Health Care Provider Institutions Research Articles

Nursing students’ experiences from clinical education using the TPSN model

BackgroundThe TPSN model is an innovative model to create an integration and structured relationship between educational and healthcare provider institutions. This model is done to reduce the theoretical-practical gap in nursing. The present study aimed to explore the experiences of nursing students.MethodsIn a conventional content analysis, 11 undergraduate nursing students, 7 graduate nursing students, and 4 doctoral students were selected. Data was collected through focus group discussions and individual interviews.ResultsThe findings from analyzing the students’ experiences who had received education using this model resulted in four main categories: the feeling of being a nurse, an integrated and collaborative clinical education platform, the development of nursing clinical education, and educational challenges.ConclusionThe TPSN model provides a suitable platform for nursing clinical education. This model helps students integrate theoretical knowledge with clinical practice and helps them act as professional nurses in the future.

Rehabilitation of Patients with Arthrogenic Muscular Inhibition in Pathologies of Knee Using Virtual Reality.

Arthrogenic muscle inhibition (AMI) refers to muscular alterations that are generated, producing biomechanical motor control and movement problems, leading to deficiencies in strength and atrophy. Currently, there exist methods that involve virtual reality (VR) and have been well perceived by physiotherapists. The present research measured the potential benefits in terms of therapeutic adherence and speed of recovery, through a comparative analysis in a healthcare provider institution, in Medellín, Colombia, with and without the aid of VR. For this purpose, dynamometry, and surface electromyography (sEMG) signal acquisition tools were used. The treatment involved neuromodulation, ranges of motion and mobility work, strengthening and reintegration into movement, complemented with TENS, NMENS and therapeutic exercise, where the patient was expected to receive a satisfactory and faster adherence and recovery. A group of 15 people with AMI who include at least 15 min of VR per session in their treatment were compared with another group who received only the base treatment, i.e., the control group. Analyzing the variables individually, it is possible to affirm that VR, as a complement, statistically significantly improved the therapeutic adherence in 33.3% for CG and 37.5% for IG. Additionally, it increased strength with both legs, the symmetry between them, and decreased the level of pain and stiffness that is related to mobility.

Fragmentation of Care and Its Association With Survival and Costs for Patients With Breast Cancer in Colombia

Breast cancer care requires a multimodal approach and a multidisciplinary team who must work together to obtain good clinical results. The fragmentation of care can affect the breast cancer care; however, it has not been measured in a low-resource setting. The aim of this study was to identify fragmentation of care, the geographic variation of this and its association with 4-year overall survival (OS), and costs of care for patients with breast cancer enrolled in Colombia's contributory health care system. A retrospective cohort study was conducted using administrative databases. Women with breast cancer who were treated from January 1, 2013, to December 31, 2015, were included. Fragmentation of care was the exposure, which was measured by the number of different health care provider institutions (HCPIs) that treated a patient during the first year after diagnosis. Crude mortality rates were estimated, survival functions were calculated using the nonparametric Kaplan-Meier approach, and adjusted hazard ratios (HRs) were estimated using multivariate Cox regression model to identify the association of fragmentation with 4-year OS. The association between fragmentation and costs of care was assessed using a multivariate linear regression model. A total of 10,999 patients with breast cancer were identified, and 1,332 deaths were observed. The 4-year crude mortality rate was 31.97 (95% CI, 30.25 to 33.69) per 1,000 person-years for the whole cohort, and the highest rate was in the cohort defined for the fourth quartile of the fragmentation measurement (eight or more HCPIs), 40.94 (95% CI, 36.49 to 45.39). The adjusted HR for 4-year OS was 1.04 (95% CI, 1.01 to 1.07) for each HCPI additional. The cost of care is increased for each additional HCPIs (cost ratio, 1.25; 95% CI, 1.23 to 1.26). Fragmentation of care decreases overall 4-year OS and increases the costs of care in women with breast cancer for Colombia.

An introduction to the TPSN model: a comprehensive approach to reducing the theory-practice gap in nursing

BackgroundThere are still concerns about the effectiveness of clinical education models which are done with the aim of reducing the theoretical-practical gap in nursing. In this article, we intend to describe an innovative model to create an integration and structured relationship between educational and healthcare provider institutions. The basis of this work is the full-time presence of nursing teacher in the clinical settings and the development of their role to improve the education of students and nurses and the quality of nursing services.MethodsThis was a participatory action research. This action research was implemented in four steps of problem identification, planning, action and reflection. Interviews, focus groups and observation were used for the qualitative part. Clinical Learning Environment Inventory (CLEI), Job Satisfaction in Nursing Instrument questionnaires and Patient Satisfaction with Nursing Care Quality Questionnaire were completed before and after the study. Qualitative content analysis, paired and independent t test were used for data analysis.ResultsThe academic-practice integration Model of TPSN is a dynamic and interactive model for accountability in nursing Discipline. Unlike the medical education model that includes patients, students, and physicians as the three points of a triangle, this model, which is shaped like a large triangle, places the person in need of care and treatment (patient, client, family, or society) in the center of the triangle, aiming to focus on the healthcare receiver. The model consists of three components (Mentoring component, Preceptorship component, and integrated clinical education component). Each of the components of this model alone will not be able to eliminate the ultimate goal of bridging the theory-practice gap.ConclusionsA new and innovative model was proposed to reduce the theory-practice gap in the present study. This model increases the collaboration between educational institutions and healthcare settings compared with the previous models. The TPSN model helps students, nurses, and nursing instructors integrate theoretical knowledge with clinical practice and act as professional nurses.

Ethical Issues in Patient Data Ownership.

Patient data have conventionally been thought to be well protected by the privacy laws outlined in the United States. The increasing interest of for-profit companies in acquiring the databases of large health care systems poses new challenges to the protection of patients’ privacy. It also raises ethical concerns of sharing patient data with entities that may exploit it for commercial interests and even target vulnerable populations. Recognizing that every breach in the confidentiality of large databases exposes millions of patients to the potential of being exploited is important in framing new rules for governing the sharing of patient data. Similarly, the ethical aspects of data voluntarily and altruistically provided by patients for research, which may be exploited for commercial interests due to patient data sharing between health care entities and third-party companies, need to be addressed. The rise of technologies such as artificial intelligence and the availability of personal data gleaned by data vendor companies place American patients at risk of being exploited both intentionally and inadvertently because of the sharing of their data by their health care provider institutions and third-party entities.

Survei Kepuasan Kerja Pelanggan Internal (Pegawai) di RSUD K.R.M.T Wongsonegoro Kota Semarang

Hospital as the health care provider institutions need to keep the employee performance as a service quality’s major factor that given to customers. K.R.M.T Wongsonegoro Regional Public Hospital that gave the public health services had done to measure the internal customer (employee) satisfaction through internal customer (employee) survey since 2018. This study aims to analyze the employee’s expectation and satisfaction suitability to the factors that affect work satisfaction as a service quality development in K.R.M.T Wongsonegoro Regional Public Hospital Semarang. This study used survey method. Also used descriptive study design by quantitative-qualitative approach and cross sectional time. Dependent variable is internal customer (employee) satisfaction, while leadership, compensation, work environment, a promotion chance, and supervise as independent variabels. The index average of internal customer (employee) satisfaction as much as 73,8% with satisfaction details related to control of leadership 75%, compensation (75%), work environment (73%), a promotion chance (74%), and supervision (74%). This item can be concluded that internal customers (employee) in K.R.M.T Wongsonegoro Regional Public Hospital Semarang 2019 is quite satisfied with the institution services seen from leadership and compensation items provided that motivated their satisfaction, but compensation and the promotion chance need to be improved.

SOPHIA: System for Ophthalmic Image Acquisition, Transmission, and Intelligent Analysis

Ocular diseases are one of the main causes of irreversible disability in people in productive age. In 2020, approximately 18% of the worldwide population was estimated to suffer of diabetic retinopathy and diabetic macular edema, but, unfortunately, only half of these people were correctly diagnosed. On the other hand, in Colombia, the diabetic population (8% of the country’s total population) presents or has presented some ocular complication that has led to other associated costs and, in some cases, has caused vision limitation or blindness. Eye fundus images are the fastest and most economical source of ocular information that can provide a full clinical assessment of the retinal condition of patients. However, the number of ophthalmologists is insufficient and the clinical settings, as well as the attention of these experts, are limited to urban areas. Also, the analysis of said images by professionals requires extensive training, and even for experienced ones, it is a cumbersome and error-prone process. Deep learning methods have marked important breakthroughs in medical imaging due to outstanding performance in segmentation, detection, and disease classification tasks. This article presents SOPHIA, a deep learning-based system for ophthalmic image acquisition, transmission, intelligent analysis, and clinical decision support for the diagnosis of ocular diseases. The system is under active development in a project that brings together healthcare provider institutions, ophthalmology specialists, and computer scientists. Finally, the preliminary results in the automatic analysis of ocular images using deep learning are presented, as well as future work necessary for the implementation and validation of the system in Colombia.

Implementation of the clinical practice guideline for individuals with amputations in Colombia: a qualitative study on perceived barriers and facilitators

BackgroundThe issue of lower extremity amputation has been in the Colombian political agenda for its relationship with the armed conflict and antipersonnel mines. In 2015 the Colombian Ministry of Health published a national clinical practice guideline (CPG) for amputee patients. However, there is a need to design implementation strategies that target end-users and the context in which the CPG will be used. This study aims to identify users’ perceptions about the barriers and facilitators for implementing the guideline for the care of amputee patients in a middle-income country such as Colombia.MethodsSemi-structured interviews were conducted with 38 users, including patients, health workers, and administrative staff of institutions of the health system in Colombia. Individuals were purposively selected to ensure different perspectives, allowing a balance of individual positions.ResultsAccording to participants’ perceptions, barriers to implementation are classified as individual barriers (characteristics of the amputee patient and professionals), health system barriers (resource availability, timely care, information systems, service costs, and regulatory changes), and barriers related to clinical practice guidelines (utility, methodological rigour, implementation flexibility, and characteristics of the group developing the guidelines).ConclusionsOur study advances knowledge on the perceived individual and health system barriers and facilitators for the implementation of the CPG for amputee patients in Colombia. Importantly, the governance, financial, and service delivery arrangements of the Colombian health system are determining factors in implementing CPGs. For example, the financial arrangements between the insurance companies and the health care provider institutions were identified as barriers for the implementation of recommendations related to the continuity and opportunity of care of patients with amputations. The design of implementation strategies that successfully address the individual behaviours and the contextual health systems arrangements may significantly impact the health care process for amputee patients in Colombia.

Factors Involved in the Development of Inhibitory Antibodies in Patients with Hemophilia in Colombia: A Case-Control Study.

Background:The appearance of inhibitory antibodies against antihemophilic factors is one of the most serious complications related to hemophilia.Objective:The objective of this study was to identify variables and factors related to the development of inhibitory antibodies in a group of patients undergoing antihemophilic therapy in Colombia.Methods:A case-control study in patients with hemophilia treated in Specialized Healthcare Provider Institutions (IPS-E) in 21 cities of Colombia of any age and with a diagnosis of inhibitory antibodies against factor VIII or IX during 2016. Four controls per case paired by age and type of hemophilia were used. Sociodemographic, clinical, and pharmacological variables were identified and analyzed.Results:Seventeen patients with inhibitory antibodies and 68 controls with hemophilia were identified. The mean age was 28.3 ± 17.8 years. A total of 94.1% had hemophilia A, and 88.2% of the cases and 50.0% of the controls had severe hemophilia; 47.1% of the cases and 54.4% of the controls were receiving prophylaxis with coagulation factors. Multivariate analysis showed that having severe hemophilia (OR:17.0, 95%CI:1.32–219.60) and lack of knowledge of the coagulation factor with which the patient was treated before entering the care program in the IPS-E (OR:8.9, 95%CI:1.82–43.75) were significantly associated with a higher probability of developing inhibitory antibodies.Conclusion and relevance:Coagulation factors associated with the development of inhibitory antibodies were severe hemophilia and lack of knowledge of the type of factor used prior to entering the follow-up cohort.

Effect of Service Quality on Integrated Antenatal Care Patient Satisfaction

The increase in the health service is very important to be made by health care provider institutions such as clinics in order to improve patient satisfaction. But in the last few years many decline the number of visits the patient at the clinic. This is due to the existence of the dissatisfaction felt by the patient over a given service. The purpose of the study to find out the influence of the quality of service to the satisfaction of the Patients current study. Design Integrated ANC namely observational analytic quantitative approach. The research of the variable quality of service as the independent variable and the dependent variable as patient satisfaction. The population of the research that is Integrated in the entire patient ANC Clinics Kupang (nutrition, BP, KIA, LAborat and Loket) Mojokerto with the average number of patients per month as many as 777 patients. Smapel taken with the technique of systematic sampling as much as 117 respondents. Data collected by questionnaire instrument and processed by using coding, editing, tabulating and scoring as well as tested with test statistic spearman rho and linear regression. Research results throughout the dimensions of service quality affects patient satisfaction whereas that can be seen from the value of ρ value < 0.05 for all dimensions so partial dimensions of service quality affects patient satisfaction. Similarly, on the results of the regression simultaneously or synchronously also showed the same results, namely the value of p value < 0.05, so can be conclusion that simultaneously or synchronously dimensions of service quality affects patient satisfaction

Percepción de los usuarios frente a la calidad del servicio de salud en consulta externa en una Institución Prestadora de Servicios de Salud

Introducción. La comprensión de la calidad de los servicios de salud depende de diversos factores relacionados con la percepción del paciente sobre la atención, los elementos del entorno, factorestécnicos, el trato, entre otros, requiere un análisis desde la perspectiva del paciente. Objetivo. Determinar la percepción de los usuarios de la calidad en la prestación del servicio de salud en consulta externa en una Institución Prestadora de Salud durante el segundo semestre del 2017 en Boyacá-Colombia. Método. Estudio descriptivo, enfoque cuantitativo y diseño transversal, los datos se recolectaron con la encuesta SERVQUAL a 143 usuarios. Resultados. El promedio general de las cinco dimensiones de expectativas fue de 4.4714, es decir, el 89.428% del rango del porcentaje de satisfacción, lo que significa que los usuarios tienen un rango satisfactorio según sus expectativas. El resultado general de las cinco dimensiones de percepciones fue de 4.1309, equivalente a 82.618% del rango del porcentaje de satisfacción, reportando que los usuarios tienen un rango satisfactorio según sus percepciones. Conclusiones. Es recomendable que, desde la gerencia administrativa de la Institución Prestadora de Salud, se generen estrategias organizacionales que permitan promover cambios en cuanto a la infraestructura, equipos, personal, material de comunicación e información, limpieza y comodidad.

Patient-Centered Care

..........In the context of patient services constrained by cost barriers, physicians often find it unfavorable to choose an option that prioritizes patient interest. As has been the practice of physicians since Hippocrates, physicians position themselves as the one who best knows what is the most appropriate for the patient. This is in contrary to the concept of patient-centered care. Supported by the ethical principle of patient autonomy, patient-centered services / PCC (LBP/Layanan Berpusat Pasien) empower patients through the provision of more clear and accurate information, allowing patients to be partners in decision-making concerning their health........The cultural shift and the way services are delivered to the patients must be designed, managed and rewarded financially. Patients are no longer merely customers who receive services, but partners in the process of prevention and cure of the disease. The expected benefits of patient-centered services are greater patient and family satisfaction, increased reputation of the physician or the health care provider institution, increased morale and clinical productivity of supporting staffs, and cost savings and service efficiency.......

Patients’ perspectives of emergency care quality and priorities for care improvement

Purpose Studies have examined strategies implemented to strengthen quality of emergency care in healthcare provider institutions in Ghana. But few studies have focused on what determines quality of emergency care from the patient’s perspective. The purpose of this paper is to fill that gap by examining factors salient to gauging quality of emergency care and priority areas for care improvement. Design/methodology/approach Cross-sectional data were collected from patients admitted in emergency units of public hospitals in two regions: Greater Accra and Central Regions. A structured questionnaire designed with inputs from emergency medicine physicians and patients was used to collect data from 381 patients. Principal component analysis (PCA) and logistic regression models were computed to respectively determine salient measures of emergency care quality and their association with patient overall perceived quality of emergency care. Findings Using the PCA, four factors (social and relational care, attentive prehospitalised care, ward quality and privacy and medical supplies) were derived as salient measures of emergency care quality. All the factors derived had statistically significant association with patient overall perception of quality. Originality/value Emergency care quality improvement strategies that incorporate the dimensions identified can produce effective therapeutic outcomes.

Routine health check-ups: A boon or a burden?

Healthcare provider institutions in India now offer structured health check-up 'packages' for routine screening of common diseases. While some tests included within their ambit are in keeping with international and Indian recommendations, some are entirely unwarranted. Unnecessary and inappropriate screening tests may cause more harm than benefit. Besides financial and resource burden, there may be over-diagnosis and over-treatment, psychological distress due to false-positive test results, harm from invasive follow-up tests, and false reassurance due to false-negative test results. Clinicians must ensure a net benefit from tests and interventions in order to efficiently deliver preventive services. We reviewed current screening guidelines for cardiovascular disease and common cancers, and surveyed multiple 'packages' provided at 8 centres in Mumbai, India. We put forth our recommendations for routine health screening in asymptomatic adults in India.

An inspector calls

Purpose – The purpose of this paper is to summarise key concepts within clinical governance by reference to literature, and to present the topic of statutory clinical governance inspections of hospitals. Design/methodology/approach – Conceptual paper in form of extended editorial; rapid, non-systematic review of basic clinical governance literature from UK, Republic of Ireland and Australia. Findings – The Mid-Staffordshire Hospitals report (Francis, 2013) is evidence that, more than 15 years after its inception, clinical governance in the UK has not yet fulfilled its mission. This report has stimulated the subjection of all NHS provider institutions to a statutory inspection regime. Two different yet complementary, authoritative perspectives on clinical governance are identified and discussed. Whilst the inspection regimes methodology is under review, the object of inspection is not. The object of inspection could usefully be broadened to bring the arms length planning and funding bodies associated with provision under closer scrutiny for their obligation to engage constructively and collaboratively with providers in difficulty. Research limitations/implications – A more extensive, systematic study of international literature will provide a foundation for international comparison studies which will enable participants in clinical governance to learn from each other. Practical implications – The information contained in this brief review will assist practices of governance inspection and local self-governance. Originality/value – Other studies (e.g. Brennan and Flynn 2013) have garnered definitions of clinical governance from other health systems, which tend to emphasise accountability as the key concept. Inspired by Halligan (2006), the present contribution stresses leadership and empowerment alongside accountability (in the sense of enabling “every clinical team to put quality at the heart of their moment-to moment care of patients”. It implies that accountability to “create an environment in which excellence in clinical care will flourish” should lie not only with individual clinical departments and healthcare provider institutions but also with funding and planning bodies such as the Clinical Commissioning Groups, recently introduced in the UK. The latter are not subject to the same inspection regime as providers but could usefully be made more accountable to engage constructively and collaboratively with providers in difficulty (Colin-Thomé, 2013).

Percepción de necesidades en cuidadores familiares de adultos internados en una unidad de cuidados intensivos de una institución prestadora de salud (IPS) privada en Villavicencio, Colombia

Introducción: Ingresar a un familiar en una unidad de cuidados intensivos (UCI) es una experiencia abrumadora para la familia, reconocida como esencial en la salud del paciente. El cuidador, como miembro significativo de la familia, se expone también a situaciones angustiantes que le generan necesidades que se deben identificar para promover su bienestar y calidad de vida. Objetivos: Describir las necesidades del cuidador familiar de pacientes adultos crónicos hospitalizados en UCI en una institución prestadora de salud privada en Villavicencio, Colombia. Material y métodos: Estudio descriptivo, de corte transversal y de tipo cuantitativo. Se utilizó el instrumento Critical Care Family Needs Inventory (CCFNI), de Nancy Molter y Jane Leske, que valora el grado de importancia que los familiares les otorgan a las necesidades de apoyo, comodidad, información, proximidad y seguridad cuando tienen a un familiar ingresado en la UCI. Se entrevistaron cuidadores familiares (n = 37) durante un trimestre y se procesó la información en SPSS versión 14. Resultados: La necesidad considerada más importante es la de seguridad, con el 86 %; seguida de la de información, con el 82 %, y de proximidad, con un 78 %. Conclusiones: Para enfermería, las necesidades sentidas por los cuidadores familiares de adultos en condición de cronicidad hospitalizados en una UCI son base para ofrecer cuidado integral y hacer de la experiencia en UCI momentos menos desalentadores.

Profiling health-care accreditation organizations: an international survey

To describe global patterns among health-care accreditation organizations (AOs) and to identify determinants of sustainability and opportunities for improvement. Web-based questionnaire survey. Organizations offering accreditation services nationally or internationally to health-care provider institutions or networks at primary, secondary or tertiary level in 2010. s) External relationships, scope and activity public information. Forty-four AOs submitted data, compared with 33 in a survey 10 years earlier. Of the 30 AOs that reported survey activity in 2000 and 2010, 16 are still active and stable or growing. New and old programmes are increasingly linked to public funding and regulation. While the number of health-care AOs continues to grow, many fail to thrive. Successful organizations tend to complement mechanisms of regulation, health-care funding or governmental commitment to quality and health-care improvement that offer a supportive environment. Principal challenges include unstable business (e.g. limited market, low uptake) and unstable politics. Many organizations make only limited information available to patients and the public about standards, procedures or results.

The Advantages and Limitations of International Classification of Diseases, Injuries and Causes of Death from Aspect of Existing Health Care System of B and H

CONFLICT OF INTEREST: NONE DECLAREDIntroductionThe International classification of diseases (ICD) is the most important classification in medicine. It is used by all medical professionals.ConceptThe basic concept of ICD is founded on the standardization of the nomenclature for the names of diseases and their basic systematization in the hierarchically structured category.Advantages and disadvantagesThe health care provider institutions such as hospitals are subjects that should facilitate implementation of medical applications that follows the patient medical condition and facts connected with him. The definitive diagnosis that can be coded using ICD can be achieved after several visits of patient and rarely during the first visit.ConclusionThe ICD classification is one of the oldest and most important classifications in medicine. In the scope of ICD are all fields of medicine. It is used in statistical purpose and as a coding system in medical databases.