Health Care Quality Indicators Research Articles

ISQUA16-1665HOSPITAL INFORMATION TECHNOLOGY INFRASTRUCTURE AFFECTS QUALITY OF CARE

To investigate the association between hospital information technology (IT) infrastructure that facilitates the retrieval of evidence-based practice recommendations and hospital compliance to healthcare quality indicators (QIs). A cross-sectional study was conducted on Japanese hospitals using survey data and administrative data. Firstly, a questionnaire survey as part of the Minds-QIP Project was conducted by mailing the administrators of hospitals participating in the Quality Indicator/Improvement Project (QIP). The survey …

Disparities in reportable quality metrics by insurance status in the primary spine neoplasm population

Background ContextThe Centers for Medicare and Medicaid Services (CMS) defines “adverse quality events” as the incidence of certain complications such as postsurgical hematoma or iatrogenic pneumothorax during an inpatient stay. Patient safety indicators (PSI) are a means to measure the incidence of these adverse events. When adverse events occur, reimbursement to the hospital decreases. The incidence of adverse quality events among patients hospitalized for primary spinal neoplasms is unknown. Similarly, it is unclear what the impact of insurance status is on adverse care quality among this patient population. PurposeWe aimed to determine the incidence of PSI among patients admitted with primary spinal neoplasms, and to determine the association between insurance status and the incidence of PSI in this population. Study DesignThis is a retrospective cohort study. Patient SampleWe included all patients, 18 years and older, in the Nationwide Inpatient Sample (NIS) who were hospitalized for primary spine neoplasms from 1998 to 2011. Outcome MeasuresIncidence of PSI from 1998 to 2011 served as outcome variable. MethodsThe NIS was queried for all hospitalizations with a diagnosis of primary spinal neoplasm during the inpatient episode from 1998 to 2011. Incidence of PSI was determined using publicly available lists of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes. Logistic regression models were used to determine the effect of primary payer status on PSI incidence. All comparisons were made between privately insured patients and Medicaid or self-pay patients. ResultsWe identified 6,095 hospitalizations in which a primary spinal neoplasm was recorded during the inpatient episode. We excluded patients younger than 18 years and those with “other” or “missing” primary insurance status, leaving 5,880 patients for analysis. After adjusting for patient demographics and hospital characteristics, Medicaid or self-pay patients had significantly greater odds of experiencing one or more PSI (odds ratio [OR] 1.81 95% confidence interval [CI] 1.11–2.95) relative to privately insured patients. ConclusionsAmong patients hospitalized for primary spinal neoplasms, primary payer status predicts the incidence of PSI, an indicator of adverse health-care quality used to determine hospital reimbursement by the CMS. As reimbursement continues to be intertwined with reportable quality metrics, identifying vulnerable populations is critical to improving patient care.

Evaluation der populationsbezogenen ‚Integrierten Versorgung Gesundes Kinzigtal‘ (IVGK). Ergebnisse zur Versorgungsqualität auf der Basis von Routinedaten

Background and objectivesThe management company “Gesundes Kinzigtal GmbH” signed an agreement on integrated healthcare with the statutory health insurer AOK Baden-Württemberg, effective as of November 1, 2005. The aim of the evaluation was to check whether the extent of overuse and underuse of healthcare services in the area of intervention declined or increased compared with usual care. MethodsLongitudinal study with non-randomised control group based on health insurers’ claims data from the years 2004–2011. Intervention group: residents of the Kinzigtal region insured by AOK. Control group: persons insured with the AOK in other regions of Baden-Württemberg. Healthcare quality indicators were derived from other studies and guidelines. Fifteen out of the 18 indicators related to overuse or underuse; three related to an outcome, namely avoidable hospital stays, the appearance of fractures in patients with osteoporosis, and mortality. Trend and outcome analyses rely on Poisson and Cox regressions adjusted for age, sex, the Charlson Index, and multimorbidity. ResultsTwo out of 5 indicators for overuse and 2 out of 10 for underuse showed significant improvement for the intervention population relative to the control group. The risk of a fracture in patients with osteoporosis (HR: 0.809; 95 % CI: 0.740 to 0.885; p<0.0001) and mortality (HR: 0.944; 95% CI; 0.899-0.991; p=0.0194) were significantly lower in the Kinzigtal population. No negative trends were found. ConclusionsCompared with the control group, which represents the secular trend, significant improvements of healthcare quality in the intervention group (6 out of 18 indicators) are considerably more frequent than significant changes for the worse (0 out of 18 indicators). To date, the effects are not very strong, as all insured persons from the Kinzigtal form the basis of the analysis irrespective of their participation in the integrated care program. Claims data are appIicable to indicator based evaluation, but it would be necessary to consider additional years to see whether observed positive trends could be enhanced.

Insurance status and reportable quality metrics in the cervical spine fusion population

Background ContextThe incidence of adverse care quality events among patients undergoing cervical fusion surgery is unknown using the definition of care quality employed by the Centers for Medicare and Medicaid Services (CMS). The effect of insurance status on the incidence of these adverse quality events is also unknown. PurposeThis study determined the incidence of hospital-acquired conditions (HAC) and patient safety indicators (PSI) in patients with cervical spine fusion and analyzed the association between primary payer status and these adverse events. Study DesignThis is a retrospective cohort design. Patient SampleAll patients in the Nationwide Inpatient Sample (NIS) aged 18 and older who underwent cervical spine fusion from 1998 to 2011 were included. Outcome MeasuresIncidence of HAC and PSI from 1998 to 2011 served as outcome variables. MethodsWe queried the NIS for all hospitalizations that included a cervical fusion during the inpatient episode from 1998 to 2011. All comparisons were made between privately insured patients and Medicaid or self-pay patients because Medicare enrollment is confounded with age. Incidence of nontraumatic HAC and PSI was determined using publicly available lists of International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes. We built logistic regression models to determine the effect of primary payer status on PSI and nontraumatic HAC. ResultsWe identified 419,424 hospitalizations with cervical fusion performed during an inpatient episode. The estimated national incidences of nontraumatic HAC and PSI were 0.35% and 1.6%, respectively. After adjusting for patient demographics and hospital characteristics, Medicaid or self-pay patients had significantly greater odds of experiencing one or more HAC (odds ratio [OR] 1.51 95% conflict of interest [CI] 1.23–1.84) or PSI (OR 1.52 95% CI 1.37–1.70) than the privately insured cohort. ConclusionsAmong patients undergoing inpatient cervical fusion, primary payer status predicts PSI and HAC (both indicators of adverse health-care quality used to determine hospital reimbursement by CMS). As the US health-care system transitions to a value-based payment model, the cause of these disparities must be studied to improve the quality of care delivered to vulnerable patient populations.

"No more amputations": a complex scientific problem and a challenge for effective preventive strategy implementation on vascular field.

Lower limb vascular amputations represent serious problem in the vascular care. As a consequence of critical limb ischemia, often associated with diabetes, it is highly critical to health care service aiming at prevention of limb loss. Understanding of the nature and complexity of amputation scenario is paramount for the effective preventive strategy planning and implementation. Amputation incidence and data of the trends show high variability in the international reports. Variability is also remarkable in a more granular, regional comparison. Different calculation methods for incidence fraction, varying epidemiological, demographic features of the populations, different socio-economic, cultural backgrounds and disparity in vascular care are the main factors contributing to this variability in reports. Lower limb amputations can be considered as a valuable healthcare quality indicator with some limitations. One of these limitations is the lower actionability that corresponds to the reduced ability of health care providers to intervene influencing the burden of amputations. Lower limb vascular amputations represent a lifetime risk, therefore not only the effective revascularization is to be achieved but the importance of the early recognition of peripheral arterial disease, no delay in referral to special vascular care, effective vascular risk prevention and collaboration in multidisciplinary teams should be also emphasized.

Medida de la eficiencia de la atención primaria en Barcelona incorporando indicadores de calidad

ObjectiveTo demonstrate the impact of the incorporation of quality indicators in assessing the technical efficiency of primary healthcare teams. The processes through which primary healthcare resources have been allocated since the onset of the financial crisis in 2008 have focussed on quantitative rather than qualitative indicators. MethodsThis study applies data envelopment analysis (DEA) techniques to 58 primary healthcare teams from three different primary healthcare services from the province of Barcelona (Spain). We combine publicly available information from the regional government of Catalonia with data requested from the Catalan Health System Observatory. The analysis compares the results of three models, thereby allowing shifts in the efficiency of primary healthcare teams to be identified in terms of the (lack of) consideration for healthcare quality indicators. ResultsOnly 16% of the primary healthcare teams were found to be efficient according to the baseline models, which only incorporated input and output quantity indicators. However, once proxies for healthcare quality are included in the analysis, this percentage increases to 58.6%. No meaningful differences in primary healthcare team efficiency were found between public and privately owned centres, between regional primary care services and organisational models, or between rural and urban teams. ConclusionsThe results suggest the need to incorporate healthcare quality indicators as outputs when considering criteria for the streamlining of primary healthcare services. Failure to incorporate quality indicators is associated with various primary healthcare concepts.

Quality of psoriasis care in Germany: results of the national health care study "PsoHealth3".

Two national surveys conducted in 2005 and 2007 indicated deficits in psoriasis care and induced the composition of the ''National Goals for Health Care in Psoriasis 2010-2015''. The aim of this work was to (1) evaluate the quality of care for patients with psoriasis in Germany, (2) compare this with prior psoriasis studies PsoHealth1 (2005) and PsoHealth2 (2007), and (3) review the implementation of national treatment goals. By means of a cross sectional study the following indicators of health care quality were collected: psoriasis severity (Psoriasis Area Severity Index (PASI) and proportion of PASI >20), quality of life (Dermatology Life Quality Index (DLQI) were corporated: proportion of DLQI >10), previous systemic treatment, inpatient treatment, and days absent from work due to psoriasis. Between January 2013 and March 2014, 1265 patients from 82 dermatological centres were included (mean age of 52 years). 9.2 % had a PASI >20 (2007: 11.6 %; 2005: 17.8 %). 21.3 % reported strong quality of life restrictions (DLQI >10) (2007: 28.2 %; 2005: 34.0 %). 59.5 % had received a systemic treatment at least once within the last 5 years (2007: 47.3 %; 2005: 32.9 %). 20.1 % were treated inpatient within the last 5 years (2007: 20.1 %; 2005: 26.9 %). The current data indicate a better health care situation for psoriasis in Germany. The implementation of the S3-Guideline and the ''National Goals for Health Care in Psoriasis 2010-2015'' could have been contributing factors.

A new quality indicator of colonoscopy: caveat emptor

Quality indicators of health care should measure endpoints that closely reflect patient outcomes. Further, they should be feasible to measure accurately in clinical practice and demonstrate evidence of variable performance. An additional important consideration is the potential for a candidate quality indicator to distort provider behavior in ways that could adversely affect patient outcomes or costs of care or that could be gamed, where the target measure is achieved but without reflecting high-quality care. “Gaming” in reference to quality indicators refers to behaviors that help satisfy the target set for the indicator but do not improve and are likely to detract from optimal or the most cost-effective patient care.

Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS-1) Methodology.

BackgroundThe National Quality Forum previously approved a quality indicator for mortality after congenital heart surgery developed by the Agency for Healthcare Research and Quality (AHRQ). Several parameters of the validated Risk Adjustment for Congenital Heart Surgery (RACHS‐1) method were included, but others differed. As part of the National Quality Forum endorsement maintenance process, developers were asked to harmonize the 2 methodologies.Methods and ResultsParameters that were identical between the 2 methods were retained. AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases (SID) 2008 were used to select optimal parameters where differences existed, with a goal to maximize model performance and face validity. Inclusion criteria were not changed and included all discharges for patients <18 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for congenital heart surgery or nonspecific heart surgery combined with congenital heart disease diagnosis codes. The final model includes procedure risk group, age (0–28 days, 29–90 days, 91–364 days, 1–17 years), low birth weight (500–2499 g), other congenital anomalies (Clinical Classifications Software 217, except for 758.xx), multiple procedures, and transfer‐in status. Among 17 945 eligible cases in the SID 2008, the c statistic for model performance was 0.82. In the SID 2013 validation data set, the c statistic was 0.82. Risk‐adjusted mortality rates by center ranged from 0.9% to 4.1% (5th–95th percentile).ConclusionsCongenital heart surgery programs can now obtain national benchmarking reports by applying AHRQ Quality Indicator software to hospital administrative data, based on the harmonized RACHS‐1 method, with high discrimination and face validity.

The involvement of medical doctors in hospital governance and implications for quality management: a quick scan in 19 and an in depth study in 7 OECD countries.

BackgroundHospital governance is broadening its orientation from cost and production controls towards ‘improving performance on clinical outcomes’. Given this new focus one might assume that doctors are drawn into hospital management across OECD countries. Hospital performance in terms of patient health, quality of care and efficiency outcomes is supposed to benefit from their involvement. However, international comparative evidence supporting this idea is limited. Just a few studies indicate that there may be a positive relationship between medical doctors being part of hospital boards, and overall hospital performance. More importantly, the assumed relationship between these so-called doctor managers and hospital performance has remained a ‘black-box’ thus far. However, there is an increasing literature on the implementation of quality management systems in hospitals and their relation with improved performance. It seems therefore fair to assume that the relation between the involvement of doctors in hospital management and improved hospital performance is partly mediated via quality management systems. The threefold aim of this paper is to 1) perform a quick scan of the current situation with regard to doctor managers in hospital management in 19 OECD countries, 2) explore the phenomenon of doctor managers in depth in 7 OECD countries, and 3) investigate whether doctor involvement in hospital management is associated with more advanced implementation of quality management systems.MethodsThis study draws both on a quick scan amongst country coordinators in OECD’s Health Care Quality Indicator program, and on the DUQuE project which focused on the implementation of quality management systems in European hospitals.ResultsThis paper reports two main findings. First, medical doctors fulfil a broad scope of managerial roles at departmental and hospital level but only partly accompanied by formal decision making responsibilities. Second, doctor managers having more formal decision making responsibilities in strategic hospital management areas is positively associated with the level of implementation of quality management systems.ConclusionsOur findings suggest that doctors are increasingly involved in hospital management in OECD countries, and that this may lead to better implemented quality management systems, when doctors take up managerial roles and are involved in strategic management decision making.

Evolving Concepts of Patient-Centered Care and the Assessment of Patient Care Experiences: Optimism and Opposition.

In his seminal work on health care quality, Avedis Donabedian noted that patient satisfaction was a key indicator of health care quality, and in the 1970s and 1980s a great deal of research explored the determinants of patient satisfaction. Subsequently, attention shifted toward assessing care experiences, and there is now a large body of evidence related to the reliability and validity of survey-based assessments of care. As the use of such surveys has increased, so too have concerns about the validity and uses of such surveys. The available research, however, indicates that such surveys are reliable, valid, correlated across individuals and settings with other quality indicators, and predictive of better outcomes. Patient experiences are now routinely measured, and substantial effort is being devoted to providing high-quality patient-centered care. Providing patient-centered care need not divert resources away from other quality improvement efforts. Improving the infrastructure supporting certain aspects of care may have broad effects because system changes can influence multiple outcomes. Thus, rather than detract from general quality improvement efforts, making changes that facilitate patient-centered care may lead to broader improvements. There is good reason to be optimistic that our health care system will increasingly be "patient centered."

Assessment of Healthcare Providers’ Performance Considering Three Healthcare Quality Indicators: A Review Article

Context: In many healthcare systems, the quality of the healthcare delivered is monitored using a number of “indicators.” In the present review, we investigate studies that address issues with the care delivered by healthcare providers. To do this, we employ indicators of the quality of those healthcare services. Evidence Acquisition: The studies for the review were identified by searching a number of electronic databases, including Cochrane Library, PubMed, Scopus, Ovid (Medline), the Social Sciences Citation Index, SID (Scientific Information Database, or Persian database), and Iran Medex (Persian database). Of 8,850 studies published between January 1971 and May 2015, 53 met the study criteria and were reviewed. In this study, the following key words were searched, both alone and in combination: health, healthcare, health care, provider*, effectiveness, quality, clinical outcome, patient satisfaction, and quality of life. We also considered healthcare quality indicators such as “clinical outcome,” “patient satisfaction,” and “quality of life” for our assessment of the quality of healthcare providers. Results: Of the 53 papers selected, 18 assessed the quality of care provided for cardiovascular disorders, 12 studied cancer conditions, eight dealt with metabolic disorders and diabetes, six focused on acute infection, three assessed orthopedics and trauma conditions, two studied pediatric conditions, two assessed obstetrics and gynecology conditions, one dealt with asthma and allergic disease conditions, and one assessed geriatric conditions. In our assessment of improvements in healthcare providers’ performance based on healthcare quality indicators, improvements in clinical outcomes ranged from 26.6% for cancer conditions to 98.8% for pediatric and gynecological conditions. An acceptable level of patient satisfaction was achieved in the range of 30.2% for cancer conditions to 96.0% for pediatric conditions, while improvements to quality of life ranged from 12.5% for cancer conditions to 88.7% for acute infection. Conclusions: Taking account of three indicators for assessing the quality of healthcare providers (clinical outcome, patient satisfaction, and quality of life), the highest improvement levels among providers were observed for pediatric and gynecological conditions, and the lowest improvement levels were found for cancer conditions.

Early surgery within 2 days for hip fracture is not reliable as healthcare quality indicator

PurposeTo analyze prospectively the influence of the timing of surgery on morbidity and mortality, and to assess whether the early surgery within 2 days admission may be a reliably healthcare quality indicator. MethodsProspective observational study of 628 patients age 60 or older who had been co-managed between surgeons and internists. Based on the literature, many potential factors influencing outcomes were collected to control confounding regard to surgery delay, complications and mortality. Multivariate logistic regression and Cox regression models were used to assess effects on the delay and mortality, respectively. ResultsMean Charlson index was 2.3, and 284 patients had at least 3 comorbidities. Mean timing of surgery was 3.6 days (range 0–20). 418 patients were fit for surgery, of which 180 underwent surgery within 2 days. Delay for surgery more than 2 days was significantly associated with ASA >2, Charlson >2 and anticoagulant therapy. Medical complications were not significantly associated with delayed surgery more than 2 days. Mortality rate was 0.9% in-hospital, 3.4 at 1 month, 7.0% at 3 months, and 13.6% at 12 months. There were no significant differences in in-hospital, 3-month or 1-year mortality between patients operated within 2 days and those operated at 3–4 days, but delayed more than 4 days was associated with higher 1-year mortality. Likewise, patients readmitted within 30 days had higher in-hospital mortality. Excluding unfit for surgery patients at admission, there was no significant difference in 3-month or 1-year mortality between patients operated within 2 days and those with delayed surgery. ConclusionsDelaying surgery up to 4 days was not associated with higher morbidity or mortality rates. We recommend concentrating more on preoperative optimizing the condition of patient with sufficient medical treatment rather than being bound by a universal timing of surgery.

PATIENT’S SATISFACTION OF EMERGENCY DEPARTMENT AFFILIATED HOSPITAL OF BABOL UNIVERSITY OF MEDICAL SCIENCES IN 2013 -14

BACKGROUND AND OBJECTIVE: Patient satisfaction in emergency departments is an indicator of healthcare quality, evaluation of which can promote awareness of the relevant authorities regarding its status. This study aimed to evaluate patient satisfaction in emergency departments in hospitals affiliated to Babol University of Medical Sciences. METHODS: This cross-sectional study was performed in patients admitted to emergency departments in hospitals affiliated to Babol University of Medical Sciences, Babol, Iran, during a period of eight months (2013-2014). The participants were chosen through convenience sampling. Information regarding hospital environment, facilities, and nursing team was collected using a standard questionnaire. Standard questionnaire responses were classified to” don’t happen, dissatisfied, low, medium and high satisfaction”. Then medium and high responses classified to favorable satisfaction (above average) and low or dissatisfied responses were classified to unfavorable satisfaction. In case the patients were unable to fill-out the questionnaire, their companion completed it for them. FINDINGS: Overall, 444 (87.9%) patients expressed optimum satisfaction. The highest rate of dissatisfaction (14.8%, n=74) was related to environment and services, while the highest rate of satisfaction (49.3%, n=246) was pertinent to nursing staff. The results indicated that the rate of satisfaction in residents of rural areas was 0.55 times higher than in urban residents (OR: 1.55, 95% CI: 1.12-2.70, p=0.02), 50% lower in patients compared to companions (OR: 0.55, 95% CI: 0.36-0.83, p=0.05),and in the evening shift was 0.65 times higher than in those admitted in the morning (OR: 1.65, 95% CI: 1.06-2.58, p=0.03). Moreover, this rate in patients admitted at night shift was 0.74 times higher than in those admitted in the morning (OR: 1.74, 95% CI: 1.12-2.70, p=0.01). CONCLUSION: This study demonstrated optimum patient satisfaction in emergency departments in hospitals affiliated to Babol University of Medical Sciences.

Reporting and use of the OECD Health Care Quality Indicators at national and regional level in 15 countries.

OECD member states are involved since 2003 in a project coordinated by the OECD on Health Care Quality Indicators (HCQI). All OECD countries are biennially requested by the OECD to deliver national data on the quality indicators for international benchmarking purposes. Currently, there is no knowledge whether the OECD HCQI information is used by the countries themselves for healthcare system accountability and improvement purposes. The objective of the study is to explore the reporting and use of OECD HCQI in OECD member-states. Data were collected through a questionnaire sent to all OECD member-states containing factual questions on the reporting on all OECD HCQ-indicators. Responses were received between June and December 2014. In this timeframe, two reminders were sent to the participants. The work progress was presented during HCQI Meetings in November 2014 and May 2015. Fifteen countries reported to have a total of 163 reports in which one or more HCQIs were reported. One hundred and sixteen were national and 47 were regional reports. Forty-nine reports had a general system focus, 80 were disease specific, 10 referred to a specific type of care setting, 22 were thematic and 2 were a combination of two (disease specific for a particular type of care and thematic for a specific type of care). Most reports were from Canada: 49. All 15 countries use one or more OECD indicators. The OECD quality indicators have acquired a clear place in national and regional monitoring activities. Some indicators are reported more often than others. These differences partly reflect differences between healthcare systems. Whereas some indicators have become very common, such as cancer care indicators, others, such as mental healthcare and patient experience indicators are relatively new and require some more time to be adopted more widely.

Thirty-day readmissions following adult spinal deformity surgery: an analysis of the National Surgical Quality Improvement Program (NSQIP) database

BackgroundAdult spine deformity surgery (ASDS) is a significantly invasive procedure with a relatively high complication rate. The thirty-day hospital readmission rate following surgery is an important quality measure monitored by multiple quality reporting agencies. PurposeThis study seeks to determine the risk factors for 30- day readmission rate in patients undergoing ASDS and identify the risk factors associated with readmission. Study DesignThis is a retrospective multicenter study. MethodsThe National Surgical Quality Improvement Program database, which is a large multi-institutional database, was searched for patients that underwent ASDS from 2011 to 2013. The patients were identified by searching seven Current Procedural Terminology codes most commonly used for spinal deformity surgery. Twenty-seven preoperative variables, including patient demographics and comorbidities, intraoperative parameters, and postoperative complications were analyzed to identify risk factors for readmission. ResultsA total of 747 adult patients who underwent ASDS were identified. Of the 747 patients, 7.5% (56/747) were readmitted within 30 days. The most common causes of readmission were infection (n=11), hematoma or seroma formation (n=5), and postoperative pain (n=3). Univariate analysis revealed male gender (p=.038, odds ratio [OR]=1.83) and pulmonary embolism before discharge (p=.048, OR=8.44) to be associated with readmission. In multivariate analysis, obesity (p=.047, OR=1.80), peripheral vascular disease (p=.045, OR=17.52), pulmonary embolism before discharge (p=.012, OR=10.35), and total or partial dependent preoperative functional health status (p=.041, OR=2.45), were found to be independent risk factors for readmission. Age, smoking, and resident involvement during surgical procedure were among the many factors not associated with increased risk of readmission. ConclusionsThe 30-day readmission rate for ASDS is increasingly becoming a significant health-care quality indicator. Patients with the aforementioned significant risk factors should be closely followed up, which can potentially avoid subsequent readmission.

Assessing the Associations of Patient-Reported Perceptions of Patient-Centered Care as Supplemental Measures of Health Care Quality in VA.

Patient-reported experience measures (PREMs) are useful for assessing health care quality and safety and patients' perceptions of health care. We aimed to assess the relationship between PREMS [e.g., measures of patient-centered care (PCC)] and health care quality metrics. We conducted a national survey via mail. Survey data were supplemented with US Department of Veteran Affairs (VA) administrative data. Veteran (n = 5512) VA health care users participated in the study. PCC measures included: patient activation; shared decision-making(SDM); empathy and holistic care; chronic illness care; perceptions of participation, respect for choices, and support; and overall health care experience. Health care quality measures included: preventive care screening receipt; chronic condition management (diabetes, hypertension); and health care utilization (hospitalizations, emergency room (ER) visits). Analyses included: bivariate comparisons of PCC measures by health care quality measures; and multivariate linear regression to identify variables associated with attaining multiple positive health care quality indicators (when controlling for potential confounders). PREMs assessing factors relating to patient-provider communication (e.g., empathic provider care, shared decision-making) are mainly related to clinical indicators representing good chronic condition management, while those relating more broadly to health care in general (e.g., patient activation, chronic illness care) are mainly related to measures of appropriate health care use (e.g., preventive care screening receipt; potentially avoidable hospitalizations; unscheduled care, such as ER visits). When controlling for potential confounders, higher perceptions of the decision-making effectiveness component of SDM (β = 0.004, p = 0.03) and empathy and holistic care (β = 0.01, p = 0.02) showed a weak but positive relationship with attaining a greater number of positive health care quality indicators, while a weak but negative relationship emerged for perceptions of participation, respect for choices, and support (β = -0.003, p = 0.03) and overall VA experiences (β = -0.10, p = 0.04). PREMs that measure PCC offer rich data about health care quality while engaging patients, and considering patient experiences and preferences, in performance assessment. PREMs may be used to supplement existing performance metrics.

Patient Safety in Surgical Care

The 1999 report of the Institute of Medicine, To Err Is Human: Building a Safer Health System, made national headlines with its estimates of the frequency and severity of adverse events in health care, including that as many as 98,000 medical error–related deaths occur each year in the United States. The observation that the basic principles of human error are highly applicable to clinical practice has markedly advanced our understanding and willingness to address error in this setting. This review seeks to address the characteristics of systems in general and the system of surgical care in particular. It describes the growing knowledge of factors that affect human performance and how these factors contribute to adverse surgical outcomes. The review also outlines current obstacles to improving safety, identifies systems approaches to making improvements, and discusses ways in which surgeons can take the lead in overcoming these obstacles. An overall goal is that acceptance of error and a willingness to investigate its underlying causes will allow health care professionals to make use of the lessons learned from study of nonmedical systems. Tables include definitions of terms related to patient safety, the operation profile, handoff coordination and communication objectives and relevant strategies, nonmedical system techniques applicable to medical systems, Agency for Healthcare Quality and Research patient safety indicators, National Quality Forum list of health care facility–related serious reportable events, and examples of surgically relevant quality improvement practices appropriate for widespread implementation. Figures include the Swiss Cheese Model representing the relationship between latent and active errors and adverse outcomes, a schematic depiction of the process by which system failures may lead to injury, the Systems Engineering in Patient Safety Model of work system and patient safety, and a depiction of contrasting characteristics of medical practice in the 20th and 21st centuries.This review contains 4 figures, 7 tables, and 165 references.

The Health Tourists' Satisfaction Level of Services Provided: A Cross-Sectional Study in Iran.

Introduction:Patient satisfaction with provided services is used as an indicator of health care quality. Patient satisfaction is defined as patient perception of provided care compared to expected care. This study was administered to evaluate the health tourists’ satisfaction of provided services in Lorestan University of Medical Sciences affiliated hospitals in 2015.Method:In this descriptive case study, 1800 (696 (54.4%) men and 812 (45.6%) women, 74.5 province native) patients were selected by random sampling from among the patients of Lorestan University of Medical Sciences affiliated hospitals in 2015 spring. The data collection instrument is a semi-structured questionnaire in this study. The questionnaire has 62 general and specific items. Each of the specific items is scaled on four points; satisfied, fairly satisfied, dissatisfied and O.K. In order to analyze the data both descriptive and inferential statistics were used.Results:Poldokhtar Imam Khomeini Hospital had the highest Level of satisfaction of 68 percent in all aspects (hoteling, discharge, paramedical, nurses, medical and admission) among the studied hospitals. Kuhdasht Imam Khomeini hospital had the lowest level of satisfaction of 53 percent. The overall satisfaction level in all hospitals was 61%.Discussion and Conclusion:Despite the shortcomings observed in different areas, the results of the present study are in an intermediate status compared to other studies. While treating patients, patient-centered issue and patients ‘need and preferences should be focused on to enhance health care quality. Considering Patients preferences not only are morally good but also lead to improved care and access to sustainable care practices. Therefore it is needed to drive organizational management approach toward the customer preferences management and needs.

Healthcare Quality Indicators for Physiotherapy Management in Hip and Knee Osteoarthritis and Rheumatoid Arthritis: A Delphi Study

The aim of the present study was to develop healthcare quality indicators (HCQIs) for the physiotherapy (PT) management of patients with hip or knee osteoarthritis (HKOA) or rheumatoid arthritis (RA) in the Netherlands. Two multidisciplinary expert panels, including patients, were instituted. A draft HCQI set was derived from recommendations included in two existing Dutch PT guidelines for HKOA and RA. The panels suggested additional topics, after which a Delphi procedure was performed. All propositions were scored for their potential to represent good-quality PT care (score range 0-9). Based on predefined rules, the Delphi panel HCQIs were discussed and selected. Lastly, every indicator was rephrased, resulting in its output consisting of a numerator and denominator, to facilitate comparisons within and among practices. After two Delphi rounds, two final sets of 17 HCQI - one for HKOA and one for RA - were composed, both containing 16 process indicators (regarding initial assessment, treatment and evaluation) and one outcome indicator. Two sets of HCQIs for PT management in HKOA and RA were developed for measuring the quality of PT care in daily clinical practice. Each indicator was formulated in a measurable way. Future research should focus on the feasibility of both indicator sets for daily clinical practice.