Healthcare Performance Indicators Research Articles

Leadership support and satisfaction of healthcare professionals in China’s leading hospitals: a cross-sectional study

BackgroundHealthcare professionals’ job satisfaction is a critical indicator of healthcare performance, pivotal in addressing challenges such as hospital quality outcomes, patient satisfaction, and staff retention rates. Existing evidence underscores the significant influence of healthcare leadership on job satisfaction. Our study aims to assess the impact of leadership support on the satisfaction of healthcare professionals, including physicians, nurses, and administrative staff, in China’s leading hospitals.MethodsA cross-sectional survey study was conducted on healthcare professionals in three leading hospitals in China from July to December 2021. These hospitals represent three regions in China with varying levels of social and economic development, one in the eastern region, one in the central region, and the third in the western region. Within each hospital, we employed a convenience sampling method to conduct a questionnaire survey involving 487 healthcare professionals. We assessed perceived leadership support across five dimensions: resource support, environmental support, decision support, research support, and innovation encouragement. Simultaneously, we measured satisfaction using the MSQ among healthcare professionals.ResultsThe overall satisfaction rate among surveyed healthcare professionals was 74.33%. Our study revealed significant support from senior leadership in hospitals for encouraging research (96.92%), inspiring innovation (96.30%), and fostering a positive work environment (93.63%). However, lower levels of support were perceived in decision-making (81.72%) and resource allocation (80.08%). Using binary logistic regression with satisfaction as the dependent variable and healthcare professionals’ perceived leadership support, hospital origin, job role, department, gender, age, education level, and professional designation as independent variables, the results indicated that support in resource provision (OR: 4.312, 95% CI: 2.412 ∼ 7.710) and environmental facilitation (OR: 4.052, 95% CI: 1.134 ∼ 14.471) significantly enhances healthcare personnel satisfaction.ConclusionThe findings underscore the critical role of leadership support in enhancing job satisfaction among healthcare professionals. For hospital administrators and policymakers, the study highlights the need to focus on three key dimensions: providing adequate resources, creating a supportive environment, and involving healthcare professionals in decision-making processes.

Sustainable Approach to Justice, Equity, Diversity, and Inclusion Through Better Quality Measurement.

The US health care industry has broadly adopted performance and quality measures that are extracted from electronic health records and connected to payment incentives that hope to improve declining life expectancy and health status and reduce costs. While the development of a quality measurement infrastructure based on electronic health record data was an important first step in addressing US health outcomes, these metrics, reflecting the average performance across diverse populations, do not adequately adjust for population demographic differences, social determinants of health, or ecosystem vulnerability. Like society as a whole, health care must confront the powerful impact that social determinants of health, race, ethnicity, and other demographic variations have on key health care performance indicators and quality metrics. Tools that are currently available to capture and report the health status of Americans lack the granularity, complexity, and standardization needed to improve health and address disparities at the local level. In this article, we discuss the current and future state of electronic clinical quality measures through a lens of equity.

MEDICAL AND SOCIAL REASONING FOR IMPROVING THE ORGANISATION OF PREVENTING AND FIGHTING SKIN CANCER IN THE CONDITIONS OF THE PUBLIC HEALTH SYSTEM DEVELOPMENT

Introduction. Scientific reasoning for improving the organisation of cancer prevention and the providing onco-dermatological care to the population in the conditions of the public health system development.
 Materials and methods. The article includes the method of system approach as well as bibliosemantic, epidemiological, medical and statistical, sociological, expert assessment, content analysis, structural and logical analysis, modelling methods. Sources of information are the data from scientific literature, the Center for Medical Statistics of the Ministry of Health Care of Ukraine, the National Cancer Registry of Ukraine, the sociological research among various groups of participants in providing healthcare services and strategic documents of the national and international levels.
 Results. Unfavourable trends in skin malignancies spread, an increase in their contribution to the burden of the disease and the imperfection of the organisation of skin cancer prevention and the onco-dermatological care to the population were revealed. According to the principles of the state policy and the recommendations of the international organisations the directions of improving the preventive, therapeutic and diagnostic services were reasoned out on the basis of the data from the scientific literature, epidemiological research, spread, locational, gender and age peculiarities of skin cancer among the population, risk factors for their development, estimating the health care resource support, scale and results of the activities, studies of the patients, doctors and health care professionals' opinions. The modern functional-organisational model of the prevention system and control of skin cancer in the conditions of the public health system development with the definition of its principles, structures and functions was reasoned and worked out.
 Conclusions. The practical implementation of the measures for improving the prevention organisation and therapeutic and diagnostic work to fight skin cancer and the developed functional and organisational model of the system of prevention and control of onco-dermatological pathology in conditions of the public health development will effectively prevent onco-dermatological diseases, reduce the burden of skin cancer, improve people’s health and health care performance indicators and contribute to the health care sustainable development and the population’s well-being.

A30Safe Interdepartmental Learning from clinical incidents using a Quality Improvement Framework

Mistakes are an inherent learning opportunity within healthcare that can be used to prevent future loss of lives and reduce suffering. We aim to create a safe learning space within our organization that can be embedded within our quality improvement (QI) process. We have designed a bespoke framework ( Safe Interdepartmental Learning with a Quality Improvement Framework Our tertiary hospital clinical governance team in collaboration with the multi-professional education, simulation, and patient safety departments has identified 5 topics based on the root cause analysis of serious clinical incidents. This description from our recent cohort involves the recruitment of 5 different specialty teams, each consisting of 1 experienced consultant faculty and 3 other facilitating clinicians with different levels of experience in healthcare simulation. The teams prepared and designed the most suitable clinical scenario progression to address the learning objectives based on their allocated topics. Learner and peer feedback along with reflections on the session, highlighted possible change ideas to modify the subsequent scenario running. Over a period of 6 months, different learner sets were involved in the same simulation exercise with 2 further iterative modifications. The 5 teams have generated a total of 15 hours of simulation sessions using standard pre-briefing, debriefing, and evidence-based simulation techniques. The level of independent facilitation and mentoring by more advanced debriefers has been adjusted to fit the individual pace of experiential learning. To further enhance the embedded faculty development a total of 270 minutes of online discussion, reflections, and 15 topics were presented by the facilitators to create a multi-professional learning experience. The content was structured to reflect the national outcome’s framework for faculty development and the ASPIH standards guidance for simulation-based education. The recorded simulation sessions, debriefing, and topic discussions have generated a useful asynchronous online reference for the current and future cohorts. The feasibility of implementing this simulation programme integrated with a QI framework is a major step for our future prospective evaluation of the impact of translational simulation as theorized in the current literature [2] on patient outcomes and healthcare performance indicators. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Infant Mortality Trends and Determinants in Kazakhstan

Infant mortality rate (IMR) is a crucial indicator of healthcare performance and a reflection of a country’s socioeconomic development. We analyzed the trends of IMR in Central Asia (CA) countries and its determinants in Kazakhstan, which is a middle-income country. Linear regression was used for IMR trend analysis in CA countries from 2000 to 2020 and for exploring associations between IMR and socioeconomic factors, health service-related factors, and population health indicators-related factors. A gamma generalized linear model was applied to define associations with various determinants. Our analysis revealed that IMR has decreased in all CA countries, with Kazakhstan having the lowest rate in 2000 and 2020. Our results suggest that socioeconomic indicators, such as total unemployment, Gini index, current health expenditure, gross domestic product (GDP), proportion of people living in poverty, and births by 15–19-year-old mothers, were associated with increased infant mortality rates. Improving socioeconomic conditions, investing in healthcare systems, reducing poverty and income inequality, and improving access to education, are all potential issues for further development. Addressing these factors may be critical for improving maternal and child health outcomes in the region.

Evaluation of patient satisfaction with the virtual clinic in Jazan City: Saudi Arabia

Patient satisfaction is a key component in the quality of care and is an element in the dissemination and adoption of virtual clinic facilities. Evaluating patient satisfaction has become an essential indicator of healthcare performance and outcomes. The aim of the study was to evaluate patient satisfaction with the virtual clinic. A cross-sectional study was conducted using a convenience sample of 305 patients visiting a virtual clinic at three general hospitals in the Jazan region of Saudi Arabia. The study was conducted using a quantitative descriptive correlational design. The researcher employed the Telehealth Satisfaction Scale to assess patient satisfaction with virtual clinic care. Satisfaction scores were compared between groups using an independent sample t-test and one-way analysis of variance. The study indicated that patients reported a high degree of satisfaction with their virtual clinic. Most scale item averages were greater than 3, indicating ratings of "good" to "excellent" satisfaction. There was no statistically significant relationship between patient satisfaction with the virtual clinic and sociodemographic characteristics. Despite the fact that virtual clinics in the healthcare sector in the Jazan area are relatively new, the survey results show high levels of satisfaction with the service. The courtesy, respect, sensitivity, and friendliness of the virtual clinic staff and respecting patients' privacy were essential to patients, demonstrating that virtual clinics may improve access to care.

Specifications of a Queuing Model-Driven Decision Support System for Predicting the Healthcare Performance Indicators Pertaining to the Patient Flow

This article has developed specifications for a new model-driven decision support system (DSS) that aids the key stakeholders of public hospitals in estimating and tracking a set of crucial performance indicators pertaining to the patients flow. The developed specifications have considered several requirements for ensuring an effective system, including tracking the performance indicator on the level of the entire patients flow system, paying attention to the dynamic change of the values of the indicator’s parameters, and considering the heterogeneity of the patients. According to these requirements, the major components of the proposed system, which include a comprehensive object-based queuing model and an object-oriented database, have been specified. In addition to these components, the system comprises the equations that produce the required predictions. From the system output perspective, these predictions act as a foundation for evaluating the performance indicators as well as developing policies for managing the patients flow in the public hospitals.

Exploring patient experiences of cancer care in Northern Ireland: A thematic analysis of free-text responses to the 2018 Northern Ireland Patient Experience Survey (NICPES)

BackgroundCancer diagnosis, treatment and survivorship is multifaceted, and the cancer patient experience can serve as a key indicator of healthcare performance and quality. The purpose of this paper was to analyse free-text responses from the second Northern Ireland Cancer Patient Experience Survey (NICPES) in 2018, to understand experiences of care, emerging themes and identify areas for improvement.MethodsA 72-item questionnaire (relating to clinical care experience, socio-demographics and 3 free-text questions) was distributed to all Health & Social Care Northern Ireland patients that met the inclusion criteria (≥ 16 years old; confirmed primary diagnosis of cancer and discharged between 1st May and 31st October 2017) in June 2018. Participants could complete the questionnaire online or access a free telephone support line if required. Open-ended free text responses were analysed thematically to identify common themes. Free text responses were divided into positive or negative comments.ResultsIn total, 3,748 people responded to the survey, with 2,416 leaving at least one free text comment (69 %). Women aged 55–74 years were most likely to comment. Overall, 3,644 comments were left across the three comments boxes, which were categorised as either positive (2,462 comments; 68 %) or negative / area for improvement (1,182 comments; 32 %). Analysis of free text responses identified six common themes (staff; speed [diagnosis and treatment]; safety; system; support services and specific concerns), which were all related to the overarching theme of survival. Staff was the largest single theme (1,458 responses) with overwhelmingly positive comments (1,322 responses; 91 %), whilst safety (296 negative comments; 70 %) and system (340 negative comments; 81 %) were predominantly negative. Negative comments relating to primary care, aftercare and the cancer system were reported.ConclusionsThe high response rate to the free text comments indicates patients were motivated to engage. Analysis indicates most comments provided were positive in nature. Most survey respondents reported a positive experience in relation to staff. However, there were a number of areas for improvement including the aftercare experience, and a perceived disconnect between primary care and cancer services. These results can help inform the effective delivery of cancer services in Northern Ireland.

Exploring the actionability of healthcare performance indicators for quality of care: a qualitative analysis of the literature, expert opinion and user experience

BackgroundThis study explores the meaning of actionable healthcare performance indicators for quality of care-related decisions. To do so, we analyse the constructs of fitness for purpose and fitness for use...

Effects of SARS-CoV-2 (COVID-19) Pandemic on Primary Health Care Service Delivery and Data Management in Nigeria, July 2020

Primary health care, the foundation of healthcare systems around the world, recognized for its ability to deliver efficient, equitable, high-quality, patient-centered care. As with the rest of the world, Nigeria is currently dealing with COVID-19 pandemic. On February 27, 2020, the first case of COVID-19 in Nigeria was reported. As of July 31 2020, there were over Forty Thousand cases and 900 deaths. We assessed the effects of SARS-CoV-2 on primary health care service delivery and data management in Nigeria A desk review (secondary data analysis) of health data submitted monthly (January 2020 – May 2020 reporting period) on National Health Management Information System hosted on the national instance of the District Health Information System was conducted. Other procedures include: Selection of primary healthcare performance indicators, download of data from District Health Information System, data cleaning and analysis There was no significant impact on the completeness of the report for the month of March, April and May 2020 which dropped from 83.2% in February, 2020 to 82.7%, 82.7% and 82.4% in March, April and May, 2020 respectively. Amidst the increasing number of COVID-19 cases in the FCT despite the total lockdown proclaimed by the government, other PHC indicators had also been on the decline. Since the first confirmed COVID-19 case in Lagos, PHC indicators had been on the decline. In Ogun state, Total facility attendance declined significantly in the month of March and April when the lockdown was implemented. Although fixed sessions for routine immunization increased, antenatal attendance declined and Penta dropout rate increased over the period of the lockdown. Access to healthcare is a fundamental human right, but the strain that the COVID 19 pandemic has placed on Nigerian citizens especially in areas where restrictive measures were met has in turn, affected many people’s access to healthcare.Funding Statement: The author(s) received no specific funding for this work.Declaration of Interests: The authors have no conflicts of interest to declare. Ethics Approval Statement: Not required.

Predictors of (in)efficiencies of Healthcare Expenditure Among the Leading Asian Economies - Comparison of OECD and Non-OECD Nations.

PurposeThe goal of this study was to assess the effectiveness of healthcare spending among the leading Asian economies.MethodsWe have selected a total of nine Asian nations, based on the strength of their economic output and long-term real GDP growth rates. The OECD members included Japan and the Republic of Korea, while the seven non-OECD nations were China, India, Indonesia, Malaysia, Pakistan, the Philippines, and Thailand. Healthcare systems efficiency was analyzed over the period 1996–2017. To assess the effectiveness of healthcare expenditure of each group of countries, the two-way fixed effects model (country- and year effects) was used.ResultsQuality of governance and current health expenditure determine healthcare system performance. Population density and urbanization are positively associated with a healthy life expectancy in the non-OECD Asian countries. In this group, unsafe water drinking has a statistically negative effect on healthy life expectancy. Interestingly, only per capita consumption of carbohydrates is significantly linked with healthy life expectancy. In these non-OECD Asian countries, unsafe water drinking and per capita carbon dioxide emissions increase infant mortality. There is a strong negative association between GDP per capita and infant mortality in both sub-samples, although its impact is far larger in the OECD group. In Japan and South Korea, unemployment is negatively associated with infant mortality.ConclusionJapan outperforms other countries from the sample in major healthcare performance indicators, while South Korea is ranked second. The only exception is per capita carbon dioxide emissions, which have maximal values in the Republic of Korea and Japan. Non-OECD nations’ outcomes were led by China, as the largest economy. This group was characterized with substantial improvement in efficiency of health spending since the middle of the 1990s. Yet, progress was noted with remarkable heterogeneity within the group.

Defining ambulatory care sensitive conditions for adults in Portugal

BackgroundAmbulatory Care Sensitive Conditions (ACSCs) are health conditions for which adequate management, treatment and interventions delivered in the ambulatory care setting could potentially prevent hospitalization. Which conditions are sensitive to ambulatory care varies according to the scope of health care services and the context in which the indicator is used. The need for a country-specific validated list for Portugal has already been identified, but currently no national list exists. The objective of this study was to develop a list of Ambulatory Care Sensitive Conditions for Portugal.MethodsA modified web-based Delphi panel approach was designed, in order to determine which conditions can be considered ACSCs in the Portuguese adult population. The selected experts were general practitioners and internal medicine physicians identified by the most relevant Portuguese scientific societies. Experts were presented with previously identified ACSC and asked to select which could be accepted in the Portuguese context. They were also asked to identify other conditions they considered relevant. We estimated the number and cost of ACSC hospitalizations in 2017 in Portugal according to the identified conditions.ResultsAfter three rounds the experts agreed on 34 of the 45 initially proposed items. Fourteen new conditions were proposed and four achieved consensus, namely uterine cervical cancer, colorectal cancer, thromboembolic venous disease and voluntary termination of pregnancy. In 2017 133,427 hospitalizations were for ACSC (15.7% of all hospitalizations). This represents a rate of 1685 per 100,000 adults. The most frequent diagnosis were pneumonia, heart failure, chronic obstructive pulmonary disease/chronic bronchitis, urinary tract infection, colorectal cancer, hypertensive disease atrial fibrillation and complications of diabetes mellitus.ConclusionsNew ACSC were identified. It is expected that this list could be used henceforward by epidemiologic studies, health services research and for healthcare management purposes. ACSC lists should be updated frequently. Further research is necessary to increase the specificity of ACSC hospitalizations as an indicator of healthcare performance.

Analysis the Role of Management for Achieving of Public Health Coverage Programs at Public Health Care in Bengkulu

Background: Public Health Care is a primary public health service center. It is also as a promotive and preventive service provider with a target group and community to maintain and improve health and prevent disease. In the implementation of the health program the management function in the public health center is called planning (P), Mobilizing implementation (MI), Supervision Control Assessment (SCA). The purpose of conducting a public health care management analysis is Planning (P), Mobilizing Implementation (M.I), and Supervision Control Assessment (SCA) on the achievement of public health care performance indicators in Bengkulu City. Study Design: The research design used is exploratory or non-experinmental research for qualitative methods and analytic research designs are cross sectional observational approaches for quantitative methods with hypothesis testing. Informants in this qualitative study were carried out by means of purposive sampling, namely by conducting interviews with all the Head of Public Health Center. The sample in this study amounted to 80 samples consisting of the head of the Public Health Center, the person in charge of the program and the implementer of the Public health care program/activity Results: There is a relationship between Management functions (planning, mobilizing implementation, controlling assessment control) to the achievement of the performance of the Environmental Health, Nutrition, Prevention and Disease Control program at Bengkulu City Health Center; Conclusion: The implementation of management functions (Planning, Mobilizing Implementation, Supervision Control Assessment) influences the Environmental Health, Nutrition, Disease Prevention and Control program in Bengkulu City Health center.

The role of education and ethnicity on amenable mortality due to five leading non-communicable diseases among Blacks and Whites in the United States, 1990-2015

Background General mortality consistently declined in the United States (US) from 1969 to 2013. During the same period, a decrease has been described in the percentage of deaths attributed to main non-communicable diseases (NCD) including heart disease, cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), cerebrovascular diseases and diabetes. Amenable mortality trend and pace has been proposed as a good indicator of health care performance. We aimed to measure the impact of attained education and ethnicity on amenable mortality caused by cancer, CVD, COPD, cerebrovascular disease and diabetes among Non-Hispanic Whites (NHW) and Non-Hispanic Blacks (NHB) in the US from 1990 to 2015. Methods We analyzed data from death certificates downloaded from the US National Center for Health Statistics using a modified version of the Nolte’s list of amenable mortality causes related to appropriate health care. The US Population estimates (1990 to 2015) by age, gender and ethnicity came from the US Census Bureau. We analyzed annual percentage changes in age-standardized mortality rates for cancer, CVD, COPD, cerebrovascular disease and diabetes for the period 1990-2015. Results Between the time periods of 1990 and 2015, age-adjusted amenable mortality rates due to the five studied causes of death increased among the uneducated, while it decreased among the most educated in both sexes and races. Age-standardized NCD amenable mortality rates were higher among the least educated NHB and NHW males, compared to NHB and NHW females respectively during the entire period. The least educated NHW men and women born in the 1980’s presented cancer amenable mortality rates almost 3 times higher than those NHW men and women born in 1955; however, among the most educated NHW individuals, no significant differences were found in amenable mortality across birth cohorts. No notable variation was observed among NHB born before or after 1955, a finding that was consistent for all five studied diseases as well as the combined adjusted-amenable mortality rate. NHW men and women showed the greatest gap between the most and the least educated. Findings also demonstrated that a disparate cohort and year of death effect between the most and the least educated groups widened the gap in cause specific amenable mortality risk and ratio among NHW. Conclusions Our analysis showed a strong effect of attained education as a key factor for developing and directing health programs aiming to decrease NCD mortality among predominant US races. This reality calls for interventions targeting disadvantaged groups, to remove barriers to quality healthcare, and a healthy longer life. Assertive policy efforts should be made in the US to implement universal healthcare that includes quality curative medicine and innovative preventive services for all, thereby reducing the growing disparities in segments of the population and leading to a more efficient use of available resources.

Estimation the effectiveness of public governance of the health system in the context of sustainable development

The article is devoted to assessing the effectiveness of public administration of the health system, taking into account the medical reforms carried out in post-socialist countries in the context of sustainable development. During the study, the authors revealed that one of the main problems in achieving the sustainable development goal - “ensuring a healthy lifestyle and promoting well-being for all at any age” is the lack of a sound methodology for assessing the effectiveness of public administration reforms in the healthcare system. On the example of the Republic of Kazakhstan, a comprehensive analysis of the effectiveness of the health system was carried out, based on data from medical and demographic indicators, financing indicators, as well as an integrated indicator of assessing the effectiveness of the health system - the expected life expectancy of the population. Based on economic and mathematical methods in management, a forecast of the expected life expectancy of the population was carried out; the results of forecast calculations show that in the medium term, the indicator of the expected life expectancy of the population will have a slight upward trend. As the main recommendations for improving the effectiveness of public administration of the health system in transformational economies, the authors substantiated the need to determine the key parameters of a unified methodology for assessing the effectiveness of the health system. The use of a unified system of healthcare performance indicators makes it possible to assess the degree to which goals have been achieved to increase the efficiency of resource use and ensure a high level of quality and accessibility of medical services.

Operating room effectiveness: a lean health-care performance indicator

Purpose Overall equipment effectiveness (OEE) is a performance indicator that is been used to measure manufacturing productivity. The purpose of this paper is to propose the operating room effectiveness for hospital operating rooms (ORs), adapted from the OEE, to measure performance and identify losses based on lean health-care principles. Design/methodology/approach The present study is an exploratory, descriptive and applied research work. Literature review, documents of the hospital, observation and interviews with employees of a large university hospital in southern Brazil were analyzed to organize the proposed effectiveness indicator. After that, historical data of the ORs was collected and the usefulness of the indicator was analyzed. The indicator was applied for 10 months and validated with an expert committee from the hospital. Findings The present study describes an adaptation of a performance indicator to ORs of hospitals, allowing to classify its types of operational losses in a lean health-care context. The application of this indicator and the development of improvement actions to a university hospital, resulted in operational efficiency gains of 12 per cent and estimated annual savings of US$400,000. Practical implications ORs are a critical service for hospitals. This paper presents a new way to measure the performance of ORs and identify their main types of wastes. It also shows how to implement it and the potential gains of its application. The main research limitations are related to technical analysis of care data from doctors and nurses involved. Originality/value This paper fulfills the need to study how ORs performance can be measured and its operational wastes can be identified. In addition, this paper classifies the planning, performance and quality related losses, which can be used by researchers and practitioners to improve the performance of operation rooms.

A survey of patient satisfaction of obstetric anaesthesia service in Tuen Mun Hospital, Hong Kong

Patient satisfaction is an important healthcare performance indicator that has come to the forefront in recent years. Although patient satisfaction surveys have been performed assessing various medical services, there is a lack of survey evaluating patient satisfaction towards the anaesthesia services in Hong Kong. In this study, we looked into the perioperative concerns and patient satisfaction in a group of obstetric patients undergoing anaesthesia for caesarean section (CS) in Tuen Mun Hospital (TMH), which is a large regional hospital in Hong Kong with more than 5500 deliveries per year. Between June 2017 and May 2018, 263 Chinese obstetric patients undergoing elective or emergency CS were recruited into the survey. The median of the satisfaction mark obtained was 139 out of 190. Patients were less satisfied in the aspect of “fear” and “discomfort”, which were correlated with severe postoperative pain, general anaesthesia and emergent CS. Improvement in pain management program and alleviating fear and discomfort were recommended. Follow-up survey is recommended to assess the effectiveness of improvement measures. Further patient satisfaction survey can be considered in other patient groups.

Impact of disease-specific care certification on clinical outcome and healthcare performance of myocardial infarction in Taiwan.

The relationship between certification for specific disease care and clinical outcome was not well known. Previous studies regarding the effect of certification for acute stroke centers were limited by their cross-sectional design. This study aimed to investigate the effect of disease-specific care (DSC) certification on healthcare performance and clinical outcome of acute myocardial infarction (AMI). This retrospective, longitudinal, controlled study was performed by analyzing the nationwide Taiwan Clinical Performance Indicators dataset from 2011 to 2018. Hospitals undergoing DSC certification for coronary care and reporting AMI indicators 1 year before, during, and 1 year after certification were included in group C, whereas hospitals not seeking DSC certification but reporting AMI indicators during the same period were included in group U. The primary endpoint was in-hospital mortality of AMI. In total, 20 hospitals (9 in group C and 11 in group U) and up to 16 173 AMI cases were included for analysis. In-hospital mortality was similar between both groups at baseline. However, the in-hospital mortality was significantly improved during and after certification periods in comparison with that at baseline in group C (6.8% vs 8.4%, p = 0.04; 6.7% vs 8.4%, p = 0.02), whereas there was no significant change in group U, resulting in a statistically significant difference between both groups during and after certification periods (odds ratio = 0.74 [95% CI = 0.60-0.91] and 0.78 [95% CI = 0.64-0.96]). Compared with group U, the improvement in healthcare performance indicators, such as door-to-electrocardiography time <10 minutes, blood testing for low-density lipoprotein cholesterol level, prescribing a beta-blockade or a P2Y12 receptor inhibitor during hospitalization, prescribing a statin on discharge, and consultation for cardiac rehabilitation, was significant in group C. The current study demonstrated the beneficial effect of DSC certification on clinical outcome of AMI probably mediated through quality improvement during the healthcare process.

Poverty Does Make Us Sick.

This study evaluates the direct causal effects of household wealth on health. We discuss several specific mechanisms that that could relate poverty with worse health and hypothesize that poverty will undermine population health. This hypothesis was tested based on data drawn from a recent cross-country survey in 12 post-Soviet countries and Mongolia using classic regression (OLS) and instrumental variable 2SLS regressions. The results indicate that poverty does indeed lead to worsening health. This negative effect of poverty on health remains unchanged after controlling for a wide range of individual characteristics, healthcare performance indicators, trust in individuals, government, parliament, and political parties, as well as country-level unobserved characteristics. Using an instrumental variable increases our confidence in being able to isolate the effects of poverty on health status and confirms that our results are not due to endogeneity. In addition, the strong negative effect of poverty on health remains robust to the use of a set of country-level aggregated indicators (e.g. GDP and Gini) instead of country dummies, the employment of a subjective self-assessment indicator of poverty instead of an objective one, and an alternative conceptualization of health status as a binomial variable (for bad and very bad health) instead of a continuous one.

Statistical Process Control Charts for Monitoring Staphylococcus aureus Bloodstream Infections in Australian Health Care Facilities.

Staphylococcus aureus bloodstream infection (SAB) in health care settings contributes significantly to mortality, and improved processes are associated with reduced burden of infection. In Australia, health care-associated SAB (HA-SAB) rates are reported as a health care performance indicator, but standardized methods for analyzing longitudinal data are not applied. Our objective was to evaluate the utility of statistical process control chart methodology for reporting HA-SAB and flagging higher than expected rates. A real-world test data set was defined as HA-SAB surveillance data collected by 155 Australian health care facilities between June 1, 2015, and June 30, 2017. This included 788 HA-SAB events, corresponding to an overall rate of 0.7 HA-SAB events per 10 000 occupied bed-days. The u-chart was selected as an appropriate tool, given the need for reporting natural units (HA-SAB rates) to a range of stakeholders. Facility-level data were plotted as u-charts, applying warning and control limits (2- and 3-SD thresholds, respectively). Sixty-eight of the 155 participating facilities (43.9%) observed at least 1 HA-SAB event during the studied period. Using the traditional method of Poisson modeling, 56 of these 68 facilities demonstrated overdispersion with variance-to-mean ratio spanning 1.03 to 42.82. Modeling by negative binomial (NB) distribution was therefore applied to enhance functionality. The u-chart is an accessible method for monitoring HA-SAB, interpretable by a range of stakeholders. We demonstrate the benefit of NB modeling to account for overdispersion, providing an effective tool to avoid inappropriate flags while maintaining early detection of out-of-control systems throughout a wide range of health care settings.