Quality Of Care Indicators Research Articles

Recovery time and its predictors of severe acute malnutrition among under five children admitted at the therapeutic feeding center of Hiwot Fana comprehensive specialized hospital, eastern Ethiopia, 2024: a semi-parametric model

BackgroundEarly recovery is a performance indicator of quality care for children under five admitted due to severe acute malnutrition (SAM) at therapeutic feeding centers. Despite the available interventions to tackle such nutritional problems, there is limited information on the time to recovery and its predictors among children with severe acute malnutrition in Ethiopia, more particularly in the study setting.ObjectiveThe study aimed to assess the time to recovery from severe acute malnutrition and its predictors among children aged 6–59 months admitted to the therapeutic feeding center (TFC) of Hiwot Fana Comprehensive Specialized Hospital (HFCSH), eastern Ethiopia, from 1st September 2019 to 1st March 012024.MethodsA retrospective cohort study was conducted at the therapeutic feeding center of HFCSH among a randomly selected sample of 349 patients with severe acute malnutrition who were undergoing therapeutic feeding. Data were collected using a data abstraction tool and then stored in Epi-data version 4.6 and STATA version 17.0 statistical software. Descriptive statistics, Kaplan–Meier (KM) plots, median survival times, the log-rank test, and the Cox proportional hazards regression model were used to report the findings of this study. After performing the Cox proportional hazards regression, the model goodness of fit and assumptions were checked. Finally, the association between independent variables and the time to recovery in days was assessed using the multivariable Cox proportional hazards model, and the variables with a p-value <0.05 were considered statistically significant.ResultsThe median survival time to recovery among the patients with severe acute malnutrition was 17 days [95% confidence interval (CI): 16–18]. The incidence density recovery rate was 5.7 (95%CI, 4.9–6.6) per 100 person-days of observation. Factors that affected the time to recovery included residing in rural areas [adjusted hazard ratio (AHR) = 2.072; 95%CI = 1.336–3.215], being vaccinated according to age (AHR = 1.848; 95%CI = 1.162–2.939), and lack of analgesic administration (AHR = 0.685; 95%CI = 0.472–0.995).ConclusionThe median survival time to recovery in this study was found to be optimal. Residency, vaccination status of the child, and analgesic administration were the determinant factors. Paying attention to vaccination coverage, fever management, and pain management as part of the protocol helps reduce the length of hospital stay by facilitating recovery rates among severely malnourished children under five in Ethiopia.

Using patient-reported experiences to inform the use of foam dressings for hard-to-heal wounds: perspectives from a wound care expert panel.

Caring for patients with hard-to-heal (chronic) wounds requires a multifaceted approach that addresses their diverse needs, which can contribute to the complexity of care. Wound care providers must have a comprehensive understanding of the patient's comorbid conditions and psychosocial issues to provide personalised and effective treatment. Key quality indicators for effective wound care involves not only selecting appropriate local wound care products, such as foam dressings, but also addressing individual patient experiences of wound-related pain, odour, itch, excessive wound drainage, and self-care needs. The purpose of this review is to inculcate the wound care practice community, research scientists and healthcare industry with a sense of accountability in order to work collaboratively in addressing these unmet care needs.

Stereotactic radiotherapy for patients with bone metastases: a selected group with low rate of radiation treatment during the last month of life?

BackgroundComplex high-precision radiotherapy, such as stereotactic body radiotherapy (SBRT), should only be offered to patients with sufficiently long survival. In the context of bone metastases radiotherapy, low rates of treatment close to the end of life, e.g. last 30 days (RT30), may serve as a quality of care indicator. While traditional, pain-relieving short-course regimens have been studied comprehensively, real-world SBRT results are still limited.MethodsRetrospective analysis (2010–2023, n = 1117 episodes) of patients with bone metastases treated with traditional single-fraction (8 Gy × 1) or multi-fraction regimens (often 4 Gy × 5 or 3 Gy × 10) compared to stereotactic single-fraction (12–16 Gy × 1) or multi-fraction regimens.ResultsExcept for gender, almost all baseline variables were uneven distributed. Failure to complete fractionated radiotherapy was uncommon in the stereotactic (4%) and non-stereotactic group (3%), p = 1.0. With regard to RT30, relevant differences emerged (19% for 8-Gy single-fraction versus 0% for stereotactic single-fraction, p = 0.01). The corresponding figures were 11% for multi-fraction non-stereotactic and 2% for multi-fraction stereotactic, p = 0.08. Median overall survival was shortest after 8-Gy single-fraction irradiation (4.2 months) and longest after stereotactic multi-fraction treatment (13.9 months). Neither stereotactic radiotherapy nor multi-fraction treatment improved survival in multivariate Cox regression analysis. Factors significantly associated with longer survival included better performance status, lower LabBM score (5 standard blood test results), stable disease outside of irradiated area(s), metachronous distant metastases, longer time interval from metastatic disease to bone irradiation, and outpatient status.ConclusionThe implementation of SBRT for selected patients has resulted in low rates of non-completion and RT30. Optimal selection criteria remain to be determined, but in current clinical practice we exclude patients with poor performance status, unfavorable blood test results (high LabBM score) and progressive disease sites not amenable to SBRT. Established, guideline-endorsed short-course regimens, especially 8-Gy single-fraction treatment, continue to represent an important palliative approach.

Nurse-led framework to improve the safety and quality of residential aged care (HIRAID® Aged Care): protocol for a stepped-wedge cluster randomised controlled trial

BackgroundThe health issues experienced by older people can often be severe and complex, and an increasing number are using residential aged care services to meet their care needs. High-quality nursing care is fundamental to the health and safety of aged care residents and is contingent on nurses’ accurate assessment, informed decision-making, and delivery of timely interventions. However, the role of the aged care nurse is often challenging, impeded by factors such as understaffing, high workloads, and a lack of access to clinical infrastructure and resources. When these challenges mount, residents are put at greater risk of adverse outcomes, such as avoidable clinical deterioration and hospital transfers. This study describes the adaptation and implementation of the emergency nursing framework, HIRAID® (History including Infection risk, Red Flags, Assessment, Interventions, Diagnostics, reassessment, communication and plan)—a tool to assist nurses’ assessment, decision-making and care in residential aged care.MethodsThe HIRAID® framework will be adapted for residential aged care using a real-time Delphi and panel of aged care and nursing experts. The co-designed HIRAID® Aged Care framework will be trialled in 23 residential aged care homes in Sydney, Australia, in a modified stepped-wedge cluster randomised controlled trial design. All homes will be randomised into one of four clusters. Outcomes of interest include the rate of clinical deterioration events resulting from nurses’ actions, the rate of hospital transfers determined to be inappropriate, performance against the national mandatory aged care quality indicators, resident satisfaction with care, nurse and medical staff satisfaction with communication, and the quality of nursing documentation. These outcomes will be evaluated using a combination of qualitative and quantitative analysis of routinely collected resident data, expert assessments of facility documentation events against validated criteria, and pre- and post-intervention surveys of residents, family carers, nurses, and medical staff.DiscussionThis protocol describes a pragmatic trial that aims to translate an evidence-based framework from the emergency care context into residential aged care. The adapted HIRAID® Aged Care framework will be the first of its kind to standardise and guide holistic nursing assessment, decision-making, and documentation in residential aged care in Australia.Ethics and disseminationThis research has been approved by the Western Sydney Local Health District Human Research Ethics Committee: 2023/ETH00523. A waiver of consent has been approved to access resident health data and nursing documentation at each participating site.Trial registrationAustralian and New Zealand Clinical Trial Registry, ACTRN12623000481673. Registered 12 May 2023.Protocol versionVersion 1.0 6 February 2024.

Evaluation of the Interdisciplinary Care Home-bAsed Reablement Program (I-CHARP) for People Living With Cognitive Impairment and Dementia in Care Homes.

Major knowledge and practice gaps exist in aged care home services to support independence of older people with dementia. This research evaluates an adaptation of a community-based rehabilitation model for care homes, namely Interdisciplinary Care Home-bAsed Reablement Program (I-CHARP), by examining whether (and, if so, how) I-CHARP produces its intended effects and how this programme can be practicably implemented, sustained and scaled up across care homes in Australia. I-CHARP is a 4-month bio-behavioural-environmental rehabilitation model of care, integrated in care home services, supported through the deployment of an implementation strategy, the Research Enabled Aged Care Homes (REACH) network. It consists of (1) 8-12 full individual sessions and additional eight brief follow-ups per resident, tailored to the resident's needs, delivered primarily by a team of an occupational therapist, registered nurse and other allied health staff; (2) environmental modifications/assistive devices up to the value of $400 per resident; and (3) engagement of intervention care home staff, managers and regular visitors. An overarching evaluation approach is participatory action research using a cluster quasi-experimental design and mixed methods. It involves testing of the implementation strategy (REACH network and other approaches) while observing/gathering information on the intervention (I-CHARP) and related outcomes in three cycles. Participants include residents (aged ≥ 60 years with early stages of dementia) and care staff from 16 care homes. Care quality indicators, health care costs, field notes and semi-structured interviews/focus groups with intervention site staff, regular visitors and managers will provide further insights into I-CHARP processes and implementation issues. In the final phase of the project, an Agile Implementation Playbook will be developed for the delivery of reablement care that can be used in routine practice across care homes in Australia. The study findings will also inform future policy development and strategic directions for dementia care in care homes. Australian New Zealand Clinical Trial Registry, ACTRN12623000885695 Registered 16 August 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386088. 1.0 dated 20 July 2023.

Quality indicators of long-term care for older people in OECD countries; a rapid scoping review

Abstract Background The COVID-19 pandemic has exposed the vulnerability of older people living in long-term care facilities (LTCF), highlighting the urgent need for research on the quality of care for this group of the population. There is no universal definition for quality of care in LTCF, and yet, multiple tools and indicators have been developed to measure it. In this rapid scoping review, we aim to provide a comprehensive overview of the current knowledge on quality of care concepts and indicators for older people in LTCF in OECD countries. Methods This review follows the World Health Organization (WHO) guide for rapid reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) extension for scoping reviews, including protocol registration (https://doi.org/10.17605/OSF.IO/34B2S). The electronic bibliographic databases MEDLINE (PubMed), EMBASE, and CINAHL were searched in September 2023 for studies published between 2013 and 2023 for quality indicators in LTCF. Experts in quality of care in LTCF were contacted and consulted to retrieve sources of grey literature. Information on the definition or framework of quality of care, quality of care dimensions, measurement instruments, context and purpose of the measurement will be extracted. Results Of the 8,516 identified records, 6,449 were screened by title and abstract after removing duplicates. A total of 469 publications will be screened in full-text. Experts recommended 40 websites to be screened for quality indicators. The PRISMA flowchart diagram will be provided to describe the selection process. Conclusions This review aims to improve the quality of care for older people living in LTCF. Our results will identify which concepts and dimensions of care are currently being measured in OECD countries, whether they are backed by any definition and scientific framework of quality of care for older residents of LTCF, and whether there is consideration of closing gaps in quality measurement. Key messages • Quality of care is an understudied field in the context of long-term care facilities for older people. • In order to further improve quality in long-term care for older people, it is necessary to systematically review the current state of knowledge on quality concepts and indicators.

Multidisciplinary protocol to reduce surgical readmissions in Australia: American College of Surgeons National Surgical Quality Improvement Program.

Unplanned readmissions in general surgery are an important quality indicator of patient care and are associated with increased costs to healthcare services. This study aims to implement a multidisciplinary protocol in a single institution in a tertiary referral hospital to monitor and reduce unplanned readmission rates. A prospective cohort study using an institution-based protocol was conducted over an 18-month period including patients undergoing a general surgical procedure. The protocol included: (i) implementation of a surgical readmissions nurse-patient liaison; (ii) access to a surgical walk-in clinic; and (iii) early post-discharge phone contact. Data included demographic details, index procedure, hospital length of stay (LOS), and whether contact between patient/nurse occurred upon discharge. The primary outcome was the cause and rate of 30-day readmissions. Secondary outcomes were mortality, use of surgical clinic, emergency department presentations, and complications. After protocol implementation, 874 patients underwent a general surgical procedure, with 354 (49%) being male and an overall median age of 53.0 years (interquartile range: 36.0-67.0). The overall readmission rate was 5.6% (n = 49), with a median LOS after readmission of 4 days. Compared with historical pre-protocol ACS-NSQIP data, this reflects a 30% reduction compared to that of readmission rate of 7.9%, P = 0.03. The multidisciplinary protocol was efficacious in significantly reducing unplanned readmissions. Continued audits and monitoring of factors associated with readmissions are required to help design targeted projects that may lead to improved outcomes, lower costs, increased patient satisfaction, and better efficiency within our healthcare system.

The maternity dashboard is an effective tool for the improvement of maternal and neonatal care outcomes: a prospective observational study from Iraq

Background: The implementation of maternal dashboards in hospitals is both feasible and effective in improving healthcare quality. The dashboards provide rapid feedback on local outcomes in an accessible format and enable early detection of potential problems. They serve as a simple computerized tool that graphically presents the health facility’s clinical data, utilizing a traffic-light coding system so as to alert front-line staff about changes in the frequency of clinical outcomes. Aim: The aim of this study was to assess the effectiveness of the maternity dashboard in improving maternal health, reducing Neonatal Intensive Care Unit (NICU) admissions, as well as enhancing maternal and neonatal outcomes in an Iraqi hospital. Methodology: Data were collected over one year, from January 1st to December 30th, 2023. A prospective observational study (hospital-based record review) was conducted at the Obstetrics and Gynaecology Teaching Hospital in Kerbala, Iraq. Data were obtained from the medical records of all patients admitted to the obstetrical ward for labor, delivery, and the postpartum period during 2023. The maternal dashboard, a traffic light program (green, amber, red), was used in order to monitor outcomes. Data were collected manually from the outpatient department, the labor ward, the NICU registers, and the electronic records by using Excel. Results: A total of 136,519 women (who were either pregnant, in labor, or postpartum for up to 42 days) were admitted to the Obstetrics and Gynaecology Teaching Hospital in Kerbala during the study period, with 18,791 of them delivering. The implementation of the maternity dashboard resulted in significant changes: the normal vaginal delivery rate increased from 66% to 68% (p=0.0024), the caesarean section rate decreased from 33% to 31% (p=0.0001), the stillbirth monthly cases declined from 16±5 to 12±3 (p<0.05), the NICU admission monthly instances decreased from 96±14 to 71±17 (p<0.05), and early neonatal death monthly cases were reduced from 12±5 to 9±3 (p<0.05). Conclusion: The study results show that maternity dashboards are vital instruments for monitoring and improving the quality of maternity care. They effectively enhance maternal and neonatal care quality indicators when comparing results before and after their implementation.

On the issue of the effectiveness of the civil law method in the regulation of health protection relations

The subject of the study is the rights of citizens to health protection, as well as the possibility of their transformation in the direction of strengthening the legal nature of these relations. In the context of the dominance of the sectoral approach in law, the author develops ideas about subjective law as an effective regulator of patient behavior. The opinion is expressed that the responsibility of the subject's independent choice can give a new impetus to improving the level of quality indicators of medical care, ensuring the timeliness, qualification and comprehensiveness of examinations. An attempt has been made to shift the focus in the process of streamlining relations from the subject of legal regulation to methods. New opportunities have been identified to increase the level of the legal nature of court decisions that can take into account the objective need to expand the scope of private law (civil) ways of influencing the patient on the medical process. The dialectical method has become the main research method. The conditions for improving medical care are revealed, taking into account the differences between public law and civil law regulatory methods in solving problems of law enforcement practice. The scientific novelty is that the examples of legal practice have provided new knowledge necessary for the development of existing doctrinal approaches in legal science. The limitations of the sectoral approach in law, due to the high degree of dynamism of society, are convincingly argued. It has been established that orientation to the subject of legal regulation, as an unconditionally dominant factor in choosing a strategy and tactics for streamlining relations, does not always ensure the completeness of the legal nature of judicial acts. The emphasis of legal regulation in health protection is focused on the priority use of public law (or "organizing") methods that guarantee the mass provision of medical care designed for everyone. The possibility of providing quality indicators of care to a specific patient with special health characteristics and conditions for receiving it is still secondary. It is necessary to actively apply civil law methods of protecting the right to health protection, while skillfully using the resource potential of the law.

Exploring Recidivism in Cardiac Surgical ICU: Can this Understanding Translate to Enhanced Patient Outcomes?

The need for reinstitution of intensive care unit (ICU) care ("recidivism") in post-cardiac surgery patients is associated with increased morbidity, mortality, resource use, and healthcare costs. Recidivism is propounded as a quality indicator of ICU care. There is a paucity of studies from India regarding cardiac surgical ICU readmissions, their outcomes, and risk factors. Nested case-control study including 1,711 consecutive adult patients who underwent cardiac surgery over a two-year period at a tertiary care institute. The patients were grouped into recidival (R) and control (C) groups. The reasons for readmission, outcomes, and predictive risk factors were analyzed. Fifty-four of 1,711 (3.1%) patients were readmitted to ICU, main reasons being cardiac arrhythmias (24, 41%), pericardial effusion (9, 15.2%), and infection (8, 13.5%). Readmission was significantly higher for valvular interventions (39 patients, 24.3%, mitral valve 25 patients) than coronary artery bypass grafting (13, 10.6%), P value 0.003*. On multivariate analysis, EuroSCORE 2 (>5), age, surgical reexploration, postoperative pulmonary complications, and infections were independently associated with a need for ICU readmission. The mortality rate among the readmitted patients was 7.4% compared to 1.4% overall mortality. The mean total postoperative length of stay was significantly longer for recidival patients (17.6 ± 14 days vs 7.6 ± 2.4 days; P < 0.0001). Recidivism is associated with longer hospital stay, suboptimal outcomes as well higher risk of mortality. Postoperative cardiac dysrhythmia was the most common cause of recidivism in our cohort. Early identification of patients at risk for recidivism and timely management of cardiopulmonary complications can translate to better outcomes.

Enhancing readmission prediction models by integrating insights from home healthcare notes: Retrospective cohort study

BackgroundHospital readmission is an important indicator of inpatient care quality and a significant driver of increasing medical costs. Therefore, it is important to explore the effects of postdischarge information, particularly from home healthcare notes, on enhancing readmission prediction models. Despite the use of natural language processing (NLP) and machine learning in prediction model development, current studies often overlook insights from home healthcare notes. ObjectiveThis study aimed to develop prediction models for 30-day readmissions using home healthcare notes and structured data. In addition, it explored the development of 14- and 180-day prediction models using variables in the 30-day model. DesignA retrospective observational cohort study. Setting(s)This study was conducted at Ajou University School of Medicine in South Korea. ParticipantsData from electronic health records, encompassing demographic characteristics of 1819 participants, along with information on conditions, drug, and home healthcare, were utilized. MethodsTwo distinct models were developed for each prediction window (30-, 14-, 180-day): the traditional model, which utilized structured variables alone, and the common data model (CDM)-NLP model, which incorporated structured and topic variables extracted from home healthcare notes. BERTopic facilitated topic generation and risk probability, representing the likelihood of documents being assigned to specific topics. Feature selection involved experimenting with various algorithms. The best-performing algorithm, determined using the area under the receiver operating characteristic curve (AUROC), was used for model development. Model performance was assessed using various learning metrics including AUROC. ResultsAmong 1819 patients, 251 (13.80 %) experienced 30-day readmission. The least absolute shrinkage and selection operator was used for feature extraction and model development. The 15 structured features were used in the traditional model. Moreover, five additional topic variables from the home healthcare notes were applied in the CDM-NLP model. The AUROC of the traditional model was 0.739 (95 % CI: 0.672–0.807). The AUROC of the CDM-NLP model was high at 0.824 (95 % CI: 0.768–0.880), which indicated an outstanding performance. The topics in the CDM-NLP model included emotional distress, daily living functions, nutrition, postoperative status, and cardiorespiratory issues. In extended prediction model development for 14- and 180-day readmissions, the CDM-NLP consistently outperformed the traditional model. ConclusionsThis study developed effective prediction models using both structured and unstructured data, thereby emphasizing the significance of postdischarge information from home healthcare notes in readmission prediction.

Adherence to clinical care standards and mortality after hip fracture surgery in New South Wales, 2015-2018: a retrospective population-based study.

To determine whether adherence to hip fracture clinical care quality indicators influences mortality among people who undergo surgery after hip fracture in New South Wales, both overall and by individual indicator. Retrospective population-based study; analysis of linked Australian and New Zealand Hip Fracture Registry (ANZHFR), hospital admissions, residential aged care, and deaths data. People aged 50 years or older with hip fractures who underwent surgery in 21 New South Wales hospitals participating in the ANZHFR, 1 January 2015 - 31 December 2018. Thirty-day (primary outcome), 120-day, and 365-day mortality (secondary outcomes) by clinical care indicator adherence level (low: none to three of six indicators achieved; moderate: four indicators achieved; high: five or six indicators achieved) and by individual indicator. Registry data were available for 9236 hip fractures in 9058 people aged 50 years or older during 2015-2018; the mean age of patients was 82.8 years (standard deviation, 9.3 years), 5510 patients were women (69.4%). Complete data regarding adherence to clinical care indicators were available for 7951 fractures (86.1%); adherence to these indicators was high for 5135 (64.6%), moderate for 2249 (28.3%), and low for 567 fractures (7.1%). After adjustment for age, sex, comorbidity, admission year, pre-admission walking ability, and residential status, 30-day mortality risk was lower for high (adjusted relative risk [aRR], 0.40; 95% confidence interval [CI], 0.30-0.52) and moderate indicator adherence hip fractures (aRR, 0.61; 95% CI, 0.46-0.82) than for low indicator adherence hip fractures, as was 365-day mortality (high adherence: aRR, 0.59 [95% CI, 0.51-0.68]; moderate adherence: aRR, 0.74 [95% CI, 0.63-0.86]). Orthogeriatric care (365 days: aRR, 0.78; 95% CI, 0.61-0.98) and offering mobilisation by the day after surgery (365 days: aRR, 0.74; 95% CI, 0.67-0.83) were associated with lower mortality risk at each time point. Clinical care for two-thirds of hip fractures attained a high level of adherence to the six quality care indicators, and short and longer term mortality was lower among people who received such care than among those who received low adherence care.

Impact of in situ simulation training on quality of postnatal stabilization and resuscitation—a before-and-after, non-controlled quality improvement study

This study aimed to evaluate the impact of in situ simulation-based training on quality indicators of patient care at a level IV neonatal intensive care unit. A before-and-after, non-controlled quality improvement study was performed at the Division of Neonatology, Medical University of Graz. The educational intervention comprised a period of 4 months, with structured in situ simulation training delivered regularly for neonatal providers and nurses in interprofessional teams. The primary study outcome was the quality of non-technical skills and team interaction during actual postnatal stabilization and resuscitation. This was assessed using video recording during two 2-month observational phases before (pre-training) and after the educational intervention (post-training). Delivery room video recordings were assessed by two external, blinded neonatologists using the Anaesthetists’ Non-Technical Skills (ANTS) score. Furthermore, we collected clinical patient data from video-recorded neonates during the pre- and post-training periods, and training participants’ individual knowledge of neonatal resuscitation guidelines was assessed using a before- and after-questionnaire. A total of 48 healthcare professionals participated in 41 in situ simulation trainings. The level of non-technical skills and team interaction was already high in the pre-training period, and it did not further improve afterwards. Nonetheless, we observed a significant increase in the teamwork event “evaluation of plans” (0.5 [IQR 0.0–1.0] versus 1.0 [1.0–2.0], p = 0.049). Following the educational intervention, training participants’ knowledge of neonatal resuscitation guidelines significantly improved, although there were no differences in secondary clinical outcome parameters.Conclusion: We have successfully implemented a neonatal in situ simulation training programme. The observed improvement in one teamwork event category in the post-training period demonstrates the effectiveness of the training curriculum, while also showing the potential of in situ simulation training for improving postnatal care and, ultimately, patient outcome. What is Known:• In situ simulation-based training is conducted in the real healthcare environment, thus promoting experiential learning which is closely aligned with providers’ actual work.• In situ simulation-based training may offer an additional benefit for patient outcomes in comparison to other instructional methodologies.What is New:• This observational study investigated translational patient outcomes in preterm neonates before and after delivery of high-frequency in situ simulation-based training at a level IV neonatal intensive care unit.• There was a significant increase in the frequency of one major teamwork event following the delivery of in situ simulation-based training, indicating a notable improvement in the non-technical skills domain, which is closely linked to actual team performance.

Construction of sensitive quality indicators for rapid rehabilitation care of patients after combined pancreaticoduodenectomy

AimTo construct evidence-based sensitive quality indicators for patients’ rapid rehabilitation care after combined pancreaticoduodenectomy (PD) and to provide a reference for clinical nursing professionals to scientifically evaluate the quality of patients’ rehabilitation post-PD.BackgroundSince PD is associated with higher surgical risk and anastomotic complications, it leads to higher complication rates and longer postoperative recovery cycles. This reiterates the need for rapid recovery of patients after PD; however, the evaluation of sensitive nursing care indicators regarding rapid recovery post-PD has not yet been established to date.MethodsBased on the Donabedian structure-process-result theory model, we used available literature, semi-structured interviews, the Delphi method, and hierarchical analysis to establish a sensitive indicator system for patients’ rapid rehabilitation after PD and evaluate the importance of such indicators.ResultsThere were two rounds of expert correspondence, and the effective recovery rate of the questionnaires of these rounds was 100%. The expert authority coefficients, as well as the Kendall coordination coefficients of the expert opinions, were 0.859 and 0.872 as well as 0.423 and 0.431, with statistically significant differences (p < 0.05), respectively. Consequently, we developed a sensitive quality index system for patients’ rapid rehabilitation care after combined PD, including 3 first-level, 12 s-level, and 23 third-level indexes, respectively.ConclusionThe constructed sensitive quality index system developed for patients’ rapid rehabilitation nursing care after combined PD is standardized, practical, and aligned with the specialty characteristics. Furthermore, this might help greatly in improving the quality and safety of patients’ rapid rehabilitation nursing care after combined PD, standardizing nursing management skills, and enhancing nursing quality.

Applying Newly Identified Financially Focused Home Care Quality and Performance Indicators In Alberta's $23.5B/annum Health System - Preliminary Findings

Through a multi-phased mixed-method research program including an international scoping review and a modified-Delphi panel with expert policy/academic/operational representatives from across Canada, three health-system, financially focused quality and performance home care indicators were identified. This presentation will provide preliminary results of the application of the three financial indicators on overall health-system measures, system utilization and population outcomes within the province of Alberta. The time-period covered is the last five years data leading up to the start of the deceleration of the covid-19 global pandemic. Based on provincial annual financial reporting, baseline 2016/17 fiscal year home care expenditures were $585K, this rose to significantly to $716M for fiscal year 2019/20, with the most significant increase (13%) occurred between the 2017/18 and 2018/19 years. Prior to 2016/17 home care expenditures increased at a rate less than 3%. These significant home care investments increased the percent of the overall expenditures in Alberta from 3.94 to 4.6%. Furthermore, the average annual expenditures per home care client rose from $5,417 to $6,112. During this same time-period, numerous health-system indicators shifted to more favorable positions, with notable decreases in acute care days prior to death, number of those waiting in hospital for LTC, and preventing/delaying the need for LTC overall. Based on comparisons of home care investments on the overall health-system and key health-system performance indicators focused on measuring system efficiencies, preliminary examinations suggest that significant home care focused investments in Alberta significantly improved health-system performance, efficiencies, and overall outcomes for the population.

Quality of care for community-dwelling older adults living with dementia in BC: an interrupted time-series analysis to examine the effect of the COVID-19 pandemic

ObjectiveQuality care for older adults living with dementia (OALwD) is a priority in Canada, nationally, and British Columbia (BC), provincially. The COVID-19 pandemic likely changed care quality, but this has not been assessed. We are examining the effect of pandemic-related policy changes on quality of care for community-dwelling OALwD in BC. ApproachThis population-based retrospective cohort study uses linked administrative data to examine trends in population-level indicators of quality care from 2016-2023. We will compare effects among community-dwelling BC residents aged 65+ with dementia and those without dementia. Indicators including hospitalization rate and medication use were selected, based on the Institute of Medicine’s six dimensions of quality (e.g., effectiveness, safety). Interrupted time series (ITS) analysis will examine changes between “pre-pandemic” and “in-pandemic” periods. Equity will be assessed through stratification by sociodemographic variables. Anticipated ResultsPercent change in the level and slope of each indicator’s trend will be reported. Single ITS will identify the effect of the pandemic on each outcome in the dementia group only. Controlled ITS will identify whether changes differ from those observed in older adults without dementia. Together, observed changes in the indicators and differences across equity factors will inform an interpretation of the overall effect of the pandemic on quality of care for community-dwelling OALwD in BC. ImplicationsWe will determine whether quality of care changed for older adults because of the pandemic and whether changes differed for OALwD. This knowledge will inform practice and policy for delivery of high quality, proactive dementia care.

Nursing outcomes and social support intervention for diabetes self-management: consensus study

Highlights Self-management of type 2 diabetes allows for better health outcomes, maintains independence, and improves quality of life for longer periods of time. Nursing interventions help professionals accurately assess the health status and outcomes of the target population while providing scientific evidence. The nursing professional is a significant source of social support in the self-management of diabetes mellitus. The outcomes achieved by patients are the most important indicators of quality in health care, allowing clarifying nursing knowledge and determining the effectiveness of care. Introduction: Diabetes mellitus is one of the most prevalent chronic noncommunicable diseases in the world. Objective: To validate by expert consensus the Nursing Outcomes Classification (NOC) self-management: diabetes (1619) and social support (1504), as well as to validate the intervention of social support for adults in the self-management of type 2 diabetes mellitus (DM2). Materials and Methods: A consensus study. Several phases were delimited for validation: the first was to validate the results and indicators; the second was to construct and validate the conceptual and operational definitions; and the magnitude of the selected indicators; and the third was to design and validate the intervention of social support for adults in the self-management of DM2. Results: 28 indicators were selected and validated by experts out of the 44 that make up the nursing outcome of self-management: diabetes, and 9 indicators out of the 12 that make up the social support outcome, both with a Content Validity Index (CVI) of 0.98. As for the intervention, a social support intervention was designed for the self-management of DM2, individualized, and made up of 4 sessions. The components of the intervention include generalities of DM2, healthy life habits, safe care, and emotional support. Discussion: Nursing professionals must evaluate people who experience diabetes, and their capacity for self-management and social support in order to provide appropriate interventions and evaluate their effectiveness. Conclusions: The study significantly evidenced the validation of the two nursing outcomes and their respective indicators, added to the conceptual and operational definitions, and their magnitude. How to cite this article: Garizábalo-Dávila Claudia Milena, Cañon-Montañez Wilson, Rodríguez-Acelas Alba Luz. Nursing Outcomes and Social Support Intervention for Diabetes Self-management: Consensus Study. Revista Cuidarte. 2024;15(3):e3742. https://doi.org/10.15649/cuidarte.3742

Level of Compliance with Spanish Guideline Recommendations in the Management of Asthma.

To describe the clinical management of asthmatic patients and the level of compliance with the Guía Española para el Manejo del Asma (GEMA, Spanish Guidelines for Asthma Management) in the influential al area of Virgen de la Victoria University Hospital, Málaga (Spain). Descriptive, cross-sectional study in asthma patients from the Virgen de la Victoria University Hospital influential area, Málaga (Spain). Asthma Control Test (ACT) results, demographic and clinical characteristics, and GEMA indicators of quality asthma care were obtained from each participating patient. Two hundred and eighty-eight patients (64.2% woman, mean age 48.6 years) were included in the study. The evaluation of the level of compliance with the GEMA quality indicators showed that in 20.8% of the patients the diagnosis of asthma was confirmed by spirometry and bronchodilator test, and 52.5% of the patients with suspicion of allergic asthma performed a sensitization test. Among the smoker patients, 76.3% were recommended to stop smoking; 14.2% of the patients received a paper-based educational plan. Regarding asthma treatment, 92.3% of patients with persistent asthma received inhaled glucocorticoids (IGC). IGC and LABA were the most common treatments for asthma, used in combination (ICG + LABA) in 139 (48.3%) patients; 32.6% discontinued SABA treatment during the study period. Asthma was well controlled in 54.9% of the patients (ACT score ≥20), and 13.9% of the patients registered exacerbations during the previous year with a mean (SD) of 1.38 (0.74) events. Most of the GEMA quality indicators of asthma care are not followed in real-world clinical practice. Specialists select the best option among the available treatments but there is an unmet need for training plans in other relevant aspects, such as diagnosis and/or disease monitoring.

Hospital Patient Satisfaction With Nursing Care in Saudi Arabia.

Introduction Patient satisfaction is a critical indicator of health care quality, yet research exploring patient satisfaction with nursing care in Saudi Arabia (SA) remains limited. This study investigated patients' satisfaction with nursing care quality during their hospitalization in SA. Material and methods A cross-sectional study was conducted using a convenience sample of 746 patients from five hospitals infive different regions of SA. Data were collected using the Newcastle Satisfaction With Nursing Scale (NSMS), which has been shown to be valid and reliable. Results The average overall patient satisfaction with nursing care was 71.16 ± 13.51 out of 95 (75.96%), indicating a high level of satisfaction with the nursing care the patients received. The highest-scoring items of patient satisfaction were the nurses' manners when carrying out their duties, the amount of privacy the nurses provided and their capability to performtheir jobs. However, the level of satisfaction regarding the frequency of nurse check-ins, time spent with patients, and support provided to patients' relatives indicated areas for potential improvement. Also, patients with primary education who were divorced or married and those admitted to the gynecology ward were more satisfied with nursing care. Conclusion This study's findings indicate that the patients were highly satisfied with the care their nurses provided, although opportunities for improvement in some areas of nursing care were identified. These findings may encourage nurses to be more attentive in meeting their patients' needs according to best nursing practices. It is recommended that hospital administrators prioritize initiatives to enhance the quality of nursing care, thereby improving overall patient satisfaction.

Reducing 30-day Acute Care Readmissions for Heart Failure Patients Through Implementation of a Discharge Bundle.

Hospital readmissions have been a long-standing problem in the American health care system. Despite many efforts, programs, papers, and interventions identified and studied, 14% of all adult admissions result in a readmission. Readmissions are mostly considered preventable and are considered an indicator of care quality for a hospital. Due to unexpected readmissions, patients are at an increased risk for illness or injury, increased stress, financial strain, and diminished quality of life. Readmissions also negatively impact hospital systems related to decreased bed availability, stretched resources, and potential financial penalties and payment reductions. Patients with an admission related to heart failure are at an increased risk of readmission, with a national readmission rate of 23%. The quality improvement project was implemented on two telemetry units at an acute care hospital. A gap analysis identified procedural and organizational reasons for readmission in the heart failure population at an acute care hospital. Using evidence-based best practice guidelines established by the American Heart Association, American College of Cardiology, and the Heart Failure Society of America, a four-pronged proactive discharge bundle was implemented using the plan-do-study-act framework for continuous improvement. All patients admitted to the telemetry units with a primary or secondary diagnosis of heart failure received the discharge planning bundle: (1) an early assessment by the case management department, (2) patient-centered specialty heart failure education, (3) predischarge medication delivery, and (4) predischarge physician follow-up appointment scheduling within 7days of discharge. A total of 133 patients were evaluated for inclusion in the heart failure cohort. Of those, 52 patients received the evidence-based intervention. The evidence-based project was implemented over 7weeks, September through October of 2023 on the medical telemetry units. Of the 52 patients receiving the evidence-based sample, two of the patients experienced a readmission due to heart failure (3.85%). Incidentally, it was found that patients without a readmission had an average of 2.3 completed interventions, while those with readmissions had an average of 1.5 interventions. Case managers are an integral part of the care transition from the acute care setting back to the community. Often, it is the case manager leading this effort through various interventions. Findings from this quality improvement project suggest the use of the evidence-based, four-pronged approach to discharge planning for the heart failure patient population reduced the risk and rate of heart failure-related readmissions for the involved nursing units. These findings also surmise that there is a correlation between the number of interventions and the rate of readmission.