1
|
Sharma S, Beadle E, Caton E, Farrington K, Radnor Z. The Role of Patient-Reported Experience and Outcome Measures in Kidney Health Equity-Oriented Quality Improvement. Semin Nephrol 2024; 44:151553. [PMID: 39214734 DOI: 10.1016/j.semnephrol.2024.151553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Risk, prevalence, management, and outcomes in chronic kidney disease (CKD) are influenced by social and broader determinants of health. Consequently, there are wide-ranging kidney health inequities. As patients are key stakeholders, their perspectives on the care they receive and on health status are central in guiding health system improvement, particularly to reduce the impact of disadvantage. Patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) are important self-report tools in quality improvement, acting to guide initatives aimed at enhancing access to timely and relevant support. However, the extent to which PREMs and PROMs address the reduction of kidney health inequities is unclear. The aim of this review is to summarize how PREMs and PROMs are designed and implemented, highlighting key dimensions that are integral to health equity-oriented quality improvement in kidney care. There are several problems yet to be overcome so that such tools do not unintentionally reproduce kidney health gaps. Inclusive generation of the scope of tools, transparent reporting on attributes of patients who engage, and embedding PREMs and PROMs within a framework of value-based quality improvement is fundamental to their impact as part of equitable health system transformation.
Collapse
Affiliation(s)
- Shivani Sharma
- College of Business and Social Sciences, Aston University, Birmingham, UK.
| | - Emily Beadle
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Emma Caton
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Ken Farrington
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Renal Unit, Lister Hospital, East and North Hertfordshire NHS Foundation Trust, Stevenage, UK
| | - Zoe Radnor
- College of Business and Social Sciences, Aston University, Birmingham, UK
| |
Collapse
|
2
|
Gottumukkala V, Vetter TR, Gan TJ. Perioperative Medicine: What the Future Can Hold for Anesthesiology. Anesth Analg 2023; 136:628-635. [PMID: 36928147 DOI: 10.1213/ane.0000000000006412] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Vijaya Gottumukkala
- From the Department of Anesthesiology and Perioperative Medicine, Division of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Tong J Gan
- Division of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
3
|
Zisman-Ilani Y, Obeidat R, Fang L, Hsieh S, Berger Z. Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions. JMIR Form Res 2020; 4:e18223. [PMID: 32744509 PMCID: PMC7432149 DOI: 10.2196/18223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/21/2020] [Accepted: 05/13/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Shared decision making (SDM) is a health communication model that evolved in Europe and North America and largely reflects the values and medical practices dominant in these areas. OBJECTIVE This study aims to understand the beliefs, perceptions, and practices related to SDM and patient-centered care (PCC) of physicians in Israel, Jordan, and the United States. METHODS A hypothesis-generating comparative survey study was administered to physicians from Israel, Jordan, and the United States. RESULTS A total of 36 surveys were collected via snowball sampling (Jordan: n=15; United States: n=12; Israel: n=9). SDM was perceived as a way to inform patients and allow them to participate in their care. Barriers to implementing SDM varied based on place of origin; physicians in the United States mentioned limited time, physicians in Jordan reported that a lack of patient education limits SDM practices, and physicians in Israel reported lack of communication training. Most US physicians defined PCC as a practice for prioritizing patient preferences, whereas both Jordanian and Israeli physicians defined PCC as a holistic approach to care and to prioritizing patient needs. Barriers to implementing PCC, as seen by US physicians, were mostly centered on limited appointment time and insurance coverage. In Jordan and Israel, staff shortage and a lack of resources in the system were seen as major barriers to PCC implementation. CONCLUSIONS The study adds to the limited, yet important, literature on SDM and PCC in areas of the world outside the United States, Canada, Australia, and Western Europe. The study suggests that perceptions of PCC might widely differ among these regions, whereas concepts of SDM might be shared. Future work should clarify these differences.
Collapse
Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Rana Obeidat
- Faculty of Nursing, Zarqa University, Zarqa, Jordan
| | - Lauren Fang
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sarah Hsieh
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Zackary Berger
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| |
Collapse
|
4
|
Implementation of Febrile Infant Management Guidelines Reduces Hospitalization. Pediatr Qual Saf 2020; 5:e252. [PMID: 32190797 PMCID: PMC7056289 DOI: 10.1097/pq9.0000000000000252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 12/18/2019] [Indexed: 12/21/2022] Open
Abstract
Supplemental Digital Content is available in the text. The clinical management of well-appearing febrile infants 7−60 days of age remains variable due in part to multiple criteria differentiating the risk of a serious bacterial infection. The purpose of this quality improvement study was to standardize risk stratification in the emergency department and length of stay in the inpatient unit by implementing an evidence-based clinical practice guideline (CPG).
Collapse
|
5
|
Abstract
The rising prominence of value-based health care and population health management supports evolving perioperative surgical home (PSH) models that rely on continuously evolving evidence-based best practice and telemedicine and telehealth, including mobile technologies and connectivity. To successfully deliver greater perioperative valued-based care and to effectively contribute to sustained and meaningful perioperative population health management, the scope of existing perioperative management and its associated services and care provider skills must be expanded. This article focuses on the PSH model as continued opportunity and mechanism for delivering greater value-based, comprehensive perioperative assessment and global optimization of surgical patients.
Collapse
Affiliation(s)
- Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA; Department of Population Health, Dell Medical School at the University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA.
| |
Collapse
|
6
|
Abstract
To successfully deliver greater perioperative value-based care and to effectively contribute to sustained and meaningful perioperative population health management, the scope of existing preoperative management and its associated services and care provider skills must be expanded. New models of preoperative management are needed, which rely extensively on continuously evolving evidence-based best practice, as well as telemedicine and telehealth, including mobile technologies and connectivity. Along with conventional comorbidity optimization, prehabilitation can effectively promote enhanced postoperative recovery. This article focuses on the opportunities and mechanisms for delivering value-based, comprehensive preoperative assessment and global optimization of the surgical patient.
Collapse
Affiliation(s)
- Neil N Shah
- Department of Medicine, Dell Medical School, The University of Texas at Austin, Health Discovery Building, 1701 Trinity Street, Austin, TX 78712-1875, USA
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA; Department of Population Health, Dell Medical School, The University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA.
| |
Collapse
|
7
|
Graffigna G, Barello S. Spotlight on the Patient Health Engagement model (PHE model): a psychosocial theory to understand people's meaningful engagement in their own health care. Patient Prefer Adherence 2018; 12:1261-1271. [PMID: 30050288 PMCID: PMC6056150 DOI: 10.2147/ppa.s145646] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The concept of patient engagement in health care is gaining more and more attention not only in the scientific literature, but also as a requirement in the everyday practices of health care organizations. In general terms, the growing body of literature devoted to patient engagement is mainly inspired by the sociological and public health perspectives, which have generated various theories and models trying to explain how people become active agents in their health and care management. However, theories focusing on the psychosocial dimensions intervening in the patient engagement experience are still limited. This paper proposes a psychosocial perspective on patient engagement and discusses the Patient Health Engagement model, which is an evidence-based psychological theory built on extensive qualitative narrative research and literature analysis aimed at explaining patient engagement and its development in the patients' perspective. The model has been applied to orient patient and professional educational interventions and has contributed to the generation of the first scientific measure of the psychological experience of patients' engagement in their own care (Patient Health Engagement scale). According to this theory, patient engagement is a developmental process that involves the recovered patients' ability to have a life projectuality and goal directedness - even if living with a disease. The paper will also discuss the theoretical origins of this model and will conduct a critical comparison of the theory with the Transtheoretical Model of Change developed by Prochaska and the five-stage grief theory by Kubler-Ross.
Collapse
Affiliation(s)
- Guendalina Graffigna
- Department of Psychology, EngageMinds HUB Research Center, Università Cattolica del Sacro Cuore, Milano, Italy,
| | - Serena Barello
- Department of Psychology, EngageMinds HUB Research Center, Università Cattolica del Sacro Cuore, Milano, Italy,
| |
Collapse
|
8
|
Devji TF, Madenci AL, Carpino E, Leahy IC, Samnaliev M, Dearden JL, Weil BR, Weldon CB, Cravero J. Safety and cost-effectiveness of port removal outside of the operating room among pediatric patients. J Pediatr Surg 2016; 51:1891-1895. [PMID: 27624563 DOI: 10.1016/j.jpedsurg.2016.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/24/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE The current emphasis on fiscally responsible health spending in the era of the Affordable Care Act and other health care reform necessitates cost-conscious delivery of care. "Value" in health care is defined as the quality of care divided by the cost. As such, health systems optimize value by providing the most cost-effective care possible without sacrificing safety or outcomes. Elective, minimal risk surgical procedures in children may be value-enhanced by moving from an operating room (OR) to a more cost-efficient setting. The purpose of this study was to assess the safety and cost of performing the removal of implantable central venous access devices ("ports") in locations other than the main OR. METHODS We compared port removal at three sites: 1. Main OR, 2. Satellite OR, and 3. Clinic Procedure Room. This was a mixed-methods study including a retrospective review of medical records and prospective observation/interviewing. To calculate cost without the inherent biases of hospital charges, costs, and payments, we utilized the methodology of time-driven activity based costing. Specifically, we recorded time spent by the patient in hospital facilities and with health care personnel. This duration was then weighted with the hourly cost of each health care professional and hospital space. The Mann-Whitney U test compared time and cost across the three sites. Overall cost at each site was divided by overall cost at the referent site (Main OR) to obtain a ratio of cost savings. RESULTS A total of 120 patients (40 per site) were included in the analysis. Demographic and clinical factors were not significantly different between sites. No complication occurred with port removal at any site. Time of the entire care episode was significantly decreased in the Clinic (median 161min, 95% confidence interval [CI] 134-188min), compared to the Main OR (median 235min, 95% confidence interval [CI] 209-251min) or Satellite OR (median 228min, 95% confidence interval [CI] 211-245min). Overall cost was decreased by 25% (95% CI: 13-34%) at the Clinic and by 6% (95% CI: -2-11%) at the Satellite OR, compared to the Main OR (referent, P<0.01). CONCLUSION In our study, port removal in the Clinic Procedure Room was not associated with increased risk of negative outcomes. Shifting port removal from the Main OR to the Clinic may result in substantial cost savings.
Collapse
Affiliation(s)
- Tehsina F Devji
- Department of Anesthesiology, Preoperative and Pain Medicine, Boston Children's Hospital, Boston, MA; Harvard School of Dental Medicine, Boston, MA
| | - Arin L Madenci
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Elizabeth Carpino
- Department of Anesthesiology, Preoperative and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Izabela C Leahy
- Department of Anesthesiology, Preoperative and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Mihail Samnaliev
- Department of Anesthesiology, Preoperative and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Jennifer L Dearden
- Department of Anesthesiology, Preoperative and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Brent R Weil
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Christopher B Weldon
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Joseph Cravero
- Department of Anesthesiology, Preoperative and Pain Medicine, Boston Children's Hospital, Boston, MA.
| |
Collapse
|
9
|
Trends, Predictors, and Outcomes of Stroke After Surgical Aortic Valve Replacement in the United States. Ann Thorac Surg 2015; 101:927-35. [PMID: 26611821 DOI: 10.1016/j.athoracsur.2015.08.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/19/2015] [Accepted: 08/14/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Postoperative stroke is a devastating complication after aortic valve replacement (AVR). Our objective was to use a large national database to identify the incidence of and risk factors for stroke after AVR, as well as to determine incremental mortality, resource use, and cost of stroke. METHODS We identified 360,437 patients who underwent isolated surgical AVR between 1998 and 2011 from the National Inpatient Sample (NIH) database. Mean age was 66 ± 32 years. Multivariable regression and propensity matching were used to identify risk factors and the effect of stroke on outcomes. Patients were stratified according to the Elixhauser comorbidity score (ECS) into low- (0-5), medium- (6-15), and high-risk (16+) categories. RESULTS Stroke after AVR occurred in 5,092 (1.45%) patients. The incidence of stroke declined from 1.69% in 1999 to 0.94% in 2011 (p < 0.001). Increasing age and higher comorbidities were the main predictors of stroke (each p < 0.001). The highest-volume centers (>200 AVRs/y) had the lowest rate of stroke (1.2%). After multivariable adjustment, high-volume centers had lower odds of stroke in medium-risk (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.37-0.94) and high-risk patients (OR, 0.39; 95% CI, 0.22-0.68) compared with the lowest-volume centers. For low-risk patients, volume was not associated with stroke. Patients who experienced stroke were hospitalized for 4 days longer, had an average of $10,496 higher costs, and had 2.74 (95% CI, 1.97-3.80) times higher odds of in-hospital mortality compared with those who did not experience stroke (all p < 0.001). CONCLUSIONS The incidence of stroke after AVR has decreased but remains a significant cause of morbidity in medium- and high-risk patients. Superior outcomes can be achieved in medium- to high-risk patients at high-volume centers.
Collapse
|
10
|
Lakhman Y, D'Anastasi M, Miccò M, Scelzo C, Vargas HA, Nougaret S, Sosa RE, Chi DS, Abu-Rustum NR, Hricak H, Sala E. Second-Opinion Interpretations of Gynecologic Oncologic MRI Examinations by Sub-Specialized Radiologists Influence Patient Care. Eur Radiol 2015; 26:2089-98. [PMID: 26494640 DOI: 10.1007/s00330-015-4040-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 09/21/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine if second-opinion review of gynaecologic oncologic (GynOnc) magnetic resonance imaging (MRI) by sub-specialized radiologists impacts patient care. METHODS 469 second-opinion MRI interpretations rendered by GynOnc radiologists were retrospectively compared to the initial outside reports. Two gynaecologic surgeons, blinded to the reports' origins, reviewed all cases with discrepancies between initial and second-opinion MRI reports and recorded whether these discrepancies would have led to a change in patient management defined as a change in treatment approach, counselling, or referral. Histopathology or minimum 6-month imaging follow-up were used to establish the diagnosis. RESULTS Second-opinion review of GynOnc MRIs would theoretically have affected management in 94/469 (20 %) and 101/469 (21.5 %) patients for surgeons 1 and 2, respectively. Specifically, second-opinion review would have theoretically altered treatment approach in 71/469 (15.1 %) and 60/469 (12.8 %) patients for surgeons 1 and 2, respectively. According to surgeons 1 and 2, these treatment changes would have prevented unnecessary surgery in 35 (7.5 %) and 31 (6.6 %) patients, respectively, and changed surgical procedure type/extent in 19 (4.1 %) and 12 (2.5 %) patients, respectively. Second-opinion interpretations were correct in 103 (83 %) of 124 cases with clinically relevant discrepancies between initial and second-opinion reports. CONCLUSIONS Expert second-opinion review of GynOnc MRI influences patient care. KEY POINTS • Outside gynaecologic oncologic MRI examinations are often submitted for a second-opinion review. • One-fifth of MRIs had important discrepancies between initial and second-opinion interpretations. • Second-opinion review of gynaecologic oncologic MRI is a valuable clinical service.
Collapse
Affiliation(s)
- Yulia Lakhman
- Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA.
| | - Melvin D'Anastasi
- Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA.,Institute for Clinical Radiology, University Hospitals Munich - Campus Grosshadern, Munich, Germany
| | - Maura Miccò
- Department of Bioimaging and Radiological Science, Catholic University "A. Gemelli" Hospital, Rome, Italy
| | - Chiara Scelzo
- Surgery Department, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy
| | - Hebert Alberto Vargas
- Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA
| | - Stephanie Nougaret
- Department of Imaging, CHU Montpellier, St. Eloi Hospital, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), Montpellier, France
| | - Ramon E Sosa
- Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA
| | - Dennis S Chi
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA
| |
Collapse
|
11
|
SHEN TONY, LEE ARIEL, SHEN CAROL, LIN C. The long tail and rare disease research: the impact of next-generation sequencing for rare Mendelian disorders. Genet Res (Camb) 2015; 97:e15. [PMID: 26365496 PMCID: PMC6863629 DOI: 10.1017/s0016672315000166] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 06/25/2015] [Accepted: 06/29/2015] [Indexed: 12/11/2022] Open
Abstract
There are an estimated 6000-8000 rare Mendelian diseases that collectively affect 30 million individuals in the United States. The low incidence and prevalence of these diseases present significant challenges to improving diagnostics and treatments. Next-generation sequencing (NGS) technologies have revolutionized research of rare diseases. This article will first comment on the effectiveness of NGS through the lens of long-tailed economics. We then provide an overview of recent developments and challenges of NGS-based research on rare diseases. As the quality of NGS studies improve and the cost of sequencing decreases, NGS will continue to make a significant impact on the study of rare diseases moving forward.
Collapse
Affiliation(s)
- TONY SHEN
- Rare Genomics Institute, 5225 Pooks Hills Road, Suite 1701N, Bethesda, MD 20814, USA
- Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110, USA
| | - ARIEL LEE
- Rare Genomics Institute, 5225 Pooks Hills Road, Suite 1701N, Bethesda, MD 20814, USA
- Nova Southeastern University, College of Osteopathic Medicine, 3301 College Avenue, Ft. Lauderdale, FL 333314-796, USA
| | - CAROL SHEN
- Rare Genomics Institute, 5225 Pooks Hills Road, Suite 1701N, Bethesda, MD 20814, USA
- Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110, USA
| | - C.JIMMY LIN
- Rare Genomics Institute, 5225 Pooks Hills Road, Suite 1701N, Bethesda, MD 20814, USA
| |
Collapse
|
12
|
Tieman J, Rawlings D, Taylor J, Adams A, Mills S, Vaz H, Banfield M. Supporting service change in palliative care: a framework approach. Int J Palliat Nurs 2014; 20:349-56. [PMID: 25062381 DOI: 10.12968/ijpn.2014.20.7.349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Palliative care services are increasingly identifying areas for improvement, then trying to create appropriate changes in response. Nurses in particular are often expected to take leading roles in quality improvement (QI) but are not necessarily trained or supported in these processes. METHODS A framework approach to change was developed to guide services through a change cycle and delivered via workshops by representatives of three Australian national projects. Participants were predominantly nurses (80%), with the majority (63.7%) over the age of 50. FINDINGS The workshops and the framework were positively evaluated, with participants feeling confident in a number of QI-related activities following workshop training. CONCLUSION Recognising and addressing problems in clinical practice and service delivery is an important way for nurses to ensure quality care for patients; however, they need support in developing the skills and knowledge that are essential to successful QI activities.
Collapse
|