International Journal for Quality in Health Care最新文献

{"title":"Continuous Glucose Monitoring in Type 2 Diabetes: A Systematic Review of Barriers and Opportunities for Care Improvement.","authors":"Maria Assunta Barchiesi, Armando Calabrese, Roberta Costa, Francesca Di Pillo, Antonio D'Uffizi, Luigi Tiburzi, Erum Zahid","doi":"10.1093/intqhc/mzaf046","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf046","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus, particularly type 2 diabetes (T2DM), is a chronic disease associated with serious complications, such as heart disease, kidney failure, and blindness. Continuous glucose monitoring (CGM) systems have emerged as a more effective alternative to traditional fingerstick testing, offering patients greater control over their condition. Despite their potential benefits, several barriers to CGM sensor use persist, limiting their widespread adoption among patients with T2DM. This review explores the barriers to CGM sensor use, particularly from the patient's perspective.</p><p><strong>Methods: </strong>A systematic literature review is conducted following PRISMA guidelines. The search focuses on studies published between January 2018 and June 2024 and is performed in two primary databases, PubMed and Scopus, selected for their relevance to Type 2 diabetes research. Studies are included if they explore challenges and barriers to CGM adoption, report patient perspectives, or provide insights into the usability and accessibility of technology. The data is analysed using deductive content analysis, applying Wilson et al.'s thematic categories as a predefined framework to systematically classify and interpret barriers to CGM adoption. This approach ensures methodological consistency and alignment with existing research on eHealth adoption challenges.</p><p><strong>Results: </strong>The review identifies several key barriers to CGM sensor use despite the benefits, such as improved glucose control and reduced hypoglycaemic events. Major challenges include the high cost of sensors, wearability issues, discomfort from adhesive materials, and concerns about the visibility of the sensors. Additionally, patients report difficulties in interpreting the large volumes of data generated by CGMs, as well as discomfort or fear related to sensor insertion. Lack of technological support, low health literacy, and insufficient social support are also identified as factors contributing to non-adoption.</p><p><strong>Conclusions: </strong>Policymakers and healthcare providers are encouraged to address these barriers by developing patient-centred strategies that support the adoption of CGM sensors. Successfully overcoming these challenges can further support integrating CGM sensors with the Chronic Care Model (CCM) and Automated Insulin Delivery (AID) systems. As an implication, this integration has the potential to enhance glycemic control and improve patient quality of life in the management of Type 2 diabetes. Furthermore, addressing these barriers may drive advancements in sensor design, improve accessibility, and minimize the environmental impact of CGM sensor use.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985279","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":"Comparing continuity of care before and after disability registration: A retrospective cohort study.","authors":"Zhaoyan Piao, Heekyung Choi, Boyoung Jeon, Euna Han","doi":"10.1093/intqhc/mzaf045","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf045","url":null,"abstract":"<p><strong>Background: </strong>Persons with disabilities often encounter barriers in accessing healthcare services. However, research on the impact of disability on the continuity of care (COC) remains limited. We assessed the changes in COC among disabled individuals to monitor alterations in their healthcare accessibility.</p><p><strong>Methods: </strong>This study used the National Health Insurance Service-National Sample Cohort 2.0 DB. The Bice-Boxerman COC Index (COCI; 0-1 range; higher values indicate greater COC) was used, with disability status of the participants determined from the registered data. Propensity-score matching was conducted for the control group. Difference-in-difference analysis was conducted to evaluate pre- and post-disability changes in COC for people with disabilities relative to those without.</p><p><strong>Results: </strong>COCI values were analyzed for 9,702 participants with disabilities and 19,404 control individuals. On average, the disability group scored 0.0343 lower than the control group one year before disability registration (p = 0.001) relative to the disability registration year. Similar results were obtained for the physical disability, visual disability, and hearing disability subgroups, with scores of - 0.0342, -0.0394, and -0.0285, respectively (p < 0.0001 for all groups). On the other hand, the neurological disability subgroup showed a marginal change in the COCI score, peaking two years before disability registration (-0.0757, p < 0.0001).</p><p><strong>Conclusion: </strong>Individuals with physical, visual, and hearing disabilities showed low COCI scores, with a significant decline occurring one year before disability registration. In contrast, the control group showed no change in COC. This result highlights the need to improve healthcare continuity, particularly for individuals with the respective disabilities.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992111","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":"Key lessons for excellent healthcare leadership-a systems lens to drive safe, quality outcomes.","authors":"Kathy Eljiz, Alison Derrett, David Greenfield","doi":"10.1093/intqhc/mzaf035","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf035","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":"37 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018819","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":"A systematic review of occupational stress and burnout in emergency medical technician and paramedic populations and associated consequences.","authors":"Simran K Gill, Kennedy-Metz Lauren R","doi":"10.1093/intqhc/mzaf033","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf033","url":null,"abstract":"<p><strong>Background: </strong>With increasing job demands, structural reorganization, and lack of support, occupational stress and burnout is on the rise. These conditions can manifest in various manners that can have detrimental physical impacts such as insomnia, weight changes, and chronic fatigue. Additionally, there can be socio-emotional consequences such as strained relationships, increase in depression, and hopelessness. Within the healthcare industry, many studies have focused on physicians and nurses but have failed to investigate other healthcare providers.</p><p><strong>Methods: </strong>This systematic review was conducted within emergency medical technician (EMT) and paramedic populations. Search terms included '(stress) AND (EMT OR paramedic) AND (manage*)' through the PubMed database. Associated title/abstract screening and subsequent full text review were completed through Covidence. Inclusion criteria for measurements included physiological indices of stress, questionnaires, and/or interviews.</p><p><strong>Results: </strong>Themes of interest included physical and socioemotional impacts of occupational stress and coping strategies. For example, EMTs and paramedics suffer from higher levels of stress and insomnia than other medical professionals and the general public. Coping strategies such as increased substance use and talking to family/friends were common given the high prevalence of post-traumatic stress disorder and emotional exhaustion.</p><p><strong>Conclusion: </strong>This systematic review revealed that occupational stress and burnout are highly prevalent among EMTs and paramedics. Given the severity of symptoms, it is imperative to design and implement programs to reduce burnout. Providing greater administrative support along with mindfulness-based interventions has shown to be effective in reducing burnout in the short term. While these interventions are not effective preventative measures, future studies must be done to better understand how organizations can recognize unique stressors of these occupations and provide greater support for their employees.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":"37 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965369","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":"Dedicated rapid response team implementation associated with reductions in hospital mortality and hospital expenses: a retrospective cohort analysis.","authors":"Jacob Sessim-Filho, Renato Palacio de Azevedo, Antonildes N Assuncao-Jr, Marcia Martiniano de Sousa E Sá Morgado, Felipe Duarte Silva, Laerte Pastore, Luiz Francisco Cardoso, Fernando Ganem","doi":"10.1093/intqhc/mzaf030","DOIUrl":"10.1093/intqhc/mzaf030","url":null,"abstract":"<p><strong>Introduction: </strong>The clinical impact of the implementation of rapid response teams (RRTs) remains controversial in the literature. Furthermore, data on the financial impact of this intervention remain scarce. Therefore, we aim to assess the impact of the implementation of a dedicated RRT on hospital mortality and hospital expenses of patients experiencing acute clinical deterioration requiring an unplanned intensive care unit (ICU) admission.</p><p><strong>Methods: </strong>We conducted a retrospective single-centre cohort study of adult patients experiencing acute clinical deterioration requiring an unplanned ICU admission before and after the transition of the RRT leadership to a dedicated group on 1 June 2014. Admissions that occurred 30 days before and 30 days after were excluded because they included the training period of the team members. Therefore, the PRE group encompassed patients who required an unplanned ICU admission between 1 May 2012, and 30 April 2014, and the POST group included those admitted to the ICU between 1 July 2014, and 30 June 2016. Patients were matched by propensity score according to a calibration of 0.2 and at a 1:1 ratio using the nearest neighbour matching method. The primary outcome was in-hospital mortality, with secondary outcomes including ICU mortality, hospital and ICU length of stay, ICU readmission rate within 48 h, and hospital expenses.</p><p><strong>Results: </strong>The study included 977 consecutive patients: 470 in the PRE group and 507 in the POST group. Following propensity score matching, 343 pairs (totalling 686 patients) were identified. Analyses revealed reductions in in-hospital mortality rate (34.7% PRE vs. 22.7% POST; odds ratio 0.590 [95% CI: 0.254-0.927], P < .001) and ICU mortality rate (19.5% PRE vs. 12.8% POST; odds ratio 0.501 [95% CI: 0.087-0.915]; P = .022). Decreases in hospital and ICU length of stay and use of ICU support measures were also observed, accompanied by a 23.2% reduction in hospital expenditure (P < .001).</p><p><strong>Conclusion: </strong>Transitioning to a dedicated RRT was associated with reduced in-hospital mortality and hospital resource utilization. Future research in diverse settings and cost-effectiveness analyses are warranted to confirm these findings and explore the economic impacts of RRTs.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752621","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}

{"title":"From compliance to excellence: how can ISO 13485 standards transform quality, safety, and innovation in medical devices?","authors":"Usman Iqbal, Peter Lachman, Phillip Phan","doi":"10.1093/intqhc/mzaf032","DOIUrl":"10.1093/intqhc/mzaf032","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752655","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":"Associations of hospital unit occupancy with inpatient falls and fall-risk assessment completion: a retrospective cohort study.","authors":"Jared Chiu, Vahid Sarhangian, Sarah Tosoni, Laura Danielle Pozzobon, Lucas B Chartier","doi":"10.1093/intqhc/mzaf028","DOIUrl":"10.1093/intqhc/mzaf028","url":null,"abstract":"<p><strong>Background: </strong>Inpatient fall assessment and prevention efforts are primarily performed by nursing teams. Operating at high occupancy levels may, therefore, reduce the care team's ability to deliver these efforts in a timely and effective way. We investigated the associations of unit-level hospital occupancy with the rate of inpatient fall and the completion of patient fall-risk assessment.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from a large teaching hospital network in Ontario, between 2017 and 2020. We used a multi-state semi-Markov model to represent the time from admission to inpatient care to primary outcomes of first inpatient fall, and completion of fall-risk assessment in the presence of other competing events. Unit-level occupancy was defined as the time-dependent maximum ratio of unit census to unit capacity and further categorized based on whether it was below or above a given threshold or \"tipping point\". We estimated the tipping point as well as the association between unit-level occupancy below and above the tipping point with the cause-specific hazard rate of each outcome, adjusting the estimates for confounders.</p><p><strong>Results: </strong>The final cohort had 83 839 inpatient stays for the fall outcome and 83 853 inpatient stays for the fall-risk assessment outcome. Unit occupancy levels above the estimated tipping point of 95% were associated with an increased rate of falls [Hazard Ratio (HR): 2.10, 95% Confidence Interval (CI): 1.05-4.20], whereas occupancy levels above the estimated tipping point of 77% were associated with a decreased rate of completion of fall-risk assessment [HR: 0.87, 95% CI: 0.82-0.91].</p><p><strong>Conclusions: </strong>Our study provides evidence for a significant increase in the rate of falls and decrease in the rate of assessment completion when occupancy levels exceed certain tipping points. The results motivate the design of safety protocols tailored for periods of high-capacity strain to support nursing teams and prioritize delivery of assessments and interventions to patients at high risk of fall.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752618","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}

{"title":"In Good Hands: exploring patient safety in the Philippines.","authors":"Dalmacito A Cordero","doi":"10.1093/intqhc/mzaf031","DOIUrl":"10.1093/intqhc/mzaf031","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752657","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":"Disparities in the quality of care for adults with type 2 diabetes according to socioeconomic level and ethnicity in Mexico.","authors":"Sergio Flores-Hernández, Nadia Cerecer-Ortiz, Hortensia Reyes-Morales, Blanca Estela Pelcastre-Villafuerte, Leticia Avila-Burgos","doi":"10.1093/intqhc/mzaf029","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf029","url":null,"abstract":"<p><strong>Background: </strong>The quality and equitable accessibility of health services represent basic priorities for health systems. In Mexico, three quarters of patients with diabetes are treated at public health services shown to be heterogeneous as regards the quality of the health-care processes. This notwithstanding, no information has been published on the quality of care provided to patients with diabetes according to their socioeconomic characteristics and ethnicity. Accordingly, the objective of this study was to identify disparities in the quality of care provided to adults medically diagnosed with type 2 diabetes (T2D) according to their socioeconomic levels and ethnicity.</p><p><strong>Methods: </strong>Cross-sectional analysis based on data drawn from the 2018-19 National Health and Nutrition Survey. Quality of care was assessed from the patients' perspective. Analysis included a nationally representative sample of 4555 adults aged ≥20 years, with diagnosis of diabetes, and a subsample of 1586 adults with Hb1Ac measurements. Two multiple linear regression models were fitted to assess the relationship between the overall quality of care provided vs. the socioeconomic levels and ethnicity of patients, adjusted for covariates.</p><p><strong>Results: </strong>Nearly one-third of adults with diabetes belonged to low-socioeconomic levels, 7% were indigenous, 92% were ≥40 years old, and 50% had experienced diabetes-related complications. Respondents had been diagnosed with diabetes for 11 years on average. Patients of low-socioeconomic levels showed a higher frequency of complications and inadequate glycemic control than did those of higher levels. After adjusting for covariates, the quality of care received was poorer among T2D patients of low (-4.8 pp, 95% CI: -6.5, -3.0) and medium (-1.5 pp, 95% CI: -3.1, 0.1) socioeconomic levels compared to those in the high tier, and among indigenous (-2.7 pp, 95% CI -5.3, -0.1) vs. nonindigenous individuals.</p><p><strong>Conclusions: </strong>Overall, adults with diabetes received poor-quality health care. Furthermore, disparities exist by socioeconomic level and ethnicity in the quality of care provided. It is essential to strengthen and renew health-care policies with a view to improving outpatient care for individuals with diabetes, one of the most prevalent chronic diseases in Mexico and around the world. It is vital that efforts to ensure the health and well-being of the most socially vulnerable populations be rooted in an equity approach.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":"37 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012078","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":"Patient safety in Low- and Middle-Income Countries: how can we do better?","authors":"Anuradha Pichumani, Andrew Likaka, Ezequiel García-Elorrio, Viviana E Rodriguez","doi":"10.1093/intqhc/mzaf006","DOIUrl":"10.1093/intqhc/mzaf006","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046656","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}