Healthcare Quality Assessment Research Articles

Proposals for medical guidelines creation at the time of digital transformation of healthcare in Russian Federation

The article presents the experience of the «National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov» in creation of medical guidelines based on the patient’s route business process for vertically integrated medical information system for “Obstetrics and gynecology” and “Neonatology” (VIMIS “AKiNEO”), with simultaneous digitization of the document, describes the advantages of this an approach before the classical form of writing document.Aim. To conduct a comparative analysis of approaches to writing a medical guideline based on a digitized medical guideline and patient’s route business process for VIMIS “AKiNEO” and in the classical way.Materials and methods. The content of digitized medical guidelines and procedures for the provision of medical care, formed by experts on the basis of the “National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov” with the methodological support of the Center for Healthcare Quality Assessment and Control were used. The assessment of the methodological advantages of writing medical guidelines based on patient routes business processes in comparison with writing in the classical way was carried out using methods of analysis and synthesis.Results. Experts have created 17 patient routes using the content of digitized medical guidelines for immersion in the VIMIS “AKiNEO”. These routes fully reflect the amount and timing of medical interventions necessary to ensure the quality of medical care. Methodological approaches for writing medical guidelines based patient routes business processes have been developed. It has been demonstrated that digitizing the content of medical guidelines and medical care procedures, describing medical guidelines in the form of a business process diagram, identify “zones of uncertainty” that ar e not visible in the text document, and can significantly affec t the quality of medical care to the patient.Conclusion. The creation of regulatory legal acts on the organization and provision of medical care and medical guidelines in modern conditions of healthcare digital transformation should take place after digitizing the text of the document and creating a business process for the patient’s route, which will improve the quality of these documents.

Current Advances in Patient-Perceived Quality Assessment Within Romanian Healthcare.

The global healthcare landscape is shifting toward patient-centered care, emphasizing the integration of patient feedback into service delivery. Romania, aligning with this trend, has implemented patient-perceived quality assessment tools to enhance healthcare services and better meet patient needs and expectations. This study aims to review comprehensively the implementation and impact of these tools in Romania, focusing on their role in improving healthcare quality. By examining key assessment instruments such as the Patient Satisfaction Questionnaire (PSQ), the Service Quality (SERVQUAL) model, and the Romanian Healthcare Quality Assessment Survey (RHQAS), the research seeks to understand how these tools have been used to identify areas for improvement and drive advancements in patient care. Employing a comprehensive review methodology, the study will conduct a thorough literature search to identify relevant studies, reports, and publications, analyzing the PSQ, SERVQUAL, and RHQAS in detail to understand their measurement domains, psychometric properties, and application within Romania. Additionally, qualitative data from interviews with healthcare providers and patients may be collected to offer further insights into the use and effectiveness of these tools. The study's findings are expected to provide valuable insights into the role of patient-perceived quality assessment tools in enhancing healthcare in Romania, identifying strengths, weaknesses, and opportunities for improvement. The results will highlight the effectiveness of combining international methodologies with localized adaptations to address the specific needs of the Romanian healthcare system, ultimately contributing to the ongoing efforts to improve patient satisfaction and health outcomes by informing the development and refinement of patient-centered care initiatives in Romania.

The Experience and Needs of Living With Home Parenteral Nutrition in Adult Patients: A Meta-Synthesis ofQualitativeStudies.

Home parenteral nutrition (HPN) can improve the nutritional status of patients with gastrointestinal dysfunction. However, some patients face a series of challenges during its implementation, which significantly affect their quality of life. To explore the experience and needs of living with home parenteral nutrition in adult patients. A systematic review and meta-synthesis. A search was conducted across multiple databases, including PubMed, Embase, Cochrane Library, Web of Science, Chinese Biomedical Literature Service System, China National Knowledge Infrastructure, Wanfang Database and Wipu Database, to explore the real-life experiences and needs of adult patients receiving HPN. The search covered the period up to March 2024. Qualitative research quality was evaluated using the Joanna Briggs Institute's Australian Centre for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research. Data synthesis was performed using Thomas and Harden's method of thematic and content analysis. Twelve studies, each offering qualitative data, were analysed, resulting in the identification of four themes: positive experiences of HPN; the interplay of dynamic changes across physical, mental and social levels; self-adjustment to the new normal; and multidimensional needs of patients receiving HPN. Patients receiving HPN face multiple challenges physically, psychologically and socially. This paper also reveals the supportive needs of patients in adapting to a new lifestyle with HPN. This indicates that healthcare professionals should provide comprehensive, continuous and dynamic supportive medical services to facilitate patients' reintegration and return to normal social life. As this study constitutes a meta-synthesis, patient or public contribution is not applicable. Adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) reporting guidelines, this meta-synthesis was conducted.

Assessment of multi-professional primary healthcare center quality by patients with multimorbidity

BackgroundThe main aim of this study was to build an item bank for assessing the care quality of multi-professional healthcare centers (MPHCC) from the perspective of patients with multimorbidity. This study was part of the QUALSOPRIM (QUALité des SOins PRIMaires; primary healthcare quality) research project to create a psychometrically robust self-administered questionnaire to assess healthcare quality.MethodsFirst, twelve experts built an item bank using data from a previous qualitative work and a systematic literature review. Second, the validity of each item was assessed in a sample of patients. Adult patients with multimorbidity were recruited from six French MPHCC. Items were assessed based on ceiling effects, the level of missing or neutral responses and patient feedback. Patient feedback was recorded after the item bank completion. Based on results, items were validated, improved, or removed during expert meetings. In case of disagreement the Delphi method was used to reach consensus.ResultsThe study sample included 209 outpatients. The most frequent medical conditions were cardiovascular risk factors, cardiovascular diseases and rheumatological conditions. In total, a bank of 109 items classified in nine domains was built. The validity assessment led to the removal of 34 items. Retained items explored a variety of topics related to care quality: availability, accessibility, premises’ layout and building, technical care, expertise, organization, relationships with caregivers and communication, involvement and personal relationships.ConclusionsThis study allowed cross-validation of a bank of 75 items, leading to a complete picture of the patient perception of care quality items. Overall, patients were generally satisfied with their care at the MPHCC. Nonetheless, there were still numerous items on subjects for which patients’ satisfaction could be improved.

Assessment of Healthcare Quality Provided to Children with Malaria in Ghana.

There is a growing concern regarding the quality of care received by patients with malaria. However, the quality of care provided to children under the age of five who have contracted the disease has yet to receive sufficient attention. Accordingly, we evaluated the quality of care provided to children under five diagnosed with malaria at Princess Marie Louis (PML) Children's Hospital in Accra, Ghana. The objective of this study was to evaluate the quality of care provided to children under 5 years of age diagnosed with malaria through a quantitative approach via a cross-sectional survey. The study randomly selected 74 staff members and 301 parents whose children received malaria treatment at the PML Children's Hospital. This research encompassed a descriptive statistical summary and regression analysis. Healthcare professionals exhibited a relatively high adherence to standard protocols for malaria management. Patient satisfaction was moderate and lower than the national average. To improve patient satisfaction, an in-depth investigation of innovative and customer-oriented approaches should be conducted.

Relevance of meeting general outpatients’ information needs to their perceptions of healthcare quality in a hospital in Ghana: a Healthcare Quality Survey using modified SERVQUAL analysis

BackgroundPatients determine quality of healthcare by their perception of the gap between the healthcare they experience/receive and that which they expect. This can be influenced by the ability of healthcare...

Detection of Adverse Events With the Austrian Inpatient Quality Indicators.

Indicators based on routine data are considered a readily available and cost-effective method for assessing health care quality and safety. The Austrian Inpatient Quality Indicators (A-IQI) have been introduced in all Austrian public hospitals as a mandatory quality measurement. The purpose of this study was to assess the value of conspicuous A-IQI in predicting the presence of adverse events (AEs). We conducted an exploratory study comparing all indicator-positive patient cases contributing to 18 conspicuous A-IQI indicators to randomly selected indicator-negative control cases regarding the prevalence and severity of AEs. Structured medical record review using the Institute for Healthcare Improvement Global Trigger Tool was used as the gold standard. In 421 chart reviews, we identified 158 AEs. 70.9% (n = 112) of the AEs were found in cases with a positive indicator. The relative risk of an AE occurring was 3.47 (95% confidence interval: 2.30, 5.24) in indicator-positive cases compared to indicator-negatives. The proportion of severe events (National Coordination Council for Medication Error Reporting and Prevention Index categories H and I) was 54.5% (n = 61) in indicator-positive cases and only 15.3% (n = 7) in indicator-negative cases. Overall sensitivity of the A-IQI was 68.2%, specificity 69.4%, positive predictive value 36.0%, and negative predictive value 89.6%. Our study shows that significantly more AEs and more severe AEs were found in cases with positive A-IQI than in indicator-negative control cases. However, studies with larger numbers of cases and with larger numbers of conspicuous indicators are needed for the validation of the entire A-IQI indicator set.

CUSCO: An Unobtrusive Custom Secure Audio-Visual Recording System for Ambient Assisted Living.

The ubiquity of digital technology has facilitated detailed recording of human behaviour. Ambient technology has been used to capture behaviours in a broad range of applications ranging from healthcare and monitoring to assessment of cooperative work. However, existing systems often face challenges in terms of autonomy, usability, and privacy. This paper presents a portable, easy-to-use and privacy-preserving system for capturing behavioural signals unobtrusively in home or in office settings. The system focuses on the capture of audio, video, and depth imaging. It is based on a device built on a small-factor platform that incorporates ambient sensors which can be integrated with the audio and depth video hardware for multimodal behaviour tracking. The system can be accessed remotely and integrated into a network of sensors. Data are encrypted in real time to ensure safety and privacy. We illustrate uses of the device in two different settings, namely, a healthy-ageing IoT application, where the device is used in conjunction with a range of IoT sensors to monitor an older person's mental well-being at home, and a healthcare communication quality assessment application, where the device is used to capture a patient-clinician interaction for consultation quality appraisal. CUSCO can automatically detect active speakers, extract acoustic features, record video and depth streams, and recognise emotions and cognitive impairment with promising accuracy.

Leapfrog Safety Grades in California Hospitals: A Data Analysis.

Within the realm of health care quality assessment, quality assurance and safety grading systems play a vital role in gauging hospital performance and communicating results to the general public. The primary objective of this review is to analyze the hospitals in California through the lens of Leapfrog Safety Grades and discuss the complex interplay of geographical location, hospital size, and larger system affiliation status. Leapfrog Safety Grades, hospital characteristics, and geographic information were collected. Hospitals were categorized by geographic region, size, rural/urban classification, and larger system affiliation status. Of the 284 hospitals included in the study, 95 were given a grade of A, 68 given a grade of B, 93 given a grade of C, 23 given a grade of D, 2 given a grade of F, and 3 were not graded. The vast majority of hospitals in California were classified as urban, with 183 falling under this category. The average number of hospital beds and SD was 227 ± 47.57. On average, hospitals that received a grade of D were significantly smaller in size than those that received a grade of A, while hospitals that received a grade of B or C were similar in size. A total of 107 hospitals were affiliated with a larger health care system. About 70% of hospitals affiliated with a system received an A or B grade, while 50% of unaffiliated hospitals received an A or B grade. Results of this study demonstrate a need for improving health care access and quality in medically underserved urban and rural areas. Hospitals affiliated with a larger health care system received higher grades than unaffiliated hospitals, suggesting that affiliation may also play a role in the implementation and mitigation of factors that contribute to Leapfrog Safety Grades.

The difference in extracellular matrix metabolism in women with and without pelvic organ prolapse: A systematic review and meta-analysis.

Studies on the changes of extracellular matrix (ECM) in pelvic organ prolapse (POP) are still controversial. To identify the changes in the ECM in POP patients. Comprehensive searching in Embase, PubMed, Web of Science and the Cochrane Library was carried out until 23 February 2023. Studies comparing the protein levels of ECM-related components between women with and without POP. Quality and risk of bias were assessed using the Agency for Healthcare Research and Quality assessment. Indicators were pooled with random or fixed effect meta-analysis based on heterogeneityand sub-grouped analysed by the biopsy site. Thirty cross-sectional studies were included, comprising 840 POP cases and 755 controls. Overall results showed that the expression of type III collagen (COLIII) and several matrix metalloproteinases (MMP-1, -2 and -9) were increased, whereas those of type I collagen (COLI), and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) were decreased in patients with POP. Subgroup analysis showed that the expression of COLIII in the anterior vaginal wall (AVW) and COLIII, MMP-2 and -9 in the uterosacral ligament (USL) were consistent with the overall results. However, the expression of COLI and MMP-1 in the AVW showed no difference and the expression of COLI and MMP-1 in the USL is still controversial based on current studies. Patients with POP have lower expression of COLI and TIMP-1 and higher expression of COLIII and MMPs compared with non-POP cases, but further studies are required to investigate in specified anatomical sites.

Challenges in the maintenance of an open hospital-based cancer registry system in a low-to-middle-income country (LMIC): 2017-2022 experience.

Hospital-based cancer registries (HBCRs) record data on all patients diagnosed and/or treated for cancer at healthcare facilities and evaluate the burden of the disease and the quality of healthcare services at that hospital, helping improve patient care, and providing an assessment of healthcare quality. The CARE PH app was created as a tool to facilitate a system of hospital-based cancer registries in the Philippines, a lower middle-income country. From 2017 to 2022, a total of 60,021 cancer registrants from 44 CARE PH hospitals were entered into the database. Breast cancer was the most common primary site, accounting for 17,660 cases (29.4%). This was followed by colorectal cancer at 11.1%, cervical cancer at 6.2%, head and neck cancer at 5.9%, and prostate and other male genital cancer at 5.1%.Among the 30 data fields collected, 17 exhibited 0-20% missing data, eight displayed 21%-90% missing data, while five depicted 91%-100% missing data. Most of the data fields with missing data are in the treatment and follow-up modules, which are stored in separate forms in a patient's record. Digital transformation of hospitals from paper-based charts to electronic medical records, and the integration of the HBCR to the EMR and hospital information system, will likely be the best solution for these limitations. It is recommended that the creation and maintenance of HBCRs nationwide must be harmonized, and embedded in all relevant national programs and legislations. The development of an information technology process that is based on a cancer patient's journey, should be built on an open system embedded in a well designed enterprise architecture, functioning under the guidance of a strong leadership and governance team. All these must be present in order to create and maintain a robust HBCR that is useful for furthering cancer registry and research in the country.

Unveiling the strong positive relationship: Maternal characteristics and neonatal outcomes in the Better Outcomes in Labour Difficulty (BOLD) study - a secondary analysis validating neonatal near miss classification.

The near miss concept, denoting near collisions between aircraft, originated in aeronautics, but has recently been transferred to the neonatal context as a way of evaluating the quality of health services for newborns, especially in settings with reduced child mortality. However, there is yet no consensus regarding the underlying criteria. The most common indicators used to assess health care quality include mortality (maternal and neonatal) and life-threatening conditions. Using the World Health Organization (WHO) Better Outcomes in Labour Difficulty (BOLD) prospective cohort study data set, we conducted a secondary analysis to validate the near miss concept and explore the association between maternal and neonatal outcomes. We studied 10 203 singleton mothers treated between December 2014 and November 2015 in nine Nigerian and four Ugandan hospitals. We validated the near miss concept by testing the diagnostic accuracy (sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and odds ratio (OR)) using death as the reference variable and calculating the maternal and neonatal case fatality rates. We performed ordinal and binomial logistic regression, with the independent variables being those that had P < 0.1 in the univariate analyses. We considered the significance level of 5%. We validated the neonatal near miss concept using the BOLD study data. We observed maternal and neonatal case fatality rates of 70.2% and 6.5%, with an increasing severity relationship between maternal and neonatal outcomes (P < 0.05). Ordinal logistic regression showed that gestational age <37 or >41 weeks and <8 antenatal consultations were related to a higher risk of neonatal severe outcomes, while maternal age between 30 and 34 years functioned as a protective factor against severe neonatal outcomes (SNO). Binomial logistic regression showed gestational age <37(OR = 1.46; 95% confidence interval (CI) = 1.07-1.94) or >41 weeks (OR = 2.26; 95% CI = 1.55-3.20), low educational level (OR = 1.76; 95% CI = 1.12-2.69), overweight/obesity (OR = 1.23; 95% CI = 1.02-1.47), one previous cesarean section (OR = 1.90; 95% CI = 1.36-2.61), one previous abortion (OR = 1.25; 95% CI = 1.00-1.56), and previous chronic condition (OR = 1.83; 95% CI = 1.37-2.41) were risk factors for SNO. The neonatal near miss concept could be used as a parameter for analysis in different health systems, to ensure that measuring of neonatal severity is comparable across health care units. In this analysis, we observed a progressive association between maternal severity and the severity of the newborns' outcomes.

Exploring older people’s understanding of the QOL-ACC, a new preference-based quality-of-life measure, for quality assessment and economic evaluation in aged care: the impact of cognitive impairment and dementia

BackgroundQuality-of-life is an essential outcome for quality assessment and economic evaluation in health and social care. The-Quality-of-Life – Aged Care Consumers (QOL-ACC) is a new preference-based quality-of-life measure, psychometrically validated with older people in aged care. More evidence is needed to inform the self-report reliability of the QOL-ACC in older people with varying levels of cognitive impairment and dementia.MethodsA think-aloud protocol was developed and applied with older residents. The Mini Mental State Examination (MMSE) was applied to assign participants to no cognitive impairment (NCI - MMSE score ≥ 27) and cognitive impairment (MMCI - MMSE score < 27) subgroups. Three independent raters utilised a Tourangeau survey response model-based framework to identify response issues. Data were compared across cognition subgroups and synthesized using a ‘traffic light’ grading to classify frequency and type of response issues. Gradings were utilised to assess self-report reliability according to different levels of cognitive impairment.ResultsQualitative data from 44 participants (NCI = 20, MMCI = 24) were included for analysis. Response issues were more evident in the cognitive impairment subgroup than the no cognitive impairment subgroup. All participants who received a ‘red’ grade had an MMSE score of < 20 and 66% of ‘amber’ grades occurred in the cognitive impairment subgroup.ConclusionsThe QOL-ACC is able to be completed reliably by older residents with an MMSE score > 17. Future research is needed to assess the generalisability of these findings to other preference-based quality of life instruments and for older people in other care settings including health systems.

Patients’ needs and experiences of telerehabilitation after total hip and knee arthroplasty: A qualitative systematic review and meta-synthesis

Background The number of patients undergoing joint replacement procedures is continuously increasing. Tele-equipment is progressively being employed for postrehabilitation of total hip and knee replacements. Gaining a comprehensive understanding of the experiences and requirements of patients undergoing total hip and knee arthroplasty who participate in telerehabilitation can contribute to the enhancement of telerehabilitation programs and the overall rehabilitation and care provided to this specific population. Objective To explore the needs and experiences of total hip and knee arthroplasty patients with telerehabilitation. Design Systematic review and qualitative synthesis. Methods Electronic databases PubMed, Web of Science, The Cochrane Library, Embase, CINAHL, Scopus, ProQuest, CNKI, Wanfang Data, VIP, and SinoMed were systematically searched for information on the needs and experiences of telerehabilitation for patients with total hip arthroplasty and total knee arthroplasty in qualitative studies. The search period was from the creation of the database to March 2024. Literature quality was assessed using the 2016 edition of the Australian Joanna Briggs Institute Centre for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research. A pooled integration approach was used to integrate the findings inductively. Results A total of 11 studies were included and 4 themes were identified: the desire to communicate and the need to acquire knowledge; accessible, high-quality rehabilitation services; positive psychological experiences; the dilemmas of participating in telerehabilitation. Conclusions This study's findings emphasize that the practical needs and challenges of total hip and knee arthroplasty patients’ participation in telerehabilitation should be continuously focused on, and the advantages of telerehabilitation should be continuously strengthened to guarantee the continuity of patients’ postoperative rehabilitation and to promote their postoperative recovery.

Patient Satisfaction With Dental Services.

Patient satisfaction is an integral aspect of healthcare quality assessment, and it plays a crucial role in evaluating the effectiveness of healthcare services. This systematic review investigates patient satisfaction with dental services provided by public dental hospitals in rural and remote areas of Saudi Arabia. The study conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards. It involved a comprehensive search across multiple databases, including Medline, Cochrane, Embase, and CINAHL, with tailored search strategies for each database using MeSH terms and keywords. To ensure inclusivity, the search covered publications in both English and Arabic and included Google Scholar for gray literature. Inclusion criteria focused on empirical studies conducted in rural and remote public hospitals in Saudi Arabia, published between 2013 and January 2023, assessing patient satisfaction in oral or dental care for adult patients. Data screening and extraction followed a rigorous two-step process, and a narrative synthesis was used to analyze and summarize the findings. The findings reveal a complex landscape of patient satisfaction in these settings, with varying levels of contentment reported. While more than 50% of patients expressed satisfaction with the quality of dental care, significant challenges related to accessibility were evident. Patients residing in remote and rural areas often had to travel long distances to access dental clinics, resulting in dissatisfaction. Demographic factors, particularly education and age, were identified as significant influencers of patient satisfaction, with more educated individuals tending to be less satisfied. This study emphasizes the importance of continuous monitoring of patient satisfaction to enhance service delivery, particularly in public dental clinics serving remote and rural areas. Addressing issues related to access, availability, clinical quality, and effective communication is vital for improving patient satisfaction in these healthcare settings. The study concludes with recommendations for policymakers, including the development of quality assurance policies, cost mitigation strategies, and targeted interventions to address demographic disparities and enhance patient satisfaction with dental care services.

Prevalence and Risk Factors Associated with Maternal Near Miss Events in the Upper East Region of Ghana

A maternal near miss (MNM) event is a severe life-threatening maternal morbidity that reflects quality of obstetric care. It is considered a proxy of maternal mortality and predictor of quality obstetric care. The major underlying causes of MNM are hypertensive disorders, obstetric hemorrhage, sepsis and abortion complications. MNM is a more frequent event than maternal mortality and share several features together. Inquiries intodeficiencies andcritical assessment of health care quality, identify health system deficiencies, and help develop robust strategies for maternal care. We conducted a cross-sectional descriptive study to determine the prevalence and underlying causes of MNM. The study respondents were women aged 15 - 49 years with pregnancy experience in 2020 who had health facility care. Primary and secondary data were collected at households and health facilities respectively using electronic platform, KoBoCollect. STATA version 15.0 was used to analyze the data. The prevalence of MNM was 11.30%. The main underlying causes were complications of caesarean section, hypertensive disorders, anemia, obstructed labor, and antepartum hemorrhage. The main signal functions of emergency obstetric and newborn care (EmONC) employed to avert death were parenteral antibiotics, blood transfusion, caesarean section, and magnesium sulphate. The prevalence of MNM in the Upper East region was high. The region can reduce severe maternal morbidity and mortality by strengthening health systems, improving access to high-quality obstetric care and training healthcare providers to prevent and treat the major underlying causes of MNM identified in this study. Keywords: Ghana, MNM, Mortality, Prevalence, Antepartum, Hemorrhage, EmONC.

Development and validation of primary health care quality assessment tool

BackgroundAssessing the quality of health services gives insights to managers about the status of services delivered by them, especially from the client’s perspective. Although various tools have been developed to measure the quality of primary health care (PHC), no specific tool was found in this field in Iran. Therefore, the present study was conducted to develop and validate the quality assessment tool of PHC in Iran.MethodsThis methodological study was conducted in 2021. In the first step, based on a literature review, an initial questionnaire was designed, and its face validity, content validity, construct validity, and reliability were evaluated. Descriptive tests, Kolmogorov-Smirnov, exploratory factor analysis, Kaiser-Myer-Olkin (KMO), and Cronbach’s alpha were performed by using SPSS 22.ResultsThe initial questionnaire included 33 items, of which three items were removed due to inconsistency with factorization. The final questionnaire consisted of 30 items and nine dimensions: interaction, efficiency, timeliness, accuracy, consultation, tangibility, safety, accessibility, and environment. The KMO and Cronbach’s alpha index values were 0.734 and 0.82, respectively, indicating acceptable reliability and validity. The developed dimensions represented about 73% of the total variance.ConclusionThe designed questionnaire has relatively good validity and reliability and can be used to measure the quality of PHC and to identify weaknesses in service delivery. However, researchers should carefully examine it to enhance its applicability as a standard tool for measuring PHC quality.

Assessment of healthcare application quality: Development of a standardized methods for healthcare professionals

The advancement of the mobile app market is reshaping healthcare, emphasizing the imperative for quality and efficacy in health applications. This methodology has been devised to assess mobile health applications, aiming to assist healthcare professionals in selecting apps for e-healthcare consumers. Key facets of this approach are:•A stringent selection process within mobile app stores•A standardized assessment using the Mobile App Rating Scale to achieve consistent and replicable evaluations, systematically organizing app evaluations•A comprehensive framework guiding healthcare practitioners in determining which apps to integrate into clinical practice and which to excludeCentral to this method is the emphasis on distinguishing apps that enhance clinical practice from those that fall short in important areas such as the effectiveness of proposed health features, data accuracy, adherence to clinical guidelines, data security, and user privacy. With heightened attention to usability and accessibility, the methodology also addresses the common risks inherent in mHealth implementation, ensuring that selected apps not only meet technical criteria but also align with the broader healthcare ecosystem's needs and challenges.

Association between sedentary behavior and risk of cognitive decline or mild cognitive impairment among the elderly: a systematic review and meta-analysis.

Existing evidence on the association between sedentary behavior (SB) and cognitive function remains inconclusive. Therefore, this study investigated the association between SB and the risk of cognitive decline (CD) or mild cognitive impairment (MCI) in the elderly. A comprehensive search was independently conducted by two researchers (XC and GQ) in seven electronic databases, including Medline (via PubMed), China Biology Medicine, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang database, and VIP database for Chinese technical periodicals, covering studies published from the inception of database to June 2023. Studies that investigated the relationship between SB and the risk of CD or MCI in the elderly were included. The quality of the literature was assessed using the Newcastle-Ottawa Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) assessment tools. The combined effect size analysis, subgroup analysis, and publication bias assessment were performed using STATA 14.0. A total of 13 cross-sectional and 6 cohort studies involving 81,791 individuals were included, comprising 17 high-quality studies and 2 medium-quality studies. We found that SB was significantly associated with an increased risk of CD [odds ratio (OR) = 1.69, 95% confidence intervals (CI): 1.47-1.94] or MCI (OR = 1.34, 95% CI: 1.14-1.56) among the elderly. Subgroup analysis stratified according to comorbidity, lifestyle, family structure, publication year, and region showed statistical differences between groups, and the consistency of the results revealed the sources of the heterogeneity. This meta-analysis showed that SB is positively associated with the risk of CD or MCI in the elderly, providing a higher level of evidence for the promotion of healthy behaviors by clinicians and health policymakers. Due to the number and quality of the included articles, more high-quality longitudinal studies are needed to further confirm our findings.

Birinci basamak sağlık hizmetlerinin kalitesinin değerlendirilmesine yönelik küresel çabaların genel değerlendirmesi

The quality of health care has been the subject of research for many years. However, the studies have mostly focused on the problems of clinical medicine, and relatively little work has been done on the quality of primary health care. As the health systems around the world are faced with social, economic, and demographical challenges, countries started to lean towards primary health care which can adapt and respond to an ever-changing world. Quality primary health care is shown to provide accessible, affordable, comprehensive, continuous, coordinated and people-centered care in the community. It plays an important role in ensuring equity in health, reducing morbidity and mortality, optimizing efficient use of resources, achieving better health outcomes, and improving the health of populations. Over the past decades, quality improvement has received increasing attention as a systematic approach guided by scientific evidence-based data; and is regarded the crucial component of health systems strengthening. The global health community has made concrete efforts to improve the quality of health care across primary, secondary and tertiary levels of health systems. Several organizations have developed frameworks and quality indicators to be used as quality assessment tools, and countries have defined their own national frameworks, quality indicators and standards to assess the quality of primary health care. The current study aims to provide a chronological review of the global efforts towards quality assessment in primary health care.