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Hill MJ, Sapp S, McCants S, Campbell J, Taylor A, Stockman JK, Santa Maria D. An Examination of Perceptions among Black Women on Their Awareness of and Access to Pre-Exposure Prophylaxis (PrEP). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1084. [PMID: 39200693 PMCID: PMC11354061 DOI: 10.3390/ijerph21081084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/09/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024]
Abstract
Cisgender Black women (CBW) experience 67% of new HIV diagnoses among women in the South. Progress toward ending the HIV epidemic requires researchers to explore perceptions of factors related to the decision to initiate pre-exposure prophylaxis (PrEP) among CBW. Qualitative methods were used to explore how social and structural constructs influence individual decisions to use PrEP among 20 CBW through focus groups. The thematic data analysis identified how facilitators and barriers to PrEP uptake aligned with an external locus of control (LOC) [e.g., media influences on understanding of PrEP] or an internal LOC (e.g., awareness of personal vulnerability to HIV). Several participants highlighted that their PrEP knowledge was rooted in an external LOC, such as media campaigns. A participant stated, 'But even with the commercial, it wasn't representation for me.' Another participant described her personal HIV vulnerability in her sexual relationship as an internal LOC, stating, 'Not ignorance, it's maybe just not accepting the true reality of this can be contracted even from someone that you believe that you trust.' Due to gaps in media marketing, healthcare providers should be aware that some female patients may perceive that PrEP is not for them. Provider-led sexual health discussions are urgently needed to bridge the gap between PrEP eligibility and initiation.
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Affiliation(s)
- Mandy J. Hill
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA; (S.S.); (A.T.)
| | - Sarah Sapp
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA; (S.S.); (A.T.)
| | - Shadawn McCants
- Allies in Hope Houston, Houston, TX 77030, USA; (S.M.); (J.C.)
| | | | - Akeria Taylor
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA; (S.S.); (A.T.)
| | - Jamila K. Stockman
- Department of Medicine, University of California, La Jolla, San Diego, CA 92093, USA;
| | - Diane Santa Maria
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA;
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2
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Donohue E, Halgunseth LC, Mauldin L, Donorfio LKM, Bellizzi KM. Parent-Child Grief Interactions: A Qualitative Analysis and Conceptual Framework of the Lived Experiences of Young Widowed Parents. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231169139. [PMID: 37028444 DOI: 10.1177/00302228231169139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
A young parent's death is an unexpected event that incurs family stress and grief for the surviving parent and young children. However, few studies have examined widowed parents' grief experiences and parent-child interactions following a co-parent's death. Guided by phenomenology, this qualitative study examined the lived experiences of (N = 12) surviving parents grieving the loss of their co-parent. Data were collected using semi-structured interviews and analyzed using an inductive analytic procedure. Findings included themes of (1) not showing grief with child; (2) talking through grief/emotions with child; (3) maintaining connection between deceased parent and child; (4) timing of sharing things with children; and (5) utilizing bereavement and group support. These findings suggest that support services for surviving parents include providing information to them about the timing of when to share mementos with children and psychoeducation on emotion sharing and masking as part of the grief process with young children.
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Affiliation(s)
- Erin Donohue
- Department of Psychology, College of Saint Benedict and Saint John's University, St Joseph, MN, USA
| | - Linda C Halgunseth
- Department of Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
| | - Laura Mauldin
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Laura K M Donorfio
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Keith M Bellizzi
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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Velie RE, Poulos HM, Green JM. Exploring lake user and manger knowledge of aquatic invasive species in New Hampshire freshwater lake systems, USA. J Nat Conserv 2023. [DOI: 10.1016/j.jnc.2023.126405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Wilf-Miron R, Avni S, Valinsky L, Myers V, Ziv A, Peretz G, Luxenburg O, Saban M, Feder-Bubis P. Developing a National Set of Health Equity Indicators Using a Consensus Building Process. Int J Health Policy Manag 2022; 11:1522-1532. [PMID: 34273926 PMCID: PMC9808363 DOI: 10.34172/ijhpm.2021.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/30/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Considerable health inequities documented in Israel between communities, populations and regions, undermine the rights of all citizens to optimal health. The first step towards health equity is agreement on a set of national indicators, reflecting equity in healthcare provision and health outcomes, and allowing monitoring of the impact of interventions on the reduction of disparities. We describe the process of reaching a consensus on a defined set of national equity indicators. METHODS The study was conducted between January 2019 and June 2020, in a multistage design: (A) Identifying appropriate and available inequity measures via interviews with stakeholders. (B) Agreement on the screening criteria (public health importance; gap characteristics; potential for change; public interest) and relative weighting. (C) Constructing the consultation framework as an online, 3-round Delphi technique, with a range of experts recruited from the health, welfare and education sectors. RESULTS Participants were of diverse age, gender, geographic location, religion and ethnicity, and came from academia, healthcare provision, government ministries and patient representative groups. Thirty measures of inequity, presented to participants, represented the following domains: Health promotion (11 indicators), acute and chronic morbidity (11), life expectancy and mortality (2), health infrastructures and affordability of care (4), education and employment (2). Of the 77 individuals contacted, 75 (97%) expressed willingness to participate, and 55 (73%) completed all three scoring rounds. The leading ten indicators were: Diabetes care, childhood obesity, adult obesity, distribution of healthcare personnel, fatal childhood injuries, cigarette smoking, infant mortality, ability to afford care, access to psychotherapy and distribution of hospital beds. Agreement among raters, measured as intra-class correlation coefficient (ICC), was 0.75. CONCLUSION A diverse range of consultants reached a consensus on the most important national equity indicators, including both clinical and system indicators. Results should be used to guide governmental decision-making and inter-sectoral strategies, furthering the pursuit of a more equitable healthcare system.
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Affiliation(s)
- Rachel Wilf-Miron
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Avni
- Strategic and Economic Planning Administration, Ministry of Health, Jerusalem, Israel
| | - Liora Valinsky
- Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Vicki Myers
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Arnona Ziv
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Gidi Peretz
- Strategic and Economic Planning Administration, Ministry of Health, Jerusalem, Israel
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Mor Saban
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Paula Feder-Bubis
- Department of Health Policy and Management, Faculty of Health Sciences & Guildford Glazer Faculty of Business and management, Ben Gurion University of the Negev, Beersheba, Israel
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Howard I, Cameron P, Castrén M, Wallis L, Lindström V. Multi-method versus single method appraisal of clinical quality indicators for the emergency medical services. Int J Qual Health Care 2021; 33:6047025. [PMID: 33367636 DOI: 10.1093/intqhc/mzaa171] [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: 07/31/2020] [Revised: 11/30/2020] [Accepted: 12/24/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Quality Indicator (QI) appraisal protocol is a novel methodology that combines multiple appraisal methods to comprehensively assess the 'appropriateness' of QIs for a particular healthcare setting. However, they remain inadequately explored compared to the single appraisal method approach. OBJECTIVES To describe and test a multi-method QI appraisal protocol versus the single method approach, against a series of QIs previously identified as potentially relevant to the prehospital emergency care setting. METHODS An appraisal protocol was developed consisting of two categorical-based appraisal methods, combined with the qualitative analysis of the discussion generated during the consensus application of each method. The output of the protocol was assessed and compared with the application and output of each method. Inter-rater reliability (IRR) of each particular method was evaluated prior to group consensus rating. Variation in the number of non-valid QIs and the proportion of non-valid QIs identified between each method and the protocol were compared and assessed. RESULTS There was mixed IRR of the individual methods. There was similarly low-to-moderate correlation of the results obtained between the particular methods (Spearman's rank correlation = 0.42, P < 0.001). From a series of 104 QIs, 11 non-valid QIs were identified that were shared between the individual methods. A further 19 non-valid QIs were identified and not shared by each method, highlighting the benefits of a multi-method approach. The outcomes were additionally evident in the group discussion analysis, which in and of itself added further input that would not have otherwise been captured by the individual methods alone. CONCLUSION The utilization of a multi-method appraisal protocol offers multiple benefits, when compared to the single appraisal approach, and can provide the confidence that the outcomes of the appraisal will ensure a strong foundation on which the QI framework can be successfully implemented.
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Affiliation(s)
- Ian Howard
- Department of Clinical Science and Education, Sjukhusbacken 10, Södersjukhuset, Karolinska Institutet, Stockholm 171 77, Sweden.,Division of Emergency Medicine, Private Bag X1, Matieland, Stellenbosch University, Stellenbosch, Western Cape 7602, South Africa
| | - Peter Cameron
- School of Public Health and Preventative Medicine, 553 St Kilda Road, Monash University, Melbourne, VIC 3800, Australia
| | - Maaret Castrén
- Department of Emergency Medicine and Services, Topeliuksenkatu 5, Helsinki University Hospital, Helsinki 00280, Finland
| | - Lee Wallis
- Division of Emergency Medicine, Private Bag X1, Matieland, Stellenbosch University, Stellenbosch, Western Cape 7602, South Africa.,Division of Emergency Medicine, Private Bag X3, Rondebosch, University of Cape Town, Cape Town 7700, South Africa
| | - Veronica Lindström
- Department of Neurobiology, Care Sciences and Society, Section of Nursing, Nobels väg 5, Solna, Karolinska Institutet, Stockholm 171 77, Sweden.,Academic EMS, Sjukhusbacken 10, Södersjukhuset, Karolinska Institutet, Stockholm 171 77, Sweden
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Curtis K, Nahidi S, Gabbe B, Vallmuur K, Martin K, Shaban RZ, Christey G. Identifying the priority challenges in trauma care delivery for Australian and New Zealand trauma clinicians. Injury 2020; 51:2053-2058. [PMID: 32698960 DOI: 10.1016/j.injury.2020.07.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/09/2020] [Accepted: 07/14/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Injury is a leading cause of death and disability world-wide. Little is known about the day-to-day challenges the trauma clinicians face in their practice that they feel could be improved through an increased evidence base. This study explored and ranked the trauma clinical practice research priorities of trauma care professionals across Australia and New Zealand. METHODS A modified-Delphi study was conducted between September 2019 and January 2020. The study employed two rounds of online survey of trauma professionals from relevant Australia and New Zealand professional organisations using snowballing method. Participants were asked to rank the importance of 29 recommendations, each corresponding to a key challenge in trauma care delivery. Decisions on the priorities of the challenges were determined by a consensus of >70% of respondents ranking the challenge as important or very important. RESULTS One hundred and fifty-five participants completed Round One, and 106 participants completed Round Two. A total of 15 recommendations reached >70% in Round One. Nine recommendations also reached >70% consensus in Round Two. Recommendations ranked highest were 'Caring for elderly trauma patients', 'Identifying and validating key performance indicators for trauma system benchmarking and improvement', and 'Management of traumatic brain injury'. CONCLUSION This study identified the priority areas for trauma research as determined by clinician ranking of the most important for informing and improving their practice. Addressing these areas generates potential to improve the quality and safety of trauma care in Australian and New Zealand.
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Affiliation(s)
- Kate Curtis
- The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney, Australia; Trauma Quality Improvement Sub-Committee, Royal Australasian College of Surgeons, Australia; Australasian Trauma Society, Australia; Australian Trauma Quality Improvement Program (AusTQIP), Australia; Illawarra Shoalhaven Local Health District, NSW, Australia; University of Wollongong, Faculty of Science, Medicine and Health, Wollongong, Australia.
| | - Shizar Nahidi
- The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney, Australia
| | - Belinda Gabbe
- Australasian Trauma Society, Australia; Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia
| | - Kirsten Vallmuur
- Australian Trauma Quality Improvement Program (AusTQIP), Australia; Queensland University of Technology, Australian Centre for Health Services Innovation, Faculty of Health, School of Public Health and Social Work, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland Health, Australia
| | - Katherine Martin
- Trauma Quality Improvement Sub-Committee, Royal Australasian College of Surgeons, Australia; Australasian Trauma Society, Australia
| | - Ramon Z Shaban
- The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW, Australia; Centre for Infectious Diseases and Microbiology and the Directorate of Nursing, Midwifery and Clinical Governance, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Grant Christey
- Trauma Quality Improvement Sub-Committee, Royal Australasian College of Surgeons, Australia; Australasian Trauma Society, Australia; Australian Trauma Quality Improvement Program (AusTQIP), Australia; Centre for Infectious Diseases and Microbiology and the Directorate of Nursing, Midwifery and Clinical Governance, Western Sydney Local Health District, Westmead, NSW, Australia; Waikato District Health Board, Hamilton, New Zealand; Waikato Clinical School, University of Auckland, Auckland, New Zealand
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7
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Perlin A, Kroshus E. Content analysis of concussion education for coaches of youth and high school sport. Brain Inj 2020; 34:905-913. [PMID: 32362145 DOI: 10.1080/02699052.2020.1755894] [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] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Describe the extent to which concussion education provided to coaches of US high school and youth sport is inclusive of information necessary for them to engage in target behaviors related to the prevention, identification and management of concussion. METHODS Sport organizations included in the sample were US state high school governing bodies and national governing bodies (NGBs) for youth sports with the highest concussion incidence rates. The concussion education resources made available online for coaches by these organizations were coded for content relevant to concussion prevention, identification and management. RESULTS All but one state high school governing body required coach concussion education, two NGBs required coach education, seven recommended it and only one did not require or recommend it. All educational materials covered at least 84% (n = 16/19) of the relevant knowledge domains. DISCUSSION Existing concussion education for coaches is addressing most, but not all, topics that may help coaches engage in concussion prevention, identification and management. Additional program development work is warranted to augment educational content related to coach communication about concussion safety with athletes and parents. Content appropriateness notwithstanding, further research is needed to understand the acceptability, efficacy, and implementation of concussion education for coaches.
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Affiliation(s)
- Amit Perlin
- Tulane Brain Institute, Tulane University New Orleans, Louisiana, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute , Seattle, Washington, USA
| | - Emily Kroshus
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute , Seattle, Washington, USA.,Department of Pediatrics, University of Washington , Seattle, Washington, USA
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Education, exposure and experience of prehospital teams as quality indicators in regional trauma systems. Eur J Emerg Med 2017; 23:274-278. [PMID: 25715020 DOI: 10.1097/mej.0000000000000255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Indicators to measure the quality of trauma care may be instrumental in benchmarking and improving trauma systems. This retrospective, observational study investigated whether data on three indicators for competencies of Dutch trauma teams (i.e. education, exposure, experience; agreed upon during a prior Delphi procedure) can be retrieved from existing registrations. The validity and distinctive power of these indicators were explored by analysing available data in four regions. METHODS Data of all polytrauma patients treated by the Helicopter Emergency Medical Services were collected retrospectively over a 1-year period. During the Delphi procedure, a polytrauma patient was defined as one with a Glasgow Coma Scale of 9 or less or a Paediatric Coma Scale of 9 or less, together with a Revised Trauma Score of 10 or less. Information on education, exposure and experience of the Helicopter Emergency Medical Services physician and nurse were registered for each patient contact. RESULTS Data on 442 polytrauma patients could be retrieved. Of these, according to the Delphi consensus, 220 were treated by a fully competent team (i.e. both the physician and the nurse fulfilled the three indicators for competency) and 22 patients were treated by a team not fulfilling all three indicators for competency. Across the four regions, patients were treated by teams with significant differences in competencies (P=0.002). CONCLUSION The quality indicators of education, exposure and experience of prehospital physicians and nurses can be measured reliably, have a high level of usability and have distinctive power.
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9
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McKenzie E, Potestio ML, Boyd JM, Niven DJ, Brundin-Mather R, Bagshaw SM, Stelfox HT. Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making. Health Expect 2017; 20:1367-1374. [PMID: 28561887 PMCID: PMC5689241 DOI: 10.1111/hex.12576] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 12/21/2022] Open
Abstract
Background Providers have traditionally established priorities for quality improvement; however, patients and their family members have recently become involved in priority setting. Little is known about how to reconcile priorities of different stakeholder groups into a single prioritized list that is actionable for organizations. Objective To describe the decision‐making process for establishing consensus used by a diverse panel of stakeholders to reconcile two sets of quality improvement priorities (provider/decision maker priorities n=9; patient/family priorities n=19) into a single prioritized list. Design We employed a modified Delphi process with a diverse group of panellists to reconcile priorities for improving care of critically ill patients in the intensive care unit (ICU). Proceedings were audio‐recorded, transcribed and analysed using qualitative content analysis to explore the decision‐making process for establishing consensus. Setting and participants Nine panellists including three providers, three decision makers and three family members of previously critically ill patients. Results Panellists rated and revised 28 priorities over three rounds of review and reached consensus on the “Top 5” priorities for quality improvement: transition of patient care from ICU to hospital ward; family presence and effective communication; delirium screening and management; early mobilization; and transition of patient care between ICU providers. Four themes were identified as important for establishing consensus: storytelling (sharing personal experiences), amalgamating priorities (negotiating priority scope), considering evaluation criteria and having a priority champion. Conclusions Our study demonstrates the feasibility of incorporating families of patients into a multistakeholder prioritization exercise. The approach described can be used to guide consensus building and reconcile priorities of diverse stakeholder groups.
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Affiliation(s)
| | - Melissa L Potestio
- Alberta Health Services, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jamie M Boyd
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.,W21C Research and Innovation Centre, University of Calgary, Calgary, AB, Canada
| | - Daniel J Niven
- Alberta Health Services, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Sean M Bagshaw
- Department of Critical Care, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Calgary, AB, Canada
| | - Henry T Stelfox
- Alberta Health Services, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
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Fekri O, Leeb K, Gurevich Y. Systematic approach to evaluating and confirming the utility of a suite of national health system performance (HSP) indicators in Canada: a modified Delphi study. BMJ Open 2017; 7:e014772. [PMID: 28404612 PMCID: PMC5775456 DOI: 10.1136/bmjopen-2016-014772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Evaluating an existing suite of health system performance (HSP) indicators for continued reporting using a systematic criteria-based assessment and national consensus conference. DESIGN Modified Delphi approach with technical and leadership groups, an online survey of stakeholders and convening a national consensus conference. SETTING A national health information steward, the Canadian Institute for Health Information (CIHI). PARTICIPANTS A total of 73 participants, comprised 61 conference attendants/stakeholders from across Canada and 12 national health information steward staff. PRIMARY AND SECONDARY OUTCOME MEASURES Indicator dispositions of retention, additional stakeholder consultation, further redevelopment or retirement. RESULTS 4 dimensions (usability, importance, scientific soundness and feasibility) typically used to select measures for reporting were expanded to 18 criteria grouped under the 4 dimensions through a process of research and testing. Definitions for each criterion were developed and piloted. Once the definitions were established, 56 of CIHI's publicly reported HSP indicators were evaluated against the criteria using modified Delphi approaches. Of the 56 HSP indicators evaluated, 9 measures were ratified for retirement, 7 were identified for additional consultation and 3 for further research and development. A pre-Consensus Conference survey soliciting feedback from stakeholders on indicator recommendations received 48 responses (response rate of 79%). CONCLUSIONS A systematic evaluation of HSP indicators informed the development of objective recommendations for continued reporting. The evaluation was a fruitful exercise to identify technical considerations for calculating indicators, furthering our understanding of how measures are used by stakeholders, as well as harmonising actions that could be taken to ensure relevancy, reduce indicator chaos and build consensus with stakeholders.
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Affiliation(s)
- Omid Fekri
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - Kira Leeb
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - Yana Gurevich
- Canadian Institute for Health Information, Toronto, Ontario, Canada
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Ohtera S, Kanazawa N, Ozasa N, Ueshima K, Nakayama T. Proposal of quality indicators for cardiac rehabilitation after acute coronary syndrome in Japan: a modified Delphi method and practice test. BMJ Open 2017; 7:e013036. [PMID: 28132004 PMCID: PMC5278298 DOI: 10.1136/bmjopen-2016-013036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Cardiac rehabilitation is underused and its quality in practice is unclear. A quality indicator is a measurable element of clinical practice performance. This study aimed to propose a set of quality indicators for cardiac rehabilitation following an acute coronary event in the Japanese population and conduct a small-size practice test to confirm feasibility and applicability of the indicators in real-world clinical practice. DESIGN AND SETTING This study used a modified Delphi technique (the RAND/UCLA appropriateness method), a consensus method which involves an evidence review, a face-to-face multidisciplinary panel meeting and repeated anonymous rating. Evidence to be reviewed included clinical practice guidelines available in English or Japanese and existing quality indicators. Performance of each indicator was assessed retrospectively using medical records at a university hospital in Japan. PARTICIPANTS 10 professionals in cardiac rehabilitation for the consensus panel. RESULTS In the literature review, 23 clinical practice guidelines and 16 existing indicators were identified to generate potential indicators. Through the consensus-building process, a total of 30 indicators were assessed and finally 13 indicators were accepted. The practice test (n=39) revealed that 74% of patients underwent cardiac rehabilitation. Median performance of process measures was 93% (IQR 46-100%). 'Communication with the doctor who referred the patient to cardiac rehabilitation' and 'continuous participation in cardiac rehabilitation' had low performance (32% and 38%, respectively). CONCLUSIONS A modified Delphi technique identified a comprehensive set of quality indicators for cardiac rehabilitation. The single-site, small-size practice test confirmed that most of the proposed indicators were measurable in real-world clinical practice. However, some clinical processes which are not covered by national health insurance in Japan had low performance. Further studies will be needed to clarify and improve the quality of care in cardiac rehabilitation.
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Affiliation(s)
- Shosuke Ohtera
- Department of Health Informatics, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Natsuko Kanazawa
- Clinical Research Center, National Hospital Organization, Tokyo, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Kenji Ueshima
- Department of EBM Research, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
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12
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Soria-Aledo V, Angel-Garcia D, Martinez-Nicolas I, Rebasa Cladera P, Cabezali Sanchez R, Pereira García LF. Development and pilot study of an essential set of indicators for general surgery services. Cir Esp 2016; 94:502-510. [PMID: 27499298 DOI: 10.1016/j.ciresp.2016.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 06/06/2016] [Accepted: 06/27/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION At present there is a lack of appropriate quality measures for benchmarking in general surgery units of Spanish National Health System. The aim of this study is to present the selection, development and pilot-testing of an initial set of surgical quality indicators for this purpose. METHODS A modified Delphi was performed with experts from the Spanish Surgeons Association in order to prioritize previously selected indicators. Then, a pilot study was carried out in a public hospital encompassing qualitative analysis of feasibility for prioritized indicators and an additional qualitative and quantitative three-rater reliability assessment for medical record-based indicators. Observed inter-rater agreement, prevalence adjusted and bias adjusted kappa and non-adjusted kappa were performed, using a systematic random sample (n=30) for each of these indicators. RESULTS Twelve out of 13 proposed indicators were feasible: 5 medical record-based indicators and 7 indicators based on administrative databases. From medical record-based indicators, 3 were reliable (observed agreement >95%, adjusted kappa index >0.6 or non-adjusted kappa index >0.6 for composites and its components) and 2 needed further refinement. CONCLUSIONS Currently, medical record-based indicators could be used for comparison purposes, whilst further research must be done for validation and risk-adjustment of outcome indicators from administrative databases. Compliance results in the adequacy of informed consent, diagnosis-to-treatment delay in colorectal cancer, and antibiotic prophylaxis show room for improvement in the pilot-tested hospital.
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Affiliation(s)
- Victor Soria-Aledo
- Sección de Gestión de Calidad de la Asociación Española de Cirujanos, Servicio de Cirugía General, Hospital Morales Meseguer, Murcia, España; Departamento de Cirugía, Facultad de Medicina, Universidad de Murcia, Murcia, España
| | - Daniel Angel-Garcia
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Ismael Martinez-Nicolas
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
| | - Pere Rebasa Cladera
- Sección de Gestión de Calidad de la Asociación Española de Cirujanos, Departamento de Cirugía, Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, España
| | - Roger Cabezali Sanchez
- Sección de Gestión de Calidad de la Asociación Española de Cirujanos, Servicio de Cirugía, Fundación Hospital de Calahorra, Calahorra, La Rioja, España
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Stelfox HT, Straus SE. Measuring quality of care: considering conceptual approaches to quality indicator development and evaluation. J Clin Epidemiol 2013; 66:1328-37. [PMID: 24018342 DOI: 10.1016/j.jclinepi.2013.05.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 04/25/2013] [Accepted: 05/17/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In this article, we describe one approach for developing and evaluating quality indicators. STUDY DESIGN AND SETTING We focus on describing different conceptual approaches to quality indicator development, review one approach for developing quality indicators, outline how to evaluate quality indicators once developed, and discuss quality indicator maintenance. RESULTS The key steps for developing quality indicators include specifying a clear goal for the indicators; using methodologies to incorporate evidence, expertise, and patient perspectives; and considering contextual factors and logistics of implementation. The Strategic Framework Board and the National Quality Measure Clearinghouse have developed criteria for evaluating quality indicators that complement traditional psychometric evaluations. Optimal strategies for quality indicator maintenance and dissemination have not been determined, but experiences with clinical guideline maintenance may be informative. CONCLUSION For quality indicators to effectively guide quality improvement efforts, they must be developed, evaluated, maintained, and implemented using rigorous evidence-informed practices.
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Affiliation(s)
- Henry T Stelfox
- Department of Critical Care Medicine, Institute for Public Health, University of Calgary, Teaching Research & Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada T2N 4Z6; Department of Medicine, Institute for Public Health, University of Calgary, Teaching Research & Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada T2N 4Z6; Department of Community Health Sciences, Institute for Public Health, University of Calgary, Teaching Research & Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada T2N 4Z6.
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