Hybrid journal (It can contain Open Access articles) ISSN (Print) 1353-4505 - ISSN (Online) 1464-3677 Published by Oxford University Press[406 journals]
Authors:Huang C; Daniels R, Lembo A, et al. Pages: 191 - 198 Abstract: ObjectiveIn this study, we aim to describe the post-sepsis syndrome from the perspective of the sepsis survivors.Design and SettingThe study is a prospective, observational online international survey.ParticipantsSepsis survivors enrolled via social media from 13 September 2014 to 13 September 2016.InterventionsNone.Main Outcome MeasuresPhysiologic, physical and psychological function post-sepsis; and patient satisfaction with sepsis-centered care.Results1731 completed surveys from 41 countries were analyzed, with 79.9% female respondents, age 47.6 ± 14.4 years. The majority of respondents (47.8%) had sepsis within the last year. Survivors reported an increase in sensory, integumentary, digestive, breathing, chest pain, kidney and musculoskeletal problems after sepsis (all P-value <0.0001). Physical functions such as daily chores, running errands, spelling, reading and reduced libido posed increased difficulty (all P-value <0.0001). Within 7 days prior to completing the survey, the survivors reported varying degrees of anxiety, depression, fatigue and sleep disturbance. Sepsis survivors reported dissatisfaction with a number of hospital support services, with up to 29.3% of respondents stating no social services support was provided for their condition.ConclusionsSepsis survivors suffer from a myriad of physiologic, physical and psychological challenges. Survivors overall reveal dissatisfaction with sepsis-related care, suggesting areas for improvement both in-hospital and post-discharge. PubDate: Mon, 15 Apr 2019 00:00:00 GMT DOI: 10.1093/intqhc/mzy137 Issue No:Vol. 31, No. 3 (2019)
Authors:Saluja S; Mukhopadhyay S, Amundson J, et al. Pages: 166 - 172 Abstract: PurposeQuality of care is an emerging area of focus in the surgical disciplines. However, much of the emphasis on quality is limited to high-income countries. To address this gap, we conducted a systematic review of the literature on the quality of essential surgical care in low- and middle- income countries (LMIC).Data sourcesWe searched PubMed, Cinahl, Embase and CAB s using three domains: quality of care, surgery and LMIC.Study selectionWe limited our review to studies of essential surgeries that pertained to all three search domains.Data extractionWe extracted data on study characteristics, type of surgery and the way in which quality was studied.Results of data synthesis354 studies were included. 281 (79.4%) were single-center studies and nearly half (n = 169, 46.9%) did not specify the level of facility. 207 studies reported on mortality (58.47%) and 325 reported on a morbidity (91.81%), most commonly surgical site infection (n = 190, 53.67%). Of the Institute of Medicine domains of quality, studies were most commonly of safety (n = 310, 87.57%) and effectiveness (n = 180, 50.85%) and least commonly of equity (n = 21, 5.93%).ConclusionWe find that while there are numerous studies that report on some aspects of quality of care, much of the data is single center and observational. Additionally, there is variability on which outcomes are reported both within and across specialties. Finally, we find under-reporting of parameters of equity and timeliness, which may be critical areas for research moving forward. PubDate: Wed, 18 Jul 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy141 Issue No:Vol. 31, No. 3 (2018)
Authors:Reed J; Green S, Howe C. Pages: 173 - 182 Abstract: PurposeAn increasing number of implementation and improvement frameworks seek to describe and explain how change is made in healthcare. This paper aims to explore how existing frameworks conceptualize the influence of complexity in translating evidence into practice in healthcare.Data sourcesA database was interrogated using a search strategy to identify publications that present frameworks and models for implementation and improvement.Study selectionTen popular implementation and improvement frameworks were purposively selected.Data extractionComparative analysis was conducted using an analytical framework derived from SHIFT-Evidence, a framework that conceptualizes complexity in implementation and improvement initiatives.ResultsCollectively the frameworks accounted for key concepts of translating evidence in complex systems: understanding the uniqueness of each setting; the interdependency of practices/processes and the need to respond to unpredictable events and emergent learning. The analysis highlighted heterogeneity of the frameworks in their focus on different aspects of complexity. Differences include the extent to which problems and solutions are investigated or assumed; whether endpoints are defined as the uptake of interventions or achievement of goals; and emphasis placed on fixed-term interventions versus continual improvement. None of the individual frameworks reviewed incorporated all the implications of complexity, as described by SHIFT-Evidence.ConclusionThis research identifies the differences in how implementation and improvement frameworks consider complexity, suggesting that SHIFT-Evidence offers a more comprehensive overview compared with the other frameworks. The similarity of concepts across the frameworks suggests growing consensus in the literature, with SHIFT-Evidence providing a conceptual bridge between the implementation and improvement fields. PubDate: Fri, 27 Jul 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy158 Issue No:Vol. 31, No. 3 (2018)
Authors:Rios-Zertuche D; Zúñiga-Brenes P, Palmisano E, et al. Pages: 183 - 190 Abstract: ObjectivePresent methods to measure standardized, replicable and comparable metrics to measure quality of medical care in low- and middle-income countries.DesignWe constructed quality indicators for maternal, neonatal and child care. To minimize reviewer judgment, we transformed criteria from check-lists into data points and decisions into conditional algorithms. Distinct criteria were established for each facility level and type of care. Indicators were linked to discharge diagnoses. We designed electronic abstraction tools using computer-assisted personal interviewing software.SettingWe present results for data collected in the poorest areas of Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and the state of Chiapas in Mexico (January—October 2014).ResultsWe collected data from 12 662 medical records. Indicators show variations of quality of care between and within countries. Routine interventions, such as quality antenatal care (ANC), immediate neonatal care and postpartum contraception, had low levels of compliance. Records that complied with quality ANC ranged from 68.8% [confidence interval (CI):64.5–72.9] in Costa Rica to 5.7% [CI:4.0–8.0] in Guatemala. Less than 25% of obstetric and neonatal complications were managed according to standards in all countries.ConclusionsOur study underscores that, with adequate resources and technical expertise, collecting data for quality indicators at scale in low- and middle-income countries is possible. Our indicators offer a comparable, replicable and standardized framework to identify variations on quality of care. The indicators and methods described are highly transferable and could be used to measure quality of care in other countries. PubDate: Mon, 18 Jun 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy136 Issue No:Vol. 31, No. 3 (2018)
Authors:Goetz K; Jossen M, Rosemann T, et al. Pages: 199 - 204 Abstract: ObjectiveThe study aimed to evaluate quality of care and to determine which aspects are associated with the willingness to recommend the general practitioner (GP) as a part of patient loyalty.DesignThis was an exploratory study which collected patient data from ambulatory care in the German part of Switzerland between 2013 and 2016.SettingPrimary care in Switzerland.ParticipantsIncluded patients from 79 primary care practices who volunteered to participate in the quality management system European Practice Assessment. Patients were afterwards asked to complete the European Task Force on Patient Evaluations of General Practice Care instrument.InterventionsDescribing influencing factors of quality of care on recommendation of the GP from the perspective of the patients.Main outcome measuresPatient perspective on quality of care.ResultsSurvey respondent rate was 81.3%. Over 69% of the respondents were willing to recommend their GP. ‘Listening to you’ (94.2%) and ‘interest in your personal situation’ (93.0%) as a part of the domain ‘relationship and communication’ were rated as the highest quality criteria. The lowest rate was found for ‘being able to speak to the GP on the telephone’ (30.0%) and ‘waiting time in the waiting room’ (50.6%). Patient loyalty, in terms of willingness to recommend the GP, was strongly associated with most of the items under the ‘relationship and communication’ section but also with having more physician’s assistants in the practice.ConclusionsThe results are important for understanding patients’ priorities with regard to general practice care. Patient assessment allows us to identify possible areas for quality improvement within the practice and could provide feedback. PubDate: Tue, 03 Jul 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy142 Issue No:Vol. 31, No. 3 (2018)
Authors:Doolan-Noble F; Barson S, Lyndon M, et al. Pages: 205 - 211 Abstract: ObjectiveTo establish aspirational ‘gold standards’ for a suite of System-Level Measures (SLMs) being used by Counties Manukau Health (CM Health), a New Zealand (NZ) District Health Board.DesignThis study employed a multi-stage, multi-method modified Delphi consensus process.SettingThe Delphi consensus process involved virtual (email) communication between participants (Round 1) and a structured face-to-face meeting (Round 2) held in Auckland, NZ.ParticipantsParticipants comprised of health professionals, managers, academics and quality improvement experts with an interest in the use of SLMs.InterventionsParticipants in the first round received a letter requesting their participation in an anonymous Delphi. The second round involved national and international health system experts taking part in a structured, facilitated face-to-face meeting. Participants reviewed 15 SLMs in total. The SLMs all related to the three domains of the Triple Aim: Population Health, e.g. life expectancy at birth; Patient Experience of Care, e.g. rate of adverse events; and Cost and Productivity, e.g. healthcare expenditure per capita.Main Outcome MeasuresFor a proposed gold standard to be agreed and established for each SLM.ResultsTwelve participants took part in Round 1, with 19 participating in Round 2. The process established agreement on a gold standard for each of the 15 reviewed SLMs.ConclusionWe demonstrated that the Delphi consensus process can be used to establish gold standards for a suite of SLMs used by a NZ Health Board (CM Health). PubDate: Fri, 08 Jun 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy122 Issue No:Vol. 31, No. 3 (2018)
Authors:Occelli P; Quenon J, Kret M, et al. Pages: 212 - 218 Abstract: ObjectiveTo assess the impact of a vignette-based analysis of adverse events (AEs) on the safety climate (SC) of care units.DesignProspective, open, cluster (a unit) randomised controlled trial.SettingEighteen acute care units of seven hospitals in France.ParticipantsHealthcare providers who worked in the units.InterventionVignette-based analyses of AEs were conducted with unit’s providers once per month for six consecutive months. The AEs were real cases that occurred in other hospitals. The hospital risk manager conducted each analysis as follows: analysis of the immediate and root causes of the AE; assessment of the care unit’s vulnerabilities and existing barriers in the occurrence of an identical AE and search for solutions.Main Outcome MeasureSC was measured using the French version of the Hospital Survey on Patient Safety Culture questionnaire. The primary outcome was the difference in the ‘Organisational learning and continuous improvement’ dimension score, from before to after the analyses.ResultsMedian participation rate in the analyses was 20% (range: 7–45%). Before intervention, the response rate to the SC survey was 80% (n = 210) in the intervention group and 73% (n = 191) in the control group. After intervention, it was 59% (n = 141) and 63% (n = 148), respectively. The dimension score evolved differently for the groups from before to after intervention (intervention: +10.2 points ±8.8; control: −3.0 points ±8.5, P = 0.04). Side effects were not measured.ConclusionsVignette-based analysis was associated with the improvement of the perception of participants regarding their institution’s capacity for organisational learning and continuous improvement. PubDate: Mon, 18 Jun 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy126 Issue No:Vol. 31, No. 3 (2018)
Authors:Berdot S; Korb-Savoldelli V, Jaccoulet E, et al. Pages: 219 - 224 Abstract: ObjectivesTo evaluate the return on investment (ROI) and quality improvement after implementation of a centralized automated-dispensing system after 8 years of use.DesignProspective evaluation of ROI; before and after study to evaluate dispensing errors; user satisfaction questionnaire after 8 years of use.SettingThe study was conducted at a French teaching hospital in the pharmacy department, which is equipped with decentralized automated medication cabinets in the wards.ParticipantsPharmacy staff (technicians and residents).Intervention(s)Implementation of a centralized automated-dispensing robot.Main Outcome Measure(s)The true ROI was prospectively and annually compared to estimated returns calculated after implementation and upgrade of the robot; dispensing errors determined by observation of global deliveries and the satisfaction of users based on a validated questionnaire were evaluated.ResultsFollowing the upgrade, we found little difference for the ROI (+1.86%). The payback period increased by almost 3 years. There was a significant reduction of dispensing errors, from 2.9% to 1.7% (P < 0.001). User satisfaction of the robot by the pharmacy staff was reported (score of 5.52 ± 1.20 out of 7).ConclusionsThese systems are worthwhile investments and largely contribute to improving the quality and safety of the medication process. PubDate: Wed, 11 Jul 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy152 Issue No:Vol. 31, No. 3 (2018)
Authors:Berdot S; Blanc C, Chevalier D, et al. Pages: 225 - 230 Abstract: ObjectiveTo compare the costs and benefits of an automated-drug dispensing cabinet (ADC) versus traditional floor stock storage (TFSS).DesignA quasi-experimental multicenter study conducted during 2015.SettingA teaching hospital (814 beds) equipped with 43 ADCs and a not-for-profit teaching hospital (643 beds) equipped with 38 TFSS systems, in Paris, France.ParticipantsAll the wards of the two hospitals were included in the study.Intervention(s)ADC versus TFSS.Main Outcome Measure(s)A composite outcome composed of cost and benefits.ResultsThe total cost with payback period was substantially higher for the ADCs (574 006€ for 41 ADCs) than TFSS (190 305€ for 30 TFSS systems). The mean number of costly drugs and units were significantly higher for ADCs (P < 0.001). There was no significant difference in the mean number of overall drugs and units. There were significantly fewer urgent global deliveries with ADCs than TFSS units. Nurses’ satisfaction with ADCs was high and the prevalence of medication process errors related to ADCs was low. No event due to storage errors was reported for ADCs and nine events were reported for TFSS units. On the contrary, informatic-related events increased with the use of ADCs, as expected.ConclusionsOverall, ADCs are well-established in wards and are particularly appreciated by nurses. A significant difference in the initial investment cost was confirmed, but it must be adjusted over time. This difference is offset in the long-term by gains in preparation time and fewer medication process errors, securing the medication process. PubDate: Wed, 18 Jul 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy155 Issue No:Vol. 31, No. 3 (2018)
Authors:Hanaoka S; Matsumoto K, Kitazawa T, et al. Pages: 231 - 237 Abstract: ObjectiveTo analyze the chronological change in social burden of dementia in Japan for policy implications of appropriate resource allocation and quality improvement.DesignNational, population-based, observational study from 2002 to 2014.SettingSeven nationwide data sets from Japanese official statistics.MethodComprehensive Cost of Illness method.Main outcome measuresThe outcome variables included healthcare services, nursing care services, informal care (unpaid care offered by family and relatives), mortality cost and morbidity cost.ResultsThe number of patients with dementia increased 2.50 times from 0.42 million in 2002 to 1.05 million in 2014. While the number of patients living in homes and communities increased by 3.22 times that of patients living in nursing care facilities increased by 1.42 times. The total social burden increased 2.06–2.27 times from JPY 1.84–2.42 to 3.79–5.51 trillion (JPY 1 trillion = US$ 100 billion). Regarding the total burden, the proportion of informal care provided increased from 36.6–51.9% to 37.7–57.2%. Furthermore, the proportion of primary caretakers aged ≥70 years increased from 27.6% to 37.6%.ConclusionsOwing to the promotion of ‘Deinstitutionalization’ (shift of nursing care site from in-facilities to in-home and in-community), ‘Elderly care by the elderly,’ and ‘Earlier diagnosis of dementia,’ the average cost per patient reduced by 0.82–0.91 times from JPY 4.37–5.77 to 3.60–5.24 million. Therefore, the management of informal care in a manner that does not exceed the acceptable limit of the patients’ caretakers, while maintaining patient safety and quality of care, is imperative. PubDate: Sat, 29 Sep 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy176 Issue No:Vol. 31, No. 3 (2018)
Authors:Reed J; Howe C, Doyle C, et al. Pages: 238 - 244 Abstract: BackgroundEvidence translation and improvement research indicate that healthcare contexts are complex systems, characterized by uncertainty and surprise, which often defy orchestrated intervention attempts. This article reflects on the implications of complexity on attempts to translate evidence, and on a newly published framework for Successful Healthcare Improvements From Translating Evidence in complex systems (SHIFT-Evidence).DiscussionSHIFT-Evidence positions the challenge of evidence translation within the complex and evolving context of healthcare, and recognizes the wider issues practitioners routinely face. It is empirically grounded, and designed to be comprehensive, practically relevant and actionable. SHIFT-evidence is summarized by three principles designed to be intuitive and memorable: ‘act scientifically and pragmatically’; ‘embrace complexity’; and ‘engage and empower’. Common challenges and strategies to overcome them are summarized in 12 ‘simple rules’ that provide actionable guidance.ConclusionSHIFT-Evidence provides a practical tool to guide practice and research of evidence translation and improvement within complex dynamic healthcare settings. Implications are that improvement initiatives and research study designs need to take into account the unique initial conditions in each local setting; conduct needs to respond to unpredictable effects and address dependent problems; and evaluation needs to be sensitive to evolving priorities and the emergent range of activities required to achieve improvement. PubDate: Sat, 04 Aug 2018 00:00:00 GMT DOI: 10.1093/intqhc/mzy160 Issue No:Vol. 31, No. 3 (2018)
Hybrid journal (It can contain Open Access articles)
[406 journals]
