Quality in health care : QHC最新文献

{"title":"The extent of patients' understanding of the risk of treatments.","authors":"A. Lloyd","doi":"10.1136/QHC.0100014.","DOIUrl":"https://doi.org/10.1136/QHC.0100014.","url":null,"abstract":"The scientific understanding of how people perceive and code risks and then use this information in decision making has progressed greatly in the last 20 years. There is considerable evidence that people employ simplifying heuristics in judgement and decision making. These heuristics may lead to bias in how people interpret information. However, much of our understanding of risk perception is based on laboratory studies. It is much less clear whether risk perception in the real world (as in the case of medical treatments) exhibits the same patterns and biases. This paper reviews the published literature on risk perception in patients who face substantial treatment risks. It examines how accurate patients' perception of risk is, what factors affect the perception of risk, and several possible explanations for why patients' risk perception is not always accurate.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"279 1","pages":"i14-8"},"PeriodicalIF":0.0,"publicationDate":"2001-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86737920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engaging patients in decisions: a challenge to health care delivery and public health.","authors":"R. Thomson, A. Bowling, F. Moss","doi":"10.1136/QHC.0100001.","DOIUrl":"https://doi.org/10.1136/QHC.0100001.","url":null,"abstract":"Many have argued that good quality health care includes involvement of patients in decisions about their care. Furthermore, care should only be judged as appropriate if, as well as meeting professional and societal safeguards and concerns, patient preferences and patient values have been incorporated within the decision making process.1 Few would disagree with this in principle. However, despite the importance of patient views and the value of engaging patients in all aspects of care being acknowledged within mainstream health policy, the changes needed in clinical practice and delivery of health care that will move policy from lip service to a reality have yet to be made.\u0000\u0000Indeed, the changes needed will challenge some of the assumptions of health care and will raise many complex questions. For example, patients who do not wish actively to engage in decision making, particularly in taking responsibility for decisions on their treatment, may be inadvertently …","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"1 1","pages":"i1"},"PeriodicalIF":0.0,"publicationDate":"2001-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82738716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preferences and understanding their effects on health.","authors":"K. McPherson, A. Britton","doi":"10.1136/qhc.0100061","DOIUrl":"https://doi.org/10.1136/qhc.0100061","url":null,"abstract":"Preference for a particular intervention may, possibly via complicated pathways, itself confer an outcome advantage which will be subsumed in unblind randomised trials as part of the measured effectiveness of the intervention. Where more attractive interventions are compared with less attractive ones, any difference could therefore be a consequence of attractiveness and not its intrinsic worth. For health promotion interventions this is clearly important, but we cannot tell how important it is for therapeutic interventions without special studies to measure or refute such effects. These are difficult to do and are complex. Until the therapeutic effects of preference itself are more clearly understood, understanding the true therapeutic effects will be compromised, at least in principle.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"53 1","pages":"i61-6"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84451230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a questionnaire measuring patient satisfaction with general practitioner services.","authors":"S Grogan,&nbsp;M Conner,&nbsp;P Norman,&nbsp;D Willits,&nbsp;I Porter","doi":"10.1136/qhc.9.4.210","DOIUrl":"https://doi.org/10.1136/qhc.9.4.210","url":null,"abstract":"<p><strong>Background: </strong>In order that patient satisfaction may be assessed in a meaningful way, measures that are valid and reliable are required. This study was undertaken to assess the construct validity and internal reliability of the previously developed Patient Satisfaction Questionnaire (PSQ).</p><p><strong>Method: </strong>A total of 1390 patients from five practices in the North of England, the Midlands, and Scotland completed the questionnaire. Responses were checked for construct validity (including confirmatory factor analysis to check the factor structure of the scale) and internal reliability.</p><p><strong>Results: </strong>Confirmatory factor analysis showed that items loaded on the appropriate factors in a five factor model (doctors, nurses, access, appointments, and facilities). Scores on the specific subscales showed highly significant positive correlations with general satisfaction subscale scores suggesting construct validity. Also, the prediction (derived from past research) that older people would be more satisfied with the service was borne out by the results (F (4, 1312) = 57.10; p < 0.0001), providing further construct validation. The five specific subscales (doctors, nurses, access, appointments, and facilities), the general satisfaction subscale, and the questionnaire as a whole were found to have high internal reliability (Cronbach's alpha = 0.74-0.95).</p><p><strong>Conclusion: </strong>The results suggest that the PSQ is a valid and internally reliable tool for assessing patient satisfaction with general practitioner services.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 4","pages":"210-5"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.4.210","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21925394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Voluntary reporting system in anaesthesia: is there a link between undesirable and critical events?","authors":"P Y Boëlle,&nbsp;P Garnerin,&nbsp;J F Sicard,&nbsp;F Clergue,&nbsp;F Bonnet","doi":"10.1136/qhc.9.4.203","DOIUrl":"https://doi.org/10.1136/qhc.9.4.203","url":null,"abstract":"<p><strong>Background: </strong>Reporting systems in anaesthesia have generally focused on critical events (including death) to trigger investigations of latent and active errors. The decrease in the rate of these critical events calls for a broader definition of significant anaesthetic events, such as hypotension and bradycardia, to monitor anaesthetic care. The association between merely undesirable events and critical events has not been established and needs to be investigated by voluntary reporting systems.</p><p><strong>Objectives: </strong>To establish whether undesirable anaesthetic events are correlated with critical events in anaesthetic voluntary reporting systems.</p><p><strong>Methods: </strong>As part of a quality improvement project, a systematic reporting system was implemented for monitoring 32 events during elective surgery in our hospital in 1996. The events were classified according to severity (critical/undesirable) and nature (process/outcome) and control charts and logistic regression were used to analyse the data.</p><p><strong>Results: </strong>During a period of 30 months 22% of the 6439 procedures were associated with anaesthetic events, 15% of which were critical and 31% process related. A strong association was found between critical outcome events and critical process events (OR 11.5 (95% confidence interval (CI) 4.4 to 27.8)), undesirable outcome events (OR 4.8 (95% CI 2.0 to 11.8)), and undesirable process events (OR 4.8 (95% CI 1.3 to 13.4)). For other classes of events, risk factors were related to the course of anaesthesia (duration, occurrence of other events) and included factors determined during the pre-anaesthetic visit (risk of haemorrhage, difficult intubation or allergic reaction).</p><p><strong>Conclusion: </strong>Undesirable events are associated with more severe events and with pre-anaesthetic risk factors. The way in which information on significant events can be used is discussed, including better use of preoperative information, reduction in the collection of redundant information, and more structured reporting.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 4","pages":"203-9"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.4.203","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21925393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Patient Outcomes.: Marie T Nolan and Victoria Mock (Pp 248; pound23.00). California: Sage Publications, 2000. 0 7619 1505 2.","authors":"Whitty","doi":"10.1136/qhc.9.4.265","DOIUrl":"https://doi.org/10.1136/qhc.9.4.265","url":null,"abstract":"","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 4","pages":"265"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.4.265","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21925401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance management at the crossroads in the NHS: don't go into the red.","authors":"R G Thomson,&nbsp;J Lally","doi":"10.1136/qhc.9.4.201","DOIUrl":"https://doi.org/10.1136/qhc.9.4.201","url":null,"abstract":"","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 4","pages":"201-2"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.4.201","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21925392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Errors in health care management: what do they cost?","authors":"K D Rigby,&nbsp;J C Litt","doi":"10.1136/qhc.9.4.216","DOIUrl":"https://doi.org/10.1136/qhc.9.4.216","url":null,"abstract":"<p><strong>Background: </strong>Iatrogenic injuries are relatively common and a potentially avoidable source of morbidity. The economic evaluation of this area has been limited by the lack of good quality national data to provide an estimate of incidence, associated disability, and preventability of iatrogenic injuries. Two recent surveys, the Quality in Australian Health Care Study (QAHCS) and the Utah Colorado Study (UTCOS), have now made this feasible.</p><p><strong>Aims: </strong>To determine the direct costs associated with iatrogenic injuries occurring in a hospital setting.</p><p><strong>Methods: </strong>The QAHCS was used as a representative national source of information on the incidence, disability, and preventability of iatrogenic injuries. Costs were calculated using information from Australian disease related groups (AN-DRGs) relative to the injury categories.</p><p><strong>Results: </strong>The cost of just 12 preventable iatrogenic injuries is significant (0.25 million US dollars) and accounts for 2-3% of the annual budget of a typical Australian community based hospital of 120 beds. Costing data provide additional useful information for policy and decision makers.</p><p><strong>Conclusion: </strong>Costing iatrogenic injuries is an important component of the impact of these events. An ongoing national database of iatrogenic injuries is necessary to assist in identifying the incidence of these injuries, monitoring trends, and providing data for cost estimates and economic evaluations.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 4","pages":"216-21"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.4.216","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21925395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The potential use of decision analysis to support shared decision making in the face of uncertainty: the example of atrial fibrillation and warfarin anticoagulation.","authors":"A Robinson,&nbsp;R G Thomson","doi":"10.1136/qhc.9.4.238","DOIUrl":"https://doi.org/10.1136/qhc.9.4.238","url":null,"abstract":"<p><p>The quality of patient care is dependent upon the quality of the multitude of decisions that are made daily in clinical practice. Increasingly, modern health care is seeking to pursue better decisions (including an emphasis on evidence-based practice) and to engage patients more in decisions on their care. However, many treatment decisions are made in the face of clinical uncertainty and may be critically dependent upon patient preferences. This has led to attempts to develop decision support tools that enable patients and clinicians to make better decisions. One approach that may be of value is decision analysis, which seeks to create a rational framework for evaluating complex medical decisions and to provide a systematic way of integrating potential outcomes with probabilistic information such as that generated by randomised controlled trials of interventions. This paper describes decision analysis and discusses the potential of this approach with reference to the clinical decision as to whether to treat patients in atrial fibrillation with warfarin to reduce their risk of stroke.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 4","pages":"238-44"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.4.238","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21925398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial interventions for schizophrenia.","authors":"C Adams,&nbsp;P Wilson,&nbsp;A M Bagnall","doi":"10.1136/qhc.9.4.251","DOIUrl":"https://doi.org/10.1136/qhc.9.4.251","url":null,"abstract":"This paper summarises the research evidence presented in a recent issue of Effective Health Care on psychosocial interventions used in the management of schizophrenia.1 This is the second bulletin on the management of schizophrenia and, as with the previous issue on drug treatments,2 draws upon evidence from systematic reviews carried out by the Cochrane Schizophrenia Group.3\u0000\u0000For schizophrenia, as with any potentially disabling illness, comprehensive care involves a combination of pharmacological treatments, the provision of ongoing support, valid information, and treatment or rehabilitative strategies. This review divides non-pharmacological interventions into three treatment strategies: (1) those that seek primarily to support or educate; (2) those that provide specific skills training; and (3) those that are problem or symptom focused.\u0000\u0000Most of the information contained in this bulletin has been extracted from Cochrane reviews. These reviews have been acknowledged in the recent National Service Framework for Mental Health as important sources of information for clinical decision making.4\u0000\u0000As with the preceding bulletin on drug treatments,2 efforts have been made to present clinically meaningful data. For a more detailed discussion of each area the reader is referred to the original reviews which are regularly updated in the Cochrane Library.5 Unless stated otherwise, patients in the studies of non-pharmacological interventions are also being prescribed medication. Most of the trial participants were adults and no studies focused specifically on the care of adolescents or the elderly.\u0000\u0000### SUPPORTIVE EDUCATIONAL INTERVENTIONS\u0000\u0000Patients with schizophrenia and their carers should expect support and have a right to be well informed about the illness.6 Supportive educational packages aim to provide structure to what may otherwise be a haphazard process and can be implemented by any trained person.7 Support involves helping everyone to come to terms with a potentially stigmatising and disabling major mental illness, and …","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 4","pages":"251-6"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.4.251","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21925399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}