Healthcare Quality Improvement Research Articles

Internalized Stigma in Hidradenitis Suppurativa: A Multicenter Cross-Sectional Study

Background: Hidradenitis suppurativa (HS) causes significant physical, social, and psychological burdens. Internalized stigma, acceptance of negative attitudes and stereotypes of society regarding a person’s illness, has not been studied previously in HS. Objectives: The objective of this study was to investigate the internalized stigma state of HS patients and identify the factors affecting it. Methods: This multicenter, prospective, cross-sectional study included 731 patients. Internalized Stigma Scale (ISS), Hurley staging, Physician Global Assessment, Dermatology Life Quality Index (DLQI), Skindex-16, Beck Depression Inventory-II (BDI-II), and Visual Analog Scale (VAS)-pain score were used in the study. Results: The mean ISS value (57.50 ± 16.90) was comparable to the mean ISS values of studies in visible dermatological and various psychiatric diseases. A significant correlation was found between the mean values of ISS and all disease activity scores, quality of life measures, BDI-II, and VAS-pain scores. Obesity, family history, low education and income level, vulva/scrotum involvement and being actively treated are significant and independent predictive factors for high internalized stigma in multivariate analysis. Conclusions: HS patients internalize society’s negative judgements, which may create a profound negative effect on access to health care. Therefore, in addition to suppressing disease activity, addressing internalized stigma is fundamental for improving health care quality.

Patients' Perspectives of Interprofessional Collaboration in Breast Cancer Unit.

Interprofessional teamwork provides significant benefits for patients. However, qualitative research on interprofessional collaboration in the breast cancer unit is uncommon. Therefore, a qualitative study was conducted to assess the perceptions of outpatient breast cancer patients regarding interprofessional collaboration in the breast care unit of an Indonesian referral center hospital. The teamwork involved in the interprofessional collaboration included breast cancer specialists, pharmacists, and nurses. In this study, in-depth interviews were performed with nine breast cancer outpatients. All interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. The findings were divided into two categories to gather breast cancer patients' viewpoints on interprofessional collaboration: (1) obstacle components to interprofessional collaboration: incompleteness of health personnel, no justification from health personnel, no knowledge of patients about health professionals, no involvement of patients in the therapy decision making; (2) enabling elements: patient-oriented, patient expectations, collaboration among healthcare personnel, patient participation in interprofessional collaboration, health personnel responsibilities, comprehensive hospital services. Respondents assumed interprofessional collaboration positively. However, several obstacles must be overcome to implement interprofessional collaboration in a breast care setting effectively. The research findings can be utilized to establish interprofessional collaborations aimed at improving quality healthcare in breast cancer units.

The acceptability of implementing patient-reported measures in routine maternity care: A systematic review.

Patient-reported measures (PRMs) are becoming popular as they might influence clinical decisions, help to deliver patient-centered care, and improve health care quality. However, the limited knowledge and consensus about the acceptability of implementing PRMs in maternity care hinder their widespread use in clinical practice, and evidence-based recommendations are lacking. This systematic review aims to synthesize available evidence on the acceptability of implementing PRMs in routine maternity care. Literature on the implementation of PRMs in maternity care was electronically searched in six databases (PsycARTICLES, PubMed, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and CINAHL), screened and selected for the topic of "acceptability". Theoretical Framework of Acceptability was used as the basic framework guiding data analysis and synthesis. Evidence was thematically analyzed and synthesized. Mixed Method Appraisal Tool and GRADE-CERQual approach were used to assess the quality of studies and evaluate the confidence in the review findings. Overall, 4971 articles were screened. From 24 studies, we identified five themes regarding the acceptability of implementing PRMs in routine maternity care: (1) user's action and behavior, (2) stakeholders' attitudes, (3) perceived benefits, (4) perceived challenges and risks, and (5) stakeholders' preferences and suggestions on implementation. While pregnant and postpartum women, health professionals and other stakeholders involved in maternity care were generally positive about the implementation of PRMs in routine care and recognized the potential benefits (eg health improvement, women empowerment, care and services improvement and healthcare system advancement), they pointed out possible challenges and risks in answering PRMs questions, responding to answers, and setting up integrated information systems as well as suggested solutions in the aspects of PRMs data collection, follow-up care, and system-level management. The confidence in the review findings was moderate due to methodological limitations of included studies. Available empirical evidence suggested that the use of PRMs in routine maternity care is acceptable among stakeholders involved in maternity care and the potential benefits of its integration in routine clinical practice to healthcare improvement has been recognized. However, possible challenges in data collection, follow-up care arrangement and system-level integration should be appropriately addressed.

Implementation and Evaluation of an Interprofessional Health Systems Science Professional Development Program.

Few interprofessional development programs focused on learning knowledge and skills in health systems science (HSS) have been described. The authors implemented a professional development program (the HSS Academy) for interprofessional clinicians and trainees. The authors describe the HSS Academy, report preliminary outcomes, and describe strategies for use in other programs. The HSS Academy (an 8-month active learning classroom and project-based curriculum) was implemented at Penn State College of Medicine in 2015. To create an interprofessional environment, participants were selected from various professions and phases of training. The curriculum was anchored in HSS competencies (e.g., high-value care, quality improvement, social determinants of health, health system strategy and delivery) and included 2 distinct threads focused on systems thinking competencies and academic skill development. It featured course speakers and faculty from diverse roles and disciplines both inside and outside the health system, application of HSS competencies in local system contexts, and networking with interprofessional colleagues. From 2015 to 2021, 121 of 128 participants, including physicians, medical students, and nurses, completed the HSS Academy (95% completion rate). Over 90 individuals, including faculty and system leaders, contributed to the HSS Academy as educators. Comparisons of pre-post evaluations demonstrated statistically significant self-perceived improvements in HSS knowledge and skills, systems thinking, and HSS teaching knowledge and skills. Projects (n = 110) most commonly focused on health care delivery, quality improvement, or patient safety. Teaching strategies to meet each objective, several barriers encountered, and strategies to address those barriers are described. Next steps will be to address financial support for creating and sustaining the HSS Academy, ensure a mutually shared understanding of the HSS Academy's goals among all stakeholders, facilitate meaningful change from scholars' work, and provide networking and opportunities for scholars to continue work in HSS after completion of the HSS Academy.

Health insurers' use of quality improvement expenses to achieve a minimum medical loss ratio requirement

AbstractHealth insurer medical loss ratios (MLRs) are the percentage of premium dollar spent on medical claims and healthcare quality improvement expenses (QIEs). QIEs include activities to improve patient health outcomes and safety, reduce medical errors, and prevent hospital readmissions. The Affordable Care Act mandates minimum MLRs in certain health insurance markets lest rebates be paid to policyholders. QIEs are reported in all markets regardless of whether that market is subject to minimum MLR requirements. Using health insurer statutory filings for a sample of group market insurers from 2010 to 2018, we employ a mixed regression discontinuity/regression kink approach to evaluate whether QIEs are used by insurers as a potential strategy for meeting the minimum MLR requirement. We show that health insurers' QIE increase in the loss ratio until meeting the minimum MLR requirement, have a significant discontinuous jump at the threshold, and decrease above the threshold after the introduction of the MLR mandate.

АНАЛИЗ РАБОТЫ С ОБРАЩЕНИЯМИ В СФЕРЕ ОХРАНЫ ЗДОРОВЬЯ ГРАЖДАН НА РЕГИОНАЛЬНОМ УРОВНЕ

Significance. Increasing involvement of patients in quality improvement of health care is a global trend. Appeals of the citizens to the state authorities are the easiest way to protect the rights of the citizens in the field of health care. The increased social activity of the citizens and transparency of the state authorities have determined the increase in the number of complaints and appeals of the citizens to the state authorities and medical organizations regarding provision of medical care. Handling appeals and complaints is a systemic problem of the Russian healthcare. Organization of monitoring over incoming information will make it possible to organize systematic work to protect the rights of the citizens in the field of health care, to improve health care quality and accessibility. The purpose of the study is to analyze organization of activities for handling appeals in public health protection at the regional level in order to develop proposals aimed at improving efficiency of appeals’ handling. Material and Methods. Material: official data of the Ministry of Health of the Chelyabinsk region. Research methods: mathematical and statistical; analytical (quantitative, structural, comparative). Results. A growth trend in the number of public appeals to the health executive authorities both at the federal and regional levels has been identified, including dynamics in the increase in the number of appeals related to the provision of medical care, financing and staff remuneration in medical organizations. Regional features of the structure of public appeals submitted to the Ministry of Health of the Chelyabinsk region have been determined. Results of the analysis of the appeal handling in medical chats in the Telegram messenger in 2022, as part of the “ZdravControl” project implementation have been presented. Conclusion. Results of the analysis of the public appeal handling in the field of public health protection at the regional level substantiate the need for developing a set of organizational measures to improve organization of care delivery in the region, and raising public awareness about their rights in the field of public health protection. Implementation of the “ZdravControl” project will make it possible to reduce the number of appeals submitted by the residents directly to the health executive authorities, as well as distribute the appeals by source and method of receipt.

Suicide in services for mental health and substance use: A national hybrid registry surveillance system.

Suicide is strongly associated with mental health and substance use disorders, which makes mental health- and substance misuse services important areas for suicide prevention. The aim of The Norwegian Surveillance System for Suicide in Mental Health and Substance Use Services is to describe all suicide deaths in Norway that occur within one year after contact with mental health and substance misuse services. The study uses a hybrid registry case series design. It consists of a yearly linkage between the Norwegian Cause of Death Registry and the Norwegian Patient Registry, which is linked with a questionnaire. The linkage is conducted by using a cryptographic hash function of the deceased's personal id, thus ensuring that the project can link data across sources without the use of directly identifiable information. This indirect linkage ensures the deceased's confidentiality. Moreover, the The Norwegian Surveillance System for Suicide shows how administratively collected data can be harnessed and used for surveillance. Both use of hybrid registry designs and linkage through cryptographic hash functions might contribute to the development of health informatics as well as quality improvement in health care.

Relationship Between Patient-Centered Primary Care Provider Communication and Emergency Room Visits in the Medicaid Population in North Carolina, United States.

Medicaid, a joint federal-state program, finances health care for eligible low-income individuals and families in the United States. Medicaid patients use disproportionately more emergency room (ER) services than other patients in the United States. Inadequate provider communication during primary care visits might be one reason for this well-documented phenomenon. The goal of the study was to examine how patient-centered provider communication related to ER use by Medicaid patients in North Carolina. A 2015 state-wide cross-sectional telephone survey of NC adult Medicaid patients (n = 2652) was based on the CAHPS methodology. Predictors were 4 patient-centered provider communication characteristics assessed by patients. The outcome was the number of ER visits during 6 months prior to the survey. We used negative binomial regression to examine the relationship. Effective patient-centered provider communication index was associated with 19% fewer ER visits (P < .05). Provider's respect for patients had the biggest impact on the number of visits (37% fewer ER visits, P < .001). Easy to understand provider explanations were associated with 18% fewer ER visits (P < .05). Longer (>1 year) patient continuity with the current primary care provider was associated with 36% to 38% fewer ER visits (P < .001). Health care quality improvement should focus on training providers how to show respect, give easily understood explanations, and maintain good interpersonal relationships with patients. Relevant agencies should emphasize training and accreditation with a specific emphasis on communication of providers delivering care to Medicaid patients.

Transition readiness measures for adolescents with chronic illness: A scoping review of new measures

BackgroundThe transition from pediatric to adult care settings for adolescents and young adults living with chronic conditions can be challenging and has been associated with declines in health and access to care. Well-validated measures of patients’ transition readiness are critical, both for use in the clinical setting and to rigorously evaluate transition support programs for the purposes of research and health care quality improvement. ObjectivesThis review aimed to build off existing reviews and 1) identify and describe all newly developed and validated measures for the assessment of transition readiness for youth with chronic illness from the period of 2018–2022, and 2) evaluate their measurement properties and identify gaps in measurement testing. MethodsElectronic searches were conducted in MEDLINE, EMBASE, CINAHL and PsychINFO to identify articles developing and validating transition readiness in individuals aged 12–26 years with a chronic illness between 2018 and 2022. Two reviewers independently selected articles for review and assessed quality of measurement properties. Results22 studies met inclusion criteria reporting on 21 different tools. 9 studies reported on the development and evaluation of a new tool, and 13 reported on the adaptation, modification, and/or translation of an existing tool. Most adapted tools were translations and adaptations of the Transition Readiness Assessment Questionnaire (TRAQ) (n = 7). While some of these studies demonstrated sufficient internal consistency and structural validity, few met the COSMIN criteria for reliability and hypothesis testing and none met the criteria for cross-cultural validity. Criterion validity and measurement error were not assessed in any studies. ConclusionMany new transition readiness measures continue to be developed in recent years, yet few have undergone rigorous psychometric evaluation. The TRAQ was the existing measure most often used as a model for developing new or modified tools. There remains a clear need for further validation of existing measures of patients’ readiness to transition as opposed to continuing to develop new measures.

Development of the key performance indicators for digital health interventions: A scoping review.

Digital health interventions offer new methods for delivering healthcare, with the potential to innovate healthcare services. Key performance indicators play a role in the evaluation, measurement, and improvement in healthcare quality and service performance. The aim of this scoping review was to identify current knowledge and evidence surrounding the development of key performance indicators for digital health interventions. A literature search was conducted across ten key databases: AMED - The Allied and Complementary Medicine Database, CINAHL - Complete, Health Source: Nursing/Academic Edition, MEDLINE, APA PsycINFO, EMBASE, EBM Reviews - Cochrane Database of Systematic Reviews, EBM Reviews - Database of Abstracts of Reviews of Effects, EBM Reviews - Health Technology Assessment, and IEEE Xplore. Five references were eligible for the review. Two were articles on original research studies of a specific digital health intervention, and two were overviews of methods for developing digital health interventions (not specific to a single digital health intervention). All the included reports discussed the involvement of stakeholders in developing key performance indicators for digital health interventions. The step of identifying and defining the key performance indicators was completed using various methodologies, but all centred on a form of stakeholder involvement. Potential options for stakeholder involvement for key performance indicator identification include the use of an elicitation framework, a factorial survey approach, or a Delphi study. Few articles were identified, highlighting a significant gap in evidence-based knowledge in this domain. All the included articles discussed the involvement of stakeholders in developing key performance indicators for digital health interventions, which were performed using various methodologies. The articles acknowledged a lack of literature related to key performance indicator development for digital health interventions. To allow comparability between key performance indicator initiatives and facilitate work in the field, further research would be beneficial to develop a common methodology for key performance indicators development for digital health interventions.

Building a Functional Resonance Analysis Method Model: Practical Guidance on Qualitative Data Collection and Analysis

The Functional Resonance Analysis Method (FRAM) is a novel research methodology that uses qualitative data collection methods to map and model complex healthcare processes by identifying and depicting the cumulative activities required to produce an outcome. The FRAM aims to identify the variability that can emerge in a process when healthcare activities are performed under dynamic conditions. With this knowledge, health care system design, safety, and quality improvement recommendations can be developed with a greater understanding of everyday process functionality. Researchers interested in using the FRAM require both an understanding of the methodology itself, as well as an understanding of how to effectively plan and conduct qualitative research. The purpose of this paper is to provide practical guidance to researchers on planning and operationalizing qualitative data collection and analysis methods to inform the building of a FRAM model. A combination of literature and practical experience will be used to examine and suggest appropriate ways for researchers to carry out this work.

The effect of process quality improvement and lean practices on competitive performance in the UAE healthcare industry

The purpose of this paper is to empirically examine a theoretical model which identifies the effect of process quality improvement and lean practices on competitive performance in the healthcare industry in the United Arab Emirates (UAE). The study uses a quantitative research technique with convenient cluster sampling through applying a descriptive, causal and analytical research design. A valid sample size of 270 respondents is used for analysis by linear regression and hypothesis testing using SPSS. The results indicate a direct significant relationship between process quality improvement and a direct significant relationship between lean practices and competitive performance. Given the substantial resources spent and efforts to improve healthcare quality, the absence of studies demonstrating the impact of quality-related operations and activities would require future research. Hospitals in one city in UAE have access that limits the research results. It is recommended that future research assess more variables dependency on the healthcare sector that can affect increase competitiveness. The research provides some managerial implications that could help hospital managerial members improve their healthcare delivery system's leanness and quality improvement to get competitiveness. Quality improvement and lean practices help increase competitive performance and can assist the healthcare sector in providing better service using these practices that have never been considered in research.

Assessment of Implementation of the Star Rating System in Primary Health Facilities: Experience from Tanzania

Introduction: The Star Rating Assessment (SRA) system was established by the Tanzanian government as a method to improve the quality of healthcare. To identify factors influencing SRA implementation, we looked at the deployment of SRA Systems in Kibaha Town and Rufiji District Councils. Methods: To comprehend the experiences of distinct healthcare professionals and Quality Improvement Teams (QITs) on implementation of SRA, we used a descriptive cross-sectional study methodology. Focus Group Discussions (FGDs) and in-depth interviews (IDIs) were used to gather data, which was then evaluated using qualitative content analysis. Results: According to the study’s findings, the majority of group discussion participants were not aware of the SRA system, the QIT members were unaware of their responsibilities for implementing Quality Improvement Plans (QIPs), and the Council Health Management Teams (CHMT) members were not including QIP follow-up in their quarterly supportive supervisions. Shortage of staff, financial resources, insufficient staff training on the SRA system, and insufficient support from CHMT were among the stated difficulties experienced during the deployment of the SRA system. Discussion: The provision of high-quality healthcare in the study sites has improved as a result of the introduction of the SRA system. Nonetheless, there is a need to support healthcare facilities during implementation and provide them with greater training on the standards assessed by SRA.

Relationships of Job Satisfaction and Caring Behaviors among Nurses Working in Inpatient Wards in Indonesia

Nurse job satisfaction must be adequately managed to improve working performance, particularly in applying caring behavior in nursing services. Caring behavior is an essential and fundamental component of the nursing profession. It can affect the quality of health services by increasing patient satisfaction, patient recovery processes, and hospital revenue. This study aimed to determine the relationship between job satisfaction and caring behavior among hospital nurses in Banda Aceh. This cross-sectional study was conducted in a public hospital for two weeks in December 2022 and involved 173 nurses selected using the total sampling technique. The Caring Behavior Inventory-24 (CBI-24) questionnaire and the Job Satisfaction Survey (JSS) were used to collect data. The Chi-square test showed a relationship between job satisfaction and nurses’ caring behavior (p=0.001). It can be concluded that job satisfaction influences nurses’ caring behavior, which impacts improving health care quality.

Characteristics of unintentional injuries in hospitalised children and adolescents - national retrospective study

Introduction/Objective. Unintentional injuries is a global health issue among children and adolescents. The aim of this study was to examine the characteristics of unintentional injuries divided according to different age groups and sex among the children and adolescents who have been hospitalized in public hospitals of the Republic of Srpska, Bosnia and Herzegovina. Methods. A retrospective analysis of the e-base of the Agency for Certification, Accreditation and Health Care Quality Improvement of the Republic of Srpska data were collected from 10 public hospitals for patients aged ? 19 years, who have been hospitalized for unintentional injuries in the period of January 2018 and December 2020. Results. The study identified 1336 patients who were hospitalized for unintentional injuries, most of whom were boys (67.4%). Falls were the most frequent cause of hospitalization in children of all age categories (aged 1 (70.6%), 1?4 (59.1%), 5?9 (68.5%)) and adolescents aged 10?14 (64.1%), while road traffic injuries were the leading cause of hospitalization in adolescents aged 15?19 (62.6%). The cause of injury for the hospitalized patients were significantly related to age (p &lt; 0.001) and sex (p &lt; 0.05) groups. According to the nature of the injury in relation to the area of the body, the most frequent injuries were to the head (41.1%), caused by traffic accidents and falls. Conclusion. Since falls and road traffic injuries were the leading causes of hospitalization, preventive measures should be taken to reduce the frequency of these injuries.

Evaluation of the ICD-10 system in coding revascularisation procedures in patients with peripheral arterial disease in England: A retrospective cohort study using national administrative and clinical databases.

Many studies evaluating care in hospitals in England use the Hospital Episode Statistics (HES) administrative database. The aim of this study was to explore whether the International Classification of Diseases 10th Revision (ICD-10) system used by HES supported the evaluation of care received by patients with peripheral arterial disease (PAD) who had revascularisation. This retrospective cohort study used records on patients who had revascularisation for PAD between 1st January 2017 and 31st December 2019 in England, collected prospectively in the National Vascular Registry (NVR) and linked to HES. Patients were excluded if their NVR record did not have a match in HES, due to lack of consent or different admission and procedure dates. Agreement between different presentations of PAD recorded in the NVR and the ICD-10 diagnostic codes recorded in HES was evaluated using the unweighted Kappa statistic and sensitivity and specificity. Agreement between the NVR and HES was also assessed for gender, age, comorbidities, mode of admission, and procedure type and side. In total, 20,603 patients who had 24,621 admissions were included in the study. Agreement between NVR and HES on patient gender (Kappa=0.98), age (Kappa=0.98), mode of admission (Kappa=0.80), and procedure type and side (Kappa=0.92 and 0.87, respectively) was excellent. When all diagnostic fields in HES were explored, substantial agreement was observed for chronic ischaemia with tissue loss (Kappa=0.63), but it was lower for chronic ischaemia without tissue loss (Kappa=0.32) and acute limb ischaemia (Kappa=0.15). Agreement on comorbidities was mixed; excellent for diabetes (Kappa=0.82), moderate for chronic lung disease (Kappa=0.56), chronic kidney disease (Kappa=0.56), and ischaemic heart disease (Kappa=0.45) and fair for chronic heart failure (Kappa=0.35). The diagnostic ICD-10 codes currently used in HES cannot accurately differentiate between stages of PAD. Therefore, studies using HES to examine patterns of care and outcomes for patients with PAD are likely to suffer from misclassification bias. Adopting an extended ICD-10 system or the ICD-11 version released to the World Health Organisation member states in 2022, may overcome this problem. Healthcare Quality Improvement Partnership (HQIP).

Surfacing the causal assumptions and active ingredients of healthcare quality improvement interventions: An application to primary care opioid prescribing.

Efforts to maximize the impact of healthcare improvement interventions are hampered when intervention components are not well defined or described, precluding the ability to understand how and why interventions are expected to work. We partnered with two organizations delivering province-wide quality improvement interventions to establish how they envisaged their interventions lead to change (their underlying causal assumptions) and to identify active ingredients (behavior change techniques [BCTs]). The interventions assessed were an audit and feedback report and an academic detailing program. Both focused on supporting safer opioid prescribing in primary care in Ontario, Canada. Data collection involved semi-structured interviews with intervention developers (n = 8) and a content analysis of intervention documents. Analyses unpacked and articulated how the interventions were intended to achieve change and how this was operationalized. Developers anticipated that the feedback report would provide physicians with a clear understanding of their own prescribing patterns in comparison to others. In the feedback report, we found an emphasis on BCTs consistent with that assumption (feedback on behavior; social comparison). The detailing was designed to provide tailored support to enable physicians to overcome barriers to change and to gradually enact specific practice changes for patients based on improved communication. In the detailing materials, we found an emphasis on instructions on how to perform the behavior, for a range of behaviors (e.g., tapering opioids, treating opioid use disorder). The materials were supplemented by detailer-enacted BCTs (e.g., social support [practical]; goal setting [behavior]; review behavioral goal[s]). The interventions included a small range of BCTs addressing various clinical behaviors. This work provides a methodological example of how to apply a behavioral lens to surface the active ingredients, target clinical behaviors, and causal assumptions of existing large-scale improvement interventions that could be applied in other contexts to optimize effectiveness and facilitate scale and spread.

Vision Screening in Older Adults Admitted with a Fragility Hip Fracture: A Healthcare Quality Improvement Report.

This healthcare quality improvement report focussed on the effectiveness of an orthoptic-led inpatient vision screening service at Nottingham University Hospitals for older adults admitted with a fragility hip fracture. The service was developed in response to national guidance, which recommended a multifactorial assessment, including a vision assessment for older adults presenting following a fall. Vision screening was carried out by orthoptists on eligible patients ≥65 years of age admitted to the trauma and orthopaedic wards with a hip fracture. Retrospective data for patients screened between 2015-2019 were analysed, including: patient demographics; screening eligibility and outcome; ophthalmology referrals made; ophthalmology appointment attendance; and outcome. Of the 3321 patients admitted with a hip fracture between 2015-2019, 2033 (61%) were eligible for vision screening and 1532 (75%) of these were screened. Furthermore, 784 (51%) of the patients screened had an ocular abnormality requiring an ophthalmology referral, or a sight test at an optician. Only 144 of the 383 (38%) who required an ophthalmology referral via the GP were successfully referred, and only 107 of the 186 (58%) patients who were given appointments attended them. Additionally, 98 of 107 had pathology, with cataracts the most common finding (51%), and 61 of 98 (62%) patients had treatable vision impairment. We found a large proportion of fragility hip fracture patients with impaired vision, much of which was treatable and could be detected effectively with orthoptic-led bedside screening. The most common eye problem in those referred to ophthalmology was cataracts. An internal referral pathway to ophthalmology is proposed. There is a need to investigate reasons for disengagement with eye care services in this population.

The evaluation of the Plan-Do-Study-Act cycles for a healthcare quality improvement intervention in primary care.

The Plan-Do-Study-Act (PDSA) cycle is an iterative framework that has been gaining traction in primary care for quality improvement. However, its implementation remains understudied. This study evaluated the completion, achievement of goal, content quality, and enablers and barriers associated with completion of high-quality PDSA cycles in cardiovascular disease management in general practices. This study analysed data from intervention practices of the QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living people with coronary heart disease (QUEL) study. Content quality of cycles was assessed using a scoring system created based on established criteria of ideal PDSA cycles in the healthcare context. Practice-level factors associated with completion and cycles achieving the planned goal were explored through logistic regression models, and with content quality score through linear regression model. Enablers and barriers were assessed using thematic analysis of practices' responses to the PDSA sections. Ninety-seven cycles were reported by 18/26 (69%) practices. Seventy-seven percent of the cycles were completed and 68% achieved the planned goal. Content quality was low, with a median score of 56% (interquartile interval: 44%, 67%). Odds of cycles that were completed and achieved what was planned increased by 3.6- and 9.6-fold, respectively, with more general practitioners (GPs) within practices. Content quality was higher by 15% with more GPs. Lack of interprofessional engagement was a barrier to implementation. Cycles were well completed, but poor in content quality, with high variability between practices. Human or capital resources and organisational support may be critical for the completion and cycles achieving the planned goals.

IMPROVEMENT OF THE MEDICAL CARE QUALITY MANAGEMENT MODEL BASED ON THE INTERNAL AUDIT MECHANISM IN THE HEALTHCARE FACILITY

Introduction. Internal audit aims to improve the processes and outcomes of medical services by systematically reviewing the components of medical care in terms of certain criteria and implementing changes where the service does not reach the expected level. Severization of requirements for HCF service quality and increasing competition in HCFs require the elaboration and implementation of dynamic continuous internal mechanisms, which will contribute to healthcare quality improvement, professional development of medical personnel, and the increased satisfaction of medical service consumers. Objective: Elaboration of a medical and social internal audit mechanism in order to improve medical care quality at the level of a healthcare facility. Materials and Methods. We used system analysis, meta-analysis, descriptive modeling, medical and sociological survey, statistical analysis, and logical generalization in the study. Data collection methods were: a survey and copying of data from the primary accounting and reporting documents. Results. The study involved 226 patients with chronic noncommunicable diseases who were followed up at Sumy HCFs. The correspondence between the actual data in the outpatient medical records with the protocol’s quality indicators was assessed. Internal audit of the subjects’ satisfaction with medical services showed that they were sufficiently aware of the disease course, complication prevention, and the risks of non-compliance – 97% of patients confirmed that they received detailed information from their physician; however, they did not comply with the doctor's recommendations or complied poorly. Conclusions. We registered subjects’ poor compliance and unsatisfactory attitude towards the follow-up procedure. The development and implementation of the medical and social mechanism of internal audit contributed to the practical adoption of a management decision to ensure the continuous improvement of medical care quality for patients with chronic noncommunicable diseases, namely additional behavioral approaches to increase the level of patients’ compliance with the doctor's recommendations and their active involvement in follow-up control.