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Jesus TS, Buschbacher J, Struhar J, Walters T, Lopez C, Fernandez A, Gracz K, Colby K. What Is So Great about Inpatient Rehabilitation from the Patient Experience Perspective: Qualitative Content Analysis of an Appreciative Inquiry during a Bedside Experience Rounding. Healthcare (Basel) 2024; 12:1711. [PMID: 39273734 PMCID: PMC11394889 DOI: 10.3390/healthcare12171711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Positive person-centered attributes of inpatient rehabilitation need to be identified from the patient's perspective to be further developed and sustained. PURPOSE To identify which attributes patients openly evoke as being great care experiences, using an open appreciative inquiry during the inpatient rehabilitation stay. METHODS Qualitative secondary analysis of appreciative patient comments during a bedside patient experience rounding facilitated by a neutral party was performed. Two independent analysts employed an inductive, summative form of content analysis. RESULTS Among 150 patients rounded, 122 provided categorizable appreciative accounts. Over two-thirds of the patients (67.2%) focused on "staff attributes" in their great-experience accounts. Those attributes were mostly interpersonal such as being "attentive & caring-beyond clinical duty" and being "encouraging (but not too hard) & reassuring". These interpersonal staff attributes were reported with words showing deep levels of personal significance or patient appreciation. Beyond staff attributes, the perceived quality of "patient care" (31.1%) and opportunities for "leisure and social activities" (9.0%) were also frequently evoked. Amenities like food or customer service were the least evoked, rarely so as an exclusive attribute (0.8% for each). CONCLUSIONS The human(e) factor, especially the interpersonal qualities of staff, emerged as greatly appreciated from the patient experience perspective during inpatient rehabilitation. These experiences help identify which person-centered attributes of care might be further developed and sustained.
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Affiliation(s)
- Tiago S Jesus
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Julia Buschbacher
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Jan Struhar
- Shirley Ryan AbilityLab, Chicago, IL 60611, USA
| | - Taylor Walters
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | | | | | | | - Karen Colby
- Shirley Ryan AbilityLab, Chicago, IL 60611, USA
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Jesus TS, Stern BZ, Lee D, Zhang M, Struhar J, Heinemann AW, Jordan N, Deutsch A. Systematic review of contemporary interventions for improving discharge support and transitions of care from the patient experience perspective. PLoS One 2024; 19:e0299176. [PMID: 38771768 PMCID: PMC11108181 DOI: 10.1371/journal.pone.0299176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/03/2024] [Indexed: 05/23/2024] Open
Abstract
AIM To synthesize the impact of improvement interventions related to care coordination, discharge support and care transitions on patient experience measures. METHOD Systematic review. Searches were completed in six scientific databases, five specialty journals, and through snowballing. Eligibility included studies published in English (2015-2023) focused on improving care coordination, discharge support, or transitional care assessed by standardized patient experience measures as a primary outcome. Two independent reviewers made eligibility decisions and performed quality appraisals. RESULTS Of 1240 papers initially screened, 16 were included. Seven studies focused on care coordination activities, including three randomized controlled trials [RCTs]. These studies used enhanced supports such as improvement coaching or tailoring for vulnerable populations within Patient-Centered Medical Homes or other primary care sites. Intervention effectiveness was mixed or neutral relative to standard or models of care or simpler supports (e.g., improvement tool). Eight studies, including three RCTs, focused on enhanced discharge support, including patient education (e.g., teach back) and telephone follow-up; mixed or neutral results on the patient experience were also found and with more substantive risks of bias. One pragmatic trial on a transitional care intervention, using a navigator support, found significant changes only for the subset of uninsured patients and in one patient experience outcome, and had challenges with implementation fidelity. CONCLUSION Enhanced supports for improving care coordination, discharge education, and post-discharge follow-up had mixed or neutral effectiveness for improving the patient experience with care, compared to standard care or simpler improvement approaches. There is a need to advance the body of evidence on how to improve the patient experience with discharge support and transitional approaches.
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Affiliation(s)
- Tiago S. Jesus
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
- Center for Education in Health Science, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Brocha Z. Stern
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Dongwook Lee
- Center for Child Development & Research, Sensory EL, ROK, Dept. of Physical Medicine and Rehabilitation Medicine, Korehab Clinic, Dubai, UAE
| | - Manrui Zhang
- Center for Education in Health Science, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Jan Struhar
- Nerve, Muscle and Bone Innovation Center & Oncology Innovation Center, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Allen W. Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine and Rehabilitation Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Dept. of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, United States of America
| | - Anne Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine and Rehabilitation Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Center for Health Care Outcomes, RTI International, Chicago, Illinois, United States of America
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Garratt AM, Engen K, Kjeldberg IR, Nordvik JE, Ringheim I, Westskogen L, Becker F. Use of EQ-5D-5L for Assessing Patient-Reported Outcomes in a National Register for Specialized Rehabilitation. Arch Phys Med Rehabil 2024; 105:40-48. [PMID: 37236496 DOI: 10.1016/j.apmr.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To compare problems reported on EQ-5D-5L dimensions, index, and EQ visual analog scale (VAS) scores in patients receiving specialized rehabilitation in Norway with general population norms. DESIGN Multicenter observational study. SETTING Five specialist rehabilitation facilities participating in a national rehabilitation register between March 11, 2020, and April 20, 2022. PARTICIPANTS 1167 inpatients admitted (N=1167), with a mean age of 56.1 (range, 18-91) years; 43% were female. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES EQ-5D-5L dimension, index, and EQ VAS scores. RESULTS At admission, mean±SD EQ-5D-5L index scores were 0.48 (0.31) compared to 0.82 (0.19) for general population norms. EQ VAS scores were 51.29 (20.74) compared to 79.46 (17.53) for population norms. Together with those for the 5 dimensions, these differences were all statistically significant (P<.01). Compared to population norms, patients undergoing rehabilitation had more health states as assessed by the 5 dimensions (550 vs 156) and EQ VAS (98 vs 49). As hypothesized, EQ-5D-5L scores were associated with number of diagnoses, admission to/from secondary care, and help with completion. At discharge there were statistically significant improvements in all EQ-5D-5L scores that compare favorably with available estimates for minimal important differences. CONCLUSIONS The large deviations in scores at admission and score changes at discharge lend support to EQ-5D-5L application in national quality measurement. Evidence for construct validity was found through associations with number of secondary diagnoses and help with completion.
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Affiliation(s)
| | - Kathrine Engen
- Department of Rehabilitation, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | | | - Jan Egil Nordvik
- Division for Quality and Clinical Pathways, Norwegian Directorate of Health, Oslo, Norway; Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Inge Ringheim
- Division of Physical Medicine & Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway
| | - Lise Westskogen
- Division for Quality and Clinical Pathways, Norwegian Directorate of Health, Oslo, Norway
| | - Frank Becker
- Division for Quality and Clinical Pathways, Norwegian Directorate of Health, Oslo, Norway; Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway; Department of Physical Medicine and Rehabilitation, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Crick JP, Rethorn TJ, Beauregard TA, Summers R, Rethorn ZD, Quatman-Yates CC. The Use of Quality Improvement in the Physical Therapy Literature: A Scoping Review. J Healthc Qual 2023; 45:280-296. [PMID: 37428943 DOI: 10.1097/jhq.0000000000000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Quality improvement (QI) is a useful methodology for improving healthcare, often through iterative changes. There is no prior review on the application of QI in physical therapy (PT). PURPOSE AND RELEVANCE To characterize and evaluate the quality of the QI literature in PT. METHODS We searched four electronic databases from inception through September 1, 2022. Included publications focused on QI and included the practice of PT. Quality was assessed using the 16-point QI Minimum Quality Criteria Set (QI-MQCS) appraisal tool. RESULTS Seventy studies were included in the review, 60 of which were published since 2014 with most ( n = 47) from the United States. Acute care ( n = 41) was the most prevalent practice setting. Twenty-two studies (31%) did not use QI models or approaches and only nine studies referenced Revised Standards for QI Reporting Excellence guidelines. The median QI-MQCS score was 12 (range 7-15). CONCLUSIONS/IMPLICATIONS Quality improvement publications in the PT literature are increasing, yet there is a paucity of QI studies pertaining to most practice settings and a lack of rigor in project design and reporting. Many studies were of low-to-moderate quality and did not meet minimum reporting standards. We recommend use of models, frameworks, and reporting guidelines to improve methodologic rigor and reporting.
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Jesus TS, Stern BZ, Struhar J, Deutsch A, Heinemann AW. The use of patient experience feedback in rehabilitation quality improvement and codesign activities: Scoping review of the literature. Clin Rehabil 2022; 37:261-276. [DOI: 10.1177/02692155221126690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To characterize the literature, reported enablers, and gaps on the use of patient experience feedback for person-centered rehabilitation quality improvement and codesign activities. Design Scoping Review. Data sources Scientific databases (PubMed, CINAHL, Rehabdata, Scopus, Web of Science, ProQuest), website searches (e.g. Beryl Institute), snowballing, and key-informant recommendations. Methods Two independent reviewers performed title and abstract screenings and full-text reviews. Eligibility focused on English-language, peer-reviewed (all time) and gray literature (last five years) that used patient experience feedback in rehabilitation improvement activities. The aims, settings, methods, findings, implications, and reported limitations were extracted, followed by content analyses identifying reported enablers and gaps. Results Among the 901 unique references and 52 full texts reviewed, ten were included: four used patient experience surveys for improving patient experiences; six used codesign methodologies to engage patient feedback in service improvement activities. Implementation enablers included securing managerial support, having a structured methodology and facilitator, using efficient processes, engaging staff experiences, and using appreciative inquiry. Reported study gaps included limited follow-up, low sample sizes, analytical limitations, lack of reported limitations, or narrow range of perspectives (e.g. not from people with severe impairments). Conclusion Few examples of the use of patient experience feedback in quality improvement or codesign activities were found in the rehabilitation literature. Patient experience improvement activities relied exclusively on retrospective survey data, which were not combined with often more actionable forms (e.g. qualitative, real time) of patient experience feedback. Further research might consider design of activities that collect and use patient experience feedback for rehabilitation service improvements.
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Affiliation(s)
- TS Jesus
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - BZ Stern
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Struhar
- Nerve, Muscle + Bone Innovation Center & Oncology Innovation Center, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - A Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- RTI International, Chicago, IL, USA
| | - AW Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Taylor SM, Slowinske L, Dennison M, Manusky C, Tan S, Patel K, Brewington D. Inpatient rehabilitation wheelchair management quality improvement project: Implications for patients with spinal cord injury. J Spinal Cord Med 2022; 46:414-423. [PMID: 35108164 PMCID: PMC10114970 DOI: 10.1080/10790268.2021.2019656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CONTEXT/OBJECTIVE Evaluate hospital fleet wheelchair (WC) requests submitted by physical therapists (PT) for patients with spinal cord injury (SCI) to trial and use during inpatient rehabilitation. DESIGN Quality improvement project secondary analysis of delivery process and WC trials. SETTING Urban inpatient rehabilitation hospital. PARTICIPANTS Internal review of 4,371 WC requests narrowed to 750 patients with SCI. INTERVENTIONS PTs submitted WC requests between March 25, 2017, and September 30, 2019. OUTCOME MEASURES WC delivery timeframe, level of SCI, type of WC. RESULTS PTs requested power (28%), and manual WC bases: standard (19.1%), tilt (18.9%), ultralight rigid (18.9%), ultralight folding (13.5%), and recliner (1.6%) respectively. Patients received fleet WCs 49.9% of the time within specified urgency timeframes. A Chi-Square test showed a significant association between WC request urgency and fulfillment within established timeframes (χ2 = 19.68, P < 0.001, n = 750). Broken down by urgency level: 60.0% low (n = 12), 56.2% medium (n = 244), and 39.9% high (n = 118) received their WC within established timeframes. Patients with cervical level SCI (n = 162) had the highest mean wait time of 8.28 days for power WCs. The second highest wait time was 6.29 days (SD 6.6) for manual ultralight rigid WCs (n = 34). CONCLUSION Inpatient fleet WC delivery is critical to patients with SCI. Variation occurs by WC type requested and by the level of injury. Gaps exist in providing appropriate WCs in facility timeframe guidelines by the level of urgency that is within 24 h for high, 3-5 days for medium, and 5-7 days for low.
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Affiliation(s)
- Sally M Taylor
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.,Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Laura Slowinske
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department at Northwestern Medicine, Northwestern Medical Group Women's Health Physical Therapy, Chicago, Illinois, USA
| | - Michael Dennison
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Colton Manusky
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shawn Tan
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kinjal Patel
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Jacobs ML, Mlinac ME. Healthcare Quality Improvement Competency: A Clinical and Training Imperative for Geropsychology. J Clin Psychol Med Settings 2021; 28:897-908. [PMID: 34596823 DOI: 10.1007/s10880-021-09824-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
Quality improvement (QI) work is increasingly necessary to ensure healthcare is delivered safely, efficiently, and equitably. As geropsychologists play an increasingly vital role in healthcare service delivery for older adults, it is imperative that they develop professional competence in QI, yet there is little formal QI training aimed at geropsychologists or to graduate students pursuing geropsychology. This article aims to elucidate the importance of QI education and training in geropsychology. In line with the Pikes Peak model for training in professional geropsychology, we outline QI knowledge and skills competencies for geropsychology training and suggest a rubric for integrating QI education into academic and clinical training from graduate school to professional practice. We provide recommended readings that geropsychology educators can read to become familiar with QI or use as part of a syllabus. Finally, we offer some recommendations for how current and future geropsychologists can be leaders in quality improvement work.
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Affiliation(s)
- M Lindsey Jacobs
- Research & Development Service, Tuscaloosa VA Medical Center, 3701 Loop Road, Tuscaloosa, AL, 35404, USA.
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA.
| | - Michelle E Mlinac
- VA Boston Healthcare System, Jamaica Plain, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Jesus TS, von Zweck C, Mani K, Kamalakannan S, Bhattacharjya S, Ledgerd R. Mapping the occupational therapy workforce research worldwide: Study protocol for a scoping review. Work 2021; 70:677-686. [PMID: 34719464 PMCID: PMC7612721 DOI: 10.3233/wor-210777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Human Resources for Health (HRH) research informs the development of evidence-based, population-centered HRH policies and practices. Occupational therapists are key human resources for meeting the health, rehabilitation, and occupational needs of the population worldwide. Yet, the global status of the occupational therapy workforce research remains unchartered. OBJECTIVES This study protocol depicts the methods to map out and synthesize the occupational therapy workforce research worldwide. METHODS Six scientific-literature databases and key international institutional websites will be systematically searched, complemented by snowballing searches and recommendations from key global, regional, or national representatives of the World Federation of Occupational Therapists. Two independent reviewers will screen titles-and-abstracts and then full-texts against the eligibility criteria, e.g., 10 categories of workforce research. Educational research, non-empirical papers, and papers (or their summaries) not available in English, Spanish or Portuguese are excluded. Data extraction (e.g., methods, geographies, aims, key findings) will be conducted by one author and fully verified by another. The extracted data will be computed as well as subject to content analysis to provide quantitative map of the literature and of the contents addressed, e.g., per inclusion category. CONCLUSION The results of this review can inform wide consultation processes and strategic, concerted local and global developments of the occupational therapy workforce.
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Affiliation(s)
- Tiago S. Jesus
- Global Health and Tropical Medicine (GHTM) and WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine – NOVA University of Lisbon (IHMT-UNL), Lisbon, Portugal
| | - Claudia von Zweck
- World Federation of Occupational Therapists (WFOT), Geneva, Switzerland
| | - Karthik Mani
- Department of Occupational Therapy, School of Health Professions, The University of Texas Medical Branch at Galveston, TX, USA
| | - Suresh Kamalakannan
- Public Health Foundation of India (PHFI), South Asia Centre for Disability Inclusive Development and Research (SACDIR), Indian Institute of Public Health – Hyderabad (IIPH-H), Hyderabad, India
| | - Sutanuka Bhattacharjya
- Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Ritchard Ledgerd
- World Federation of Occupational Therapists (WFOT), Geneva, Switzerland
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Jesus TS, Kondilis E, Filippon J, Russo G. Impact of economic recessions on healthcare workers and their crises' responses: study protocol for a systematic review of the qualitative and quantitative evidence for the development of an evidence-based conceptual framework. BMJ Open 2019; 9:e032972. [PMID: 31748311 PMCID: PMC6886968 DOI: 10.1136/bmjopen-2019-032972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION During economic recessions, health professionals face reduced income and labour opportunities, hard conditions often exacerbated by governments' policy responses to crises. Growing evidence points to non-negligible effects on national health workforces and health systems-decrease in motivation, burnout, migration-arising from the combination of crisis-related factors. However, no theoretical conceptualisation currently exists framing the impacts recessions have on human resources for health (HRH), or on their reactions. METHODS AND ANALYSIS This paper lays out a protocol for a systematic review of the existing qualitative, quantitative and mixed-method evidence on the economic recessions and HRH; results from the review will be used to develop a conceptual framework linking existing theories on recessions, austerity measures, health systems and population health, with a view of informing future health policies. Eight relevant databases within the health, health systems, multidisciplinary and economic literature will be searched, complemented by secondary searches and experts' input. Eligible studies will present primary quantitative or qualitative evidence on HRH impacts, or original secondary analyses. We will cover the 1970-2019 period-the modern age of global economic recessions-and full texts in English, Spanish, Italian, French, Portuguese or Greek. Two reviewers will independently assess, perform data extraction and conduct quality appraisal of the texts identified. A 'best-fit' framework synthesis will be applied to summarise the findings, using an a priori, theoretically driven framework. That preliminary framework was built by the research team to inform the searches, and will be appraised by external experts. ETHICS AND DISSEMINATION In addition to peer-reviewed publications, the new framework will be presented in global health systems research conferences and inform regional policy dialogue workshops in Latin America on economic recessions and health systems. PROSPERO REGISTRATION NUMBER CRD42019134165.
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Affiliation(s)
- Tiago Silva Jesus
- Global Health and Tropical Medicine, WHO Collaborating Center on Health Workforce Policy and Planning, New University of Lisbon, Institute of Hygiene and Tropical Medicine, Lisbon, Portugal
| | - Elias Kondilis
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Jonathan Filippon
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Giuliano Russo
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
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Crossing the Global Quality Chasm in Health Care: Where Does Rehabilitation Stand? Arch Phys Med Rehabil 2019; 100:2215-2217. [DOI: 10.1016/j.apmr.2019.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 11/20/2022]
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Zeisberger M, Nowik D, Beck L, Märtin S, Beckmann U, Meyer T. Quality management in medical rehabilitative care by the German statutory pension insurance scheme. Eur J Phys Rehabil Med 2019; 55:845-851. [PMID: 31556507 DOI: 10.23736/s1973-9087.19.05575-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper aims to provide an insight into the quality management approach for medical rehabilitation services of the German statutory pension insurance scheme. In the 1990s, the German statutory pension insurance scheme initiated a quality management programme in rehabilitation, which is subject to continuous development. The main objective of implementing quality management in rehabilitative care was quality control and quality improvement. To achieve these goals, five main tools for quality measurements were applied: a classification of therapeutic services, standards of rehabilitative interventions, patient surveys, peer review, and surveys that address structure of care. These tools enable the assessment of the structural and process quality of rehabilitative care, as well as aspects of rehabilitation outcome. As a result, quality of rehabilitation care becomes more measurable, transparent, and hence can be improved on well-founded grounds. These measurements allow implementing comparisons and benchmarking of rehabilitation facilities, thereby creating incentives for quality improvements. Therefore, the development and implementation of quality management measures in facilities of inpatient and outpatient medical rehabilitation is an ongoing process and expands to other areas of rehabilitation.
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Affiliation(s)
- Marlen Zeisberger
- Unit of Integrative Rehabilitation Research, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
| | - Daniel Nowik
- Unit of Integrative Rehabilitation Research, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany.,School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - Larissa Beck
- German Statutory Pension Insurance Scheme, Berlin, Germany
| | | | | | - Thorsten Meyer
- Unit of Integrative Rehabilitation Research, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany - .,School of Public Health, University of Bielefeld, Bielefeld, Germany
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12
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Tumin D, Akpan US, Kohler JA, Uffman JC. Publication Bias Among Conference Abstracts Reporting on Pediatric Quality Improvement Projects. Am J Med Qual 2019; 35:274-280. [DOI: 10.1177/1062860619873716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study evaluated progress to publication of pediatric quality improvement (QI) projects initially presented as national conference abstracts, according to project findings and other characteristics. QI abstracts were identified among presentations at the 2010-2015 American Academy of Pediatrics National Conference & Exhibition, and publications were tracked through June 2018. Positive findings (improvement on at least 1 quantitative project outcome), interventions, and analyses were correlated with journal publication. Of 142 abstracts, 128 (90%) reported positive findings. Forty-nine positive abstracts and 3 abstracts reporting negative results resulted in publication (38% vs 21%, respectively; P = .256). Median time to publication was 1.2 years for projects with positive findings, compared to >3 years for abstracts with negative findings ( P = .029). Ninety percent of abstracts reported positive findings, and these abstracts progressed to publication more quickly. Overcoming publication bias for pediatric QI projects may enhance selection of promising interventions as new projects are designed.
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Affiliation(s)
- Dmitry Tumin
- Brody School of Medicine at East Carolina University, Greenville, NC
| | - Uduak S. Akpan
- Brody School of Medicine at East Carolina University, Greenville, NC
| | - John A. Kohler
- Brody School of Medicine at East Carolina University, Greenville, NC
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13
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Guo M, Fortin C, Mayo AL, Robinson LR, Lo A. Quality Improvement in Rehabilitation: A Primer for Physical Medicine and Rehabilitation Specialists. PM R 2019; 11:771-778. [PMID: 30729748 DOI: 10.1002/pmrj.12130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/25/2019] [Indexed: 11/06/2022]
Abstract
Physiatrists in all practice settings can improve the care of rehabilitation patients through the rigorous application of quality improvement (QI) methodology. This primer provides a step-by-step guide to QI in rehabilitation settings for academic and community physiatrists, using the Model for Improvement. Key concepts discussed include Plan-Do-Study-Act cycles, setting optimal aim statements and measures, involving the rehabilitation team, diagnostic tools to understand root causes of quality problems, selection of change concepts and ideas, and utilizing run charts for data analysis. A QI project focused on the secondary prevention of vascular complications in amputees with diabetes admitted to inpatient rehabilitation is used as an illustrative example throughout the primer.
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Affiliation(s)
- Meiqi Guo
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Chris Fortin
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada.,Bridgepoint Active Healthcare, Sinai Health System, Toronto, Canada
| | - Amanda L Mayo
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Lawrence R Robinson
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Alexander Lo
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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