Journal of Healthcare Quality Research最新文献

{"title":"Evaluation of the degree of implementation of zero projects in critical care units of Galicia (Spain) through internal audits","authors":"I. Losada-Castillo,&nbsp;M.O. Roca-Bergantiños,&nbsp;R. Vázquez-Mourelle,&nbsp;Group of Auditors for Zero Projects in Critical Units in Galicia","doi":"10.1016/j.jhqr.2024.06.008","DOIUrl":"10.1016/j.jhqr.2024.06.008","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to assess the implementation of Zero Projects in Critical Care Units (CCUs) through Internal Audits (IA).</div></div><div><h3>Materials and methods</h3><div>Design: Real-time observational safety analysis. A questionnaire was developed with defined items to ensure objectivity. After IAs, a survey was conducted with the auditors. Scope: 11 CCUs in hospitals of the Servizo Galego de Saúde and Ribera-POVISA. Patients or participants: 24 auditors in 9 teams composed of medical, nursing, and quality personnel from health areas and 34 patients were assessed. Main variables of interest: Compliance with the quality standard (≥60% of items), strengths, areas for improvement, auditor's interest in IA, conformity with the organization and items.</div></div><div><h3>Results</h3><div>100% CCUs met the quality standard. 18.03% of items were fulfilled by all CCUs. Strengths: staff motivation, positive reception of auditors, and use of computer tools in some CCUs. Areas for improvement: deficit of automatic systems for controlling endotracheal tube cuff pressure (compliance rate in 9.1% of CCUs), training needs, communication issues, and not using checklists (45.5% of the reports). Auditors found IA very interesting, and 19% suggested improving organization and items.</div></div><div><h3>Conclusions</h3><div>All CCUs met the previously agreed-upon quality standard. Numerous improvement opportunities were identified and communicated to the audited CCUs. For greater homogeneity and objectivity, a review of previously agreed items and definitions is required.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 6","pages":"Pages 356-364"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spanish adolescent patients with cancer and main caregivers: Using perceptions of care to drive change in healthcare","authors":"A. Molina-Prado ,&nbsp;A. Pérez de Albéniz ,&nbsp;G. Medin ,&nbsp;V. Pérez-Alonso ,&nbsp;E. Carceller ,&nbsp;B. Huguet-Rodríguez ,&nbsp;C. Garrido-Colino","doi":"10.1016/j.jhqr.2024.07.002","DOIUrl":"10.1016/j.jhqr.2024.07.002","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine whether there are differences in care experience of adolescent cancer patients and their main caregiver, treated in Adolescent Cancer Units (ACUs), compared to those treated in Non-Adolescent Cancer Units (NACUs), including the COVID-19 pandemic period.</div></div><div><h3>Method</h3><div>Measurement of Reported Experience in adolescent oncology patients (12–19 years old) and caregivers through ad hoc surveys. The responses of the study group of patients and caregivers treated in Adolescent Units were compared with the group not treated in them.</div></div><div><h3>Results</h3><div>It is noted that many respondents consider that they have not been affected by the COVID-19 pandemic. Significant differences were seen in communication, with better perception by the group of patients treated in ACU (87.1%) and caregivers of ACU (97.3%) compared to patients and caregivers of NACU (53.3% and 68.2% respectively). Regarding information received about the side effects, a better perception was observed among patients treated in the ACU than in the NACU (<em>p</em> <!-->=<!--> <!-->0.247). In the transmission of information and the possibility of fertility preservation, a significant difference was observed in favour of ACU in patients and direct caregivers (<em>p</em> <!-->=<!--> <!-->0.010 and <em>p</em> <!-->=<!--> <!-->0.018).</div></div><div><h3>Conclusions</h3><div>ACU represents an improvement in the quality perceived by patients and main caregiver on key points in the comprehensive care of the adolescent with cancer such as information, participation in the process and decision making, approach to side effects, psychological care and help in returning to normal life. However, fertility and strategies for talking about the cancer experience, were identified as areas for future improvement.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 6","pages":"Pages 373-380"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of citizens’ choice between public and private hospitals","authors":"S. Parrado ,&nbsp;J. Rama ,&nbsp;A.-M. Reynaers","doi":"10.1016/j.jhqr.2024.09.001","DOIUrl":"10.1016/j.jhqr.2024.09.001","url":null,"abstract":"<div><h3>Objective</h3><div>This study assesses what factors determine citizens’ preferences for a public or private hospital (assuming the choice is free of charge) according to the severity of the disease.</div></div><div><h3>Material and method</h3><div>A web-based discrete choice experiment was carried out with 1777 individuals distinguishing between a control group (posed with a simple choice for each health condition) and added information for respondents of the treatment groups (distance, waiting time, advice from the family doctor, and recommendations from the social context). The relevance of these factors in relation to the severity of one's illness is investigated. The outcome variable is the choice of a public versus a private hospital for the treatment of a health issue of a different severity.</div></div><div><h3>Results</h3><div>The severity of the health issue has a moderator effect on the additional information for the treatment groups. Waiting time has a direct positive impact on the patient's preferred choice for a private hospital both for severe and non-severe health issues. Distance to the hospital and the family doctor's recommendation positively impact the preferred choice for a private hospital for non-severe health issues but not for severe health issues. Covariates like gender and age are not relevant in explaining the effects of the treatments, and educational level has a positive impact on one of the treatments: advice from the patient's environment. Satisfaction with public hospitals has a positive impact on all treatments.</div></div><div><h3>Conclusions</h3><div>Results indicate that waiting time is a key factor in choosing a private hospital against the majority-stated preference for a public hospital.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 6","pages":"Pages 391-398"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Instruments and Warning Signs for Identifying and Evaluating the Frequency of Adverse Events in Intermediate and Long-Term Care Centres: A Narrative Systematic Review","authors":"S. Malgrat-Caballero ,&nbsp;A. Kannukene ,&nbsp;C. Orrego","doi":"10.1016/j.jhqr.2024.06.004","DOIUrl":"10.1016/j.jhqr.2024.06.004","url":null,"abstract":"<div><h3>Introduction</h3><p>There is a lack of data about adverse events (AE) in intermediate and long-term care centers (ILCC). We aimed to synthesize the available scientific evidence on instruments used to identify and characterize AEs. We also aimed to describe the most common adverse events in ILCCs.</p></div><div><h3>Material and methods</h3><p>A narrative systematic review of the literature was conducted according to Prisma recommendations. The PubMed database was searched for articles published between 2000 and 2021. Two reviewers independently screened and reviewed the studies through blind and independent review. We evaluated bias risk with Cochrane's risk of bias tool. Disagreements were resolved by consensus. Discrepancies that were not resolved by discussion were discussed with a third reviewer. Descriptive data was extracted and qualitative content analysis was performed.</p></div><div><h3>Results</h3><p>We found 2191 articles. Based on the inclusion and exclusion criteria, 272 papers were screened by title and abstract, and 66 studies were selected for full review. The instruments used to identify AEs were mostly tools to identify specific AEs or risks of AEs (94%), the remaining 6% were multidimensional. The most frequent categories detected medication-related AEs (<em>n</em> <!-->=<!--> <!-->26, 40%); falls (<em>n</em> <!-->=<!--> <span>7, 11%); psychiatric AEs (6.9%); malnutrition (4.6%), and infections (4.6%). The studies that used multidimensional tools refer to frailty, dependency, or lack of energy as predictors of AEs. However, they do not take into account the importance of detecting AEs. We found 2–11 adverse drug events (ADE) per resident/month. We found a prevalence of falls (12.5%), delirium (9.6–89%), pain (68%), malnutrition (2–83%), and pressure ulcers (3–30%). Urinary tract infections, lower respiratory tract infections, skin and soft tissue infections, and gastroenteritis were the most common infections in this setting. Transitions between different care settings (from hospitals to ILCC and vice versa) expose AE risk.</span></p></div><div><h3>Conclusion</h3><p>There are many instruments to detect AEs in ILCC, and most have a specific approach. Adverse events affect a significant proportion of patients in ILCC, the nurse-sensitive outcomes, nosocomial infections, and adverse drug events are among the most common.</p><p>The systematic review was registered with Prospero, ID: CRD42022348168.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 5","pages":"Pages 315-326"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Planificación operativa en servicios sanitarios: ¿cómo lo hacemos posible?","authors":"","doi":"10.1016/j.jhqr.2024.04.007","DOIUrl":"10.1016/j.jhqr.2024.04.007","url":null,"abstract":"<div><h3>Introduction and objective</h3><p>The Catalan Health Service carries out the operational planning of service delivery and organization. The goal is to describe the methodology and procedure followed to perform these functions.</p></div><div><h3>Methods</h3><p>The process of operational planning in healthcare services (OPHS) is continuous, dynamic, participatory, objective, and adaptable. OPHS can be divided into three stages prior to implementation and evaluation: Service delivery planning, Organization of healthcare resources, and Procurement planning.</p></div><div><h3>Results</h3><p>Three examples of projects are presented following the POSS framework. It is essential to adapt the process to the characteristics of each project.</p></div><div><h3>Conclusions</h3><p>The proposed framework is useful to achieve high quality and equity in access to services.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 5","pages":"Pages 327-335"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute bronchiolitis: The economic impact of non-compliance with national guidelines","authors":"S. Poço Miranda ,&nbsp;H. Rodrigues ,&nbsp;S. Oliveira","doi":"10.1016/j.jhqr.2024.06.005","DOIUrl":"10.1016/j.jhqr.2024.06.005","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Acute bronchiolitis is a common reason for admission to the </span>pediatric<span> emergency department. Evidence has shown that most interventions do not change the natural course of the disease.</span></p></div><div><h3>Material and methods</h3><p>This study aimed to evaluate the economic impact of the non-compliance with the acute bronchiolitis<span> Portuguese national guideline. A retrospective study of pediatric emergency episodes of a Portuguese hospital that had a diagnosis of acute bronchiolitis during 2019, was conducted.</span></p></div><div><h3>Results</h3><p>The sample included 344 emergency episodes. Non-compliance with the guideline occurred in 71.8% of the episodes, mostly due to unjustified treatment. Following guideline in the studied hospital for one year would have resulted in an estimated overall 76.6% cost reduction, with a reduction in mean direct costs per patient of 14.93 €, corresponding to a medium saving of 3.89 € for each patient and a reduction of 11.03 € for the Portuguese National Health Service<span><span>. Analyzing the unjustified mean direct costs, of these 2.97 € were related to inpatient diagnostic tests and therapeutic and the remaining 11.96 € were related to </span>outpatient therapy. Mean direct costs imputed to the patient for outpatient treatment represented only 3.31 €, therefore most of mean direct costs is paid by the National Health Service.</span></p></div><div><h3>Conclusions</h3><p>Compliance with guideline would allow the reduction of total estimated costs by about 76.6%, representing a waste of resources, without compromising the quality of care provided. Most of the cost associated with non-compliance with the guideline is justified by outpatient therapy, 67% of which was paid by the National Health Service.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 5","pages":"Pages 299-305"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacto de la implantación del programa internacional de Guías de Buenas Prácticas (BPSO®) en los resultados de salud en un hospital público","authors":"A.B. Arredondo-Provecho ,&nbsp;M. Martínez-Piédrola ,&nbsp;D. Guadarrama-Ortega ,&nbsp;A.M. Morales-Guijarro ,&nbsp;V. Ruiz-Luján ,&nbsp;M. Acevedo-García","doi":"10.1016/j.jhqr.2024.06.006","DOIUrl":"10.1016/j.jhqr.2024.06.006","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze the impact on patient health outcomes after implementing 4 Good Practice Guidelines (GPG) in a level II public university hospital.</p></div><div><h3>Method</h3><p>A quasi-experimental pre-post study was carried out at the Hospital Universitario Fundación Alcorcón, belonging to the Servicio Madrileño de Salud (SERMAS) of the Community of Madrid. Anonymized patient health indicator data from February 2018 to December 2022 from a total of 4853 patient records were analyzed. Inclusion criteria all patients defined in the scope of each GBP. The sample analyzed was patients discharged in the last 5 working days of the month for all GBPs, except in Ostomy and Stroke, for which 100% of patients discharged during the month were included.</p></div><div><h3>Results</h3><p>The main results were: incidence of pressure injury from 2.70% (2017) to 1.03% (2022); stoma marking from 66.67% (2017) to 75% (2022); exclusive breastfeeding from 50% (2017) to 61.54% (2022); neurological assessment on admission from 75.56% (2017) to 85.60% (2022).</p></div><div><h3>Conclusions</h3><p>The implementation of the GBPs led to an improvement in the health indicators of patients admitted to the target units. Improvements were observed in both process and outcome indicators.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 5","pages":"Pages 306-314"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing the management of chronic diseases in clinical practice: The CARABELA methodology","authors":"","doi":"10.1016/j.jhqr.2024.06.001","DOIUrl":"10.1016/j.jhqr.2024.06.001","url":null,"abstract":"","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 5","pages":"Pages 336-339"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A propósito de una encuesta sobre riesgos de la enfermedad de Chagas","authors":"","doi":"10.1016/j.jhqr.2023.09.001","DOIUrl":"10.1016/j.jhqr.2023.09.001","url":null,"abstract":"","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 5","pages":"Pages 340-342"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41138916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiencia de los pacientes con enfermedades inflamatorias inmunomediadas atendidos en una unidad de atención integral multidisciplinar","authors":"","doi":"10.1016/j.jhqr.2024.04.006","DOIUrl":"10.1016/j.jhqr.2024.04.006","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the aspects with the greatest impact on the satisfaction of patients treated in a multidisciplinary unit specialising in immune-mediated inflammatory diseases (IMIDs) and to identify areas for improvement in the care model.</p></div><div><h3>Methods</h3><p>Cross-sectional descriptive study using a satisfaction survey structured in three blocks: sociodemographic variables, functional aspects of the unit and satisfaction with the professionals. Immediate satisfaction was measured on aspects related to the care received, the physical structure and the likelihood of recommending the unit.</p></div><div><h3>Results</h3><p>A total of 168 patients completed the surveys, the mean score of overall satisfaction with the unit was 4.75 (SD:0.4). The regression model showed the relationship between overall satisfaction and unit signage (OR:3.558, p<!--> <!-->=<!--> <!-->0.045, 95% CI: 1.027-12.33), coordination between professionals (OR:9.043, p<!--> <!-->=<!--> <!-->0.000, 95% CI: 2.79-29.28) and participation in decision making (OR: 44.836, p<!--> <!-->=<!--> <!-->0.000, 95% CI: 5.49-365.97). In terms of immediate satisfaction, the overall Net Promoter Score (NPS) was 87 (excellent). The mean score for coordination with Primary Care was 4.54 (SD:0.8) and they scored waiting time to be seen with 4.49 (SD:0.8), so they have been considered an area for improvement The mean score for coordination with Primary Care was 4.54 (SD:0.8) and they scored waiting time to be seen with 4.49 (SD:0.8), so both were considered areas for improvement.</p></div><div><h3>Conclusions</h3><p>Coordination between intra-centre professionals and patient participation in decision-making explain the excellent level of patient satisfaction. The monitoring of satisfaction has made it possible to implement immediate improvement actions.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 5","pages":"Pages 283-290"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}