Organization Of Care Services Research Articles

Acesso e equidade nos serviços de saúde: uma revisão estruturada

RESUMO Artigo de revisão de literatura sobre a organização de serviços da Atenção Primária à Saúde em suas dimensões de acesso e equidade. Os artigos foram identificados nas bases de dados da Biblioteca Virtual em Saúde (Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde - Bireme). Palavras-chave: 'acesso aos serviços de saúde' e 'equidade'; período: 1993 a 2013. Dos 31 artigos encontrados, 29 estão em português, um em inglês e um em espanhol, publicados por 16 diferentes periódicos; 18 artigos (58,06%) referem-se à organização de serviços de saúde e 13 (41,94%) à equidade. A maioria (80,64%) utilizou abordagem qualitativa. Mais estudos são necessários a fim de avaliar se os sistemas de saúde tiveram impactos mensuráveis em termos de acesso e equidade.

The Unintended Consequences of Health Information Technology Revisited.

The introduction of health information technology into clinical settings is associated with unintended negative consequences, some with the potential to lead to error and patient harm. As adoption rates soar, the impact of these hazards will increase. Over the last decade, unintended consequences have received great attention in the medical informatics literature, and this paper seeks to identify the major themes that have emerged. Rich typologies of the causes of unintended consequences have been developed, along with a number of explanatory frameworks based on socio-technical systems theory. We however still have only limited data on the frequency and impact of these events, as most studies rely on data sets from incident reporting or patient chart reviews, rather than undertaking detailed observational studies. Such data are increasingly needed as more organizations implement health information technologies. When outcome studies have been done in different organizations, they reveal different outcomes for identical systems. From a theoretical perspective, recent advances in the emerging discipline of implementation science have much to offer in explaining the origin, and variability, of unintended consequences. The dynamic nature of health care service organizations, and the rapid development and adoption of health information technologies means that unintended consequences are unlikely to disappear, and we therefore must commit to developing robust systems to detect and manage them.

APA Foundation Recognizes Leaders in Minority Mental Health

Back to table of contents Previous article Next article Association NewsFull AccessAPA Foundation Recognizes Leaders in Minority Mental HealthLindsey McClenathanLindsey McClenathanSearch for more papers by this authorPublished Online:24 Jun 2016https://doi.org/10.1176/appi.pn.2016.7a14AbstractThe awards honor individuals and programs that are making a difference in improving the care of underserved minority members with mental illness.The 2016 APA Foundation Awards for Advancing Minority Mental Health were announced at the annual benefit of the American Psychiatric Association Foundation, held in conjunction with APA’s 2016 Annual Meeting in Atlanta in May.Gathering for a photo after presentation of the APA Foundation Awards for Advancing Minority Mental Health were (from left) Ranna Parekh, M.D., director of APA’s Division of Diversity and Health Equity; Saul Levin, M.D., M.P.A., APA CEO and medical director and chair of the Foundation’s Board of Directors; Altha Stewart, M.D., a member of the APA Board of Trustees; award winners Kenneth Fung, M.D., Nubia Lluberes-Rincon, M.D., and Olga El Sehamy and her son, Alex El Sehamy; and Uyen-Khanh Quang-Dang, M.D., M.Sc., a member of the APA Foundation’s Board of Directors. Parekh, Stewart, and Quang-Dang presented the awards.David HathcoxThe awards, created in 2003, recognize psychiatrists, other health professionals, and organizations that have undertaken innovative efforts to raise awareness of mental illness in underserved minority communities, increase access to care, overcome cultural barriers to care, and improve the quality of care for underserved minorities, particularly those in the public health system or with severe mental illness.Here are brief descriptions of this year’s winners:Kenneth Fung, M.D., of Toronto is a co-founder of the Asian Initiative in Mental Health Program (AIM) at the Toronto Western Hospital. This program serves the local, underserved Cantonese- and Mandarin-speaking communities and is a training ground for medical students and residents interested in cross-cultural psychiatry. In addition to his efforts to increase culturally competent mental health care through AIM, Fung provides psychiatric consultation and training to minority mental health care service organizations. Also, he has engaged with local media to promote mental health and advocate for stigma reduction in local minority populations and has co-led numerous research studies.Nubia Lluberes-Rincon, M.D., of Freedom, Pa., is pursuing a fellowship in forensic psychiatry to allow her to help close the gap between psychiatric services and the correctional system in the United States. Lluberes-Rincon, a former APA Diversity Leadership Fellow, has spent time providing mental health education to the Hispanic community in Texas and creating a documentary on bipolar disorder. In West Virginia, where African Americans, LGBT, and other minority groups are in need of additional support, she re-established electroconvulsive therapy at a hospital serving these populations and provided community education to fight stigma surrounding mental illness.Deaf and Hard of Hearing Program of Lifeline Connections of Vancouver, Wash., provides high-quality treatment and support for people who are deaf and have a substance use disorder, allowing equal access to treatment in American Sign Language (ASL), the clients’ first language. This dynamic eliminates complications and barriers that a third-party interpreter may introduce to the therapeutic relationship and therefore improves treatment outcomes. The program offers both individual and group counseling and hosts an alumni program to help clients live sober lives. The Deaf and Hard of Hearing Program has clients who have been sober and in recovery for many years. Adelante of Suffolk County Inc. in Central Islip, N.Y., serves local low-income families, many of whom are Hispanic. In order to address the mental health of its clients, Adelante runs a Supported Housing and Behavioral Program in which all staff are bilingual (English-Spanish) and able to provide care in the clients’ first (and potentially only) language. Adelante collaborates with Alcoholics Anonymous and a local clinical facility offering treatment for adults with serious mental illness. Additionally, the Supported Housing and Behavioral Program offers pre-vocational services to prepare their clients for employment and training in life skills to provide a holistic approach to the overall well-being of the individual. ■More information on the Awards for Advancing Minority Mental Health can be accessed here.Lindsey McClenathan is the development officer in the APA Foundation. ISSUES NewArchived

Spatial analysis of avoidable hospitalizations due to tuberculosis in Ribeirao Preto, SP, Brazil (2006-2012).

ABSTRACTOBJECTIVE To describe the spatial distribution of avoidable hospitalizations due to tuberculosis in the municipality of Ribeirao Preto, SP, Brazil, and to identify spatial and space-time clusters for the risk of occurrence of these events.METHODS This is a descriptive, ecological study that considered the hospitalizations records of the Hospital Information System of residents of Ribeirao Preto, SP, Southeastern Brazil, from 2006 to 2012. Only the cases with recorded addresses were considered for the spatial analyses, and they were also geocoded. We resorted to Kernel density estimation to identify the densest areas, local empirical Bayes rate as the method for smoothing the incidence rates of hospital admissions, and scan statistic for identifying clusters of risk. Softwares ArcGis 10.2, TerraView 4.2.2, and SaTScanTM were used in the analysis.RESULTS We identified 169 hospitalizations due to tuberculosis. Most were of men (n = 134; 79.2%), averagely aged 48 years (SD = 16.2). The predominant clinical form was the pulmonary one, which was confirmed through a microscopic examination of expectorated sputum (n = 66; 39.0%). We geocoded 159 cases (94.0%). We observed a non-random spatial distribution of avoidable hospitalizations due to tuberculosis concentrated in the northern and western regions of the municipality. Through the scan statistic, three spatial clusters for risk of hospitalizations due to tuberculosis were identified, one of them in the northern region of the municipality (relative risk [RR] = 3.4; 95%CI 2.7–4,4); the second in the central region, where there is a prison unit (RR = 28.6; 95%CI 22.4–36.6); and the last one in the southern region, and area of protection for hospitalizations (RR = 0.2; 95%CI 0.2–0.3). We did not identify any space-time clusters.CONCLUSIONS The investigation showed priority areas for the control and surveillance of tuberculosis, as well as the profile of the affected population, which shows important aspects to be considered in terms of management and organization of health care services targeting effectiveness in primary health care.

Framingham risk score in impaired glucose tolerant population: A sub analysis of Diabetes Prevention and Awareness Program of Pakistan.

Objective:To assess the 10-year risk of coronary artery disease (CAD) in subjects with impaired glucose tolerance (IGT) using Framingham risk score.Methods:Data for this study was collected from Diabetes Prevention and Awareness Program. Primary prevention team visited different primary health care centers, factories, service organizations and offices within Karachi, Pakistan. IGT was diagnosed according to World Health Organization criteria after taking informed consent. Information regarding social-demography, dietary habits and physical activities were obtained by a designed questionnaire on one-to-one based interview. Framingham risk score (FRS) was used to assess risk of developing CAD.Results:A total of 315 subjects with IGT were recruited for the study. Mean age of subjects was 44.1 ± 9.8 years and mean BMI was 27.3 ± 5.0 kg/m2. Overall, 31.4% of the participants were at risk of having CAD. Males were 6.4 times and hypertensive subjects were 2.44 times more likely to have CAD in next 10 years.Conclusion:According to the findings of the study, male and hypertensive IGT subjects were more likely to develop CAD in next 10 years. Community based awareness programs are needed to educate people regarding healthy lifestyle in order to reduce the risk of IGT and CAD.

System podstawowej opieki medycznej we Włoszech – przegląd

Italian Primary Care System has been modelled after the NHS in UK and was established in 1978. In 2000 Italy's healthcare system was regarded, by a World Health Organization's ranking, as the 2nd best in the world after France;since then, the performance has constantly decreased mainly because ofthe austerity policy. This austerity policy is notjustified by the Official OECD figures which show that Italian Health Care expenditures are below the average in OECD Countries. Quality outcomes almost always show a clear North-South divide in almost all health care sectors. Responsibility for health care is now shared between the central government and 19 regions and 2 autonomous provinces (Trento and Bolzano), which traditionally differ a lot in terms ofeconomic development, per capita income, demography and culture. Disparities can be found in almost any area of health care provision, in health policy making, health care expenditure, quality of health care, public satisfaction and health care services organization. The pros ofthe Italian Primary Care System are the continuity of care and the universalism; the cons are the crippling bureaucracy, the workload, the lack of basic social benefits for GPs such as subsidized sick leaves and the lack of University Department of Primary Care and finally the absence of any perspective of professional development in the Academic field. (Less)

Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians

ObjectivesIndigenous Australians have a disproportionately high burden of chronic illness, and relatively poor access to healthcare. This paper examines how a national multicomponent programme aimed at improving prevention and management...

Changes in Quality Indicators Relating to Organization of Primary Care Services between 2007 and 2010 in São Paulo State, Brazil.

Changes in Quality Indicators Relating to Organization of Primary Care Services between 2007 and 2010 in São Paulo State, Brazil.

P02.05 Sexual health literacy – an emerging framework for research and intervention to improve sexual health for gay men

Introduction Health literacy is an important determinant of health yet has not been formally applied to sexual health. An expert event brought 38 researchers, community members, and service providers together to explore gay men’s sexual health literacy (SHL). Methods Using a World Cafe method, three rounds of discussion posed questions about SHL in relation to gay men, providers, and underlying systems. Documented notes were analysed thematically through two rounds of group synthesis and a subsequent review by one investigator. Results SHL was influenced by ways men access information, through peer networks, and coded communications with prospective partners. The Internet influences access to, delivery of and engagement with information, while new technologies and changing sexual norms complicate message consistency and risk assessment. Actionable risk assessment requires numeracy skills. Gay men were generally perceived to have high SHL with concern that SHL may be lower for some sub-populations (e.g., youth, immigrant men). Participants valued bottom-up/community-based over top-down/expert models of providing SHL. Health care provider attitudes, cultural competency, knowledge and communication skills were seen as key determinants of SHL and non-traditional health sectors also play key roles (e.g., education, pornography). Underlying determinants of SHL included stigma related to HIV or sexual orientation, access and organisation of health care services, systemic shifts to self-care models, political ideologies and funding. Syndemic, intersectional, and holistic health approaches to SHL were advocated. Participants recognised the strong history of activism and mobilisation within gay communities as integral to SHL. Conclusion Critical health literacy has been a core component of the gay men’s health movement to date. Innovations in biomedical technologies and access to online information are critically shaping experiences of SHL for gay men. The expanded theoretical framework emerging from these findings serves as a starting point to inform enhancing SHL and designing effective interventions. Disclosure of interest statement The authors have no conflict of interest to disclose.

Bicriteria elective surgery scheduling using an evolutionary algorithm

Current social and economic environment forces better practices among health care service organizations. Portuguese National Health Plan outlines the urgency of improving the efficiency of the health care systems installed capacity, and reducing the waiting lists for surgery. This work aims to contribute to these objectives by developing a bicriteria optimization methodology that allows to streamline the surgery scheduling problem at a Lisbon public hospital. An evolutionary algorithm to approximate the set of non-dominated solutions of this bicriteria optimization problem is presented. Tests performed using hospital data show a good performance of the algorithm proposed. Instances with 508 to 2306 elective surgeries are solved in less than 80 seconds. A very good representation of the Pareto front was achieved thus providing the opportunity to implement a better decision-making process at the hospital. This study presents a powerful method with potential to improve the delivery of surgical activity in the hospital under study.

Discrepancies in assessing home care workers' working conditions in a Norwegian home care service: differing views of stakeholders at three organizational levels.

BackgroundThe present study is a follow-up study of factors contributing to an undesirable quality of work environment and sick leave rate in the home care services in a Norwegian municipality. The underlying assumption is that organizational discrepancies in the perceptions and appraisals of significant factors and processes in an organization have detrimental effects on the management of the organization and on work environment conditions. Thus, the study aim is to explore potential organizational discrepancies in the appraisals of factors relating to home care workers’ working conditions.MethodsThe study, using a mixed-methods design, comprised six home care units. It included survey responses of home care workers (80 respondents, response rate 54 %) and qualitative descriptions of stakeholders’ appraisals of organizational issues gathered through semi-structured interviews (33 interviews with stakeholders at three organizational levels).ResultsEmployees at different organizational levels in the home care services expressed divergent appraisals of factors related to the working conditions of home care workers, including impact of organizational measures (i.e. time pressure, work tasks, a new work program, organizational changes, budget model, budget allocation and coping strategies). Survey responses supported interview descriptions by home care workers. Results suggest that organizational discrepancy serve as an important barrier to a sustainable, well-functioning organization in general and to quality-enhancing changes to work procedures in particular.ConclusionsIt is recommended to improve communication channels and facilitate the exchange of information across levels to ensure a common understanding of matters significant to the organization of the home care services and to the work environment of home care workers. The prevalence and impact of organizational discrepancy should be included in organization research, particularly when exploring explanatory factors of an unhealthy organization.

Do Pediatric Patients Who Receive Care Across Multiple Health Systems Have Higher Levels of Repeat Testing?

Repetition by clinicians of the same tests for a given patient is common. However, not all repeat tests are necessary for optimal care and can result in unnecessary hardship. Limited evidence suggests that an electronic health record may reduce redundant laboratory testing and imaging by making previous results accessible to physicians. The purpose of this study is to establish a baseline by characterizing repeat testing in a pediatric population and to identify significant risk factors associated with repeated tests, including the impact of using multiple health systems. A population-based retrospective cross-sectional design was used to examine initial and repeat test instances, defined as a second test following an initial test of the same type for the same patient. The study population consisted of 8760 children with 1-25 test claims over a 1-year period. The study setting included all health care service organizations in Minnesota that generated these claims. In all, 17.2% of tests met the definition of repeat test instances, with several risk factors associated with per patient repeat test levels. The incidence of repeat test instances per patient was significantly higher when patients received care from more than 1 health system (adjusted incidence rate ratio 1.4; 95% confidence interval: 1.3-1.5). Repeat test levels are significant in pediatric populations and potentially actionable. Interoperable health information technology may reduce the incidence of repeat test instances in pediatric populations by making prior test results readily accessible. (Population Health Management 2016;19:102-108).

Trends in hospitalization due to cardiovascular conditions sensitive to primary health care.

To analyze the trend in hospitalizations for primary care-sensitive cardiovascular conditions for residents of the state of Paraná, Brazil, from 2000 to 2011. Ecological, time series study of the rates of hospitalization for cardiovascular diseases in residents aged 35-74 years old by sex, age and main diagnosis for hospitalization. Data from the Hospital Information System of the Unified Health System (SIH-SUS) and polynomial regression models for trend analyses were used. Hospitalization rates for cardiovascular conditions decreased during the period (r2 = 0.96; p < 0.001), with similar decreasing patterns for males and females, in all age ranges, although always higher for males. Although hospitalization trends for hypertension, heart failure and cerebrovascular disease decreased, angina remained stable for males and females. A downward trend in hospital admissions due to primary care-sensitive cardiovascular conditions in the state of Paraná between 2000 and 2011 may have resulted from the expansion of the health network of and the access to primary health attention, as well as other factors that influence this set of diseases, such as improved socioeconomic conditions of the population, organization of primary care services for higher age ranges and women and decrease in risk factors.

Adolescents leaving mental health or social care services: predictors of mental health and psychosocial outcomes one year later.

BackgroundUK service structure necessitates a transition out of youth services at a time of increased risk for the development and onset of mental disorders. Little is currently known about the mental health and psychosocial outcomes of leaving services at this time. The aim of this study was to determine predictors of mental health and social adjustment in adolescents leaving mental health or social care services.MethodsA cohort (n = 53) of 17 year olds were interviewed and assessed when preparing to leave adolescent services and again 12 months later. Their mental health and psychosocial characteristics were compared to a same-age community sample group (n = 1074).ResultsAt discharge 34 (64%) met DSM IV criteria for a current psychiatric diagnosis and only 3 (6%) participants met operational criteria for successful outcomes at follow-up. Impairments in mental health, lack of employment, education or training and low preparedness were associated with poor outcomes.ConclusionsThe findings suggest the current organisation of mental health and care services may not be fit for purpose and even unwittingly contribute to persistent mental illness and poor psychosocial outcomes. A redesign of services should consider a model where the timing of transition does not fall at the most hazardous time for young people, but is sufficiently flexible to allow young people to move on when they are personally, socially and psychologically most able to succeed. Assessment of a young person’s readiness to transition might also be useful. A youth focused service across the adolescent and early adult years may be better placed to avoid young people falling through the service gap created by poor transitional management.

Development (f)or Maintenance? An Empirical Study on the Use of and Need for HR Practices to Retain Older Workers in Health Care Organizations

The aims of this article are to (a) examine the prevalence of HR (HRM and HRD) practices to retain older workers in health care organizations; (b) evaluate those HR practices that are specifically designed to facilitate the retention of older workers; and (c) classify those HR practices against the needs of older workers, line managers, and HR professionals. To achieve these aims, 51 interviews were conducted with older workers, line managers, and HR professionals working in 15 Dutch hospitals and care service organizations in late 2010. The study had a mixed-methods setup in that the collected information was partly quantitative (figures about the prevalence and outcomes of practices), and partly qualitative (incorporating illustrative reflections or observations offered by interviewees), the latter complementing the former. Maintenance HR practices (practices that are focused on retaining older workers in their current jobs) appeared to be by far more prevalent compared to development HR practices (practices that are focused on advancement, growth and accomplishment, and that encourage individual workers to achieve new and challenging levels of functioning). In general, both types of HR practices were evaluated as successful by older workers, line managers, and HR professionals. Unexpectedly, the successful evaluations of the maintenance practices appeared to be attributed to developmental rather than maintenance processes. Furthermore, the needs of older workers appeared to be strongly related to both development practices and, although to a lesser degree, maintenance practices. The article concludes with relevant directions for future research.

An Evaluation on In-Patient Satisfaction at Meridian Equator Hospital Nairobi , Kenya

The provision of high-quality, affordable, health care services is an increasingly difficult and challenging venture. Due to the complexities of health care services and systems, investigating and interpreting the use, costs, quality, accessibility, delivery, organization, financing, and outcomes of health care services is key to informing government officials, insurers, providers, consumers, and others making decisions about health-related issues. A major component of quality of health care is patient satisfaction. Patient satisfaction is a crucial and critical indicator of quality health care provisioning and function of a health facility. In addition, the analysis of patient satisfaction and the correlation between various health care services is critical in planning and management of health care organizations (World Health Organization, 2005).

Práticas clínicas e o cuidado possível no CAPSi: perspectivas de uma equipe interdisciplinar

The Center for Psychological Care of Children and Adolescents (CAPSi) has been considered the major public health institution providing daily care for children and adolescents requiring mental health care. It is a service that replaces the asylum model, proposing operations in intersectoral care networks. However, studies discussing its mode of operation and clinical efficacy are still scarce. This article presents the results of a descriptive and exploratory study whose aim was to present the key aspects of running a CAPSi located in a small town of the State of Rio de Janeiro. We used a qualitative approach to conduct documentary research, to interview the professionals of that center and to take part in the staff meetings and therapeutic activities as observers over three months. Interpretation of empirical material was performed through thematic analysis, taking into account the following thematic axes: specificities of the municipality studied; relationship between the center and the party-political context; organization of care services; relationship with the health system and the intersectoral network; care supporting strategies. We observed that clinical proposals are guided by the concern to manage care according to patient demands, by means of therapeutic projects which must be collectively implemented by the staff. Clinical and institutional supervision has shown to be an important support of daily practice, as well as the mediation of inter-professional relationships. One of the main challenges of this CAPSi is dealing with the feeling that it needs to meet, all by itself, all the demands that involve the psychic suffering of its public. The scarcity of those services within the network and the political pressure are issues that go hand in hand with the daily difficulties in dealing with the psychic suffering of the children and their relatives. Despite all that, the professionals and their supervisor keep investing in the permanent building of a creative and sensitive work that is sensitive to the psychosocial issues of their patients.Keywords: CAPSi, mental health, childhood, interdisciplinary staff, health care.

Geografia da saúde no cruzamento de saberes

Scientific EditorTitular Professor, Department of Environmental Health Faculdade de Saude Publica da Universidade de Sao PauloE-mail: lena@usp.brThe dossier of articles in Health Geography is one of the results of the I Congress on the Health Geog -raphy of Portuguese Speaking Countries (Geosaude 2014), which took place in early 2014 at the Universi -dade de Coimbra, Portugal. The topic of the Congress was Health Geography in Knowledge Crossover, with a logic covering multiple dimensions. The Congress brought together researchers from different knowl -edge areas who had contributed to re-directing the health agenda, as the preface to the annals shows. Health Geography is a way of studying health that is both very old and very modern. There are multiple relationships between geography and health condi -tions and disease, involving social, environmental, political, human, behavioral, cultural, historical and biological dimensions. However, throughout history, the emphasis placed on the relationship of space with human health has waxed and waned. In the last few decades, faced with environmental, social and economic crises that impact on health and, consequently, on health care systems, Health Geography has renewed and expanded itself with innovative methods of research and treating data, bringing new reflections and contributing greatly to understanding health and disease conditions from a collective perspective. This contribution, however, goes beyond the panorama of past, current and future collective health; it has taken on a crucial role in health care service planning and organization and making health promoting actions in the territory more efficient, based on real data and actual demand.If Medical Geography (as it was commonly known) was formerly strongly marked by drawing up maps of diseases, today it is much more than maps and diseases. Nowadays, covering more than spatial distribution of diseases, it has come to be known as Health Geography. Maps continue to be its most expressive language, but they are just one re-search stage, important for formulating etiological hypothesis and establishing spatial relationships. The following citation from Rita Barradas Barata, a well-known Brazilian epidemiologist, highlights the importance of the geographic method.The advantage of using geographical spaces as indicators of living conditions means taking the complexity of social organization as a whole, rather than fragmenting it into different variables (Barata, 2012, p. 35). Thus, the use of geo-processing and Geographic Information Systems - GIS, has become popular not only to understand the spatial distribution of health care risks and to make etiological hypotheses but also to deal with them more efficiently in the terri-tory, as they enable health inequalities and inequi-ties there to be identified.The 4 studies in the dossier were selected by the Geosaude 2014 Scientific Committee and the Saude e Sociedade Editorial Committee from the 954 scien -tific studies submitted to the Congress. They portray different foci of current Health Geography and were produced by researchers from Portugal and Brazil.The article

Identification of quality care standards and development of indicators in oncology.

239 Background: Continuous assessment of clinical practice is a fundamental strategy for improving quality care. The generation of indicators in the context of clinical practice standards is the key factor for its success. The purpose of this work is to identify and establish standards in medical care of patients with breast, lung and colon cancer and to develop their indicators. Methods: The project was performed in 4 cycles: (1) Identification of clinical care standards for patients with lung, colon and breast cancer through research for scientific evidence. It was structured in four stages: diagnosis and treatment for every cancer and organisation of palliative care services at the end of life, equal for all three groups. (2) Revision of standards by an expert group of 9 oncologists. (3) Selection of standards for the generation of the indicators using the Delphi method, modified by a panel of experts consisted of 39 oncologists. (4) Development of indicators for the selected standards. Results: During the first revision 98 recommendations and standards were approved and selected by the group of experts and presented to the second panel of experts. Finally through the Delphi method 50 standards were selected, applicable to national level. For each one of the 50 standards an indicator was formed, 10 indicators for the organisational stage, 10 for the palliative care and 10 indicators specific for the diagnosis and treatment of each one of the cancer groups (colon, breast and lung). Conclusions: A total of 50 indicators were generated as measurement of parameters related to the quality of clinical practice and the organisation of care for patients with breast, colon and lung cancer. Their use is fundamental in identifying areas for improvement that will allow the identification of future strategies of quality care.

Health care delivery for head-and-neck cancer patients in Alberta: a practice guideline.

The treatment of head-and-neck cancer is complex and requires the involvement of various health care professionals with a wide range of expertise. We describe the process of developing a practice guideline with recommendations about the organization and delivery of health care services for head-and-neck cancer patients in Alberta. Outcomes of interest included composition of the health care team, qualification requirements for team members, cancer centre and team member volumes, infrastructure needs, and wait times. A search for existing practice guidelines and a systematic review of the literature addressing the organization and delivery of health care services for head-and-neck cancer patients were conducted. The search included the Standards and Guidelines Evidence (sage) directory of cancer guidelines and PubMed. One practice guideline was identified for adaptation. Three additional practice guidelines provided supplementary evidence to inform guideline recommendations. Members of the Alberta Provincial Head and Neck Tumour Team (consisting of various health professionals from across the province) provided expert feedback on the adapted recommendations through an online and in-person review process. Selected experts in head-and-neck cancer from outside the province participated in an external online review. The recommendations outlined in this practice guideline are based on existing guidelines that have been modified to fit the Alberta context. Although specific to Alberta, the recommendations lend credence to similar published guidelines and could be considered for use by groups lacking the resources of appointed guideline panels. The recommendations are meant to be a guide rather than a fixed protocol. The implementation of this practice guideline will depend on many factors, including but not limited to availability of trained personnel, adequate funding of infrastructure, and collaboration with other associations of health care professionals in the province.