Journal articles on the topic 'Prehospital care; Quality indicators; Quality improvement'
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Pap, Robin, Craig Lockwood, Matthew Stephenson, and Paul Simpson. "Development and testing of Australian prehospital care quality indicators: study protocol." BMJ Open 10, no. 7 (July 2020): e038310. http://dx.doi.org/10.1136/bmjopen-2020-038310.
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IntroductionHistorically, ambulance services were established to provide rapid transport of patients to hospital. Contemporary prehospital care involves provision of sophisticated ‘mobile healthcare’ to patients across the lifespan presenting with a range of injuries or illnesses of varying acuity. Because of its young age, the paramedicine profession has until recently experienced a lack of research capacity which has led to paucity of a discipline-specific, scientific evidence-base. Therefore, the performance and quality of ambulance services has traditionally been measured using simple, evidence-poor indicators forming a deficient reflection of the true quality of care and providing little direction for quality improvement efforts. This paper reports the study protocol for the development and testing of quality indicators (QIs) for the Australian prehospital care setting.Methods and analysisThis project has three phases. In the first phase, preliminary work in the form of a scoping review was conducted which provided an initial list of QIs. In the subsequent phase, these QIs will be developed by aggregating them and by performing related rapid reviews. The summarised evidence will be used to support an expert consensus process aimed at optimising the clarity and evaluating the validity of proposed QIs. Finally, in the third phase those QIs deemed valid will be tested for acceptability, feasibility and reliability using mixed research methods. Evidence-based indicators can facilitate meaningful measurement of the quality of care provided. This forms the first step to identify unwarranted variation and direction for improvement work. This project will develop and test quality indicators for the Australian prehospital care setting.Ethics and disseminationThis project has been approved by the University of Adelaide Human Research Ethics Committee. Findings will be disseminated by publications in peer-reviewed journals, presentations at appropriate scientific conferences, as well as posts on social media and on the project’s website.
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Ma, Junxiong, Xuejie Dong, Yinzi Jin, and Zhi-Jie Zheng. "Health Care Quality Improvement for ST-Segment Elevation Myocardial Infarction: A Retrospective Study Based on Propensity-Score Matching Analysis." International Journal of Environmental Research and Public Health 18, no. 11 (June 4, 2021): 6045. http://dx.doi.org/10.3390/ijerph18116045.
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Reducing the treatment delay by organizing delivery of care on a regional basis is a priority for improving the quality of ST-segment elevated myocardial infarction (STEMI) care. This study aimed to evaluate the impact of the combined measures on quality metrics of healthcare delivery in Suzhou. The data were collected from the National Chest Pain Center (CPC) Data Reporting Database. 4775 patients were recruited, and after propensity-score matching, 1078 pairs were finally included for analysis. We examined the changes in quality metrics of care including prehospital and in-hospital processes, and clinic outcomes. Quality improvement (QI) implementation improved most process indicators. However, these improvements did not yield decreased in-hospital mortality. The door-to-balloon and the FMC-to-device time decreased from 85.0 and 98.0 min to 78 and 88 min, respectively (p < 0.001). Cases transferred directly via EMS had a greater improvement in most of process indicators. The proportion of patients transferred directly via EMS was 10.3%, much lower than that of self-transported patients at 58.3%. Tertiary hospitals showed greater performance improvement in process indicators than secondary hospitals. The percentage of cases using EMS remained low for suburban areas. The establishment of coordinated STEMI care needs to be accompanied with solving the fragmented situation of the prehospital and hospital care, and patient delay should be addressed, especially in suburban areas and on transferred-in inpatients.
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Howard, Ian, Nicholas Castle, Loua Al Shaikh, and Robert Owen. "Improving the prehospital management of ST elevation myocardial infarction: a national quality improvement initiative." BMJ Open Quality 8, no. 2 (June 2019): e000508. http://dx.doi.org/10.1136/bmjoq-2018-000508.
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ST elevation myocardial infarction (STEMI) is a time-dependent clinical emergency. Early recognition and intervention in the clinical course of STEMI are key to reducing mortality and morbidity. As a result, the benefits of the prehospital management of patients presenting with STEMI are well supported by the literature. Given these benefits, much of the focus on the development of quality and performance measures for Emergency Medical Services has focused on STEMI care. Historically, within Qatar, however, no measures of prehospital STEMI care have previously existed and as such, little is understood regarding the quality of prehospital care delivered to patients with STEMI. The overall aim of this national initiative was to improve the effectiveness of the prehospital care of patients with STEMI, to a minimum compliance of 75%, as measured by four process measures and one bundle measure, over a 12-month period. Initial efforts were aimed at the development of relevant indicators to guide assessment and identifying an appropriate patient cohort to test improvement efforts. Using these measures and criteria, the project team highlighted several areas for potential improvement centred on three key domains within the service: clinical practice, training and clinical equipment/medication. There was significant and sustained improvement across all measures recorded. For the bundle measure, the median proportional compliance increased from 39% pre-improvement activities to 76% post-improvement activities and remained sustained at 12 months post-implementation. The initiative was successful in meeting all of its aims and furthermore showed sustained compliance at 12 months post-implementation, thanks in part to what were designed to be changes that were simple, yet pragmatic, and readily producible at scale. While a formal cost analysis was not conducted, the improvement activities capitalised on existing organisational structures and processes with the resultant cost perceived to be negligible.
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Amaral, Colton B., Daniel C. Ralston, and Torben K. Becker. "Prehospital point-of-care ultrasound: A transformative technology." SAGE Open Medicine 8 (January 2020): 205031212093270. http://dx.doi.org/10.1177/2050312120932706.
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Point-of-care ultrasound at the bedside has evolved into an essential component of emergency patient care. Current evidence supports its use across a wide spectrum of medical and traumatic diseases in a variety of settings. The prehospital use of ultrasound has evolved from a niche technology to impending widespread adoption across emergency medical services systems internationally. Recent technological advances and a growing evidence base support this trend. However, concerns regarding feasibility, education, and quality assurance must be addressed proactively. This topical review describes the history of prehospital ultrasound, initial training needs, ongoing skill maintenance, quality assurance and improvement requirements, available devices, and indications for prehospital ultrasound.
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Turner, Janette, A. Niroshan Siriwardena, Joanne Coster, Richard Jacques, Andy Irving, Annabel Crum, Helen Bell Gorrod, et al. "Developing new ways of measuring the quality and impact of ambulance service care: the PhOEBE mixed-methods research programme." Programme Grants for Applied Research 7, no. 3 (April 2019): 1–90. http://dx.doi.org/10.3310/pgfar07030.
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BackgroundAmbulance service quality measures have focused on response times and a small number of emergency conditions, such as cardiac arrest. These quality measures do not reflect the care for the wide range of problems that ambulance services respond to and the Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) programme sought to address this.ObjectivesThe aim was to develop new ways of measuring the impact of ambulance service care by reviewing and synthesising literature on prehospital ambulance outcome measures and using consensus methods to identify measures for further development; creating a data set linking routinely collected ambulance service, hospital and mortality data; and using the linked data to explore the development of case-mix adjustment models to assess differences or changes in processes and outcomes resulting from ambulance service care.DesignA mixed-methods study using a systematic review and synthesis of performance and outcome measures reported in policy and research literature; qualitative interviews with ambulance service users; a three-stage consensus process to identify candidate indicators; the creation of a data set linking ambulance, hospital and mortality data; and statistical modelling of the linked data set to produce novel case-mix adjustment measures of ambulance service quality.SettingEast Midlands and Yorkshire, England.ParticipantsAmbulance services, patients, public, emergency care clinical academics, commissioners and policy-makers between 2011 and 2015.InterventionsNone.Main outcome measuresAmbulance performance and quality measures.Data sourcesAmbulance call-and-dispatch and electronic patient report forms, Hospital Episode Statistics, accident and emergency and inpatient data, and Office for National Statistics mortality data.ResultsSeventy-two candidate measures were generated from systematic reviews in four categories: (1) ambulance service operations (n = 14), (2) clinical management of patients (n = 20), (3) impact of care on patients (n = 9) and (4) time measures (n = 29). The most common operations measures were call triage accuracy; clinical management was adherence to care protocols, and for patient outcome it was survival measures. Excluding time measures, nine measures were highly prioritised by participants taking part in the consensus event, including measures relating to pain, patient experience, accuracy of dispatch decisions and patient safety. Twenty experts participated in two Delphi rounds to refine and prioritise measures and 20 measures scored ≥ 8/9 points, which indicated good consensus. Eighteen patient and public representatives attending a consensus workshop identified six measures as important: time to definitive care, response time, reduction in pain score, calls correctly prioritised to appropriate levels of response, proportion of patients with a specific condition who are treated in accordance with established guidelines, and survival to hospital discharge for treatable emergency conditions. From this we developed six new potential indicators using the linked data set, of which five were constructed using case-mix-adjusted predictive models: (1) mean change in pain score; (2) proportion of serious emergency conditions correctly identified at the time of the 999 call; (3) response time (unadjusted); (4) proportion of decisions to leave a patient at scene that were potentially inappropriate; (5) proportion of patients transported to the emergency department by 999 emergency ambulance who did not require treatment or investigation(s); and (6) proportion of ambulance patients with a serious emergency condition who survive to admission, and to 7 days post admission. Two indicators (pain score and response times) did not need case-mix adjustment. Among the four adjusted indicators, we found that accuracy of call triage was 61%, rate of potentially inappropriate decisions to leave at home was 5–10%, unnecessary transport to hospital was 1.7–19.2% and survival to hospital admission was 89.5–96.4% depending on Clinical Commissioning Group area. We were unable to complete a fourth objective to test the indicators in use because of delays in obtaining data. An economic analysis using indicators (4) and (5) showed that incorrect decisions resulted in higher costs.LimitationsCreation of a linked data set was complex and time-consuming and data quality was variable. Construction of the indicators was also complex and revealed the effects of other services on outcome, which limits comparisons between services.ConclusionsWe identified and prioritised, through consensus processes, a set of potential ambulance service quality measures that reflected preferences of services and users. Together, these encompass a broad range of domains relevant to the population using the emergency ambulance service. The quality measures can be used to compare ambulance services or regions or measure performance over time if there are improvements in mechanisms for linking data across services.Future workThe new measures can be used to assess different dimensions of ambulance service delivery but current data challenges prohibit routine use. There are opportunities to improve data linkage processes and to further develop, validate and simplify these measures.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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McDonald, Neil, Nicola Little, Rob Grierson, and Erin Weldon. "Sex and Gender Equity in Prehospital Electrocardiogram Acquisition." Prehospital and Disaster Medicine 37, no. 2 (March 9, 2022): 164–70. http://dx.doi.org/10.1017/s1049023x2200036x.
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AbstractIntroduction:Research in cardiac care has identified significant gender-based differences across many outcomes. Women with heart disease are less likely both to be diagnosed and to receive standard care. Gender-based disparities in the prehospital setting are under-researched, but they were found to exist within rates of 12-lead electrocardiogram (ECG) acquisition within one urban Emergency Medical Services (EMS) agency.Study Objective:This study evaluates the quality improvement (QI) initiative that was implemented in that agency to raise overall rates of 12-lead ECG acquisition and reduce the gap in acquisition rates between men and women.Methods:This QI project included two interventions: revised indications for 12-lead acquisition, and training that highlighted sex- and gender-based differences relevant to patient care. To evaluate this project, a retrospective database review identified all patient contacts that potentially involved cardiac assessment over 18 months. The primary outcome was the rate of 12-lead acquisition among patients with qualifying complaints. This was assessed by mean rates of acquisition in before and after periods, as well as segmented regression in an interrupted time series. Secondary outcomes included differences in rates of 12-lead acquisition, both overall and in individual complaint categories, each compared between men/women and before/after the interventions.Results:Among patients with qualifying complaints, the mean rate of 12-lead acquisition in the lead-in period was 22.5% (95% CI, 21.8% - 23.2%) with no discernible trend. The protocol change and training were each associated with a significant absolute level increase in the acquisition rate: 2.09% (95% CI, 0.21% - 4.0%; P = .03) and 3.2% (95% CI, 1.18% - 5.22%; P = .003), respectively. When compared by gender and time period, women received fewer 12-leads than men overall, and more 12-leads were acquired after the interventions than before. There were also significant interactions between gender and period, both overall (2.8%; 95% CI, 1.9% - 3.6%; P < .0001) and in all complaint categories except falls and heart problems.Conclusion:This QI project resulted in an increase in 12-leads acquired. Pre-existing gaps in rates of acquisition between men and women were reduced but did not disappear. On-going research is examining the reasons behind these differences from the perspective of prehospital providers.
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Xantus, Gabor Zoltan, Penny Allen, Sharon Norman, and Peter Laszlo Kanizsai. "Mortality benefit of crystalloids administered in 1–6 hours in septic adults in the ED: systematic review with narrative synthesis." Emergency Medicine Journal 38, no. 6 (April 15, 2021): 430–38. http://dx.doi.org/10.1136/emermed-2020-210298.
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BackgroundBased on the 2018 update of the Surviving Sepsis Campaign, the Committee for Quality Improvement of the NHSs of England recommended the instigation of the elements of the ‘Sepsis-6 bundle’ within 1 hour to adult patients screened positive for sepsis. This bundle includes a bolus infusion of 30 mL/kg crystalloids in the ED. Besides the UK, both in the USA and Australia, compliance with similar 1-hour targets became an important quality indicator. However, the supporting evidence may neither be contemporaneous nor necessarily valid for emergency medicine settings.MethodA systematic review was designed and registered at PROSPERO to assess available emergency medicine/prehospital evidence published between 2012 and 2020, investigating the clinical benefits associated with a bolus infusion of a minimum 30 mL/kg crystalloids within 1 hour to adult patients screened positive for sepsis. Due to the small number of papers that addressed this volume of fluids in 1 hour, we expanded the search to include studies looking at 1–6 hours.ResultsSeven full-text articles were identified, which investigated various aspects of the fluid resuscitation in adult sepsis. However, none answered completely to the original research question aimed to determine either the effect of time-to-crystalloids or the optimal fluid volume of resuscitation. Our findings demonstrated that in the USA/UK/Australia/Canada, adult ED septic patients receive 23–43 mL/kg of crystalloids during the first 6 hours of resuscitation without significant differences either in mortality or in adverse effects.ConclusionThis systematic review did not find high-quality evidence supporting the administration of 30 mL/kg crystalloid bolus to adult septic patients within 1 hour of presentation in the ED. Future research must investigate both the benefits and the potential harms of the recommended intervention.
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Pap, Robin, Craig Lockwood, Matthew Stephenson, and Paul Simpson. "Indicators to measure prehospital care quality." JBI Database of Systematic Reviews and Implementation Reports 16, no. 11 (November 2018): 2192–223. http://dx.doi.org/10.11124/jbisrir-2017-003742.
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Dagher, Michel, and Robert J. Lloyd. "Developing EMS Quality Assessment Indicators." Prehospital and Disaster Medicine 7, no. 1 (March 1992): 69–74. http://dx.doi.org/10.1017/s1049023x00039248.
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AbstractAn emergency medical service (EMS) system is part of a broad health care system which no longer can be concerned exclusively with patient transportation. Integration of prehospital and in-hospital emergency care must be achieved to provide quality patient care. This article suggests modifications in the Joint Commission on Accreditation of Healthcare Organization's (JCAHO) 10-Step Model indicators that should help in an evaluation of the issues associated with the diversion of patients from Emergency Departments. The JCAHO model is one that can be used to help integrate prehospital and inhospital care.
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Voskanyan, Yu E. "Epidemiology of Medical Errors and Incidents in Emergency Medicine." Russian Sklifosovsky Journal "Emergency Medical Care" 11, no. 2 (September 8, 2022): 301–16. http://dx.doi.org/10.23934/2223-9022-2022-11-2-301-316.
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Relevance the issues of patient care and quality management have acquired particular relevance in modern healthcare. Improvement in the clinical performance of medical technologies has led to a significant reduction in deaths and complications associated with the disease and side effects of interventions. As a result, the share of additional harm related to the process of providing medical services has become more noticeable. Accurate data regarding the type, frequency and severity of active threats and incidents they cause are needed to reduce the likelihood and severity of additional harm. In this respect, emergency medical care is the subject of special attention and is characterized by the greatest difficulty in terms of obtaining valid and relevant information about deviations associated with health worker performance, equipment operation and patient behavior.The aim of the study was to explore the main epidemiological characteristics of medical errors and incidents associated with the provision of emergency medical care.Material and methods We present a literature review followed by an analytical study of the epidemiology of incidents and active threats (including medical errors) that precede those incidents in various areas of emergency medical care. By an incident, the authors understood an event with a patient that was more related to the process of providing medical care than to the course of the disease or comorbid conditions which led or could lead to causing additional harm. Active threats included events that subsequently became the direct cause of the incident (medical errors and malpractice, mistakes and deviations in patient behavior, emergency situations in the physical environment). By the “mortality from adverse events”, the authors understood the proportion of deaths from adverse events among all hospitalized patients. By the concept of “lethality associated with adverse events”, the authors denoted the proportion of deaths from adverse events among all the patients affected by adverse events. The search for information was carried out for the period of 1995–2021 using the following medical databases: medline; cochrane collaboration; embase; scopus; isi web of science. For analysis, we used prospective and retrospective observational studies of high methodological quality, meta-analyses and systematic reviews. For the statistical evaluation of frequency characteristics, indicators of incidence, prevalence, and incidence density were used. The calculation of generalized frequency indicators for large samples was carried out with a 95% confidence interval.Results The epidemiology of medical errors and incidents depends on the area in which emergency care is provided. For prehospital emergency medical care, there are 12.45 medical errors and 4.50 incidents with consequences for every 100 visits. In emergency departments, one in fourteen patients suffers additional harm which in 10.14% of cases has severe consequences, and in 3.18% of cases leads to unexpected death. In intensive care units, incidents related to the provision of medical care are recorded in every third patient in the amount of 1.55 per 1 patient. Of these, 58.67% of incidents are accompanied by harm, but the fatality associated with the incidents is only 0.77%. The prevalence of patients affected by incidents during the provision of anesthesia for children is almost 2 times higher than for adults (4.79% vs. 2.03%). At the same time, mortality due to anesthesia-related incidents in children is 11 times lower than in adults (0.27% versus 3.09%). The author draws attention to a number of factors contributing to the development of incidents during the provision of emergency medical care. These include environmental complexity, suboptimal configuration of the workspace, technological interface complexity, the effects of acute stress on performers, and organizational vulnerabilities. A special role was assigned to environmental complexity which was studied in detail both in terms of the complexity of the tasks being solved, and in connection with obstacles to solving problems. It was shown that the intensity of the influence of various components of environmental complexity is not the same in different departments providing emergency care. Particular attention was paid to the fact that organizational vulnerabilities reduce the effectiveness of protective mechanisms during the interaction of the human factor with a complex environment.Conclusion The study showed that the provision of emergency medical care is associated with moderately high risks of incidents, including severe and critical consequences for patients. The main factor contributing to the development of incidents is environmental complexity which becomes much harder to counter under the influence of organizational vulnerabilities. Identification and registration of errors and incidents in units providing medical care is difficult due to the short time of contact with patients, the high speed of situation update, and the constant impact of chronic and acute stressors on staff. In this connection, the optimization and improvement of the efficiency of the system for recording errors and incidents in departments providing emergency medical care remains an area for improvement.
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KOTLIAR, A., S. DUBROV, S. SEREDA, M. DENISYUK, and G. PONYATOVSKA. "INFLUENCE OF IRRATIONAL PRESCRIPTION OF ANTIBACTERIAL THERAPY ON THE PROGNOSIS OF TREATMENT AND SURVIVAL IN PATIENTS WITH COVID-19." PAIN, ANAESTHESIA & INTENSIVE CARE, no. 4(97) (November 25, 2021): 69–74. http://dx.doi.org/10.25284/2519-2078.4(97).2021.248405.
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IIntroduction. The COVID-19 pandemic became a major challenge for healthcare systems around the world. The development and improvement of basic treatments for coronavirus patients is important to improve public health and improve quality of life after recovery. The aim of the study: to determine the frequency and structure of prescribing antibacterial drugs in the prehospital and hospital stages, used in patients with COVID-19. Assess the relationship between irrational use of antibacterial drugs with the length of hospital stay of patients with coronavirus disease, the risk of transfer to the intensive care unit (ICU) and mortality. Materials and methods: Statistical, retrospective analysis of 400 case histories of patients with COVID-19 who were treated at the Municipal Non-Profit Enterprise «Kyiv City Clinical Hospital №17» (KNP «KMKL#17») for the period from September 2020 to November 2021 with severe coronavirus disease. Results: 400 medical charts were selected for the study, which were divided into two groups according to the purpose of antibacterial therapy. Of the group of patients who received pre-hospital antibacterial therapy (200 people), indications for its appointment had only 7 % of patients. Among the group receiving antibacterial drugs there is a prolongation of the length of stay in the hospital, the risk of transfer to ICU increases. There is also higher risk of mortality in patients of group 1 (14,5 %), compared with group 2 (8 %), whose antibacterial drugs were not prescribed at the prehospital stage. Conclusion: as a result of the study it was found that patients who were unreasonably prescribed antibacterial therapy prolongs the period of general hospitalization by 2.3 ± 0.8 days, increasing the need for transfer of patients due to deterioration to ICU by an average of 13 %, increase in the incidence of antibiotic-associated diarrhea by 7-8 %, and there is a tendency to increase mortality from COVID-19. Antibacterial drugs should be used only on the basis of indications in the case of proven bacterial co-infection (superinfection) or reasonable suspicion of it in patients with respiratory disease caused by SARS-CoV-2 and in no case should be prophylactic.
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Phillips, Frank, and Mariah Sturges. "776 Quality Improvement in Prehospital Burn Care." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S195—S196. http://dx.doi.org/10.1093/jbcr/irac012.329.
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Abstract Introduction Burn center implemented a new quality improvement program with emergency medical services (EMS) that examined patient care prior to arrival. Inconsistencies were noted with key interventions that would improve patient’s overall health. These included oxygen administration, fluid resuscitation, pain management, and the application of sterile dressings. There was also improvement in the transfer of care from EMS to receiving hospital. Methods Patient care reports were examined to see the quality of care that was being given in the prehospital setting. Based on these results, education in the form of a lecture and prior cases are presented routinely to different emergency medical services. To improve transfer of care at bed side from EMS, “burn page” was created. This is a page sent directly to charge nurse of burn unit, emergency department, attending physicians of burn unit, outreach coordinator, and prehospital care coordinator. This allows for improved preparation to receive burn patient from EMS. After the patient is received from EMS, a patient follow up is provided by the prehospital care coordinator to EMS within 24 hours. The patient care report from EMS is reviewed along with the care currently being provided by the burn unit. A case review is scheduled with EMS to examine the care provided and see where improvement can be made with both EMS care and the transition of care at the bed side. This case review also allows the EMS crew to see how the patient is doing a few weeks later. Results The burn center has noticed drastic improvement of care in the prehospital setting. This includes hitting critical bench marks as described in the introduction. This improvement is seen at the transition of care at bedside and in patient care reports done by EMS. These EMS providers also express the improvement of how patients are transferred to the burn center and a sense of trust that the patient will have excellent burn care. They also express that creating the patient follow ups and case reviews helps close the loop in patient care resulting in better burn care being provided in the prehospital setting. Conclusions With noticing what critical bench marks that were not being met regarding burn care in the prehospital setting, corrective actions can be created that will establish a closed loop that drastically improves care. From the point of injury to the end of stay in the burn unit, patient care has been drastically improved.
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Howard, Ian, Peter Cameron, Lee Wallis, Maaret Castren, and Veronica Lindstrom. "Quality Indicators for Evaluating Prehospital Emergency Care: A Scoping Review." Prehospital and Disaster Medicine 33, no. 1 (December 10, 2017): 43–52. http://dx.doi.org/10.1017/s1049023x17007014.
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AbstractIntroductionHistorically, the quality and performance of prehospital emergency care (PEC) has been assessed largely based on surrogate, non-clinical endpoints such as response time intervals or other crude measures of care (eg, stakeholder satisfaction). However, advances in Emergency Medical Services (EMS) systems and services world-wide have seen their scope and reach continue to expand. This has dictated that novel measures of performance be implemented to compliment this growth. Significant progress has been made in this area, largely in the form of the development of evidence-informed quality indicators (QIs) of PEC.ProblemQuality indicators represent an increasingly popular component of health care quality and performance measurement. However, little is known about the development of QIs in the PEC environment. The purpose of this study was to assess the development and characteristics of PEC-specific QIs in the literature.MethodsA scoping review was conducted through a search of PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA); EMBase (Elsevier; Amsterdam, Netherlands); CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science (Thomson Reuters; New York, New York USA); and the Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom). To increase the sensitivity of the literature, a search of the grey literature and review of select websites was additionally conducted. Articles were selected that proposed at least one PEC QI and whose aim was to discuss, analyze, or promote quality measurement in the PEC environment.ResultsThe majority of research (n=25 articles) was published within the last decade (68.0%) and largely originated within the USA (68.0%). Delphi and observational methodologies were the most commonly employed for QI development (28.0%). A total of 331 QIs were identified via the article review, with an additional 15 QIs identified via the website review. Of all, 42.8% were categorized as primarily Clinical, with Out-of-Hospital Cardiac Arrest contributing the highest number within this domain (30.4%). Of the QIs categorized as Non-Clinical (57.2%), Time-Based Intervals contributed the greatest number (28.8%). Population on Whom the Data Collection was Constructed made up the most commonly reported QI component (79.8%), followed by a Descriptive Statement (63.6%). Least reported were Timing of Data Collection (12.1%) and Timing of Reporting (12.1%). Pilot testing of the QIs was reported on 34.7% of QIs identified in the review.ConclusionOverall, there is considerable interest in the understanding and development of PEC quality measurement. However, closer attention to the details and reporting of QIs is required for research of this type to be more easily extrapolated and generalized.HowardI, CameronP, WallisL, CastrenM, LindstromV. Quality indicators for evaluating prehospital emergency care: a scoping review. Prehosp Disaster Med. 2018;33(1):43–52.
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Chrusch, Carla A., Claudio M. Martin, and The Quality Improvement in Critical Care Project. "Quality Improvement in Critical Care: Selection and Development of Quality Indicators." Canadian Respiratory Journal 2016 (2016): 1–11. http://dx.doi.org/10.1155/2016/2516765.
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Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole.Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time.Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process.Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods.Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts.
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Baker, Richard. "Monitoring for improvement: Quality indicators for diabetes care." Primary Care Diabetes 1, no. 1 (February 2007): 3–4. http://dx.doi.org/10.1016/j.pcd.2006.11.002.
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SUSERUD, B.-O., K.-A. WALLMAN-C:SON, and H. HALJAM??E. "Assessment of the quality improvement of prehospital emergency care in Sweden." European Journal of Emergency Medicine 5, no. 4 (December 1998): 407???414. http://dx.doi.org/10.1097/00063110-199812000-00005.
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Mattera, Connie J. "The evolving change in paradigm from quality assurance to continuous quality improvement in prehospital care." Journal of Emergency Nursing 21, no. 1 (February 1995): 46–52. http://dx.doi.org/10.1016/s0099-1767(95)80017-4.
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Kolozsvári, László Róbert, and Imre Rurik. "Quality improvement in primary care. Financial incentives related to quality indicators in Europe." Orvosi Hetilap 154, no. 28 (July 2013): 1096–101. http://dx.doi.org/10.1556/oh.2013.29631.
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Quality improvement in primary care has been an important issue worldwide for decades. Quality indicators are increasingly used quantitative tools for quality measurement. One of the possible motivational methods for doctors to provide better medical care is the implementation of financial incentives, however, there is no sufficient evidence to support or contradict their effect in quality improvement. Quality indicators and financial incentives are used in the primary care in more and more European countries. The authors provide a brief update on the primary care quality indicator systems of the United Kingdom, Hungary and other European countries, where financial incentives and quality indicators were introduced. There are eight countries where quality indicators linked to financial incentives are used which can influence the finances/salary of family physicians with a bonus of 1–25%. Reliable data are essential for quality indicators, although such data are lacking in primary care of most countries. Further, improvement of indicator systems should be based on broad professional consensus. Orv. Hetil., 2013, 154, 1096–1101.
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Raj, Raashi, Hugh McGuire, and Pilar Pinilla Dominguez. "Introduction to quality standards and indicators." IHOPE Journal of Ophthalmology 1 (May 12, 2022): 46–49. http://dx.doi.org/10.25259/ihopejo_5_2022.
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The objective of this article is to describe NICE’s role regarding quality improvement in health and social care in England and to gain an insight into how NICE quality standards and indicators are used in the health and social care system. NICE is the national point of reference for advice on safe, effective, and cost-effective health and social care. NICE achieves this by providing advice aligned to the needs, uses, and demands of the resource constrained system. NICE’s role in quality improvement follows a stepwise progression starting with evidence-based guidance and recommendations through to quality standards and indicators. These are aimed to contribute to improved outcomes in health and social care.
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Bombardier, Claire, and Samra Mian. "Quality indicators in rheumatoid arthritis care: using measurement to promote quality improvement." Annals of the Rheumatic Diseases 72, suppl 2 (December 19, 2012): ii128—ii131. http://dx.doi.org/10.1136/annrheumdis-2012-202259.
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Jovanović, Svetlana, Maja Milošević, Irena Aleksić-Hajduković, and Jelena Mandić. "Quality indicators of dental health care in Serbia." Serbian Dental Journal 66, no. 1 (March 1, 2019): 36–42. http://dx.doi.org/10.2478/sdj-2019-0005.
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Summary Health care has witnessed considerable progresses toward quality improvement over the past two decades. More precisely, there have been global efforts aimed to improve this aspect of health care along with experts and decision-makers reaching the consensus that quality is one of the most significant dimensions and features of health system. Quality health care implies highly efficient resource use in order to meet patient’s needs in terms of prevention and treatment. Quality health care is provided in a safe way while meeting patients’ expectations and avoiding unnecessary losses. The mission of continuous improvement in quality of care is to achieve safe and reliable health care through mutual efforts of all the key supporters of health system to protect patients’ interests. A systematic approach to measuring the process of care through quality indicators (QIs) poses the greatest challenge to continuous quality improvement in health care. Quality indicators are quantitative indicators used for monitoring and evaluating quality of patient care and treatment, continuous professional development (CPD), maintaining waiting lists, patients and staff satisfaction, and patient safety.
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Iqbal, Usman, and Yu-Chuan (Jack) Li. "Quality indicators and incentive programs for health care improvement." International Journal for Quality in Health Care 29, no. 4 (August 2017): 441. http://dx.doi.org/10.1093/intqhc/mzx098.
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Owen, J. B., and J. F. Wilson. "Improving quality of care: Challenges to implementing quality indicators." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 16030. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.16030.
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16030 Background: To assess the overall quality of cancer care, efforts seek consensus quality indicators that crosscut health services. Although pilot programs have collected and analyzed relevant clinical data, they have been unable to collect radiation oncology (RO) data detailed enough to assess the quality of services or to inform key decision makers. Quality Research in Radiation Oncology (QRRO) conducted retrospective surveys of national practice since 1973 with major positive impact on the quality of practice through recursive processes. Methods: From Donabedian’s model of quality assessment, QRRO analyzes crucial quality components by conducting Facilities, Process, and Outcomes Surveys. Survey design allows calculation of national averages for patients treated with RO and comparisons by key factors. Evolving data collection methods allow assessment of modern technologies. Methods start with definition and measurement of evidence-based quality indicators but allow greater detail and specification than most other quality measurement efforts. Results: QRRO showed that radiation dose affected outcomes for prostate cancer patients. Higher radiation doses were associated with improved local tumor control rates and treatment techniques affected toxicity rates. These results, presented widely in numerous venues, stimulated dose escalation clinical trials. Trials conducted in the USA all used QRRO results as critical data, providing the major impetus to test new directions in dose escalation and new methods to target delivery more precisely. National practice shifted to higher doses and use of conformal techniques. The dataset is unique in providing cross-sectional information on practice patterns with a wide variety of treatment approaches from many institutions and sufficient details of treatment delivery to allow examination of questions about quality and effects of techniques. Conclusions: Mounting societal demands for improvement in the quality of care, ever increasing complexity of radiation therapy, and escalating use of multi-modality treatment make continuing to measure, report, and improve quality of care in RO crucial to patients and the profession. Methods must keep pace with new technologies and techniques in radiation therapy. [Supported by NCI grant CA 65435]. No significant financial relationships to disclose.
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Steel, Alistair, Charlotte Haldane, and Dan Cody. "Impact of videolaryngoscopy introduction into prehospital emergency medicine practice: a quality improvement project." Emergency Medicine Journal 38, no. 7 (February 15, 2021): 549–55. http://dx.doi.org/10.1136/emermed-2020-209944.
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IntroductionAdvanced airway management is necessary in the prehospital environment and difficult airways occur more commonly in this setting. Failed intubation is closely associated with the most devastating complications of airway management. In an attempt to improve the safety and success of tracheal intubation, we implemented videolaryngoscopy (VL) as our first-line device for tracheal intubation within a UK prehospital emergency medicine (PHEM) setting.MethodsAn East of England physician–paramedic PHEM team adopted VL as first line for undertaking all prehospital advanced airway management. The study period was 2016–2020. Statistical process control charts were used to assess whether use of VL altered first-pass intubation success, frequency of intubation-related hypoxia and laryngeal inlet views. A survey was used to collect the team’s views of VL introduction.Results919 patients underwent advanced airway management during the study period. The introduction of VL did not improve first-pass intubation success, view of laryngeal inlet or intubation-associated hypoxia. VL improved situational awareness and opportunities for training but performed poorly in some environments.ConclusionDespite the lack of objective improvement in care, subjective improvements meant that overall PHEM clinicians wanted to retain VL within their practice.
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Bao, Huan, Sumian Zhang, Junjie Hao, Lian Zuo, Xiahong Xu, Yumei Yang, Hua Jiang, and Gang Li. "Improving the Prehospital Identification and Acute Care of Acute Stroke Patients: A Quality Improvement Project." Emergency Medicine International 2022 (February 9, 2022): 1–5. http://dx.doi.org/10.1155/2022/3456144.
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Background. There are a large number of stroke patients in China, and there is currently a lack of prehospital acute stroke care training programs. Aim. To develop a prehospital emergency medical service (PEMS) training program to improve the prehospital identification and acute care of acute stroke. Methods. Forty prehospital emergency doctors whose service stations are located within a 10 km radius from Shanghai Pudong New Area Medical Emergency Service Center took this course on November 13, 2014. A questionnaire was designed to evaluate the PEMS personnel’s knowledge in stroke and acute stroke care and was conducted before and after training as an assessment of the effectiveness of training. The patient population in this study included a baseline cohort before training and a prospective cohort after training, each composed of patients who were sent to Shanghai East Hospital South Stoke Center within one year. The transit time, final diagnosis, administration of thrombolysis, and door-to-needle time (DNT) were collected and analyzed. Results. After the training, 100% of the PEMS personnel were competent to identify stroke cases using the Cincinnati prehospital stroke scale (CPSS). All participants realized that intravenous thrombolysis therapy in a time-sensitive manner is the most effective way to treat acute ischemic stroke. Although there was no difference in first-aid transit time before and after training, the stroke diagnosis rate improved by 6.5% after training P = 0.03 . The thrombolysis rate increased to 29.6% from 24.3% but did not reach statistical significance. Compared to 84.0 minutes (standard deviation: 23.1 minutes) before the training, the average DNT after training was 53 minutes (standard deviation: 15.0 minutes), demonstrating a remarkable reduction P < 0.01 . Conclusion. The training program effectively improved the PEMS personnel’s knowledge in stroke and stroke acute care.
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Gupta, Maruti. "Quality improvement in anaesthesiology." International Journal of Research in Medical Sciences 7, no. 8 (July 25, 2019): 3216. http://dx.doi.org/10.18203/2320-6012.ijrms20193423.
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In recent times, numerous efforts have been made in the field of medicine to improve the methodology of measuring and reporting the quality of care delivered to patients. Most of these efforts have been executed in the western population, because of an efficient system of Incident Reporting. Quality Measurement in healthcare typically means quantifying processes of care that have a direct relationship to positive health outcomes. Quality in anaesthesia is usually measured by perioperative mortality, morbidity and Incidents. Quality measurement is not only important for the clientele but also for the employer, to make choices and healthcare provider to introspect his performance. It is an effective method of giving feedback to anaesthesiologists, doctors and paramedical staff to address quality issues and bring about improvement. Without Quality Measurement, improvement in quality, if at all, would be expected to be very slow and clientele would be blindfolded in taking important decisions pertaining to health care. The concepts of quality assurance and quality control are rapidly gaining popularity in surgical sciences as the society is heading towards social, technical and clinical advancements globally. In times to come, quality of anaesthesia services will be closely monitored by quality indicators and will become a benchmark for assessment of the healthcare provider and the hospital. At present, the need of the hour is to devise ways and means to measure the quality of care being provided by the healthcare provider and adopt these evolutionary practices aimed at improving anaesthesia delivery services in a medical setup.
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Gorzkiewicz, Vanita, Jeanie Lacroix, and Kori Kingsbury. "Cardiac Care Quality Indicators: A New Hospital-Level Quality Improvement Initiative for Cardiac Care in Canada." Healthcare Quarterly 15, no. 1 (February 7, 2012): 22–25. http://dx.doi.org/10.12927/hcq.2012.22771.
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El Sayed, Mazen J. "Measuring Quality in Emergency Medical Services: A Review of Clinical Performance Indicators." Emergency Medicine International 2012 (2012): 1–7. http://dx.doi.org/10.1155/2012/161630.
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Measuring quality in Emergency Medical Services (EMSs) systems is challenging. This paper reviews the current approaches to measuring quality in health care and EMS with a focus on currently used clinical performance indicators in EMS systems (US and international systems). The different types of performance indicators, the advantages and limitations of each type, and the evidence-based prehospital clinical bundles are discussed. This paper aims at introducing emergency physicians and health care providers to quality initiatives in EMS and serves as a reference for tools that EMS medical directors can use to launch new or modify existing quality control programs in their systems.
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Shaikh, Farhan. "Quality indicators and improvement measures for pediatric intensive care units." Journal of Pediatric Critical Care 7, no. 5 (2020): 260. http://dx.doi.org/10.4103/jpcc.jpcc_100_20.
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Ramsay, Daniel P., Phillip Quinn, Veronica Gin, Timothy D. Starkie, Robert A. Fry, and Samuel Grummitt. "National quality improvement indicators project: an initial descriptive study." Anaesthesia and Intensive Care 49, no. 6 (November 2021): 455–67. http://dx.doi.org/10.1177/0310057x211027884.
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Background Anaesthesia Quality Improvement New Zealand developed a set of five quality improvement indicators pertaining to postoperative nausea and vomiting, pain, respiratory distress, hypothermia and a prolonged post-anaesthesia care unit stay. This study sought to assess the proportion of eligible institutions that were able to measure and provide data on these indicators, produce an initial national estimate of these, and a measure of variability in the quality improvement indicators across hospitals in New Zealand. Methods All public hospitals that provide a representative to Anaesthesia Quality Improvement New Zealand were eligible for inclusion. Participating institutions were required to provide the number and proportion of patients with each of the five quality improvement indicators over a continuous 2-week period between 1 June 2019 and 25 October 2019. The overall percentage of patients and the median percentage with each outcome were calculated. Results A total of 79.2% of eligible hospitals participated. The median incidence of the indicators ranged from 1.67% for respiratory distress to 6.31% for prolonged post-anaesthesia care unit stay. The indicator with the largest interquartile range was hypothermia and the smallest was respiratory distress (13.48 and 2.29, respectively). A large variation was seen for prolonged post-anaesthesia care unit stay, hypothermia, pain and postoperative nausea and vomiting. Conclusion The majority of eligible institutions were able to measure and provide data on the quality improvement indicators. There was a low rate of respiratory distress with low variability. A large amount of variability was observed in the other indicators. Future studies are needed to explore the nature of this variability.
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Hansen, Gregory, Simerpreet Bal, Kerri Lynn Schellenberg, Susan Alcock, and Esseddeeg Ghrooda. "Prehospital Management of Acute Stroke in Rural versus Urban Responders." Journal of Neurosciences in Rural Practice 08, S 01 (August 2017): S033—S036. http://dx.doi.org/10.4103/jnrp.jnrp_2_17.
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ABSTRACT Objective: Stroke guideline compliance of rural Canadian prehospital emergency medical services (EMS) care in acute stroke is unknown. In this quality assurance study, we sought to compare rural and urban care by prehospital EMS evaluation/management indicators from patients assessed at an urban Canadian stroke center.Materials and Methods: One hundred adult patients were randomly selected from the stroke registry. Patients were transported through Rural EMS bypass protocols or urban EMS protocols (both bypass and direct) to our stroke center between January and December 2013. Patients were excluded if they were first evaluated at any other health center. Prehospital care was assessed using ten indicators for EMS evaluation/management, as recommended by acute stroke guidelines. Results: Compliance with acute stroke EMS evaluation/management indicators were statistically similar for both groups, except administrating a prehospital diagnostic tool (rural 31.8 vs. urban 70.3%; P = 0.002). Unlike urban EMS, rural EMS did not routinely document scene time. Conclusion: Rural EMS responders' compliance to prehospital stroke evaluation/management was similar to urban EMS responders. Growth areas for both groups may be with prehospital stroke diagnostic tool utilization, whereas rural EMS responders may also improve with scene time documentation.
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Fasola, Gianpiero, Jessica Menis, Alessandro Follador, Elisa De Carlo, Francesca Valent, Giuseppe Aresu, Alessandro De Pellegrin, et al. "INTEGRATED CARE PATHWAYS IN LUNG CANCER: A QUALITY IMPROVEMENT PROJECT." International Journal of Technology Assessment in Health Care 34, no. 1 (2018): 3–9. http://dx.doi.org/10.1017/s026646231700441x.
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Background:Non small cell lung cancer (NSCLC) diagnosis and treatment is a highly complex process, requiring managerial skills merged with clinical knowledge and experience. Integrated care pathways (ICPs) might be a good strategy to overview and improve patient's management. The aim of this study was to review the ICPs of NSCLC patients in a University Hospital and to identify areas of quality improvement.Materials and Methods:The electronic medical records of 169 NSCLC patients visited at the University Hospital were retrospectively reviewed. Quality of care (QoC) has been measured trough fifteen indicators, selected according main international Guidelines and approved by the multi-disciplinary team for thoracic malignancies. Results have been compared with those of a similar retrospective study conducted at the same hospital in 2008.Results:A total of 146 patients were considered eligible. Eight of fifteen indicators were not in line with the benchmarks. We compared the results obtained in the two separate periods. Moreover, we process some proposal to be discussed with the general management of the hospital, aimed to redesign NSCLC care pathways.Conclusions:ICPs confirm to be feasible and to be an effective tool in real life. The periodic measurement of QoC indicators is necessary to ensure clinical governance of patients pathways.
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Awawdi, Khaled, Carmel Armon, Itzhak Kimiagar, Mahdi Tarabeih, and Riad Abu Rakia. "Post-Stroke Quality of Life Outcomes After Instituting New Stroke Care Quality Indicators." European Journal of Medical and Health Sciences 3, no. 1 (January 8, 2021): 9–15. http://dx.doi.org/10.24018/ejmed.2021.3.1.641.
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Background: In 2013 the Israel Ministry of Health identified the care and treatment of acute cerebral ischemic stroke as failing to achieve expected standards. The Ministry decided to raise standards by defining and instituting, nationwide, a battery of linked care quality indicators to be applied across all relevant facilities and contexts. Five indicators were selected for five key junctures in the AIS care process.
Methods: This paper presents and analyses the effects of the implementation of these new care quality indicators on the post-discharge quality of life outcomes of Israeli stroke sufferers. The patient sample comprises patients from Israel’s Central region, where stroke care provision and access is relatively high, and from the peripheral North region, where provision and access are limited.
Results: Those who were not treated with thrombolytic treatment and/or cerebral blood vessel catheterization, those who suffered severer strokes, women, the older age groups, non-Jews and North region residents display significantly worse physical functioning outcomes and worse quality of life outcomes on all indicators.
Conclusions: Stroke care access and provision disparities translate into significantly higher rates of post-discharge disability, impaired physical and social functioning, and a lower quality of life.
The effectiveness of healthcare improvement by the deployment of care indicators is closely associated with the lifestyle, socio-demographic and socioeconomic status of different population groups. The effective implementation of quality care indicators also relies heavily on closing the access and provision gaps between the populations living in central and peripheral areas. Two obvious directions for action are to expand and improve the rehabilitation care network and to combat the age discrimination in hospital stroke treatment.
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Blum, Nava, Dafna Halperin, and Youssef Masharawi. "Ambulatory and Hospital-based Quality Improvement Methods in Israel." Health Services Insights 7 (January 2014): HSI.S11027. http://dx.doi.org/10.4137/hsi.s11027.
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This review article compares ambulatory and hospital-based quality improvement methods in Israel. Data were collected from: reports of the National Program for Quality Indicators in community, the National Program for Quality Indicators in Hospitals, and from the Organization for Economic Cooperation and Development (OECD) Reviews of Health Care Quality.
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Aeyels, Daan, Peter R. Sinnaeve, Marc J. Claeys, Sofie Gevaert, Danny Schoors, Walter Sermeus, Massimiliano Panella, Ellen Coeckelberghs, Luk Bruyneel, and Kris Vanhaecht. "Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey." Acta Cardiologica 73, no. 6 (December 13, 2017): 518–27. http://dx.doi.org/10.1080/00015385.2017.1411664.
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Karon, Sarita L., and David R. Zimmerman. "Using Indicators To Structure Quality Improvement Initiatives in Long-Term Care." Quality Management in Health Care 4, no. 3 (1996): 54–76. http://dx.doi.org/10.1097/00019514-199604030-00008.
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Roberts, David H., Geoffrey S. Gilmartin, Naama Neeman, Joanne E. Schulze, Sabrina Cannistraro, Long H. Ngo, Mark D. Aronson, and J. Woodrow Weiss. "Design and Measurement of Quality Improvement Indicators in Ambulatory Pulmonary Care." Chest 136, no. 4 (October 2009): 1134–40. http://dx.doi.org/10.1378/chest.09-0619.
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Hickey, A. "Using clinical indicators in a quality improvement programme targeting cardiac care." International Journal for Quality in Health Care 16, suppl_1 (April 1, 2004): i11—i25. http://dx.doi.org/10.1093/intqhc/mzh032.
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Barnsley, Jan, Louise Lemieux-Charles, and G. Ross Baker. "Selecting Clinical Outcome Indicators for Monitoring Quality of Care." Healthcare Management Forum 9, no. 1 (April 1996): 5–12. http://dx.doi.org/10.1016/s0840-4704(10)60938-6.
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Clinical outcome indicators are used to identify opportunities for improvement in patient care processes. This paper focuses on issues specific to the selection of clinical outcome indicators for use in assessing performance within and between hospitals. The issues and examples are based on the experiences of a university research team that worked in collaboration with a group of teaching hospitals to develop and monitor clinical outcome indicators. Four sets of issues are discussed: the intended use, and end users of indicator information; aspects of indicator validity; data quality; and dissemination and use of indicator information. Recommendations are made that apply to individual hospitals, groups of hospitals and health care systems.
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Blum, Daniel, Alison Thomas, Claire Harris, Jay Hingwala, William Beaubien-Souligny, and Samuel A. Silver. "An Environmental Scan of Canadian Quality Metrics for Patients on In-Center Hemodialysis." Canadian Journal of Kidney Health and Disease 7 (January 2020): 205435812097531. http://dx.doi.org/10.1177/2054358120975314.
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Background: Quality metrics or indicators help guide quality improvement work by reporting on measurable aspects of health care upon which improvement efforts can focus. For recipients of in-center hemodialysis (ICHD) in Canada, it is unclear what ICHD quality indicators exist and whether they adequately cover different domains of health care quality. Objectives: To identify and evaluate current Canadian ICHD quality metrics to document a starting point for future collaborations and standardization of quality improvement in Canada. Design: Environmental scan of quality metrics in ICHD, and subsequent indicator evaluation using a modified Delphi approach. Setting: Canadian ICHD units. Participants: Sixteen-member pan-Canadian working group with expertise in ICHD and quality improvement. Measurements: We classified the existing indicators based on the Institute of Medicine (IOM) and Donabedian frameworks. Methods: Each metric was rated by a 5-person subcommittee using a modified Delphi approach based on the American College of Physicians/Agency for Healthcare Research and Quality criteria. We shared these consensus ratings with the entire 16-member panel for additional comments. Results: We identified 27 metrics that are tracked across 8 provinces, with only 9 (33%) tracked by multiple provinces (ie, more than 1 province). We rated 9 metrics (33%) as “necessary” to distinguish high-quality from low-quality care, of which only 2 were tracked by multiple provinces (proportion of patients by primary access and rate of vascular access-related bloodstream infections). Most (16/27, 59%) indicators assessed the IOM domains of safe or effective care, and none of the “necessary” indicators measured the IOM domains of timely, patient-centered, or equitable care. Limitations: The environmental scan is a nonexhaustive list of quality indicators in Canada. The panel also lacked representation from patients, administrators, and allied health professionals, with more representation from academic sites. Conclusions: Quality indicators in Canada mainly focus on safe and effective care, with little provincial overlap. These results highlight current gaps in quality of care measurement for ICHD, and this initial work should provide programs with a starting point to combine highly rated indicators with newly developed indicators into a concise balanced scorecard that supports quality improvement initiatives across all aspects of ICHD care. Trial Registration: not applicable.
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Nadziakiewicz, Małgorzata, and Alina Mikolajczyk. "The Quality and Safety of Health Care Services." Management Systems in Production Engineering 27, no. 2 (June 1, 2019): 100–104. http://dx.doi.org/10.1515/mspe-2019-0017.
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Abstract This article presents the quality, safety and assessment system as the important tools to supervise the health care organization. Quality is the sum of the properties and characteristics of a product, process or service that is appropriate to meet the complex requirements. In the case of health care is difficult to valuate quality, the universal indicators become useful tool. The development of quality indicators requires collecting of data and their proper processing. The high quality of medical services requires continuous improvement and adaptation to patients’ needs. The quality indicators, for example, refer directly to the effects of therapy and are used to measure the success or failure of the applied therapeutic methods. Measuring the results of activities indicates only the level of quality of the services provided. The data helps to analyze information and improve the quality and safety of health care services.
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Calvet, Xavier, Roberto Saldaña, Daniel Carpio, Miguel Mínguez, Isabel Vera, Berta Juliá, Laura Marín, and Fransesc Casellas. "Improving Quality of Care in Inflammatory Bowel Disease Through Patients’ Eyes: IQCARO Project." Inflammatory Bowel Diseases 26, no. 5 (October 21, 2019): 782–91. http://dx.doi.org/10.1093/ibd/izz126.
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Abstract Background Quality improvement is a major topic in inflammatory bowel disease (IBD) care, and measuring quality of care (QoC) is necessary for QoC improvement. Most QoC projects or consensus statements are designed from the health care professional point of view. Having QoC indicators designed for and fully evaluable by patients may provide a key tool for external evaluation of QoC improvement measures. The aim of the IQCARO project was to identify indicators to measure QoC from the IBD patient’s point of view. Methods An extensive review of the literature to identify indicators of QoC was performed; first the identified indicators were reviewed by a steering committee including patients, nurses, IBD specialists, and methodologists. Then 2 focus groups of IBD patients analyzed the QoC indicators to determine whether they could be understood and evaluated by patients. The final QoC indicators were selected by a group of IBD patients using a Delphi consensus methodology. Results An initial list of 54 QoC indicators was selected by the steering committee. The QoC indicators were evaluated by 16 patients who participated in 2 focus groups. They identified 21 indicators that fulfilled the understandability and evaluability requirements. The 10 most relevant QoC indicators were selected by 26 patients with IBD using a Delphi consensus. The selected items covered important aspects of QoC, including professionalism, patients’ autonomy, information, accessibility, and continuity of care. Conclusions The present Delphi consensus identified QoC indicators that are useful for developing and measuring improvement strategies in the management of IBD.
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Kashani, Kianoush, Mitchell Howard Rosner, Michael Haase, Andrew J. P. Lewington, Donal J. O'Donoghue, F. Perry Wilson, Mitra K. Nadim, et al. "Quality Improvement Goals for Acute Kidney Injury." Clinical Journal of the American Society of Nephrology 14, no. 6 (May 17, 2019): 941–53. http://dx.doi.org/10.2215/cjn.01250119.
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AKI is a global concern with a high incidence among patients across acute care settings. AKI is associated with significant clinical consequences and increased health care costs. Preventive measures, as well as rapid identification of AKI, have been shown to improve outcomes in small studies. Providing high-quality care for patients with AKI or those at risk of AKI occurs across a continuum that starts at the community level and continues in the emergency department, hospital setting, and after discharge from inpatient care. Improving the quality of care provided to these patients, plausibly mitigating the cost of care and improving short- and long-term outcomes, are goals that have not been universally achieved. Therefore, understanding how the management of AKI may be amenable to quality improvement programs is needed. Recognizing this gap in knowledge, the 22nd Acute Disease Quality Initiative meeting was convened to discuss the evidence, provide recommendations, and highlight future directions for AKI-related quality measures and care processes. Using a modified Delphi process, an international group of experts including physicians, a nurse practitioner, and pharmacists provided a framework for current and future quality improvement projects in the area of AKI. Where possible, best practices in the prevention, identification, and care of the patient with AKI were identified and highlighted. This article provides a summary of the key messages and recommendations of the group, with an aim to equip and encourage health care providers to establish quality care delivery for patients with AKI and to measure key quality indicators.
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Guillem, Vicente, Eduardo Diaz Rubio, Carlos Camps, Javier Cassinello, Daniel E. Castellano, Alfredo Carrato, and Pedro Gascon. "Identification of quality care indicators in prostate cancer." Journal of Clinical Oncology 35, no. 8_suppl (March 10, 2017): 213. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.213.
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213 Background: Despite the attempts made to improve prostate cancer management with the development and implementation of clinical practice guidelines, the inefficiencies and differences that usually occur in ordinary clinical care of patients with prostate cancer significantly contribute to increase the variations in the patterns of care and patients outcomes, and costs to the health system. The goal of this project was to establish parameters for improving the care of patients with prostate cancer through the development and validation of quality indicators for the management of this disease. Methods: The ECO Foundation is a platform of experts representing the major Spanish hospitals involved in the treatment of cancer patients. A multidisciplinary group of experts supported by ECO, extracted potential indicators for prostate cancer care from the relevant medical literature. After two consecutive rounds of rating in a modified Delphi approach, followed by a consensus discussion, the expert panel prioritized the indicators selected. Results: Forty indicators were selected with a high level of agreement. They were grouped into four main groups: general, localized disease, metastasized disease, and results-related indicators. Only two indicators did not reach an agreement or disagreement. The indicators with the highest level of agreement ( > 95%) were the appropriateness of diagnostic confirmation through the pathology report; patient participation in clinical decisions; complete re-staging with study of regional and bone extension; or the establishment of individual therapeutic plan with multidisciplinary participation. Conclusions: We conclude that currently available prostate cancer quality indicators represent clinical practices that are necessary for high-quality care in prostate cancer. The finalized indicator list can be directly adopted or adapted for deployment within a performance improvement program.
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Farhat, Hassan, Guillaume Alinier, Kawther El Aifa, Khawla Athemneh, Padarath Gangaram, Ricardo Romero, Mohamed Chaker Khenissi, Loua Al Shaikh, and James Laughton. "Quality improvement tools to manage emergency callbacks from patients with diabetes in a prehospital setting." BMJ Open Quality 12, no. 1 (January 2023): e002007. http://dx.doi.org/10.1136/bmjoq-2022-002007.
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Diabetes is rising at an alarming rate, as 1 in 10 adults worldwide now lives with the disease. In Qatar, a middle eastern Arab country, diabetes prevalence is equally concerning and is predicted to increase from 17% to 24% among individuals aged 45 and 54 years by 2050. While most healthcare strategies focus on preventative and improvement of in-hospital care of patients with diabetes, a notable paucity exists concerning diabetes in the prehospital setting should ideally be provided. This quality improvement study was conducted in a middle eastern ambulance service and aimed to reduce ambulance callbacks of patients with diabetes-related emergencies after refusing transport to the hospital at the first time. We used iterative four-stage problem-solving models. It focused on the education and training of both paramedics and patients. The study showed that while it was possible to reduce the rate of ambulance callbacks of patients with diabetes, this was short-lived and numbers increased again. The study demonstrated that improvements could be effective. Hence, changes that impacted policy, systems of care and ambulance protocols directed at managing and caring for patients with diabetes-related prehospital emergencies may be required to reify them.
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Scott, John W., Jeanne D’Arc Nyinawankusi, Samuel Enumah, Rebecca Maine, Eric Uwitonze, Yihan Hu, Ignace Kabagema, Jean Claude Byiringiro, Robert Riviello, and Sudha Jayaraman. "Improving prehospital trauma care in Rwanda through continuous quality improvement: an interrupted time series analysis." Injury 48, no. 7 (July 2017): 1376–81. http://dx.doi.org/10.1016/j.injury.2017.03.050.
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Yamamoto-Mitani, Noriko, Yumiko Saito, Manami Takaoka, Yukari Takai, and Ayumi Igarashi. "Nurses’ and Care Workers’ Perception of Care Quality in Japanese Long-Term Care Wards: A Qualitative Descriptive Study." Global Qualitative Nursing Research 5 (January 2018): 233339361881218. http://dx.doi.org/10.1177/2333393618812189.
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Despite the growing importance of long-term care for older adults, there has been limited attention to its quality assurance issues in Japan. To start planning the initiation of continuous quality improvement in long-term care hospitals, we explored how nurses and care workers themselves perceived current approaches to quality assurance and improvement on their ward. We interviewed 16 licensed nurses and nine care workers, transcribed and analyzed data using qualitative content analysis techniques, and derived six categories: keeping clients alive is barely possible, the absence of a long-term care practice model, the lack of quality indicators, long-term care hospitals as places for castaways, client quality of life as a source of satisfaction, and conflict between staff and client well-being. To develop continuous quality improvement in Japanese long-term care hospitals, it may be first necessary to introduce a practice model of long-term care and mechanisms to evaluate quality.
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Van Heng, Yang, Chan Davoung, and Hans Husum. "Non-Doctors as Trauma Surgeons? A Controlled Study of Trauma Training for Non-Graduate Surgeons in Rural Cambodia." Prehospital and Disaster Medicine 23, no. 6 (December 2008): 483–89. http://dx.doi.org/10.1017/s1049023x00006282.
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AbstractIntroduction:Due to the accelerating global epidemic of trauma, efficient and sustainable models of trauma care that fit low-resource settings must be developed. In most low-income countries, the burden of surgical trauma is managed by non-doctors at local district hospitals.Objective:This study examined whether it is possible to establish primary trauma surgical services of acceptable quality at rural district hospitals by systematically training local, non-graduate, care providers.Methods:Seven district hospitals in the most landmine-infested provinces of Northwestern Cambodia were selected for the study. The hospitals were referral points in an established prehospital trauma system. During a four-year training period, 21 surgical care providers underwent five courses (150 hours total) focusing on surgical skills training. In-hospital trauma deaths and postoperative infections were used as quality-of care indicators. Outcome indicators during the training period were compared against pre-intervention data.Results:Both the control and treatment populations had long prehospital transport times (three hours) and were severely injured (median Injury Severity Scale Score = 9). The in-hospital trauma fatality rate was low in both populations and not significantly affected by the intervention. The level of post-operative infections was reduced from 22% to 10.3% during the intervention (95% confidence interval for difference 2.8–20.2%). The trainees' selfrating of skills (Visual Analogue Scale) before and after the training indicated a significantly better coping capacity.Conclusions:Where the rural hospital is an integral part of a prehospital trauma system, systematic training of non-doctors improves the quality of trauma surgery. Initial efforts to improve trauma management in low-income countries should focus on the district hospital.
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Arvidsson, Eva, Rob Dijkstra, and Zalika Klemenc-Ketiš. "Measuring quality in primary healthcare – opportunities and weaknesses." Slovenian Journal of Public Health 58, no. 3 (June 26, 2019): 101–3. http://dx.doi.org/10.2478/sjph-2019-0013.
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Abstract The easy access to data from electronic patient records has made using this type of data in pay-for-performance systems increasingly common. General practitioners (GPs) throughout Europe oppose this for several reasons. Not all data can be used to derive good quality indicators and quality indicators can’t reflect the broad scope of primary care. Qualities like person-centred care and continuity are particularly difficult to measure. The indicators urge doctors and nurses to spend too much time on the registration and administration of required data. However, quality indicators can be very useful as starting points for discussions about quality in primary care, with the purpose being to initiate, stimulate and support local improvement work. This led to The European Society for Quality and Patient Safety in General Practice (EQuiP) feeling the urge to clarify the different aspects of quality indicators by updating their statement on measuring quality in Primary Care. The statement has been endorsed by the Wonca Europe Council in 2018.
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Grypdonck, Lies, Bert Aertgeerts, Frank Luyten, Hub Wollersheim, Johan Bellemans, Koen Peers, Sabine Verschueren, Patrik Vankrunkelsven, and Rosella Hermens. "Development of Quality Indicators for an Integrated Approach of Knee Osteoarthritis." Journal of Rheumatology 41, no. 6 (April 15, 2014): 1155–62. http://dx.doi.org/10.3899/jrheum.130680.
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Objective.Osteoarthritis (OA) is a common cause of disability worldwide. Knee OA care is often suboptimal. A first necessary step in quality improvement is to gain a clear insight into usual care. We developed a set of evidence-based quality indicators for multidisciplinary high-quality knee OA care.Methods.A Rand-modified Delphi method was used to develop quality indicators for knee OA diagnosis, therapy, and followup. Recommendations were extracted from international guidelines as well as existing sets of quality indicators and scored by a multidisciplinary expert panel. Based on median score, prioritization, and agreement, recommendations were labeled as having a high, uncertain, or low potential to measure quality of care and were discussed in a consensus meeting for inclusion or exclusion. Two final validation rounds yielded a core set of recommendations, which were translated into quality indicators.Results.From a total of 86 recommendations and existing indicators, a core set of 29 recommendations was derived that allowed us to define high-quality knee OA care. From this core set, 22 recommendations were considered to be measurable in clinical practice and were transformed into a final set of 21 quality indicators regarding diagnosis, lifestyle/education/devices, therapy, and followup.Conclusion.Our study provides a robust set of 21 quality indicators for high-quality knee OA care, measurable in clinical practice. These process indicators may be used to measure usual care and evaluate quality improvement interventions across the entire spectrum of disciplines involved in knee OA care.