Half Of Facilities Research Articles

A SURVEY OF THE PRACTICE OF CERVICAL TRACTION REDUCTION IN THE WESTERN CAPE

A retrospective follow-up study was done, assessing regional practices in acute cervical reduction in hospitals in the Western Cape. The constitutional court ruled on the urgency in managing cervical dislocations, and our task is to ensure that medical treatment is optimized to comply with best medical practice and the apex court. A questionnaire was distributed and completed by emergency departments at each hospital, the results retrieved, analysed, and compared to a similar survey done in 2016.Protocols for managing cervical spine dislocations had improved from 80% having no protocols to only over half of facilities (52,6%) not having protocols in place. Inadequate equipment availability remained a problem with only 50% of facilities having adequate equipment available in 2016 to 43,6% in 2023. 10,3% of participants did not know if there was equipment available. In terms of knowledge, there remained poor formal training with a drop from 93% participants identifying that the main indication to attempt emergency cervical reduction was acute cervical dislocation with worsening neurology, to only 46,2%. However, there was an increase in the number of participants who thought reduction was safe. The same percentage of participants from 2016 to 2023 would attempt emergency cervical reduction if given adequate training.Previously we found that most Western Cape hospitals had inadequate protocols, training, and equipment for cervical reductions. In 2023, more hospitals in the Province have protocols in place for cervical reductions and the same percentage of doctors would attempt emergency cervical reduction with adequate training. However, equipment and training for management of acute cervical dislocations has not improved.We conclude that most Western Cape Hospitals are unprepared to adequately manage acute cervical dislocations.

COVID-19 Response Among US Hospitals with Emerging Special Pathogen Programs.

In February 2015, the US Department of Health and Human Services developed a tiered hospital network to deliver safe and effective care to patients with Ebola virus disease (EVD) and other special pathogens. The tiered network consisted of regional special pathogen treatment centers, state- or jurisdiction-designated treatment centers, assessment hospitals able to safely isolate a patient until a diagnosis of EVD was confirmed and transfer the patient, and frontline healthcare facilities able to identify and isolate patients with EVD and facilitate transport to higher-tier facilities. The National Emerging Special Pathogens Training and Education Center (NETEC) was established in tandem to support the development of healthcare facility special pathogen management capabilities. In August 2020, 20 hospitals that previously received an onsite readiness consultation by NETEC were surveyed to assess how special pathogen programs were leveraged for COVID-19 response. All surveyed facilities indicated their programs were leveraged for COVID-19 response in at least 1 of the following ways: NETEC-sponsored resources and training, utilization of patient isolation spaces, specially trained staff, and supplies. Personal protective equipment shortages were experienced by 95% of facilities, with 80% of facilities reporting that special pathogens program personal protective equipment was used to support facility response to COVID-19 admissions. More than half of facilities (63%) reported leveraging biocontainment unit staff to provide training and education to frontline staff during initial response to COVID-19. These findings have implications for planning and investments to avoid the panic-then-forget cycle that hinders sustained preparedness for future special pathogens.

4354 The Impact of the 2014 Kidney Allocation System on Waitlisting Rates at the Dialysis Facility Level

OBJECTIVES/GOALS: The new Kidney Allocation System (KAS) was implemented in 2014 and it is not fully understood how its changes to patient incentives may have impacted dialysis facility waitlisting rates. We examine differences in facility performance and how such differences may have been impacted by this policy change. METHODS/STUDY POPULATION: We used Dialysis Facility Report data from 2011 to 2017 to study waitlisting rates at 3,392 dialysis facilities in the US, using waitlisting counts in the numerator, and the total number of ESRD patients in a facility as the denominator. We examined changes in waitlisting rates over by year at the facility, regional, and national level, and report national trends in waitlisting pre- and post-KAS. Facilities were stratified based on waitlisting rate in 2011 and then we examined whether each facility moved into a higher or lower quartile or stayed in the same quartile in 2017. RESULTS/ANTICIPATED RESULTS: Among n = 3,392 dialysis facilities, the average change in dialysis facility waitlisting rates from 2011 to 2017 was −4.74 percentage points (range -54.4% to 42.3%). Average change in dialysis facility waitlisting rates from 2011 to 2014 was −0.57 percentage points while the average change in dialysis facility waitlisting rates from 2014 to 2017 was −4.17 percentage points. Half of facilities in the 2011 lowest quartile remained in the lowest quartile in 2017; 45% of facilities in the top 2011 quartile dropped into a lower quartile. The middle 2 quartiles were fairly evenly split between worsening, improving, and not changing. DISCUSSION/SIGNIFICANCE OF IMPACT: Average waitlisting rates have declined since KAS implementation. Many facilities switched quartiles from 2011-17 suggesting that facility waitlisting rates are unstable over time. The decline in waitlisting rates post-KAS suggests that new allocation rules may be discouraging patients and/or providers from getting ESRD patients waitlisted.

Distribution of maternity waiting homes and their correlation with perinatal mortality and direct obstetric complication rates in Ethiopia

BackgroundEthiopia has been expanding maternity waiting homes to bridge geographical gaps between health facilities and communities in order to improve access to skilled care. In 2015, the Ministry of Health revised its national guidelines to standardize the rapid expansion of waiting homes. Little has been done to document their distribution, service availability and readiness. This paper addresses these gaps as well as their association with perinatal mortality and obstetric complication rates.MethodsWe utilized data from the 2016 national Emergency Obstetric and Newborn Care assessment, a census of 3804 public and private health facilities. Data were collected between May and December 2016 through interviews with health care workers, record reviews, and observation of infrastructure. Descriptive statistics describe the distribution and characteristics of waiting homes and linear regression models examined the correlation between independent variables and institutional perinatal and peripartum outcomes.ResultsNationally, about half of facilities had a waiting home. More than two-thirds of facilities in Amhara and half of the facilities in SNNP and Oromia had a home while the region of Gambella had none. Highly urbanized regions had few homes.Conditions were better among homes at hospitals than at health centers. Finished floors, electricity, water, toilets, and beds with mattresses were available at three (or more) out of four hospital homes. Waiting homes in pastoralist regions were often at a disadvantage.Health facilities with waiting homes had similar or lower rates of perinatal death and direct obstetric complication rates than facilities without a home. The perinatal mortality was 47% lower in hospitals with a home than those without. Similarly, the direct obstetric complication rate was 49% lower at hospitals with a home compared to hospitals without.ConclusionsThe findings should inform regional maternal and newborn improvement strategies, indicating gaps in the distribution and conditions, especially in the pastoralist regions. The impact of waiting homes on maternal and perinatal outcomes appear promising and as homes continue to expand, so should efforts to regularly monitor, refine and document their impact.

Understanding performance data: health management information system data accuracy in Southern Nations Nationalities and People\u2019s Region, Ethiopia

BackgroundHealth management information system (HMIS) is a system whereby health data are recorded, stored, retrieved and processed to improve decision-making. HMIS data quality should be monitored routinely as production of high quality statistics depends on assessment of data quality and actions taken to improve it. Thus, this study assessed accuracy of the routine HMIS data.MethodsFacility based cross-sectional study was conducted in Southern Nations Nationalities and People’s region in 2017. Document review was done in 163 facilities of different levels. Statistical Package for the Social Sciences (SPSS) for windows version 20 was used to perform data analysis. Data accuracy was presented in terms of mean and standard deviation of data verification factor.ResultsThough inaccuracy was noted for all data elements, 96.9 and 84.7% of facilities reported institutional maternal death and skilled birth attendance within acceptable range respectively while confirmed malaria (45.4%), antenatal care fourth visit (46.6%), postnatal care (55.2%), fully immunized (55.8%), severe acute malnutrition (54.6%) and total malaria (50.3%) were reported accurately only by about half of facilities. Antenatal care fourth visit was over reported by 24% while total malaria was under reported by 28%. Reasons for variations included technical, behavioral and organizational factors.ConclusionsMajority of facilities over reported services while under reporting diseases. Data quality should be monitored routinely against data quality parameters quantitatively and/or qualitatively to catch-up country’s information revolution agenda.

Abortion in Zimbabwe: A national study of the incidence of induced abortion, unintended pregnancy and post-abortion care in 2016.

BackgroundZimbabwe has the highest contraceptive prevalence rate in sub-Saharan Africa, but also one of the highest maternal mortality ratios in the world. Little is known, however, about the incidence of abortion and post-abortion care (PAC) in Zimbabwe. Access to legal abortion is rare, and limited to circumstances of rape, incest, fetal impairment, or to save the woman’s life.ObjectivesThis paper estimates a) the national provision of PAC, b) the first-ever national incidence of induced abortion in Zimbabwe, and c) the proportion of pregnancies that are unintended.MethodsWe use the Abortion Incidence Complications Method (AICM), which indirectly estimates the incidence of induced abortion by obtaining a national estimate of PAC cases, and then estimates what proportion of all induced abortions in the country would result in women receiving PAC. Three national surveys were conducted in 2016: a census of health facilities with PAC capacity (n = 227), a prospective survey of women seeking abortion-related care in a nationally-representative sample of those facilities (n = 127 facilities), and a purposive sample of experts knowledgeable about abortion in Zimbabwe (n = 118). The estimate of induced abortion, along with census and Demographic Health Survey data was used to estimate unintended pregnancy.ResultsThere were an estimated 25,245 PAC patients treated in Zimbabwe in 2016, but there were critical gaps in their care, including stock-outs of essential PAC medicines at half of facilities. Approximately 66,847 induced abortions (uncertainty interval (UI): 54,000–86,171) occurred in Zimbabwe in 2016, which translates to a national rate of 17.8 (UI: 14.4–22.9) abortions per 1,000 women 15–49. Overall, 40% of pregnancies were unintended in 2016, and one-quarter of all unintended pregnancies ended in abortion.ConclusionZimbabwe has one of the lowest abortion rates in sub-Saharan Africa, likely due to high rates of contraceptive use. There are gaps in the health care system affecting the provision of quality PAC, potentially due to the prolonged economic crisis. These findings can inform and improve policies and programs addressing unsafe abortion and PAC in Zimbabwe.

Vaccine wastage in Nigeria: An assessment of wastage rates and related vaccinator knowledge, attitudes and practices.

The introduction of new vaccines highlights concerns about high vaccine wastage, knowledge of wastage policies and quality of stock management. However, an emphasis on minimizing wastage rates may cause confusion when recommendations are also being made to reduce missed opportunities to routinely vaccinate children. This concern is most relevant for lyophilized vaccines without preservatives [e.g. measles-containing vaccine (MCV)], which can be used for a limited time once reconstituted. We sampled 54 health facilities within 11 local government areas (LGAs) in Nigeria and surveyed health sector personnel regarding routine vaccine usage and wastage-related knowledge and practices, conducted facility exit interviews with caregivers of children about missed opportunities for routine vaccination, and abstracted vaccine stock records and vaccination session data over a 6-month period to calculate wastage rates and vaccine vial usage patterns. Nearly half of facilities had incomplete vaccine stock data for calculating wastage rates. Among facilities with sufficient data, mean monthly facility-level wastage rates were between 18 and 35% across all reviewed vaccines, with little difference between lyophilized and liquid vaccines. Most (98%) vaccinators believed high wastage led to recent vaccine stockouts, yet only 55% were familiar with the multi-dose vial policy for minimizing wastage. On average, vaccinators reported that a minimum of six children must be present prior to opening a 10-dose MCV vial. Third dose of diphtheria-tetanus-pertussis vaccine (DTP3) was administered in 84% of sessions and MCV in 63%; however, the number of MCV and DTP3 doses administered were similar indicating the number of children vaccinated with DTP3 and MCV were similar despite less frequent MCV vaccination opportunities. Among caregivers, 30% reported being turned away for vaccination at least once; 53% of these children had not yet received the missed dose. Our findings show inadequate implementation of vaccine management guidelines, missed opportunities to vaccinate, and lyophilized vaccine wastage rates below expected rates. Missed opportunities for vaccination may occur due to how the health system's contradicting policies may force health workers to prioritize reduced wastage rates over vaccine administration, particularly for multi-dose vials.

National Assessment of Data Quality and Associated Systems-Level Factors in Malawi.

Routine health data can guide health systems improvements, but poor quality of these data hinders use. To address concerns about data quality in Malawi, the Ministry of Health and National Statistical Office conducted a data quality assessment (DQA) in July 2016 to identify systems-level factors that could be improved. We used 2-stage stratified random sampling methods to select health centers and hospitals under Ministry of Health auspices, included those managed by faith-based entities, for this DQA. Dispensaries, village clinics, police and military facilities, tertiary-level hospitals, and private facilities were excluded. We reviewed client registers and monthly reports to verify availability, completeness, and accuracy of data in 4 service areas: antenatal care (ANC), family planning, HIV testing and counseling, and acute respiratory infection (ARI). We also conducted interviews with facility and district personnel to assess health management information system (HMIS) functioning and systems-level factors that may be associated with data quality. We compared systems and quality factors by facility characteristics using 2-sample t tests with Welch's approximation, and calculated verification ratios comparing total entries in registers to totals from summarized reports. We selected 16 hospitals (of 113 total in Malawi), 90 health centers (of 466), and 16 district health offices (of 28) in 16 of Malawi's 28 districts. Nearly all registers were available and complete in health centers and district hospitals, but data quality varied across service areas; median verification ratios comparing register and report totals at health centers ranged from 0.78 (interquartile range [IQR]: 0.25, 1.07) for ARI and 0.99 (IQR: 0.82, 1.36) for family planning to 1.00 (IQR: 0.96, 1.00) for HIV testing and counseling and 1.00 (IQR: 0.80, 1.23) for ANC. More than half (60%) of facilities reported receiving a documented supervisory visit for HMIS in the prior 6 months. A recent supervision visit was associated with better availability of data (P=.05), but regular district- or central-level supervision was not. Use of data by the facility to track performance toward targets was associated with both improved availability (P=.04) and completeness of data (P=.02). Half of facilities had a full-time statistical clerk, but their presence did not improve the availability or completeness of data (P=.39 and P=.69, respectively). Findings indicate both strengths and weaknesses in Malawi's HMIS performance, with key weaknesses including infrequent data quality checks and unreliable supervision. Efforts to strengthen HMIS in low- and middle-income countries should be informed by similar assessments.

The UN Commission on Life Saving Commodities 3 years on: global progress update and results of a multicountry assessment

In September, 2012, the UN Commission on Life Saving Commodities (UNCoLSC) outlined a plan to expand availability and access to 13 life saving commodities. We profile global and country progress against these recommendations between 2012 and 2015. For 12 countries in sub-Saharan Africa that were off-track to achieve the Millennium Development Goals for maternal and child survival, we reviewed key documents and reference data, and conducted interviews with ministry staff and partners to assess the status of the UNCoLSC recommendations. The RMNCH fund provided short-term catalytic financing to support country plans to advance the commodity agenda, with activities coded by UNCoLSC recommendation. Our network of technical resource teams identified, addressed, and monitored progress against cross-cutting commodity-related challenges that needed coordinated global action. In 2014 and 2015, child and maternal health commodities had fewer bottlenecks than reproductive and neonatal commodities. Common bottlenecks included regulatory challenges (ten of 12 countries); poor quality assurance (11 of 12 countries); insufficient staff training (more than half of facilities on average); and weak supply chains systems (11 of 12 countries), with stock-outs of priority commodities in about 40% of facilities on average. The RMNCH fund committed US$175·7 million to 19 countries to support strategies addressing crucial gaps. $68·2 million (39·0%) of the funds supported systems-strengthening interventions with the remainder split across reproductive, maternal, newborn, and child health. Health worker training ($88·6 million, 50·4%), supply chain ($53·3 million, 30·0%), and demand generation ($21·1 million, 12·0%) were the major topics of focus. All priority commodities are now listed in the WHO Essential Medicines List; appropriate price reductions were secured; quality manufacturing was improved; a fast-track registration mechanism for prequalified products was established; and methods were developed for advocacy, quantification, demand generation, supply chain, and provider training. Slower progress was evident around regulatory harmonisation and quality assurance. Much work is needed to achieve full implementation of the UNCoLSC recommendations. Coordinated efforts to secure price reductions beyond the 13 commodities and improve regulatory efficiency, quality, and supply chains are still needed alongside broader dissemination of work products. Governments of Norway (NORAD) and the UK (DFID).

Intervention Improved Health Workers’ Neonatal Resuscitation Skills and Knowledge, but Not Neonatal Mortality

Health care workers who participated in a mobile phone-based safe delivery intervention had greater skills and knowledge regarding neonatal resuscitation than control workers, according to a cluster-randomized clinical trial conducted at 70 health care facilities in rural Ethiopia. (1) Neonatal resuscitation skills scores six months and 12 months after implementation of the safe delivery app intervention were higher among intervention health care workers than among controls (mean differences, 6.0 and 8.8 points, respectively); neonatal resuscitation knowledge was higher among intervention health care workers than among controls at six months postimplementation (mean difference, 1.7 points), but not at 12 months. The intervention was not associated with a significant change in perinatal mortality of infants delivered at study health care facilities. The safe delivery app was designed to provide health care workers in low-income countries with the knowledge and skills to manage obstetric and neonatal emergencies; the app consisted of videos on topics such as neonatal resuscitation, as well as a catalog of essential obstetric drugs and equipment. To examine whether use of the app was associated with changes in perinatal mortality rates and in health care workers' knowledge and skill levels, researchers conducted a cluster-randomized clinical trial of health care facilities in five rural districts of Ethiopia's Oromiya region. Of the 131 facilities that were screened, 70 met the study's eligibility criteria (i.e., having a midwife or health extension worker on staff and having been the site of deliveries in the previous year) and were included in the study sample. Half of eligible facilities were randomly selected to the intervention group and were supplied with smartphones loaded with the safe delivery app; health care workers at intervention facilities received a one-day training session on how to use the phones and app. The other half of facilities were selected to the control group, and did not receive phones or additional training; the researchers ensured that both intervention and control facilities had an adequate package of drugs and equipment. Between September 2013 and February 2015, data were collected on women delivering at study facilities and on their birth outcomes; women were contacted in person or by phone seven days after delivery to follow up about perinatal mortality. In addition, facility health care workers' knowledge and skills regarding neonatal resuscitation were assessed by questionnaire and structured assessment tools (e.g., simulated scenarios using mannequins) before implementation of the intervention and at six and 12 months afterward. Descriptive and logistic regression analyses were used to compare perinatal mortality rates at intervention and control facilities, and to compare health care workers' neonatal resuscitation knowledge and skills index scores over time. The analysis sample included 1,474 women in the intervention group and 1,665 in the control group. Most women in each group (>85%) reported being younger than 29, having a primary or lower education and being a housewife; more than one-third of women in each group were pregnant for the first time. …

Service integration to reduce HIV-associated TB mortality.

Tuberculosis (TB) remains a leading cause of human immunodeficiency virus (HIV) associated mortality and morbidity among both adults and children worldwide,1,2 with an estimated 390 000 deaths from HIV-associated TB in 2014.3 Recent systematic reviews have found that TB is the most common cause of death in hospitalised adults and children living with HIV,4 and is responsible for 40% of causes of death confirmed by autopsy among people living with HIV.5 Preventing, diagnosing and treating TB in HIV-positive individuals remains an urgent public health priority. The provision of integrated TB and HIV services at the same place and time for people living with HIV is one of the key recommendations for HIV-associated TB.6 Integration can be achieved in different ways, including partial or full integration or co-location of services using either TB or HIV as an entry point.7 This issue of Public Health Action provides a before–after evaluation of the impact of integrating of TB and HIV activities across 12 ‘one-stop’ services in two districts of Rwanda.8 Key activities included providing HIV counselling and testing in TB clinics, providing antiretroviral therapy in the TB clinic for the duration of TB treatment, screening all HIV patients for TB and contact tracing for TB patients via home-based visits. HIV testing, cotrimoxazole prophylaxis and initiation of antiretroviral therapy (ART) all increased after implementation of the service in both districts. Qualitative research indicated high levels of client and health provider satisfaction. Other indicators were unchanged. There are limitations to the study. Sources of bias include the fact that data were assessed retrospectively, and less than half of facilities in the two districts were assessed. In particular, it is unclear how these facilities and districts were chosen, and the reported outcomes may not be representative of other sites. Nevertheless, operational research reports such as this are valuable in providing programme managers with an insight into what can be achieved in programmatic settings, in contrast to the carefully controlled and well-resourced context of a randomised trial.9 For Rwanda, this study provides some direction for action to further reduce HIV-associated TB mortality. The findings suggest that further improvements can be made in initiating ART in TB patients (only 71% initiated in Kicukiro district) and to improve outcomes of TB treatment, in particular to reduce the relatively high mortality (11–15%), which is likely multifactorial and deserving of further investigation. Delayed diagnosis, late initiation of treatment, suboptimal adherence to treatment, and type of TB disease (pulmonary or extrapulmonary) can all contribute to increased mortality in co-infected patients. Furthermore, the provision of isoniazid preventive therapy (IPT) = is not widely practised and reported in Rwanda, and this also requires urgent attention. Finally, there are other components to successful integration of HIV and TB care that are important to implement and monitor. Future studies reporting on the outcomes of integrated TB and HIV services are encouraged to report on the additional components, including earlier and prompt TB diagnosis, provision of IPT, and HIV testing and TB screening among family members of people living with HIV,6 all of which remain major challenges in the implementation of TB-HIV collaborative activities.10

Quality of care to prevent and treat postpartum hemorrhage and pre-eclampsia/eclampsia : an observational assessment in Madagascar's hospitals

In Madagascar, where more than half of women give birth without skilled attendants, quality improvement of health services may ameliorate community perception of facility-based delivery care, thereby increasing the skilled birth attendance rate. For women who do deliver in a facility, a higher quality of services will lead to better outcomes, moving the country closer to reaching Millennium Development Goals 4 and 5. To guide the quality improvement processes at health facilities in Madagascar, this study assessed the quality of care at facilities with respect to interventions addressing the main causes of maternal and newborn complications with a focus on postpartum hemorrhage (PPH) and pre-eclampia/eclampsia (PE/E). The study targeted all health facilities with a high volume of deliveries through inventories of medications and material, interviews with health providers, and observations of routine care and complicated cases. A total of 36 health facilities were included in the study, and interviews were carried out with 139 providers. Observations were made of 323 antenatal consultations and 347 labor and delivery clients, including 255 observations of the first stage of labor and 288 at the second or third stages. The main challenges to providing high-quality services as revealed by the inventory are the low availability of clinical protocols and guidelines for providers, and syringes, needles, and IV infusion sets to give uterotonics. Also, communication equipment and emergency transport were available in half of facilities, and a safe water source within 500 meters was available in only 67%. Regarding provider knowledge as measured by the interviews, the strongest areas of knowledge were detection of lacerations and conducting a physical examination; the weakest were on management of uterine atony or of retained placenta, stabilizing the mother with magnesium sulphate and anti-hypertensives, initial steps in management of severe PE, management of convulsions, and essential equipment and supplies needed. Technical support or supervision of providers was often nonexistent or inadequate. Some aspects of the observed care were of moderately high quality, such as infection prevention and provision of prophylactic oxytocin. However, compliance with all elements of the active management of the third stage of labor (i.e., oxytocin within one minute of delivery, controlled cord traction, and uterine massage after delivery of the placenta) occurred in only 13% of observed deliveries. In only 48% of observed antenatal care consultations was blood pressure measured using correct technique, and in only 29% did the provider perform or refer the pregnant woman for proteinuria screening. During cases of postpartum hemorrhage management, manual removal of placenta (MRP) was attempted in five cases but in none was it carried out according to the guidelines. In several cases of severe pre-eclampsia and one case of eclampsia, magnesium sulphate, the drug of choice, was not given. Overall, quality improvement is urgently needed to provide prophylactic oxytocin to all women within one minute of delivery, and to supply magnesium sulphate to all maternities for treatment of severe PE/E, among other interventions. To build on existing favorable policies to improve maternal and newborn health care in Madagascar, quality improvement efforts should target provider and facility readiness. In addition, national guidelines and protocols need to be updated and operationalized according to an appropriate national strategy that includes a budgeted action plan, follow-up, and performance-based recognition of providers and facilities. A national strategy is critical to ensure that all partners in the health system support it. An increase in the government's participation in funding for health (more than 12%, per the Abuja recommendation) would facilitate this program. Provider competencies can be maintained through regular practice with low-cost anatomical simulators and through use of regular updates and reminders to providers on clinical protocols via cell phones. In addition, accountability can be promoted by an adequate health management information system that collects data on the main causes of maternal and neonatal deaths, adequate supply at facilities of oxytocin, magnesium sulphate and other lifesaving drugs, and routine presentation of this information in regional and national fora.

The index of tobacco treatment quality: development of a tool to assess evidence-based treatment in a national sample of drug treatment facilities

BackgroundQuitting smoking improves health and drug use outcomes among people in treatment for substance abuse. The twofold purpose of this study is to describe tobacco treatment provision across a representative sample of U.S. facilities and to use these data to develop the brief Index of Tobacco Treatment Quality (ITTQ).MethodsWe constructed survey items based on current tobacco treatment guidelines, existing surveys, expert input, and qualitative research. We administered the survey to a stratified sample of 405 facility administrators selected from all 3,800 U.S. adult outpatient facilities listed in the SAMHSA Inventory of Substance Abuse Treatment Services. We constructed the ITTQ with a subset of 7 items that have the strongest clinical evidence for smoking cessation.ResultsMost facilities (87.7%) reported that a majority of their clients were asked if they smoke cigarettes. Nearly half of facilities (48.6%) reported that a majority of their smoking clients were advised to quit. Fewer (23.3%) reported that a majority of their smoking clients received tobacco treatment counseling and even fewer facilities (18.3%) reported a majority of their smoking clients were advised to use quit smoking medications. The median facility ITTQ score was 2.57 (on a scale of 1–5) and the ITTQ displayed good internal consistency (Cronbach’s alpha = .844). Moreover, the ITTQ had substantial test-retest reliability (.856), and ordinal confirmatory factor analysis found that our one-factor model for ITTQ fit the data very well with a CFI of 0.997 and an RMSEA of 0.042.ConclusionsThe ITTQ is a brief and reliable tool for measuring tobacco treatment quality in substance abuse treatment facilities. Given the clear-cut room for improvement in tobacco treatment, the ITTQ could be an important tool for quality improvement by identifying service levels, facilitating goal setting, and measuring change.

Survey on nosocomial infection of tuberculosis in nursing homes for elderly in Osaka City

To ascertain tuberculosis (TB) infection control measures and incidence of TB in nursing homes for elder. The questionnaire on TB infection control was distributed to all nursing homes in Osaka City in 2005. The questionnaire was returned from 197 (90%) out of 219 facilities. In more than half of facilities, infection control committee was organized (57%) and automated ventilation system was installed (59%). In almost all facilities, residents had annual chest X-ray screening (94%). Respiratory symptoms were checked for residents and "day service" users in majority of facilities. 100% of employees had annual chest X-ray screening. However TB education session for employees was held annually in only 40% of facilities. Education materials on TB were distributed in 19%. Tuberculin skin test (TST) was conducted for new employees in 31%. TB patients were diagnosed in 22% of facilities in the past 3 years from 2002 to 2004. Incidence rate of TB is 75.2 per 100,000 for residents and 24.1 per 100,000 for employees. Analysis showed that TB incidence rate is higher in facilities with larger number of residents and in facilities where infection control committee is organized, and facilities where TST is conducted for new employees. In Osaka City, TB infection control was more often implemented in facilities where TB patient was diagnosed. When age structure is taken into consideration, TB incidence rate of employees or residents was lower than general population. Nosocomial TB infection does not seem to be occurring in nursing homes. However, as TB patients were diagnosed occasionally, TB infection control measures should be strengthened in Osaka City.

Many Facilities Are Embracing Culture Change

Many Facilities Are Embracing Culture Change

阪神・淡路大震災における社会福祉施設の避難拠点としての役割

This study is to investigate how social welfare facilities coped as shelter after the Hanshin-Awaji Earthquake. We collect 196 respondents with questionnaire method out of 384 facilities in the Hyogo prefecture disaster areas. We find that the half of facilities became the shelter for elderly and handicapped refugees in spite of various difficulties. Many elderly and handicapped refugees was accepted in the bed room of the facilities. The date to become normal administration is due to styles of acceptance. If they accommodate rooms for refugees, the administration can be reopened earlier. Social welfare facilities accepted mainly elderly and handicapped refugees in this disaster. The study show that it is very important to cooperate with their neighborhoods, their family, volunteer groups, and other social welfare facilities.