PubMed Health⌕ Search

Biomedical subjects

Jan Mainz

Publications and source records attributed to Jan Mainz.

At least 19 recordsLinked to original sources
PubMed2005

[Health-related quality of life as an outcome measure].

Objective health measures often correlate poorly with the personal burden of illness. Thus, over recent years, there has been a growing interest in health-related quality of life (QOL) as an outcome measure when evaluating treatment effects and health. Self-report instruments are the most commonly used method for measuring QOL, and estimates of reliability and validity assist the selection of appropriate QOL measures. The primary criteria for evaluating QOL instruments are test-retest reliability, internal consistency, content validity, criteria validity, construct validity and responsiveness. Responsiveness refers to an instrument's sensitivity towards changes in health. Knowledge about the methods used when validating QOL instruments may increase confidence in QOL as a relevant outcome measure in medical science. In the clinical setting, using QOL measures may help patients communicate their problems and help doctors and nurses to identify patients' major concerns.

Humans↗
PubMed2005

Parents' priorities and satisfaction with acute pediatric care.

OBJECTIVE: To identify parents' priorities and satisfaction in relation to pediatric care to assess nurses' and physicians' ability to provide care and treatment that fulfill parents' needs. DESIGN, SETTING, AND PARTICIPANTS: The study took place in the pediatric ward of a regional hospital in Denmark. It included 300 parents of children admitted for acute care, and the data were collected by means of a self-administered questionnaire. After admission, parents were asked about priorities. After discharge from the hospital, parents were asked to report their level of satisfaction with the elements of care they had received during their stay. RESULTS: A total of 253 questionnaires were returned for the first section (a response rate of 84%), and 170 questionnaires were returned for the second section (response rate of 67%). The greatest gap between priorities and satisfaction was in the waiting time related to admission, waiting time related to fulfillment of the child's needs, and information given about care and treatment. Parents were most satisfied with the nurses' behavior; however, physicians' performance was given the highest priority score. CONCLUSIONS: Parents' priorities and assessments of inpatient pediatric care rest heavily on the communication between physicians and parents. The present study pointed to the need for improved and clearer communication. In addition, the poor performance with regard to waiting time indicates that this is a major area for improvement.

Adult↗
PubMed2005

Errors in the medication process: frequency, type, and potential clinical consequences.

OBJECTIVE: To investigate the frequency, type, and consequences of medication errors in more stages of the medication process, including discharge summaries. DESIGN: A cross-sectional study using three methods to detect errors in the medication process: direct observations, unannounced control visits, and chart reviews. With the exception of errors in discharge summaries all potential medication error consequences were evaluated by physicians and pharmacists. SETTING: A randomly selected medical and surgical department at Aarhus University Hospital, Denmark. STUDY PARTICIPANTS: Eligible in-hospital patients aged 18 or over (n = 64), physicians prescribing drugs and nurses dispensing and administering drugs. MAIN OUTCOME MEASURES: Frequency, type, and potential clinical consequences of all detected errors compared with the total number of opportunities for error. RESULTS: We detected a total of 1065 errors in 2467 opportunities for errors (43%). In worst case scenario 20-30% of all evaluated medication errors were assessed as potential adverse drug events. In each stage the frequency of medication errors were-ordering: 167/433 (39%), transcription: 310/558 (56%), dispensing: 22/538 (4%), administration: 166/412 (41%), and finally discharge summaries: 401/526 (76%). The most common types of error throughout the medication process were: lack of drug form, unordered drug, omission of drug/dose, and lack of identity control. CONCLUSION: There is a need for quality improvement, as almost 50% of all errors in doses and prescriptions in the medication process were caused by missing actions. We assume that the number of errors could be reduced by simple changes of existing procedures or by implementing automated technologies in the medication process.

Adult↗
PubMed2005

Clinical quality indicators of venous leg ulcers: development, feasibility, and reliability.

In the clinical setting, diagnosis and treatment of venous leg ulcers can vary considerably from patient to patient. The first step to reducing this variation is to document venous leg ulcer care through use of quantitative scientific documentation principles. This requires the development of valid and reliable evidence-based quality indicators of venous leg ulcer care. A Scandinavian multidisciplinary, cross-sectional panel of wound healing experts developed clinical quality indicators on the basis of scientific evidence from the literature and subsequent group nominal consensus of the panel; an independent medical doctor tested the feasibility and reliability of these clinical indicators, assessing the quality of medical technical care on 100 consecutive venous leg ulcer patients. Main outcome measures were healing, recurrence, pain, venous disease diagnosis, differential diagnosis and treatment, and inter- and intra-rater reliability. The indicators proved feasible and reliable to measure (inter-rater kappa = 0.79, P < 0.01 and intra-rater kappa = 0.89, P < 0.1). Within 3 months of initial examination, venous etiology was verified by duplex in 61 of the 98 participating patients (62%) and 31 (32%) were assessed for venous surgery. Distal arterial pressure was measured following initial examination in 33 of the patients (34%). All patients (100%) were prescribed compression therapy. Of the 98 patients, 11 (11%) had ulcers recur in 3 months and 72 (73%) healed in 12 months, which is in line with the literature. It is feasible to reliably measure the quality of medical technical venous leg ulcer care in the clinical setting using a few strategic clinically relevant indicators of quality.

Aged↗
PubMed2004

Quality improvement in an outpatient department for subacute low back pain patients: prospective surveillance by outcome and performance measures in a health technology assessment perspective.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To develop clinical indicators and standards in an outpatients' department for sub acute low back pain patients. SUMMARY OF BACKGROUND DATA: A systematic quantitative surveillance to assess quality of care was implemented using outcome and performance measures. These measures were developed within the framework of Health Technology Assessment, which comprises the areas of healthcare technology, patient, organization, and economy. METHODS: A multidisciplinary project group defined 1) clinical indicators in terms of outcome and performance measures and 2) the corresponding standards using the available evidence from literature. Observed outcomes were compared with the standards. Associations between process and outcome measures were investigated. RESULTS: A total of 300 patients were included consecutively. In relation to technology, the standards for the field of application were fulfilled (e.g., not too many patients were x-rayed). With respect to effectiveness, the observed rate of patients reaching a 50% cutoff point of improvement of pain and function did not fulfill the standards. In relation to patient aspects, the standards of, for example, proper understanding of patient education and satisfaction, were fulfilled. In relation to organization, nearly one third of the patients were referred later to the department than the recommended 24 weeks. This refer variable showed an association to a reduced chance of scoring "better" or "much better" in "patients global assessment." The chance was reduced by 50% if patients were referred later than 12 weeks after onset of pain. In relation to economy, the cost of gaining a quality adjusted life-year by a course in the department was considerably lower than by comparison with total hip arthroplasty. CONCLUSIONS: Surveillance by clinical indicators in relation to the four areas of health technology assessment provides quantitative information that is meaningful for various stakeholders on important aspects of the quality of care (including consumers), provides a basis for quality improvement, and provides data for analysis of possible important relationships between structure, process, and outcome.

Acute Disease↗
PubMed2004

Nationwide continuous quality improvement using clinical indicators: the Danish National Indicator Project.

OBJECTIVE: In most countries there is no mandatory national system to track the quality of care delivered to the citizens. This paper describes an example of a national indicator project that aims at documenting and improving the quality of care nationwide. ANALYSIS: The Danish National Indicator Project was established in 2000 as a nationwide multidisciplinary quality improvement project. From 2000 to 2002, disease-specific clinical indicators and standards were developed for six diseases (stroke, hip fracture, schizophrenia, acute gastrointestinal surgery, heart failure, and lung cancer). Indicators and standards have been implemented in all clinical units and departments in Denmark treating patients with the six diseases, and participation is mandatory. All clinical units and departments receive their results every month. National and regional audit processes are organized to explain the results and to prepare implementation of improvements. All results are published in order to inform the public, and to give patients and relatives the opportunity to make informed choices. CONCLUSION: The surveillance of health care quality is greatly aided by the use of relevant quantitative indicators. This paper describes how it is possible to organize nationwide monitoring using clinical indicators.

Delivery of Health Care↗
PubMed2004

Venous leg ulcer patient priorities and quality of care: results of a survey.

A comprehensive patient evaluation of quality of care encompasses assessment and patient-rated prioritization of the various provisions of care. One hundred consecutive venous leg ulcer patients treated in a multidisciplinary wound healing center were invited to participate in a cross-sectional study to assess the quality of and assign priority to 28 aspects of medical technical, interpersonal, and organizational care. The response rate to the mailed questionnaire and follow-up telephone survey was 80%. Almost half (46%) of patients (median age 76 years, range 30 to 92) had an ulcer history of >5 years. Seventy-three patients (91%) were satisfied with the overall quality of care. A linear relationship was observed between average assessment score and the relative importance of the quality aspects studied. The quality of medical technical care and empathy aspects of interpersonal care received the most positive assessments and were given highest priority. Next in importance were the quality and coherence of information provided and cooperation between different healthcare sectors. Organizational aspects of care were less positively assessed and received lower priority ratings. Venous leg ulcer care, as provided in a multidisciplinary wound healing center, was assessed as satisfactory by patients, but areas for improvement - notably, cooperation between healthcare sectors and continuity of care - were observed.

Adult↗
PubMed2003

Defining and classifying clinical indicators for quality improvement.

OBJECTIVE: This paper provides a brief review of definitions, characteristics, and categories of clinical indicators for quality improvement in health care. ANALYSIS: Clinical indicators assess particular health structures, processes, and outcomes. They can be rate- or mean-based, providing a quantitative basis for quality improvement, or sentinel, identifying incidents of care that trigger further investigation. They can assess aspects of the structure, process, or outcome of health care. Furthermore, indicators can be generic measures that are relevant for most patients or disease-specific, expressing the quality of care for patients with specific diagnoses. CONCLUSIONS: Monitoring health care quality is impossible without the use of clinical indicators. They create the basis for quality improvement and prioritization in the health care system. To ensure that reliable and valid clinical indicators are used, they must be designed, defined, and implemented with scientific rigour.

Humans↗
PubMed2003

Developing evidence-based clinical indicators: a state of the art methods primer.

OBJECTIVE: To describe steps in developing and testing clinical indicators based on state of the art methods in previous literature and experience in the Danish National Indicator Project. ANALYSIS: The development process includes a planning phase, where the clinical area to be evaluated is chosen and the measurement team selected and organized. The planning phase is followed by a development phase where clinical indicators are prioritized and selected by the measurement team on the basis of documentation and knowledge from the scientific literature. When clinical indicators have been selected, specific measure specifications should be designed, including inclusion and exclusion criteria for the target population, description of a risk adjustment strategy, identification of data sources, description of data collection procedures, and an analytical plan for data analyses. Before clinical indicators are implemented they should be tested for reliability and validity. Preliminary tests may identify areas requiring further modifications and specifications of the indicators. CONCLUSION: Using clinical indicators for quality assessment represents an important approach to documenting the quality of care. Consumers of indicator information (clinicians, administrators, purchasers, regulators, and patients) need reliable and valid information for benchmarking, making judgments, and determining priorities, accountability and quality improvement. This underlines the fact that clinical indicators must be developed and tested with scientific rigor in a transparent process.

Benchmarking↗
PubMed2002

[Shared care--integrated cooperation across the sector boundaries about patient's course. Modern health care system cooperates].

Shared care programmes have been introduced in Denmark for areas, such as diabetes, asthma, and dementia. Over a three-year period, the communication and co-operation between the health sectors have improved. Specific demands on hospital referral and discharge letters have resulted in improved quality of contents and structure. This review shows that there is limited ongoing research on shared care and that the end points including formulations like "improved co-operation" have been too broad. Almost no research is available on specific improvements obtained by shared care. The study shows that implementation of shared care research programmes with specific end points is very extensive. Only 10 per cent of the present studies have specific end points, and 75 per cent of these show positive effects of shared care programmes. The GP Consulting System in Denmark has proved most useful in the progress of shared care. Future research in shared care should focus on specific end points, in which analyses of patient's course are fundamental in an effort to obtain improvements.

Community Health Services↗