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Roberts N, Jacmon H, Scanlon B, Battersby C, Buttrum P, James C. How can we meet the needs of patients, their families and their communities? A qualitative study including clinicians, consumer representatives, patients, and community members. BMC Health Serv Res 2023; 23:809. [PMID: 37507758 PMCID: PMC10385916 DOI: 10.1186/s12913-023-09814-9] [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: 06/30/2022] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The Diversity Working Group was formed in response to Australian Quality and Safety Health Care Standards that require organisations plan service delivery that incorporates information about the diversity of consumers, and those at higher risk of harm. METHODS A qualitative gap analysis was conducted by a team from varied professional backgrounds including a clinician researcher, a nurse researcher with expertise in culturally and linguistically diverse care and a consumer representative with expertise in advocacy and carer representation. Qualitative questions were co-designed, using a person-centred care lens. Community organisation members, and clinicians and patients from both ambulatory and inpatient areas were approached. Responses were coded independently and synthesised using a Framework Methodology. RESULTS In total 3 community organisation members, 40 clinicians and 30 patients consented to participate in the qualitative study over a period of three weeks. There were three key themes across responses, 'What are diverse needs?'; 'Assigning people to a group does not address a need'; 'Unplanned care makes people feel vulnerable'. Those patients who are isolated, for any number of reasons, were identified as at greater risk of harm. CONCLUSION Taking a person-centred approach can potentially better understand the needs of patients and communities so that this information can be incorporated into health service delivery. Resources are needed to support patients and their families at times of transition care, particularly when care is unplanned.
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Affiliation(s)
- Natasha Roberts
- University of Queensland Centre for Clinical Research, Butterfield St, Herston, QLD, 4029, Australia.
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Herston, Australia.
| | - Helene Jacmon
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Brighid Scanlon
- Royal Brisbane and Women's Hospital, Herston, Australia
- School of Public Health, Queensland University Technology, Kelvin Grove, QLD, Australia
| | | | - Peter Buttrum
- Royal Brisbane and Women's Hospital, Herston, Australia
- The University of Queensland, St Lucia, QLD, Australia
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2
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Saut AM, Berssaneti FT, Ho LL, Berger S. How do hospitals engage patients and family members in quality management? A grounded theory study of hospitals in Brazil. BMJ Open 2022; 12:e055926. [PMID: 35985775 PMCID: PMC9396118 DOI: 10.1136/bmjopen-2021-055926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient and family engagement (PFE) is considered an essential element of the transformation of the healthcare system. However, it is characterised by its complexity and a small number of institutions that have implemented the mechanisms of engagement. OBJECTIVE To understand PFE in quality management (QM) in the hospital environment. DESIGN A qualitative approach was guided by the grounded theory based in Straussian perspective. Data were gathered using semistructured interviews. The coding was performed by excerpts, using an inductive approach and the constant comparison technique. SETTING AND PARTICIPANTS A total of seven Brazilian hospitals were selected based on the theoretical sampling technique. RESULTS A total of five categories emerged, namely: patient partner, mechanisms of engagement, internal structure for engagement, maturity of the QM system and openness to change. Externally, three contextual factors can impact the engagement: the local health system, the profile of the community and the change in access to the information. At the centre of the change is the balance in power relations between patients and professionals, the sharing of information from the hospital and a proactive attitude towards improving services. CONCLUSIONS The PFE involves a cultural and process change. Cultural change is represented by 'openness', that is, openness to learn, to listen and to consider new perspectives. The change in processes is in turn characterised by the phrase 'test and venture' because the model to be adopted may be different between hospitals. The patient's perspective allows actions to be driven towards what really matters to them, ensuring quality of service and safety, obtaining a new perspective to understand and solve problems, and stimulating a sense of urgency, more empathy and compassion in professionals.
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Affiliation(s)
- Ana Maria Saut
- Polytechnic School, Production Engineering Department, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Linda Lee Ho
- Polytechnic School, Production Engineering Department, University of Sao Paulo, Sao Paulo, Brazil
| | - Simone Berger
- Polytechnic School, Production Engineering Department, University of Sao Paulo, Sao Paulo, Brazil
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3
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Beuken JA, Bouwmans MEJ, Dolmans DHJM, Hornstra SPA, Vogt L, Verstegen DML. Design, implementation and evaluation of a postgraduate workshop on cross-border healthcare in Europe – Mixed methods research. INTERNATIONAL JOURNAL OF CARE COORDINATION 2022. [DOI: 10.1177/20534345221117920] [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
Introduction In European border regions, healthcare providers join forces to make full use of the potential of healthcare. Trainees need to be aware of the challenges and opportunities of cross-border healthcare. To increase such awareness, a workshop was designed, implemented and evaluated. The workshop was entitled ‘Creating cross-border collaborators’ and combined elements of contextual, collaborative and reflective learning. The aim of the study was to understand how this workshop enhanced trainees’ awareness of challenges and opportunities of cross-border healthcare. Methods Using a mixed-methods approach, focus-group interviews (QUAL) were held with trainees ( N = 16) and trainees ( N = 13) completed a survey (QUAN) about their workshop experiences. The workshop was held three times for three different groups of trainees. Results Quantitative analysis (of surveys) demonstrated increased self-reported awareness of cross-border healthcare. All learning principles contributed to this awareness, however reflective learning slightly less. Qualitative analysis (of focus-group interviews) unearthed the following four themes: (1) Attention to cross-border healthcare fostered awareness of its complexity; (2) real-life examples stimulated recognition of challenges and opportunities; (3) discussions in interdisciplinary and international groups helped to see different perspectives; and (4) reflection made trainees think about their own role and perspective. Quantitative and qualitative data are strongly cohered. Conclusion According to participating trainees, a workshop with elements of contextual, collaborative and reflective learning did improve trainee awareness of cross-border healthcare. This study highlights that theoretical insights into learning can and should inform the design and evaluation of workshops.
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Affiliation(s)
- Juliëtte A Beuken
- Department of Educational Development and Research/School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Mara EJ Bouwmans
- Department of Educational Development and Research/School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Diana HJM Dolmans
- Department of Educational Development and Research/School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Steven PA Hornstra
- Academy for Postgraduate Medical Education, Maastricht University Medical Center + , Maastricht, the Netherlands
| | - Lina Vogt
- AIXTRA – Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen, Aachen, Germany
- Clinic for Anaesthesiology, University Hospital RWTH Aachen, Medical Faculty, RWTH Aachen, Aachen, Germany
| | - Daniëlle ML Verstegen
- Department of Educational Development and Research/School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
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Key Patient Experience Drivers That Result in Exemplary Overall Provider Performance Ratings in the Ambulatory Environment: A Quantitative Study. J Ambul Care Manage 2022; 45:182-190. [PMID: 35612389 DOI: 10.1097/jac.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study highlights the key drivers that form particular patient impressions resulting in exemplary overall provider performance ratings across service lines in the ambulatory environment. Two national samples of CG-CAHPS data were analyzed. Results indicate variance of impact among all CG-CAHPS questions on "top-box" scores for overall rating of provider among specialties. Interestingly, the same 5 explanatory variables-provider listened carefully, provider spent enough time, provider showed respect, provider knew important information about medical history, and provider explained things clearly-had the greatest explanatory power across the primary and specialty care samples when analyzed via multiple logistic regression analysis.
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Wang Y, Ye B, Zhu Y, Wang X, Liang Y. Association of Hospital Characteristics and Previous Hospitalization-Related Experiences with Patients’ Perceptions of Hospital Care in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137856. [PMID: 35805515 PMCID: PMC9265902 DOI: 10.3390/ijerph19137856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023]
Abstract
Patients’ perceptions of healthcare vary over time and by setting, and previous studies have rarely focused on these factors. We aimed to measure patients’ perceptions of hospital care in China and to examine how patients’ perceptions of hospital care vary by hospital characteristics (differences in setting) and previous hospitalization-related experiences (changes with time). We conducted a national cross-sectional survey of 7267 inpatients between July 2014 and April 2015 in China. Hospital characteristics measured were hospital technical level, hospital type, teaching status, and the ratio of doctors/nurses to ward beds. Previous hospitalization-related experiences measured were current admission length, number of previous admissions, and hospital selection (hospital advertisements or personal recommendations). Patients’ perceptions of hospital care included perceptions of doctors, nurses, and hospital organization. Scores were highest for perceptions of nurses, followed by perceptions of doctors, and hospital organization. Of the five hospital characteristics rated, the technical level was most strongly associated with patient perceptions of healthcare. The effect of hospital admission length and frequency of hospitalization on patients’ perceptions was represented by a √-shaped dose–response curve (scores were initially high, then decreased, then rebounded to higher than the initial scores). Patients who selected a hospital with hospital advertisements gave lower scores than those without hospital advertisements, and patients who selected a hospital with personal recommendations gave higher scores than those without If the observed √-shaped dose–response curves indicate a causal relationship between patients’ perceptions and hospital admission length or frequency of hospitalization, this may help to guide the timing of patient satisfaction assessments. The negative association between patient perception and advertising, and the positive association with personal recommendations (word-of-mouth) and hospital technical level, could provide important information for clinicians and hospital administrators.
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Affiliation(s)
- Yufan Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China; (Y.W.); (B.Y.); (X.W.)
| | - Beizhu Ye
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China; (Y.W.); (B.Y.); (X.W.)
| | - Yimei Zhu
- School of Media, Communication and Sociology, University of Leicester, Leicester LE1 7JA, UK;
| | - Xiaoyu Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China; (Y.W.); (B.Y.); (X.W.)
| | - Yuan Liang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China; (Y.W.); (B.Y.); (X.W.)
- Correspondence:
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Cardinali F, Carzaniga S, Duranti G, Labella B, Lamanna A, Cerilli M, Caracci G, Carinci F. A nationwide participatory programme to measure person-centred hospital care in Italy: Results and implications for continuous improvement. Health Expect 2021; 24:1145-1157. [PMID: 34014021 PMCID: PMC8369125 DOI: 10.1111/hex.13231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/01/2021] [Accepted: 02/21/2021] [Indexed: 02/06/2023] Open
Abstract
Background Patient‐centredness has been targeted by the Italian government as a key theme for the future development of health services. Objective Measuring patient‐centred health services in partnership with citizens, health professionals and decision makers. Design National participatory survey in a large test set of hospitals at national level. Setting and participants A total of 387 hospital visits conducted in 16 Italian regions by over 1,500 citizens and health professionals during 2017‐2018. Main variables and outcome measures An ad hoc checklist was used to assess person‐centredness in hospital care through 243 items, grouped in 4 main areas, 12 sub‐areas and 29 person‐centred criteria (scored 0‐10). GEE linear multivariate regression was used to explore the relation between hospital characteristics and person‐centredness. Results Person‐centred scores were moderately high, with substantial variation overall (median score: 7.0, range: 3.2‐9.5) and by area (Care Processes: 6.8, 2.0‐9.8; Access: 7.4, 2.7‐9.7; Transparency: 6.7, 3.4‐9.5 and Relationship: 7.3, 0.8‐10.0). Multivariate regression found higher scores for increasing volumes of activity (quartile increase: +0.21; 95% CI: 0.13, 0.29) and lower scores in the south and islands (−1.03; −1.62,‐0.45). Discussion The checklist has been applied successfully by over 1,500 collaborators who assessed hospitals in 16 distinct Regions and Autonomous Provinces of Italy. Despite an overall positive mark, all scores were highly variable by location and hospital characteristics. Conclusion and patient or public contribution A national participatory programme to improve patient‐centredness in Italian hospitals highlighted critical areas with the direct input of citizens.
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Affiliation(s)
- Flavia Cardinali
- Italian National Agency for Regional Health Services (AGENAS), Roma, Italy
| | - Sara Carzaniga
- Italian National Agency for Regional Health Services (AGENAS), Roma, Italy
| | - Giorgia Duranti
- Italian National Agency for Regional Health Services (AGENAS), Roma, Italy
| | - Barbara Labella
- Italian National Agency for Regional Health Services (AGENAS), Roma, Italy
| | - Alessandro Lamanna
- Italian National Agency for Regional Health Services (AGENAS), Roma, Italy
| | - Micaela Cerilli
- Italian National Agency for Regional Health Services (AGENAS), Roma, Italy
| | - Giovanni Caracci
- Italian National Agency for Regional Health Services (AGENAS), Roma, Italy
| | - Fabrizio Carinci
- Italian National Agency for Regional Health Services (AGENAS), Roma, Italy.,University of Bologna, Bologna, Italy
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7
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Gremyr I, Elg M, Eriksson E, Halldórsson Á, Smith F, Gustavsson S. Exploring power shifts as an enabler for a strengthened patient role in quality improvements: a Swedish survey study. BMJ Open Qual 2021; 10:bmjoq-2020-001185. [PMID: 33648954 PMCID: PMC7925245 DOI: 10.1136/bmjoq-2020-001185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives This study examined the relationship between professionals’ perceptions of a strengthened role for the patient and of patient involvement in quality improvement (QI) and whether professionals’ experiences in improvement science were a moderator on such a relationship. Design From a predominantly close-ended, 44-item questionnaire, 4 questions specifically concerning professionals′ perception on patient involvement in QI were analysed. Setting Three Swedish regions. Participants 155 healthcare professionals who had previously participated in courses in improvement science. Results The covariate patient involvement was significantly related to a perceived strengthened patient role. There was also a significant interaction effect between degree of patient involvement and professionals’ experience in the area of improvement science on a strengthened patient role. The result shows that there is a relationship between the perceived level of patient involvement in improvements and professionals’ perceptions of a strengthened patient role. In this study, the covariate, perceived patient involvement, was significantly related to experiences of more equal relationships between patients and healthcare professionals. There was also a significant interaction effect between the degree of patient involvement and professionals’ experience in the area of improvement science, for a more equal relationship between patients and healthcare professionals. Conclusion Increased patient involvement in QI is a means of strengthening the patient role and supporting a more equal relation between patients and healthcare professionals. Furthermore, empirical evidence shows that the healthcare professionals’ experiences in the area of improvement science support a strengthened patient role and a more equal power relationship, but for this to happen, the mindset of professionals is key. Future research is needed to capture and investigate the experiences from patients and relatives about being involved in QI in healthcare, and to study the effects on quality in care processes.
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Affiliation(s)
- Ida Gremyr
- Department of Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden
| | - Mattias Elg
- Department of Management and Engineering, Linköpings Universitet, Linkoping, Sweden
| | - Erik Eriksson
- Department of Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden
| | - Árni Halldórsson
- Department of Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden
| | - Frida Smith
- Department of Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden.,Department of Care Development, Regional Cancer Centre West, Goteborg, Sweden
| | - Susanne Gustavsson
- Hospital Administration Management, Skaraborg Hospital Skövde, Skovde, Sweden
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8
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Stolt M, Koskenvuori J, Edvardsson D, Katajisto J, Suhonen R. Validation of the Finnish Person-Centered care Climate Questionnaire-Patient and testing the relationship with individualised care. Int J Older People Nurs 2020; 16:e12356. [PMID: 33125839 DOI: 10.1111/opn.12356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/16/2020] [Accepted: 10/08/2020] [Indexed: 01/22/2023]
Abstract
AIMS The aim of the study was two-fold: (1) to test the psychometric properties of the Person-Centered care Climate Questionnaire-Patient-Finnish version (PCQ-P-Fin), and (2) to examine the associations between older patients' perceptions of the PCC climate and their perceptions of individuality in care delivered within acute care settings for older people. DESIGN An exploratory, correlational, cross-sectional survey design. METHODS The study was conducted within acute care settings for older people with heart failure (n = 111, response rate 54%). Data were collected with self-completed questionnaires, the Person-Centered care Climate Questionnaire-Patient version (PCQ-P-Fin) and the Individualized Care Scale-Patient (ICS-Patient-B), between 6/2016 and 5/2017. Data were analysed using descriptive statistics, Pearson's correlation coefficients, exploratory factor analysis and a Rasch analysis. RESULTS The PCQ-P-Fin showed satisfactory structural, construct and concurrent validity and high reliability. The ICS-B-Patient and the PCQ-P-Fin correlated strongly positive suggesting an association between the perceptions of individuality in care and the care climate. CONCLUSION The PCQ-P-Fin is a useful, reliable and valid tool. Characteristics of the care environment, especially the climate and the extent to which this is perceived to be person-centred, may be used to enhance perceptions of individualised care.
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Affiliation(s)
- Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Janika Koskenvuori
- Department of Nursing Science, University of Turku, Turku, Finland.,HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - David Edvardsson
- School of Nursing and Midwifery, La Trobe University, Australia.,Department of Nursing, Umeå University, Umeå, Sweden
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland.,Welfare Division, City of Turku, Turku, Finland
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Bucknall TK, Hutchinson AM, Botti M, McTier L, Rawson H, Hitch D, Hewitt N, Digby R, Fossum M, McMurray A, Marshall AP, Gillespie BM, Chaboyer W. Engaging patients and families in communication across transitions of care: An integrative review. PATIENT EDUCATION AND COUNSELING 2020; 103:1104-1117. [PMID: 32029297 DOI: 10.1016/j.pec.2020.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/15/2020] [Accepted: 01/23/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine the current evidence about patient and family engagement in communication with health professionals during transitions of care to, within and from acute care settings. METHODS An integrative review using seven international databases was conducted for 2003-2017. Forty eligible studies were analysed and synthesised using framework synthesis. RESULTS Four themes: 1) Partnering in care: patients and families should be partners in decision-making and care; 2) Augmenting communication during transitions: intrinsic and extrinsic factors supported transition communication between patients, families and health professionals; 3) Impeding information exchange: the difficulties faced by patients and families taking an active role in transition; and 4) Outcomes of communication during transitions: reported experiences for patients, families and health professionals. CONCLUSION While attitudes towards engaging patients and family in transition communication in acute settings are generally positive, current practices are variable. Structural supports for practice are not always present. PRACTICE IMPLICATIONS Organisational strategies to improve communication must incorporate an understanding of patient needs. A structured approach which considers timing, privacy, location and appropriateness for patients and families is needed. Communication training is required for patients, families and health professionals. Health professionals must respect a patient's right to be informed by regularly communicating.
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Affiliation(s)
- Tracey K Bucknall
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia.
| | | | - Mari Botti
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Lauren McTier
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Helen Rawson
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Danielle Hitch
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Nicky Hewitt
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Robin Digby
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Mariann Fossum
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Anne McMurray
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Andrea P Marshall
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Brigid M Gillespie
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Wendy Chaboyer
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
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Harrington RL, Hanna ML, Oehrlein EM, Camp R, Wheeler R, Cooblall C, Tesoro T, Scott AM, von Gizycki R, Nguyen F, Hareendran A, Patrick DL, Perfetto EM. Defining Patient Engagement in Research: Results of a Systematic Review and Analysis: Report of the ISPOR Patient-Centered Special Interest Group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:677-688. [PMID: 32540224 DOI: 10.1016/j.jval.2020.01.019] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 01/17/2020] [Accepted: 01/30/2020] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Lack of clarity on the definition of "patient engagement" has been highlighted as a barrier to fully implementing patient engagement in research. This study identified themes within existing definitions related to patient engagement and proposes a consensus definition of "patient engagement in research." METHODS A systematic review was conducted to identify definitions of patient engagement and related terms in published literature (2006-2018). Definitions were extracted and qualitatively analyzed to identify themes and characteristics. A multistakeholder approach, including academia, industry, and patient representation, was taken at all stages. A proposed definition is offered based on a synthesis of the findings. RESULTS Of 1821 abstracts identified and screened for eligibility, 317 were selected for full-text review. Of these, 169 articles met inclusion criteria, from which 244 distinct definitions were extracted for analysis. The most frequently defined terms were: "patient-centered" (30.5%), "patient engagement" (15.5%), and "patient participation" (13.4%). The majority of definitions were specific to the healthcare delivery setting (70.5%); 11.9% were specific to research. Among the definitions of "patient engagement," the most common themes were "active process," "patient involvement," and "patient as participant." In the research setting, the top themes were "patient as partner," "patient involvement," and "active process"; these did not appear in the top 3 themes of nonresearch definitions. CONCLUSION Distinct themes are associated with the term "patient engagement" and with engagement in the "research" setting. Based on an analysis of existing literature and review by patient, industry, and academic stakeholders, we propose a scalable consensus definition of "patient engagement in research."
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Affiliation(s)
| | - Maya L Hanna
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT USA
| | | | - Rob Camp
- Community Advisory Board Programme, EURORDIS, Barcelona, Spain
| | | | - Clarissa Cooblall
- Scientific & Health Policy Initiatives, ISPOR, Lawrenceville, NJ, USA
| | - Theresa Tesoro
- Scientific & Health Policy Initiatives, ISPOR, Lawrenceville, NJ, USA
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11
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Sehlbach C, Govaerts MJB, Mitchell S, Teunissen TGJ, Smeenk FWJM, Driessen EW, Rohde GGU. Perceptions of people with respiratory problems on physician performance evaluation-A qualitative study. Health Expect 2019; 23:247-255. [PMID: 31747110 PMCID: PMC6978864 DOI: 10.1111/hex.12999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Despite increasing calls for patient and public involvement in health-care quality improvement, the question of how patient evaluations can contribute to physician learning and performance assessment has received scant attention. OBJECTIVE The objective of this study was to explore, amid calls for patient involvement in quality assurance, patients' perspectives on their role in the evaluation of physician performance and to support physicians' learning and decision making on professional competence. DESIGN A qualitative study based on semi-structured interviews. SETTING AND PARTICIPANTS The study took place in a secondary care setting in the Netherlands. The authors selected 25 patients from two Dutch hospitals and through the Dutch Lung Foundation, using purposive sampling. METHODS Data were analysed according to the principles of template analysis, based on an a priori coding framework developed from the literature about patient empowerment, feedback and performance assessment. RESULTS The analysis unearthed three predominant patient perspectives: the proactive perspective, the restrained perspective and the outsider perspective. These perspectives differed in terms of perceived power dynamics within the doctor-patient relationship, patients' perceived ability, and willingness to provide feedback and evaluate their physician's performance. Patients' perspectives thus affected the role patients envisaged for themselves in evaluating physician performance. DISCUSSION AND CONCLUSION Although not all patients are equally suitable or willing to be involved, patients can play a role in evaluating physician performance and continuing training through formative approaches. To involve patients successfully, it is imperative to distinguish between different patient perspectives and empower patients by ensuring a safe environment for feedback.
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Affiliation(s)
- Carolin Sehlbach
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Marjan J B Govaerts
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Truus G J Teunissen
- Patient Contributor, and Researcher at the Department of Medical Humanities, Amsterdam Public Health research institute (APH), Amsterdam UMC Free University Medical Centre, Amsterdam, The Netherlands
| | - Frank W J M Smeenk
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.,Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Erik W Driessen
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Gernot G U Rohde
- Department of Respiratory Medicine, University Hospital, Goethe University, Frankfurt, Germany
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12
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Patient, Family, and Community Advisory Councils in Health Care and Research: a Systematic Review. J Gen Intern Med 2019; 34:1292-1303. [PMID: 30051331 PMCID: PMC6614241 DOI: 10.1007/s11606-018-4565-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/29/2018] [Accepted: 06/30/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patient-centeredness is a characteristic of high-quality medical care and requires engaging community members in health systems' decision-making. One key patient engagement strategy is patient, family, and community advisory boards/councils (PFACs), yet the evidence to guide PFACs is lacking. Systematic reviews on patient engagement may benefit from patient input, but feasibility is unclear. METHODS A team of physicians, researchers, and a PFAC member conducted a systematic review to examine the impact of PFACs on health systems and describe optimal strategies for PFAC conduct. We searched MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and Social Science Citation Index from inception through September 2016, as well as pre-identified websites. Two reviewers independently screened and abstracted data from studies, then assessed randomized studies for risk of bias and observational studies for quality using standardized measures. We performed a realist synthesis-which asks what works, for whom, under what circumstances-of abstracted data via 12 monthly meetings between investigators and two feedback sessions with a hospital-based PFAC. RESULTS Eighteen articles describing 16 studies met study criteria. Randomized studies demonstrated moderate to high risk of bias and observational studies demonstrated poor to fair quality. Studies engaged patients at multiple levels of the health care system and suggested that in-person deliberation with health system leadership was most effective. Studies involving patient engagement in research focused on increasing study participation. PFAC recruitment was by nomination (n = 11) or not described (n = 5). No common measure of patient, family, or community engagement was identified. Realist synthesis was enriched by feedback from PFAC members. DISCUSSION PFACs engage communities through individual projects but evidence of their impact on outcomes is lacking. A paucity of randomized controlled trials or high-quality observational studies guide strategies for engagement through PFACs. Standardized measurement tools for engagement are needed. Strategies for PFAC recruitment should be investigated and reported. PFAC members can feasibly contribute to systematic reviews. REGISTRATION AND FUNDING SOURCE A protocol for record eligibility was developed a priori and was registered in the PROSPERO database of systematic reviews (registration number CRD42016052817). The Department of Veterans Affairs' Office of Academic Affiliations, through the National Clinician Scholars Program, funded this study.
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Weber A, Harrison TM. Reducing toxic stress in the neonatal intensive care unit to improve infant outcomes. Nurs Outlook 2019; 67:169-189. [PMID: 30611546 PMCID: PMC6450772 DOI: 10.1016/j.outlook.2018.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/27/2018] [Accepted: 11/16/2018] [Indexed: 02/08/2023]
Abstract
In 2011, the American Academy of Pediatrics (AAP) published a technical report on the lifelong effects of early toxic stress on human development, and included a new framework for promoting pediatric health: the Ecobiodevelopmental Framework for Early Childhood Policies and Programs. We believe that hospitalization is a specific form of toxic stress for the neonatal patient, and that toxic stress must be addressed by the nursing profession in order to substantially improve outcomes for the critically ill neonate. Approximately 4% of normal birthweight newborns and 85% of low birthweight newborns are hospitalized each year in the highly technological neonatal intensive care unit (NICU). Neonates are exposed to roughly 70 stressful procedures a day during hospitalization, which can permanently and negatively alter the infant's developing brain. Neurologic deficits can be partly attributed to the frequent, toxic, and cumulative exposure to stressors during NICU hospitalization. However, the AAP report does not provide specific action steps necessary to address toxic stress in the NICU and realize the new vision for pediatric health care outlined therein. Therefore, this paper applies the concepts and vision laid out in the AAP report to the care of the hospitalized neonate and provides action steps for true transformative change in neonatal intensive care. We review how the environment of the NICU is a significant source of toxic stress for hospitalized infants. We provide recommendations for caregiving practices that could significantly buffer the toxic stress experienced by hospitalized infants. We also identify areas of research inquiry that are needed to address gaps in nursing knowledge and to propel nursing science forward. Finally, we advocate for several public policies that are not fully addressed in the AAP technical report, but are vital to the health and development of all newborns.
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Affiliation(s)
- Ashley Weber
- University of Cincinnati College of Nursing, 310 Proctor Hall, 3110 Vine St, Cincinnati, OH 45221, USA
| | - Tondi M. Harrison
- The Ohio State University, Newton Hall, College of Nursing, 1585 Neil Avenue, Columbus OH, 43210 USA
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Flott K, Darzi A, Mayer E. Care pathway and organisational features driving patient experience: statistical analysis of large NHS datasets. BMJ Open 2018; 8:e020411. [PMID: 29982201 PMCID: PMC6042542 DOI: 10.1136/bmjopen-2017-020411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify the care pathway and organisational factors that predict patient experience. DESIGN Statistical analysis of large National Health Service (NHS) datasets. SETTING ANDPARTICIPANTS England; acute NHS organisational-level data. PRIMARY AND SECONDARY OUTCOME MEASURES The relationship of care pathway and organisational variables to organisation-level patient experience. RESULTS A framework of 18 care pathway and organisational variables were created based on the existing literature. 11 of these correlated to patient experience in univariate analyses. Multicollinearity tests resulted in 1 of the 11 variables holding a correlation to another variable larger than r=0.70. A significant multilinear regression equation, including the final 10 variables, was found (F(10,108)=6.214, p<0.00), with an [Formula: see text] of 0.365. Two variables were significant in predicting better in patient experience: Amount of support to clinical staff (beta=0.2, p=0.02) and the proportion of staff who would recommend the trust as a place to work or receive treatment (beta=0.26, p=0.01). Two variables were significant in predicting a negative impact on the patient's rating of their experience: Number of patients spending over 4 hours from decision to admit to admission (beta=-1.99, p=0.03) and the percentage of estates and hotel services contracted out (beta=-0.23, p=0.01). CONCLUSIONS These results indicate that augmenting clinical support and investing in the mechanisms that facilitate positive staff experience is essential to delivering appropriate, informative and patient-centric care. Reducing wait times and the extent of external contracting within hospitals is also likely to improve patient ratings of experience. Understanding the relationship between patient experience and objective, measurable organisational features promote a more patient-centric interpretation of quality and compel a better use of patient experience feedback to drive improvement.
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Affiliation(s)
- Kelsey Flott
- NIHR Imperial Patient Safety Translational Research Centre (PSTRC), Imperial College London, London, UK
| | - Ara Darzi
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Erik Mayer
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
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Eriksson EM, Raharjo H, Gustavsson S. Exploring complaints by female and male patients at Swedish hospitals using a probabilistic graphical model. Scand J Caring Sci 2018; 32:1148-1156. [PMID: 29460969 DOI: 10.1111/scs.12560] [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] [Received: 09/29/2017] [Accepted: 01/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients' complaints have been highlighted as important for constructively improving healthcare services. In so doing, it may be important to identify disparities in experiences based on patients' demographics, such as sex. AIM To explore hospital recorded complaints addressing potential sex differences and whether complaints were reported by the patient or a relative. METHODS Quantitative study of all 835 closed patient complaints during 2013 at three mid-sized hospitals in Sweden. The complaints were categorisation based on perceived quality theory and analysed using a probabilistic graphical model. The findings were validated through qualitative interviews. FINDINGS Female patients were more likely than male patients to report dissatisfaction with interpersonal issues, whereas male patients were more likely to report dissatisfaction with administration. If a complaint from a male patient had been reported by a relative, the matter was more likely to be interpersonal. Improvement suggestions were predominantly reported by staff. However, patients and relatives proved more likely than staff to report improvement suggestions when dissatisfied with interpersonal matters. CONCLUSION Using a Bayesian network, this article suggests that complaints in health care should be more holistically understood and the factors should be viewed as interconnected. This article addresses complaints as an important source of identifying not only perceived healthcare deficiencies and sex disparities, but also improvement suggestions.
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Affiliation(s)
- Erik Masao Eriksson
- Department of Technology Management and Economics, Centre for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
| | - Hendry Raharjo
- Department of Technology Management and Economics, Centre for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
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Pougheon Bertrand D, Minguet G, Gagnayre R, Lombrail P. Lessons from patient and parent involvement (P&PI) in a quality improvement program in cystic fibrosis care in France. Orphanet J Rare Dis 2018; 13:19. [PMID: 29799378 PMCID: PMC6225648 DOI: 10.1186/s13023-017-0751-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Quality Improvement Programs (QIP) in cystic fibrosis (CF) care have emerged as strategies to reduce variability of care and of patient outcomes among centres facilitating the implementation of Best Practices in all centres. The US CF Foundation developed a Learning and Leadership Collaborative program which was transposed in France in 2011. Patient and parent involvement (P&PI) on the local quality teams (QTs) is one dimension of this complex intervention. The conditions and effects of this involvement needed to be evaluated. METHODS In all settings, patients and parents were recruited by their centre care team. They were trained to QI method and tools and contributed their own expertise to improve the process of care. This involvement has been analyzed in the frame of the whole process evaluation. Observations and interviews conducted during the course of the first training year explored the motivations of the patients and parents to participate and the vision of the health care teams. A research study was carried out after three years with the patients/parents and the professionals to assess the French QIP's effectiveness using a questionnaire to report their opinions on various components of the program, including their experience of P&PI. Responses were analyzed in view of identifying consensus and dissensus between the two groups. RESULTS At the introduction of the program, P&PI was an opportunity for healthcare providers to reflect on their conceptions of these individuals both as patients and as healthcare system users. Curiosity about the teams' functioning, the various center organizations and outcomes led patients to overcome their initial barriers to participation. Seventy-six people including 12 patients/parents from the 14 pilot centres responded to the questionnaire after 3 years. Consensus between professionals and patients/parents was high on most items characterizing the performance of the QIP, QT effectiveness and QT functioning. Patients, parents and professionals agreed on the main characteristics of care such as an optimized organization, multidisciplinary care and patient-centredness. Regarding the use of patient electronic records, the use of care guidelines or the organization of support in the patient community, responses were not consensual amongst patients/parents and a source of dissensus between the two groups. All agreed that the French QIP created good conditions for their involvement. In the end, both groups agreed that it was difficult to attribute the paternity of some changes specifically to any member in the team. DISCUSSION Perspectives such as an educational framework to develop the skills and behaviors of professionals engaged in collaborative practice with patients and families and large patient experience surveys could be used to capture patients' experience of care in the improvement work. CONCLUSION Success factors for patient/parent long-term involvement in QIPs have been identified. Answers to questions raised by the stakeholders about the feasibility, efficiency and usefulness of P&PI in this CF QIP could be given but new questions arose about the sustainability of continuous quality improvement over time.
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Affiliation(s)
| | | | - Rémi Gagnayre
- LEPS EA3412, Sorbonne Paris Cité University, Bobigny, France
| | - Pierre Lombrail
- LEPS EA3412, Sorbonne Paris Cité University, Bobigny, France
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Engelhard EAN, Smit C, Kroon FP, Nieuwkerk PT, Reiss P, Brinkman K, Geerlings SE. A Survey of Patients' Perspectives on Outpatient HIV Care in the Netherlands. Infect Dis Ther 2017; 6:443-452. [PMID: 28677021 PMCID: PMC5595778 DOI: 10.1007/s40121-017-0164-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction Responding to patients’ needs and preferences is important in the delivery of outpatient care. Recent and systematically collected data reflecting human immunodeficiency virus (HIV)-infected patients’ opinions on how their outpatient care should be delivered are lacking. Our aim was to identify aspects of care that people with HIV in outpatient care in The Netherlands consider important and to evaluate the extent to which the received care meets their expectations. Methods We measured patient preferences and experiences in a nationwide sample of HIV-infected patients using a modified, previously validated questionnaire (QUOTE-HIV). Results The aspects of care that were considered most important were specific expertise of the care provider in HIV medicine, the care provider taking the patient seriously and receiving adequate information about treatment options. In addition, confidentiality of HIV status at the outpatient clinic was a major concern. Patient experiences were positive, with the majority of the respondents indicating that they always or usually received care in accordance with their preferences. Conclusion HIV-infected patients greatly value having care providers with HIV-specific expertise. Safeguarding the privacy of HIV status and the provision of information about treatment options are matters that deserve continuous attention in the delivery of outpatient HIV care. Electronic supplementary material The online version of this article (doi:10.1007/s40121-017-0164-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esther A N Engelhard
- Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands.
- Stichting HIV Monitoring, Amsterdam, The Netherlands.
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Frank P Kroon
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Pythia T Nieuwkerk
- Department of Medical Psychology, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Reiss
- Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
- Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Suzanne E Geerlings
- Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
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Frohmader TJ, Lin F, Chaboyer WP. Structures, processes and outcomes of the Aussie Heart Guide Program: A nurse mentor supported, home based cardiac rehabilitation program for rural patients with acute coronary syndrome. Aust Crit Care 2017; 31:93-100. [PMID: 28487185 DOI: 10.1016/j.aucc.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/30/2017] [Accepted: 03/31/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation has a number of benefits for patients, yet participation in it is sub-optimal, especially in regional Australia. Innovative models of cardiac rehabilitation are needed to improve participation. Providing nurse mentors to support patients transitioning from hospital to home represents a new model of service delivery in Australia. OBJECTIVES To explore the impact of a home-based cardiac rehabilitation program in assisting patients to recover from Acute Coronary Syndrome and meeting the expectations of nurse mentors delivering the program. METHODS This case study was underpinned by the structure, process and outcomes model and occurred in three Australian hospitals 2008-2011. Thirteen patients recovering from acute coronary syndrome were interviewed by telephone and seven nurse mentors completed a survey after completing the program. FINDINGS Mentor perceptions concerning the structures of the home-based CR program included the timely recruitment of patients, mentor training to operationalise the program, commitment to development of the mentor role, and the acquisition of knowledge and skills about cognitive behavioural therapy and patient centred care. Processes included the therapeutic relationship between mentors and patients, suitability of the program and the promotion of healthier lifestyle behaviours. Outcomes identified that patients were satisfied with the program's audiovisual resources, and the level of support and guidance provided by their nurse mentors. Mentors believed that the program was easy to use in terms of its delivery. DISCUSSION AND CONCLUSION Patients believed the program assisted their recovery and were satisfied with the information, guidance and support received from mentors. There were positive signs that the program influenced patients' decisions to change unhealthy lifestyle behaviours. Outcomes highlighted both rewards and barriers associated with mentoring patients in their homes by telephone. Experience gained from developing a therapeutic relationship with patients during their recovery, assisted nurses in developing the mentor role.
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Affiliation(s)
- Terence J Frohmader
- Department of Intensive Care Medicine, Launceston General Hospital, 274-280 Charles Street, Launceston, Tasmania, Australia.
| | - Frances Lin
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
| | - Wendy P Chaboyer
- NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
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Edvardsson D, Watt E, Pearce F. Patient experiences of caring and person-centredness are associated with perceived nursing care quality. J Adv Nurs 2016; 73:217-227. [DOI: 10.1111/jan.13105] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2016] [Indexed: 12/28/2022]
Affiliation(s)
- David Edvardsson
- La Trobe University/Austin Health Clinical School of Nursing; Melbourne Victoria Australia
- Department of Nursing; Umea University; Sweden
| | - Elizabeth Watt
- La Trobe University/Austin Health Clinical School of Nursing; Melbourne Victoria Australia
| | - Frances Pearce
- Clinical Education Unit; Austin Health; Melbourne Victoria Australia
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Fradgley EA, Paul CL, Bryant J, Oldmeadow C. Getting right to the point: identifying Australian outpatients' priorities and preferences for patient-centred quality improvement in chronic disease care. Int J Qual Health Care 2016; 28:470-7. [PMID: 27283439 DOI: 10.1093/intqhc/mzw049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To identify specific actions for patient-centred quality improvement in chronic disease outpatient settings, this study identified patients' general and specific preferences among a comprehensive suite of initiatives for change. DESIGN AND SETTING A cross-sectional survey was conducted in three hospital-based clinics specializing in oncology, neurology and cardiology care located in New South Wales, Australia. PARTICIPANTS AND MEASURES Adult English-speaking outpatients completed the touch-screen Consumer Preferences Survey in waiting rooms or treatment areas. Participants selected up to 23 general initiatives that would improve their experience. Using adaptive branching, participants could select an additional 110 detailed initiatives and complete a relative prioritization exercise. RESULTS A total of 541 individuals completed the survey (71.1% consent, 73.1% completion). Commonly selected general initiatives, presented in order of decreasing priority (along with sample proportion), included: improved parking (60.3%), up-to-date information provision (15.0%), ease of clinic contact (12.9%), access to information at home (12.8%), convenient appointment scheduling (14.2%), reduced wait-times (19.8%) and information on medical emergencies (11.1%). To address these general initiatives, 40 detailed initiatives were selected by respondents. CONCLUSIONS Initiatives targeting service accessibility and information provision, such as parking and up-to-date information on patient prognoses and progress, were commonly selected and perceived to be of relatively greater priority. Specific preferences included the need for clinics to provide patient-designated parking in close proximity to the clinic, information on treatment progress and test results (potentially in the form of designated brief appointments or via telehealth) and comprehensive and trustworthy lists of information sources to access at home.
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Affiliation(s)
- Elizabeth A Fradgley
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Christine L Paul
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia Hunter Medical Research Institute, New Lambton, New South Wales, Australia Health Behaviour Research Group, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christopher Oldmeadow
- Public Health Research Program, Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, New South Wales, Australia
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Bucknall TK, Hutchinson AM, Botti M, McTier L, Rawson H, Hewitt NA, McMurray A, Marshall AP, Gillespie BM, Chaboyer W. Engaging patients and families in communication across transitions of care: an integrative review protocol. J Adv Nurs 2016; 72:1689-700. [DOI: 10.1111/jan.12953] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Tracey K. Bucknall
- Centre for Quality and Patient Safety Research School of Nursing and Midwifery Faculty of Health Deakin University Geelong Victoria Australia
- Alfred Health Melbourne Victoria Australia
| | - Alison M. Hutchinson
- Centre for Quality and Patient Safety Research School of Nursing and Midwifery Faculty of Health Deakin University Geelong Victoria Australia
- Centre for Nursing Research – Deakin University and Monash Health Partnership Melbourne Victoria Australia
| | - Mari Botti
- Centre for Quality and Patient Safety Research School of Nursing and Midwifery Faculty of Health Deakin University Geelong Victoria Australia
- Epworth HealthCare Melbourne Victoria Australia
| | - Lauren McTier
- Centre for Quality and Patient Safety Research School of Nursing and Midwifery Faculty of Health Deakin University Geelong Victoria Australia
| | - Helen Rawson
- Centre for Quality and Patient Safety Research School of Nursing and Midwifery Faculty of Health Deakin University Geelong Victoria Australia
- Centre for Nursing Research – Deakin University and Monash Health Partnership Melbourne Victoria Australia
| | - Nicky A. Hewitt
- Centre for Quality and Patient Safety Research School of Nursing and Midwifery Faculty of Health Deakin University Geelong Victoria Australia
- Alfred Health Melbourne Victoria Australia
| | - Anne McMurray
- School of Nursing and Midwifery Griffith University and Menzies Health Institute Gold Coast Queensland Australia
| | - Andrea P. Marshall
- School of Nursing and Midwifery and National Health and Medical Research Council Centre for Research Excellence in Nursing Interventions for Hospitalised Patients Griffith University Gold Coast Queensland Australia
| | - Brigid M. Gillespie
- School of Nursing and Midwifery and National Health and Medical Research Council Centre for Research Excellence in Nursing Interventions for Hospitalised Patients Griffith University Gold Coast Queensland Australia
| | - Wendy Chaboyer
- National Health and Medical Research Council Centre for Research Excellence in Nursing Interventions for Hospitalised Patients School of Nursing and Midwifery Centre for Health Practice Innovation Menzies Health Institute Griffith University Gold Coast Queensland Australia
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Groene O, Arah OA, Klazinga NS, Wagner C, Bartels PD, Kristensen S, Saillour F, Thompson A, Thompson CA, Pfaff H, DerSarkissian M, Sunol R. Patient Experience Shows Little Relationship with Hospital Quality Management Strategies. PLoS One 2015; 10:e0131805. [PMID: 26151864 PMCID: PMC4494712 DOI: 10.1371/journal.pone.0131805] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/07/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for public reporting or reimbursement. However, it is currently unclear whether hospitals with more mature quality management systems or stronger focus on patient involvement and patient-centered care strategies perform better on patient-reported experience. We assessed the effect of such strategies on a range of patient-reported experience measures. MATERIALS AND METHODS We employed a cross-sectional, multi-level study design randomly recruiting hospitals from the Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey between May 2011 and January 2012. Each hospital contributed patient level data for four conditions/pathways: acute myocardial infarction, stroke, hip fracture and deliveries. The outcome variables in this study were a set of patient-reported experience measures including a generic 6-item measure of patient experience (NORPEQ), a 3-item measure of patient-perceived discharge preparation (Health Care Transition Measure) and two single item measures of perceived involvement in care and hospital recommendation. Predictor variables included three hospital management strategies: maturity of the hospital quality management system, patient involvement in quality management functions and patient-centered care strategies. We used directed acyclic graphs to detail and guide the modeling of the complex relationships between predictor variables and outcome variables, and fitted multivariable linear mixed models with random intercept by hospital, and adjusted for fixed effects at the country level, hospital level and patient level. RESULTS Overall, 74 hospitals and 276 hospital departments contributed data on 6,536 patients to this study (acute myocardial infarction n = 1,379, hip fracture n = 1,503, deliveries n = 2,088, stroke n = 1,566). Patients admitted for hip fracture and stroke had the lowest scores across the four patient-reported experience measures throughout. Patients admitted after acute myocardial infarction reported highest scores on patient experience and hospital recommendation; women after delivery reported highest scores for patient involvement and health care transition. We found no substantial associations between hospital-wide quality management strategies, patient involvement in quality management, or patient-centered care strategies with any of the patient-reported experience measures. CONCLUSION This is the largest study so far to assess the complex relationship between quality management strategies and patient experience with care. Our findings suggest absence of and wide variations in the institutionalization of strategies to engage patients in quality management, or implement strategies to improve patient-centeredness of care. Seemingly counterintuitive inverse associations could be capturing a scenario where hospitals with poorer quality management were beginning to improve their patient experience. The former suggests that patient-centered care is not yet sufficiently integrated in quality management, while the latter warrants a nuanced assessment of the motivation and impact of involving patients in the design and assessment of services.
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Affiliation(s)
- Oliver Groene
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Red de investigación en servicios de salud en enfermedades crónicas REDISSEC, Barcelona, Spain
| | - Onyebuchi A. Arah
- Department of Epidemiology, The Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Niek S. Klazinga
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul D. Bartels
- Danish Clinical Registries, Aarhus, Denmark, and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Solvejg Kristensen
- Danish Clinical Registries, Aarhus, Denmark, and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Florence Saillour
- Unité Méthodes Evaluation en Santé, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Andrew Thompson
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Caroline A. Thompson
- Palo Alto Medical Foundation Research Institute (PAMFRI), Palo Alto, California, United States of America
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Maral DerSarkissian
- Department of Epidemiology, The Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain
- Red de investigación en servicios de salud en enfermedades crónicas REDISSEC, Barcelona, Spain
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Aghaei Hashjin A, Delgoshaei B, Kringos DS, Tabibi SJ, Manouchehri J, Klazinga NS. Implementing hospital quality assurance policies in Iran. Int J Health Care Qual Assur 2015; 28:343-55. [DOI: 10.1108/ijhcqa-03-2014-0034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to provide an overview of applied hospital quality assurance (QA) policies in Iran.
Design/methodology/approach
– A mixed method (quantitative data and qualitative document analysis) study was carried out between 1996 and 2010.
Findings
– The QA policy cycle forms a tight monitoring system to assure hospital quality by combining mandatory and voluntary methods in Iran. The licensing, annual evaluation and grading, and regulatory inspections statutorily implemented by the government as a national package to assure and improve hospital care quality, while implementing quality management systems (QMS) was voluntary for hospitals. The government’s strong QA policy legislation role and support has been an important factor for successful QA implementation in Iran, though it may affected QA assessment independency and validity. Increased hospital evaluation independency and repositioning, updating standards, professional involvement and effectiveness studies could increase QA policy impact and maturity.
Practical implications
– The study highlights the current QA policy implementation cycle in Iranian hospitals. It provides a basis for further quality strategy development in Iranian hospitals and elsewhere. It also raises attention about finding the optimal balance between different QA policies, which is topical for many countries.
Originality/value
– This paper describes experiences when implementing a unique approach, combining mandatory and voluntary QA policies simultaneously in a developing country, which has invested considerably over time to improve hospital quality. The experiences with a mixed obligatory/voluntary approach and comprehensive policies in Iran may contain lessons for policy makers in developing and developed countries.
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Page K, Marwick TH, Lee R, Grenfell R, Abhayaratna WP, Aggarwal A, Briffa TG, Cameron J, Davidson PM, Driscoll A, Garton-Smith J, Gascard DJ, Hickey A, Korczyk D, Mitchell JA, Sanders R, Spicer D, Stewart S, Wade V. A systematic approach to chronic heart failure care: a consensus statement. Med J Aust 2014; 201:146-50. [PMID: 25128948 DOI: 10.5694/mja14.00032] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Indexed: 11/17/2022]
Abstract
The National Heart Foundation of Australia assembled an expert panel to provide guidance on policy and system changes to improve the quality of care for people with chronic heart failure (CHF). The recommendations have the potential to reduce emergency presentations, hospitalisations and premature death among patients with CHF. Best-practice management of CHF involves evidence-based, multidisciplinary, patient-centred care, which leads to better health outcomes. A CHF care model is required to achieve this. Although CHF management programs exist, ensuring access for everyone remains a challenge. This is particularly so for Aboriginal and Torres Strait Islander peoples, those from non-metropolitan areas and lower socioeconomic backgrounds, and culturally and linguistically diverse populations. Lack of data and inadequate identification of people with CHF prevents efficient patient monitoring, limiting information to improve or optimise care. This leads to ineffectiveness in measuring outcomes and evaluating the CHF care provided. Expanding current cardiac registries to include patients with CHF and developing mechanisms to promote data linkage across care transitions are essential. As the prevalence of CHF rises, the demand for multidisciplinary workforce support will increase. Workforce planning should provide access to services outside of large cities, one of the main challenges it is currently facing. To enhance community-based management of CHF, general practitioners should be empowered to lead care. Incentive arrangements should favour provision of care for Aboriginal and Torres Strait Islander peoples, those from lower socioeconomic backgrounds and rural areas, and culturally and linguistically diverse populations. Ongoing research is vital to improving systems of care for people with CHF. Future research activity needs to ensure the translation of valuable knowledge and high-quality evidence into practice.
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Affiliation(s)
- Karen Page
- National Heart Foundation of Australia, Melbourne, VIC, Australia.
| | | | - Rebecca Lee
- National Heart Foundation of Australia, Melbourne, VIC, Australia
| | - Robert Grenfell
- National Heart Foundation of Australia, Melbourne, VIC, Australia
| | | | - Anu Aggarwal
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Tom G Briffa
- School of Population Health, University of Western Australia, Perth, WA, Australia
| | - Jan Cameron
- Cardiovascular Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - Patricia M Davidson
- Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Sydney, NSW, Australia
| | - Andrea Driscoll
- Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Jacquie Garton-Smith
- Cardiovascular Health Network, Department of Health Western Australia, Perth, WA, Australia
| | - Debra J Gascard
- Heart Failure Care, Monash Health, Melbourne, VIC, Australia
| | - Annabel Hickey
- Advanced Heart Failure and Cardiac Transplant Unit, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Dariusz Korczyk
- Heart Failure Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | - Rhonda Sanders
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Deborah Spicer
- Community Heart Failure Nursing, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Simon Stewart
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Vicki Wade
- National Heart Foundation of Australia, Sydney, NSW, Australia
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Aghaei Hashjin A, Kringos DS, Manoochehri J, Ravaghi H, Klazinga NS. Implementation of patient safety and patient-centeredness strategies in Iranian hospitals. PLoS One 2014; 9:e108831. [PMID: 25268797 PMCID: PMC4182570 DOI: 10.1371/journal.pone.0108831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/27/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine the extent of implementation for patient safety (PS) and patient-centeredness (PC) strategies and their association with hospital characteristics (type, ownership, teaching status, annual evaluation grade) in Iran. METHODS A cross-sectional study through an adapted version of the MARQuIS questionnaire, eliciting information from hospital and nursing managers in 84 Iranian hospitals on the implementation of PS and PC strategies in 2009-2010. RESULTS The majority of hospitals reported to have implemented 84% of the PS and 72% of the PC strategies. In general, implementation of PS strategies was unrelated to the type of hospital, with the exception of health promotion reports, which were more common in the Social Security Organization (SSO), and MRSA testing, which was reported more often in nonprofit hospitals. MRSA testing was also more common among teaching hospitals compared to non-teaching hospitals. The higher grade hospitals reported PS strategies significantly more frequently than lower grade hospitals. Overall, there was no significant difference in the reported implementation of PC strategies across general and specialized hospitals; except for the provision of information in different languages and recording of patient's diet which were reported significantly more often by general than specialized hospitals. Moreover, patient hotel services were more common in private compared to public hospitals. CONCLUSIONS Despite substantial reporting of PS and PC strategies, there is still room for strengthening standard setting on safety, patient services and patient-centered information strategies in Iranian hospitals. To assure effective implementation of PS and PC strategies, enforcing standards, creating a PS and PC culture, increasing organizational responsiveness, and partnering with patients and their families need more attention.
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Affiliation(s)
- Asgar Aghaei Hashjin
- Department of Public Health, Academic Medical Center (AMC)/University of Amsterdam, Amsterdam, the Netherlands
- Department of Health Services Management, School of Health Services Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Dionne S. Kringos
- Department of Public Health, Academic Medical Center (AMC)/University of Amsterdam, Amsterdam, the Netherlands
| | - Jila Manoochehri
- Department of Quality Improvement, Tehran Heart Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Ravaghi
- Department of Health Services Management, School of Health Services Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Niek S. Klazinga
- Department of Public Health, Academic Medical Center (AMC)/University of Amsterdam, Amsterdam, the Netherlands
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Rozenblum R, Gianola A, Ionescu-Ittu R, Verstappen A, Landzberg M, Gurvitz M, Jenkins K, Bates DW, Marelli AJ. Clinicians' Perspectives on Patient Satisfaction in Adult Congenital Heart Disease Clinics-A Dimension of Health Care Quality Whose Time Has Come. CONGENIT HEART DIS 2014; 10:128-36. [DOI: 10.1111/chd.12190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Ronen Rozenblum
- Brigham and Women's Hospital; Harvard University; Boston Mass USA
| | - Ann Gianola
- Adult Congenital Heart Association; Philadelphia Pa USA
| | - Raluca Ionescu-Ittu
- McGill Adult Unit for Congenital Heart Disease; McGill University Health Center; Montreal Canada
| | | | | | | | - Kathy Jenkins
- Children's Hospital Boston; Harvard University; Boston Mass USA
| | - David W. Bates
- Brigham and Women's Hospital; Harvard University; Boston Mass USA
| | - Ariane J. Marelli
- McGill Adult Unit for Congenital Heart Disease; McGill University Health Center; Montreal Canada
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Braithwaite J, Marks D, Taylor N. Harnessing implementation science to improve care quality and patient safety: a systematic review of targeted literature. Int J Qual Health Care 2014; 26:321-9. [DOI: 10.1093/intqhc/mzu047] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Groene O, Sunol R, Klazinga NS, Wang A, Dersarkissian M, Thompson CA, Thompson A, Arah OA. Involvement of patients or their representatives in quality management functions in EU hospitals: implementation and impact on patient-centred care strategies. Int J Qual Health Care 2014; 26 Suppl 1:81-91. [PMID: 24615596 PMCID: PMC4001693 DOI: 10.1093/intqhc/mzu022] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The objective of this study was to describe the involvement of patients or their representatives in quality management (QM) functions and to assess associations between levels of involvement and the implementation of patient-centred care strategies. DESIGN A cross-sectional, multilevel STUDY DESIGN that surveyed quality managers and department heads and data from an organizational audit. SETTING Randomly selected hospitals (n = 74) from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). PARTICIPANTS Hospital quality managers (n = 74) and heads of clinical departments (n = 262) in charge of four patient pathways (acute myocardial infarction, stroke, hip fracture and deliveries) participated in the data collection between May 2011 and February 2012. MAIN OUTCOME MEASURES Four items reflecting essential patient-centred care strategies based on an on-site hospital visit: (1) formal survey seeking views of patients and carers, (2) written policies on patients' rights, (3) patient information literature including guidelines and (4) fact sheets for post-discharge care. The main predictors were patient involvement in QM at the (i) hospital level and (ii) pathway level. RESULTS Current levels of involving patients and their representatives in QM functions in European hospitals are low at hospital level (mean score 1.6 on a scale of 0 to 5, SD 0.7), but even lower at departmental level (mean 0.6, SD 0.7). We did not detect associations between levels of involving patients and their representatives in QM functions and the implementation of patient-centred care strategies; however, the smallest hospitals were more likely to have implemented patient-centred care strategies. CONCLUSIONS There is insufficient evidence that involving patients and their representatives in QM leads to establishing or implementing strategies and procedures that facilitate patient-centred care; however, lack of evidence should not be interpreted as evidence of no effect.
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Affiliation(s)
- Oliver Groene
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Green CA, Estroff SE, Yarborough BJH, Spofford M, Solloway MR, Kitson RS, Perrin NA. Directions for future patient-centered and comparative effectiveness research for people with serious mental illness in a learning mental health care system. Schizophr Bull 2014; 40 Suppl 1:S1-S94. [PMID: 24489078 PMCID: PMC3911266 DOI: 10.1093/schbul/sbt170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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De Feo E, de Belvis AG, Silenzi A, Specchia ML, Gallì P, Ricciardi W. Patient-centeredness and e-health among Italian hospitals: results of a cross-sectional web-based survey. Telemed J E Health 2012; 18:791-6. [PMID: 23082793 DOI: 10.1089/tmj.2011.0234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Given the growing recognition of patient-centeredness as a healthcare quality indicator and its limited implementation in practice, our study evaluated how the Italian hospitals (ItHs), including research hospitals (IRCCSs), research teaching hospitals (THs), and independent public hospital trusts (AOs), address the dimension of online data access through their institutional Web sites to promote a patient-centered care. MATERIALS AND METHODS To address patient-centeredness and e-health, eight specific indicators adapted from the Euro Health Consumer Index were evaluated from 169 ItHs: online booking of healthcare services; access to medical records; register of legitimate doctors; waiting times for most commonly delivered healthcare services; transport information; centralized booking; public relations office; and pain management hospital committee. Univariate and bivariate statistics and a logistic regression analysis have been performed. RESULTS The majority of the ItHs were under public ownership, and half of them are located in Northern Italy. From the logistic regression analysis, AOs appeared to be more likely to develop a patient-centered healthcare approach (odds ratio [OR]=3.69; 95% confidence interval [CI] 1.14-11.89) compared with IRCCSs or THs. In addition, when grouped together, all public hospitals show more than threefold higher implementation of patient-centeredness strategies (OR=3.60; 95% CI 1.49-8.72) with respect to private ones. Northern hospitals are more likely to ensure wider implementation of a patient-centered approach to healthcare (OR=3.37; 95% CI 1.49-7.62). CONCLUSIONS According to our results, most of the ItHs are under public ownership, and half of them are located in the northern regions of Italy. The higher implementation of patient-centeredness strategies observed for Northern hospitals highlights interregional disparity in healthcare that needs a coordinated effort at both the hospital and policymaker levels to ensure a widespread implementation of patient-centered care among all Italian regions.
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Affiliation(s)
- Emma De Feo
- Institute of Hygiene and Public Health, Catholic University of Sacred Heart, Rome, Italy.
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Elg M, Engström J, Witell L, Poksinska B. Co‐creation and learning in health‐care service development. JOURNAL OF SERVICE MANAGEMENT 2012. [DOI: 10.1108/09564231211248435] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mainil T, Van Loon F, Botterill D, Dinnie K, Platenkamp V, Meulemans H. Framing and measuring international patient management. Adv Health Care Manag 2012; 13:145-159. [PMID: 23265070 DOI: 10.1108/s1474-8231(2012)0000013011] [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: 06/01/2023]
Abstract
PURPOSE Hospitals need to determine if an international patient department is a necessity to communicate with and manage international patients. DESIGN/METHODOLOGY/APPROACH A benchmarking instrument was created to assess the level of professionalism in managing international patients, including reviewing and validating processes by two university hospitals, professionals, and an expert panel. FINDINGS First, the differences between the hospitals depended on the will of the hospital to engage in such activities. Second, the differences depended on the embedding national context in which the hospital was situated. Further validation revealed the importance of other supportive services, such as cultural sensitivity and language. Finally, the microlevel phenomenon of international patient departments is placed within a macrolevel transnational health region development scheme. ORIGINALITY/VALUE This study focused on the supply of services with respect to international patient departments, which could be related to efficiency and sustainability on a public health and health systems level.
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Affiliation(s)
- Tomas Mainil
- Centre for Cross-cultural Understanding (CCU), NHTV Breda University of Applied Sciences, Breda, The Netherlands
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Lee HR. The role of the Korean Hospital Association in Korea's healthcare accreditation system. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2012. [DOI: 10.5124/jkma.2012.55.1.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hae-Ran Lee
- Hallym University Medical Center, Anyang, Korea
- Evaluation and Training Committee of Korean Hospital Association, Anyang, Korea
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Groene O, Mora N, Thompson A, Saez M, Casas M, Suñol R. Is the maturity of hospitals' quality improvement systems associated with measures of quality and patient safety? BMC Health Serv Res 2011; 11:344. [PMID: 22185479 PMCID: PMC3267703 DOI: 10.1186/1472-6963-11-344] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 12/20/2011] [Indexed: 11/17/2022] Open
Abstract
Background Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. Methods The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. Results Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. Conclusions We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement system is associated with lower rates of adjusted hospital complications. A number of methodological and logistic hurdles remain to link hospital quality improvement systems to outcomes. Further research should aim at identifying the latent dimensions of quality improvement systems that predict quality and safety outcomes. Such research would add pertinent knowledge regarding the implementation of organizational strategies related with quality of care outcomes.
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Affiliation(s)
- Oliver Groene
- Avedis Donabedian University Institute, Autonomous University of Barcelona, Barcelona, Spain.
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Groene O. Patient centredness and quality improvement efforts in hospitals: rationale, measurement, implementation. Int J Qual Health Care 2011; 23:531-7. [PMID: 21862449 DOI: 10.1093/intqhc/mzr058] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
QUALITY PROBLEM Patient-centred care is increasingly being acknowledged as an integral part of evaluating health care. Yet, from a quality improvement perspective the rationale, measurement and implementation of strategies to improve patient-centred care is often subject to debate. OBJECTIVE The aim of this paper is to review why quality improvement efforts should embrace patient-centredness, to examine some of the measurement issues and to assess conceptual underpinnings that should inform both measurement and actions to improve patient-centred care. LESSONS The causal pathway through which quality improvement affects and/or is associated with patient centredness is complex and goes beyond patients' rights and assessing patient views. Interventions to improve patient-centred care should reflect on key rationale, measurement strategy and underlying theory.
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Affiliation(s)
- Oliver Groene
- Department of Health Services Research & Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Elg M, Witell L, Poksinska B, Engström J, Mi Dahlgaard‐Park S, Kammerlind P. Solicited diaries as a means of involving patients in development of healthcare services. INTERNATIONAL JOURNAL OF QUALITY AND SERVICE SCIENCES 2011. [DOI: 10.1108/17566691111146050] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Luxford K, Safran DG, Delbanco T. Promoting patient-centered care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience. Int J Qual Health Care 2011; 23:510-5. [PMID: 21586433 DOI: 10.1093/intqhc/mzr024] [Citation(s) in RCA: 262] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To investigate organizational facilitators and barriers to patient-centered care in US health care institutions renowned for improving the patient care experience. DESIGN A qualitative study involving interviews of senior staff and patient representatives. Semi-structured interviews focused on organizational processes, senior leadership, work environment, measurement and feedback mechanisms, patient engagement and information technology and access. SETTING Eight health care organizations across the USA with a reputation for successfully promoting patient-centered care. PARTICIPANTS Forty individuals, including chief executives, quality directors, chief medical officers, administrative directors and patient committee representatives. RESULTS Interviewees reported that several organizational attributes and processes are key facilitators for making care more patient-centered: (i) strong, committed senior leadership, (ii) clear communication of strategic vision, (iii) active engagement of patient and families throughout the institution, (iv) sustained focus on staff satisfaction, (v) active measurement and feedback reporting of patient experiences, (vi) adequate resourcing of care delivery redesign, (vii) staff capacity building, (viii) accountability and incentives and (ix) a culture strongly supportive of change and learning. Interviewees reported that changing the organizational culture from a 'provider-focus' to a 'patient-focus' and the length of time it took to transition toward such a focus were the principal barriers against transforming delivery for patient-centered care. CONCLUSIONS Organizations that have succeeded in fostering patient-centered care have gone beyond mainstream frameworks for quality improvement based on clinical measurement and audit and have adopted a strategic organizational approach to patient focus.
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Affiliation(s)
- Karen Luxford
- 1Harkness Fellow, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Cárcamo CR. [Perceived quality: illusion or perception]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2011; 26:184-187. [PMID: 21429780 DOI: 10.1016/j.cali.2010.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Revised: 12/04/2010] [Accepted: 12/07/2010] [Indexed: 05/30/2023]
Abstract
Patients as human beings determined by their structure cannot, while having an experience, distinguish between an illusion and reality, therefore they experience the different domains of existence and the different domains of reality. For them, the perception of service quality is experienced as a personal domain of reality, and this reality is a personal construction, generating as many realities as patients perceiving their experience with elements of their experience, whose distinctions that validate it are not necessarily shared or agreed. Health management must abandon the idea in that it is possible to build an objective quality service, to be able to make progress in building effective communication strategies and common consensus criteria for a quality service of distinction, in order to achieve effective satisfaction and patient loyalty.
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Affiliation(s)
- C R Cárcamo
- Hospital Clínico Mutual de Seguridad C.Ch.C., Universidad Adolfo Ibáñez, Santiago, Chile.
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Groene O, Suñol R. Factors associated with the implementation of quality and safety requirements for cross-border care in acute myocardial infarction: Results from 315 hospitals in four countries. Health Policy 2010; 98:107-13. [PMID: 21075263 DOI: 10.1016/j.healthpol.2010.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 05/12/2010] [Accepted: 05/12/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cross-border patients have specific quality and safety requirements for hospital care. Little is known to what extent hospitals meet these requirements. We aim to assess their current level, and the factors associated with their implementation. METHODS A cross-sectional survey of 315 hospitals and cardiology departments in the Czech Republic, France, Poland and Spain. Employing bi-variate statistics and logistic regression analysis, we assess quality and safety requirements for cross-border patients and their association with hospital characteristics, cross-border care arrangements, proximity to EU borders, the hospital's quality improvement system, and country. RESULTS Certain quality and safety requirements are frequently met (administrative support or informed consent using forms in various EU languages) while others are widely absent (case-managers, contacts to patients' general practitioners). Due to communication problems, it is often not possible to inform patients about their condition and treatment. Discharge summaries are rarely available in other than the vernacular languages, and medication upon discharge and arranging back-transfer occur occasionally only. Logistic regression analysis suggests a strong effect of country-level covariates (followed by type of hospital, hospital size and hospital's quality improvement system), but covariates are not consistently associated with higher rates of implementation. Hospitals with existing cross-border care collaboration do not differ substantially from hospitals without such arrangements. CONCLUSION Cross-border patients have specific quality and safety requirements that are not always met. Various factors are associated with these requirements; however, the trend is not systematic and the underlying mechanisms need to be studied further to inform policy decisions.
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Affiliation(s)
- Oliver Groene
- Avedis Donabedian Research Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health, C/ Provenza, 293, pral., 08037 Barcelona, Spain.
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Groene O, Klazinga N, Wagner C, Arah OA, Thompson A, Bruneau C, Suñol R. Investigating organizational quality improvement systems, patient empowerment, organizational culture, professional involvement and the quality of care in European hospitals: the 'Deepening our Understanding of Quality Improvement in Europe (DUQuE)' project. BMC Health Serv Res 2010; 10:281. [PMID: 20868470 PMCID: PMC2949856 DOI: 10.1186/1472-6963-10-281] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/24/2010] [Indexed: 11/16/2022] Open
Abstract
Background Hospitals in European countries apply a wide range of quality improvement strategies. Knowledge of the effectiveness of these strategies, implemented as part of an overall hospital quality improvement system, is limited. Methods/Design We propose to study the relationships among organisational quality improvement systems, patient empowerment, organisational culture, professionals' involvement with the quality of hospital care, including clinical effectiveness, patient safety and patient involvement. We will employ a cross-sectional, multi-level study design in which patient-level measurements are nested in hospital departments, which are in turn nested in hospitals in different EU countries. Mixed methods will be used for data collection, measurement and analysis. Hospital/care pathway level constructs that will be assessed include external pressure, hospital governance, quality improvement system, patient empowerment in quality improvement, organisational culture and professional involvement. These constructs will be assessed using questionnaires. Patient-level constructs include clinical effectiveness, patient safety and patient involvement, and will be assessed using audit of patient records, routine data and patient surveys. For the assessment of hospital and pathway level constructs we will collect data from randomly selected hospitals in eight countries. For a sample of hospitals in each country we will carry out additional data collection at patient-level related to four conditions (stroke, acute myocardial infarction, hip fracture and delivery). In addition, structural components of quality improvement systems will be assessed using visits by experienced external assessors. Data analysis will include descriptive statistics and graphical representations and methods for data reduction, classification techniques and psychometric analysis, before moving to bi-variate and multivariate analysis. The latter will be conducted at hospital and multilevel. In addition, we will apply sophisticated methodological elements such as the use of causal diagrams, outcome modelling, double robust estimation and detailed sensitivity analysis or multiple bias analyses to assess the impact of the various sources of bias. Discussion Products of the project will include a catalogue of instruments and tools that can be used to build departmental or hospital quality and safety programme and an appraisal scheme to assess the maturity of the quality improvement system for use by hospitals and by purchasers to contract hospitals.
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Affiliation(s)
- Oliver Groene
- Avedis Donabedian University Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health, Barcelona, Spain.
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Vallejo P, Suñol R. MARQulS: quality improvement strategies for European cross-border healthcare. Qual Saf Health Care 2009; 18 Suppl 1:i1-2. [PMID: 19188455 PMCID: PMC2629852 DOI: 10.1136/qshc.2008.032110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- P Vallejo
- Avedis Donabedian University Institute-Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Provença 2963, Barcelona, Spain.
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Groene O, Klazinga N, Walshe K, Cucic C, Shaw CD, Suñol R. Learning from MARQuIS: future direction of quality and safety in hospital care in the European Union. Qual Saf Health Care 2009; 18 Suppl 1:i69-74. [PMID: 19188465 PMCID: PMC2629925 DOI: 10.1136/qshc.2008.029447] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
This article summarises the significant lessons to be drawn from, and the policy implications of, the findings of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project--a part of the suite of research projects intended to support policy established by the European Commission through its Sixth Framework Programme. The article first reviews the findings of MARQuIS and their implications for healthcare providers (and particularly for hospitals), and then addresses the broader policy implications for member states of the European Union (EU) and for the commission itself. Against the background of the European Commission's Seventh Framework Programme, it then outlines a number of future areas for research to inform policy and practice in quality and safety in Europe. The article concludes that at this stage, a unique EU-wide quality improvement system for hospitals does not seem to be feasible or effective. Because of possible future community action in this field, attention should focus on the use of existing research on quality and safety strategies in healthcare, with the aim of combining soft measures to accelerate mutual learning. Concrete measures should be considered only in areas for which there is substantial evidence and effective implementation can be ensured.
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Affiliation(s)
- O Groene
- Avedis Donabedian University Institute, UAB, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
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