tested and modified using half-samples. Models were assessed using goodness-of-fit measures. Scale reliability and validity were tested with Cronbach's <span style="font-style:italic;">α</span> coefficient and correlation of total SEHC score with two global satisfaction items, respectively.<div class="boxTitle">Setting</div>We administered a web-based survey from January to May 2015 to healthcare staff participating in initiatives aimed at delivering better care and reducing costs.<div class="boxTitle">Participants</div>The overall response rate was 38% (<span style="font-style:italic;">N</span> = 1089), and respondents were from 86 healthcare projects. A total of 928 respondents completed the SEHC survey in full and were used in this study.<div class="boxTitle">Main Outcome Measures</div>Model fit of 18 SEHC items and total SEHC score.<div class="boxTitle">Results</div>The mean SEHC score was 77.6 (SD: 19.0). A one-factor model of job satisfaction had high loadings on all items, and demonstrated adequate model fit (second half-sample RMSEA: 0.069). The scale demonstrated high reliability (Cronbach's alpha = 0.942) and validity (<span style="font-style:italic;">r</span> = 0.77 and 0.76, both <span style="font-style:italic;">P</span> < 0.05).<div class="boxTitle">Conclusions</div>The SEHC appears to measure a single general job satisfaction construct. The scale has adequate reliability and validity to recommend its use to assess satisfaction among multidisciplinary, U.S. healthcare staff. Our findings suggest that this survey is a good candidate for reduction to a short-form, and future research should validate this survey in other healthcare populations.</span>
      PubDate: 2017-02-17
  • Experimenting the hospital survey on patient safety culture in prevention
           facilities in Italy: psychometric properties
    • Authors: Tereanu C; Smith SA, Sampietro G, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture (HSOPS) was designed to assess staff views on patient safety culture in hospital. This study examines psychometrics of the Italian translation of the HSOPS for use in territorial prevention facilities.<div class="boxTitle">Design</div>After minimal adjustments and pre-test of the Italian version, a qualitative cross-sectional study was carried out.<div class="boxTitle">Setting</div>Departments of Prevention (DPs) of four Local Health Authorities in Northern Italy.<div class="boxTitle">Participants</div>Census of medical and non-medical staff (n. 479).<div class="boxTitle">Intervention</div>Web-based self-administered questionnaire.<div class="boxTitle">Main outcome measures</div>Descriptive statistics, internal reliability, Confirmatory Factor Analysis (CFA) and intercorrelations among survey composites.<div class="boxTitle">Results</div>Initial CFA of the 12 patient safety culture composites and 42 items included in the original version of the questionnaire revealed that two dimensions (Staffing and Overall Perception of Patient Safety) and nine individual items did not perform well among Italian territorial Prevention staff. After dropping those composites and items, psychometric properties were acceptable (comparative fit index = 0.94; root mean square error of approximation = 0.04; standardized root mean square residual = 0.04). Internal consistency for each remaining composite met or exceeded the criterion 0.70. Intercorrelations were all statistically significant.<div class="boxTitle">Conclusions</div>Psychometric analyses provided overall support for 10 of the 12 initial patient safety culture composites and 33 of the 42 initial composite items. Although the original instrument was intended for US Hospitals, the Italian translation of the HSOPS adapted for use in territorial prevention facilities performed adequately in Italian DPs.</span>
      PubDate: 2017-02-15
  • Examining the nature of interprofessional interventions designed to
           promote patient safety: a narrative review
    • Authors: Reeves S; Clark E, Lawton S, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Purpose</div>This narrative review aimed to scope the patient safety literature to identify interprofessional intervention approaches, sources of evidence and reported outcomes.<div class="boxTitle">Data sources</div>Two major databases (MEDLINE and CINAHL) were searched from 2005 to 2015.<div class="boxTitle">Study selection</div>A total of 1552 abstracts were initially identified. After screening these abstracts, 129 full papers were obtained. Further screening resulted in a total of 89 papers included in this review.<div class="boxTitle">Data extraction</div>The following information was extracted from each included paper: details on the patient safety intervention, study methods employed and outcomes reported.<div class="boxTitle">Results of data synthesis</div>It was found that the bulk of the included studies was undertaken in a North American acute care context. Most often, studies involved qualified professionals from nursing and medicine collaborating in hospitals and medical centres. Nearly half the studies reported in this review employed educational interventions, such as TeamSTEPPS, aimed at enhancing practitioners’ competence of delivering safe patient care. Nearly a third of studies involved practice-based interventions (e.g. checklists) aimed at improving the delivery of safe care. Most of the studies used a quasi-experimental design and typically gathered survey data. The majority reported outcomes related to changes in professionals’ attitudes, knowledge and skills. There were, however, fewer studies reporting changes in practitioners’ safety behaviours, organizational practices or patient benefit.<div class="boxTitle">Conclusion</div>The use of different interprofessional interventions are key activities involved in promoting safe patient care practices. However, further work is needed to strengthen these interventions and their evaluations.</span>
      PubDate: 2017-02-15
  • Factors constraining patient engagement in implantable medical device
           discussions and decisions: interviews with physicians
    • Authors: Gagliardi AR; Lehoux P, Ducey A, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>Patient engagement (PE) is warranted when treatment risks and outcomes are uncertain, as is the case for higher risk medical devices. Previous research found that patients were not engaged in discussions or decisions about implantable medical devices. This study explored physician views about engaging patients in such discussions.<div class="boxTitle">Design</div>Qualitative interviews using a basic descriptive approach.<div class="boxTitle">Setting</div>Canada.<div class="boxTitle">Participants</div>Practicing cardiovascular and orthopaedic physicians.<div class="boxTitle">Main outcome measures</div>Level, processes and determinants of PE in medical device discussions and decisions.<div class="boxTitle">Results</div>Views were largely similar among 10 cardiovascular and 12 orthopaedic physicians interviewed. Most said that it was feasible to inform and sometimes involve patients in discussions, but not to partner with them in medical device decision-making. PE was constrained by patient (comfort with PE, technical understanding, physiologic/demographic characteristics, prognosis), physician (device preferences, time), health system (purchasing contracts) and device factors (number of devices on market, comparative advantage). A framework was generated to help physicians engage patients in discussions about medical devices, even when decisions may not be preference sensitive due to multiple constraints on choice.<div class="boxTitle">Conclusions</div>This study identified that patients are not engaged in discussions or decisions about implantable medical devices. This may be due to multiple constraints. Further research should establish the legitimacy, prevalence and impact of constraining factors, and examine whether and how different levels and forms of PE are needed and feasible.</span>
      PubDate: 2017-02-13
  • Professional attitudes toward incident reporting: can we measure and
           compare improvements in patient safety culture?
    • Authors: Tricarico P; Castriotta L, Battistella C, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>To establish categories of professionals’ attitudes toward incident reporting by analyzing the trends in incident reporting while accounting for general risk indicators.<div class="boxTitle">Design</div>The incident reporting system was evaluated over 6 years. Reporting rates, stratified by year and profession, were estimated using the non-mandatory reported events/full-time equivalent (NM-IR/FTE) rate. Other indicators were collected using the hospital's official database. Staff attitudes toward self-reporting were analyzed. Univariate and multivariable analyses were performed.<div class="boxTitle">Setting</div>A 1000-bed Italian academic hospital.<div class="boxTitle">Participants</div>Staff of the hospital (over 3200 professionals).<div class="boxTitle">Interventions</div>None.<div class="boxTitle">Main outcome measures</div>NM-IT/FTE rates, self-reported rates, patient complaints/praises, work accidents among professionals and 30-day readmissions.<div class="boxTitle">Results</div>The overall reporting rate was 0.44 (95% confidence interval [CI]: 0.42–0.46) among doctors and 0.40 (95% CI: 0.39–0.41) among nurses. Between 2010 and 2015, only the doctors’ reporting rate increased significantly (<span style="font-style:italic;">P</span> = 0.04), from 0.29 (95% CI: 0.25–0.34) to 0.67 (95% CI: 0.60–0.73). Patient complaints decreased from 384 to 224 (<span style="font-style:italic;">P</span> < 0.001) and work accidents decreased from 296 to 235 (<span style="font-style:italic;">P</span> = 0.01), while other indicators remained constant. Multivariable logistic regression showed that self-reporting was more likely among nurses than doctors (odds ratio: 1.51; 95% CI: 1.31–1.73) and for severe events than near misses (odds ratio: 1.78; 95% CI: 1.11–2.87).<div class="boxTitle">Conclusions</div>Because the doctors’ reporting rates increased during the study period, doctors may be more likely to report adverse events than nurses, although nurses reported more events. Incident reporting trends and other routinely collected risk indicators may be useful to improve our understanding and measurement of patient safety issues.</span>
      PubDate: 2017-02-04
  • Unplanned readmissions within 30 days after discharge: improving quality
           through easy prediction
    • Authors: Casalini F; Salvetti S, Memmini S, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>To propose an easy predictive model for the risk of rehospitalization, built from hospital administrative data, in order to prevent repeated admissions and to improve transitional care.<div class="boxTitle">Design</div>Retrospective cohort study.<div class="boxTitle">Setting</div>Azienda Ospedaliero Universitaria Pisana (Pisa University Hospital).<div class="boxTitle">Participants</div>Patients residing in the territory of the province of Pisa (Tuscany Region) with at least one unplanned hospital admission leading to a medical Diagnosis-Related Group (DRG) in the calendar year 2012.<div class="boxTitle">Intervention</div>We compared two groups of patients: patients coded as ‘RA30’ (readmitted within 30 days after the previous discharge) and patients coded as ‘NRA30’ (either admitted only once or readmitted after 30 days since the latest discharge).<div class="boxTitle">Main Outcome Measures</div>The effect of age, sex, length of stay, number of diagnoses, normalized number of admissions and presence of diseases on the probability of rehospitalization within 30 days after discharge was evaluated.<div class="boxTitle">Results</div>The significant variables included in the predictive model were: age, odds ratio (OR) = 1.018, 95% confidence interval (CI) = 1.011–1.026; normalized number of admissions, OR = 1.257, CI = 1.225–1.290; number of diagnoses, OR = 1.306, CI = 1.174–1.452 and presence of cancer diagnosis, OR = 1.479, CI = 1.088–2.011.<div class="boxTitle">Conclusions</div>The model can be easily applied when discharging patients who have been hospitalized after an access to the Emergency Department to predict the risk of rehospitalization within 30 days. The prediction can be used to activate focused hospital-primary care transitional interventions. The model has to be validated first in order to be implemented in clinical practice.</span>
      PubDate: 2017-02-04
  • Leveraging the full value and impact of accreditation
    • Authors: Nicklin W; Fortune T, van Ostenberg P, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div>Providing high quality and safe patient care is a challenge in the current rapidly changing and complex health care environment. A variety of independent tools and methodologies contribute to this effort, e.g. regulatory requirements, quality improvement tools and accreditation methodologies. A concern is that each alone will not achieve the tipping point in health care quality that is required. This paper suggests that the methodology and application of accreditation have the potential to be the force to bring these approaches into alignment and ultimately measurably improve the quality of care.</span>
      PubDate: 2017-02-04
  • Quality of antenatal care and client satisfaction in Kenya and Namibia
    • Authors: Do M; Wang W, Hembling J, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>Despite much progress in maternal health service coverage, the quality of care has not seen parallel improvement. This study assessed the quality of antenatal care (ANC), an entry point to the health system for many women.<div class="boxTitle">Design</div>The study used data from recent Service Provision Assessment (SPA) surveys of nationally representative health facilities in Kenya and Namibia.<div class="boxTitle">Setting</div>Kenya and Namibia represent the situation in much of sub-Saharan Africa, where ANC is relatively common but maternal mortality remains high.<div class="boxTitle">Participants</div>The SPA comprised an inventory of health facilities that provided ANC, interviews with ANC providers and clients, and observations of service delivery.<div class="boxTitle">Interventions</div>Not applicable.<div class="boxTitle">Main Outcome Measures</div>Quality was measured in terms of structure and process of service provision, and client satisfaction as the outcome of service provision.<div class="boxTitle">Results</div>Wide variations in structural and process attributes of quality of care existed in both Kenya and Namibia; however, better structural quality did not translate to better service delivery process or greater client satisfaction. Long waiting time was a common problem and was generally more serious in hospitals and health centers than in clinics and smaller facilities; it was consistently associated with lower client satisfaction. The study also indicates that the provider's technical preparedness may not be sufficient to provide good-quality services and to ensure client satisfaction.<div class="boxTitle">Conclusions</div>Findings highlight important program implications, including improving ANC services and promoting their use at health clinics and lower-level facilities, and ensuring that available supplies and equipment are used for service provision.</span>
      PubDate: 2017-02-02
  • Evaluation of a novel mentor program to improve surgical care for US
    • Authors: Berian JR; Thomas JM, Minami CA, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>To evaluate a novel mentor program for 27 US surgeons, charged with improving quality at their respective hospitals, having been paired 1:1 with 27 surgeon mentors through a state-wide quality improvement (QI) initiative.<div class="boxTitle">Design</div>Mixed-methods utilizing quantitative surveys and in-depth semi-structured interviews.<div class="boxTitle">Setting</div>The Illinois Surgical Quality Improvement Collaborative (ISQIC) utilized a novel Mentor Program to guide surgeons new to QI.<div class="boxTitle">Participants</div>All mentor–mentee pairs received the survey (<span style="font-style:italic;">n</span> = 27). Purposive sampling identified a subset of mentors (<span style="font-style:italic;">n</span> = 8) and mentees (<span style="font-style:italic;">n</span> = 4) for in-depth semi-structured interviews.<div class="boxTitle">Intervention</div>Surgeons with expertise in QI mentored surgeons new to QI.<div class="boxTitle">Main outcome measures</div>(i) Quantitative: self-reported satisfaction with the mentor program; (ii) Qualitative: key themes suggesting actions and strategies to facilitate mentorship in QI.<div class="boxTitle">Results</div>Mentees expressed satisfaction with the mentor program (<span style="font-style:italic;">n</span> = 24, 88.9%) and agreed that mentorship is vital to ISQIC (<span style="font-style:italic;">n</span> = 24, 88.9%). Analysis of interview data revealed four key themes: (i) nuances of data management, (ii) culture of quality and safety, (iii) mentor–mentee relationship and (iv) logistics. Strategies from these key themes include: utilize raw data for in-depth QI understanding, facilitate presentations to build QI support, identify opportunities for in-person meetings and establish scheduled conference calls. The mentor's role required sharing experiences and acting as a resource. The mentee's role required actively bringing questions and identifying barriers.<div class="boxTitle">Conclusions</div>Mentorship plays a vital role in advancing surgeon knowledge and engagement with QI in ISQIC. Key themes in mentorship reflect strategies to best facilitate mentorship, which may serve as a guide to other collaboratives.</span>
      PubDate: 2017-02-02
  • A flowchart for building evidence-based care bundles in intensive care:
           based on a systematic review
    • Authors: Borgert M; Binnekade J, Paulus F, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Purpose</div>The Institute for Healthcare Improvement is the founder of the care bundled approach and described the methods used on how to develop care bundles. However, other useful methods are published as well. In this systematic review, we identified what different methods were used to design care bundles in intensive care units. The results were used to build a comprehensive flowchart to guide through the care bundle design process.<div class="boxTitle">Data sources</div>Electronic databases were searched for eligible studies in PubMed, EMBASE and CINAHL from January 2001 to August 2014.<div class="boxTitle">Study selection</div>There were no restrictions on the types of study design eligible for inclusion. Methodological quality was assessed by using the Downs & Black-checklist or Appraisal of Guidelines, REsearch and Evaluation II.<div class="boxTitle">Data extraction</div>Data extraction was independently performed by two reviewers.<div class="boxTitle">Results of data synthesis</div>A total of 4665 records were screened and 18 studies were finally included. The complete process of designing bundles was reported in 33% (6/18). In 50% (9/18), one of the process steps was described. A narrative report was written about care bundles in general in 17% (3/18). We built a comprehensive flowchart to visualize and structure the process of designing care bundles.<div class="boxTitle">Conclusion</div>We identified useful methods for designing evidence-based care bundles. We built a comprehensive flowchart to provide an overview of the methods used to design care bundles so that others could choose their own applicable method. It guides through all necessary steps in the process of designing care bundles.</span>
      PubDate: 2017-02-02
  • Reliability of clinical impact grading by healthcare professionals of
    • Authors: Bourne RS; Shulman R, Tomlin M, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>To identify between and within profession-rater reliability of clinical impact grading for common critical care prescribing error and optimisation cases. To identify representative clinical impact grades for each individual case.<div class="boxTitle">Design</div>Electronic questionnaire.<div class="boxTitle">Setting</div>5 UK NHS Trusts.<div class="boxTitle">Participants</div>30 Critical care healthcare professionals (doctors, pharmacists and nurses).<div class="boxTitle">Intervention</div>Participants graded severity of clinical impact (5-point categorical scale) of 50 error and 55 optimisation cases.<div class="boxTitle">Main Outcome Measures</div>Case between and within profession-rater reliability and modal clinical impact grading.<div class="boxTitle">Methods</div>Between and within profession rater reliability analysis used linear mixed model and intraclass correlation, respectively.<div class="boxTitle">Results</div>The majority of error and optimisation cases (both 76%) had a modal clinical severity grade of moderate or higher. Error cases: doctors graded clinical impact significantly lower than pharmacists (−0.25; <span style="font-style:italic;">P</span> < 0.001) and nurses (−0.53; <span style="font-style:italic;">P</span> < 0.001), with nurses significantly higher than pharmacists (0.28; <span style="font-style:italic;">P</span> < 0.001). Optimisation cases: doctors graded clinical impact significantly lower than nurses and pharmacists (−0.39 and −0.5; <span style="font-style:italic;">P</span> < 0.001, respectively). Within profession reliability grading was excellent for pharmacists (0.88 and 0.89; <span style="font-style:italic;">P</span> < 0.001) and doctors (0.79 and 0.83; <span style="font-style:italic;">P</span> < 0.001) but only fair to good for nurses (0.43 and 0.74; <span style="font-style:italic;">P</span> < 0.001), for optimisation and error cases, respectively.<div class="boxTitle">Conclusions</div>Representative clinical impact grades for over 100 common prescribing error and optimisation cases are reported for potential clinical practice and research application. The between professional variability highlights the importance of multidisciplinary perspectives in assessment of medication error and optimisation cases in clinical practice and research.</span>
      PubDate: 2017-01-31
  • De-freezing frozen patient management
    • Authors: Kobo-Greenhut A; SHNIFI A, TAL-OR E, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>To compare the effectiveness of two methods in encouraging the consideration of a leap from one patient management routine to another: (i) real-time review of the facts by an external medical team (ii) implementation of the ‘re-thinking-protocol’ (‘de-Freezing’) by both treating and external medical teams.<div class="boxTitle">Design</div>Students accompanied doctors, nurses and patients as non-interrupting observers. When an obvious gap between the expected and actual findings occurred, it was discussed four times: by two teams (treating team, external medical team) in two discussion modes (real-time review, de-Freezing-questionnaire). The students then recorded if a leap was considered for each discussion.<div class="boxTitle">Setting</div>The study was conducted in the emergency department of the Baruch Padeh Medical Centre, Poriya, Israel.<div class="boxTitle">Participants</div>All patients were included during times when both medical teams (treating, external) were present.<div class="boxTitle">Intervention(s)</div>During 14 periods of 5–7 h each, 459 patients were sampled. In 183 patients, 200 gaps were discovered.<div class="boxTitle">Results</div>The external team considered a leap 76 times, compared with 47 by the treating team (<span style="font-style:italic;">P</span> < 0.001). Using the de-Freezing-protocol, the treating team considered a leap 133 times. Interestingly, even the external team benefited from the de-Freezing protocol and considered a leap 140 times (NS compared to the treating team).<div class="boxTitle">Conclusions</div>While the importance of timely leaping from one patient management routine to another is emphasized in the training of physicians, medical teams too often fail to do so. The de-Freezing-protocol inexpensively encourages the consideration of a leap beyond what is evoked by the involvement of an external team. The protocol is applicable to all medical processes and should be incorporated into medical practice and education.</span>
      PubDate: 2017-01-17
  • Consumer satisfaction with tertiary healthcare in China: findings from the
           2015 China National Patient Survey
    • Authors: Sun J; Hu G, Ma J, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>This study aims to develop understanding of Chinese patient satisfaction with tertiary hospitals.<div class="boxTitle">Design</div>The study draws on data collected from the 2015 China National Patient Survey. A Likert five-point scale was used to formulate the questionnaires. Descriptive analysis and logistic regression analysis were conducted.<div class="boxTitle">Setting</div>A structured questionnaire was used by 1432 interviewers to interview 27 475 outpatients and 19 938 inpatients in 136 tertiary hospitals from 31 provinces.<div class="boxTitle">Participants</div>Outpatients in the dispensing area and inpatients in the discharging area were randomly interviewed.<div class="boxTitle">Main Outcome Measure(s)</div>Key domains of the questionnaire include the layout of service functions, environment maintenance, process management, quality of care, humane care and the patient–doctor relationship. Within each domain, several indicators were set, and each indicator was given a statement.<div class="boxTitle">Results</div>The overall satisfaction scores are 4.42 ± 0.68 and 4.67 ± 0.62 for outpatient and inpatient, respectively. The domains with highest satisfaction are ‘diagnosis and treatment’ for outpatient and ‘nursing care’ for inpatient. Outpatients were least satisfied with long waiting time, while inpatients were least satisfied with the food. The strongest predictor of overall satisfaction appears to be ‘patient–doctor relationship’ for both outpatients (OR = 3.53, 95% CI: 3.17–3.92) and inpatients (OR = 7.34, 95% CI: 5.55–9.70).<div class="boxTitle">Conclusions</div>Chinese hospitals need to pay more attention to offering more humane care to patients, hospital environment and process management improvement, reducing waiting times for seeing doctors and outpatient testing, and improving amenity services such as better food in the wards.</span>
      PubDate: 2017-01-17
  • A framework of comfort for practice: An integrative review identifying the
           multiple influences on patients’ experience of comfort in healthcare
    • Authors: Wensley C; Botti M, McKillop A, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Purpose</div>Comfort is central to patient experience but the concept of comfort is poorly defined. This review aims to develop a framework representing patients’ complex perspective of comfort to inform practice and guide initiatives to improve the quality of healthcare.<div class="boxTitle">Data sources</div>CINAHL, MEDLINE Complete, PsycINFO and Google Scholar (November 2016); reference lists of included publications.<div class="boxTitle">Study selection</div>Qualitative and theoretical studies advancing knowledge about the concept of comfort in healthcare settings. Studies rated for methodological quality and relevance to patients’ perspectives.<div class="boxTitle">Data extraction</div>Data on design, methods, features of the concept of comfort, influences on patients’ comfort. Data were systematically coded and categorized using Framework method.<div class="boxTitle">Results of data synthesis</div>Sixty-two studies (14 theoretical and 48 qualitative) were included. Qualitative studies explored patient and staff perspectives in varying healthcare settings including hospice, emergency departments, paediatric, medical and surgical wards and residential care for the elderly. From patients’ perspective, comfort is multidimensional, characterized by relief from physical discomfort and feeling positive and strengthened in one's ability to cope with the challenges of illness, injury and disability. Different factors are important to different individuals. We identified 10 areas of influence within four interrelated levels: patients’ use of self-comforting strategies; family presence; staff actions and behaviours; and environmental factors.<div class="boxTitle">Conclusion</div>Our data provide new insights into the nature of comfort as a highly personal and contextual experience influenced in different individuals by different factors that we have classified into a framework to guide practice and quality improvement initiatives.</span>
      PubDate: 2017-01-17
  • Assessing patient safety culture in Tunisian operating rooms: A
           multicenter study
    • Authors: Mallouli M; Tlili M, Aouicha W, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>To assess the patient safety culture (PSC) in operating rooms (ORs) and to determine influencing factors.<div class="boxTitle">Design</div>A cross-sectional descriptive multicenter study which was conducted over a period of 7 months (October 2014–April 2015) using the French validated version of the Hospital Survey On Patient Safety Culture questionnaire.<div class="boxTitle">Setting</div>Of the note, 15 ORs of public and private healthcare institutions.<div class="boxTitle">Participants</div>In total, there were 368 participants including surgeons, anesthesiologists, surgical and anesthesia technicians, nurses and caregivers, divided into 316 professionals exercising in public sector and 52 working in private one.<div class="boxTitle">Main Outcome Measure(s)</div>A self-administrated questionnaire investigating 10 dimensions of PSC (including 45 items), two items examining the staff perception of patient safety quality and reporting events, and five items regarding demographic characteristics of respondents.<div class="boxTitle">Results</div>The participation rate in the study was 70.8%. All 10 dimensions were to be improved. The overall perception of patient safety had a score of 34.9%. The dimension that had the lowest score (20.5%) was the non-punitive response to error, and the one that had the highest score (41.67%) was teamwork in the ORs. Three dimensions were developed in private sector, and none in public hospitals.<div class="boxTitle">Conclusion</div>This study showed that the level of the PSC needs to be improved not only in public hospitals but also in private ones. The obtained results highlight the importance of implementing quality management systems and developing PSC.</span>
      PubDate: 2017-01-10
  • Factors precipitating the risk of aspiration in hospitalized patients:
           findings from a multicentre critical incident technique study
    • Authors: Palese A; Lesa L, Stroppolo G, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>To elucidate factors, other than those clinical, precipitating the risk of aspiration in hospitalized patients.<div class="boxTitle">Design</div>The Critical Incident Technique was adopted for this study in 2015.<div class="boxTitle">Setting</div>Three departments located in two academic hospitals in the northeast of Italy, equipped with 800 and 1500 beds, respectively.<div class="boxTitle">Participants</div>A purposeful sample of 12 registered nurses (RN), all of whom (i) had reported one or more episodes of aspiration during the longitudinal survey, (ii) had worked ≥3 years in the department, and (iii) were willing to participate, were included.<div class="boxTitle">Main Outcome Measure(s)</div>Antecedent factors involved in episodes of aspiration as experienced by RNs were collected through an open-ended interview, and qualitatively analysed.<div class="boxTitle">Results</div>In addition to clinical factors, other factors interacting with each other may precipitate the risk of aspiration episodes during hospitalization: at the nursing care level (misclassifying patients, transferring tasks to other healthcare professionals and standardizing processes to remove potential threats); at the family level (misclassifying patients, dealing with the cultural relevance of eating) and at the environmental level (positioning the patient, managing time pressures, distracting patient while eating, dealing with food consistency and irritating oral medication).<div class="boxTitle">Conclusions</div>At the hospital level, an adequate nursing workforce and models of care delivery, as well as time for initial and continuing patient and family assessment are required. At the unit level, patient-centred models of care aimed at reducing care standardization are also recommended; in addition, nursing, family and environmental factors should be recorded in the incident reports documenting episodes of aspiration.</span>
      PubDate: 2016-12-29
  • Evaluation of a care transition program with pharmacist-provided
           home-based medication review for elderly Singaporeans at high risk of
    • Authors: Cheen M; Goon C, Ong W, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Objective</div>This study aimed to determine whether pharmacist-provided home-based medication review (HBMR) can reduce readmissions in the elderly.<div class="boxTitle">Design</div>Retrospective cohort study.<div class="boxTitle">Setting</div>Patient's home.<div class="boxTitle">Participants</div>Records of patients referred to a care transition program from March 2011 through March 2015 were reviewed. Patients aged 60 years and older taking more than 5 medications and had at least 2 unplanned admissions within 3 months preceding the first home visit were included.<div class="boxTitle">Intervention</div>Pharmacist-provided HBMR.<div class="boxTitle">Main outcome measures</div>Primary outcome was readmission rate over 6 months after the first home visit. Secondary outcomes included emergency department (ED) visits, outpatient visits and mortality. Drug-related problems (DRPs) were reported for the HBMR group. Multivariate incidence rate ratios (IRR) and hazard ratio (HR) were calculated with adjustments for covariates.<div class="boxTitle">Results</div>The study included 499 patients (97 HBMR, 402 no HBMR). Pharmacist-provided HBMR reduced readmissions by 26% (IRR = 0.74, 95% CI: 0.59–0.92, <span style="font-style:italic;">P</span> = 0.007), reduced ED visits by 20% (IRR = 0.80, 95% CI: 0.66–0.98, <span style="font-style:italic;">P</span> = 0.030) and increased outpatient visits by 16% (IRR = 1.16, 95% CI: 0.95–1.41, <span style="font-style:italic;">P</span> = 0.150). There were 8 and 44 deaths in the HBMR and no HBMR groups respectively (HR = 0.73, 95% CI: 0.29–1.81, <span style="font-style:italic;">P</span> = 0.492). Pharmacists identified 464 DRPs, with 169 (36.4%) resolved within 1 month after the home visit.<div class="boxTitle">Conclusions</div>The study suggests that pharmacist-provided HBMR is effective in reducing readmissions and ED visits in the elderly. More studies in the Asian population are needed to determine its long term benefits and patient's acceptability.</span>
      PubDate: 2016-12-29
  • Learning from the design, development and implementation of the Medication
           Safety Thermometer
    • Authors: Rostami P; Power M, Harrison A, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle"> </div><div class="boxTitle">Quality issue</div>Approximately 10% of patients are harmed by healthcare, and of this harm 15% is thought to be medication related. Despite this, medication safety data used for improvement purposes are not often routinely collected by healthcare organizations over time.<div class="boxTitle">Initial assessment</div>A need for a prospective medication safety measurement tool was identified.<div class="boxTitle">Choice of solution</div>The aim was to develop a tool to allow measurement and aid improvement of medication safety over time. The methodology used for the National Health Service (NHS) Safety Thermometer was identified as an approach. The resulting tool was named the ‘Medication Safety Thermometer’.<div class="boxTitle">Implementation</div>The development of the Medication Safety Thermometer was facilitated by a multidisciplinary steering group using a Plan, Do, Study, Act (PDSA) method. Alpha and beta testing occurred over a period of 9 months. The tool was officially launched in October 2013 and continued to be improved until May 2016 using ongoing user feedback.<div class="boxTitle">Evaluation</div>Feedback was gained through paper and online forms, and was discussed at regular steering group meetings. This resulted in 16 versions of the tool. The tool is now used nationally, with over 230 000 patients surveyed in over 100 NHS organizations. Data from these organizations are openly accessible on a dedicated website.<div class="boxTitle">Lessons learned</div>Measuring harm from medication errors is complex and requires steps to measure individual errors, triggers of harm and actual harm. PDSA methodology can be effectively used to develop measurement systems. Measurement at the point of care is beneficial and a multidisciplinary approach is vital.</span>
      PubDate: 2016-12-29
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
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