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At least 19 recordsLinked to original sources
PubMed1990

Environmental safety: an essential element of quality care.

Quality care results when nurses conform to standards of practice. Health care providers are accountable for compliance with laws that set standards for environmental safety, standards set by accrediting bodies, state practice acts, and community and institutional standards. Conformance with standards requires continuous monitoring, updating of information, and staff education. The PACU is a busy place with rapid changes in patient census, patient status, and staffing needs. It may seem difficult to allot time for safety education and practice sessions. The authors offer suggestions, using fire safety as an example, for providing a safe environment for patients and personnel in the PACU.

Accident Prevention↗
PubMed1994

Musculoskeletal Injuries in the Workplace: Defining Quality Care.

Quality health care for a specific medical condition may be defined as adherence to an algorithm in which decision points are based on established medical practice as supported in the literature. The decision points can be considered either a "stan-dard of care" if there is definitive scientific evidence for their validity or a "guide-line for care" if there is only a consensus of medical opinion available. Algorithms for musculoskeletal injuries can be and have been successfully applied to patients in the workers' compensation setting. They can function as a concurrent surveil-lance system and are well accepted by physicians, patients, and industry if imple-mented by unbiased medical experts. A high level of quality care is attained by following such algorithms. Other goals achieved are early functional restoration as measured by return to work, a more efficient use of diagnostic studies, and avoidance of unnecessary therapeutic interventions, with the result that treatment is more cost-effective. Such a program that strives for high-quality care and emphasizes appropriate utilization will realize cost savings that may be far greater and longer lasting than the financial saving seen with arbitrary spending caps and fee controls.

Journal Article↗
PubMedDate not supplied

Review: feedback about practice patterns for measurable improvements in quality of care--a challenge for PROs under the Health Care Quality Improvement Program.

The Health Care Quality Improvement Program (HCQIP), administered by the Health Care Financing Administration and implemented through Utilization and Quality Control Peer Review Organizations (PROs), is a new approach to monitoring the health care received by Medicare beneficiaries. The HCQIP shifts the focus of the PRO program from regulatory quality management to quality improvement principles. Through a series of cooperative projects, each focusing on a specific medical condition or procedure, PROs will conduct pattern analysis and share information about these analyses with health care organizations for the purpose of stimulating internal quality improvement efforts. As a fundamental shift in the way PROs have conducted quality-related activities, the HCQIP presents PROs with numerous challenges. This paper provides insight into one of their most significant challenges, the development of a model for constructive, nonevaluative feedback. Successful HCQIP feedback efforts may serve as models for quality management programs that will accompany national health care reform.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2003

National and state trends in quality of care for acute myocardial infarction between 1994-1995 and 1998-1999: the medicare health care quality improvement program.

BACKGROUND: National efforts have focused attention on quality of care, but relatively little is known about whether, and to what extent, improvement has occurred during this recent period. Furthermore, the variability of the recent change over time is not known. METHODS: We sought to determine national and state trends in quality of care for Medicare patients hospitalized with acute myocardial infarction (AMI) between 1994-1995 (n = 234754 discharges) and 1998-1999 (n = 35713 discharges) as part of the Centers for Medicare & Medicaid Services (CMS) National AMI Project. We assessed change in evidence-based, guideline-recommended processes of care. RESULTS: Nationally, among patients without contraindications to therapy, discharge beta-blocker prescription increased by 20.5 percentage points (50.3% to 70.7%); early administration of beta-blocker increased by 17.4 percentage points (51.1% to 68.4%); discharge angiotensin-converting enzyme inhibitor prescription for systolic dysfunction increased by 8.0 percentage points (62.8% to 70.8%); early administration of aspirin increased by 6.6 percentage points (76.4% to 82.9%); and aspirin prescribed at discharge increased by 5.6 percentage points (77.3% to 82.9%) (P<.001 for all categories). Smoking cessation counseling decreased by 3.6 percentage points (40.8% to 37.2%; P<.001). Rates of acute reperfusion therapy did not significantly change (59.2% to 60.6%; P =.35). The median time from hospital arrival to initiation of thrombolytic therapy decreased by 7 minutes (P<.001); and the median time from hospital arrival to initiation of primary percutaneous transluminal coronary angioplasty decreased by 12 minutes (P =.09). CONCLUSIONS: During this 4-year period, quality of care for AMI improved, but substantial variation was observed at both time points. While meaningful population-based improvement has been achieved, ample opportunities for improvement exist. Further work is required to elucidate the strategies associated with improvements in quality of care.

Adrenergic beta-Antagonists↗
PubMed2003

Syndromic management of sexually transmitted diseases in Botswana's primary health care: quality of care aspects.

OBJECTIVES: To evaluate the quality of care of the syndromic management of sexually transmitted diseases (STDs) in Botswana's primary health care. METHODS: Participative observations of 224 consecutive consultations of patients with STDs (135 females and 89 males) by nurses. Twenty-one cases were excluded because no STD checklist was filled in. Criteria for acceptable history taking, physical examination and correct treatment were agreed upon. RESULTS: The quality of history taking and physical examination was acceptable for 25% and 23% of the women and for 54% and 57% of the men, respectively. Approximately, 65% of the women and 81% of the men received appropriate treatment. On average, consultations took 5.4 min for women and 4.6 min for men. STD contacts comprised 11% of STD cases. Advice on partner notification was provided to 66% of the women and 86% of men, and 75% and 89%, respectively, were counselled on the use of condoms. In half of the health facilities the lack of a fixed light source was the main constraint in carrying out a vaginal speculum examination. The availability of antibiotics and condoms was excellent. In 40% of the health facilities, all STD algorithms were displayed in the consultation room. CONCLUSION: One-third of women and one-fifth of men did not receive appropriate treatment for their STD, in spite of excellent provision of drugs. Although Botswana health workers perform relatively well on partner notification and counselling, there is considerable scope for improving the quality of medical history and clinical examination, especially in women. Emphasis should be given on training health workers in clinical examinations, in particular in pelvic examinations, and to supervision and in-service training.

Adolescent↗
PubMed1995

What is important in psychiatric outpatient care? Quality of care from the patient's perspective.

The development of quality assurance programmes for psychiatric care has increased the interest in quality of care and accountability from the patient's perspective. The aims of this study were threefold. First, to map descriptive characteristics of ideal outpatient psychiatric care through open-ended patient interviews, using a sample of 94 psychiatric outpatients, second, to have another sample of 84 outpatients rank the importance of 57 treatment characteristics extracted from the qualitative analysis of the interviews, and third to make comparisons with a previously performed investigation on quality of care of psychiatric inpatients. Results of the content analysis showed that characteristics of ideal outpatient treatment could be classified in eight content categories: accessibility of care, treatment content, staff-patient relationship, continuity of care, staff's professionalism, patient information/co-influence, treatment environment and cost of care. Results from the patients' rating of the importance of treatment characteristics showed that patients put the highest emphasis on staff's empathetic qualities in being interested, understanding, listening and respecting patients. Comparisons with the previously studied inpatient sample, showed great similarities in what was considered important to reach a satisfactory care situation. It is concluded that in order to secure content validity of investigations of the quality of psychiatric care from the patient's perspective, effort should be put into including the areas of staff-patient relationship and patient information and co-influence.

Adult↗
PubMed1993

What is important in psychiatric inpatient care? Quality of care from the patient's perspective.

The development of quality assurance programs for psychiatric care has increased the interest in quality of care and accountability from the patient's perspective. However, most investigations of patient satisfaction use instruments which rate aspects of care defined and held to be important by professionals and care givers. The aims of this study were 2-fold. To map descriptive characteristics of ideal inpatient psychiatric care through open patient interviews, using a sample of 78 hospitalized patients and, secondly, based on a content analysis of these interviews, to have another sample of 77 hospitalized patients rank the importance of 48 treatment characteristics extracted from the qualitative analysis. Results of the content analysis showed that characteristics of ideal inpatient treatment could be classified in six categories: staff-patient relationship, patient co-influence, treatment content, activities, ward atmosphere and staff competence. Results from the patients' rating of the importance of treatment characteristics showed that patients put the highest emphasis on staff empathic qualities: being caring, interested and understanding, respecting patients, devoting time to patients, and creating a safe treatment environment. The least importance was ascribed to characteristics of the physical environment and daily routines on the ward. It is concluded that in order to secure content validity of investigations of the quality of psychiatric inpatient care from the patient's perspective, effort should be put into including the areas of staff-patient relationships and patient information and co-influence.

Adult↗
PubMed1998

Diabetic patients in primary health care--quality of care three years apart.

OBJECTIVE: To compare registering of diabetic complications and metabolic control in diabetic subjects in primary health care in 1992 and 1995. DESIGN: Cross-sectional surveys of medical records. SETTING: Three community health centres in Stockholm County. SUBJECTS: Diabetic patients aged 18-84 years in 1992 (n = 177) and in 1995 (n = 413). MAIN OUTCOME MEASURES: Rate of noted diabetic complications and metabolic values. RESULTS: Retinopathy examination was noted in 64% in 1992 versus 65% in 1995, neuropathy examination in 44 versus 49%, and urine examination in 88% versus 73% (p < 0.001). HbA1c was examined in 52% in 1992 versus 68% (p < 0.001) in 1995, fasting blood glucose in 89 versus 90%, and cholesterol in 34 versus 42%. Acceptable HbA1c values were noted in 51% in 1992 versus 46% in 1995. Smoking habits were available in 26% in 1992 versus 53% in 1995 (p < 0.001) and BMI in 5 versus 39% (p < 0.001). Diabetic blindness was present in 2.2% in 1995, uraemia in 0.3%, and amputation due to gangrene in 1.2%. CONCLUSION: Documented examination rates of diabetic patients are unacceptably low, and the metabolic level unsatisfactory in most cases. Severe complications are, however, rare.

Adult↗