Assess Quality Of Care Research Articles

Latent structure and factor reliability of the National Health Service Community Mental Health Service User Questionnaire

Background National Health Service use the Community Mental Health Service User Questionnaire (NHS-CMH) to assess care quality. However, its reliability and internal validity is uncertain. Aims To test the NHS-CMH structure, reliability and item-level characteristics. Methods We used data from 11,373 participants who answered the 2017 NHS-CMH survey. First, we estimated the NHS-CMH structure using Exploratory Factor Analysis (EFA) in half of the dataset. Second, we tested the best EFA-derived model with Confirmatory Factor Analysis (CFA). We tested the internal validity, construct reliability (omega – ω), explained common variance of each factor (ECV), and item thresholds. Results EFA suggested a 4-factor solution. The structure derived from the EFA was confirmed, demonstrating good reliability for the four correlated dimensions: “Relationship with Staff” (ω = 0.952, ECV = 40.1%), “Organizing Care” (ω = 0.855, ECV = 21.4%), “Medication and Treatments” (ω = 0.837, ECV = 13.3%), and “Support and Well-being” (ω = 0.928, ECV = 25.3%). A second-order model with a high-order domain of “Quality of Care” is also supported. Conclusions The NHS-CMH can be used to reliably assess four user-informed dimensions of mental health care quality. This model offers an alternative for its current use (item-level and untested sum scores analysis).

Patient Portal Use, Perceptions of Electronic Health Record Value, and Self-Rated Primary Care Quality Among Older Adults: Cross-sectional Survey.

BackgroundOlder adults are increasingly accessing information and communicating using patient-facing portals available through their providers’ electronic health record (EHR). Most theories of technology acceptance and use suggest that patients’ overall satisfaction with care should be independent of their chosen level of portal engagement. However, achieving expected benefits of portal use depends on demonstrated support from providers to meet these expectations. This is especially true among older adults, who may require more guidance. However, little is known about whether misalignment of expectations around technology-facilitated care is associated with lower perceptions of care quality.ObjectiveThe aims of this study were to analyze whether older adults’ assessment of primary care quality differs across levels of patient portal engagement and whether perceptions of how well their provider uses the EHR to support care moderates this relationship.MethodsWe conducted a cross-sectional survey analysis of 158 older adults over the age of 65 (average age 71.4 years) across Michigan using a 13-measure composite of self-assessed health care quality. Portal use was categorized as none, moderate (use of 1-3 functionalities), or extensive (use of 4-7 functionalities). EHR value perception was measured by asking respondents how they felt their doctor’s EHR use improved the patient–provider relationship.ResultsModerate portal users, compared to those who were extensive users, had lower estimated care quality (–0.214 on 4-point scale; P=.03). Differences between extensive portal users and nonportal users were not significant. Quality perception was only particularly low among moderate portal users with low EHR value perception; those with high EHR value perception rated quality similarly to other portal user groups.ConclusionsOlder adults who are moderate portal users are the least satisfied with their care, and the most sensitive to perceptions of how well their provider uses the EHR to support the relationship. Encouraging portal use without compromising perceptions of quality requires thinking beyond patient-focused education. Achieving value from use of patient-facing technologies with older adults is contingent upon matched organizational investments that support technology-enabled care delivery. Providers and staff need policies and practices that demonstrate technology adeptness. Older adults may need more tailored signaling and accommodation for technology to be maximally impactful.

Quality of Maternal Death Documentation in Afghanistan: A Retrospective Health Facility Record Review

Objectives: To assess the quality of health facility documentation related to maternal deaths at health facilities in Afghanistan.Methods: Analysis of a subset of findings from the 2016 National Maternal and Newborn Health Quality of Care Assessment in Afghanistan. At each facility, maternity registers were reviewed to obtain data related to maternity caseload, and number and causes of maternal deaths in the year preceding the survey. Detailed chart reviews were conducted for up to three maternal deaths per facility. Analyses included completeness of charts, quality of documentation, and cause of death using WHO application of International Statistical Classification of Disease to deaths during pregnancy, childbirth and the puerperium.Key findings: Only 129/226 (57%) of facilities had mortality registers available for review on the day of assessment and 41/226 (18%) had charts documenting maternal deaths during the previous year. We reviewed 68 maternal death cases from the 41 facilities. Cause of death was not recorded in nearly half of maternal death cases reviewed. Information regarding mode of birth was missing in over half of the charts, and one third did not capture gestational age at time of death. Hypertensive disorders of pregnancy and obstetric hemorrhage were the most common direct causes of death, followed by maternal sepsis and unanticipated complications of clinical management including anesthesia-related complications. Documented indirect causes of maternal deaths were anemia, cardiac arrest, kidney and hepatic failure. Charts revealed at least eight maternal deaths from indirect causes that were not captured in register books, indicating omission or misclassification of registered deaths.Conclusion: Considerable gaps in quality of recordkeeping exist in Afghanistan, including underreporting, misclassification and incompleteness. This hampers efforts to improve quality of maternal and newborn health data and priority setting.

Amputation Care Quality and Satisfaction With Prosthetic Limb Services: A Longitudinal Study of Veterans With Upper Limb Amputation

This study sought to measure and identify factors associated with satisfaction with care among veterans. The metrics were colelcted for those receiving prosthetic limb care at the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) care settings and at community-based care providers.A longitudinal cohort of veterans with major upper limb amputation receiving any VA care from 2010 to 2015 were interviewed by phone twice, 1 year apart. Care satisfaction was measured by the Orthotics and Prosthetics User's Survey (OPUS) client satisfaction survey (CSS), and prosthesis satisfaction was measured by the OPUS client satisfaction with device (CSD), and the Trinity Amputation and Prosthetic Experience Scale satisfaction scales. The Quality of Care index, developed for this study, assessed care quality. Bivariate analyses and multivariable linear regressions identified factors associated with CSS. Wilcoxon Mann-Whitney rank tests and Fisher exact tests compared CSS and Quality of Care items at follow-up for those with care within and outside of the VA and DoD.The study included 808 baseline participants and 585 follow-up participants. Device satisfaction and receipt of amputation care in the prior year were associated with greater satisfaction with care quality. Persons with bilateral amputation were significantly less satisfied with wait times. Veterans who received amputation care in the VA or DoD had better, but not statistically different, mean (SD) CSS scores: 31.6 (22.6) vs 39.4 (16.9), when compared with those who received care outside the VA or DoD. Those with care inside the VA or DoD were also more likely to have a functional assessment in the prior year (33.7% vs 7.1%, P = .06), be contacted by providers (42.7% vs 18.8%, P = .07), and receive amputation care information (41.6% vs 0%, P =.002). No statistically significant differences in CSS, Quality of Care scores, or pain measures were observed between baseline and follow-up. In regression models, those with higher CSD scores and with prior year amputation care had higher satisfaction when compared to those who had not received care.Satisfaction with prosthetic limb care is associated with device satisfaction and receipt of care within the prior year. Veterans receiving amputation care within the VA or DoD received better care quality scores than those receiving prosthetic care outside of the VA or DoD. Satisfaction with care and quality of care were stable over the 12 months of this study. Findings from this study can serve as benchmarks for future work on care satisfaction and quality of amputation rehabilitative care.

Gender discrimination as a barrier to high-quality maternal and newborn health care in Nigeria: findings from a cross-sectional quality of care assessment

BackgroundPoor reproductive, maternal, newborn, child, and adolescent health outcomes in Nigeria can be attributed to several factors, not limited to low health service coverage, a lack of quality care, and gender inequity. Providers’ gender-discriminatory attitudes, and men’s limited positive involvement correlate with poor utilization and quality of services. We conducted a study at the beginning of a large family planning (FP) and maternal, newborn, child, and adolescent health program in Kogi and Ebonyi States of Nigeria to assess whether or not gender plays a role in access to, use of, and delivery of health services.MethodsWe conducted a cross-sectional, observational, baseline quality of care assessment from April–July 2016 to inform a maternal and newborn health project in health facilities in Ebonyi and Kogi States. We observed 435 antenatal care consultations and 47 births, and interviewed 138 providers about their knowledge, training, experiences, working conditions, gender-sensitive and respectful care, and workplace gender dynamics. The United States Agency for International Development’s Gender Analysis Framework was used to analyze findings.ResultsSixty percent of providers disagreed that a woman could choose a family planning method without a male partner’s involvement, and 23.2% of providers disagreed that unmarried clients should use family planning. Ninety-eight percent believed men should participate in health services, yet only 10% encouraged women to bring their partners. Harmful practices were observed in 59.6% of deliveries and disrespectful or abusive practices were observed in 34.0%. No providers offered clients information, services, or referrals for gender-based violence. Sixty-seven percent reported observing or hearing of an incident of violence against clients, and 7.9% of providers experienced violence in the workplace themselves. Over 78% of providers received no training on gender, gender-based violence, or human rights in the past 3 years.ConclusionAddressing gender inequalities that limit women’s access, choice, agency, and autonomy in health services as a quality of care issue is critical to reducing poor health outcomes in Nigeria. Inherent gender discrimination in health service delivery reinforces the critical need for gender analysis, gender responsive approaches, values clarification, and capacity building for service providers.

Forensic medical report as a basis for changing the medical care procedure (the case of otorhinolaryngology)

The objective of the study is to develop and test a mechanism that allows the creation of hypotheses regarding the necessary provisions to update the medical care procedure, based on the analysis of forensic medical examinations (FME) conclusions, including issues on the assessment of the medical care quality. At present, the medical care procedure is determined by experts. This approach needs to be redesigned, but there is no formalized mechanism for doing so. The study presents the analysis of all the FME in the field of otorhinolaryngology performed in two FME bureaus of the constituent entities of the Russian Federation. Facts were revealed that provided adequate quality of medical care in specific cases and facts that did not affect the quality of medical care. These hypotheses should be considered by experts as primary for inclusion of new provisions in regulations or exclusion of those that do not affect the quality of medical care.

Organizational context of quality assessment of follow-up care for patients with stable coronary heart disease by primary care general practitioners

The high prevalence of coronary heart disease (CHD) in the Russian population warrants the importance of the quality of medical care for such patients during the follow-up care in accordance with established criteria. Objective. To evaluate the quality of the follow-up care of patients with stable CHD performed by primary care general practitioners in health care facilities in the constituent entities of the Russian Federation. Material and methods. During field visit of the experts of the National Medical Research Center for Therapy and Preventive Medicine in 38 constituent entities of the Russian Federation, outpatient records of randomly selected patients with CHD during visits of outpatient departments of primary health care facilities were analyzed. Data were collected and analyzed using a unified developed algorithm (checklist) for assessing the availability and quality of follow-up care in accordance with the requirements of the procedure for follow-up care for adults, approved by Order of the Ministry of Health of the Russian Federation dated March 29, 2019 No. 173n, and the Ministry of Health guidelines “Stable Coronary Heart Disease” (2020). Results. Data from 751 outpatient records of patients with stable CHD were included in the analysis. The mean age of the patients was 65.2±11.1 years (65.2±11.1 years in females and 65.2±11.1 years in males). The proportion of female patients was 47.8%. The follow-up care by primary care general practitioners was performed well-timed in 66.0% of cases (496 patients). The proportions of males and females were comparable, 50.6% and 49.4%, respectively. In 20.1% of cases (153 patients), the minimum recommended frequency of visits (examinations, consultations) by the primary care general practitioners was not observed. More than half of the irregularly followed-up patients (56%) were males. In 12.5% of patients at the last follow-up visit, blood pressure (BP) did not reach the target values specified in the clinical guidelines, and in 5.4% of patients followed up for more than a year, BP was above 180/90 mm Hg;this group consisted of male patients. It should be noted that in 88% of patients’ outpatient records there was no information about LDL cholesterol levels, and among patients with reported LDL cholesterol levels the target values were achieved only in 57.7% of cases. Conclusions. The results of the analysis showed inadequate quality of follow-up care for patients with stable coronary heart disease. The data collection was carried out during the evolving COVID-19 pandemic, which may have affected the results, so the situation is still being monitored. The systemic methodical defects of the follow-up care for patients with stable coronary heart disease revealed in this analysis, as well as the suggestions made, can be the basis for the organization of routine internal quality control of medical care in outpatient settings for chronically ill patients. (English) [ABSTRACT FROM AUTHOR] Ð’N‹N

Big data analysis on medical services in coronary heart disease for outpatient care quality management and assessment of the risk of the adverse outcomes

Big data analysis on medical services in coronary heart disease for outpatient care quality management and assessment of the risk of the adverse outcomes

Clinical Recommendations of the Russian Gastroenterological Association on Diagnosis and Treatment of Infectious Esophagitis

Aim. Current clinical recommendations aim to provide gastroenterologists, general practitioners (family doctors), endoscopists and infectionists with modern methods for diagnosis and treatment of infectious esophagitis.Key points. Infectious esophagitis is an esophageal disease of fungal, viral, bacterial or parasitic origin. Esophagus may be affected per se or conjointly in a common gastrointestinal infection. All patients suspected for infectious esophagitis, unless contraindicated, are advised an esophagogastroduodenoscopy with biopsy to confirm diagnosis. Selected incidents of infectious esophagitis require a histological, immunohistochemical examination or polymerase chain reaction-based diagnosis to verify the infectious agent. Uncomplicated infectious esophagitis requires a conservative therapy, mostly on an outpatient basis. However, cases of severe odynophagia, dysphagia, severe pain syndrome, high complication risks (e.g., esophageal ulcer bleeding in thrombocytopenia), severe immunodeficiency, generalised forms of disease and severe concomitant disorders are considered for hospital care. The clinical recommendations outline criteria for the medical care quality assessment and provide relevant information to the patient.Conclusion. Diagnosis of infectious esophagitis capitalises on the clinical picture (odynophagia, dysphagia), presence of immunosuppression, endoscopic and histological evidence. All patients with infectious esophagitis of verified origin are recommended a suitable etiotropic therapy.

OP447 Feasibility And Validity Of Real-World Data As Evidence Of Effectiveness - Experience From Breast Cancer Care In Scotland

IntroductionData from randomized controlled trials (RCTs) are the primary source for health technology assessment (HTA) however these are limited by strict patient inclusion criteria, leading to concerns about whether treatment benefit estimates are accurate for all patients (generalizability). Real-World Data (RWD) have been proposed as a solution however as these are observational data there is additional potential for bias when estimating treatment effectiveness. To maximize the utility of RWD it is useful to consider the whole process of evidence generation and robustly address issues of feasibility and validity.MethodsA series of complementary studies investigated whether population-based routinely collected health data from Scotland are suitable for estimating the effectiveness of chemotherapy for early breast cancer. Firstly, a prognostic score was validated in this population. Secondly, a comparison of RWD and randomized trial effectiveness estimates was made to investigate feasibility and validity of several methods – Propensity Score Matching (PSM), Instrumental variables (IV) and Regression Discontinuity. Finally, effectiveness estimates in trial underrepresented groups were produced.ResultsPSM and IV were feasible and produced results in relatively close agreement with randomized data. Effectiveness estimates in trial underrepresented groups (women over 70 years and women with high comorbidity) were consistent with an approximate one-third reduction in the risk of death from breast cancer. This is equivalent to approximately a 3–4 percentage point difference in all cause mortality over 10 years in these groups.ConclusionsRWD are a feasible for generating estimates of effectiveness of adjuvant chemotherapy in early stage breast cancer. The process of using RWD for this purpose should include careful assessment of data quality and comparison of alternative strategies for causal identification in the context of available randomized data.

Functional Recovery Rate: A Feasible Method for Evaluating and Comparing Rehabilitation Outcomes Between Skilled Nursing Facilities

ObjectivesThe recovery of patients' physical function and the rate at which this occurs are important parameters for evaluating value in post-acute care (PAC). However, no metrics are presently used to compare skilled nursing facilities (SNFs) based on the functional recovery rates (FRRs) for patients in their care. The objectives of this study were to examine whether the average FRR differed significantly among SNFs and to compare the FRR to other measures currently used to assess care quality in SNFs. DesignRetrospective observational study. Setting and Participants3913 patients discharged from hospitals in one health system to one of 10 partner SNFs between January 2017 and September 2019. MethodsThe FRR—the difference in Activity Measure for Post-Acute Care 6-Clicks basic mobility score from SNF admission to discharge relative to the SNF length of stay (in days)—was the primary outcome. Secondary outcomes included metrics from the SNF Quality Reporting Program (functional recovery alone, discharge to the community, and 30-day hospital readmission). Differences in patients' outcomes between SNFs were tested using multiple regression in order to adjust for patient characteristics. ResultsAcross the 10 SNFs, the highest adjusted mean FRR was 0.70 [95% confidence interval (CI): 0.55, 0.90] and the lowest was 0.39 (95% CI: 0.33, 0.46) points per day. Two SNFs had an adjusted mean FRR statistically higher, and 2 had an FRR statistically lower, than the sample mean (0.50, 95% CI: 0.48-0.52). SNF rankings varied by metric. Conclusions and ImplicationsIndividual SNFs vary in their mean FRR for patients making it a potentially useful measure of value for comparing SNFs. Standardized measurement and reporting of FRR could be beneficial to patients and their families as they consider specific SNFs for necessary post-acute rehabilitation and to hospital systems seeking to identify high-value PAC providers with whom to partner in collaborative care models.

Managed care improves prognosis in acute myocardial infarction survivors. Data from the MAnaged Care for Acute Myocardial Infarction Survivors (MACAMIS) Programme

Abstract Background Mortality following acute myocardial infarction (MI) remains high despite progress in pharmacotherapy and interventional treatment. In 2017 a nation-wide system of managed care for MI survivors comprising a continuum of acute treatment of MI, staged revascularization, cardiac rehabilitation, cardiac electrotherapy and cardiac ambulatory care within one year following MI was implemented in Poland. The managed care programme (MCP) includes also the quality of care assessment based on clinical measures (e.g. cardiovascular risk factors control) as well as on the rate of minor and major cardiovascular events. The goal of the analysis was to assess the overall mortality of MI survivors participating and not participating in the MCP. Methods The database of survivors of acute MI discharged from hospital from October 1, 2017 to December 31, 2018 was analyzed. Patients who died within 10 days after discharge were excluded from the analysis. The primary end-point was defined as death from any cause. Propensity-Score Matching (PSM) using nearest neighbor matching was used to form comparable groups of patients participating and not participating in the MCP. The Cox proportional hazard regression analysis was used to assess the relation between MCP and the overall mortality. Results MCP was implemented in the first stage in 48 hospitals spread around the country (about 34% of all hospitals treating acute MI patients in Poland). Out of 87739 analyzed patients (age: 68.1±11.9 years; 55581 men and 32158 women) 34064 were hospitalized in hospitals with MCP implemented. Altogether 10404 patients (11.9% of the whole cohort; 30.5% of those hospitalized in hospitals with MCP implemented) participated in MCP. They were matched with 10404 patients not participating in the MCP. During 324.8±140.5 days of follow-up 7413 patients died. One-year mortality was lower in patients participating in the MCP both when we analyzed the whole cohort (4.4% vs. 9.5%; p<0.001) as well as when we limited the analysis to the PSM groups (4.4% vs. 6.5%; p<0.001, figure 1). MCP was related to the overall mortality in univariate (HR 0.43 [0.39–0.48]) as well as in multivariate analysis (0.64 [0.57–0.71]) in the whole cohort as well as in the PSM cohort (HR 0.63 [0.56–0.72] and 0.64 [0.56–0.72] for the univariate and multivariate analysis respectively). When we limited the analysis to hospitals in which MCP was implemented one-year mortality was 4.3% vs. 6.3% (p<0.001) whereas univariate HR was 0.51 (0.44–0.60) and multivariate HR 0.52 (0.44–0.61). Conclusion The implemented in Poland nation-wide system of managed care for MI survivors is related to improved survival. Therefore, the Ministry of Health plans to implement the programme in all cardiac centers in Poland. Funding Acknowledgement Type of funding source: None

Online Abortion Drug Sales in Indonesia: A Quality of Care Assessment.

This study sought to understand the experience of buying misoprostol online for pregnancy termination in Indonesia. We conducted a mystery client study August through October, 2019. Interactions were analyzed quantitatively and qualitatively, along with the contents of the packages. One hundred ten sellers were contacted, from whom mystery clients made 76 purchases and received 64 drug packages. Almost all sellers sold “packets” containing multiple drugs; 73 percent of packets contained misoprostol, and 47 percent contained at least 800 mcg of misoprostol. Thirty‐four packets contained insufficient drugs to complete an abortion. When compared to WHO standards, 87 percent of sellers imparted incomplete information about potential physical effects; no seller provided information about possible complications. Women buying misoprostol from informal online drugs sellers will be underprepared for understanding potential side effects and complications. Educational activities are needed to increase women's access to information about safe use of misoprostol as a harm reduction strategy.

Nurse staffing and care process factors in paediatric emergency department-An administrative data study.

To describe the nurse-patient ratio in the paediatric emergency department and whether it is related to emergency care process measurements: length of stay and the number of patients who leave before treatment is completed. Despite abundant data on nurse staffing, little is known about its relationship with process variables in paediatric emergency departments. This was a cross-sectional study. Administrative data regarding 21,956 patients and nurse staffing (N=49) were collected from a university hospital's paediatric emergency department between 1 January-30 June 2019. Summary statistics were calculated, differences in the variables were assessed by Kruskal-Wallis and chi-square tests, and relations between them were explored by linear regression analysis. This study is reported in accordance with the STROBE guidelines. Nurse-patient ratios varied between shifts and were highest at night (mean 0.75; range 0.3-5.3) and the lowest in the evenings (mean 0.17; range 0.1-0.8). Increases in numbers of nurses in the paediatric emergency department reduced the length of stay by 2% per additional nurse on average, and nurse-patient ratios were negatively related to frequencies of patients leaving before treatment completion. The results indicate that nurse-patient ratios affect paediatric patient care processes. Staffing levels are negatively related to emergency department length of stay and influence factors that could reduce numbers of patients who leave before treatment completion. Because the nurse-patient ratio affects the care process, it should be used together with other process measurements when assessing care quality in paediatric emergency departments.

Patient Reported Outcome Measures (PROMs) for quality of care assessment: a pilot study protocol

Abstract Background There is emerging interest in integrating Patient Reported Outcome Measures (PROMs) into the assessment of care quality. This study protocol aims at testing the collection and use of PROMs for evaluating and comparing health outcomes by patients with colorectal cancer. This is part of a project of the Istituto Superiore di Sanità and Gruppo Italiano di Reti Oncologiche (GIRO) aimed at promoting Value-Based Healthcare (VBHC) for performance evaluation of oncological healthcare providers. Methods A multicentric prospective observational study will be conducted at the seven GIRO oncological hospitals. For each hospital, 40 colorectal cancer patients undergoing either surgery or surgery plus neoadjuvant therapy, will be recruited (20 colon; 20 rectum) over 12 months. The data will be collected twice (before and after surgery) or three times for patients undergoing neoadjuvant therapy, by using EORTC-C30, a generic module for cancer patients and EORTC-CR29, a specific module for colorectal cancer patients. Collected data will be analyzed descriptively and the scores of each hospital will be compared to the overall scores of all the centers. Additional medical information will be used to adjust for the center casemix. Feedback from health professionals and patients will be collected through structured questionnaires and focus groups. Results The results will be interpreted to assess and compare the health outcomes reported by the patients among the GIRO hospitals. Feedback from health professionals and patients will help identify barriers and facilitators of implementation of PROs collection. Conclusions PROMs have the potential to systematically incorporate the patient perspective into the health outcome measurements for performance evaluation and benchmarking, which is essential to delivering high-value patient-centered care. The PROMs collected in this study will be integrated in a set of process and outcome indicators previously defined within same project. Key messages Patient-Reported Outcome Measures (PROMs) have the potential to systematically incorporate the patient perspective, which is essential to delivering high-value patient-centered care. It is critical to integrate PROMs in performance evaluation and comparison among oncological healthcare providers for improving the quality of care in a Value-Based Healthcare perspective.

The integrated approach to implementation of expertise of medical interventions

The article analyzes and systematizes legislative rules of the medical care quality expertise. The paramount place of clinical recommendations in development of legal acts regulating expertise and assessment of medical care quality, quality control and safety of medical activity is determined.

Hospital-provision of essential primary care in 56 countries: determinants and quality.

ObjectiveTo estimate the use of hospitals for four essential primary care services offered in health centres in low- and middle-income countries and to explore differences in quality between hospitals and health centres.MethodsWe extracted data from all demographic and health surveys conducted since 2010 on the type of facilities used for obtaining contraceptives, routine antenatal care and care for minor childhood diarrhoea and cough or fever. Using mixed-effects logistic regression models we assessed associations between hospital use and individual and country-level covariates. We assessed competence of care based on the receipt of essential clinical actions during visits. We also analysed three indicators of user experience from countries with available service provision assessment survey data.FindingsOn average across 56 countries, public hospitals were used as the sole source of care by 16.9% of 126 012 women who obtained contraceptives, 23.1% of 418 236 women who received routine antenatal care, 19.9% of 47 677 children with diarrhoea and 18.5% of 82 082 children with fever or cough. Hospital use was more common in richer countries with higher expenditures on health per capita and among urban residents and wealthier, better-educated women. Antenatal care quality was higher in hospitals in 44 countries. In a subset of eight countries, people using hospitals tended to spend more, report more problems and be somewhat less satisfied with the care received.ConclusionAs countries work towards achieving ambitious health goals, they will need to assess care quality and user preferences to deliver effective primary care services that people want to use.

Evaluating the Quality of Home Care in China Using the Home Care Quality Assessment Tool.

This study aimed to evaluate the quality of home care in China using the Home Care Quality Assessment Tool (HCQuAT). We recruited 38 home health agencies in Shanghai, China, which included 18 in urban areas, 11 in suburban areas, and nine in rural areas. Data on quality of home care from each agency were collected by trained staff using the HCQuAT. On average, these home health agencies scored 74.28/100.00 (SD = 6.80) on the HCQuAT, with an excellence rate of 39.5% and a failing rate of 23.7%. The mean scores on the structure quality module, process quality module, and outcome quality module were 71.2 ± 21.8, 86.6 ± 9.2, and 44.1 ± 37.5, respectively. Significant differences existed across geographic locations (p = .018). Significant variations were identified in the quality of home care across quality modules and geographic locations. Outcome quality and quality in rural areas were lower than those for their counterparts.

Racial and Ethnic Disparities in Patient Experiences in the United States: 4-Year Content Analysis of Twitter.

BackgroundRacial and ethnic minority groups often face worse patient experiences compared with the general population, which is directly related to poorer health outcomes within these minority populations. Evaluation of patient experience among racial and ethnic minority groups has been difficult due to lack of representation in traditional health care surveys.ObjectiveThis study aims to assess the feasibility of Twitter for identifying racial and ethnic disparities in patient experience across the United States from 2013 to 2016.MethodsIn total, 851,973 patient experience tweets with geographic location information from the United States were collected from 2013 to 2016. Patient experience tweets included discussions related to care received in a hospital, urgent care, or any other health institution. Ordinary least squares multiple regression was used to model patient experience sentiment and racial and ethnic groups over the 2013 to 2016 period and in relation to the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014.ResultsRacial and ethnic distribution of users on Twitter was highly correlated with population estimates from the United States Census Bureau’s 5-year survey from 2016 (r2=0.99; P<.001). From 2013 to 2016, the average patient experience sentiment was highest for White patients, followed by Asian/Pacific Islander, Hispanic/Latino, and American Indian/Alaska Native patients. A reduction in negative patient experience sentiment on Twitter for all racial and ethnic groups was seen from 2013 to 2016. Twitter users who identified as Hispanic/Latino showed the greatest improvement in patient experience, with a 1.5 times greater increase (P<.001) than Twitter users who identified as White. Twitter users who identified as Black had the highest increase in patient experience postimplementation of the ACA (2014-2016) compared with preimplementation of the ACA (2013), and this change was 2.2 times (P<.001) greater than Twitter users who identified as White.ConclusionsThe ACA mandated the implementation of the measurement of patient experience of care delivery. Considering that quality assessment of care is required, Twitter may offer the ability to monitor patient experiences across diverse racial and ethnic groups and inform the evaluation of health policies like the ACA.

Abstract 4256: Multiplex fast FISH assay for detecting ROS1, RET and MET aberrations in FFPE specimens using BioView image analysis

Abstract Background: Biomarker testing in lung cancer is often limited by a lack of sufficient formalin fixed, paraffin embedded (FFPE) tissue for comprehensive genomic profiling. To promote personalized therapy for lung cancer, a multiplex FISH assay was developed to simultaneously assess aberrations in ROS1, RET, and MET on a single FFPE specimen slide. Methods: Specimens included primary tumor (N = 39) as well as biopsies from a variety of metastatic sites (N = 16). These included 12 samples with ROS1 rearrangements, 3 samples with RET rearrangements, and 11 samples with MET amplification reported by a previously validated laboratory test method. A probe mix contained 6 differentially labeled fluorescent probes: 3' ROS1, 5' ROS1, 3' RET, 5' RET, MET and CEP7. The probes were formulated in Vysis IntelliFISH Hybridization Buffer to allow for a 2 h hybridization time. BioView imaging platform and Duet software algorithm were used to perform automated slide scanning and digital analysis. Specimens were considered positive for ROS1 or RET rearrangement if &amp;gt;15% evaluated cells contained a break apart (rearranged) signal. Specimens were considered positive for MET amplification if &amp;gt;15% of cells had MET/CEP7 ratio &amp;gt;2 and positive for polysomy if &amp;gt;15% of cells had 5 or more MET signals copies. Results: The 6 color FISH assay was 97% concordant for ROS1 rearrangement and 100% concordant for RET rearrangement. The average background percentage of positive tumor cells in cases without known gene rearrangements was approximately 5%, yielding a negative cutoff threshold of approximately 15%, in accordance with cutoff thresholds reported in literature. The 6 color FISH assay was 91% concordant for MET amplification or polysomy. Results were interpretable for 98% of targets analyzed by the 6 color FISH method. Four samples failed on analysis for one of the targets due to lack of sufficient cells or lack of adequate hybridization signal. Conclusion: A newly developed 6-color FISH assay allows simultaneous detection of three genomic abnormalities using only 1 specimen slide. This feature combined with rapid hybridization in IntelliFISH buffer and automated BioView slide imaging and analysis can significantly increase the yield of molecular testing on limited lung cancer tissue samples. Careful pathologic correlation for tumor cell identification and careful assessment of hybridization quality are necessary to optimize the accuracy of this test method. Citation Format: Irina A. Sokolova, Patrick Bedroske, Tatyana A. Grushko, Amber R. Schneider, Kristine Jacobson, Jesse S. Voss, Yishay Tauber, Yossi Avisror, Vitaliy Shkolnik, Katerina Pestova, Katherine B. Geiersbach. Multiplex fast FISH assay for detecting ROS1, RET and MET aberrations in FFPE specimens using BioView image analysis [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4256.