Quality in health care : QHC最新文献_第2页

The Evidence-Based Primary Care Handbook.: Mark Gabbay, editor. (Pp 314; pound19.50). London: Royal Society of Medicine, 1999. 1 85315 415 6Quality in Health Care 2000;9:264-265. 循证初级保健手册。马克·加贝，编辑。(页314;pound19.50)。伦敦:皇家医学学会，1999。1 85315 415 6保健质量2000;9:264-265。

Quality in health care : QHC Pub Date : 2000-12-01 DOI: 10.1136/qhc.9.4.264

Baker

引用次数: 5

Complications of diabetes: renal disease and promotion of self-management. 糖尿病并发症:肾脏疾病和促进自我管理。

Quality in health care : QHC Pub Date : 2000-12-01 DOI: 10.1136/qhc.9.4.257

A Melville, R Richardson, D Lister-Sharp, A McIntosh

{"title":"Complications of diabetes: renal disease and promotion of self-management.","authors":"A Melville, R Richardson, D Lister-Sharp, A McIntosh","doi":"10.1136/qhc.9.4.257","DOIUrl":"https://doi.org/10.1136/qhc.9.4.257","url":null,"abstract":"This paper is an edited version of Effective Health Care volume 6 number 1,1 which summarises information originally derived from systematic reviews undertaken to inform national clinical practice guidelines,23 supplemented and re-analysed by the NHS Centre for Reviews and Dissemination.\u0000\u0000Raised blood glucose levels and related microvascular disease are associated with progressive damage to the kidneys. This damage becomes detectable when protein (primarily albumin) is excreted in the urine in higher concentrations than normal. As the severity of the damage increases, the quantity of protein in the urine also increases. When the level of albumin in the urine is fairly low, the condition is known as microalbuminuria or incipient nephropathy; higher albumin excretion is described as proteinuria. Eventually the condition can lead to renal failure.2\u0000\u0000Epidemiological studies report prevalence rates of microalbuminuria in patients with type 2 diabetes ranging from 8% to 32% with most estimates being around 25%.4–15 Prevalence estimates for proteinuria range from 5% to 19% with most studies giving rates of around 15%.569–111516 This variation may be a product of the criteria used to define the condition, the stage of the disease, and the methods used to assess it. Figures from the UK Prospective Diabetes Study (UKPDS), based on 3867 patients, suggest that about 12% have microalbuminuria (although using a high threshold) and 1.9% have proteinuria at the time of diagnosis of diabetes.17 A US study which followed 794 patients with type 2 diabetes who were initially free from proteinuria (defined as ≥30 μg protein/l urine) found that 1.3% developed renal failure within 10 years.18\u0000\u0000A substantial proportion of patients treated in renal units in the UK have diabetes. Diabetic nephropathy is the most common single cause of renal failure among …","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 4","pages":"257-63"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.4.257","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21925402","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}

引用次数: 28

Modern measurement for a modern health service. 现代卫生服务的现代计量。

Quality in health care : QHC Pub Date : 2000-12-01 DOI: 10.1136/qhc.9.4.199

P M Wilcock, R G Thomson

{"title":"Modern measurement for a modern health service.","authors":"P M Wilcock, R G Thomson","doi":"10.1136/qhc.9.4.199","DOIUrl":"https://doi.org/10.1136/qhc.9.4.199","url":null,"abstract":"The use of performance measures that enable aspects of health care delivered in different institutions to be compared are fraught with difficulties. However, despite inherent international concerns—about validity, comparability, and usefulness—they are here to stay. The challenge for all health systems is to find ways of using performance measures to promote real improvements in care. Questions such as whether public disclosure of comparative performance measures should be used to make external judgements—for example, in the form of league tables—or whether are they better used as tools for internal reflection to support quality improvement are the focus of active international debate. Changes in the use of performance data in any system have implications for others.1 The new approach to be implemented in the UK will therefore be watched with interest.\u0000\u0000The recently published 10 year plan for the NHS2 contained an initiative that has profound implications for both performance management and quality of care. The NHS performance assessment framework (PAF)3 already makes comparative indicator data publicly available, including clinical indicators such as readmission rates and perioperative mortality rates. The annual publication of these performance indicators4 by the NHS is about to be supplemented by a new “traffic light” …","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 4","pages":"199-200"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.4.199","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21926139","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}

引用次数: 56

Evidence-based patient empowerment. 基于证据的患者赋权。

Quality in health care : QHC Pub Date : 2000-12-01 DOI: 10.1136/qhc.9.4.200

M Wensing

引用次数: 4

New Zealand and United Kingdom experiences with the RAND modified Delphi approach to producing angina and heart failure criteria for quality assessment in general practice. 新西兰和英国的经验与兰德修改德尔福方法制定心绞痛和心力衰竭的质量评估标准在一般做法。

Quality in health care : QHC Pub Date : 2000-12-01 DOI: 10.1136/qhc.9.4.222

S A Buetow, G D Coster

{"title":"New Zealand and United Kingdom experiences with the RAND modified Delphi approach to producing angina and heart failure criteria for quality assessment in general practice.","authors":"S A Buetow, G D Coster","doi":"10.1136/qhc.9.4.222","DOIUrl":"https://doi.org/10.1136/qhc.9.4.222","url":null,"abstract":"Objectives: (1) To describe the development of minimum review criteria for the general practice management in New Zealand (NZ) of two chronic diseases: stable angina and systolic heart failure, and (2) to compare the NZ angina criteria with a set produced in Manchester to assess the extent to which use of the same approach to criteria development yields similar criteria.Methods: A modified Delphi approach, based on the RAND consensus panel method, was used to produce minimum criteria for reviewing the recorded management of heart failure and angina in NZ general practice. The criteria for angina were compared with those produced in the UK, including assessment of the extent to which each set describes actions that the other panel agrees are necessary to record.Results: For each condition we report minimum criteria describing actions rated as (a) necessary to record and (b) inappropriate to take but, if taken, necessary to record. Although strong scientific evidence underpins approximately one quarter and one third, respectively, of the final sets of NZ and UK angina criteria for actions necessary to record, the NZ criteria agree strongly with the UK criteria (33 of 39 criteria, 85%) but there is less UK agreement with the NZ angina criteria (28 of 40 criteria, 70%).Conclusion: Despite the lack of scientific evidence for up to three quarters of angina care in general practice, the RAND based approach to criteria development was used in NZ to reproduce most of the UK angina criteria for actions rated as necessary to record in general practice. It is important to make explicit whether ratings of necessity and appropriateness apply to the recording of actions or to the actions themselves.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 4","pages":"222-31"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.4.222","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21925396","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}

引用次数: 17

What is a prescribing error? 什么是处方错误?

Quality in health care : QHC Pub Date : 2000-12-01 DOI: 10.1136/qhc.9.4.232

B Dean, N Barber, M Schachter

{"title":"What is a prescribing error?","authors":"B Dean, N Barber, M Schachter","doi":"10.1136/qhc.9.4.232","DOIUrl":"https://doi.org/10.1136/qhc.9.4.232","url":null,"abstract":"Objective: To develop a practitioner led definition of a prescribing error for use in quantitative studies of their incidence.Design: Two stage Delphi technique.Subjects: A panel of 34 UK judges, which included physicians, surgeons, pharmacists, nurses and risk managers.Main outcome measures: The extent to which judges agreed with a general definition of a prescribing error, and the extent to which they agreed that each of 42 scenarios represented a prescribing error.Results: Responses were obtained from 30 (88%) of 34 judges in the first Delphi round, and from 26 (87%) of 30 in the second round. The general definition of a prescribing error was accepted. The panel reached consensus that 24 of the 42 scenarios should be included as prescribing errors and that five should be excluded. In general, transcription errors, failure to communicate essential information, and the use of drugs or doses inappropriate for the individual patient were considered prescribing errors; deviations from policies or guidelines were not.Conclusions: Health care professionals are in broad agreement about the types of events that should be included and excluded as prescribing errors. A general definition of a prescribing error has been developed, together with more detailed guidance regarding the types of events that should be included. This definition allows the comparison of prescribing error rates among different prescribing systems and different hospitals, and is suitable for use in both research and clinical governance initiatives.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 4","pages":"232-7"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.4.232","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21925397","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}

引用次数: 413

Consumer and professional standards: working towards consensus. 消费者和专业标准:努力达成共识。

Quality in health care : QHC Pub Date : 2000-09-01 DOI: 10.1136/qhc.9.3.190

C Williamson

引用次数: 14

Quality improvement programme for cardiovascular disease risk factor recording in primary care. 初级保健中心血管疾病危险因素记录的质量改进方案。

Quality in health care : QHC Pub Date : 2000-09-01 DOI: 10.1136/qhc.9.3.175

E Ketola, R Sipilä, M Mäkelä, M Klockars

{"title":"Quality improvement programme for cardiovascular disease risk factor recording in primary care.","authors":"E Ketola, R Sipilä, M Mäkelä, M Klockars","doi":"10.1136/qhc.9.3.175","DOIUrl":"https://doi.org/10.1136/qhc.9.3.175","url":null,"abstract":"Objectives: Evaluation of the effect of a quality improvement programme on cardiovascular disease (CVD) risk factor recording and risk factor levels in a controlled study at two primary health care centres serving 26,000 inhabitants in Northern Helsinki.Methods: From a random sample of patient records from 1995 (n=1,066), 1996 (n=1,042), and 1997 (n=1,040) the frequency of CVD risk factor recording was measured and the changes in mean levels of total cholesterol, blood glucose, blood pressure, and body weight were monitored during the follow up period. The intervention programme (1995-1996) consisted of lectures and meetings of multiprofessional teams, development of local guidelines, and introduction of a structured risk factor recording sheet as part of the patient records.Results: After the quality improvement period all risk factors were better recorded at the intervention station than at the control station (p<0.001). More high risk CVD patients were detected from the general population at the intervention station. The mean values of most measured risk factors changed during the intervention. During the follow up period differences were observed between the two health stations in the time trends for body weight, body mass index (BMI), total cholesterol, and glucose levels. Risk factor levels of high risk patients receiving CVD treatment decreased during the intervention.Conclusions: A simple quality improvement programme improved the practice of recording risk factors for CVD which resulted in earlier detection of patients with a high risk of developing the disease.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 3","pages":"175-80"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.3.175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21814076","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}

引用次数: 27

Adverse events in health care. 卫生保健中的不良事件。

Quality in health care : QHC Pub Date : 2000-09-01 DOI: 10.1136/qhc.9.3.198

M García-Martín, P Lardelli-Claret, J J Jiménez-Moleón

引用次数: 5

Information technology for quality health care: a summary of United Kingdom and United States experiences. 信息技术促进高质量卫生保健:英国和美国经验总结。

Quality in health care : QHC Pub Date : 2000-09-01 DOI: 10.1136/qhc.9.3.181

D E Detmer

{"title":"Information technology for quality health care: a summary of United Kingdom and United States experiences.","authors":"D E Detmer","doi":"10.1136/qhc.9.3.181","DOIUrl":"https://doi.org/10.1136/qhc.9.3.181","url":null,"abstract":"“ What is new and significant must always be connected with old roots, the truly vital roots that are chosen with great care from the ones that merely survive .” Bela Bartok \u0000\u0000The explicit use of health information technology (HIT) to enable threshold improvements in the delivery of health care services is beginning to emerge as a serious objective for health care organisations and systems. Many readers who are very knowledgeable of quality measurement are relatively uninformed about health informatics and the converse is also true. It is for these readers that this paper is written. Specifically, the objective of this review of HIT in the UK and USA will focus upon salient features, deployment, and related policy issues. Particular attention will be given to areas in which threshold improvements in quality now exist or are likely to be forthcoming. Comments are organised to relate at the level of the individual, teams or microsystems, organisations, and larger systems, including national information infrastructures.\u0000\u0000Health care information technology is a broader phenomenon than it is deep. Over the past 30 years the information technology revolution developed slowly from roots in Turing's military intelligence machines of World War II to DARPA and the present day Internet when the pace picked up. While the telephone took 40 years to reach 10 million people, it only took 4–5 years for the Internet to reach 100 million. Despite successes being clouded by hype and hope, the Internet consumer health market is projected to reach $1.7 billion by 2003.\u0000\u0000Randomised trials now confirm the early evidence that health care quality can be significantly improved through health informatics.1 Evidence of improved access and cost effectiveness should soon follow.2 Over the next two decades e-health could deliver patient, provider, and planner/manager interactions for all aspects of health …","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 3","pages":"181-9"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.3.181","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21814077","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}

引用次数: 58