International journal for quality in health care : journal of the International Society for Quality in Health Care最新文献

{"title":"Multisector Collaborations at Children's Hospitals in the United States to Address Social Drivers of Health.","authors":"Ulfat Shaikh, Melissa Gosdin, Elizabeth Helmke","doi":"10.1093/intqhc/mzaf067","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf067","url":null,"abstract":"<p><strong>Background: </strong>Child health is influenced by a range of social drivers. This necessitates a multipronged approach to pediatric care with collaborative efforts of multiple sectors. Children's hospitals have unique expertise and resources to identify pressing issues in child health and partner with community organizations and local governing bodies to address gaps in child health. The goal of this study was to identify multisector collaborations that children's hospitals in the United States engage in, facilitators and challenges of these efforts, and best practices that hospitals can employ to implement and sustain such collaborations.</p><p><strong>Methods: </strong>An environmental scan was conducted utilizing the following approaches: a content analysis of Community Health Needs Assessments (CHNA) and implementation strategies at 35 children's hospitals, and semi-structured qualitative interviews with leaders who manage community partnerships at 14 select children's hospitals. This purposive sample was selected for national representation, including geographic location, size, and type of pediatric hospital. Qualitative relational analysis enabled exploration of descriptive and interpretive meanings within CHNA documents. Audio recordings were transcribed, the interview guide focused on domains of the Practical Robust Implementation and Sustainability Model (PRISM) implementation science framework, and interviews were conducted and analyzed by a team of qualitative researchers.</p><p><strong>Results: </strong>Most hospitals engaged in multisector collaborations that addressed health disparities. The most frequently identified priorities included mental and behavioral health, access to health services, neighborhood safety and violence prevention, early childhood education, and chronic disease prevention. Key challenges were limited funding for multisector collaboration, shortage of staff with training and experience in multisector work, and variable readiness of community partners. Facilitators included adequate staffing and funding, community trust, and building on existing partnerships. All hospitals highlighted the crucial need to build trust within the community as a key factor to implement successful multisector collaborations. Best practices included examining the hospital's internal organization to avoid duplication of efforts, leveraging existing hospital resources to support local initiatives, incorporating community partners and financially supporting their efforts, creating avenues for bidirectional communication with community partners, measuring and tracking effectiveness of collaborations, and developing infrastructures to keep projects moving forward despite staff turnover.</p><p><strong>Conclusion: </strong>Efforts to transform child health care from sick-care systems to community-integrated systems require children's hospitals to partner with community-based organizations to extend their reach and effectiveness. ","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664148","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":"Barriers and breakthroughs: Policy reflections on healthcare for persons with disability in the Philippines.","authors":"Danilo V Rogayan, Ivan N Palencia","doi":"10.1093/intqhc/mzaf066","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf066","url":null,"abstract":"","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664146","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":"Barriers and Facilitators to the Use of Virtual Wards: A Systematic Review of the Qualitative Evidence.","authors":"Sara Cucurachi, Sinéad Lydon, Laura Louise Moens, Tanja Manser, Paul O'Connor","doi":"10.1093/intqhc/mzaf065","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf065","url":null,"abstract":"<p><strong>Background: </strong>Virtual wards offer an alternative to traditional inpatient care, delivering acute care, monitoring, and treatment at home to prevent hospital admissions or facilitate early discharge. The aim of our qualitative systematic review was to understand the barriers to and facilitators for the successful implementation and sustainability of virtual wards from the perspective of any involved stakeholder using behavioural change models.</p><p><strong>Methods: </strong>The review protocol was registered on PROSPERO (CRD42024519627). The following databases were searched: Medline, EMBASE, CINAHL, PsycINFO, and Academic Search Complete. A three-stage deductive content analysis (DCA), as recommended for applying the COM-B (Capability, Opportunity, and Motivation- Behaviour) and TDF (Theoretical Domains Framework) to qualitative data, was conducted to categorise and map the barriers and facilitators to virtual wards identified in the included studies, using the TDF domains as a guiding framework.</p><p><strong>Results: </strong>Searches initially identified 7,489 articles. Sixteen studies met the inclusion criteria. Common barriers for patients and family members were the lack of language skills, technical skills, and medical knowledge. Caregivers were also required to take on significant medical responsibilities while patients had to remain self-motivated. The introduction of appropriate training was seen as a valuable facilitator. Healthcare providers faced numerous technological barriers that had the potential to affect care delivery. Strong leadership was an essential facilitator for effective care coordination in virtual wards. From a healthcare system perspective, the availability of resources such as staffing, equipment, and funding, along with standardized protocols, is crucial for the successful implementation of virtual wards.</p><p><strong>Conclusions: </strong>Virtual wards can ease hospital capacity issues and support the delivery of safe and effective care in patients' own homes. However, to realise this potential, we must understand the barriers and facilitators to the use and successful implementation of virtual wards for patients, carers, and healthcare professionals. This understanding will allow targeted strategies and interventions to be developed to support both the delivery and receipt, of care on virtual wards.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664147","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":"Availability of six sigma trials for quality improvement in health care: an emerging challenge.","authors":"Ivan David Lozada-Martinez, Ornella Fiorillo-Moreno, Jessica Manosalva-Sandoval, Yelson Alejandro Picón-Jaimes","doi":"10.1093/intqhc/mzaf062","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf062","url":null,"abstract":"","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612778","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":"Factors that Influence the Implementation of Quality Improvement Programs.","authors":"Joseph Adrien Emmanuel Demes, Lambert Farand, Marie-Pascale Pomey, Francois Champagne","doi":"10.1093/intqhc/mzaf061","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf061","url":null,"abstract":"<p><strong>Introduction: </strong>Access to poor-quality care has adverse effects in terms of morbidity and mortality. Hence, the need to find strategies to improve processes and systems to satisfy patients and enable access to good-quality care. In Haiti, the Ministry of Public Health and Population, donors, and technical and financial partners emphasize quality improvement programs such as the HEALTHQUAL program. It has become an essential approach in the Haitian health system. While quality improvement programs are relatively new to Haiti, little data is available on the factors that can facilitate or hinder their implementation.</p><p><strong>Methodology: </strong>An evaluative research (implementation analysis) using a multiple case study design was conducted with a qualitative approach. Thirty-eight semi-structured interviews were conducted, observations were made, and documents were analysed. Data analysis was performed using the constant comparative method and a synthetic analysis framework with predefined categories (program components, facilitating factors, inhibiting factors, mechanisms, consequences, and interactions between model elements). Subsequently, these categories were analysed using Atlas.ti software, with additional codes emerging and being incorporated into the predefined categories. Memos and a research journal were used during data collection and analysis.</p><p><strong>Results: </strong>The main facilitating factors include collaboration between the institutional and community levels, leadership, coordination and collaboration within a multidisciplinary team, external pressures, the characteristics of the networks, team ownership of the process, and quality infrastructure.The main inhibiting factors comprise the socio-political context, organisational culture, the influence of previous decisions (policy legacy), provider perceptions of HEALTHQUAL, the lack of accountability mechanisms, an unsuitable health information system, and resource unavailability.</p><p><strong>Conclusion: </strong>Based on these observations, leaders and decision-makers are encouraged to consider these contextual factors when planning and implementing the HEALTHQUAL program in Haiti. It is important to consider a range of contextual variables to understand implementation at any given time.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612779","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":"Temporal dynamics of patient complaints in new hospitals: A dynamic time warping and impulse response function analysis of the South Korean healthcare system.","authors":"Young Gyu Kwon, Myeong Namgung, Song Hee Park, Mi Kyung Kim, Jae Chol Choi, Daun Jeong, Chan Woong Kim","doi":"10.1093/intqhc/mzaf060","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf060","url":null,"abstract":"<p><strong>Background: </strong>Patient complaints are critical indicators for improving healthcare quality and patient safety, offering insights into systemic issues within medical institutions. Newly operational hospitals, owing to operational instability and limited resources, are more prone to frequent complaints, reflecting several service delivery problems. Despite the significance of these complaints, systematic analyses of how they evolve and how each complaint domain influences patient harm in new South Korean hospitals have been scarce.</p><p><strong>Method: </strong>We analysed 1,113 patient complaints collected from March 2022 to June 2024 from a newly operational hospital in South Korea. These complaints were categorised into three major domains: Clinical (Quality, Safety), Management (Environment, Institutional Processes), and Relationship (Listening, Communication, Respect and Patient Rights) using the Healthcare Complaints Analysis Tool. Based on a vector autoregression model, we employed dynamic time warping to examine temporal patterns among the complaints and impulse response function analysis to assess the influence of these factors on patient harm over time.</p><p><strong>Results: </strong>The results identified that in the early stages of hospital operations, Clinical Safety and Patient Harm were closely clustered, indicating a strong association between clinical factors and patient harm. In the mid-term period (September 2022 to February 2023), Respect and Patient Rights and Environment became major clusters, indicating a shift towards Management and Relationship issues as primary causes of complaints. In the later term (March 2023 to June 2024), Environment became clustered with Listening and Communication, whereas Patient Harm became more independent. Impulse response function analysis showed that Clinical factors had a strong, immediate positive impact (0.91017, p < 0.01 on Day 1) on patient harm that gradually decreased over the subsequent ten-day period. Management factors exhibited a smaller initial effect (0.00756, p < 0.05 on Day 1) but demonstrated a gradual, cumulative pattern over time. Relationship factors initially had a minimal impact (0.04551, p < 0.1 on Day 1) but became more significant in later days (0.06566, p < 0.01 on Day 3).</p><p><strong>Conclusion: </strong>Clinical safety has an immediate, significant negative impact on patients in new hospitals, requiring prompt attention. As hospitals stabilise, Management and Relationship factors play a significant role in patient safety. Our findings underscore the need for dynamic resource allocation and strategic planning that evolves from focusing on clinical safety to incorporating management improvements and patient-centred communication strategies to enhance patient safety and service quality in new hospitals in South Korea.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612780","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":"Did the introduction of an electronic booking form for elective caesarean section improve compliance with guidelines for gestational age at delivery?","authors":"Julian Vitali, Sarah Janssens, Neha Ravi, Huda Safa","doi":"10.1093/intqhc/mzaf059","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf059","url":null,"abstract":"<p><strong>Background: </strong>The Preterm Birth Collaborative in Australia aims to reduce unnecessary preterm and early-term deliveries, addressing preterm birth as a leading cause of infant mortality and long-term disability. Mater Mother's Hospital (MMH), a tertiary obstetric centre, participates in the national \"Every Week Counts\" initiative to minimise unnecessary early-term caesarean sections (CS). Elective CS before 39 weeks raises the risk of neonatal intensive care unit (NICU) admissions and developmental delays. MMH introduced an electronic CS booking form to improve compliance with clinical guidelines for gestational age at birth and to reduce unwarranted clinical variation.</p><p><strong>Methods: </strong>A single-centre retrospective audit analysed CS data prior to and post implementing the electronic booking form. Data from three months pre- and three months post- were extracted from hospital records, assessing demographics, clinical indication, and compliance with national or hospital guidelines. The booking form, created with OnBase software, provided a recommended delivery window based on risk factors, requiring justification for deviations. Compliance with guidelines and rates of unplanned labour before scheduled CS were assessed.</p><p><strong>Results: </strong>Six months of CS were reviewed, among 1,059 screened patients, 557 elective CS cases were assessed, with 283 pre-implementation and 274 post-implementation. Overall compliance with clinical guidelines improved from 90.5% to 94.5% (p = 0.06). A significant improvement was observed in patients with maternal or fetal risk factors, increasing compliance from 86.8% to 93.3% (p = 0.04). Compliance among low-risk patients remained high (95.2% pre-implementation vs. 96.8% post-implementation, p = 0.52). The proportion of CS cases presenting with spontaneous rupture of membranes (SROM) or labour before the scheduled procedure remained unchanged (23.6% vs. 24.8%, p = 0.75).</p><p><strong>Conclusion: </strong>The introduction of an electronic CS booking form in conjunction to clinical prioritisation improved compliance with clinical guidelines for recommended gestational age at time of delivery, particularly for patients with maternal or neonatal risk factors. While the booking form did not significantly impact overall compliance or the rate of patients presenting with SROM or in labour requiring emergency CS, it highlights the valuable role of digital innovation in reducing unwarranted clinical variation. Future research should explore broader implementation across various healthcare settings.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586111","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":"Safety rounds as a strategy for continuous quality and safety improvement in healthcare processes.","authors":"Julio J Lopez-Picazo, Inmaculada Vidal-Abarca, Juana M Marín-Martínez, Mercedes López-Ibáñez","doi":"10.1093/intqhc/mzaf049","DOIUrl":"10.1093/intqhc/mzaf049","url":null,"abstract":"<p><strong>Background: </strong>Safety rounds (SR) emerged as a tool to engage healthcare leaders in patient safety, inspired by the LEAN 'Gemba' visits. While SRs have shown potential to improve safety culture and clinical practices, their effectiveness varies. Success depends on engaged leadership, regular implementation, and a focus on continuous improvement, involving staff in identifying and addressing safety issues. However, evidence on SRs effectiveness remains fragmented. This study aims to design, implement, and evaluate a strategy for using SRs to improve quality and safety in healthcare processes within an integrated health area, contributing to the global understanding of SR adaptation across different healthcare settings.</p><p><strong>Methods: </strong>A five-year quasi-experimental pre-post study was conducted (2018-2023) in a Spanish integrated healthcare area. A multidisciplinary group designed and deployed SRs in five key care settings: Primary Care, Outpatient Consultation, Emergency Services, Hospitalization, and Surgery. SRs were structured in four stages: team formation, indicator assessment, improvement proposal, and dissemination of results. A total of 41 SRs were conducted, assessing 122 indicators. Measurements included the Hospital Survey on Patient Safety Culture (HSOPS) and patient safety incident reports.</p><p><strong>Results: </strong>41 SRs were conducted across 5 clinical settings, with an average compliance rate of 71% for assessed indicators. Of the 122 indicators assessed, 87 (71%) met the standard compliance threshold. The number of safety incident reports increased by 27% from 2017 to 2023. Significant improvements were noted in 'Management Support for Patient Safety' and 'Feedback and Communication', while decreases occurred in dimensions such as 'Perception of Safety'.</p><p><strong>Discussion: </strong>SR, when systematically designed, can improve safety culture and healthcare quality, particularly in communication and leadership. Declines in some dimensions indicate a need for continuous refinement of SR strategies. Further research is needed to optimize SR impact across diverse contexts.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113284","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":"Inpatient falls and pressure ulcers as nursing quality indicators in national benchmarking-a retrospective observational registry study.","authors":"Terhi Lemetti, Anniina Heikkilä, Asta Heikkilä, Kristiina Junttila, Marja Kaunonen, Tiina Kortteisto, Anu Nurmeksela, Susanne Salmela, Pia-Maria Tanttu, Tarja Tervo-Heikkinen","doi":"10.1093/intqhc/mzaf055","DOIUrl":"10.1093/intqhc/mzaf055","url":null,"abstract":"<p><strong>Background: </strong>Collecting data of quality of care and using these data in research and in developing clinical practice has become more systematic worldwide. Globally, one of the goals is to advance benchmarking nursing-sensitive quality of care between healthcare organizations. Inpatient falls and hospital-acquired pressure ulcers are widely used as nursing-sensitive quality indicators in benchmarking, as they are related to additional healthcare costs and the decrease in patients' quality of life. The aim of this study was to explore the prevalence of inpatient falls and hospital-acquired pressure ulcers among adult patients in Finnish acute and psychiatric care based on national nursing-sensitive benchmarking data.</p><p><strong>Methods: </strong>The retrospective observational registry study was conducted in Finnish adult inpatient units in acute and psychiatric care between 2021 and 2022. The benchmarking data of inpatient falls covered 10 hospitals and hospital-acquired pressure ulcer data covered 11 hospitals. Frequencies and percentages were used to describe the results.</p><p><strong>Results: </strong>The data of inpatient falls covered a total of 2 518 152 patient days (per month min 70 581; max 122 628) and the data included 4526 falls. Of them, the number of falls with an injury was 1866 (41%), totalling 0.74 falls with an injury per 1000 patient days. In the hospital-acquired pressure ulcer data, there were 48 155 patients. Of them, 88% (n = 42 402) had their skin condition visually assessed from head-to-toe. A total of 3214 (7.6%) patients had pressure ulcers, of which 1917 (4.5%) were hospital-acquired pressure ulcers. The prevalence of hospital-acquired pressure ulcers in Stages 2-4 was 1.4% (n = 579). The highest inpatient fall rate was in psychogeriatric units, whereas the highest hospital-acquired pressure ulcer rate was in intensive care units.</p><p><strong>Conclusion: </strong>The low prevalence rates of inpatient falls and hospital-acquired pressure ulcers indicate that the quality of nursing care in Finland is on a good level when compared to international research findings. However, there is still room for improvement, especially in units with a high number of adverse events. Results provide information about nursing care quality to further develop clinical practice. The experiences and principles obtained in benchmarking nursing quality can be utilized in creating an official national quality register for nursing-sensitive quality indicators.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12249166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500225","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":"Impact of pay-for-performance program on postoperative infection and revision risk in diabetic patients with hip replacement: a Taiwanese Cohort Study.","authors":"Hsiu-Ling Huang, Chuan-Yu Kung, Ying-Chao Lin, Yeong-Ruey Chu, Pei-Tseng Kung, Shun-Mu Wang, Wen-Chen Tsai","doi":"10.1093/intqhc/mzaf051","DOIUrl":"10.1093/intqhc/mzaf051","url":null,"abstract":"<p><strong>Background: </strong>Diabetes Mellitus is a prevalent chronic disease with considerable global health implications. The Pay-for-Performance (P4P) program is a health insurance payment system designed to improve the quality and efficiency of diabetes care. This study explored the effect of P4P participation on postoperative infection, revision surgery risk, and associated factors among patients with type 2 diabetes undergoing hip replacement surgery.</p><p><strong>Methods: </strong>This retrospective cohort study utilized data from Taiwan's National Health Insurance Research Database (NHIRD), which included a parent population of 2 697 279 individuals with diabetes between 2010 and 2016. A total of 26 682 subjects with type 2 diabetes (P4P: 3 190; non-P4P: 23 492) who met the enrollment criteria were selected. Propensity score matching with a ratio of 1:3 (P4P: non-P4P) was performed, resulting in a final sample of 12 440 participants (P4P = 3 110; non-P4P = 9 330). All participants were followed for postoperative outcomes until 2018. The differences between the two groups in postoperative infection and revision risks were assessed using a bivariate log-rank test. The Cox proportional hazards model with a competing risk approach was employed to estimate relative risks and identify factors associated with postoperative infection and revision surgery.</p><p><strong>Results: </strong>P4P participants exhibited a lower postoperative infection rate compared with nonparticipants (3.73% vs. 4.56%, P = .042) and a lower relative risk of postoperative infection [adjusted hazard ratio (AHR): 0.80, 95% confidence interval (CI): 0.65-0.99]. The beneficial effect of P4P on infection reduction was significant in specific subgroups: patients aged 55-64 years, with a monthly salary of NT$22 801-NT$28 800, and a Charlson Comorbidity Index (CCI) of 0 (P < .05). Although P4P participants had a lower revision surgery rate (1.54% vs. 2.03%) and a lower relative risk of revision (AHR: 0.90, 95% CI: 0.65-1.24), this difference was nonsignificant (P = .522).</p><p><strong>Conclusions: </strong>Participation in a P4P program was associated with a lower risk of postoperative infection among patients with diabetes undergoing surgery. However, the impact on revision arthroplasty risk was nonsignificantly different between the P4P and non-P4P. These findings offer valuable insights for health-care policymakers in optimizing diabetes care policies and refining P4P program design.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251885","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}