Quality Assurance In Health Care Research Articles

IS PATIENT SAFETY AT THE HEART OF MEDICAL EDUCATION IN INDONESIA? REFLECTION ON THE IMPACT OF THE NATIONAL EXAMINATION

ABSTRACT Background: National examinations in Indonesia (UKMPPD) has been implemented since 2007 as a quality assurance method for medical graduates and medical schools. The impact of UKMPPD has been studied since then, where one of the consequences were related to how it affected medical education and curricula. This study explored the consequences of UKMPPD, focusing on how the students, teachers, and medical schools’ leaders relate the examination with patient care. This study aimed to explore the impact of UKMPPD on medical education, which focusing on the issue of patient safety. Methods: This study was part of a doctoral project, using a qualitative method with a modified grounded theory approach. The perspectives of multiple stakeholders on the impact of the UKMPPD were explored using interview and focus groups. Interviews were conducted with medical schools’ representatives (vice deans/ programme directors), while focus groups were conducted with teachers and students. A sampling framework was used by considering the characteristics of Indonesian medical schools based on region, accreditation status, and ownership (public/ private). Data was analysed using open coding and thematic framework as part of the iterative process. Results: The UKMPPD affected how the stakeholders viewed this high-stakes examination and the education delivered in their medical schools. One of the consequences revealed how stakeholders viewed the UKMPPD and its impact on patient care. Participants viewed the UKMPPD as a method of preparation for graduates’ real clinical practice. The lack of reference for patient safety as the impact of the UKMPPD in this study showed that there were missing links in how stakeholders perceived the examination as part of quality assurance in health care. Conclusion: The UKMPPD as a high-stakes examination has a powerful impact in changing educational policy and programmes in Indonesia. However, in Indonesia, the examination brought in the reflection on how the “patient” element was lacking from medical education. This research offers an insight on the concept of patient safety in Indonesia and how the stakeholders could approach the issue. Keywords: UKMPPD, national licensing examination, impact, competence, patient safety, curriculum

Prerequisites of Quality Assurance in Health Sector: A Literary Review

Healthcare could be an extremely competitive world business. Individuals settle for to visit remote components of the globe so as to receive the service quality they hope for. Patients sometimes favor to visit personal hospitals, hoping to receive high service quality. Issues regarding the standard of health care have up high on the international agenda in recent years, as countries attempt to strengthen their health systems and deliver universal health coverage. Due to demand of quality assurance in health care, this study was conducted to spot the conditions of quality assurance for victorious implementation of tending establishments through a scientific review of literature. This study identifies the service quality factors that are important patient satisfaction in the context quality assurance prerequisites such as Continuous process ,Systematic process, Plan-Do-Check–Act cycle (PDCA-cycle), patient-centeredness, process improvement in health care, Cooperation between professional, Quality assurance level (a) the structural level (b) indicators that are associated with processes of care (c) clinical outcomes, Dedicated Top management leadership that is Commitment to Quality Improvement, Five broad attributes as Reliability, Assurance, Tangibles, Empathy, Responsiveness, Transformation of organisational culture, Employee education and training, Quality measurement and statistical analysis at all levels, Bench marking ,Employee empowerment, Affordability and convenience ,TQM model Six Sigma were identified as factors essential for quality assurance of any health care setting.

Survival benefit for patients treated in a certified head and neck tumor center.

Increasing effort has been put in the implementation and certification of head and neck tumor centers in order to establish standardized, quality assured health care for head and neck tumor patients. This study evaluated survival rates after treatment in a certified head and neck tumor center (CHNTC) vs. a non-certified head and neck tumor center (non-CHNTC) in Middle Franconia, Germany. Age, sex, possible obituary, and typical relevant prognostic variables were analyzed. Diagnosis was recorded according to ICD10. Clinical and pathological TNM staging, tumor grading, localization, R-stage, and morphology were assessed (ICD-0). Patients diagnosed with oral cancer (N=1047) were divided into groups based on where they received their primary treatment; CHNTCs or non-CHNTCs. Patients treated at CHNTCs had significantly higher survival rates vs. those treated at non-CHNTC (p=0.023) in univariate analysis. In a Cox regression model, survival rates for patients with pN0 and pN+ stage were similar at both types of centers. Men with pN0 had significantly lower survival rates (HR=0.497, p<0.001). Age had a statistically significant influence on survival rates independently from pN stage (HR=1.031 per year, p<0.001 in both groups). Patients treated at CHNTC had better survival rates than those treated at non-CHNTC.

Swedish guidelines for registry-based randomized clinical trials

During the last decade Sweden has invested in a national infrastructure for collection of structured clinical data in the form of healthcare registries (in Sweden known as Kvalitetsregister). These data can be combined with other public data using the national personal identifiers that are issued to Swedish citizens. The healthcare registries have an almost complete coverage of Swedish healthcare, and a large network of clinicians is involved in the quality assurance and continuous improvement of healthcare using these registries. Uppsala Clinical Research Center (UCR) has been a technology provider of large-scale national registries and has a strong background in clinical trial management. This effort combines the areas of healthcare registries and clinical trials into a novel way of performing clinical trials to be able to: 1) run clinical trials as an integrated part of normal clinic workflow; and 2) leverage the nationwide network of outcome reporting. This strategy was shown to be successful in the TASTE (Thrombus Aspiration in Myocardial Infarction) study. When TASTE had been published, the New England Journal of Medicine wrote a perspective on the study calling it ‘The randomized registry trial—the next disruptive technology in clinical research?’ Since then several studies have been conducted in this way with great success. UCR has been appointed, by Clinical Studies Sweden and the Swedish Research Council, to develop the Swedish national guidelines for registry-based randomized clinical trials in order to ensure the possibility for more organizations to run this kind of study. This paper describes key concepts of register-based randomized clinical trials and the development of Swedish national guidelines.

Implementing Lean Management Techniques at a Radiation Oncology Department.

Lean management (LM) principles were first developed by a Japanese manufacturing company to maximise value and minimise waste in the automotive industry. However, these principles can also be applied in the healthcare sector. This study aimed to illustrate the process of implementing LM principles in a radiation oncology department to streamline workflow and identify and reduce waste. This study took place in the Department of Radiation Oncology, Royal Hospital, Muscat, Oman, in December 2016. A value stream map (VSM) was created for the chain of processes followed in the department. A waste analysis was conducted to determine which processes did not add value for the patient or healthcare provider. Based on the VSM analysis, only six out of 13 steps were found to be of value. Necessary and unnecessary non-value-adding activities were identified. Sources of waste included parking and registration. In addition, variabilities in workload were noted. Overall, LM principles improve workflow, reduce waste and enhance patient and staff satisfaction. In the current study, the application of LM principles helped to improve value in a radiation oncology department.

A retrospective audit evaluating the effectiveness of a falls risk assessment tool

Clinical audit is based on the concept of quality assurance in health care. It is important for all health care providers especially specialists and consultants to be aware of the principles governing clinical audit in addition to the methods in conducting such an audit.•To assess the knowledge and attitude of medical postgraduate students on clinical audit.•To evaluate the effectiveness of an interventional program conducted to educate the principles and methods of conducting clinical audit to medical postgraduates.The study was done in 92 postgraduate medical students in our institute using a pre-test and post-test questionnaire, evaluating their knowledge on different perspectives of medical audit and also assessing the change in their attitude towards audit after an educative interventional program. The questionnaire consisted of 13 knowledge questions and 3 attitude questions. Each question was scored and the overall maximum score was 35.The mean post-test score (24.45 ± 3.21) was significantly higher than the mean pre-test score (16.18 ± 3.41) using paired t-test (p < 0.001) indicating that the educational intervention was effective in improving the understanding of the candidates on clinical audit.It is imperative for all medical postgraduates to realize the importance of clinical audit in addition to acquiring the skill of conducting a meaningful and successful clinical audit. Attainment of such a competency can be achieved through planned repeated interventions and help usher in an era of best quality of patient care.

Einflussgrößen auf die Krankenhaussterblichkeit bei Patienten mit Sepsis – Entwicklung eines risikoadjustierten Modells auf Basis der Leistungsdaten deutscher Krankenhäuser

BackgroundInpatient administrative data from hospitals is already used nationally and internationally in many areas of internal and public quality assurance in healthcare. For sepsis as the principal condition, only a few published approaches are available for Germany. The aim of this investigation is to identify factors influencing hospital mortality by employing appropriate analytical methods in order to improve the internal quality management of sepsis. MethodsThe analysis was based on data from 754,727 DRG cases of the CLINOTEL hospital network charged in 2015. The association then included 45 hospitals of all supply levels with the exception of university hospitals (range of beds: 100 to 1,172 per hospital). Cases of sepsis were identified via the ICD codes of their principal diagnosis. Multiple logistic regression analysis was used to determine the factors influencing in-hospital lethality for this population. The model was developed using sociodemographic and other potential variables that could be derived from the DRG data set, and taking into account current literature data. The model obtained was validated with inpatient administrative data of 2016 (51 hospitals, 850,776 DRG cases). ResultsFollowing the definition of the inclusion criteria, 5,608 cases of sepsis (2016: 6,384 cases) were identified in 2015. A total of 12 significant and, over both years, stable factors were identified, including age, severity of sepsis, reason for hospital admission and various comorbidities. The AUC value of the model, as a measure of predictability, is above 0.8 (H-L test p>0.05, R2 value=0.27), which is an excellent result. ConclusionThe CLINOTEL model of risk adjustment for in-hospital lethality can be used to determine the mortality probability of patients with sepsis as principal diagnosis with a very high degree of accuracy, taking into account the case mix. Further studies are needed to confirm whether the model presented here will prove its value in the internal quality assurance of hospitals.

Improved Cardiovascular Risk Factors Control Associated with a Large-Scale Population Management Program Among Diabetes Patients

BackgroundOptimal cardiovascular risk factors control among individuals with diabetes remains a challenge. We evaluated changes in glucose, lipid, and blood pressure control among diabetes patients after implementation of a large-scale population management program, known as Preventing Heart Attacks and Strokes Everyday, at Kaiser Permanente Northern California (KPNC), during 2004-2013. MethodsWe used National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set cut points to identify prevalence of poor glycemic (hemoglobin A1c > 9%) control, good lipid control (low-density lipoprotein cholesterol < 100 mg/dL), and good blood pressure control (blood pressure < 140/90 mm Hg) in each year (N range = 98,345 to 122,177 over the entire period). We assessed trends in risk factor control based on Joinpoint regression and average annual percentage change (AAPC) compared with published National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set commercial rates. ResultsWe found that the prevalence of poor glycemic control (hemoglobin A1c > 9%) declined in both KPNC and nationally, but was statistically significant only in KPNC (AAPC = −4.8; P < .05). The prevalence of good lipid control (low-density lipoprotein cholesterol < 100 mg/dL) increased significantly in KPNC (47% to 71%; AAPC = +4.3; P < .05), but there was no significant improvement nationally (40% to 44%; AAPC = +1.4; P = .2). The prevalence of blood pressure control (<140/90 mm Hg) was higher in KPNC (77% to 82%; AAPC = +1.1; P < .05) versus nationally (57% to 62%; AAPC = +1.9; P < .05) during the reported years 2007-2013. ConclusionsRelative to national benchmarks, a substantially greater improvement in risk factor control among adults with diabetes was observed after implementation of a comprehensive population management program.

A study on the effectiveness of teaching the principles and methods of clinical audit to medical postgraduates

BackgroundClinical audit is based on the concept of quality assurance in health care. It is important for all health care providers especially specialists and consultants to be aware of the principles governing clinical audit in addition to the methods in conducting such an audit. Objectives•To assess the knowledge and attitude of medical postgraduate students on clinical audit.•To evaluate the effectiveness of an interventional program conducted to educate the principles and methods of conducting clinical audit to medical postgraduates. MethodsThe study was done in 92 postgraduate medical students in our institute using a pre-test and post-test questionnaire, evaluating their knowledge on different perspectives of medical audit and also assessing the change in their attitude towards audit after an educative interventional program. The questionnaire consisted of 13 knowledge questions and 3 attitude questions. Each question was scored and the overall maximum score was 35. ResultsThe mean post-test score (24.45 ± 3.21) was significantly higher than the mean pre-test score (16.18 ± 3.41) using paired t-test (p < 0.001) indicating that the educational intervention was effective in improving the understanding of the candidates on clinical audit. ConclusionIt is imperative for all medical postgraduates to realize the importance of clinical audit in addition to acquiring the skill of conducting a meaningful and successful clinical audit. Attainment of such a competency can be achieved through planned repeated interventions and help usher in an era of best quality of patient care.

The Impact of Quality Assurance Initiatives and Workplace Policies and Procedures on HIV/AIDS-Related Stigma Experienced by Patients and Nurses in Regions with High Prevalence of HIV/AIDS

Stigma is commonly experienced by people living with HIV/AIDS and by those providing care to HIV/AIDS patients. Few intervention studies have explored the impact of workplace policies and/or quality improvement on stigma. We examine the contribution of health care workplace policies, procedures and quality assurance initiatives, and self- and peer-assessed individual nurse practices, to nurse-reported HIV/AIDS-stigma practices toward patients living with HIV/AIDS and nurses in health care settings. Our sample of survey respondents (n = 1157) included managers (n = 392) and registered/enrolled nurses (n = 765) from 29 facilities in 4 countries (South Africa, Uganda, Jamaica, Kenya). This is one of the first studies in LMIC countries to use hierarchical linear modeling to examine the contributions of organizational and individual factors to HIV/AIDS stigma. Based on our results, we argue that organizational interventions explicitly targeting HIV/AIDS stigma are required to reduce the incidence, prevalence and morbidity of HIV/AIDS.

Health equity monitoring for healthcare quality assurance

Population-wide health equity monitoring remains isolated from mainstream healthcare quality assurance. As a result, healthcare organizations remain ill-informed about the health equity impacts of their decisions – despite becoming increasingly well-informed about quality of care for the average patient. We present a new and improved analytical approach to integrating health equity into mainstream healthcare quality assurance, illustrate how this approach has been applied in the English National Health Service, and discuss how it could be applied in other countries. We illustrate the approach using a key quality indicator that is widely used to assess how well healthcare is co-ordinated between primary, community and acute settings: emergency inpatient hospital admissions for ambulatory care sensitive chronic conditions (“potentially avoidable emergency admissions”, for short). Whole-population data for 2015 on potentially avoidable emergency admissions in England were linked with neighborhood deprivation indices. Inequality within the populations served by 209 clinical commissioning groups (CCGs: care purchasing organizations with mean population 272,000) was compared against two benchmarks – national inequality and inequality within ten similar populations – using neighborhood-level models to simulate the gap in indirectly standardized admissions between most and least deprived neighborhoods. The modelled inequality gap for England was 927 potentially avoidable emergency admissions per 100,000 people, implying 263,894 excess hospitalizations associated with inequality. Against this national benchmark, 17% of CCGs had significantly worse-than-benchmark equity, and 23% significantly better. The corresponding figures were 11% and 12% respectively against the similar populations benchmark. Deprivation-related inequality in potentially avoidable emergency admissions varies substantially between English CCGs serving similar populations, beyond expected statistical variation. Administrative data on inequality in healthcare quality within similar populations served by different healthcare organizations can provide useful information for healthcare quality assurance.

Updating the guidelines for national assessors using the Delphi method

National assessors are key in maintaining governance and quality assurance in health and social care, by working with employers to ensure that suitable appointments are made for consultant applied psychologist posts. The Delphi method was used as a consensus building tool to update the guidelines for national assessors, to correspond with current practice. The results indicated that there was a need to clarify the remit of the role of a national assessor. Providing up to date and clear guidance for national assessors and employing organisations maintains safe practice and high professional standards.

The Effect of Medical Recording Training on Quantity and Quality of Recording in Gynecology Residents of Tabriz University of Medical Sciences.

Introduction: Medical records contain valuable information about a patient's medical history and treatment. Patient safety is one of the most important dimensions of health care quality assurance and performance improvement. Completing the process of documentation is necessary to continue patient care and continuous quality improvement of basic services. The aim of the present study was to evaluate the effect of medical recording education on the quantity and quality of recording in gynecology residents of Tabriz University of Medical Sciences. Methods: This study is a quasi-experimental study and was conducted at Al-Zahra Teaching Hospital, Tabriz, Iran, in 2016. Thirty-two second through fourth year gynecologic residents of Tabriz University of Medical Sciences who were willing to participate in the study were included by census sampling and participated in training workshop. Three evaluators reviewed the residents’ records before and after training course by a checklist. Statistical analyses were performed using SPSS 13 software. P-values less than 0.05 were considered statistically significant. Results: The results showed that before the intervention, there were significant differences in the quantity of information status among the evaluators and no significant difference was observed in the recording of qualitative status. After the workshop, among the 3 evaluators, there were also significant differences in the quantity of data recording status; however, no significant change was observed in recording of qualitative status. Conclusion: The study findings revealed that a sectional training course of correct and standardized medical records has no effect on reforming the process of recording.

Automated annotation and classification of BI-RADS assessment from radiology reports

The Breast Imaging Reporting and Data System (BI-RADS) was developed to reduce variation in the descriptions of findings. Manual analysis of breast radiology report data is challenging but is necessary for clinical and healthcare quality assurance activities.The objective of this study is to develop a natural language processing (NLP) system for automated BI-RADS categories extraction from breast radiology reports. We evaluated an existing rule-based NLP algorithm, and then we developed and evaluated our own method using a supervised machine learning approach. We divided the BI-RADS category extraction task into two specific tasks: (1) annotation of all BI-RADS category values within a report, (2) classification of the laterality of each BI-RADS category value. We used one algorithm for task 1 and evaluated three algorithms for task 2. Across all evaluations and model training, we used a total of 2159 radiology reports from 18 hospitals, from 2003 to 2015.Performance with the existing rule-based algorithm was not satisfactory. Conditional random fields showed a high performance for task 1 with an F-1 measure of 0.95. Rules from partial decision trees (PART) algorithm showed the best performance across classes for task 2 with a weighted F-1 measure of 0.91 for BIRADS 0-6, and 0.93 for BIRADS 3-5. Classification performance by class showed that performance improved for all classes from Naïve Bayes to Support Vector Machine (SVM), and also from SVM to PART.Our system is able to annotate and classify all BI-RADS mentions present in a single radiology report and can serve as the foundation for future studies that will leverage automated BI-RADS annotation, to provide feedback to radiologists as part of a learning health system loop.

Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis.

Introduction: To facilitate provision of pre-exposure prophylaxis (PrEP) in low- and middle-income countries (LMIC), a better understanding of potential demand and user preferences is required. This review assessed awareness and willingness to use oral PrEP among men who have sex with men (MSM) in LMIC.Methods: Electronic literature search of Cochrane library, Embase, PubMed, PsychINFO, CINHAL, Web of Science, and Google Scholar was conducted between July and September 2016. Reference lists of relevant studies were searched, and three authors contacted for additional data. Non-peer reviewed publications were excluded. Studies were screened for inclusion, and relevant data abstracted, assessed for bias, and synthesized.Results: In total, 2186 records were identified, of which 23 studies involving 14,040 MSM from LMIC were included. The proportion of MSM who were aware of PrEP was low at 29.7% (95% CI: 16.9–44.3). However, the proportion willing to use PrEP was higher, at 64.4% (95% CI: 53.3–74.8). Proportions of MSM aware of PrEP was <50% in 11 studies and 50–70% in 3 studies, while willingness to use PrEP was <50% in 6 studies, 50–70% in 9 studies, and over 80% in 5 studies. Several factors affected willingness to use PrEP. At the individual domain, poor knowledge of PrEP, doubts about its effectiveness, fear of side effects, low perception of HIV risk, and the need to adhere or take medicines frequently reduced willingness to use PrEP, while PrEP education and motivation to maintain good health were facilitators of potential use. Demographic factors (education, age, and migration) influenced both awareness and willingness to use PrEP, but their effects were not consistent across studies. At the social domain, anticipated stigma from peers, partners, and family members related to sexual orientation, PrEP, or HIV status were barriers to potential use of PrEP, while partner, peer, and family support were facilitators of potential use. At the structural domain, concerns regarding attitudes of healthcare providers, quality assurance, data protection, and cost were determinants of potential use.Conclusions: This review found that despite low levels of awareness of PrEP, MSM in LMIC are willing to use it if they are supported appropriately to deal with a range of individual, social, and structural barriers.

Performance Indicators Development in Function of Croatian’s Hospitals Efficiency and Quality Monitoring (Note 1)

&lt;p&gt;&lt;em&gt;The aim of this paper is to explore issues of hospital’s performance indicators development in Croatia. Accepted standards and regulations require defining of key performance and quality indicators of healthcare organizations. Performance indicators are defined at the sector level. Healthcare organizations are obligated to measure and track performance in accordance with the standards of quality assurance in health care and defined strategic objectives. Tracking performance is important for financing of healthcare organizations and performance monitoring of selected institution’s program goals and healthcare system in general.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;For hospitals, it is important to monitor and improve the quality. For that purposes they need to develop adequate and comparable performance indicators. In order to create comparable indicators it is necessary to conduct a detailed analysis of performance measurement of related hospitals in Croatia and Europe. The basis for performance measurement is information that institution owns, acquires and processes. In order to be relevant, indicators need quality information basis for their measurement.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;This paper analyzes the current performance indicators of selected Croatian and European hospitals’ performance measurement models. Based on the analysis, as the result of paper, we propose indicators for one hospital in Croatia. Authors propose a methodology for development of indicators, as well as a way of measuring and monitoring performance. Through a case study, we explore the use of performance indicators in monitoring and improving the quality of hospitals. Special emphasis has been placed on the role of performance indicators in the financing of health care institutions, and mutual comparison of hospitals as the basis for the development and improvement of the institution’s quality. &lt;/em&gt;&lt;/p&gt;

CLINICAL QUALITY STRATEGY FACILITATES EFFECTIVE QUALITY SYSTEM IMPLEMENTATION FOR PREVENTION OF HEALTHCARE ASSOCIATED INFECTIONS

Introduction: Healthcare-associated infections (HAI) can develop either as a direct result of healthcare intervention such as medical or surgical treatment or from being in contact with a healthcare setting. The need of hour is getting the right approach of personnel in clinical community towards infection prevention, patient safety and clean environment. An established quality system enables an organisation to achieve this goal set out in its quality strategy. Objective: This study was carried out with the objective to assess clinical quality strategies facilitation to implement quality systems compliance to national standards, policies, laws, legislations and regulations related to hospital associated infections in hospital settings. Methodology: Audit tools, check lists and protocols based on the process were carried out in the high risk areas, and the surveillance was done by using a targeted quality assurance plan. Process compliance was verified with national standards. Results: Compliance was 65 % in the process of area of disinfection, hand-washing, use of isolation rooms for infected patients, reminders to limit catheter use, use of gloves and gowns, sterilization, biological waste management, training on awareness of policies, laws and legislation. The quality system was not practiced effectively at hospital level for the mentioned categories. The survey showed that hospitals do not have adequate Antimicrobial Programs. Resource availability is also an additional problem faced in the hospitals Conclusions: We emphasize by implementing quality assurance practices, which focus on systems and processes, as per the laid down policies, uses existing data to analyze service delivery processes, can improve the quality of service related to HAI. Key words: healthcare associated infections, quality strategy, quality standards, quality assurance, and continuous quality improvement. Normal 0 21 false false false RO X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi; mso-fareast-language:EN-US;}

Russian experience and perspectives of quality assurance in healthcare through standards of care

ObjectivesThe main reform of healthcare system in Russia had begun by introduction of compulsory healthcare insurance in 1993. Since this time, Russia went through number of steps of healthcare system modernization. Most attention was paid to the resource allocation, medical equipment and drug provision, the problem of the low quality of care was repeatedly addressed. Major direction of the efforts was the creation of obligatory technical standards of care. MethodsI studied the volume of publication found in MEDLINE for period 1991–2014 and in the relevant Russian journals not covered by MEDLINE as well as legislation on health care introduced since 1991. ResultsThe review found that despite some increase in volume of funding of health care system, and provision of incentives for quality, the progress with health care quality assurance is slow. The methodology of development of evidence based guidelines is not accepted. The control over conflict of interest of participants of the development of the guiding documents is not introduced. Economic factors are not systematically addressed in decisions on provision of health care interventions. The practice of the health technology assessment does not exist. The system of financial incentives for the quality of care dominates and is developing without evidence based criteria and evidence of its efficacy. ConclusionThe documents prescribing quality healthcare are developing non-systematically in Russia. The acceptance of the modern methodology of guideline development, health technology assessment and control over conflict of interest is needed as a minimum prerequisite for the progress in the quality assurance.

Analysis of costs and benefits of a re-accreditation of a Swiss acute care hospital

Accreditation of hospitals and other institutions is a widely used instrument for the quality assurance in health care. However, relevant literature regarding the economic evaluation of hospital accreditation is still missing. To date no formal Cost-Benefit Analysis (CBA) or Cost-Utility Analysis (CUA) has been carried out. This study uses an existing framework specifically developed for the economic evaluation of hospital accreditation. Based on this framework, we identify and quantify the costs and selected benefits of the re-accreditation of a Swiss acute care hospital. Costs are identified and quantified by conducting key informant and expert interviews. Benefits are identified by hospital experts and rated using a newly developed validation tool. Costs of the re-accreditation amount to about CHF 870'000 (internal and external costs). Benefits in quality management (QM) and in the critical incident reporting system (CIRS) are quantified and rated by the hospital experts in the following order: (1) development or promotion of a quality or safety culture, (2) implementation of a hospital-wide complaint management, (3) fulfillment of the hospital vision, (4) improved image upon stakeholders (patients, suppliers etc.), (5) improved image in policy, (6) quality dashboard, (7) preparation of centralized quality documents, and (8) avoidance of liability cases. This study provides detailed information about costs and selected benefits associated with the re-accreditation of a Swiss acute care hospital. As opposed to the costs, benefits could not be monetized but were quantified using an expert rating to illustrate the impacts of the re-accreditation. Overall, our study confirms the difficulties in the economic evaluation of hospital accreditation, but it makes a step towards a formal CUA.

Voluntary and mandatory quality assurance in mental health care: European examples

Since the turn of the century, quality assurance (QA) programs are increasingly being implemented; both generally in health systems and specifically for mental health services. These QA programs can be implemented on a mandatory basis as well as voluntarily. Benefits of mandatory QA programs are a reliable, country-wide dataflow, as well as their long-term sustainability and comparability. Shortcomings relate to the limitations imposed by legal requirements. Benefits of voluntary QA programs are their freedom and flexibility in terms of methods and data sources. Shortcomings relate to the impossibility of country-wide implementation and a lack of sustainability, as well as to the data quality. Examples for QA in mental health care from different European countries show that mandatory and voluntary QA initiatives could complement each other. Specialist medical societies play an important role in the development of voluntary QA and the promotion of high quality care. An example is the accreditation to mental health services offered by the Royal College of Psychiatrists in the United Kingdom.