International Journal for Quality in Health Care最新文献

{"title":"The influence mechanism analysis of family doctor team effectiveness: a mixed-method approach.","authors":"Anning He, Zhimin Guo, Tao Zhang, Meng Zhang, Ziling Ni","doi":"10.1093/intqhc/mzae101","DOIUrl":"10.1093/intqhc/mzae101","url":null,"abstract":"<p><strong>Background: </strong>Team-based delivery of family doctor services is associated with improved patient experiences, better health outcomes, and more efficient healthcare utilization. Team effectiveness is related to the team's output, and family doctor team effectiveness (FDTE) directly impacts the quality and efficiency of contracted family doctor services. We aimed to explore the path and mechanisms influencing FDTE, propose strategies for improvement, and enhance both team effectiveness and service quality.</p><p><strong>Methods: </strong>The literature review, key informant interviews, expert consultation, and questionnaire survey were employed. The questionnaire, based on the input-mediator-output-input model, was designed to measure FDTE and its influencing factors. Using stratified random sampling, we distributed the questionnaire to family doctors in both developed and underdeveloped areas of Zhejiang Province, China. We performed hierarchical linear regression analysis to examine the relationship between team effectiveness and influencing factors. Subsequently, we used structural equation model (SEM) to explore and validate the relationships and mechanisms of action among \"team input factors,\" \"member input factors,\" \"team behavioral process,\" and \"team emotional process\" on team effectiveness.</p><p><strong>Results: </strong>The questionnaire was divided into five main sections: \"team input factors,\" \"member input factors,\" \"team behavioral process,\" \"team emotional process,\" and \"team effectiveness,\" with 11 dimensions and 42 items. A total of 508 valid questionnaires were returned. The main factors influencing FDTE are team composition (β = -0.116, P < .01), goals and systems (β = 0.165, P < .01), cooperative attitude (β = 0.123, P < .05), team behavioral process (β = 0.161, P < .001), and team emotional process (β = 0.193, P < .001). SEM analysis revealed that team input factors, member input factors, and team behavioral process had direct and indirect effects on team effectiveness, while the team emotional process had a direct effect.</p><p><strong>Conclusions: </strong>It is recommended to optimize the basic inputs of family doctor teams, enhance the intrinsic motivation of team members, promote team interaction and cooperation, and foster a positive atmosphere for family doctor teamwork.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Underreporting of adverse events to health authorities by healthcare professionals: a red flag-raising descriptive study.","authors":"Maude Lavallée, Sonia Corbin, Pallavi Pradhan, Laura Blonde Guefack, Magalie Thibault, Julie Méthot, Anick Bérard, Marie-Eve Piché, Fernanda Raphael Escobar Gimenes, Rosalie Darveau, Isabelle Cloutier, Jacinthe Leclerc","doi":"10.1093/intqhc/mzae109","DOIUrl":"https://doi.org/10.1093/intqhc/mzae109","url":null,"abstract":"<p><strong>Background: </strong>An adverse event (AE) is any undesirable medical manifestation in an individual who has received pharmacological treatment. To be considered serious (SAE), it needs to meet minimally one of the severity criteria by Health Canada. The most recent data (2006) suggested that AEs were underreported (<6%) to health authorities. In Canada, since the implementation of Vanessa's Law (2019), hospitals are required to report SAEs, however this law remains relatively unknown.. The objectives of the study were: 1) to document the incidence of any adverse event (AE) and serious adverse event (SAE) over time in a \"real\" clinical context, 2) to quantify SAEs reported to Health Canada, and 3) to assess whether Vanessa's Law has led to an increase in mandatory reporting to Health Canada.</p><p><strong>Method: </strong>We carried out a descriptive retrospective study at the Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, including 500 patients hospitalized between 2018/01/01 and 2021/12/31 and randomized into 4 cohorts (125 patients/year). Descriptive and comparative analyses were performed.</p><p><strong>Results: </strong>The characteristics of the cohorts were: 43.6% women; median age: 69 years [min-max: 21-96 years], number of comorbidities: 4 [1-12]. During their hospitalization, patients consumed 18 different drug products [2-56] and the median of observed SAEs/patients was 0 [0-10] (total: 302). The overall percentage of SAEs reported to Health Canada was 0%, before and following the implementation of Vanessa's Law.</p><p><strong>Conclusion: </strong>According to 500 electronic medical records, SAEs were underreported to Health Canada, even after the implementation of Vanessa's law.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of a newly launched Canadian fast-track ultrasound clinic by rheumatologists for the diagnosis of giant cell arteritis.","authors":"Jean-Charles Mourot, Sai Yan Yuen, Mihaela Luminita Popescu, Nicolas Richard","doi":"10.1093/intqhc/mzae103","DOIUrl":"10.1093/intqhc/mzae103","url":null,"abstract":"<p><strong>Background: </strong>Giant cell arteritis (GCA) can present diagnostic challenges and early diagnosis is crucial due to potential ischemic complications. Recent guidelines suggest that a suspected diagnosis should be confirmed with temporal artery biopsy or imaging, including ultrasound (US). In our Canadian setting, point-of-care temporal artery US was near unavailable, and biopsy remains the standard of care. We hypothesize that launching a fast-track US clinic by rheumatologists may spare the need for a temporal artery biopsy. Therefore, this study aimed to assess the diagnostic performance of US in this newly launched fast-track clinic.</p><p><strong>Methods: </strong>In this single-center retrospective cross-sectional analysis, 99 visits were identified from the fast-track clinic between January 2020 and July 2022. Each subject had an US according to a standard protocol for suspicion of either new-onset or relapse of GCA. Ultrasonographers were rheumatologists who acquired training on vascular US techniques before launching the clinic. For each patient presenting with suspected new-onset GCA, the pretest probability was calculated using the Southend GCA probability score. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the rheumatologist clinical diagnosis as the gold standard for GCA diagnosis.</p><p><strong>Results: </strong>A total of 22 subjects had a diagnostic of GCA and 77 had another diagnostic. Patients with and without GCA were, respectively, 81.8% versus 72.7% females, had a mean age of 76.6 ± 7.7 versus. 74.8 ± 9.8 years, and a mean CRP of 73.4 ± 57.8 versus 38.3 ± 59.9 mg/l. Temporal artery US demonstrated a sensitivity of 86.3% [95% confidence interval (CI), 65.1-97.1%], a specificity of 90.9% (95% CI, 82.2-6.3%), a PPV of 73.1% (95% CI, 56.8-84.9%), and a NPV of 95.9% (95% CI, 89.0-.5%). 14 patients had a suspicion of relapse and were all correctly identified by the US. Among those with suspicion of new-onset 27, 34 and 24 US were performed for high, intermediate, and low pretest probability of GCA, respectively. The high-risk subgroup demonstrated higher PPV while similar sensitivity/specificity was observed between all three subgroups.</p><p><strong>Conclusion: </strong>Our results highlight the benefits of US as a key diagnostic tool for GCA, particularly when combined with clinical evaluations. An excellent discriminative ability for diagnosis of GCA was shown in this newly launched clinic suggesting that the role of TAB may need to be redefined. These findings will guide on broader implementation of US programs for GCA.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Development of Safety Culture among Physicians with Text Mining of Patient Safety Reports: A Retrospective Study.","authors":"Daisuke Koike, Masahiro Ito, Akihiko Horiguchi, Hiroshi Yatsuya, Atsuhiko Ota","doi":"10.1093/intqhc/mzae108","DOIUrl":"https://doi.org/10.1093/intqhc/mzae108","url":null,"abstract":"<p><strong>Background: </strong>Safety culture development is essential for patient safety in healthcare institution. Perceptions of patient safety and cultural changes are shown up in patient safety reports, however, were rarely investigated. The aim of this study was to investigate the perception of physicians and to explore the development of safety culture using quantitative content analysis for patient safety reports.</p><p><strong>Methods: </strong>A retrospective analysis of free descriptions of harmful patient safety reports submitted by physicians was performed. Natural language processing and text analysis were conducted using the 'KH Coder'. A co-occurrence analysis was performed in each period to identify and analyze the safety concepts. The study period was grouped into three for comparison.</p><p><strong>Results: </strong>The patient safety reports from physicians were collected between April 2004 and March 2020. Of these, 3351 reports were harmful; 839 reports were included in period 1, 1016 reports in period 2, and 1496 reports in period 3. Natural language processing identified 316 307 words in the free descriptions of 3351 reports. We identified seven concepts from the cluster in co-occurrence analysis as follows: 'explanation of adverse event to patients and families,' 'central venous catheter,' 'intraoperative procedure and injury,' 'minimally invasive surgery,' 'life-threatening events,' 'blood loss,' and 'medical emergency team and critical care.' These seven concepts showed significant differences among the three periods, except for 'blood loss'. The 'explanation of adverse event to patients and families' decreased in proportion from 11.3% to 8.8% (p<0.05). The 'central venous catheter' decreased from 17.3% to 11.3% (p<0.01). Meanwhile, 'minimally invasive surgeries' and 'intraoperative procedures' increased from 3.9% to 12.9% (p<0.01) and from 10.8% to 14.6% (p<0.05), respectively. Focusing on patients' events, 'life-threatening events' decreased from 13.0% to 8.1% (p<0.01); however, 'medical emergency teams and critical care' increased from 3.3% to 10.6% (p<0.01).</p><p><strong>Conclusion: </strong>Free description in patient safety reports is useful for evaluating the safety culture. Co-occurrence analysis revealed multiple concepts of physicians' perceptions. Quantitative content analysis revealed changes in perceptions and attitudes, and a disclosure policy of adverse events and priority of patient care appeared with the development of safety culture.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges to implementing clinical guidelines for preparticipation physical evaluations in youth sports.","authors":"Tammy Ng, Jesslyn Magee-Gonzalez, Sandra L Taylor, Ulfat Shaikh","doi":"10.1093/intqhc/mzae099","DOIUrl":"10.1093/intqhc/mzae099","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use and De-implementation of Fecal Occult Blood Tests in the Acute Care Setting: A Systematic Review and Meta-Analysis.","authors":"Rebekah O Russell, Alejandro C Arroliga, Nanette L Myers, Gerald O Ogola, Tresa McNeal, Niket Sonpal, Christian Cable, Valerie Danesh","doi":"10.1093/intqhc/mzae102","DOIUrl":"https://doi.org/10.1093/intqhc/mzae102","url":null,"abstract":"<p><strong>Background: </strong>To determine methods of FOBT de-implementation in acute care practice while summarizing the reasons and contraindications for inappropriate FOBT in acute care settings. Fecal occult blood testing is valuable for colorectal cancer screening in ambulatory settings but is not valuable for diagnostics in acute care with consistent indications for discontinuation as a tradition-based practice.</p><p><strong>Methods: </strong>We included all English language prospective and retrospective evaluation studies of FOBT use in acute care settings with or without de-implementation interventions and published as original research articles in peer-reviewed journals. A meta-analysis of FOBT positivity was conducted using a random effects model. Quality was assessed using Critical Appraisals Skills Programme criteria.</p><p><strong>Results: </strong>Of 2,471 abstract/titles screened, 157 full-text articles were reviewed, and 22 articles met inclusion criteria of measuring prevalence or de-implementation of FOBT use in acute care settings. All 22 studies evaluated either FOBT use or de-implementation. Twenty articles reported FOBT positivity, with some illustrating that FOBT results were inconsequential to subsequent endoscopy decisions (n=7, 32%). The included studies represent a publication date range spanning 32 years, with limited documentation of de-implementation strategies. Four published studies described system-level disinvestment to administratively eliminate access to inpatient FOBT orders.</p><p><strong>Conclusion: </strong>Overall, all studies endorsed that the use of FOBTs in acute care settings results in increased workload and/or cost without diagnostic benefit. Critical appraisal of low-value tradition-based practices such as FOBT use in acute care settings are essential for deploying deliberate and effective de-implementation strategies.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting holistic and inclusive care for women: a call for updated health policies.","authors":"Danilo V Rogayan, Joseline R Tamoria, Karen P Andres","doi":"10.1093/intqhc/mzae098","DOIUrl":"10.1093/intqhc/mzae098","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future of global graduate training in quality improvement and patient safety.","authors":"Yash B Shah, Akshay S Krishnan, P J Kumar, Varun Jayanti, Zachary N Goldberg, Reece Hinchcliff, David B Nash","doi":"10.1093/intqhc/mzae094","DOIUrl":"10.1093/intqhc/mzae094","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous iron staining: real-world incidence, preventability, and mitigation tools from a long-term quality improvement project.","authors":"Martin L Canning, Jodie B Hillen, Maya Kashiwagi, Negin Alizadeh, Christopher R Freeman","doi":"10.1093/intqhc/mzae096","DOIUrl":"10.1093/intqhc/mzae096","url":null,"abstract":"<p><strong>Background: </strong>Iron deficiency is the leading cause of anaemia worldwide and is increasingly treated with intravenous (IV) iron therapy. Staining from IV iron therapy is a rare but significant and preventable adverse event. To mitigate patient harm, a health-service-wide quality improvement project was implemented. This study aimed to determine the real-world impact of a quality improvement project on IV iron staining incidents and preventability.</p><p><strong>Methods: </strong>A retrospective chart audit was undertaken for all IV iron staining episodes reported in a directorate-wide clinical incident reporting database (RiskMan) between 2016 and 2022. Incidence rates of IV iron staining, preventability, and stain severity were compared pre- and post-implementation of a standardized IV iron procedure.</p><p><strong>Results: </strong>Over 7 years, 103 IV iron stains were identified, resulting in a staining rate of 0.31 stains per 100 infusions (pre 0.27% and post 0.34%, P = .25). Implementation of the standardized IV iron procedure resulted in improvements in pharmacist review of the medication order (61.8% versus 89.7%, P < .01), use of the statewide IV iron infusion consent form (27.3% versus 76.9%, P < .01), and appropriate cannula site (14.3% versus 52.5%, P < .01). Smaller stain sizes were associated with cessation of the infusion at identification of extravasation (312 cm2 versus 35 cm2) (P = .04). Preventability was assigned to 86% of stains.</p><p><strong>Conclusion: </strong>The incidence rate of IV iron staining in a real-world clinical setting is 0.31%. There was increased compliance with several best practice principles and 86% of stains were preventable. Early identification and intervention of potential staining incidents results in smaller iron stains for patients. Quality improvement tools developed for this project can contribute to patient outcomes internationally.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International research priorities for integrated care and cross-boundary working: an electronic Delphi study.","authors":"Jason Scott, Justin Waring, Aaron Asibi Abuosi, Yakubu Adole Agada-Amade, Jibril Muhammad Bashar, Aoife De Brún, Henry Cann, Philip Crowley, Lindsay H Dewa, Samantha Spanos, Siri Wiig","doi":"10.1093/intqhc/mzae095","DOIUrl":"10.1093/intqhc/mzae095","url":null,"abstract":"<p><strong>Background: </strong>Integrated care can be broadly defined as the delivery of high-quality and safe care for patients as they cross organizational boundaries or when care is delivered with multiple health care teams, professions, or organizations. Successful integration of care services is contingent on multiple and complex factors across macro, meso, and micro levels of health and social care systems in lower-, middle-, and higher-income countries. Previous priorities for the future development of integrated care have focused on designing and implementing models or approaches to integrated care rather than establishing the research needed to underpin them. This study aimed to address this evidence gap by developing a consensus on international research priorities related to integration of care and cross-boundary working.</p><p><strong>Methods: </strong>We conducted a sequential electronic Delphi (eDelphi) study from September 2023 to December 2023. The eDelphi process consisted of initial priority generation followed by two rounds of consensus development via an online survey. Sixty-six priorities were generated by 19 delegates at an international conference workshop titled, 'Priority setting for future research on integration of care and cross-boundary working'. Workshop delegates then identified other experts in integrated care and cross-boundary working from their networks. In each eDelphi round, participants then provided item-by-item responses using a seven-point Likert scale, with consensus defined a priori as ≥80% agreement (strongly agree or agree). Priorities that reached consensus were conceptually grouped into topics.</p><p><strong>Results: </strong>Twenty-five of 66 unique (37.9%) research priorities achieved consensus after two eDelphi rounds. In Round 1, 63/85 (74.1%) experts from 10 countries across 4 continents achieved consensus on 12/66 (18.2%) priorities. In Round 2, 51/63 (81.0%) experts achieved consensus on a further 13/54 (24.1%) priorities. From the 25 priorities, we derived six conceptual groupings that represent broad topics for future research on integrated care and cross-boundary working: (i) access to care, (ii) data sharing and technology, (iii) measurement of care quality, (iv) patient experience and satisfaction, (v) service design, integration and governance, and (vi) teamwork and leadership.</p><p><strong>Conclusion: </strong>Integrating care services and improving cross-boundary working is important for improving the quality of care provided to patients, regardless of country. Therefore, the conceptual topics and individual priorities identified in this study can inform policymakers, practitioners, and researchers when designing or evaluating integrated care services across the world in pursuit of improved integrated care systems.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}