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Bottle A, Kristensen PK. Variation in quality of care between hospitals: how to identify learning opportunities. BMJ Qual Saf 2024; 33:413-415. [PMID: 38458746 DOI: 10.1136/bmjqs-2024-017071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Affiliation(s)
- Alex Bottle
- School of Public Health, Imperial College London Faculty of Medicine, London, UK
| | - Pia Kjær Kristensen
- Clinical Epidemiology, Aarhus Universitetshospital, Aarhus, Denmark
- Orthopedic, Region Hospital Horsens, Horsens, Denmark
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2
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Catlow J, Sharp L, Wagnild J, Lu L, Bhardwaj-Gosling R, Ogundimu E, Kasim A, Brookes M, Lee T, McCarthy S, Gray J, Sniehotta F, Valori R, Westwood C, McNally R, Ruwende J, Sinclair S, Deane J, Rutter M. Nationally Automated Colonoscopy Performance Feedback Increases Polyp Detection: The NED APRIQOT Randomized Controlled Trial. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00449-X. [PMID: 38759827 DOI: 10.1016/j.cgh.2024.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND & AIMS Postcolonoscopy colorectal cancer incidence and mortality rates are higher for endoscopists with low polyp detection rates. Using the UK's National Endoscopy Database (NED), which automatically captures real-time data, we assessed if providing feedback of case-mix-adjusted mean number of polyps (aMNP), as a key performance indicator, improved endoscopists' performance. Feedback was delivered via a theory-informed, evidence-based audit and feedback intervention. METHODS This multicenter, prospective, NED Automated Performance Reports to Improve Quality Outcomes Trial randomized National Health Service endoscopy centers to intervention or control. Intervention-arm endoscopists were e-mailed tailored monthly reports automatically generated within NED, informed by qualitative interviews and behavior change theory. The primary outcome was endoscopists' aMNP during the 9-month intervention. RESULTS From November 2020 to July 2021, 541 endoscopists across 36 centers (19 intervention; 17 control) performed 54,770 procedures during the intervention, and 15,960 procedures during the 3-month postintervention period. Comparing the intervention arm with the control arm, endoscopists during the intervention period: aMNP was nonsignificantly higher (7%; 95% CI, -1% to 14%; P = .08). The unadjusted MNP (10%; 95% CI, 1%-20%) and polyp detection rate (10%; 95% CI, 4%-16%) were significantly higher. Differences were not maintained in the postintervention period. In the intervention arm, endoscopists accessing NED Automated Performance Reports to Improve Quality Outcomes Trial webpages had a higher aMNP than those who did not (aMNP, 118 vs 102; P = .03). CONCLUSIONS Although our automated feedback intervention did not increase aMNP significantly in the intervention period, MNP and polyp detection rate did improve significantly. Engaged endoscopists benefited most and improvements were not maintained postintervention; future work should address engagement in feedback and consider the effectiveness of continuous feedback. CLINICAL TRIALS REGISTRY www.isrctn.org ISRCTN11126923 .
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Affiliation(s)
- Jamie Catlow
- Gastroenterology, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom.
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Janelle Wagnild
- Department of Mathematical Sciences, Durham University, Durham, United Kingdom
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Rashmi Bhardwaj-Gosling
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom; Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, United Kingdom
| | - Emmanuel Ogundimu
- Department of Mathematical Sciences, Durham University, Durham, United Kingdom
| | - Adetayo Kasim
- Department of Mathematical Sciences, Durham University, Durham, United Kingdom
| | - Matthew Brookes
- Department of Gastroenterology, Royal Wolverhampton Hospitals National Health Service Trust, Wolverhampton, United Kingdom; Deparment of Gastroenterology, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Thomas Lee
- Gastroenterology, Northumbria Healthcare National Health Service Foundation Trust, North Shields, United Kingdom
| | - Stephen McCarthy
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Joanne Gray
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Falko Sniehotta
- Social and Preventive Medicine, Centre for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Mannheim, Germany
| | - Roland Valori
- Department of Gastroenterology, Gloucestershire Hospitals National Health Service Foundation Trust, Gloucester, United Kingdom
| | - Claire Westwood
- Department of Gastroenterology, North Tees and Hartlepool National Health Service Foundation Trust, Stockton on Tees, United Kingdom
| | - Richard McNally
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Josephine Ruwende
- Public Health, National Health Service London, London, United Kingdom
| | - Simon Sinclair
- Department of Gastroenterology, North Tees and Hartlepool National Health Service Foundation Trust, Stockton on Tees, United Kingdom
| | - Jill Deane
- Department of Gastroenterology, North Tees and Hartlepool National Health Service Foundation Trust, Stockton on Tees, United Kingdom
| | - Matt Rutter
- Department of Gastroenterology, North Tees and Hartlepool National Health Service Foundation Trust, Stockton on Tees, United Kingdom
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Allan S, Ward T, Eisner E, Bell IH, Cella M, Chaudhry IB, Torous J, Kiran T, Kabir T, Priyam A, Richardson C, Reininghaus U, Schick A, Schwannauer M, Syrett S, Zhang X, Bucci S. Adverse Events Reporting in Digital Interventions Evaluations for Psychosis: A Systematic Literature Search and Individual Level Content Analysis of Adverse Event Reports. Schizophr Bull 2024:sbae031. [PMID: 38581410 DOI: 10.1093/schbul/sbae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
BACKGROUND Digital health interventions (DHIs) have significant potential to upscale treatment access to people experiencing psychosis but raise questions around patient safety. Adverse event (AE) monitoring is used to identify, record, and manage safety issues in clinical trials, but little is known about the specific content and context contained within extant AE reports. This study aimed to assess current AE reporting in DHIs. STUDY DESIGN A systematic literature search was conducted by the iCharts network (representing academic, clinical, and experts by experience) to identify trials of DHIs in psychosis. Authors were invited to share AE reports recorded in their trials. A content analysis was conducted on the shared reports. STUDY RESULTS We identified 593 AE reports from 18 DHI evaluations, yielding 19 codes. Only 29 AEs (4.9% of total) were preidentified by those who shared AEs as being related to the intervention or trial procedures. While overall results support the safety of DHIs, DHIs were linked to mood problems and psychosis exacerbation in a few cases. Additionally, 27% of studies did not report information on relatedness for all or at least some AEs; 9.6% of AE reports were coded as unclear because it could not be determined what had happened to participants. CONCLUSIONS The results support the safety of DHIs, but AEs must be routinely monitored and evaluated according to best practice. Individual-level analyses of AEs have merit to understand safety in this emerging field. Recommendations for best practice reporting in future studies are provided.
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Affiliation(s)
- Stephanie Allan
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Thomas Ward
- School of Mental Health and Psychological Sciences, Department of Psychology Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
| | - Imogen H Bell
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Matteo Cella
- School of Mental Health and Psychological Sciences, Department of Psychology Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Imran B Chaudhry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
- Ziauddin University and Hospital Karachi, Karachi, Pakistan
- Pakistan Institute of Living & Learning, Karachi, Pakistan
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tayyeba Kiran
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Thomas Kabir
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Aansha Priyam
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
| | - Cara Richardson
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
| | - Ulrich Reininghaus
- School of Mental Health and Psychological Sciences, Department of Psychology Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anita Schick
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias Schwannauer
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Suzy Syrett
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Xiaolong Zhang
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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4
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Lu L, Catlow J, Rutter MD, Sharp L. Initiatives to increase colonoscopy capacity - is there an impact on polyp detection? A UK National Endoscopy Database analysis. Endoscopy 2024; 56:302-310. [PMID: 37989199 PMCID: PMC10978102 DOI: 10.1055/a-2214-9840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/26/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND To address mismatch between routine endoscopy capacity and demand, centers often implement initiatives to increase capacity, such as weekend working or using locums/agency staff (insourcing). However, there are concerns that such initiatives may negatively impact quality. We investigated polyp detection for weekend vs. weekday and insourced vs. standard procedures using data from the UK National Endoscopy Database. METHODS We conducted a national, retrospective, cross-sectional study of diagnostic colonoscopies performed during 01/01-04/04/2019. The primary outcome was mean number of polyps (MNP) and the secondary outcome was polyp detection rate (PDR). Multi-level mixed-effect regression, fitting endoscopist as a random effect, was used to examine associations between procedure day (weekend/weekday) and type (insourced/standard) and these outcomes, adjusting for patient age, sex, and indication. RESULTS 92 879 colonoscopies (weekends: 19 977 [21.5 %]; insourced: 9909 [10.7 %]) were performed by 2496 endoscopists. For weekend colonoscopies, patients were less often male or undergoing screening-related procedures; for insourced colonoscopies, patients were younger and less often undergoing screening-related procedures (all P < 0.05). Fully adjusted MNP was significantly lower for weekend vs. weekday (incidence rate ratio [IRR] 0.86 [95 %CI 0.83-0.89]) and for insourced vs. standard procedures (IRR 0.91 [95 %CI 0.87-0.95]). MNP was highest for weekday standard procedures and lowest for weekend insourced procedures; there was no interaction between procedure day and type. Similar associations were found for PDR. CONCLUSIONS Strategies to increase colonoscopy capacity may negatively impact polyp detection and should be monitored for quality. Reasons for this unwarranted variation require investigation.
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Affiliation(s)
- Liya Lu
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Jamie Catlow
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom
- Gastroenterology, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Matthew D. Rutter
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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Armstrong N, Sutton E, Chew S, Tarrant C. Identifying patients with additional needs isn't enough to improve care: harnessing the benefits and avoiding the pitfalls of classification. BMJ Qual Saf 2024; 33:152-155. [PMID: 38135496 DOI: 10.1136/bmjqs-2023-016809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Natalie Armstrong
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Elizabeth Sutton
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Sarah Chew
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Carolyn Tarrant
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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Clark JA, Smith LK, Armstrong N. Midwives' and obstetricians' practice, perspectives and experiences in relation to altered fetal movement: A focused ethnographic study. Int J Nurs Stud 2024; 150:104643. [PMID: 38043485 DOI: 10.1016/j.ijnurstu.2023.104643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Reducing avoidable stillbirth is a global priority. The stillbirth rate in England compares unfavourably to that of some other high-income countries. Poorly-managed episodes of altered fetal movement have been highlighted as a key contributor to avoidable stillbirth, and strategies introduced in England in 2016 to reduce perinatal mortality included recommendations for the management of reduced fetal movement. Despite a downward trend in stillbirth rates across the UK, the effects of policies promoting awareness of fetal movement remain uncertain. OBJECTIVE To provide in-depth knowledge of how practice and clinical guidance relating to altered fetal movement are perceived, enacted and experienced by midwives and obstetricians, and explore the relationship between recommended fetal movement care and actual fetal movement care. DESIGN A focused ethnographic approach comprising over 180 h of observation, 15 interviews, and document analysis was used to explore practice at two contrasting UK maternity units. SETTINGS Antenatal services at two UK maternity units, one in the Midlands and one in the North of England. PARTICIPANTS Thirty-six midwives, obstetricians and sonographers and 40 pregnant women participated in the study across 52 observed care episodes and relevant unit activity. Twelve midwives and three obstetricians additionally participated in formal semi-structured interviews. METHODS Fieldnotes, interview transcripts, policy documents, maternity notes and clinical guidelines were analysed using a modified constant comparison method to identify important themes. RESULTS fetal movement practice was mostly consistent and in line with guideline recommendations. Notwithstanding, most midwives and obstetricians had concerns about this area of care, including challenges in diagnosis, conflicting evidence about activity, heightened maternal anxiety, and high rates of monitoring and intervention in otherwise low-risk pregnancies. To address these issues, midwives spent considerable time reassuring women through information and regular monitoring, and coaching them to perceive fetal movement more accurately. CONCLUSIONS Practice relating to altered fetal movement might be more uniform than in the past. However, a heightened focus on fetal movement is associated by some midwives and obstetricians with potential harms, including increased anxiety in pregnancy, and high rates of monitoring and intervention in pregnancies where there are no 'objective concerns'. Challenges in diagnosing a significant change in fetal movement with accuracy might mean that interventions and resources are not being directed towards those pregnancies most at risk. More research is needed to determine how healthcare professionals can engage in conversations about fetal movement and stillbirth to support safe outcomes and positive experiences in pregnancy and birth. REGISTRATION Not registered. TWEETABLE ABSTRACT Midwives and obstetricians take #reducedfetalmovement seriously but worry this 'unreliable' symptom increases anxiety, monitoring and intervention in many 'low risk' pregnancies.
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Affiliation(s)
- Julia A Clark
- Department of Population Health Sciences, University of Leicester, Leicester, UK; School of Health Science, The University of Nottingham, Nottingham, UK.
| | - Lucy K Smith
- Department of Population Health Sciences, University of Leicester, Leicester, UK.
| | - Natalie Armstrong
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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Mahoney LB, Huang JS, Lightdale JR, Walsh CM. Pediatric endoscopy: how can we improve patient outcomes and ensure best practices? Expert Rev Gastroenterol Hepatol 2024; 18:89-102. [PMID: 38465446 DOI: 10.1080/17474124.2024.2328229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Strategies to promote high-quality endoscopy in children require consensus around pediatric-specific quality standards and indicators. Using a rigorous guideline development process, the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) was developed to support continuous quality improvement efforts within and across pediatric endoscopy services. AREAS COVERED This review presents a framework, informed by the PEnQuIN guidelines, for assessing endoscopist competence, granting procedural privileges, audit and feedback, and for skill remediation, when required. As is critical for promoting quality, PEnQuIN indicators can be benchmarked at the individual endoscopist, endoscopy facility, and endoscopy community levels. Furthermore, efforts to incorporate technologies, including electronic medical records and artificial intelligence, into endoscopic quality improvement processes can aid in creation of large-scale networks to facilitate comparison and standardization of quality indicator reporting across sites. EXPERT OPINION PEnQuIN quality standards and indicators provide a framework for continuous quality improvement in pediatric endoscopy, benefiting individual endoscopists, endoscopy facilities, and the broader endoscopy community. Routine and reliable measurement of data, facilitated by technology, is required to identify and drive improvements in care. Engaging all stakeholders in endoscopy quality improvement processes is crucial to enhancing patient outcomes and establishing best practices for safe, efficient, and effective pediatric endoscopic care.
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Affiliation(s)
- Lisa B Mahoney
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Jeannie S Huang
- Rady Children's Hospital, San Diego, CA and University of California San Diego, La Jolla, CA, USA
| | - Jenifer R Lightdale
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Sutton E, Armstrong N, Locock L, Conroy S, Tarrant C. Visual identifiers for people with dementia in hospitals: a qualitative study to unravel mechanisms of action for improving quality of care. BMJ Qual Saf 2023; 32:600-607. [PMID: 37230759 PMCID: PMC10511993 DOI: 10.1136/bmjqs-2022-015162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Hospitalised people with dementia (PwD) experience worse care and more patient safety incidents than non-dementia patients. Visual identifiers are commonly used to identify patients who have a diagnosis of dementia, with the aim of promoting more personalised care. However, little is known about how they work in practice, nor about the potential unintended consequences that might arise from their use. We aim to identify the mechanisms through which visual identifiers could support good care for PwD, how and why their use may have negative consequences and the conditions for their effective use. METHODS We conducted interviews with 21 dementia leads and healthcare professionals, 19 carers and two PwD, and produced case studies of visual identification systems in four UK acute hospital trusts between 2019 and 2021. Analysis drew on the concept of classification to identify and explore mechanisms of action. RESULTS We identified four mechanisms through which visual identifiers could help towards providing good care for PwD: enabling coordination of care at organisational level; signalling eligibility for dementia-specific interventions; informing prioritisation of resources on wards; and acting as a quick reference cue for staff. But identifier effectiveness could be undermined by: lack of standardisation and consistency; a lack of closely coupled information about individual needs; and stigma associated with a dementia diagnosis. Identifier effectiveness was dependent on their implementation being supported through staff training, resources directed and efforts to develop a supportive culture for caring for this patient group. CONCLUSION Our research highlights the potential mechanisms of action of visual identifiers and their possible negative consequences. Optimising the use of identifiers requires consensus on the rules of classification and the symbols used, and closely coupled patient information. Organisations need to provide support, offer the right resources and training and engage meaningfully with carers and patients about the use of identifiers.
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Affiliation(s)
| | | | - Louise Locock
- HSRU, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
| | - Simon Conroy
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
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Saut AM, Ho LL, Berger S, Berssaneti FT. How did healthcare professionals define patient engagement in quality management? A survey study. BMC Health Serv Res 2023; 23:173. [PMID: 36803492 PMCID: PMC9942306 DOI: 10.1186/s12913-023-09098-z] [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: 07/20/2022] [Accepted: 01/24/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Patient and family engagement (PFE) can positively impact the patient experience and care process outcomes. There is no unique type of PFE, and the process is usually defined by the quality management department or professionals responsible for this process in the hospital. The objective of this study is to define PFE in quality management based on the professional's perspective. METHOD A survey was carried out with 90 professionals from Brazilian hospitals. There were two questions aimed at understanding the concept. The first was a multiple-choice question to identify synonyms. The second was an open-ended question to develop the definition. A content analysis methodology was employed by applying techniques for thematic and inferential analysis. RESULTS Three words were classified as synonyms by more than 60% of respondents: involvement, participation, and centered care. The participants described patient participation at both the individual (related to the treatment) and organizational levels (related to quality improvement). The PFE in the treatment is related to the development, discussion and decision-making about the therapeutic plan, participation in each step of care, and knowledge of the institution's quality and safety processes. At the organizational level, engagement in quality improvement includes the involvement of the P/F in all processes of the institution, from strategic planning to the design or improvement processes, as well as active participation in institutional committees or commissions. CONCLUSION The professionals defined engagement in two levels (individual and organizational) and the results suggest that their point of view can influence the practice in the hospitals. Professionals of hospitals that implemented mechanisms of consult defined PFE more in the individual level. On the other hand, professionals of hospitals that implemented mechanisms of involvement considered PFE more focus in the organizational level.
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Affiliation(s)
- Ana Maria Saut
- Polytechnic School - Production Engineering Department, University of São Paulo (USP), Av. Prof. Luciano Gualberto, 1380, São Paulo, 05508-010, Brazil. .,Engineering School - Production Engineering Coordination, Mackenzie Presbyterian University, São Paulo, Brazil.
| | - Linda Lee Ho
- grid.11899.380000 0004 1937 0722Polytechnic School - Production Engineering Department, University of São Paulo (USP), Av. Prof. Luciano Gualberto, 1380, São Paulo, 05508-010 Brazil
| | - Simone Berger
- grid.11899.380000 0004 1937 0722Polytechnic School - Production Engineering Department, University of São Paulo (USP), Av. Prof. Luciano Gualberto, 1380, São Paulo, 05508-010 Brazil
| | - Fernando Tobal Berssaneti
- grid.11899.380000 0004 1937 0722Polytechnic School - Production Engineering Department, University of São Paulo (USP), Av. Prof. Luciano Gualberto, 1380, São Paulo, 05508-010 Brazil
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Desveaux L, Rosenberg-Yunger ZRS, Ivers N. You can lead clinicians to water, but you can't make them drink: the role of tailoring in clinical performance feedback to improve care quality. BMJ Qual Saf 2023; 32:76-80. [PMID: 36597998 DOI: 10.1136/bmjqs-2022-015149] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Laura Desveaux
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada .,Institute for Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Zahava R S Rosenberg-Yunger
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada.,Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Noah Ivers
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Lawton R, Thomas EJ. Overcoming the ‘self-limiting’ nature of QI: can we improve the quality of patient care while caring for staff? BMJ Qual Saf 2022; 31:857-859. [DOI: 10.1136/bmjqs-2022-015272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2022] [Indexed: 11/03/2022]
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12
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Preparing for audit and feedback: practical considerations. INT J EVID-BASED HEA 2022; 20:111-112. [DOI: 10.1097/xeb.0000000000000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duncan EM, Ivers NM, Grimshaw JM. Channelling the force of audit and feedback: averting the dark side. BMJ Qual Saf 2022; 31:695-697. [PMID: 35351778 DOI: 10.1136/bmjqs-2021-014520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Eilidh M Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Noah M Ivers
- Family Practice Health Centre, Women's College Hospital, Toronto, Ontario, Canada.,Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada .,Medicine, University of Ottawa, Ottawa, Ontario, Canada
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