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Nkoane NL. Experiences of operational managers regarding record keeping by new professional nurses in public hospitals in the North West province, South Africa. Health SA 2023; 28:2257. [PMID: 37670752 PMCID: PMC10476500 DOI: 10.4102/hsag.v28i0.2257] [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: 11/15/2022] [Accepted: 06/28/2023] [Indexed: 09/07/2023] Open
Abstract
Background Documentation can be written or computerised and is used to communicate healthcare and treatment among healthcare professionals. Documentation is the tool that records and measures the healthcare provided to patients, and it must be accurate, complete and timely. Aim This study aims to explore and describe the experiences of the operational managers regarding record keeping by new nurses in selected public hospitals in South Africa. Setting The study was conducted in selected public hospitals in the North West province. Method This study used a qualitative, explorative and descriptive approach with a purposive sampling method. A total of 35 operational managers participated in the process of data collection. Results The following themes emerged from this study: gaps in record keeping, the impact of inaccurate documentation and the need for improvement in record keeping. Conclusion The study has shown the need to bring technological innovation to strengthen the effective improvement of digitalisation in nursing record keeping in the facilities furthermore, nurses should be supported through programmes on intentional and mindful record keeping curbing the incidences of inaccuracy and incompleteness. Contribution This study's findings confirmed that new nurses were not consistent with accurate documentation of patient records, and this needs further strengthening in public hospitals to have an impact on the health and safety of the patient.
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Affiliation(s)
- Naomi L Nkoane
- Department of Health Studies, College of Human Science, University of South Africa, Pretoria, South Africa
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Yu Y, Qiao L, Han J, Wang W, Kang W, Zhang Y, Shang S, Meng R, Zhuo L, Zhan S, Xi Y, Wang S. Integrated database-based Screening Cohort for Asian Nomadic descendants in China (Scan-China): Insights on prospective ethnicity-focused cancer screening. Epidemiol Health 2023; 45:e2023048. [PMID: 37080725 PMCID: PMC10593583 DOI: 10.4178/epih.e2023048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/29/2023] [Indexed: 04/22/2023] Open
Abstract
Established in 2017, the Screening Cohort for Asian Nomadic descendants in China (Scan-China) has benefited over 180,000 members of a multi-ethnic population, particularly individuals of Mongolian descent compared with the general population (Han ethnicity), in the Inner Mongolia Autonomous Region, China. This cohort study aims to evaluate the effectiveness of cancer screening and serve as a real-world data platform for cancer studies. The 6 most prevalent cancers in China are considered-namely, breast, lung, colorectal, gastric, liver and esophageal cancer. After baseline cancer risk assessments and screening tests, both active and passive follow-up (based on the healthcare insurance database, cancer registry, the front page of hospital medical records, and death certificates) will be conducted to trace participants' onset and progression of cancers and other prevalent chronic diseases. Scan-China has preliminarily found a disproportionately lower screening participation rate and higher incidence/mortality rates of esophageal and breast cancer among the Mongolian population than among their Han counterparts. Further research will explore the cancer burden, natural history, treatment patterns, and risk factors of the target cancers.
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Affiliation(s)
- Yuelin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Liying Qiao
- Center for Disease Control and Prevention in Inner Mongolia, Hohhot, China
| | - Jing Han
- Center for Disease Control and Prevention in Inner Mongolia, Hohhot, China
| | - Weiwei Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Weiwei Kang
- Center for Disease Control and Prevention in Inner Mongolia, Hohhot, China
| | - Yunjing Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shu Shang
- Center for Disease Control and Prevention in Inner Mongolia, Hohhot, China
| | - Ruogu Meng
- National Institute of Health Data Science, Peking University, Beijing, China
| | - Lin Zhuo
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yunfeng Xi
- Center for Disease Control and Prevention in Inner Mongolia, Hohhot, China
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Leung T, Cai Y, Cao J, He Q, Wang X, Lu Y, Liang H, Xu D, Liao J. The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China. J Med Internet Res 2022; 24:e40082. [PMID: 36459416 PMCID: PMC9758641 DOI: 10.2196/40082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/27/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC. OBJECTIVE This study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement. METHODS Eleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted κ for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement. RESULTS Only 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95% CI 0.24-0.49); for physical examination, 0.27 (95% CI 0.12-0.42); for laboratory and imaging tests, -0.03 (95% CI -0.20 to 0.14); and for treatment, 0.22 (95% CI 0.07-0.37). The weighted κ for diagnosis was 0.32 (95% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place. CONCLUSIONS There was low agreement between VPs and USPs in PHC quality assessment. This may reflect the "know-do" gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study.
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Affiliation(s)
| | - Yiyuan Cai
- Department of Epidemiology and Medical Statistics, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Jin Cao
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Qianyu He
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaohui Wang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Lu
- Department of Preventive Medicine & Maternal and Child Health, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Huijuan Liang
- Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, China
| | - Dong Xu
- Center for World Health Organization Studies, Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China.,ACACIA Lab for Implementation Research, Southern Medical University Institute for Global Health, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Jing Liao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Meng S, Wang Q, Wu Y, Xue H, Li L, Ye R, Chen Y, Pappas L, Akhtar M, Dill SE, Sylvia S, Zhou H, Rozelle S. The know-do gap in quality of health for chronic non-communicable diseases in rural China. Front Public Health 2022; 10:953881. [PMID: 36062129 PMCID: PMC9435052 DOI: 10.3389/fpubh.2022.953881] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
Proper management of non-communicable diseases (NCDs) is a severe challenge to China's rural health system. This study investigates what influences the poor medical treatment of NCDs (diabetes and angina) by evaluating the "know-do gap" between provider knowledge and practice. To determine whether low levels of provider knowledge low quality of patient care is the primary constraint on the quality of NCDs diagnosis and treatment in rural China. Providers from Village Clinics (VC) and Township Health Centers (THC), and Standardized Patients (SP) were selected by a multi-stage random sampling method. Clinical vignettes were administered to 306 providers from 103 VCs and 50 THCs in rural Sichuan Province. SPs presented diabetes symptoms completed 97 interactions with providers in 46 VCs and 51 THCs; SPs presented angina symptoms completed 100 interactions with providers in 50 VCs and 50 THCs. Process quality, diagnosis quality, and treatment quality were assessed against national standards for diabetes and angina. Two-tailed T-tests and tests of proportions for continuous outcomes and tests of proportions for binary dependent variables were used to compare vignette and SP results. Differences between vignette and SP data calculated the know-do gap. Regression analyses were used to examine the providers/facility characteristics and knowledge/practice associations. THC providers demonstrated significantly more knowledge in vignettes and better practices in SP visits than VC providers. However, levels of knowledge were low overall: 48.2% of THC providers and 28.2% of VC providers properly diagnosed type 2 diabetes, while 23.8% of THC providers and 14.7% of VC providers properly diagnosed angina. With SPs, 2.1% of THC providers and 6.8% of VC providers correctly diagnosed type 2 diabetes; 25.5% of THC providers and 12.8% of VC providers correctly diagnosed angina. There were significant know-do gaps in diagnosis process quality, diagnosis quality, and treatment quality for diabetes (p < 0.01), and in diagnosis process quality (p < 0.05) and treatment quality for angina (p < 0.01). Providers in rural China display low levels of knowledge when treating diabetes and angina. Despite low knowledge, evidence of the know-do gap indicates that low-quality healthcare is the primary constraint on the quality of NCD diagnosis and treatment in rural China. Our research findings provide a new perspective for the evaluation of the medical quality and a technical basis for the development of new standardized cases in the future.
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Affiliation(s)
- Sha Meng
- Department of Health Behavior and Social Medicine, West China School of Public Health, West China Fourth Hospital, West China Hospital, Sichuan University, Chengdu, China,Department of Operation Management, West China Hospital, Sichuan University, Chengdu, China
| | - Qingzhi Wang
- Department of Health Behavior and Social Medicine, West China School of Public Health, West China Fourth Hospital, West China Hospital, Sichuan University, Chengdu, China
| | - Yuju Wu
- Department of Health Behavior and Social Medicine, West China School of Public Health, West China Fourth Hospital, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Xue
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Linhua Li
- Department of Health Behavior and Social Medicine, West China School of Public Health, West China Fourth Hospital, West China Hospital, Sichuan University, Chengdu, China
| | - Ruixue Ye
- Department of Health Behavior and Social Medicine, West China School of Public Health, West China Fourth Hospital, West China Hospital, Sichuan University, Chengdu, China
| | - Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lucy Pappas
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Muizz Akhtar
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Sarah-Eve Dill
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Huan Zhou
- Department of Health Behavior and Social Medicine, West China School of Public Health, West China Fourth Hospital, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Huan Zhou
| | - Scott Rozelle
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
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Gettel CJ, Canavan ME, Greenwood-Ericksen MB, Parwani VL, Ulrich AS, Pilgrim RL, Venkatesh AK. A Cross-Sectional Analysis of High-Acuity Professional Services Performed by Urban and Rural Emergency Care Physicians Across the United States. Ann Emerg Med 2021; 78:140-149. [PMID: 33771412 DOI: 10.1016/j.annemergmed.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 08/18/2020] [Accepted: 11/24/2020] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE We seek to examine differences in the provision of high-acuity professional services between rural and urban physicians receiving reimbursement for emergency care evaluation and management services from Medicare fee-for-service Part B. METHODS Using the 2017 Medicare Public Use Files, we performed a cross-sectional analysis and defined the primary outcome, the proportion of high-acuity charts (PHAC), at the physician level as the proportion of services provided as 99285 and 99291 emergency care evaluation and management service codes relative to all such codes. After accounting for unique clinician-level characteristics, we categorized individual physicians by PHAC quintiles and conducted ordered logistic regression analyses reporting adjusted marginal probabilities to examine associations with rurality. RESULTS A total of 34,256 physicians providing emergency care had a median PHAC of 66.8% (interquartile range 55.6% to 75.7%), with 89.2% practicing in an urban setting. Urban and rural physicians had respective median PHACs of 67.6% (interquartile range 57.1% to 76.2%) and 57.9% (interquartile range 42.7% to 69.4%). Urban and rural physicians had respective adjusted marginal probabilities of 15.2% and 11.8% of being in the highest PHAC quintile, and respective adjusted marginal probabilities of 14.3% and 18.2% of being in the lowest PHAC quintile. CONCLUSION In comparison with rural physicians, urban physicians providing emergency care received reimbursements for a greater PHAC when caring for Medicare fee-for-service beneficiaries. Policymakers must consider these differences in the design and implementation of new emergency care payment policies.
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Affiliation(s)
- Cameron J Gettel
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
| | - Maureen E Canavan
- Department of Internal Medicine, Cancer Outcomes and Public Policy and Effectiveness Research (COPPER), Yale School of Medicine, New Haven, CT
| | | | - Vivek L Parwani
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Andrew S Ulrich
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | | | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT
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