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Bernet NS, Everink IHJ, Hahn S, Bauer S, Schols JMGA. Comparing risk-adjusted inpatient fall rates internationally: validation of a risk-adjustment model using multicentre cross-sectional data from hospitals in Switzerland and Austria. BMC Health Serv Res 2024; 24:331. [PMID: 38481303 PMCID: PMC10935870 DOI: 10.1186/s12913-024-10839-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 03/07/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Inpatient falls in hospitals are an acknowledged indicator of quality of care. International comparisons could highlight quality improvement potential and enable cross-national learning. Key to fair cross-national comparison is the availability of a risk adjustment model validated in an international context. This study aimed to 1) ascertain that the variables of the inpatient fall risk adjustment model do not interact with country and thus can be used for risk adjustment, 2) compare the risk of falling in hospitals between Switzerland and Austria after risk adjustment. METHODS The data on inpatient falls from Swiss and Austrian acute care hospitals were collected on a single measurement day in 2017, 2018 and 2019 as part of an international multicentre cross-sectional study. Multilevel logistic regression models were used to screen for interaction effects between the patient-related fall risk factors and the countries. The risks of falling in hospital in Switzerland and in Austria were compared after applying the risk-adjustment model. RESULTS Data from 176 hospitals and 43,984 patients revealed an inpatient fall rate of 3.4% in Switzerland and 3.9% in Austria. Two of 15 patient-related fall risk variables showed an interaction effect with country: Patients who had fallen in the last 12 months (OR 1.49, 95% CI 1.10-2.01, p = 0.009) or had taken sedatives/psychotropic medication (OR 1.40, 95% CI 1.05-1.87, p = 0.022) had higher odds of falling in Austrian hospitals. Significantly higher odds of falling were observed in Austrian (OR 1.38, 95% CI 1.13-1.68, p = 0.002) compared to Swiss hospitals after applying the risk-adjustment model. CONCLUSIONS Almost all patient-related fall risk factors in the model are suitable for a risk-adjusted cross-country comparison, as they do not interact with the countries. Further model validation with additional countries is warranted, particularly to assess the interaction of risk factors "fall in the last 12 months" and "sedatives/psychotropic medication intake" with country variable. The study underscores the crucial role of an appropriate risk-adjustment model in ensuring fair international comparisons of inpatient falls, as the risk-adjusted, as opposed to the non-risk-adjusted country comparison, indicated significantly higher odds of falling in Austrian compared to Swiss hospitals.
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Affiliation(s)
- Niklaus S Bernet
- School of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, Bern, 3008, Switzerland.
| | - Irma H J Everink
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, PO BOX 616, Maastricht, 6200 MD, the Netherlands
| | - Sabine Hahn
- School of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, Bern, 3008, Switzerland
| | - Silvia Bauer
- Institute of Nursing Science, Medical University of Graz, Neue Stiftingtalstraße 6/P06-WEST, 8010, Graz, Austria
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, PO BOX 616, Maastricht, 6200 MD, the Netherlands
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Monzio Compagnoni M, Caggiu G, Allevi L, Barbato A, Carle F, D'Avanzo B, Di Fiandra T, Ferrara L, Gaddini A, Giordani C, Sanza M, Saponaro A, Scondotto S, Tozzi VD, Corrao G, Lora A. Assessment and Monitoring of the Quality of Clinical Pathways in Patients with Depressive Disorders: Results from a Multiregional Italian Investigation on Mental Health Care Quality (the QUADIM Project). J Clin Med 2023; 12:jcm12093297. [PMID: 37176737 PMCID: PMC10179491 DOI: 10.3390/jcm12093297] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Ensuring adequate quality of care to patients with severe mental disorders remains a challenge. The implementation of clinical indicators aimed at assessing the quality of health care pathways delivered is crucial for the improvement of mental health services (MHS). This study aims to evaluate the quality of care delivered to patients who are taken-into-care with depressive disorders by MHS. Thirty-four clinical indicators concerning accessibility, appropriateness, continuity, and safety were estimated using health care utilization databases from four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily). A total of 78,924 prevalent patients treated for depressive disorders in 2015 were identified, of whom 15,234 were newly engaged by MHS. During the year of follow-up, access to psychotherapeutic interventions was low, while the intensity was adequate; 5.1% of prevalent patients received at least one hospitalization in a psychiatric ward (GHPW), and 3.3% in the cohort of newly engaged in services. Five-out-of-10 patients had contact with community services within 14 days after GHPW discharge, but less than half of patients were persistent to antidepressant drug therapy. Furthermore, prevalent patients showed an excess of mortality compared to the general population (SMR = 1.35; IC 95%: 1.26-1.44). In conclusion, the quality of health care is not delivered in accordance with evidence-based mental health standards. Evaluation of health interventions are fundamental strategies for improving the quality and equity of health care.
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Affiliation(s)
- Matteo Monzio Compagnoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Giulia Caggiu
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, 23900 Lecco, Italy
| | - Liliana Allevi
- Department of Mental Health and Addiction Services, ASST Lecco, 23900 Lecco, Italy
| | - Angelo Barbato
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Flavia Carle
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Barbara D'Avanzo
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Teresa Di Fiandra
- Psychologist, Previously General Directorate for Health Prevention, Ministry of Health, 00144 Rome, Italy
| | - Lucia Ferrara
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, 20100 Milan, Italy
| | | | - Cristina Giordani
- Department of Health Planning, Italian Health Ministry, 00144 Rome, Italy
| | - Michele Sanza
- Department of Mental Health and Addiction Disorders Forlì-Cesena, AUSL Romagna, 48121 Cesena, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, 40127 Bologna, Italy
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, 90145 Palermo, Italy
| | - Valeria D Tozzi
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, 20100 Milan, Italy
| | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Antonio Lora
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, 23900 Lecco, Italy
- Consultant for General Directorate for Welfare, 20124 Milan, Italy
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Gwon YG, Han SJ, Kim KH. Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study. J Prev Med Public Health 2023; 56:248-254. [PMID: 37287202 DOI: 10.3961/jpmph.23.015] [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: 01/09/2023] [Accepted: 03/24/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES Measuring the quality of care is paramount to inform policies for healthcare services. Nevertheless, little is known about the quality of primary care and acute care provided in Korea. This study investigated trends in the quality of primary care and acute care. METHODS Case-fatality rates and avoidable hospitalization rates were used as performance indicators to assess the quality of primary care and acute care. Admission data for the period 2008 to 2020 were extracted from the National Health Insurance Claims Database. Case-fatality rates and avoidable hospitalization rates were standardized by age and sex to adjust for patients' characteristics over time, and significant changes in the rates were identified by joinpoint regression. RESULTS The average annual percent change in age-/sex-standardized case-fatality rates for acute myocardial infarction was -2.3% (95% confidence interval, -4.6 to 0.0). For hemorrhagic and ischemic stroke, the age-/sex-standardized case-fatality rates were 21.8% and 5.9%, respectively in 2020; these rates decreased since 2008 (27.1 and 8.7%, respectively). The average annual percent change in age-/sex-standardized avoidable hospitalization rates ranged from -9.4% to -3.0%, with statistically significant changes between 2008 and 2020. In 2020, the avoidable hospitalization rates decreased considerably compared with the 2019 rate because of the coronavirus disease 2019 pandemic. CONCLUSIONS The avoidable hospitalization rates and case-fatality rates decreased overall during the past decade, but they were relatively high compared with other countries. Strengthening primary care is an essential requirement to improve patient health outcomes in the rapidly aging Korean population.
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Affiliation(s)
- Yeong Geun Gwon
- Review and Assessment Research Division, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Seung Jin Han
- Primary Care Improvement Division, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Kyoung Hoon Kim
- International Policy Research Division, Health Insurance Review & Assessment Service, Wonju, Korea
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Assessing equity and quality indicators for older people – Adaptation and validation of the Assessing Care of Vulnerable Elders (ACOVE) checklist for the Portuguese care context. BMC Geriatr 2022; 22:561. [PMID: 35790949 PMCID: PMC9256534 DOI: 10.1186/s12877-022-03104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 04/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Development has promoted longer and healthier lives, but the rise in the proportion of older adults poses new challenges to health systems. Susceptibilities of older persons resulting from lower knowledge about services availability, health illiteracy, lower income, higher mental decline, or physical limitations need to be identified and monitored to assure the equity and quality of health care. The aim of this study was to develop equity indicators for the Assessing Care of Vulnerable Elders (ACOVE)-3 checklist and perform the first cross-cultural adaptation and validation of this checklist into Portuguese. Methods A scoping literature review of determinants or indicators of health (in)equity in the care of older people was performed. A total of 5 language experts and 18 health professionals were involved in the development and validation of the equity and quality indicators through expert opinion and focus groups. Data collected from focus groups was analyzed through directed or conventional content analysis. The usefulness of the indicators was assessed by analyzing the clinical records of 30 patients. Results The literature review revealed that there was a worldwide gap concerning equity indicators for older people primary health care. A structured and complete checklist composed of equity and quality indicators was obtained, validated and assessed. A significant number of non-screened quality or equity related potential occurrences that could have been avoided if the proposed indicators were implemented were detected. The percentage of non-registered indicators was 76.6% for quality and 96.7% for equity. Conclusions Applying the proposed checklist will contribute to improve the monitoring of the clinical situation of vulnerable older people and the planning of medical and social actions directed at this group. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03104-5.
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The quality of mental health care delivered to patients with schizophrenia and related disorders in the Italian mental health system. The QUADIM project: a multi-regional Italian investigation based on healthcare utilisation databases. Epidemiol Psychiatr Sci 2022; 31:e15. [PMID: 35156603 PMCID: PMC8851066 DOI: 10.1017/s2045796022000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS To evaluate the quality of mental health care delivered to patients with schizophrenia and related disorders taken-in-care by mental health services in four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily). METHODS Thirty-one clinical indicators concerning accessibility, appropriateness, continuity and safety were defined and estimated using healthcare utilisation (HCU) databases, containing data on mental health treatments, hospital admissions, outpatient interventions, lab tests and drug prescriptions. RESULTS A total of 70 586 prevalent patients with schizophrenia and related disorders treated in 2015 were identified, of whom 1752 were newly taken-in-care by the facilities of regional mental health services. For most patients community care was accessible and moderately intensive. However, care pathways were not implemented based on a structured assessment and only half of the patients received psychosocial treatments. One patient out of ten had access to psychological interventions and psychoeducation. Activities specifically addressed to families involved a third of prevalent patients and less than half of new patients. One patient out of six was admitted to a community residential facility, and one out of ten to a General Hospital Psychiatric Ward (GHPW); higher values were identified in new cases. In general hospitals, few patients had a length of stay (LoS) of more than 30 days, while one-fifth of the admissions were followed by readmission within 30 days of discharge. For two-thirds of patients, continuity of community care was met, and six times out of ten a discharge from a GHPW was followed by an outpatient contact within 2 weeks. For cases newly taken-in-care, the continuity of community care was uncommon, while the readiness of outpatient contacts after discharge was slightly more frequent. Most of the patients received antipsychotic medication, but their adherence to long-term treatment was low. Antipsychotic polytherapy was frequent and the control of metabolic side effects was poor. The variability between regions was high and consistent in all the quality domains. CONCLUSIONS The Italian mental health system could be improved by increasing the accessibility to psychosocial interventions, improving the quality of care for newly taken-in-care patients, focusing on somatic health and mortality, and reducing regional variability. Clinical indicators demonstrate the strengths and weaknesses of the mental health system in these regions, and, as HCU databases, they could be useful tools in the routine assessment of mental healthcare quality at regional and national levels.
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Rocco I, Tamburis O, Pecoraro F, Luzi D, Corso B, Minicuci N. Quality of child healthcare in European countries: common measures across international databases and national agencies. Eur J Public Health 2021; 31:679-687. [PMID: 34480552 PMCID: PMC8504999 DOI: 10.1093/eurpub/ckab086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The evaluation of child healthcare is not yet widely explored, especially from a cross-country comparison perspective. The routine adoption of measures by national assessment agencies is under-investigated. Though the guiding principles developed at international level call for a child-centric multi-dimensional evaluation of child care, its feasibility is hampered by the availability of robust and harmonized data. Methods To explore the data availability, international databases (IDBs) were scrutinized and measures dealing with child health-related issues were collated. In parallel, an ad hoc questionnaire was administrated to 30 Country Agents (CAs) to gather measures routinely adopted at local level. To facilitate the comparison of measures, a three-level conceptual map was developed. Results The IDBs yielded at 207 measures that pertained mainly to non-health determinants of health, whereas the 352 measures obtained from CAs focused on process and outcome. A set of 33 common measures that related to immunization, morbidity and mortality were identified. Conclusions A limited set of measures used both in IDBs and at national level identify common areas of concerns that certainly capture crucial issues with child prevention and health outcomes. However, they are far from satisfying a child-centric multi-dimensional approach to the evaluation of child well-being and well-becoming. There is room for improvement at both international and national levels. IDBs should include and harmonize measures that concern the provision of child-centric services and encompass physical, social and mental development. At the national level, efforts towards the inclusion of measures that concern non-health determinants of health should be pursued.
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Affiliation(s)
- Ilaria Rocco
- Departement of Biomedical sciences, Neuroscience Institute, National Research Council, Padova, Italy
| | - Oscar Tamburis
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
| | - Fabrizio Pecoraro
- Departement of Social sciences and humanities, cultural heritage, Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Daniela Luzi
- Departement of Social sciences and humanities, cultural heritage, Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Barbara Corso
- Departement of Biomedical sciences, Neuroscience Institute, National Research Council, Padova, Italy
| | - Nadia Minicuci
- Departement of Biomedical sciences, Neuroscience Institute, National Research Council, Padova, Italy
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Luzi D, Rocco I, Tamburis O, Corso B, Minicuci N, Pecoraro F. Variability in the assessment of children's primary healthcare in 30 European countries. Int J Qual Health Care 2021; 33:6101213. [PMID: 33449077 PMCID: PMC7869189 DOI: 10.1093/intqhc/mzab007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 12/12/2020] [Accepted: 01/13/2021] [Indexed: 12/17/2022] Open
Abstract
Background The high variability in the types and number of measures adopted to evaluate childcare across European countries makes it necessary to investigate country practices to identify trends in setting national priorities in the assessment of child well-being. Objective This paper intends to investigate country practices under the lens of variability to explore possible trends in setting national priority in the evaluation of childcare. In particular, it analyses variability considering to what extent this depends on the tendency of adopting a broad vision (i.e. selecting measures for a larger variety of aspects) or whether this is influenced by the choice of adopting an in-depth approach (i.e. using more measures to analyse a specific aspect) Methods An ad hoc questionnaire was administered to a national expert in each country and yielded 352 measures. To analyse variability, the breadth in the number of aspects considered was explored using a convergence index, while the depth in the distribution of measures in each aspect was investigated by computing a coefficient of variation. Countries were grouped by adopting a hierarchical clustering approach. Results There is a high variability across countries in the selection of measures that cover different aspects of childcare. Preferences in the distribution of measures are significant even at the domain level and in countries that use a limited number of measures and become more evident at the category and sub-category levels. The statistical analysis clusters countries in four main groups and two outliers. The in-depth distribution of measures focused on a specific aspect shows a homogeneous pattern, with the identification of two main groups of countries. Conclusions A limited set of measures are shared across countries hampering a robust comparison of paediatric models. The selection of measures shows that the evaluation is closely related to national priorities as resulting from the number and types of measures adopted. Moreover, a range of a reasonable number of measures can be hypothesized to address the quality of childcare under a multi-dimensional perspective.
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Affiliation(s)
- daniela Luzi
- National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32, Rome, Lazio 00185, Italy
| | - Ilaria Rocco
- National Research Council, Neuroscience Institute, Via Giustiniani 2, Padua, Veneto 35128, Italy
| | - Oscar Tamburis
- National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32, Rome, Lazio 00185, Italy
| | - Barbara Corso
- National Research Council, Neuroscience Institute, Via Giustiniani 2, Padua, Veneto 35128, Italy
| | - Nadia Minicuci
- National Research Council, Neuroscience Institute, Via Giustiniani 2, Padua, Veneto 35128, Italy
| | - Fabrizio Pecoraro
- Address reprint requests to: Fabrizio Pecoraro, National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32, Rome, Lazio 00185, Italy. Tel: +39-06492724278; Fax: 39-06-4938-3724; E-mail:
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de Lima IB, Bernadi FA, Yamada DB, Vinci ALT, Rijo RPCL, Alves D, Furegato ARF. The use of indicators for the management of Mental Health Services. Rev Lat Am Enfermagem 2021; 29:e3409. [PMID: 33852681 PMCID: PMC8040785 DOI: 10.1590/1518-8345.4202.3409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/31/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify indicators that can be used in the management of Mental Health Services. METHOD an integrative review in which we adopted the Population, Concept, and Context strategy to formulate the following Guiding Question: "Which indicators can be used for the management of mental health services?". RESULTS a total of 22 articles were included and divided into two main groups: countries with initial high income (54%) as well as low- and middle-income countries (46%). We identified 5 studies that had experienced the use of indicators, 5 studies that had reported partial implementation, 9 studies that did not report use or implementation, 1 study on the indicator selection process, 1 as an implementation pilot, and a final study with a discussion for implementation. High-income countries also find it difficult to implement mental health indicators. The main difficulties in adopting the use of indicators are lack of basic mental health services, financial resources, legislation, political interest, and guidelines for its management. CONCLUSION it is unusual to find a descriptive comparison of quality monitoring programs at the system level in the technical-scientific literature related to mental health indicators.
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Affiliation(s)
- Inacia Bezerra de Lima
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | | | - Diego Bettiol Yamada
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | | | | | - Domingos Alves
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Antonia Regina Ferreira Furegato
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Qin VM, McPake B, Raban MZ, Cowling TE, Alshamsan R, Chia KS, Smith PC, Atun R, Lee JT. Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample. BMC Health Serv Res 2020; 20:372. [PMID: 32366235 PMCID: PMC7197140 DOI: 10.1186/s12913-020-05194-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 04/06/2020] [Indexed: 12/16/2022] Open
Abstract
Background Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. Method We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. Findings Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR = 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR = 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR = 2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR = 1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII = 7.45 vs 1.64). Conclusion Our findings suggest that urban areas have achieved better prevention and management of non-communicable disease than rural areas, but access to healthcare was equivalent. A better understanding of the causes of the observed variations is needed to develop appropriate policy interventions which address these disparities.
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Affiliation(s)
- Vicky Mengqi Qin
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Thomas E Cowling
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Riyadh Alshamsan
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Peter C Smith
- Centre for Health Economics, University of York, York, UK.,Imperial College London, London, UK
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - John Tayu Lee
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
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Maritz R, Scheel-Sailer A, Schmitt K, Prodinger B. Overview of quality management models for inpatient healthcare settings. A scoping review. Int J Qual Health Care 2020; 31:404-410. [PMID: 30165702 DOI: 10.1093/intqhc/mzy180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 06/26/2018] [Accepted: 08/03/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This scoping review aimed to generate an overview of existing quality management (QM) models for inpatient healthcare published in peer-reviewed literature. DATA SOURCES Peer-reviewed publications published until June 2016 were retrieved from the databases Medline, PubMed, CINAHL and Cochrane Library using search terms related to QM and models. STUDY SELECTION Publications mentioning a QM model for general application in healthcare or inpatient care in their title or abstract were included. Languages considered were: English, French, German, Italian and Spanish. DATA EXTRACTION Data extraction was 3-fold. First, publication characteristics were summarized. Second, the frequency of each identified model was documented and the publications were divided into conceptual and implementation publications. Third, relevant QM models were identified and information regarding the model, including content and relationship with other models, was extracted. RESULTS OF DATA SYNTHESIS Of 925 retrieved publications, 213 were included. The included publications reported on 64 different QM models that were suitable for or used in inpatient care. Seventeen models were identified as being relevant. The 17 models were then categorized into three different levels: conceptual quality improvement models, concrete application models and country specific adaptations. CONCLUSION This scoping review provides an overview of 17 existing QM models for inpatient care and their relationships with each other. Various types of models with differing aspects and components exist. In searching for QM models, many different concepts like QM system, accreditation or methodologies appeared. For future investigation, concepts of interest should be clarified.
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Affiliation(s)
- Roxanne Maritz
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Anke Scheel-Sailer
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.,Swiss Paraplegic Centre, Nottwil, Switzerland
| | | | - Birgit Prodinger
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.,Faculty of Applied Health and Social Sciences, University of Applied Sciences Rosenheim, Rosenheim, Germany
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Carinci F, Uccioli L, Massi Benedetti M, Klazinga NS. An in-depth assessment of diabetes-related lower extremity amputation rates 2000-2013 delivered by twenty-one countries for the data collection 2015 of the Organization for Economic Cooperation and Development (OECD). Acta Diabetol 2020; 57:347-357. [PMID: 31605210 DOI: 10.1007/s00592-019-01423-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND International comparisons of diabetes-related lower extremity amputation rates are still hampered by different criteria used for data collection and analysis. We aimed to evaluate trends and variation of major/minor amputations, using agreed definitions adopted by the Organization for Economic Cooperation and Development in 2015. METHODS Direct age-sex standardized rates were calculated per 100,000 subjects per year between 2000 and 2013, using major/minor amputations with diabetes diagnosis as numerators and the total population or number of people with diabetes as denominators. Longitudinal trends were investigated using generalized estimating equations. RESULTS Twenty-one countries reported major amputations referred to the general population, showing a mean reduction from 10.8 to 7.5 per 100,000 (- 30.6%). Eleven countries also reported major amputations among people with diabetes, showing a mean reduction from 182.9 to 128.3 per 100,000 (- 29.8%). Minor amputations remained stable over the study period. Longitudinal trends showed a significant average annual decrease of - 0.19 per 100,000 in the general population (95% CI - 0.36 to - 0.02; p = .03) and - 4.52 per 100,000 among subjects with diabetes (95% CI - 6.09 to - 2.94; p < .001). The coefficient of variation of major amputation rates between countries was fairly high (64%-in the total population, 67% among people with diabetes). CONCLUSIONS The study highlighted a clinically significant reduction of major amputations, in both the general population and among people with diabetes. The use of standardized definitions, while increasing the comparability of multinational data, highlighted remarkable differences between countries. These results can help identifying and sharing best practices effectively on a global scale.
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Affiliation(s)
- Fabrizio Carinci
- Department of Statistical Sciences, University of Bologna, Via Belle Arti 41, 40126, Bologna, Italy.
- National Agency for Regional Health Services (AGENAS), Via Puglie 23, 00187, Rome, Italy.
| | - Luigi Uccioli
- Department of Systems Medicine, Università Tor Vergata, Rome, Italy
| | | | - Nicolaas Sieds Klazinga
- Health Division, Organisation for Economic Co-operation and Development (OECD), Paris, France
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Cinaroglu S. Efficiency in health services based on professionals consensus quality indicators. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1724436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Songul Cinaroglu
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Beytepe, Ankara, Turkey
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Does size matter? The impact of caseload and expertise concentration on AMI 30-day mortality-A comparison across 10 OECD countries. Health Policy 2019; 123:441-448. [PMID: 30905525 DOI: 10.1016/j.healthpol.2019.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the variability of hospital performance within and across countries, using 30-day acute myocardial infarction (AMI) mortality, and to study the impact of hospital characteristics on performance. STUDY SETTING Hospital-level adjusted risk standardized mortality rates (RSMR) and hospital characteristics were collected from 10 OECD and two collaborating countries including 1,163 hospitals. STUDY DESIGN Associations between RSMR and hospital characteristics were studied using univariate and multivariate linear regressions. Clusters of hospitals were created using hierarchical clustering and mortality compared using linear regression. FINDINGS Wide variation between countries was found for RSMR and hospital characteristics. Regression models showed large country effects. A high volume of AMI admission was associated with lower RSMR in a model using a restricted number of hospital characteristics (-0.83, p < 0.001) but not in a model using all characteristics (-1.03, p = 0.06). Analysis within countries supported this association. Hospital clusters showed clear differences in characteristic distributions but no difference in RSMR. CONCLUSIONS The effect of volume may support policies toward a concentration of services within the hospital sector. The effect of other hospital characteristics was inconclusive and suggests the importance of system-wide characteristics or pathways of care (i.e. timeliness and nature of initial response and during transportation to a hospital, transfers between hospitals, post-discharge organization) in explaining variation.
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Sheikh JI, Cheema S, Chaabna K, Lowenfels AB, Mamtani R. Capacity building in health care professions within the Gulf cooperation council countries: paving the way forward. BMC MEDICAL EDUCATION 2019; 19:83. [PMID: 30871521 PMCID: PMC6417223 DOI: 10.1186/s12909-019-1513-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 03/07/2019] [Indexed: 05/13/2023]
Abstract
BACKGROUND There is a worldwide shortage of health care workers. This problem is particularly severe in the Gulf Cooperation Council (GCC) countries because of shortages in certain medical disciplines, due to a lack of nationally-trained professionals and a less developed educational system compared to other high income countries. Consequently, GCC countries are heavily dependent on an expatriate health care workforce; a problem exacerbated by high turnover. We discuss challenges and potential strategies for improving and strengthening capacity building efforts in health care professions in the GCC. MAIN TEXT In the GCC, there are 139 schools providing professional health education in medicine, dentistry, pharmacy, nursing, midwifery, and other specialties. Health education school density reported for the GCC countries ranges between 2.2 and 2.8 schools per one million inhabitants, except in Oman where it is 4.0 per one million inhabitants. The GCC countries rely heavily on expatriate health professionals. The number of physicians and nurses in the GCC countries are 2.1 and 4.5 per 1000 respectively, compared to 2.8 and 7.9 among member countries of the Organisation for Economic Cooperation and Development (OECD). Interestingly, the number of dentists and pharmacists is higher in the GCC countries compared to OECD countries. A nationally trained health care workforce is essential for the GCC countries. Physiotherapy and occupational therapy are two identified areas where growth and development are recommended. Custom-tailored continuing medical education and continuing professional development (CPD) programs can augment the skills of health practitioners, and allow for the expansion of their scope of practice when warranted. CONCLUSION Capacity building can play an essential role in addressing the major health challenges and improving the overall quality of health care in the region. Efforts aimed at increasing the number of locally-trained graduates and developing and implementing need-based CPD programs are vital for capacity building and lifelong learning in health care professions.
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Affiliation(s)
| | - Sohaila Cheema
- Institute for Population Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Karima Chaabna
- Institute for Population Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Albert B. Lowenfels
- Department of Surgery and Family Medicine, New York Medical College, Valhalla, NY USA
| | - Ravinder Mamtani
- Institute for Population Health, Weill Cornell Medicine-Qatar, Doha, Qatar
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Al-Katheeri H, El-Jardali F, Ataya N, Abdulla Salem N, Abbas Badr N, Jamal D. Contractual health services performance agreements for responsive health systems: from conception to implementation in the case of Qatar. Int J Qual Health Care 2018; 30:219-226. [PMID: 29401263 DOI: 10.1093/intqhc/mzy006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/09/2018] [Indexed: 12/22/2022] Open
Abstract
Objective Despite their use worldwide, strategy-based performance management is limited in the Eastern Mediterranean Region. This article explores Qatar's experience, the first from the Region, in implementing contractual agreements between healthcare providers and the regulator-Ministry of Public Health-to align strategy, performance and accountabilities. Design mixed-methods including tools development and pilot-testing, guided by performance management cycle with a focus on knowledge translation and key principles: feasibility; mandatory participation; participatory approach through Steering Committee. Setting All public, private and semi-governmental hospitals and primary healthcare centers. Intervention(s) (i) semi-structured interviews; (ii) review of 4982 indicators; (iii) Delphi technique for selecting indicators with > 80% agreement on importance and > 60% agreement on feasibility; (iv) capacity-building of providers and Ministry staff and 2-month pilot assessed by questionnaire with indicators scoring > 3 considered valid, reliable and feasible; and (v) 1-year grace period assessed by questionnaire. Main Outcome Measure(s) Approach strengths and challenges; Data collection and healthcare quality improvements. Results Contracts mandate reporting 25 hospital and 15 primary healthcare indicators to the regulator, which delivers confidential benchmarking reports to providers. Scorecards were discussed with the regulator for evidence-informed policymaking. The approach uncovered system-related challenges and learning for public and private sectors: providers commended the participatory approach (82%) and indicated that contracts enabled collecting valid and timely data (64%) and improved healthcare quality (55%). Conclusion This experience provides insights for countries implementing performance management, responsive regulation and public-private partnerships. It suggests that contractual agreements can be useful, despite their mandatory nature, if clear principles are applied early on.
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Affiliation(s)
- Huda Al-Katheeri
- Healthcare Quality and Patient Safety Department, Ministry of Public Health, PO Box 42, Doha, Qatar
| | - Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.,Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.,Center for Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.,Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL-209, 1280 Main St. West, Hamilton, Ontario, Canada L8S 4K1
| | - Nour Ataya
- Department of Health Management and Policy, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.,Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Noura Abdulla Salem
- Healthcare Quality and Patient Safety Department, Ministry of Public Health, PO Box 42, Doha, Qatar
| | - Nader Abbas Badr
- Healthcare Quality and Patient Safety Department, Ministry of Public Health, PO Box 42, Doha, Qatar
| | - Diana Jamal
- Department of Health Management and Policy, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.,Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
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Fischer M, Heinrichs H. Dimensions, Dialectic, Discourse. Three Political Perspectives on the Sustainability of the German Healthcare System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1526. [PMID: 30029496 PMCID: PMC6068714 DOI: 10.3390/ijerph15071526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/15/2018] [Accepted: 07/17/2018] [Indexed: 12/01/2022]
Abstract
This review article deals with the topic of sustainability in the German healthcare system and presents an overview of how the six articles of our research relate to one another. After introducing to the context of the research, its internal principles, and the methods applied, three perspectives are presented, each also discussed in terms of the respective literature in sustainability science and political science. The review concludes by presenting a circular model and by discussing the general limitations as well as the practical implications of our research.
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Affiliation(s)
- Matthias Fischer
- Comparative Politics and German Government, Institute of Political Science and Sociology, University of Würzburg, Wittelsbacherplatz 1, 97074 Würzburg, Germany.
| | - Harald Heinrichs
- Sustainability and Politics, Institute of Sustainability Governance, Leuphana University of Lüneburg, Universitätsallee 1, 21335 Lüneburg, Germany.
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Development of a core set of quality indicators for paediatric primary care practices in Europe, COSI-PPC-EU. Eur J Pediatr 2018; 177:921-933. [PMID: 29654400 DOI: 10.1007/s00431-018-3140-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 03/28/2018] [Indexed: 10/17/2022]
Abstract
UNLABELLED Paediatric ambulatory healthcare systems in Europe are, because of historical reasons, diverse and show strikingly different outcomes. All across Europe, the benchmarking of structures, processes and outcomes could reveal opportunities for improving Paediatric Primary Care (PPC). The aim of this study was to develop a set of Quality Indicators (QIs) to assess and monitor PPC in Europe. In a three-step process, we used the available external evidence and European expert consensus in a modified RAND/UCLA Appropriateness Method (RAM) to develop an indicator set. (1) A broad literature and online research of published QI and guidelines yielded an inventory of 1516 QI. (2) A collaborative panel of paediatric senior experts from the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) from 15 European countries participated in a first consensus process to reduce the initial indicator inventory by eliminating not PPC-focused indicators and duplicates. (3) In a second consensus process, the panel rated the QI regarding validity and feasibility. The final QI set "COSI-PPC-EU" consists of 42 indicators in five categories of PPC: (A) health promotion/prevention/screening (13 QI), (B) acute care (9 QI), (C) chronic care (8 QI), (D) practice management (3 QI) and (E) patient safety (9 QI). CONCLUSION COSI-PPC-EU represents a consented set of a limited number of valid quality indicators for the application in paediatric primary care in different healthcare systems throughout Europe. What is Known: • Paediatric ambulatory healthcare systems in Europe are diverse and show strikingly different outcomes. • There are known gaps in quality performance measures of paediatric primary care in Europe. Pre-existing sets of quality indicators are predominantly limited to national populations, specific diseases and hospital care. What is New: • A set of 42 quality indicators for primary paediatric care in Europe was developed in a multi-country collaborative effort. The method combined a systematic literature review and a consensus process among European paediatric experts. • The quality indicator set can facilitate quality improvement of PPC. After studying the feasibility, providers can use COSI-PPC-EU to monitor, compare and improve performance of practices, regions and countries.
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18
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Vähäniemi A, Warwick-Smith K, Hätönen H, Välimäki M. A national evaluation of community-based mental health strategies in Finland. Int J Qual Health Care 2018; 30:57-64. [PMID: 29300900 DOI: 10.1093/intqhc/mzx166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/28/2017] [Indexed: 11/14/2022] Open
Abstract
Objective High-quality mental health care requires written strategies to set a vision for the future, yet, there is limited systematic information available on the monitoring and evaluation of such strategies. The aim of this nationwide study is to evaluate local mental health strategies in community-based mental health services provided by municipalities. Design and setting Mental health strategy documents were gathered through an online search and an e-mail survey of the local authorities of all Finnish mainland municipalities (n = 320). Participants Out of 320 municipalities, documents for 129 municipalities (63 documents) were included in the study. Intervention The documents obtained (n = 63) were evaluated against the World Health Organization checklist for mental health strategies and policies. Main outcome measures Evaluation of the process, operations and content of the documents, against 31 indicators in the checklist. Results Out of 320 Finnish municipalities, 40% (n = 129) had a mental health strategy document available and 33% (n = 104) had a document that was either in preparation or being updated. In these documents, priorities, targets and activities were clearly described. Nearly all (99%) of the documents suggested a commitment to preventative work, and 89% mentioned a dedication to developing community-based care. The key shortfalls identified were the lack of consideration of human rights (0%), the limited consideration of research (5%) and the lack of financial planning (28%) to successfully execute the plans. Of the documents obtained, 60% covered both mental health and substance abuse issues. Conclusions This study contributes to the limited evidence base on health care strategy evaluations. Further research is needed to understand the potential impact of policy analysis.
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Affiliation(s)
- Anu Vähäniemi
- Department of Nursing Science, University of Turku, 20014 Turun Yliopisto, Finland
| | - Katja Warwick-Smith
- Department of Nursing Science, University of Turku, 20014 Turun Yliopisto, Finland
| | - Heli Hätönen
- Department of Nursing Science, University of Turku, 20014 Turun Yliopisto, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, 20014 Turun Yliopisto and Turku University Hospital, PL 52, 20521 Turku, Finland.,Hong Kong Polytechnic University, Hong Kong, China (SAR)
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19
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A Methodological Framework for the Integrated Design of Decision-Intensive Care Pathways—an Application to the Management of COPD Patients. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2017; 1:157-217. [DOI: 10.1007/s41666-017-0007-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 09/21/2017] [Accepted: 10/02/2017] [Indexed: 12/23/2022]
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20
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Alshamsan R, Lee JT, Rana S, Areabi H, Millett C. Comparative health system performance in six middle-income countries: cross-sectional analysis using World Health Organization study of global ageing and health. J R Soc Med 2017; 110:365-375. [PMID: 28895493 DOI: 10.1177/0141076817724599] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective To assess and compare health system performance across six middle-income countries that are strengthening their health systems in pursuit of universal health coverage. Design Cross-sectional analysis from the World Health Organization Study on global AGEing and adult health, collected between 2007 and 2010. Setting Six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Participants Nationally representative sample of adults aged 50 years and older. Main outcome measures We present achievement against key indicators of health system performance across effectiveness, cost, access, patient-centredness and equity domains. Results We found areas of poor performance in prevention and management of chronic conditions, such as hypertension control and cancer screening coverage. We also found that cost remains a barrier to healthcare access in spite of insurance schemes. Finally, we found evidence of disparities across many indicators, particularly in the effectiveness and patient centredness domains. Conclusions These findings identify important focus areas for action and shared learning as these countries move towards achieving universal health coverage.
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Affiliation(s)
- Riyadh Alshamsan
- 1 College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11632, Saudi Arabia.,2 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London SW7 2AZ, UK
| | - John Tayu Lee
- 2 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London SW7 2AZ, UK.,3 Saw Swee Hock School of Public Health, University of Singapore, Singapore 117549
| | - Sangeeta Rana
- 4 Field Epidemiology Service South East and London, Public Health England, London SE1 6LH, UK.,5 Imperial College Healthcare NHS Trust, London SW7 2AZ, UK
| | - Hasan Areabi
- 1 College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11632, Saudi Arabia
| | - Christopher Millett
- 2 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London SW7 2AZ, UK
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Franck LS, Ferguson D, Fryda S, Rubin N. The influence of family accommodation on pediatric hospital experience in Canada. BMC Health Serv Res 2017; 17:561. [PMID: 28810855 PMCID: PMC5558698 DOI: 10.1186/s12913-017-2529-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goals of our study were to describe the types of family accommodation for parents of hospitalized children and to examine their influence on the pediatric hospital experience. METHODS This multi-site cohort survey included 10 hospitals in Ontario Province, Canada. Participants were parents of inpatient children (n = 1240). Main outcome measures included ratings of three parent-reported measures of hospital experience: overall hospital experience; willingness to recommend the hospital to family or friends; and how much the accommodation type helped parent stay involved in their child's hospital care. RESULTS Parents most often stayed in the child's room (74.7%), their own home (12.3%), hotel (4.0%) or a Ronald McDonald House (3.0%). Accommodation varied based on hospital, parent and child factors. Length of stay and the child's health status were significant predictors for overall hospital experience and recommending the hospital to family or friends, but accommodation type was not. Families who stayed at a Ronald McDonald House reported greater involvement in their child's care compared with other accommodation types (odds ratio: 1.54-20.73 for contrasted accommodation types). CONCLUSION Use of different overnight accommodations for families of hospitalized pediatric patients in Canada is similar to a previous report of U.S. family hospital accommodations. In contrast to the previous U.S. findings, Canadian hospital experience scores were lower and accommodation type was not a significant predictor of overall hospital experience or willingness to recommend the hospital. In Canada, as in the U.S., families who stayed at a Ronald McDonald House reported that this accommodation type significantly improved their ability to be involved in their child's care.
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Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing, University of California, 2 Koret Way, N411Y, Box 0606, San Francisco, CA, 94143-0606, USA.
| | - Deron Ferguson
- ABILITY Network, Inc., 500 Union St., Suite 940, Seattle, WA, 98101, USA
| | - Sarah Fryda
- National Research Corporation, 1245 Q St., Lincoln, NE, 68508, USA
| | - Nicole Rubin
- Impact Solutions, 14 Buck Meadow Drive, Portola Valley, CA, 94028, USA
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“The final arbiter of everything”: a genealogy of concern with patient experience in Britain. SOCIAL THEORY & HEALTH 2017. [DOI: 10.1057/s41285-017-0045-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Using Local Data to Improve Care and Collaborative Practice: Insights From a Qualitative Study. J Nurs Care Qual 2017; 33:E1-E7. [PMID: 28658185 DOI: 10.1097/ncq.0000000000000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A qualitative study was undertaken to explore the experiences and perceptions of project leaders, clinicians, managers, and mentors associated with the implementation of a strategy aimed at enhancing clinicians' ability to use data to guide quality improvement projects. Our study findings elucidated the value and benefits including (1) using data to understand local context and move forward and (2) improving care and engaging in collaborative professional practice.
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Scherz N, Valeri F, Rosemann T, Djalali S. Quality of secondary prevention of coronary heart disease in Swiss primary care: Lessons learned from a 6-year observational study. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 118-119:40-47. [PMID: 27987567 DOI: 10.1016/j.zefq.2016.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Across Europe, great variations have been identified in the quality of preventive healthcare services delivered in primary care (PC). We aimed to assess the quality of secondary prevention in Swiss PC patients with coronary heart disease (CHD) and its evolution over six years. METHODS In the database of the Swiss «Family Medicine ICPC Research using Electronic Medical Records» (FIRE) project, we identified electronical record data of 2,807 patients with CHD treated for at least 15 months between 2009 and 2014. Primary outcome was the proportion of patients per year meeting four quality indicators of the British Quality and Outcome Framework (QOF): 1) blood pressure (BP) ≤ 150mmHg, 2) total serum cholesterol ≤ 5mmol/L, 3) prescription of anti-platelet therapy, 4) recommended drug prescriptions for patients with previous myocardial infarction (MI). Secondary outcome was the proportion of patients who were ineligible for indicator calculation because of incomplete record data. RESULTS From 2009 to 2014, 85.9, 83.1, 82.0, 81.9, 81.5, and 81.0 % of the patients met BP targets and 73.6, 77.0, 69.2, 73.6, 69.4, and 69.1% met cholesterol targets. Anti-platelet therapy was prescribed to 74.8, 76.1, 73.9, 70.2, 72.2, and 72.5 % of the patients. Finally, 83.3, 84.4, 87.5, 75.6, 89.8, and 89.2 % of the patients with previous MI received the recommended drug therapy. Changes over time were not significant. Missing BP records concerned 12.4-15.9 % of the patients, and missing cholesterol records 69.0-75.6 %. Females and patients with less cardiovascular comorbidities were more likely to show missing records. CONCLUSIONS Quality of secondary prevention did not improve when measured against QOF indicators in the period under investigation. Missing data in electronic medical records inhibited full quality indicator assessment. Especially in female patients and those with less cardiovascular comorbidity, closer medical documentation should be encouraged in order to facilitate quality of care measurements.
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Affiliation(s)
- Nathalie Scherz
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Sima Djalali
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
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