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Azami-Aghdash S, Moosavi A, Gharaee H, Sadeghi G, Mousavi Isfahani H, Ghasemi Dastgerdi A, Mohseni M. Development of quality indicators to measure pre-hospital emergency medical services for road traffic injury. BMC Health Serv Res 2021; 21:235. [PMID: 33726709 PMCID: PMC7970773 DOI: 10.1186/s12913-021-06238-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 03/03/2021] [Indexed: 01/01/2023] Open
Abstract
Background Pre-Hospital Emergency Care (PEC) is a fundamental property of prevention of Road Traffic Injuries (RTIs). Thus, this sector requires a system for evaluation and performance improvement. This study aimed to develop quality indicators to measure PEC for RTIs. Methods Following the related literature review, 14 experts were interviewed through semi-structured interviews to identify Quality Measurement Indicators (QMIs). The extracted indicators were then categorized into three domains: structure, performance, and management. Finally, the identified QMIs were confirmed through two rounds of the Delphi technique. Results Using literature review 11 structural, 13 performance, and four managerial indicators (A total of 28 indicators) were identified. Also, four structural, four performance, and three managerial indicators (A total of 11indicators) were extracted from interviews with experts. Two indicators were excluded after two rounds of Delphi’s technics. Finally, 14 structural, 16 performance and, seven managerial indicators (A total of 37indicators) were finalized. Conclusion Due to the importance and high proportion of RTIs compared to other types of injuries, this study set out to design and evaluate the QMIs of PEC delivered for RTIs. The findings of this research contribute to measuring and planning aimed at improving the performance of PEC. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06238-1.
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Affiliation(s)
- Saber Azami-Aghdash
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Moosavi
- Department of Health and Community Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Hojatolah Gharaee
- District Health Center of Hamadan City, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ghader Sadeghi
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haleh Mousavi Isfahani
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Ghasemi Dastgerdi
- Disaster and Emergency Medical Management Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Mohseni
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Dasari M, Johnson ED, Montenegro JH, Griswold DP, Jiménez MF, Puyana JC, Rubiano AM. A consensus statement for trauma surgery capacity building in Latin America. World J Emerg Surg 2021; 16:4. [PMID: 33516227 PMCID: PMC7847173 DOI: 10.1186/s13017-021-00347-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/18/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Trauma is a significant public health problem in Latin America (LA), contributing to substantial death and disability in the region. Several LA countries have implemented trauma registries and injury surveillance systems. However, the region lacks an integrated trauma system. The consensus conference's goal was to integrate existing LA trauma data collection efforts into a regional trauma program and encourage the use of the data to inform health policy. METHODS We created a consensus group of 25 experts in trauma and emergency care with previous data collection and injury surveillance experience in the LA. region. Experts participated in a consensus conference to discuss the state of trauma data collection in LA. We utilized the Delphi method to build consensus around strategic steps for trauma data management in the region. Consensus was defined as the agreement of ≥ 70% among the expert panel. RESULTS The consensus conference determined that action was necessary from academic bodies, scientific societies, and ministries of health to encourage a culture of collection and use of health data in trauma. The panel developed a set of recommendations for these groups to encourage the development and use of robust trauma information systems in LA. Consensus was achieved in one Delphi round. CONCLUSIONS The expert group successfully reached a consensus on recommendations to key stakeholders in trauma information systems in LA. These recommendations may be used to encourage capacity building in trauma research and trauma health policy in the region.
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Affiliation(s)
- Mohini Dasari
- University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | | | | | - Dylan P. Griswold
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital & University of Cambridge, Cambridge, UK
- Stanford School of Medicine, Stanford, CA USA
| | | | - Juan Carlos Puyana
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213 USA
| | - Andres M. Rubiano
- MEDITECH Foundation, Santiago de Cali, Valle de Cauca, Colombia
- Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia
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Al-Hatmi AMS, Al-Shuhoumi MA, Denning DW. Estimated Burden of Fungal Infections in Oman. J Fungi (Basel) 2020; 7:5. [PMID: 33374846 PMCID: PMC7823708 DOI: 10.3390/jof7010005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022] Open
Abstract
For many years, fungi have emerged as significant and frequent opportunistic pathogens and nosocomial infections in many different populations at risk. Fungal infections include disease that varies from superficial to disseminated infections which are often fatal. No fungal disease is reportable in Oman. Many cases are admitted with underlying pathology, and fungal infection is often not documented. The burden of fungal infections in Oman is still unknown. Using disease frequencies from heterogeneous and robust data sources, we provide an estimation of the incidence and prevalence of Oman's fungal diseases. An estimated 79,520 people in Oman are affected by a serious fungal infection each year, 1.7% of the population, not including fungal skin infections, chronic fungal rhinosinusitis or otitis externa. These figures are dominated by vaginal candidiasis, followed by allergic respiratory disease (fungal asthma). An estimated 244 patients develop invasive aspergillosis and at least 230 candidemia annually (5.4 and 5.0 per 100,000). Only culture and microscopy are currently available for diagnosis, so case detection is suboptimal. Uncertainty surrounds these figures that trigger the need for urgent local epidemiological studies with more sensitive diagnostics.
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Affiliation(s)
- Abdullah M. S. Al-Hatmi
- Department of microbiology, Natural & Medical Sciences Research Center, University of Nizwa, Nizwa 616, Oman
- Department of microbiology, Centre of Expertise in Mycology Radboudumc/CWZ, 6500 Nijmegen, The Netherlands
- Foundation of Atlas of Clinical Fungi, 1214GP Hilversum, The Netherlands
| | | | - David W. Denning
- Manchester Fungal Infection Group, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, UK;
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Pap R, Lockwood C, Stephenson M, Simpson P. Indicators to measure prehospital care quality: a scoping review. ACTA ACUST UNITED AC 2019; 16:2192-2223. [PMID: 30439748 DOI: 10.11124/jbisrir-2017-003742] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The purpose of this scoping review was to locate, examine and describe the literature on indicators used to measure prehospital care quality. INTRODUCTION The performance of ambulance services and quality of prehospital care has traditionally been measured using simple indicators, such as response time intervals, based on low-level evidence. The discipline of paramedicine has evolved significantly over the last few decades. Consequently, the validity of utilizing such measures as holistic prehospital care quality indicators (QIs) has been challenged. There is growing interest in finding new and more significant ways to measure prehospital care quality. INCLUSION CRITERIA This scoping review examined the concepts of prehospital care quality and QIs developed for ambulance services. This review considered primary and secondary research in any paradigm and utilizing any methods, as well as text and opinion research. METHODS Joanna Briggs Institute methodology for conducting scoping reviews was employed. Separate searches were conducted for two review questions; review question 1 addressed the definition of prehospital care quality and review question 2 addressed characteristics of QIs in the context of prehospital care. The following databases were searched: PubMed, CINAHL, Embase, Scopus, Cochrane Library and Web of Science. The searches were limited to publications from January 1, 2000 to the day of the search (April 16, 2017). Non-English articles were excluded. To supplement the above, searches for gray literature were performed, experts in the field of study were consulted and applicable websites were perused. RESULTS Review question 1: Nine articles were included. These originated mostly from England (n = 3, 33.3%) and the USA (n = 3, 33.3%). Only one study specifically aimed at defining prehospital care quality. Five articles (55.5%) described attributes specific to prehospital care quality and four (44.4%) articles considered generic healthcare quality attributes to be applicable to the prehospital context. A total of 17 attributes were identified. The most common attributes were Clinical effectiveness (n = 17, 100%), Efficiency (n = 7, 77.8%), Equitability (n = 7, 77.8%) and Safety (n = 6, 66.7%). Timeliness and Accessibility were referred to by four and three (44.4% and 33.3%) articles, respectively.Review question 2: Thirty articles were included. The predominant source of articles was research literature (n = 23; 76.7%) originating mostly from the USA (n = 13; 43.3%). The most frequently applied QI development method was a form of consensus process (n = 15; 50%). A total of 526 QIs were identified. Of these, 283 (53.8%) were categorized as Clinical and 243 (46.2%) as System/Organizational QIs. Within these categories respectively, QIs related to Out-of-hospital cardiac arrest (n = 57; 10.8%) and Time intervals (n = 75; 14.3%) contributed the most. The most commonly addressed prehospital care quality attributes were Appropriateness (n = 250, 47.5%), Clinical effectiveness (n = 174, 33.1%) and Accessibility (n = 124, 23.6%). Most QIs were process indicators (n = 386, 73.4%). CONCLUSION Whilst there is paucity in research aiming to specifically define prehospital care quality, the attributes of generic healthcare quality definitions appear to be accepted and applicable to the prehospital context. There is growing interest in developing prehospital care QIs. However, there is a need for validation of existing QIs and de novo development addressing broader aspects of prehospital care.
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Affiliation(s)
- Robin Pap
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.,School of Science and Health, Western Sydney University, Sydney, Australia
| | - Craig Lockwood
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Matthew Stephenson
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Paul Simpson
- School of Science and Health, Western Sydney University, Sydney, Australia
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Abstract
Introduction Historically, the quality and performance of prehospital emergency care (PEC) has been assessed largely based on surrogate, non-clinical endpoints such as response time intervals or other crude measures of care (eg, stakeholder satisfaction). However, advances in Emergency Medical Services (EMS) systems and services world-wide have seen their scope and reach continue to expand. This has dictated that novel measures of performance be implemented to compliment this growth. Significant progress has been made in this area, largely in the form of the development of evidence-informed quality indicators (QIs) of PEC. Problem Quality indicators represent an increasingly popular component of health care quality and performance measurement. However, little is known about the development of QIs in the PEC environment. The purpose of this study was to assess the development and characteristics of PEC-specific QIs in the literature. METHODS A scoping review was conducted through a search of PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA); EMBase (Elsevier; Amsterdam, Netherlands); CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science (Thomson Reuters; New York, New York USA); and the Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom). To increase the sensitivity of the literature, a search of the grey literature and review of select websites was additionally conducted. Articles were selected that proposed at least one PEC QI and whose aim was to discuss, analyze, or promote quality measurement in the PEC environment. RESULTS The majority of research (n=25 articles) was published within the last decade (68.0%) and largely originated within the USA (68.0%). Delphi and observational methodologies were the most commonly employed for QI development (28.0%). A total of 331 QIs were identified via the article review, with an additional 15 QIs identified via the website review. Of all, 42.8% were categorized as primarily Clinical, with Out-of-Hospital Cardiac Arrest contributing the highest number within this domain (30.4%). Of the QIs categorized as Non-Clinical (57.2%), Time-Based Intervals contributed the greatest number (28.8%). Population on Whom the Data Collection was Constructed made up the most commonly reported QI component (79.8%), followed by a Descriptive Statement (63.6%). Least reported were Timing of Data Collection (12.1%) and Timing of Reporting (12.1%). Pilot testing of the QIs was reported on 34.7% of QIs identified in the review. CONCLUSION Overall, there is considerable interest in the understanding and development of PEC quality measurement. However, closer attention to the details and reporting of QIs is required for research of this type to be more easily extrapolated and generalized. Howard I , Cameron P , Wallis L , Castren M , Lindstrom V . Quality indicators for evaluating prehospital emergency care: a scoping review. Prehosp Disaster Med. 2018;33(1):43-52.
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Education, exposure and experience of prehospital teams as quality indicators in regional trauma systems. Eur J Emerg Med 2017; 23:274-278. [PMID: 25715020 DOI: 10.1097/mej.0000000000000255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Indicators to measure the quality of trauma care may be instrumental in benchmarking and improving trauma systems. This retrospective, observational study investigated whether data on three indicators for competencies of Dutch trauma teams (i.e. education, exposure, experience; agreed upon during a prior Delphi procedure) can be retrieved from existing registrations. The validity and distinctive power of these indicators were explored by analysing available data in four regions. METHODS Data of all polytrauma patients treated by the Helicopter Emergency Medical Services were collected retrospectively over a 1-year period. During the Delphi procedure, a polytrauma patient was defined as one with a Glasgow Coma Scale of 9 or less or a Paediatric Coma Scale of 9 or less, together with a Revised Trauma Score of 10 or less. Information on education, exposure and experience of the Helicopter Emergency Medical Services physician and nurse were registered for each patient contact. RESULTS Data on 442 polytrauma patients could be retrieved. Of these, according to the Delphi consensus, 220 were treated by a fully competent team (i.e. both the physician and the nurse fulfilled the three indicators for competency) and 22 patients were treated by a team not fulfilling all three indicators for competency. Across the four regions, patients were treated by teams with significant differences in competencies (P=0.002). CONCLUSION The quality indicators of education, exposure and experience of prehospital physicians and nurses can be measured reliably, have a high level of usability and have distinctive power.
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Bradley NL, Garraway N, Bell N, Lakha N, Hameed SM. Data capture and communication during transfers to definitive care in an inclusive trauma system. Injury 2017; 48:1069-1073. [PMID: 28314465 DOI: 10.1016/j.injury.2016.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/24/2016] [Accepted: 11/04/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Background trauma survivors in rural areas transferred to urban centers have higher mortality than trauma patients admitted directly to urban centers. Transfer data in trauma registries is important for injury control. Prehospital and early physiologic data may reflect processes of pre-hospital care. British Columbia currently has no standardized process for trauma patient data transfer. PATIENTS AND METHODS We performed a retrospective data analysis for major trauma patients (ISS>15) transferred to a Level I trauma center over a 1year period (n=243). Completion rates of paramedic form and ATLS primary survey variables were extracted. Nominal and interval descriptives were calculated. Documentation rates were considered deficient at <80% and severely deficient <60%. Odds ratios were calculated for primary facility data based on ISS ≥30 vs ISS <30, with 2-sided p-values for confidence intervals RESULTS: Two hundred forty-three patients met inclusion criteria with a mean ISS of 26. Most injured patients were male (79%), the predominant mechanism was blunt (93%) and the average age at injury was 51 years old. Two hundred eighteen patients arrived by Emergency Health Services, and 140 (64%) of EHS pre-hospital forms were transferred with the patient chart. Pre-hospital airway, physiologic data, and GCS completion rates were severely deficient (43-49%). Primary facility data was adequately completed for airway management, systolic blood pressure, and heart rate in (80-83%). Completion rates were deficient for respiratory rate, GCS and temperature (60-77%). An ISS score ≥30 was significantly associated with a lower completion rate for GCS. DISCUSSION AND CONCLUSION Overall, documentation for inter-hospital transfer of major trauma patients in BC has significant deficiencies. Physiologic and basic ATLS variables are often omitted in transferred charts. The potential for adverse events is high but performance improvement is achievable. We recommend education, training and a standardized trauma transfer protocol to improve system-wide information transfer.
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Affiliation(s)
- Nori L Bradley
- Department of Trauma, Acute Care Surgery and Critical Care, University of British Columbia, Canada.
| | - Naisan Garraway
- Department of Trauma, Acute Care Surgery and Critical Care, University of British Columbia, Canada.
| | - Nathaniel Bell
- College of Nursing, University of South Carolina, United States.
| | - Nasira Lakha
- Trauma Services, Vancouver General Hospital, Canada.
| | - S Morad Hameed
- Department of Trauma, Acute Care Surgery and Critical Care, University of British Columbia, Canada.
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Al-Ahmad M, Alowayesh MS, Carroll NV. Economic burden of refractory chronic spontaneous urticaria on Kuwait's health system. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:163-9. [PMID: 27274290 PMCID: PMC4869626 DOI: 10.2147/ceor.s98848] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Chronic spontaneous urticaria (CSU) is a common problem worldwide. We evaluated the direct medical costs of treating patients with refractory CSU and the budget effect of omalizumab use in these patients in Kuwait. Methods The prevalence of CSU was estimated using the Delphi method. Medical records of patients with refractory CSU in Kuwait were reviewed. Costs were calculated from a health system perspective. One-way sensitivity analyses were conducted on the price and utilization of each cost component. Results Before omalizumab use, the total direct costs of treating 1,293 patients with refractory CSU were estimated to be USD 3,650,733 per year. This estimation was principally generated by outpatient visits. After omalizumab use, the cost was sensitive to price variation and estimated to be USD 15,828,612 per year. All other direct costs were reduced. Conclusion The economic burden of refractory CSU in Kuwait is high. Omalizumab use is costly, but its administration reduces all other direct costs.
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Affiliation(s)
- Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait
| | - Maryam S Alowayesh
- Pharmacy Practice Department, Faculty of Pharmacy, Kuwait University, Kuwait
| | - Norman V Carroll
- Division of Pharmacoeconomics and Health Outcomes, School of Pharmacy, Virginia Commonwealth University, VA, USA
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Oliver GJ, Walter DP. A Call for Consensus on Methodology and Terminology to Improve Comparability in the Study of Preventable Prehospital Trauma Deaths: A Systematic Literature Review. Acad Emerg Med 2016; 23:503-10. [PMID: 26844807 DOI: 10.1111/acem.12932] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 11/04/2015] [Accepted: 11/09/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The study of preventable deaths is essential to trauma research for measuring service quality and highlighting avenues for improving care and as a performance indicator. However, variations in the terminology and methodology of studies on preventable prehospital trauma death limit the comparability and wider application of data. The objective of this study was to describe the heterogeneity in terminology and methodology. METHODS We performed a systematic literature review and report this using the PRISMA guidelines. Searches were conducted using PubMed (including Medline), Ovid, and Embase databases. Studies, with a full text available in English published between 1990 and 2015, meeting the following inclusion criteria were included: analysis of 1) deaths from trauma, 2) occurring in the prehospital phase of care, and 3) application of criteria to ascertain whether deaths were preventable. One author screened database results for relevance by title and abstract. The full text of identified papers was reviewed for inclusion. The reference list of included papers was screened for studies not identified by the database search. Data were extracted on predefined core elements relating to preventability reporting and definitions using a standardized form. RESULTS Twenty-seven studies meeting the inclusion criteria were identified: 12 studies used two categories to assess the preventability of death while 15 used three categories. Fifteen variations in the terminology of these categories and combination with death descriptors were found. Eleven different approaches were used in defining what constituted a preventable death. Twenty-one included survivability of injuries as a criterion. Methods used to determine survivability differed and eight variations in parameters for categorization of deaths were used. Nineteen used panel review in determining preventability with six implementing panel blinding. Panel composition varied greatly by expertise of personnel. Separation of prehospital deaths differed with 10 separating those dead at scene (DAS) and dead on arrival, three excluding those DAS, three excluding deaths prior to EMS arrival, and 11 not separating prehospital deaths. CONCLUSIONS The heterogeneity in methodology, terminology, and definitions of "preventable" between studies render data incomparable. To facilitate common understanding, comparability, and analysis, a commonly agreed ontology by the prehospital research community is required.
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Affiliation(s)
- Govind J. Oliver
- British Red Cross Research Fellow; London
- Humanitarian and Conflict Response Institute; University of Manchester; Manchester UK
| | - Darren P. Walter
- Humanitarian and Conflict Response Institute; University of Manchester; Manchester UK
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Al-Busaidi N, Habibulla Z, Bhatnagar M, Al-Lawati N, Al-Mahrouqi Y. The Burden of Asthma in Oman. Sultan Qaboos Univ Med J 2015; 15:e184-e190. [PMID: 26052450 PMCID: PMC4450780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/07/2014] [Accepted: 10/23/2014] [Indexed: 06/04/2023] Open
Abstract
Asthma is a common lung disease worldwide, although its prevalence varies from country to country. Oman is ranked in the intermediate range based on results from the International Study of Asthma and Allergies in Childhood. A 2009 study revealed that the majority of asthmatic patients in Oman reported both daytime and nocturnal symptoms, while 30% of adults and 52% of children reported absences from work or school due to their symptoms. Despite these findings, there is little data available on the economic burden of asthma in Oman. The only accessible information is from a 2013 study which concluded that Oman's highest asthma-related costs were attributable to inpatient (55%) and emergency room (25%) visits, while asthma medications contributed to less than 1% of the financial toll. These results indicate a low level of asthma control in Oman, placing a large economic burden on healthcare providers. Therefore, educating asthmatic patients and their families should be prioritised in order to improve the management and related costs of this disease within Oman.
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Affiliation(s)
- Nasser Al-Busaidi
- Department of Medicine, Respiratory Unit and, Royal Hospital, Muscat, Oman
| | - Zulfikar Habibulla
- Department of Medicine, Respiratory Unit and, Royal Hospital, Muscat, Oman
| | | | - Nabil Al-Lawati
- Department of Medicine, Respiratory Unit and, Royal Hospital, Muscat, Oman
| | - Yaqoub Al-Mahrouqi
- Department of Medicine, Respiratory Unit and, Royal Hospital, Muscat, Oman
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Exploring the characteristics of high-performing hospitals that influence trauma triage and transfer. J Trauma Acute Care Surg 2015; 78:300-5. [DOI: 10.1097/ta.0000000000000506] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Pittet V, Burnand B, Yersin B, Carron PN. Trends of pre-hospital emergency medical services activity over 10 years: a population-based registry analysis. BMC Health Serv Res 2014; 14:380. [PMID: 25209450 PMCID: PMC4169798 DOI: 10.1186/1472-6963-14-380] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 09/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background The number of requests to pre-hospital emergency medical services (PEMS) has increased in Europe over the last 20 years, but epidemiology of PEMS interventions has little be investigated. The aim of this analysis was to describe time trends of PEMS activity in a region of western Switzerland. Methods Use of data routinely and prospectively collected for PEMS intervention in the Canton of Vaud, Switzerland, from 2001 to 2010. This Swiss Canton comprises approximately 10% of the whole Swiss population. Results We observed a 40% increase in the number of requests to PEMS between 2001 and 2010. The overall rate of requests was 35/1000 inhabitants for ambulance services and 10/1000 for medical interventions (SMUR), with the highest rate among people aged ≥ 80. Most frequent reasons for the intervention were related to medical problems, predominantly unconsciousness, chest pain respiratory distress, or cardiac arrest, whereas severe trauma interventions decreased over time. Overall, 89% were alive after 48 h. The survival rate after 48 h increased regularly for cardiac arrest or myocardial infarction. Conclusion Routine prospective data collection of prehospital emergency interventions and monitoring of activity was feasible over time. The results we found add to the understanding of determinants of PEMS use and need to be considered to plan use of emergency health services in the near future. More comprehensive analysis of the quality of services and patient safety supported by indicators are also required, which might help to develop prehospital emergency services and new processes of care.
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Affiliation(s)
- Valérie Pittet
- Institute of social & preventive medicine (IUMSP), Lausanne University Hospital, Route de la Corniche 10, CH-1010 Lausanne, Switzerland.
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Al-Busaidi NH, Habibullah Z, Soriano JB. The asthma cost in oman. Sultan Qaboos Univ Med J 2013; 13:218-23. [PMID: 23862026 DOI: 10.12816/0003226] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/30/2012] [Accepted: 10/14/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES This study evaluates the direct costs of treating asthma in Oman. METHODS Asthma prevalence and unit cost estimates were based on results from a panel using the Delphi technique, and were applied to the total Omani population aged 5 and older to obtain the number of people diagnosed with asthma. The estimates from the Delphi exercise were multiplied by the percentage of patients using government facilities to estimate the number of asthma patients managed in Oman. Treatment costs were also calculated using data from the Delphi exercise and the Asthma Insights and Reality for the Gulf and Near East study (reported in Omani riyals [OMR] and US dollars [USD]). RESULTS The prevalence of asthma was estimated to be 7.3% of adults (n = 96,470) and 12.7% of children (n = 58,344). Of these, 95% of both adults and children were estimated to be using government healthcare facilities. Inpatient visits accounted for the largest proportion of total direct costs (55%), followed by emergency room and outpatient visits (25% and 20%, respectively) and medications (<0.2%). The annual cost of treatment excluding medications, was OMR 34,273,696 (USD 89,111,609) for adults and OMR 27,014,735 (USD 70,238,311) for children. Including medications, the total annual direct cost of asthma treatment was estimated to be over OMR 61,500,294 (USD 159,900,761). CONCLUSION Given the high medical expenditures associated with facility visits relative to the lower medication costs, the focus of Oman's asthma cost savings should be on improving asthma control rather than reducing medication costs.
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Hoogervorst EM, van Beeck EF, Goslings JC, Bezemer PD, Bierens JJLM. Developing process guidelines for trauma care in the Netherlands for severely injured patients: results from a Delphi study. BMC Health Serv Res 2013; 13:79. [PMID: 23452394 PMCID: PMC3621215 DOI: 10.1186/1472-6963-13-79] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 02/14/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In organised trauma systems the process of care is the key to quality. Nevertheless, the optimal process of trauma care remains unclear due to lack of or inconclusive evidence. Because monitoring and improving the performance of a trauma system is complex, this study aimed to develop consensus-based process guidelines for trauma care in the Netherlands for severely injured patients. METHODS A five-round Delphi study was conducted with 141 participants that represent all professions involved in trauma care. Sensitivity analyses were carried out to evaluate whether consensus extended across all professions and to detect possible bias. RESULTS Consensus was reached on 21 guidelines within 4 categories: timeliness, actions, competent teams and interdisciplinary process. Timeliness guidelines set specific critical limits and definitions for 10 time intervals in the time period from an emergency call until the patient leaves the trauma room. Action guidelines reflect aspects of appropriate care and strongly rely on the international Advanced Trauma Life Support principles. Competence guidelines include flow charts to assess the competence of prehospital and emergency department teams. Essential to competent teams are education and experience of all team members. The interdisciplinary process guideline focuses on cooperation, communication and feedback within and between all professions involved. Consensus was extended across all professions and no bias was detected. CONCLUSIONS In this Delphi study, a large expert panel agreed on a set of guidelines describing the optimal process of care for severely injured trauma patients in the Netherlands. In addition to time intervals and appropriate actions, these guidelines emphasise the importance of team competence and interdisciplinary processes in trauma care. The guidelines can be seen as a description of a best practice and a new field standard in the Netherlands. The next step is to implement the guidelines and monitor the performance of the Dutch trauma system based on the guidelines.
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Abstract
OBJECTIVE To evaluate the direct costs of treating asthma in Kuwait. MATERIALS AND METHODS Population figures were obtained from the 2005 census and projected to 2008. Treatment profiles were obtained from the Asthma Insights and Reality for the Gulf and Near East (AIRGNE) study. Asthma prevalence and unit cost estimates were based on results from a Delphi technique. These estimates were applied to the total Kuwaiti population aged 5 years and over to obtain the number of people diagnosed with asthma. The estimates from the Delphi exercise and the AIRGNE results were used to determine the number of asthma patients managed in government facilities. Direct drug costs were provided by the Ministry of Health. Treatment costs (Kuwaiti dinars, KD) were also calculated using the Delphi exercise and the AIRGNE data. RESULTS The prevalence of asthma was estimated to be 15% of adults and 18% of children (93,923 adults; 70,158 children). Of these, 84,530 (90%) adults and 58,932 (84.0%) children were estimated to be using government healthcare facilities. Inpatient visits accounted for the largest portion of total direct costs (43%), followed by emergency room visits (29%), outpatient visits (21%) and medications (7%). The annual cost of treatment, excluding medications, was KD 29,946,776 (USD 107,076,063) for adults and KD 24,295,439 (USD 86,869,450) for children. Including medications, the total annual direct cost of asthma treatment was estimated to be over KD 58 million (USD 207 million). CONCLUSIONS Asthma costs Kuwait a huge sum of money, though the estimates were conservative because only Kuwaiti nationals were included. Given the high medical expenditures associated with emergency room and inpatient visits, relative to lower medication costs, efforts should be focused on improving asthma control rather than reducing expenditure on procurement of medication.
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Affiliation(s)
- Mousa Khadadah
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait.
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Abstract
A mass casualty event is a situation in which the need for medical care and resources, including personnel, exceeds that which is available. As the largest component of the health care workforce, nurses represent a significant resource that can be called on to act as first responders during a mass casualty. However, current education and national guidelines fail to provide specific instruction on pre-hospital nursing considerations and interventions. This article provides evidence-based guidelines designed for nurses to use when acting as first responders during a disaster and presents recommendations for future nursing practice related to mass casualty events.
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Krüger AJ, Lockey D, Kurola J, Di Bartolomeo S, Castrén M, Mikkelsen S, Lossius HM. A consensus-based template for documenting and reporting in physician-staffed pre-hospital services. Scand J Trauma Resusc Emerg Med 2011; 19:71. [PMID: 22107787 PMCID: PMC3282653 DOI: 10.1186/1757-7241-19-71] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 11/23/2011] [Indexed: 11/10/2022] Open
Abstract
Background Physician-staffed pre-hospital units are employed in many Western emergency medical services (EMS) systems. Although these services usually integrate well within their EMS, little is known about the quality of care delivered, the precision of dispatch, and whether the services deliver a higher quality of care to pre-hospital patients. There is no common data set collected to document the activity of physician pre-hospital activity which makes shared research efforts difficult. The aim of this study was to develop a core data set for routine documentation and reporting in physician-staffed pre-hospital services in Europe. Methods Using predefined criteria, we recruited sixteen European experts in the field of pre-hospital care. These experts were guided through a four-step modified nominal group technique. The process was carried out using both e-mail-based communication and a plenary meeting in Stavanger, Norway. Results The core data set was divided into 5 sections: "fixed system variables", "event operational descriptors", " patient descriptors", "process mapping", and "outcome measures and quality indicators". After the initial round, a total of 361 variables were proposed by the experts. Subsequent rounds reduced the number of core variables to 45. These constituted the final core data set. Emphasis was placed on the standardisation of reporting time variables, chief complaints and diagnostic and therapeutic procedures. Conclusions Using a modified nominal group technique, we have established a core data set for documenting and reporting in physician-staffed pre-hospital services. We believe that this template could facilitate future studies within the field and facilitate standardised reporting and future shared research efforts in advanced pre-hospital care.
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Affiliation(s)
- Andreas J Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway.
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Abstract
OBJECTIVE Multiple quality indicators are available to evaluate adult trauma care, but their characteristics and outcomes have not been systematically compared. We sought to systematically review the evidence about the reliability, validity, and implementation of quality indicators for evaluating trauma care. DATA SOURCES Search of MEDLINE, EMBASE, CINAHL, and The Cochrane Library up to January 14, 2009; the Gray Literature; select journals by hand; reference lists; and articles recommended by experts in the field. STUDY SELECTION Studies were selected that evaluated the reliability, validity, or the impact of one or more quality indicators on the quality of care delivered to patients ≥ 18 yrs of age with a major traumatic injury. DATA EXTRACTION Reviewers with methodologic and content expertise conducted data extraction independently. DATA SYNTHESIS The literature search identified 6869 citations. Review of abstracts led to the retrieval of 538 full-text articles for assessment; 40 articles were selected for review. Of these, 20 (50%) articles were cohort studies and 13 (33%) articles were case series. Five articles used control groups, including three before and after case series, a case-control study, and a nonrandomized controlled trial. A total of 115 quality indicators in adult trauma care was identified, predominantly measures of hospital processes (62%) and outcomes (17%) of care. We did not identify any posthospital or secondary injury prevention quality indicators. Reliability was described for two quality indicators, content validity for 22 quality indicators, construct validity for eight quality indicators, and criterion validity for 46 quality indicators. A total of 58 quality indicators was implemented and evaluated in three studies. Eight quality indicators had supporting evidence for more than one measurement domain. A single quality indicator, peer review for preventable death, had both reliability and validity evidence. CONCLUSIONS Although many quality indicators are available to measure the quality of trauma care, reliability evidence, validity evidence, and description of outcomes after implementation are limited.
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Palter VN, MacRae HM, Grantcharov TP. Development of an objective evaluation tool to assess technical skill in laparoscopic colorectal surgery: a Delphi methodology. Am J Surg 2011; 201:251-9. [DOI: 10.1016/j.amjsurg.2010.01.031] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/19/2010] [Accepted: 01/19/2010] [Indexed: 10/19/2022]
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Laudermilch DJ, Schiff MA, Nathens AB, Rosengart MR. Lack of emergency medical services documentation is associated with poor patient outcomes: a validation of audit filters for prehospital trauma care. J Am Coll Surg 2009; 210:220-7. [PMID: 20113943 DOI: 10.1016/j.jamcollsurg.2009.10.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 10/15/2009] [Accepted: 10/20/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Our previous Delphi study identified several audit filters considered sensitive to deviations in prehospital trauma care and potentially useful in conducting performance improvement, a process currently recommended by the American College of Surgeons Committee on Trauma. This study validates 2 of those proposed audit filters. STUDY DESIGN We studied 4,744 trauma patients using the electronic records of the Central Region Trauma registry and Emergency Medical Services (EMS) patient logs for the period January 1, 2002, to December 31, 2004. We studied whether requests by on-scene Basic Life Support (BLS) for Advanced Life Support (ALS) assistance or failure by EMS personnel to record basic patient physiology at the scene was associated with increased in-hospital mortality. We performed multivariate analyses, including a propensity score quintile approach, adjusting for differences in case mix and clustering by hospital. RESULTS Overall mortality was 6.1%. A total of 28.2% (n = 1,337) of EMS records were missing patient scene physiologic data. Multivariate analysis revealed that patients missing 1 or more measures of patient physiology at the scene had increased risk of death (adjusted odds ratio = 2.15; 95% CI, 1.13 to 4.10). In 17.4% (n = 402) of cases BLS requested ALS assistance. Patients for whom BLS requested ALS had a similar risk of death as patients for whom ALS was initially dispatched (odds ratio = 1.04; 95% CI, 0.51 to 2.15). CONCLUSIONS Failure of EMS to document basic measures of scene physiology is associated with increased mortality. This deviation in care can serve as a sensitive audit filter for performance improvement. The need by BLS for ALS assistance was not associated with increased mortality.
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Affiliation(s)
- Alison Kitson
- Discipline of Nursing, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia
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22
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Dixon AE, Sugar EA, Zinreich SJ, Slavin RG, Corren J, Naclerio RM, Ishii M, Cohen RI, Brown ED, Wise RA, Irvin CG. Criteria to screen for chronic sinonasal disease. Chest 2009; 136:1324-1332. [PMID: 19581356 DOI: 10.1378/chest.08-1983] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Sinusitis and rhinitis are associated with uncontrolled asthma. There are no simple, validated tools to screen for these diseases. The objective of this study was to assess instruments to assist in the diagnosis of chronic sinonasal disease. METHODS Participants without acute sinonasal symptoms underwent an extensive evaluation. The results were submitted to an expert panel that used the Delphi method to achieve consensus. Using the consensus diagnosis of the panel, we determined the sensitivity and specificity of test procedures to diagnose chronic sinonasal disease. We determined the reproducibility of the most sensitive and specific instrument in a separate cohort. RESULTS Fifty-nine participants were evaluated, and the expert panel reached consensus for all (42 participants with chronic sinonasal disease, 17 participants without chronic sinonasal disease). A six-item questionnaire based on the frequency of nasal symptoms was the most sensitive tool used to diagnose sinonasal disease (minimum specificity, 0.90). Reproducibility testing in a separate cohort of 63 participants (41 chronic sinonasal disease with asthma, 22 chronic sinonasal disease without asthma) showed a concordance correlation coefficient of 0.91 (95% CI, 0.85 to 0.94) when this questionnaire was limited to five items (ie, excluding a question on smell). This five-item questionnaire had a sensitivity of 0.90 (95% CI, 0.77 to 0.97), a specificity of 0.94 (95% CI, 0.71 to 1.00), and an area under the receiver operating characteristic curve of 0.97 (95% CI, 0.93 to 1.0). Sinus CT scans and nasal endoscopy lacked sensitivity for use in the diagnosis of chronic sinonasal disease. CONCLUSIONS We have developed a sensitive, specific, and reproducible instrument to screen for chronic sinonasal disease. Validation studies of this five-item questionnaire are needed, including in patients with asthma.
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Affiliation(s)
- Anne E Dixon
- Department of Medicine, University of Vermont, Burlington, VT.
| | | | | | | | | | | | | | - Rubin I Cohen
- Department of Pulmonary and Sleep Medicine, North Shore-Long Island Jewish Medical Center, New Hyde Park, NY
| | | | | | - Charles G Irvin
- Department of Medicine, University of Vermont, Burlington, VT
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Haas B, Nathens AB. Pro/con debate: is the scoop and run approach the best approach to trauma services organization? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:224. [PMID: 18828868 PMCID: PMC2592727 DOI: 10.1186/cc6980] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
You are asked to be involved in organizing a trauma service for a major urban center. You are asked to make a decision on whether the services general approach to trauma in the city (which does have a well-established trauma center) will be scoop and run (minimal resuscitation at the scene with a goal to getting the patient to a trauma center as quickly as possible) or on-the-scene resuscitation with transfer following some degree of stabilization.
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Affiliation(s)
- Barbara Haas
- Department of Surgery, University of Toronto, St Michael's Hospital, Queen Wing, 3N-073, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8.
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Stannard A, Tai NR, Bowley DM, Midwinter M, Hodgetts TJ. Key Performance Indicators in British Military Trauma. World J Surg 2008; 32:1870-3. [DOI: 10.1007/s00268-008-9583-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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