International journal for quality in health care : journal of the International Society for Quality in Health Care
-
Int J Qual Health Care · Feb 1998
The impact of a multidisciplinary approach on caring for ventilator-dependent patients.
To determine the clinical and financial outcomes of a highly structured multidisciplinary care model for patients in an intensive care unit (ICU) who require prolonged mechanical ventilation. The structured model outcomes (protocol group) are compared with the preprotocol outcomes. ⋯ Implementation of a structured multidisciplinary care model to care for a heterogeneous population of ventilator-dependent ICU patients was associated with significant reductions in ICU and hospital lengths of stay, charges, and costs. Mortality rates were unaffected.
-
Int J Qual Health Care · Oct 1997
The policy implications of using hospital and physician volumes as "indicators" of quality of care in a changing health care environment.
There is growing interest in the quality of health care and in using quality measures to direct patients to hospitals and providers offering high quality, low cost health care. The dilemma is that, while there is an increasing need for quality indicators as a result of a changing health care environment, this changing environment has important implications for the use of some of these measures. Since the 1970s, a growing body of research in the U. ⋯ S. We then discuss policy considerations and cautions in using volumes, along with suggestions for future research. Our purpose is to point out potential problems and clarify confusions about the use of volumes, so that policymakers and practitioners can be sensitive to the potential minefields they are traversing.
-
Int J Qual Health Care · Jun 1997
Multicenter StudyThe relationship between choice of outcome measure and hospital rank in general surgical procedures: implications for quality assessment.
Institutional complication rates are often used to assess hospital quality of care, particularly for conditions and procedures where mortality rates are not useful because deaths are rare. The objective of this study was to assess the correlation among hospital quality assessment rankings based on adjusted mortality, complication and failure-to-rescue rates. ⋯ For general surgical procedures, hospital rank using the complication rate is poorly correlated with rankings using the death or failure rate. Complication rates should be used with great caution and should not be used in isolation when assessing hospital quality of care.
-
Int J Qual Health Care · Feb 1997
Patients' satisfaction with surgical care impaired by cuts in expenditure and after interventions to improve nursing care at a surgical clinic.
Between 1991 and 1994 the number of beds in the surgical clinic at a central hospital in Southern Sweden was cut back by almost 50%. To develop the nursing care and to control the effects of the budgetary cuts, an intervention, including nursing care development, of an organization that would secure continuity in the nurse-patient relationship, individually planned care and quality assurance for aspects believed to be crucial to the quality of nursing care was implemented. The aim of this study was to analyse patients' satisfaction with surgical nursing care between, under and after the last cut in expenditure and the concluded intervention. ⋯ Subsample analysis showed lower scores for patient satisfaction if the respondents were women, young, or acutely ill when admitted. While surveys carried out between 1991 and 1993 showed an overall improvement in the quality of care, as measured by patient satisfaction, it remained at the same level in 1994 as in 1993, or decreased, regarding patient contacts with staff and physicians, involvement in decision-making, anxiety before examination/treatment, anxiety regarding professional secrecy, opportunity to influence the solution to their physical problems, chance to get sleep without being disturbed, physical nursing care and preparations before discharge. Thus a deterioration in quality seemed to take place in 1994 indicating that the cuts in expenditure may have been too hard and had been made at the expense of patient satisfaction.
-
Int J Qual Health Care · Dec 1996
Influence of location and staff knowledge on quality of retail pharmacy prescribing for childhood diarrhea in Kenya.
Retail pharmacies are important sources of advice on pharmaceuticals in developing countries, where many purchasing decisions are unmediated by medical professionals. For childhood diarrhea, choice of drug sales in pharmacies has been found to be consistently poor, whether with or without prescription, as evidenced by a low use of effective oral rehydration salts (ORS) and high use of marginally effective or ineffective products such as antimotility agents, adsorbents, and antimicrobials. Little information is available about factors influencing prescribing by pharmacy personnel in these settings. This paper reports results of an analysis which examined the influence of rural versus urban location, neighborhood socio-economic status (SES), and clinical knowledge of pharmacy assistants on quality of prescribing in retail pharmacies in Kenya. ⋯ Location of a retail pharmacy in a rural area or in a low-income urban neighborhood was associated with suboptimal quality of prescribing as evidenced by lower use of ORS. No relationship between clinical knowledge and quality of practice was detected. Future research is needed to examine such factors as the influence of intra-pharmacy authority structure, perceived efficacy of pharmaceuticals, local patterns of physician practice, and economic incentives on the quality of prescribing.