International journal for quality in health care : journal of the International Society for Quality in Health Care
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Int J Qual Health Care · Feb 2003
Review Comparative StudyDevelopment of appropriateness criteria for colonoscopy: comparison between a standardized expert panel and an evidence-based medicine approach.
To assess the degree of agreement between appropriateness criteria for the use of colonoscopy developed by a standardized expert panel method and evidence from published studies. ⋯ Evidence for the appropriateness of most indications for colonoscopy could not be derived directly from the published literature. Agreement between appropriateness criteria developed by an expert panel and evidence from published studies was moderate to good, where available. New approaches should be sought in order to systematically integrate complementary evidence obtained from clinical trials and expert panels into practice guidelines.
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Int J Qual Health Care · Jun 2000
ReviewClinical indicators in accreditation: an effective stimulus to improve patient care.
The Australian Council on Healthcare Standards (ACHS) established the Care Evaluation Program (CEP) of clinical performance measures in its accreditation program to increase the clinical component of that program and to increase medical practitioner involvement in formal quality activities in their health care organizations. From the introduction of a set of generic indicators in 1993 the program expanded through all of the various medical disciplines and from January 2000 there will be 18 sets (well over 200 indicators) in the program. More than half of Australia's acute hospitals (covering the majority of patient separations) are monitoring the indicators and reporting clinical data twice yearly to the ACHS. ⋯ The program remains unique in the scope of the medical disciplines covered and in the formal provider involvement with indicator development. Both the clinical component of accreditation and clinician involvement in quality activities have been increased in an educational process. However, not all of the indicators are of equal value and a reduction in the number of indicators to a 'core' group of the most reliable and responsive ones is in process.
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Int J Qual Health Care · Feb 1999
ReviewDevelopment and application of a generic methodology to assess the quality of clinical guidelines.
Despite clinical guidelines penetrating every aspect of clinical practice and health policy, doubts persist over their ability to improve patient care. We have designed and tested a generic critical appraisal instrument, that assesses whether developers have minimized the biases inherent in creating guidelines, and addressed the requirements for effective implementation. ⋯ Use of this instrument should encourage developers to create guidelines that reflect relevant research evidence more accurately. Potential users or groups adapting guidelines for local use could apply the instrument to help decide which one to follow. The National Health Service Executive is using the instrument to assist in deciding which guidelines to recommend to the UK National Health Service. This methodology forms the basis of a common approach to assessing guideline quality in Europe.
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The concept of cultural safety arose from the colonial context of New Zealand society. In response to the poor health status of Maori, the indigenous people of New Zealand, and their insistence that service delivery change profoundly, nursing has begun a process of self examination and change in nursing education, prompted by Maori nurses. Nursing and midwifery organizations moved to support this initiative as something which spoke truly of nursing and New Zealand society. ⋯ But its introduction into nursing education has been controversial. It became highly publicized in the national media, and the role and function of the Nursing Council of New Zealand was questioned. This paper discusses the New Zealand experience of introducing cultural safety into nursing education.