Quality Of Care Information Research Articles

Accelerating Clinical Text Annotation in Underrepresented Languages: A Case Study on Text De-Identification.

Clinical notes contain valuable information for research and monitoring quality of care. Named Entity Recognition (NER) is the process for identifying relevant pieces of information such as diagnoses, treatments, side effects, etc., and bring them to a more structured form. Although recent advancements in deep learning have facilitated automated recognition, particularly in English, NER can still be challenging due to limited specialized training data. This exacerbated in hospital settings where annotations are costly to obtain without appropriate incentives and often dependent on local specificities. In this work, we study whether this annotation process can be effectively accelerated by combining two practical strategies. First, we convert usually passive annotation tasks into a proactive contest to motivate human annotators in performing a task often considered tedious and time-consuming. Second, we provide pre-annotations for the participants to evaluate how recall and precision of the pre-annotations can boost or deteriorate annotation performance. We applied both strategies to a text de-identification task on French clinical notes and discharge summaries at a large Swiss university hospital. Our results show that proactive contest and average quality pre-annotations can significantly speed up annotation time and increase annotation quality, enabling us to develop a text de-identification model for French clinical notes with high performance (F1 score 0.94).

Patient perceptions of care quality and discharge information following same-day cardiac catheterization laboratory procedures: A mixed-methods study.

To examine patients' perceptions of care quality following a same-day procedure in the cardiac catheterization laboratory and understand the extent to which they were prepared for discharge. Single-centre, mixed-methods study. Postdischarge, online survey of patients who underwent a same-day procedure in the cardiac catheterization laboratory (n= 150) and one-on-one interviews with 13 of these patients. Survey responses were positive with mean scores between 4.39-4.83 out of five and 63.3% of respondents (n= 95) extremely likely to recommend the service to others. Interview data analysis identified three themes: the care experience, information and education for safe discharge, and follow-up needs. Participants spoke highly of their interactions with clinicians and were satisfied with their care experience. Mode and content of information delivered varied, with some participants lacking guidance about postdischarge health management and clarity about follow-up plans. Participants were patients.

Hearing Loss and Healthcare Satisfaction

Patient satisfaction with care has become increasingly important since Medicare’s shift to value-based reimbursement models using the Hospital Care Quality Information from the Consumer Perspective survey. Effective communication plays an underappreciated role in satisfaction with care. Hearing loss impacts two-thirds of adults over 70 years and is a barrier to communication. Previous research has found that adults with hearing loss have poorer health outcomes and incur higher medical expenditures. The present study aims to explore the association of hearing loss on satisfaction with care. Nationally representative data from the 2015 Medicare Current Beneficiary Survey (MCBS) collected information on self-reported hearing with a hearing aid (no trouble, a little trouble, or a lot of trouble) and satisfaction with quality of health care (very satisfied/satisfied and dissatisfied/very dissatisfied) for all adult Medicare beneficiaries. A weighted sample of 48.6 million Medicare Beneficiaries was analyzed using logistic regression, adjusted for sex, race, educational attainment, income, general health, and functional limitations in instrumental activities of daily living. The adjusted model found that compared to adults with no hearing trouble, those with a little trouble hearing and a lot of trouble hearing had 1.47 times (95% CI: 1.06, 2.03) and 1.74 times higher odds (95% CI: 1.15, 2.62) higher odds of reporting dissatisfaction with care, respectively. Hearing loss, possibly mediated by its impact on communication, is associated with satisfaction with care. Given the emphasis placed on patient-reported satisfaction value-based reimbursement programs, hearing loss may represent a potential, low-risk/high-reward area of intervention to improve satisfaction.

The Patient Perspective on Patient-Reported Outcome Measures Following Elective Hand Surgery: A Convergent Mixed-Methods Analysis

Patient-reported outcome measures (PROMs) have traditionally been used for research purposes, but are now being used to evaluate outcomes from the patient's perspective and inform ongoing management and quality of care. We used quantitative and qualitative approaches to evaluate the short-version Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the Patient-Specific Functional Scale (PSFS) with regard to patient preference and measurement of patient goals and their responsiveness after treatment. Patients 18 years or older undergoing elective hand surgery received the QuickDASH and PSFS questionnaires before and at 6 weeks after surgery. Two additional questions intended to elicit patients' preferences regarding the QuickDASH and PSFS were included. Responsiveness was measured by change in pre- to postoperative score. We analyzed patients' responses to the 2 additional questions to identify themes in PROM preferences. Results from the quantitative and qualitative analyses were combined into a convergent mixed-methods (eg, quantitative and qualitative) analysis. Thirty-eight patients completed preoperative questionnaires; 25 (66%) completed postoperative questionnaires. Seventeen patients (77%) preferred the PSFS, 3 (14%) had no preference, 2 (9%) preferred the QuickDASH. The average change from pre- to postoperative QuickDASH was -10 (SD, 20), and that of the PSFS was -27 (SD, 26). Ten patients (40%) reported QuickDASH score changes above the minimal clinically importance difference (MCID), 17 patients (68%) reported PSFS score changes above the MCID. Content analysis revealed 4 themes in preference for a PROM: instrument simplicity (ease of instrument understanding and completion), personalized assessment (individualization and relevance), goal directed (having measurable aims or objectives), distinct items (concrete or specific instrument items or functions). Most patients felt the PSFS better measured their goals because it is a simple, personalized instrument with distinct domains. Whereas standardized PROMs may better compare across populations, physicians, or conditions, employing PROMs that address patient-specific goals may better assess aspects of care most important to patients. A combination of these 2 types of PROMs can be used to assess outcomes and inform quality of care.

State-of-the-art methods in healthcare text classification system: AI paradigm.

Machine learning has shown its importance in delivering healthcare solutions and revolutionizing the future of filtering huge amountd of textual content. The machine intelligence can adapt semantic relations among text to infer finer contextual information and language processing system can use this information for better decision support and quality of life care. Further, a learnt model can efficiently utilize written healthcare information in knowledgeable patterns. The word-document and document-document linkage can help in gaining better contextual information. We analyzed 124 research articles in text and healthcare domain related to the ML paradigm and showed the mechanism of intelligence to capture hidden insights from document representation where only a term or word is used to explain the phenomenon. Mostly in the research, document-word relations are identified while relations with other documents are ignored. This paper emphasizes text representations and its linage with ML, DL, and RL approaches, which is an important marker for intelligence segregation. Furthermore, we highlighted the advantages of ML and DL methods as powerful tools for automatic text classification tasks.

Trusting Sources of Information on Quality of Physician Care.

Reporting healthcare quality has become an important factor in healthcare delivery. Prior research has shown that patient-consumers do not frequently use information on websites reporting physician quality to guide their choice of physicians. Our aim is to understand the contextual and personal characteristics that influence patient-consumers’ decisions to trust or ignore information sources about healthcare quality. We use data from Finding Quality Doctors: How Americans Evaluate Provider Quality in the US, 2014, to examine factors that explain trust in sources reporting healthcare quality provided by physicians. Using factor analysis, 3 overarching information sources were identified: (1) employers and healthcare providers; (2) user advocacy sources; and (3) insurance companies and government. We use multiple regression analysis to understand the factors that impact trust in these 3 information sources. Our study found that contrary to previous findings, health status was not a significant factor that affects trust in sources reporting care quality data. Also, age was the only factor that significantly correlated with trusting information from all 3 sources. Specifically, younger adults trusted information from all sources compared to older adults. Furthermore, political affiliation, employment status, income, and area of residence correlated with trusting care quality information from either companies and government agencies or family and social network sources. Results suggest that individual and contextual characteristics are significant factors in trusting information sources regardless of health status and these should be taken into consideration by those promoting public reporting of healthcare quality information.

Quality of care reported by proxies - Does resident cognition count?

Resident self-reports are considered the primary source of quality of care information, but proxy reports by family or staff can also be used to supplement or substitute resident reports. This study analyses how the results of proxy reports vary according to residents’ cognition level. The data set used covers proxy reports of family ( n = 558) and staff ( n = 801), divided by the availability of resident self-reports (family yes n = 289, no n = 269; staff yes 393, no = 408). Family and staff proxies assessed residents’ quality of care as better when resident self-reports were also available, and quality of care tended to be assessed as poorer among those with higher cognitive decline. The results of this methodological study indicate the importance of using several proxy evaluations; however, these can only supplement resident self-reports, not replace them. The interpretation rules acknowledging dependency between residents’ cognition and proxy assessments could be used as a basis for future comparisons of quality improvement in long-term care and for painting a more comprehensive picture of service quality.

The Dialysis Facility Compare Five-Star Rating System at 2 Years.

The 1997 Balanced Budget Act required the Centers for Medicare and Medicaid Services (CMS) to develop and implement a method to measure and report the quality of kidney dialysis services provided by Medicare ([1][1]). As a result, CMS launched the Dialysis Facility Compare (DFC) website in 2001,

The ParkinsonNet approach: a model of integrated care for long term conditions

Introduction: Patients with Parkinson’s disease need long term care and support. ParkinsonNet implemented a model of integrated care provided by a network of specialists. This model is also promising for other long term conditions. Description of policy context and objective: Advances in medical knowledge and technology, escalating healthcare costs, and rising patient expectations and involvement in their care are changing the management of chronic diseases. Before the introduction of ParkinsonNet, Dutch patients were dissatisfied with their care. Treatment was mainly focused on suppression of symptoms with drugs, referral to other disciplines was arbitrary, care was delivered by professionals who had no Parkinson’s specific training or expertise, interdisciplinary collaboration between medical specialists and allied healthcare professionals was inadequate and patients were not involved in decisions about their treatment. ParkinsonNet was developed to tackle these problems by standardizing and integrating the delivery of care to patients. Targeted population: More than 30,000 persons with Parkinson’s disease in the Netherlands. Highlights: (innovation, impact and outcomes) ParkinsonNet established 70 regional networks of selected and highly motivated health professionals (for example neurologists, Parkinson’s nurses, physiotherapists, speech-language therapists, social workers) across the entire country. Treatment guidelines were developed for several disciplines and served as the foundation of compulsory training programs for professionals. Through ongoing treatment of large number of patients, the knowledge and expertise of the specialized networks grew exponentially. ParkinsonNet established an online information technology platform called the Parkinson healthcare finder that allows patients to identify ParkinsonNet specialists. ParkinsonNet also facilitates web based communities for patients and professionals. The Parkinson Atlas displays quality of care information at the level of regional networks such as numbers of hip fractures. Over 10 years after the first ParkinsonNet networks, the referral of patients to trained providers improved and the adherence to treatment guidelines increased. Furthermore, the number of fractures decreased significantly, which led to a significant drop in healthcare costs. Moreover, patients appreciate the ability to identify experts themselves and ParkinsonNet specialists work with greater job satisfaction. Patients do complain that the ParkinsonNet “label” does not guarantee high quality care. ParkinsonNet is therefore creating a quality of care registry to provide information about the level of expertise and quality of care delivered by all individual ParkinsonNet specialists. Transferability: We have successfully developed a ParkinsonNet network within the health system of Kaiser Permanente and in one region in Germany, and we will start implementing this model in several other countries. ParkinsonNet can be a model for other long term conditions where management is similarly impaired by lack of expertise among professionals, poor interprofessional collaboration, and a lack of tools to empower patients. Conclusions: ParkinsonNet is a model where care is delivered by a restricted number of trained professionals who collaborate within regional networks. This network based healthcare empowers patients, promotes self management, improves quality of care, and lowers healthcare costs.

Role of in-hospital care quality in reducing anxiety and readmissions of kidney transplant recipients

BackgroundA total of 17,000 patients receive kidney transplants each year in the United States. The 30-day readmission rate for kidney transplant recipients is over 30%. Our research focuses on the relationship between the quality of care delivered during the patient's hospital stay for a kidney transplant, and the patient health outcomes and readmissions related to the transplant. MethodsWe interviewed 20 kidney transplant recipients at a major transplant center in the United States. Findings from these interviews were used to inform the data collection using structured surveys, which were administered to an additional 77 kidney transplant recipients. We used ordinary least squares regression to predict the effects of two dimensions of in-hospital care quality–information consistency and empathetic care delivery–on level of patient anxiety 1 week following discharge. Further, we estimated a logistic regression to predict the effect of anxiety, combined with the two dimensions of in-hospital care quality, on occurrence of 30-day readmissions. ResultsPatient anxiety levels 1 wk after discharge are significantly associated with information consistency and empathetic delivery of care. Patient anxiety 1 wk after discharge is associated with occurrence of 30-d readmissions. The logistic regression model indicates that the risk of getting readmitted is 110% higher for a one unit increase in patient anxiety level 1 wk after discharge. Finally, patient anxiety fully mediates the effects of consistency of information and empathetic care delivery on occurrence of 30-d readmissions (50.96% of the effect is mediated). ConclusionsOur study suggests two ways of preventing readmissions through reduction of postdischarge anxiety: (1) standardizing in-hospital care, so that information received by patients is consistent, and (2) by training caregivers to be more empathetic toward patients during the delivery of this information.

Using Social Media, Online Social Networks, and Internet Search as Platforms for Public Health Interventions: A Pilot Study.

To pilot public health interventions at women potentially interested in maternity care via campaigns on social media (Twitter), social networks (Facebook), and online search engines (Google Search). Primary data from Twitter, Facebook, and Google Search on users of these platforms in Los Angeles between March and July 2014. Observational study measuring the responses of targeted users of Twitter, Facebook, and Google Search exposed to our sponsored messages soliciting them to start an engagement process by clicking through to a study website containing information on maternity care quality information for the Los Angeles market. Campaigns reached a little more than 140,000 consumers each day across the three platforms, with a little more than 400 engagements each day. Facebook and Google search had broader reach, better engagement rates, and lower costs than Twitter. Costs to reach 1,000 targeted users were approximately in the same range as less well-targeted radio and TV advertisements, while initial engagements-a user clicking through an advertisement-cost less than $1 each. Our results suggest that commercially available online advertising platforms in wide use by other industries could play a role in targeted public health interventions.

Amount and timing of group-based childcare from birth and cognitive development at 51 months

This study investigated whether the amount and timing of group-based childcare between birth and 51 months were predictive of cognitive development at 51 months, taking into account other non-parental childcare, demographic characteristics, cognitive development at 18 months, sensitive parenting and a stimulating home environment. Children’s (N=978) cognitive development was assessed at 51 months with four subscales of the British Ability Scales: two verbal and two non-verbal. Mothers were interviewed and observed at 3, 10, 18, and 36 months and the quality of group care was assessed at 10, 18, and 36 months (N=239) if it was used for ≥12 hours per week. Age of starting in group care and amount were highly associated (r = -.75). Multiple regressions indicated that, controlling for other factors, higher cognitive development and particularly non-verbal ability was associated with more hours per week in group care from 0 to 51 months, or an earlier start, or group care before age 2. Nevertheless, the majority of variance was explained by other predictors: sex (girl), higher cognitive development at 18 months, older mother, first language English, mother of white ethnic background, with more qualifications, higher family social class, more maternal responsivity at 10 months and a more stimulating home learning environment (HLE) at 36 months. Hours per week in relative care or home-based care were not significant predictors of cognitive scores. For the smaller relatively advantaged sample who had group care quality information (N=239), quality was a marginal predictor of better cognitive development but age of starting group care was not. Most variance was explained by 18 month cognitive development, maternal education, and family social class.

Physician Quality Reporting System (PQRS) for Interventional Pain Management Practices: Challenges and Opportunities

Basing their rationale on multiple publications from Institute of Medicine (IOM), specifically Crossing the Quality Chasm, policy makers have focused on a broad range of issues, including assessment of the influence of medical practice organization structures on quality performance and development of quality measures. The 2006 Tax Relief and Health Care Act established the Physician Quality Reporting System (PQRS), to enable eligible professionals to report health care quality and health outcome information that cannot be obtained from standard Medicare claims. However, the Patient Protection and Affordable Care Act (ACA) of 2010 required the Centers for Medicare and Medicaid Services (CMS) to incorporate a combination of cost and quality into the payment systems for health care as a precursor to value-based payments. The final change to PQRS pending initiation after 2018, is based on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which has incorporated alternative payment models and merit-based payment systems. Recent publication of quality performance scores by CMS has been less than optimal. When voluntary participation began in July 2007, providers were paid a bonus for reporting quality measures from 2008 through 2014, ranging from 0.5% to 2% of the Medicare Part B allowed charges furnished during the reporting period. Starting in 2015, penalties started for nonparticipation. Eligible professionals and group practices that failed to satisfactorily report data on quality measures during 2014 are subject to a 2% reduction in Medicare fee-for-service amounts for services furnished by the eligible professional or group practice during 2016. The CMS proposed rule for 2016 physician payments contained a number of provisions with proposed updates to the PQRS and Physician Value-Based Payment Modifier among other changes. The proposed rule is the first release since MACRA repealed the sustainable growth rate formula. CMS proposed to continue many existing policies regarding PQRS from 2015 to 2016. In addition, 2016 will be the year that is utilized to determine the 2018 PQRS payment adjustment. However, after 2018 the PQRS payment adjustment will be transitioned to the Merit-Based Incentive Payment System (MIPS), as required by MACRA. Overall, there will be over 280 measures in the 2016 PQRS. Readers might be surprised to find out that despite the cost intensity including time requirements personnel, the negative payment adjustments, are only the tip of the iceberg of cost. Indeed, all of the above may only be one-third or one-fourth of the cost to completely implement the PQRS system. Thus far, data across all specialties shows participation to be around 50%. In addition, penalties for lack of reporting of PQRS measures stands to be controversial to the Supreme Court ruling that unfunded mandates must not be permitted and also lack of significant relationships with improvement in quality in the overall analysis in multiple publications. Key words: Value-based modifier, Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), alternative payment models (APMs), merit based payment systems, negative payments, bonuses

APLIKASI DESKTOP PASIEN RAWAT JALAN PADA KLINIK MEKAR SARI MEDIKA MENGGUNAKAN METODOLOGI BERORIENTASI OBYEK

Pursue the world of business in the health sector needs support right information to manage health care services for the purpose of a health service can be implemented as expected. The dependence in the business world of computer-based information systems is rapidly increasing, making it difficult for a business organization to compete without the support of information systems that address the needs mempu. In thismatter as a desktop application into an ease of software in any application of computerized technology, as well as software (software). A desktop application that is designed to be answering the needs of users, who apply into the computerized system. So from that point on in the wake of an application can improve the system must be ensured before. Thus, as stated above, the Blooms Sari Medical Clinic is an organization that is engaged in work to improve health care quality and patient information needed in order to be accepted quickly and precisely so that the quality of service standards can be satisfied. To achieve these objectives, Sari Medical Clinic blooms are still using manual system of recording data in particular, causing health care to the patient to be slow. To answer this, we need a system of outpatient health services to support the smooth. The key to successful implementation of an outpatient information system is to understand the needs of the administration of the Medical Clinic and Sari Bloom understands the development of strategies that can facilitate the adoption and use of a new technology.

Postscript: research agenda to guide the next generation of public reports for consumers.

There is significant interest in building the next generation of public reporting tools that will more effectively engage consumers and better enable them to make use of comparative performance information when selecting a provider. Demand for public reporting tools that make health care cost and quality information transparent is fueled by a variety of market forces underway. A host of public reporting efforts and studies have identified a number of challenges, highlighting that we still do not understand how best to design public reports to meet the needs of the consumer. We identify five areas for additional research that, if addressed, could foster better design and delivery of quality and cost information to consumers.

Designing a method to assess and improve the quality of healthcare in Nephrology by means of the Delphi technique.

Free choice is not easy when there is a lack of information. Methods for evaluating quality of care to provide patients with comprehensive and understandable information on hospital departments are therefore necessary. To draft a methodological proposal for evaluating quality of care of hospital departments, the data of which can provide citizens with useful care quality information. The proposal should be based on consensus and on the experience of medical specialists, defining thus complementary paths to improvement. A Delphi study on the quality of care in Nephrology, comprising three phases: assessment results, necessary means for quality, and importance of medical advice and surveys among specialists. The questionnaire was administered to a panel of 32 nephrologists. The nephrologists accepted the outcome criteria on quality of care 55/62 (89%), as well as the proposed means for quality of care 87/92 (95%). 81% of the nephrologists reported the validity and topicality of providing patients with specialist advice as to the most adequate department to better treat their kidney diseases. 86% of the panellists deemed appropriate to include surveys on medical advice as additional criteria for the evaluation of quality of care. It is possible to obtain a consensus-based methodological proposal for the evaluation and improvement of quality of care which includes results on quality of care, means for quality of care, and medical advice based on surveys carried out among specialists to identify the best Nephrology departments. This method could provide reliable and understandable guidance for citizens.

Measuring healthcare quality: the challenges

Current health care quality performance indicators appear to be inadequate to inform the public to make the right choices. The aim of this paper is to define a framework and an organizational setting in which valid and reliable healthcare information can be produced to inform the general public about healthcare quality. To improve health care quality information, the paper explores the analogy between financial accounting, which aims to produce valid and reliable information to support companies informing their shareholders and stakeholders, and healthcare aiming to inform future patients about healthcare quality. Based on this analogy, the authors suggest a measurement framework and an organizational setting to produce healthcare information. The authors suggest a five-quality element framework to structure quality reporting. The authors also indicate the best way to report each type of quality, comparing performance indicators with certification/accreditation. Health gain is the most relevant quality indicator to inform the public, but this information is the most difficult to obtain. Finally, the organizational setting, comparable to financial accounting, required to provide valid, reliable and objective information on healthcare quality is described. Framework elements should be tested in quantitative studies or case studies, such as a performance indicator's relative value compared to accreditation/certification. There are, however, elements that can be implemented right away such as third party validation of healthcare information produced by healthcare institutions. Given the money spent on healthcare worldwide, valid and reliable healthcare quality information's value can never be overestimated. It can justify delivering "expensive healthcare, but also points the way to savings by stopping useless healthcare. Valid and reliable information puts the patient in the driver's seat and enables him or her to make the right decision when choosing their healthcare provider.

The Challenge of Quality in Breast Care: Beyond Accreditation

The Challenge of Quality in Breast Care: Beyond Accreditation

Information technology and voluntary quality disclosure by hospitals

Information asymmetry between consumers and health care providers is a well-known phenomenon in health care systems. Disclosure of health care quality information is one important mechanism through which hospitals can signal performance to potential patients and competitors, yet little is known about the organizational factors that contribute to voluntary disclosure. In this study we develop an empirical model to investigate the factors associated with choosing to participate in a voluntary quality disclosure initiative, specifically isolating the importance of information technology (IT) in facilitating disclosure. We extend the scope of prior work on the quality disclosure choice by augmenting it with an important decision variable: the operational costs of collecting and reporting quality data. We suggest that IT can facilitate disclosure by reducing these costs, thereby extending the literature on the value of IT. Empirical findings using data from a major voluntary quality disclosure program in California hospitals support our assertion related to the role of IT. Our results further highlight other hospital characteristics contributing to disclosure. We discuss implications of these findings for research and practice.

The Relative Importance of Quality of Care Information When Choosing a Hospital for Surgical Treatment: A Hospital Choice Experiment

The Relative Importance of Quality of Care Information When Choosing a Hospital for Surgical Treatment: A Hospital Choice Experiment