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Showing 1 - 200 of 369 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: 79, 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: 5)
American Historical Review     Hybrid Journal   (Followers: 120, 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: 146, SJR: 3.047, h-index: 201)
American J. of Hypertension     Hybrid Journal   (Followers: 19, 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: 23)
Annals of Botany     Hybrid Journal   (Followers: 33, SJR: 1.912, h-index: 124)
Annals of Occupational Hygiene     Hybrid Journal   (Followers: 24, 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: 9, 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: 18, 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: 25, 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: 46, SJR: 0.144, h-index: 15)
Behavioral Ecology     Hybrid Journal   (Followers: 47, SJR: 1.698, h-index: 92)
Bioinformatics     Hybrid Journal   (Followers: 222, SJR: 4.643, h-index: 271)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 10, SJR: 1.646, h-index: 149)
Biometrika     Hybrid Journal   (Followers: 18, 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: 15, SJR: 1.955, h-index: 55)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 132, 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: 43, 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: 32, SJR: 1.267, h-index: 38)
British J. of Aesthetics     Hybrid Journal   (Followers: 24, SJR: 0.217, h-index: 18)
British J. of Criminology     Hybrid Journal   (Followers: 489, SJR: 1.373, h-index: 62)
British J. of Social Work     Hybrid Journal   (Followers: 77, 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: 55, 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: 37, SJR: 4.827, h-index: 192)
CESifo Economic Studies     Hybrid Journal   (Followers: 15, SJR: 0.501, h-index: 19)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.436, h-index: 76)
Children and Schools     Hybrid Journal   (Followers: 5, 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: 58, 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: 23, SJR: 0.47, h-index: 28)
Computer J.     Hybrid Journal   (Followers: 8, SJR: 0.371, h-index: 47)
Conservation Physiology     Open Access   (Followers: 1)
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: 2)
Early Music     Hybrid Journal   (Followers: 13, SJR: 0.124, h-index: 11)
Economic Policy     Hybrid Journal   (Followers: 47, SJR: 2.052, h-index: 52)
ELT J.     Hybrid Journal   (Followers: 25, SJR: 1.26, h-index: 23)
English Historical Review     Hybrid Journal   (Followers: 45, 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: 1, 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: 46, 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: 141, 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: 25, 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: 19, SJR: 1.126, h-index: 118)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 24, 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: 17, 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: 29, 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: 24, 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: 46, 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: 19, SJR: 0.664, h-index: 60)
History Workshop J.     Hybrid Journal   (Followers: 25, SJR: 0.313, h-index: 20)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 22, SJR: 0.115, h-index: 13)
Human Molecular Genetics     Hybrid Journal   (Followers: 10, SJR: 4.288, h-index: 233)
Human Reproduction     Hybrid Journal   (Followers: 74, SJR: 2.271, h-index: 179)
Human Reproduction Update     Hybrid Journal   (Followers: 15, SJR: 4.678, h-index: 128)
Human Rights Law Review     Hybrid Journal   (Followers: 60, SJR: 0.7, h-index: 21)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 53, SJR: 1.233, h-index: 88)
ICSID Review     Hybrid Journal   (Followers: 8)
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: 7, 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. Data Privacy Law     Hybrid Journal   (Followers: 27)
Intl. Health     Hybrid Journal   (Followers: 4, SJR: 0.835, h-index: 15)
Intl. Immunology     Hybrid Journal   (Followers: 4, 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: 50, SJR: 0.613, h-index: 19)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 115, 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: 18, 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: 4, 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: 34, SJR: 0.231, h-index: 21)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 13, SJR: 0.833, h-index: 12)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.052, h-index: 42)
Intl. Mathematics Research Surveys - advance access     Hybrid Journal  
Intl. Political Sociology     Hybrid Journal   (Followers: 24, 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: 33, 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: 38, 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: 20, 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: 43, SJR: 1.341, h-index: 96)
J. of Chromatographic Science     Hybrid Journal   (Followers: 18, SJR: 0.448, h-index: 42)
J. of Church and State     Hybrid Journal   (Followers: 11, SJR: 0.167, h-index: 11)
J. of Competition Law and Economics     Hybrid Journal   (Followers: 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: 38, 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: 2)
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: 32, SJR: 2.909, h-index: 69)
J. of Environmental Law     Hybrid Journal   (Followers: 25, SJR: 0.457, h-index: 20)
J. of European Competition Law & Practice     Hybrid Journal   (Followers: 19)
J. of Experimental Botany     Hybrid Journal   (Followers: 13, 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: 21, SJR: 0.399, h-index: 10)
J. of Infectious Diseases     Hybrid Journal   (Followers: 39, SJR: 4, h-index: 209)
J. of Insect Science     Open Access   (Followers: 9, SJR: 0.388, h-index: 31)

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Journal Cover International Journal for Quality in Health Care
  [SJR: 1.593]   [H-I: 69]   [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  [369 journals]
  • Simplified Chinese Abstracts *
    • PubDate: 2017-02-01
  • Abstracts en este número *
    • PubDate: 2017-02-01
  • Traditional Chinese Abstracts *
    • PubDate: 2017-02-01
  • Resumos neste número *
    • PubDate: 2017-02-01
  • French Abstracts *
    • PubDate: 2017-02-01
  • Japanese Abstracts *
    • PubDate: 2017-02-01
  • Performance measures, perceptions of quality and safety, and experience of
           adverse events
    • Authors: Iqbal U; Li Y.
      PubDate: 2017-02-01
  • Metafrontier frameworks for studying hospital productivity growth and
           quality changes
    • Authors: Chen K; Chien L, Hsu Y, et al.
      Abstract: AbstractObjectiveThe objective of this study was to evaluate productivity growth and quality changes among different levels of accredited hospitals.DesignThis study used an attribute-incorporating Malmquist productivity index (MPI) under the metafrontier framework. This is the first attempt to compare productivity changes among hospitals operating under different production frontiers.ParticipantsThe data consisted of 20 academic medical centers (AMCs), 61 metropolitan hospitals (MPs) and 112 local community hospitals (LCs) in Taiwan during the period 2007–2010.Main outcome measuresThis study measured productivity growth and further identified technological gaps and catch-ups in different groups of hospitals with respect to the metafrontier. At the same time, comparisons of changes in quality among different levels of hospitals were also examined.ResultsWe found that the sample hospitals of AMCs and MPs experienced productivity improvements mainly due to technological progress, but their efficiency and technology gap ratio (TGR) deteriorated. As for LCs, progress in technology along with improvements in their efficiency and TGR led to the highest productivity upgrade among the three groups of hospitals. We also found that the sample hospitals among the three groups showed improvements in quality. Moreover, hospitals in the local community group exhibited greater quality progress than the AMCs and MPs over the sample period.ConclusionThis paper presents a number of useful decompositions of the metafrontier MPI, which can provide useful insights into changes that are due to efficiency, quality improvements and/or technological changes in the healthcare sector.
      PubDate: 2017-02-01
  • Measuring inequality in physician distributions using spatially adjusted
           Gini coefficients
    • Authors: Hsu Y; Lin W, Tien JJ, et al.
      Abstract: AbstractObjectiveTo measure inequality in physician distributions using Gini coefficient and spatially adjusted Gini coefficients.DesignMeasurements were based on the distribution of physician data from the Taiwan National Health Insurance Research Database (NHIRD) and population data from the Ministry of the Interior in Taiwan.SettingsThe distribution of population and physicians in Taiwan from 2001 to 2010.ParticipantsThis study considered 35 000 physicians who are registered in Taiwan.Main Outcome MeasuresTo calculate the Gini coefficient and spatially adjusted Gini coefficients in Taiwan from 2001 to 2010.ResultsThe Gini coefficient for each year, from 2001 to 2010, ranged from 0.5128 to 0.4692, while the spatially adjusted Gini coefficients based on travel time and travel distance ranged, respectively, from 0.4324 to 0.4066 and from 0.4408 to 0.4178. We found that, in each year, irrespective of the type of spatial adjustment, the spatially adjusted Gini coefficient was smaller than the Gini coefficient itself. Our empirical findings support that the Gini coefficient may overestimate the maldistribution of physicians.ConclusionsOur simulations demonstrate that increasing the number of physicians in medium-sized cities (such as capitals of counties or provinces), and/or improving the transportation time between medium-sized cities and rural areas, could be feasible solutions to mitigate the problem of geographical maldistribution of physicians.
      PubDate: 2017-02-01
  • Building bridges: engaging medical residents in quality improvement and
           medical leadership
    • Authors: Voogt JJ; van Rensen EJ, van der Schaaf MF, et al.
      Abstract: AbstractObjectiveTo develop an educational intervention that targets residents’ beliefs and attitudes to quality Improvement (QI) and leadership in order to demonstrate proactive behaviour.DesignTheory-driven, mixed methods study including document analysis, interviews, observations and open-ended questionnaires.SettingSix Dutch teaching hospitals.InterventionUsing expertise from medicine, psychology, organizational and educational sciences we developed a situated learning programme named Ponder and IMProve (PIMP). The acronym PIMP reflects the original upbeat name in Dutch, Verwonder & Verbeter. It has a modern, positive meaning that relates to improving your current circumstances. In quarterly 1-h sessions residents are challenged to identify daily workplace frustrations and translate them into small-scale QI activities.Main outcome measuresOrganizational awareness, beliefs and attitudes to QI and organizational responsibilities, resident behaviour, barriers and facilitators to successful learning and the programme's potential impact on the organization.ResultsOverall, 19 PIMP meetings were held over a period of 3 years. Residents defined 119 PIMP goals, resolved 37 projects and are currently working on another 39 projects. Interviews show that PIMP sessions make residents more aware of the organizational aspects of their daily work. Moreover, residents feel empowered to take up the role of change agent. Facilitators for success include a positive cost-benefit trade-off, a valuable group process and a safe learning environment.ConclusionThis article demonstrates the added value of multidisciplinary theory-driven research for the design, development and evaluation of educational programmes. Residents can be encouraged to develop organizational awareness and reshape their daily frustrations in QI work.
      PubDate: 2017-02-01
  • Patient experience assessment in pediatric hospitals in Argentina
    • Authors: Dackiewicz N; Rodriguez S, Irazola V, et al.
      Abstract: AbstractObjectiveTo create a hospital pediatric inpatient experience survey based on the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (CAHPS® Hospital Survey).DesignSurvey development based on: (i) Translation and back translation, (ii) Review by experts, (iii) Cultural adaptation: qualitative evaluation of dimensions with reformulation and adaptation of items, (iv) Local cognitive evaluation and (v) Final measurement of its psychometric properties. Inspection, content validity and reliability assessment through internal consistency (Cronbach's alpha coefficient) and inter-item correlation. Factor analysis matrix: extraction, selection and rotation.SettingTwo pediatric hospitals in Buenos Aires, Argentina: Hospital de Pediatría ‘Garrahan’ (HG) and Hospital de Niños ‘Ricardo Gutiérrez’ (HRG).ParticipantsParents or caregivers of pediatric patients hospitalized for at least 24 h.ResultsA feasible and easy to administer 21-item instrument was developed. One thousand and thirty-two surveys were analyzed, 630 (61%) in HG and 402 (39%) in HRG. Population: mothers of admitted children were interviewed 85% of the time, 61% (625) had completed minor schooling to high school education; 365 families (35%) had unsatisfied basic needs and 51% (529) did not have health insurance. Reliability: adequate Cronbach's alpha scores were found with correlation 0.7 or higher in most domains. Validity: a direct correlation was observed between overall positive opinion and quality of care perceived with the survey, and an indirect correlation (perceived low quality) with higher level of schooling and health insurance ownership.ConclusionAn instrument with adequate psychometric properties was adapted to evaluate patients and families’ perceptions of quality of care received during children's hospitalization.
      PubDate: 2017-02-01
  • Providing antenatal corticosteroids for preterm birth: a quality
           improvement initiative in Cambodia and the Philippines
    • Authors: Smith J; Gupta S, Williams E, et al.
      Abstract: AbstractObjectiveTo determine whether a simple quality improvement initiative consisting of a technical update and regular audit and feedback sessions will result in increased use of antenatal corticosteroids among pregnant women at risk of imminent preterm birth delivering at health facilities in the Philippines and Cambodia.DesignNon-randomized, observational study using a pre-/post-intervention design conducted between October 2013 and June 2014.SettingA total of 12 high volume facilities providing Emergency Obstetric and Newborn Care services in Cambodia (6) and Philippines (6).InterventionA technical update on preterm birth and use of antenatal corticosteroids, followed by monthly audit and feedback sessions.Main Outcome MeasureThe proportion of women at risk of imminent preterm birth who received at least one dose of dexamethasone.ResultsCoverage of at least one dose of dexamethasone increased from 35% at baseline to 86% at endline in Cambodia (P < 0.0001) and from 34% at baseline to 56% at endline in the Philippines (P < 0.0001), among women who had births at 24–36 weeks. In both settings baseline coverage and magnitude of improvement varied notably by facility. Availability of dexamethasone, knowledge of use and cost were not major barriers to coverage.ConclusionsA simple quality improvement strategy was feasible and effective in increasing use of dexamethasone in the management of preterm birth in 12 hospitals in Cambodia and Philippines.
      PubDate: 2017-02-01
  • Understanding and using quality information for quality improvement: The
           effect of information presentation
    • Authors: Zwijnenberg NC; Hendriks M, Delnoij DJ, et al.
      Abstract: AbstractObjectiveTo examine how information presentation affects the understanding and use of information for quality improvement.DesignAn experimental design, testing 22 formats, and showing information on patient safety culture. Formats differed in visualization, outcomes and benchmark information.Intervention(s)Respondents viewed three randomly selected presentation formats in an online survey, completing several tasks per format.SettingThe hospital sector in the Netherlands.ParticipantsA volunteer sample of healthcare professionals, mainly nurses, working in hospitals. Main Outcome Measure(s): The degree to which information is understandable and usable (accurate choice for quality improvement, sense of urgency to change and appraisal of one's own performance).ResultsAbout 115 healthcare professionals participated (response rate 25%), resulting in 345 reviews.UnderstandabilityInformation in tables (P = 0.007) and bar charts (P 
      PubDate: 2017-02-01
  • Are process performance measures associated with clinical outcomes among
           patients with hip fractures? A population-based cohort study
    • Authors: Kristensen P; Thillemann T, Søballe K, et al.
      Abstract: AbstractObjectivesTo examine the association between process performance measures and clinical outcome among patients with hip fracture.DesignNationwide, population-based follow-up study.SettingPublic Danish hospitals.ParticipantsA total of 25 354 patients 65 years or older who were admitted with a hip fracture in Denmark between 2010 and 2013.InterventionThe process performance measures, including systematic pain assessment, early mobilization, basic mobility assessment at arrival and at discharge, post-discharge rehabilitation program, anti-osteoporotic medication and prevention of future fall accidents measures, were analysed individually as well as an opportunity-based score defined as the proportion of all relevant performance measures fulfilled for the individual patient (0–50%, 50–75% and 75–100%).Main Outcome MeasuresThirty-day mortality, 30-day readmission after discharge and length of stay (LOS).ResultsFulfilling 75–100% of the relevant process performance measures was associated with lower 30-day mortality (22.6% vs. 8.5%, adjusted odds ratio (OR) 0.31 (95% CI: 0.28–0.35)) and lower odds for readmission (21.7% vs. 17.4%, adjusted OR 0.78 (95% CI: 0.70–0.87)). The overall opportunity score for quality of care was not associated with LOS (adjusted OR 1.00 (95% CI: 0.98–1.04)). Mobilization within 24 h postoperatively was the process with the strongest association with lower 30-day mortality, readmission risk and shorter LOS.ConclusionsHigher quality of in-hospital care and in particular early mobilization was associated with a better clinical outcome, including lower 30-day mortality, among patients with hip fracture.
      PubDate: 2017-02-01
  • Work characteristics and psychological symptoms among GPs and community
           nurses: a preliminary investigation in China
    • Authors: Zhang L; Wang F, Cheng Y, et al.
      Abstract: AbstractObjectiveTo determine the effect of work characteristics on the psychological symptoms of general practitioners’ (GPs) and community nurses.Design, setting and participantsA stratified sampling cross-sectional survey was performed at the 12 community health services centres involved 233 GPs and 202 community nurses in three cities of Hubei Province in central China. The independent variables were career prospects, superior recognition, salary fairness, professional–patient relationship and self-perceived workload. The dependent variables were the General Health Questionnaire.ResultsThe generalized linear regression showed the career prospects had a significant association with GPs’ psychological health, whereas career prospects, self-perceived workload and superior recognition had significant association on the psychological health of community nurses. However, salary fairness and professional–patient relationship were not statistically significant for GPs or community nurses.ConclusionsA better understanding of the effects of career prospects on the psychological health of GPs and community nurses, and improvements in superior recognition and workload on the psychological health of community nurses, would improve psychological symptoms of primary-level medical staff.
      PubDate: 2017-02-01
  • Improvement in quality of hospital care during accreditation: A nationwide
           stepped-wedge study
    • Authors: Bogh S; Falstie-Jensen A, Hollnagel E, et al.
      Abstract: AbstractObjectiveTo assess changes over time in quality of hospital care in relation to the first accreditation cycle in Denmark.Design, setting and participantsWe performed a multi-level, longitudinal, stepped-wedge, nationwide study of process performance measures to evaluate the impact of a mandatory accreditation programme in all Danish public hospitals. Patient-level data (n = 1 624 518 processes of care) on stroke, heart failure, ulcer, diabetes, breast cancer and lung cancer care were obtained from national clinical quality registries.InterventionThe Danish Healthcare Quality Programme was introduced in 2009, aiming to create a framework for continuous quality improvement.Main outcomeChanges in week-by-week trends of hospital care during the study period of 269 weeks prior to, during and post-accreditation.ResultsThe quality of hospital care improved over time throughout the study period. The overall positive change in trend odds ratio (OR) = 1.002 per week; 95% confidence interval (CI: 0.997–1.006) observed when comparing the period during accreditation with the period prior to accreditation was not significant. However, when restricting the analyses to processes of care where the performance did not meet target values for satisfactory quality prior to accreditation, we found a significant positive change in trend (OR = 1.006 per week; 95% CI: 1.001–1.011). When comparing the post-accreditation period with the period during accreditation, we found a significantly reduced trend (OR = 0.994 per week; 95% CI: 0.988–0.999), indicating the improvement in quality of care continued but at a lower rate than during accreditation.ConclusionThese findings support the hypothesis that hospital accreditation leads to improvements in patient care.
      PubDate: 2017-02-01
  • Perceptions of quality and safety and experience of adverse events in 27
           European Union healthcare systems, 2009–2013
    • Authors: Filippidis FT; Mian SS, Millett C.
      Abstract: AbstractObjectiveTo assess trends in the perception of quality and safety between 2009 and 2013 in the European Union (EU).DesignWe analysed data from waves 72.2 and 80.2 of the Eurobarometer survey. Multilevel logistic regression models adjusted for sociodemographic factors and country-level health expenditure were fitted to assess changes between 2009 and 2013 in each of the assessed outcomes.SettingTwenty-seven EU member states.ParticipantsA total of n = 26 663 (2009) and n = 26 917 (2013) individuals aged ≥15 years.Main outcome measure(s)Outcomes included the perception of being harmed in hospital and non-hospital care; rating of the overall quality of the healthcare system; and personal or family experience of adverse events.ResultsRespondents in 2013 were more likely to think that it was likely to be harmed in hospital (Odds Ratio [OR] = 1.09; 95% Confidence Interval [CI]: 1.05–1.13; P
      PubDate: 2017-02-01
  • Routine quality care assessment of schizophrenic disorders using
           information systems
    • Authors: Lora A; Monzani E, Ibrahim B, et al.
      Abstract: AbstractObjectiveTo assess the quality of mental healthcare provided to patients with schizophrenic disorders in the Italian region of Lombardy.DesignForty-one clinical indicators were applied to Lombardy's healthcare databases containing data on mental health treatments, hospital admissions, somatic health treatments and pharmaceutical prescriptions.SettingAll public departments of mental health and private residential facilities in Lombardy.ParticipantsAll 28 227 patients with schizophrenic disorders that were under the care of Lombardy mental health services in 2009.InterventionsN/A.Main outcome measuresN/A.ResultsThe care that was delivered to patients and family members was more frequent for first-episode cases than for prevalent ones. Seven out of ten patients made use of continuing care and, after hospitalization, more than half of the discharged patients received a follow-up visit by community mental health centre staff within 2 weeks of their discharge. Psychotherapeutic and psychoeducative treatments, such as employment and independent living support, were not widespread among these discharged patients. Antipsychotic drug dosage was usually within the recommended range. The adherence of first-episode patients to antipsychotic treatment was lower than that of prevalent patients, and the monitoring of metabolic side effects was not always consistent. Inappropriateness of hospital care, in terms of longer admission, readmission, compulsory admission and restraint, was limited. Mortality during the period was significant.ConclusionsClinical indicators demonstrate the strengths and weaknesses of the mental health system in Lombardy and they can be useful tools in the routine assessment of mental healthcare quality.
      PubDate: 2017-02-01
  • Defining a typology of primary care practices: a novel approach
    • Authors: Senn N; Cohidon C, Zuchuat J.
      Abstract: AbstractObjectiveTo define a typology of primary care (PC) practices based on a mixed inductive/deductive approach that uses a large number of variables describing organizational and demographic characteristics of practices and a priori hierarchical structuring of the data.DesignSecondary analysis of the Swiss part of the QUALICOPC study using a multiple factor analysis approach incorporating 74 variables hierarchically structured and including information on infrastructures, clinical care, workforces, accessibility and geographic location of PC practices.SettingSwitzerland.ParticipantsTwo hundred randomly selected PC practices.Main Outcome MeasuresTypology of PC practices based on axes identified through the multiple factorial approach.ResultsThe factorial analysis extracted two uncorrelated axes summarizing 17% of the global variance. The first axis is mainly associated with two dimensions related to the comprehensiveness of services, namely ‘clinical care provided’ (Pearson's r = 0.73) and ‘available infrastructures’ (r = 0.78). The second axis is mainly associated with the workforce in the practice such as the number of general practitioners or other health workers (r = 0.69). Swiss PC practices were mapped using these two axes.ConclusionsThis innovative approach allows defining a global typology of PC practices. Based upon Swiss data, two axes were identified to globally describe PC organization: comprehensiveness of services and workforces development. This exploratory study demonstrates a promising way, first to characterize globally one or several PC models that emerge from complex features, second to compare more accurately PC organization between countries and finally to assess how these models might be associated with patients’ outcomes.
      PubDate: 2017-02-01
  • The effect of a short educational intervention on the use of urinary
           catheters: a prospective cohort study
    • Authors: Blondal K; Ingadottir B, Einarsdottir H, et al.
      Abstract: AbstractObjectiveTo assess the effectiveness of implementation of evidence-based recommendations to reduce catheter-associated urinary tract infections (CAUTIs).DesignProspective cohort study, conducted in 2010–12, with a before and after design.SettingA major referral university hospital.ParticipantsData were collected before (n = 244) and 1 year after (n = 255) the intervention for patients who received urinary catheters.InterventionThe intervention comprised two elements: (i) aligning doctors’ and nurses’ knowledge of indications for the use of catheters and (ii) an educational effort consisting of three 30- to 45-minute sessions on evidence-based practice regarding catheter usage for nursing personnel on 17 medical and surgical wards.Main Outcome MeasuresThe main outcome measures were the proportion of (i) admitted patients receiving urinary catheters during hospitalization, (ii) catheters inserted without indication, (iii) inpatient days with catheter and (iv) the incidence of CAUTIs per 1000 catheter days. Secondary outcome measures were the proportion of (i) catheter days without appropriate indication and (ii) patients discharged with a catheter.ResultsThere was a reduction in the proportion of inpatient days with a catheter, from 44% to 41% (P = 0.006). There was also a reduction in the proportion of catheter days without appropriate indication (P
      PubDate: 2017-02-01
  • Best of both worlds: combining evidence with local context to develop a
           nursing shift handover blueprint
    • Authors: Smeulers M; Vermeulen H.
      Abstract: AbstractObjectiveStandardization of the handover process is deemed necessary to ensure continuity and safety of care. However, local context is considered of equal importance to improve the handover process. Our objective was to determine what recommendations on standardized shift handover nurses make, if we combine evidence from the literature with the local context of the nurses.DesignA RAND-modified Delphi consensus process that combines evidence from systematic reviews with expert opinion of local nurses and an evaluation of the consensus process with a survey.SettingOne academic medical center in the Netherlands.ParticipantsTwenty nurses from surgical, medical, neurological, psychiatric, cardiology, children's and gynecology departments.ResultsFour systematic reviews on nursing handover were included to compose provisional recommendations on how, what, where and the preconditions of shift handover. Nurses reached consensus on a final set of 18 recommendations for a nursing shift handover blueprint: how (1 recommendation), what (12 recommendations), where (3 recommendations) and the preconditions (2 recommendations), which were structured with the mnemonic NURSEPASS. The nurses assessed the method as an effective approach to develop a local blueprint.ConclusionsEvidence-based consensus is a feasible method to combine evidence from the literature with local context. We anticipate that implementation of the resulting tailored blueprint for nursing shift handover will be facilitated due to the method used. Through evaluation of its effectiveness, we intend to add to the body of evidence on development and implementation of effective nursing handover, which is an essential link for continuity and safety of care.
      PubDate: 2017-02-01
  • The effect of a nurse-led telephone-based care coordination program on the
           follow-up and control of cardiovascular risk factors in patients with
           coronary artery disease
    • Authors: Wong N; Chua S, Gao F, et al.
      Abstract: AbstractObjectiveWe sought to analyse the impact of a care coordination protocol on transiting patients with coronary artery disease who had undergone percutaneous coronary intervention (PCI) to primary care and its effect on cardiovascular risk factor control.DesignA prospective observational study involving 492 patients who had undergone PCI either electively or after an acute coronary syndrome.SettingA tertiary institution in Singapore.ParticipantsPatients who had undergone a PCI either electively or after an acute coronary syndrome.InterventionsThe SCORE (Standardized Care for Optimal Outcomes, Right-Siting and Rapid Re-evaluation) program was a nurse-led, telephone-based, care coordination protocol.Main Outcome MeasuresTransition to primary care within 1 year of enrolment, the achievement of low-density lipoprotein (LDL) level of
      PubDate: 2017-02-01
  • Content validity of a health science evidence-based practice questionnaire
           (HS-EBP) with a web-based modified Delphi approach
    • Authors: Fernández-Domínguez J; Sesé-Abad A, Morales-Asencio J, et al.
      Abstract: AbstractObjectiveTo develop a tool for measuring evidence-based practice (EBP) and to evaluate its content validity by Delphi technique. A five-factor/dimensions latent structure for the EBP construct was defined a priori and operationalized.DesignOnline Delphi technique.Setting and ParticipantsA group of 32 national EBP experts from different health professions.InterventionThe experts rated the initial questionnaire items according to adequacy and relevance criteria using four-point Likert scales and including open fields for suggestions, with basic and supplementary criteria consensus established a priori.Main Outcome MeasureLevel of consensus in the Content Validity Index Item.ResultsAn EBP construct solution was designed with the elements that constitute the operationalization proposal of the EBP. This initial version consisted of 76 items, whereas the version arising from the Delphi study was made up of 73 items. In the first round, 13 items did not reach the minimum level of consensus, and 12 of these were reformulated. Three additional items were removed in the second round.ConclusionsA new psychometric tool forms measuring EBP with a five-factor structure, and 73 items obtained adequate content validity evidence based on expert opinion.
      PubDate: 2017-02-01
  • The influence of emergency department crowding on the efficiency of care
           for acute stroke patients
    • Authors: Tsai M; Yen Y, Su C, et al.
      Abstract: AbstractObjectiveTo investigate the impact of emergency department (ED) crowding (number of ED patients) and number of ED staff on the efficiency of the ED care process for acute stroke patients.DesignRetrospective cohort study conducted from 1 May 2008 to 31 December 2013.SettingLargest primary stroke center (3000-bed tertiary academic hospital) in southern Taiwan.ParticipantsPatients aged 18–80 years presenting to the ED with acute stroke symptoms ≤3 h from symptom onset (n = 1142).Main Outcome MeasuresDoor-to-assessment time (DTA), door-to-computed tomography completion time (DTCT) and door-to-needle time (DTN).ResultsOf the 785 patients with ischemic stroke, 90 (11.46%) received thrombolysis. In the multivariate regression analysis, the number of ED patients and the number of attending physicians were significantly associated with delayed DTA and DTCT but not DTN. Initial assessment by a resident was also associated with delayed DTA and DTCT. The number of nurses was associated with delayed DTCT and DTN.ConclusionsAlthough ED crowding was not associated with delayed DTN, it predicted delayed DTA and DTCT in thrombolysis-eligible stroke patients. The number of attending physicians affected initial assessment and DTCTs, whereas the number of nurses impacted thrombolytic administration times.
      PubDate: 2017-02-01
  • Drug-dispensing problems community pharmacists face when patients are
           discharged from hospitals: a study about 537 prescriptions in Alsace
    • Authors: Michel B; Hemery M, Rybarczyk-Vigouret M, et al.
      Abstract: AbstractObjectivesTo identify both type and frequency of the challenges community pharmacists face when dispensing drugs from hospital discharge prescriptions, to describe the measures undertaken to resolve the issues at stake and to list their consequences.DesignWe carried out an observational study in the community pharmacies of the French region of Alsace and asked the community pharmacy staff to review 537 hospital discharge prescriptions in 2013 using anonymous data collection forms.Setting and ParticipantsNineteen community pharmacies.Main outcome measuresNumber of patients informed about their medication (at hospital and/or community pharmacy), type and frequency of issues encountered during drug dispensing, type and frequency of measures undertaken to resolve the issues, type and frequency of the consequences regarding drug dispensing.ResultsCommunity pharmacists faced 165 challenges from 145 hospital discharge prescriptions (i.e. 27.5% out of 528 analysed prescriptions), mostly correlated to the quality of the prescriptions (n = 100, 60.6%) or to logistical matters (n = 54, 32.7%). A mere 36.8% of the patients received information pertaining to their medication while being hospitalized. Of note, 40.5% of the prescriptions were delivered to pharmacies within 2 days following the patients’ discharge. In order to resolve the different issues preventing drugs from being dispensed (n = 33/145 prescriptions), pharmacists sought information, mainly from patients, colleagues and hospital prescribers. The pharmacists were able to dispense all the drugs prescribed in 138 out of 145 cases (95.2%).ConclusionsThis study highlighted the challenges encountered by community pharmacists and their significant contribution to the continuity of care upon patients being discharged from hospitals.
      PubDate: 2017-02-01
  • Effect of the medical insurance on the quality of care for Chinese
           patients with chronic heart failure
    • Authors: Fu R; Bao H, Su S, et al.
      Abstract: AbstractObjectiveTo assess the effect of medical insurance on the quality of care for patients with chronic heart failure (CHF).DesignSeven quality indicators were used to assess the association between medical insurance and quality of care. Statistical analyses were conducted using multilevel logistic models for the total population and the subpopulation stratified by sex and age.ParticipantsIn total, 1862 CHF patients who were admitted in 20 tertiary hospitals between 1 January 2009 and 31 October 2010.ResultsOf 1862 patients, 53.8% patients had basic medical insurance and 26.9% patients paid the hospital costs by themselves. After adjusting for confounding factors, patients with New Rural Cooperative Medical Scheme (NRCMS) were more likely to receive warfarin (odds ratios [OR], 3.89; 95% confidence interval [CI], 1.08–13.99; P = 0.038), but less likely to receive aldosterone receptor antagonist (OR, 0.21; 95% CI, 0.08–0.56; P = 0.002) than patients without any medical insurance. Urban Employee Basic Medical Insurance (UEBMI) and NRCMS were associated with more use of discharge instructions ([OR, 3.54; 95% CI, 2.44–5.13; P 
      PubDate: 2017-02-01
  • Intra-hospital correlations among 30-day mortality rates in 18 different
           clinical and surgical settings
    • Authors: Guida P; Iacoviello M, Passantino A, et al.
      Abstract: AbstractObjectiveTo examine whether a correlation exists in hospitals among 30-day mortality rates for different types of hospitalizations.DesignCross-sectional study of hospital care based on publically available Italian data from the National Outcome Evaluation Program Edition 2015 of the Italian Agency for Regional Health Services.Setting and ParticipantsPatients hospitalized with a diagnosis of congestive heart failure, acute myocardial infarction, chronic renal failure, chronic obstructive pulmonary disease exacerbation, femoral neck fracture, ischemic stroke and non-variceal upper gastrointestinal bleeding, or those who underwent isolated cardiac valve procedure, isolated coronary artery bypass graft surgery, non-ruptured abdominal aortic aneurysm repair and interventions for the following tumors: colon, kidney, brain, lung, stomach, rectal, liver or pancreatic cancer.Main Outcome MeasuresCondition-specific 30-day crude and risk-adjusted mortality rates.ResultsA total of 808 280 admissions were reported from 844 institutions (median of 4 conditions evaluated per hospital; interquartile range 2–8). Volumes and outcome varied by clinical and surgical conditions across hospitals. Out of 153 pairs of different conditions, 41 were statistically significant in terms of concordance with crude mortality rates and 44 for their adjusted values. The hospital mean percentile rank for 30-day mortality, a composite measure that summarized the multiple indicators, increased significantly alongside number of conditions per hospital with a significant reduction of mortality when most of the studied conditions were treated in the same hospital.ConclusionsThe variability in 30-day mortality rates at hospital level and the correlation between risk mortality rates suggest that there may be common hospital-wide factors influencing short-term mortality.
      PubDate: 2017-02-01
  • Cost-effectiveness of implementing the chronic care model for HIV care in
    • Authors: Broughton EI; Muhire M, Karamagi E, et al.
      Abstract: AbstractObjectiveThe chronic care model (CCM) is an integrated, population-based approach for treating those with chronic diseases that involves patient self-management, delivery system design and decision support for clinicians to ensure evidence-based care. We sought to determine effectiveness and cost-effectiveness of implementing the CCM for HIV care in Uganda.DesignThis controlled, pre/post-intervention study used difference-in-differences analysis to evaluate effectiveness of the CCM to improve patient adherence to antiretroviral therapy (ART) and CD4 counts.SettingOne district hospital and two smaller facilities each in one intervention and one control district in Uganda.ParticipantsAbout 46 randomly sampled patients receiving HIV services at three control sites and 56 patients from three intervention sites.InterventionTwo group training sessions and monthly coaching visits from improvement experts over 1 year, implementing the CCM.Main Outcome Measure(s)Patient adherence to ART prescriptions (pill counts) and CD4 counts were measured at baseline and en dline.ResultsThe odds of increased CD4 in the intervention group was 3.2 times higher than controls (P = 0.022). Clinician-reported ART adherence was 60% (P = 0.001) higher in the intervention group. The intervention cost $11 740 and served 7016 patients ($1.67 per patient). Incremental cost-effectiveness ratios of the intervention compared to business-as-usual was $6.90 per additional patient with improved CD4 and $3.40 per additional ART patient with stable or improved adherence.ConclusionFor modest expenditure, it is possible to improve indicators of HIV care quality using the CCM. We recommended implementing the CCM in Uganda; it may be applicable in similar settings in other countries.
      PubDate: 2017-02-01
  • Patient satisfaction with ambulatory care in Germany: effects of patient-
           and medical practice-related factors
    • Authors: Auras S; Ostermann T, de Cruppé W, et al.
      Abstract: AbstractObjectiveThe study aimed to illustrate the effect of the patients’ sex, age, self-rated health and medical practice specialization on patient satisfaction.DesignSecondary analysis of patient survey data using multilevel analysis (generalized linear mixed model, medical practice as random effect) using a sequential modelling strategy. We examined the effects of the patients’ sex, age, self-rated health and medical practice specialization on four patient satisfaction dimensions: medical practice organization, information, interaction, professional competence.SettingThe study was performed in 92 German medical practices providing ambulatory care in general medicine, internal medicine or gynaecology.ParticipantsIn total, 9888 adult patients participated in a patient survey using the validated ‘questionnaire on satisfaction with ambulatory care—quality from the patient perspective [ZAP]’.Main outcome measure(s)We calculated four models for each satisfaction dimension, revealing regression coefficients with 95% confidence intervals (CIs) for all independent variables, and using Wald Chi-Square statistic for each modelling step (model validity) and LR-Tests to compare the models of each step with the previous model.ResultsThe patients’ sex and age had a weak effect (maximum regression coefficient 1.09, CI 0.39; 1.80), and the patients’ self-rated health had the strongest positive effect (maximum regression coefficient 7.66, CI 6.69; 8.63) on satisfaction ratings. The effect of medical practice specialization was heterogeneous.ConclusionsAll factors studied, specifically the patients’ self-rated health, affected patient satisfaction. Adjustment should always be considered because it improves the comparability of patient satisfaction in medical practices with atypically varying patient populations and increases the acceptance of comparisons.
      PubDate: 2017-02-01
  • A randomized comparison between league tables and funnel plots to inform
           health care decision-making
    • Authors: Anell A; Hagberg O, Liedberg F, et al.
      Abstract: AbstractObjectiveComparison of provider performance is commonly used to inform health care decision-making. Little attention has been paid to how data presentations influence decisions. This study analyzes differences in suggested actions by decision-makers informed by league tables or funnel plots.DesignDecision-makers were invited to a survey and randomized to compare hospital performance using either league tables or funnel plots for four different measures within the area of cancer care. For each measure, decision-makers were asked to suggest actions towards 12–16 hospitals (no action, ask for more information, intervene) and provide feedback related to whether the information provided had been useful.SettingSwedish health care.ParticipantsTwo hundred and twenty-one decision-makers at administrative and clinical levels.InterventionData presentations in the form of league tables or funnel plots.Main outcome measuresNumber of actions suggested by participants. Proportion of appropriate actions.ResultsFor all four measures, decision-makers tended to suggest more actions based on the information provided in league tables compared to funnel plots (44% vs. 21%, P
      PubDate: 2017-02-01
  • Associations between job demands, work-related strain and perceived
           quality of care: a longitudinal study among hospital physicians
    • Authors: Krämer T; Schneider A, Spieß E, et al.
      Abstract: AbstractObjectiveDrawing on a sample of hospital physicians, we attempted to determine prospective associations between three job demands, work-related strain and perceived quality of care.DesignLongitudinal follow-up study with with a 1-year time lag.SettingPhysicians of two acute-care hospitals in Germany (one general urban and one children's hospital).Study participantsNinety-five physicians filled out a standardized questionnaire.Main outcomes measuresPhysicians’ evaluations of quality of care at both waves.ResultsOur results support the hypothesis that job demands directly influence quality of care irrespective of strain. Specifically, high social stressors (β = −0.15, P = 0.036) and time pressure (β = −0.19, P = 0.031) were associated with decreased quality of care over time. We additionally observed reversed effects from quality of care at baseline to time pressure at follow-up (β = −0.35, P = 0.006). Contrary to expectations, physicians’ work-related strain did not mediate the job demands–quality of care-relationship, nor were strain-to-stressor effects observed.ConclusionsOur results corroborate that hospital work environments with high demands have a direct impact on physician-perceived quality of care. In turn, poor care practices contribute to increased job demands. Our findings also emphasize that further understanding is required of how physicians’ workplace conditions affect job demands, well-being, and quality of care, respectively.
      PubDate: 2017-02-01
  • Triple Aim in Canada: developing capacity to lead to better health, care
           and cost
    • Authors: Farmanova E; Kirvan C, Verma J, et al.
      Abstract: AbstractQuality problemMany modern health systems strive for ‘Triple Aim’ (TA)—better health for populations, improved experience of care for patients and lower costs of the system, but note challenges in implementation. Outcomes of applying TA as a quality improvement framework (QI) have started to be realized with early lessons as to why some systems make progress while others do not.Initial assessmentLimited evidence is available as to how organizations create the capacity and infrastructure required to design, implement, evaluate and sustain TA systems.Choice of solutionTo support embedding TA across Canada, the Canadian Foundation for Healthcare Improvement supported enrolment of nine Canadian teams to participate in the Institute for Healthcare Improvement's TA Improvement Community.ImplementationStructured support for TA design, implementation, evaluation and sustainability was addressed in a collaborative programme of webinars and action periods. Teams were coached to undertake and test small-scale improvements before attempting to scale.EvaluationA summative evaluation of the Canadian cohort was undertaken to assess site progress in building TA infrastructure across various healthcare settings. The evaluation explored the process of change, experiences and challenges and strategies for continuous QI.Lessons learnedDelivering TA requires a sustained and coordinated effort supported by strong leadership and governance, continuous QI, engaged interdisciplinary teams and partnering within and beyond the healthcare sector.
      PubDate: 2017-02-01
  • Usefulness of quality indicators for antibiotic use: case study for the
    • Authors: van der Velden AW; Roukens M, van de Garde E, et al.
      Abstract: AbstractQuality problemInappropriate antibiotic use drives development of antimicrobial resistance. Worldwide, guideline adherence for antibiotic treatment of infectious disease is far from optimal. Insight in prescribing quality is pivotal for healthcare professionals and policy makers to intervene appropriately.Initial assessmentsEuropean countries uniformly monitor antibiotic use, which is reported yearly by the European Centre for Disease Prevention and Control. Unfortunately, this has not had enough impact to decrease prescribing and resistance levels.Choice of solutionQuality indicators (QIs) could provide better insight in prescribing quality and enable benchmarking to other countries; this could trigger action to improve antimicrobial prescribing. European Surveillance of Antimicrobial Consumption (ESAC) proposed 12 antibiotic QIs.ImplementationTrends in use of antibiotic subgroups and the 12 ESAC QI values were determined for Dutch primary care (2004–2013); outcomes were compared to other European countries. Dutch antibiotic use is low within the European context. Nitrofurantoin use is higher than the European average, use of small-spectrum antibiotics lowers. Use of macrolides, quinolones and amoxicillin/clavulanate declined, which was not supported by the broad/narrow QI results.EvaluationQIs expressing antibiotic subgroup use in Defined Daily Doses/1000 inhabitants/day, particularly small-spectrum and non-first choices, provide proper insight in prescribing quality and are useful for benchmarking purposes. QIs measuring percentages were not considered useful. The broad/narrow ratio could be more informative when adjusted to national guidelines, or when more antibiotic subgroups are included based on better European consensus.Lessons learntBenchmarking the above mentioned Dutch QI values to other countries provides direction for three specific strategies to further improve Dutch antibiotic prescribing practice.
      PubDate: 2017-02-01
  • The application of the Global Trigger Tool: a systematic review
    • Authors: Hibbert PD; Molloy CJ, Hooper TD, et al.
      Abstract: AbstractPurposeThis study describes the use of, and modifications and additions made to, the Global Trigger Tool (GTT) since its first release in 2003, and summarizes its findings with respect to counting and characterizing adverse events (AEs).Data sourcesPeer-reviewed literature up to 31st December 2014.Study selectionA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Data extractionTwo authors extracted and compiled the demographics, methodologies and results of the selected studies.Results of data synthesisOf the 48 studies meeting the eligibility criteria, 44 collected data from inpatient medical records and four from general practice records. Studies were undertaken in 16 countries. Over half did not follow the standard GTT protocol regarding the number of reviewers used. ‘Acts of omission’ were included in one quarter of studies. Incident reporting detected between 2% and 8% of AEs that were detected with the GTT. Rates of AEs varied in general inpatient studies between 7% and 40%. Infections, problems with surgical procedures and medication were the most common incident types.ConclusionThe GTT is a flexible tool used in a range of settings with varied applications. Substantial differences in AE rates were evident across studies, most likely associated with methodological differences and disparate reviewer interpretations. AE rates should not be compared between institutions or studies. Recommendations include adding ‘omission’ AEs, using preventability scores for priority setting, and re-framing the GTT's purpose to understand and characterize AEs rather than just counting them.
      PubDate: 2017-02-01
  • How to do better health reform: a snapshot of change and improvement
           initiatives in the health systems of 30 countries
    • Authors: Braithwaite J; Matsuyama Y, Mannion R, et al.
      Abstract: AbstractHealth systems are continually being reformed. Why, and how? To answer these questions, we draw on a book we recently contributed, Healthcare Reform, Quality and Safety: Perspectives, Participants, Partnerships and Prospects in 30 Countries. We analyse the impact that these health-reform initiatives have had on the quality and safety of care in an international context—that is, in low-, middle- and high-income countries—Argentina, Australia, Brazil, Chile, China, Denmark, England, Ghana, Germany, the Gulf states, Hong Kong, India, Indonesia, Israel, Italy, Japan, Mexico, Myanmar, New Zealand, Norway, Oman, Papua New Guinea (PNG), South Africa, the USA, Scotland and Sweden. Popular reforms in less well-off countries include boosting equity, providing infrastructure, and reducing mortality and morbidity in maternal and child health. In countries with higher GDP per capita, the focus is on new IT systems or trialling innovative funding models. Wealthy or less wealthy, countries are embracing ways to enhance quality of care and keep patients safe, via mechanisms such as accreditation, clinical guidelines and hand hygiene campaigns. Two timely reminders are that, first, a population's health is not determined solely by the acute system, but is a product of inter-sectoral effort—that is, measures to alleviate poverty and provide good housing, education, nutrition, running water and sanitation across the population. Second, all reformers and advocates of better-quality of care should include well-designed evaluation in their initiatives. Too often, improvement is assumed, not measured. That is perhaps the key message.
      PubDate: 2017-02-01
School of Mathematical and Computer Sciences
Heriot-Watt University
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