Evaluation Of Health Care Quality Research Articles

¿Qué hay de la calidad asistencial en la sanidad penitenciaria? Una revisión sistemática

Objective To analyze healthcare quality assessment in prisons through a systematic review of the available scientific evidence. Material and method A literature search was performed in Medline, Excerpta Medica, Índice Médico Español, the Cochrane Library, and the official web pages of prison administrations in various countries. Data on the organizational model of healthcare in prisons in different countries, the methods used in quality assessment and results were gathered. Results There is little documentation on the subject, and it is not widely disseminated. Models of healthcare organization differ both among different countries and within the same country. There is no common model for evaluating healthcare quality in prisons. The most highly developed system is used in the prison administration of England and Wales. No article describing the whole evaluation process in prisons, including analysis of opportunities for improvement to evaluation of the results of the solutions proposed, was found. Conclusions Few documents were found on healthcare quality in prisons. Various models of healthcare organization are used in the correctional setting. There is no common methodology to assess healthcare quality and results. Tools for needs’ detection should be a priority as part of a broader model aimed at improving healthcare quality in prisons.

The Deserved Care Framework for Evaluating Health Care Quality

Excessively narrow definitions of health care quality do not identify certain important components of health care for clinicians, providers, or patients. Excessively broad definitions drive up health care costs and encourage unjustified interventions. This article proposes a framework for examining health care quality that distinguishes between what patients need, want, and deserve, and it advances the idea that deserved care is the relevant concept of care to inform health policy debates.

Decisions, decisions: why the quality of medical decisions matters.

Questions about the process leading to particular medical decisions are seldom addressed in discussions of health care quality. In some cases, strict adherence to treatment protocols may overlook important elements in the clinical decision-making process, such as physicians' judgment and patients' preferences. Papers by Annette O'Connor and colleagues and Karen Sepucha and colleagues are welcome additions to this debate because they highlight the importance of the medical decision-making process; they suggest that the quality of this process should be considered when evaluating health care quality. I explore some key limitations and uncertainties that must be addressed before work in this area can become broadly applicable.

Factors Influencing Consumers' Selection of a Primary Care Physician

There is a growing body of literature regarding patient choice of health care plans, patient satisfaction, and patient evaluation of health care quality, but there is little information concerning the factors that influence the initial selection of a primary care physician (PCP). This exploratory study identifies and conceptualizes the physician selection dimensions which include: physician reputation/manner, physician record, physician search, consumer self-awareness, physician location, physician qualifications, physician demographics, office atmospherics, house calls/insurance, and valuing patient opinion. The study also develops and tests a scale for PCP selection using factor analysis which is demonstrated to be valid, and determines significant differences of variables, which include education level, gender, and age, using a summated scale. The study is of use to physicians in their targeting and communication strategies, and to researchers seeking to refine the scale.

Patients’ and relatives’ experiences and perspectives of ‘Good’ and ‘Not so Good’ quality care

To explore patients' and relatives' perceptions of care and identify key criteria used to evaluate quality care, via descriptions of actual care experiences. A qualitative approach using Grounded Theory was adopted; data collected by semistructured interviews, from a purposive sample of 34 acute medical patients and 7 relatives, was subjected to question and thematic analysis. The nature of the care provided and interpersonal aspects of caring emerged as key quality issues for patients. Good Quality Care was characterized as individualized, patient focused and related to need; it was provided humanistically, through the presence of a caring relationship by staff who demonstrated involvement, commitment and concern. Care described as 'Not so Good' was routine, unrelated to need and delivered in an impersonal manner, by distant staff who did not know or involve patients. Empirical evidence was found which support these findings, which are in opposition of the received view that patients place greater emphasis on the technical aspects of care tasks. The quality issues identified as important by patients and relatives in this study are not always evaluated in care audits. Those responsible for evaluating health care quality might consider combining traditional (professional/technical) audit criteria with those used by health care users to achieve a more comprehensive evaluation.

The National Outcomes Management Project: a benchmarking collaborative.

Traditional evaluation of health care quality usually involves the measurement of the structure, process, and outcome of care. Most quality improvement programs involve a cycle that includes a setting of goals, a measurement of either process or outcomes, and a real-time or retrospective feedback of the results of data measurement. Benchmarking, a well-known efficient business technology, can lead to practice innovations necessary to survive in an environment that has a need for decreasing cost and increasing quality. The purpose of this article is to present a novel use of benchmarking in managed ambulatory behavioral health care and its application in a model collaborative outcome management project at more than 16 sites and nine states in the United States.

How Consumers Evaluate Health Care Quality

This article is the third and final article in a series which examines the way in which consumers assess information regarding the quality of health care services. The previous article focused on consumers' perceptions of health care plans and health insurance companies. This article examines the views of health care consumers regarding hospitals and doctors.

How Consumers Evaluate Health Care Quality

This article is the second in a series which examines the way in which consumers assess information regarding the quality of health care services. In the previous article it was demonstrated that, in the view of health care consumers, three major perceptions held by health care consumers, are: (1) substantial differences in quality exist among health care providers, (2) little information is available that allows for the comparison of health care providers on issues related to quality, and (3) when such information is available it is found to be useful and often serves as the basis for decision regarding the choice of health care providers. We further discussed the short coming of marketing strategies based on complex quality indicators and the difficulties of image advertising in an age of institutional mistrust. The reader is reminded that these findings relate to the subjective assessments of consumers, not to objective facts concerning health care delivery.

How Consumers Evaluate Health Care Quality

Information is a critical factor in marketing health care services. Consumers evaluate information according to its source. This report is the first of a three-part series examining the way in which Americans evaluate the quality of consumer information as they make decisions on health care products and services. This report provides an overview of the study. The next two installations will focus, respectively, on health plans, hospital and doctors.

Patrones de frecuentación y factores asociados al ingreso en el hospital de las urgencias hospitalarias por asma y por enfermedad pulmonar obstructiva crónica

The aim of this study was to describe the epidemiological characteristics of emergencies caused by asthma and chronic obstructive pulmonary disease (COPD) at the Hospital Clínico Universitario of Valencia (Spain) and to analyze factors related to hospital admissions for the same causes. Emergency room medical records for 1993 to 1995 of patients older than 14 years of age were examined to identify those due to asthma or COPD, according to established protocol. Demographic variables were described, followed by Poisson regression analysis of time and seasonal factors affecting emergencies. Factors related to hospital admission were analyzed by logistic regression, taking into account age group, sex, place of residence, and the year, month, day and hour of emergency room arrival. Asthma patients amounted to 1% of emergencies, while COPD patients accounted for 2%. The admission rate for women with asthma was higher than for men (F/M ratio = 0.78), whereas the rate for men with COPD was higher than for women (F/M ratio = 3.14). The largest age groups with asthma emergencies included young people aged 15 to 24 years old and those over 60. Hospital admissions or transfers to other hospitals were ordered for 17.4% of asthma patients and 38.8% of COPD patients. Nearly a third of COPD patients and a fifth of asthma patients were readmitted within the ten days following the first emergency. Clear temporal patterns of COPD emergency were observed for month (most occurring in winter), day of the week (most on Monday) and hour of the day (most during daytime hours, with fewer at midday). The time patterns were less evident for asthma emergencies, although the likelihood of admission because of asthma varied by month and day of the week. Emergency room records may be useful for studying the patterns of respiratory disease presentation. Other possible uses are epidemiologic monitoring and evaluation of health care quality.

What patients should ask of consumers' guides to health care quality.

Consumers' guides that profile the quality of care of individual health care providers may be influential in shaping health care markets. We propose four simple questions that can be used to evaluate such guides: (a) Does the guide measure distinct and important domains of health care quality? (b) Are the individual measures of quality described simply and precisely? (c) Do the measures take into account relevant differences between patients? (d) Are the ratings of quality presented fairly? Using these four questions, we examine the validity of one prominent guide that annually identifies America's best hospitals and present a set of recommendations for the design of future guides. Although the evaluation of health care quality is undoubtedly complex, the four questions that we pose provide a basis for developing a more rational approach to informing the public about health care quality.

The changing role of the consumer in health care quality

Traditionally, health care quality has been provider defined and focused, even though consumers define and evaluate health care quality. And, there is no relationship between consumer and provider perceptions of quality. Importantly, consumers use their evaluations when they decide to sue, recommend or return for services, and comply with treatment regimens. This article examines the changing role of the consumer in health care quality, explicates the need for a change in the health care paradigm, and suggests strategies for increasing patient participation in health care planning and quality assessment.

Data sources for health care quality evaluation.

The central purpose of this article is to review the major approaches to evaluation of health care quality in terms of its use of different data sources. The areas of application, advantages, and disadvantages of seven data sources are presented, including direct observation, clinical records, record abstracts, clinical and administrative staff survey, patient survey, significant others survey, and population survey. Then the selection of data sources is discussed as this process is influenced by the answers to seven critical questions concerning the context of the quality assurance effort.

Evaluation of health care quality by consumers.

Ideological and conceptual issues arising out of the involvement of consumers in health care quality determination are identified. Historically and currently, criteria and procedures for quality review and assessment have reflected the values and interests of the professional providers of health care. This perspective restricts the role of the consumer to that of either a nonparticipant or a data source, at best. If the social values and merits for health care provision of consumer involvement in quality determination are to be realized, then this perspective will need to be modified, and our knowledge base of consumer criteria of health care quality will need to be enlarged. Although the perspectives of probiders and consumers are thought to the antagonistic, they may not, in fact, be so. Some suggested areas of needed research, necessary to policy development and implementation, are offered.