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Abdissa Z, Alemu K, Lemma S, Berhanu D, Defar A, Getachew T, Schellenberg J, Marchant T, Shiferaw S, Tariku A, Guadu T, Taye G, Zelalem M, Persson LA. Effective coverage of antenatal care services in Ethiopia: a population-based cross-sectional study. BMC Pregnancy Childbirth 2024; 24:330. [PMID: 38678206 PMCID: PMC11055385 DOI: 10.1186/s12884-024-06536-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 04/21/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Antenatal care (ANC) is a principal component of safe motherhood and reproductive health strategies across the continuum of care. Although the coverage of antenatal care visits has increased in Ethiopia, there needs to be more evidence of effective coverage of antenatal care. The 'effective coverage' concept can pinpoint where action is required to improve high-quality coverage in Ethiopia. Effective coverage indicates a health system's performance by incorporating need, utilization, and quality into a single measurement. The concept includes the number of contacts, facility readiness, interventions received, and components of services received. This study aimed to measure effective antenatal care coverage in Ethiopia. METHODS A two-stage cluster sampling method was used and included 2714 women aged 15-49 years and 462 health facilities from six Ethiopian regions from October 2019 to January 2020. The effective coverage cascade was analyzed among the targeted women by computing the proportion who received four or more antenatal care visits where the necessary inputs were available, received iron-folate supplementation and two doses of tetanus vaccination according to process quality components of antenatal care services. RESULTS Of all women, 40% (95%CI; 38, 43) had four or more visits, ranging from 3% in Afar to 74% in Addis Ababa. The overall mean health facility readiness score of the facilities serving these women was 70%, the vaccination and iron-folate supplementation coverage was 26%, and the ANC process quality was 64%. As reported by women, the least score was given to the quality component of discussing birth preparedness and complication readiness with providers. In the effective coverage cascade, the input-adjusted, intervention-adjusted, and quality-adjusted antenatal coverage estimates were 28%, 18%, and 12%, respectively. CONCLUSION The overall effective ANC coverage was low, primarily due to a considerable drop in the proportion of women who completed four or more ANC visits. Improving quality of services is crucial to increase ANC up take and completion of the recommended visits along with interventions increasing women's awareness.
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Affiliation(s)
- Zewditu Abdissa
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- Department of Environmental Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Seblewengel Lemma
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Della Berhanu
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Atkure Defar
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Theodros Getachew
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Joanna Schellenberg
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Tanya Marchant
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Solomon Shiferaw
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amare Tariku
- Department of Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Guadu
- Department of Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Girum Taye
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Meseret Zelalem
- Maternal, Child and Adolescent Health Service Lead Executive Office, Federal Ministry of Health, Addis Ababa, Ethiopia
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lars Ake Persson
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Platz T, Schmidt-Wilcke T, Groß M, Friederich C, Pohl M. [Certification by the German Society for Neurorehabiliation, DGNR : Performance and quality of the "Centers for weaning from a ventilator in early neurological and neurosurgical rehabilitation"]. Nervenarzt 2024; 95:152-158. [PMID: 37668662 PMCID: PMC10850186 DOI: 10.1007/s00115-023-01540-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Certification of centers for weaning from a ventilator in neurological neurosurgical early rehabilitation (NNER) by the German Society for Neurorehabilitation (DGNR) is possible since 1 October 2021. OBJECTIVE The results of certification of facilities in the first year after starting the procedure are presented. MATERIAL AND METHODS As part of the certification process 28 criteria are assessed including a set of mandatory characteristics of the facility. The criteria are divided into structural criteria (i = 7), diagnostic criteria (i = 6), personnel criteria (i = 3), internal organization criteria (i = 7), and quality management criteria (i = 5). RESULTS A total of 13 centers were certified in the first year, with a combined total of 283 beds for weaning from a ventilator in the NNER and served 2278 persons to be weaned from a ventilator in the year before certification, with a median of 134 per facility (range 44-414). Only rarely was weaning unsuccessful, requiring conversion to home mechanical ventilation before discharge (invasive home mechanical ventilation median per facility 10 persons, range 2-25; non-invasive home mechanical ventilation median 0 persons, range 0-57). A high level of process and structural quality was documented for the certified centers: across all areas of assessment, the individual certification criteria were met in the vast majority of cases (median degree of complete fulfilment 86%) or met with improvement potentials documented by the auditors (median 11%). CONCLUSION Successful weaning in NNER and a high level of process and structural quality can be demonstrated by the certification results of centers that follow this integrative approach to weaning from a ventilator in a NNER setting.
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Affiliation(s)
- Thomas Platz
- AG Neurorehabilitation, Universitätsmedizin Greifswald, Fleischmannstraße 44, 17475, Greifswald, Deutschland.
- Institut für Neurorehabilitation und Evidenzbasierung, An-Institut der Universität Greifswald, BDH-Klinik Greifswald, Greifswald, Deutschland.
| | - Tobias Schmidt-Wilcke
- Neurologisches Zentrum, Bezirksklinikum Mainkofen, Deggendorf, Deutschland
- Institut für Klinische Neurowissenschaften und Medizinische Psychologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Martin Groß
- Evangelisches Krankenhaus Oldenburg, Oldenburg, Deutschland
- Oldenburger Forschungsnetzwerk Notfall- und Intensivmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | | | - Marcus Pohl
- VAMED Klinik Schloss Pulsnitz, Pulsnitz, Deutschland
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Gardner M, Hanno EC, Jones SM, Lesaux NK. Exploring early educator burnout and process quality in a statewide sample. J Sch Psychol 2023; 99:101214. [PMID: 37507181 DOI: 10.1016/j.jsp.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/20/2022] [Accepted: 04/20/2023] [Indexed: 07/30/2023]
Abstract
Building on literature linking educators' psychosocial well-being to early education and care quality, this study analyzed early educators' (N = 648) reports of burnout across a range of group-based care types in one state and examined the relation of burnout to setting quality. Confirmatory factor analysis showed the burnout measure, a self-reported emotional exhaustion scale, had a one-factor structure and adequate internal consistency among educators working in a range of early education and care settings. Measured by the scale, educators on average reported infrequent feelings of burnout. There were small but statistically significant differences in burnout scores by setting type, with Head Start educators on average reporting modestly more frequent burnout symptoms than educators in community-based centers (β=0.29,b = 0.30, SE = 0.13, p = 0.014) or family childcare settings (β=0.57,b = 0.60, SE = 0.14, p < 0.001). Only one significant association was observed between educators' self-reported burnout scores and setting quality after accounting for educator and setting characteristics: a negative association with child involvement (β = - 0.09,b = -0.04, SE = 0.02, p = 0.03). These findings contribute to the field's understanding of burnout as a component of educator well-being and provide initial insight about targeting supports to improve educator well-being.
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Affiliation(s)
- Madelyn Gardner
- Graduate School of Education, Harvard University, 14 Appian Way, Cambridge, MA 02138, USA.
| | - Emily C Hanno
- Graduate School of Education, Harvard University, 14 Appian Way, Cambridge, MA 02138, USA
| | - Stephanie M Jones
- Graduate School of Education, Harvard University, 14 Appian Way, Cambridge, MA 02138, USA
| | - Nonie K Lesaux
- Graduate School of Education, Harvard University, 14 Appian Way, Cambridge, MA 02138, USA
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Smith-Nielsen J, Wendelboe KI, Mohr JEW, Væver MS, Pontoppidan M, Helmerhorst K, Egmose I. Promoting interactive skills and mind-mindedness among early childcare professionals: study protocol for a randomized wait-list controlled trial comparing the Circle of Security approach with care as usual in center-based childcare (the SECURE project). BMC Psychol 2022; 10:153. [PMID: 35717243 PMCID: PMC9206123 DOI: 10.1186/s40359-022-00835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background In countries where the majority of young children are enrolled in professional childcare, the childcare setting constitutes an important part of children’s caregiving environment. Research consistently shows that particularly the quality of the daily interactions and relationship between young children and their professional caregivers have long-term effects on a range of developmental child outcomes. Therefore, professional caregivers’ capacity for establishing high quality interactions with the children in their care is an important target of intervention. Methods A prospective, parallel, cluster-randomized wait-list controlled trial is used to test the efficacy of the attachment- and mentalization theory informed Circle of Security (COS) approach adapted to the childcare setting (COS-Classroom) on caregiver interactive skills and mind-mindedness. Participants are professional caregivers of children aged 0–2.9 years working in center-based childcare in Denmark. Approximately 31 childcare centers, corresponding to an estimated 113 caregivers, are expected to participate. The primary outcome is caregiver Sensitive responsiveness measured with the Caregiver Interactive Profile Scales (CIP-scales). Secondary outcomes include caregiver Mind-mindedness, the five remaining CIP-scales (Respect for autonomy, Structure and limit setting, Verbal communication, Developmental stimulation, and Fostering positive peer interactions), and caregivers’ resources to cope with work-related stress. Data on structural factors (e.g., staff stability, caregiver-child ratio, and level of pre-service education), caregiver attachment style, acceptability and feasibility of the COS-C together with qualitative data on how the participants experience the COS-C is additionally collected to investigate moderating and confounding effects. Discussion Examining the effectiveness of the COS-C in center-based childcare contributes to the knowledge of evidence-based intervention programs and can potentially improve the caregiver quality early childcare. Trial registration: ClinicalTrials.gov: NCT04654533. Prospectively registered December 4, 2020, https://clinicaltrials.gov/ct2/show/NCT04654533.
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Affiliation(s)
- Johanne Smith-Nielsen
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark.
| | | | | | - Mette Skovgaard Væver
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark
| | - Maiken Pontoppidan
- Department of Health, VIVE-The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1353, Copenhagen, Denmark
| | - Katrien Helmerhorst
- Department of Pedagogy and Educational Sciences, Child and Family Welfare, University of Groningen, Grote Rozenstraat 38, 9712 TJ, Groningen, The Netherlands
| | - Ida Egmose
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark
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Zhou W, Jian W, Wang Z, Pan J, Hu M, Yip W. Impact of global budget combined with pay-for-performance on the quality of care in county hospitals: a difference-in-differences study design with a propaensity-score-matched control group using data from Guizhou province, China. BMC Health Serv Res 2021; 21:1296. [PMID: 34856985 PMCID: PMC8641159 DOI: 10.1186/s12913-021-07338-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Provider payment system has a profound impact on health system performance. In 2016, a number of counties in rural Guizhou, China, implemented global budget (GB) for county hospitals with quality control measures. The aim of this study is to measure the impact of GB combined with pay-for-performance on the quality of care of inpatients in county-level hospitals in China. METHODS Inpatient cases of four diseases, including pneumonia, chronic asthma, acute myocardial infarction and stroke, from 16 county-level hospitals in Guizhou province that implemented GB in 2016 were selected as the intervention group, and similar inpatient cases from 10 county-level hospitals that still implemented fee-for-services were used as the control group. Propensity matching score (PSM) was used for data matching to control for age factors, and difference-in-differences (DID) models were constructed using the matched samples to perform regression analysis on quality of care for the four diseases. RESULTS After the implementation of GB, rate of sputum culture in patients with pneumonia, rate of aspirin at discharge, rate of discharge with β-blocker and rate of smoking cessation advice in patients with acute myocardial infarction increased. Rate of oxygenation index assessment in patient with chronic asthma decreased 20.3%. There are no significant changes in other indicators of process quality. CONCLUSIONS The inclusion of pay-for-performance in the global budget payment system will help to reduce the quality risks associated with the reform of the payment system and improve the quality of care. Future reform should also consider the inclusion of the pay-for-performance mechanism.
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Affiliation(s)
- Wuping Zhou
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China.
| | - Zhifan Wang
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jay Pan
- West China Research Center for Rural Health Development, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Min Hu
- School of Public Health, Fudan University, Shanghai, China
| | - Winnie Yip
- Harvard School of Public Health, Boston, MA, USA
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Michaely H. [Structured reporting in daily practice-status quo and future]. Radiologe 2021; 61:1014-9. [PMID: 34487199 DOI: 10.1007/s00117-021-00902-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
CLINICAL/METHODICAL ISSUE Introduction and application of structured reporting in radiology private practice. STANDARD RADIOLOGICAL METHODS Ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT), digital x‑ray (DR), mammography (MG). METHODOLOGICAL INNOVATIONS Structuring and predefinition of entire reports and report parts. PERFORMANCE Structured reporting in radiology presumably allows for higher report quality, reproducibility and easier access to data mining. Also the communication with the referring physicians can be improved. Although these advantages are well acknowledged, structured reporting does not prevail in private radiology practices. This article sheds light on the current situation of structured reporting in radiology private practice and provides information for the faltering implementation as well as perspective for individual potential solutions to overcome this situation. ACHIEVEMENTS Structured reporting is not yet standard. Growing acceptance of structured reporting can be expected. PRACTICAL RECOMMENDATIONS The application of structured reporting can improve report quality. The use of structured reporting should be considered for common examinations.
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Schulz AA, Wirtz MA. Assessment of the quality of woman-centred midwifery care from the mothers' perspective: A structural analysis of cross-sectional survey data. Z Evid Fortbild Qual Gesundhwes 2021:S1865-9217(21)00142-2. [PMID: 34474989 DOI: 10.1016/j.zefq.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Development and psychometric evaluation of a multidimensional model and assessment scales measuring core aspects of the quality of woman-centred midwifery care processes in Germany. DESIGN & PARTICIPANTS 201 women, who received midwifery care during their pregnancy in 2018, were enrolled 6 to 18 months after birth. Data were assessed in a retrospective cross-sectional survey in Germany. MEASUREMENTS Established scales that are used in health care were adapted to the context of woman-centred midwifery care: Shared Decision-Making (SDM-Q-9-M), Empathy (CARE-M), Internal Team Participation (TEAM-M) and Professional Competence (PC-M). Confirmatory factor analyses were adapted to prove (a) the homogeneity of the single scales and (b) the multidimensional structure of the entire item pool. FINDINGS Appropriate to good model fit was confirmed for both the single assessments (CFI ≥ .96; SRMR ≤ .032) and the multidimensional model (CFI=.96; SRMR=.049). Minor model modifications reflecting local item dependencies had to be considered for the scales SDM-Q-9-M, TEAM-M, and PC-M. For the CARE-M scale, Participatory Communication proved to be a separate, second structural component. CONCLUSIONS Shared Decision-Making, Empathy, Internal Team Participation, and Professional Competence constitute core components of woman-centred midwifery care processes. A multi-dimensional assessment is now available measuring women's experiences with midwifery care. The assessment provides an essential component to master the complex challenge of measuring the quality of midwifery care inside and outside the hospital by means of a standardised and validated assessment.
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Petersen W, Bierke S, Häner M. [Quality in sports orthopedics and traumatology: more than just return to play]. Chirurg 2021. [PMID: 34251478 DOI: 10.1007/s00104-021-01442-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 10/20/2022]
Abstract
Quality assessment is gaining in importance in sports orthopedics and traumatology. Structural, process and results quality are differentiated as central quality dimensions in healthcare. Structural quality is understood to mean the capabilities of the institution involved in patient care with its human and material resources. Structural quality can be documented using institutional certificates (e.g. knee center of the German Knee Society, DKG) or personal certificates (e.g. DKG knee surgeon). Process quality evaluates all medical, nursing and administrative activities that are involved in the care process. The outcome quality describes changes in the patient's state of health that can be attributed to medical, nursing and physiotherapeutic measures. The measurement of the outcome quality can be broken down into objective and subjective parameters. In terms of subjective parameters patient reported outcome measures (PROM) play a major role. Another quality initiative in recent years can be seen in healthcare research. In this context medical registers play a role in which long-term healthcare data are prospectively collated and involves data on the quality of the process and outcome. The outcome quality is also the focus of value-based reimbursement systems.
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Flohé S, Bieler D, Ruchholtz S. [Measurability of the quality of care of the severely injured]. Chirurg 2021; 92:881-890. [PMID: 34223917 DOI: 10.1007/s00104-021-01445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/26/2022]
Abstract
The care of severely injured patients is characterized by the heterogeneity of the clinical picture and the time-critical aspects of many forms of treatment in the acute phase, so that quality measurement and assessment is always complex. In order to be able to operate a meaningful and structured quality management the quality must be validly measured and it must be defined what quality is. To handle this complex picture the quality of care for the severely injured is divided into three levels: structural quality, process quality and outcome quality. With respect to structural quality there are clear guidelines for personnel and structural equipment of hospitals for the optimal care of severely injured patients. This is regularly checked in Germany through trauma center certification as part of the TraumaNetzwerk DGU®. Process quality can also be measured in the care of severely injured patients. With the TraumaRegister DGU® annual report in 2017, 14 newly developed quality indicators were introduced. Due to the comprehensive participation of hospitals in the TraumaRegister DGU® structured external quality assurance is possible in addition to internal process analysis. With respect to the quality of the outcome patient reported outcome measures (PROM) have become increasingly more important in addition to the mortality. The PROMs that are used to assess the consequences of injuries are typically multidimensional and capture not only aspects of physical health but also enable self-assessment of the mental health status by the patient.
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Affiliation(s)
- S Flohé
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Städtisches Klinikum Solingen, Solingen, Deutschland
| | - D Bieler
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs‑, Hand- und Plastische Chirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland.
| | - S Ruchholtz
- Universitätsklinikum Gießen und Marburg, Standort Marburg, Zentrum für Orthopädie und Unfallchirurgie, Marburg, Deutschland
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Szczotkowski D, Neik C, Polak U, Wittwer M, Kohlmann T. [Evaluation of medical insurance consultant reports within the German Statutory Accident Insurance-Methodology and results of a peer review procedure]. Unfallchirurg 2021; 124:48-58. [PMID: 32488320 PMCID: PMC7810618 DOI: 10.1007/s00113-020-00824-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
BACKGROUND Accident insurance consultants (D-physicians) are qualified specialists with particular expertise in occupational medicine. Within the medical treatment procedure of the German Statutory Accident Insurance (DGUV), D‑physicians must make a report on the medical care after occupational accidents. This nationwide evaluation aimed to systematically measure the quality of documentation of these medical reports. Peer review is a common method to ensure process quality. MATERIAL AND METHODS For each included D‑physician 30 reports of more severe cases from 2017 were randomly selected. The reports were anonymized and randomly assigned to a peer reviewer. Peer reviewers used a web-based checklist with nine rating categories and dichotomous response format (deficiency/no deficiency). To evaluate overall quality each report was rated with an overall grade from 1 (very good) to 6 (insufficient). RESULTS A total of 30,384 reports were evaluated by 82 peer reviewers. One third of the reports contained no deficiencies. Most deficiencies were found in the category on information about the accident. The mean overall grade for each D‑physician was 2.6 and ranged from 1.5 (best) to 4.1 (worst). All evaluated D‑physicians were given an individual quality report which described the main findings. CONCLUSION The first nationwide peer review of the DGUV proved to be a practical and valid quality assurance procedure to evaluate the medical reports of D‑physicians. The quality of the reports was in general good. The DGUV plans to repeat the peer review process taking further groups of D‑physicians into consideration.
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Affiliation(s)
- D Szczotkowski
- Institut für Community Medicine, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Deutschland.
| | - C Neik
- Institut für Community Medicine, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Deutschland
| | - U Polak
- Deutsche Gesetzliche Unfallversicherung e. V., Glinkastraße 40, Berlin, 10117, Deutschland
| | - M Wittwer
- Deutsche Gesetzliche Unfallversicherung e. V., Glinkastraße 40, Berlin, 10117, Deutschland
| | - T Kohlmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Deutschland
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Gramer G, Brockow I, Labitzke C, Fang-Hoffmann J, Beivers A, Feyh P, Hoffmann GF, Nennstiel U, Sommerburg O. Implementing a tracking system for confirmatory diagnostic results after positive newborn screening for cystic fibrosis-implications for process quality and patient care. Eur J Pediatr 2021; 180:1145-1155. [PMID: 33104872 PMCID: PMC7940155 DOI: 10.1007/s00431-020-03849-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 11/26/2022]
Abstract
Newborn screening for cystic fibrosis (CF-NBS) was introduced in Germany in 2016. Currently, systematic follow-up of positive CF-NBS results is not implemented or reimbursed in the NBS program. We investigated results of confirmatory testing over 24 months after implementation of CF-NBS for a large German NBS center before and after introduction of an active tracking system and performed a cost calculation for tracking. Results are compared with the federal state of Bavaria, where a centralized tracking system has been in place for many years. At the NBS center, 244 of 281,907 children had a positive CF-NBS result requiring diagnostic confirmation. Before implementation of a telephone tracking system, only 43% of confirmatory results were returned despite repeated written requests. The consecutive strategy including telephone tracking led to an increase of resolved cases to 84%. However, the centralized tracking system in Bavaria, assigning children with positive CF-NBS directly to a responsible CF-center, resolved 99% of cases. The calculated additional cost for a tracking system in Germany including telephone tracking is 1.20€ per newborn screened.Conclusion: The implementation of a tracking system achieves a distinct improvement in CF-NBS with justifiable costs. The effect can be limited by absence of centralized organization of confirmatory testing. What is Known: • Newborn screening for cystic fibrosis (CF-NBS) has been performed for many years in several countries worldwide • While many studies have focused on different CF-NBS strategies, the organization of confirmatory testing and process quality concerning returned information to the NBS center has so far received less attention. What is New: • The implementation of an active tracking system achieves a distinct improvement of clarified cases after positive CF-NBS with justifiable costs. • The effect of a tracking system can be limited by the absence of a centralized organization of confirmatory testing.
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Affiliation(s)
- Gwendolyn Gramer
- Center for Pediatric and Adolescent Medicine, Department of General Pediatrics, Division of Neuropediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Inken Brockow
- Screening Center, Bavarian Health and Food Safety Authority (LGL), Veterinaerstrasse 2, 85764 Oberschleissheim, Germany
| | - Christiane Labitzke
- Translational Lung Research Center (TLRC), German Lung Research Center (DZL), University of Heidelberg, Heidelberg, Germany
| | - Junmin Fang-Hoffmann
- Center for Pediatric and Adolescent Medicine, Department of General Pediatrics, Division of Neuropediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Andreas Beivers
- University of Applied Sciences (Hochschule) Fresenius, Infanteriestraße 11a, 80797 Munich, Germany
| | - Patrik Feyh
- Center for Pediatric and Adolescent Medicine, Department of General Pediatrics, Division of Neuropediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Georg F. Hoffmann
- Center for Pediatric and Adolescent Medicine, Department of General Pediatrics, Division of Neuropediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Uta Nennstiel
- Screening Center, Bavarian Health and Food Safety Authority (LGL), Veterinaerstrasse 2, 85764 Oberschleissheim, Germany
| | - Olaf Sommerburg
- Translational Lung Research Center (TLRC), German Lung Research Center (DZL), University of Heidelberg, Heidelberg, Germany
- Center for Pediatric and Adolescent Medicine, Division of Pediatric Pulmonology & Allergy and Cystic Fibrosis Center, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
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Waldstein W, Bouché PA, Pottmann C, Faschingbauer M, Aldinger PR, Windhager R, Merle C. Quantitative and individualized assessment of the learning curve in preoperative planning of the acetabular cup size in primary total hip arthroplasty. Arch Orthop Trauma Surg 2021; 141:1601-1608. [PMID: 33709204 PMCID: PMC8354891 DOI: 10.1007/s00402-021-03848-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 02/27/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of the present study was to investigate the learning curves of 2 trainees with different experience levels to reach proficiency in preoperative planning of the cup size based on learning curve cumulative summation (LC-CUSUM) statistics and a cumulative summation (CUSUM) test. MATERIALS AND METHODS One-hundred-twenty patients who had undergone primary total hip arthroplasty with a cementless cup were selected. Preoperative planning was performed by an experienced orthopedic surgeon. Trainee 1 (student) and trainee 2 (resident) planned the cup size. The trainees were blinded to the preoperative plan and the definitive cup size. Only after a cup size was chosen, the trainees were unblinded to the preoperative plan of the surgeon. LC-CUSUM was applied to both trainees to determine when proficiency in determining the appropriate cup size was reached. A CUSUM test was applied to ensure retention of proficiency. RESULTS With reference to the preoperative plan of the surgeon, LC-CUSUM indicated proficiency after 94 planning attempts for trainee 1 and proficiency after 66 attempts for trainee 2, respectively. Trainee 1 and 2 maintained proficiency thereafter. With reference to the definitive cup size, LC-CUSUM did not signal competency within the first 120 planning attempts for trainee 1. Trainee 2 was declared competent after 103 attempts and retained competency thereafter. CONCLUSIONS LC-CUSUM/CUSUM allow for an individualized, quantitative and continuous assessment of planning quality. Based on LC-CUSUM statistics, the two trainees of this study gain proficiency in planning of the acetabular cup size after 50-100 attempts when an immediate feedback is provided. Previous experience positively influences the performance. The study serves as basis for the medical education of students and residents in joint replacement procedures.
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Affiliation(s)
- W. Waldstein
- Department of Orthopedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P. A. Bouché
- Department of Orthopaedic Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - C. Pottmann
- Department of Orthopedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M. Faschingbauer
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - P. R. Aldinger
- Department of Orthopaedic Surgery Paulinenhilfe, Diakonie Klinikum, Stuttgart, Germany
| | - R. Windhager
- Department of Orthopedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - C. Merle
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
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Dippmann AK, Damrau C, Hengelbrock J, Albert US, Lebeau A, Lux MP, Veit C. [Are men and women with breast cancer treated equally in Germany?]. Z Evid Fortbild Qual Gesundhwes 2020; 155:1-10. [PMID: 32861615 DOI: 10.1016/j.zefq.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Within the statutory health insurance system of the Federal Republic of Germany, a system of quality assurance has been implemented and operationalised through the measurement of quality indicators. For breast surgery, these quality indicators are mainly based on recommendations of the German clinical guideline for screening, diagnosis, therapy and follow-up of breast cancer. The 2018 update of this guideline includes a new chapter on breast cancer in men. The aim of this analysis is to examine whether male and female patients with breast cancer are treated equally where appropriate and recommended by the clinical guideline, as measured by the quality indicators. METHOD Data of ten quality assurance indicators were analysed, for each indicator separately, stratified by sex and pooled over a 5-year period to gain statistical power. This dataset constitutes the largest data pool of men with surgical interventions for breast neoplasm in Germany. Indicator results were then compared between male and female cases. Additional subgroup analyses were carried out for two quality indicators with substantial outcome difference between male and female cases in order to detect possible differences in the treatment of breast cancer between different medical departments. RESULTS The database of the ten quality assurance indicators comprised 551,221 patients (546,324 females and 4,897 males) between 2014 and 2018. Pooled data of nine quality indicators (QIs) showed statistically significant outcome differences between male and female cases. In spite of pooling, the male sample size of four QIs was too small to allow for statistically reliable comparisons between male and female patients. Outcome differences in the remaining five QIs may, on the one hand, be explained by anatomical differences and different extent of the surgery, and on the other hand they confirm international data for lower HER2-positivity rates in male breast cancer patients. However, two process indicators, aiming at pretherapeutic biopsy and sentinel lymph node biopsy in invasive breast cancer recommended by the clinical guideline, show substantial differences of more than 6 percentage points between the sexes: although recommended by the clinical guideline, both procedures are carried out less often in male cases. Further analysis regarding the medical departments that recorded the treatment revealed that risk for non-adherence to guideline recommendation was high if treatment took place in non-gynaecological departments. Compared to gynaecological departments, procedures such as pretherapeutic biopsy and sentinel lymph node biopsy were carried out less frequently if cases were documented to be handled by surgery or plastic surgery departments. DISCUSSION AND CONCLUSION Analysis of breast surgery quality indicators reveals a lower level of adherence to guideline recommendations for men with breast cancer compared to women in some aspects of the guideline, as measured by statutory quality indicators in breast surgery. Male breast cancer might be a rare disease, but nevertheless, awareness-rising is needed in diagnostics, treatment and interdisciplinarity in order to avoid inequality between the sexes.
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Affiliation(s)
- Anja Katharina Dippmann
- IQTIG - Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Deutschland.
| | - Claudia Damrau
- IQTIG - Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Deutschland
| | - Johannes Hengelbrock
- IQTIG - Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Deutschland
| | - Ute-Susann Albert
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Annette Lebeau
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf und Gemeinschaftspraxis für Pathologie, Lübeck, Deutschland
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Kinder- und Frauenklinik St. Louise, St. Vincenz-Krankenhaus Paderborn, Paderborn, Deutschland
| | - Christof Veit
- IQTIG - Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Deutschland
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Scholz R, Hönning A, Seifert J, Spranger N, Stengel D. Effectiveness of architectural separation of septic and aseptic operating theatres for improving process quality and patient outcomes: a systematic review. Syst Rev 2019; 8:16. [PMID: 30626433 PMCID: PMC6325836 DOI: 10.1186/s13643-018-0937-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Architectural division of aseptic and septic operating theatres is a distinct structural feature of surgical departments in Germany. Internationally, hygienists and microbiologists mainly recommend functional separation (i.e. aseptic procedures first) without calling for separate operating floors and rooms. However, patients with severe musculoskeletal infections (e.g. joint empyema, spondylodiscitis, deep implant-associated infections) may benefit from the permanent availability of septic operating capacities without delay caused by an ongoing aseptic surgical program. A systematic literature review on the influence of a structural separation of septic and aseptic operating theatres on process and/or outcome quality has not yet been conducted. METHODS Systematic literature search in PubMed MEDLINE, Ovid Embase, CINAHL and the Cochrane Library, screening of referenced citations, and assessment of grey literature. RESULTS A total of 572 articles were found through the systematic literature search. No head-to-head studies (neither randomised, quasi-randomised nor observational) were identified which examined the impact of structural separation of septic and aseptic operating theatres on process and/or outcome quality. CONCLUSIONS This review did not identify evidence in favour nor against architectural separation of septic or aseptic operating theatre. Specifically, there is no evidence of a harmful effect of architectural separation. Unless prospective studies, ideally randomised trials, will be available, it is unjustified to call for abolishing established hospital structures. Future investigations must address patient-centered endpoints, surgical site infections, process quality and hospital economy. SYSTEMATIC REVIEW REGISTRATION PROSPERO (International prospective register of systematic reviews): CRD42018086568.
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Affiliation(s)
- Romy Scholz
- Centre for Clinical Research, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Alexander Hönning
- Centre for Clinical Research, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany.
| | - Julia Seifert
- Department of Trauma and Orthopaedic Surgery, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Nikolai Spranger
- Department of Trauma and Orthopaedic Surgery, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Dirk Stengel
- Centre for Clinical Research, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany.,Department of Trauma and Orthopaedic Surgery, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany.,Hospital Group of the Statutory Accident Insurance, Berlin, Germany
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Abstract
Widespread issues regarding quality in nursing homes call for an improved understanding of the relationship with costs. This relationship may differ in European countries, where care is mainly delivered by nonprofit providers. In accordance with the economic theory of production, we estimate a total cost function for nursing home services using data from 45 nursing homes in Switzerland between 2006 and 2010. Quality is measured by means of clinical indicators regarding process and outcome derived from the minimum data set. We consider both composite and single quality indicators. Contrary to most previous studies, we use panel data and control for omitted variables bias. This allows us to capture features specific to nursing homes that may explain differences in structural quality or cost levels. Additional analysis is provided to address simultaneity bias using an instrumental variable approach. We find evidence that poor levels of quality regarding outcome, as measured by the prevalence of severe pain and weight loss, lead to higher costs. This may have important implications for the design of payment schemes for nursing homes.
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Affiliation(s)
- L Di Giorgio
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Washington, United States
- Institute of Economics (IdEP), Università della Svizzera italiana (USI), Lugano, Switzerland
| | - M Filippini
- Institute of Economics (IdEP), Università della Svizzera italiana (USI), Lugano, Switzerland
- Department of Management, Technology and Economics, ETH, Zurich, Switzerland
| | - G Masiero
- Institute of Economics (IdEP), Università della Svizzera italiana (USI), Lugano, Switzerland.
- Department of Management, Information and Production Engineering (DIGIP), University of Bergamo, Bergamo, Italy.
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16
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Bauer M, Riech S, Brandes I, Waeschle RM. [Advantages and disadvantages of different methods for the implementation and the support of standard operating procedures: From PDF files to an app- and webbased SOP management system]. Anaesthesist 2016; 64:874-83. [PMID: 26481389 DOI: 10.1007/s00101-015-0074-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The quality assurance of care and patient safety, with increasing cost pressure and performance levels is of major importance in the high-risk and high cost area of the operating room (OR). Standard operating procedures (SOP) are an established tool for structuring and standardization of the clinical treatment pathways and show multiple benefits for quality assurance and process optimization. OBJECTIVES An internal project was initiated in the department of anesthesiology and a continuous improvement process was carried out to build up a comprehensive SOP library. MATERIAL AND METHODS In the first step the spectrum of procedures in anesthesiology was transferred to PDF-based SOPs. The further development to an app-based SOP library (Aesculapp) was due to the high resource expenditure for the administration and maintenance of the large PDF-based SOP collection and to deficits in the mobile availability. The next developmental stage, the SOP healthcare information assistant (SOPHIA) included a simplified and advanced update feature, an archive feature previously missing and notably the possibility to share the SOP library with other departments including the option to adapt each SOP to the individual situation. A survey of the personnel showed that the app-based allocation of SOPs (Aesculapp, SOPHIA) had a higher acceptance than the PDF-based developmental stage SOP form. CONCLUSION The SOP management system SOPHIA combines the benefits of the forerunner version Aesculapp with improved options for intradepartmental maintenance and administration of the SOPs and the possibility of an export and editing function for interinstitutional exchange of SOPs.
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Affiliation(s)
- M Bauer
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland
| | - S Riech
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland
| | - I Brandes
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland
| | - R M Waeschle
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland.
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Abstract
BACKGROUND Certified Prostate Centers proclaim congruent process and outcome quality results for treatment of prostate carcinoma. Therapy in accordance with the guidelines after presentation of the patient in an interdisciplinary conference and regular documented follow up are not in themselves a guarantee for good quality results (complication free, continence, erectile function, negative surgical margins, biochemical recurrence free), and are significantly influenced by factors not contained within the certification framework. DISCUSSION An association between exceeding the minimum number of operations and quality assurance exists, if at all, only vaguely and on no account justifies the absolute numbers necessary for certification. Although good measuring instruments for a Pentafecta analysis are available, the gathering of quality results for a center are limited to questionnaires for functional quality results and in the non-differentiated request for a pT2R1 rate of under 10 % for oncological quality results. CONCLUSIONS The reasons for this systematic ignoring of the for the patient so important quality results with a simultaneous excessive regard for standardizing organizational procedure processes are manifold. They comprise valid verifiability of process quality, the unclear effects of standardized treatment pathways on actual operation quality and the capitulation to statistical and patient determined problems with sufficient acquisition of comparable functional OP results. Whereas the outcome quality is more important than the process quality for patients with prostate carcinoma, the certified centers conduct themselves in exactly the opposite manner, thus creating a virtually insoluble dilemma.
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Affiliation(s)
- C Hampel
- Urologische Klinik und Poliklinik der Universitätsmedizin, Johannes-Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
| | - F Roos
- Urologische Klinik und Poliklinik der Universitätsmedizin, Johannes-Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - J W Thüroff
- Urologische Klinik und Poliklinik der Universitätsmedizin, Johannes-Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - A Neisius
- Urologische Klinik und Poliklinik der Universitätsmedizin, Johannes-Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
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Frakt AB, Trafton J, Pizer SD. Maintenance of access as demand for substance use disorder treatment grows. J Subst Abuse Treat 2015; 55:58-63. [PMID: 25795602 DOI: 10.1016/j.jsat.2015.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 02/18/2015] [Accepted: 02/22/2015] [Indexed: 11/16/2022]
Abstract
Due to the Affordable Care Act and other recent laws and regulations, funding for substance use disorder (SUD) treatment is on the rise. In the 2000s, the Veterans Health Administration (VA) implemented several initiatives that increased funding for SUD treatment during a period of growth in demand for it. A key question is whether access to and intensity of treatment kept pace or declined. Using VA SUD treatment funding data and patient-level records to construct performance measures, we studied the relationship between funding and access during the VA expansion. Overall, we observed an increase in access to and intensity of VA SUD care associated with increased funding. The VA was able to increase funding for and expand the population to which it offered SUD treatment without diminishing internal access and intensity.
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Affiliation(s)
- Austin B Frakt
- Healthcare Financing & Economics, VA Boston Healthcare System and School of Medicine, Boston University, 150 S. Huntington Ave, Boston, MA 02130 USA.
| | - Jodie Trafton
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park CA, USA
| | - Steven D Pizer
- Healthcare Financing & Economics, VA Boston Healthcare System and School of Pharmacy and Department of Economics, Northeastern University, Boston, MA
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Menzel S, Buchecker M, Schulz T. Forming social capital--does participatory planning foster trust in institutions? J Environ Manage 2013; 131:351-362. [PMID: 24211564 DOI: 10.1016/j.jenvman.2013.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/22/2013] [Accepted: 10/05/2013] [Indexed: 06/02/2023]
Abstract
Participatory planning that includes interest groups and municipal representatives has been presented as a means to deal with the increasing difficulty to reach arrangements due to progressively scarce land resources. Under dispute is whether collaborative forms of planning augment social capital or whether they might actually cause the destruction of such a valuable social commodity. In this paper we focus on trust in institution as a specific dimension of social capital because we argue that this is one of the effects the convenors of such participatory planning procedures are most interested in. We pursue a pre-post design and survey advisory group members of five on-going river-related planning processes in Switzerland. Controlling for generalised trust, we investigate how trust in institutions is affected over time by the quality of such processes and the degree of participation they offer. We find that generalised trust is highly correlated with initial levels of trust and so is process quality. Particularly the latter finding challenges the usually assumed direction of causality according to which process quality influences trust building. Additionally, we find a positive (non-significant) effect of process quality on changes in trust, while a higher degree of participation rather seems to hinder trust building. We suppose this indicates that under the conditions of limited time and resources more attention should be paid to how to improve the quality of participatory processes than putting much effort in increasing the degree of participation.
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Affiliation(s)
- Susanne Menzel
- Swiss Federal Institute for Forest, Snow and Landscape Research, Economics and Social Sciences, Zürcherstrasse 111, CH-8903 Birmensdorf, Switzerland.
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Hyppönen H, Saranto K, Vuokko R, Mäkelä-Bengs P, Doupi P, Lindqvist M, Mäkelä M. Impacts of structuring the electronic health record: a systematic review protocol and results of previous reviews. Int J Med Inform 2013; 83:159-69. [PMID: 24374018 DOI: 10.1016/j.ijmedinf.2013.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 11/27/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE This paper (1) presents the protocol of an on-going systematic literature review on the methods of structuring electronic health record (EHR) data and studying the impacts of implemented structures, thus laying basis for the analysis of the empirical articles (2) describes previous reviews published on the subject and retrieved during the search of bibliographic databases, and (3) presents a summary of the results of previous reviews. METHODS Cochrane instructions were exploited to outline the review protocol - phases and search elements. Test searches were conducted to refine the search. The abstracts and/or full texts of review papers captured by the search were read by two of the team members independently, with disagreements first negotiated between them and if necessary eventually resolved in the team meetings. Additional review articles were picked from the reference lists of the reviews included in our search results. The elements defined in the search strategy and analytic framework were converted to a data extraction tool, which was tested by extracting data from the reviews captured by the search. Descriptive analysis of the extracted data was conducted. RESULTS The 12-stage review protocol that we developed includes definition of the problem, the search strategy and search terms, testing the strategy, conducting the search, updating search from references found, removing duplicates, defining the inclusion and exclusion criteria, exclusion and inclusion of papers, definition of the analytic framework to extract data, extracting data and reporting results. Our searches in fifteen electronic bibliographic databases retrieved 27 reviews, of which 14 were included for full text analysis. Of these, 11 focused on medical and three on nursing record structures. The data structures included forms, ontologies, classifications and terminologies. Some evidence was found on data structure impact on information quality, process quality and efficiency, but not on patients or professionals. CONCLUSIONS The 12 step review protocol resulted in a variety of reviews of different ways to structure EHR data. None of them compared outcomes of different structuring methods; all had a narrower definition of the Intervention (a specific EHR structure) and Outcome (a specific impact category). Several reviews missed a clear connection between the data structures (interventions) and outcomes, indicating that the methods and applications for structuring patient data have rarely been viewed as independent variables. The review protocol should be defined in a manner that allows replication of the review. There are different ways of structuring patient data with varying impacts, which should be distinguished in further empirical studies, as well as reviews.
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Affiliation(s)
- Hannele Hyppönen
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland.
| | | | - Riikka Vuokko
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland
| | - Päivi Mäkelä-Bengs
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland
| | - Persephone Doupi
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland
| | - Minna Lindqvist
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland
| | - Marjukka Mäkelä
- Institute for Health and Welfare (THL), Service System Department, Finland
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Seidel RP, Lux MP, Hoellthaler J, Beckmann MW, Voigt W. Economic constraints - the growing challenge for Western breast cancer centers. Breast Care (Basel) 2013; 8:41-7. [PMID: 24715842 PMCID: PMC3971806 DOI: 10.1159/000348356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Breast cancer care in Western countries has reached a considerable level of quality and standardization, which has contributed to the decline in breast cancer mortality. Certified Breast Cancer Centers (BCC) represent an important element of this development. Related to changes in reimbursement and growing costs, BCC face economic constraints which ultimately could endanger the achievements of the past. Thus, BCC have to optimize their care strategies from an economic perspective, particularly by increasing efficiency but also by adapting their service portfolio. This could result in competitive advantages and additional revenue by increasing case numbers and extra charges to patients. Furthermore, an intensification of collaboration with the outpatient sector resulting in an integrated and managed 'trans-sectoral' care approach which could allow to shift unprofitable procedures to the outpatient sector - in the sense of a win-win situation for both sectors and without loss of care quality - seems reasonable. Structured and specialized consulting approaches can further be a lever to fulfill economic requirements in order to avoid cuts in medical care quality for the sake of a balanced budget. In this review, economic constraints of BCC with a focus on the German healthcare system and potential approaches to ameliorate these financial burdens are being discussed.
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Affiliation(s)
- Rene P. Seidel
- Siemens AG, Healthcare Sector, Customer Solutions Division, H CX CRM-VA HCC ONC, Friedrich Alexander University, Erlangen, Germany
| | - Michael P. Lux
- University Breast Centre Franconia, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Josef Hoellthaler
- Siemens AG, Healthcare Sector, Customer Solutions Division, H CX CRM-VA HCC ONC, Friedrich Alexander University, Erlangen, Germany
| | - Matthias W. Beckmann
- University Breast Centre Franconia, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Wieland Voigt
- Siemens AG, Healthcare Sector, Customer Solutions Division, H CX CRM-VA HCC ONC, Friedrich Alexander University, Erlangen, Germany
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