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Tsuei SHT. Reflection on 30 years of Taiwanese national health insurance: Analysis of Taiwanese health system progress, challenges, and opportunities. J Formos Med Assoc 2024:S0929-6646(24)00350-4. [PMID: 39089963 DOI: 10.1016/j.jfma.2024.07.030] [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: 05/22/2024] [Revised: 07/21/2024] [Accepted: 07/28/2024] [Indexed: 08/04/2024] Open
Abstract
On the eve of Taiwan's National Health Insurance's 30th birthday, this study reviews the policy and performance trajectory of the Taiwanese health system. Taiwan has controlled their health spending well and grown increasingly reliant on private financing. The floating-point global budget payment preferentially rewards outpatient-based services, but this has not affected the hospital-centric market composition, which persists despite several primary-care friendly developments. The outcomes suggest improving health care workforce and resource availability, good patient-centredness, respectable technical efficiency, and impressive patient care satisfaction. However, there are worrisome trends for financial barriers to access and allocative efficiency. Evidence on clinical quality suggests that hospitals are performing well though the primary care setting might not be. Overall, the public remains satisfied despite signs of lagging improvement in health outcomes, worsening maternal mortality rate, and persistently incomplete financial risk protection. Identifying what drives the worsening financial barriers of access and persistent financial risk is necessary for further discussions on potential financing adjustments. Improving allocative efficiency could draw on a combination of supporting the functions and quality of primary care alongside patient-oriented education and incentives. Further data on causes of slow health status improvement and rebounding maternal mortality rate is necessary.
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Affiliation(s)
- Sian Hsiang-Te Tsuei
- Faculty of Medicine, University of British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Canada.
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2
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Liu M, Yu Q, Liu Y. Developing quality indicators for cancer hospitals in China: a national modified Delphi process. BMJ Open 2024; 14:e082930. [PMID: 38594187 PMCID: PMC11015267 DOI: 10.1136/bmjopen-2023-082930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVE Although demand and supply of cancer care have been rapidly increasing in recent decades, there is a lack of systemic quality measurement for cancer hospitals in China. This study aimed to develop a set of core indicators for measuring quality of care for cancer hospitals in China. DESIGN The development of quality indicators was based on a literature review and a two-round modified Delphi survey. The theoretical framework and initial indicators were identified through the comprehensive literature review, and the selection of quality indicators relied on experts' consensus on the importance and feasibility of indicators by the modified Delphi process. In addition, indicator weight was identified using the analytical hierarchical process method and percentage weight method. SETTING AND PARTICIPANTS A panel of leading experts including oncologists, cancer care nurses, quality management experts from various regions of China were invited to participate in the two-round modified Delphi process from October to December 2020. A total of 25 experts completed the two-round modified Delphi process. RESULTS The experts reached consensus on a set of 47 indicators, comprising 17 structure indicators, 19 process indicators and 11 outcome indicators. Experts gave much higher weight to outcome indicators (accounting for 53.96% relative weight) than to structure (16.34%) and process (29.70%) indicators. In addition, experts also showed concerns and gave suggestions on data availability of specific outcome indicators. CONCLUSIONS Drawing on the comprehensive literature review and the modified Delphi process, this study developed a core set of quality indicators that can be used to evaluate quality performance of cancer hospitals. This is helpful in supporting quality cancer care in China and will provide new insights into the systemic measurement of cancer care internationally.
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Affiliation(s)
- Meicen Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qingyuan Yu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Fernandes CJ, Gautham KS. Organization of care of infants with congenital diaphragmatic hernia-Building a high-functioning CDH program. J Perinatol 2024; 44:339-347. [PMID: 37798339 DOI: 10.1038/s41372-023-01789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/09/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
Infants born with congenital diaphragmatic hernia have high mortality and morbidity and require coordinated multidisciplinary care for optimal outcomes. Over the past several decades numerous articles have been published on the technical aspects of the care of these patients demonstrating both the variation in management across institutions as well as the desirability and need for standardization of care. Unfortunately, none have focused on the organization of care for CDH patients encompassing the range from early prenatal diagnosis to long-term postnatal care. However, to achieve optimal care and optimal outcomes, it is important to not only have excellent technical surgical and medical care but also to have an organized, systematic, and purposefully designed program for the delivery of healthcare to infants with this condition. In this article, based on our experience and drawing on general principles of building clinical programs, we describe the important elements of an ideal CDH program.
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Affiliation(s)
- Caraciolo J Fernandes
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA.
| | - Kanekal S Gautham
- Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, FL, USA
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McGowan JG, Martin GP, Krapohl GL, Campbell DA, Englesbe MJ, Dimick JB, Dixon-Woods M. What are the features of high-performing quality improvement collaboratives? A qualitative case study of a state-wide collaboratives programme. BMJ Open 2023; 13:e076648. [PMID: 38097243 PMCID: PMC10729078 DOI: 10.1136/bmjopen-2023-076648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Despite their widespread use, the evidence base for the effectiveness of quality improvement collaboratives remains mixed. Lack of clarity about 'what good looks like' in collaboratives remains a persistent problem. We aimed to identify the distinctive features of a state-wide collaboratives programme that has demonstrated sustained improvements in quality of care in a range of clinical specialties over a long period. DESIGN Qualitative case study involving interviews with purposively sampled participants, observations and analysis of documents. SETTING The Michigan Collaborative Quality Initiatives programme. PARTICIPANTS 38 participants, including clinicians and managers from 10 collaboratives, and staff from the University of Michigan and Blue Cross Blue Shield of Michigan. RESULTS We identified five features that characterised success in the collaboratives programme: learning from positive deviance; high-quality coordination; high-quality measurement and comparative performance feedback; careful use of motivational levers; and mobilising professional leadership and building community. Rigorous measurement, securing professional leadership and engagement, cultivating a collaborative culture, creating accountability for quality, and relieving participating sites of unnecessary burdens associated with programme participation were all important to high performance. CONCLUSIONS Our findings offer valuable learning for optimising collaboration-based approaches to improvement in healthcare, with implications for the design, structure and resourcing of quality improvement collaboratives. These findings are likely to be useful to clinicians, managers, policy-makers and health system leaders engaged in multiorganisational approaches to improving quality and safety.
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Affiliation(s)
- James G McGowan
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Graham P Martin
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Greta L Krapohl
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Dixon-Woods
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Negele D, Lauerer M, Nagel E, Ulrich V. How to further develop quality competition in the German healthcare system? Results of a Delphi expert study. Health Policy 2023; 138:104937. [PMID: 38039559 DOI: 10.1016/j.healthpol.2023.104937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Many international healthcare systems use quality competition to improve the quality of care. The corresponding instruments include quality measurement, public reporting, selective contracting, and pay for performance. The German healthcare system clearly shows that the possibilities are often limited in the status quo. Therefore, a need for practicable and evidence-based proposals are necessary to further the development of quality competition. METHODS We conducted a national analysis and an international comparison (Switzerland, Netherlands and USA) as a pre-study to derive recommendations. On this basis, we designed a Delphi study with a consensus objective. Experts from relevant stakeholder groups in the German healthcare system were selected using purposive sampling for this study. RESULTS The experts saw potential for quality improvement in the further development of quality competition. Quality measurement and public reporting were rated as empowering tools. There was mostly disagreement on whether quality competition should be further developed in a more regulatory or entrepreneur-based manner. However, there was a clear consensus that further development must be coordinated between the stakeholders, step-by-step and scientifically supported. In addition, the impulse should be supported by a legislatively introduced reform. CONCLUSIONS Finally, these empirically based recommendations highlight the need for a coordinated coexistence of a top-down and a bottom-up approach. The developed blueprint proposal serves as an impetus for practical considerations of implementation.
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Affiliation(s)
- Daniel Negele
- Chair of Public Finance, University of Bayreuth, VWL III, Bayreuth 95447, Germany; Institute for Medical Management and Health Sciences, University of Bayreuth, Bayreuth 95444, Germany.
| | - Michael Lauerer
- Institute for Medical Management and Health Sciences, University of Bayreuth, Bayreuth 95444, Germany
| | - Eckhard Nagel
- Institute for Medical Management and Health Sciences, University of Bayreuth, Bayreuth 95444, Germany
| | - Volker Ulrich
- Chair of Public Finance, University of Bayreuth, VWL III, Bayreuth 95447, Germany
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Chen M, Zhang X, Liu C, Chen H, Wang D, Liu C. Effects of public reporting of prescription indicators on patient choices: evidence from propensity scores matching. Front Pharmacol 2023; 14:1110653. [PMID: 37876730 PMCID: PMC10591321 DOI: 10.3389/fphar.2023.1110653] [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: 11/29/2022] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Background: Public reporting on health providers' performance (PRHPP) is increasingly used for empowering patients. This study aimed to test the effect of PRHPP using the theory of the consumer choice model. Methods: The study was conducted in 10 primary care institutions in Hubei province, China. Information related to the percentage of prescriptions requiring antibiotics, the percentage of prescriptions requiring injections, and average costs per prescription for each prescriber was calculated, ranked and displayed in a public place on a monthly basis. A questionnaire survey was undertaken on 302 patients 10 months after the initiation of the PRHPP, tapping into patient awareness, understanding, perceived value and use of the information in line with the theory of the consumer choice model. The fitness of data with the model was tested using structural equation modelling. The patients who were aware of the PRHPP were compared with those who were unaware of the PRHPP. The propensity score method (considering differences between the two groups of patients in age, gender, education, health and income) was used for estimating the effects of the PRHPP. Results: About 22% of respondents were aware of the PRHPP. Overall, the patients showed limited understanding, perceived value and use of the disclosed information. The data fit well into the consumer choice model. Awareness of the PRHPP was found to be associated with increased understanding of the antibiotic (p = 0.028) and injection prescribing indictors (p = 0.030). However, no significant differences in perceived value and use of the information (p > 0.097) were found between those who were aware and those who were unaware of the PRHPP. Conclusion: Although PRHPP may improve patient understanding of the prescribing performance indicators, its impacts on patient choices are limited due to low levels of perceived value and use of information from patients. Additional support is needed to enable patients to make informed choices using the PRHPP.
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Affiliation(s)
- Manli Chen
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China
- Research Center for the Development of Traditional Chinese Medicine, Key Research Institute of Humanities and Social Sciences of Hubei Province, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Haihong Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Dan Wang
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China
- Research Center for the Development of Traditional Chinese Medicine, Key Research Institute of Humanities and Social Sciences of Hubei Province, Wuhan, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Söderlund R. Signalling waiting times to citizens on public oral healthcare providers' websites. Acta Odontol Scand 2023; 81:517-527. [PMID: 37155352 DOI: 10.1080/00016357.2023.2204934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
Objective: The study aimed to analyse the usefulness of signalling waiting times to citizens on the websites of public primary oral healthcare providers in Finland. Finnish laws require this signalling.Material and methods: We gathered data with two cross-sectional surveys in 2021. One electronic questionnaire was for Finnish-speaking citizens in Southwest Finland. The other was for public primary oral healthcare managers (n = 159). We also gathered data on 15 public primary oral healthcare providers' websites. For the theoretical framework, we combined the agency and signalling theories.Results: Of the citizen respondents (n = 411), 57% knew about the waiting time signalling on the websites. The respondents considered waiting time a high-priority criterion in choosing a dentist, but they rarely searched for information anywhere on the choice of a dentist, wanting to visit the dentist they had earlier visited. The quality of signalled waiting times was low. One out of five managers (response rate 62%) answered that signalled waiting times were based on speculation.Conclusions: Waiting times were signalled to comply with the legislation rather than to inform citizens and to reduce information asymmetry. Further research is needed to acquire information on rethinking waiting time signalling and its desired goals.
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Affiliation(s)
- Riitta Söderlund
- Unit of Information Systems Science, University of Turku, Turku, Finland
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Sharma A, Logan B, Estrada-Merly N, Lehmann LE, Rangarajan HG, Preussler JM, Troy JD, Akard LP, Bhatt NS, Truong TH, Wood WA, Strouse C, Juckett M, Khera N, Rizzo D, Saber W. Impact of Public Reporting of Center-Specific Survival Analysis Scores on Patient Volumes at Hematopoietic Cell Transplant Centers. Transplant Cell Ther 2023:S2666-6367(23)01296-4. [PMID: 37220838 DOI: 10.1016/j.jtct.2023.05.013] [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: 04/20/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The Center for International Blood and Marrow Transplant Research (CIBMTR) reports the outcomes of allogeneic hematopoietic cell transplantation (alloHCT) at United States transplant centers (TC) annually through its Center-Specific Survival Analysis (CSA). The CSA compares the actual 1-year overall survival (OS) and predicted 1-year OS rate after alloHCT at each TC, which is then reported as 0 (OS as expected), -1 (OS worse than expected), or +1 (OS better than expected). OBJECTIVE We evaluated the impact of public reporting of TC performance on their alloHCT patient volumes. STUDY DESIGN Ninety-one TCs that serve adult or combined adult and pediatric populations and had CSA scores reported for 2012-2018 were included. We analyzed prior-calendar year TC volume, prior-calendar year CSA score, whether the CSA score had changed in the prior year from two years earlier, calendar year, TC type (adult only vs. combined adult and pediatric), and years of alloHCT experience for their impact on patient volumes. RESULTS A CSA score of -1, as compared with 0 or +1, was associated with an 8%-9% reduction in the mean TC volume (P < 0.001) in the subsequent year, adjusting for the prior year center volume. Additionally, being a TC neighboring an index TC with a -1 CSA score, was associated with a 3.5% increase in mean TC volume (P = 0.04). CONCLUSION Our data show that public reporting of CSA scores is associated with changes in alloHCT volumes at TCs. Additional investigation into the causes of this shift in patient volume and the impact on outcomes is ongoing.
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Affiliation(s)
- Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN.
| | - Brent Logan
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI; CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Noel Estrada-Merly
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Leslie E Lehmann
- Dana Farber Cancer Institute/Boston Children's Hospital, Boston, MA
| | - Hemalatha G Rangarajan
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Nationwide Children's Hospital, Columbus, OH
| | - Jaime M Preussler
- National Marrow Donor Program®/Be The Match®, CIBMTR® (Center for International Blood and Marrow Transplant Research), Minneapolis, MN
| | - Jesse D Troy
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Luke P Akard
- Indiana Blood and Marrow Transplantation, Franciscan Health, Indianapolis, IN
| | - Neel S Bhatt
- University of Washington School of Medicine, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplant, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Tony H Truong
- Division of Pediatric Oncology, Blood and Marrow Transplant, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - William A Wood
- Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Christopher Strouse
- Division of Hematology, Oncology, and Bone Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Mark Juckett
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | - Douglas Rizzo
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Wael Saber
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Deutsch A, Palmer L, Vaughan M, McMullen T, Kwon S, Karmarkar A, Ingber MJ. Reliability and Validity of the Inpatient Rehabilitation Facility Discharge Mobility and Self-Care Quality Measures. J Am Med Dir Assoc 2023; 24:723-728.e4. [PMID: 37030324 DOI: 10.1016/j.jamda.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/28/2023] [Accepted: 03/12/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE To describe the reliability and validity of the publicly reported facility-level quality measures Inpatient Rehabilitation Facility (IRF) Discharge Mobility Score for Medical Rehabilitation Patients ("Discharge mobility score") and IRF Discharge Self-Care Score for Medical Rehabilitation Patients ("Discharge self-care score"). DESIGN Observational study using standardized patient assessment data to examine facility-level split-half reliability and construct validity of quality measure scores. SETTING AND PARTICIPANTS All IRFs (n = 1117) in the United States with at least 20 Medicare stays. Facility-level quality measure scores were calculated from 2017 data on 428,192 Medicare (fee-for-service and Medicare Advantage) IRF patient stays. METHODS Using clinician-reported assessment data, we calculated facility-level mobility and self-care quality measure scores and examined reliability of these scores using split-half analysis and Pearson product-moment correlations, Spearman rank correlations, and intraclass correlation coefficients (ICC2,1). We examined construct validity of these scores by comparing facility-level quality measure scores by facility stroke disease-specific certification status. RESULTS Reported as percentages meeting or exceeding expectations, IRF quality measure scores ranged from 8.3% to 90.1% for mobility and 9.0% to 90.3% for self-care. IRF scores, when split in half to examine reliability, showed strong, positive correlations for the mobility (Pearson = 0.898, Spearman = 0.898, ICC = 0.898) and self-care (Pearson = 0.886, Spearman = 0.874, ICC = 0.886) scores. When stratified by provider volume, ICCs remained strong. Construct validity analyses showed IRFs with stroke disease-specific certification had higher mean and median scores than IRFs without certification, and a greater proportion of IRFs that were certified had higher scores. CONCLUSION AND IMPLICATIONS Our results support the reliability and construct validity of the IRF quality measures Discharge mobility and Discharge self-care scores. Reported as percentages meeting or exceeding expectations, these quality measures are designed to be more consumer-friendly compared to change scores.
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Nguyen OT, Turner K, Parekh A, Alishahi Tabriz A, Hanna K, Merlo LJ, Hong YR. Merit-based incentive payment system participation and after-hours documentation among US office-based physicians: Findings from the 2021 National Electronic Health Records Survey. J Eval Clin Pract 2023; 29:397-402. [PMID: 36416004 DOI: 10.1111/jep.13796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND After-hours documentation burden among US clinicians is often uncompensated work and has been associated with burnout, leading health systems to identify root causes and seek interventions to reduce this. A few studies have suggested quality programme participation (e.g., Merit-Based Incentive Payment System [MIPS]) was associated with a higher administrative burden. However, the association between MIPS participation and after-hours documentation has not been fully explored. Thus, this study aims to assess whether participation in the MIPS programme was independently associated with after-hours documentation burden. METHODS We used 2021 data from the National Electronic Health Records Survey. We used a multivariable ordinal logistic regression model to assess whether MIPS participation was associated with the amount of after-hours documentation burden when controlling for other factors. We controlled for physician age, specialty, sex, number of practice locations, number of physicians, practice ownership, whether team support (e.g., scribes) is used for documentation tasks, and whether the practice accepts Medicaid patients. RESULTS We included 1801 office-based US physician respondents with complete data for variables of interest. After controlling for other factors, MIPS participation was associated with greater odds of spending a greater number of hours on after-hours documentation (odds ratio = 1.44, 95% confidence interval 1.06-1.95). CONCLUSIONS MIPS participation may increase after-hours documentation burden among US office-based physicians, suggesting that physicians may require additional resources to more efficiently report data.
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Affiliation(s)
- Oliver T Nguyen
- Department of Health Outcomes and Behaviour, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Kea Turner
- Department of Health Outcomes and Behaviour, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.,Department of Oncologic Science, University of South Florida, Tampa, Florida, USA.,Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Arpan Parekh
- Department of Community Health & Family Medicine, University of Florida, Gainesville, Florida, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behaviour, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.,Department of Oncologic Science, University of South Florida, Tampa, Florida, USA
| | - Karim Hanna
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Lisa J Merlo
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida, USA
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11
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Kirkegaard A, Mitchell L, Ball L, Williams LT. Developing the Quality in Nutrition Care Model for Dietitians (QUINCE-MOD) in primary care: A mixed-method survey of healthcare consumers and professionals. J Hum Nutr Diet 2023; 36:311-322. [PMID: 35822586 PMCID: PMC10087511 DOI: 10.1111/jhn.13065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/16/2022] [Accepted: 06/24/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Evidence-based models are effective tools for informing quality improvement activities in health care. The Quality in Nutrition Care (QUINCE) model is an evidence-based model that describes quality nutrition care in the primary care setting but has not been applied to primary care dietetics. The present study comprised two phases. In the first phase, the study aimed to evaluate and compare healthcare consumers and professional perspectives on the importance of the 10 statements to understand their relevance for dietetics care. In the second phase, the study aimed to test and enhance the QUINCE model using healthcare consumer and professional responses to statements that were identified as relevant to primary care dietetics in the first phase. METHODS Quantitative and qualitative data were collected using an online survey comprising statements describing quality dietetic care adapted from the complexity literature. Quantitative data were analysed using descriptive statistical analysis to investigate statement importance as rated by participants using a six-point Likert scale. Qualitative content analysis was performed on the qualitative data using a deductive-inductive approach to identify patterns in the data. The QUINCE model was compared with identified patterns and modified as appropriate. RESULTS One hundred and fourteen consumers and 107 primary care professionals agreed on the importance of seven statements but expressed divergent views on the remaining three statements that addressed: (1) access to medical records; (2) access to performance and safety information; and (3) variation in care between dietitians. The QUINCE model was modified to produce the Quality in Nutrition Care Model for Dietitians (QUINCE-MOD) describing quality dietetic care in the primary care setting. CONCLUSIONS Consumers and professionals share views on some aspects of quality dietetic care but diverge on other aspects. The QUINCE-MOD is an evidence-based, complexity-informed model that describes components of quality relevant to primary care dietetics. The model should be applied at the practice level to reflect the unique perspective of quality at that level.
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Affiliation(s)
- Amy Kirkegaard
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Lana Mitchell
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Lauren Ball
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Lauren T Williams
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
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Chen J, Miraldo M. The impact of hospital price and quality transparency tools on healthcare spending: a systematic review. HEALTH ECONOMICS REVIEW 2022; 12:62. [PMID: 36515792 PMCID: PMC9749158 DOI: 10.1186/s13561-022-00409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Global spending on health was continuing to rise over the past 20 years. To reduce the growth rates, alleviate information asymmetry, and improve the efficiency of healthcare markets, global health systems have initiated price and quality transparency tools in the hospital industry in the last two decades. OBJECTIVE : The objective of this review is to synthesize whether, to what extent, and how hospital price and quality transparency tools affected 1) the price of healthcare procedures and services, 2) the payments of consumers, and 3) the premium of health insurance plans bonding with hospital networks. METHODS A literature search of EMBASE, Web of Science, Econlit, Scopus, Pubmed, CINAHL, and PsychINFO was conducted, from inception to Oct 31, 2021. Reference lists and tracked citations of retrieved articles were hand-searched. Study characteristics were extracted, and included studies were scored through a risk of bias assessment framework. This systematic review was reported according to the PRISMA guidelines and registered in PROSPERO with registration No. CRD42022319070. RESULTS Of 2157 records identified, 18 studies met the inclusion criteria. Near 40 percent of studies focused on hospital quality transparency tools, and more than 90 percent of studies were from the US. Hospital price transparency reduced the price of laboratory and imaging tests except for office-visit services. Hospital quality transparency declined the level or growth rates of healthcare spending, while it adversely and significantly raised the price of healthcare services and consumers' payment in higher-ranked or rated facilities, which was referred to as the reputation premium in the healthcare industry. Hospital quality transparency not only leveraged private insurers bonding with a higher-rated hospital network to increase premiums, but also induced their anticipated pricing behaviors. CONCLUSION Hospital price and quality transparency was not effective as expected. Future research should explore the understudied consequences of hospital quality transparency programs, such as the reputation/rating premium and its policy intervention.
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Affiliation(s)
- Jinyang Chen
- School of Public Administration and Policy, Renmin University of China, No.59 Zhongguan Cun Avenue, Beijing, 100872 China
- Centre for Health Economics and Policy Innovation, Business School, Imperial College London, London, UK
| | - Marisa Miraldo
- Centre for Health Economics and Policy Innovation, Business School, Imperial College London, London, UK
- Department of Economics and Public Policy, Business School, Imperial College London, London, UK
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Ivanković D, Allin S, Daniel I, Sodhi S, Dundas T, Morris K, Sidhom P, Klazinga N, Kringos D. Use of Performance Data by Mid-Level Hospital Managers in Ontario: Results of a Province-Wide Survey and a Comparison with Hospital Managers in Europe. Healthc Policy 2022; 18:44-60. [PMID: 36495534 PMCID: PMC9764444 DOI: 10.12927/hcpol.2022.26971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
This paper provides insights into the use of performance data by middle managerial staff in Ontario hospitals in 2019 and compares the results to a study conducted in Europe in the same year. A total of 236 managers working in 61 hospitals across Ontario provided responses to the survey. Compared to their European colleagues, Ontario respondents self-assessed using significantly more performance data for managerial decision making. The use of performance data in Ontario was mostly motivated by external accountability requirements, followed by internal quality improvement efforts. Ontario managers also reported accessibility, appropriateness and timeliness of data and human resources and engagement as the biggest barriers to further performance data utilization. Comparative studies, such as the one this paper is based on, provide the foundation for drawing lessons across jurisdictions. This paper also affirms the importance of hospital middle management in moving from quality assurance to quality improvement efforts and developing sustainable learning healthcare organizations and systems.
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Affiliation(s)
- Damir Ivanković
- HealthPros PhD Fellow, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Sara Allin
- Associate Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Imtiaz Daniel
- Lecturer, Institute of Health Policy, Management and Evaluation, University of Toronto; Chief, Research and Analysis, Ontario Hospital Association, Toronto, ON
| | - Sundeep Sodhi
- Director, Strategy and Member Relations, Ontario Hospital Association, Toronto, ON
| | | | - Kathleen Morris
- Vice President, Research and Analysis, Canadian Institute for Health Information, Toronto, ON
| | - Patricia Sidhom
- Program Consultant, Health Workforce Information, Canadian Institute for Health Information, Toronto, ON
| | - Niek Klazinga
- Professor of Social Medicine, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dionne Kringos
- Associate Professor, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Poppy A, Ziniel SI, Hyman D. Variability in Serious Safety Event Classification among Children's Hospitals: A Measure for Comparison? Pediatr Qual Saf 2022; 7:e613. [PMID: 38585504 PMCID: PMC10997282 DOI: 10.1097/pq9.0000000000000613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/17/2022] [Indexed: 04/09/2024] Open
Abstract
Introduction Hospitals have no standard for measuring comparative rates of serious safety events (SSE). A pediatric hospital safety collaborative has used a common definition and measurement system to classify SSE and calculate a serious safety event rate. An opportunity exists to evaluate the use of this measurement system. Methods A web-based survey utilizing 7 case vignettes was sent to 132 network hospitals to assess agreement in classifying the vignettes as SSEs. Respondents classified the vignettes according to the taxonomy used at their respective organizations for deviations and SSE classification. Results Of the 82 respondents, 67 (82%) utilized the same SSE classification system. Respondents did not assess deviations for 2 of the 7 vignettes, which had clear deviations. Of the remaining 5 vignettes, 3 had a substantial agreement of deviation (>85%, Gwet's AC ≥ 0.68), and 2 had fair agreement (<70%, Gwet's AC ≤ 0.39). Four of the 7 vignettes had a substantial agreement on SSE classification (>80%; Gwet's AC ≥ 0.80), and 3 had slight to moderate agreement (<70%, Gwet's AC ≤ 0.78). Conclusions Results demonstrated agreement and variability in determining deviation and SSE classification in the 7 vignettes. Although the SSE methodology and metric used by participant pediatric hospitals yields generally similar review results, one must be cautious in using the SSE rate to compare patient safety outcomes across different hospitals.
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Affiliation(s)
- Amy Poppy
- From the Children’s Hospital Colorado, Division of Quality and Patient Safety, Aurora, Colorado
| | - Sonja I Ziniel
- Children’s Hospital Colorado Division of Quality and Patient Safety and University of Colorado School of Medicine, Department of Pediatrics, Section of Pediatric Hospital Medicine, Aurora, Colorado
| | - Daniel Hyman
- Children’s Hospital of Philadelphia Center for Healthcare Quality and Analytics and Perelman School of Medicine, Department of Pediatrics and the Leonard Davis Institute, University of Pennsylvania Philadelphia, Pennsylvania
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Strumann C, Geissler A, Busse R, Pross C. Can competition improve hospital quality of care? A difference-in-differences approach to evaluate the effect of increasing quality transparency on hospital quality. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1229-1242. [PMID: 34997865 PMCID: PMC9395484 DOI: 10.1007/s10198-021-01423-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Public reporting on the quality of care is intended to guide patients to the provider with the highest quality and to stimulate a fair competition on quality. We apply a difference-in-differences design to test whether hospital quality has improved more in markets that are more competitive after the first public release of performance data in Germany in 2008. Panel data from 947 hospitals from 2006 to 2010 are used. Due to the high complexity of the treatment of stroke patients, we approximate general hospital quality by the 30-day risk-adjusted mortality rate for stroke treatment. Market structure is measured (comparatively) by the Herfindahl-Hirschman index (HHI) and by the number of hospitals in the relevant market. Predicted market shares based on exogenous variables only are used to compute the HHI to allow a causal interpretation of the reform effect. A homogenous positive effect of competition on quality of care is found. This effect is mainly driven by the response of non-profit hospitals that have a narrow range of services and private for-profit hospitals with a medium range of services. The results highlight the relevance of outcome transparency to enhance hospital quality competition.
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Affiliation(s)
- Christoph Strumann
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
| | | | - Reinhard Busse
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | - Christoph Pross
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
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16
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Paluch J, Kohr J, Squires A, Loving V. Patient-centered Care and Integrated Practice Units: Embracing the Breast Care Continuum. JOURNAL OF BREAST IMAGING 2022; 4:413-422. [PMID: 38416987 DOI: 10.1093/jbi/wbac031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Indexed: 03/01/2024]
Abstract
Patient-centered care is a health care approach optimized for the needs of the patient. As patients have sought more autonomy in recent years, this model has been more frequently adopted. Breast radiologists aspiring to advance patient-centered care should seek greater ownership of the breast diagnostic imaging and intervention workflows, helping their patients navigate the complex breast care landscape with patients' preferences taken into account. Applying this approach to breast radiology will increase patient satisfaction and compliance while also limiting wasted health care dollars, unnecessary diagnostic delays, and overall confusion. Herein, the benefits of patient-centered breast radiology are discussed, and numerous suggestions and case examples are provided to help readers reshape their practice toward the priorities of their patients.
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Affiliation(s)
- Jeremy Paluch
- Virginia Mason Medical Center, Department of Radiology, Seattle, WA, USA
| | - Jennifer Kohr
- Virginia Mason Medical Center, Department of Radiology, Seattle, WA, USA
| | | | - Vilert Loving
- Banner MD Anderson Cancer Center, Division of Diagnostic Imaging, Gilbert, AZ, USA
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17
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Rodrigues D, Street A, Santos MJ, Rodrigues AM, Marques-Gomes J, Canhão H. Using Patient-Reported Outcome Measures to Evaluate Care for Patients With Inflammatory Chronic Rheumatic Disease. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:S1098-3015(22)02000-9. [PMID: 35753905 DOI: 10.1016/j.jval.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/21/2022] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Few countries integrate patient-reported outcome measures (PROMs) in routine performance assessment and those that do focus on elective surgery. This study addresses the challenges of using PROMs to evaluate care in chronic conditions. We set out a modeling strategy to assess the extent to which changes over time in self-reported health status by patients with inflammatory chronic rheumatic disease are related to their biological drug therapy and rheumatology center primarily responsible for their care. METHODS Using data from the Portuguese Register of Rheumatic Diseases, we assess health status using the Health Assessment Questionnaire-Disability Index for rheumatic patients receiving biological drugs between 2000 and 2017. We specify a fixed-effects model using the least squares dummy variables estimator. RESULTS Patients receiving infliximab or rituximab report lower health status than those on etanercept (the most common therapy) and patients in 4 of the 26 rheumatology centers report higher health status than those at other centers. CONCLUSIONS PROMs can be used for those with chronic conditions to provide the patient's perspective about the impact on their health status of the choice of drug therapy and care provider. Care for chronic patients might be improved if healthcare organizations monitor PROMs and engage in performance assessment initiatives on a routine basis.
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Affiliation(s)
- Daniela Rodrigues
- NIHR Imperial Patient Safety Translational Research Center, Institute of Global Health Innovation, Department of Surgery & Cancer, Imperial College London, London, England, UK.
| | - Andrew Street
- Department of Health Policy, London School of Economics and Political Science, London, England, UK
| | - Maria José Santos
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal; JE Fonseca Lab, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Maria Rodrigues
- EpiDoC Unit, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal; CHRC, Comprehensive Health Research Center, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal; Rheumatology Unit, University Central Hospital Lisbon (CHULC), Lisboa, Portugal; ReumaPt, Sociedade Portuguesa de Reumatologia, Lisboa, Portugal
| | - João Marques-Gomes
- Nova School of Business and Economics, Carcavelos, Portugal; NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Helena Canhão
- EpiDoC Unit, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal; CHRC, Comprehensive Health Research Center, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal; Rheumatology Unit, University Central Hospital Lisbon (CHULC), Lisboa, Portugal; ReumaPt, Sociedade Portuguesa de Reumatologia, Lisboa, Portugal
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18
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Dhamanti I, Rachman T, Nurhaida I, Muhamad R. Challenges in Implementing the WHO Hospital Readiness Checklist for the COVID-19 Pandemic in Indonesian Hospitals: A Qualitative Study. J Multidiscip Healthc 2022; 15:1395-1402. [PMID: 35775028 PMCID: PMC9239387 DOI: 10.2147/jmdh.s362422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To assist hospitals in preparing for a surge of patients during the COVID-19 pandemic, the World Health Organization (WHO) published an assessment tool called the rapid hospital readiness checklist. This checklist has been used by numerous countries, including Indonesia. However, several technical issues were discovered, primarily as a result of the manual recording of the checklist on a spreadsheet. This study aimed to identify challenges related to the hospital readiness checklist that was implemented in Indonesia. Materials and Methods This qualitative study used focus group discussions to collect data. The study was conducted in East Java, Indonesia, in October 2021, with the participation of nine organizations from the provinces of East Java and Bali. Data were thematically analyzed, and the findings were presented in a narrative format. Results Hospital participants had experience in filling out a hospital readiness checklist every 3 months. Some challenges faced by the hospital was the need to manually enter data into the checklist, lack of coordination and communication, there were various perceptions in hospitals as there was no technical guide in completing the checklist, absence of feedback, and the data returning empty due to filling errors. Additionally, City X health office also identified challenges in monitoring and evaluating the hospital checklists. Conclusion This study, which included both hospitals and the health office, described the challenges encountered in the assessment of the hospital readiness checklist. Both hospitals and DHO experienced some challenges with the current system. The checklist has the potential to evolve into a public reporting to improve efficiency and faster decision-making.
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Affiliation(s)
- Inge Dhamanti
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- Center for Patient Safety Research, Universitas Airlangga, Surabaya, Indonesia
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- Correspondence: Inge Dhamanti, Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia, Tel +62 31 5920 948, Email
| | - Taufik Rachman
- Center for Patient Safety Research, Universitas Airlangga, Surabaya, Indonesia
- Department of Criminal Law, Faculty of Law, Universitas Airlangga, Surabaya, Indonesia
| | - Ida Nurhaida
- Faculty of Computer Science, Universitas Mercu Buana, West Jakarta, Indonesia
| | - Rosediani Muhamad
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- Outpatient and Staff Clinics, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Hanson K, Brikci N, Erlangga D, Alebachew A, De Allegri M, Balabanova D, Blecher M, Cashin C, Esperato A, Hipgrave D, Kalisa I, Kurowski C, Meng Q, Morgan D, Mtei G, Nolte E, Onoka C, Powell-Jackson T, Roland M, Sadanandan R, Stenberg K, Vega Morales J, Wang H, Wurie H. The Lancet Global Health Commission on financing primary health care: putting people at the centre. Lancet Glob Health 2022; 10:e715-e772. [PMID: 35390342 PMCID: PMC9005653 DOI: 10.1016/s2214-109x(22)00005-5] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Kara Hanson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Nouria Brikci
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Darius Erlangga
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Abebe Alebachew
- Breakthrough International Consultancy, Addis Ababa, Ethiopia
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Ina Kalisa
- World Health Organization, Kigali, Rwanda
| | | | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - David Morgan
- Health Division, The Organisation for Economic Co-operation and Development, Paris, France
| | | | - Ellen Nolte
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Chima Onoka
- Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Roland
- Department of Public Health and Primary Care, University of Cambridge, UK
| | | | | | | | - Hong Wang
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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20
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Anderson NN, Dong K, Baker GR, Moody L, Scane K, Urquhart R, Wodchis WP, Gagliardi AR. Impacts of patient and family engagement in hospital planning and improvement: qualitative interviews with patient/family advisors and hospital staff. BMC Health Serv Res 2022; 22:360. [PMID: 35303884 PMCID: PMC8932199 DOI: 10.1186/s12913-022-07747-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background Patient engagement (PE) in hospital planning and improvement is widespread, yet we lack evidence of its impact. We aimed to identify benefits and harms that could be used to assess the impact of hospital PE. Methods We interviewed hospital-affiliated persons involved in PE activities using a qualitative descriptive approach and inductive content analysis to derive themes. We interpreted themes by mapping to an existing framework of healthcare performance measures and reported themes with exemplar quotes. Results Participants included 38 patient/family advisors, PE managers and clinicians from 9 hospitals (2 < 100 beds, 4 100 + beds, 3 teaching). Benefits of PE activities included 9 impacts on the capacity of hospitals. PE activities involved patient/family advisors and clinicians/staff in developing and spreading new PE processes across hospital units or departments, and those involved became more adept and engaged. PE had beneficial effects on hospital structures/resources, clinician staff functions and processes, patient experience and patient outcomes. A total of 14 beneficial impacts of PE were identified across these domains. Few unintended or harmful impacts were identified: overextended patient/family advisors, patient/family advisor turnover and clinician frustration if PE slowed the pace of planning and improvement. Conclusions The 23 self reported impacts were captured in a Framework of Impacts of Patient/Family Engagement on Hospital Planning and Improvement, which can be used by decision-makers to assess and allocate resources to hospital PE, and as the basis for ongoing research on the impacts of hospital PE and how to measure it. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07747-3.
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Affiliation(s)
- Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, M5G2C4, Toronto, Canada
| | - Kelly Dong
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Lesley Moody
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Kerseri Scane
- Patient Partnerships, University Health Network, Toronto, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Walter P Wodchis
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, M5G2C4, Toronto, Canada.
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21
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Chaulk D, Tran T, Neeley A, Giardino A. Children's hospital quality ratings: where are we and can we do better? Hosp Pract (1995) 2022; 49:405-412. [PMID: 35253559 DOI: 10.1080/21548331.2022.2050650] [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: 10/18/2022]
Abstract
Hospital quality ratings are intended to guide patients and payers to the highest quality hospitals. Their success in achieving this goal has been limited by inconsistencies between ratings and questionable data collection methods. Despite these shortcomings, their popularity and their importance are increasing. There is little published on how these quality rankings pertain to children's hospitals. The majority of what is available analyzes the US News and World Report's Best Children's Hospitals Survey and the Leapfrog Group's Pediatric Care survey. We provide a narrative review of the literature and our interpretation of the relative strengths and weaknesses of these tools, including a letter grade comparison. Based on our analysis, we provide potential improvements to these rating systems that may benefit both the patient, payer, and the hospital.
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Affiliation(s)
- David Chaulk
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Theresa Tran
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Allison Neeley
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Angelo Giardino
- Department of Pediatrics Chair, University of Utah School of Medicine, Salt Lake City, Utah, USA
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22
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Willmington C, Belardi P, Murante AM, Vainieri M. The contribution of benchmarking to quality improvement in healthcare. A systematic literature review. BMC Health Serv Res 2022; 22:139. [PMID: 35109824 PMCID: PMC8812166 DOI: 10.1186/s12913-022-07467-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/03/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Benchmarking has been recognised as a valuable method to help identify strengths and weaknesses at all levels of the healthcare system. Despite a growing interest in the practice and study of benchmarking, its contribution to quality of care have not been well elucidated. As such, we conducted a systematic literature review with the aim of synthesizing the evidence regarding the relationship between benchmarking and quality improvement. We also sought to provide evidence on the associated strategies that can be used to further stimulate quality improvement. METHODS We searched three databases (PubMed, Web of Science and Scopus) for articles studying the impact of benchmarking on quality of care (processes and outcomes). Following assessment of the articles for inclusion, we conducted data analysis, quality assessment and critical synthesis according to the PRISMA guidelines for systematic literature review. RESULTS A total of 17 articles were identified. All studies reported a positive association between the use of benchmarking and quality improvement in terms of processes (N = 10), outcomes (N = 13) or both (N = 7). In the majority of studies (N = 12), at least one intervention, complementary to benchmarking, was undertaken to stimulate quality improvement. The interventions ranged from meetings between participants to quality improvement plans and financial incentives. A combination of multiple interventions was present in over half of the studies (N = 10). CONCLUSIONS The results generated from this review suggest that the practice of benchmarking in healthcare is a growing field, and more research is needed to better understand its effects on quality improvement. Furthermore, our findings indicate that benchmarking may stimulate quality improvement, and that interventions, complementary to benchmarking, seem to reinforce this improvement. Although this study points towards the benefit of combining performance measurement with interventions in terms of quality, future research should further analyse the impact of these interventions individually.
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Affiliation(s)
- Claire Willmington
- Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Piazza Martiri della Libertà, 33, Pisa, Italy
| | - Paolo Belardi
- Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Piazza Martiri della Libertà, 33, Pisa, Italy.
| | - Anna Maria Murante
- Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Piazza Martiri della Libertà, 33, Pisa, Italy
| | - Milena Vainieri
- Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Piazza Martiri della Libertà, 33, Pisa, Italy
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23
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Tierney KI, Fishman S. Accounting for Past Patient Composition In Evaluations of Quality Reporting. Health Serv Res 2022; 57:668-680. [DOI: 10.1111/1475-6773.13942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Katherine I. Tierney
- Department of Sociology Western Michigan University 1903 W. Michigan Ave Kalamazoo MI
| | - Samuel Fishman
- Department of Sociology Duke University 417 Chapel Drive Durham NC
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Clancy C, Goodrich K, Moody-Williams J, Sheares KD, O'Kane ME, Cha S, Agrawal S. Quality, Safety, and Standards Organizations COVID-19 Impact Assessment: Lessons Learned and Compelling Needs. NAM Perspect 2021; 2021:202107d. [PMID: 34611603 PMCID: PMC8486423 DOI: 10.31478/202107d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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