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Quality improvement in health care

I-Shiang Tzeng, Su-Hsun Liu, Kuan-Fu Chen, Chin-Chieh Wu, Jih-Chang Chen
To reduce patient boarding time at the emergency department (ED) and to improve the overall quality of the emergent care system in Taiwan, the Minister of Health and Welfare of Taiwan (MOHW) piloted the Grading Responsible Hospitals for Acute Care (GRHAC) audit program in 2007-2009.The aim of the study was to evaluate the impact of the GRHAC audit program on the identification and management of acute myocardial infarction (AMI)-associated ED visits by describing and comparing the incidence of AMI-associated ED visits before (2003-2007), during (2007-2009), and after (2009-2012) the initial audit program implementation...
October 2016: Medicine (Baltimore)
Francesca Taylor, Jennifer Hare, Gill Combes
BACKGROUND: Many patients with end-stage kidney disease (ESKD) have significant psychosocial needs as a consequence of their illness and treatment. Unmet needs can impact negatively on their health and well-being. Patients want improved psychosocial support particularly in relation to coping and adjustment. Little is known about the relevance and applicability to patients of intervention approaches to support their psychosocial needs. OBJECTIVES: To explore patients' attitudes to different intervention approaches that could be developed to help them cope with the psychosocial stressors of ESKD, and to assess the potential acceptability of these approaches...
October 18, 2016: Journal of Renal Care
Chris S Ivanoff, Krassimira Yaneva, Diana Luan, Bogomil Andonov, Reena R Kumar, Anirudha Agnihotry, Athena E Ivanoff, Dimitrios Emmanouil, Luiz Evaristo Ricci Volpato, Filip Koneski, Ilijana Muratovska, Huda A Al-Shehri, Sara M Al-Taweel, Michele Daly
BACKGROUND: Training culturally competent graduates who can practice effectively in a multicultural environment is a goal of contemporary dental education. The Global Oral Health Initiative is a network of dental schools seeking to promote global dentistry as a component of cultural competency training. OBJECTIVE: Before initiating international student exchanges, a survey was conducted to assess students' awareness of global dentistry and interest in cross-national clerkships...
October 18, 2016: International Dental Journal
Arturo Vargas Bustamante, Ana Martinez, Xiao Chen, Hector P Rodriguez
We examine whether workplace climate-quality of staff relationships (QSR) and manageable clinic workload (MCW) are related to better patient care experiences and diabetes care in community health centers (CHCs) catering to Latino and Chinese patients. Patient experience surveys of adult patients with type 2 diabetes and workplace climate surveys of clinicians and staff from CHCs were included in an analytic sample. Comparisons of means analyses examine patient and provider characteristics. The associations of QSR, MCW and the diabetes care management were examined using regression analyses...
October 17, 2016: Journal of Community Health
Zahra Rafii, Fazlollah Ahmadi, Sayed Mohamad Kazem Nourbakhsh, Ebrahim Hajizadeh
Introduction: Medical advances have improved life expectancy and survival of patients with thalassemia. However, as getting older, patients with thalassemia experience different complications which impair their quality of life. The aim of this study was to examine the effects of a nurse-implemented orientation program on quality of life in patients with thalassemia. Methods: A convenience sample of 55 patients with thalassemia were recruited in this quasi-experimental study. Patients were randomly allocated to control or experimental groups...
September 2016: Journal of Caring Sciences
Sezai Özkan, Jos J Mellema, Adam Nazzal, Sang-Gil Lee, David Ring
PURPOSE: Information gathering is a key component of shared decision making and has a measurable effect on treatment decisions. Access to health information might improve quality of care in hand surgery. Our purpose was to identify socio-demographic, condition-related, and psychosocial factors associated with online information-seeking behavior in patients with hand and upper-extremity conditions. METHODS: From June 2015 to February 2016, we enrolled 134 patients with an upper-extremity condition who presented to an outpatient hand surgery office at an urban level I trauma center in this cross-sectional study...
October 14, 2016: Journal of Hand Surgery
David M Levine, Jeffrey A Linder, Bruce E Landon
Importance: Widespread deficits in the quality of US health care were described over a decade ago. Since then, local, regional, and national efforts have sought to improve quality and patient experience, but there is incomplete information about whether such efforts have been successful. Objective: To measure changes in outpatient quality and patient experience in the United States from 2002 to 2013. Design, Setting, and Participants: We analyzed temporal trends from 2002 to 2013 using quality measures constructed from the Medical Expenditure Panel Survey (MEPS), a nationally representative annual survey of the US population that collects data from individual respondents as well as respondents' clinicians, hospitals, pharmacies, and employers...
October 17, 2016: JAMA Internal Medicine
Jay A Harolds
Mainly due to the positive effect on quality and safety from the Veterans Health Administration National Surgical Quality Improvement Program (VASQIP), a National Surgical Quality Improvement Program (NSQIP) for private hospitals was begun, which is now under the auspices of the American College of Surgeons (ACS). More than 600 hospitals now participate in the ACS-NSQIP. The information gained by the institutions is typically utilized to initiate quality improvement activities. The ACS-NSQIP also shares information on how to get better results, has national meetings, and provides other support...
October 5, 2016: Clinical Nuclear Medicine
Renée J Roberts, Ashley E Wilson, Zenaide Quezado
Six Sigma and Lean methodologies are effective quality improvement tools in many health care settings. We applied the DMAIC methodology (define, measure, analyze, improve, control) to address deficiencies in our pediatric anesthesia supply chain. We defined supply chain problems by mapping existing processes and soliciting comments from those involved. We used daily distance walked by anesthesia technicians and number of callouts for missing supplies as measurements that we analyzed before and after implementing improvements (anesthesia cart redesign)...
October 3, 2016: Anesthesia and Analgesia
Paul E Farmer, Joseph J Rhatigan
Shortages of trained health care workers plague low- and middle-income countries around the world. When resources are scarce, the ability to support medical education is severely constrained. While there are many important "building blocks" of health systems that need to be bolstered in low- and middle-income countries, the authors propose that U.S. academic medicine can make unique contributions in the realm of human resource development-specifically, increasing the supply of physicians who directly provide health care to the populations they serve and who often manage and lead these health systems...
October 4, 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Michael Trujillo, Paul B Perrin, Karoline Doser, Anne Norup
Objective: No studies have examined the impact of personality traits on mental health among caregivers of individuals with severe brain injury. Therefore, the purpose of the current study was to construct linear growth models to examine whether the personality traits of family members of individuals with severe brain injury could predict the trajectories of their own mental health-related quality of life (HRQoL), anxiety, and depression beginning in a neurointensive care unit through 1 year after injury. Method: Danish family members of individuals with severe brain injury (n = 52) completed the Short Form-36 assessing mental HRQoL (vitality, social functioning, role limitations-emotional, mental health), anxiety, and depression across 5 time points during the 1st year after injury...
October 17, 2016: Rehabilitation Psychology
Orion Mowbray, Tiffany Washington, Greg Purser, Jay O'Shields
OBJECTIVES: To examine the intersection of depression and alcohol use among older adults with multiple chronic health conditions (MCCs). DESIGN: Wave 1 data from the National Social Life, Health and Aging Project (2005-06). SETTING: Community-based sampling throughout the United States. PARTICIPANTS: Individuals aged 57 to 85 who identified as active alcohol consumers (N = 1,643). MEASUREMENTS: Participants reported whether they currently had MCCs, problem drinking (defined as affirming two or more of the four CAGE screening questions), symptoms associated with depression, and other social and health measures...
October 17, 2016: Journal of the American Geriatrics Society
Sairam Parthasarathy, Mary A Carskadon, Girardin Jean-Louis, Judith Owens, Adam Bramoweth, Daniel Combs, Lauren Hale, Elizabeth Harrison, Chantelle N Hart, Brant P Hasler, Sarah M Honaker, Elisabeth Hertenstein, Samuel Kuna, Clete Kushida, Jessica C Levenson, Caitlin Murray, Allan I Pack, Vivek Pillai, Kristi Pruiksma, Azizi Seixas, Patrick Strollo, Saurabh S Thosar, Natasha Williams, Daniel Buysse
A wealth of scientific knowledge is being generated in sleep and circadian science. In order for us to realize the return on investment for such scientific knowledge and to improve the health of the nation, we need to disseminate and implement research findings into practice. An implementation gap - termed a "quality chasm" by the Institutes of Medicine - separates the scientific knowledge we possess and the implementation of such knowledge into preventative interventions or healthcare treatments. It is frequently reported that a time lag of 17 years transpires before medical research reaches clinical practice...
October 10, 2016: Sleep
Arthur Kavanaugh, Philip Helliwell, Christopher T Ritchlin
INTRODUCTION: Psoriatic arthritis (PsA) is underdiagnosed and has a substantial impact on quality of life, disability, and work productivity. The population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey examined the impact of PsA on patients' activities of daily living and unmet treatment needs. METHODS: This large-scale, random digit dialing, telephone survey of patients self-reporting a diagnosis of psoriasis and/or PsA was conducted in North America and Europe...
June 2016: Rheumatol Ther
Marina Amaral de Ávila de Machado, Alessandra Maciel Almeida, Adriana Maria Kakehasi, Francisco de Assis Acurcio
INTRODUCTION: In Brazil, patients with ankylosing spondylitis (AS) have access to free-of-charge comprehensive therapeutic care through the Brazilian National Health System. We collected prospective data on patients with AS receiving anti-tumor necrosis factor (anti-TNF) therapy through the Brazilian National Health System in Belo Horizonte City in order to evaluate the effectiveness, quality-of-life outcomes and safety of this therapy. METHODS: This was a prospective study that included 87 patients receiving their first course of anti-TNF agents (adalimumab, etanercept or infliximab)...
June 2016: Rheumatol Ther
Craig S Rosen, Kathryn J Azevedo, Quyen Q Tiet, Carolyn J Greene, Amanda E Wood, Patrick Calhoun, Thomas Bowe, Bruce P Capehart, Eric F Crawford, Mark A Greenbaum, Alex H S Harris, Michael Hertzberg, Steven E Lindley, Brandy N Smith, Paula P Schnurr
OBJECTIVE: This study assessed whether adding telephone care management to usual outpatient mental health care improved treatment attendance, medication compliance, and clinical outcomes of veterans with posttraumatic stress disorder (PTSD). METHODS: In a multisite randomized controlled trial, 358 veterans were assigned to either usual outpatient mental health treatment (N=165) or usual care plus twice-a-month telephone care management (TCM) and support in the first three months of treatment (N=193)...
October 17, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
Philip Kemp, Moorene Gilding, Khooseal Seewooruttun, Hannah Walsh
Background With a rise in the number of unqualified staff providing health and social care, and reports raising concerns about the quality of care provided, there is a need to address the learning needs of clinical support workers. This article describes a qualitative evaluation of a service improvement project that involved a work-based learning approach for clinical support workers on mental health inpatient wards. Aim To investigate and identify insights in relation to the content and process of learning using a work-based learning approach for clinical support workers...
September 14, 2016: Nursing Standard
Natalie K Bradford, Liam J Caffery, Anthony C Smith
INTRODUCTION: With the escalating costs of health care, issues with recruitment and retention of health practitioners in rural areas, and poor economies of scale, the question of delivering people to services or services to people is a dilemma for health authorities around the world. People living in rural areas have poorer health outcomes compared to their urban counterparts, and the problem of how to provide health care and deliver services in rural locations is an ongoing challenge...
October 2016: Rural and Remote Health
Brett K Beaulieu-Jones, Casey S Greene
Patient interactions with health care providers result in entries to electronic health records (EHRs). EHRs were built for clinical and billing purposes but contain many data points about an individual. Mining these records provides opportunities to extract electronic phenotypes, which can be paired with genetic data to identify genes underlying common human diseases. This task remains challenging: high quality phenotyping is costly and requires physician review; many fields in the records are sparsely filled; and our definitions of diseases are continuing to improve over time...
October 12, 2016: Journal of Biomedical Informatics
Mina S Makary, Summit H Shah, Shantanu Warhadpande, Ivan G Vargas, James Sarbinoff, Joshua D Dowell
PURPOSE: The association of retrievable inferior vena cava filters (IVCFs) with adverse events has led to increased interest in prompt retrieval, particularly in younger patients given the progressive nature of these complications over time. This study takes a design-of-experiments (DOE) approach to investigate methods to best improve filter retrieval rates, with a particular focus on younger (<60 years) patients. METHODS: A DOE approach was executed in which combinations of variables were tested to best improve retrieval rates...
October 12, 2016: Journal of the American College of Radiology: JACR
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