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Okeke N, Hennessey KC, Sitapati AM, Weisshaar D, Shah NP, Alicki R, Haft H. Sustainable Approach to Justice, Equity, Diversity, and Inclusion Through Better Quality Measurement. Circ Cardiovasc Qual Outcomes 2024:e010791. [PMID: 38618717 DOI: 10.1161/circoutcomes.123.010791] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
The US health care industry has broadly adopted performance and quality measures that are extracted from electronic health records and connected to payment incentives that hope to improve declining life expectancy and health status and reduce costs. While the development of a quality measurement infrastructure based on electronic health record data was an important first step in addressing US health outcomes, these metrics, reflecting the average performance across diverse populations, do not adequately adjust for population demographic differences, social determinants of health, or ecosystem vulnerability. Like society as a whole, health care must confront the powerful impact that social determinants of health, race, ethnicity, and other demographic variations have on key health care performance indicators and quality metrics. Tools that are currently available to capture and report the health status of Americans lack the granularity, complexity, and standardization needed to improve health and address disparities at the local level. In this article, we discuss the current and future state of electronic clinical quality measures through a lens of equity.
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Affiliation(s)
- Nkem Okeke
- Medicalincs, Silver Spring, MD (N.O.)
- Harvard Medical School, Center for Primary Care, Boston, MA (N.O.)
| | - Kerrilynn C Hennessey
- Department of Medicine, Section of Cardiovascular Medicine, Dartmouth Hitchcock Health, Lebanon, NH (K.C.H.)
| | - Amy M Sitapati
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego Health (A.M.S.)
| | - Dana Weisshaar
- Institute of Medical Educators, Kaiser Permanente Santa Clara, CA (D.W.)
| | - Nishant P Shah
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC (N.P.S)
| | - Rebecca Alicki
- American Heart Association, Department of Quality, Outcomes Research and Analytics, Dallas, TX (R.A.)
| | - Howard Haft
- University of Maryland School of Medicine, Division of Health Sciences and Human Services, Baltimore (H.H.)
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Alvares LTDEA, Rangel AG, Campos LN, Viana SW, Kim AWS, Sampaio NZ, Ferreira R, Silva JB, Mooney DP, Camargo CP. Expanding Global Surgery Education in Brazil: Perspectives after the 35th Brazilian Surgical Congress. Rev Col Bras Cir 2024; 51:e20243667. [PMID: 38324886 PMCID: PMC10826473 DOI: 10.1590/0100-6991e-20243667-en] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/15/2023] [Indexed: 02/09/2024] Open
Abstract
The 35th Brazilian Congress of Surgery marked a turning point for surgical education in the country. For the first time, the Brazilian College of Surgeons included Global Surgery on the main congressional agenda, providing a unique opportunity to rethink how surgical skills are taught from a public health perspective. This discussion prompts us to consider why and how Global Surgery education should be expanded in Brazil. Although Brazilian researchers and institutions have contributed to the fields expansion since 2015, Global Surgery education initiatives are still incipient in our country. Relying on successful strategies can be a starting point to promote the area among national surgical practitioners. In this editorial, we discuss potential strategies to expand Global Surgery education opportunities and propose a series of recommendations at the national level.
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Affiliation(s)
| | - Ayla Gerk Rangel
- - Harvard Medical School, Program in Global Surgery and Social Change - Boston - Massachusetts - Estados Unidos
| | | | | | | | | | - Roseanne Ferreira
- - McMaster University, Department of Health Research Methods, Evidence and, Impact - Hamilton - Ontario - Canadá
| | | | - David P Mooney
- - Boston Children's Hospital - Boston - Massachusetts - Estados Unidos
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Gisslander K, Rutherford M, Aslett L, Basu N, Dradin F, Hederman L, Hruskova Z, Kardaoui H, Lamprecht P, Lichołai S, Musial J, O'Sullivan D, Puechal X, Scott J, Segelmark M, Straka R, Terrier B, Tesar V, Tesi M, Vaglio A, Wandrei D, White A, Wójcik K, Yaman B, Little MA, Mohammad AJ. Data quality and patient characteristics in European ANCA-associated vasculitis registries: data retrieval by federated querying. Ann Rheum Dis 2024; 83:112-120. [PMID: 37907255 PMCID: PMC10804071 DOI: 10.1136/ard-2023-224571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/13/2023] [Accepted: 09/16/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES This study aims to describe the data structure and harmonisation process, explore data quality and define characteristics, treatment, and outcomes of patients across six federated antineutrophil cytoplasmic antibody-associated vasculitis (AAV) registries. METHODS Through creation of the vasculitis-specific Findable, Accessible, Interoperable, Reusable, VASCulitis ontology, we harmonised the registries and enabled semantic interoperability. We assessed data quality across the domains of uniqueness, consistency, completeness and correctness. Aggregated data were retrieved using the semantic query language SPARQL Protocol and Resource Description Framework Query Language (SPARQL) and outcome rates were assessed through random effects meta-analysis. RESULTS A total of 5282 cases of AAV were identified. Uniqueness and data-type consistency were 100% across all assessed variables. Completeness and correctness varied from 49%-100% to 60%-100%, respectively. There were 2754 (52.1%) cases classified as granulomatosis with polyangiitis (GPA), 1580 (29.9%) as microscopic polyangiitis and 937 (17.7%) as eosinophilic GPA. The pattern of organ involvement included: lung in 3281 (65.1%), ear-nose-throat in 2860 (56.7%) and kidney in 2534 (50.2%). Intravenous cyclophosphamide was used as remission induction therapy in 982 (50.7%), rituximab in 505 (17.7%) and pulsed intravenous glucocorticoid use was highly variable (11%-91%). Overall mortality and incidence rates of end-stage kidney disease were 28.8 (95% CI 19.7 to 42.2) and 24.8 (95% CI 19.7 to 31.1) per 1000 patient-years, respectively. CONCLUSIONS In the largest reported AAV cohort-study, we federated patient registries using semantic web technologies and highlighted concerns about data quality. The comparison of patient characteristics, treatment and outcomes was hampered by heterogeneous recruitment settings.
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Affiliation(s)
- Karl Gisslander
- Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
| | | | - Louis Aslett
- Department of Mathematical Science, University of Durham, Durham, UK
| | - Neil Basu
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | | | - Lucy Hederman
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Zdenka Hruskova
- Department of Nephrology, General University Hospital, Prague, Czech Republic
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hicham Kardaoui
- National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, Universitat zu Lubeck, Lubeck, Germany
| | - Sabina Lichołai
- Division of Molecular Biology and Clinical Genetics, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Musial
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Declan O'Sullivan
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Xavier Puechal
- National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
- French Vasculitis Study Group, Paris, France
| | - Jennifer Scott
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Mårten Segelmark
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Endocrinology, Nephrology and Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Richard Straka
- General University Hospital in Prague, Praha, Czech Republic
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
- French Vasculitis Study Group, Paris, France
| | - Vladimir Tesar
- Department of Nephrology, General University Hospital, Prague, Czech Republic
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michelangelo Tesi
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Firenze, Italy
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Firenze, Italy
| | - Dagmar Wandrei
- Clinical Trials Unit, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Arthur White
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Krzysztof Wójcik
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Beyza Yaman
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Mark A Little
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Aladdin J Mohammad
- Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
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Corrêa FF, Carrilho TRB, Bonilha EDA, Keller VN, de Melo TC, Kac G, Diniz CSG. Analysis of the quality of prenatal data of pregnant women attended at Healthcare Services in the city of São Paulo between 2012 and 2020. Rev Bras Epidemiol 2023; 26:e230051. [PMID: 37971113 PMCID: PMC10662653 DOI: 10.1590/1980-549720230051] [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: 07/05/2023] [Revised: 09/04/2023] [Accepted: 09/14/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To analyze the quality of data collected during prenatal care recorded in the Integrated Health Care Management System (SIGA) of the Municipal Department of Health of São Paulo from 2012 to 2020. METHODS Descriptive study using SIGA data and the variables: maternal height (cm), weight (kg) measured throughout pregnancy, gestational age at prenatal consultation, systolic (SBP) and diastolic (DBP) blood pressure (in mmHg), and body mass index (BMI) at the beginning of pregnancy (up to 8 weeks). Quality analysis was carried out by calculating the indicators: percentage of incompleteness and zero values of all variables studied, percentage of implausible values for height, weight, BMI; preference for terminal digit of weight and height, and normality of distributions. RESULTS The database of pregnant women made available for analysis included 8,046,608 records and 1,174,115 women. The percentage of incompleteness and zero values was low (<1%) in all original variables of the system. There are more records at the end of pregnancy. For the four original variables of interest in the database (weight, height, SBP, DBP), there is a clear preference for the terminal digit. The variables of interest did not present an approximately normal distribution during the evaluated period. CONCLUSION The quality analysis showed the need for improving the standardization of information collection and recording, the rounding of measurements and the need for encouraging pregnant women to start prenatal care as soon as possible, in such a way that it is important to invest in data quality, through educational resources for professionals who work in health care.
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Affiliation(s)
| | - Thaís Rangel Bousquet Carrilho
- Universidade Federal do Rio de Janeiro, Josué de Castro
Nutrition Institute, Nutritional Epidemiology Observatory – Rio de Janeiro (RJ),
Brazil
| | - Eliana de Aquino Bonilha
- Centro Universitário São Camilo – São Paulo (SP),
Brazil
- Universidade de São Paulo, School of Public Health, Gender,
Evidence and Health Study Group – São Paulo (SP), Brazil
| | - Victor Nahuel Keller
- Universidade Federal do Rio de Janeiro, Josué de Castro
Nutrition Institute, Nutritional Epidemiology Observatory – Rio de Janeiro (RJ),
Brazil
| | | | - Gilberto Kac
- Universidade Federal do Rio de Janeiro, Josué de Castro
Nutrition Institute, Nutritional Epidemiology Observatory – Rio de Janeiro (RJ),
Brazil
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Topmiller M, McCann J, Hoang H, Rankin J, Grandmont J, Pelzer M, Sripipatana A. Health centres and social determinants of health: an analysis of enabling services provision and clinical quality. Fam Med Community Health 2023; 11:e002227. [PMID: 37775110 PMCID: PMC10546097 DOI: 10.1136/fmch-2023-002227] [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] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE It is well known that social determinants of health (SDOH), including poverty, education, transportation and housing, are important predictors of health outcomes. Health Resources and Services Administration (HRSA)-funded health centres serve a patient population with high vulnerability to barriers posed by SDOH and are required to provide services that enable health centre service utilisation and assist patients in navigating barriers to care. This study explores whether health centres with higher percentages of patients using these enabling services experience better clinical performance and outcomes. DESIGN AND SETTING The analysis uses organisational characteristics, patient demographics and clinical quality measures from HRSA's 2018 Uniform Data System. Health centres (n=875) were sorted into quartiles with quartile 1 (Q1) representing the lowest utilisation of enabling services and quartile 4 (Q4) representing the highest. The researchers calculated a service area social deprivation score weighted by the number of patients for each health centre and used ordinary least squares to create adjusted values for each of the clinical quality process and outcome measures. Analysis of variance was used to test differences across enabling services quartiles. RESULTS After adjusting for patient characteristics, health centre size and social deprivation, authors found statistically significant differences for all clinical quality process measures across enabling services quartiles, with Q4 health centres performing significantly better than Q1 health centres for several clinical process measures. However, these Q4 health centres performed poorer in outcome measures, including blood pressure and haemoglobin A1c control. CONCLUSION These findings emphasise the importance of how enabling services (eg, translation services, transportation) can address unmet social needs, improve utilisation of health services and reaffirm the challenges inherent in overcoming SDOH to improve health outcomes.
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Affiliation(s)
- Michael Topmiller
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Jessica McCann
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Hank Hoang
- US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Rockville, Maryland, USA
| | - Jennifer Rankin
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Jene Grandmont
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Molly Pelzer
- US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Rockville, Maryland, USA
| | - Alek Sripipatana
- US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Rockville, Maryland, USA
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Prusaczyk A, Gujski M, Onyśków W, Żuk P, Warsz L, Nitsch-Osuch A, Oberska J, Bogdan M. Efficiency and Effectiveness of Patient Care Provided by Physicians in Rural and Urban Areas in Poland. Med Sci Monit 2023; 29:e939169. [PMID: 37553822 PMCID: PMC10424557 DOI: 10.12659/msm.939169] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/30/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The health sector in Poland is currently facing challenges such as limited financial resources, poor infrastructure, and insufficient human resources. To address these issues, increasing cost-effectiveness at the individual physician level has become essential. This study aimed to evaluate the efficiency and effectiveness of patient care at the level of individual primary health care physicians and to compare the performance of physicians working in urban and rural areas. MATERIAL AND METHODS Thirteen original effectiveness indicators were developed based on a literature review, expert consultations, and a pilot study at the Medical and Diagnostic Center in Siedlce. The indicators were used to evaluate the effectiveness of physicians and compare physicians' characteristics working in rural and urban areas. The study extracted data on physicians' characteristics and used the indicators to evaluate their effectiveness. RESULTS Physicians working in rural areas treated more patients due to staff shortages. However, physicians working in urban areas demonstrated greater effectiveness in performing routine and advanced health checks and mammograms. Despite this advantage, the average life expectancy of patients was higher among patients of physicians working in rural areas. CONCLUSIONS Five indicators developed in the study formed a scale, which is a step toward developing a uniform effectiveness indicator. Further research on consistently measuring effectiveness could significantly impact the development of sociometric research methodology. This study highlights the differences in efficiency and effectiveness of physicians working in rural vs urban areas and underscores the need for healthcare policymakers to consider these differences in addressing healthcare resource allocation.
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Affiliation(s)
| | - Mariusz Gujski
- Department of Public Health, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Onyśków
- Foundation for the Development of Social Research, Cracow, Poland
| | - Paweł Żuk
- Medical and Diagnostic Center, Siedlce, Poland
| | | | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Oberska
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Bogdan
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
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Batista J, Cruz EDDEA, Silva DPDA, Nazário SDAS, Antunes BCS. Impact of surgical checklists on the time of surgical processes: a cross-sectional study. Rev Col Bras Cir 2023; 50:e20233425. [PMID: 36790228 PMCID: PMC10519694 DOI: 10.1590/0100-6991e-20233425-en] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/29/2022] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVES to analyze the impact of the use of checklists on the mean time of the operative processes of patients undergoing hip and knee arthroplasties. METHOD cross-sectional and analytical research conducted between November/2020 and March/2022 with retrospective consultation in a simple random sample of 291 medical records, distributed in three periods (2010/2013/2016). Descriptive and inferential statistics were used for data analysis; p=0.05 values indicated significance. RESULTS there was a reduction in the time of entry-exit from the operating room (p=0.002), surgery (p<0.001) and between the onset-anesthesia and the beginning-incision (p=0.021). There was no difference in time between patients with and without the use of checklists (p=0.05) in relation to the variables onset-anesthesia, onset-incision, time of anesthesia and surgery. CONCLUSION the implementation of checklists potentially contributed to reduce the time of use of the operating room. The nonassociation of its use with the increase in the mean time of the processes in the operating room shows that its application does not interfere negatively in this indicator.
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Affiliation(s)
- Josemar Batista
- - Universidade Federal do Paraná, Programa de Pós-graduação em Enfermagem - Curitiba - PR - Brasil
| | | | | | - Saimon DA Silva Nazário
- - Universidade Federal do Paraná, Programa de Pós-graduação em Enfermagem - Curitiba - PR - Brasil
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Piątek S, Urbański F, Karczmarz S, Prusaczyk A, Sobiczewski P, Bogdan M, Gujski M, Bidziński M. Assessment of Hospital Volume in the Surgical Management of Endometrial and Ovarian Cancer: A Polish Population-Based Study. Med Sci Monit 2023; 29:e938776. [PMID: 36650732 PMCID: PMC9875547 DOI: 10.12659/msm.938776] [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: 12/29/2022] Open
Abstract
BACKGROUND Surgery is a cornerstone in management of ovarian and endometrial cancer. The European Society of Gynecological Oncology introduced quality indicators to improve management of these cancers. The optimal annual number of surgeries per unit was established for high-quality surgical treatment. MATERIAL AND METHODS The database of the National Health Fund on surgical management of endometrial and ovarian cancer was analyzed. Patients treated between 2017 and 2020 were included. Departments where patients underwent surgery were divided according to number of surgeries performed per year in endometrial cancer: ≥80, 79-50, 49-20, 19-0; and ovarian cancer: ≥100, 99-50, 49-20, 19-0. Optimal number of surgeries per center was defined as at least 100 and 80 surgeries per year in ovarian and endometrial cancer, respectively. RESULTS Totally, there were 22 325 surgeries in 316 units and 10 381 surgeries in 251 units due to endometrial and ovarian cancer, respectively. Most surgeries in endometrial cancer (n=15 077; 67.5%) and ovarian cancer (n=9642; 92.88%) were performed in departments that did not meet optimal criteria in number of surgeries. Between 2017 and 2019, an increasing trend in number of surgeries per year in endometrial and ovarian cancer was found. In 2020, there was a decrease in the number of surgeries by 7.8% (n=453) and 8.6% (n=234) in endometrial and ovarian cancer, respectively. CONCLUSIONS In Poland, surgical treatment of ovarian and endometrial cancer is decentralized. Most cancer patients underwent surgery in low-volume general gynecologic departments. The COVID-19 pandemic impaired cancer management, leading to a decreased number of surgeries.
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Affiliation(s)
- Szymon Piątek
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | | | - Artur Prusaczyk
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland,Value Based Care Employers’ Union (SPOIWO), Warsaw, Poland
| | - Piotr Sobiczewski
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Magdalena Bogdan
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Gujski
- Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Bidziński
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Souza JE, Ferreirai RV, Saluja S, Amundson J, Citron I, Truche P, Roa L, Zimmerman K, Jenny HE, Bowder AN, Gomes PHDAS, Correia JDEO, Meara J, Alonso N. Surgical capacity assessment in the state of Amazonas using the surgical assessment tool. Cross-sectional study. Rev Col Bras Cir 2022; 49:e20223368. [PMID: 36134849 PMCID: PMC10578809 DOI: 10.1590/0100-6991e-20223368-en] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Brazil is a country with universal health coverage, yet access to surgery among remote rural populations remains understudied. This study assesses surgical care capacity among hospitals providing care for the rural populations in the Amazonas state of Brazil through in-depth facility assessments. METHODS a stratified randomized cross-sectional evaluation of hospitals that self-report providing surgical care in Amazonas was conducted from July 2016 to March 2017. The Surgical Assessment Tool (SAT) developed by the World Health Organization and the Program in Global Surgery and Social Change at Harvard Medical School was administered at remote hospitals, including a retrospective review of medical records and operative logbooks. RESULTS 18 hospitals were surveyed. Three hospitals (16.6%) had no operating rooms and 12 (66%) had 1-2 operating rooms. 14 hospitals (77.8%) reported monitoring by pulse oximetry was always present and six hospitals (33%) never have a professional anesthesiologist available. Inhaled general anesthesia was available in 12 hospitals (66.7%), but 77.8% did not have any mechanical ventilation device. An average of 257 procedures per 100,000 were performed. 10 hospitals (55.6%) do not have a specific post-anesthesia care unit. For the regions covered by the 18 hospitals, with a population of 497,492 inhabitants, the average surgeon, anesthetist, obstetric workforce density was 6.4. CONCLUSION populations living in rural areas in Brazil face significant disparities in access to surgical care, despite the presence of universal health coverage. Development of a state plan for the implementation of surgery is necessary to ensure access to surgical care for rural populations.
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Affiliation(s)
- José Emerson Souza
- - University of the State of Amazonas, Department of Surgery - Manaus - AM - Brasil
| | | | - Saurabh Saluja
- - Harvard Medical School, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine - Boston - Massachusetts - Estados Unidos
| | - Julia Amundson
- - Harvard Medical School, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine - Boston - Massachusetts - Estados Unidos
| | - Isabelle Citron
- - Harvard Medical School, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine - Boston - Massachusetts - Estados Unidos
| | - Paul Truche
- - Harvard Medical School, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine - Boston - Massachusetts - Estados Unidos
| | - Lina Roa
- - Harvard Medical School, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine - Boston - Massachusetts - Estados Unidos
| | - Kathrin Zimmerman
- - Harvard Medical School, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine - Boston - Massachusetts - Estados Unidos
| | - Hillary E Jenny
- - Harvard Medical School, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine - Boston - Massachusetts - Estados Unidos
| | - Alexis N Bowder
- - Harvard Medical School, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine - Boston - Massachusetts - Estados Unidos
| | | | | | - John Meara
- - Harvard Medical School, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine - Boston - Massachusetts - Estados Unidos
- - Boston Children's Hospital, Department of Plastic and Oral Surgery - Boston - Massachusetts - Estados Unidos
| | - Nivaldo Alonso
- - University of São Paulo, Department of Surgery - São Paulo - SP - Brasil
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10
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Campos LN, Salgado LS, Viana SW, Bezerra AH, Mishaly A, Ribeiro LS, Yabrude ATZ, Aquino CMDE, Ferreira RV, Ferreira JL, Botelho F. Global Surgery at the National Landscape: Perspectives after the XXXIV Brazilian Congress of Surgery. Rev Col Bras Cir 2022; 49:e20223189. [PMID: 35319566 PMCID: PMC10578818 DOI: 10.1590/0100-6991e-20223189] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022] Open
Abstract
The XXXIV Brazilian Congress of Surgery included Global Surgery for the first time in its scientific program. Global Surgery is any action in research, clinical practice, and policy-making that aims to improve access and quality of care in surgical specialties. In 2015, The Lancet Commission on Global Surgery highlighted that five billion people lack safe, timely, and affordable surgical care. Even more critical, nine of ten people cannot access essential surgical care in low and middle-income countries, where a third of the worldwide population resides, and only 6% of global surgical procedures are performed. Although Brazilian researchers and institutions have been contributing to lay the movement's foundations since 2014, Global Surgery remains a barely debated subject in the country. It is urgent to expand the field and break paradigms regarding the surgeons' role in public health in Brazil. Accomplishing these standards requires a joint effort to strategically allocate resources and identify collaboration opportunities, including those from medical societies and regulatory bodies. As members of the International Student Surgical Network of Brazil - a nonprofit organization by and for students, residents, and young physicians focused on Global Surgery - we review why investing in surgery is cost-effective to strengthen health systems, reduce morbimortality, and lead to economic development. Additionally, we highlight and propose key recommendations to foster the field at the national level.
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Affiliation(s)
- Letícia Nunes Campos
- - International Student Surgical Network of Brazil - Brasil
- - Universidade de Pernambuco, Faculdade de Ciências Médicas - Recife - PE - Brasil
| | - Lucas Sousa Salgado
- - International Student Surgical Network of Brazil - Brasil
- - União Educacional do Vale do Aço, Faculdade de Medicina - Ipatinga - MG - Brasil
| | - Sofia Wagemaker Viana
- - International Student Surgical Network of Brazil - Brasil
- - Kursk State Medical University, Faculdade de Medicina - Kursk - Kurskaya Oblast - Rússia
| | - Aristócles Hítallo Bezerra
- - International Student Surgical Network of Brazil - Brasil
- - Centro Universitário Unifacisa, Faculdade de Medicina - Campina Grande - PB - Brasil
| | - Asher Mishaly
- - International Student Surgical Network of Brazil - Brasil
- - Universidade Nove de Julho, Faculdade de Medicina - São Paulo - SP - Brasil
| | - Lívia Sousa Ribeiro
- - International Student Surgical Network of Brazil - Brasil
- - Universidade Federal do Recôncavo da Bahia, Centro de Ciências da Saúde - Santo Antônio de Jesus - BA - Brasil
| | - Angela Theresa Zuffo Yabrude
- - International Student Surgical Network of Brazil - Brasil
- - Universidade Regional de Blumenau, Faculdade de Medicina - Blumenau - SC - Brasil
| | - Caroline Marques DE Aquino
- - International Student Surgical Network of Brazil - Brasil
- - Universidade Nove de Julho, Faculdade de Medicina - São Paulo - SP - Brasil
| | - Rodrigo Vaz Ferreira
- - Universidade do Estado do Amazonas, Disciplina de Cirurgia - Manaus - AM - Brasil
| | - Júlia Loyola Ferreira
- - McGill University - Montreal - Quebec - Canadá
- - Montreal Children's Hospital, McGill University Health Center, Harvey E. Beardmore Division of Pediatric Surgery - Montreal - Quebec - Canadá
| | - Fabio Botelho
- - McGill University - Montreal - Quebec - Canadá
- - Montreal Children's Hospital, McGill University Health Center, Harvey E. Beardmore Division of Pediatric Surgery - Montreal - Quebec - Canadá
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11
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Hassan N, van Mens LJ, Kiltz U, Andreoli L, Delgado-Beltran C, Ovseiko PV, Gossec L, Coates LC. Gender equity in academic rheumatology: is there a gender gap at European rheumatology conferences? RMD Open 2022; 8:e002131. [PMID: 35246471 PMCID: PMC8900061 DOI: 10.1136/rmdopen-2021-002131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/09/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To obtain an overview of gender equity at European rheumatology conferences. METHODS The proportion of women invited as either moderators or speakers to the European Alliance of Associations for Rheumatology (EULAR) annual congresses and national conferences in Europe was calculated from the published congress materials from EULAR annual congresses (2015-2019) and the 2019 national conferences of France, Germany, Italy, Spain and the UK. Data from EULAR congresses were further categorised by type of session. Significance testing was conducted using χ2 tests with the level of statistical significance set at p<0.05. RESULTS The proportion of combined women moderators and speakers at EULAR varied from 40% to 43% between 2015 and 2019 with no obvious trend over time. There were higher proportions of women in the Health Professionals in Rheumatology and People with Arthritis and Rheumatism sessions (>50% consistently). However, these sessions represent <25% of EULAR congress invitations. Representation of women at the EULAR congress in 2019 (39.6%) was significantly higher than at the national congresses in France (28.6%) and Germany (29.6%) but similar to that observed in Italy (33.7%), Spain (41.7%) and the UK (42%). CONCLUSION Women account for less than half of invited moderators and speakers at the conferences reviewed. Compared with historical EULAR data in 2003 (16%) and in 2004 (19%), the gender gap at EULAR congresses has narrowed considerably, but there remains a need to monitor and improve women's representation.
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Affiliation(s)
- Neelam Hassan
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
- Department of Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Leonieke Jj van Mens
- Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Uta Kiltz
- Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Pavel V Ovseiko
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Laura C Coates
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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12
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Abstract
To determine whether a community-based physical rehabilitation program could improve the prognosis of patients who had undergone percutaneous coronary intervention after acute myocardial infarction, we randomly divided 164 consecutive patients into 2 groups of 82 patients. Patients in the rehabilitation group underwent 3 months of supervised exercise training, then 9 months of community-based, self-managed exercise; patients in the control group received conventional treatment. The primary endpoint was major adverse cardiac events (MACE) during the follow-up period (25 ± 15.4 mo); secondary endpoints included left ventricular ejection fraction, 6-minute walk distance, and laboratory values at 12-month follow-up. During the study period, the incidence of MACE was significantly lower in the rehabilitation group (13.4% vs 24.4%; P <0.01). Cox proportional hazards regression analysis indicated a significantly lower risk of MACE in the rehabilitation group (hazard ratio=0.56; 95% CI, 0.37-0.82; P=0.01). At 12 months, left ventricular ejection fraction and 6-minute walk distance in the rehabilitation group were significantly greater than those in the control group (both P <0.01), and laboratory values also improved. These findings suggest that community-based physical rehabilitation significantly reduced MACE risk and improved cardiac function and physical stamina in patients who underwent percutaneous coronary intervention after acute myocardial infarction.
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Affiliation(s)
- Meiling Xiao
- Department of Cardiovascular Medicine, The Fourth People's Hospital of Shenyang, Shenyang, People's Republic of China
| | - Yinjun Li
- Department of Cardiovascular Medicine, The Fourth People's Hospital of Shenyang, Shenyang, People's Republic of China
| | - Xiaodan Guan
- Department of Cardiovascular Medicine, The Fourth People's Hospital of Shenyang, Shenyang, People's Republic of China
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13
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Sivera F, Alunno A, Najm A, Avcin T, Baraliakos X, Bijlsma JW, Badreh S, Burmester G, Cikes N, Da Silva JA, Damjanov N, Dougados M, Dudler J, Edwards CJ, Iagnocco A, Lioté F, Nikiphorou E, van Onna M, Stones SR, Vassilopoulos D, Haines C, Ramiro S. 2019 EULAR points to consider for the assessment of competences in rheumatology specialty training. Ann Rheum Dis 2020; 80:65-70. [PMID: 32788400 DOI: 10.1136/annrheumdis-2020-218015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/20/2020] [Revised: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Striving for harmonisation of specialty training and excellence of care in rheumatology, the European League Against Rheumatism (EULAR) established a task force to develop points to consider (PtCs) for the assessment of competences during rheumatology specialty training. METHODS A systematic literature review on the performance of methods for the assessment of competences in rheumatology specialty training was conducted. This was followed by focus groups in five selected countries to gather information on assessment practices and priorities. Combining the collected evidence with expert opinion, the PtCs were formulated by the multidisciplinary task force, including rheumatologists, medical educationalists, and people with rheumatic and musculoskeletal diseases. The level of agreement (LoA) for each PtC was anonymously voted online. RESULTS Four overarching principles and 10 PtCs were formulated. The overarching principles highlighted the importance of assessments being closely linked to the rheumatology training programme and protecting sufficient time and resources to ensure effective implementation. In the PtCs, two were related to overall assessment strategy (PtCs 1 and 5); three focused on formative assessment and portfolio (PtCs 2-4); three focused on the assessment of knowledge, skills or professionalism (PtCs 6-8); one focused on trainees at risk of failure (PtC 9); and one focused on training the trainers (PtC 10). The LoA (0-10) ranged from 8.75 to 9.9. CONCLUSION These EULAR PtCs provide European guidance on assessment methods throughout rheumatology training programmes. These can be used to benchmark current practices and to develop future strategies, thereby fostering continuous improvement in rheumatology learning and, ultimately, in patient care.
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Affiliation(s)
- Francisca Sivera
- Department of Clinical Medicine, Miguel Hernandez University of Elche, Elche, Spain .,Department of Rheumatology, Hospital General Universitario Elda, Elda, Spain
| | - Alessia Alunno
- Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Aurélie Najm
- INSERM UMR1238, University of Medicine, CHU Nantes, Nantes, France.,Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Johannes W Bijlsma
- Department of Rheumatology and Clinical Immunology, UMCUtrecht, Utrecht, Netherlands
| | - Sara Badreh
- EULAR Patient Research Partner, Stockholm, Sweden
| | - Gerd Burmester
- Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Nada Cikes
- Division of Clinical Immunology and Rheumatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Jose Ap Da Silva
- Reumatologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Maxime Dougados
- Rheumatologie B, Hopital Cochin, Paris, Île-de-France, France
| | - Jean Dudler
- Service de Rhumatologie, HFR Fribourg, Hôpital Cantonal, Fribourg, Switzerland
| | - Christopher J Edwards
- Musculoskeletal Research Unit, NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Annamaria Iagnocco
- Academic Rheumatology Center, Università degli Studi di Torino, Torino, Italy
| | - Frédéric Lioté
- Department of Rhumatologie, Hôpital Lariboisière, Paris, France.,INSERM UMR-1132, University of Paris, Paris, France
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, London, UK
| | - Marloes van Onna
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | - Dimitrios Vassilopoulos
- 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, Athens University School of Medicine, Athens, Greece
| | - Catherine Haines
- Center for Teaching and Learning, University of Oxford, Oxford, UK
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
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14
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Landewé RBM, Schulze-Koops H. Response to: 'Should patients starting biologics be screened for COVID-19?' by Cardenas-de la Garza et al. Ann Rheum Dis 2020; 81:e151. [PMID: 32699038 DOI: 10.1136/annrheumdis-2020-218470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Robert B M Landewé
- Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands .,Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Internal Medicine IV, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
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15
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Krusche M, Burmester GR, Knitza J. Digital crowdsourcing: unleashing its power in rheumatology. Ann Rheum Dis 2020; 79:1139-1140. [PMID: 32527863 PMCID: PMC7456558 DOI: 10.1136/annrheumdis-2020-217697] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic forces the whole rheumatic and musculoskeletal diseases community to reassemble established treatment and research standards. Digital crowdsourcing is a key tool in this pandemic to create and distil desperately needed clinical evidence and exchange of knowledge for patients and physicians alike. This viewpoint explains the concept of digital crowdsourcing and discusses examples and opportunities in rheumatology. First experiences of digital crowdsourcing in rheumatology show transparent, accessible, accelerated research results empowering patients and rheumatologists.
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Affiliation(s)
- Martin Krusche
- Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd R Burmester
- Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
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16
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Landewé RB, Machado PM, Kroon F, Bijlsma HW, Burmester GR, Carmona L, Combe B, Galli M, Gossec L, Iagnocco A, Isaacs JD, Mariette X, McInnes I, Mueller-Ladner U, Openshaw P, Smolen JS, Stamm TA, Wiek D, Schulze-Koops H. EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Ann Rheum Dis 2020; 79:851-858. [PMID: 32503854 DOI: 10.1136/annrheumdis-2020-217877] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [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: 05/05/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 12/30/2022]
Abstract
The provisional EULAR recommendations address several aspects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus, and the disease caused by SARS-CoV-2, COVID-19 and are meant for patients with rheumatic and musculoskeletal diseases (RMD) and their caregivers. A task force of 20 members was convened by EULAR that met several times by videoconferencing in April 2020. The task force finally agreed on five overarching principles and 13 recommendations covering four generic themes: (1) General measures and prevention of SARS-CoV-2 infection. (2) The management of RMD when local measures of social distancing are in effect. (3) The management of COVID-19 in the context of RMD. (4) The prevention of infections other than SARS-CoV-2. EULAR considers this set of recommendations as a 'living document' and a starting point, which will be updated as soon as promising new developments with potential impact on the care of patients with RMD become available.
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Affiliation(s)
- Robert Bm Landewé
- Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands .,Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
| | - Féline Kroon
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Gerd R Burmester
- Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Loreto Carmona
- Depratment of Rheumatology, Instituto de Salud Musculoesquelética, Madrid, Spain
| | - Bernard Combe
- Immunorhumatologie, CHU Lapeyronie, Montpellier, France
| | - Massimo Galli
- Department of infectious diseases, Universita degli Studi di Milano, Milano, Lombardia, Italy
| | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France.,APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - John D Isaacs
- Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Institute of Cellular Medicine, Newcastle upon Tyne, UK
| | - Xavier Mariette
- Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux universitaires Paris-Sud - Hôpital Bicêtre, Le Kremlin Bicêtre, France.,3Université Paris-Sud, Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Ulf Mueller-Ladner
- Rheumatology and Clinical Immunology, Giessen University, Bad Nauheim, Germany
| | - Peter Openshaw
- National Heart & Lung Institute, Imperial College London Faculty of Medicine, London, London, UK
| | - Josef S Smolen
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | | | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig Maximilian University of Munich, Munich, Germany
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17
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Verstraeten SPA, van Oers HAM, Mackenbach JP. Contribution of amenable mortality to life expectancy differences between the Dutch Caribbean islands of Aruba and Curaçao and the Netherlands. Rev Panam Salud Publica 2020; 44:e38. [PMID: 32435265 PMCID: PMC7236862 DOI: 10.26633/rpsp.2020.38] [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] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/24/2020] [Indexed: 12/14/2022] Open
Abstract
Objective. To identify specific health care areas whose optimization could improve population health in the Dutch Caribbean islands of Aruba and Curaçao. Methods. Comparative observational study using mortality and population data of the Dutch Caribbean islands and the Netherlands. Mortality trends were calculated, then analyzed with Joinpoint software, for the period 1988–2014. Life expectancies were computed using abridged life tables for the most recent available data of all territories (2005–2007). Life expectancy differences between the Dutch Caribbean and the Netherlands were decomposed into cause-specific contributions using Arriaga’s method. Results. During the period 1988–2014, levels of amenable mortality have been consistently higher in Aruba and Curaçao than in the Netherlands. For Aruba, the gap in amenable mortality with the Netherlands did not significantly change during the study period, while it widened for Curaçao. If mortality from amenable causes were reduced to similar levels as in the Netherlands, men and women in Aruba would have added, respectively, 1.19 years and 0.72 years to their life expectancies during the period 2005–2007. In Curaçao, this would be 2.06 years and 2.33 years. The largest cause-specific contributions were found for circulatory diseases, breast cancer, perinatal causes, and nephritis/nephrosis (these last two causes solely in Curaçao). Conclusions. Improvements in health care services related to circulatory diseases, breast cancer, perinatal deaths, and nephritis/nephrosis in the Dutch Caribbean could substantially contribute to reducing the gap in life expectancy with the Netherlands. Based on our study, we recommend more in-depth studies to identify the specific interventions and resources needed to optimize the underlying health care areas.
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Affiliation(s)
- Soraya P A Verstraeten
- Institute for Public Health (Volksgezondheid Instituut Curaçao) Institute for Public Health (Volksgezondheid Instituut Curaçao) Ministry of Health, Environment and Nature Willemstad Curaçao Institute for Public Health (Volksgezondheid Instituut Curaçao), Ministry of Health, Environment and Nature, Willemstad, Curaçao
| | - Hans A M van Oers
- Ministry of Health, Welfare and Sport Ministry of Health, Welfare and Sport The Hague the Netherlands Ministry of Health, Welfare and Sport, The Hague, the Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus MC Department of Public Health, Erasmus MC Rotterdam the Netherlands Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
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18
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Khanna N, Gritzer L, Klyushnenkova E, Montgomery R, Dark M, Shah S, Shaya F. Practice Transformation Analytics Dashboard for Clinician Engagement. Ann Fam Med 2019; 17:S73-S76. [PMID: 31405880 PMCID: PMC6827660 DOI: 10.1370/afm.2382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/21/2018] [Accepted: 01/31/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Practice transformation in primary care is a movement toward data-driven redesign of care, patient-centered care delivery, and practitioner activation. A critical requirement for achieving practice transformation is availability of tools to engage practices. METHODS A total of 48 practices with 109 practice sites participate in the Garden Practice Transformation Network in Maryland (GPTN-Maryland) to work together toward practice transformation and readiness for the Quality Payment Program implemented by the Centers for Medicare & Medicaid Services. Practice-specific data are collected in GPTN-Maryland by practices themselves and by practice transformation coaches, and are provided by the Centers for Medicare & Medicaid Services. These data are overwhelming to practices when presented piecemeal or together, a barrier to practices taking action to ensure progress on the transformation spectrum. The GPTN-Maryland team therefore created a practice transformation analytics dashboard as a tool to present data that are actionable in care redesign. RESULTS When practices reviewed their data provided by the Centers for Medicare & Medicaid Services using the dashboard, they were often seeing, for the first time, cost data on their patients, trends in their key performance indicator data, and their practice transformation phase. Overall, 72% of practices found the dashboard engaging, and 48% found the data as presented to be actionable. CONCLUSIONS The practice transformation analytics dashboard encourages practices to advance in practice transformation and improvement of patient care delivery. This tool engaged practices in discussions about data, care redesign, and costs of care, and about how to develop sustainable change within their practices. Research is needed to study the impact of the dashboard on costs and quality of care delivery.
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Affiliation(s)
- Niharika Khanna
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lauren Gritzer
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Elena Klyushnenkova
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Michael Dark
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Savyasachi Shah
- University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Fadia Shaya
- University of Maryland School of Pharmacy, Baltimore, Maryland
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19
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Rivas R, Montazeri N, Le NX, Hristidis V. Automatic Classification of Online Doctor Reviews: Evaluation of Text Classifier Algorithms. J Med Internet Res 2018; 20:e11141. [PMID: 30425030 PMCID: PMC6256102 DOI: 10.2196/11141] [Citation(s) in RCA: 12] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/21/2018] [Accepted: 09/04/2018] [Indexed: 12/02/2022] Open
Abstract
Background An increasing number of doctor reviews are being generated by patients on the internet. These reviews address a diverse set of topics (features), including wait time, office staff, doctor’s skills, and bedside manners. Most previous work on automatic analysis of Web-based customer reviews assumes that (1) product features are described unambiguously by a small number of keywords, for example, battery for phones and (2) the opinion for each feature has a positive or negative sentiment. However, in the domain of doctor reviews, this setting is too restrictive: a feature such as visit duration for doctor reviews may be expressed in many ways and does not necessarily have a positive or negative sentiment. Objective This study aimed to adapt existing and propose novel text classification methods on the domain of doctor reviews. These methods are evaluated on their accuracy to classify a diverse set of doctor review features. Methods We first manually examined a large number of reviews to extract a set of features that are frequently mentioned in the reviews. Then we proposed a new algorithm that goes beyond bag-of-words or deep learning classification techniques by leveraging natural language processing (NLP) tools. Specifically, our algorithm automatically extracts dependency tree patterns and uses them to classify review sentences. Results We evaluated several state-of-the-art text classification algorithms as well as our dependency tree–based classifier algorithm on a real-world doctor review dataset. We showed that methods using deep learning or NLP techniques tend to outperform traditional bag-of-words methods. In our experiments, the 2 best methods used NLP techniques; on average, our proposed classifier performed 2.19% better than an existing NLP-based method, but many of its predictions of specific opinions were incorrect. Conclusions We conclude that it is feasible to classify doctor reviews. Automatically classifying these reviews would allow patients to easily search for doctors based on their personal preference criteria.
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Affiliation(s)
- Ryan Rivas
- Department of Computer Science and Engineering, University of California, Riverside, Riverside, CA, United States
| | - Niloofar Montazeri
- Department of Computer Science and Engineering, University of California, Riverside, Riverside, CA, United States
| | - Nhat Xt Le
- Department of Computer Science and Engineering, University of California, Riverside, Riverside, CA, United States
| | - Vagelis Hristidis
- Department of Computer Science and Engineering, University of California, Riverside, Riverside, CA, United States
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20
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Marcolino MS, Oliveira JADQ, Silva GKME, Dias TD, Marino BCA, Antunes AP, Ribeiro AL, Cardoso CS. Satisfaction of Emergency Physicians with the Care Provided to Patients with Cardiovascular Diseases in the Northern Region of Minas Gerais. Arq Bras Cardiol 2018; 111:151-159. [PMID: 30183981 PMCID: PMC6122911 DOI: 10.5935/abc.20180143] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/26/2018] [Accepted: 04/11/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The dissatisfaction of health professionals in emergency services has a negative influence on both the quality of care provided for acute myocardial infarction (AMI) patients and the retention of those professionals. OBJECTIVE To assess physicians' satisfaction with the structure of care and diagnosis at the emergency services in the Northern Region of Minas Gerais before the implementation of the AMI system of care. METHODS This cross-sectional study included physicians from the emergency units of the ambulance service (SAMU) and level II, III and IV regional hospitals. Satisfaction was assessed by using the CARDIOSATIS-Team scale. The median score for each item, the overall scale and the domains were calculated and then compared by groups using the non-parametric Mann-Whitney test. Correlation between time since graduation and satisfaction level was assessed using Spearman correlation. A p value < 0.05 was considered significant. RESULTS Of the 137 physicians included in the study, 46% worked at SAMU. Most of the interviewees showed overall dissatisfaction with the structure of care, and the median score for the overall scale was 2.0 [interquartile range (IQR) 2.0-4.0]. Most SAMU physicians expressed their dissatisfaction with the care provided (54%), the structure for managing cardiovascular diseases (52%), and the technology available for diagnosis (54%). The evaluation of the overall satisfaction evidenced that the dissatisfaction of SAMU physicians was lower when compared to that of hospital emergency physicians. Level III/IV hospital physicians expressed greater overall satisfaction when compared to level II hospital physicians. CONCLUSION This study showed the overall dissatisfaction of the emergency physicians in the region assessed with the structure of care for cardiovascular emergencies.
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Affiliation(s)
- Milena Soriano Marcolino
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
- Medical School, Universidade Federal de Minas Gerais, Belo
Horizonte, MG - Brazil
| | - João Antonio de Queiroz Oliveira
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
- Medical School, Universidade Federal de Minas Gerais, Belo
Horizonte, MG - Brazil
| | - Grace Kelly Matos e Silva
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | - Thatiane Dantas Dias
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | - Barbara Campos Abreu Marino
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | - Antonio Luiz Ribeiro
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
- Medical School, Universidade Federal de Minas Gerais, Belo
Horizonte, MG - Brazil
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Forbes LJ, Marchand C, Doran T, Peckham S. The role of the Quality and Outcomes Framework in the care of long-term conditions: a systematic review. Br J Gen Pract 2017; 67:e775-84. [PMID: 28947621 DOI: 10.3399/bjgp17X693077] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/12/2017] [Indexed: 11/24/2022] Open
Abstract
Background Improving care for people with long-term conditions is central to NHS policy. It has been suggested that the Quality and Outcomes Framework (QOF), a primary care pay-for-performance scheme that rewards practices for delivering effective interventions in long-term conditions, does not encourage high-quality care for this group of patients. Aim To examine the evidence that the QOF has improved quality of care for patients with long-term conditions. Design and setting This was a systematic review of research on the effectiveness of the QOF in the UK. Method The authors searched electronic databases for peer-reviewed empirical quantitative research studying the effect of the QOF on a broad range of processes and outcomes of care, including coordination and integration of care, holistic and personalised care, self-care, patient experience, physiological and biochemical outcomes, health service utilisation, and mortality. Because the studies were heterogeneous, a narrative synthesis was carried out. Results The authors identified three systematic reviews and five primary research studies that met the inclusion criteria. The QOF was associated with a modest slowing of both the increase in emergency admissions and the increase in consultations in severe mental illness (SMI), and modest improvements in diabetes care. The nature of the evidence means that the authors cannot be sure that any of these associations is causal. No clear effect on mortality was found. The authors found no evidence that the QOF influences integration or coordination of care, holistic care, self-care, or patient experience. Conclusion The NHS should consider more broadly what constitutes high-quality primary care for people with long-term conditions, and consider other ways of motivating primary care to deliver it.
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Arakawa T, Magnabosco GT, Andrade RLDP, Brunello MEF, Monroe AA, Ruffino-Netto A, Scatena LM, Villa TCS. Tuberculosis control program in the municipal context: performance evaluation. Rev Saude Publica 2017; 51:23. [PMID: 28380207 PMCID: PMC5575720 DOI: 10.1590/s1518-8787.2017051006553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/14/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The objective of this study is to evaluate the performance of the Tuberculosis Control Program in municipalities of the State of São Paulo. METHODS This is a program evaluation research, with ecological design, which uses three non-hierarchical groups of the municipalities of the State of São Paulo according to their performance in relation to operational indicators. We have selected 195 municipalities with at least five new cases of tuberculosis notified in the Notification System of the State of São Paulo and with 20,000 inhabitants or more in 2010. The multiple correspondence analysis was used to identify the association between the groups of different performances, the epidemiological and demographic characteristics, and the characteristics of the health systems of the municipalities. RESULTS The group with the worst performance showed the highest rates of abandonment (average [avg] = 10.4, standard deviation [sd] = 9.4) and the lowest rates of supervision of Directly Observed Treatment (avg = 6.1, sd = 12.9), and it was associated with low incidence of tuberculosis, high tuberculosis and HIV, small population, high coverage of the Family Health Strategy/Program of Community Health Agents, and being located on the countryside. The group with the best performance presented the highest cure rate (avg = 83.7, sd = 10.5) and the highest rate of cases in Directly Observed Treatment (avg = 83.0, sd = 12.7); the group of regular performance showed regular results for outcome (avg cure = 79.8, sd = 13.2; abandonment avg = 9.5, sd = 8.3) and supervision of the Directly Observed Treatment (avg = 42.8, sd = 18.8). Large population, low coverage of the Family Health Strategy/Program of Community Health Agents, high incidence of tuberculosis and AIDS, and being located on the coast and in metropolitan areas were associated with these groups. CONCLUSIONS The findings highlight the importance of the Directly Observed Treatment in relation to the outcome for treatment and raise reflections on the structural and managerial capacity of municipalities in the implementation of the Tuberculosis Control Program. OBJETIVO Avaliar o desempenho do Programa de Controle da Tuberculose em municípios paulistas. MÉTODOS Pesquisa de avaliação de serviços, com delineamento ecológico, utilizando três agrupamentos não hierárquicos de municípios paulistas de acordo com seu desempenho em relação a indicadores operacionais. Foram selecionadas 195 cidades com no mínimo cinco casos novos de tuberculose notificados no Sistema de Notificação do Estado de São Paulo e 20.000 habitantes ou mais em 2010. A análise de correspondência múltipla foi utilizada para a identificação da associação entre os grupos de distintos desempenhos e as características epidemiológicas, demográficas e de sistemas de saúde dos municípios. RESULTADOS O grupo de pior desempenho apresentou as taxas mais elevadas de abandono (média [md] = 10,4; desvio padrão [dp] = 9,4) e as menores proporções de efetivação de Tratamento Diretamente Observado (md = 6,1; dp = 12,9) e esteve associado à baixa incidência de tuberculose, alta confecção tuberculose e HIV, pequeno porte populacional, alta cobertura de Estratégia Saúde da Família/Programa de Agentes Comunitários em Saúde e localização no interior. O grupo de melhor desempenho apresentou a maior taxa de cura (md = 83,7; dp = 10,5) e a maior proporção de casos em Tratamento Diretamente Observado (md = 83,0; dp = 12,7); enquanto o grupo de desempenho regular mostrou resultados regulares de desfecho (cura: md = 79,8; dp = 13,2; abandono: md = 9,5; dp = 8,3) e de efetivação do Tratamento Diretamente Observado (md = 42,8; dp = 18,8). Grande porte populacional, baixa cobertura de Estratégia Saúde da Família/Programa de Agentes Comunitários em Saúde, alta incidência de tuberculose e aids, e localização no litoral e em áreas metropolitanas estiveram associados com esses grupos. CONCLUSÕES Os achados destacam a importância do Tratamento Diretamente Observado em relação ao desfecho do tratamento e levantam reflexões sobre a capacidade estrutural e gerencial dos municípios na operacionalização do Programa de Controle da Tuberculose.
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Affiliation(s)
- Tiemi Arakawa
- Programa de Pós-Graduação Enfermagem em Saúde Pública. Escola de Enfermagem de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
| | - Gabriela Tavares Magnabosco
- Programa de Pós-Graduação Enfermagem em Saúde Pública. Escola de Enfermagem de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
| | - Rubia Laine de Paula Andrade
- Departamento Materno-Infantil e Saúde Pública. Escola de Enfermagem de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
| | - Maria Eugenia Firmino Brunello
- Departamento Materno-Infantil e Saúde Pública. Escola de Enfermagem de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
| | - Aline Aparecida Monroe
- Departamento Materno-Infantil e Saúde Pública. Escola de Enfermagem de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
| | - Antonio Ruffino-Netto
- Departamento de Medicina Social. Faculdade de Medicina de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
| | - Lucia Marina Scatena
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal do Triângulo Mineiro. Uberaba, MG, Brasil
| | - Tereza Cristina Scatena Villa
- Departamento Materno-Infantil e Saúde Pública. Escola de Enfermagem de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
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Prytherch H, Nafula M, Kandie C, Brodowski M, Marx I, Kubaj S, Omogi I, Zurkuhlen A, Herrler C, Goetz K, Szecsenyi J, Marx M. Quality management: where is the evidence? Developing an indicator-based approach in Kenya. Int J Qual Health Care 2017; 29:19-25. [PMID: 27940522 PMCID: PMC5461473 DOI: 10.1093/intqhc/mzw147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 10/08/2016] [Accepted: 11/22/2016] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The 2030 Sustainable Development Agenda emphasizes the importance of quality of care in the drive to achieve universal health coverage. Despite recent progress, challenges in service delivery, efficiency and resource utilization in the health sector remain. OBJECTIVE The Ministry of Health Department of Standards and Regulations sought to operationalize the Kenya Quality Assurance Model for Health. To this end, the European Practice Assessment (EPA) was adapted to the area of Reproductive and Maternal and Neonatal Health. METHODS The adaptation process made use of a ten step-modified RAND Corporation/University of California Los Angeles (UCLA) Appropriateness Method. The steps included a scoping workshop, definition of five critical domains of quality in the Kenyan context ('People, Management, Clinical Care, Quality & Safety, Interface between inpatients and outpatients care'), a review of policy documents, management and clinical guidelines, grey and scientific literature to identify indicators in use in the Kenyan health system and an expert panel process to rate their feasibility and validity. RESULTS The resulting 278 indicators, clustered across the five domains, were broken-down into 29 dimensions and assigned measure specifications. A set of data collection tools were developed to furnish the indicators and piloted at two health facilities. They were subsequently finalized for use in 30 health facilities in 3 counties. CONCLUSIONS The integrative and indicator-based aspects of the EPA process could be readily adapted to facilitate the operationalization of a practical quality assurance approach in Kenya.
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Affiliation(s)
- Helen Prytherch
- evaplan at the University Hospital, Heidelberg, Germany
- Swiss Tropical and Public Health Institute, University of Basel, Basel 4002, Switzerland
| | - Maureen Nafula
- Institute of Health Policy, Management and Research (IHPMR), Nairobi, Kenya
| | - Charles Kandie
- Head of Department of Standards and Regulatory Services, Ministry of Health, Nairobi, Kenya
| | - Marc Brodowski
- Institute for Applied Quality Improvement & Research in Health Care (AQUA), Göttingen, Germany
| | - Irmgard Marx
- evaplan at the University Hospital, Heidelberg, Germany
| | - Sandy Kubaj
- evaplan at the University Hospital, Heidelberg, Germany
| | - Irene Omogi
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Health Programme, Kenya
| | | | - Claudia Herrler
- Institute for Applied Quality Improvement & Research in Health Care (AQUA), Göttingen, Germany
| | - Katja Goetz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Joachim Szecsenyi
- Institute for Applied Quality Improvement & Research in Health Care (AQUA), Göttingen, Germany
- Department of General Medicine and Health Service Research, University of Heidelberg, Heidelberg, Germany
| | - Michael Marx
- evaplan at the University Hospital, Heidelberg, Germany
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
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Wechsler LR, Demaerschalk BM, Schwamm LH, Adeoye OM, Audebert HJ, Fanale CV, Hess DC, Majersik JJ, Nystrom KV, Reeves MJ, Rosamond WD, Switzer JA. Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 48:e3-e25. [PMID: 27811332 DOI: 10.1161/str.0000000000000114] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Telestroke is one of the most frequently used and rapidly expanding applications of telemedicine, delivering much-needed stroke expertise to hospitals and patients. This document reviews the current status of telestroke and suggests measures for ongoing quality and outcome monitoring to improve performance and to enhance delivery of care. METHODS A literature search was undertaken to examine the current status of telestroke and relevant quality indicators. The members of the writing committee contributed to the review of specific quality and outcome measures with specific suggestions for metrics in telestroke networks. The drafts were circulated and revised by all committee members, and suggestions were discussed for consensus. RESULTS Models of telestroke and the role of telestroke in stroke systems of care are reviewed. A brief description of the science of quality monitoring and prior experience in quality measures for stroke is provided. Process measures, outcomes, tissue-type plasminogen activator use, patient and provider satisfaction, and telestroke technology are reviewed, and suggestions are provided for quality metrics. Additional topics include licensing, credentialing, training, and documentation.
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Borzecki AM, Chen Q, Mull HJ, Shwartz M, Bhatt DL, Hanchate A, Rosen AK. Do Acute Myocardial Infarction and Heart Failure Readmissions Flagged as Potentially Preventable by the 3M Potentially Preventable Readmissions Software Have More Process-of-Care Problems? Circ Cardiovasc Qual Outcomes 2016; 9:532-41. [PMID: 27601460 DOI: 10.1161/circoutcomes.115.002509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/15/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The 3M Potentially Preventable Readmissions (3M-PPR) software matches clinically related index admission and readmission diagnoses that may signify in-hospital or postdischarge quality problems. To assess whether the PPR algorithm identifies preventable readmissions, we compared processes of care between PPR software-flagged and nonflagged cases. METHODS AND RESULTS Using 2006 to 2010 national VA administrative data, we identified acute myocardial infarction and heart failure discharges associated with 30-day all-cause readmissions, then flagged cases (PPR-Yes/PPR-No) using the 3M-PPR software. To assess care quality, we abstracted medical records of 100 readmissions per condition using tools containing explicit processes organized into admission work-up, in-hospital evaluation/treatment, discharge readiness, postdischarge period. We derived quality scores, scaled to a maximum of 25 per section (maximum total score=100) and compared cases on total and section-specific mean scores. For acute myocardial infarction, 77 of 100 cases were flagged as PPR-Yes. Section quality scores were highest for in-hospital evaluation/treatment (20.5±2.8) and lowest for postdischarge care (6.8±9.1). Total and section-related mean scores did not differ by PPR status; respective PPR-Yes versus PPR-No total scores were 61.6±11.1 and 60.4±9.4; P=0.98. For heart failure, 86 of 100 cases were flagged as PPR-Yes. Section scores were highest for discharge readiness (18.8±2.4) and lowest for postdischarge care (7.3±8.1). Like acute myocardial infarction, total and section-related mean scores did not differ by PPR status; PPR-Yes versus PPR-No total scores were 61.2±10.8 and 63.4±7.0, respectively; P=0.47. CONCLUSIONS Among VA acute myocardial infarction and heart failure readmissions, the 3M-PPR software does not distinguish differences in case-level quality of care. Whether 3M-PPR software better identifies preventable readmissions by using other methods to capture poorly documented processes or performing different comparisons requires further study.
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Affiliation(s)
- Ann M Borzecki
- From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.).
| | - Qi Chen
- From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.)
| | - Hillary J Mull
- From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.)
| | - Michael Shwartz
- From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.)
| | - Deepak L Bhatt
- From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.)
| | - Amresh Hanchate
- From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.)
| | - Amy K Rosen
- From the Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC Campus, Bedford, MA (A.M.B.); Department of Health Policy and Management, Boston University School of Public Health, MA (A.M.B.); Department of Medicine (A.M.B., A.H.) and Department of Surgery (H.J.M., A.K.R.), Boston University School of Medicine, MA; CHOIR, Boston VA Campus, MA (Q.C., H.J.M., M.S., A.H., A.K.R.); Boston University Questrom School of Business, MA (M.S.); Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (D.L.B.); and Department of Medicine, Harvard Medical School, Boston, MA (D.L.B.)
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Affiliation(s)
- Frederick A Masoudi
- From Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora.
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Anger JT, Alas A, Litwin MS, Chu SD, Bresee C, Roth CP, Rashid R, Shekelle P, Wenger NS. The Quality of Care Provided to Women with Urinary Incontinence in 2 Clinical Settings. J Urol 2016; 196:1196-200. [PMID: 27164512 DOI: 10.1016/j.juro.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Our aim was to test the feasibility of a set of quality of care indicators for urinary incontinence and at the same time measure the care provided to women with urinary incontinence in 2 clinical settings. MATERIALS AND METHODS This was a pilot test of a set of quality of care indicators. A total of 20 quality of care indicators were previously developed using the RAND Appropriateness Method. These quality of care indicators were used to measure care received for 137 women with a urinary incontinence diagnosis in a 120-physician hospital based multispecialty medical group. We also performed an abstraction of 146 patient records from primary care offices in Southern California. These charts were previously used as part of ACOVE (Assessing Care of Vulnerable Elders Project). As a post-hoc secondary analysis, the 2 populations were compared with respect to quality, as measured by compliance with the quality of care indicators. RESULTS In the ACOVE population, 37.7% of patients with urinary incontinence underwent a pelvic examination vs 97.8% in the multispecialty medical group. Only 15.6% of cases in the multispecialty medical group and 14.2% in ACOVE (p = 0.86) had documentation that pelvic floor exercises were offered. Relatively few women with a body mass index of greater than 25 kg/m(2) were counseled about weight loss in either population (20.9% multispecialty medical group vs 26.1% ACOVE, p = 0.76). For women undergoing sling surgery, documentation of counseling about risks was lacking and only 9.3% of eligible cases (multispecialty medical group only) had documentation of the risks of mesh. CONCLUSIONS Quality of care indicators are a feasible means to measure the care provided to women with urinary incontinence. Care varied by population studied and yet deficiencies in care were prevalent in both patient populations studied.
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Affiliation(s)
- Jennifer T Anger
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, University of California-Los Angeles, Los Angeles, California.
| | - Alexandriah Alas
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, University of California-Los Angeles, Los Angeles, California
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Department of Health Policy and Management, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California
| | - Stephanie D Chu
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Catherine Bresee
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, University of California-Los Angeles, Los Angeles, California
| | - Carol P Roth
- Southern California Evidence-Based Practice Center, RAND Corp., Santa Monica, California
| | - Rezoana Rashid
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, University of California-Los Angeles, Los Angeles, California
| | - Paul Shekelle
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Veterans Administration Greater West Los Angeles Medical Center, Los Angeles, California; Southern California Evidence-Based Practice Center, RAND Corp., Santa Monica, California
| | - Neil S Wenger
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Veterans Administration Greater West Los Angeles Medical Center, Los Angeles, California
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Corrêa ADG, Makdisse M, Katz M, Santana TC, Yokota PKO, Galvão TDFG, Bacal F. Analysis Treatment Guideline versus Clinical Practice Protocol in Patients Hospitalized due to Heart Failure. Arq Bras Cardiol 2016; 106:210-7. [PMID: 26815461 PMCID: PMC4811276 DOI: 10.5935/abc.20160018] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/21/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Despite the availability of guidelines for treatment of heart failure (HF), only a few studies have assessed how hospitals adhere to the recommended therapies. OBJECTIVES Compare the rates of adherence to the prescription of angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers (ACEI/ARB) at hospital discharge, which is considered a quality indicator by the Joint Commission International, and to the prescription of beta-blockers at hospital discharge, which is recommended by national and international guidelines, in a hospital with a case management program to supervise the implementation of a clinical practice protocol (HCP) and another hospital that follows treatment guidelines (HCG). METHODS Prospective observational study that evaluated patients consecutively admitted to both hospitals due to decompensated HF between August 1st, 2006, and December 31st, 2008. We used as comparing parameters the prescription rates of beta-blockers and ACEI/ARB at hospital discharge and in-hospital mortality. RESULTS We analyzed 1,052 patients (30% female, mean age 70.6 ± 14.1 years), 381 (36%) of whom were seen at HCG and 781 (64%) at HCP. The prescription rates of beta-blockers at discharge at HCG and HCP were both 69% (p = 0.458), whereas those of ACEI/ARB were 83% and 86%, respectively (p = 0.162). In-hospital mortality rates were 16.5% at HCP and 27.8% at HCG (p < 0.001). CONCLUSION There was no difference in prescription rates of beta-blocker and ACEI/ARB at hospital discharge between the institutions, but HCP had lower in-hospital mortality. This difference in mortality may be attributed to different clinical characteristics of the patients in both hospitals.
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Affiliation(s)
| | | | - Marcelo Katz
- Hospital Israelita Albert Einstein, São Paulo, SP
- Brasil
| | | | | | | | - Fernando Bacal
- Hospital Israelita Albert Einstein, São Paulo, SP
- Brasil,Instituto do Coração da Faculdade de
Medicina da USP, São Paulo, SP - Brasil
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Norrving B, Bray BD, Asplund K, Heuschmann P, Langhorne P, Rudd AG, Wagner M, Wiedmann S, Wolfe CDA. Cross-National Key Performance Measures of the Quality of Acute Stroke Care in Western Europe. Stroke 2015; 46:2891-5. [PMID: 26265128 DOI: 10.1161/strokeaha.115.008811] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 01/16/2015] [Accepted: 07/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE There are no agreed measures of stroke care quality that enable the standardized comparison of stroke care between countries. We aimed to develop a set of measures of quality of acute stroke care involving stroke quality registers in Western Europe. METHODS A multinational working group identified 6 regional or national stroke quality registers in Europe and reviewed their data sets, performance measures, and the method by which these had been developed. Measures used in the registers were presented for discussion to a consensus group of representatives from the quality registers identified, as well as other stroke experts, and the final set of common performance measures was agreed through majority consensus. RESULTS Thirty final performance measures were agreed by the European consensus group, encompassing the domains of coordination of care (stroke unit-based care), diagnosis (brain imaging, vascular imaging, cardiac arrhythmia detection, and therapy assessment), preservation of neural tissue (thrombolytic therapy and door-to-needle time), prevention of complications (dysphagia screening), initiation of secondary prevention (antiplatelet, anticoagulation, lipid lowering, blood pressure lowering, carotid surgery, time from vascular imaging to carotid surgery, and smoking cessation), survival (90-day poststroke mortality), and functional outcomes (90-day modified Rankin Scale). CONCLUSIONS On the basis of experience of quality registers in Europe, we have proposed a common set of performance measures that will facilitate the international comparison of acute stroke care quality.
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Affiliation(s)
- Bo Norrving
- From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.)
| | - Benjamin D Bray
- From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.).
| | - Kjell Asplund
- From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.)
| | - Peter Heuschmann
- From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.)
| | - Peter Langhorne
- From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.)
| | - Anthony G Rudd
- From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.)
| | - Markus Wagner
- From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.)
| | - Silke Wiedmann
- From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.)
| | - Charles D A Wolfe
- From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.)
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Wiedmann S, Hillmann S, Abilleira S, Dennis M, Hermanek P, Niewada M, Norrving B, Asplund K, Rudd AG, Wolfe CDA, Heuschmann PU. Variations in acute hospital stroke care and factors influencing adherence to quality indicators in 6 European audits. Stroke 2014; 46:579-81. [PMID: 25550369 DOI: 10.1161/strokeaha.114.007504] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We compared compliance with standards of acute stroke care between 6 European audits and identified factors associated with delivery of appropriate care. METHODS Data were derived from stroke audits in Germany, Poland, Scotland, Catalonia, Sweden, and England/Wales/Northern-Ireland participating within the European Implementation Score (EIS) collaboration. Associations between demographic and clinical characteristics with adherence to predefined quality indicators were investigated by hierarchical logistic regression analyses. RESULTS In 2007/2008 data from 329 122 patients with stroke were documented. Substantial variations in adherence to quality indicators were found; older age was associated with a lower probability of receiving thrombolytic therapy, anticoagulant therapy, or stroke unit treatment and a higher probability of being tested for dysphagia. Women were less likely to receive anticoagulant or antiplatelet therapy or stroke unit treatment. No major weekend effect was found. CONCLUSIONS Detected variations in performance of acute stroke services were found. Differences in adherence to quality indicators might indicate population subgroups with specific needs for improving care delivery.
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Affiliation(s)
- Silke Wiedmann
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom.
| | - Steffi Hillmann
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Sònia Abilleira
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Martin Dennis
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Peter Hermanek
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Maciej Niewada
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Bo Norrving
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Kjell Asplund
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Anthony G Rudd
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Charles D A Wolfe
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Peter U Heuschmann
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
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Müller-Barna P, Hubert GJ, Boy S, Bogdahn U, Wiedmann S, Heuschmann PU, Audebert HJ. TeleStroke units serving as a model of care in rural areas: 10-year experience of the TeleMedical project for integrative stroke care. Stroke 2014; 45:2739-44. [PMID: 25147327 DOI: 10.1161/strokeaha.114.006141] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke Unit care improves stroke prognosis and is recommended for all patients with stroke. In rural areas, population-wide implementation of Stroke Units is challenging. Therefore, the TeleMedical Project for integrative Stroke Care (TEMPiS) was established in 2003 as a TeleStroke Unit network to overcome this barrier in Southeast Bavaria/Germany. Evaluation of its implementation between 2003 and 2005 had revealed improved process quality and clinical outcomes compared with matched hospitals without TeleStroke Units. Data on sustainability of these effects are lacking. METHODS Effects on the stroke care of the local population were analyzed by using data from official hospital reports. Prospective registries from 2003 to 2012 describe processes and outcomes of consecutive patients with stroke and transient ischemic attack treated in TEMPiS hospitals. Quality indicators assess diagnostics, treatment, and outcome. Rates and timeliness of intravenous thrombolysis as well as data on teleconsultations and secondary interhospital transfers were reported over time. RESULTS Within the covered area, network implementation increased the number of patients with stroke and transient ischemic attack treated in hospitals with (Tele-)Stroke Units substantially from 19% to 78%. Between February 2003 and December 2012, 54 804 strokes and transient ischemic attacks were treated in 15 regional hospitals, and 31 864 teleconsultations were performed. Intravenous thrombolysis was applied 3331 stroke cases with proportions increasing from 2.6% to 15.5% of all patients with ischemic stroke. Median onset-to-treatment times decreased from 150 (interquartile range, 127-163) to 120 minutes (interquartile range, 90-160) and door-to-needle times from 80 (interquartile range, 68-101) to 40 minutes (interquartile range, 29-59). CONCLUSIONS TeleStroke Units can provide sustained high-quality stroke care in rural areas.
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Affiliation(s)
- Peter Müller-Barna
- From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Gordian J Hubert
- From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Boy
- From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Bogdahn
- From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Silke Wiedmann
- From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter U Heuschmann
- From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heinrich J Audebert
- From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany
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Affiliation(s)
- James M McCabe
- From the Division of Cardiology, University of Washington, Seattle (J.M.M.); Division of Cardiovascular Medicine, Lahey Clinic, Burlington, MA (F.S.R.); and Tufts Medical School, Boston, MA (F.S.R.).
| | - Frederic S Resnic
- From the Division of Cardiology, University of Washington, Seattle (J.M.M.); Division of Cardiovascular Medicine, Lahey Clinic, Burlington, MA (F.S.R.); and Tufts Medical School, Boston, MA (F.S.R.).
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Vituri DW, Évora YDM. Reliability of indicators of nursing care quality: testing interexaminer agreement and reliability. Rev Lat Am Enfermagem 2014; 22:234-40. [PMID: 26107830 PMCID: PMC4292599 DOI: 10.1590/0104-1169.3262.2407] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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] [Received: 04/26/2013] [Accepted: 09/03/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE this study sought to test the interexaminer agreement and reliability of 15 indicators of nursing care quality. METHODS this was a quantitative, methodological, experimental, and applied study conducted at a large, tertiary, public teaching hospital in the state of Paraná. For data analysis, the Kappa (k) statistic was applied to the categorical variables - indicators 1 to 11 and 15 - and the interclass correlation coefficient (ICC) to the continuous variables - indicators 12, 13, and 14, with the corresponding 95% confidence intervals. The categorical data were analyzed using the Lee software, elaborated by the Laboratory of Epidemiology and Statistics of Dante Pazzanese Institute of Cardiology - Brazil, and the continuous data were assessed using BioEstat 5.0. RESULTS the k-statistic results indicated excellent agreement, which was statistically significant, and the values of the ICC denoted excellent and statistically significant reproducibility/agreement relative to the investigated indicators. CONCLUSION the investigated indicators exhibited excellent reliability and reproducibility, thus showing that it is possible to formulate valid and reliable assessment instruments for the management of nursing care.
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Affiliation(s)
- Dagmar Willamowius Vituri
- Doctoral student, Escola de Enfermagem de Ribeirão Preto,
Universidade de São Paulo, WHO Collaborating Centre for Nursing Research
Development, Ribeirão Preto, SP, Brazil. RN, Hospital Universitário, Universidade
Estadual de Londrina, Londrina, PR, Brazil
| | - Yolanda Dora Martinez Évora
- PhD, Full Professor, Escola de Enfermagem de Ribeirão Preto,
Universidade de São Paulo, WHO Collaborating Centre for Nursing Research
Development, Ribeirão Preto, SP, Brazil
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Kristensen GB, Aakre KM, Kristoffersen AH, Sandberg S. How to conduct External Quality Assessment Schemes for the pre-analytical phase? Biochem Med (Zagreb) 2014; 24:114-22. [PMID: 24627720 PMCID: PMC3936964 DOI: 10.11613/bm.2014.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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] [Received: 11/11/2013] [Accepted: 01/03/2014] [Indexed: 12/01/2022] Open
Abstract
In laboratory medicine, several studies have described the most frequent errors in the different phases of the total testing process, and a large proportion of these errors occur in the pre-analytical phase. Schemes for registration of errors and subsequent feedback to the participants have been conducted for decades concerning the analytical phase by External Quality Assessment (EQA) organizations operating in most countries. The aim of the paper is to present an overview of different types of EQA schemes for the pre-analytical phase, and give examples of some existing schemes. So far, very few EQA organizations have focused on the pre-analytical phase, and most EQA organizations do not offer pre-analytical EQA schemes (EQAS). It is more difficult to perform and standardize pre-analytical EQAS and also, accreditation bodies do not ask the laboratories for results from such schemes. However, some ongoing EQA programs for the pre-analytical phase do exist, and some examples are given in this paper. The methods used can be divided into three different types; collecting information about pre-analytical laboratory procedures, circulating real samples to collect information about interferences that might affect the measurement procedure, or register actual laboratory errors and relate these to quality indicators. These three types have different focus and different challenges regarding implementation, and a combination of the three is probably necessary to be able to detect and monitor the wide range of errors occurring in the pre-analytical phase.
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Affiliation(s)
| | - Kristin Moberg Aakre
- The Norwegian EQA Program (NKK), Bergen,
Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen,
Norway
| | - Ann Helen Kristoffersen
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen,
Norway
- Noklus (Norwegian Centre for Quality Improvement of Primary Care Laboratories), University of Bergen, Bergen,
Norway
| | - Sverre Sandberg
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen,
Norway
- Noklus (Norwegian Centre for Quality Improvement of Primary Care Laboratories), University of Bergen, Bergen,
Norway
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Meneghelo RS, Morhy SS, Zucchi P. Time of exercise as indicator of quality control in ergometry services. Arq Bras Cardiol 2014; 102:151-5. [PMID: 24676370 PMCID: PMC3987341 DOI: 10.5935/abc.20140005] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 09/01/2013] [Accepted: 09/19/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The search for quality requires assessment tools in the various subdivisions of a health complex. In diagnostic medicine, they are scarce and in ergometry suggestions of indicators were not found. OBJECTIVE To establish indicator for quality control on ergometry based on III Guidelines of the Brazilian Cardiology Society About Ergometric Test; to verify the percentage of tests that have presented the indicator within the compliance in two services of the same institution before and after the publication of the document. METHODS A critical analysis of the guidelines in the search for indicator that would present: accuracy, reliability, simplicity, validity, sensitivity and ability to quantitatively measure the variations in the behavior of quality criteria and that would be applicable to all tests. The indicator was applied in tests of 2010 and 2011 prior to the publication, and after it was adopted by two services of the same institution. RESULTS The indicator that has met the criteria was the percentage of ergometric tests with exercise duration between 8 and 12 minutes. In the years 2010 and 2011, respectively, the percentage of ergometric tests within compliance were 85.5% and 86.1% (p=0.068) at the General Hospital, and 81.5% and 85.7% (p<0.001) the Service of Periodic Health Assessment. CONCLUSION The exercise time between 8 and 12 minutes can be used as a quality criterion in ergometric and services where it was applied, at least 80% of the ergometric tests were compliant.
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Affiliation(s)
| | | | - Paola Zucchi
- Grupo Interdepartamental de Economia da Saúde-GRIDES - Universidade
Federal de São Paulo-UNIFESP, São Paulo, SP - Brazil
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McCabe JM, Kennedy KF, Eisenhauer AC, Waldman HM, Mort EA, Pomerantsev E, Resnic FS, Yeh RW. Reporting trends and outcomes in ST-segment-elevation myocardial infarction national hospital quality assessment programs. Circulation 2013; 129:194-202. [PMID: 24249721 DOI: 10.1161/circulationaha.113.006165] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND For patients who undergo primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction, the door-to-balloon time is an important performance measure reported to the Centers for Medicare & Medicaid Services (CMS) and tied to hospital quality assessment and reimbursement. We sought to assess the use and impact of exclusion criteria associated with the CMS measure of door-to-balloon time in primary PCI. METHODS AND RESULTS All primary PCI-eligible patients at 3 Massachusetts hospitals (Brigham and Women's, Massachusetts General, and North Shore Medical Center) were evaluated for CMS reporting status. Rates of CMS reporting exclusion were the primary end points of interest. Key secondary end points were between-group differences in patient characteristics, door-to-balloon times, and 1-year mortality rates. From 2005 to 2011, 26% (408) of the 1548 primary PCI cases were excluded from CMS reporting. This percentage increased over the study period from 13.9% in 2005 to 36.7% in the first 3 quarters of 2011 (P<0.001). The most frequent cause of exclusion was for a diagnostic dilemma such as a nondiagnostic initial ECG, accounting for 31.2% of excluded patients. Although 95% of CMS-reported cases met door-to-balloon time goals in 2011, this was true of only 61% of CMS-excluded cases and consequently 82.6% of all primary PCI cases performed that year. The 1-year mortality for CMS-excluded patients was double that of CMS-included patients (13.5% versus 6.6%; P<0.001). CONCLUSIONS More than a quarter of patients who underwent primary PCI were excluded from hospital quality reports collected by CMS, and this percentage has grown substantially over time. These findings may have significant implications for our understanding of process improvement in primary PCI and mechanisms for reimbursement through Medicare.
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Affiliation(s)
- James M McCabe
- Division of Cardiology, University of Washington, Seattle (J.M.M.); Division of Cardiology, St. Luke's/Mid America Heart Institute, Kansas City, MO (K.F.K.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.C.E.); Division of Cardiology, North Shore Medical Center, Salem, MA (H.M.W.); Department of Medicine (E.A.M.) and Cardiology Division (E.P., R.W.Y.), Massachusetts General Hospital, Boston; and Division of Cardiovascular Medicine, Lahey Clinic/Tufts Medical School, Burlington, MA (F.S.R.)
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Greaves F, Millett C, Pape UJ, Soljak M, Majeed A. Association between primary care organisation population size and quality of commissioning in England: an observational study. Br J Gen Pract 2012; 62:e46-54. [PMID: 22520680 PMCID: PMC3252539 DOI: 10.3399/bjgp12x616364] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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] [Received: 05/05/2011] [Revised: 06/14/2011] [Accepted: 07/19/2011] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The ideal population size of healthcare commissioning organisations is not known. AIM To investigate whether there is a relationship between the size of commissioning organisations and how well they perform on a range of performance measures. DESIGN AND SETTING Cross-sectional, observational study of performance in all 152 primary care trusts (PCTs) in England. METHOD Comparison of PCT size against 36 indicators of commissioning performance, including measures of clinical and preventative effectiveness, patient centredness, access, cost, financial ability, and engagement. RESULTS Fourteen of the 36 indicators have an unadjusted relationship (P<0.05) with size of the PCT. With 10 indicators, there was increasing quality with larger size. However, when population factors including deprivation, ethnicity, rurality, and age were included in the analysis, there was no relationship between size and performance for any measure. CONCLUSION There is no evidence to suggest that there is an optimum size for PCT performance. Observed variations in PCT performance with size were explained by the characteristics of the populations they served. These findings suggest that configuration of clinical commissioning groups should be geared towards producing organisations that can function effectively across their key responsibilities, rather than being based on the size of their population alone.
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Affiliation(s)
- Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, London.
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Morgan CL, Beerstecher HJ. Primary care funding, contract status, and outcomes: an observational study. Br J Gen Pract 2006; 56:825-9. [PMID: 17132348 PMCID: PMC1927089] [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] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND The introduction of the Quality and Outcomes Framework (QOF) provides a quantitative way of assessing quality of care in general practice. We explore the achievements of general practice in the first year of the QOF, with specific reference to practice funding and contract status. AIM To determine the extent to which differences in funding and contract status affect quality in primary care. DESIGN OF STUDY Cross-sectional observational study using practice data obtained under the Freedom of Information Act 2000. SETTING One hundred and sixty-four practices from six primary care trusts (PCTs) in England. METHOD Practice data for all 164 practices were collated for income and contract status. The outcome measure was QOF score for the year 2004-2005. All data were analysed statistically. RESULTS Contract status has an impact on practice funding, with Employed Medical Services (EMS) and Personal Medical Services (PMS) practices receiving higher levels of funding than General Medical Services (GMS) practices (P<0.001). QOF scores also vary according to contract status. Higher funding levels in EMS practices are associated with lower QOF scores (P=0.04); while GMS practices exhibited the opposite trend, with higher-funded practices achieving better quality scores (P<0.001). CONCLUSION GMS practices are the most efficient contract status, achieving high quality scores for an average of pound 62.51 per patient per year. By contrast, EMS practices are underperforming, achieving low quality scores for an average of pound 105.37 per patient per year. Funding and contract status are therefore important factors in determining achievement in the QOF.
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Abstract
Despite the substantial amount of asthma-related information available on the internet, little is known about the quality of such information. We assessed asthma-related information on the Korean internet intended as an educational material for asthma patients. By entering the key word, 'asthma', into 4 popular search engines, 32 web sites were identified and categorized with respect to authorship. The core asthma educational concepts and Health On the Net Code of Conduct principles were used to evaluate informational value and justifiability of unreliable information. Eight of 32 web sites were categorized as western physician, seventeen as oriental physician, four as commercial, and three as others. The mean number of core asthma educational concepts on the whole web sites was 2.7 out of 8. By type of authorship, 1.7 on the commercial sites, 2.1 on the oriental physician sites, 3.5 on the western physician sites, and 5.0 on the others sites in decreasing order. One of the western physician sites, two of the commercial sites, and all of the oriental physician and others sites contained unreliable information. However all of them except one site failed to satisfy our criteria of justifiability. Asthma-related information currently available on the Korean internet is highly variable in quality and lacks core asthma educational concepts and justifiability.
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Affiliation(s)
- Heung-Woo Park
- Department of Internal Medicine, National Rehabilitation Hospital, Seoul, Korea
| | - Kyung-Up Min
- Division of Allergy, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - You-Young Kim
- Division of Allergy, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Heon Cho
- Division of Allergy, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Talbot-Smith A, Gnani S, Pollock AM, Gray DP. Questioning the claims from Kaiser. Br J Gen Pract 2004; 54:415-21; discussion 422. [PMID: 15186560 PMCID: PMC1266198] [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] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The article by Feachem et al, published in the BMJ in 2002, claimed to show that, compared with the United Kingdom (UK) National Health Service (NHS), the Kaiser Permanente healthcare system in the United States (US) has similar healthcare costs per capita, and performance that is considerably better in certain respects. AIM To assess the accuracy of Feachem et al's comparison and conclusions. METHOD Detailed re-examination of the data and methods used and consideration of the 82 letters responding to the article. RESULTS Analyses revealed four main areas in which Feachem et al's methodology was flawed. Firstly, the populations of patients served by Kaiser Permanente and by the NHS are fundamentally different. Kaiser's patients are mainly employed, significantly younger, and significantly less socially deprived and so are healthier. Feachem et al fail to adjust adequately for these factors. Secondly, Feachem et al have wrongly inflated NHS costs by omitting substantial user charges payable by Kaiser members for care, excluding the costs of marketing and administration, and deducting the surplus from Kaiser's costs while underestimating the capital charge element of the NHS budget and other costs. They also used two methods of converting currency, the currency rate and a health purchasing power parity conversion. This is double counting. Feachem et al reported that NHS costs were 10% less per head than Kaiser. Correcting for the double currency conversion gives the NHS a 40% cost advantage such that per capita costs are 1161 dollars and 1951 dollars for the NHS and Kaiser, respectively. Thirdly, Feachem et al use non-standardised data for NHS bed days from the Organisation for Economic Cooperation and Development, rather than official Department of Health bed availability and activity statistics for England. Leaving aside the non-comparability of the population and lack of standardisation of the data, the result is to inflate NHS acute bed use and underestimate the efficiency of performance by at least 10%. Similar criticisms apply to their selective use of performance measures. Finally, Feachem et al claim that Kaiser is a more integrated system than the NHS. The NHS provides health care to around 60 million people free at the point of delivery, long-term and psychiatric care, and continuing care after 100 days whereas Kaiser provides care to 6 million people, mainly employed and privately insured. Important functions, such as health protection, education and training of healthcare professionals, and research and development are not included or properly costed in Feachem et al's integrated model. CONCLUSION We have re-examined the statements made by Feachem et al and show that the claims are unsupported by the evidence. The NHS is not similar to Kaiser in coverage, costs or performance.
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Affiliation(s)
- Alison Talbot-Smith
- Public Health Policy Unit, School of Public Policy, University College London, London
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