Hospital Quality Indicators Research Articles

Hospital Quality Indicators for Opioid-Exposed Infants: Results From an Expert Consensus Panel.

To elicit expert consensus on quality indicators for the hospital-based care of opioid-exposed infants. We used the ExpertLens online platform to conduct a 3-round modified Delphi panel. Expert panelists included health care providers, parents in recovery, quality experts, and public health experts. We identified 49 candidate quality indicators from a literature review and environmental scan. A total of 32 experts rated the importance and feasibility of the indicators using a 9-point Likert scale (Round 1), reviewed and discussed the initial ratings (round 2), and revised their original ratings (Round 3). Numeric scores corresponded with descriptive ratings of "low" (1-3), "uncertain" (4-6), or "high" (7-9). We measured consensus using the RAND/UCLA Appropriateness Method. Candidate quality indicators assessed structures, processes, and outcomes in multiple domains of clinical care. After the final round, 36 indicators were rated "high" on importance and feasibility. Experts had strong consensus on the importance of quality indicators to assess universal screening of pregnant people for substance use disorder, hospital staff training, standardized assessment for neonatal opioid withdrawal syndrome, nonpharmacologic interventions, and transitions of care. For indicators focused on processes and outcomes, experts saw feasibility as dependent on the information routinely documented in electronic medical records or billing records. To present a more complete picture of hospital quality, experts suggested development of composite measures that summarize quality across multiple indicators. A panel of experts reached consensus on a range of quality indicators for hospital-based care of opioid-exposed infants, with potential for use in national benchmarking, intervention studies, or hospital performance measurement.

Training and Mentoring: Preparation of Digitization-Based Quality Indicators at Bunda General Hospital

Training and Mentoring: Preparation of Digitization-Based Quality Indicators at Bunda General Hospital

Length of Hospitalization and Mortality among Stroke Patients before and after the Implementation of a Specialized Unit: A Retrospective Cohort Study Using Real-World Data from One Reference Hospital in Southern Brazil.

Stroke constitutes a significant global cause of mortality and disability. The implementation of stroke units influences hospital quality indicators, guiding care management. We aimed to compare hospital length of stay (LOS), in-hospital mortality, and post-discharge mortality between stroke patients admitted in the pre- and post-implementation periods of a stroke unit in a public hospital in southern Brazil. This retrospective cohort study used real-world data from one reference hospital, focusing on the intervention (stroke unit) and comparing it to the general ward (control). We analyzed the electronic medical records of 674 patients admitted from 2009 to 2012 in the general ward and 766 patients from 2013 to 2018 in the stroke unit. Admission to the stroke unit was associated with a 43% reduction in the likelihood of prolonged hospitalization. However, there was no significant difference in the risk of in-hospital mortality between the groups (Hazard ratio = 0.90; Interquartile range = 0.58 to 1.39). The incidence of death at three, six and twelve months post-discharge did not differ between the groups. Our study results indicate significant improvements in care processes for SU patients, including shorter LOS and better adherence to treatment protocols. However, our observations revealed no significant difference in mortality rates, either during hospitalization or after discharge, between the SU and GW groups. While SU implementation enhances efficiency in stroke care, further research is needed to explore long-term outcomes and optimize management strategies.

Developing quality indicators for cancer hospitals in China: a national modified Delphi process

ObjectiveAlthough demand and supply of cancer care have been rapidly increasing in recent decades, there is a lack of systemic quality measurement for cancer hospitals in China. This study aimed...

Factors Affecting Waiting Time for Outpatient Prescription Services in BPJS Patients at the Pharmacy Installation of the M Natsir Solok Regional General Hospital Year 2022

Modern hospital services are currently associated with one of the hospital quality indicators, namely waiting time, this waiting time is closely related to the level of patient satisfaction. The purpose of this study was to see what factors influence waiting time at the outpatient pharmacy installation at RSUD M Natsir Solok. Methods The research was conducted using a cross-sectional study design approach. The factors that influence the waiting time examined in this study are the type of prescription, the number of prescription items, the completeness of the amount of drug administration, the price of the BPJS prescriber, facilities, infrastructure and manpower. The results showed that there were more types of prescription types of officinalis (87.5%) than magistralis prescriptions (12.5%), the number of prescription items was more that did not comply with WHO standards (> 2 items) namely (77.2%), the completeness of the number of drug administration was obtained more many medicines were given in full (86.6%), BPJS prescription prices were obtained according to standards (90.4%), facilities, infrastructure, and staff were found to be incompatible with PMK and technical instructions. The conclusion in this study is that the most related factor is the type of recipe. Efforts that can be made by the hospital are to make improvements in efforts to increase waiting time to standard by maximizing power and increasing the power of the hospital. Keywords: factors that affect waiting time: BJPS prescription

Does commission on cancer (CoC) accreditation mitigate the effect of care fragmentation on clinical outcome in localized rectal cancer?

BackgroundStudies of fragmented care (FC) in rectal cancer have not adjusted for indicators of hospital quality and may misrepresent the effects of FC. MethodsWe queried the National Cancer Database to identify patients undergoing care for clinical stage II and III rectal adenocarcinoma between 2006 and 2019. Those undergoing FC were sub-categorized based on whether (FC CoC) or not (FC non-CoC) they received systemic therapy at CoC accredited facilities. Results44,339 patients met inclusion criteria; 23,921 (54 ​%) underwent FC, 16,929 (71 ​%) FC non-CoC. Differences in utilization of neoadjuvant therapy (92.3 ​% vs 89.7 ​% vs 89.5 ​%, p ​< ​0.01) and 5-year overall survival (76.1 vs 75.5 vs 74.1 %, p ​< ​0.01) between treatment cohorts were marginal. ConclusionIn patients undergoing multimodality therapy for rectal cancer, care fragmentation is not associated with long-term clinical outcome. Decisions regarding where these patients go for systemic therapy may be safely made on the basis of ease of access.

Providing Nursing Care to Patients with Mental Disorders Based on King's Goal Attainment Theory: A Quasi-experimental Study

Background: Failure in treatment plans is very common in patients with mental disorders due to the patient's non-adherence to treatment, which has serious effects on public health and imposes additional costs on the community. Thus, patient-centered methods can be used to empower patients to improve their mental health care. Objectives: This study aimed to examine the effect of King's patient-centered nursing as a goal-attainment process in patients with mental disorders to improve interpersonal, personal, and social systems and adaptive responses in these patients. Methods: A quasi-experimental single-group study with a pre-test/post-test design was conducted on 34 patients with mental disorders. The patients were selected using convenience sampling from patients admitted to psychiatric centers in Tehran in 2022. First, the socio-demographic information questionnaire was completed for all patients. Then, an intervention program designed based on King's goal attainment process was implemented for the patients: (1) nursing assessment (identification of the patient's needs and problems according to the mutual understanding between the patient and the nurse and based on three personal, interpersonal, and social systems using King's standard checklist), (2) planning with the participation of the patient (setting at least 3 goals, prioritizing the goals, and formulating a care plan for each goal), (3) interventions (interactive sessions and presentation of educational content), and (4) evaluation (determining the level of patient's adaptive responses using the same checklist). Data analysis was performed using descriptive and inferential statistics, including the paired samples t-test and analysis of covariance (ANCOVA), with SPSS-26 software. Results: Thirty patients with an average age of 39.23 ± 6.33 were examined in this study. The initial assessment showed that the main problem faced by the patients was related to the interpersonal system (communication and interaction), followed by the personal system (self-perception) and social system (control). The post-intervention evaluation showed that the patients scored higher in all three personal, interpersonal, and social systems, and there was a statistically significant difference in their scores for these systems (P &lt; 0.001). Moreover, socio-demographic variables had no significant effect on the patients' adaptive responses (P &gt; 0.05). Conclusions: In line with King's theory, the present study showed the benefits of patient-centered care protocols, such as interpersonal relationship development, improvement of self-perception, and patients' interactive performance. Ultimately, this theory can lead to improving the patient's health status and the hospital's quality indicators. Therefore, nurses can enhance the effectiveness of nursing care, especially in psychiatric departments, using patient-centered care protocols based on King's theory.

Development of Hand Hygiene Monitoring System Based on Android Mobile Application and User Perspective

Hand hygiene plays a crucial role in promoting overall health and preventing the spread of diseases. The World Health Organization reported that the prevalence of healthcare-associated infections (HAIs) ranges from 3-12% in high-income countries and 5-19% in low-and middle-income countries. Improved hand hygiene compliance can substantially reduce HAI rates. In Indonesia, the Ministry of Health has designated handwashing compliance as a compulsory quality indicator for hospitals. Introducing a mobile app can improve hand hygiene practices. This study aims to develop and design an Android mobile application that serves as an easy-to-operate hand hygiene monitoring system and to understand user perspectives. The study used Agile Methods for app development and a qualitative approach to know users' perspectives. Respondents (n=10) from AMC Muhammadiyah Hospital, including the IPC team, department heads, and administrators, were interviewed. The result revealed that mobile application is easy to use and have an attractive user interface. Users expressed the application's user-friendliness and utility in conducting observations. Nonetheless, they identified some drawbacks, such as lagging issues and a complicated manual installation process due to the app's unavailability on Playstore. Users expect the app's future inclusion on Play Store for simplified installation and request its development for iOS to cater to hospital staff using iPhones.

Stability of hospital quality indicators over time: A multi-year observational study of German hospital data.

Retrospective hospital quality indicators can only be useful if they are trustworthy signals of current or future quality. Despite extensive longitudinal quality indicator data and many hospital quality public reporting initiatives, research on quality indicator stability over time is scarce and skepticism about their usefulness widespread. Based on aggregated, widely available hospital-level quality indicators, this paper sought to determine whether quality indicators are stable over time. Implications for health policy were drawn and the limited methodological foundation for stability assessments of hospital-level quality indicators enhanced. Two longitudinal datasets (self-reported and routine data), including all hospitals in Germany and covering the period from 2004 to 2017, were analysed. A logistic regression using Generalized Estimating Equations, a time-dependent, graphic quintile representation of risk-adjusted rates and Spearman's rank correlation coefficient were used. For a total of eight German quality indicators significant stability over time was demonstrated. The probability of remaining in the best quality cluster in the future across all hospitals reached from 46.9% (CI: 42.4-51.6%) for hip replacement reoperations to 80.4% (CI: 76.4-83.8%) for decubitus. Furthermore, graphical descriptive analysis showed that the difference in adverse event rates for the 20% top performing compared to the 20% worst performing hospitals in the two following years is on average between 30% for stroke and AMI and 79% for decubitus. Stability over time has been shown to vary strongly between indicators and treatment areas. Quality indicators were found to have sufficient stability over time for public reporting. Potentially, increasing case volumes per hospital, centralisation of medical services and minimum-quantity regulations may lead to more stable and reliable quality of care indicators. Finally, more robust policy interventions such as outcome-based payment, should only be applied to outcome indicators with a higher level of stability over time. This should be subject to future research.

Advance Care Planning in Belgium

This paper aims to 1) describe current levels of Advance Care Planning (ACP) development since 2002 in Belgium, 2) report on challenges and opportunities to inspire other countries with similar contextual characteristics and 3) support further development of ACP practice and research in Belgium. To address these aims, we consulted local researchers, 12 domain experts and (grey) literature (regulatory documents, reports, policy documents and practice guidelines) on ACP, palliative care, and related healthcare topics. Since 2002, when the Patient’s Right Law was passed in the federal Parliament, Belgium has had a specific medicolegal context for ACP. Initiatives to improve the uptake of ACP have been taken, e.g. standardised documentation, reimbursement codes for physicians provided by the government, and implementation of quality indicators in hospitals and nursing homes. Most of these initiatives are grassroots or predominantly oriented towards a single group of professions, e.g. general practitioners, disregarding the role that other professions can play. The patient groups most often targeted are those with cancer and older adults. Limited but growing attention is given to those with low health literacy or other minority groups. Main barriers to ACP in Belgium are: no unified platform to exchange outcomes of ACP discussions or advance directives between healthcare professionals and though efforts are made, ACP is still predominantly oriented towards documentation.

Description and Implications of Falls in Patients Hospitalized Due to COVID-19.

Many hospital quality indicators, including falls, worsened during the COVID-19 pandemic. Patients hospitalized with COVID-19 may be at risk for falling due to the disease itself, patient characteristics, or aspects of care delivery. To describe and explore falls in patients hospitalized with COVID-19. We pooled data from 107 hospitalized adult patients who fell between March 2020 and April 2021. Patients who fell had a current, pending, or recent diagnosis of COVID-19. We analyzed patient characteristics, fall circumstances, and patient and organizational contributing factors using frequencies, the chi-square test, and Fisher's exact test. Patient contributing factors included patients' lack of safety awareness, impaired physical function, and respiratory concerns. Organizational contributing factors related to staff and the isolation environment. Recommendations for managing fall risk in patients hospitalized with COVID-19 include frequent reassessment of risk, consideration of respiratory function as a risk factor, ongoing patient education, assisted mobility, and adequate staff training.

Does cost minimization of hypofractionated radiation therapy content all health stakeholders?

Does cost minimization of hypofractionated radiation therapy content all health stakeholders?

Developing online medical service quality indicators in China from the perspective of online-offline integration: a modified Delphi-AHP study.

Online medical services are developing rapidly worldwide, and policies encourage the integrated development of online and offline services in China. However, there is a lack of comprehensive and systematic quality indicators for online medical services to ensure patients' safety. This study aimed to construct a set of quality indicators from the perspective of online-offline integration, to provide a basis for the evaluation and management of online medical service quality. Based on the literature review, we included 53 potential indicators. In two rounds of consultations, we invited 21 and 19 experts, respectively, to rate the importance and feasibility of each indicator via email. We used the modified Delphi method and analytic hierarchy process to determine the final indicators and their weights. We used experts' positive coefficient, authority coefficient, and opinion coordination degree to test the reliability and validity of experts. After two rounds of Delphi consultation, the experts' positive coefficients were 90.48% and 89.47%, and the authoritative coefficients were both over 0.7. An online medical service quality index system for public hospitals in China was developed with 4 primary indicators, 13 secondary indicators, and 34 tertiary indicators. Among the primary indicators, the weights of structure, process, outcome, and integration quality were 0.22, 0.26, 0.34, and 0.18, respectively. We constructed the first set of online medical service quality indicators for public hospitals in China from the perspective of online-offline integration. It could be applied as a standardized and meaningful guide for online medical service evaluation and quality development.

Nurses Performance regarding Using of APACHE Score for Patients with Cardiac Surgery

The assessment of the risk of death and the estimated length of stay in the intensive care unit is a relevant clinical practice to predict the severity of the disease and to outline effective strategies for patient improvement and hospital quality indicators

Quality Indicators in Critical Access Hospitals, Small Rural, and Urban Hospitals

Purpose: Critical Access Hospitals (CAHs) have served their rural communities since they were created in the 1990s. CAHs have been exempt from the multiple organizational performance-based approaches that use financial incentives and thus quality indicators targeting CAHs specifically do not exist. Reports have suggested indicators that are appropriate for rural hospitals and CAHs but none have included all types of quality indicators - structures, work processes, outcomes, and quality improvement (QI) activities. Using a subset of the National Database of Nursing Quality Indicators® (NDNQI®) we assessed whether existing indicators for the work environment (structure), patient - and nurse outcomes are appropriate for CAHs. Methods: Using 2017 NDNQI® data on 16 structure and outcome indicators (8 work environment, 6 patient- and 2 nurse outcomes) were extracted. Employing bootstrapped confidence intervals CAHs were compared to other small (less than 50 beds) rural and urban hospitals. Findings: 103 CAHs, 63 small rural hospitals and 91 small urban hospitals had data on at least one indicator (range 87-239 for each indicator). There were no differences between CAHs and other small rural and urban hospitals for 15 of the 16 quality indicators. CAHs had fewer bachelor prepared nurses compared to urban hospitals. Conclusion: Our results suggest that quality indicators for structure and outcomes currently used in approximately 2000 hospitals are also applicable for CAHs. Whether they apply to all 1350 CAHs and can be used to guide benchmarking and QI in CAHs needs further study. Keywords: Critical Access Hospitals, Quality Indicators, National Database of Nursing Quality Indicators®DOI: https://doi.org/10.14574/ojrnhc.v23i1.733

Budgetary investment in evidence-based practice by chief nurses and stronger EBP cultures are associated with less turnover and better patient outcomes.

Hospitals and healthcare systems strive to meet benchmarks for the National Database of Nursing Quality Indicator (NDNQI) measures, Centers for Medicare & Medicaid Services (CMS) Core Measures, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) outcome indicators. Prior research indicates that Chief Nursing Officers and Executives (CNOs, CNEs) believe that evidence-based practice (EBP) is important for ensuring the quality of care, but they allocate little funding to its implementation and report it as a low priority in their healthcare system. It is not known how EBP budget investment by chief nurses affects NDNQI, CMS Core Measures, and HCAHPS indicators or key EBP attributes and nurse outcomes. This study aimed to generate evidence on the relationships among the budget devoted to EBP by chief nurses and its impact on key patient and nurse outcomes along with EBP attributes. A descriptive correlational design was used. An online survey was sent to CNO and CNE members (N = 5026) of various national and regional nurse leader professional organizations across the United States in two recruitment rounds. Data collected included CNO/CNE EBP Beliefs, EBP Implementation, and perceived organizational culture of EBP; organizational culture, structure, personnel, and resources for EBP; percent of budget dedicated to EBP; key performance measures (NDNQI, CMS Core Measures, HCAHPS); nurse satisfaction; nurse turnover; and demographic questions. Descriptive statistics were used to summarize sample characteristics. Kendall's Tau correlation coefficients were calculated among EBP budget, nursing outcome measures, and EBP measures. One hundred and fifteen CNEs/CNOs completed the survey (a 2.3% response rate). The majority (60.9%) allocated <5% of their budget to EBP, with a third investing none. An increase in EBP budget was associated with fewer patient falls and trauma, less nursing turnover, and stronger EBP culture and other positive EBP attributes. A greater number of EBP projects were also associated with better patient outcomes. Chief nurse executives and CNOs allocate very little of their budgets to EBP. When CNEs and CNOs invest more in EBP, patient, nursing, and EBP outcomes improve. System-wide implementation of EBP, which includes appropriate EBP budget allocation, is necessary for improvements in hospital quality indicators and nursing turnover.

Changes in failure to rescue after gastrectomy at a large-volume center with a 16-year experience in Korea

Failure to rescue (FTR), the mortality rate among patients with complications, is gaining attention as a hospital quality indicator. However, comprehensive investigation into FTR has rarely been conducted after radical gastrectomy for gastric cancer patients. This study aimed to assess FTR after radical gastrectomy and investigate the associations between FTR and clinicopathologic factors, operative features, and complication types. From 2006 to 2021, 16,851 gastric cancer patients who underwent gastrectomy were retrospectively analyzed. The incidence and risk factors were analyzed for complications, mortality, and FTR. Seventy-six patients had postoperative mortality among 15,984 patients after exclusion. The overall morbidity rate was 10.49% (1676/15,984 = 10.49%), and the FTR rate was 4.53% (76/1676). Risk factor analysis revealed that older age (reference: < 60; vs. 60–79, adjusted odds ratio [OR] 2.07, 95% confidence interval [CI] 1.13–3.79, P = 0.019; vs. ≥ 80, OR 3.74, 95% CI 1.57–8.91, P = 0.003), high ASA score (vs. 1 or 2, OR 2.79, 95% CI 1.59–4.91, P < 0.001), and serosa exposure in pathologic T stage (vs. T1, OR 2.74, 95% CI 1.51–4.97, P < 0.001) were associated with FTR. Moreover, patients who underwent gastrectomy during 2016–2021 were less likely to die when complications occurred than patients who received the surgery in 2006–2010 (OR 0.35, 95% CI 0.18–0.68, P = 0.002). This investigation of FTR after gastrectomy demonstrated that the risk factors for FTR were old age, high ASA score, serosa exposure, and operation period. FTR varied according to the complication types and the period, even in the same institution.

Women's choices of hospital for breast cancer surgery in Italy: Quality and equity implications

This paper employs mixed logit regression to investigate the effects of providers characteristics on women's choice of hospital for breast surgery. Patient level data are used to model choices in Tuscany region, Italy. In particular, we focus on the effects of travel time and hospital quality indicators including quality standard (volumes of breast surgery), measurement of process (waiting times) and quality of surgical procedures. Variation in preferences related to individual characteristics such as age, education and travel distance from the hospital are also considered. Findings show that, on average, women prefer closer hospital with longer waiting times and higher quality (high volumes of interventions). We found preference heterogeneity associated to education: travel distance affects choice especially among less educated women (regardless of age), while among younger women (<65 years), less educated ones prefer shorter waiting times. These results could be used to optimize the allocation of resources toward breast cancer units that meet quality and efficacy standards to increase the efficiency and responsiveness of breast cancer care.

SG-APSIC1170: Reduction of hospital-onset MRSA bacteremia with chlorhexidine baths among MRSA-colonized patients

Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is a major concern for hospitalized patients in Singapore. Hospital-onset (HO) MRSA bacteremia is monitored at the national level as an indicator of hospital quality. Patients who have colonized with methicillin-resistant Staphylococcus aureus (MRSA) are more likely to develop an MRSA infection in the future. A topical antiseptic solution or cloth called chlorhexidine gluconate (CHG) is effective against several gram-positive and gram-negative bacteria, including MRSA. Methods: The following control measures were present before and throughout the study period: (1) active screening of MRSA upon admission; (2) initiation of contact precaution once MRSA is detected; and (3) emphasis on strict hand hygiene. In January 2021, an intervention was for routine application of CHG bathing as follows: (1) training materials were developed; (2) train-the-trainer sessions were organized; (3) compliance regarding the application of CHG baths was monitored; and (4) the postimplementation process was reviewed. Results: There was no change of hand hygiene rate before and after implementation. In 2020, 17 cases of MRSA bacteremia occurred in the hospital, with an infection incidence of 0.54 per 10,000 patient days. In 2021, there were 10 cases of HO-MRSA bacteremia infection, with an overall rate of was 0.30 per 10,000 patient days. Conclusions: Daily bathing with chlorhexidine reduced the risk of MRSA acquisition and of hospital-acquired bacteremia.

Quality Improvement in Critical Care Areas using the Lean Six Sigma approach

Background: An intensive care unit provides critical lifesaving care and as such, this study is done to understandthe compliance of the nursing staffs working in the ICUs of a 350 bedded urban tertiary care hospital in India,towards the quality indicators functional in its critical area areas using the Lean Six Sigma approach and studyingthe deviation between the knowledge and practice.Materials and Methods: An observational cross-sectional study was done among the nursing staffs of differentICUs, using google form questionnaire and checklists. Lean Six Sigma was used as a study tool. A sample size of164 was considered using Convenience Sampling. And data analysis was done using the SPSS version 28.0.0.0.Results: An increase in the bed occupancy, ALOS and HAIs among the ICU patients was markedly observed. Thechi-square analysis revealed significant difference (3) = 18.0231, p &lt; 0.05) and ( (3) = 11.48, p &lt; 0.05) in practice,among the nursing staffs with respect to the quality indicators based on different variables.Conclusion: Hospital quality indicators and the correct way to follow them, is necessary to deliver a qualityhealthcare service experience to the patients admitted in the critical care areas of the hospital.