Outpatient Quality Research Articles

May Glymphatic Drainage Improve Life Quality in Progressive Multiple Sclerosis Outpatients?

The cerebral fluid-dynamic system plays a critical role in maintaining brain health and function. Recent studies identify the glymphatic system as primarily responsible for removing waste products and toxins from brain tissue. In recent years, we have achieved beneficial improvements in MS patients' symptoms and lifestyle using a specific Fluid Dynamic Intensive MAM (FD-MAM) protocol. We treated 40 outpatients with progressive MS, aged 45-55 years and with EDSS scores from 6 to 9. We applied FD-MAM in 10 daily sessions over two weeks. Before and after glymphatic drainage by FD-MAM, we assessed each patient's clinical status and quality of life using six validated questionnaires. Data from the six validated questionnaires administered to the 40 MS patients show an improvement in 83% of the scores. At the same time, we observed a shift from pathological to physiological values in 50% of the pathological scores after 10 sessions of FD-MAM protocol. This study confirms the positive improvements on life quality in outpatients with progressive multiple sclerosis after one cycle of Fluid Dynamic Intensive MAM (FD-MAM) protocol. Initial follow-up on few patients treated with the FD-MAM protocol suggests that the results persist for six to ten months post-treatment. Future detailed studies, on MS outpatients' larger cohort, are essential to assess the duration of results and its effect on glymphatic system.

The great recession, neurotic personality, and subjective sleep quality among patients with mood disorders

Previous studies exploring the effects of the business cycle on sleep have mostly focused on the general population, and their results have been inconclusive. This study aimed to explore the effects of the 2008 economic crisis and personality traits on the subjective sleep quality of outpatients with mood disorders. In this cross-sectional study, patients with mood disorders were recruited from two medical centers and a psychiatric hospital. Socio-demographics, the Eysenck Personality Questionnaire-Revised, and the Pittsburgh Sleep Quality Index (PSQI) were collected through in-person interviews. Candidate predictors significantly associated with PSQI scores in univariate analysis were included in a multiple linear regression model. There were 334 participants; 29% had unipolar depression, and 71% had bipolar affective disorder. The average PSQI score was 11.0 (±4.0). A higher degree of neuroticism [β(se) = 0.49 (0.07), p < 0.001] and recession period (vs. recovery period) [β(se) = 1.72 (0.47), p < 0.001] were associated with a higher PSQI score after adjusting for education, occupational class, and diagnosis. In conclusion, neuroticism and macroeconomy were independent predictors of subjective sleep quality in patients with mood disorders. This study suggests that large-scale economic crises have negative impacts on the sleep health of high-risk clinical populations.

A community hospital cancer services approach to the reduction of OP-35 rule hospitalizations.

e23036 Background: Acute inpatient hospital care contributes substantially to variation in cancer care costs across the United States. The CMS Hospital Outpatient Quality Reporting Program’s OP-35 rule penalizes health systems for having higher-than-expected rates of emergency department (ED) visits or inpatient admissions for ten potentially preventable conditions within 30 days of receiving chemotherapy. To commence a systematic, automated, risk-adapted program to maximize safety outcomes, we identified independent risk factors specific to cancer patients in the Inova Health System (a 5-hospital, 5 million-patients hospital system in Virginia/greater metropolitan DC). Methods: We identified all cancer patients who received chemotherapy within the previous 30 days and presented to the ED or were admitted between 1/1/2018 to 12/31/2021 for one of the OP-35 toxicities as their primary or secondary diagnoses at the time of the acute care evaluation. Data included demographics, insurance coverage, cancer diagnosis, co-morbidities, and status (alive/dead) at last follow up. A zero-truncated Poisson regression analysis was performed in R v4.1.1. We further performed risk analysis within comorbid conditions by creating a matched cohort of patients by sex, age at first treatment, race, and cancer type who did not have an ED or admission visit due to OP-35 events during this same period. Propensity score matching was performed using R package MatchIt v4.5.1. Results: Among the 1,618 patients identified, the most frequent events were pain, sepsis, and fever. 56% of patients were female with an overall median age of 64 (range = [20, 95]). Men were predicted to have 16% more visits than females. 45% had commercial insurance, 39% were on Medicare, and 15% were on Medicaid or charity care. 39% had two or more visits during the 4 years of the study, and among those patients, the most frequent cancer types were gastrointestinal (32%) and breast (22%). Self-reported latino patients constituted 4% of all patients but had the highest average number of events (median = 2.07, range = [1, 9]). Patients who reported more-than-one-race or Asian ancestry had the lowest median number of events (1.56 and 1.64, respectively). In the matched cohort analysis, five co-morbidities were statistically significant (p &lt; 0.05): a previous history of coagulopathy/pulmonary emboli, myocardial infarction, cardiac arrhythmias, depression, and weight loss (concordance = 0.58). 46% of all patients with an event had at least one of these 5 comorbidities. Conclusions: Demographic factors and specific comorbid conditions were associated with risk for requiring acute care intervention for chemotherapy toxicities. Future interventions will include introduction of risk-reducing monitoring in the outpatient setting for higher risk patients identified in this investigation to reduce the need for ED visits and inpatient hospitalizations.

The Correlation Between Physical Activity and Sleep Quality in Elderly Outpatients with Hypertension at Sokaraja I Public Health Care Center, Banyumas Regency

Background: Physical activity is one effort that can control blood pressure in people with hypertension. Physical activity that is carried out excessively will result in a person experiencing fatigue easily so that it will have an impact on the quality of his sleep. Objective: This study was to determine the relationship between physical activity and sleep quality in elderly outpatients with hypertension at the Sokaraja 1 Public Health Center, Banyumas Regency. Method: This type of search used correlational analysis with a cross-sectional design approach. The time of the study was from February to March 2023. The population in this study were elderly outpatients with hypertension at the Sokaraja 1 Health Center, Banyumas Regency. The sampling technique used a non-probability sampling technique with purposive sampling, namely as many as 59 respondents. Results: The results showed that most respondents did heavy physical activity as much as 23 (39.0%), and respondents who had good sleep quality as many as 39 (66.1%). of statistical tests using the Chi-Square test obtained the results of calculating p-value = 0.00 &lt;? = 0.05 so that Ho was rejected and Ha was accepted. Based on the results of this research, it can be concluded that there is a relationship between physical activity and sleep quality in the elderly in Sokaraja I public health care center, Banyumas Regency. Conclusion: It can be concluded that there is a relationship between physical activity and sleep quality in elderly outpatients with hypertension at the Sokaraja 1 Public Health Center, Banyumas Regency. The heavier the activity, the better the quality of sleep so that blood pressure can be controlled and can reduce the risk of complications.

Impact of Outpatient Quality Services on Patient Satisfaction

Abstract: Background: The success and survival of any healthcare organization depends on the patient’s satisfaction and quality. Patient satisfaction plays a vital role in the performance of care. Objective: To identify the factors influencing patient satisfaction with outpatient quality services in public and private hospitals. Materials and Methods: The study was conducted on outpatient patients from different public and private hospital settings in Karachi, Pakistan. Data was collected through virtual tools such as Google Docs, asking about their experience of outdoor patients (OPD) in public or private hospitals. Using a non-probability, convenience sampling technique, a 5% margin of error and a confidence interval of 95%, the sample size was calculated as 377 participants rounded off to 400. Respondents were divided into males and females who visited any specialty department or general OPD. A self-administered questionnaire was designed to gather data, and a digital tool such as Google Docs was used to reach a wider audience. The reliability of the pre-validated tools has been assessed through Cronbach’s alpha. The Cronbach alpha for outpatient quality services is 0.717, and patients’ satisfaction is 0.98. The data were analyzed using the SPSS 25V by IBM Corporation. Result: Most respondents were from the age group (26-35 years), making up 42% of the entire population. Data gathered showed private hospitals preference over public hospitals and satisfaction as well. All the quality service variables identified in the study had a direct relationship with patient satisfaction except waiting time, which had a negative relationship. Regression Analysis showed a positive impact on the availability of services; thus 1% increase in service will lead to a 0.484% change in patient satisfaction. A negative relationship was also witnessed with a 1% increase in waiting time patient satisfaction is down by 0.119%. Conclusion: The level of satisfaction in public hospitals was not quite adequate, and the services were correspondingly rated as exceptional. The findings suggest that focusing on the nature of physician-related services, waiting for test results, and waiting for appointments are the most important factors impacting patient satisfaction in the outpatient division.

Hubungan Kualitas Pelayanan Keperawatan Dengan Kepuasan Pasien Rawat Jalan di RSBT Karimun Tahun 2023

The quality of health services is a manifestation of the results of the performance of health workers which results in patient satisfaction, if the service meets or exceeds what the patient expected (Antari, 2019). Service quality is assessed from five variables, namely Reliability, Responsiveness, Physical Evidence, Guarantee and Empathy. The aim of the research was to determine the relationship between the quality of nursing services and the level of outpatient satisfaction at RSBT Karimun in 2023. The research carried out was descriptive correlational research and a cross-sectional approach. The sampling method used was consecutive sampling with a sample size of 174 outpatients at Bakti Timah Karimun Hospital in 2023. Research data was collected by filling in questionnaires by respondents. The research data were analyzed univariately with frequency tables and bivariate tests with the Chi Square test. The results of the univariate analysis show a picture of Service Quality from the reliability variable. The results of the bivariate analysis of the Reliability and Satisfaction variables were obtained, so it can be concluded that there is a significant relationship between service quality and satisfaction of outpatients at Bakti Timah Karimun Hospital in 2023. It is hoped that this research's suggestions will enable the educational institution at Awalbros University, Batam, to increase nurses' knowledge about the quality of nursing services. to increase patient satisfaction.

Sleep quality of adult psychiatric outpatients at Chris Hani Baragwanath Academic Hospital.

Sleep disorders are increasingly prevalent among the general population and individuals with mental disorders. However, little research has focused on the sleep quality of psychiatric patients beyond depression, despite its relevance in diagnostic criteria. This study aimed to assess overall sleep quality in psychiatric outpatients and to assess for an association with socio-demographic variables. This study took place at the adult psychiatric outpatient department of Chris Hani Baragwanath Academic Hospital. A cross-sectional study design was employed to evaluate overall sleep quality using the self-administered Pittsburgh Sleep Quality Index (PSQI), a validated tool. The PSQI yields a global score ranging from 0 to 21, with scores of 5 or greater indicating poor sleep quality. Eligibility was determined through structured clinical interviews and data obtained from participant records. Poor sleep quality was found in 50% of participants. Sleep quality did not differ significantly based on sex or age. Subscale analysis revealed reduced sleep duration and efficiency, nocturnal disturbances and daytime dysfunction. Additionally, 38% of participants required pharmacological intervention for sleep issues, despite lacking a diagnosis of primary or comorbid sleep disorders. Half of the psychiatric outpatients experienced poor sleep quality, irrespective of socio-demographic factors, psychiatric diagnosis, symptom remission or medication type. This study highlights the importance of addressing sleep disturbances as comorbid conditions in psychiatric patients. Comprehensive evaluation and management of sleep quality can lead to improved patient outcomes and quality of life.

Assessing Medication Use Quality in Older Outpatients Using the Beers Criteria: Findings from a Single-Center Retrospective Study.

No comprehensive assessment of the quality of medications used in older outpatients has been conducted in Thailand. This study aimed to ascertain the prevalence of and factors contributing to older outpatients&apos; use of potentially inappropriate medications (PIMs). This cross-sectional study retrospectively assessed the prescriptions of older (≥60 years) outpatients at a secondary-care hospital. For PIM identification, the 2019 American Geriatric Society (AGS) Beers criteria were applied, considering all five PIM categories: PIM category I (medications that are potentially inappropriate in most older adults), II (disease-/syndrome-exacerbating drugs), III (medications that should be used with caution), IV (clinically important drug-drug interactions), and V (medications that should be avoided or have their dosage reduced based on renal function). This study included 22,099 patients (mean age, 68.86±7.64 years). Nearly three-fourths of patients were prescribed PIMs, with 68.90%, 7.68%, 44.23%, 15.66%, and 3.05%, respectively, receiving category I-V medications. The positive factors associated with PIM use included female sex (odds ratio [OR]=1.08; 95% confidence interval [CI], 1.01-1.16), age ≥75 years (OR=1.10; 95% CI, 1.01-1.21), polypharmacy (OR=10.21; 95% CI, 9.31-11.21), ≥3 diagnostic categories (OR=2.31; 95% CI, 2.14-2.50), and ≥3 chronic morbidities (OR=1.46; 95% CI, 1.26-1.68). The negative factor associated with PIM use was a comorbidity score of ≥1 (OR=0.78; 95% CI, 0.71-0.86). PIM use among older outpatients remains highly prevalent in clinical practice. The results of this study identified polypharmacy as the strongest factor affecting PIM use.

Improving bowel preparation for colonoscopy with a smartphone application driven by artificial intelligence

Optimal bowel preparation is a prerequisite for a successful colonoscopy; however, the rate of inadequate bowel preparation remains relatively high. In this study, we establish a smartphone app that assesses patient bowel preparation using an artificial intelligence (AI)-based prediction system trained on labeled photographs of feces in the toilet and evaluate its impact on bowel preparation quality in colonoscopy outpatients. We conduct a prospective, single-masked, multicenter randomized clinical trial, enrolling outpatients who own a smartphone and are scheduled for a colonoscopy. We screen 578 eligible patients and randomize 524 in a 1:1 ratio to the control or AI-driven app group for bowel preparation. The study endpoints are the percentage of patients with adequate bowel preparation and the total BBPS score, compliance with dietary restrictions and purgative instructions, polyp detection rate, and adenoma detection rate (secondary). The prediction system has an accuracy of 95.15%, a specificity of 97.25%, and an area under the curve of 0.98 in the test dataset. In the full analysis set (n = 500), adequate preparation is significantly higher in the AI-driven app group (88.54 vs. 65.59%; P < 0.001). The mean BBPS score is 6.74 ± 1.25 in the AI-driven app group and 5.97 ± 1.81 in the control group (P < 0.001). The rates of compliance with dietary restrictions (93.68 vs. 83.81%, P = 0.001) and purgative instructions (96.05 vs. 84.62%, P < 0.001) are significantly higher in the AI-driven app group, as is the rate of additional purgative intake (26.88 vs. 17.41%, P = 0.011). Thus, our AI-driven smartphone app significantly improves the quality of bowel preparation and patient compliance.

Measuring Ambulatory Racial and Ethnic Neurologic Disparities With the Axon Registry.

The primary objective is to examine potential racial and ethnic (R/E) disparities in ambulatory neurology quality measures within the American Academy of Neurology Axon Registry. R/E disparities in neurologic US morbidity and mortality have been clearly documented. Despite these findings, there have been no nationwide examinations of how ambulatory neurologic care affects these negative health outcomes. This was a retrospective nonrandomized cohort study of patients in the AAN Axon Registry. The Axon Registry is a neurology-specific outpatient quality registry that collects, reports, and analyzes real-world deidentified electronic health record (EHR) data. Patients were included in the study if they contributed toward one of the selected quality measures for multiple sclerosis, epilepsy, Parkinson disease, or headache during the study period of January 1, 2019-December 31, 2019. Descriptive analyses of patient demographics were performed and then stratified by race and ethnicity. There were a total of 633,672 patients included in these analyses. Separate analyses were performed for race (64% White, 8% Black, 1% Asian, and 27% unknown) and ethnicity (52% not Hispanic, 5% Hispanic, and 43% unknown). The mean age ranged from 18 to 55 years, with 61% female and 39% male. Quality measures were chosen based on completeness of R/E data and were either process or outcomes focused. Statistically significant differences were noted after controlling for multiple comparisons. The large proportion of missing or unknown R/E data and low overall rate of performance on these quality measures made the relevance of small differences difficult to determine. This analysis demonstrates the feasibility of using the Axon Registry to assess neurologic disparities in outpatient care. More education and training are required on the accurate capture of R/E data in the EHR.

Predictors of Incident Heart Failure Diagnosis Setting: Insights From the Veterans Affairs Healthcare System

BackgroundEarly recognition of heart failure (HF) can reduce morbidity, yet HF is often diagnosed only after symptoms require urgent treatment. ObjectivesThe authors sought to describe predictors of HF diagnosis in the acute care vs outpatient setting within the Veterans Health Administration (VHA). MethodsThe authors estimated whether incident HF diagnoses occurred in acute care (inpatient hospital or emergency department) vs outpatient settings within the VHA between 2014 and 2019. After excluding new-onset HF potentially caused by acute concurrent conditions, they identified sociodemographic and clinical variables associated with diagnosis setting and assessed variation across 130 VHA facilities using multivariable regression analysis. ResultsThe authors identified 303,632 patients with new HF, with 160,454 (52.8%) diagnosed in acute care settings. In the prior year, 44% had HF symptoms and 11% had a natriuretic peptide tested, 88% of which were elevated. Patients with housing insecurity and high neighborhood social vulnerability had higher odds of acute care diagnosis (adjusted odds ratio: 1.22 [95% CI: 1.17-1.27] and 1.17 [95% CI: 1.14-1.21], respectively) adjusting for medical comorbidities. Better outpatient quality of care (blood pressure control and cholesterol and diabetes monitoring within the prior 2 years) predicted a lower odds of acute care diagnosis. Likelihood of acute care HF diagnosis varied from 41% to 68% across facilities after adjusting for patient-level risk factors. ConclusionsMany first HF diagnoses occur in the acute care setting, especially among socioeconomically vulnerable populations. Better outpatient care was associated with lower rates of an acute care diagnosis. These findings highlight opportunities for timelier HF diagnosis that may improve patient outcomes.

The butterfly effect: How an outpatient quality improvement project affected inpatient opioid's prescribing habits.

The aim of the study was to assess whether a quality improvement project focused on providers' education of responsible opioid prescribing, creating order sets to facilitate pre- and post-operative adjunct use, and decreasing the number of opioids prescribed following elective outpatient surgery affected opioid prescribing habits and the use of adjunct pain medication on the inpatient Emergency General Surgery (EGS) service. Inpatient EGS opioid prescribing habits following laparoscopic cholecystectomy, laparoscopic and open inguinal hernia repair, or open umbilical hernia repair during the pre- and post-Acute Care Surgery Division-Quality Improvement (QI) periods were recorded retrospectively. Demographics, type and dose of opioids, and non-opioid adjuncts prescribed were collected. Opioids were converted to oral morphine equivalents (OME). Pre- and post-QI data were compared. Post-QI discharge opioids prescribed were compared to reported use of opioids. Patients' rating of pain management is reported. One hundred twenty-two and 62 patients were included during the pre- and post- QI periods, respectively. Post-QI, opioid prescribing decreased, and adjunct prescribing increased (31.1% vs. 72.6%; p < 0.001) at discharge. Interestingly, higher 24 h pre-discharge OME was associated with a higher OME prescribed at discharge (B = 1.255 [0.377 - 2.134]; p = 0.005). Of the 47 EGS patients who followed up in clinic post-ACS QI, 89.4% rated their pain management as excellent/good, 8.5% as fair, and 2.1% as poor. Implementation of a multifaceted approach to decrease opioid prescribing in the outpatient setting organically affected opioid prescribing habits at discharge for inpatients.

S1470 A Quality Improvement Project to Increase Bariatric Surgery Referrals at an Urban Primary Care Clinic

Introduction: According to the American Society for Metabolic and Bariatric Surgery, bariatric surgery is recommended for all patients with a BMI of 40 or higher. Bariatric surgery is also recommended for patients with a BMI of 35 or higher and one or more obesity-related comorbidity. Incidentally, we have observed that patients who meet these BMI cutoffs are often not referred to bariatric surgery. We sought to quantify whether or not patients meeting these criteria are appropriately referred to bariatric surgery, and if not, to improve the number of bariatric surgery conversations and referrals at an urban primary care clinic. Methods: A retrospective study was performed that involved collecting data from the out-patient electronic medical record (EMR). Patients included in this study had both a BMI of 35 or higher and a formal diagnosis of diabetes mellitus, indicating that they would warrant referral to bariatric surgery for an initial evaluation based on current guidelines. Charts were reviewed for each patient to determine if they 1) had been seen by a bariatric surgeon, 2) had been referred to but not established care with a bariatric surgeon, or 3) had been counseled by their primary care provider about the potential benefits of weight-loss surgery. Additional variables collected were as follows: sex, age, BMI, and ethnicity. Results: Overall, data was collected on 70 patients total (19 males, 51 females) from an urban primary care clinic. The average age of the patients included was 55.7 years-old. The average BMI across the group was 43.3, and all patients carried a formal diagnosis of diabetes. Only 11.4% (8/70) of patients had actually established care and been seen by bariatric surgery for an initial evaluation, but 25.7% (18/70) had been formally referred to bariatric surgery. Conversations about weight-loss surgery were documented in progress notes for 27.1% (19/70) of patients. Conclusion: Of the 70 patients included in this study, only 18 patients were referred to bariatric surgery despite all of them meeting criteria to warrant referral. This study confirms our hypothesis that there is a need to improve the rate at which primary care providers refer patients with a BMI of 35 and obesity-related comorbidity or a BMI of 40 to bariatric surgery for a preliminary evaluation. To address this, we have implemented an out-patient quality improvement program to ensure both conversations about weight-loss surgery and bariatric surgery referrals occur for patients who necessitate them.

An Appraisal of the Quality of Outpatient Healthcare Services and Patients’ Satisfaction at a Nigerian Mission Health Facility

The cardinal goal of the hospital is to provide quality healthcare services to the patients, which is measured by patient’s satisfaction. This study aimed to determine patients’ knowledge and satisfaction about the factors that contribute to quality of outpatients’ healthcare services, to determine whether socio-demographic factors have any effect on patient satisfaction and to determine the effect of educational intervention on their knowledge and satisfaction. A quasi-experimental study (in which before-after technique) was carried over six months period. Systematic sampling technique was used to recruit adult patients exiting the out-patient department of the hospital. A semi-structured, interviewer administered modified SERVQUAL questionnaire was used to assess satisfaction and knowledge, followed by educational intervention and subsequently post intervention assessment after two months. The data generated were analysed using SPSS software version, 26. Three hundred and fifty adult patients participated in the pre-intervention stage while 165 patients were interviewed post-intervention. The proportion of the participants who had good knowledge pre-intervention, was high (91.7%) while 88.3% were satisfied with the quality of healthcare services. The empathy domain had the highest mean score of 4.02 while the responsiveness domain had lowest mean score of 3.29. Post-intervention, the knowledge level improved from 91.7% to 95.2% and satisfaction improved from 88.3% to 96.2% with mean score of 4.14. Gender did not have any influence on the level of knowledge and satisfaction across the various domains. However, there was increased satisfaction among the older patients (≥50 years) which was statistically significant [Tangible domain (X2 = 22.621, P = 0.000)]. Educational intervention was effective in improving level of knowledge about the factors that influence quality of care and level of satisfaction with the quality of care received at the hospital. The hospital management needs to prioritize interventions to improve the responsiveness of the services provided in the hospital to improve the quality of service and enhance patients’ satisfaction.

THE RELATIONSHIP OF SERVICE QUALITY TO OUTPATIENT SATISFACTION AT THE BALOI PERMAI HEALTH CENTER IN 2022

The aim of this study was to determine the relationship between service quality and satisfaction of outpatients at the Baloi Permai Health Center. The method used is quantitative method with survey research used is cross sectional to determine the effect of health service quality on patient satisfaction at the Baloi Permai Health Center. The results of this study were carried out by a chi square statistical test showing that the quality of patient care at the Baloi Permai Health Center was considered good by 81,2% with a total of 81 respondents. While patients who said they were not good were 18,8% with a total of 19 respondents. Patient Satisfaction at the Baloi Permai Public Health Center who rated satisfaction as much as 68% with a total of 68 respondents. While patients who said they were not good were 32% with a total of 32 respondents. Since the p value is 0,000 &lt;0,05, thereby H0 is rejected and H1 is accepted, thus it can be concluded that there is a relationship between service quality and outpatient patient satisfaction at the Baloi Peria Health Center in 2022.

Observational Trends in Publicly Reported Quality Measures of Hospital Outpatient Quality Reporting Program, 2013-2019.

In 2011, the Centers for Medicare & Medicaid Services (CMS) implemented the Hospital Outpatient Quality Reporting Program to assess the quality of outpatient imaging efficiency (OIE). In this study, trends in hospital performance on these national hospital OIE measures a year after inception and public reporting were described. An observational trend analysis was conducted using 2013-2019 data from CMS 6 OIE measures. The trend analysis of metric scores indicates year-to-year variability in all 6 OIE variables. The reporting of these measures appears to have effectively improved the efficiency of most of the measures since the inception of the program.

Development and validation of a quality indicator system for outpatient service in Shenzhen, China.

Outpatient services account for a large part of healthcare in China, and to survive in the competition with other hospitals, the management needs to understand and measure outpatient services quality for healthcare improvement and patient retention. There is a lack of comprehensive standardized outpatient healthcare quality measurement tools from patients' perspective in China. This study aimed to develop and test a quality indicator system for outpatient services assessment in the Chinese healthcare sector. Twenty-nine indicators were generated using literature review and focus group interviews. A modified Delphi process with the analytic hierarchy process was conducted to screen and determine the final indicators with 13 interdisciplinary panelists through two-round email surveys. A two-level and three-column questionnaire was distributed to 250 outpatients in Shenzhen to pretest the indicator system. The validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient and degree of concentration of opinions. The reliability of the questionnaire was assessed using Cronbach's alpha coefficient and inter-subscale correlation. Of the two rounds of Delphi consultation, the active coefficients were 76.92% and 80%, and the authoritative coefficients were both 0.88. An assessment system for the Chinese outpatient services quality was constructed with six first-level dimensions and 23 second-level indicators. The weights of safety, tangibility, reliability, responsiveness, assurance and empathy were 0.286, 0.096, 0.088, 0.135, 0.226 and 0.169, respectively. For the pretest, Cronbach's alpha values for the importance of the indicator, perception of quality of service and expected quality of service were 0.96, 0.94 and 0.96, respectively. The values of the Kaiser-Meyer-Olkin test were 0.94, 0.93 and 0.95. All Bartlett's test results showed that the correlation matrix was significant (P < 0.001). A multidimensional quality indicator system from patients' perspective was developed for the outpatient services assessment in China's healthcare sector. It has good validity and reliability and can be applied as a standardized tool by healthcare managers and policymakers in China to measure patients' perceptions and expectations.

Effects of Service Quality and Patient Satisfaction on Patient Adherence at the Outpatient Rehabilitation Department of Fatmawati National Hospital in Jakarta

Introductions: The quality of services and patient satisfaction play an important role in increasing patient adherence. Fatmawati hospital is the national tertiary hospital in Indonesia that has a rehabilitation outpatient department as one of its excellent services. The rehabilitation outpatient department deals with patients that have chronic diseases. Many studies reported that patients with chronic disease verge on having less satisfaction and adherence. Meanwhile, patient satisfaction is used to evaluate health providers' quality. Therefore, this research intended to assess the effect of rehabilitation outpatient service quality and patient satisfaction on patient adherence at Fatmawati hospital. Methods: Cross-sectional study was conducted from December 2021 – to February 2022. Two hundred patients were included with a convenient sampling method. SPPS 25 Software was run to analyze the pilot study data, descriptive statistics, and multivariate regression. Results: According to the finding of this study, most patients had a positive experience in terms of service quality and patient satisfaction. As a result, its have a significant and positive effect on patient adherence. The structural equation Y = 7,502+0,211(X1)+0,822(X2) represents if service quality and patient satisfaction are equal to zero or constant, then patient adherence has a value of 7,502 units. If the quality of service were increased by one unit, the other variable equal to zero and constant, the value of patient adherence would increase by 0,211. On the other hand, patient adherence will be increased by 0,822 units when one unit increases patient satisfaction. Conclusion: The results suggest that improving service quality and patient satisfaction is an effective strategy for health providers in improving patient adherence in the rehabilitation outpatient department.

Association of Patient and Primary Care Provider Factors with Outpatient COPD Care Quality.

Large gaps exist between guideline-recommended outpatient chronic obstructive pulmonary disease (COPD) care and clinical practice. Seeking to design effective interventions, we identified patient and primary care provider (PCP) characteristics associated with receiving evidence-based COPD care. We performed an observational study of adults aged ≥ 40 years with clinically diagnosed COPD who received care at 2 University of Washington-affiliated primary care clinics between June 1, 2011, and June 1, 2013. Our primary outcome was the proportion of evidence-based outpatient COPD quality measures received through primary or pulmonary care. Among all patients, we assessed spirometry completion, respiratory symptom identification, smoking status ascertainment, oxygen saturation measurement, and guideline-concordant inhaled therapy prescription. We also determined confirmation of airflow obstruction, oxygen prescription, smoking cessation intervention, and pulmonary rehabilitation referral if eligible. We used multivariable mixed effects linear regression to estimate the association of patient and PCP characteristics with the primary outcome. Among 641 patients, 382 were male (59.6%) with mean age 63.6 (standard deviation [SD] 10.6) years. Most patients currently smoked (N=386, 60.2%). Patients saw 150 unique PCPs during 5.3 (SD 3.2) PCP visits, with 107 completing pulmonary referrals (16.7%). Patients received 67.5% (SD 18.4%) of eligible (median 7 [interquartile range 6-7]) evidence-based quality measures. After adjustment, pulmonary referral was associated with a higher receipt of outpatient quality measures (ß117.7%, 95% confidence interval: 12.6%, 22.7%). Patient demographics, comorbidities, and PCP identity/characteristics were not associated with outpatient care quality. The quality of outpatient COPD care was suboptimal. Future studies should investigate if engaging pulmonologists in COPD management improves care quality.

Development of an Oncology Acute Care Risk Prediction Model.

Acute care utilization (ACU), including emergency department (ED) visits or hospital admissions, is common in patients with cancer and may be preventable. The Center for Medicare & Medicaid Services recently implemented OP-35, a measure in the Hospital Outpatient Quality Reporting Program focused on ED visits and inpatient admissions for 10 potentially preventable conditions that arise within 30 days of chemotherapy. This new measure exemplifies a growing focus on preventing unnecessary ACU. However, identifying patients at high risk of ACU remains a challenge. We developed a real-time clinical prediction model using a discrete point allocation system to assess risk for ACU in patients with active cancer. We performed a retrospective cohort analysis of patients with active cancer from a large urban academic medical center. The primary outcome, ACU, was evaluated using a multivariate logistic regression model with backward variable selection. We used estimates from the multivariate logistic model to construct a risk index using a discrete point allocation system. Eight thousand two hundred forty-six patients were included in the analysis. ED utilization in the last 90 days, history of chronic obstructive pulmonary disease, congestive heart failure or renal failure, and low hemoglobin and low neutrophil count significantly increased risk for ACU. The model produced an overall C-statistic of 0.726. Patients defined as high risk (achieving a score of 2 or higher on the risk index) represented 10% of total patients and 46% of ACU. We developed an oncology acute care risk prediction model using a risk index-based scoring system, the REDUCE (Reducing ED Utilization in the Cancer Experience) score. Further efforts to evaluate the effectiveness of our model in predicting ACU are ongoing.