COVID-19 Pandemic and Consecutive Changes in Geriatric Rehabilitation Structures and Processes - A Deeper Attempt to Explain the COVID Rehabilitation Paradox (Lessons to Learn to Ensure High Quality of Care in GR Services)

PURPOSE Innovative devices are often targeted at increasing access, improving quality, or reducing costs—the three axes of the infamous Iron Triangle of Health Care, which are notoriously difficult to simultaneously optimize. The main aim of this study was to demonstrate that disruptive technologies, if high quality and appropriately implemented, can result in improved access, cost, and quality of care, overcoming the conventional constraints of the Iron Triangle framework. METHODS Our team conducted a global value chain analysis of the Pocket Colposcope in Lima, Peru, and developed surveys and conducted in-depth interviews to evaluate Pocket Colposcope stakeholders. All surveys were developed with consultations from the Duke Evidence Lab and had institutional review board approval. RESULTS The global value chain identified 5 leverage points: regulatory approval, task shifting, collaboration, telemedicine, and patient acceptance. We also identified stakeholders and processes that affect the degree to which the Pocket Colposcope is successfully implemented. Of women surveyed, 39.4% answered that they had previously wanted a cervical cancer screening test, but had been unable to receive one as a result of some barrier. The most common responses were distance to clinics (31.0%), participants could not leave work (27.6%), and patients were afraid of receiving a cancer diagnosis (20.7%). All 4 midwives who participated in the focus group identified the portability of the Pocket Colposcope as the device’s most appealing feature. Providers identified the quality of the image, cost to patient, and ease of use as the 3 most important aspects of the Pocket Colposcope. CONCLUSION The Pocket Colposcope provides an opportunity to make high-quality diagnostic technology more accessible at a cheaper price for more people. Often, disruptive technology in low-income settings is expected to increase access at the cost of reducing quality. In the case of the Pocket Colposcope, the disruptive technology is significantly cheaper than existing technology, but quality is still high enough to succeed.

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P3415Will less developed countries be capable of giving high-quality universal coverage to cardiovascular disease survivors? Results from a national health survey, Chile ENS 2016–2017

European Heart Journal ◽

10.1093/eurheartj/ehz745.0289 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P Margozzini ◽

A Passi ◽

M Kruk ◽

G Danaei

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Care ◽

Quality Of Care ◽

National Health ◽

Health Survey ◽

Universal Coverage ◽

National Health Survey ◽

High Quality

Abstract Background Chilean Health System has fully implemented Universal Health Coverage (UHC) for acute cardiovascular events since 2005. Age-adjusted cardiovascular mortality has decreased, but there is limited information about coverage and quality of chronic health care given to cardiovascular disease (CVD) survivors at the national level. Purpose To assess the prevalence and quality of care in Chilean adult CVD survivors. Methods Chilean National Health Survey 2016–2017 (ENS 2016–2017) is a random stratified multistage sample of non-institutionalized population over 14 years (n=6240). Age, education, gender, rural/urban and geographical area weighted prevalence of CVD survivors (self-reported medical diagnosis of myocardial infarction or cerebrovascular attack) were calculated. High quality of care was defined as meeting six criteria simultaneously: under 70mg% LDL- C level, statin use, aspirin use, blood pressure under 130/80 mmHg, HgA1C<7 or 8 (>74-year-old) and non-smoking. Quality of care was explored using multivariate linear and logistic regression adjusting by age, gender, education and year of diagnosis (before or after UHC). Results Weighted national prevalence of CVD survivors in over 20-year-old population was 6.1%. The sample size for the CVD survivor analyses was n=455. 28.7% of CVS had their first event before the year 2005 (n=141). Overall 27.9% had LDL-C under 70mg%, 37.8% used statins, 41.4% used aspirin, 37.8% had controlled blood pressure, 78.3% were non-smokers and 84.3% had good glycemic control. National “high quality of care” prevalence in CVD survivors was 0.3%, 0.4% and 0.1% for men and women respectively. LDL and Blood pressure control prevalence (meet both criteria simultaneously) was 4,4%. In the adjusted multivariate model age was associated to a higher number of quality criteria achievement. Conclusion The number of CVD survivors in Chile is a huge challenge for the health care system. Universal coverage does not guarantee the quality of chronic life long care. Specific surveillance in high-risk population is needed to assess the system's effectiveness and accountability. Acknowledgement/Funding ENS 2016-2017 was funded by the chilean Ministry of Health (MINSAL)

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Telestroke and Teleneurology

10.1093/med/9780190066475.003.0008 ◽

2021 ◽

pp. 95-108

Author(s):

Hartmut Gross ◽

Jeffrey A. Switzer

Keyword(s):

Health Care ◽

Quality Of Care ◽

Health Care Professionals ◽

Stroke Patients ◽

High Quality ◽

Optimal Care ◽

Widespread Application ◽

Rural Sites ◽

Physician Liability

Evaluation and treatment of acute stroke is the oldest and most widespread application of telemedicine. Telestroke systems allow provision of the same high quality of care provided at specialized stroke centers to patients at emergency departments without stroke coverage. The early treatment achieved with telestroke leads to better functional outcomes in stroke patients, thereby lowering overall cost of patient care. Telestroke networks facilitate optimal care, decrease hospital and physician liability, educate health care professionals, and keep many patients closer to home. Admissions to, rather than transfers from, rural sites retain hospitalization revenues locally and help keep small, financially struggling hospitals viable.

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Characteristics of primary care practices associated with high quality of care

Canadian Medical Association Journal ◽

10.1503/cmaj.121802 ◽

2013 ◽

Vol 185 (12) ◽

pp. E590-E596 ◽

Cited By ~ 37

Author(s):

M.-D. Beaulieu ◽

J. Haggerty ◽

P. Tousignant ◽

J. Barnsley ◽

W. Hogg ◽

...

Keyword(s):

Primary Care ◽

Quality Of Care ◽

High Quality ◽

Care Practices ◽

Primary Care Practices

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FUTURE DIRECTIONS: DISSEMINATION OF STANDARDIZED GERIATRIC SURGERY CARE NATIONALLY

Innovation in Aging ◽

10.1093/geroni/igz038.1489 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S401-S401

Author(s):

Mark Katlic

Keyword(s):

Older Adults ◽

Quality Of Care ◽

Surgical Care ◽

First Year ◽

Geriatric Surgery ◽

High Quality ◽

Future Directions ◽

Medical Centers ◽

National Initiative

Abstract The American College of Surgeon’s Coalition for Quality in Geriatric Surgery will formally launch a national initiative aimed to improve the quality of surgical care for all older adults in July 2019. The first-year goal will be to recruit and successfully verify 100+ medical centers. This presentation will provide an overview of dissemination efforts for the standards set for providing high quality surgical care for older adults as well as processes to measure the quality of care provided to older adults at these medical centers. It our vision that this national initiative will lead the effort to the improvement of surgical care of all older adults.

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An Environmental Scan and Evaluation of Home Dialysis Quality Indicators Currently Used in Canada

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120977391 ◽

2020 ◽

Vol 7 ◽

pp. 205435812097739

Author(s):

Lisa Dubrofsky ◽

Ali Ibrahim ◽

Karthik Tennankore ◽

Krishna Poinen ◽

Sachin Shah ◽

...

Keyword(s):

Quality Improvement ◽

Quality Of Care ◽

Peritoneal Dialysis ◽

Quality Indicators ◽

Patient Centered ◽

High Quality ◽

Home Dialysis ◽

Environmental Scan ◽

Starting Point

Background: Quality indicators are important tools to measure and ultimately improve the quality of care provided. Performance measurement may be particularly helpful to grow disciplines that are underutilized and cost-effective, such as home dialysis (peritoneal dialysis and home hemodialysis). Objective: To identify and catalog home dialysis quality indicators currently used in Canada, as well as to evaluate these indicators as a starting point for future collaboration and standardization of quality indicators across Canada. Design: An environmental scan of quality indicators from provincial organizations, quality organizations, and stakeholders. Setting: Sixteen-member pan-Canadian panel with expertise in both nephrology and quality improvement. Patients: Our environmental scan included indicators relevant to patients on home dialysis. Measurements: We classified existing indicators based on the Institute of Medicine (IOM) and Donabedian frameworks. Methods: To evaluate the indicators, a 6-person subcommittee conducted a modified version of the Delphi consensus technique 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 further examination. We rated items from 1 to 9 on 6 domains (1-3 does not meet criteria to 7-9 meets criteria) as well as a global final rating (1-3 unnecessary to 7-9 necessary) to distinguish high-quality from low-quality indicators. Results: Overall, we identified 40 quality indicators across 7 provinces, with 22 (55%) rated as “necessary” to distinguish high quality from poor quality care. Ten indicators were measured by more than 1 province, and 5 of these indicators were rated as necessary (home dialysis prevalence, home dialysis incidence, anemia target achievement, rates of peritonitis associated with peritoneal dialysis, and home dialysis attrition). None of these indicators captured 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. Conclusions: These results provide Canadian home dialysis programs with a starting point on how to measure quality of care along with the current gaps. This work is an initial and necessary step toward future collaboration and standardization of quality indicators across Canada, so that home dialysis programs can access a smaller number of highly rated balanced indicators to motivate and support patient-centered quality improvement initiatives.

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The Admin Effect: Managing the Orthodontic Patient Journey to Ensure Patient Satisfaction and Quality of Care

Primary Dental Journal ◽

10.1308/205016816820209433 ◽

2016 ◽

Vol 5 (4) ◽

pp. 61-62

Author(s):

Isobel Fennell ◽

Suzi Rammell ◽

Jen Blakeman

Keyword(s):

Patient Satisfaction ◽

Quality Of Care ◽

Positive Experience ◽

High Quality ◽

Patient Journey ◽

Seamless Care

By continually assessing the administrative processes we aim to ensure the patient's journey is a positive experience from the outset. We are able to review and adopt change where necessary and recognise areas in need of modification. Being proactive as a team is paramount in providing high quality and seamless care for our patients at all times.

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Practice-Changing Strategies to Deliver Affordable, High-Quality Cancer Care: Summary of an Institute of Medicine Workshop

Journal of Oncology Practice ◽

10.1200/jop.2013.001123 ◽

2013 ◽

Vol 9 (6S) ◽

pp. 54s-59s ◽

Cited By ~ 6

Author(s):

Erin P. Balogh ◽

Peter B. Bach ◽

Peter D. Eisenberg ◽

Patricia A. Ganz ◽

Robert J. Green ◽

...

Keyword(s):

Quality Of Care ◽

21St Century ◽

Cancer Care ◽

Institute Of Medicine ◽

High Quality ◽

Quality Cancer Care

The authors summarize presentations and discussion from the Delivering Affordable Cancer Care in the 21st Century workshop and focus on proposed strategies to improve the affordability of cancer care while maintaining or improving the quality of care.

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