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Lynch C, Reguilon I, Langer DL, Lane D, De P, Wong WL, Mckiddie F, Ross A, Shack L, Win T, Marshall C, Revheim ME, Danckert B, Butler J, Dizdarevic S, Louzado C, Mcgivern C, Hazlett A, Chew C, O'connell M, Harrison S. A comparative analysis: international variation in PET-CT service provision in oncology-an International Cancer Benchmarking Partnership study. Int J Qual Health Care 2021; 33:6030987. [PMID: 33306102 PMCID: PMC7896108 DOI: 10.1093/intqhc/mzaa166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/28/2020] [Revised: 11/10/2020] [Accepted: 12/11/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To explore differences in position emission tomography-computed tomography (PET-CT) service provision internationally to further understand the impact variation may have upon cancer services. To identify areas of further exploration for researchers and policymakers to optimize PET-CT services and improve the quality of cancer services. Design Comparative analysis using data based on pre-defined PET-CT service metrics from PET-CT stakeholders across seven countries. This was further informed via document analysis of clinical indication guidance and expert consensus through round-table discussions of relevant PET-CT stakeholders. Descriptive comparative analyses were produced on use, capacity and indication guidance for PET-CT services between jurisdictions. Setting PET-CT services across 21 jurisdictions in seven countries (Australia, Denmark, Canada, Ireland, New Zealand, Norway and the UK). Participants None. Intervention(s) None. Main Outcome Measure(s) None. Results PET-CT service provision has grown over the period 2006–2017, but scale of increase in capacity and demand is variable. Clinical indication guidance varied across countries, particularly for small-cell lung cancer staging and the specific acknowledgement of gastric cancer within oesophagogastric cancers. There is limited and inconsistent data capture, coding, accessibility and availability of PET-CT activity across countries studied. Conclusions Variation in PET-CT scanner quantity, acquisition over time and guidance upon use exists internationally. There is a lack of routinely captured and accessible PET-CT data across the International Cancer Benchmarking Partnership countries due to inconsistent data definitions, data linkage issues, uncertain coverage of data and lack of specific coding. This is a barrier in improving the quality of PET-CT services globally. There needs to be greater, richer data capture of diagnostic and staging tools to facilitate learning of best practice and optimize cancer services.
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Affiliation(s)
- Charlotte Lynch
- International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, 2 2 Redman Place, London, E20 1JQ, UK
| | - Irene Reguilon
- International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, 2 2 Redman Place, London, E20 1JQ, UK.,Brand & Strategy, eConsult Health Ltd, 46-48 East Street, Surrey, KT17 1HQ, UK
| | - Deanna L Langer
- Cancer Imaging, Ontario Health (Cancer Care Ontario), 620 University Avenue, Toronto, ON M5G 2L7, Canada
| | - Damon Lane
- Radiology, Pacific Radiology, 123 Victoria Street, Christchurch Central, Christchurch 8013, New Zealand
| | - Prithwish De
- Surveillance and Cancer Registry, Ontario Health (Cancer Care Ontario), 620 University Avenue, Toronto, ON M5G 2L7, Canada
| | - Wai-Lup Wong
- Nuclear Medicine, Mount Vernon Hospital, East and North Hertfordshire NHS Trust, Rickmansworth Road, Northwood, HA6 2RN, UK
| | - Fergus Mckiddie
- Nuclear Medicine and PET Department, NHS Grampian, 2 Eday Road, Aberdeen AB15 6RE, UK
| | - Andrew Ross
- Dalhousie Medical School, Dalhousie University, 6299 South Street, Halifax, Nova Scotia, NS B3H 4R2, Canada
| | - Lorraine Shack
- Surveillance and Reporting, Alberta Health Services (Cancer Control Alberta), 10030-107 Street NW, Edmonton, Alberta, T5J 3E4, Canada
| | - Thida Win
- General and Respiratory Medicine, Lister Hospital, East and North Hertfordshire NHS Trust, Coreys Mill Lane, Stevenage, SG1 4AB, UK
| | - Christopher Marshall
- Wales Research and Diagnostic PET Imaging Centre, Cardiff University, Cardiff University School of Medicine Health Park, Cardiff, CF14, 4XN, UK
| | - Mona-Eliszabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Pb 4950 Nydalen, Oslo, 0424, Norway
| | - Bolette Danckert
- Research Centre, Danish Cancer Society, Strandboulevarden 49, 2100 Kobenhavn, Denmark
| | - John Butler
- International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, 2 2 Redman Place, London, E20 1JQ, UK.,Gynaecology Department, Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ, UK
| | - Sabina Dizdarevic
- Imaging and Nuclear Medicine, Brighton and Sussex University Hospital Trust, Kemptown, Brighton, BN2 1ES, United Kingdom and Brighton and Sussex Medical School, University of Sussex and Brighton, London Road, Brighton, BN1 4GE, UK
| | - Cheryl Louzado
- Strategy Implementation Planning & Partner Relations, Canadian Partnership Against Cancer, 145 King St, Toronto, ON M5H 1J8, Canada
| | - Canice Mcgivern
- Department of Regional Medical Physics, Belfast Health and Social Care Trust, 83 Shankill Road, Belfast, BT13 1FD, UK
| | - Anne Hazlett
- Department of Regional Medical Physics, Belfast Health and Social Care Trust, 83 Shankill Road, Belfast, BT13 1FD, UK
| | - Cindy Chew
- School of Medicine, Dentistry and Nursing, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Martin O'connell
- Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, DO7 R2WY, Ireland
| | - Samantha Harrison
- International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, 2 2 Redman Place, London, E20 1JQ, UK
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Mwanga-Amumpaire J, Alfvén T, Obua C, Källander K, Migisha R, Stålsby Lundborg C, Ndeezi G, Kalyango JN. Appropriateness of Care for Common Childhood Infections at Low-Level Private Health Facilities in a Rural District in Western Uganda. Int J Environ Res Public Health 2021; 18:7742. [PMID: 34360041 DOI: 10.3390/ijerph18157742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022]
Abstract
In Uganda, >50% of sick children receive treatment from primary level-private health facilities (HF). We assessed the appropriateness of care for common infections in under-five-year-old children and explored perspectives of healthcare workers (HCW) and policymakers on the quality of healthcare at low-level private health facilities (LLPHF) in western Uganda. This was a mixed-methods parallel convergent study. Employing multistage consecutive sampling, we selected 110 HF and observed HCW conduct 777 consultations of children with pneumonia, malaria, diarrhea or neonatal infections. We purposively selected 30 HCW and 8 policymakers for in-depth interviews. Care was considered appropriate if assessment, diagnosis, and treatment were correct. We used univariable and multivariable logistic regression analyses for quantitative data and deductive thematic analysis for qualitative data. The proportion of appropriate care was 11% for pneumonia, 14% for malaria, 8% for diarrhea, and 0% for neonatal infections. Children with danger signs were more likely to receive appropriate care. Children with diarrhea or ability to feed orally were likely to receive inappropriate care. Qualitative data confirmed care given as often inappropriate, due to failure to follow guidelines. Overall, sick children with common infections were inappropriately managed at LLPHF. Technical support and provision of clinical guidelines should be increased to LLPHF.
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Braithwaite J, Mannion R, Matsuyama Y, Shekelle P, Whittaker S, Al-Adawi S, Ludlow K, James W, Ting HP, Herkes J, Ellis LA, Churruca K, Nicklin W, Hughes C. Accomplishing reform: successful case studies drawn from the health systems of 60 countries. Int J Qual Health Care 2018; 29:880-886. [PMID: 29036604 PMCID: PMC5890865 DOI: 10.1093/intqhc/mzx122] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 06/05/2017] [Accepted: 08/31/2017] [Indexed: 11/14/2022] Open
Abstract
Healthcare reform typically involves orchestrating a policy change, mediated through some form of operational, systems, financial, process or practice intervention. The aim is to improve the ways in which care is delivered to patients. In our book 'Health Systems Improvement Across the Globe: Success Stories from 60 Countries', we gathered case-study accomplishments from 60 countries. A unique feature of the collection is the diversity of included countries, from the wealthiest and most politically stable such as Japan, Qatar and Canada, to some of the poorest, most densely populated or politically challenged, including Afghanistan, Guinea and Nigeria. Despite constraints faced by health reformers everywhere, every country was able to share a story of accomplishment-defining how their case example was managed, what services were affected and ultimately how patients, staff, or the system overall, benefited. The reform themes ranged from those relating to policy, care coverage and governance; to quality, standards, accreditation and regulation; to the organization of care; to safety, workforce and resources; to technology and IT; through to practical ways in which stakeholders forged collaborations and partnerships to achieve mutual aims. Common factors linked to success included the 'acorn-to-oak tree' principle (a small scale initiative can lead to system-wide reforms); the 'data-to-information-to-intelligence' principle (the role of IT and data are becoming more critical for delivering efficient and appropriate care, but must be converted into useful intelligence); the 'many-hands' principle (concerted action between stakeholders is key); and the 'patient-as-the-pre-eminent-player' principle (placing patients at the centre of reform designs is critical for success).
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Affiliation(s)
- Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney, NSW 2109, Australia
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Edgbaston, Birmingham B15 2TT, England
| | - Yukihiro Matsuyama
- The Canon Institute for Global Studies, 11th Floor, ShinMarunouchi Building, 5-1 Marunouchi 1-chome, Chiyoda-ku, Tokyo 100-6511, Japan
| | - Paul Shekelle
- Division of General Internal Medicine, West Los Angeles Veterans Affairs Medical Center, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA.,Division of General Internal Medicine, University of California, 911 Broxton Plaza, Los Angeles, CA 90095, USA
| | - Stuart Whittaker
- School of Public Health and Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, 7925, South Africa.,School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Lynnwood Rd, Hatfield, Pretoria, 0002, South Africa
| | - Samir Al-Adawi
- College of Medicine, Sultan Qaboos University, Al Khoudh, Muscat 123, Oman
| | - Kristiana Ludlow
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney, NSW 2109, Australia
| | - Wendy James
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney, NSW 2109, Australia
| | - Hsuen P Ting
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney, NSW 2109, Australia
| | - Jessica Herkes
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney, NSW 2109, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney, NSW 2109, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney, NSW 2109, Australia
| | - Wendy Nicklin
- International Society for Quality in Health Care (ISQua), 4th Floor, Huguenot House, 35-38 St Stephens Green, Dublin 2, D02 NY63, Ireland
| | - Clifford Hughes
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney, NSW 2109, A ustralia.,International Society for Quality in Health Care (ISQua), 4th Floor, Huguenot House, 35-38 St Stephens Green, Dublin 2, D02 NY63, Ireland
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Sunol R, Wagner C, Arah OA, Shaw CD, Kristensen S, Thompson CA, Dersarkissian M, Bartels PD, Pfaff H, Secanell M, Mora N, Vlcek F, Kutaj-Wasikowska H, Kutryba B, Michel P, Groene O. Evidence-based organization and patient safety strategies in European hospitals. Int J Qual Health Care 2014; 26 Suppl 1:47-55. [PMID: 24578501 PMCID: PMC4001691 DOI: 10.1093/intqhc/mzu016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2014] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To explore how European hospitals have implemented patient safety strategies (PSS) and evidence-based organization of care pathway (EBOP) recommendations and examine the extent to which implementation varies between countries and hospitals. DESIGN Mixed-method multilevel cross-sectional design in seven countries as part of the European Union-funded project 'Deepening our Understanding of Quality improvement in Europe' (DUQuE). SETTING AND PARTICIPANTS Seventy-four acute care hospitals with 292 departments managing acute myocardial infarction (AMI), hip fracture, stroke, and obstetric deliveries. Main outcome measure Five multi-item composite measures-one generic measure for PSS and four pathway-specific measures for EBOP. RESULTS Potassium chloride had only been removed from general medication stocks in 9.4-30.5% of different pathways wards and patients were adequately identified with wristband in 43.0-59.7%. Although 86.3% of areas treating AMI patients had immediate access to a specialist physician, only 56.0% had arrangements for patients to receive thrombolysis within 30 min of arrival at the hospital. A substantial amount of the total variance observed was due to between-hospital differences in the same country for PSS (65.9%). In EBOP, between-country differences play also an important role (10.1% in AMI to 57.1% in hip fracture). CONCLUSIONS There were substantial gaps between evidence and practice of PSS and EBOP in a sample of European hospitals and variations due to country differences are more important in EBOP than in PSS, but less important than within-country variations. Agencies supporting the implementation of PSS and EBOP should closely re-examine the effectiveness of their current strategies.
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Affiliation(s)
- Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, C/Provenza 293 pral, 08037 Barcelona, Spain. ;
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