Evaluation Of Health Care Quality Research Articles

Development of quality indicators to evaluate the quality of care for people with Differences of Sex Development (DSD).

Introduction Achieving evidence-based, high quality medical care is the overarching goal of healthcare quality management. Quality indicators (QI) serve as proxies to show whether good quality is reached or not. This article describes the development of QI for the evaluation of healthcare quality in the area of Differences of Sex Development (DSD). Methods Following the model of Donabedian, the aim was to develop QI to assess defined relevant aspects of the quality of structures, processes, and outcomes of care in DSD. Ten DSD clinical centres and two self-advocacy groups in Germany included in the DSDCare project were involved in the development of the QI and a benchmarking system. The development of the QI involved several structured steps: Analysis of guidelines and recommendations, literature review, qualitative interviews with key stakeholders in the field of DSD and patients or their carers. QI were discussed in a multi-stage systematic consensus process and assessed in terms of their relevance, feasibility, and practicability. Results In a multi-stage systematic consensus process involving medical and psychological experts from a range of disciplines, people with DSD and their families, and representatives of self-advocacy groups we have developed a set of 37 QI (22 structure, seven process, and eight outcome quality). The QI serve to evaluate care in the field of DSD and may add to the German criteria for certification of Centres for Rare Conditions formulated by the National Action League for People with Rare Diseases (NAMSE) in this area of expertise. Conclusion We have succeeded in developing and jointly adopting a set of quality indicators that consider a wide range of perspectives on the quality of care for people with DSD and their families. These QI have been found to be relevant, feasible and practicable and they are now used for a yearly quality benchmarking in the participating DSD centres.

Satisfaction-based patient classification: Improving the quality of healthcare services

ABSTRACT Patient satisfaction is crucial for evaluating healthcare quality. However, its potential as a patient classification strategy remains to be explored, leaving healthcare institutions without clear guidance in this regard. This study introduces a comprehensive approach for classifying health service patients based on their satisfaction levels with the aim of enhancing service quality and overall patient experience. The proposed model involved five key steps: questionnaire, data analysis, classification analysis, classification function, action and check. The analytical support for this approach was derived from factor analysis, k-means clustering, and multiple discrimination analysis. In this study, 288 valid responses were collected from medical and dental clinics in Brazil, which comprised a convenience sample. This approach identified four quality factors – interaction, physical environment, service outcome, and waiting time – and two patient groups based on satisfaction levels, highlighting service outcome and waiting time as pivotal factors in patient clustering. This study addressed the challenges of identifying target patient groups and classifying them to enhance satisfaction while maintaining the quality of healthcare services. Future studies could replicate this methodology by incorporating variables that capture client-specific organizational relationships. This will contribute to refining strategies for enhancing service quality and patient satisfaction in diverse healthcare settings.

Client satisfaction on family planning, its myths, and misconceptions among women in Wolaita zone, Southern Ethiopia: A mixed methods design

BackgroundClient satisfaction has been recognized as an essential component in evaluating healthcare quality. In Wolaita Zone, there was a lack of research on the myths, misconceptions, and elements linked to client satisfaction with family planning. This study aimed to assess the myths and misconceptions of family planning and the factors associated with women's satisfaction with family planning services. MethodsWe used a mixed methods study design (cross-sectional study design with a phenomenological design of the qualitative study). For the survey, 777 women were selected using multistage sampling, while purposive sampling was used to recruit in-depth interview participants. We used STATA version 15 and NVIVO version 12 software. ResultsOnly two-thirds, 534 (68.7 %) [95 % CI = 65.4%–71 %] clients, were satisfied with the family planning service. Clients who attended secondary education and above (AOR = 1.84; 95 % CI: 1.07, 3.23) and (AOR = 3.04; 95 % CI: 1.37, 6.72) did not wait to get the service (AOR = 5.11; 95 % CI: 1.98, 13.20), attended family planning service in a facility with convenient working hours (AOR = 4.43; 95 % CI: 2.25–8.74) and with posters in the waiting room (AOR = 3.48; 95 % CI: 1.22–9.94), comfortable with the cleanliness of clinic (AOR = 2.08; 95 % CI: 1.20, 3.94), whose Privacy was maintained (AOR = 9.56; 95 % CI: 5.02, 18.20), who were given information on the possible side effects of a method (AOR = 2.77; 95 % CI: 1.75–4.39), and on how the method works (AOR = 2.57; 95 % CI: 1.49–4.43) had higher odds of satisfaction. Also, various myths and misconceptions, such as implants moving to other parts of the body, implants causing paralysis, affecting routine activities, “womb of the woman may not hold the baby”, etc., were identified in a qualitative study. ConclusionsClient satisfaction in this study is low. An improved provider approach that suits on-site advocacy and the quality of counselling during the family planning service is needed. There is also a need to improve waiting time, working hours, cleanliness, awareness creation for both couples, and maintaining clients' privacy.

Evaluating the impact of socioeconomic status on patient satisfaction in radiation oncology.

e23166 Background: Patient satisfaction (PS) is a critical indicator in evaluating healthcare quality. While the impact of socioeconomic status (SES), on healthcare outcomes is well-documented, its specific connection to PS in the context of radiation oncology remains unclear. This study aims to delineate the correlation between SES, as determined by the Area Deprivation Index (ADI), and PS within our healthcare system. Methods: In this single institution study, National Research Council (NRC) PS survey questionnaires were prospectively collected from patients who visited 4 separate outpatient academic radiation oncology sites between May 2021 and November 2023. Area Deprivation Index (ADI) data for these patients was sourced from the Neighborhood Atlas, encompassing both national percentiles and state deciles, with higher values indicating a greater level of SES disadvantage. To assess the data, univariate (UVA) and multivariable (MVA) logistic regression analyses were performed on the survey's recommendation scores, which ranged from 0 to 10, with scores of 9 or higher suggesting a greater propensity to recommend the facility or provider. Results: Our analysis included 7,501 survey responses with a cohort that was majority female (55.3%), curative intent (81.5%), and had a breast cancer diagnosis (30.4%). Most survey responses were follow-up visits (69.0%). Mean state and national ADI scores were 3.94 and 50.75, respectively. The UVA revealed curative intent (OR 1.68, p < 0.001), follow-up visits (OR 1.69, p < 0.001), and breast cancer diagnosis (OR 1.42, p = 0.018) as predictors of higher likelihood to recommend the facility or the provider. Patients with a national ADI above the mean were less likely to recommend the facility (OR 0.81, p = 0.050) or the provider (OR 0.71, p = 0.002). The MVA, outlined in Table 1, showed the influence of national ADI on provider recommendations remained significant (OR 0.730, p = 0.005) but not for facility recommendations (OR 0.832, p = 0.089). All other variables remained significant on the MVA. Conclusions: Respondents experiencing greater SES disadvantage were significantly less likely to recommend their provider. These findings underscore the necessity of incorporating SES as a factor when evaluating PS. Further research is necessary to determine the root cause of the impact of SES on PS and to explore the complex dynamics of patient-provider interactions. [Table: see text]

Multi-directional Robust Benefit of the Doubt model: An application to the measurement of the quality of acute care services in OECD countries

While individual metrics in evaluating healthcare quality offer in-depth insights into particular areas, they frequently fail to encompass all pertinent information. Consequently, there is a growing need to develop composite measures that comprehensively assess the overall quality or performance of specific care services, especially those not covered by official OECD measures. A novel multi-directional robust Benefit-of-the-doubt approach is proposed to measure overall acute care services quality through a composite indicator while, at the same time, highlighting the potential improvement directions for each single component indicator. First, an approach based on simulated data has been carried out to better describe the advantages of the proposed approach, and then the methodology has been applied to country-level OECD data drawn from the Healthcare Quality and Outcomes programme.

THE RELATIONSHIP ANALYSIS OF INTERPERSONAL CARE AND CONTINUITY OF CARE WITH THE PATIENT SATISFACTION INDEX IN THE OUTPATIENT POLYCLINIC OF TGK.CHIK DITIRO PIDIE REGIONAL HOSPITAL

Patient satisfaction is an important indicator in evaluating health care quality. Outpatient care are one type of hospital service that requires quality assessment aspects, and nursing services are an integral part of hospital services. This research was conducted to determine the relationship between interpersonal care and continuity of care with patient satisfaction index in outpatient polyclinics. This study is quantitative research with a cross-sectional design. The respondents in this study were patients who received outpatient services at the Polyclinic of Tgk. Chik Ditiro Pidie Regional Hospital, totaling 209 respondents selected by Probability sampling. The study was conducted in October 2023. The Spearman test showed a relationship between interpersonal care (p=0,000; r=0.490) with patient satisfaction index, interpersonal communication (p=0.000; r=0.498) with patient satisfaction index, interpersonal style (p=0.000; r=0.509) with patient satisfaction index, decision making p=0.000; r=0.482) with patient satisfaction index. The relationship between continuity of care (p=0,000; r=0,478) with patient satisfaction index, long-term patient and medical partnerships (p=0.000; r=0.508) with patient satisfaction index, doctor and nurse information of patient medical record (p=0.000; r=0.338) with patient satisfaction index and service facilities (p=0.000; r=0.545) with patient satisfaction index at the outpatient polyclinic of Tgk.Chik Ditiro Pidie Regional Hospital. The results of the linear regression test of the service facilities are the most related to the patient satisfaction index (coeff=-0,662; p=0,000). Service facilities are the variables most related to the patient satisfaction index at the outpatient polyclinic of RSUD Tgk. Chik Ditiro Pidie.

Advancing Quality in Health Economics and Dentistry: A Comprehensive Review

This review delves into the intersection of precision-driven healthcare and economic considerations within dentistry. Emphasizing meticulous care and resource allocation, it draws on seminal literature to present qualitative narratives of resilience and transformative experiences. Technology is highlighted as a promising catalyst, but challenges underscore the need for a universal lexicon in healthcare quality evaluation. Beyond scholarly discourse, the exposition becomes a chronicle of the human spirit, navigating the complex healthcare landscape. It encapsulates triumphs, reflecting not just metrics but the shared humanity in dental interventions and economic decisions. In the pursuit of quality, it portrays a scientific account marked by resilience, innovation, and commitment, shaping a healthcare environment where each individual's journey unfolds with enduring well-being and joyous smiles.

The Usefulness of Present-on-Admission Data as an Indicator of Healthcare Quality Evaluation Using the Korean National Hospital Discharge in-Depth Injury Survey Data from 2006 to 2019.

Comorbidities of a principal diagnosis have varying impacts on disease and require different management depending on the onset timing. This study investigated the usefulness of present-on-admission (POA), specifically focusing on decubitus ulcers, delirium, and hypokalemia, as an indicator of healthcare quality. We analyzed patient discharge data for 14 years from 2006 to 2019 using Korean National Hospital Discharge In-Depth Injury Survey (KNHDIS). Out of 3,231,731 discharged patients, 19,871 had secondary diagnosis codes for decubitus ulcers (n=10,390, 52.3%), delirium (n=6103, 30.7%), or hypokalemia (n=3378, 17.0%). Analysis of patients with secondary diagnoses of decubitus ulcers, delirium, or hypokalemia revealed notable differences in demographics, including gender distribution, mean age, admission route, insurance type, surgical intervention rates, mortality rates, and length of stay (LOS). Among patients with one of the top 20 principal diagnoses, those with secondary diagnoses of decubitus ulcers, delirium, or hypokalemia exhibited higher odds of surgery, increased mortality risks, and longer LOS compared to those without these secondary diagnoses. All three of these diseases commonly occur postoperatively or during treatment and thus should be designated as potentially preventable complications that require special attention, and should also be considered as quality-of-care indicators.

Implementation of Specialized Pharmaceutical Care Hospital Outpatient Clinics in a Hospital Pharmacy Department

ObjectiveTo describe the organization of patient care into Specialized Pharmaceutical Care Hospital Outpatient Clinics in a Hospital Pharmacy Department, to evaluate their healthcare quality, and the quality perceived by outpatients. MethodA retrospective observational study in a High-Level Hospital Pharmacy Department during three periods (years 2010, 2013 and 2016); description of the organization at the levels of structure, human resources, material resources and working procedures; evaluation of healthcare quality through the analysis of three variables in terms of procedure: prior appointment compliance, waiting time and documentation of pharmaceutical care; evaluation of quality perceived by outpatients through a satisfaction survey; comparative statistical analysis of means (Student's t) and proportions (Pearson's chi square). ResultsFifteen (15) specialized outpatient clinics were opened and managed by 18 pharmacists; between the initial and final periods of the study (2010 vs. 2016), the compliance with previous appointments was of 61.3% vs. 88.8% (p <0001), waiting time was 27.6±12.1 vs. 12.1±5.4 minutes (p <0.0001), documentation of pharmaceutical care in the clinical record was of 2.3% vs. 9.81%% (p <0.0001), and the overall satisfaction perceived by the patients was 6.63±2.36 vs. 9.16±1.27 (p <0.01). ConclusionsThe model of Specialized Pharmaceutical Care Hospital Outpatient Clinics exposed, focused on the patient and with continuity of care, has improved the quality of care and the quality perceived by the patients and it's in optimal conditions to investigate its contribution on health outcomes and on the health system through a better quality, safety and efficiency of pharmacotherapy.

Assessing care quality: impact on renal outcomes in non-diabetic chronic kidney disease patients

Abstract Background Chronic kidney disease (CKD) is a major global noncommunicable disease, with significant burden on healthcare systems. Quality indicators (QIs) are useful tools for evaluating healthcare quality, but existing QIs for renal care mainly focus on dialysis population. This study aims to explore the association between quality of renal care and outcomes in non-diabetic CKD patients. Methods This study utilized Taiwan's National Health Insurance claims data and death registries to enroll non-diabetic adults with advanced CKD (stage 3B-5) from 2016 to 2019, following them through 2020. QIs evaluated included prescription of renin-angiotensin system (RAS) inhibitors, testing for proteinuria, and avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs). An overall quality score was calculated by summing scores of each QI. The primary outcome was long-term dialysis, and secondary outcomes included death, acute kidney injury (AKI), hyperkalemia, and acidosis. Univariate and multivariate Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of the effects of QIs on outcomes. Results Among 27,842 patients, 59.8% received RAS inhibitors, 56.5% underwent proteinuria testing, and NSAIDs were avoided in 97.9% of cases. Only 33.5% received the highest QI score of 3. Multivariate Cox proportional hazard models showed that higher overall quality scores were associated with a lower risk of long-term dialysis (HR 0.87, 95% CI 0.83-0.92), death (HR 0.90, 95% CI 0.86-0.94), and acidosis (HR 0.87, 95% CI 0.79-0.96). Additionally, higher overall quality scores were borderline associated with a lower risk of AKI and hyperkalemia. Conclusions QIs for renal care were associated with better outcomes in non-diabetic patients with advanced-stage CKD, particularly in long-term dialysis, death, and acidosis. More patients need to be prescribed RAS inhibitors and tested for proteinuria to achieve better quality of renal care. Key messages • Our study shows quality of renal care can impact outcomes for non-diabetic CKD patients, with higher quality indicator scores associated with lower risk of long-term dialysis, death, and acidosis. • Prescription of RAS inhibitors had the most significant protective effect, but more patients need to be prescribed RAS inhibitors and tested for proteinuria to achieve better renal care quality.

Patient satisfaction with advanced physiotherapy practice internationally: Protocol for a systematic mixed studies review.

Patient satisfaction is a complex construct consisting of human and system attributes. Patient satisfaction can afford insight into patient experience, itself a key component of evaluating healthcare quality. Internationally, advanced physiotherapy practice (APP) extends across clinical fields and is characterised as a higher level of practice with a high degree of autonomy and complex decision making. Patient satisfaction with APP appears positive. While evidence synthesis of patient satisfaction with APP exists, no systematic review has synthesised evidence across clinical fields. Therefore, the objectives of this systematic review are 1) to evaluate patient satisfaction with APP internationally, and 2) to evaluate human and system attributes of patient satisfaction with APP. A systematic mixed studies review using a parallel-results convergent synthesis design will be conducted. Searches of Medline, Embase, Web of Science, CINAHL, Cochrane, PEDro and grey literature databases will be conducted from inception to 18/7/2023. Studies of APP (World Physiotherapy definition) whereby practitioners a) have advanced clinical and analytical skills that influence service improvement and provide clinical leadership, b) have post-registration masters level specialisation (or equivalence), c) deliver safe, competent care to patients with complex needs and d) may use particular occupational titles; that measure patient satisfaction across all clinical fields and countries will be included. Two reviewers will screen studies, extract data, assess methodological quality of included studies (mixed methods appraisal tool), and contribute to data synthesis. Quantitative data will undergo narrative synthesis (textual descriptions) and qualitative data thematic synthesis (analytical themes). Integration of data syntheses will inform discussion. This systematic review will provide insight into patient satisfaction with APP internationally, exploring attributes that influence satisfaction. This will aid design, implementation, or improvement of APP and facilitate the delivery of patient-centred, high-quality healthcare. Lastly, this review will inform future methodologically robust research investigating APP patient satisfaction and experience.

Perspectives of cardiac rehabilitation in patients who had a stroke: a protocol for a qualitative study review

IntroductionStroke has a high incidence and disability rate, and its recurrence and readmission rates are rising, making it the second-leading cause of mortality in the globe. Cardiac rehabilitation is a...

The relationship between the pharmacist's role, patient understanding and satisfaction during the provision of a cost-effective pharmacist-led intervention.

This study aimed to investigate the relationship between the pharmacist's role, patient understanding and satisfaction during the provision of a cost-effective pharmacist-led intervention using structural equation modelling (SEM). SEM is a group of statistical techniques used in different disciplines to model latent variables and evaluate theories. A validated questionnaire was used to gather patient views on a pharmacist-led intervention. A conceptual model was developed to test the statistical significance of the relationship between patient understanding and satisfaction, the pharmacist's role and patient understanding, the pharmacist's role and patient satisfaction. In addition, the study evaluated the model's in-sample and out-of-sample predictive power. The analysis tested fours hypotheses (H): 1) There was no significant relationship between patient understanding and patient satisfaction; 2) There was no significant relationship between the pharmacist's role and patient understanding; 3) There was no significant relationship between the pharmacist's role and patient satisfaction; 4) The in-sample and out-of-sample predictive power of the model. Data were analysed using Smart-PLS software version 3.2.8. Two hundred and forty-six patients returned the questionnaire. Construct reliability, validity (Cronbach's alpha〉0.70, ⍴A>0.70, ⍴C>0.70), average extracted variance (AVE〉0.50) and discriminant validity (HTMT<0.85) were confirmed. The structural model and hypothesis testing results showed that all hypotheses were supported in this study. Path coefficients and effect sizes suggested that the pharmacist's role played a significant part in patient understanding (H2, β=0.650, f2 =0.730, p<0.001), which then influenced patient satisfaction (H1, β=0.474, f2 =0.222, p<0.001). The in-sample and out-of-sample predictive powers were moderate. Patient satisfaction is becoming an integral component in healthcare provision and evaluation of healthcare quality. The results support using structural equation modelling to assess the link between the pharmacist's role and patient understanding and satisfaction when delivering cost-effective pharmacist-led interventions.

Improving patient satisfaction for patients with acute neurological symptoms by increased flow from the front door of hospital and more specific documentation in medical record notes: a quality improvement project

Patient experience is considered essential in evaluating healthcare quality. One of the most important parameters that influence patient satisfaction is perception of throughput time, defined as the time from hospital...

Measuring quality and value in genetic counseling: The current landscape and future directions.

Genetic counselors strive to provide high-quality genetic services. To do so, it is essential to define quality in genetic counseling and identify opportunities for improvement. This Professional Issues article provides an overview of the evaluation of healthcare quality in genetic counseling. The National Society of Genetic Counselors' Research, Quality, and Outcomes Committee partnered with Discern Health, a value-based healthcare policy consulting firm, to develop a care continuum model of genetic counseling. Using the proposed model, currently available quality measures relevant to genetic counseling in the US healthcare system were assessed, allowing for the identification of gaps and priority areas for further development. A total of 560 quality measures were identified that can be applied to various aspects of the care continuum model across a range of clinical specialty areas in genetic counseling, although few measures were specific to genetic counseling or genetic conditions. Areas where quality measures were lacking included: attitudes toward genetic testing, family communication, stigma, and issues of justice, equity, diversity, and inclusion. We discuss these findings and other strategies for an evidence-based approach to quality in genetic counseling. Strategic directions for the genetic counseling profession should include a consolidated approach to research on quality and value of genetic counseling, development of quality metrics and patient-experience measures, and engagement with other improvement activities. These strategies will allow for benchmarking, performance improvement, and future implementation in accountability programs which will strengthen genetic counseling as a profession that provides evidence-based high-quality care to all patients.

PediHome: Development of a Family-Reported Measure of Pediatric Home Healthcare Quality.

No validated tools exist to measure pediatric home healthcare quality. The objective of this work was to develop a family-reported survey (PediHome) to measure the quality of home healthcare for children with medical complexity (CMC). A national multidisciplinary expert panel (N=19) was convened to develop survey content domains. Panelist were joined by 3 additional experts to rank candidate survey items for importance and evaluate relevance and structure. Cognitive interviews were conducted with English-speaking (n=12) and Spanish-speaking (n=4) family caregivers of CMC to revise problematic items and clarify response options. A cross-sectional survey was then fielded (6/1/20-10/31/20) to parents whose children receive healthcare at 2 regional academic medical centers. The final measure included N=28 total items with 4 items quantifying access, 1 evaluating overall quality rating, and 21 items assessing provider tasks (11 home nursing only, 2 certified nursing assistant/home health aide only, and 1 dual). Out of 312 caregivers of CMC, 142 (46%) responded and one-half (n=68, 48%) reported a child receiving home nursing. They received a weekly median of 58.4% (IQR ±31.2%) of approved nursing hours with 55% reporting a missed nursing shift within the last month. Median overall quality was 75-9 (0-10 scale) and median scores on specific quality items ranged from 31-4 to 43-4 (0-4 scale). PediHome is a new content-valid family-reported measure of home healthcare quality for CMC that is useful for evaluating healthcare quality across several domains. Future work will involve assessing PediHome's construct and predictive validity.

Relationship between patient experience and hospital readmission: system-level survey with deterministic data linkage method

BackgroundLinkage of public healthcare data provides powerful resources for studying from a comprehensive view of quality of care than information for a single administrative database. It is believed that positive patient experiences reflect good quality of health care and may reduce patient readmission. This study aimed to determine the relationship between patient experience and hospital readmission at a system level by linking anonymous experience survey data with de-identified longitudinal hospital administrative admissions data.MethodsData were obtained by linking two datasets with anonymised individual-level records from seven largest-scale acute public hospitals over seven geographical clusters in Hong Kong. Selected records in the two datasets involving patient experience survey (PES) (2013 survey dataset) and healthcare utilization (admissions dataset) were used. Following data cleaning and standardization, a deterministic data linkage algorithm was used to identify pairs of records uniquely matched for a list of identifiers (10 selected variables) between two datasets. If patient’s record from the survey dataset matched with the hospitalization records in the admissions dataset, they were included in the subsequent analyses. Bivariate analyses and multivariable logistic regression models were performed to evaluate the associations between hospital readmission in the next calendar month and patient experience.ResultsThe overall matching rate was 62.1% (1746/2811) for PES participants aged 45 or above from the survey dataset. The average score for overall inpatient experience was 8.10 (SD = 1.53). There was no significant difference between matched patients and unmatched patients in terms of their score for the perception of overall quality of care received during hospitalization (X2 = 6.931, p-value = 0.14) and score for overall inpatient experience (X2 = 7.853, p-value = 0.25). In the multivariable model, readmission through the outpatient department (planned admission) in the next calendar month was significantly associated with a higher score given to the overall quality of care received (adjusted OR = 1.54, 95%CI = 1.09–2.17), while such association was absent for readmission through Accident and Emergency department (adjusted OR = 0.75, 95%CI = 0.50–1.12).ConclusionsThis study demonstrated the feasibility of routine record linkage, with the limited intrusion of patients’ confidentiality, for evaluating health care quality. It also highlights the significant association between readmission through planned readmission and a higher score for overall quality of care received. A possible explanation might be the perceived better co-ordination between outpatient departments and inpatient service and the well-informed discharge plan given to this group of patients.

Factors Associated with Congestion and Overcrowding of Patient in the Outpatient Department and Clinic Department in National Eye Hospital, Colombo, Sri Lanka

The National Eye Hospital (NEH) is the largest referral centre of excellence for eye care in Sri Lanka. Patients from every part of the country come to the NEH for treating various eye diseases and the hospital has been overburdened with the problem of congestion and overcrowding. Congestion and overcrowding of patients are considered as a critical parameter in the evaluation of healthcare quality, safety, productivity, and patients’ satisfaction towards healthcare services1. This study aims to assess patient congestion and overcrowding in the outpatient department and clinic department in National Eye Hospital (NEH) Sri Lanka. National Eye Hospital provides treatment, training, rehabilitation and social welfare to the patients. Medical students, post graduate trainers in ophthalmology, ophthalmic technologist are the main categories of that. Most of the patients attend to the NEH, at least with one by stander. Prompt attention, availability of investigation facility, availability of drugs and devices, minimum waiting list for surgery and credibility of service provision are the main reasons for attending to the NEH. A cross-sectional study was conducted from November 2021 to January 2022 in the OPD and Clinic Department of NEH Hospital. More congestion was seen during morning compared to the afternoon. It is proposed to separate the OPD, Clinic, A&amp;E and investigation area. Also it is propsed to introduce separate entrance to OPD,Clinic and A&amp;E department.

Surveying the Landscape of Quality-of-Care Measures for Mental and Substance Use Disorders.

Quality measures that are used to evaluate health care services have a central role in monitoring and incentivizing quality improvement and the provision of evidence-based treatment. This systematic scan aimed to catalog quality-of-care measures for mental and substance use disorders and assess gaps and redundancies to inform efforts to develop and retire measures. Quality measure inventories were analyzed from six organizations that evaluate health care quality in the United States. Measures were included if they were defined via symptoms or diagnoses of mental and substance use disorders or specialty treatments or treatment settings for adults. Of 4,420 measures analyzed, 635 (14%) met inclusion criteria, and 376 unique quality-of-care measure constructs were cataloged and characterized. Symptoms or diagnoses of disorders were most commonly used to define measures (46%, N=172). Few measures were available for certain disorders (e.g., anxiety disorders), evidence-based treatments (e.g., psychotherapy), and quality domains (e.g., equity). Only one in four measures was endorsed by the National Quality Forum, which independently and critically evaluates quality measures. Among measures that were actively in use for national quality improvement initiatives (N=319), process measures (57%) were most common, followed by outcome measures (30%), the latter of which focused most often on experience of care. A vast landscape of mental and substance use disorder quality-of-care measures currently exists, and continued efforts to harmonize duplicative measures and to develop measures for underrepresented evidence-based treatments and quality domains are warranted. The authors recommend reinvesting in a national, centralized system for measure curation, with a stakeholder-centered process for independent measure review and endorsement.

Perioperative Stroke and Thirty-Day Hospital Readmission After Cardiac Surgeries: State Inpatient Database Study.

BackgroundReadmission rates are an important metric for evaluating healthcare quality. Stroke is a major complication following cardiac surgery. Our study aimed to evaluate the frequency and predictors of 30-day unplanned hospital readmission after cardiac surgeries and to evaluate the impact of perioperative stroke on readmission.MethodsSurgical discharge records spanning the years of 2008 through 2011 were analyzed utilizing California State Inpatient Database. International Classification of Diseases, ninth revision-Clinical Modification (ICD-9-CM) codes and Clinical Classification Software (CCS) codes were used to identify surgeries and variables of interest. Surgical records were then followed up for 30 days through linking admission records. Perioperative stroke was defined as brain infarction of ischemic or hemorrhagic etiology that occurred during or within 30 days after surgery.ResultsBaseline characteristics associated with increased readmission rates were female gender, age above 65, non-white race, lower income, and increased number of comorbidities. Among 199,617 hospitalizations for cardiac surgeries, 1,817 (0.91%) patients developed perioperative stroke. The rate of readmission in perioperative stroke patients was 21.89%. They had a longer length of hospital stay and their discharge was vastly non-routine (84%). Our univariate analysis yielded significant association between stroke and readmission rates (odds ratio: 1.82, 95% confidence interval: 1.63 - 2.04). This association failed to remain significant upon controlling for other variables in our multivariate analysis.ConclusionBaseline patient characteristics and perioperative complications are significant predictors of readmission. More than one in five patients who develop a stroke after cardiac surgery are readmitted to the hospital within 30 days of discharge.