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

{"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":"Availability of Six Sigma trials for quality improvement in healthcare: an emerging challenge.","authors":"Ivan David Lozada-Martinez, Ornella Fiorillo-Moreno, Jessica Manosalva-Sandoval, Yelson Alejandro Picón-Jaimes","doi":"10.1093/intqhc/mzaf062","DOIUrl":"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":"2025-07-04","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":"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":"Variations in length of stay and cost of pediatric pneumonia hospitalizations according to patient and institutional factors.","authors":"Hyejin Lee, Jin-Won Noh, Sanghee Lee, Jung-Kyu Choi, Jung-Hoe Kim, Hae-Jong Lee, Jin Yong Lee","doi":"10.1093/intqhc/mzaf054","DOIUrl":"10.1093/intqhc/mzaf054","url":null,"abstract":"<p><strong>Background: </strong>There have been consistent reports on variation in the treatment of pediatric pneumonia. In Korea, healthcare institutions are categorized into four types according to inpatient capacity and patient acuity: tertiary general hospitals (≥500 beds), general hospitals (100-499 beds), hospitals (30-99 beds), and clinics (<30 beds). We sought to examine the length of stay and cost for all-cause pediatric pneumonia across these different types of healthcare institutions.</p><p><strong>Methods: </strong>We conducted a retrospective, observational study of all cases of pediatric inpatients aged 18 and under who were hospitalized for pneumonia between 2010 and 2019 using claim data. Pneumonia was defined based on the claim diagnosis. The trends of length of stay and cost over the years were analyzed using linear regression. A multilevel analysis was conducted at two hierarchical levels (individual and institutional). Results are presented from the unadjusted baseline model (Model 1) to the fully adjusted model (Model 4), which accounted for both individual and institutional factors, with primary emphasis on Model 4.</p><p><strong>Results: </strong>Among the 2 921 096 cases, hospitals accounted for the largest proportion of hospitalization, with a total of 1 389 925 cases (47.58%) (P < .0001). The average length of stay for pneumonia cases was 5.77 days (SD 5.96) and hospitals had the longest average stay at 5.85 days (SD 7.59) (P < .0001). The average cost for pneumonia hospitalizations was $125.11 (SD 45.13), with tertiary general hospitals having the highest average cost at $159.20 (SD 73.30) (P < .0001). In the fully adjusted model (Model 4), the intra-class correlation (ICC) for length of stay attributed to -healthcare institutions ranged from 20.43 to 35.61. Clinics had the highest ICC for length of stay, with ranges from 43.07 to 52.64. For hospitalization costs, the ICC for healthcare institutions ranged from 53.39 to 70.78. Hospitals had highest ICC values for hospitalization costs, ranging from 65.82 to 84.07.</p><p><strong>Conclusion: </strong>Substantial variation exists in the length of stay and costs for pediatric pneumonia hospitalizations across different types of healthcare institutions. This variation was particularly pronounced in hospitals and clinics. To enhance the quality of pneumonia care and reduce this variability, policy interventions such as the promotion of clinical guidelines and institutional quality assessments are necessary.</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":"144532821","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":"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}

{"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":"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":2.2,"publicationDate":"2025-07-04","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":"Correction to: Use of wireless geographic locating system to improve medical equipment utilization and medical quality.","authors":"","doi":"10.1093/intqhc/mzaf053","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf053","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":"37 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610873","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":"Identification of key factors influencing patient satisfaction for practical prioritization in healthcare settings: a nationwide survey analysis.","authors":"Jinhee Park, Jinhyun Kim","doi":"10.1093/intqhc/mzaf052","DOIUrl":"10.1093/intqhc/mzaf052","url":null,"abstract":"<p><strong>Background: </strong>Understanding the factors influencing patient satisfaction is essential for improving healthcare services. However, the diverse elements affecting patient satisfaction at medical institutions make it impractical and inefficient to enhance all factors simultaneously. The purpose of this study is to analyze the factors influencing patient satisfaction based on the Patient Experience Survey and to identify key predictors ranked by importance for efficient application in clinical and hospital settings.</p><p><strong>Methods: </strong>A total of 69 562 survey responses were obtained from the Korean Medical Service Experience Survey conducted between 2019 and 2023. Patients satisfying the following specific conditions were extracted and categorized based on the type of medical institution (clinic or hospital) and care modality (outpatient or inpatient): outpatients visiting a clinic (N = 26 349), outpatients visiting a hospital (N = 9861), and inpatients admitted to a hospital (N = 1617). For each category, factors influencing the patients' overall satisfaction with their medical experience and their intention to recommend the hospital or clinic were analyzed. To assess the magnitude and importance of these factors, Spearman's rank correlation analysis and a regression tree model were used. The study also compared whether key predictive factors of patient satisfaction differed by medical institution type (clinic vs. hospital) and care modality (outpatient vs. inpatient), as well as by the specific patient satisfaction outcome measure (overall satisfaction vs. intention to recommend).</p><p><strong>Results: </strong>The analysis revealed that patient satisfaction was determined by different factors depending on the outcome measure. For overall satisfaction, the most significant predictor was satisfaction with treatment outcomes, while for intention to recommend, the most influential factor was the convenience of the medical facility. These findings were consistent across medical institution types (clinic or hospital) and care modalities (outpatient or inpatient). The attitude of healthcare providers (doctors or nurses) also emerged as a key predictor of patient satisfaction, though its importance varied depending on the type of medical institution and care modality.</p><p><strong>Conclusion: </strong>Satisfaction with treatment outcomes and convenience of the medical facility were the most important predictor of overall satisfaction and intention to recommend, respectively. These findings reinforce that prioritizing the clinical effectiveness of care-rather than focusing solely on service-related features-is essential for achieving high patient satisfaction. Because of utilizing a large-scale dataset and identifying predictors ranked by importance, this study is expected to contribute effectively to decision-making processes regarding the future development and improvement of healthcare institutions.</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":"144251884","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":"Toward a greener healthcare: unveiling the carbon costs of dialysis in China and the path to sustainability.","authors":"Junxiong Ma, Shuhong Bi, Runming Du, Wangteng Jiao, Zhisheng Liang, Qinfeng Zhou, Shuduo Zhou, Yuhang Pan, Wen Tang, Haibin Zhang, Zhijie Zheng, Ming Xu, Tao Wang, Gordon G Liu, Zhenyu Zhang","doi":"10.1093/intqhc/mzaf050","DOIUrl":"10.1093/intqhc/mzaf050","url":null,"abstract":"<p><strong>Background: </strong>The healthcare sector plays a significant role in greenhouse gas emissions, hospitals contributed about 5.2% of the global carbon footprint, totaling 10.8 billion tons. It highlights China's healthcare emissions and the potential benefits of energy-efficient technologies in medical settings, including different dialysis treatments. The healthcare sector, a major emissions source, could reduce its impact through sustainable practices.</p><p><strong>Methods: </strong>This retrospective cross-sectional study evaluated the annual carbon footprint of patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). We analyzed demographic characteristics and carbon consumption across both groups, distinguishing the environmental impacts of HD and PD. Linear regression models were used to identify factors influencing carbon emissions.</p><p><strong>Results: </strong>The study included 271 dialysis patients, comprising 143 HD and 128 PD cases. The annual carbon footprints of HD and PD were 3063.1 kg CO2-eq and 436.4 kg CO2-eq, respectively. For HD, the largest contributors to carbon emissions were equipment power consumption (43%) and medical consumables (23%), while for PD, discharge medication (49%) and medical supplies (48%) dominated. The carbon footprint of HD remained stable at 2500-3500 kg CO2-eq per year, while PD ranged from 200-800 kg CO2-eq per year, with no significant changes over extended dialysis periods. Factors such as age, occupation, and geographical location showed varying effects on the carbon footprints of HD and PD.</p><p><strong>Conclusions: </strong>This study offers a framework for quantifying ecological benefits from optimized clinical pathways. The findings suggest that promoting peritoneal dialysis could significantly reduce the healthcare sector's carbon footprint, advancing efforts toward sustainability and environmentally responsible healthcare delivery.</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":"144236738","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":"Assessing surgical non-technical skills: a paradigm shift for improved patient care and outcomes.","authors":"Jesse Ey, Ellie Treloar, Matheesha Herath, David Greenfield, Guy J Maddern","doi":"10.1093/intqhc/mzaf058","DOIUrl":"10.1093/intqhc/mzaf058","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":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562617","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}