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

{"title":"Readability and clinical accuracy of AI-generated hospital discharge instructions: an audit of three large language models.","authors":"Rajat Goel","doi":"10.1093/intqhc/mzag140","DOIUrl":"10.1093/intqhc/mzag140","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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979235","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":"Patient engagement and feasibility of a QR code-based digital information tool in the emergency department.","authors":"Akash Manes, Ivjot Samra, Ekaterina Fedosova, Joban Sran, Amir Behboudi","doi":"10.1093/intqhc/mzag100","DOIUrl":"10.1093/intqhc/mzag100","url":null,"abstract":"<p><strong>Background: </strong>Patients frequently seek guidance on non-urgent administrative and informational needs, such as sick notes, finding a family physician, and pharmacy access, during emergency department (ED) visits. Limited primary care availability contributes to these inquiries and may increase communication demands on clinical staff. This project aimed to assess the feasibility and patient engagement of a low-cost digital intervention using quick response (QR) codes.</p><p><strong>Methods: </strong>We conducted a prospective observational quality improvement study from June to December 2025 in a community ED. Twenty informational posters, containing four scannable QR codes, were placed in high-visibility public areas. Each QR code linked to a mobile-friendly resource: a virtual sick note, a tool to find a family doctor, directions to the nearest 24-hour pharmacy, and directions to the nearest pharmacy. Automated scan analytics were used to assess patient engagement and feasibility, defined by sustained use over time and absence of technical or workflow disruptions.</p><p><strong>Results: </strong>During the 6-month study period, the four QR codes were scanned 1,895 times. The virtual sick note (43.2%) and find a family doctor tool (30.3%) were the most frequently accessed resources, followed by the 24-hour pharmacy (20.4%) and local pharmacy (6.1%). Scan activity occurred daily throughout the study period, with no reported technical issues or disruptions to clinical workflow.</p><p><strong>Conclusion: </strong>QR code-based informational posters demonstrated consistent patient engagement and addressed common non-urgent informational needs without increasing staff workload. This low-cost, easily scalable digital tool was feasible to implement within routine ED operations and may support future patient-directed digital self-service initiatives.</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":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148582089","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":"The outcomes of Lean management in a large academic hospital in Finland in 2018-2023: a qualitative study.","authors":"Irmeli Hirvelä, Elina Reponen, Mervi Javanainen, Riikka Lämsä, Vesa Niskanen, Paulus Torkki","doi":"10.1093/intqhc/mzag079","DOIUrl":"10.1093/intqhc/mzag079","url":null,"abstract":"<p><strong>Background: </strong>Lean management (LM) has been implemented in healthcare organizations, promising efficient operations, rapid patient access to care, improved staff satisfaction, and lower costs. However, the use of LM is questioned because there is no strong evidence of its outcomes, so proof of long-term and organization-wide use is needed. The aim of the study is to increase understanding of the long-term effects of LM in healthcare.</p><p><strong>Methods: </strong>This is a case study done at the Helsinki University Hospital in Finland. A retrospective qualitative study was conducted in three sectors (A, B, and C) of the hospital. Fourteen healthcare leaders from three sectors participated in interviews by answering structured and open-ended questions. The interviews were used to evaluate the outcomes that are experienced by the leaders in the hospital setting over a 5-year period, and evaluate indicators that they used to assess these outcomes. The interviews were analyzed using qualitative and quantitative content analysis with ATLAS.ti analysis software (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany).</p><p><strong>Results: </strong>The outcomes of LM can be grouped into three main categories (organization, patient, and staff) that are divided into six subcategories: experiential, care-related, work-related, economic, leadership and management, and image effects. The leaders experienced the greatest benefits on the organization level, as it enhanced the effectiveness of the organization's structure and operations, fostered continuous development, improved staff retention and attraction, and promoted patient-centredness. According to the leaders, the most important benefits for patients included improved access to care, better care flow, enhanced safety of care, and greater participation in improving operations. In addition, the leaders highlighted that the biggest benefits for staff were increased work satisfaction, work competence, work commitment, and ethical behaviour. We found that the use of LM also has disruptive and contradictory effects caused by the lack of organization-wide Lean commitment and structure, and the media have a bias towards negative portrayals of hospital efficiency.</p><p><strong>Conclusion: </strong>We found that six subcategories provide a comprehensive framework for qualitatively assessing organization-wide experienced outcomes of LM in the hospital. Our findings emphasize that the organization should be fully committed to the Lean method, and its structure should be clear so that the best benefits of LM can be achieved. We noticed that more qualitative LM research is needed to complement the Lean knowledge gained from quantitative research, develop more comprehensive and high-quality evaluation indicators, and increase evidence for its use in healthcare.</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":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166877","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":"Operational inefficiency and perceived quality in a paediatric day hospital: a lean-informed study of patient flow, caregiver and staff perceptions.","authors":"Mario Casolino, Lavinia Benedetti, Giovanni Gioiello, Daniele Mascia, Martina Vardabasso","doi":"10.1093/intqhc/mzag087","DOIUrl":"10.1093/intqhc/mzag087","url":null,"abstract":"<p><strong>Background: </strong>Lean management is widely promoted in healthcare to improve efficiency; however, evidence is sparse concerning how Lean-informed organisational settings directly influence patient experience and frontline staff perceptions of Lean processes, particularly in paediatric day hospital (DH) environments where clinical complexity and family-centred care create inherent conflicts between standardisation and adaptability.</p><p><strong>Methods: </strong>We conducted an observational cross-sectional study using several quantitative data sources, supplemented by qualitative insights from semi-structured staff interviews in an Italian paediatric DH following staff introduction to Lean concepts (Sept-Nov 2024). We integrated: (i) Value Stream Mapping and timed caregiver tracking to evaluate patient flow and waiting; (ii) a caregiver satisfaction survey at discharge; and (iii) a staff survey plus interviews capturing perceptions of Lean. Analyses were descriptive and exploratory.</p><p><strong>Results: </strong>Process performance: The DH exhibited substantial variation; only 11.4% of procedures occurred precisely on schedule, and non-value-added time constituted approximately 65% of each stay. Patient experience: Despite these inefficiencies, caregiver satisfaction remained consistently high (median 5/5). Satisfaction was only weakly correlated with waiting times or schedule deviations but strongly associated with transparent information and respectful staff interactions. Staff perceptions: The majority viewed Lean as practical and valuable, especially among those previously trained; however, many cited obstacles such as insufficient managerial support and resistance to change, with older staff expressing more scepticism than younger colleagues.</p><p><strong>Conclusions: </strong>High caregiver satisfaction coexisted with considerable operational inefficiencies, suggesting that relational care mitigates the impact of delays. These findings demonstrate that efficiency metrics alone do not fully represent perceived quality in paediatric settings. Lean implementation should balance efficiency, clinical adaptability, and family-centred care.</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":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148285079","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":"Bringing artificial intelligence to the front lines: PMcardio for detecting occlusive myocardial infarction in STEMI and STEMI-equivalent activations.","authors":"Mohamad Bahrou, Karthik Missula, Ted Amadi, Asad Cheema, Momin Siddique","doi":"10.1093/intqhc/mzag131","DOIUrl":"10.1093/intqhc/mzag131","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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922507","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: High-quality primary healthcare: addressing the challenges here and now.","authors":"","doi":"10.1093/intqhc/mzag120","DOIUrl":"10.1093/intqhc/mzag120","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":"38 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908586","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":"Interventions to improve Cultural Safety in healthcare in CANZUS countries: a systematic mixed studies review of First Nations Peoples' experiences.","authors":"Anne van der Breggen, Stuart Leske, Judith A Dean, Saira Sanjida, Jane Wallace, Natasha Lee, James Ward","doi":"10.1093/intqhc/mzag057","DOIUrl":"10.1093/intqhc/mzag057","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Assessing patient perspectives is fundamental to determining whether anti-racism and cultural training programs and services associated with an intervention achieve their intended outcomes, yet reviews frequently focus on health provider perspectives. This systematic review, therefore, aimed to investigate First Nations Peoples' experiences, as patients, of interventions to improve their Cultural Safety and experiences in secondary and tertiary healthcare settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;American Psychological Association's PsycInfo (via EBSCOhost), Cumulative Index to Nursing and Allied Health Literature Complete (via EBSCOhost), PubMed, and Scopus (via Elsevier) were all searched from inception to 9 December 2025. Eligible intervention studies needed to report the experiences of First Nations' people as care recipients in secondary and tertiary healthcare settings. Eligible study countries were Australia, Canada, Aotearoa (New Zealand), and the United States of America (USA). General study quality was assessed using the Mixed Methods Appraisal Tool. Study quality was also examined with a modified version of the Aboriginal and Torres Strait Islander Quality Appraisal Tool to provide a First Nations perspective. Qualitative meta-aggregation was conducted to synthesize both qualitative and quantitative data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 22 reports (11 qualitative, 7 quantitative, and 4 mixed methods) of 20 eligible studies, including 2092 First Nations care recipients. Interventions and quantitative outcomes were heterogeneous, precluding meta-analysis. Four studies reported on cultural training for health professionals, with the remainder service-level interventions. The qualitative meta-aggregation resulted in six synthesized findings, which reflected the mechanisms by which these programs worked and their outcomes. Four synthesized findings described mechanisms. These included emotional and practical support; acknowledgement, respect, and support for culture; feeling accepted, heard, valued, safe, comfortable, and respected; and navigating treatment and the system. The two synthesized findings related to outcomes concerned perceptions of health services and, relatedly, impacts on health service access. Quality appraisal revealed no discussion of existing and newly created intellectual property considerations. Study limitations included undefined terminology, terms being used interchangeably, and a few studies from the USA and Aotearoa (New Zealand).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Published intervention studies assessing First Nations care recipients' experiences appear to be increasing. Future interventions must clearly define the terminology in the intervention, use mixed-methods approaches, and report intellectual property considerations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;Systematic review: PROSPERO, CRD42024521218 (prospective, available at https://www.crd.york.ac.uk/PROSPE","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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849299","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":"Illness does not stop childhood: rethinking play as a dimension of quality in paediatric healthcare.","authors":"Katherine Andrea Dinamarca-Aravena, Ezequiel García-Elorrio","doi":"10.1093/intqhc/mzag107","DOIUrl":"10.1093/intqhc/mzag107","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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709362","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":"Assessment of knowledge, attitudes, and practices around cervical cancer screening in the Gulu district of Northern Uganda: a cross-sectional study.","authors":"Tana Chongsuwat, Andre Nana, Aaliyah O Ibrahim, Ann E Evensen, James H Conway, Sumba O Pius, Ibrahim Sseddangira, Usman Iqbal, William Oloya","doi":"10.1093/intqhc/mzag118","DOIUrl":"10.1093/intqhc/mzag118","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer is a global health issue, particularly Sub-Saharan Africa, including Uganda, where it poses a severe burden. Despite the availability of screening methods, uptake remains low due to various barriers, such as limited resources and a lack of awareness. This study primarily aimed to assess the knowledge, attitudes, and practices related to cervical cancer screening among men and women in the Gulu District of Northern Uganda, with secondary objectives on understanding gender differences, the impact of HIV status, and identifying barriers to screening.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in December 2021 using a structured questionnaire administered in both English and Acholi to evaluate participants' knowledge of cervical cancer, attitudes toward the disease, and screening practices. We described knowledge, attitudes, and practices, and applied logistic regression to explore the associations between gender, HIV status, and correctness of responses.</p><p><strong>Results: </strong>A total of 379 participants aged 18 years and above were included. Most respondents self-reported low overall knowledge of cervical cancer (n = 298 of 376 responses, 79.3%), which is reflected in the low percentage of correct responses to questions related to the recommended age for screening (1.9%) and the frequency of screening for HIV-negative/unknown (4.5%), and HIV-positive (9.8%) persons. Gender and HIV status among female respondents were not associated with knowledge levels. Stigma related to cervical cancer was reported among 40.8% of participants (n = 147 out of 360 responses). Most participants never had a pelvic exam for cervical cancer (n = 183 out of 258 responses, 70.9%) or testing for HPV (n = 198 out of 246 responses, 80.5%). Among women living with HIV-, 41.7% (n = 20 of 48 respondents) reported having received a pelvic examination for cervical cancer screening, and 18.6% (n = 8 of 43 respondents) reported having been screened for HPV. The majority identified cost (n = 166 out of 273 responses, 60.8%) and access to healthcare facilities (n = 246 out of 373 responses, 66%) as barriers to screening.</p><p><strong>Conclusion: </strong>The study highlights a low level of knowledge, understanding, and practice concerning cervical cancer screening, emphasizing the need for targeted interventions to reduce stigma and increase awareness of recommended screening intervals and risk reduction methods in Northern Uganda. Improving accessibility and affordability of screening services may also help reduce persistent structural barriers to screening.</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":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809776","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":"Clinical champions as an implementation strategy: evidence and practical considerations.","authors":"Ulfat Shaikh, John Brennan, Anuradha Pichumani, Shin Ushiro","doi":"10.1093/intqhc/mzag114","DOIUrl":"10.1093/intqhc/mzag114","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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804357","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}