Quality Standards Of Care Research Articles

Mindful leadership for personal and organisational resilience

Given that the volatility, uncertainty, complexity, and ambiguity (i.e., "VUCA" nature) of our world will likely continue to increase over time, it is clear that learning how to develop our inner capabilities of mindfulness and resiliency is of the utmost priority for us as individuals, organisations, communities, and nations. In today's world - and tomorrow's - such capacity development for ourselves, our leaders, and our organisations is vital to bringing a deeper wisdom and care to our lives and work, and to our human flourishing. In our increasingly VUCA world of ever-increasing complexity, old norms, skillsets, and "business and usual" norms are simply insufficient to assure sustainable success. The kind of high-performance protocols that were once reserved for world-class athletes, martial artists, elite military troops, and sports teams, or monastic adepts, have now become essential training for any leader, professional, or organisation intent on assuring high standards for safety, quality care, sustained success, well-being, and meaningful beneficial influence in their medical centres and communities. Could it be that the global surge of interest in mindfulness and resiliency reflects a wise and evolutionary impulse perfectly adapted and responsive to meeting the challenges and realising the opportunities of the VUCA world in which we live and serve as dedicated health caring providers and practitioners?

One-to-one care routines and compliance with the national professional recommendation on continuous intrapartum support in Norway: A national survey.

INTRODUCTIONIn 2010, the Norwegian Directorate of Health introduced the guideline ‘Safe maternity services – quality standards for maternal care’. These standards include adequate staffing with health care personnel for birth units to ensure responsible monitoring and treatment. Birth units are to follow the professional recommendation that every woman has a midwife present during established labor. This study presents data from birth units on compliance with the national recommendation for one-to-one care during labor.METHODSA web-based questionnaire was emailed to chief midwives of all birth units in Norway (n=48) in May 2018. The questionnaire contained a total of nine multiple-choice, scaled-response-format, and free-text questions.RESULTSThe questionnaire response rate was 100%. All birth units reported that they offered women one-to-one care during labor to a large extent. Sixty-five per cent of the birth units had procedures to ensure that midwives were present during established labor. Deviations from the recommendation were recorded in one-fourth of birth units. Thirty-eight per cent of respondents reported that staff training had been provided; 56% of birth units stated that the recommendation led to an increased presence of midwives during labor. Financial constraints (35%) and difficulty of compliance (27%) were cited as obstacles to meeting the recommendation for one-to-one care during labor.CONCLUSIONSThe majority of birth units reported that they follow the recommendation for one-to-one care during established labor, but compliance with this recommendation in practice remains unclear. Areas of improvement relate to routines describing the presence of midwives during labor, registration of deviations, and staff training in one-to-one care.

The group care quality standards assessment: A framework for assessment, quality improvement, and effectiveness

Concerns about the quality of residential care for children and youth are longstanding. These concerns prompted a Florida-based initiative aimed at transforming residential care through the integration of research-informed practice standards, on-going assessment, and continuous quality improvement. The initiative resulted in the development of the Group Care Quality Standards and the Group Care Quality Standards Assessment (GCQSA) as mechanisms for guiding transformation efforts. In this article, we elaborate on the conceptual and implementation frameworks guiding the development and efforts to scale up the GCQSA throughout Florida. We begin by summarizing empirical sources that informed the guiding frameworks. Next, we describe the project phases highlighting the aims, methods and summarizing results where relevant. The aim of this article is to offer a working blue print to guide the adaptation of quality initiatives in other child welfare organizations or jurisdictions while taking into consideration the fit of such initiatives within the service environment and the complexities of system-wide change.

Evidence-Based Pediatric Practice: Producing Better Care and Higher Quality Standards

Evidence-Based Pediatric Practice: Producing Better Care and Higher Quality Standards

Outcome-based providing and commissioning: pathways and standards.

Aims and methodImplementation of evidence-based psychosocial interventions in accordance with National Institute of Health and Care Excellence guidelines and quality standards has been incomplete. This project involved allocation of adults under mental health services to six guideline categories, completion of a clinician- and patient-rated outcome measure, and individual assessment against clinical standards. RESULTS: In the first 3 months of the project, 5048 patients were allocated to a pathway and 3734 (73%) were assessed against at least one of the relevant standards. All were assessed using the Health of the Nation Outcome Scales (91-93% of scales completed) and 1866 (36%) completed the patient-rated outcome measure, DIALOG.Clinical implicationsClinicians will allocate patients to pathways, complete outcome measures and assess against standards, providing data to guide practice, service design and costing of mental health systems with supporting technology to assist data entry and presentation. This has the potential to provide much improved and readily accessible information about individual outcomes and standards for people with mental health problems and those working with them. It could also provide a method for payment for services which directly support good clinical practice.Declaration of interestNone.

RS22. Achieving Quality Standards for Optimal Medical Care of Lower Extremity Peripheral Artery Disease at a Large University Hospital System

RS22. Achieving Quality Standards for Optimal Medical Care of Lower Extremity Peripheral Artery Disease at a Large University Hospital System

Current status of multidisciplinary care in psoriatic arthritis in Spain: NEXUS 2.0 project

Objective(1) To analyse the implementation of multidisciplinary care models in psoriatic arthritis (PsA) patients, (2) To define minimum and excellent standards of care. MethodsA survey was sent to clinicians who already performed multidisciplinary care or were in the process of undertaking it, asking: (1) Type of multidisciplinary care model implemented; (2) Degree, priority and feasibility of the implementation of quality standards in the structure, process and result for care. In 6 regional meetings the results of the survey were presented and discussed, and the ultimate priority of quality standards for care was defined. At a nominal meeting group, 11 experts (rheumatologists and dermatologists) analysed the results of the survey and the regional meetings. With this information, they defined which standards of care are currently considered as minimum and which are excellent. ResultsThe simultaneous and parallel models of multidisciplinary care are those most widely implemented, but the implementation of quality standards is highly variable. In terms of structure it ranges from 22% to 74%, in those related to process from 17% to 54% and in the results from 2% to 28%. Of the 25 original quality standards for care, 9 were considered only minimum, 4 were excellent and 12 defined criteria for minimum level and others for excellence. ConclusionsThe definition of minimum and excellent quality standards for care will help achieve the goal of multidisciplinary care for patients with PAs, which is the best healthcare possible.

The increasing cost of pediatric otolaryngology care

IntroductionDefining the costs associated with healthcare is vital to determining and understanding ways to reduce costs and improve quality of healthcare delivery.The objective of the present study was to identify the current public health burden of inpatient admissions for conditions commonly treated by pediatric otolaryngologists and compare trends in healthcare utilization with other common surgical diagnoses. MethodsA retrospective cohort study using the Kids’ Inpatient Database for pediatric discharges in the United States from 2000 to 2012. A list of the top 500 admission diagnoses was identified and subsequently grouped into surgical diagnoses typically managed by otolaryngologists and those managed by any other surgical discipline with the top 10 in each category included. Database analyses generated national estimates of summary statistics and comparison of trends over the twelve-year period. ResultsOf the top pediatric admission diagnoses, the most common conditions managed by surgical specialties involved inflammatory or infectious causes. Hospital charges significantly increased during this time across all diagnoses. On average, the charges for otolaryngologic diagnoses increased by 37.13% while costs increased by almost 12%. In comparison, the charges for non-otolaryngologic diagnoses increased by 35.87% and the costs by 10.43%. ConclusionsThe public health impact and rising costs of healthcare are substantial. It is of critical significance that the healthcare system be aware of opportunities and lessons that may be learned across specialties to identify the primary drivers of healthcare cost while maintaining high quality standards for patient care.

Understanding how distance to facility and quality of care affect maternal health service utilization in Kenya and Haiti: A comparative geographic information system study.

In 2000, the United Nations established eight Millennium Development Goals (MDG) to combat worldwide poverty, disease, and lack of primary education. Goal number five aimed to reduce the maternal mortality ratio by three quarters and provide universal access to reproductive healthcare services by 2015. While there has been some progress, MDG 5 fell far short of target goals, highlighting the necessity of further improvement in global maternal health. Using Geographic Information Systems (GIS), this study aims to understand how distance to facility and quality of care, which are components of access, affect maternal service utilization in two of the world's poorest countries, Haiti and Kenya. Furthermore, this study examines how this relationship may change or hold between urban and rural regions. Data from the United States Agency for International Development Demographic and Health Survey and Service Provision Assessment were linked spatially in a GIS model, drawing comparisons among distance to facility, quality of care, and maternal health service utilization. Results show that in both rural and urban regions, access to maternal health service and maternal health service utilization share a similar spatial pattern. In urban regions, pockets of maternal health disparities exist despite close distance to facility and standard quality of care. In rural regions, there are areas with long distances to facilities and low quality of care, resulting in poor maternal service usage. This study highlights the usefulness of GIS as a tool to evaluate disparities in maternal healthcare provision and usage.

Development of a consumer experience reporting questionnaire for residential aged care homes in Australia.

To develop and pilot a short interview tool to be implemented by the Australian Aged Care Quality Agency (AACQA) in residential aged care, to inform prospective consumers about the quality of care and services received-the consumer experience report (CER). Twenty-four questions addressing the four Aged Care Quality Standards were piloted with 140 residents and 48 representatives (including 27 resident-representative pairs). A method for approximating random selection was also trialled. Fifty-two residents were interviewed twice, one week apart, and each question's usability was rated by 11 surveyors and two interpreters. Selection criteria for questions included consumer preference, test-retest reliability, resident-representative agreement, usability and low missing data. Nineteen questions performed well on missing data, 16 on test-retest, 17 on resident-representative agreement and 12 on usability. Ten quantitative and two open-ended questions were selected. The CER questions proved suitable to collect data systematically on consumer experience in residential aged care. AACQA (now the Aged Care Quality and Safety Commission) uses the CER interview to support their audit process, and aggregated results are published online.

Using the RE-AIM framework for dissemination and implementation of psychosocial distress screening.

To evaluate the RE-AIM framework's effect on retention of participants and implementation outcomes of a 5-year cancer research education programme on psychosocial distress screening in cancer centres across the United States. A one-group pre-/post-test design was used to evaluate the programme on participant retention and implementation outcomes at 6, 12 and 24months after enrolling in the programme (baseline) and analysed using descriptive statistics. Seventy-two cancer centres participated in four cohorts. Participant retention was 100%. At baseline and 24months, respectively, 52 (72%) and 64 (88%) of the cancer centres had formulated a psychosocial distress screening policy; 51 (71%) and 70 (98%) had started screening in more than one clinic/population; 15 (21%) and 45 (63%) had started auditing health records for documentation of screening. Each outcome rate improved at the cancer-centre level over the 24months. RE-AIM can be used as a framework for cancer research education programmes. Future research is needed on the use of a randomised adaptive design to test the optimal support for implementation of quality care standards according to cancer centres' needs.

The efficiency and quality of the care pathway for adult patients being referred to the East Lancashire and Blackburn with Darwen Oral Surgery Services.

To evaluate the quality of the care pathway for adult patients being referred to the East Lancashire Blackburn with Darwen Oral Surgery Service using the referral management system between 2013 and 2014. In the 2013–14 financial year, of the 5,285 referrals that were made to the Oral Surgery Service, 1,962 (37%) were directed to a primary care location for management. After being referred to a primary care location, 92% of patients had been seen within eight weeks. In total, £232,320 was paid to the providers for their service. The East Lancashire Blackburn with Darwen Oral Surgery Services delivered in primary care was found to be effective, with a good standard of quality care. There is ease of access in the community, and reduced waiting times for treatment. It is cost effective with a decreased spend to secondary care. However, there were no cost savings to the commissioners, as overall secondary care activity has not reduced.

AB123. 230. Fragility hip fracture & mortality: a 4-year single institution, multiple surgeon and retrospective cohort study

Background: Fragility hip fractures are the most common serious injury of our older patients. Due to increasing life expectancy worldwide, the current global prevalence of hip fractures (~2 million) is predicted to increase threefold by 2050. Recent studies show that hip fracture registries may be contributing to a reduction in 30-day mortality. The objective of the present study was threefold: (I) to assess the local hospital compliance with international hip fracture quality care standards over the years 2013–2016; (II) to establish the local hospital inpatient, 30-day and 1-year mortality rates for a 4-year cohort of fragility hip fracture patients (n=646 patients); and (III) to perform a logistical regression analysis to ascertain associations between patient and organisational variables and increased risk of death within 1-year post fragility hip fracture in our cohort.

An evaluation of the mourning tradition, the "First Feast," in the context of palliative care: The possibility of incorporating cultural rituals into palliative care.

Grief is intertwined with cultural and religious rituals that are highly appreciated in the quality standards of palliative care. Here, we aimed to investigate whether a cultural mourning ritual, the "First Feast," can be used by palliative care teams to ease the grief response of the deceased patient's relatives. A questionnaire with 23 questions about the prevalence of the First Feast tradition, the content, the pros and cons, and whether it would be useful for the grieving relatives of deceased patients was prepared and given to the palliative care patients' relatives. The data were evaluated using the chi-square test. A total of 427 participants were enrolled in the study; 60.7% were female and the mean age was 36 (±13.4). A total of 76.8% of the participants were from the Tokat region and 77.8% (n = 332) performed the First Feast tradition. A significant difference was observed among participants with Tokat origins and non-Tokat origins in terms of awareness of the tradition (84.8% and 69.7%, respectively; p = 0.001). Ninety-one percent of the participants acknowledged that the tradition helped to ease the grief response of the relatives. The First Feast, a mourning tradition performed in Tokat and other parts of Turkey, might be a useful auxiliary method for palliative care teams to help grieving families.

Overcoming Barriers to Growth in Home-Based Palliative Care.

Home-based palliative care fills a critical gap between acute care (during crises) and hospice care for seriously ill patients. As of 2018, home-based palliative care capacity in the United States has not scaled to meet patient needs. The Center to Advance Palliative Care (CAPC) conducted a needs assessment to catalog and analyze barriers to growth in the field of home-based palliative care. Home-based palliative care program leaders were surveyed and interviewed to elicit information about program characteristics, barriers to meeting national palliative care quality standards or to program growth, and essential elements of program sustainability. Home-based palliative care program leaders cited their major challenges as being: a lack of clarity on the applicability of national standards to home-based programs, a lack of sustainable financing methods for home-based palliative care, and lack of awareness of existing support resources for program design and leadership development. Home-based palliative care programs will benefit from improved professional awareness of national quality standards and existing technical assistance. New prospects for alternative payment models that allow for sustainable interdisciplinary home-based care represent a promising opportunity for the field.

Exploring mistreatment of women during childbirth in a peri-urban setting in Kenya: experiences and perceptions of women and healthcare providers

BackgroundIn Kenya, indirectly caused maternal deaths form a significant portion of all maternal deaths within the health system. Many of these deaths are avoidable and occur during delivery and labor. Poor quality health service has been a recurring concern among women in Kenya, with women reporting interactions with healthcare workers that are often demeaning and abusive. This paper explores the experiences and perceptions of both female patients and healthcare workers regarding mistreatment during childbirth. This study aims to provide recommendations on how dignified care can be made the norm, specifically focusing on a peri-urban setting in Kenya.MethodsThe research was accomplished using qualitative research methods with focus group discussions and in depth interviews with women and healthcare workers. The aim was to gain a deeper understanding of the manifestations of mistreatment within the context of a peri-urban setting in Kenya.ResultsFemale patients reported different forms of mistreatment, such as verbal abuse, physical abuse, neglect, discrimination, abandonment, poor rapport and failure of the health system to uphold professional standards. The healthcare workers described a health system that was weak and fragmented with poor policy support particularly for the new free maternity services policy leading to the mistreatment of women.ConclusionNewly formed County Governments need to provide resources for a functioning health system to ensure an enabling environment for the provision of high quality maternal health services. This process can include feedback loops with maternity clients to ensure woman-centered services. Policy makers need to strengthen oversight for the implementation of the free maternity services Community health volunteers can be trained to provide this information. Professional associations that govern the standards of quality care for healthcare workers need to address the mistreatment through retraining and norms transformation.

How the use of business intelligence tools in the fistula sector can improve surgical performance

Aims: The aim of Operation Fistula’s ongoing work is to incentivize our partnering clinical teams by providing performance-based funding. We do this using a coordinated chain of business intelligence tools, and by sharing detailed customized visual dashboards so they can track both patient outcomes and surgical performance. We have repurposed a number of leading business intelligence tools to create a patient tracking and performance management system. This platform combines several technologies to collect, store, and analyze data, which we communicate with our partners.
 Methods: In order for data to be collected into our system, our partner surgeons and nurses input patient data directly into customized, standardized, electronic forms on a tablet or phone. Results are uploaded in real time, and feed into the data visualization software. Our London-based team is then able to create data visualization dashboards, based on the collected data, which are shared with stakeholders in our partnering countries.
 Results: We are tracking surgical outcomes using our mobile data collection and visualization programmes. We are also measuring the impact of the digital performance-based funding model, currently being used in the SAVA region in Madagascar. Our partnering clinical teams have responded positively to the introduction of our system, which we have found to ensure quality standards of care.
 Conclusions: The initial phase of this work has yielded positive results. We have seen increased engagement and motivation from our partnering clinical staff, which exemplifies how both a performance-based funding system, and access to digestible data, can improve surgical performance.

International consensus on quality standards for brain health-focused care in multiple sclerosis

Background: Time matters in multiple sclerosis (MS). Irreversible neural damage and cell loss occur from disease onset. The MS community has endorsed a management strategy of prompt diagnosis, timely intervention and regular proactive monitoring of treatment effectiveness and disease activity to improve outcomes in people with MS. Objectives: We sought to develop internationally applicable quality standards for timely, brain health–focused MS care. Methods: A panel of MS specialist neurologists participated in an iterative, online, modified Delphi process to define ‘core’, ‘achievable’ and ‘aspirational’ time frames reflecting minimum, good and high care standards, respectively. A multidisciplinary Reviewing Group (MS nurses, people with MS, allied healthcare professionals) provided insights ensuring recommendations reflected perspectives from multiple stakeholders. Results: Twenty-one MS neurologists from 19 countries reached consensus on most core (25/27), achievable (25/27) and aspirational (22/27) time frames at the end of five rounds. Agreed standards cover six aspects of the care pathway: symptom onset, referral and diagnosis, treatment decisions, lifestyle, disease monitoring and managing new symptoms. Conclusion: These quality standards for core, achievable and aspirational care provide MS teams with a three-level framework for service evaluation, benchmarking and improvement. They have the potential to produce a profound change in the care of people with MS.

Use of Service Provision Assessments and Service Availability and Readiness Assessments for monitoring quality of maternal and newborn health services in low-income and middle-income countries

Improving the quality of maternal and newborn health (MNH) services is key to reducing adverse MNH outcomes in low-income and middle-income countries (LMICs). The Service Provision Assessment (SPA) and Service...

Awareness and accessibility of the Dutch mental health care system for people with borderline intellectual functioning or mild intellectual disabilities

PurposeIn The Netherlands, curative mental health care and supportive care for people with an intellectual disability (ID) are organised in separate domains. Prevalence of mental health problems is known to be high among people with borderline intellectual functioning (BIF) or mild intellectual disabilities (MID). By contrast, according to recent findings, prevalence of BIF and MID is high among patients in mental health care (17.5–58 per cent). In The Netherlands, a new quality standard of care (QSOC) on mental health care for people with BIF or MID is developed. It is designed to supplement existing guidelines on mental health care so that they can be used appropriately in people with BIF or MID and meant for use in both mental health care organisations (MHCO) as in organisations for ID care. To a large extent, the QSOC should describe the existing practice. This paper aims to discuss these issues.Design/methodology/approachTo assess the existing practice in current mental health care for people with BIF or MID in The Netherlands, the authors examined the views and accessibility of MHCO on the mental health care for patients with and IQ<85. In addition, the authors reviewed published criteria for in- and exclusion of all 39 top clinical mental health care departments for criteria on BIF or (mild) ID.FindingsThe authors found there is a clear awareness of the high prevalence of BIF and MID among large Dutch MHCO. Dutch MHCO estimate the prevalence of BIF and MID among their patients to be around 30 per cent. Nonetheless, most MCHO surveyed (76 per cent) indicated they do not routinely estimate or measure IQ among their patients and 53 per cent of MHCO indicated not having knowledge and expertise on the dual diagnoses of mental health problems and BIF or MID. Fitting in with the new QSOC most of the MHCO (59 per cent) agreed on the statement in the survey that professionals should be able to treat patients with BIF or ID and all but one of the MHCO stated to have some form of collaboration with an institute for ID care.Originality/valueThe authors concluded there is a clear awareness of the high prevalence of BIF and MID among large Dutch MHCO. The new QSOC on mental health care for people with BIF or MID can help improve accessibility and quality of mental health care for these patients.