Quality in health care : QHC最新文献_第6页

Changing clinical practice: views about the management of adult asthma. 改变临床实践:对成人哮喘管理的看法。

Quality in health care : QHC Pub Date : 1999-12-01 DOI: 10.1136/qshc.8.4.253

S Dawson, K Sutherland, S Dopson, R Miller

{"title":"Changing clinical practice: views about the management of adult asthma.","authors":"S Dawson, K Sutherland, S Dopson, R Miller","doi":"10.1136/qshc.8.4.253","DOIUrl":"https://doi.org/10.1136/qshc.8.4.253","url":null,"abstract":"A case study of clinical practice in adult asthma is presented. The case is part of a larger project, funded by the North Thames NHS Executive Research and Development Programme, that sought to explore the part played by clinicians in the implementation of research and development into practice in two areas: adult asthma and glue ear in children. The first case of glue ear in children was reported in a previous issue of this journal (Quality in Health Care 1999;8:99-107). Background information from secondary sources on the condition, treatment, and organisation and location of care is followed by an account of the results of semistructured interviews with 159 clinicians. The findings are reported in two sections: clinical management and the organisation of care, and clinicians' accounts of what, why, and how they introduce changes into their practice. The way clinicians talk about their learning, their expressed views on acceptable practice, and their willingness to change were shown to be informed by construction of legitimate and sufficient evidence, respected colleagues, and accumulated individual experience. There was little open acknowledgment of the influence of organisational factors in influencing practice. To investigate whether relationships between task performance and organisational arrangements found in other sectors apply to UK health, more robust measures by which performance can be evaluated are needed.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 4","pages":"253-61"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.4.253","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21691722","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: 22

Management of gynaecological cancers. 妇科癌症的处理。

Quality in health care : QHC Pub Date : 1999-12-01 DOI: 10.1136/qshc.8.4.270

A Melville, A Eastwood, J Kleijnen, H Kitchener, P Martin-Hirsch, L Nelson

引用次数: 12

The increasing importance of patient surveys. 病人调查的重要性日益增加。

Quality in health care : QHC Pub Date : 1999-12-01 DOI: 10.1136/qshc.8.4.212

P D Cleary

引用次数: 297

Quality of life as an instrument for need assessment and outcome assessment of health care in chronic patients. 生活质量作为慢性病患者医疗保健需求评估和结果评估的工具。

Quality in health care : QHC Pub Date : 1999-12-01 DOI: 10.1136/qshc.8.4.247

G A van den Bos, A H Triemstra

{"title":"Quality of life as an instrument for need assessment and outcome assessment of health care in chronic patients.","authors":"G A van den Bos, A H Triemstra","doi":"10.1136/qshc.8.4.247","DOIUrl":"https://doi.org/10.1136/qshc.8.4.247","url":null,"abstract":"Introduction Quality of life is generally acknowledged as a central concept in health care, but its full application in healthcare research and clinical practice are still being debated. With an increasing prevalence of chronic diseases and the focus of health care expanding from “adding years to life” to “adding life to years”, there is a growing interest in assessments of quality of life in health care. Measures of quality of life have been used almost exclusively in health services research to assess outcomes of care—that is, eVectiveness of care. Arguments in favour of this “outcome approach” are based upon the growth of the healthcare system, the need for cost containment, and the ensuing call for evidence-based health care. Less attention has been given to the use of quality of life for monitoring health needs as an index of the relative appropriateness of health care. Although the “outcome approach” is already widely established, the “need approach” has only recently gained attention. Chronically ill patients are particularly likely to benefit from need assessment and the routine use of patient derived data in making decisions about the distribution, access, and content of long term care. Comprehensive evaluations of health care must involve assessments of outcomes and needs. It is only by including both these assessments that the process of care for patients with a chronic disease can be improved. This article aims to clarify the interrelation between quality of life and quality of care. To elucidate this association we will use examples from our research on patients with stroke. The objectives are (a) to describe the necessity and use of measures of quality of life in health services research; (b) to examine the use of measures of quality of life to study outcomes of care and to illustrate how these measures can be used to assess the need for care; and (c) to discuss problems in quality assurance that are related to the comprehensiveness of chronic care.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 4","pages":"247-52"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.4.247","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692503","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: 51

Patient care: what drives us to change? 病人护理:是什么促使我们做出改变?

Quality in health care : QHC Pub Date : 1999-12-01 DOI: 10.1136/qshc.8.4.209

G M Cochrane

引用次数: 268

The learning organisation: a necessary setting for improving care? 学习型组织:改善护理的必要环境?

Quality in health care : QHC Pub Date : 1999-12-01 DOI: 10.1136/qshc.8.4.211

P Garside

引用次数: 281

Is the emergency readmission rate a valid outcome indicator? 急诊再入院率是一个有效的结果指标吗?

Quality in health care : QHC Pub Date : 1999-12-01 DOI: 10.1136/qshc.8.4.234

G C Leng, D Walsh, F G Fowkes, C P Swainson

{"title":"Is the emergency readmission rate a valid outcome indicator?","authors":"G C Leng, D Walsh, F G Fowkes, C P Swainson","doi":"10.1136/qshc.8.4.234","DOIUrl":"https://doi.org/10.1136/qshc.8.4.234","url":null,"abstract":"Objectives: The principal aim was to determine whether the emergency readmission rate varies between medical specialties, and to identify whether differences in emergency readmission rates between hospital trusts can be reduced by standardising for specialty. Possible factors influencing emergency readmission were also investigated, including frequency of previous admission and cause of readmission.Design: Emergency readmission rates were obtained from the Scottish Morbidity Record scheme (SMR1) using record linkage, standardised for age and sex. Rates throughout Scotland were analysed by specialty, and rates for general medicine compared among teaching hospital trusts. Cause of emergency readmission was determined from hospital records in a random sample (177 patients).Setting: Medical specialties throughout Scotland.Subjects: All patients readmitted as an emergency within 28 days of discharge (October 1990 to September 1994).Results: Emergency readmissions varied markedly between medical specialties, with highest rates in nephrology (24.2%, 95% CI 23.5 to 24.8) and haematology (20.4%, 95% CI 19.9 to 20.9), and the lowest in homeopathy (2.2%, 95% CI 1.6 to 2.7) and metabolic diseases (3.5%, 95% CI 2.4 to 4.5). The largest number of emergency readmissions was in general medicine, accounting for 63% of the total. Restricting emergency readmission rates to general medicine significantly altered previous rates. In the year preceding the emergency readmission, 59% of all patients had been admitted to hospital at least once, and most emergency readmissions (73.3%) resulted from a chronic underlying condition.Conclusions: Significant variations in emergency readmission rates occurred between medical specialties, suggesting that differences between hospital trusts are influenced by differences in specialties and thus case mix. The majority of emergency readmissions occurred in patients with an underlying chronic condition, and many had a history of multiple previous hospital admissions. The emergency readmission rate is therefore unlikely to be a valid outcome indicator reflecting quality of care until routine data are available for standardisation by case mix.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 4","pages":"234-8"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.4.234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692501","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: 29

A team quality improvement sequence for complex problems. 针对复杂问题的团队质量改进序列。

Quality in health care : QHC Pub Date : 1999-12-01 DOI: 10.1136/qshc.8.4.239

J Ovretveit

{"title":"A team quality improvement sequence for complex problems.","authors":"J Ovretveit","doi":"10.1136/qshc.8.4.239","DOIUrl":"https://doi.org/10.1136/qshc.8.4.239","url":null,"abstract":"To solve complex quality problems teams need to follow a systematic sequence of inquiry and action. In this article a practical description of a team quality improvement sequence (TQIS) is given based on the experience of the more successful teams in the Norwegian total quality management experiment. There are nine phases in the sequence and teams have the flexibility to choose the best quality methods for completing each phase. The strengths of the framework are in ensuring that personnel time is used cost effectively and that changes are made which result in measurable improvement. One limitation is that the framework has not been as widely tested as FOCUS-PDCA (find, organise, clarify, understand, select-plan, do, check, act) and other frameworks to which the TQIS framework is compared. It is proposed that if team projects are to be the main vehicle for quality improvement, then their work must be made more cost effective. The article aims to stimulate research into the conditions necessary for different quality teams to be successful in health care, and draws on the research to propose a \"risk of team failure index\" to improve the management of such teams.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 4","pages":"239-46"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.4.239","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692502","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: 37

Management of sickness absence: a quality improvement study from Slovenia. 病假管理:斯洛文尼亚质量改进研究。

Quality in health care : QHC Pub Date : 1999-12-01 DOI: 10.1136/qshc.8.4.262

J Kersnik

{"title":"Management of sickness absence: a quality improvement study from Slovenia.","authors":"J Kersnik","doi":"10.1136/qshc.8.4.262","DOIUrl":"https://doi.org/10.1136/qshc.8.4.262","url":null,"abstract":"Problem: A need to improve the communication system between general practitioners (GPs) and the national health insurance institute's (NHII) committee of experts for the referral and approval of sickness leave for patients.Design: A structured low cost quality improvement method for motivating GPs to change their current practice was developed.Background and setting: The study was done in Kranj health district in Slovenia. GPs and members of the committee of experts identified potential problems using a cause and effect diagram. The study period for baseline data collection was from November 1996 to December 1996, and the re-evaluation took place in May 1997. All GPs in Kranj health district (n = 78) took part. Data were collected on 443 patients referred by GPs to the NHII committee during the first phase of the study and 590 patients during the re-evaluation phase.Key measures for improvement: Reducing the number of cases reported by members of the committee of experts as causing problems after the intervention. Feedback to GPs about the success of the process.Strategies for change: A combination of methods was used: posted feedback, a guideline on record keeping, and a guideline, called AID (analysis of incidental deviations from expected service--in Slovene: analiza izjemnih dogodkov), on processing medical documentation.Effects of change: An overall drop was observed in the number of cases that caused problems (from 44% to 26%, p < 0.001). The most common problem at baseline (19.4% of the problems) was the seventh most common at the re-evaluation, then contributing only 9.2% of total problems (p = 0.02).Lessons learnt: The results support a quality improvement philosophy that empowers \"owners\" of the process to be the key resource in managing change, and they show the importance of the inner motivation of those involved. Despite working in a country undergoing transition, medical professionals were still willing to improve their performance. Nevertheless, structures and funding are needed to foster quality improvement initiatives and implement national policy on quality in health care.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 4","pages":"262-9"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.4.262","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21691723","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: 9

Perceptions of good medical practice in the NHS: a survey of senior health professionals. 国民保健制度中对良好医疗实践的看法:对高级卫生专业人员的调查。

Quality in health care : QHC Pub Date : 1999-12-01 DOI: 10.1136/qshc.8.4.213

A Hutchinson, M Williams, K Meadows, R S Barbour, R Jones

{"title":"Perceptions of good medical practice in the NHS: a survey of senior health professionals.","authors":"A Hutchinson, M Williams, K Meadows, R S Barbour, R Jones","doi":"10.1136/qshc.8.4.213","DOIUrl":"https://doi.org/10.1136/qshc.8.4.213","url":null,"abstract":"Objectives: To categorize senior health professionals' experience with poor medical practice in hospitals and in general practice, to describe perceptions which senior NHS staff have of good medical practice, and to describe how problems of poor medical practice are currently managed.Design: A postal questionnaire survey. The questionnaire sought perceptions of good medical practice, asked participants to characterise deviations from good practice, and to describe experience with managing poor performance at the time of the introduction of the General Medical Council (GMC) performance procedures.Setting: A range of NHS settings in the UK: hospital trusts, health authorities/boards, local medical committees, community health councils.Subjects: Senior health professionals involved in the management of medical professional performance.Main measures: Perceptions of what constitutes good medical practice.Results: Most respondents considered that persistent problems related to clinical practice (diagnosis, management, and outcome and prescribing) would require local management and, possibly, referral to the GMC performance procedures. Informal mechanisms, including informal discussion, education, training, and work shifting, were the most usual means of handling a doctor whose performance was poor. Many took a less serious view of deficiencies in performance on manner and attitude and communication, although consultation skills rather than technical skills comprised the greatest number of complaints about doctors.Conclusions: Senior NHS professionals seem reluctant to consider persistently poor consultation skills in the same critical light as they do persistently poor technical practice. These attitudes may need to change with the implementation of clinical governance and updated guidance from the GMC on what constitutes good medical practice.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 4","pages":"213-8"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.4.213","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692498","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: 9