Quality in health care : QHC最新文献

{"title":"Management of major trauma: changes required for improvement.","authors":"J Dyas,&nbsp;P Ayres,&nbsp;M Airey,&nbsp;J Connelly","doi":"10.1136/qshc.8.2.78","DOIUrl":"https://doi.org/10.1136/qshc.8.2.78","url":null,"abstract":"<p><strong>Aims: </strong>To describe the views of key healthcare professionals on the changes they considered to be important in the reduction of major trauma mortality between 1988 and 1995 in Leeds.</p><p><strong>Methods: </strong>Qualitative unstructured interviews with a purposive sample of 10 healthcare professionals deemed to be key personnel by an experienced consultant who had provided acute trauma care throughout the relevant period. Each interview was tape recorded and transcribed; each transcript was analysed for important themes by two independent researchers who then discussed their results to resolve any differences in interpretation.</p><p><strong>Results: </strong>Three categories of change became evident: \"policy\", \"infrastructure\", and \"philosophy of care\". Each of these categories seemed to be equally important. Policy changes identified as important were the Royal College of Surgeons of England's report into trauma care (1988), the setting of standards for paramedic training, and the national audit of major trauma outcomes. Important infrastructure changes identified were training in advanced trauma life support, decreased ambulance response times, reorganisation towards \"consultant led\" hospital services, and an emphasis on quality monitoring. Changes in philosophy of care were increases in levels of teamwork, commitment, communication, and confidence. Together these facilitated an overall restructuring and refocusing of care.</p><p><strong>Conclusions: </strong>No individual change is seen as dominant for improved care, but rather a strategic mixture of facilitating national and regional policy guidance, organisational restructuring, and congruent professional attitudes were integral components leading to the observed changes. Improving outcomes in other areas is likely to involve an integrated series of changes which must be managed as a total system.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 2","pages":"78-85"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.2.78","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417811","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":"Day surgery in Scotland: patient satisfaction and outcomes.","authors":"J Bain,&nbsp;H Kelly,&nbsp;D Snadden,&nbsp;H Staines","doi":"10.1136/qshc.8.2.86","DOIUrl":"https://doi.org/10.1136/qshc.8.2.86","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate patients' views on the process and outcome of day surgery in Scotland, and to study patients' satisfaction with care in a range of specific procedures.</p><p><strong>Design: </strong>Questionnaires completed by a census of day case surgery patients within a band of 25 procedures under the umbrella of five broad groups: (1) general surgery; (2) urology; (3) gynaecology; (4) orthopaedics; (5) ear, nose, and throat; ophthalmology.</p><p><strong>Setting: </strong>13 hospitals in six health board areas in Scotland.</p><p><strong>Subjects: </strong>During the period 1995-6, 5069 day case patients were asked to complete a questionnaire within two weeks of their operation and discharge from hospital.</p><p><strong>Main outcome measures: </strong>Arrangements before admission; immediate postoperative symptoms and complications; problems experienced after discharge; readmission after discharge.</p><p><strong>Results: </strong>A response rate of 68% was obtained from 13 sites ranging from 43% to 82%. The overall satisfaction score was 85. A total of 894 patients (26%) experienced pain after surgery and 783 (23%) had relatively minor medical problems after discharge. In total, 265 (7.8%) patients were readmitted to hospital after discharge. Few notable differences existed between specialties or hospitals in terms of satisfaction scores, although notable pain was experienced more frequently in gynaecology and general surgery patients. Readmission was more common for urological procedures.</p><p><strong>Conclusion: </strong>Overall, patient satisfaction with day case surgery was high. Dissatisfaction was largely related to waiting times between admission, operation, and discharge. The amount of pain experienced also had a notable impact on the level of patient satisfaction. Day surgery is not without complications, with 26% of patients experiencing notable degrees of pain; 23% having minor medical problems after discharge; and 8% of respondents having to reattend hospital with problems relating to their original operations.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 2","pages":"86-91"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.2.86","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417812","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":"Some limits to evidence-based medicine: a case study from elective orthopaedics.","authors":"E Ferlie,&nbsp;M Wood,&nbsp;L Fitzgerald","doi":"10.1136/qshc.8.2.99","DOIUrl":"https://doi.org/10.1136/qshc.8.2.99","url":null,"abstract":"<p><p>There has been growing interest in recent years in the application of the principles of evidence-based medicine (EBM), although implementation is complex. Scientific, organisational, and behavioural factors all combine to shape clinical behaviour change. Case study based qualitative data are presented which illuminate such processes within one clinical setting (elective orthopaedics), drawn from a larger study. It is suggested that (1) there are alternative models of what constitutes \"evidence\" in use; (2) scientific knowledge is in part socially constructed; and (3) clinical professionals retain a monopoly of technical knowledge. The implication is that there may be severe obstacles to the rapid or broad implementation of EBM.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 2","pages":"99-107"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.2.99","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417814","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":"Clinician education: a key to implementing asthma guidelines?","authors":"C Griffiths,&nbsp;G Feder","doi":"10.1136/qshc.8.2.73","DOIUrl":"https://doi.org/10.1136/qshc.8.2.73","url":null,"abstract":"","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 2","pages":"73-4"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.2.73","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417989","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":"Antimicrobial prophylaxis in colorectal surgery.","authors":"A M Glenny,&nbsp;F Song","doi":"10.1136/qshc.8.2.132","DOIUrl":"https://doi.org/10.1136/qshc.8.2.132","url":null,"abstract":"volume 4,no 5,which is an update of a system-atic review of randomised controlled trials(RCTs) examining the eVectiveness of diVer-ent antimicrobial regimens used for the preven-tion of surgical wound infection in patientsundergoing colorectal surgery. Details of thereview’s methodology are publishedelsewhere.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 2","pages":"132-6"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.2.132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417988","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":"A model for continuous quality improvement in small scale practices.","authors":"H Geboers,&nbsp;R Grol,&nbsp;W van den Bosch,&nbsp;H van den Hoogen,&nbsp;H Mokkink,&nbsp;P van Montfort,&nbsp;H Oltheten","doi":"10.1136/qshc.8.1.43","DOIUrl":"https://doi.org/10.1136/qshc.8.1.43","url":null,"abstract":"During the past decade new models for quality improvement in health care were developed based on experiences in industry. These models became known as total quality management or continuous quality improvement and are now widely and successfully used in larger healthcare organisations. In general practice several tools are used to improve care, such as vocational training, continuous medical education, peer review, audit, and guideline development. Although valuable, these tools usually focus more on improving professional performance than on comprehensive care provision delivered by teams. Little is known about the use of continuous quality improvement in small scale general practice. The question is whether it is possible to translate the principles of continuous quality improvement into a model for quality improvement for general practice. Simply adopting the strategies of continuous quality improvement used in hospitals or larger organisations may fail because of the specific characteristics of general practice. Most of these practices have, for example, a hierarchical structure in which the general practitioner (GP) is not only the manager but also is often the owner. In many countries general practices have a small staV who lack the time for quality improvement activities. The aim of this article is to reflect on the applicability of continuous quality improvement in small scale practices. Firstly, the characteristics of general practice will be discussed. Secondly, the essential elements of continuous quality improvement are presented by giving a short review of previous publications. Finally, these elements are translated into a framework of practical possibilities for quality improvement in general practice, which results in a model for quality improvement that may be feasible and applicable in small scale general practice. Examples from a study on quality management in general practice done in the Netherlands are used to illustrate the model. 17","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 1","pages":"43-8"},"PeriodicalIF":0.0,"publicationDate":"1999-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.1.43","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417981","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":"Empowering patients using computer based health support systems.","authors":"D H Gustafson,&nbsp;F M McTavish,&nbsp;E Boberg,&nbsp;B H Owens,&nbsp;C Sherbeck,&nbsp;M Wise,&nbsp;S Pingree,&nbsp;R P Hawkins","doi":"10.1136/qshc.8.1.49","DOIUrl":"https://doi.org/10.1136/qshc.8.1.49","url":null,"abstract":"With the increased pressure to contain healthcare costs, it is critical to find more eVective ways of providing information, emotional support, decision making, and behaviour change assistance for patients. In the United States, a doctor spends approximately 18 minutes in face to face contact with the patient during each clinic appointment. 1 During morning hospital rounds, physicians spend on average just over four minutes in the patient’s room. 2 It has been proposed that ideal physician communication with patients with breast cancer should be tailored to patients’ needs or coping styles to reduce their distress. 3 However, in an environment of continued pressure to reduce healthcare costs, it is virtually impossible for doctors to give patients adequate information or even direct them to appropriate support resources. If costs are to be reduced while at the same time improving patient support we must find new ways to help patients to cope with their disease, make necessary decisions, and gain emotional support. Computer systems can help to fill this void. A key problem encountered by people facing a health crisis is that they are often given information when they are least able to take it in, such as at the time of diagnosis. SiminoV and others have concluded that nearly all studies point to serious gaps in patient recall and understanding of the information they are given. 34","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 1","pages":"49-56"},"PeriodicalIF":0.0,"publicationDate":"1999-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.1.49","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417983","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":"Patient centred assessment of quality of life for patients with four common conditions.","authors":"D A Ruta,&nbsp;A M Garratt,&nbsp;I T Russell","doi":"10.1136/qshc.8.1.22","DOIUrl":"https://doi.org/10.1136/qshc.8.1.22","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the reliability, validity, and responsiveness of a new quality of life measure, the patient generated index (PGI) of quality of life, in patients with four common clinical conditions.</p><p><strong>Design: </strong>Prospective one year follow up study.</p><p><strong>Setting: </strong>Outpatient departments and four general practices in Grampian, Scotland.</p><p><strong>Subjects: </strong>1746 patients consulting a general practitioner in one of four practices, or referred to outpatients from all Grampian practices over a four month period, with low back pain, menorrhagia, suspected peptic ulcer, and varicose veins.</p><p><strong>Main outcome measures: </strong>Postal questionnaire including the PGI, SF-36 health survey, and clinically derived condition specific measures of disease severity.</p><p><strong>Results: </strong>Test-retest reliability was satisfactory for group comparisons (intraclass correlation coefficient 0.65). Validity was confirmed by the observed association of the PGI with the SF-36, condition specific instruments, and sociodemographic variables. For low back pain, the PGI and the SF-36 pain scale were found to be most responsive to clinical change. For patients with menorrhagia and suspected peptic ulcer, only the condition specific instruments detected larger changes than the PGI.</p><p><strong>Conclusions: </strong>It is possible to develop a patient generated index of quality of life that not only assesses the extent to which patients' expectations are matched by reality but also satisfies criteria of reliability and responsiveness to change. Further work is required to make the PGI more acceptable and meaningful to patients, but it is believed that it offers an exciting new approach to the evaluation of medical care.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 1","pages":"22-9"},"PeriodicalIF":0.0,"publicationDate":"1999-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.1.22","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417977","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":"Unmet care demands as perceived by stroke patients: deficits in health care?","authors":"W J op Reimer,&nbsp;R J Scholte de Haan,&nbsp;P T Rijnders,&nbsp;M Limburg,&nbsp;G A van den Bos","doi":"10.1136/qshc.8.1.30","DOIUrl":"https://doi.org/10.1136/qshc.8.1.30","url":null,"abstract":"OBJECTIVES: To describe unmet care demands as perceived by stroke patients and to identify sociodemographic and health characteristics associated with these unmet demands to investigate the appropriateness of health care. SETTING: Sample of patients who participated in a multicentre study (23 hospitals) on quality of care in The Netherlands. PATIENTS: Non-institutionalised patients who had been admitted to hospital because of stroke. Patients were interviewed six months (n = 382) and five years (n = 224) after stroke. DESIGN: Six months after stroke data were collected on: (a) sociodemographic characteristics in terms of age, sex, living arrangement, educational level, and regional level of urbanisation; (b) health characteristics in terms of cognitive function, disability, emotional distress, and general health perception; (c) utilisation of professional care; and (d) unmet care demands as perceived by patients. Data on utilisation of care and unmet demands were also collected five years after stroke. Data were collected from June 1991 until December 1996. RESULTS: The percentage of unmet care demands was highest at six months after stroke (n = 120, 31%). Multiple logistic regression analyses showed that disabled patients were more likely to be unmet demanders for therapy, (I)ADL care and aids (range odds ratio (OR) = 3.5 to 7.9) than to be no demanders, whereas emotionally distressed patients were more likely to be unmet demanders for psychosocial support (OR = 3.8). When comparing unmet demanders with care users only for (instrumental) activities of daily living (I)ADL care differences were found: men (OR = 3.8), disabled patients (OR = 3.0), and emotionally distressed patients (OR = 6.5) were more likely to be users. CONCLUSIONS: Patients who perceived an unmet care demand do appear genuinely to have an unmet care need as supported by assessment of their health status: (a) types of unmet care demands correspond with types of health problems and (b) unmet demanders were in general unhealthier than no demanders and more comparable with care users for health characteristics. IMPLICATIONS: To improve an equitable distribution of healthcare services, guidelines for indicating and allocating health care have to be developed and should be based on scientific evidence and consensus meetings including professionals' and patients' perspectives.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 1","pages":"30-5"},"PeriodicalIF":0.0,"publicationDate":"1999-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.1.30","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417979","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":"Patient education in the year 2000: tailored decision support, empowerment, and mutual aid.","authors":"A M O'Connor","doi":"10.1136/qshc.8.1.5","DOIUrl":"https://doi.org/10.1136/qshc.8.1.5","url":null,"abstract":"","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"1999-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.1.5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417982","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}