Health Service Quality Improvement Research Articles

Adherence to treatment in pulmonary tuberculosis: Rodgers' evolutionary concept analysis.

Adherence to treatment is essential for the management of pulmonary tuberculosis. Nurses and healthcare professionals play a significant role in promoting adherence behavior among this population. Nevertheless, defining adherence to treatment within this particular population remains complex. This study aimed to explore and clarify the concept of adherence to treatment among individuals with pulmonary tuberculosis. Rodgers' evolutionary concept analysis was employed in this study. A literature search was conducted in the PubMed and Scopus databases to identify relevant studies published between July 2013 and July 2023. The attributes of adherence to treatment in pulmonary tuberculosis consist of multiple components: biological, individual, social, health service, and policy-making processes. Antecedents include various patient-related factors as well as factors associated with clinical conditions and patient-health professional engagement. Three consequences of the concept have emerged: enhanced treatment efficacy, increased commitment to tuberculosis treatment adherence, and improved health service quality. This study provides a comprehensive operational definition of adherence to tuberculosis treatment, including its attributes, antecedents, and consequences. This framework will assist nurses in evaluating adherence more effectively. However, further research into the experiences of individuals adhering to tuberculosis treatment is needed to confirm and enhance these strategies.

Applying models of co-production in the context of health and well-being. A narrative review to guide future practice.

Recent years have seen a dramatic growth in interest in the nature and extent of co-production in the health and social care sectors. Due to the proliferation of work on co-production, there is variation in practice in how co-production is defined, understood, and used in practice. We conducted a narrative review to explore, and provide an overview of, which models of health and social care co-production have been developed, applied, and critiqued over recent decades. Seventy-three peer-reviewed articles met our inclusion criteria. In this set of articles, we identified three broad types of models: conceptual/theoretical, practice-oriented, and presenting a typology. We found that practice-oriented models, predominantly from the Health Services Research and Quality Improvement literature, had largely not drawn on conceptual/theoretical models from the disciplinary fields of Public Administration & Management and Sociology. In particular, they have largely neglected theoretical perspectives on relationships and power and agency in co-production work. The concepts of Service-Dominant Logic and Public Service-Dominant Logic as ways to think about the joint, collaborative process of producing new value, particularly in the context of the use of a service, have also been neglected. Our review has identified distinct literatures which have contributed a variety of models of health and social care co-production. Our findings highlight under-explored dimensions of co-production that merit greater attention in the health and social care contexts. The overview of models of co-production we provide aims to offer a useful platform for the integration of different perspectives on co-production in future research and practice in health and social care.

Interventions to improve system-level coproduction in the Cystic Fibrosis Learning Network

BackgroundCoproduction is defined as patients and clinicians collaborating equally and reciprocally in healthcare and is a crucial concept for quality improvement (QI) of health services. Learning Health Networks (LHNs) provide...

Talking about borderline personality disorder, shaping care: The multiple doings of narratives.

This article focuses on the narratives that circulate about borderline personality disorder (BPD) in health-care settings in Australia and the effects such narratives can have on how people practice and seek out care. People with a BPD diagnosis frequently access health-care services, often encountering stigma and discrimination. Drawing on narrative theory, we critically unpack the circulation and capacities of BPD narratives and the ways they can often contribute to poor and troubling experiences. This article is based on qualitative interviews with people living with a BPD diagnosis, as well as health practitioners who work with people with a BPD diagnosis. Our findings identified insidious and powerful BPD narratives that circulate in health-care settings, particularly in short-term, acute, or non-specialist contexts, such as emergency departments and in-patient units. These narratives influenced the ways that participants both practiced and sought out care. To improve health service quality for people with a BPD diagnosis, or those experiencing mental distress, it is important to challenge the sociocultural-political norms and relations that can influence approaches to care and practice. Disrupting and reframing negative BPD narratives and raising awareness about the impact of stories that are told about BPD have the potential to generate social change.

Young people’s experiences of being involved in quality improvement of youth mental health services

BackgroundThere is a worldwide concern regarding young people’s mental health and the complexities of designing mental health services to meet these challenges. By integrating user knowledge in the design of mental health services, the services will be better suited to meet the distinctive requirements of youth, as well as uphold their entitlement to participate and influence. This study delves into the viewpoints of young people with experience from mental health services, exploring their perceived advantages and challenges related to their involvement in the enhancement of mental health services’ quality.MethodsA qualitative study with in-depth interviews and thematic analysis were conducted. Ten young, experienced users participated in the study.ResultsYouth user involvement in quality improvement of mental health services yielded notable benefits experienced as fostering personal recovery. Simultaneously, this involvement entailed challenging responsibilities. The participants experienced challenges associated with navigating their memories and expressing concern for their peers. The success of user involvement was closely associated with open-minded cooperative healthcare professionals, facilitation within the services, and provision of support for the young participants.ConclusionsThis study elucidates perceived benefits and challenges related to user involvement at an organizational level. It identifies pivotal conditions to success and underscores the value of incorporating user experience in the improvement of services, not only to create services tailored to the needs of youth but also to instill a positive self-identity and empower those participating. Recognizing the value of experienced users in quality improvement of the services will promote development of youth-friendly services.

AI-Based Forecasting Models' Outcomes for Improving Health Service Quality

AI-Based Forecasting Models' Outcomes for Improving Health Service Quality

Essential health services delivery and quality improvement actions under drought and food insecurity emergency in north-east Uganda

BackgroundEssential health services can be disrupted due to several naturally occurring public health emergencies such as drought, flood, earthquake and outbreak of infectious diseases. However, little evidence exists on the status of essential health services delivery under the effect of drought and food insecurity. North-east Uganda is severely affected by prolonged drought that significantly affected the livelihood of the residents. Therefore, we aimed to determine the current status of essential health services and quality improvement (QI) actions in health facilities in north-east Uganda.MethodsWe used a descriptive cross-sectional study design to assess the availability of essential health service and quality improvement activities in drought and food insecurity affected districts of north-east Uganda. We included a total of 150 health facilities from 15 districts with proportionated multistage sampling method. We interviewed health facilities’ managers and services focal persons using structured questionnaire and observation checklist. We used a descriptive statistic to analyze the data with SPSS version 22.ResultsA few health facilities (8.7%) had mental health specialist. There was also lack of capacity building training on essential health services. Considerable proportion of health facilities had no non-communicable diseases (38.3%), mental health (47.0%), and basic emergency obstetric care (40.3%) services. Stock out of essential medicines were observed in 20% of health facilities. There was lack of supportive supervision, and poor documentation of QI activities.ConclusionEssential health service and QI were suboptimal in drought and food insecure emergency affected districts. Human resource deployment (especially mental health specialist), provision of capacity building training, improving non-communicable diseases, mental health and basic emergency obstetric care services are required to improve availability of essential health services. Supporting supply chain management to minimize stock out of medicines, and promoting QI activities are also vital to assure quality of health service in drought and food insecurity affected districts in north-Eastern Uganda.

Adjusting for Congenital Heart Surgery Risk Using Administrative Data.

Congenital heart surgery (CHS) encompasses a heterogeneous population of patients and surgeries. Risk standardization models that adjust for patient and procedural characteristics can allow for collective study of these disparate patients and procedures. We sought to develop a risk-adjustment model for CHS using the newly developed Risk Stratification for Congenital Heart Surgery for ICD-10 Administrative Data (RACHS-2) methodology. Within the Kids' Inpatient Database 2019, we identified all CHSs that could be assigned a RACHS-2 score. Hierarchical logistic regression (clustered on hospital) was used to identify patient and procedural characteristics associated with in-hospital mortality. Model validation was performed using data from 24 State Inpatient Databases during2017. Of 5,902,538 total weighted hospital discharges in the Kids' Inpatient Database 2019, 22,310 pediatric cardiac surgeries were identified and assigned a RACHS-2 score. In-hospital mortality occurred in 543 (2.4%) of cases. Using only RACHS-2, the mortality mode had a C-statistic of 0.81 that improved to 0.83 with the addition of age. A final multivariable model inclusive of RACHS-2, age, payer, and presence of a complex chronic condition outside of congenital heart disease further improved model discrimination to 0.87 (P< 0.001). Discrimination in the validation cohort was also very good with a C-statistic of 0.83. We created and validated a risk-adjustment model for CHS that accounts for patient and procedural characteristics associated with in-hospital mortality available in administrative data, including the newly developed RACHS-2. Our risk model will be critical for use in health services research and quality improvement initiatives.

Assistance of Health Personnel in The Implementation of Calibration Results in Public Hospitals Dr. Iskak Tulungagung

Optimal quality of health services depends on the accuracy of medical devices. In an effort to improve quality standards, Dr. General Hospital Iskak Tulungagung implements a program to assist health workers in understanding and applying the results of medical device calibration. This research aims to increase health workers' knowledge about calibration, strengthen patient confidence, and improve the accuracy of diagnosis and treatment. This research contributes to improving the competency of health workers and increasing patient satisfaction through assistance in implementing calibration results. This contribution is important in building public trust in health services. The mentoring program involves regular counseling, practical workshops, skills training, as well as individual mentoring by a team of calibration experts. A feedback system is also implemented for continuous evaluation and improvement. This research shows a significant increase in health workers' understanding of medical device calibration. Patients report higher levels of satisfaction with services provided by healthcare professionals who use calibrated devices. This mentoring program was successful in increasing health workers' understanding of calibration, building patient trust, and increasing the accuracy of diagnosis and treatment. This success indicates the importance of assistance in the context of implementing calibration results in hospitals. The results of this research have positive implications for improving health service quality standards. These implications extend to the health education sector and clinical practice, strengthening evidence-based practice and increasing public trust in the health system. Thus, the mentoring program becomes a viable model for improving the quality of health services in hospitals and other health institutions

Developing E-Health Kia as an Innovation on Maternal and Child Health Services Based on Android Application for Quality Improvement of Health Services in Indonesia

Purpose: The objective of this research was to develop KIA E-Health, as a novelty, in maternal health services based on the Android application to improve the quality of Indonesian health services. Theoretical Framework: The main activities of the SSM are the main actions to implement the SSM's health efforts, while other main activities are aimed at improving the objectives of the main SSM activities. Method: The method used in this research was the SDLC (Software Development Life Cycle), a cycle used for the creation or development of information systems, with the aim of solving problems effectively, the development of the selected system is the waterfall method. Results and conclusions: They saw that the application of E-Health KIA is the validity of the experts, that is, the value of the participants and nurses. In the app display indicator, you saw a good image of 27 people (90%) in the app operating indicator, and the OS reached 20 people (66%) in the app material presentation indicator, in which 28 people were suitable, or in the app language usage indicators, all respondents indicated that it was easily understood. Research Implications: Healthcare personnel must innovate in the service to improve the quality of excellent service, meet the needs and expectations of patients. Originality/value: It is important to innovate in health services, including maternal health (HCM), to improve the quality of service, with the aim of achieving patient satisfaction. Kia E-Health is one of the technology-based services to improve the quality of services.

Facilitators for and Barriers to the Implementation of Performance Accountability Mechanisms for Quality Improvement in the Delivery of Maternal Health Services in a District Hospital in Pwani Region, Tanzania.

Tanzania experiences a burden of maternal mortality and morbidity. Despite the efforts to institute accountability mechanisms, little is known about quality improvement in the delivery of maternal health services. This study aimed at exploring barriers and facilitators to enforcing performance accountability mechanisms for quality improvement in maternal health services. A case study design was used to conduct semi-structured interviews with thirteen key informants. Data were analyzed using thematic analyses. The findings were linked to two main performance accountability mechanisms: maternal and perinatal death reviews (MPDRs) and monitoring and evaluation (M&E). Prioritization of the maternal health agenda by the government and the presence of maternal death review committees were the main facilitators for MPDRs, while negligence, inadequate follow-up, poor record-keeping, and delays were the main barriers facing MPDRs. M&E was facilitated by the availability of health management information systems, day-to-day ward rounds, online ordering of medicines, and the use of biometrics. Non-use of data for decision-making, supervision being performed on an ad hoc basis, and inadequate health workforce were the main barriers to M&E. The findings underscore that barriers to the performance accountability mechanisms are systemic and account for limited effectiveness in the improvement of quality of care.

Behaviour change, the itchy spot of healthcare quality improvement: How can psychology theory and skills help to scratch the itch?

Despite the clear utility and transferability, National Health Service (NHS) quality improvement initiatives have yet to benefit fully from what is already known within health psychology. Thus far, evidence from established, seminal behaviour change theory and practice have been ignored in favour of newly developed models and frameworks. Further, whilst there is a growing interest in what is commonly referred to as 'human factors' of change and improvement, there is scant transferability of known psychologically informed implementation skills into routine NHS Improvement practice. The science and practice of healthcare improvement is growing, and the behaviour change aspect is critical to sustainable outcomes. Therefore, this paper offers practical guidance on how seminal psychological behaviour change theory and motivational interviewing (a person-centred skills-based approach specifically developed to support people through change) can be combined to better address individual and organisational change within a healthcare improvement context.

A Primary Care Mental Health Pathway for Children and Youth: A Mental Health Services Quality Improvement Initiative in Ontario

We introduce the innovative components of a primary care pathway for child and youth mental health (MH) in Ontario. We share our experiences with developing and implementing the pathway that supports inter-provider communication, standardized screening, timely access to community MH services, and is adaptable to different services and settings.

Barriers to the Utilization of Primary Health Centers (PHCs) in Iraq

Primary care has been viewed as a means to ensure equitable access to care, enhance efficiency within healthcare systems, and improve health service quality. In recent decades, Iraq has transformed its compromised health system, shifting the healthcare model from hospital-based to primary care through primary health centers (PHCs) and referral mechanisms. Based on an extensive literature review, this qualitative paper explores the healthcare utilization of PHCs in different regions of Iraq. It also identifies some barriers to PHC use and recommends evidence-based approaches for improving PHCs' performance. Some reported challenges to better utilizing PHCs were the poor quality of services, patient dissatisfaction, long walking distance to a health center, and limited availability and affordability of the medications. If Iraq is to use primary care as a tool in achieving sustainable development goals (SDGs), collaborative efforts addressing the facility-related factors should be a priority.

Contribution of Results-Based Financing in Quality Improvement of Health Services at Primary Healthcare Facilities: Findings from Tanzania Star Rating Assessment

Background: Performance-based financing (PBF) is an important mechanism for improving the quality of health services in low- and middle- income countries. In 2014, Tanzania launched a countrywide quality approach known as Star Rating Assessment (SRA) which aims to assess the quality of healthcare service delivery in all Primary Health Care (PHC) Facilities in the country. Furthermore, by 2018 (2015-2018), the country rolled out RBF initiatives into eight regions in which PHC facilities were paid incentives based on their level of achievement in SRA assessments. This study aims to compare performance in quality between PHC facilities under RBF regions and non-RBF regions using the findings from the twophases SRA assessments; baseline (2015/16) and follow-up (2017/18). Methods: Analysis of performance of SRA indicators in the SRA service areas were identified based on the star rating tool that was used. The star rating tool had 12 service areas. For the sake of this implementation study, only seven service areas were included. The purposive sampling of the areas was used to select the areas that had direct influence of RBF in health facilities improvement. We used a t-test to determine whether there were differences in assessment star rating scores between the regions that implemented RBF and those, which did not at each assessment (both baseline and reassessment). All results were considered significant at p&lt;0.05. The 95% Confidence Interval was also reported. Results: The mean value was found to be 61.26 among facilities exposed to RBF compared to 51.28 among those not exposed to RBF. The study showed the mean difference score to be 10.79, with a confidence interval at 95% to be -1.24 to 22.84, suggesting that there was (no) a significant difference in the facilities based on RBF exposure during baseline assessment. The p-value of 0.07 was not statistically significant. Overall, there was an increment in facilities scoring the recommended 3+stars and above by 17.39% between the assessments, the difference was significant (p=0.0001). When the regions were stratified based on RBF intervention; facilities under RBF improved in 3+ stars by 10.63% higher compared to those that were not under RBF; however, the difference was not statistically significant (p=0.06) Conclusion: Improvement of Health services needs to adhere to all six WHO building blocks and not to a sole financing. The six WHO building blocks are 1. Service delivery 2. Health workforce 3. Health information systems 4. Access to essential medicines 5. Financing 6. Leadership/governance. Probably, RBF found not to influence star rating because other blocks were not considered in this intervention. We need to integrate all the six WHO building blocks whenever we want to improve health services provision.

EHealth literacy and its associated factors in Ethiopia: Systematic review and meta-analysis.

Electronic health has the potential benefit to the health system by improving health service quality efficiency effectiveness and reducing the cost of care. Having good e-health literacy level is considered essential for improving healthcare delivery and quality of care as well as empowers caregivers and patients to influence control care decisions. Many studies have done on eHealth literacy and its determinants among adults, however, inconsistent findings from those studies were found. Therefore, this study was conducted to determine the pooled magnitude of eHealth literacy and to identify associated factors among adults in Ethiopia through systematic review and meta-analysis. Search of PubMed, Scopus, and web of science, and Google Scholar was conducted to find out relevant articles published from January 2028 to 2022. The Newcastle-Ottawa scale tool was used to assess the quality of included studies. Two reviewers extracted the data independently by using standard extraction formats and exported in to Stata version11 for meta-analysis. The degree of heterogeneity between studies was measured using I2 statistics. The publication bias between studies also checked by using egger test. The pooled magnitude of eHealth literacy was performed using fixed effect model. After go through 138 studies, five studies with total participants of 1758 were included in this systematic review and Meta-analysis. The pooled estimate of eHealth literacy in Ethiopia was found 59.39% (95%CI: 47.10-71.68). Perceived usefulness (AOR = 2.46; 95% CI: 1.36, 3.12),educational status(AOR = 2.28; 95% CI: 1.11, 4.68), internet access (AOR = 2.35; 95% CI: 1.67, 3.30), knowledge on electronic health information sources(AOR = 2.60; 95% CI: 1.78, 3.78), electronic health information sources utilization (AOR = 2.55; 95%CI: 1.85, 3.52), gender (AOR = 1.82; 95% CI: 1.38, 2.41) were identified significant predictors of e-health literacy. This systematic review and meta-analysis found that more than half of study participants were eHealth literate. This finding recommends that creating awareness about importance of eHealth usefulness and capacity building to enhance and encouraging to use electronic sources and availability of internet has para amount to solution to increase eHealth literacy level of study participants.

Emergency health surge support: Lessons learned from a review of Red Cross responses, 2015-2019.

The nature of humanitarian response has evolved in response to increasing humanitarian needs, number and scale of emergencies, and the expansion of certified Emergency Medical Teams. This research examines the International Federation of Red Cross and Red Crescent Societies' clinical and public health Emergency Response Units in emergencies from 2015 through 2019 using a mixed methods approach, consisting of a desk review and primary qualitative data, to inform prioritization of response activities and optimization of health surge support in emergencies. Identified opportunities for improvement include needs assessment, increased modularity, context-appropriate support/integration, human resources and capacity building, monitoring and evaluation, and the overall nature of health surge response to various emergency types. Greater focus on public health response; standardizing deployment criteria, standard operating procedures, and monitoring for clinical surge support; and regional and local capacity building could all improve health service quality and sustainability and facilitate more cost-effective emergency response.

Assessing the service quality at health service facilities during the COVID-19 pandemic in North Buton District, Indonesia

Background: The degree of quality health is greatly influenced by existing health services. Thus, assessing the service quality during the COVID-19 pandemic is necessary. Objective: This study aimed to describe the quality of services in health service facilities in North Buton District during the pandemic. Method: A descriptive survey research was conducted in 2021. A total of 400 respondents were selected using accidental sampling. Data were analyzed using descriptive statistics and presented in the form of frequency distribution tables and narratives. Results: The quality of service (tangible, reliability, responsiveness, assurance, and empathy) was sufficient. Changes in the quality of health services were more likely related to changes in service flow and operating hours. However, although the service quality was adequate, some respondents (8% to 12%) complained about unavailability of hand sanitizer in the waiting room, inadequate detailed information related to COVID-19, slow registration process, lack of medical personnel, and less friendly healthcare workers. Conclusion: This study may serve as input for health policymakers and hospital and public health center managers to improve health service quality.

Special care in dental curriculum: A transversal axis for integrating oral health with systemic health.

Distance between dentistry and medicine is a traditional and historical obstacle that affects multiple levels of the health system, especially the health policies to improve health service quality. Changes in dental education, especially involving the adoption of integrative health models in professional development, are considered essential for reducing this gap. We aimed to show a dental curriculum focused on special care as a tool for medicine-dentistry integration. In this study, we present a new proposal for an undergraduate dental curriculum in which topics related to special care are addressed transversally and are the core for interdisciplinary integration of oral health with systemic health. We also describe how themes related to dental home care and hospital dentistry were included in this course as basic professional competencies. This initiative is aligned with the global trend to adopt educational systems that contribute to the reduction of health care inequalities and improve health service quality.

COVID-19 Mortality Characteristics During First to Third Pandemic Wave in Malang

Background: The epidemic of SARS-CoV-2 has spread worldwide for about one and half years, including in Indonesia, with several peaks in cases and mortality rates. A descriptive pattern of Covid 19 inpatients in Saiful Anwar General Hospital Malang needed to improve health service quality and reduce mortality rates. &#x0D; Aim: Determine the descriptive pattern of inpatients Covid 19 in the internal medicine ward in Saiful Anwar General Hospital from March 2020 until February 2022.&#x0D; Methods: This descriptive study was conducted from March 2020 to July 2021 and used convenience sampling due to sample availability. A total of 137 hospitalized patients in December 2020, 387 in July 2021, and 113 in February 2022 patients were included with information about age, sex, medical diagnosis, comorbid, and outcome, which was obtained from medical records. Descriptive analysis was used to explore frequency distribution and analysis.&#x0D; Results: We found several factors associated with the frequency of SARS-CoV-2 cases. Overall, these results emphasize the role of comorbidity as a possible driver of the COVID‑19 case fatality rate.&#x0D; Conclusion: In the three waves of Covid 19 in Indonesia, the highest case fatality rate was during the Delta variant in July 2021, where more factors significantly affected case mortality.