Health Care Quality Measures Research Articles

One for all? Assessing the quality of Italian hospital care with the “benefit of the doubt” composite indicator methods

Quality assessment in healthcare systems is challenging due to the multidimensional nature of healthcare services. This study evaluates the overall quality provided by hospitals using composite indicators under the Benefit of the Doubt (BoD) approach, which determines the weights of the indicators with minimal assumptions. We used data from 2015-2020 for Italian Local Health Authorities (LHAs) for 21 outcome measures, applying various non-parametric methods to address aggregation and weighting challenges. Our results show that the BoD measures are robust and effectively capture the dynamics of the quality of LHA, even during external shocks such as the COVID-19 pandemic. This research highlights the importance of methodological choices in the construction of composite indicators and demonstrates the effectiveness of the BoD approach in providing a comprehensive measure of healthcare quality.

Rural-Urban Disparities in Hospital Services and Outcomes for Children With Medical Complexity

Limited availability of inpatient pediatric services in rural regions has raised concerns about access, safety, and quality of hospital-based care for children. This may be particularly important for children with medical complexity (CMC). To describe differences in the availability of pediatric services at acute care hospitals where rural- and urban-residing CMC presented for hospitalization; identify rural-urban disparities in health care quality and in-hospital mortality; and determine whether the availability of pediatric services at index hospitals or the experience of interfacility transfer modified rural-urban differences in outcomes. This retrospective cohort study examined all-payer claims data from Colorado, Massachusetts, and New Hampshire from 2012 to 2017. Analysis was conducted from May 2023 to July 2024. Participants included CMC younger than 18 years residing in these states and hospitalized during the study period. Rural or urban residence was determined using Rural-Urban Commuting Area codes. Hospitals were categorized as children's hospitals or general hospitals with comprehensive, limited, or no dedicated pediatric services using American Hospital Association survey data. Interfacility transfers between index and definitive care hospitals were identified using health care claims. In-hospital mortality, all-cause 30-day readmission, medical-surgical safety events, and surgical safety events were operationalized using Agency for Healthcare Research and Quality measure specifications. Among 36 943 CMC who experienced 79 906 hospitalizations, 16 525 (44.7%) were female, 26 034 (70.5%) were Medicaid-insured, and 34 008 (92.1%) were urban-residing. Rural-residing CMC were 6.55 times more likely to present to hospitals without dedicated pediatric services (rate ratio [RR], 6.55 [95% CI, 5.86-7.33]) and 2.03 times more likely to present to hospitals without pediatric beds (RR, 2.03 [95% CI, 1.88-2.21]) than urban-residing CMC, with no significant differences in interfacility transfer rates. In unadjusted analysis, rural-residing CMC had a 44% increased risk of in-hospital mortality (RR, 1.44 [95% CI, 1.03-2.02]) with no significant differences in other outcomes. Adjusting for clinical characteristics, the difference in in-hospital mortality was no longer significant. Index hospital type was not a significant modifier of observed rural-urban outcomes, but interfacility transfer was a significant modifier of rural-urban differences in surgical safety events. In this cohort study, rural-residing CMC were significantly more likely to present to hospitals without dedicated pediatric services. These findings suggest that efforts are justified to ensure that all hospital types are prepared to care for CMC.

Electronic Health Record Nudges and Health Care Quality and Outcomes in Primary Care

Nudges have been increasingly studied as a tool for facilitating behavior change and may represent a novel way to modify the electronic health record (EHR) to encourage evidence-based care. To evaluate the association between EHR nudges and health care outcomes in primary care settings and describe implementation facilitators and barriers. On June 9, 2023, an electronic search was performed in PubMed, Embase, PsycINFO, CINAHL, and Web of Science for all articles about clinician-facing EHR nudges. After reviewing titles, abstracts, and full texts, the present review was restricted to articles that used a randomized clinical trial (RCT) design, focused on primary care settings, and evaluated the association between EHR nudges and health care quality and patient outcome measures. Two reviewers abstracted the following elements: country, targeted clinician types, medical conditions studied, length of evaluation period, study design, sample size, intervention conditions, nudge mechanisms, implementation facilitators and barriers encountered, and major findings. The findings were qualitatively reported by type of health care quality and patient outcome and type of primary care condition targeted. The Risk of Bias 2.0 tool was adapted to evaluate the studies based on RCT design (cluster, parallel, crossover). Studies were scored from 0 to 5 points, with higher scores indicating lower risk of bias. Fifty-four studies met the inclusion criteria. Overall, most studies (79.6%) were assessed to have a moderate risk of bias. Most or all descriptive (eg, documentation patterns) (30 of 38) or patient-centeredness measures (4 of 4) had positive associations with EHR nudges. As for other measures of health care quality and patient outcomes, few had positive associations between EHR nudges and patient safety (4 of 12), effectiveness (19 of 48), efficiency (0 of 4), patient-reported outcomes (0 of 3), patient adherence (1 of 2), or clinical outcome measures (1 of 7). This systematic review found low- and moderate-quality evidence that suggested that EHR nudges were associated with improved descriptive measures (eg, documentation patterns). Meanwhile, it was unclear whether EHR nudges were associated with improvements in other areas of health care quality, such as effectiveness and patient safety outcomes. Future research is needed using longer evaluation periods, a broader range of primary care conditions, and in deimplementation contexts.

The effect of health facility ownership on perceived healthcare quality: evidence from Ghana.

Whether private healthcare providers should be encouraged over public providers remains unclear. On the one hand, because private providers are profit-driven, they are more motivated to compete for demand by enhancing quality if demand is elastic. However, because they are more motivated to maximize revenue, they may sacrifice quality to maximize profit. A crucial factor in determining whether private providers should be encouraged is the extent to which their quality exceeds or falls short of that of the public provider. This study, therefore, investigates whether the public and private differ in providing quality healthcare services using the 2014 Ghana Demographic and Health Survey. Our measure of healthcare quality is based on patient satisfaction level with nine healthcare services (cleanliness, waiting time, comfort and safety, consultation time, privacy, listening, explanation, treatment advice and confidentiality) provided by public and private healthcare facilities. We applied an instrumental variable approach to account for endogeneity issues related to the patient's choice of healthcare provider. We find that private facility users have a higher probability of being very satisfied with "waiting time", "consultation time", "listening", "cleanliness", "comfort and safety", "confidentiality", and "privacy" than public users, thus suggesting that private facilities provide better service than public. We thus recommend encouraging the private sector to enter the healthcare market. We also find that failing to account for endogeneity in provider choice when estimating the effect of healthcare facility ownership on healthcare service quality underestimates the effects.

Healthcare quality improvement: It's time to update the Donabedian approach with a complex systems perspective.

There is broad consensus that healthcare systems are complex systems, which as a result, face complex problems. From this perspective, quality of care can be conceptualised as an emergent outcome of the healthcare system, that is more than the sum of individual components of care (in terms of inputs and processes), and quality improvement as a complex systems problem. However, traditional approaches, such as Donabedian's structure/process/outcome framework, are rooted in a linear, reductionist perspective, that fails to recognise that quality of care is created in the context of complex healthcare systems, and the many interactions and uncertainties at play that shape quality of care and health outcomes. A paradigm shift is needed from a reductionist to a systems thinking approach if we are to better understand and improve quality of care. Such a shift begins with asking different research questions, situated within the system context, that focus on identifying how interventions may contribute to system improvement, as opposed to seeking to directly link interventions with quality of care outcomes. In contrast to traditional healthcare quality measures focusing on single components of the system in isolation, research needs to explicitly consider quality of care as an emergent system outcome and identify new indicators and methods of assessment that provide insight into how the healthcare system functions as an interconnected whole. It is an opportune moment to harness the energy of the international healthcare quality movement to drive the innovation needed in research and practice to adopt a systems thinking approach.

The maternal and newborn health eCohort to track longitudinal care quality: study protocol and survey development.

The MNH eCohort was developed to fill gaps in maternal and newborn health (MNH) care quality measurement. In this paper, we describe the survey development process, recruitment strategy, data collection procedures, survey content and plans for analysis of the data generated by the study. We also compare the survey content to that of existing multi-country tools on MNH care quality. The eCohort is a longitudinal mixed-mode (in-person and phone) survey that will recruit women in health facilities at their first antenatal care (ANC) visit. Women will be followed via phone survey until 10-12 weeks postpartum. User-reported information will be complemented with data from physical health assessments at baseline and endline, extraction from MNH cards, and a brief facility survey. The final MNH eCohort instrument is centered around six key domains of high-quality health systems including competent care (content of ANC, delivery, and postnatal care for the mother and newborn), competent systems (prevention and detection, timely care, continuity, integration), user experience, health outcomes, confidence in the health system, and economic outcomes. The eCohort combines the maternal and newborn experience and, due to its longitudinal nature, will allow for quality assessment according to specific risks that evolve throughout the pregnancy and postpartum period. Detailed information on medical and obstetric history and current health status of respondents and newborns will allow us to determine whether women and newborns at risk are receiving needed care. The MNH eCohort will answer novel questions to guide health system improvements and to fill data gaps in implementing countries.

Comparing methods for assessing the reliability of health care quality measures.

Quality measurement plays an increasing role in U.S. health care. Measures inform quality improvement efforts, public reporting of variations in quality of care across providers and hospitals, and high-stakes financial decisions. To be meaningful in these contexts, measures should be reliable and not heavily impacted by chance variations in sampling or measurement. Several different methods are used in practice by measure developers and endorsers to evaluate reliability; however, there is uncertainty and debate over differences between these methods and their interpretations. We review methods currently used in practice, pointing out differences that can lead to disparate reliability estimates. We compare estimates from 14 different methods in the case of two sets of mental health quality measures within a large health system. We find that estimates can differ substantially and that these discrepancies widen when sample size is reduced.

Conceptual and methodological recommendations for assessing the empirical validity of process measures of health care quality.

Conceptual and methodological recommendations for assessing the empirical validity of process measures of health care quality.

Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study

BackgroundHospital-onset bacteraemia and fungaemia (HOB) is being explored as a surveillance and quality metric. The objectives of the current study were to determine sources and preventability of HOB in hospitalised...

Alternative Payment Models and Performance in Federally Qualified Health Centers

ImportanceSeveral state Medicaid agencies have transitioned from traditional fee-for-service to a value-centric alternative payment model (APM) to reimburse federally qualified health centers (FQHCs). Little is known about the effects of this shift on FQHC performance.ObjectiveTo assess the association between APMs and the clinical performance, payer mix, risk profile, and financial sustainability of FQHCs.Design, Setting, and ParticipantsThis retrospective cohort study was performed in 684 FQHCs (representing 37 states plus the District of Columbia) that continuously operated between January 2009 and December 2021. Data on payer mix (eg, type of insurance) and risk profile (eg, proportion of patients with chronic conditions) of FQHC patients were obtained from the Uniform Data System, and clinic-level financial data (eg, revenue) were obtained from Internal Revenue Service form 990 tax documents. Data were analyzed between November 2022 and October 2023.ExposureInitial rollout of a value-based payment model (ie, an APM) for FQHCs, as offered by state Medicaid program, between January 2013 and December 2021.Main Outcomes and MeasuresThe main outcomes were 4 audited process measures of health care quality (cervical and colorectal cancer screening and body mass index [BMI] assessment for adults and children) and 2 intermediate health outcome measures (hypertension control and diabetes control). A difference-in-differences design was used with staggered implementation comparing FQHCs before and after the initial APM rollout vs contemporaneous changes in FQHCs in states without APMs.ResultsA total of 684 FQHCs (8892 FQHC-years) that served 17 823 959 patients in 2021 (57.3% female) were included in the study. Among FQHCs in states implementing APMs, significant differential increases in 3 of the 4 process quality measures were observed compared with FQHCs in states that did not implement an APM: colorectal cancer screening (3.24 percentage points [pp]; 95% CI, 1.40-5.08 pp), adult BMI (3.19 pp; 95% CI, 0.70-5.68 pp), and child BMI (4.50 pp; 95% CI, 1.83-7.17 pp). There were also modest differential improvements in blood pressure control for individuals with hypertension (1.02 pp; 95% CI, 0.04-2.00 pp) and blood glucose control for individuals with type 2 diabetes (1.02 pp; 95% CI, 0.02-2.02 pp) compared with FQHCs in states without an APM. There was no evidence that the APM rollout was associated with clinics selecting healthier patients (–0.01 pp; 95% CI, –0.21 to 0.19 pp) or stinting on care (–0.02 visits; 95% CI, –0.08 to 0.04 visits).Conclusions and RelevanceIn this cohort study, introduction of Medicaid APM options for FQHCs was associated with modest, statistically significant increases in quality concentrated among FQHCs with APM models that explicitly incentivized quality. This finding suggests that APMs can be both a financially viable and a health-promoting model for reimbursement in the health care safety net.

Exploring the safety reporting culture among healthcare practitioners in Saudi hospitals: a comprehensive 2022 national study

BackgroundWith the rise in medical errors, establishing a strong safety culture and an effective incident reporting system is crucial. As part of the Saudi National Health Transformation Vision of 2030, multiple projects have been initiated to periodically assess healthcare quality measures and ensure a commitment to continuous improvement. Among these is the Hospital Survey on Patient Safety Culture National Project (HSPSC), conducted regularly by the Saudi Patient Safety Center (SPSC). However, comprehensive tools for assessing reporting culture are lacking. Addressing this gap can enhance reporting, efficiency, and health safety.ObjectiveThis paper aims to investigate the reporting practices among healthcare professionals (HCPs) in Saudi Arabian hospitals and examine the relationship between reporting culture domains and other variables such as hospital bed capabilities and HCPs’ work positions.MethodsThe study focuses on measuring the reporting culture-related items measures and employs secondary data analysis using information from the Hospital Survey on Patient Safety Culture conducted by the Saudi Center for Patient Safety in 2022, encompassing hospitals throughout Saudi Arabia. Data incorporated seven items in total: four items related to the Response to Error Domain, two related to the Reporting Patient Safety Events Domain, and one associated with the number of events reported in the past 12 months.ResultsThe sample for the analyzed data included 145,657 HCPs from 392 hospitals. The results showed that the average positive response rates for reporting culture-related items were between 50% and 70%. In addition, the research indicated that favorable response rates were relatively higher among managerial and quality/patient safety/risk management staff. In contrast, almost half had not reported any events in the preceding year, and a quarter reported only 1 or 2 events. Pearson correlation analysis demonstrates a strong negative correlation between bed capacity and reporting safety events, response to error, and number of events reported (r = -0.935, -0.920, and − 0.911, respectively; p < 0.05), while a strong positive correlation is observed between reporting safety events and response to error (r = 0.980; p < 0.01).ConclusionsAlmost 75% of the HCPs reported fewer safety events over the last 12 months, indicating an unexpectedly minimal recorded occurrence variance ranging from 0 to 2 incidents.

Split-sample reliability estimation in health care quality measurement: Once is not enough.

To examine the sensitivity of split-sample reliability estimates to the random split of the data and propose alternative methods for improving the stability of the split-sample method. Data were simulated to reflect a variety of real-world quality measure distributions and scenarios. There is no date range to report as the data are simulated. Simulation studies of split-sample reliability estimation were conducted under varying practical scenarios. All data were simulated using functions in R. Single split-sample reliability estimates can be very dependent on the random split of the data, especially in low sample size and low variability settings. Averaging split-sample estimates over many splits of the data can yield a more stable reliability estimate. Measure developers and evaluators using the split-sample reliability method should average a series of reliability estimates calculated from many resamples of the data without replacement to obtain a more stable reliability estimate.

New evidence on the impacts of cross-market hospital mergers on commercial prices and measures of quality.

To examine the impact of "cross-market" hospital mergers on prices and quality and the extent to which serial acquisitions contribute to any measured effects. 2009-2017 commercial claims from the Health Care Cost Institute (HCCI) and quality measures from Hospital Compare. Event study models in which the treated group consisted of hospitals that acquired hospitals further than 50 miles, and the control group was hospitals that were not part of any merger activity (as a target or acquirer) during the study period. We extracted data for 214 treated hospitals and 955 control hospitals. Six years after acquisition, cross-market hospital mergers had increased acquirer prices by 12.9% (CI: 0.6%-26.6%) relative to control hospitals, but had no discernible impact on mortality and readmission rates for heart failure, heart attacks and pneumonia. For serial acquirers, the price effect increased to 16.3% (CI: 4.8%-29.1%). For all acquisitions, the price effect was 21.8% (CI: 4.6%-41.7%) when the target's market share was greater than the acquirer's market share versus 9.7% (CI: -0.5% to 20.9%) when the opposite was true. The magnitude of the price effect was similar for out-of-state and in-state cross-market mergers. Additional evidence on the price and quality effects of cross-market mergers is needed at a time when over half of recent hospital mergers have been cross-market. To date, no hospital mergers have been challenged by the Federal Trade Commission on cross-market grounds. Our study is the third to find a positive price effect associated with cross-market mergers and the first to show no quality effect and how serial acquisitions contribute to the price effect. More research is needed to identify the mechanism behind the price effects we observe and analyze price effect heterogeneity.

The Impact of Medicaid Accountable Care Organizations on Health Care Utilization, Quality Measures, Health Outcomes and Costs from 2012 to 2023: A Scoping Review.

Most of the evidence regarding the success of ACOs is from the Medicare program. This review evaluates the impacts of ACOs within the Medicaid population. We identified 32 relevant studies published between 2012 and 2023 which analyzed the association of Medicaid ACOs and health care utilization (n = 21), quality measures (n = 18), health outcomes (n = 10), and cost reduction (n = 3). The results of our review regarding the effectiveness of Medicaid ACOs are mixed. Significant improvements included increased primary care visits, reduced admissions, and reduced inpatient stays. Cost reductions were reported in a few studies, and savings were largely dependent on length of attribution and years elapsed after ACO implementation. Adopting the ACO model for the Medicaid population brings some different challenges from those with the Medicare population, which may limit its success, particularly given differences in state Medicaid programs.

Reliabilität des Strukturierten Dialogs in der gesetzlich verpflichtenden Qualitätssicherung

BackgroundQuality measurement in the German statutory program for quality in health care follows a two-step process. For selected areas of health care, quality is measured via performance indicators (first step). Providers failing to achieve benchmarks in these indicators subsequently enter into a peer review process (second step) and are asked by the respective regional authority to provide a written statement regarding their indicator results. The statements are then evaluated by peers, with the goal to assess the provider’s quality of care. In the past, similar peer review-based approaches to the measurement of health care quality in other countries have shown a tendency to lack reliability. So far, the reliability of this component of the German statutory program for quality in health care has not been investigated. MethodUsing logistic regression models, the influence of the respective regional authority on the peer review component of health care quality measurement in Germany was investigated using three exemplary indicators and data from 2016. ResultsBoth the probability that providers are asked to provide a statement as well as the results produced by the peer review process significantly depend on the regional authority in charge. This dependence cannot be fully explained by differences in the indicator results or by differences in case volume. ConclusionsThe present results are in accordance with earlier findings, which show low reliability for peer review-based approaches to quality measurement. Thus, different results produced by the peer review component of the quality measurement process may in part be due to differences in the way the review process is conducted. This heterogeneity among the regional authorities limits the reliability of this process. In order to increase reliability, the peer review process should be standardized to a higher degree, with clear review criteria, and the peers should undergo comprehensive training for the review process. Alternatively, the future peer review component could be adapted to focus rather on identification of improvement strategies than on reliable provider comparisons.

Prenatal Care Initiation and Exposure to Teratogenic Medications

With new legal abortion restrictions, timing of prenatal care initiation is critical to allow for discussion of reproductive options among pregnancies exposed to teratogenic medications. To investigate the prevalence of prenatal exposure to teratogenic medications and prenatal care initiation across gestational weeks. This descriptive, population-based cross-sectional study used health encounter data from a national sample of individuals with employer-sponsored health insurance. A validated algorithm identified pregnancies among persons identifying as female that ended with a live or nonlive outcome between January 2017 and December 2019. Data were analyzed from December 2022 to December 2023. Prenatal exposure to any of 137 teratogenic medications, measured via pharmacy and medical claims. Measurement of prenatal care initiation was adapted from the Children's Health Care Quality Measures. Prevalence of prenatal exposure to teratogens and prenatal care initiation by gestational week. Timing of prenatal teratogenic exposure was compared with timing of prenatal care initiation and legal abortion cutoffs. Among 639 994 pregnancies, 472 472 (73.8%; 95% CI, 73.7%-73.9%) had a live delivery (mean [SD] age, 30.9 [5.4] years) and 167 522 (26.2%; 95% CI, 26.1%-26.3%) had a nonlive outcome (mean [SD] age, 31.6 [6.4] years). Of pregnancies with live deliveries, 5.8% (95% CI, 5.7%-5.8%) were exposed to teratogenic medications compared with 3.1% (95% CI, 3.0%-3.2%) with nonlive outcomes. Median time to prenatal care was 56 days (IQR, 44-70 days). By 6 weeks' gestation, 8186 pregnancies had been exposed to teratogenic medications (25.2% [95% CI, 24.7%-25.7%] of pregnancies exposed at any time during gestation; 1.3% [95% CI, 1.3%-1.3%] of all pregnancies); in 6877 (84.0%; 95% CI, 83.2%-84.8%), prenatal care was initiated after 6 weeks or not at all. By 15 weeks, teratogenic exposures had occurred for 48.9% (95% CI, 48.4%-49.5%) of all teratogen-exposed pregnancies (2.5% [2.4-2.5] of all pregnancies); prenatal care initiation occurred after 15 weeks for 1810 (16.8%; 95% CI, 16.1%-17.5%) with live deliveries and 2975 (58.3%; 95% CI, 56.9%-59.6%) with nonlive outcomes. Teratogenic medications most used within the first 15 gestational weeks among live deliveries included antiinfectives (eg, fluconazole), anticonvulsants (eg, valproate), antihypertensives (eg, lisinopril), and immunomodulators (eg, mycophenolate). For nonlive deliveries, most antihypertensives were replaced by vitamin A derivatives. In this cross-sectional study, most exposures to teratogenic medications occurred in early pregnancy and before prenatal care initiation, precluding prenatal risk-benefit assessments. Prenatal care commonly occurred after strict legal abortion cutoffs, prohibiting consideration of pregnancy termination if concerns about teratogenic effects arose.

P335 Development and validation of a Belgian set of quality indicators for inflammatory bowel diseases

Abstract Background Quality indicators are standardized, evidence-based measures of health care quality, categorised as structure (to assess the care setting), process (to assess high-quality care actions by healthcare professionals) or outcome indicators (results of actions undertaken by healthcare professionals). Several quality indicator sets have been developed to standardise, measure and optimise IBD care. Our aim was to develop and validate a set to assess IBD care in Belgium and to select a subset of indicators with room for improvement that can be used to implement and improve care in clinical practice. Methods The importance of 221 quality indicators (49 structure, 135 process and 37 outcome) identified through literature was scored on a 10-point Likert scale in a two-round modified Delphi exercise by IBD experts. In a third round, the experts indicated and ranked their top 10 indicators with most room for improvement benefitting the patient in the Belgian healthcare system to agree on an improvement subset. In parallel, patient perspectives were collected through two linguistic patient focus groups, one in Flemish (6 participants) and one in French (4 participants). A final consensus meeting was organised to discuss 1) the patient perspectives gained through the focus groups, 2) the results of two Delphi scoring rounds and 3) the results of the additional ranking round. Indicators scoring ≥7 by ≥80% of the participants during the second scoring round, or based on agreement during the consensus meeting, were included in the final set. Results Thirty-two experts (11 IBD nurses and 21 clinicians including 2 paediatricians) participated in all three voting rounds, of which 19 also participated in the consensus meeting (6 IBD nurses and 13 IBD clinicians including 2 IBD paediatricians). In total, 199 quality indicators were agreed upon to assess IBD care in Belgium (41 structure, 123 process and 35 outcome). Eighteen (3 structure, 14 process and 1 outcome; Table) were retained in the improvement subset, related to patient characteristics, endoscopy guidelines, infection prevention, steroid use, the IBD care team, services provided in the IBD clinic, the documentation of patient characteristics, the care pathway and the monitoring of disease activity. The decision to include the latter five themes was driven by the importance to patients, which was evident from the patient focus groups. Conclusion An evidence and consensus based set of quality indicators was developed and validated - including an improvement subset - allowing Belgian IBD centres to evaluate quality of provided care, set up quality improvement projects and potentially launch a benchmarking study.

Developing an initial set of quality indicators for chiropractic care: a scoping review

BackgroundQuality indicators are standardized, evidence-based measures of health care quality. Currently, there is no basic set of quality indicators for chiropractic care published in peer-reviewed literature. The goal of this research is to develop a preliminary set of quality indicators, measurable with administrative data.MethodsWe conducted a scoping review searching PubMed/MEDLINE, CINAHL, and Index to Chiropractic Literature databases. Eligible articles were published after 2011, in English, developing/reporting best practices and clinical guidelines specifically developed for, or directly applicable to, chiropractic care. Eligible non-peer-reviewed sources such as quality measures published by the Centers for Medicare and Medicaid Services and the Royal College of Chiropractors quality standards were also included. Following a stepwise eligibility determination process, data abstraction identified specific statements from included sources that can conceivably be measured with administrative data. Once identified, statements were transformed into potential indicators by: 1) Generating a brief title and description; 2) Documenting a source; 3) Developing a metric; and 4) Assigning a Donabedian category (structure, process, outcome). Draft indicators then traversed a 5-step assessment: 1) Describes a narrowly defined structure, process, or outcome; 2) Quantitative data can conceivably be available; 3) Performance is achievable; 4) Metric is relevant; 5) Data are obtainable within reasonable time limits. Indicators meeting all criteria were included in the final set.ResultsLiterature searching revealed 2562 articles. After removing duplicates and conducting eligibility determination, 18 remained. Most were clinical guidelines (n = 10) and best practice recommendations (n = 6), with 1 consensus and 1 clinical standards development study. Data abstraction and transformation produced 204 draft quality indicators. Of those, 57 did not meet 1 or more assessment criteria. After removing duplicates, 70 distinct indicators remained. Most indicators matched the Donabedian category of process (n = 35), with 31 structure and 4 outcome indicators. No sources were identified to support indicator development from patient perspectives.ConclusionsThis article proposes a preliminary set of 70 quality indicators for chiropractic care, theoretically measurable with administrative data and largely obtained from electronic health records. Future research should assess feasibility, achieve stakeholder consensus, develop additional indicators including those considering patient perspectives, and study relationships with clinical outcomes.Trial registrationOpen Science Framework, https://osf.io/t7kgm

Satisfaction levels of patients attending the outpatient department of a tertiary care center of India

Introduction and aim. Any hospital’s outpatient department (OPD) is regarded as the storefront of the facility, and patient satisfaction is an important measure of healthcare quality. Hence, this cross-sectional study was conducted in different OPDs at a tertiary care center. Material and methods. Two hundred patients were recruited, and structured personal interviews were conducted with questions based on the Patient Satisfaction Questionnaire Short Form (PSQ-18). T-tests and analysis of variance (ANOVA) were used to compare satisfaction scores between variables. Results. Upon analysis, 86% of the patients rated their overall experience as either ‘very good’ or ‘good’. Interpersonal manners (mean score±SD; 4.60±0.55), communication (4.39±0.66), general satisfaction (4.03±0.79), and technical qualities (3.86±0.57) were the domains in which the patients were most satisfied, while time spent with the doctor (3.77±0.89), accessibility and convenience (3.77±0.67), and financial aspects (3.37±0.83) were the areas that lagged. Conclusion. Satisfaction scores were found to vary significantly with gender, age, waiting times, and the number of visits per day. Regular patient satisfaction surveys should be conducted in all hospitals for devising interventions to provide patients with the best possible care.

Patient satisfaction and associated factors among insured and uninsured patients in Deder General Hospital, eastern Ethiopia: a facility-based comparative cross-sectional study.

Patient satisfaction is a crucial measure of healthcare quality, as dissatisfied patients are more likely to miss appointments, disregard treatment plans, and leave hospitals, leading to poor treatment outcomes. Therefore, the study aimed to compare levels of satisfaction with health services and associated factors among insured and uninsured patients in Deder General Hospital, eastern Ethiopia. A comparative cross-sectional study with 532 participants was conducted from December 1-30, 2021. Data was collected through a structured questionnaire, analyzed using SPSS, and predictors assessed using a multivariate logistic regression model. Statistical significance was set at p < 0.05. Overall, patient satisfaction with health services was 65.6% (95% CI: 61.5-69.5), and the level of patient satisfaction with health services among insured and noninsured patients was 68.8% (95% CI: 62.8-74.4) and 62.4% (95% CI: 56.8-68.0), respectively. In the final model of multivariable analysis, factors such as educational status of secondary school (AOR = 4.90; 95% CI: 2.05-11.76), and a higher level (AOR = 3.08; 95% CI: 1.05-9.03), getting the entire prescribed drugs (AOR = 3.49; 95% CI: 1.43-8.54), getting some of the ordered drugs (AOR = 3.34; 95% CI: 1.61-6.94), paying less than 100 Ethiopian birrs (AOR = 4.85; 1.35-17.40) were significantly associated with patient satisfaction among insured patients. Whereas getting the entire and some prescribed drugs were (AOR = 6.28; 95% CI: 3.26-12.05), and (AOR = 3.40; 95% CI: 1.70-6.78) times more likely to be satisfied with the service among noninsured patients as compared to their counterparts, respectively. The study found that about six in 10 patients in the study area were satisfied with healthcare services, with insurance patients reporting higher satisfaction. Factors such as receiving prescribed drugs, paying less than 100 Ethiopian birr, having a secondary school education, and having a higher education were associated with satisfaction.