Quality in health care : QHC最新文献

{"title":"Development and validation of a core outcome measure for palliative care: the palliative care outcome scale. Palliative Care Core Audit Project Advisory Group.","authors":"J Hearn,&nbsp;I J Higginson","doi":"10.1136/qshc.8.4.219","DOIUrl":"https://doi.org/10.1136/qshc.8.4.219","url":null,"abstract":"<p><strong>Objectives: </strong>To develop an outcome measure for patients with advanced cancer and their families which would cover more than either physical symptoms or quality of life related questions. To validate the measure in various specialist and non-specialist palliative care settings throughout the UK.</p><p><strong>Design: </strong>A systematic literature review of measures appropriate for use in palliative care settings was conducted. In conjunction with a multidisciplinary project advisory group, questions were chosen for inclusion into the scale based on whether they measured aspects of physical, psychological, or spiritual domains pertinent to palliative care, and whether similar items had shown to be valid as part of another measure. A staff completed version was developed to facilitate data collection on all patients throughout their care, and a patient completed version was designed to enable the patient to contribute to the assessment of their outcomes when possible. A full validation study was conducted to evaluate construct validity, internal consistency, responsiveness to change over time, and test-retest reliability. Assessments were timed.</p><p><strong>Setting: </strong>Eight centres in England and Scotland providing palliative care, including inpatient care, outpatient care, day care, home care, and primary care.</p><p><strong>Patients: </strong>A total of 450 patients entered care during the study period. Staff collected data routinely on patients in care long enough to be assessed (n = 337). Of these, 262 were eligible for patient participation; 148 (33%) went on to complete a questionnaire.</p><p><strong>Main measures: </strong>The Palliative Care Outcome Scale (POS), the European Organisation for Research on Cancer Treatment, and the Support Team Assessment Schedule.</p><p><strong>Results: </strong>The POS consists of two almost identical measures, one of which is completed by staff, the other by patients. Agreement between staff and patient ratings was found to be acceptable for eight out of 10 items at the first assessment. The measure demonstrated construct validity (Spearman rho = 0.43 to 0.80). Test/re-test reliability was acceptable for seven items. Internal consistency was good (Cronbach's alpha = 0.65 (patients), 0.70 (staff)). Change over time was shown, but did not reach statistical significance. The questionnaire did not take more than 10 minutes to complete by staff or patients.</p><p><strong>Conclusion: </strong>The POS has acceptable validity and reliability. It can be used to assess prospectively palliative care for patients with advanced cancer.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 4","pages":"219-27"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.4.219","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692499","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":"Clinical governance: bridging the gap between managerial and clinical approaches to quality of care.","authors":"S A Buetow,&nbsp;M Roland","doi":"10.1136/qshc.8.3.184","DOIUrl":"https://doi.org/10.1136/qshc.8.3.184","url":null,"abstract":"<p><p>Clinical governance has been introduced as a new approach to quality improvement in the UK national health service. This article maps clinical governance against a discussion of the four main approaches to measuring and improving quality of care: quality assessment, quality assurance, clinical audit, and quality improvement (including continuous quality improvement). Quality assessment underpins each approach. Whereas clinical audit has, in general, been professionally led, managers have driven quality improvement initiatives. Quality assurance approaches have been perceived to be externally driven by managers or to involve professional inspection. It is discussed how clinical governance seeks to bridge these approaches. Clinical governance allows clinicians in the UK to lead a comprehensive strategy to improve quality within provider organisations, although with an expectation of greatly increased external accountability. Clinical governance aims to bring together managerial, organisational, and clinical approaches to improving quality of care. If successful, it will define a new type of professionalism for the next century. Failure by the professions to seize the opportunity is likely to result in increasingly detailed external control of clinical activity in the UK, as has occurred in some other countries.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 3","pages":"184-90"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.3.184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692492","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":"Reducing errors in medicine.","authors":"D M Berwick,&nbsp;L L Leape","doi":"10.1136/qshc.8.3.145","DOIUrl":"https://doi.org/10.1136/qshc.8.3.145","url":null,"abstract":"","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 3","pages":"145-6"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.3.145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21691227","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":"Judging journalism: how should the quality of news reporting about clinical interventions be assessed and improved?","authors":"V A Entwistle,&nbsp;I S Watt","doi":"10.1136/qshc.8.3.172","DOIUrl":"https://doi.org/10.1136/qshc.8.3.172","url":null,"abstract":"Health care receives a lot of attention in the media. Rarely a day goes by without the wonders or horrors of some screening programme, drug, surgical procedure, or clinical service being discussed in the pages of our newspapers and on our television screens. Most of the major newspapers and television channels employ correspondents who specialise in health and medicine. Every day, these correspondents expect to be alerted to many potential “stories” by medical journals, policy makers, health service managers, professional interest groups, consumer interest groups, the pharmaceutical industry, research funders, and researchers. The correspondents’ interactions with these sources and their own activities in seeking, selecting, and structuring information all contribute to the shaping of stories. Media reports can influence the use that people make of healthcare interventions. Recent contraceptive “pill scares” communicated via the media have been associated with increases in the numbers of terminations of unwanted pregnancies among some populations, 2 although not others. 4 Women themselves have directly reported that they became pregnant after they stopped taking their oral contraceptives because of adverse media publicity. A systematic review of the eVects of media “campaigns” has shown that these can, at least in some circumstances, affect the use people make of health services. For example, publicity about the extremely high rates of hysterectomy among women in one Swiss canton appears to have triggered a fall in these rates, and there have been several examples of media campaigns that have increased the uptake of immunisations. 8 It seems likely that both healthcare professionals and the general public are influenced. Although it is not clear how and to what extent the specific characteristics of media reports of a particular issue influence their impact, most people would agree that media coverage of healthcare interventions should be of good quality. Their judgments about what constitutes good quality, however, are likely to vary according to their values and perspectives, and what they consider the purpose of such coverage to be. Representatives of diVerent groups tend to judge the quality of news reports according to diVerent criteria. The quotations in box 1 summarise several published opinions about one newspaper article that discussed possible genetic causes of asthma and the factors that aVected its publication.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 3","pages":"172-6"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.3.172","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21691156","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":"Assessing good quality dental care.","authors":"D Plamping","doi":"10.1136/qshc.8.3.148","DOIUrl":"https://doi.org/10.1136/qshc.8.3.148","url":null,"abstract":"","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 3","pages":"148"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.3.148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21691148","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 patients' attitudes to care across the primary/secondary interface: the development of the patient career diary.","authors":"R Baker,&nbsp;C Preston,&nbsp;F Cheater,&nbsp;H Hearnshaw","doi":"10.1136/qshc.8.3.154","DOIUrl":"https://doi.org/10.1136/qshc.8.3.154","url":null,"abstract":"<p><strong>Background: </strong>A growing number of new ways of organising services across the primary/secondary interface are being introduced and evaluated. The principal motive for such reorganisation is to improve the efficiency of health care. However, unless the impact of the new services on patients is investigated and taken into account, it is possible that patients' reactions could be negative, a factor that could lead to unexpected consequences in the use and costs of services.</p><p><strong>Objective: </strong>To develop a measure of patients' attitudes towards care across the interface between primary and secondary care.</p><p><strong>Design: </strong>Generation of questions to be included in the measure from a qualitative study of patients' experiences of care across the interface; administration of pilot versions of the measure to samples of patients referred to secondary care; refinement of questions guided by analysis of response patterns, principal components analysis and internal consistency; administration of the final version of the patient career diary in complete form retrospectively to patients referred to secondary care, and one section alone to patients attending outpatient departments for follow up appointments. Face validity was assessed by analysis of open comments in a sample of 50 diaries, and review of the diary by 34 health professionals. Construct validity was assessed by investigation of levels of correlation between components of each section of the diary and the components of the healthcare section overall.</p><p><strong>Setting: </strong>In the final field test, patients were attending various hospital services, including cardiology, dermatology, neurology, gynaecology, general surgery, general medicine, ophthalmology, trauma and orthopaedics, and gastroenterology.</p><p><strong>Results: </strong>The final version of the diary included 109 questions in seven sections: general practitioner (GP) visits and referral, other GP visits, first outpatient visit, other outpatient visits, inpatient stay and discharge, care after discharge, and care overall. Response rates were poor for retrospective completion of the entire diary, but excellent when a section was given separately. Principal components analysis confirmed that components relating to issues identified as important to patients in the qualitative study had been included in the diary. Levels of internal consistency were good, and comments of patients and health professionals supported validity.</p><p><strong>Conclusion: </strong>The patient career diary is a valid and reliable measure of patients' attitudes to care across the interface. It should be given in sections to ensure adequate response rates, and is suitable for use in the evaluation or quality of patterns of care across the interface. In future, the impact on patients of new ways of organising services across the interface should be investigated by use of measures such as the patient career diary.</","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 3","pages":"154-60"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.3.154","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21691153","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":"Improvement through inspection? The development of the new Commission for Health Improvement in England and Wales.","authors":"K Walshe","doi":"10.1136/qshc.8.3.191","DOIUrl":"https://doi.org/10.1136/qshc.8.3.191","url":null,"abstract":"Introduction Inspection and external review are increasingly used in healthcare systems throughout the world, in various forms, in pursuit of quality assurance and improvement. Although the experience of systems such as accreditation in those countries which have used them for decades is decidedly mixed, we are nevertheless witnessing what has been described as an explosion in external audit, regulation, review, and inspection—not just in health care, but across the public and private sector. But little evidence exists to show that regulation and inspection improve quality, and some would argue that they conflict with a modern understanding of eVective quality improvement. This article explores the contribution that external review and inspection can make to quality improvement in the context of the National Health Service (NHS) in England and Wales, where a new national statutory healthcare inspectorate is about to be established.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 3","pages":"191-201"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.3.191","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692493","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":"Practice visits as a tool in quality improvement: mutual visits and feedback by peers compared with visits and feedback by non-physician observers.","authors":"P van den Hombergh,&nbsp;R Grol,&nbsp;H J van den Hoogen,&nbsp;W J van den Bosch","doi":"10.1136/qshc.8.3.161","DOIUrl":"https://doi.org/10.1136/qshc.8.3.161","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate and compare the effects of two programmes of assessment of practice management in a practice visit: mutual visits and feedback by peers compared with visits and feedback by non-physician observers.</p><p><strong>Design: </strong>Prospective, randomised intervention study, with follow up after one year.</p><p><strong>Setting: </strong>General practices in the Netherlands in 1993 and 1994.</p><p><strong>Subjects: </strong>A total of 90 general practitioners (GPs) in 68 practices; follow up after one year comprised 81 GPs in 62 practices.</p><p><strong>Main measures: </strong>Scores on indicators and dimensions of practice management in the visit instrument to assess practice management and organisation (a validated Dutch method to assess practice management in a practice visit). Change was defined as the difference in score between the first visit and the visit after one year on 208 indicators and on 33 dimensions of practice management.</p><p><strong>Results: </strong>Data of 44 mutual visits by peers were compared with data of 46 visits by non-physician observers. After a year both programmes showed improvements on many aspects of practice management, but different aspects changed in each of the two programmes. After mutual practice visits, GPs scored significantly higher on content of the doctor's bag, on collaboration with colleagues, on collaboration with other care providers, and on accessibility of patient information than after a visit by a non-physician observer. The visits by non-physician observers resulted in a higher score on extent of use of records and on assessment on outcome and year report.</p><p><strong>Conclusion: </strong>Change after mutual practice visits and feedback by peers is more marked than after a visit and feedback by a non-physician observer.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 3","pages":"161-6"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.3.161","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21691154","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":"Practice visits as a tool in quality improvement: acceptance and feasibility.","authors":"P van den Hombergh,&nbsp;R Grol,&nbsp;H J van den Hoogen,&nbsp;W J van den Bosch","doi":"10.1136/qshc.8.3.167","DOIUrl":"https://doi.org/10.1136/qshc.8.3.167","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility and acceptance of (a) two programmes of assessment of practice management in a practice visit: mutual practice visits and feedback by peers versus visits and feedback by non-physician observers and (2) the practice visit method used in these programmes (the visit instrument to assess practice management and organisation (VIP)--a validated Dutch tool).</p><p><strong>Design: </strong>Prospective, randomised intervention study with the two programmes, follow up after one year. General practitioners (GPs) were visited after each programme and after the revisits by non-physician observers a year later.</p><p><strong>Setting: </strong>General practices in the Netherlands in 1993 and 1994.</p><p><strong>Subjects: </strong>A total of 90 GPs in 68 practices. At follow up after 1 year there were 81 GPs in 62 practices.</p><p><strong>Main measures: </strong>Scores (mainly five point scales) for questions on appreciation and acceptance; after the follow up visit a year later, scores for questions on feasibility and practicality of the improved procedure and feedback report.</p><p><strong>Results: </strong>Data of 44 mutual visits by peers were compared with data of 46 visits by non-physician observers. A visit by a non-physician observer was appreciated significantly more. After the practice visit at one year follow up, the participants reported to have appreciated the visit and the feedback report and to prefer feedback of a non-physician observer to that of a peer. Participants' reports on the procedure and the presentation of the feedback provided clues for the improvement of visit procedures.</p><p><strong>Conclusions: </strong>A practice visit and feedback by a non-physician observer is more appreciated than a visit and feedback by a colleague. A practice visit with the VIP by a non-physician observer is a simple, easy, and well accepted method for assessing practice management.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 3","pages":"167-71"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.3.167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21691155","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":"Learning from quality systems in different countries: quality improvement across borders?","authors":"F Moss,&nbsp;R Baker","doi":"10.1136/qshc.8.3.147","DOIUrl":"https://doi.org/10.1136/qshc.8.3.147","url":null,"abstract":"","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 3","pages":"147"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.3.147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21691149","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}