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Gaur S, Troost JP, Fung CM, Breeden J, Barkmeier D, Shankar PR, Khalatbari S, Davenport MS. Radiologists predict differential resource utilization but not clinical outcome in emergency department patients imaged with ultrasound for right upper quadrant pain. Abdom Radiol (NY) 2024; 49:2145-2154. [PMID: 38400982 DOI: 10.1007/s00261-024-04244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Radiologists with diverse training, specialization, and habits interpret imaging in the Emergency Department. It is necessary to understand if their variation predicts differential value. The purpose of this study was to determine whether attending radiologist variation predicts major clinical outcomes in adult Emergency Department patients imaged with ultrasound for right upper quadrant pain. METHODS Consecutive ED patients imaged with ultrasound for RUQ pain from 10/8/2016 to 8/10/2022 were included (N = 7097). The primary outcome was prediction of hospital admission by signing attending radiologist. Secondary outcomes included: ED and hospital length of stay (LOS), 30-day mortality, 30-day re-presentation rate, subspecialty consultation, advanced imaging follow up (HIDA, MRI, CT), and intervention (ERCP, drainage or surgery). Sample size was determined a priori (detectable effect size: w = 0.06). Data were adjusted for demographic data, Elixhauser comorbidities, number of ED visits in prior year, clinical data, and system factors (38 covariates). P-values were corrected for multiple comparisons (false discovery rate-adjusted p-values). RESULTS The included ultrasounds were read by 35 radiologists (median exams/radiologist: 145 [74.5-241.5]). Signing radiologist did not predict hospitalization (p = 0.85), abdominopelvic surgery or intervention within 30 days, re-presentation to the Emergency Department within 30 days, or subspecialty consultation. Radiologist did predict difference in Emergency Department length of stay (p < 0.001) although this difference was small and imprecise. HIDA was mentioned variably by radiologists (range 0-19%, p < 0.001), and mention of HIDA in the ultrasound report increased 10-fold the odds of HIDA being performed in the next 72 h (odds ratio 10.4 [8.0-13.4], p < 0.001). CONCLUSION Radiologist variability did not predict meaningful outcome differences for patients with right upper quadrant pain undergoing ultrasound in the Emergency Department, but when radiologists mention HIDA in their reports, it predicts a 10-fold increase in the odds a HIDA is performed. Radiologists are relied on for interpretation that shapes subsequent patient care, and it is important to consider how radiologist variability can influence both outcome and resource utilization.
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Affiliation(s)
- Sonia Gaur
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
| | - Jonathan P Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Christopher M Fung
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joshua Breeden
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Barkmeier
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Prasad R Shankar
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shokoufeh Khalatbari
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Matthew S Davenport
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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Fernandes CJ, Gautham KS. Organization of care of infants with congenital diaphragmatic hernia-Building a high-functioning CDH program. J Perinatol 2024; 44:339-347. [PMID: 37798339 DOI: 10.1038/s41372-023-01789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/09/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
Infants born with congenital diaphragmatic hernia have high mortality and morbidity and require coordinated multidisciplinary care for optimal outcomes. Over the past several decades numerous articles have been published on the technical aspects of the care of these patients demonstrating both the variation in management across institutions as well as the desirability and need for standardization of care. Unfortunately, none have focused on the organization of care for CDH patients encompassing the range from early prenatal diagnosis to long-term postnatal care. However, to achieve optimal care and optimal outcomes, it is important to not only have excellent technical surgical and medical care but also to have an organized, systematic, and purposefully designed program for the delivery of healthcare to infants with this condition. In this article, based on our experience and drawing on general principles of building clinical programs, we describe the important elements of an ideal CDH program.
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Affiliation(s)
- Caraciolo J Fernandes
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA.
| | - Kanekal S Gautham
- Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, FL, USA
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3
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Roden-Foreman JW, Garlow L, Riordan KM, Edlund S, Suarez V. Pilot Study of a Software Application to Identify Trauma Registry Inconsistencies. J Trauma Nurs 2024; 31:15-22. [PMID: 38193487 DOI: 10.1097/jtn.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Trauma registries are essential to the functioning of modern trauma centers, and high-quality data are necessary to identify patient care issues, develop evidence-based practice, and more. However, institutional experience suggested existing methods to evaluate data quality were insufficient. OBJECTIVE This study aims to compare a new software application developed at our trauma center to our existing trauma registry platform on the ability to identify registry inconsistencies (i.e., potential data quality issues). METHODS We conducted a pilot retrospective cohort study of patients from September 2019 to August 2020 who underwent chart review during a Level I verification visit and had been audited several times for accuracy. Registry records were processed by both validation systems, and registry inconsistencies were recorded. RESULTS In registry data for 63 patients, the new software found 225 registry inconsistencies, and the registry systems found 153 inconsistencies. The most frequent inconsistencies identified by the new software were missing or unknown procedure start times, with 18/63 (28.6%) patients affected and prehospital supplemental oxygen being blank, with 29/53 (54.7%) patients with prehospital care affected. None of the 10 most common inconsistencies detected with the registry systems were true issues. CONCLUSIONS This study found the new software application identified 47% more inconsistencies than the standard registry systems, and none of the most frequent inconsistencies detected with the registry systems were true issues pertinent to institutional practice. Centers should consider additional methods to identify registry inconsistencies as existing processes appear insufficient.
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Antonacci G, Whitney J, Harris M, Reed JE. How do healthcare providers use national audit data for improvement? BMC Health Serv Res 2023; 23:393. [PMID: 37095495 PMCID: PMC10123973 DOI: 10.1186/s12913-023-09334-6] [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: 10/03/2022] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Substantial resources are invested by Health Departments worldwide in introducing National Clinical Audits (NCAs). Yet, there is variable evidence on the NCAs' effectiveness and little is known on factors underlying the successful use of NCAs to improve local practice. This study will focus on a single NCA (the National Audit of Inpatient Falls -NAIF 2017) to explore: (i) participants' perspectives on the NCA reports, local feedback characteristics and actions undertaken following the feedback underpinning the effective use of the NCA feedback to improve local practice; (ii) reported changes in local practice following the NCA feedback in England and Wales. METHODS Front-line staff perspectives were gathered through interviews. An inductive qualitative approach was used. Eighteen participants were purposefully sampled from 7 of the 85 participating hospitals in England and Wales. Analysis was guided by constant comparative techniques. RESULTS Regarding the NAIF annual report, interviewees valued performance benchmarking with other hospitals, the use of visual representations and the inclusion of case studies and recommendations. Participants stated that feedback should target front-line healthcare professionals, be straightforward and focused, and be delivered through an encouraging and honest discussion. Interviewees highlighted the value of using other relevant data sources alongside NAIF feedback and the importance of continuous data monitoring. Participants reported that engagement of front-line staff in the NAIF and following improvement activities was critical. Leadership, ownership, management support and communication at different organisational levels were perceived as enablers, while staffing level and turnover, and poor quality improvement (QI) skills, were perceived as barriers to improvement. Reported changes in practice included increased awareness and attention to patient safety issues and greater involvement of patients and staff in falls prevention activities. CONCLUSIONS There is scope to improve the use of NCAs by front-line staff. NCAs should not be seen as isolated interventions but should be fully embedded and integrated into the QI strategic and operational plans of NHS trusts. The use of NCAs could be optimised, but knowledge of them is poor and distributed unevenly across different disciplines. More research is needed to provide guidance on key elements to consider throughout the whole improvement process at different organisational levels.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Julie Whitney
- Department of Physiotherapy, King's College London, London, UK
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, South Kensington, UK
| | - Julie E Reed
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Julie Reed Consultancy Ltd, London, UK
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Ivankovic D, Garel P, Klazinga N, Kringos D. Data-Driven Collaboration between Hospitals and Other Healthcare Organisations in Europe During the COVID-19 Pandemic: An Explanatory Sequential Mixed-Methods Study among Mid-Level Hospital Managers. Int J Integr Care 2023; 23:28. [PMID: 37333773 PMCID: PMC10275210 DOI: 10.5334/ijic.6990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Data and digital infrastructure drive collaboration and help develop integrated healthcare systems and services. COVID-19 induced changes to collaboration between healthcare organisations, which previously often happened in fragmented and competitive ways. New collaborative practices relied on data and were crucial in managing coordinated responses to the pandemic. In this study, we explored data-driven collaboration between European hospitals and other healthcare organisations in 2021 by identifying common themes, lessons learned and implications going forward. Methods Study participants were recruited from an existing Europe-wide community of mid-level hospital managers. For data collection, we ran an online survey, conducted multi-case study interviews and organised webinars. Data were analysed using descriptive statistics, thematic analysis and cross-case synthesis. Results Mid-level hospital managers from 18 European countries reported an increase in data exchange between healthcare organisations during the COVID-19 pandemic. Data-driven collaborative practices were goal-oriented and focused on the optimisation of hospitals' governance functions, innovation in organisational models and improvements to data infrastructure. This was often made possible by temporarily overcoming system complexities, which would otherwise hinder collaboration and innovation. Sustainability of these developments remains a challenge. Discussion Mid-level hospital managers form a huge potential of reacting and collaborating when needed, including rapidly setting up novel partnerships and redefining established processes. Major post-COVID unmet medical needs are linked to hospital care provision, including diagnostic and therapeutic backlogs. Tackling these will require rethinking of the position of hospitals within healthcare systems, including their role in care integration. Conclusion Learning from COVID-19-induced developments in data-driven collaboration between hospitals and other healthcare organisations is important to address systemic barriers, sustain resilience and further build transformative capacity to help build better integrated healthcare systems.
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Affiliation(s)
- Damir Ivankovic
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care, Amsterdam, The Netherlands
| | - Pascal Garel
- The European Hospital and Healthcare Federation, Brussels, Belgium
| | - Niek Klazinga
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care, Amsterdam, The Netherlands
| | - Dionne Kringos
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care, Amsterdam, The Netherlands
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Cranley LA, Lo TKT, Weeks LE, Hoben M, Ginsburg LR, Doupe M, Anderson RA, Wagg A, Boström AM, Estabrooks CA, Norton PG. Reporting unit context data to stakeholders in long-term care: a practical approach. Implement Sci Commun 2022; 3:120. [DOI: 10.1186/s43058-022-00369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
The importance of reporting research evidence to stakeholders in ways that balance complexity and usability is well-documented. However, guidance for how to accomplish this is less clear. We describe a method of developing and visualising dimension-specific scores for organisational context (context rank method). We explore perspectives of leaders in long-term care nursing homes (NHs) on two methods for reporting organisational context data: context rank method and our traditionally presented binary method—more/less favourable context.
Methods
We used a multimethod design. First, we used survey data from 4065 healthcare aides on 290 care units from 91 NHs to calculate quartiles for each of the 10 Alberta Context Tool (ACT) dimension scores, aggregated at the care unit level based on the overall sample distribution of these scores. This ordinal variable was then summed across ACT scores. Context rank scores were assessed for associations with outcomes for NH staff and for quality of care (healthcare aides’ instrumental and conceptual research use, job satisfaction, rushed care, care left undone) using regression analyses. Second, we used a qualitative descriptive approach to elicit NH leaders’ perspectives on whether the methods were understandable, meaningful, relevant, and useful. With 16 leaders, we conducted focus groups between December 2017 and June 2018: one in Nova Scotia, one in Prince Edward Island, and one in Ontario, Canada. Data were analysed using content analysis.
Results
Composite scores generated using the context rank method had positive associations with healthcare aides’ instrumental research use (p < .0067) and conceptual research use and job satisfaction (p < .0001). Associations were negative between context rank summary scores and rushed care and care left undone (p < .0001). Overall, leaders indicated that data presented by both methods had value. They liked the binary method as a starting point but appreciated the greater level of detail in the context rank method.
Conclusions
We recommend careful selection of either the binary or context rank method based on purpose and audience. If a simple, high-level overview is the goal, the binary method has value. If improvement is the goal, the context rank method will give leaders more actionable details.
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Colais P, Pinnarelli L, Mataloni F, Giordani B, Duranti G, D’Errigo P, Rosato S, Seccareccia F, Baglio G, Davoli M. The National Outcomes Evaluation Programme in Italy: The Impact of Publication of Health Indicators. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811685. [PMID: 36141957 PMCID: PMC9517347 DOI: 10.3390/ijerph191811685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 06/12/2023]
Abstract
In Italy the National Outcomes Evaluation Programme, (P.N.E.) is the most comprehensive comparative evaluation of healthcare outcomes at the national level. The aim of this report is to describe the P.N.E. and some of the most relevant results achieved. The P.N.E. analysed 184 indicators on quality of care in 2015-2020 period. The data sources are the Italian Health Information Systems. The indicators reported were: proportion of surgery within 2 days after hip fracture in the elderly (HF), 30-day mortality after hospital admission for acute myocardial infarction (AMI), proportion of reoperations within 90 days of breast-conserving surgery and proportion of primary caesarean deliveries. Risk adjustment methods were used to take into account patients' characteristics. From 2010 to 2020 the proportion of interventions within 2 days after HF increased from 31.3% to 64.6%, the AMI 30-day mortality decreased from 10.4% to 8.3%, the proportion of reinterventions within 90 days of breast-conserving surgery decreased from 12.0% to 5.9% and the proportion of primary caesarean deliveries decreased from 28.4% to 22.7%. Results by area of residence showed heterogeneity of healthcare quality. We observed a general improvement in different clinical areas not always associated with a reduction of heterogeneity among areas of residence.
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Affiliation(s)
- Paola Colais
- Department of Epidemiology, Lazio Regional Health Service, 00147 Rome, Italy
| | - Luigi Pinnarelli
- Department of Epidemiology, Lazio Regional Health Service, 00147 Rome, Italy
| | - Francesca Mataloni
- Department of Epidemiology, Lazio Regional Health Service, 00147 Rome, Italy
| | - Barbara Giordani
- Research and International Relations Unit, Italian National Agency for Regional Healthcare Services (AGENAS), 00187 Rome, Italy
| | - Giorgia Duranti
- Research and International Relations Unit, Italian National Agency for Regional Healthcare Services (AGENAS), 00187 Rome, Italy
| | - Paola D’Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Giovanni Baglio
- Research and International Relations Unit, Italian National Agency for Regional Healthcare Services (AGENAS), 00187 Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, 00147 Rome, Italy
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Zou T, Jin Y, Chuang YC, Chien CW, Tung TH. The DEMATEL method explores the interdependent relationship structure and weights for diagnosis-related groups system. Front Public Health 2022; 10:872434. [PMID: 35991048 PMCID: PMC9386257 DOI: 10.3389/fpubh.2022.872434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study constructs a structure of interaction between dimensions and criteria within the diagnosis-related groups (DRGs) system from a quantitative system and identifies key factors affecting the overall performance of medical services. Method From September to December 2020, the influence relation structure diagram (IRSD) of the dimensions and corresponding criteria was developed from the practical experience of a group of domain experts, based on the DEMATEL method. Subsequently, all dimensions and criteria construct influential weights from a systems perspective. Finally, the main influential factors were identified based on the analysis results. Results The IRSD results showed that, in the overall performance of medical services, “Medical service capacity (C1)” was the main influential dimension, influencing both “Medical service efficiency (C2)” and “Medical service safety (C3).” At the criteria level, “Case-mix index (CMI) (C12),” “Time efficiency index (C21),” and “Inpatient mortality of medium-to-low group (C32)” were the main influential criteria in the corresponding dimensions. The influential weight results showed that “Medical service capacity (C1)” was also a key dimension. “Case-mix index (CMI) (C12),” “Cost efficiency index (C22),” and “Inpatient mortality of medium-to-low group (C32)” were the key criteria in their respective dimensions. Conclusion Patients and managers should first focus on the capacity of medical service providers when making a choice or deciding using the results of the DRGs system. Furthermore, they should pay more attention to medical safety even if it is not as weighted as medical efficiency.
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Affiliation(s)
- Tong Zou
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Yanjun Jin
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Yen-Ching Chuang
- Business College, Taizhou University, Taizhou, China
- Institute of Public Health and Emergency Management, Taizhou University, Taizhou, China
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
- Ching-Wen Chien
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
- *Correspondence: Tao-Hsin Tung
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Walsh CM, Lightdale JR, Mack DR, Amil-Dias J, Bontems P, Brill H, Croft NM, Fishman DS, Furlano RI, Gillett PM, Hojsak I, Homan M, Huynh HQ, Jacobson K, Leibowitz IH, Lerner DG, Liu QY, Mamula P, Narula P, Oliva S, Riley MR, Rosh JR, Tavares M, Utterson EC, Ambartsumyan L, Otley AR, Kramer RE, Connan V, McCreath GA, Thomson MA. Overview of the Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopy: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S3-S15. [PMID: 34402484 DOI: 10.1097/mpg.0000000000003262] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Pediatric-specific quality standards for endoscopy are needed to define best practices, while measurement of associated indicators is critical to guide quality improvement. The international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) working group was assembled to develop and define quality standards and indicators for pediatric gastrointestinal endoscopic procedures through a rigorous guideline consensus process. METHODS The Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument guided PEnQuIN members, recruited from 31 centers of various practice types representing 11 countries, in generating and refining proposed quality standards and indicators. Consensus was sought via an iterative online Delphi process, and finalized at an in-person conference. Quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. RESULTS Forty-nine quality standards and 47 indicators reached consensus, encompassing pediatric endoscopy facilities, procedures, endoscopists, and the patient experience. The evidence base for PEnQuIN standards and indicators was largely adult-based and observational, and downgraded for indirectness, imprecision, and study limitations to "very low" quality, resulting in "conditional" recommendations for most standards (45/49). CONCLUSIONS The PEnQuIN guideline development process establishes international agreement on clinically meaningful metrics that can be used to promote safety and quality in endoscopic care for children. Through PEnQuIN, pediatric endoscopists and endoscopy services now have a framework for auditing, providing feedback, and ultimately, benchmarking performance. Expansion of evidence and prospective validation of PEnQuIN standards and indicators as predictors of clinically relevant outcomes and high-quality pediatric endoscopic care is now a research priority.
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Affiliation(s)
- 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, University of Toronto, Toronto, Ontario, Canada
| | - Jenifer R Lightdale
- Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Herbert Brill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Department of Paediatrics, William Osler Health System, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Matjaž Homan
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ian H Leibowitz
- Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, Department of Pediatrics, George Washington University, Washington, DC, United States
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Marta Tavares
- Division of Pediatrics, Pediatric Gastroenterology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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Ohrling M, Tolf S, Solberg-Carlsson K, Brommels M. Managers do it their way: How managers act in a decentralised healthcare services provider organisation - a mixed methods study. Health Serv Manage Res 2021; 35:215-228. [PMID: 34963355 DOI: 10.1177/09514848211065467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: Decentralisation is considered a way to get managers more committed and more prone to respond to local needs. This study analyses how managers perceive a decentralised management model within a large public healthcare delivery organisation in Sweden. Design/methodology/approach: A programme theory evaluation was performed applying direct content analysis to in-depth interviews with healthcare managers. Balance score card data were used in a blinded comparative content analysis to explore relations between performance and how the delegated authority was perceived and used by the managers. Findings: Managers' perceptions of the decentralised management model supported its intentions to enable the front-line to make decisions to better meet customer needs and flexibly adapt to local conditions. The managers appreciated and used their delegated authority. Central policies and control on human resources and investments were accepted as those are to the benefit of the whole organisation. Leadership development and organisation-wide improvement programmes were of support. Units showing high organisational performance had proactive managers, although differences in manager perceptions across units were small. Originality: This, one of the first of its kind, study of a decentralisation in service delivery organisation shows a congruence between the rationale of a management model, the managers' perceptions of the authority and accountability as well as management practises. These observations stemming from a large public primary and community healthcare organisation has not, to our knowledge, been reported and provide research-informed guidance on decentralisation as one strategy for resolving challenges in healthcare service delivery organisations.
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Affiliation(s)
- Mikael Ohrling
- 193144Stockholm Health Care Services County, Stockholm, Sweden.,Department of LIME, 411412Karolinska Institute Department of Learning Informatics Management and Ethics, Stockholm, Sweden
| | - Sara Tolf
- 411412Karolinska Institutet Department of Learning Informatics Management and Ethic, Stockholm, Sweden
| | - Karin Solberg-Carlsson
- 411412Karolinska Institutet Department of Learning Informatics Management and Ethic, Stockholm, Sweden
| | - Mats Brommels
- Department of LIME, 411412Karolinska Institute Department of Learning Informatics Management and Ethics, Stockholm, Sweden
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Alostaz Z, Rose L, Mehta S, Johnston L, Dale C. Implementation of nonpharmacologic physical restraint minimization interventions in the adult intensive care unit: A scoping review. Intensive Crit Care Nurs 2021; 69:103153. [PMID: 34920932 DOI: 10.1016/j.iccn.2021.103153] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/16/2021] [Accepted: 09/13/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To identify the elements informing the successful implementation of nonpharmacologic physical restraint minimization interventions in adult intensive care unit patients. To map those elements to innovation, context, recipients and facilitation domains of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and to describe the outcomes of those interventions. METHODOLOGY A scoping review of studies published in English reporting on restraint minimization interventions in adult intensive care units. We searched seven databases (MEDLINE, CIHAHL, Embase, Web of Science, Cochrane Library, PROSPERO and Joanna Briggs) from inception to 2021. Two authors independently screened articles for inclusion, extracted study characteristics and mapped intervention data to the i-PARIHS domains. RESULTS Seven studies met inclusion criteria. Innovations comprised multicomponent interventions including education, decision aids/protocols and restraint alternatives. No studies utilised an implementation science framework to diagnose the baseline practice context. A commonly reported barrier to restraint minimization was a risk averse culture. Change was mostly driven by the external context (i.e. national regulations). Overall, nurses were the primary facilitators and recipients of practice change. Outcomes were changes in restraint incidence and prevalence abstracted from the medical record. However, no study validated the accuracy of restraint documentation. All studies documented an initial decrease in physical restraint use, but no long-term results were reported. CONCLUSION Restraint minimization intervention studies report nurse-facilitated multicomponent interventions and short-term practice change. Future restraint minimization research incorporating implementation science frameworks, interprofessional teams and patient/family perspectives is warranted.
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Affiliation(s)
- Ziad Alostaz
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Suite 130, Toronto, ON, Canada.
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sangeeta Mehta
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada; Mount Sinai Hospital, 600 University Ave, Rm 18-216, Toronto, ON, Canada
| | - Linda Johnston
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Suite 130, Toronto, ON, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Suite 130, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
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Chaudhry NT, Franklin BD, Mohammed S, Benn J. The Secondary Use of Data to Support Medication Safety in the Hospital Setting: A Systematic Review and Narrative Synthesis. PHARMACY 2021; 9:pharmacy9040198. [PMID: 34941630 PMCID: PMC8706071 DOI: 10.3390/pharmacy9040198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To conduct a systematic review and narrative synthesis of interventions based on secondary use of data (SUD) from electronic prescribing (EP) and electronic hospital pharmacy (EHP) systems and their effectiveness in secondary care, and to identify factors influencing SUD. METHOD The search strategy had four facets: 1. Electronic databases, 2. Medication safety, 3. Hospitals and quality/safety, and 4. SUD. Searches were conducted within EMBASE, Medline, CINAHL, and International Pharmaceutical Abstracts. Empirical SUD intervention studies that aimed to improve medication safety and/or quality, and any studies providing insight into factors affecting SUD were included. RESULTS We identified nine quantitative studies of SUD interventions and five qualitative studies. SUD interventions were complex and fell into four categories, with 'provision of feedback' the most common. While heterogeneous, the majority of quantitative studies reported positive findings in improving medication safety but little detail was provided on the interventions implemented. The five qualitative studies collectively provide an overview of the SUD process, which typically comprised nine steps from data identification to analysis. Factors influencing the SUD process were electronic systems implementation and level of functionality, knowledge and skills of SUD users, organisational context, and policies around data reuse and security. DISCUSSION AND CONCLUSION The majority of the SUD interventions were successful in improving medication safety, however, what contributes to this success needs further exploration. From synthesis of research evidence in this review, an integrative framework was developed to describe the processes, mechanisms, and barriers for effective SUD.
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Affiliation(s)
- Navila Talib Chaudhry
- Research Department of Practice and Policy, UCL School of Pharmacy, 29–39 Brunswick Square, London WC1N 1AX, UK;
- Correspondence:
| | - Bryony Dean Franklin
- Research Department of Practice and Policy, UCL School of Pharmacy, 29–39 Brunswick Square, London WC1N 1AX, UK;
- Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Salmaan Mohammed
- NIHR Patient Safety Translational Research Centre, Department of Surgery and Cancer, Faculty of Medicine, St Mary’s Campus, Imperial College London, 5th Floor Wright Fleming Building, Norfolk Place, London W2 1PG, UK;
| | - Jonathan Benn
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, School of Psychology, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK;
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Zaadoud B, Chbab Y, Chaouch A. The Performance Measurement Frameworks in Healthcare: Scopus Study. JOURNAL OF HEALTH MANAGEMENT 2021. [DOI: 10.1177/09720634211011694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Object: The purpose of this article is to analyse and compare the frameworks of performance measurement in primary health care in the world. The objective is to determine whether the frameworks of performance measurement in primary health care have an influence on the performance of health centres. Method: We conducted a systematic review of the literature to: (a) identify a conceptual framework for measuring quality management systems; and (b) assess the effects of the conceptual framework on quality improvement and quality of care outcomes. We chose frameworks highly cited in the literature and analysed and compared these frameworks. Results: Eight dimensions were identified for assessing performance in primary health care facilities (PHCFs) in more than 50% frameworks: effectiveness, safety, accessibility, equity, efficiency, acceptability, patient-centredness and timeliness. Conclusion: Even if the links are not established within the framework of a scientific research, quality approaches are generally recognised as an essential tool to help establishments improve their quality of care and the safety of their patients. Until now, the evaluation of the quality of care in the 'PHCF' is not yet in place, a blatant need for performance measurement tools, relevant information, coherence between the operational and strategic levels, integration of organizational objectives in the measurement of performance in order to direct the structures towards a true management by quality.
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Affiliation(s)
- B. Zaadoud
- Laboratory of Agro-Physiology, Biotechnology, Environment and Quality, Faculty of Science, Ibn Tofail University, BP, Kénitra, Morocco
| | - Y. Chbab
- Laboratory of Agro-Physiology, Biotechnology, Environment and Quality, Faculty of Science, Ibn Tofail University, BP, Kénitra, Morocco
| | - A. Chaouch
- Laboratory of Agro-Physiology, Biotechnology, Environment and Quality, Faculty of Science, Ibn Tofail University, BP, Kénitra, Morocco
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Liu X, Liu F, Wang L, Wu M, Yang L, Wei L. Performance evaluation of medical service for breast cancer patients based on diagnosis related groups. BMC Health Serv Res 2021; 21:496. [PMID: 34030683 PMCID: PMC8147397 DOI: 10.1186/s12913-021-06439-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/26/2021] [Indexed: 11/12/2022] Open
Abstract
Background To evaluate the performance of medical service for patients with breast cancer in Henan Province, China, using diagnosis related groups (DRGs) indicators and to provide data to inform practices and policies for the prevention and control of breast cancer. Methods The data were collected from the front pages of medical records (FPMR) of all hospitals above class II that admitted breast cancer patients in Henan Province between 2016 and 2019. Breast cancer patients were the subjects in our study. China DRGs (CN-DRGs) was used as a risk adjustment tool. Three indicators, including the case mix index (CMI), number of DRGs, and total weight, were used to evaluate the range of available services for patients with breast cancer, while indicators including the charge efficiency index (CEI), time efficiency index (TEI) and inpatient mortality of low-risk group cases (IMLRG) were used to evaluate medical service efficiency and medical safety. Results Between 2016 and 2019, there were 103,760 patients with breast cancer. The total weight increased over the study period at an average annual rate of 21.71%. The TEI decreased over the study period by 15.60%. The CEI exhibited an increasing trend, but the average annual rate of increase was small (2.94%). The IMLRP was 0.02, 0, 0 and 0.01% in 2016, 2017, 2018 and 2019, respectively. Conclusion The performance of medical service improved between 2016 and 2019 for breast cancer patients discharged from study hospitals in Henan Province. The main area of improvement was in the range of available services, but medical institutions must still make efforts to improve the efficiency of medical services and ensure medical safety. DRGs is an effective evaluation tool.
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Affiliation(s)
- Xinkui Liu
- Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, 1# Jian She Dong Road, Er Qi Distict, Zhenzhou, China.
| | - Furong Liu
- Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, 1# Jian She Dong Road, Er Qi Distict, Zhenzhou, China
| | - Lin Wang
- Radiotherapy Inpatient Ward II, The First Affiliated Hospital of Zhengzhou University, 1# Jian She Dong Road, Er Qi Distict, Zhenzhou, China
| | - MengFan Wu
- Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, 1# Jian She Dong Road, Er Qi Distict, Zhenzhou, China
| | - LinPeng Yang
- Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, 1# Jian She Dong Road, Er Qi Distict, Zhenzhou, China
| | - Le Wei
- Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, 1# Jian She Dong Road, Er Qi Distict, Zhenzhou, China
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Sykes M, Thomson R, Kolehmainen N, Allan L, Finch T. Opportunities to enhance ward audit: a multi-site qualitative study. BMC Health Serv Res 2021; 21:226. [PMID: 33712006 PMCID: PMC7971099 DOI: 10.1186/s12913-021-06239-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hospitals in many countries are encouraged to develop audits to assess and improve the quality of care. Ward audit is a specific form of audit and feedback that is commonly used but little studied. The aim of this study is to describe the content and application of hospital ward audit in order to identify potential enhancements to such audits. METHODS Multiple qualitative methods were used to study a diversity sample of four English National Health Service organisations over a 16-month period. We undertook semi-structured interviews (n = 32), documentary analysis (n = 44) and 25 h of observations of healthcare workers involved in the design and implementation of ward audit. Data were analysed using framework analysis. Findings were presented iteratively to stakeholders who used them to develop a description of the content and delivery of ward audit. RESULTS Ward audit consisted of seven stages: impetus; method; preparation of staff; assessing practice; analysis; feedback; and decide on action to improve. Two key stages were the monthly assessment of practice using case note data extraction, and the resulting feedback to clinical staff, ward managers, matrons and directors of nursing. At three organisations, the case note data were extracted by staff and there was evidence that this resulted in misrepresentation of the clinical performance audited. The misrepresentation appeared to be associated with the anticipation of punitive feedback from directors of nursing and matrons, as well as time pressures and a lack clarity about the method of audit data collection. Punitive feedback was reported to occur if no data were collected, if data demonstrated poor performance or if performance did not improve. CONCLUSIONS Organisations invest considerable clinical resources in ward audit, but such audits may have unintended, potentially negative, consequences due to the impacts from punitive feedback. We discuss potential enhancements to ward audit (e.g. providing feedback recipients with suggested actions for improvement) and discuss implications for theory. There is a need to reduce the use of punitive feedback.
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Affiliation(s)
- Michael Sykes
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK.
| | - Richard Thomson
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK
| | - Niina Kolehmainen
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK
| | - Louise Allan
- South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Tracy Finch
- Coach Lane Campus West, Northumbria University, Newcastle upon Tyne, UK
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Van Schie P, Van Bodegom-Vos L, Zijdeman TM, Nelissen RGHH, Marang-Van De Mheen PJ. Awareness of performance on outcomes after total hip and knee arthroplasty among Dutch orthopedic surgeons: how to improve feedback from arthroplasty registries. Acta Orthop 2021; 92:54-61. [PMID: 33019821 PMCID: PMC7919881 DOI: 10.1080/17453674.2020.1827523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The Netherlands Registry of Orthopedic Implants (LROI) uses audit and feedback (A&F) as the strategy to improve performance outcomes after total hip and knee arthroplasty (THA/TKA). Effectiveness of A&F depends on awareness of below-average performance to initiate improvement activities. We explored the awareness of Dutch orthopedic surgeons regarding their performance on outcomes after THA/TKA and factors associated with this awareness.Methods - An anonymous questionnaire was sent to all 445 eligible Dutch orthopedic surgeons performing THA/TKA. To assess awareness on own surgeon-group performance, they were asked whether their 1-year THA/TKA revision rates over the past 2 years were below average (negative outlier), average (non-outlier), above average (positive outlier) in the funnel plot on the LROI dashboard, or did not know. Associations were determined with (1) dashboard login at least once a year (yes/no); (2) correct funnel-plot interpretation (yes/no) and; (3) recall of their 1-year THA/TKA revision rate (yes/no).Results - 44% of respondents started the questionnaire, 158 THA and 156 TKA surgeons. 55% of THA surgeons and 55% of TKA surgeons were aware of their performance. Surgeons aware of their performance more often logged in on the LROI dashboard, more often interpreted funnel plots correctly, and more often recalled their revision rate. 38% of THA and 26% of TKA surgeons scored "good" on all 3 outcomes.Interpretation - Only half of the orthopedic surgeons were aware of their performance status regarding outcomes after THA/TKA. This suggests that to increase awareness, orthopedic surgeons need to be actively motivated to look at the dashboard more frequently and educated on interpretation of funnel plots for audit and feedback to be effective.
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Affiliation(s)
- Peter Van Schie
- Department of Orthopedics, Leiden University Medical Centre, Leiden;,Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands,Correspondence:
| | - Leti Van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Tristan M Zijdeman
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Perla J Marang-Van De Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
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Pache B, Martin D, Addor V, Demartines N, Hübner M. Swiss Validation of the Enhanced Recovery After Surgery (ERAS) Database. World J Surg 2021; 45:940-945. [PMID: 33486583 PMCID: PMC7921022 DOI: 10.1007/s00268-020-05926-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 11/24/2022]
Abstract
Background Enhanced recovery after surgery (ERAS) pathways have considerably improved postoperative outcomes and are in use for various types of surgery. The prospective audit system (EIAS) could be a powerful tool for large-scale outcome research but its database has not been validated yet. Methods Swiss ERAS centers were invited to contribute to the validation of the Swiss chapter for colorectal surgery. A monitoring team performed on-site visits by the use of a standardized checklist. Validation criteria were (I) coverage (No. of operated patients within ERAS protocol; target threshold for validation: ≥ 80%), (II) missing data (8 predefined variables; target ≤ 10%), and (III) accuracy (2 predefined variables, target ≥ 80%). These criteria were assessed by comparing EIAS entries with the medical charts of a random sample of patients per center (range 15–20). Results Out of 18 Swiss ERAS centers, 15 agreed to have onsite monitoring but 13 granted access to the final dataset. ERAS coverage was available in only 7 centers and varied between 76 and 100%. Overall missing data rate was 5.7% and concerned mainly the variables “urinary catheter removal” (16.4%) and “mobilization on day 1” (16%). Accuracy for the length of hospital stay and complications was overall 84.6%. Overall, 5 over 13 centers failed in the validation process for one or several criteria. Conclusion EIAS was validated in most Swiss ERAS centers. Potential patient selection and missing data remain sources of bias in non-validated centers. Therefore, simplified validation of other centers appears to be mandatory before large-scale use of the EIAS dataset. Supplementary Information The online version contains supplementary material available at (10.1007/s00268-020-05926-z).
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Affiliation(s)
- Basile Pache
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
- Department of Gynecology, Lausanne University Hospital CHUV, Pierre Decker 2, University of Lausanne (UNIL), Lausanne, 1011, Switzerland
| | - David Martin
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
| | - Valérie Addor
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
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Serrano-Ripoll MJ, Ripoll J, Briones-Vozmediano E, Llobera J, Fiol-deRoque MA, Ricci-Cabello I. Exploring primary health care professionals' perceptions about a patient feedback intervention to improve patient safety in Spanish primary health care centres: a qualitative study. Fam Pract 2020; 37:821-827. [PMID: 32424409 DOI: 10.1093/fampra/cmaa051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient feedback interventions are receiving increasing attention given their potential to improve health care provision. However, primary health care (PHC) professionals' acceptability and perceived utility of this type of interventions remain largely unexplored. OBJECTIVES The aim of this study was to explore PHC professionals' perceptions, opinions and suggestions about a patient feedback intervention currently being designed to improve patient safety in Spanish PHC centres. METHODS We conducted an exploratory qualitative study with 43 PHC professionals. Information was obtained from three semi-structured interviews and four focus groups. All data were audio-recorded, transcribed and analyzed using content analysis by three analysts. RESULTS The patient feedback intervention was acceptable to health care professionals, who perceived it as a useful strategy to improve health care processes and activate patients. A number of factors potentially limiting the acceptability and perceived utility of the intervention were identified (low patient safety culture, low patient-centred care orientation and limited credibility of patient feedback data). Recommendations for designing and implementing the proposed intervention in the Spanish PHC centres were identified in relation to the following areas: 'collection and analysis of feedback data'; 'feedback display'; 'feedback delivery' and; 'implementation of safety improvement initiatives'. CONCLUSIONS Although the proposed intervention was generally perceived as useful and acceptable, our study identified a number of tensions about the practical aspects of using the patient-reported data and the credibility of the data and what actions would arise from its use. The intervention has been adapted to address these tensions before its formal evaluation in a randomized clinical trial.
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Affiliation(s)
- Maria J Serrano-Ripoll
- Primary Care Research Unit of Mallorca, IB-Salut, Palma.,Balearic Islands Health Research Institute, Palma.,Psychology Department, University of the Balearic Islands, Palma
| | - Joana Ripoll
- Primary Care Research Unit of Mallorca, IB-Salut, Palma.,Balearic Islands Health Research Institute, Palma.,Primary Care Preventive and Health Promotion Research Network (redIAPP), Palma
| | - Erica Briones-Vozmediano
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida.,Biomedical Research Institute of Lleida, GRECS Group, Lleida
| | - Joan Llobera
- Primary Care Research Unit of Mallorca, IB-Salut, Palma.,Balearic Islands Health Research Institute, Palma.,Primary Care Preventive and Health Promotion Research Network (redIAPP), Palma
| | - Maria A Fiol-deRoque
- Primary Care Research Unit of Mallorca, IB-Salut, Palma.,Balearic Islands Health Research Institute, Palma
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit of Mallorca, IB-Salut, Palma.,Balearic Islands Health Research Institute, Palma.,Biomedical Research Center in Epidemiology and Public Health, Madrid, Spain
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Tolf S, Mesterton J, Söderberg D, Amer-Wåhlin I, Mazzocato P. How can technology support quality improvement? Lessons learned from the adoption of an analytics tool for advanced performance measurement in a hospital unit. BMC Health Serv Res 2020; 20:816. [PMID: 32873286 PMCID: PMC7460799 DOI: 10.1186/s12913-020-05622-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/03/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Technology for timely feedback of data has the potential to support quality improvement (QI) in health care. However, such technology may pose difficulties stemming from the complex interaction with the setting in which it is implemented. To enable professionals to use data in QI there is a need to better understand of how to handle this complexity. This study aims to explore factors that influence the adoption of a technology-supported QI programme in an obstetric unit through a complexity informed framework. METHODS This qualitative study, based on focus group interviews, was conducted at a Swedish university hospital's obstetric unit, which used an analytics tool for advanced performance measurement that gave timely and case mix adjusted feedback of performance data to support QI. Data was collected through three focus group interviews conducted with 16 managers and staff. The Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework guided the data collection and analysis. RESULTS Staff and managers deemed the technology to effectively support ongoing QI efforts by providing timely access to reliable data. The value of the technology was associated with a clear need to make better use of existing data in QI. The data and the methodology in the analytics tool reflected the complexity of the clinical conditions treated but was presented through an interface that was easy to access and user friendly. However, prior understanding of statistics was helpful to be able to fully grasp the presented data. The tool was adapted to the needs and the organizational conditions of the local setting through a collaborative approach between the technology supplier and the adopters. CONCLUSIONS Technology has the potential to enable systematic QI through motivating professionals by providing timely and adequate feedback of performance. The adoption of such technology is complex and requires openness for gradual learning and improvement.
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Affiliation(s)
- Sara Tolf
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Johan Mesterton
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Ivbar Institute, Stockholm, Sweden
| | - Daniel Söderberg
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Isis Amer-Wåhlin
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Department of Women and Child Health, Karolinska Institutet, Stockholm, Sweden
| | - Pamela Mazzocato
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Department for Research, Development, Education and Innovation, Södertälje Hospital, Södertälje, Sweden
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Weidler EM, Britto MT, Sitzman TJ. Facilitators and Barriers to Implementing Standardized Outcome Measurement for Children With Cleft Lip and Palate. Cleft Palate Craniofac J 2020; 58:7-18. [PMID: 32662298 DOI: 10.1177/1055665620940187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Identify facilitators and barriers to implementing standardized outcome measurement in cleft care. DESIGN Cross-sectional, qualitative study. SETTING/PARTICIPANTS Participants included 24 providers and staff from a large, multidisciplinary cleft team in the southwest United States, 5 caregivers of children with cleft palate (with or without cleft lip) treated by this team, and 3 experts involved in implementing a cleft-specific standardized outcome measurement in the United Kingdom. INTERVENTIONS Semistructured, qualitative interviews were conducted exploring perceived facilitators and barriers to implementing standardized outcome measurement in cleft care. Interviews were audio-recorded, transcribed, and analyzed for content. The Consolidated Framework for Implementation Research was used to guide the interviews and analysis. The analysis focused on the characteristics of standardized outcome measurement that directly influence its adoption. RESULTS Participants identified both facilitators and barriers to implementing standardized outcome measurement. Facilitators included the strength and quality of evidence supporting improvements in cleft care delivery following implementation of standardized outcome measurement and the relative advantage of standardized outcome measurement over continuing the status quo. Barriers included the difficulty adapting standardized outcome measurement to meet local context and patient-specific needs and the complexity of implementing standardized outcome measurement. CONCLUSIONS Providers, staff, and caregivers involved in cleft care perceive multiple benefits from standardized outcome measurement, while also recognizing substantial barriers to its implementation. Results from this study can be used to guide development of an implementation strategy for standardized outcome measurement that builds upon perceived strengths of the intervention and reduces perceived barriers.
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Affiliation(s)
- Erica M Weidler
- Department of Clinical Research, Phoenix Children's Hospital, AZ, USA
| | - Maria T Britto
- Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH, USA
| | - Thomas J Sitzman
- Division of Plastic Surgery, Phoenix Children's Hospital, AZ, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
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de Neree Tot Babberich MPM, Ledeboer M, van Leerdam ME, Spaander MCW, van Esch AAJ, Ouwendijk RJ, van der Schaar PJ, van der Beek S, Lacle MM, Seegers PA, Wouters MWJM, Fockens P, Dekker E. Dutch Gastrointestinal Endoscopy Audit: automated extraction of colonoscopy data for quality assessment and improvement. Gastrointest Endosc 2020; 92:154-162.e1. [PMID: 32057727 DOI: 10.1016/j.gie.2020.01.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/28/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The importance of having quality assessment, assurance, and improvement tools in health care is increasingly recognized. However, the additional associated administration burden progressively interferes with the structural implementation and adoption of such tools, especially when it concerns high-volume procedures such as colonoscopies. The development of the Dutch Gastrointestinal Endoscopy Audit (DGEA), a registry with automated extraction of colonoscopy quality data, and its first results are described. METHODS In close cooperation with commercial endoscopy reporting systems and a national histopathology database, healthcare professionals performing colonoscopies initiated a quality registry that extracts data from its core hospital resource or histology database without manual interference of the healthcare providers. Data extracted consisted of patient age, gender, indication of the colonoscopy, American Society of Anesthesiologists score, Boston Bowel Preparation Score, and cecal intubation; for the colonoscopy after a positive fecal immunochemical test in the colorectal cancer screening program, other data were polyp detection rate, which was available for all 48 hospitals or endoscopy centers, and adenoma detection rate, which was available for 26 hospitals or endoscopy centers. RESULTS Between January 1, 2016 and March 31, 2019, 48 hospitals or endoscopy centers voluntarily participated in the DGEA, and 275,017 unique patients with 313,511 colonoscopies were registered. Overall missing values were limited to <1%. CONCLUSIONS The results of this study demonstrate that it is feasible to deploy a quality registry collecting uniform data without additional administration burden for healthcare professionals.
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Affiliation(s)
| | - Michiel Ledeboer
- Department of Gastroenterology & Hepatology, Deventer Hospital, Deventer, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology & Hepatology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Aura A J van Esch
- Department of Gastroenterology & Hepatology, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Rob J Ouwendijk
- Department of Gastroenterology & Hepatology, Bravis Hospital, Roosendaal, the Netherlands
| | - Peter J van der Schaar
- Department of Gastroenterology & Hepatology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Sander van der Beek
- Department of Internal Medicine, Rivierenland Hospital, Tiel, the Netherlands
| | - Miangela M Lacle
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Michel W J M Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Yigzaw KY, Budrionis A, Marco-Ruiz L, Henriksen TD, Halvorsen PA, Bellika JG. Privacy-preserving architecture for providing feedback to clinicians on their clinical performance. BMC Med Inform Decis Mak 2020; 20:116. [PMID: 32571306 PMCID: PMC7310252 DOI: 10.1186/s12911-020-01147-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background Learning from routine healthcare data is important for the improvement of the quality of care. Providing feedback on clinicians’ performance in comparison to their peers has been shown to be more efficient for quality improvements. However, the current methods for providing feedback do not fully address the privacy concerns of stakeholders. Methods The paper proposes a distributed architecture for providing feedback to clinicians on their clinical performances while protecting their privacy. The indicators for the clinical performance of a clinician are computed within a healthcare institution based on pseudonymized data extracted from the electronic health record (EHR) system. Group-level indicators of clinicians across healthcare institutions are computed using privacy-preserving distributed data-mining techniques. A clinician receives feedback reports that compare his or her personal indicators with the aggregated indicators of the individual’s peers. Indicators aggregated across different geographical levels are the basis for monitoring changes in the quality of care. The architecture feasibility was practically evaluated in three general practitioner (GP) offices in Norway that consist of about 20,245 patients. The architecture was applied for providing feedback reports to 21 GPs on their antibiotic prescriptions for selected respiratory tract infections (RTIs). Each GP received one feedback report that covered antibiotic prescriptions between 2015 and 2018, stratified yearly. We assessed the privacy protection and computation time of the architecture. Results Our evaluation indicates that the proposed architecture is feasible for practical use and protects the privacy of the patients, clinicians, and healthcare institutions. The architecture also maintains the physical access control of healthcare institutions over the patient data. We sent a single feedback report to each of the 21 GPs. A total of 14,396 cases were diagnosed with the selected RTIs during the study period across the institutions. Of these cases, 2924 (20.3%) were treated with antibiotics, where 40.8% (1194) of the antibiotic prescriptions were narrow-spectrum antibiotics. Conclusions It is feasible to provide feedback to clinicians on their clinical performance in comparison to peers across healthcare institutions while protecting privacy. The architecture also enables monitoring changes in the quality of care following interventions.
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Affiliation(s)
- Kassaye Yitbarek Yigzaw
- Norwegian Centre for E-health Research, University Hospital of North Norway, 9019, Tromsø, Norway.
| | - Andrius Budrionis
- Norwegian Centre for E-health Research, University Hospital of North Norway, 9019, Tromsø, Norway
| | - Luis Marco-Ruiz
- Norwegian Centre for E-health Research, University Hospital of North Norway, 9019, Tromsø, Norway
| | - Torje Dahle Henriksen
- Norwegian Centre for E-health Research, University Hospital of North Norway, 9019, Tromsø, Norway
| | - Peder A Halvorsen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway
| | - Johan Gustav Bellika
- Norwegian Centre for E-health Research, University Hospital of North Norway, 9019, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway
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23
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Wang EJ, Helgesen R, Johr CR, Lacko HS, Ashburn MA, Merkel PA. Targeted Program in an Academic Rheumatology Practice to Improve Compliance With Opioid Prescribing Guidelines for the Treatment of Chronic Pain. Arthritis Care Res (Hoboken) 2020; 73:1425-1429. [PMID: 32558375 DOI: 10.1002/acr.24354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/09/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The Centers for Disease Control and Prevention (CDC) and many state governments have issued guidelines for opioid prescribing for the treatment of chronic noncancer-associated pain. We sought to decrease practice variation and increase compliance with these guidelines in a tertiary academic rheumatology practice by developing an interdisciplinary opioid working group and using electronic health record (EHR)-integrated data feedback. METHODS Division leadership and providers established shared goals at interdisciplinary meetings involving rheumatology, pain medicine, nursing, and pharmacy. Interventions included educational sessions on opioid prescribing guidelines and the sharing of individual de-identified prescribing patterns. An opioid dashboard page within the EHR allowed every provider to see individualized and division-wide data that tracked process measures based on CDC and state-specific guidelines. Baseline data from June to August 2017 were compared with monthly data through December 2018. RESULTS At baseline, 40% of patients had an active opioid agreement (a Pennsylvania guideline and a New Jersey law), 25% had a urine drug screen result within 12 months of their most recent opioid prescription, and 24% had a concurrent benzodiazepine prescription. After 16 months, these percentages improved to 88%, 66%, and 16%, respectively. The average number of opioid tablets prescribed per month decreased from 59,733 to 48,966 (-18%; P = 0.02). CONCLUSION Shared goals developed through interdisciplinary input and readily accessible data feedback can markedly increase provider compliance with national and state-specific guidelines for opioid prescribing for the treatment of chronic noncancer-associated pain in rheumatology.
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Affiliation(s)
- Eric J Wang
- Hospital of the University of Pennsylvania, Philadelphia
| | | | | | - Hannah S Lacko
- Hospital of the University of Pennsylvania, Philadelphia
| | | | - Peter A Merkel
- Hospital of the University of Pennsylvania, Philadelphia
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24
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Sico JJ, Sarwal A, Benish SM, Busis NA, Cohen BH, Das RR, Finsilver S, Halperin JJ, Kelly AG, Meunier L, Phipps MS, Thirumala PD, Villanueva R, von Gaudecker J, Bennett A, Shenoy AM. Quality improvement in neurology. Neurology 2020; 94:982-990. [DOI: 10.1212/wnl.0000000000009525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/30/2020] [Indexed: 01/06/2023] Open
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25
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Marmat G, Jain P. Contingency framework for understanding quality in public and private hospitals of India. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2020. [DOI: 10.1108/ijphm-02-2019-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Health-care delivery organizations (hospitals) constitute a complex adaptive system; hence, a contingency perspective is imperative to guide the design of customized approaches to quality management in different health-care settings. Accordingly, this paper aims to propose a contingency framework to advance the understanding of the relationship between situational factors and effectiveness of quality approaches in health-care organizations (HCOs), such as hospitals in India.
Design/methodology/approach
Related literature was reviewed to identify existing research and theories related to quality and quality approaches, situational factors of the HCOs (hospitals) and some existing logical evidence on public and private hospitals in India. Then a contingencies framework for quality and quality approaches was conceptualized.
Findings
This paper proposes contingent determinants arise out of conceptualization of the HCOs (hospitals) from different system perspective such as rational system, natural system, open system and integrative system; uncertainty because of physicians’ behaviour, nurses’ approach and a dual line of authority; and the task environment such as patients, competition and economic pressure. These determinants represent situational constructs to the quality enhancement of any attempt at quality approaches. While these determinants have an influence on the quality and quality approaches of the HCOs (hospital), it is imperative to build any quality improvement strategy to work effectively, i.e., quality approach is dependent on determinants of the contingencies of the hospital’s environment, be it external or internal. Propositions for future research are also incorporated.
Research limitations/implications
This paper proposes a conceptual model as well as research propositions that need to be validated and confirmed empirically. It advances the research and theory related to quality and quality approaches in a health-care setting. It can enable policymakers, hospital managers to analyze and gauge the appropriateness of quality approaches in a given context before implementing them and could help to improve the introverted quality approaches and quality dimensions currently followed in HCOs (hospitals).
Originality/value
Contingency framework is a new approach for research on the effectiveness of quality approaches in hospitals. The fundamental idea behind this framework is that effectiveness of quality approaches can be understood best by examining its contingent determinants. Thus, it has the capacity to contribute to the efforts of government and policymakers to make the quality of care affordable to all in India. Essentially, we examine the contexts and variables that determine the effectiveness of quality approaches.
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26
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Anderson JW, Greenwood MR, Borsato GG, Kuttler KG. Alerting Wisely: Reducing Inappropriate Blood Chemistry Panel Orders Using a Clinical Decision Support Tool. J Healthc Qual 2020; 42:12-18. [DOI: 10.1097/jhq.0000000000000175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Kwak J, Wilkey AL, Abdalla M, Joshi R, Roman PEF, Greilich PE. Perioperative Blood Conservation: Guidelines to Practice. Adv Anesth 2019; 37:1-34. [PMID: 31677651 DOI: 10.1016/j.aan.2019.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Jenny Kwak
- Department of Anesthesiology and Perioperative Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Andrew L Wilkey
- Department of Anesthesia, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN 55407, USA
| | - Mohamed Abdalla
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic Lerner College of Medicine, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue/J4-331, Cleveland, OH 44196, USA
| | - Ravi Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center - Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-8894, USA
| | - Philip E F Roman
- Department of Anesthesiology, Centura St. Anthony Hospital, United States Anesthesia Partners, 11600 West 2nd Place, Lakewood, CO 80228, USA
| | - Philip E Greilich
- Cardiac Anesthesiology, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center - Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-8894, USA
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28
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Cifra CL, Tigges CR, Miller SL, Herwaldt LA, Singh H. Updates to referring clinicians regarding critically ill children admitted to the pediatric intensive care unit: a state-wide survey. ACTA ACUST UNITED AC 2019; 7:123-128. [PMID: 31652117 DOI: 10.1515/dx-2019-0048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/06/2019] [Indexed: 11/15/2022]
Abstract
Background Front-line clinicians are expected to make accurate and timely diagnostic decisions before transferring patients to the pediatric intensive care unit (PICU) but may not always learn their patients' outcomes. We evaluated the characteristics of post-transfer updates received by referring clinicians regarding PICU patients and determined preferences regarding content, delivery, and timing of such updates. Methods We administered an electronic cross-sectional survey to Iowa clinicians who billed for ≥5 pediatric patients or referred ≥1 patient to the University of Iowa (UI) PICU in the year before survey administration. Results One hundred and one clinicians (51 non-UI, 50 UI-affiliated) responded. Clinicians estimated that, on average, 8% of pediatric patients they saw over 1 year required PICU admission; clinicians received updates on 40% of patients. Seventy percent of UI clinicians obtained updates via self-initiated electronic record review, while 37% of non-UI clinicians relied on PICU communication (p = 0.013). Clinicians indicated that updates regarding diagnoses/outcomes will be most relevant to their practice. Among clinicians who received updates, 13% received unexpected information; 40% changed their practice as a result. Conclusions Clinicians received updates on less than half of the patients they referred to a PICU, although such updates could potentially influence clinical practice. Study findings will inform the development of a formal feedback system from the PICU to referring clinicians.
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Affiliation(s)
- Christina L Cifra
- Division of Pediatric Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Cody R Tigges
- Division of Pediatric Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Sarah L Miller
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Loreen A Herwaldt
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
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29
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Djordjevic IM, Vasiljevic D. The Effect of Sociodemographic Factors on the Patient Satisfaction with Health Care System. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.1515/sjecr-2017-0042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The goal of this paper is to determine the level of patient satisfaction with health care among adults in the Republic of Serbia and to analyze the correlation between the satisfaction and socio-demographic characteristics of the interviewees. The paper is based on the data provided by the National health survey of the Republic of Serbia. For the purposes of this paper, we used data on age and household of the people aged 19 and more. By eliminating the interviewees who were neither satisfied nor dissatisfied with the health care services, we obtained the sample containing 18.206 interviewees. Demographic characteristics and well-being index represented independent variables in the research. Dependent variable of the patient satisfaction was transformed into a binary variable by categorizing satisfied and very satisfied interviewees into one group and by placing dissatisfied and very dissatisfied interviewees into group of dissatisfied patients. The connection between satisfaction and predictors was examined using Chi-Square test and logistic regression. The percentage of the satisfied patients with health care was 72.9%. The satisfaction level was directly connected to age, gender, marital status, employment, region the interviewee comes from and well-being index. Patients who were more satisfied included older people, women, as well as married people, the unemployed and those living in the cities. The analysis of the financial situation shows that the poorest interviewees were the most satisfied with health care.
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Affiliation(s)
| | - Dragan Vasiljevic
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
- Institute for Public Health Kragujevac , Kragujevac , Serbia
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30
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Jeanes A, Coen PG, Gould DJ, Drey NS. Validity of hand hygiene compliance measurement by observation: A systematic review. Am J Infect Control 2019; 47:313-322. [PMID: 30322815 DOI: 10.1016/j.ajic.2018.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Hand hygiene is monitored by direct observation to improve practice, but this approach can potentially cause information, selection, and confounding bias, threatening the validity of findings. The aim of this study was to identify and describe the potential biases in hand hygiene compliance monitoring by direct observation; develop a typology of biases and propose improvements to reduce bias; and increase the validity of compliance measurements. METHODS This systematic review of hospital-based intervention studies used direct observation to monitor health care workers' hand hygiene compliance. RESULTS Seventy-one publications were eligible for review. None was free of bias. Selection bias was present in all studies through lack of data collection on the weekends (n = 61, 86%) and at night (n = 46, 65%) and observations undertaken in single-specialty settings (n = 35, 49%). We observed inconsistency of terminology, definitions of hand hygiene opportunity, criteria, tools, and descriptions of the data collection. Frequency of observation, duration, or both were not described or were unclear in 58 (82%) publications. Observers were trained in 56 (79%) studies. Inter-rater reliability was measured in 26 (37%) studies. CONCLUSIONS Published research of hand hygiene compliance measured by direct observation lacks validity. Hand hygiene should be measured using methods that produce a valid indication of performance and quality. Standardization of methodology would expedite comparison of hand hygiene compliance between clinical settings and organizations.
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Affiliation(s)
- Annette Jeanes
- Infection Control Department, University College London Hospitals, London, United Kingdom.
| | - Pietro G Coen
- Infection Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Nicolas S Drey
- School of Health Sciences, Cardiff, University of London, London, United Kingdom
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31
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D'Lima D, Arnold G, Brett SJ, Bottle A, Smith A, Benn J. Continuous monitoring and feedback of quality of recovery indicators for anaesthetists: a qualitative investigation of reported effects on professional behaviour. Br J Anaesth 2018; 119:115-124. [PMID: 28974068 DOI: 10.1093/bja/aex136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Research suggests that providing clinicians with feedback on their performance can result in professional behaviour change and improved clinical outcomes. Departments would benefit from understanding which characteristics of feedback support effective quality monitoring, professional behaviour change and service improvement. This study aimed to report the experience of anaesthetists participating in a long-term initiative to provide comprehensive personalized feedback to consultants on patient-reported quality of recovery indicators in a large London teaching hospital. Methods Semi-structured interviews were conducted with 13 consultant anaesthetists, six surgical nursing leads, the theatre manager and the clinical coordinator for recovery. Transcripts were qualitatively analysed for themes linked to the perceived value of the initiative, its acceptability and its effects upon professional practice. Results Analysis of qualitative data from participant interviews suggested that effective quality indicators must address areas that are within the control of the anaesthetist. Graphical data presentation, both longitudinal (personal variation over time) and comparative (peer-group distributions), was found to be preferable to summary statistics and provided useful and complementary perspectives for improvement. Developing trust in the reliability and credibility of the data through co-development of data reports with clinical input into areas such as case-mix adjustment was important for engagement. Making feedback specifically relevant to the recipient supported professional learning within a supportive and open collaborative environment. Conclusions This study investigated the requirements for effective feedback on quality of anaesthetic care for anaesthetists, highlighting the mechanisms by which feedback may translate into improvements in practice at the individual and peer-group level.
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Affiliation(s)
- D D'Lima
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - G Arnold
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - S J Brett
- Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, London, UK
| | - A Bottle
- School of Public Health, Imperial College London, UK
| | - A Smith
- Department of Anaesthesia, Royal Lancaster Infirmary, UK
| | - J Benn
- Patient Safety Translational Research Centre, Imperial College London, UK
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32
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Ikeda DJ, Hollander L, Weigl S, Sawicki SV, Belanger DR, West NY, Brey Magnani N, Wells CG, Gordon P, Morne J, Agins BD. The Facility-Level HIV Treatment Cascade: Using a Population Health Tool in Health Care Facilities to End the Epidemic in New York State. Open Forum Infect Dis 2018; 5:ofy254. [PMID: 30386808 PMCID: PMC6202506 DOI: 10.1093/ofid/ofy254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/18/2018] [Indexed: 11/12/2022] Open
Abstract
Background The HIV treatment cascade is a tool for characterizing population-level gaps in HIV care, yet most adaptations of the cascade rely on surveillance data that are ill-suited to drive quality improvement (QI) activities at the facility level. We describe the adaptation of the cascade in health care organizations and report its use by HIV medical providers in New York State (NYS). Methods As part of data submissions to the NYS Department of Health, sites that provide HIV medical care in NYS developed cascades using facility-generated data. Required elements included data addressing identification of people living with HIV (PLWH) receiving any service at the facility, linkage to HIV medical care, prescription of antiretroviral therapy (ART), and viral suppression (VS). Sites also submitted a methodology report summarizing how cascade data were collected and an improvement plan identifying care gaps. Results Two hundred twenty-two sites submitted cascades documenting the quality of care delivered to HIV patients presenting for HIV- or non-HIV-related services during 2016. Of 101 341 PLWH presenting for any medical care, 75 106 were reported as active in HIV programs, whereas 21 509 had no known care status. Sites reported mean ART prescription and VS rates of 94% and 80%, respectively, and 60 distinct QI interventions. Conclusions Submission of facility-level cascades provides data on care utilization among PLWH that cannot be assessed through traditional HIV surveillance efforts. Moreover, the facility-level cascade represents an effective tool for identifying care gaps, focusing data-driven improvement efforts, and engaging frontline health care providers to achieve epidemic control.
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Affiliation(s)
- Daniel J Ikeda
- New York State Department of Health AIDS Institute, New York, New York.,HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California
| | - Leah Hollander
- New York State Department of Health AIDS Institute, New York, New York
| | - Susan Weigl
- New York State Department of Health AIDS Institute, New York, New York
| | - Steven V Sawicki
- New York State Department of Health AIDS Institute, New York, New York
| | - Daniel R Belanger
- New York State Department of Health AIDS Institute, New York, New York
| | - Nova Y West
- New York State Department of Health AIDS Institute, New York, New York
| | | | | | - Peter Gordon
- Division of Infectious Diseases, Department of Medicine, Columbia University, New York, New York
| | - Johanne Morne
- New York State Department of Health AIDS Institute, New York, New York
| | - Bruce D Agins
- New York State Department of Health AIDS Institute, New York, New York.,HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California.,Institute for Implementation Science in Population Health, New York.,Graduate School of Public Health and Health Policy, City University of New York, New York
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33
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Adamson PC, Klausner JD. No benefit of chlamydia screening in primary care? Lancet 2018; 392:1381-1383. [PMID: 30343849 DOI: 10.1016/s0140-6736(18)32465-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Paul C Adamson
- Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles, CA 90025, USA
| | - Jeffrey D Klausner
- Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles, CA 90025, USA.
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34
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Abstract
Quality Improvement (QI) throughout health care in the United States continues to be of growing importance to both patients and providers. Leaders in health care including physicians, nurses, hospital administrators, and payors are all responsible for ensuring the continuation and growth of QI initiatives. This article will discuss various ways that healthcare leaders, with specific regard to orthopedic surgery, have utilized QI measures to provide better, more efficient, care to patients.
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35
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Mull HJ, Itani KMF, Pizer SD, Charns MP, Rivard PE, McIntosh N, Hawn MT, Rosen AK. Development of an Adverse Event Surveillance Model for Outpatient Surgery in the Veterans Health Administration. Health Serv Res 2018; 53:4507-4528. [PMID: 30151826 DOI: 10.1111/1475-6773.13037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Develop and validate a surveillance model to identify outpatient surgical adverse events (AEs) based on previously developed electronic triggers. DATA SOURCES Veterans Health Administration's Corporate Data Warehouse. STUDY DESIGN Six surgical AE triggers, including postoperative emergency room visits and hospitalizations, were applied to FY2012-2014 outpatient surgeries (n = 744,355). We randomly sampled trigger-flagged and unflagged cases for nurse chart review to document AEs and measured positive predictive value (PPV) for triggers. Next, we used chart review data to iteratively estimate multilevel logistic regression models to predict the probability of an AE, starting with the six triggers and adding in patient, procedure, and facility characteristics to improve model fit. We validated the final model by applying the coefficients to FY2015 outpatient surgery data (n = 256,690) and reviewing charts for cases at high and moderate probability of an AE. PRINCIPAL FINDINGS Of 1,730 FY2012-2014 reviewed surgeries, 350 had an AE (20 percent). The final surveillance model c-statistic was 0.81. In FY2015 surgeries with >0.8 predicted probability of an AE (n = 405, 0.15 percent), PPV was 85 percent; in surgeries with a 0.4-0.5 predicted probability of an AE, PPV was 38 percent. CONCLUSIONS The surveillance model performed well, accurately identifying outpatient surgeries with a high probability of an AE.
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Affiliation(s)
- Hillary J Mull
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA.,Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Kamal M F Itani
- Department of Surgery, Boston University School of Medicine, Boston, MA.,Department of Surgery, VA Boston Healthcare System, Boston, MA.,Harvard Medical School, Boston, MA
| | - Steven D Pizer
- Department of Veterans Affairs, Partnered Evidence-based Policy Resource Center (PEPReC), Boston, MA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Martin P Charns
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Peter E Rivard
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA.,Healthcare Administration, Sawyer Business School Suffolk University, Boston, MA
| | | | - Mary T Hawn
- Palo Alto VA Medical Center, Palo Alto, CA.,Stanford University School of Medicine, Stanford, CA
| | - Amy K Rosen
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA.,Department of Surgery, Boston University School of Medicine, Boston, MA
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Nag N, Tran L, Fotis K, Smith JA, Shardey GC, Baker RA, Reid CM. Structured Feedback: Acceptability and Feasibility of a Strategy to Enhance the Role of a Clinical Quality Registry to Drive Change in Cardiac Surgical Practice. Heart Lung Circ 2018; 28:1253-1260. [PMID: 30126791 DOI: 10.1016/j.hlc.2018.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 04/16/2018] [Accepted: 07/15/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) Database collects and monitors preoperative, operative, and 30-day outcome data on patients undergoing cardiac surgery, and delivers regular performance feedback reports to key personnel with intent to drive quality improvement. The current feedback approach appears to be ineffective in driving change to minimise Unit performance variation. We sought to determine the acceptability and feasibility of providing structured feedback in addition. METHODS Cardiac surgeons were surveyed to assess their evaluation of the current feedback reports and assist in developing the content of structured feedback. We then assessed acceptability and performance outcomes of control Units receiving current feedback reports via email, versus intervention Units that in addition received structured feedback. RESULTS Survey respondents assessing the current feedback report agreed that the content is relevant (95%), key performance indicators (KPIs) are useful (85%), and that it would be beneficial to compare surgeons' KPIs (75%). Survey respondents rating method of feedback, requested structured feedback sessions one to two times annually (67%; control Units), and future structured feedback (83%; intervention Units). With combined report and structured feedback, improved performance was noted for an under-performing Unit. Limitations of feedback in driving quality improvement was high performance of Units at baseline, low surgeon participation, and scheduling challenges for structured feedback. CONCLUSIONS In this pilot study, compared to the control method, structured feedback did not significantly improve communication. To maximise quality improvement efforts, a collaborative feedback approach that fosters a climate of continuous performance improvement, is recommended.
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Affiliation(s)
- Nupur Nag
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Vic, Australia.
| | - Lavinia Tran
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Vic, Australia
| | - Kathy Fotis
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Vic, Australia
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University and Department of Cardiothoracic Surgery, Monash Health, Melbourne, Vic, Australia
| | | | - Robert A Baker
- Department of Cardiac and Thoracic Surgery, Flinders Medical Centre and Flinders University, Adelaide, SA, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
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de Neree Tot Babberich MPM, Detering R, Dekker JWT, Elferink MA, Tollenaar RAEM, Wouters MWJM, Tanis PJ. Achievements in colorectal cancer care during 8 years of auditing in The Netherlands. Eur J Surg Oncol 2018; 44:1361-1370. [PMID: 29937415 DOI: 10.1016/j.ejso.2018.06.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/03/2018] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The efficacy of auditing is still a subject of debate and concerns exist whether auditing promotes risk averse behaviour of physicians. This study evaluates the achievements made in colorectal cancer surgery since the start of a national clinical audit and assesses potential signs of risk averse behaviour. METHODS Data were extracted from the Dutch ColoRectal Audit (2009-2016). Trends in outcomes were evaluated by uni and multivariable analyses. Patients were stratified according to operative risks and changes in outcomes were expressed as absolute (ARR) and relative risk reduction (RRR). To assess signs of risk averse behaviour, trends in stoma construction in rectal cancer were analysed. RESULTS Postoperative mortality decreased from 3.4% to 1.8% in colon cancer and from 2.3% to 1% in rectal cancer. Surgical and non-surgical complications increased, but with less reintervention. For colon cancer, the high-risk elderly patients had the largest ARR for complicated postoperative course (6.4%) and mortality (5.9%). The proportion of patients receiving a diverting stoma or end colostomy after a (L)AR decreased 11% and 7%, respectively. In low rectal cancer, patients increasingly received a non-diverted primary anastomosis (5.4% in 2011 and 14.4% in 2016). CONCLUSIONS No signs of risk averse behaviour was found since the start of the audit. Especially the high-risk elderly patients seem to have benefitted from improvements made in colon cancer treatment in the past 8 years. For rectal cancer, trends towards the construction of more primary anastomoses are seen. Future quality improvement measures should focus on reducing surgical and non-surgical complications.
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Affiliation(s)
- Michael P M de Neree Tot Babberich
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - Robin Detering
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Marloes A Elferink
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Michel W J M Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
| | - Pieter J Tanis
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Klein A, Hermes-Moll K, Osburg S, Walawgo T, Mödder M, Baumann W. [Feedback strategies for routine surveys of quality indicators in outpatient oncology care]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2018; 134:18-26. [PMID: 29428626 DOI: 10.1016/j.zefq.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The study deals with the efficiency and possible improvements of quality promotion with quality indicators (QI). The goal is to investigate the practical use of feedback from QI surveys in the field of oncology office practices. It captures both the acceptance of results and the independent initiation of search- and improvement strategies. The value of best practice examples is of further interest. METHODS Within one year, data of six QI of 31 physicians from 24 oncology practices were collected twice and the results were sent back in individual reports including a benchmarking. Practices with particularly good results in individual QI sectors were surveyed in semi-structured telephone interviews about their processes. Based on these results, best practice examples were created and provided to all participating practices to stimulate improvement. Further, two paper-based surveys about the acceptance and handling of results as well as the use of best practice examples were conducted. RESULTS The practices accepted the reported results as an instrument to assess their own care quality (70 %) and indicated that had been able to identify improvement potentials (75 %). Improvement strategies were developed or planned by approximately every second practice in the respective sectors. The practices were interested in the best practice examples and rated them as helpful (70 %). Many of them indicated that they were already taking up some of the suggestions for improving the organization of their own processes or were planning to do so. CONCLUSION The extraction of information on QI from patient files is a tedious task for the practices. Both the implementation of the necessary internal measures after receiving the results report as well as the adaptation of external process examples to their own processes is challenging. Nevertheless, oncology practices benefit from the feedback of the results of QI surveys and best practice examples. Thus, QI surveys and the reporting of results can actively encourage quality development.
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Affiliation(s)
- Astrid Klein
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland.
| | - Kerstin Hermes-Moll
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
| | - Sandra Osburg
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
| | - Thomas Walawgo
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
| | - Martin Mödder
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
| | - Walter Baumann
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
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Fredriksson M, Halford C, Eldh AC, Dahlström T, Vengberg S, Wallin L, Winblad U. Are data from national quality registries used in quality improvement at Swedish hospital clinics? Int J Qual Health Care 2017; 29:909-915. [DOI: 10.1093/intqhc/mzx132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 11/14/2022] Open
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Abdollahi L, Tabrizi JS, Jodati A, Safaie N, Moradi-Joo M, Daemi A. Quality of surgical scrub in a heart hospital: Do not take it for granted. J Cardiovasc Thorac Res 2017; 9:164-169. [PMID: 29118950 PMCID: PMC5670339 DOI: 10.15171/jcvtr.2017.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/16/2017] [Indexed: 01/03/2023] Open
Abstract
Introduction: The role of scrub in the prevention of post-surgery infections is well-known. This study aimed to investigate the inputs and process of surgical scrub in operating rooms of the largest heart hospital of northwest Iran.
Methods: This study took place with a before-after design as a clinical audit in 2014. A check list developed based on national and international standards of surgical hand scrub was used as the study instrument. Checklists were completed by observation of surgical team scrubbing in real situation. Descriptive statistics and graphs were used to describe the results.
Results: A compliance degree with the standards for prerequisites, equipment, general items, process and time of scrub was observed as 58%, 55%, 33%, 68% and 22%, respectively. The compliance degree after the intervention was 72%, 66%, 66%, 85% and 61%, respectively. Improvement was observed in all studied aspects of scrub. The total score of compliance with the standards changed from 47% to 70%. The main issues were incorrect order of scrubbing the areas of the hands, incorrect way of scrubbing the arms, insufficient scrubbing the arms (not above elbow), and lack of awareness about hospital’s policy on scrub time.
Conclusion: The results showed defects in the surgical scrub of the studied hospital and that the compliance with the standards can be improved by simple interventions. Periodical audit and observation of the scrub and then feedback is recommended.
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Affiliation(s)
- Leila Abdollahi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Sadegh Tabrizi
- Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmadreza Jodati
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naser Safaie
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Moradi-Joo
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Daemi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
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Abstract
BACKGROUND Preterm infants are especially vulnerable to infectious diseases. Although vaccinations are a safe and effective measure to protect preterm infants from vaccine-preventable diseases, delays in vaccinations are not uncommon. PURPOSE The goal of this quality improvement project was to improve on time vaccinations of preterm infants hospitalized in the neonatal intensive care unit. METHODS The Plan-Do-Study-Act model of quality improvement was adopted to develop, test, and implement interventions aimed at improving timely vaccination of preterm infants. The primary outcome measure of interest was the rate of on time vaccination, which was defined as the proportion of medically eligible preterm infants who received vaccinations within 2 weeks of the recommended schedule. RESULTS Baseline on time vaccination rate was only 36%. Following several Plan-Do-Study-Act cycles, a steady increase in on time vaccinations of eligible infants was observed, and a new baseline on time vaccination rate of 82% was achieved. IMPLICATIONS FOR PRACTICE Simple interventions implemented within the context of Plan-Do-Study-Act cycles are effective in improving timely vaccinations among preterm infants. IMPLICATIONS FOR RESEARCH Future research that focuses on vaccinations in preterm infants is needed to further reinforce the safety and efficacy of vaccines. Effective methods on how to disseminate and apply this knowledge to practice should also be studied.Video Abstract available at http://links.lww.com/ANC/A27.
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Morrison L, Cassidy L, Welsford M, Chan TM. Clinical Performance Feedback to Paramedics: What They Receive and What They Need. AEM EDUCATION AND TRAINING 2017; 1:87-97. [PMID: 30051016 PMCID: PMC6001722 DOI: 10.1002/aet2.10028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/18/2017] [Accepted: 01/31/2017] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Performance feedback is not always well utilized in healthcare. To more effectively incorporate it, we used a discussion of current feedback systems to explore paramedics' perceived needs regarding feedback and to understand what feedback would improve their performance as healthcare providers. METHODS We used a qualitative methodology with semistructured interviews of paramedics to explore perceptions and desires for feedback. Interpretive descriptive analysis was performed with continuous recruitment until thematic saturation was achieved. Themes were identified and a coding system was developed by two investigators separately and merged by consensus. The analysis was audited by a third investigator, and a member check was performed. RESULTS Many different ideas were discussed that were analyzed to develop several major recurrent themes. One such theme was positive perception of feedback by paramedics. Despite the positive perceptions discussed, the shortcomings of current systems were also frequently discussed as were perceived barriers to receiving meaningful feedback. The idea of following up on patients' courses/outcomes also arose frequently during the interviews. In addition, feedback and its interaction with mental health emerged as a theme in terms of its potential for both positive and negative impact. Finally, suggestions about the future were also common with paramedics providing thoughts regarding what future systems could be developed or what changes could be made to provide them with meaningful feedback. CONCLUSIONS Our findings show how paramedics perceive feedback, but still note how barriers may impair its uptake and how it may affect their mental health. Our participants also made recommendations about what they would want to see in future feedback systems. This information can provide the foundation to improve current feedback systems or structure new ones to allow paramedics to continue to develop themselves as healthcare professionals.
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Affiliation(s)
- Laura Morrison
- Division of Emergency MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Louise Cassidy
- Undergraduate Medical EducationMcMaster UniversityHamiltonOntarioCanada
| | - Michelle Welsford
- Division of Emergency MedicineMcMaster UniversityHamiltonOntarioCanada
- Centre for Paramedic Education and ResearchHamilton Health SciencesHamiltonOntarioCanada
| | - Teresa M. Chan
- Division of Emergency MedicineMcMaster UniversityHamiltonOntarioCanada
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Data transparency at the point of care: Results of patient and visitor interviews. Nursing 2017; 47:59-66. [PMID: 28121791 DOI: 10.1097/01.nurse.0000511821.03527.29] [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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Greenhalgh J, Dalkin S, Gooding K, Gibbons E, Wright J, Meads D, Black N, Valderas JM, Pawson R. Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05020] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BackgroundThe feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy.ObjectivesTo (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care.DesignTwo separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care.InterventionsAggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings.Main outcome measuresAggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being.Data sourcesSearches of electronic databases and forwards and backwards citation tracking.Review methodsRealist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care.ResultsProviders were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit.Strengths and limitationsThere was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories.ConclusionsPROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality.Future workFuture research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care.Study registrationThis study is registered as PROSPERO CRD42013005938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Sonia Dalkin
- Department of Public Health, Northumbria University, Newcastle upon Tyne, UK
| | - Kate Gooding
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Elizabeth Gibbons
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Judy Wright
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - David Meads
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Nick Black
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ray Pawson
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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Abstract
Recognizing the gap between high-quality care and the care actually provided, health care providers across the country are under increasing institutional and payer pressures to move toward more high-quality care. This pressure is often leveraged through data feedback on provider performance; however, feedback has been shown to have only a variable effect on provider behavior. This study examines the cognitive behavioral factors that influence providers to participate in feedback interventions, and how feedback interventions should be implemented to encourage more provider engagement and participation.
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D'Lima DM, Moore J, Bottle A, Brett SJ, Arnold GM, Benn J. Developing effective feedback on quality of anaesthetic care: what are its most valuable characteristics from a clinical perspective? J Health Serv Res Policy 2016; 20:26-34. [PMID: 25472987 DOI: 10.1177/1355819614557299] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Research suggests that better feedback from quality and safety indicators leads to enhanced capability of clinicians and departments to improve care and change behaviour. The aim of the current study was to investigate the characteristics of feedback perceived by clinicians to be of most value. METHODS Data were collected using a survey designed as part of a wider evaluation of a data feedback initiative in anaesthesia. Eighty-nine consultant anaesthetists from two English NHS acute Trusts completed the survey. Multiple linear regression with hierarchical variable entry was used to investigate which characteristics of feedback predict its perceived usefulness for monitoring variation and improving care. RESULTS The final model demonstrated that the relevance of the quality indicators to the specific service area (β=0.64, p=0.01) and the credibility of the data as coming from a trustworthy, unbiased source (β=0.55, p=0.01) were the significant predictors, having controlled for all other covariates. CONCLUSION For clinicians to engage with effective quality monitoring and feedback, the perceived local relevance of indicators and trust in the credibility of the resulting data are paramount.
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Affiliation(s)
- Danielle M D'Lima
- Research Psychologist, Imperial Patient Safety Translational Research Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | - Joanna Moore
- Researcher, Imperial Patient Safety Translational Research Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | - Alex Bottle
- Senior Lecturer, School of Public Health, Imperial College London, UK
| | - Stephen J Brett
- Consultant Intensivist, Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, UK
| | - Glenn M Arnold
- Consultant Anaesthetist, Department of Anaesthesia, Imperial College Healthcare NHS Trust, UK
| | - Jonathan Benn
- Lecturer, Imperial Patient Safety Translational Research Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
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Jurkowski JM, Svistova J, Nguyen T, Dennison BA. Public Reporting of Hospital-Specific Breastfeeding Measures. J Hum Lact 2016; 32:666-674. [PMID: 27565202 DOI: 10.1177/0890334416663197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Establishing breastfeeding in the first days of an infant's life is important for longer term success in breastfeeding. In 2009, New York State (NYS) was the second state to require maternity care facilities to collect infant feeding information and to publicly disseminate hospital-specific infant feeding statistics. Public reporting of these statistics as performance measures is a strategy to prompt hospitals to improve breastfeeding support. OBJECTIVE This qualitative study sought to explore how maternity care administrators and clinical staff responded to the mandate for publicly reported performance measures and whether they used this information to improve maternity care practices. METHODS This study used a stratified random sample of NYS hospitals with maternity care units. Participants were recruited by email and telephone calls. A total of 25 hospitals participated in the study, and 37 hospital administrators and staff completed in-depth interviews by telephone. The interviews were analyzed using an explanatory framework in NVivo 8. RESULTS Publicly reported hospital-specific breastfeeding measures increased attention to breastfeeding performance. Hospital administrators and staff reported comparing their relative rankings to other hospitals in the state. Some hospitals used publicly reported breastfeeding measures to monitor performance, whereas others were prompted to generate additional measures for more frequent monitoring. Hospitals with relatively low breastfeeding statistics took certain actions to improve their maternity care practices to support breastfeeding. Limitations of the usefulness of publicly reported measures were reported by interview participants. CONCLUSION Publicly reported, hospital-specific breastfeeding measures may prompt hospitals to monitor and improve maternity care practices related to supporting breastfeeding.
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Affiliation(s)
- Janine M Jurkowski
- 1 Department of Health Policy, Management and Behavior, University at Albany School of Public Health, SUNY, Rensselaer, NY, USA
| | - Juliana Svistova
- 2 Department of Social Work, Kutztown University of Pennsylvania, Kutztown, PA, USA
| | - Trang Nguyen
- 3 Office of Public Health Practice, New York State Department of Health, Albany, NY, USA
| | - Barbara A Dennison
- 1 Department of Health Policy, Management and Behavior, University at Albany School of Public Health, SUNY, Rensselaer, NY, USA.,4 Policy and Research Translation, Division of Chronic Disease Prevention, New York State Department of Public Health, Albany, NY, USA
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Chadwick LM, MacPhail A, Ibrahim JE, McAuliffe L, Koch S, Wells Y. Senior staff perspectives of a quality indicator program in public sector residential aged care services: a qualitative cross-sectional study in Victoria, Australia. AUST HEALTH REV 2016; 40:54-62. [PMID: 26164160 DOI: 10.1071/ah14197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 05/10/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aims of the present study were to describe the views of senior clinical and executive staff employed in public sector residential aged care services (RACS) about the benefits and limitations of using quality indicators (QIs) for improving care, and to identify any barriers or enablers to implementing the QI program. METHODS A cross-sectional qualitative study using semistructured interviews and direct observation of key informants involved in the QI program was performed across 20 public sector RACS in Victoria, Australia. Participants included senior clinical, executive and front-line staff at the RACS. The main outcome measures were perceived benefits and the enablers or barriers to the implementation of a QI program. RESULTS Most senior clinical and executive staff respondents reported substantive benefits to using the QIs and the QI program. A limited number of staff believed that the QI program failed to improve the quality of care and that the resource requirements outweighed the benefits of the program, resulting in disaffected staff. CONCLUSIONS The QIs and QI program acted as a foundation for improving standards of care when used at the front line or point of care. Senior executive engagement in the QI program was vital to successful implementation.
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Affiliation(s)
- Liam M Chadwick
- National University of Ireland, Galway, Irish Centre for Patient Safety, University Road, Galway, Ireland. Email
| | - Aleece MacPhail
- Ballarat Health Services, Ballarat, Vic. 3350, Australia. Email
| | | | - Linda McAuliffe
- Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Vic. 3086, Australia. Email
| | - Susan Koch
- Royal District Nursing Service Research Institute, Melbourne, Vic. 3182, Australia. Email
| | - Yvonne Wells
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Vic. 3086, Australia. Email
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Gifford W, Davies B, Rowan M, Egan M, Lefebre N, Brehaut JA. Understanding Audit and Feedback to Support Falls Prevention and Pain Management in Home Health Care. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2016. [DOI: 10.1177/1084822315599954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Audit and feedback (A&F) is commonly used to improve health care; yet enormous variability exists in effectiveness and little is known about A&F in home health care. This article explores A&F as a strategy to support evidence-based care for falls prevention and pain management. We use interviews to describe how A&F is currently used and explore how it can support patient care. Thirteen interviews were conducted with a multidisciplinary sample and descriptively analyzed. Findings showed that data were audited by frontline staff but were inconsistently fed back to the front line, and the meaning of data depended on the context and participants’ roles. Findings suggest A&F should include indicators to benchmark patient outcomes, target actionable processes of care, and be tailored to provider groups.
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Affiliation(s)
| | | | - Margo Rowan
- Rowan Research and Evaluation, Ottawa, Ontario, Canada
| | - Mary Egan
- University of Ottawa, Ottawa, Ontario, Canada
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