Quality Of Hospital Care Research Articles

Assessing Patient Safety Culture among Healthcare Providers at a Tertiary Care Hospital

Background: Patient safety is significant to improve the quality care in health-care organisations; hence, assessment of patient safety culture is the paramount need of the h. However, in middle- and low-income countries, the burden of patient safety is vital as the healthcare-related injuries and deaths are increasing, this is global health concern. The awareness of measuring patient safety culture needs to be improved in low- and middle-income countries and this can help in evaluating the culture and formulating interventions and also achieving the accreditation standards. National Accreditation Board for Hospitals (NABH) with a focus of patient safety has contributed largely in the quality of health care in Indian hospitals and witnessed progress and improvement. However, the challenges in a country like India are large and complex and need to be addressed systematically beyond the meeting accreditation standards. Aim: The aim of this study was to assess the level of perception among the healthcare providers at a tertiary care hospital. Methods: Cross-sectional study was conducted using The Hospital Survey on Patient Safety culture (HSOPSC v−1) tool to assess the level of perception of patient safety culture among healthcare providers. The survey was conducted among 400 respondents of tertiary care hospital, Bangalore, Karnataka (India) through a structured, open- and close-ended questionnaire. Participants were selected through nonprobability random sampling. Collected data were analyzed through composite scores, Chi-square, and Man–Whitney U-test for test. Results: The present study showed a highest positive response in teamwork within the units and the least in nonpunitive response to error. The domain hands off and transitions which requires cooperation from other departments also showed low positive responses in many studies including the present study (41.13%). For the data analyzed above regarding the perception of patient safety culture dimensions among the healthcare professionals, it was seen that there was a statistically significant association (0.0026) between the two variables that perception and safety culture existing in the hospital. Conclusion: After comparing between experience and level of perception among healthcare providers, it was concluded that the Chi-square value is 0.04 which is statistically significant and there is a significant association between positions and level of perception. Therefore, our study indicates that there is a high need to develop strategies related to certain safety domains that urgently need improvement in this hospital.

A co-creation roadmap towards sustainable quality of care: A multi-method study

ObjectiveHospitals demonstrated increased efforts into quality improvement over the past years. Their growing commitment to quality combined with a heterogeneity in perceptions among healthcare stakeholders cause concerns on the sustainable incorporation of quality into the daily workflow. Questions are raised on the drivers for a sustainable hospital quality policy. We aimed to identify drivers and incorporate them into a new, unique roadmap towards sustainable quality of care in hospitals.DesignA multi-method design guided by an eight-phase approach to develop a conceptual framework consists of multiple, iterative phases of data collection, synthesis and validation. Starting with a narrative review followed by a qualitative in-depth analysis and including feedback of national and international healthcare stakeholders.SettingHospitals.ResultsThe narrative review included 59 relevant papers focusing on quality improvement and the sustainability of these improved quality results. By integrating, synthesising and resynthesizing concepts during thematic and content analysis, the narrative review evolved to an integrated, co-creation roadmap. The Flanders Quality Model (FlaQuM) is presented as a driver diagram that features six primary drivers for a sustainable quality policy: (1) Quality Design and Planning, (2) Quality Control, (3) Quality Improvement, (4) Quality Leadership, (5) Quality Culture and (6) Quality Context. Six primary drivers are described in 19 building blocks (secondary drivers) and 104 evidence-based action fields.ConclusionsThe framework suggests that a manageable number of drivers, building blocks and action fields may support the sustainable incorporation of quality into the daily workflow. Therefore, FlaQuM can serve as a useful roadmap for future sustainable quality policies in hospitals and for future empirical and theoretical work in sustainable quality management.

Structural quality of labor and delivery care in government hospitals of Ethiopia: a descriptive analysis

BackgroundEthiopia has low skilled birth attendance rates coupled with low quality of care within health facilities contributing to one of the highest maternal mortality rates in Sub-Saharan Africa, at 412 deaths per 100,000 live births. There is lack of evidence on the readiness of health facilities to deliver quality labor and delivery (L&D) care. This paper describes the structural quality of routine L&D care in government hospitals of Ethiopia.MethodsA facility-based cross-sectional study design, involving census of all government hospitals in Southern Nations Nationalities and People’s Region (SNNPR) (N = 20) was conducted in November 2016 through facility audit using a structured checklist. Data collectors verified the availability and functioning of the required items through observation and interview with the heads of labor and delivery case team. An overall mean score of structural quality was calculated considering domain scores such as general infrastructure, human resource and essential drugs, supplies, equipment and laboratory services. Summary statistics such as proportion, mean and standard deviation were computed to describe the degree of adherence of the hospitals to the standards related to structural quality of routine labor and delivery care.ResultsOne third of hospitals had low readiness to provide quality routine L&D care, with only two approaching near fulfilment of all the standards. Hospitals had fulfilled 68.2% of the standards for the structural aspects of quality of L&D care. Of the facility audit criteria, the availability of essential equipment and supplies for infection prevention scored the highest (88.8%), followed by safety, comfort and woman friendliness of the environment (76.4%). Availability skilled health professionals and quality management practices scored 72.5% each, while availability of the required items of general infrastructure was 64.6%. The two critical domains with the lowest score were availability of essential drugs, supplies and equipment (52.2%); and laboratory services and safe blood supply (50%).ConclusionSubstantial capacity gaps were observed in the hospitals challenging the provision of quality routine L&D care services, with only two thirds of required resources available. The largest gaps were in laboratory services and safe blood, and essential drugs, supplies and equipment. The results suggest the need to ensure that all public hospitals in SNNPR meet the required structure to enable the provision of quality routine L&D care with emphases on the identified gaps.

JUE Insight: Is hospital quality predictive of pandemic deaths? Evidence from US counties

In the large literature on the spatial-level correlates of COVID-19, the association between quality of hospital care and outcomes has received little attention to date. To examine whether county-level mortality is correlated with measures of hospital performance, we assess daily cumulative deaths and pre-crisis measures of hospital quality, accounting for state fixed-effects and potential confounders. As a measure of quality, we use the pre-pandemic adjusted five-year penalty rates for excess 30-day readmissions following pneumonia admissions for the hospitals accessible to county residents based on ambulance travel patterns. Our adjustment corrects for socio-economic status and down-weighs observations based on small samples. We find that a one-standard-deviation increase in the quality of local hospitals is associated with a 2% lower death rate (relative to the mean of 20 deaths per 10,000 people) one and a half years after the first recorded death.

New evidence on geographic disparities in United States hospital capacity.

To characterize the quantity and quality of hospital capacity across the United States. We combine a 2017 near-census of US hospital inpatient discharges from the Healthcare Cost and Utilization Project (HCUP) with American Hospital Association Survey, Hospital Compare, and American Community Survey data. This study produces local hospital capacity quantity and care quality measures by allocating capacity to zip codes using market shares and population totals. Disparities in these measures are examined by race and ethnicity, income, age, and urbanicity. All data are derived from pre-existing sources. All hospitals and zip codes in states, including the District of Columbia, contributing complete data to HCUP in 2017 are included. Non-Hispanic Black individuals living in zip codes supplied, on average, 0.11 more beds per 1000 population (SE=0.01) than places where non-Hispanic White individuals live. However, the hospitals supplying this capacity have 0.36 fewer staff per bed (SE=0.03) and perform worse on many care quality measures. Zip codes in the most urban parts of America have the least hospital capacity (2.11 beds per 1000 persons; SEM=0.01) from across the rural-urban continuum. While more rural areas have markedly higher capacity levels, urban areas have advantages in staff and capital per bed. We do not find systematic differences in care quality between rural and urban areas. This study highlights the importance of lower hospital care quality and resource intensity in driving racial and ethnic, as well as income, disparities in hospital care-related outcomes. This study also contributes an alternative approach for measuring local hospital capacity that accounts for cross-hospital service area flows. Adjusting for these flows is necessary to avoid underestimating the supply of capacity in rural areas and overestimating it in places where non-Hispanic Black individuals tend to live.

Responding to the deteriorating patient: The rationale for treatment escalation plans.

A Treatment Escalation Plan (TEP) is a communication tool designed to improve quality of care in hospital, particularly if patients deteriorate. The aims are to reduce variation caused by discontinuity of care; avoid harms caused by inappropriate treatment and promote patients' priorities and preferences. The TEP is based on the goals of treatment - 'What are we trying to achieve?' The goals take account of the context of acute illness, the consequences of interventions and discussion with the patient. They should reflect a shift away from 'fix-it' medicine to what is realistic and pragmatic. A TEP has three escalation categories: full escalation, selected appropriate treatments and palliative/supportive care. Other appropriate/inappropriate treatments are also recorded. Treatment Escalation Plans are associated with significant reductions in intensive care unit (ICU) admissions, non-beneficial interventions, harms and complaints. Treatment Escalation Plans contribute to staff well-being by reducing uncertainty. Successful implementation requires training and education in medical decision-making and communication skills.

Analysis of Hospital-Level Readmission Rates and Variation in Adverse Events Among Patients With Pneumonia in the United States

It is known that hospitalized patients who experience adverse events are at greater risk of readmission; however, it is unknown whether patients admitted to hospitals with higher risk-standardized readmission rates had a higher risk of in-hospital adverse events. To evaluate whether patients with pneumonia admitted to hospitals with higher risk-standardized readmission rates had a higher risk of adverse events. This cross-sectional study linked patient-level adverse events data from the Medicare Patient Safety Monitoring System (MPSMS), a randomly selected medical record abstracted database, to the hospital-level pneumonia-specific all-cause readmissions data from the Centers for Medicare & Medicaid Services. Patients with pneumonia discharged from July 1, 2010, through December 31, 2019, in the MPSMS data were included. Hospital performance on readmissions was determined by the risk-standardized 30-day all-cause readmission rate. Mixed-effects models were used to examine the association between adverse events and hospital performance on readmissions, adjusted for patient and hospital characteristics. Analysis was completed from October 2019 through July 2020 for data from 2010 to 2017 and from March through April 2022 for data from 2018 to 2019. Patients hospitalized for pneumonia. Adverse events were measured by the rate of occurrence of hospital-acquired events and the number of events per 1000 discharges. The sample included 46 047 patients with pneumonia, with a median (IQR) age of 71 (58-82) years, with 23 943 (52.0%) women, 5305 (11.5%) Black individuals, 37 763 (82.0%) White individuals, and 2979 (6.5%) individuals identifying as another race, across 2590 hospitals. The median hospital-specific risk-standardized readmission rate was 17.0% (95% CI, 16.3%-17.7%), the occurrence rate of adverse events was 2.6% (95% CI, 2.54%-2.65%), and the number of adverse events per 1000 discharges was 157.3 (95% CI, 152.3-162.5). An increase by 1 IQR in the readmission rate was associated with a relative 13% higher patient risk of adverse events (adjusted odds ratio, 1.13; 95% CI, 1.08-1.17) and 5.0 (95% CI, 2.8-7.2) more adverse events per 1000 discharges at the patient and hospital levels, respectively. Patients with pneumonia admitted to hospitals with high all-cause readmission rates were more likely to develop adverse events during the index hospitalization. This finding strengthens the evidence that readmission rates reflect the quality of hospital care for pneumonia.

Effect of nurses interpersonal communication skills on quality of care in hospitals

Communication skills are considered a significant component in a nurse-patient relationship and can influence the quality care outcome. The purpose of this study is to assess Effect of Nurses Interpersonal communication skills and patient satisfaction toward quality of care services in hospitals. Descriptive design study was carried out from AL-Najaf city hospitals was conducted The present study been conducted starting the 15th of September 2021 to the 22nd of May 2022. A non-probability purposive sampling which consists a (convenience sample ) of 200 Nurses and 200 patients have been chosen and also it was selected from Hospitals and the data collected using the questionnaire have two parts, which are explained in the following Part I: Demographic data and information related to Nurses: This part consists of two sections, which are presented as follows: Section (A): Nurses Demographic Data Section (B):Nurses Interpersonal communication skills Part II: Quality of Health Care. This part consists of two sections, which are presented as follows: Section (A): patients Demographic Data; Section (B): This Section illustrates five domains to examine the patients satisfactory about the provided Quality of Health Care in the AL-Najaf city hospitals .

Patient Views on Quality of Life and Hospital Care: Results From a Qualitative Study Among Vietnamese Patients With Diabetes

ObjectivesThis study aimed to fill the gap between Vietnamese diabetic patients' needs and care through a qualitative study asking about their experiences with diabetes and quality of care.MethodsInterviews with five diabetic patients were conducted at a tertiary general hospital located in southern Vietnam. The transcribed data were first subjected to quantitative text analysis using KH Coder to identify major categories of frequently used words, followed by a qualitative analysis of selected cases using the Steps for Coding and Theorization (SCAT) method.ResultsThe major categories of frequently used words were chronic health conditions, services, facilities, insurance, patient-doctor communication, and medication. SCAT analysis of three selected cases identified six themes: “Disregarding the disease at the early stage,” “Fear of complications,” “Satisfaction with hospital services and medical staff,” “Insurance-related problems,” “Long waiting times,” and “Communication barriers between patients and doctors.” Patients were satisfied with improved hospital facilities and services; however, the overloading of one hospital led to long waiting times and communication difficulties with doctors. Difficulties with health insurance were also observed, and patients were rather passive in disease management and needed to be empowered through improved communication with doctors and other care providers.ConclusionThese findings from our trial of introducing a qualitative study into service evaluation suggest that listening to patients can help health providers learn their perspectives and be more responsive to their needs.

Thepresenceofaurinarycatheterisanimportantpredictorofin-hospitalmortalityininternalmedicinepatients.

Mortality rates are used to assess the quality of hospital care after appropriate adjustment for case-mix. Urinary catheters are frequent in hospitalized adults and might be a marker of patient frailty and illness severity. However, we know of no attempts to estimate the predictive value of indwelling catheters for specific patient outcomes. The objective of the present study was to (a) identify the variables associated with the presence of a urinary catheter and (b) determine whether it predicts in-hospital mortality after adjustment for these variables. The study population included all acutely admitted adult patients in 2020 (exploratory cohort) and January-October 2021 (validation cohort) to internal medicine, cardiologyand intensive care departments at the Laniado Hospital, a regional hospital with 400 beds in Israel. There were no exclusion criteria. The predictor variables were the presence of a urinary catheter on admission, age, gender, comorbiditiesand admission laboratory test results. We used bivariate and multivariate logistic regression to test the associations between the presence of a urinary catheter and mortality after adjustment for the remaining independent variables on admission. The presence of a urinary catheter was associated with other independent variables. In 2020, the odds of in-hospital mortality in patients with a urinary catheter before and after adjustment for the remaining predictors were 14.3 (11.6-17.7) and 6.05 (4.78-7.65), respectively. Adding the presence of a urinary catheter to the prediction logistic regression model increased its c-statistic from 0.887 (0.880-0.894) to 0.907 (0.901-0.913). The results of the validation cohort reduplicated those of the exploratory cohort. The presence of a urinary catheter on admission is an important and independent predictor of in-hospital mortality in acutely hospitalized adults in internal medicine departments.

Implementation of a protocol for neuropsychiatric disease surveillance in a general hospital

The COVID-19 pandemic increased the incidence of neuropsychiatric diseases. Proactive models of consultation-liaison psychiatry (CLP-p) could play a key role in the prevention and management of these diseases in a general hospital. To develop a protocol for implementing screening tools for neuropsychiatric symptoms in routine clinical practice. Elements of the Plan-Do-Study-Act (PDSA) model were used to modify the Neuropsychiatric Surveillance protocol implemented at a clinical hospital during the COVID-19 pandemic by members of the hospital's CLP team. A flowchart for active follow-up of neuropsychiatric symptoms during hospitalization is presented, with sequential management and referral flows, accompanied by suggestions for pre-discharge evaluation to define continuity of care actions. The COSMOS tool is also presented, designed for the detection of risk factors and actions for the prevention of neuropsychiatric diseases in general hospitals. The neuropsychiatric surveillance protocol facilitates early and timely interventions and establishes criteria for the continuity of post-discharge care. These changes could improve the quality of care in general hospitals and reduce the gap between mental and physical health.

Preventing re-admission: Are general practitioners the solution?

In the United States the Hospital Readmissions Reduction Program (HRRP) is a Medicare value-based purchasing program that encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and, in turn, reduce avoidable readmissions [ [1] Centers for Medicare and Medicaid Services. Value based programs. Hospital Readmissions Reduction Program (HRRP). https://www. cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/Value-Based-Programs/HRRP/Hospital-ReadmissionReduction-Program. Accessed February 21, 2022. Google Scholar ]. The program supports the national goal of improving health care for Americans by linking payment to the quality of hospital care. The Centers for Medicare & Medicaid Service (CMS) includes the following six condition or procedure-specific 30-day risk-standardized unplanned readmission measures in the program: Acute Myocardial Infarction, Chronic Obstructive Pulmonary Disease, Heart Failure, Pneumonia, Coronary Artery Bypass Graft Surgery, Elective Primary Hip and/or Total Knee Arthroplasty. In this issue of the Journal, John et al attempts through a prospective observational cohort study to address the issue of unplanned hospital readmission by using post discharge consultation with either general practitioners (GPs), specialist physicians or none. This study is part of phase 1 of the TARGET-READ study (Transition cAre inteRvention targeted to hiGh risk patiEnts To Reduce rEADmissions; clincialtrials.org NCTO3496896) [ [2] John G. Payrard L. Donzé J. Associations between post-discharge medical consultations and 30-day unplanned hospital readmission: A prospective observational cohort study. Eur J Intern Med. 2022; 99: 57-62https://doi.org/10.1016/j.ejim.2022.01.013 Abstract Full Text Full Text PDF Scopus (1) Google Scholar ]. Associations between post-discharge medical consultations and 30-day unplanned hospital readmission: A prospective observational cohort studyEuropean Journal of Internal MedicineVol. 99PreviewEarly readmission after hospital discharge is frequent, partly preventable, and puts a heavy burden on healthcare systems [1,2]. Many risk factors—like adverse drug events [3], physician workload [4], patients’ comorbidities [5]—and the internationally validated HOSPITAL score for 30-day potentially avoidable readmission [6] can be assessed directly during the hospital stay. However, physiological stresses experienced during hospitalization extend beyond discharge, resulting in a period of increased vulnerability [7]. Full-Text PDF Open Access

From predictions to recommendations: Tackling bottlenecks and overstaying in the Emergency Room through a sequence of Random Forests

One of the goals to improve the quality of care in hospitals is to set a maximum of four hours for patients to be diagnosed and/or receive acute care in the Emergency Room (ER). Unfortunately, this is not always true and some patients overstay. The aim of this work is threefold: (1) to identify which patients will overstay during their admission to the ER; (2) to identify which (pair of) activities might heavily influence the time spent in the ER; and (3) to recommend actions to reduce such time. For that, a sequence of insightful supervised prediction models for generating recommendations is proposed. The method provided makes it possible to generate useful/actionable recommendations for problematic patients based on activities. State of the art techniques did not manage to generate recommendations at the arrival of the patient and/or did not take the interplay between patients into account.

A retrospective study of the effects of minimally invasive colorectal surgery on Patient Safety Indicators across a five-hospital system.

The Agency for Healthcare Research and Quality uses Patient Safety Indicators (PSI) to gauge quality of care and patient safety in hospitals. PSI 90 is a weighted combination of several PSIs that primarily comprises perioperative events. This score can affect reimbursement through Medicare and hospital quality ratings. Minimally invasive surgery (MIS) has been shown to decrease adverse events and outcomes. We sought to evaluate individual PSI and PSI 90 outcomes of minimally invasive versus open colorectal surgeries using a large medical database from 5 hospitals. A health system administrative database including all inpatients from 5 acute care hospitals was queried based on ICD 10 PC codes for colon and rectal surgery procedures performed between January 2, 2018 and December 31, 2019. Surgeries were labeled as MIS (laparoscopic) or open colorectal resection surgery. Patient demographics, health information, and case characteristics were analyzed with respect to surgical approach and PSI events. Statistical relationships between surgical approach and PSI were investigated using univariate methods and multivariate logarithmic regression analysis. PSIs of interest were PSI 8, PSI 9 PSI 11, PSI 12, and PSI 13. There were 1382 operations identified, with 861 (62%) being open and 521 (38%) being minimally invasive. Logistic modeling showed no significant difference between the 2 groups for PSI 3, 6, or 8 through 15. Understanding PSI 90 and its components is important to enhance perioperative patient care and optimize reimbursement rates. We showed that MIS, despite providing known clinical benefits, may not affect scores in the PSI 90. Surgical approach may have little effect on PSIs, and other patient and system components that are more important to these outcome measures should be pursued.

요양병원 간호인력 확보수준과 요양병원 등급에 따른 입원환자 간호결과

Purpose: This study was conducted to examine the relationship between nursing outcomes of the elderly and the staffing level of registered nurses and nurse aids to enhance the quality of care in long-term care hospitals. Methods: A secondary data analysis was performed using a long-term care hospitals database collected by the Health Insurance Review and Assessment Services from October to December 2015. The database was collected from 1056 long-term care hospitals and includes variables such as Registered Nurse (RN), Nurse Aid (NA), RN and NA staffing; grade of hospitals; and 8 nursing outcome indicators. Results: Findings showed that the number of patients per RN & NA was a significant indicator of the ratio of patients with pressure ulcer improvement in the high-risk group, the decline in ADL of patients without dementia, and transfer abilities in both dementia and non-dementia groups. The nursing outcomes were closely related to the hospital grade. The better grade, the better nursing outcomes. Conclusion: Enhance nursing outcomes in elderly patients; it is required to reconsider the policies on the RN staffing ratio as a way to enhance the RN staffing ratio in long-term care hospitals.

Challenges in Access to New Therapeutic Agents: Marginalized Patients With Cancer in Pakistan and the Need for New Guidelines.

PURPOSECancer care disparities persist among the medically underserved patients with cancer in Pakistan. To determine the access that marginalized patients with cancer have to chemotherapy and newer targeted agents in Pakistan approved by essential medicine list 2017, the barriers that patients face in getting such access, the implications of the barriers for the effectiveness of treatment, and ways of overcoming those barriers, with particular attention to breast cancer (BC), diffuse large B-cell lymphoma (DLBCL), and chronic myeloid leukemia (CML), need to be addressed.METHODSA cross-sectional survey of 28 private and public cancer centers targeting more than 50% of patients with cancer for year 2018 was conducted with focus on access to optimal therapy for BC, DLBCL, and CML. To assess the impact of socioeconomic status on the effectiveness of treatment, patients were categorized into three main income groups—low, middle, and high according to gross domestic product per capita on the basis of which some patients were categorized as economically marginalized. Differences in quality of care in public and private sector hospitals were assessed by optimal delivery and completion of chemotherapy on the basis of international guidelines. Access to optimal dose and timings of targeted therapies were determined.RESULTSIn our marginalized patients, 30%-40% received optimal basic chemotherapy for BC and DLBCL. Less than 10% of patients with human epidermal growth factor receptor 2–positive BC completed 17 cycles of trastuzumab within 12 months. For DLBCL, hardly any patients received concurrent rituximab with chemotherapy for six cycles. Dose delays, modifications, and abandonment of treatment occurred in approximately 50% of the marginalized patients. In patients with CML, the compliance to imatinib/nilotinib was 85%.CONCLUSIONSignificant barriers exist in providing optimal basic and targeted therapies to our indigent patients despite government funding and availability of access programs.

Addressing the Quality of Hospital Care of Colorectal Cancer Patients Undergoing Surgery: What Can We Learn From the National Bowel Cancer Audit?

IntroductionThe National Bowel Cancer Audit (NBOCA) is the largest database in the United Kingdom that audits real-world data and allows comparison of the quality of care for colorectal cancer patients. This study aimed to highlight relevant clinical factors in the NBOCA that contribute to variation in the quality of care provided in different hospitals.MethodsData from 36,116 patients with colorectal cancer who had undergone surgery were obtained from the NBOCA. These were patients from 145 and 146 hospitals from the years 2016 and 2017, respectively. A validated multiple linear regression was performed to compare the identified clinical factors with various quality outcomes. The quality outcomes defined in this study were the length of hospital stay of more than five days, two-year mortality, 30-day unplanned readmission rate, 90-day mortality, and 18-month stoma rate.ResultsFour clinical factors (laparoscopy rate, abdominal-perineal-resection-of-rectum, pre-operative radiotherapy, and patients with distant metastases) were shown to have a significant (p < 0.05) impact on the length of hospital stay of more than five days and the 18-month stoma rate. The 18-month stoma rate was also a significant predictor (p < 0.001) with two-year mortality.ConclusionThe NBOCA should consider adjusting for these factors when reporting the quality of care provided in hospitals. Hospitals should monitor the four clinical factors for colorectal cancer patients during perioperative care. When formulating a management plan for patients with colorectal cancer, clinicians should consider these factors along with the individual patient's history.

Productivity analysis of regional-level hospital care in the Czech republic and Slovak Republic

BackgroundProviding hospital care is an essential objective of national health policies. The countries that share common history, when they emerged from the same health system and similar conditions in the early 1990s, after the division of Czechoslovakia, became the objects of evaluation of the development of technical efficiency of hospital care. The subsequent development of their health care system also was very similar, but no longer entirely identical. The article aims to identify the trends and disparities in the productivity of the capacities of hospital care on the regional level (NUTS III.) in the Czech Republic and the Slovak Republic in 2009–2018 before the COVID-19 pandemic using the multi-criteria decision methods.MethodsThe window analysis as a dynamic DEA method based on moving averages and also the Malmquist Index, that allows the evaluation of changes in relative efficiency and of changes in the production possibilities frontier have become the key methods for evaluating the over time efficiency evolution. To model technical efficiency, an output-oriented method assuming constant returns to scale was chosen. Aggregated input and output parameters for each region were the object of study.ResultsThe results showed that differences in the efficiency trends in terms of the examined parameters among the individual regions are slightly greater in the Czech Republic than in the Slovak Republic. The least efficient regions are those where capital cities are located. Furthermore, the analysis showed that in 2018 all of the Slovak Republic regions improved its productivity compared to 2009 and that technological conditions had a significant impact on this improvement. The results of the Czech Republic regions show productivity improvement in 57% of the regions that, on the contrary, was due to changes in technical efficiency.ConclusionsIt should be recommended to the state- and regional-level governments to refrain from unilaterally preferring the orientation of public policies on the efficiency of the provision of hospital care, and rather focus on increasing the quality and availability of hospital care, especially in smaller, rural, and border regions, in the interest of population safety during pandemics and other emergencies.

The Shared Experience of Insured and Uninsured Patients: A Comparative Study.

Background Despite efforts to ensure equitable quality of care for all patients, a significant gap persists between the quality of care experienced by insured and uninsured patients in Saudi Arabia. This study aims to identify and compare the differences between insured and uninsured patients in terms of their experience of quality of care in a tertiary hospital. Methods A descriptive cross-sectional study was utilized. Insured and uninsured individuals who had undergone identical medical procedures in early 2021 were identified from a public 500-bed tertiary hospital. About 350 patients participated in this study by completing an online, self-administered questionnaire, adopted by Abuosi and others in 2016, assessing six dimensions of quality of care. Results Significant differences were reported between the quality of care experienced by insured and uninsured subjects (M = 3.37, SD = 0.525, and M = 3.06, SD = 0.452, respectively, p=0.001). While insured group reported high quality of care, followed by fairness of care (r = 0.744 and r = 0.675, p ≤ 0.001, n = 175), uninsured subjects experienced less fairness with low quality of care. Conclusions The insured individuals were found to be more attentive to the quality of care offered by the hospital than their counterparts. Efforts to close the gap in quality of care should include monitoring healthcare outcomes, adopting transparency standards, and facilitating procedures to minimize barriers among patients.

СИСТЕМА МЕНЕДЖМЕНТА КАЧЕСТВА В МЕДИЦИНСКОЙ ОРГАНИЗАЦИИ: ОТ ОСНОВ ДО ПРОЦЕССНОЙ МОДЕЛИ

Objective: To analyse the effectiveness of the quality management system (QMS) based on the amount of income for improving the quality of care in medical institutions Methods: Publications on patient safety and quality management system research were identified and analysed based on the library collection resources of the Mari State University, Yoshkar-Ola, Russia and research databases. A total of 727 results were retrieved, of which the authors preselected 121 based on keywords used; after analysing significant publications, 46 sources were finally selected. Results: The quality of medical care includes the internal audit of the quality and patient safety in hospital care. In turn, the internal audit of quality and patient safety can be limited to a 'simplified model' of the quality management system. n adequately compiled, an up-to-date, applicable checklist is intended for use in the audit process. The quality of audits, the designing of effective audit procedures, and the correct completion of checklists depend on the skills and competencies of the auditor. Integrating lean manufacturing into an existing quality management system may increase the cost of 'maintenance' of these systems. However, in the long term, the economic benefit will be more evident due to continuous quality improvement, cost reduction and growth of organisational maturity. The quality management system can be used as a method for assessing the effectiveness of the management process of a medical organisation at different levels: middle, auxiliary, and managerial. In this case, the quality management system becomes a superstructure over the management system based on hierarchical groups. Conclusion: A quality management system is a complex organisational model of a medical organisation that allows you to identify and improve processes, identify inconsistencies and solve them by considering the 'transparency' and 'understanding' of processes. Keywords: Quality management system, medical organisation, process management model, the safety of medical activities, lean manufacturing, checklist, audit.