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HEALTH AND SAFETY (530 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
A Life in the Day     Hybrid Journal   (Followers: 9)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access  
Adultspan Journal     Hybrid Journal  
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 23)
African Health Sciences     Open Access   (Followers: 2)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 6)
African Journal of Health Professions Education     Open Access   (Followers: 6)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 4)
AJOB Primary Research     Partially Free   (Followers: 3)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Health Economics     Full-text available via subscription   (Followers: 13)
American Journal of Health Education     Hybrid Journal   (Followers: 30)
American Journal of Health Promotion     Hybrid Journal   (Followers: 24)
American Journal of Health Sciences     Open Access   (Followers: 6)
American Journal of Health Studies     Full-text available via subscription   (Followers: 10)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 26)
American Journal of Public Health     Full-text available via subscription   (Followers: 230)
American Journal of Public Health Research     Open Access   (Followers: 29)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4)
Annals of Global Health     Open Access   (Followers: 9)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access   (Followers: 2)
Archive of Community Health     Open Access  
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 3)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Association of Schools of Allied Health Professions     Full-text available via subscription   (Followers: 6)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 3)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 5)
Behavioral Healthcare     Full-text available via subscription   (Followers: 6)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 8)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 20)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 7)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 17)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 12)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 12)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 20)
Case Reports in Women's Health     Open Access   (Followers: 3)
Case Studies in Fire Safety     Open Access   (Followers: 13)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
Central European Journal of Public Health     Full-text available via subscription   (Followers: 4)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 10)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access  
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 2)
Conflict and Health     Open Access   (Followers: 8)
Contraception and Reproductive Medicine     Open Access  
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 3)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access   (Followers: 2)
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription  
Duazary     Open Access   (Followers: 1)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 15)
East African Journal of Public Health     Full-text available via subscription   (Followers: 3)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 16)
EcoHealth     Hybrid Journal   (Followers: 4)
Education for Health     Open Access   (Followers: 5)
electronic Journal of Health Informatics     Open Access   (Followers: 6)
ElectronicHealthcare     Full-text available via subscription   (Followers: 4)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 5)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access   (Followers: 2)
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 4)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 5)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 19)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 2)
Ethiopian Journal of Health Development     Open Access   (Followers: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 7)
Ethnicity & Health     Hybrid Journal   (Followers: 13)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 2)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-based Medicine & Public Health     Open Access   (Followers: 6)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 6)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 2)
Food and Public Health     Open Access   (Followers: 11)
Frontiers in Public Health     Open Access   (Followers: 7)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 9)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 5)
Global Health Promotion     Hybrid Journal   (Followers: 16)
Global Journal of Health Science     Open Access   (Followers: 9)
Global Journal of Public Health     Open Access   (Followers: 12)
Global Medical & Health Communication     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 3)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 16)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 7)
Health and Human Rights     Free   (Followers: 8)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 7)
Health and Social Work     Hybrid Journal   (Followers: 52)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 14)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 15)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Notions     Open Access  
Health Policy     Hybrid Journal   (Followers: 38)
Health Policy and Technology     Hybrid Journal   (Followers: 2)
Health Professional Student Journal     Open Access   (Followers: 2)
Health Promotion International     Hybrid Journal   (Followers: 21)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 10)
Health Promotion Practice     Hybrid Journal   (Followers: 15)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 48)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 41)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 11)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 2)
Health Services Insights     Open Access   (Followers: 2)
Health Systems     Hybrid Journal   (Followers: 3)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 13)
Health, Risk & Society     Hybrid Journal   (Followers: 11)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
Healthy-Mu Journal     Open Access  
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 11)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 6)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 4)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 3)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 2)
Indonesian Journal for Health Sciences     Open Access   (Followers: 1)
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 5)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 5)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 34)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 2)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 8)
International Journal of Circumpolar Health     Open Access   (Followers: 1)
International Journal of Community Medicine and Public Health     Open Access   (Followers: 5)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 20)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 16)
International Journal of Health & Allied Sciences     Open Access   (Followers: 3)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 10)

        1 2 3 | Last

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