Quality in health care : QHC最新文献

{"title":"Monitoring quality of audit in obstetrics and gynaecology.","authors":"D M Semple,&nbsp;K Khaled,&nbsp;M J Maresh","doi":"10.1136/qhc.9.1.37","DOIUrl":"https://doi.org/10.1136/qhc.9.1.37","url":null,"abstract":"<p><strong>Objective: </strong>To develop a questionnaire to assess audit activity and to use it to evaluate systematically the quality of audit in obstetrics and gynaecology within NHS hospitals in the UK.</p><p><strong>Design: </strong>Retrospective review of 212 consecutive questionnaires completed at hospital recognition committee visits for training accreditation, between 1 January 1993 and 31 August 1998, validated against hospital trust annual audit reports.</p><p><strong>Main measures: </strong>Use of seven quality criteria developed within the Royal College of Obstetricians and Gynaecologists clinical audit unit and also assessment of support for audit and participation in regional and national audit. Results were compared between 1993/4 (n = 72), 1995/6 (n = 72), and 1997/8 (n = 68) for evidence of improvement.</p><p><strong>Results: </strong>After modifications to the questionnaire the version used from 1993 proved to be a satisfactory tool with minimal need for subsequent change. The results showed that there has been a significant improvement in the quality of obstetric and gynaecology audit with time (p < 0.0001) with 36 (53%) of departments in the previous two year period meeting all seven criteria. Similarly by this stage, 60 (88%) of departments had reached the stage of re-audit and 55 (81%) had conducted patient satisfaction surveys, both of these having significantly improved with time. Critical incident monitoring also became used more widely with time. Validation of topics audited was possible for 45% of hospitals where trust annual audit reports were available and these showed a high level of correlation.</p><p><strong>Conclusions: </strong>It has proved possible to conduct an audit of audit using the current system of hospital recognition visits for training accreditation. This has shown a great variety in the depth and breadth of audit that is being undertaken within individual obstetric and gynaecology departments. Since 1993 there has been an improvement in the quality of audit programmes undertaken, in particular in the number of hospitals carrying out critical incident monitoring, patient satisfaction surveys, and re-audit. This should be associated with improvements in staff training and in patient care.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 1","pages":"37-41"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.1.37","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692547","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":"Adverse events in health care: issues in measurement.","authors":"K Walshe","doi":"10.1136/qhc.9.1.47","DOIUrl":"https://doi.org/10.1136/qhc.9.1.47","url":null,"abstract":"Adverse events—“instances which indicate or may indicate that a patient has received poor quality care”1—are used widely in healthcare quality measurement and improvement activities. Many commonly employed quality improvement mechanisms, such as incident reporting, occurrence screening, significant event auditing, processes for dealing with complaints, and (in the UK) the national confidential enquiries into various areas of clinical care are essentially focused on such adverse events. Even traditional medical quality improvement mechanisms such as mortality and morbidity conferences or death and complications meetings are predicated on the idea that by identifying and examining adverse events, we can learn lessons and change practice in ways that will make such events less likely in future and hence improve the quality of health care.\u0000\u0000The principle that studying adverse events can produce information which leads to quality improvements is far from new and has been much used outside of health care.2, 3 It has an intuitive power—after all, we all learn much as individuals from our own mistakes, and it seems reasonable to hypothesise that organisations can also learn a great deal from their errors. However, it is easy to overlook the complexities of measurement involved in defining, classifying, identifying, describing, and analysing such adverse events.4 Like any other measurement tools, those used with adverse events need to be tested to ensure that they work. This article presents an analysis of the issues involved in defining adverse events, the sources of data which can be used to identify such events, and the validity and reliability of measures of quality based on adverse events in health care.\u0000\u0000The idea that it would be useful or important to study the incidence, circumstances, or causes of adverse events in health care arises from various different but related schools of thought. For example, …","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 1","pages":"47-52"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.1.47","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692550","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":"Improving surgical care: looking beyond individual competence.","authors":"T Treasure","doi":"10.1136/qhc.9.1.2","DOIUrl":"https://doi.org/10.1136/qhc.9.1.2","url":null,"abstract":"","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 1","pages":"2-3"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.1.2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692543","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":"Disseminating healthcare information: getting the message across.","authors":"S Marriott,&nbsp;C Palmer,&nbsp;P Lelliott","doi":"10.1136/qhc.9.1.58","DOIUrl":"https://doi.org/10.1136/qhc.9.1.58","url":null,"abstract":"It has been shown that there are often significant delays in incorporating clinical recommendations into routine practice.1 The biomedical knowledge base is expected to have doubled in size within the next 20 years; however, there is already evidence that even the existing volume of scientific information is unmanageable to those who use it (box 1).2 Its sources are diffuse and disorganised. For doctors alone, these sources can include the medical and popular media; recommendations of professional, political, and legal bodies; the output from educational campaigns and programmes; as well as marketing material from commercial sectors allied to health care, in particular the pharmaceutical and medical appliances industries. These are quite apart from internal, day to day information generated within doctors' own organisations. In a review of 13 well designed qualitative or quantitative studies exploring doctors' information needs, it was ascertained that they needed enormous amounts of information most of which was usually inaccessible.3\u0000\u0000### Box 1. Factors indicating the need for more effective dissemination \u0000\u0000What are the implications of these findings in a public health service committed to providing efficient and effective care?4 Evidence-based practice calls for the rapid incorporation of best available evidence into routine practice. An important issue for those concerned with developing the policies on which clinical practice is based, including researchers, policy makers, and professional bodies, is how to connect the rapidly expanding knowledge base of health care to the needs of the professionals who deliver it. Dissemination is an essential component of the quality improvement cycle, ensuring the best available evidence is incorporated into routine practice with the smallest possible delay.\u0000\u0000In 1993, the Royal College of Psychiatrists' research unit undertook a …","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 1","pages":"58-62"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.1.58","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692552","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":"Quality improvement around the world: how much we can learn from each other.","authors":"F Moss,&nbsp;M Palmberg,&nbsp;P Plsek,&nbsp;W Schellekens","doi":"10.1136/qhc.9.1.63","DOIUrl":"https://doi.org/10.1136/qhc.9.1.63","url":null,"abstract":"<p><p>The USA National Forum on Quality Improvement in Health Care--organised by the Institute of Healthcare Improvement (Boston USA)--attracts many people from outside North America. At the 1999 meeting 20 countries were represented. A session on \"Quality improvement around the world\" was included in the pre-conference programme to bring together people working in many countries to explore and compare their experiences in a programme of short presentations (table 1). This article draws together some of the themes that emerged from the presentations and from the discussion.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 1","pages":"63-6"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.1.63","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21691769","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":"Development of an audit instrument for nursing care plans in the patient record.","authors":"C Björvell,&nbsp;I Thorell-Ekstrand,&nbsp;R Wredling","doi":"10.1136/qhc.9.1.6","DOIUrl":"https://doi.org/10.1136/qhc.9.1.6","url":null,"abstract":"<p><strong>Objectives: </strong>To develop, validate, and test the reliability of an audit instrument that measures the extent to which patient records describe important aspects of nursing care.</p><p><strong>Material: </strong>Twenty records from each of three hospital wards were collected and audited. The auditors were registered nurses with a knowledge of nursing documentation in accordance with the VIPS model--a model designed to structure nursing documentation. (VIPS is an acronym formed from the Swedish words for wellbeing, integrity, prevention, and security.)</p><p><strong>Methods: </strong>An audit instrument was developed by determining specific criteria to be met. The audit questions were aimed at revealing the content of the patient for nursing assessment, nursing diagnosis, planned interventions, and outcome. Each of the 60 records was reviewed by the three auditors independently and the reliability of the instrument was tested by calculating the inter-rater reliability coefficient. Content validity was tested by using an expert panel and calculating the content validity ratio. The criterion related validity was estimated by the correlation between the score of the Cat-ch-Ing instrument and the score of an earlier developed and used audit instrument. The results were then tested by using Pearson's correlation coefficient.</p><p><strong>Results: </strong>The new audit instrument, named Cat-ch-Ing, consists of 17 questions designed to judge the nursing documentation. Both quantity and quality variables are judged on a rating scale from zero to three, with a maximum score of 80. The inter-rater reliability coefficients were 0.98, 0.98, and 0.92, respectively for each group of 20 records, the content validity ratio ranged between 0.20 and 1.0 and the criterion related validity showed a significant correlation of r = 0.68 (p < 0.0001, 95% CI 0.57 to 0.76) between the two audit instruments.</p><p><strong>Conclusion: </strong>The Cat-ch-Ing instrument has proved to be a valid and reliable audit instrument for nursing records when the VIPS model is used as the basis of the documentation.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 1","pages":"6-13"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.1.6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692553","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":"Duties of a doctor: UK doctors and good medical practice.","authors":"I C McManus,&nbsp;D Gordon,&nbsp;B C Winder","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To assess the responses of UK doctors to the General Medical Council's (GMC) Good Medical Practice and the Duties of a Doctor, and to the GMC's performance procedures for which they provide the professional underpinning.</p><p><strong>Design: </strong>Questionnaire study of a representative sample of UK doctors.</p><p><strong>Subjects: </strong>794 UK doctors, stratified by year of qualification, sex, place of qualification (UK v non-UK), and type of practice (hospital v general practice) of whom 591/759 (78%) replied to the questionnaire (35 undelivered).</p><p><strong>Main outcome measures: </strong>A specially written questionnaire asking about awareness of Good Medical Practice, agreement with Duties of a Doctor, amount heard about the performance procedures, changes in own practice, awareness of cases perhaps requiring performance procedures, and attitudes to the performance procedures. Background measures of stress (General Health Questionnaire, GHQ-12), burnout, responses to uncertainty, and social desirability.</p><p><strong>Results: </strong>Most doctors were aware of Good Medical Practice, had heard the performance procedures being discussed or had received information about them, and agreed with the stated duties of a doctor, although some items to do with doctor-patient communication and attitudes were more controversial. Nearly half of the doctors had made or were contemplating some change in their practice because of the performance procedures; a third of doctors had come across a case in the previous two years in their own professional practice that they thought might merit the performance procedures. Attitudes towards the performance procedures were variable. On the positive side, 60% or more of doctors saw them as reassuring the general public, making it necessary for doctors to report deficient performance in their colleagues, did not think they would impair morale, were not principally window dressing, and were not only appropriate for problems of technical competence. On the negative side, 60% or more of doctors thought the performance procedures were not well understood by most doctors, were a reason for more defensive practice, and could not be used for problems of attitude. Few differences were found among older and younger doctors, hospital doctors, or general practitioners, or UK and non-UK graduates, although some differences were present.</p><p><strong>Conclusions: </strong>Most doctors working in the UK are aware of Good Medical Practice and the performance procedures, and are in broad sympathy with Duties of a Doctor. Many attitudes expressed by doctors are not positive, however, and provide areas where the GMC in particular may wish to encourage further discussion and awareness. The present results provide a good baseline for assessing changes as the performance procedures become active and cases come before the GMC over the next few years.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 1","pages":"14-22"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743494/pdf/v009p00014.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692541","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":"Drug treatments for schizophrenia.","authors":"C Adams,&nbsp;P Wilson,&nbsp;S Gilbody,&nbsp;A M Bagnall,&nbsp;R Lewis","doi":"10.1136/qhc.9.1.73","DOIUrl":"https://doi.org/10.1136/qhc.9.1.73","url":null,"abstract":"This paper summarises the research evidence presented in a recent issue of Effective Health Care on drug treatments for schizophrenia.1\u0000\u0000Schizophrenia is an illness or a group of illnesses affecting language, planning, emotion, perceptions, and movement. In the UK, approximately 250 000 people suffer from schizophrenia or a schizophrenia-like illness.2\u0000\u0000A quarter of those who have experienced an episode of schizophrenia recover and the illness does not recur. Another 25% experience an unremitting illness. The remaining 50% have a recurrent illness, but with long episodes of considerable recovery from positive symptoms such as delusions, hallucinations, disordered thinking, and catatonic movements.3 Many with recurrent illness have enduring problems from schizophrenia such as persistent psychotic symptoms, but, for most people, the problems consist of negative symptoms such as loss of enthusiasm and emotional responsiveness, apathy, and social withdrawal.3 These negative symptoms, though intrinsic to schizophrenia, are compounded by the adverse effects of drugs, living in impoverished circumstances, and by the social stigma associated with mental illness. Recovery from episodes of schizophrenia for some people is often complicated by episodes of depression, substance abuse, and anxiety. People with schizophrenia have a shortened life expectancy4 due to physical illness, accidents, and other causes of violent death, especially suicide.5\u0000\u0000Treatments for schizophrenia are divided into the so-called “physical interventions” of drugs, psychological and social managements and, rarely in the UK, electroconvulsant treatment. This article draws upon evidence from systematic reviews undertaken by the Cochrane Schizophrenia Group, and summarises the evidence on the effectiveness of the main drugs used in the treatment of schizophrenia. More detailed information is available on each treatment within the referenced reviews. These reviews are regularly updated in the Cochrane Library .6\u0000\u0000The main class of drugs used to treat or manage schizophrenia is antipsychotics …","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 1","pages":"73-9"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.1.73","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21691770","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":"Reviewing audit: barriers and facilitating factors for effective clinical audit.","authors":"G Johnston,&nbsp;I K Crombie,&nbsp;H T Davies,&nbsp;E M Alder,&nbsp;A Millard","doi":"10.1136/qhc.9.1.23","DOIUrl":"https://doi.org/10.1136/qhc.9.1.23","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature on the benefits and disadvantages of clinical and medical audit, and to assess the main facilitators and barriers to conducting the audit process.</p><p><strong>Design: </strong>A comprehensive literature review was undertaken through a thorough review of Medline and CINAHL databases using the keywords of \"audit\", \"audit of audits\", and \"evaluation of audits\" and a handsearch of the indexes of relevant journals for key papers.</p><p><strong>Results: </strong>Findings from 93 publications were reviewed. These ranged from single case studies of individual audit projects through retrospective reviews of departmental audit programmes to studies of interface projects between primary and secondary care. The studies reviewed incorporated the experiences of a wide variety of clinicians, from medical consultants to professionals allied to medicine and from those involved in unidisciplinary and multidisciplinary ventures. Perceived benefits of audit included improved communication among colleagues and other professional groups, improved patient care, increased professional satisfaction, and better administration. Some disadvantages of audit were perceived as diminished clinical ownership, fear of litigation, hierarchical and territorial suspicions, and professional isolation. The main barriers to clinical audit can be classified under five main headings. These are lack of resources, lack of expertise or advice in project design and analysis, problems between groups and group members, lack of an overall plan for audit, and organisational impediments. Key facilitating factors to audit were also identified: they included modern medical records systems, effective training, dedicated staff, protected time, structured programmes, and a shared dialogue between purchasers and providers.</p><p><strong>Conclusions: </strong>Clinical audit can be a valuable assistance to any programme which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at nurturing effective audits, valuable opportunities will be lost. Paying careful attention to the professional attitudes highlighted in this review may help audit to deliver on some of its promise.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"9 1","pages":"23-36"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qhc.9.1.23","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692546","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":"Measurement of patient perceptions of pain and disability in relation to total hip replacement: the place of the Oxford hip score in mixed methods.","authors":"R McMurray,&nbsp;J Heaton,&nbsp;P Sloper,&nbsp;S Nettleton","doi":"10.1136/qshc.8.4.228","DOIUrl":"https://doi.org/10.1136/qshc.8.4.228","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the practical difficulties experienced by patients when completing the Oxford hip score, and to highlight the need to reconsider aspects of its structure and conceptual base.</p><p><strong>Design: </strong>Qualitative study incorporating the Oxford hip score in semi-structured interviews with patients before and four months after their operation.</p><p><strong>Setting: </strong>Two hospitals in the North of England.</p><p><strong>Subjects: </strong>Osteoarthritic patients undergoing primary elective total hip replacement.</p><p><strong>Results: </strong>Use of the Oxford hip score provided quantitative data on disability in the sample, particularly about pain and immobility. It also facilitated the collection of qualitative data, serving as a useful starting point for interviews and as a prompt for indepth discussion. Concerns about the clarity, coverage, and content validity of the score were identified, however, raising questions about the measure's conceptual base.</p><p><strong>Conclusion: </strong>The Oxford hip score was found to be a useful precursor to the semi-structured interviews. However, deficiencies in instruction and lack of clarity in purpose have implications for its ongoing development and future application, both in this type of study and other, more general, contexts.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 4","pages":"228-33"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.4.228","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692500","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}