International Journal for Quality in Health Care最新文献

{"title":"Implementation of regional Acute Stroke Care Map increases thrombolysis rates in urban areas of China: an interrupted time series analysis.","authors":"Rui Wen, Miaoran Wang, Wei Bian, Haoyue Zhu, Ying Xiao, Jing Zeng, Qian He, Yu Wang, Xiaoqing Liu, Yangdi Shi, Linzhi Zhang, Zhe Hong, Bing Xu","doi":"10.1093/intqhc/mzaf022","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf022","url":null,"abstract":"<p><strong>Background: </strong>Stroke, a leading cause of global disability, where timely thrombolysis is crucial for favorable outcomes. Despite initiatives like Acute Stroke Care Maps (ASCaMs) in China aiming to improve care continuity and thrombolysis rates, the long-term effectiveness of these interventions in urban settings remains underexplored.</p><p><strong>Methods: </strong>This retrospective cohort study investigates the role of the Shenyang ASCaM in improving the thrombolysis rate with tissue plasminogen activator within 4.5 hours of ischemic stroke onset in 30 hospitals. Using interrupted time series (ITS) analysis, it compares outcomes before and after ASCaM's implementation from April 2019 to December 2021. The ASCaM strategy, featuring EMS prenotification, rapid triage, and immediate neuroimaging, is assessed. Regression models, adjusted for patient demographics and clinical scores, evaluate the intervention's impact, controlling for potential confounders.</p><p><strong>Results: </strong>In the study, 2676 patients were evaluated before the implementation of the Shenyang ASCaM, and 8277 patients were assessed during its implementation. Thrombolysis rates within the vital 4.5-hour window rose significantly from 59% before ASCaM to 72% during its implementation (P < .001), and door-to-needle time (DNT) decreased significantly by 12.269 minutes (P < .0001). Early neurological deterioration (END) incidents decreased significantly from 44% to 39.2% (adjusted OR = 0.820, P = .001), indicating improved stroke care efficiency and outcomes. ITS analysis showed a pre-implementation monthly decrease in thrombolysis rates of 0.95%, countered by a post-implementation immediate surge of 6.21% and a sustained improvement at a rate of 0.13% per month. Furthermore, Post-ASCaM, DNT reduced to 52.42 minutes, thrombolysis rates increased to 72.3%, and END incidence decreased (adjusted OR = 0.820, P = .001), indicating improved stroke care efficiency and outcomes.</p><p><strong>Conclusion: </strong>Our findings confirm that China's ASCaMs significantly enhance thrombolysis rates and ensure care continuity in managing acute stroke, indicating their long-term effectiveness in urban settings. This contributes to global stroke care improvements, emphasizing the potential for wider application and further research on sustained interventions.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":"37 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965478","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":"Dying in hospital: a retrospective medical record analysis on care in the dying phase in intensive care units and general wards.","authors":"Sophie Meesters, Aneta Schieferdecker, Sukhvir Kaur, Nikolas Oubaid, Anneke Ullrich, Karin Oechsle, Holger Schulz, Raymond Voltz, Kerstin Kremeike","doi":"10.1093/intqhc/mzaf025","DOIUrl":"10.1093/intqhc/mzaf025","url":null,"abstract":"<p><strong>Background: </strong>Care in the dying phase is often suboptimal in hospitals outside specialized palliative care. Studies of the implementation of recommendations for care in the dying phase are rare. Medical records can provide information in this regard.</p><p><strong>Methods: </strong>A retrospective analysis of medical records was conducted for 400 patients who died in six intensive care units (ICUs) and four general wards (GWs) at two German medical centres. To evaluate the care in the dying phase, we descriptively analysed 37 variables reflecting recommendations of the German Palliative Care Guideline. To identify factors associated with important aspects of care, seven of these variables were determined as appropriate for multiple logistic regression.</p><p><strong>Results: </strong>In 299/400 (74.8%) patients, recognition of the dying phase was documented. Patients with the ability to communicate were informed about the impending death in 46/121 (38.0%) and informal caregivers (ICs) in 282/390 (72.3%). Patients' wishes regarding care were documented in 33/122 (27.1%). Monitoring was rarely stopped before death, with significantly lower percentages in ICUs: e.g. vital signs in 30% [14.9% in ICUs vs. 52.9% in GWs; confidence interval (28.4, 47.6)]. Validated symptom assessment tools were used in 272/400 (68.0%), mainly for pain (66.3%). Logistic regression analysis identified setting (ICUs vs. GWs), recognition of the dying phase, patient age, communication ability, and malignant neoplasm as factors significantly associated with aspects of care.</p><p><strong>Conclusion: </strong>The dying phase was not consistently documented, many presumably nonbeneficial interventions continued until death, systematic symptom assessment beyond pain was lacking, and communication with patients and ICs was poorly documented. Findings suggest a need for setting-specific strengthening of healthcare professionals in these settings.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648539","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":"Systematic recording and discussion of intraoperative adverse events using ClassIntra: results of a qualitative context analysis before implementation.","authors":"Monika Finsterwald, Zuzanna Kita, Salome Dell-Kuster, Katrin Burri-Winkler, Anne Auderset, Judith Winkens, Christoph S Burkhart, Amanda van Vegten, Lauren Clack","doi":"10.1093/intqhc/mzaf023","DOIUrl":"10.1093/intqhc/mzaf023","url":null,"abstract":"<p><strong>Background: </strong>Intra- and postoperative adverse events (AEs) are devastating to patients and costly for healthcare systems. In 2008, the World Health Organization Surgical Safety Checklist was introduced to minimize morbidity and mortality and to enhance team performance. It consists of three parts whereof the third part, the sign-out at the end of surgery, is generally performed poorly. Addressing intraoperative AEs and discussion of the consecutive postoperative management should take place during this often-omitted sign-out. To address this issue, a national, multicentre quality improvement project (CIBOSurg-ClassIntra® for Better Outcomes in Surgery) is currently being conducted in Switzerland. This project evaluates the effectiveness and implementation of systematic recording of intraoperative AEs using ClassIntra® (a generic classification system for intraoperative AEs) and an interdisciplinary discussion during the sign-out. The current study, conducted in the preimplementation phase of CIBOSurg, aims to assess existing practices and determinants concerning the future implementation of systematic recording of intraoperative AEs, perceptions surrounding ClassIntra®, and its implementation during sign-out.</p><p><strong>Methods: </strong>A qualitative context analysis was conducted across eight hospitals in Switzerland and one in the Netherlands. Nearly 100 semistructured interviews were conducted with interdisciplinary staff from different surgical disciplines. Data were analysed using rapid analysis and concept-structuring qualitative content analysis guided by the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change.</p><p><strong>Results: </strong>Findings indicate that the sign-out is not yet implemented consistently at every participating hospital. Currently, intraoperative AEs are not being systematically recorded and discussed, despite recognition of their importance. Most interviewees considered the application and implementation of ClassIntra® to be feasible and were convinced that a systematic recording of intraoperative AEs and interdisciplinary discussion among the operative team during sign-out is particularly useful for learning and postoperative patient care. Several barriers and facilitators to the successful recording and discussion of intraoperative AEs were identified.</p><p><strong>Conclusion: </strong>The study results provide important information about current practices, while also generating insights on how to better discuss and systematically record intraoperative AEs and improve sign-out performance. Future implementation of ClassIntra® is generally perceived positively. The findings address a critical gap in surgical safety practice and provide a basis for developing multifaceted implementation strategies.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11988435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624447","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":"Evaluation of temporomandibular disorder self-management apps in Australia: a systematic review to inform clinical use.","authors":"Anita Lim, Bronwen Merner, Srividya Iyer, Michael McCullough","doi":"10.1093/intqhc/mzaf024","DOIUrl":"10.1093/intqhc/mzaf024","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to systematically evaluate apps with temporomandibular disorder (TMD) self-management content available in Australia for quality, clinical safety, self-management support functions, and contributors to app development.</p><p><strong>Methods: </strong>A systematic search of the App Store (iOS) and Google Play (Android) was conducted on 18 April 2023 (and updated 26 July 2023) to identify apps that had TMD self-management content. Two raters independently assessed app quality, clinical safety, self-management support, and contributors to app development for the involvement of people living with TMD and clinicians. Quality was evaluated using the Mobile App Rating Scale (MARS) for engagement, functionality, aesthetics, and information quality scored using a 5-point Likert scale. App clinical safety was assessed using MARS functionality (item 6) and information quality items for accuracy/relevance (item 15), scope (item 16), and visual information accuracy/clarity (item 17) (scored on a Likert scale), and the M-Health Index and Navigation Database framework questions: does the app provide any warning for use? Does the app have a crisis management feature? Can the app cause harm? (scored yes/no). Self-management support was evaluated using the Self-Management Support (SMS-14) checklist (scored yes/no). Included apps, app store descriptions, and linked websites were qualitatively evaluated to determine the contributors to app development.</p><p><strong>Results: </strong>Seven apps with TMD self-management content were available in Australia. Overall, the included apps were of acceptable quality (mean = 3.25/5) but scored poorly for engagement (2.71/5) and information (2.92/5). Clinical safety limitations identified were the inability to identify and/or direct users to support services in a crisis and inconsistent TMD information. One app (Do I Grind or Snore) was deemed potentially harmful as sleep sounds suggestive of obstructive sleep apnoea were interpreted as snoring by the app. Overall, the inclusion of self-management support functions was variable (range 1-9; mean = 4.71/14), with pain/TMD education (71%) and self-monitoring (71%) the most common. Only one app had development input from a person with lived experience of TMD.</p><p><strong>Conclusion: </strong>The quality and self-management support of apps with TMD self-management content is variable. TMD apps with activating self-management strategies and higher engagement scores are more likely to be effective. Concerningly, one app was found to be potentially harmful, and overall apps lacked user safeguards. Only one app involved a person with TMD in its development, and the authors recommend using co-design in future TMD app development to improve app quality, clinical safety, and impact.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656657","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":"Improving primary care through multidisciplinary teamwork: possibilities and challenges.","authors":"Michael Kidd, Shona Marie Bates, David Greenfield","doi":"10.1093/intqhc/mzaf021","DOIUrl":"10.1093/intqhc/mzaf021","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604794","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":"Correction to: Effects of early palliative care intervention on medical resource use among end-of-life patients.","authors":"","doi":"10.1093/intqhc/mzaf026","DOIUrl":"10.1093/intqhc/mzaf026","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":"37 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784470","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":"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 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 4,555 adults aged ≥20 years, with a diagnosis of diabetes, and a subsample of 1,586 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. non-indigenous individuals.</p><p><strong>Conclusions: </strong>Overall, adults with diabetes receive 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":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752634","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":"Look-alike, sound-alike medication perioperative incidents in a regional Australian hospital: assessment using a novel medication safety culture assessment tool.","authors":"Alexandra N Ryan, Kelvin L Robertson, Beverley D Glass","doi":"10.1093/intqhc/mzaf018","DOIUrl":"10.1093/intqhc/mzaf018","url":null,"abstract":"<p><strong>Background: </strong>Medication safety remains a global concern, with governments and organizations striving to mitigate preventable patient harm across healthcare systems. Look-alike, sound-alike medication incidents and the safety culture are widely acknowledged as a contributor to medication errors, particularly within the high-risk perioperative environment. The Medication Safety Culture Indicator Matrix (MedSCIM) is a novel tool developed by the Canadian Institute for Safe Medication Practices to assess the maturity of the medication safety culture. This study aims to delineate look-alike sound-alike (LASA) medication incidents reported in the pharmacy and perioperative settings of an Australian hospital and assess the maturity of the medication safety culture.</p><p><strong>Methods: </strong>The study setting is within a large regional hospital in Australia, servicing both adult and paediatric populations. Medication incidents from 1 April 2018 to 1 April 2023 were retrospectively gathered from the Clinical Incident Management System, Riskman®. Data and statistical analyses were carried out using Microsoft Excel®. The necessary approvals were secured from the Heath Service Human Research and Ethics Committee.</p><p><strong>Results: </strong>During the 5-year period, a total of 246 (4.1%) of the 6002 medication incidents within the health service were identified as meeting the inclusion criteria. Of the 246 medication incidents, 63.0% were identified from the Pharmacy Department, while 22.0% and 15.0% were from the Post Anaesthetic Care Unit and Anaesthetics Department, respectively. The most frequently reported incident classification in both the Anaesthetics Department and Post Anaesthetic Care Unit was 'incorrect dose', followed by 'incorrect medication'. Throughout the 5-year period, 46 (18.7%) of the 246 medication incidents were attributed to look-alike, sound-alike sources of error, predominantly identified in the Pharmacy Department (73.9%), followed by the Anaesthetics Department (17.4%) and the Post Anaesthetic Care Unit (8.7%). High-risk medications were most frequently reported to the Anaesthetics Department. Packaging (packaging alone, naming and packaging, and syringe swaps) was determined to be a contributing factor in 30 (65.2%) of the 46 LASA medication incidents. MedSCIM assessment revealed a reactive medication safety culture. Additionally, the medication incident report documentation was found to be mostly complete or semi-complete.</p><p><strong>Conclusion: </strong>Our analysis delineated medication incidents occurring across the entire medication management cycle and identified incidents related to LASA medications as a contributor to medication incidents across these clinical settings. This novel medication safety culture tool assessment highlighted opportunities for improvement with clinical incident documentation.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556805","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":"Determinants of quality in the independent and public hospital sectors in England.","authors":"Harriet Bullen, Vasudha Wattal, Rachel Meacock, Matt Sutton","doi":"10.1093/intqhc/mzaf019","DOIUrl":"10.1093/intqhc/mzaf019","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Increasing the use of independent providers has been proposed as a solution to the long waiting times at public hospitals generated by the postpandemic backlog for elective care. However, the profit-maximizing aims of some independent providers may risk cost-cutting behaviours and reduced care quality. Empirical evidence on the extent to which these concerns are borne out in practice is sparse. We aim to examine the quality of acute hospital care provided by the public and independent hospital sectors in England and explore the drivers of variation in quality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We construct a unique dataset collating publicly available Care Quality Commission (CQC) quality ratings of independent and public acute hospitals as of December 2022 and 2020. We link these to regional deprivation indices, population estimates, average household disposable incomes, and referral to treatment (RTT) data. We first categorize providers into National Health Service (NHS) and independent hospitals to analyse the association of ownership with quality ratings. To analyse ownership further, we then subcategorize independent hospitals further and consider whether the organization provides NHS-commissioned care. Thus, hospitals were categorized into seven mutually exclusive categories: NHS provider, commissioned charity, commissioned brand, commissioned independent other, noncommissioned charity, noncommissioned brand, and noncommissioned independent other. We use linear and ordered logistic regression models to assess the association of ownership with quality ratings. In supplementary analysis, we examine consistency over time by comparing the effects on 2022 ratings and 2020 ratings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 283 NHS hospitals, 47.3% (N = 134) was rated 'Good' and 41.0% (N = 116) was rated as 'Requires Improvement'. Of the 453 independent hospitals, 82.3% (N = 373) was rated 'Good' and 9.5% (N = 43) was rated as 'Requires Improvement'. On average, independent hospitals had 0.205 (Standard Error [SE] = 0.0581) higher category quality ratings than NHS providers. All types of NHS-commissioned independent sector hospitals had higher average quality ratings than NHS hospitals, as did noncommissioned branded hospitals. Quality ratings were negatively related to the number of different services provided, suggesting that specialization is associated with higher quality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;We find higher quality ratings for independent providers providing NHS-funded care, branded providers, and providers with a narrower range of services. We find no evidence to suggest that outsourced patients will experience lower quality care, although cream-skimming could still be detrimental for NHS services if they are left with a more complex case mix. Overall, our results taken together suggest that the increasing number of NHS patients treated in the independent sector does not experience a worse quality of ","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556786","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":"Creating transformative change in the disabilities field: promoting both bottom-up and top-down inclusion through the UNCRPD and QualityRights Toolkit.","authors":"Michela Atzeni, Mauro Giovanni Carta, David Greenfield","doi":"10.1093/intqhc/mzaf020","DOIUrl":"10.1093/intqhc/mzaf020","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585672","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}