Quality Of Care Levels Research Articles

Adverse events: an expensive and avoidable hospital problem

Introduction Adverse healthcare-related events (AE) entail reduced patient safety. Estimating their frequency, characteristics, avoidability and impact is a means to identify targets for improvement in the quality of care. Methods This was a descriptive observational study conducted within the Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD). The study was conducted in a high-complexity hospital in May 2019 through a two-phase electronic medical record review: (1) AE screening and epidemiological and clinical data collection and (2) AE review and classification and analysis of their impact, avoidability, and associated costs. Results A total of 636 patients were studied. The prevalence of AE was 12.4%. Death during the stay was associated with the presence of AE (OR [CI95%]: 2.15 [1.07 to 4.52]) versus absence and emergency admission (OR [CI95%]: 17.11[6.63 to 46.26]) versus scheduled. A total of 70.2% of the AEs were avoidable. Avoidable AEs were associated with the presence of pressure ulcers (OR [CI95%]: 2.77 [1.39 to 5.51]), central venous catheter (OR [CI95%]: 2.58 [1.33 to 5.00]) and impaired mobility (OR [CI95%]: 2.24[1.35 to 3.71]), versus absences. They were associated too with the stays in the intensive care unit (OR [CI95%]: 2.75 [1.07 to 7.06]) versus medical service. AEs were responsible for additional costs of €909,716.8 for extra days of stay and €12,461.9 per patient with AE. Conclusions The prevalence of AEs was similar to that found in other studies. AEs led to worse patient outcomes and were associated with the patient’s death. Although avoidable AEs were less severe, their higher frequency produced a greater impact on the patient and healthcare system. Key messages Adverse events are one of the main problems in healthcare delivery and patients who suffer from at least one AE are double as likely to die during hospitalization. Avoidable adverse events are the most frequent in health care and they are a good target where achieve improvement areas that allow getting optimal patient safety and quality of care levels. Patients hospitalized in the ICU, with the previous presence of pressure ulcers, central venous catheter, or impaired mobility were associated with the development of avoidable AE, so optimal management of these patients would reduce the impact of AE.

Assessing Nursing Homes Quality Indicators' Between-Provider Variability and Reliability: A Cross-Sectional Study Using ICCs and Rankability.

Nursing home quality indicators are often used to publicly report the quality of nursing home care. In Switzerland, six national nursing home quality indicators covering four clinical domains (polypharmacy, pain, use of physical restraints and weight loss) were recently developed. To allow for meaningful comparisons, these indicators must reliably show differences in quality of care levels between nursing homes. This study’s objectives were to assess nursing home quality indicators’ between-provider variability and reliability using intraclass correlations and rankability. This approach has not yet been used in long-term care contexts but presents methodological advantages. This cross-sectional multicenter study uses data of 11,412 residents from a convenience sample of 152 Swiss nursing homes. After calculating intraclass correlation 1 (ICC1) and rankability, we describe between-provider variability for each quality indicator using empirical Bayes estimate-based caterpillar plots. To assess reliability, we used intraclass correlation 2 (ICC2). Overall, ICC1 values were high, ranging from 0.068 (95% confidence interval (CI) 0.047–0.086) for polypharmacy to 0.396 (95% CI 0.297–0.474) for physical restraints, with quality indicator caterpillar plots showing sufficient between-provider variability. However, testing for rankability produced mixed results, with low figures for two indicators (0.144 for polypharmacy; 0.471 for self-reported pain) and moderate to high figures for the four others (from 0.692 for observed pain to 0.976 for physical restraints). High ICC2 figures, ranging from 0.896 (95% CI 0.852–0.917) (self-reported pain) to 0.990 (95% CI 0.985–0.993) (physical restraints), indicated good reliability for all six quality indicators. Intraclass correlations and rankability can be used to assess nursing home quality indicators’ between-provider variability and reliability. The six selected quality indicators reliably distinguish care differences between nursing homes and can be recommended for use, although the variability of two—polypharmacy and self-reported pain—is substantially chance-driven, limiting their utility.

Quality of Family Planning Services in Maternal and Child Health Care Centers in Damanhour City

Background: Quality of family planning services is an ever-increasing worldwide issue which is basically deserted in the developing nations. Provision of high quality family planning services that satisfy clients’ needs can ensure continued services utilization and increase contraceptive prevalence rate, lowered fertility rate, and improved women and children’s health.Aim: this study intended to assess the quality of family planning services in maternal and child health care centers in Damanhour city.Design: this was a descriptive study that utilized Dounabedian model to assess quality of family planning services structure and process and clients’ satisfaction was used as an outcome indicator.Setting: the three available maternal and child health centers in Damanhour city.Participants: all health care providers and a convenience sample of 300 non pregnant women who utilized the family planning clinics at the selected maternal and child health centers.Tools of data collection: three tools were utilized; basic data structured interview schedule for clients and health care providers, structural quality is assessed through facility audit while the process of family planning services provision was measured by using an observational checklist. After the observation of the family planning care process, an exit interview was done with the clients to measure their satisfaction with the provided family planning services.Results: The study findings revealed that none of the studied family planning clinics had high total quality of care level (structure & process) where 66.7% of them had low level of the total quality of care. However, 74.3% of the studied family planning clients were moderately satisfied with the total quality of care level (structure & process) in the studied maternal and child health centers. Finally, a significant positive correlation was confirmed between the overall family planning clients’ satisfaction level and the total quality of family planning care level; total structure and total process quality of family planning services delivery.Conclusion and recommendations: it can be concluded that family planning services in maternal and child health centers at Damanhur had low total quality of care level with moderate clients’ satisfaction. This shed the light on the urgent need for numerous quality enhancement measures to promote all quality elements in the studied maternal and child health centers. In addition to, emphasizing clients' satisfaction as a high priority output of care.

Quality of Psychosocial Care of Suicide Attempters at General Hospitals in Norway—A Longitudinal Nationwide Study

The objective of this study was to identify predictors of a high level of quality of care for suicide attempters at general hospital emergency departments in Norway. Structured interviews with key informants covering the quality of care of patients admitted following attempted suicide were conducted in 1999 and 2006 at 87% of all general hospitals. Hospitals having implemented a chain of care program for suicide attempters in 1999 maintained significantly higher levels on quality of care indicators 7 years later. Predictors of a high quality of care level were training of staff in management and care of suicide attempters and to have written guidelines for the care.

The Tyranny of Standards

IMPROVING medical care quality is a goal shared by the physician, the patient, and the bill payer. The ability to do so first of all, implies knowledge of the current quality of care level, and second, existence of mechanisms to alter substandard conditions. Quality has been defined as "the degree of adherence to a standard," and assessing the quality of medical care generally involves comparing actual care with some standard or criterion of excellence. Differences between the real and the stated ideal are then analyzed and deficiencies identified. Improved quality is determined by increased compliance with standards at the time of reassessment. We are rapidly being surrounded by standards or criteria designed for use in determining the necessity of hospital admission, appropriateness of medical service utilization, and quality of care. Criteria sets are being prepared by professional specialty societies, foundations for medical care, and experimental medical care review organizations. The