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  Subjects -> HEALTH AND SAFETY (Total: 1278 journals)
    - CIVIL DEFENSE (18 journals)
    - DRUG ABUSE AND ALCOHOLISM (87 journals)
    - HEALTH AND SAFETY (509 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (379 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (106 journals)
    - PHYSICAL FITNESS AND HYGIENE (99 journals)
    - WOMEN'S HEALTH (80 journals)

HEALTH AND SAFETY (509 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   (Followers: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 19)
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: 4)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 2)
AJOB Primary Research     Partially Free   (Followers: 2)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Health Economics     Full-text available via subscription   (Followers: 13)
American Journal of Health Education     Hybrid Journal   (Followers: 25)
American Journal of Health Promotion     Hybrid Journal   (Followers: 24)
American Journal of Health Studies     Full-text available via subscription   (Followers: 8)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 21)
American Journal of Public Health     Full-text available via subscription   (Followers: 174)
American Journal of Public Health Research     Open Access   (Followers: 27)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 8)
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  
Archives of Medicine and Health Sciences     Open Access   (Followers: 2)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 1)
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: 5)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 2)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 1)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 1)
Behavioral Healthcare     Full-text available via subscription   (Followers: 4)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 6)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 9)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 19)
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: 15)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 11)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 10)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 18)
Case Reports in Women's Health     Open Access   (Followers: 2)
Case Studies in Fire Safety     Open Access   (Followers: 11)
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: 1)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 1)
Conflict and Health     Open Access   (Followers: 8)
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 1)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access  
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: 13)
East African Journal of Public Health     Full-text available via subscription   (Followers: 2)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 16)
EcoHealth     Hybrid Journal   (Followers: 3)
Education for Health     Open Access   (Followers: 4)
electronic Journal of Health Informatics     Open Access   (Followers: 4)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 4)
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  
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 3)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 18)
Ethics, Medicine and Public Health     Full-text available via subscription  
Ethiopian Journal of Health Development     Open Access   (Followers: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 7)
Ethnicity & Health     Hybrid Journal   (Followers: 14)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 1)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 8)
Evidence-based Medicine & Public Health     Open Access   (Followers: 4)
Evidência - Ciência e Biotecnologia - Interdisciplinar     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: 3)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 10)
Frontiers in Public Health     Open Access   (Followers: 8)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 11)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 4)
Global Health Promotion     Hybrid Journal   (Followers: 15)
Global Journal of Health Science     Open Access   (Followers: 5)
Global Journal of Public Health     Open Access   (Followers: 9)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 7)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 14)
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: 9)
Health and Social Work     Hybrid Journal   (Followers: 46)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 11)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 10)
Health Issues     Full-text available via subscription   (Followers: 1)
Health Policy     Hybrid Journal   (Followers: 32)
Health Policy and Technology     Hybrid Journal  
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 20)
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: 47)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 39)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 9)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 1)
Health Services Insights     Open Access   (Followers: 1)
Health Systems     Hybrid Journal   (Followers: 2)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 10)
Health, Risk & Society     Hybrid Journal   (Followers: 9)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
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: 9)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 5)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 2)
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: 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: 6)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 4)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 31)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 2)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 7)
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: 19)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 13)
International Journal of Health & Allied Sciences     Open Access   (Followers: 1)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 7)
International Journal of Health Geographics     Open Access   (Followers: 6)
International Journal of Health Policy and Management     Open Access   (Followers: 2)
International Journal of Health Professions     Open Access   (Followers: 2)
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 12)
International Journal of Health Sciences Education     Open Access   (Followers: 2)
International Journal of Health Services     Full-text available via subscription   (Followers: 9)
International Journal of Health Studies     Open Access   (Followers: 3)
International Journal of Health System and Disaster Management     Open Access   (Followers: 2)
International Journal of Healthcare Delivery Reform Initiatives     Full-text available via subscription   (Followers: 1)

        1 2 3 | Last

Journal Cover International Journal for Quality in Health Care
  [SJR: 1.593]   [H-I: 69]   [31 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: 2017-03-29
       
  • Traditional Chinese Abstracts *
    • PubDate: 2017-03-29
       
  • Resumos neste número *
    • PubDate: 2017-03-29
       
  • Japanese Abstracts *
    • PubDate: 2017-03-29
       
  • Spanish Abstracts *
    • PubDate: 2017-03-29
       
  • Evaluating quality improvement methods and economics of preventable
           adverse events in the healthcare: From Africa to Europe
    • Authors: Syed-Abdul S; Iqbal U, Li Y.
      PubDate: 2017-03-29
       
  • Healthcare resource utilization and clinical outcomes associated with
           acute care and inpatient rehabilitation of stroke patients in Japan
    • Authors: Murata K; Hinotsu S, Sadamasa N, et al.
      Abstract: AbstractObjectiveTo investigate healthcare resource utilization and changes in functional status in stroke patients during hospitalization in an acute hospital and a rehabilitation hospital.DesignRetrospective cohort study.SettingOne acute and one rehabilitation hospital in Japan.ParticipantsPatients who were admitted to the acute hospital due to stroke onset and then transferred to the rehabilitation hospital (n = 263, 56% male, age 70 ± 12 years).Main outcome measuresHospitalization costs and functional independence measure (FIM) were evaluated according to stroke subtype and severity of disability at discharge from the acute hospital.ResultsMedian (IQR) costs at the acute hospital were dependent on the length of stay (LOS) and implementation of neurosurgery, which resulted in higher costs in subarachnoid hemorrhage [$52 413 ($49 166–$72 606) vs $14 129 ($11 169–$19 459) in cerebral infarction; and vs $15 035 ($10 920–$21 864) in intracerebral hemorrhage]. The costs at the rehabilitation hospital were dependent on LOS, and higher in patients with moderate disability than in those with mild disability [$30 026 ($18 419–$39 911) vs $18 052 ($10 631–$24 384)], while those with severe disability spent $25 476 ($13 340–$43 032). Patients with moderate disability gained the most benefits during hospitalization in the rehabilitation hospital, with a median (IQR) total FIM gain of 16 (5–24) points, compared with a modest improvement in patients with mild (6, 2–14) or severe disability (0, 0–5).ConclusionsThe costs for in-hospital stroke care were substantial and the improvement in functional status varied by severity of disability. Our findings would be valuable to organize efficient post-acute stroke care.
      PubDate: 2017-01-10
       
  • Comparability of health service use by veterans with multisymptom illness
           and those with chronic diseases
    • Authors: Gwini S; Forbes AB, Sim MR, et al.
      Abstract: AbstractObjectiveTo compare health service utilization and disability claims among military personnel with multisymptom illness (MSI) (but no chronic diseases), those with chronic disease(s) and those without MSI or chronic diseases. MSI is also known as Gulf War illness.DesignCohort study.SettingAustralia.ParticipantsIn total, 1288 participants of a Gulf War veterans’ study conducted in 2000–2003 (Wave-1) were followed up in 2011–2012 (Wave-2), aged on average 40 years. About 160 had MSI, 217 had chronic disease(s) and 911 had neither chronic disease(s) nor MSI.MethodsAt Wave-2, the cohort was linked to the national Medicare and Department of Veterans’ Affairs (DVA) databases to obtain health service utilization and disability claims data recorded between 2001 and 2012.ResultsThe likelihood of visiting a general practitioner (GP) (risk ratio [RR] = 1.04, 95% confidence interval [CI] = 0.92, 1.19) or visiting a specialist medical doctor (RR = 0.83; 95% CI = 0.54, 1.28) or hospitalizations (RR = 0.89; 95% CI = 0.61, 1.29) or) in the 12 months preceding Wave-2 or successfully claiming for DVA disability compensation (RR = 1.13; 95% CI = 0.86, 1.47) was similar for personnel with MSI and those with chronic disease(s). However, GP consultations, hospitalizations, specialist doctor consultations and disability claims were significantly higher among those with MSI than those without MSI/chronic diseases.ConclusionsHealth service use and disability claims by personnel with MSI were comparable to those with chronic disease(s), but were in excess of those without MSI/chronic diseases. Hence recognition of the high health service use by personnel with MSI is important to ensure adequate provision of health services.
      PubDate: 2017-01-10
       
  • Sharing sensitive health information through social media in the Arab
           world
    • Authors: Asiri E; Khalifa M, Shabir S, et al.
      Abstract: AbstractBackgroundSharing daily activities on social media has become a part of our lifestyle, but little is known about sharing sensitive health information in the Arab world.ObjectiveThe objective of this study is to explore how social media users in the Arab world share sensitive health information through Facebook.DesignA retrospective qualitative analysis was used in the study.Settings and participantsA total of 110 Facebook groups, related to HIV, sickle cell and depression were screened between 5 June and 1 December 2014.ResultsForty four Facebook groups met the inclusion criteria. 28 471 posts were extracted, of which 649 met inclusion criteria. Forty two percent of health information exchanged were related to HIV, 34% to depression and 24% to sickle cell diseases. The majority of postings were from Egypt 21.1%, Saudi Arabia 20%, Algeria 10% and Libya 9.2%. Male posts were 54.2% while 45.8% were posted by females. Individuals utilized Facebook groups to share personal experiences of their disease 31%, in addition to being used for seeking queries 13.6%, offering explicit advice 8.3%, reporting signs and symptoms of the disease 7.3% and posting their communication with the health-care provider 6.6%.ConclusionsUsers in the Arab world use social media to exchange sensitive health information, which could have serious implications regarding the privacy of the information shared with other members of the group. On the other hand, sharing health information could have positive effects for patients, such as sharing disease experiences and peer support. However, more work is needed to ensure that Facebook users in the Arab world are aware of the potential consequences of sharing sensitive health information through social media.
      PubDate: 2016-12-21
       
  • A literature-based economic evaluation of healthcare preventable adverse
           events in Europe
    • Authors: Agbabiaka TB; Lietz M, Mira JJ, et al.
      Abstract: AbstractPurposeTo establish from the literature, cost of preventable adverse events (PAEs) to member states of the Joint Action European Union Network for Patient Safety and Quality of Care.Data sourcesWe searched MEDLINE, EMBASE and CINAHL for studies in Europe estimating cost of adverse events (AEs) and PAEs (2000–March 2016). Using data from the literature, we estimated PAE costs based on national 2013 total health expenditure (THE) data reported by World Health Organization and converted to 2015 Euros.Study selection/Data extractionInformation on type, frequency and incremental cost per episode or estimated cost of AEs was extracted. Total annual disability-adjusted life years (DALYs) resulting from PAEs in 30 EU nations were calculated using an estimate from a published study and adjusted for the percentage of AEs considered preventable.Result of data synthesisPublished estimates of costs of AEs and PAEs vary based on the care setting, methodology, population and year conducted. Only one study was from primary care, the majority were conducted in acute care. Nine studies estimated percentage of THE caused by AEs, 13 studies calculated attributable length of stay. We estimated the annual cost of PAEs to the 30 nations in 2015 to be in the range of 17–38 billion Euros, total DALYs lost from AEs as 3.5 million, of which 1.5 million DALYs were likely due to PAEs.ConclusionThe economic burden of AEs and PAEs is substantial. However, whether patient safety interventions will be ‘cost saving’ depends on the effectiveness and costs of the interventions.
      PubDate: 2016-12-21
       
  • Developing online accreditation education resources for health care
           services: An Australian Case Study
    • Authors: Pereira-Salgado A; Boyd L, Johnson M.
      Abstract: AbstractQuality problem or issueIn 2013, ‘National Safety and Quality Health Service Standards’ accreditation became mandatory for most health care services in Australia. Developing and maintaining accreditation education is challenging for health care services, particularly those in regional and rural settings. With accreditation imminent, there was a need to support health care services through the process.Initial assessmentA needs analysis identified limited availability of open access online resources for national accreditation education.Choice of solutionA standardized set of online accreditation education resources was the agreed solution to assist regional and rural health care services meet compulsory requirements.ImplementationEducation resources were developed over 3 months with project planning, implementation and assessment based on a program logic model.EvaluationResource evaluation was undertaken after the first 3 months of resource availability to establish initial usage and stakeholder perceptions. From 1 January 2015 to 31 March 2015, resource usage was 20 272, comprising 12 989 downloads, 3594 course completions and 3689 page views. Focus groups were conducted at two rural and one metropolitan hospital (n = 16), with rural hospitals reporting more benefits. Main user-based recommendations for future resource development were automatic access to customizable versions, ensuring suitability to intended audience, consistency between resource content and assessment tasks and availability of short and long length versions to meet differing users’ needs.Lessons learnedFurther accreditation education resource development should continue to be collaborative, consider longer development timeframes and user-based recommendations.
      PubDate: 2016-12-15
       
  • Quality management: where is the evidence? Developing an
           indicator-based approach in Kenya
    • Authors: Prytherch H; Nafula M, Kandie C, et al.
      Abstract: AbstractIntroductionThe 2030 Sustainable Development Agenda emphasizes the importance of quality of care in the drive to achieve universal health coverage. Despite recent progress, challenges in service delivery, efficiency and resource utilization in the health sector remain.ObjectiveThe Ministry of Health Department of Standards and Regulations sought to operationalize the Kenya Quality Assurance Model for Health. To this end, the European Practice Assessment (EPA) was adapted to the area of Reproductive and Maternal and Neonatal Health.MethodsThe adaptation process made use of a ten step-modified RAND Corporation/University of California Los Angeles (UCLA) Appropriateness Method. The steps included a scoping workshop, definition of five critical domains of quality in the Kenyan context (‘People, Management, Clinical Care, Quality & Safety, Interface between inpatients and outpatients care’), a review of policy documents, management and clinical guidelines, grey and scientific literature to identify indicators in use in the Kenyan health system and an expert panel process to rate their feasibility and validity.ResultsThe resulting 278 indicators, clustered across the five domains, were broken-down into 29 dimensions and assigned measure specifications. A set of data collection tools were developed to furnish the indicators and piloted at two health facilities. They were subsequently finalized for use in 30 health facilities in 3 counties.ConclusionsThe integrative and indicator-based aspects of the EPA process could be readily adapted to facilitate the operationalization of a practical quality assurance approach in Kenya.
      PubDate: 2016-12-09
       
  • Incidence, risk factors and associated mortality of central
           line-associated bloodstream infections at an intensive care unit in
           northern India
    • Authors: Mishra SB; Misra RR, Azim AA, et al.
      Abstract: AbstractObjectiveTo evaluate the incidence, risk factors and associated mortality of central line-associated bloodstream infection (CLABSI) in an adult intensive care unit (ICU) in India.DesignThis prospective observational study was conducted over a period of 16 months at a tertiary care referral medical center.SettingWe conducted this study over a period of 16 months at a tertiary care referral medical center.ParticipantsAll patients with a central venous catheter (CVC) for >48 h admitted to the ICU were enrolled.Intervention and main outcome measuresPatient characteristics included were underlying disease, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE II) scores and outcome. Statistical analysis of risk factors for their association with mortality was also done.ResultsThere were 3235 inpatient-days and 2698 catheter-days. About 46 cases of CLABSI were diagnosed during the study period. The overall rate of CLABSI was 17.04 per 1000 catheter-days and 14.21 per 1000 inpatient-days. The median duration of hospitalization was 23.5 days while the median number of days that a CVC was in place was 17.5. The median APACHE II and SOFA scores were 17 and 10, respectively. Klebsiella pneumoniae was the most common organism (n = 22/55, 40%). Immunosuppressed state and duration of central line more than 10 days were significant factors for developing CLABSI. SOFA and APACHE II scores showed a tendency towards significance for mortality.ConclusionsOur results underscore the need for strict institutional infection control measures. Regular training module for doctors and nurses for catheter insertion and maintenance with a checklist on nurses’ chart for site inspection and alerts in all shifts are some measures planned at our center.
      PubDate: 2016-12-09
       
  • Beyond utilization: measuring effective coverage of obstetric care along
           the quality cascade
    • Authors: Larson E; Vail D, Mbaruku GM, et al.
      Abstract: AbstractObjectiveTo determine the effective coverage of obstetric care in a rural Tanzanian region and to assess differences in effective coverage by wealth.DesignCross-sectional structured interviews.SettingPwani Region, Tanzania.ParticipantsThe study includes 24 rural, government-managed, primary healthcare clinics and their catchment populations. From January–April 2016, we conducted a household survey of a census of women with recent deliveries, health worker knowledge surveys and facility audits.Main Outcome MeasuresWe explored the proportion of women receiving quality care through the cascade and conducted an equity analysis by wealth.ResultsIn total, 2,910 of 3,564 women (81.6%) reported delivering their most recent child in a health facility, 1,096 of whom delivered in a study facility. Using a minimum threshold of quality, the effective coverage of obstetric care was 25%. Quality was lowest in the emergency care dimensions, with the average score on the provider knowledge tests at 47% and the average provision of basic emergency obstetric services below 50%. The wealthiest 20% of women were 4.1 times as likely to deliver in facilities offering at least the minimum threshold of quality care through the cascade compared to the poorest 80% of women (95% confidence interval: 1.5–11.3).ConclusionsEffective coverage of delivery care is very low, particularly among poorer women. Health worker knowledge caused the sharpest decline in effective coverage. Measures of effective coverage are a better performance measure of under-resourced health systems than utilization. Equity analyses can further identify important discrepancies in quality across socio-economic levels.Trial RegistrationISRCTN 17107760.
      PubDate: 2016-12-05
       
  • Underlying influence of perception of management leadership on patient
           safety climate in healthcare organizations – A mediation analysis
           approach
    • Authors: Weng S; Kim S, Wu C.
      Abstract: AbstractObjectiveWe aim to draw insights on how medical staff's perception of management leadership affects safety climate with key safety related dimensions—teamwork climate, job satisfaction and working conditions.Design/SettingA cross-sectional survey using Safety Attitude Questionnaire (SAQ) was performed in a medical center in Taichung City, Taiwan. The relationships among the dimensions in SAQ were then analyzed by structural equation modeling with a mediation analysis.Participants2205 physicians and nurses of the medical center participated in the survey. Because not all questions in the survey are suitable for entire hospital staff, only the valid responses (n = 1596, response rate of 72%) were extracted for analysis.Main Outcome Measure(s)Key measures are the direct and indirect effects of teamwork climate, job satisfaction, perception of management leadership, and working conditions on safety climate.ResultsOutcomes show that effect of perception of management leadership on safety climate is significant (standardized indirect effect of 0.892 with P-value 0.002) and fully mediated by other dimensions, where 66.9% is mediated through teamwork climate, 24.1% through working conditions and 9.0% through job satisfaction.ConclusionsOur findings point to the importance of management leadership and the mechanism of its influence on safety climate. To improve safety climate, the implication is that commitment by management on leading safety improvement needs to be demonstrated when it implements daily supportive actions for other safety dimensions. For future improvement, development of a management system that can facilitate two-way trust between management and staff over the long term is recommended.
      PubDate: 2016-12-05
       
  • Between the flags: implementing a safety-net system at scale to recognise
           and manage deteriorating patients in the New South Wales Public Health
           System
    • Authors: Pain C; Green M, Duff C, et al.
      Abstract: AbstractQuality problemIn 2005, the Clinical Excellence Commission (CEC) found that unrecognised patient deterioration remained an important problem in New South Wales (NSW) public hospitals.Initial assessmentThe challenge was to design and implement an effective and sustainable safety-net system in all 225 NSW public hospitals.Designing a solutionThe CEC's system was designed in collaboration with a broad coalition of partners, including clinicians, managers, system administrators and collaborating agencies. A five-element system comprising governance, standard calling criteria in standard observation charts, two-level clinical emergency response systems (CERS) in each facility, an education programme and evaluation, was designed for state-wide implementation. This system was called ‘Between the Flags’ (BTF).ImplementationImplementation was led by the CEC on behalf of a NSW coalition, and commenced in January 2010 with the implementation of the Standard Adult General Observation Chart, awareness training for all staff and a CERS in each facility.EvaluationSince the introduction of BTF, the cardiac arrest rate has declined by 42% (P < 0.05) and the Rapid Response rate has increased by 135.9% (P < 0.05) in NSW. The strength of staff support for BTF has grown with the proportion of respondents strongly agreeing that BTF has benefitted patient safety more than doubling from 21% to 44%, and overall agreement rising from 68% to 82% between 2010 and 2012.Lessons learnedKey success factors are a focus on governance, standardisation of observation charts and striking the right balance between a rule-based approach and individual clinical judgement.
      PubDate: 2016-12-05
       
  • Evaluating the impact of continuous quality improvement methods at
           hospitals in Tanzania: a cluster-randomized trial
    • Authors: Kamiya Y; Ishijma H, Hagiwara A, et al.
      Abstract: AbstractObjectiveTo evaluate the impact of implementing continuous quality improvement (CQI) methods on patient's experiences and satisfaction in Tanzania.DesignCluster-randomized trial, which randomly allocated district-level hospitals into treatment group and control group, was conducted.SettingSixteen district-level hospitals in Kilimanjaro and Manyara regions of Tanzania.ParticipantsOutpatient exit surveys targeting totally 3292 individuals, 1688 in the treatment and 1604 in the control group, from 3 time-points between September 2011 and September 2012.InterventionImplementation of the 5S (Sort, Set, Shine, Standardize, Sustain) approach as a CQI method at outpatient departments over 12 months.Main outcome measuresCleanliness, waiting time, patient's experience, patient's satisfaction.Results:The 5S increased cleanliness in the outpatient department, patients’ subjective waiting time and overall satisfaction. However, negligible effects were confirmed for patient's experiences on hospital staff behaviours.ConclusionsThe 5S as a CQI method is effective in enhancing hospital environment and service delivery; that are subjectively assessed by outpatients even during the short intervention period. Nevertheless, continuous efforts will be needed to connect CQI practices with the further improvement in the delivery of quality health care.
      PubDate: 2016-12-05
       
  • Use of proton pump inhibitors among older Australians: national quality
           improvement programmes have led to sustained practice change
    • Authors: Pratt NL; Kalisch Ellett LM, Sluggett JK, et al.
      Abstract: AbstractObjectiveTo evaluate the impact of national multifaceted initiatives to improve use of proton pump inhibitors (PPIs) on the use of PPIs among older Australians.DesignInterrupted time series analysis using administrative health claims data from the Australian Government Department of Veterans’ Affairs (DVA).SettingAustralia.ParticipantsAll veterans and dependents who received PPIs between January 2003 and December 2013.Intervention(s)National, multifaceted interventions to improve PPI use were conducted by the Australian Government Department of Veterans’ Affairs Veterans’ MATES programme and Australia's NPS MedicineWise in April 2004, June 2006, May 2009 and August 2012.Main outcome measure(s)Trends in monthly rate of use of any PPI among the veteran population, and the monthly rate of use of low strength PPIs among all veterans dispensed a PPI.ResultsInterventions in 2004, 2006, 2009 and 2012 slowed the rate of increase in PPI use significantly, with the 2012 intervention resulting in a sustained 0.04% decrease in PPI use each month. The combined effect of all four interventions was a 20.9% (95% CI 7.8–33.9%) relative decrease in PPI use 12 months after the final intervention. The four interventions also resulted in a 42.2% (95% CI 19.9–64.5%) relative increase in low strength PPI use 12 months after the final intervention.ConclusionsNational multifaceted programmes targeting clinicians and consumers were effective in reducing overall PPI use and increasing use of low strength PPIs. Interventions to improve PPI use should incorporate regular repetition of key messages to sustain practice change.
      PubDate: 2016-12-05
       
  • What patients’ complaints and praise tell the health practitioner:
           implications for health care quality. A qualitative research study
    • Authors: Mattarozzi K; Sfrisi F, Caniglia F, et al.
      Abstract: AbstractObjectiveIn order to identify which health care aspects play a role in patient satisfaction and quality of health care, the present study analyses a large number of instances of complaint and praise.Design and settingOne thousand two hundred and thirty-five instances of complaint and one thousand five hundred thirty-six of praise submitted from patients or other souces (i.e. a patient's family member or a legal representative) to a northern-Italian hospital were analysed.Main outcome measuresWe adopted Reader and colleagues’ (2014) patients’ complaint taxonomy, in conjunction with a detailed content analysis of relationship and communication of information aspects.ResultsThe most frequent causes of complaint concerned care system management (68.1%), particularly the time taken to access treatment, and relationship aspects (52.8%). The importance of relationship aspects was confirmed by the expression of gratitude through praise (89%). The most critical factor of the relationship domain was effective communication of information to the patient (39.3%). Frequently patients complained of: (i) having received information that was inconsistent with the truth, (ii) having had difficulty in obtaining information, and (iii) untimely communication of information. Clinical aspects did not seem to be the main factors that triggered a complaint (36,8%), and, when indicated, they were almost always associated with relationship issues.ConclusionsThis study indicates that not only complaints, but also instances of praise, are a potentially important source of information regarding health care aspects that play a role in patient satisfaction and quality of care. Our findings underline the relevance of relationship aspects in determining patients’ satisfaction with the care received. In particular, health practitioners should focus their attention on how information is understood, translated and applied by patients.
      PubDate: 2016-12-05
       
  • Are the registry data reliable? An audit of a regional trauma registry
           in the Netherlands
    • Authors: Horton EE; Krijnen PP, Molenaar HM, et al.
      Abstract: AbstractObjectiveData in trauma registries need to be reliable when used for evaluation of injury management, trauma protocols and hospital statistics. The aim of this audit was to analyse the reliability of the data in the Trauma Centre West Netherlands (TCWN) region.DesignRoutinely registered trauma patients from all nine hospitals in the TCWN region were re-registered by a registrar for analysis.SettingNine hospitals in the TCWN region in the Netherlands.ParticipantsA randomly selected representative trauma population sample of 350 patients and a sample of 100 polytrauma patients were re-registered and used for analysis.InterventionRe-registration of trauma patients in the Trauma Registry.Main Outcome Measure(s)The inter-rater agreement on Injury Severity Score (ISS), number of Abbreviated Injury Scale (AIS) codes, identical codes and survival status were analysed using Kappa's coefficient and intraclass correlation coefficients.ResultsThe inter-rater agreement on ISS and number of AIS codes were, respectively, almost perfect (ICC = 0.81) and substantial (ICC = 0.76) in the trauma population sample, and substantial (ICC = 0.70) and fair (ICC = 0.33) in the polytrauma sample. For patients with serious injuries (AIS ≥ 2) in the population sample, the inter-rater agreement on ISS (ICC = 0.87) and number of AIS codes (ICC = 0.84) were almost perfect.ConclusionsThese results confirm that the Dutch regional registry system works well and may serve as a reliable basis for prospective analysis of national and international trauma care. Particular attention should be paid to the coding of polytrauma patients as discrepancies are more likely to occur in this group.
      PubDate: 2016-12-05
       
  • Improving geriatric prescribing in the ED: a qualitative study of
           facilitators and barriers to clinical decision support tool use
    • Authors: Vandenberg AE; Vaughan CP, Stevens M, et al.
      Abstract: AbstractQuality problem or issueClinical decision support (CDS) may improve prescribing for older adults in the Emergency Department (ED) if adopted by providers.Initial assessmentExisting prescribing order entry processes were mapped at an initial Veterans Administration Medical Center site, demonstrating cognitive burden, effort and safety concerns.Choice of solutionGeriatric order sets incorporating 2012 Beers guidelines and including geriatric prescribing advice and prepopulated order options were developed.ImplementationGeriatric order sets were implemented at two sites as part of the multicomponent ‘Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department’ quality improvement initiative.EvaluationFacilitators and barriers to order sets use at the two sites were evaluated. Phone interviews were conducted with two provider groups (n = 20), those ‘EQUiPPED’ with the interventions (n = 10, 5 at each site) and Comparison providers who were only exposed to order sets through a clickable option on the ED order menu within the patient's medical record (n = 10, 5 at each site). All providers were asked about order set ‘use’ and ‘usefulness’. Users (n = 11) were asked about ‘usability’.Lessons learnedOrder set adopters described ‘usefulness’ in terms of ‘safety’ and ‘efficiency’, whereas order set consultants and order set non-users described ‘usefulness’ in terms of ‘information’ or ‘training’. Provider ‘autonomy’, ‘comfort’ level with existing tools, and ‘learning curve’ were stated as barriers to use.ConclusionsQuantifying efficiency advantages and communicating safety benefit over preexisting practices and tools may improve adoption of CDS in ED and in other settings of care.
      PubDate: 2016-11-14
       
  • The Outpatient Experience Questionnaire of comprehensive public hospital
           in China: development, validity and reliability
    • Authors: Hu Y; Zhang Z, Xie J, et al.
      Abstract: AbstractObjectiveThe objective of this study is to describe the development of the Outpatient Experience Questionnaire (OPEQ) and to assess the validity and reliability of the scale.DesignLiterature review, patient interviews, Delphi method and Cross-sectional validation survey.SettingSix comprehensive public hospitals in China.ParticipantsThe survey was carried out on a sample of 600 outpatients.Main Outcome Measure(s)Acceptability of the questionnaire was assessed according to the overall response rate, item non-response rate and the average completion time. Correlation coefficients and confirmatory factor analysis were used to test construct validity. Delphi method was used to assess the content validity of the questionnaire. Cronbach's coefficient alpha and split-half reliability coefficient were used to estimate the internal reliability of the questionnaire.ResultsThe overall response rate was 97.2% and the item non-response rate ranged from 0% to 0.3%. The mean completion time was 6 min. The Spearman correlations of item-total score ranged from 0.466 to 0.765. The results of confirmatory factor analysis showed that all items had factor loadings above 0.40 and the dimension intercorrelation ranged from 0.449 to 0.773, the goodness of fit of the questionnaire was reasonable. The overall authority grade of expert consultation was 0.80 and Kendall's coefficient of concordance W was 0.186. The Cronbach's coefficients alpha of six dimensions ranged from 0.708 to 0.895, the split-half reliability coefficient (Spearman–Brown coefficient) was 0.969.ConclusionsThe OPEQ is a promising instrument covering the most important aspects which influence outpatient experiences of comprehensive public hospital in China. It has good evidence for acceptability, validity and reliability.
      PubDate: 2016-11-10
       
  • The effects of citizenship status on service utilization and general
           satisfaction with healthcare: a cross-cultural study
    • Authors: Khaled SM; Shockley B, Abdul Rahim HF.
      Abstract: AbstractObjectiveTo explore the role of citizenship status as a predictor of general satisfaction with healthcare services in Qatar, including potential interaction with utilization and health insurance coverage type.DesignA cross-sectional survey conducted in 2012.SettingA household survey in the State of Qatar in the Arab Gulf.ParticipantsA nationally representative sample of 2750 citizens and noncitizens aged 18 years and older.Main OutcomeGeneral satisfaction status with Qatar's healthcare system.MeasuresCitizenship status, healthcare utilization, health insurance type.ResultsCitizens were significantly less likely to be satisfied with Qatar's healthcare system than noncitizens (odds ratio (OR) = 0.30, P < 0.001). The association between private health insurance and overall satisfaction was not significantly different between citizens and noncitizens (P = 0.19). However, the association between utilization of healthcare services and overall satisfaction was moderated by citizenship (P < 0.001). Among citizens, non-users were less likely to be satisfied than recent users (OR = 1.88, P < 0.05), while the opposite pattern was observed among noncitizens (OR = 0.51, P < 0.05). These patterns persisted even after controlling for potential confounders.ConclusionsThe study revealed significant population differences in satisfaction between recent users and non-users within citizenship groups. These differences may stem from different expectations with respect to healthcare services. Understanding these expectations may have important policy implications for cross-cultural contexts.
      PubDate: 2016-11-10
       
  • Quality of child healthcare at primary healthcare facilities: a national
           assessment of the Integrated Management of Childhood Illnesses in
           Afghanistan
    • Authors: Mansoor G; Chikvaidze P, Varkey S, et al.
      Abstract: AbstractObjectiveTo assess quality of the national Integrated Management of Childhood Illness (IMCI) program services provided for sick children at primary health facilities in Afghanistan.DesignMixed methods including cross-sectional study.SettingThirteen (of thirty-four) provinces in Afghanistan.ParticipantsObservation of case management and re-examination of 177 sick children, exit interviews with caretakers and review of equipment/supplies at 44 health facilities.InterventionIntroduction and scale up of Integrated Management of Childhood Illnesses at primary health care facilities.Main outcome measuresCare of sick children according to IMCI guidelines, health worker skills and essential health system elements.ResultsThirty-two (71%) of the health workers were trained in IMCI and five (11%) received supervision in clinical case management during the past 6 months. On average, 5.4 out of 10 main assessment tasks were performed during cases observed, the index being higher in children seen by trained providers than untrained (6.3 vs 3.5, 95% CI 5.8–6.8 vs 2.9–4.1). In all, 74% of the 104 children who needed oral antibiotics received prescriptions, while 30% received complete and correct advice and 30% were overprescribed, and more so by untrained providers. Home care counseling was associated with provider training status (41.3% by trained and 24.5% by untrained). Essential oral and pre-referral injectable medicine and equipment/supplies were available in 66%, 23%, and 45% of health facilities, respectively.ConclusionIMCI training improved assessment, rational use of antibiotics and counseling; further investment in IMCI in Afghanistan, continuing provider capacity building and supportive supervision for improved quality of care and counseling for sick children is needed, especially given high burden treatable childhood illness.
      PubDate: 2016-11-10
       
  • Perspectives: answering questions about quality improvement: suggestions
           for investigators
    • Authors: Øvretveit J.
      Abstract: Abstract‘Does it work?’ is not the only question that practical improvers have of those investigating of quality improvements. They also want to know, ‘Will it work here? What conditions do we need to implement and sustain it? Can we adapt it? How much will it cost and save? Is there enough evidence to spread it?’This perspectives article describes methods that investigators can use to answer these questions about improvement changes and improvement methods. It suggests that one reason why research is underused by improvers is because there is little research that answers these questions that would enable improvers to decide whether or how to implement an improvement in their local setting. It shows improvers that answers are possible and where improvers might find research and reports which answer these questions. It is based on reviews of research and reports about methods for producing valid and actionable knowledge to answer these questions. It describes a new ‘quality improvement investigation movement’ which is uniting applied researchers and improvers to use innovative methods to answer these questions. These investigators recognize the strengths of the randomized controlled trail method, and how easy it is to draw the wrong conclusions from data generated using lower cost and more timely methods. It emphasizes how investigators can choose a method suited to each question, describe the limitations of the method and communicate to improvers the degree of certainty of their answers to the questions.
      PubDate: 2016-11-10
       
  • Quality agencies at the global level: characteristics and
           functions—a narrative review
    • Authors: Saturno Hernández PJ; Fernández Elorriaga M, Poblano Verástegui O, et al.
      Abstract: AbstractPurposeTo provide a comparative description of the structure, function and activities of quality agencies around the world and describe the published evidence of their impact on the health system.Data sourcesA narrative review was conducted using the information found on websites, articles, books and gray literature in English and Spanish.Study selectionThe search process included three complementary approaches: (i) websites of agencies, ministries of health and quality-related official institutions; (ii) evaluations, reports, audits or documents regarding quality agencies; and (iii) scientific articles and gray literature found (key word: quality agency) using Ebsco databases. Information was completed using the ‘snowball’ technique, tracking internet materials and citing literature of reviewed documents.Data extractionThe analytical framework to summarize the information included the agencies’ mission, structures, target institutions, activities (following a six-domain model), funding, information management and impact evaluations.Results of data synthesisInformation was found regarding quality agencies in 62 countries. Those focusing mainly on accreditation were discarded for further analysis. Agencies with a broader focus, according to the six-domain model for quality improvement (QI) strategies, were found in nine countries. Information resulted very heterogeneous in form and substance. However, they share the function of strengthening and advising on ‘public goods’, through information, knowledge management and development of standards. No impact evaluations of any type were found.ConclusionThe characteristics of existing quality agencies are very heterogeneous, being accreditation the main common focus. There is a lack of both a comprehensive approach to QI strategies and a formal assessment of their impact or contribution for improving quality.
      PubDate: 2016-11-10
       
 
 
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