Hybrid journal (It can contain Open Access articles) ISSN (Print) 1353-4505 - ISSN (Online) 1464-3677 Published by Oxford University Press[406 journals]
Authors:Hillen J; Vitry A, Caughey G. Pages: 298 - 306 Abstract: ObjectiveTo describe medication-related quality of care (MRQOC) for Australian aged care residents.DesignRetrospective cohort using an administrative healthcare claims database.SettingAustralian residential aged care.ParticipantsA total of 17 672 aged care residents who were alive at 1 January 2013 and had been a permanent resident for at least 3 months.Main outcome measuresOverall, 23 evidence-based MRQOC indicators which assessed the use of appropriate medications in chronic disease, exposure to high-risk medications and access to collaborative health services.ResultsKey findings included underuse of recommended cardiovascular medications, such as the use of statins in cardiovascular disease (56.1%). Overuse of high-risk medications was detected for medications associated with falls (73.5%), medications with moderate to strong anticholinergic properties (46.1%), benzodiazepines (41.4%) and antipsychotics (33.2%). Collaborative health services such as medication reviews were underutilised (42.6%).ConclusionMRQOC activities in this population should be targeted at monitoring and reducing exposure to antipsychotics and benzodiazepines, improving the use of preventative medications for cardiovascular disease and improving access to collaborative health services. Similarity of suboptimal MRQOC between Australia and other countries (UK, USA, Canada and Belgium) presents an opportunity for an internationally collaborative approach to improving care for aged care residents. PubDate: Wed, 15 May 2019 00:00:00 GMT DOI: 10.1093/intqhc/mzy164 Issue No:Vol. 31, No. 4 (2019)
Authors:Aron D; Tseng C, Soroka O, et al. Pages: 246 - 251 Abstract: ObjectiveTo determine if changes in overtreatment rates were associated with changes in undertreatment rates.DesignPre-test/post-test study used cross-sectional administrative data from calendar years (CYs) 2013 and 2016.SettingThe Veterans Health Administration.ParticipantsPatients with diabetes at risk for hypoglycemia (n = 171 875 and 166 703 in 2013 and 2016, respectively).InterventionObservational study of extant initiatives to reduce overtreatment.Main Outcome MeasuresOvertreatment rate of diabetes defined at the proportion of patients in the group at high risk for hypoglycemia with A1c < 7.0%. Undertreatment defined as A1C > 9%.ResultsThere was marked variation in overtreatment rates; for A1c < 7%, overtreatment rates ranged from 26.4% to 58.2% and 26.2% to 49.2% at the facility level in 2013 and 2016, respectively. The mean (±standard deviation (SD)) facility-level overtreatment rates fell from 40.3 (±5.3)% in 2013 to 37.75 (±4.70)% in 2016 (P < 0.001, paired t-test). Facility undertreatment rates ranged from 5.8% to 16.9% and 6.8% to 18.7% at the facility level in 2013 and 2016, respectively. The mean (±SD) undertreatment rate rose from 10.3 (±2.2)% in 2013 to 11.0 (±2.4)% in 2016 (P ≤ 0.001, paired t-test). However, change at individual facilities ranged from a decrease of 4.6% to an increase of 7.2%. Within year correlations were stronger than between year correlations. Overtreatment defined as A1c < 7 in this population inversely correlated strongly with undertreatment (r = −0.653, P < 0.001).ConclusionsPromotion of overtreatment reduction may be associated with an increase in undertreatment in patients with diabetes. Unintended consequence should be considered when implementing and evaluating quality measures and systems should include balancing measures to identify potential unintended harms. PubDate: Fri, 20 Jul 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy151 Issue No:Vol. 31, No. 4 (2018)
Authors:Wang Y; Lee Y, Lee W, et al. Pages: 252 - 260 Abstract: ObjectiveTo analyze the effects of chronic kidney disease (CKD) care programs on clinical outcomes.DesignAn observational, retrospective study with medical record review.SettingKaohsiung Chang Gung Memorial Hospital.ParticipantsPatients diagnosed with CKD.InterventionsCKD care programs conducted by nephrologists-based team from 2006 to 2013 in our hospital.Main Outcome MeasuresWe set 10 goals with treatment target ranges based on the guidelines suggested by the following organizations: Kidney Disease Improving Global Outcomes (2012) and the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (2003).ResultsIn total, 1486 patients were enrolled. Their average estimated glomerular filtration rate (ml/min/1.73 m2) was 31.9 at baseline and declined to 28.9 in Year 3 (P < 0.001). The all-goals attainment rate increased from 59.4% at baseline to 60.5% in Year 3, with an especially significant improvement for low-density lipoprotein (from 46.8% to 67.0%) and glycated hemoglobin (from 55.0% to 64.0%). Achievement rates decreased for hemoglobin (from 34.2% to 31.0%), calcium (from 94.6% to 92.3%) and phosphate (from 89.9% to 82.5%) between baseline and Year 3. Albuminuria was the least achieved goal (from 23.4% to 24.0%). Subgroup analysis revealed that estimated glomerular filtration rate did not decline in patients who had a good achievement rate, but decreased significantly in patients with a poor achievement rate.ConclusionEnrolment in CKD care programs resulted in a significant improvement in goal attainment by patients. Further, a good achievement rate was associated with better preservation of residual renal function. PubDate: Fri, 27 Jul 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy161 Issue No:Vol. 31, No. 4 (2018)
Authors:Kagan I; Porat N, Barnoy S. Pages: 261 - 268 Abstract: ObjectiveTo explore the disparities between patients’ and health care workers’ perception of the quality and safety culture and to explore the relationship between patient perceptions, and engagement in, and satisfaction with their care and treatment.DesignA cross-sectional study was conducted in medical–surgical wards of four Israeli general hospitals. Data were collected using a self-administered questionnaire.SettingFourteen medical–surgical wards of the four hospitals where data were collected.ParticipantsThe sample comprised of 390 physicians and nurses and 726 inpatients admitted for at least 3 days.Main outcome measuresA self-administered questionnaire that covered the following topics: (i) quality and safety culture, (ii) patient engagement, (iii) patient satisfaction, (iv) an assessment of the care quality and safety in the ward and (v) sociodemographic data. The questionnaire was translated into Arabic and Russian. Sixty nine items were directed to the staff and 71 to patients.ResultsPatients evaluated the quality and safety culture significantly higher than did the health care workers. Significant correlations were found between patients’ engagement in and satisfaction with their care and their quality and safety assessments. Their evaluation of this culture was the only predictor of their satisfaction and engagement. Arabic-speaking patients rated four variables, including patients’ satisfaction with their care, lower than did Hebrew and Russian speakers.ConclusionsPatients have sufficient experience and understanding to form an opinion of the quality and safety of their care. The lower evaluation of the quality and safety culture expressed by health care workers might stem from their more realistic expectations. PubDate: Thu, 21 Jun 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy138 Issue No:Vol. 31, No. 4 (2018)
Authors:Kiselev A; Korotin A, Posnenkova O, et al. Pages: 269 - 275 Abstract: ObjectiveIn European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines, six indications have been proposed for making a decision on myocardial revascularization in patients with stable coronary artery disease (CAD). Our aim was to study a discrepancy between the actual clinical situation and ESC/EACTS indications on performing the revascularization in patients with CAD in Russia.Design and settingWe used retrospective clinical data on patients with stable CAD enrolled in the 2012–2015 Russian Registry of Hypertension, Coronary Artery Disease, and Chronic Heart Failure.ParticipantsA total of 1522 patients with CAD (aged 53.0 ± 8.5 years, 76.2% male) were used for analysis.InterventionsAll patients were divided into two groups: 591 patients with performed myocardial revascularization (named as R-CAD) and 931 patients refused from revascularization (named as NR-CAD). Factors associated with revascularization performance were identified by discriminant function analysis.Main outcome measuresESC/EACTS indications for revascularization were assessed.ResultsA total of 1196 patients with CAD had any ESC/EACTS indication for revascularization, but only 40.2% of them had performed invasive coronary intervention. Myocardial revascularization was appropriate in 81.4% of R-CAD patients and 76.8% of NR-CAD patients. The main factor of revascularization performance was any stenosis >50% and grades III–IV of stable angina. With non-performed revascularization, the following factors were associated: limiting angina or angina equivalent, unresponsive to medical therapy, atherosclerotic peripheral arterial disease and increasing the New York Heart Association class of chronic heart failure. Most ESC/EACTS indications had little effect on decision-making on revascularization.ConclusionThere is a discrepancy between the actual clinical situation and ESC/EACTS guidelines on myocardial revascularization in patients with stable CAD in Russia. PubDate: Tue, 19 Jun 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy140 Issue No:Vol. 31, No. 4 (2018)
Authors:Mesterton J; Brommels M, Ladfors L, et al. Pages: 276 - 282 Abstract: ObjectiveThe objective of this study was to estimate case mix adjusted variations in central indicators of health outcomes in childbirth care and to assess whether hospitals who perform well on one indicator also perform well on others.DesignRegister-based study using regional administrative data, linked to clinical data and population data.SettingTwenty-one hospitals in seven Swedish regions covering 67% of deliveries in Sweden.ParticipantsThe study included 139 756 women who gave birth in 2011 and 2012.Intervention(s)N/A.Main Outcome Measure(s)Four indicators of health outcomes were studied: obstetric anal sphincter injuries (OASIS), haemorrhage >1000 ml, postpartum infection and Apgar <4 at 5 min. Variations between hospitals were estimated using fixed effects logistic regression, adjusted for numerous sociodemographic and clinical characteristics.ResultsSignificant variations after case mix adjustment were observed for all four indicators. If all hospitals had performed as the average of the top five hospitals for each indicator, a total of 890 OASIS, 2700 haemorrhages, 1500 postpartum infections and 180 instances of low Apgar would have been avoided. A certain degree of correlation was observed between different indicators of outcomes. However, no hospital had a statistically significant higher or lower rate across all four indicators of health outcomes.ConclusionsThe significant variations in all four indicators demonstrate a potential for improvement in performance at all studied hospitals. Hospital performance was not consistent across different indicators of outcomes and all hospitals have potential for improvement in certain aspects of labour management. PubDate: Thu, 19 Jul 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy153 Issue No:Vol. 31, No. 4 (2018)
Authors:Armfield N; Janda M, Obermair A. Pages: 283 - 288 Abstract: ObjectiveTo explore relationships between BMI (morbid/severe obesity; BMI ≥ 35 kg/m2 vs. non morbid/severe obesity; BMI < 35 kg/m2), postoperative health gain and hospital resource use for women who receive a Total Laparoscopic Hysterectomy (TLH) for early stage endometrial cancer.DesignSecondary analysis of RCT data (LACE Study; Total Abdominal Hysterectomy vs. TLH).Setting20 tertiary gynaecological cancer centres in Australia, New Zealand and Hong Kong.PopulationAbout 404 women who received TLH to treat early stage endometrial cancer.MethodsFor women with BMI < 35 vs. BMI ≥ 35 kg/m2, we compared (i) postoperative health gain, using utility scores derived from responses to the EQ-5D-3L health-related quality of life instrument, and (ii) inpatient hospital resource use, using adverse events, surgery duration and postoperative length of stay as indicators, to 6 months post-surgeryMain Outcome MeasuresHealth gain, resource use.ResultsMean postoperative health gain was 0.07 units, and did not vary by BMI. Women with a BMI ≥ 35 had an increased rate of severe postoperative AEs (BMI ≥ 35 RR = 1.95, P = 0.02), and the surgery took on average 9.6 min longer (BMI < 35 kg/m2 122.5 min 95% CI 117.4–127.8; BMI ≥ 35 kg/m2 132.1 min 95% CI 126.3–138.2; P = 0.02).ConclusionWhile postoperative health gain for women with BMI ≥ 35 was similar to that of women with lower BMI, the gain was achieved at the expense of greater resource use. Further work could definitively quantify the excess cost of TLH for obese patients with endometrial cancer, and investigate the potential for non-surgical treatment options, at least for those women at high risk of postoperative AEs. PubDate: Fri, 27 Jul 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy162 Issue No:Vol. 31, No. 4 (2018)
Authors:Kosilov K; Loparev S, Kuzina I, et al. Pages: 289 - 297 Abstract: ObjectiveTo study the effect of socioeconomic status (SES) on health-related quality of life (HRQoL) among persons with overactive bladder (OAB).DesignA randomized HRQoL study was conducted from the year 2014 until the year 2016 based on the OAB pathology department of the regional clinical diagnostics center.SettingThe medical institutions where the study was conducted had outpatient care.ParticipantsThe simple response frequency was 81%. A total of 1893 men and women with OAB aged 35–85 (average 58.3 years) were selected by blind random sampling. Included into the group of examined individuals were persons who diagnosis provided after the examination was OAB.InterventionEvaluation of HRQoL was conducted using the SF-6D questionnaire. The OAB diagnosis was confirmed using the OAB-questionnaire and uroflowmetry.Main outcome measure(s)We hypothesized that the impact of SES on the HRQoL of patients with OAB has significant features.ResultsDescribed for the first time were HRQoL measures in various SES levels within different ages of people suffering from OAB. The strongest relationship was identified between education level, professional activity and HRQoL measures; meanwhile the weakest relationship was between income and HRQoL measures. We also confirmed the efficiency of evaluating HRQoL while using SF-6D and SRH as an external standard.ConclusionThe improvement of HRQoL in persons with OAB is contingent upon increment in their level of awareness about the methods of OAB treatment and the effectiveness of treatment for severe symptoms of LUT pathology, increased social support and, possibly, physical activity. PubDate: Sat, 11 Aug 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy163 Issue No:Vol. 31, No. 4 (2018)
Authors:Haragus H; Deleanu B, Prejbeanu R, et al. Pages: 307 - 311 Abstract: ObjectivePerform translation, cultural adaptation and psychometric testing of the Romanian translation of the Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS_JR).DesignAssess construct validity, reliability, internal consistency and reproducibility.SettingAdults with chronic hip disability prior or at a minimum of 3 months after surgery.ParticipantsNinety-six patients (22 bilateral) with hip osteoarthritis or who had previous hip replacement or osteosynthesis for a fracture of the trochanteric region.InterventionComplete the HOOS_JR together with the Oxford Hip Score (OHS_RO), Harris Hip Score (HHS) and Euroqol EQ-5D. 57 patients repeated the HOOS_JR after 2 days.Main Outcome MeasureConvergent validity using Spearmans’s correlation coefficient; Cronbach’s alpha coefficient, intraclass correlation coefficient (ICC, two-way mixed effects model) and inter-item correlation matrix and test–retest assessment after 2 days.ResultsThe questionnaire had a high degree of reliability with a Cronbach’s α of 0.923 at the initial completion and 0.924 at the second testing. The ICC was 0.923 for average measures for the first form and 0.910 for the second form. The two results were strongly, positively and significantly correlated (rs = 0.859; P < 0.001). The Romanian HOOS_JR strongly, significantly and positively correlated with the OHS_RO (rs = −0.880 initial and rs = −0.803 s; P < 0.001) and HHS (rs = −0.731 initial and rs = −0.654 s; P < 0.001) and moderately, significantly and positively correlated with the EQ-5D Index (rs = −0.580 initial and rs = −0.542 s; P < 0.001) and VAS (rs = −0.500 initial and rs = −0.690 s; P < 0.001).ConclusionsThe translated HOOS_JR is a reliable, reproducible and valid measure of function in patients with chronic hip disability. PubDate: Fri, 20 Jul 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy156 Issue No:Vol. 31, No. 4 (2018)
Authors:Alves S; Teixeira L, Azevedo M, et al. Pages: 312 - 318 Abstract: ObjectiveTo examine the unmet needs of older clients with perceived mental health problems who attend primary healthcare services.DesignUnmet needs were derived from (i) the health concerns and caregiver network availability provided by a General Practitioner (GPs) and from (ii) a qualitative analysis of an open question about needs completed by informal caregivers (ICs) of those clients.ParticipantsThe sample comprised 436 clients with mean age of 75.2 years and 110 ICs with mean age of 56.7 years.SettingPrimary healthcare centers in the North of Portugal.Main outcome measureThe Community Assessment of Risk Instrument—CARI (Clarnette RM, Ryan JP, O’Herlihy E, et al. The community assessment of risk instrument: investigation of inter-rater reliability of an instrument measuring risk of adverse outcomes. J Frailty Aging 2015;4: 80-9; O’Caoimh R, Healy E, Connell EO, et al. The Community Assessment of Risk Tool (CART): investigation of inter-rater reliability for a new instrument measuring risk of adverse outcomes in community dwelling older adults. Irish J Med Sci 2012.) and qualitative data about needs.ResultsSeveral needs were observed in relation to (1) mental state (e.g. cognition, anxiety/depression); (2) functionality (e.g. IADLS, bathing, mobility); (3) medical state (e.g. chronic diseases, vision deficits) and (4) IC ability to meet clients’ needs. From the categorical analysis of the ICs’ answers, an amount of unmet needs not only health related but also related with referrals and legal issues were found.ConclusionsThis study shows a large number of unmet needs of older people. The evaluation of the clients combined with the evaluation of the testimonials of ICs enables the understanding of difficulties of both clients and caregivers, and which needs should be prioritized. PubDate: Wed, 18 Jul 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy154 Issue No:Vol. 31, No. 4 (2018)
Authors:Klemenc-Ketis Z; Švab I, Stepanović A, et al. Pages: 319 - 322 Abstract: In Slovenia, quality of care at the primary healthcare level is formally a priority, but the legislation to ensure quality in this area is proceeding very slowly. The first steps towards a systematic quality control system in Slovenian family medicine were implemented with the initiation of an ongoing project of renewed family medicine practices in 2011 and the introduction of quality indicators. In 2017, an initiative by the Ministry of Health and the Department of Family Medicine at the Faculty of Medicine, the University of Ljubljana, aimed to develop a new approach to quality assurance and an improvement. It comprises four main parts: the family medicine practice team, a quality control group, a quality control office and the Ministry of Health. In this plan, quality is controlled and improved at the micro, mezzo and macro levels.The described system for quality assurance and improvement is still waiting to be implemented in practice, as there is a lack of human and financial resources. PubDate: Fri, 13 Jul 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy157 Issue No:Vol. 31, No. 4 (2018)
Hybrid journal (It can contain Open Access articles)
[406 journals]
