Patient assessment of quality of care in a chronic peritoneal dialysis facility

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.

Download Full-text

Quality of care for people with dementia in general hospitals: national cross-sectional audit of patient assessment

Clinical Medicine ◽

10.7861/clinmedicine.14-5-490 ◽

2014 ◽

Vol 14 (5) ◽

pp. 490-494 ◽

Cited By ~ 8

Author(s):

Renata Souza ◽

Aarti Gandesha ◽

Chloe Hood ◽

Robert Chaplin ◽

John Young ◽

...

Keyword(s):

Quality Of Care ◽

Patient Assessment ◽

Cross Sectional ◽

General Hospitals ◽

People With Dementia

Download Full-text

Patients’ Assessment of Care for Type 2 Diabetes: Results of the Patient Assessment of Chronic Illness Care Scale in A Danish Population

10.21203/rs.3.rs-61735/v1 ◽

2020 ◽

Author(s):

Anne Frølich ◽

Ann Nielsen ◽

Charlotte Glümer ◽

Hanne Birke ◽

Christian U Eriksen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Quality Of Care ◽

Chronic Illness ◽

Diabetes Care ◽

Emergency Department Visits ◽

Descriptive Statistics ◽

Chronic Illness Care ◽

Patient Assessment

Abstract Background: The Patient Assessment of Chronic Illness Care (PACIC) scale is the most appropriate for assessing self-reported experience in chronic care. However, it has yet to be validated in a Danish diabetes population. We aimed to validate the PACIC, assess the quality of care for Danish patients with type 2 diabetes, and identify factors associated with quality of care. Methods: A survey of 7,745 individuals randomly selected from the National Diabetes Registry. Descriptive statistics inter-item and item-rest correlations and factor analysis assessed the PACIC properties. Quality of care was analysed with descriptive statistics; linear and multiple regression assessed the effect of forty-nine covariates on total and subscale scores. Results: In total, 2,696 individuals with type 2 diabetes completed ≥ 50% of items. The floor effect for individual items was 8.5-74.5%; the ceiling effect was 4.1- 47.8 %. Cronbach’s alpha was 0.73-0.86 for the five subscales. The comparative fit index (CFI) and the Tucker–Lewis index (TLI) were 0,87, and 0,84, respectively. Mean PACIC score was 2.44 (± 0.04). Respondents receiving rehabilitation and reporting primary of diabetes care had higher total mean scores; those 70 years or older had lower mean total and subscale scores. A higher number of diabetes visits were associated with higher total scores; higher number of emergency department visits were associated with lower total scores. The effect of healthcare utilisation on subscale scores varied. Conclusions: Floor effects suggest a need for further evaluation of the PACIC questionnaire in Danish settings. Total PACIC scores were lower than in other healthcare systems, possibly being a result of different contexts and cultures, and of a need for improving diabetes care in Denmark.

Download Full-text

Trends in Peritoneal Dialysis Use in the United States after Medicare Payment Reform

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.05910519 ◽

2019 ◽

Vol 14 (12) ◽

pp. 1763-1772 ◽

Cited By ~ 12

Author(s):

Caroline E. Sloan ◽

Cynthia J. Coffman ◽

Linda L. Sanders ◽

Matthew L. Maciejewski ◽

Shoou-Yih D. Lee ◽

...

Keyword(s):

United States ◽

Peritoneal Dialysis ◽

Regression Models ◽

Prospective Payment System ◽

The United States ◽

Payment Reform ◽

Logistic Regression Models ◽

Medicare Data ◽

Dialysis Facility

Background and objectivesPeritoneal dialysis (PD) for ESKD is associated with similar mortality, higher quality of life, and lower costs compared with hemodialysis (HD), but has historically been underused. We assessed the effect of the 2011 Medicare prospective payment system (PPS) for dialysis on PD initiation, modality switches, and stable PD use.Design, setting, participants, & measurementsUsing US Renal Data System and Medicare data, we identified all United States patients with ESKD initiating dialysis before (2006–2010) and after (2011–2013) PPS implementation, and observed their modality for up to 2 years after dialysis initiation. Using logistic regression models, we examined the associations between PPS and early PD experience (any PD 1–90 days after initiation), late PD use (any PD 91–730 days after initiation), and modality switches (PD-to-HD or HD-to-PD 91–730 days after initiation). We adjusted for patient, dialysis facility, and regional characteristics.ResultsOverall, 619,126 patients with incident ESKD received dialysis at Medicare-certified facilities, 2006–2013. Observed early PD experience increased from 9.4% before PPS to 12.6% after PPS. Observed late PD use increased from 12.1% to 16.1%. In adjusted analyses, PPS was associated with increased early PD experience (odds ratio [OR], 1.51; 95% confidence interval [95% CI], 1.47 to 1.55; P<0.001) and late PD use (OR, 1.47; 95% CI, 1.45 to 1.50; P<0.001). In subgroup analyses, late PD use increased in part due to an increase in HD-to-PD switches among those without early PD experience (OR, 1.59; 95% CI, 1.52 to 1.66; P<0.001) and a decrease in PD-to-HD switches among those with early PD experience (OR, 0.92; 95% CI, 0.87 to 0.98; P=0.004).ConclusionsMore patients started, stayed on, and switched to PD after dialysis payment reform. This occurred without a substantial increase in transfers to HD.

Download Full-text

The Teamwork Study: enhancing the role of non-GP staff in chronic disease management in general practice

Australian Journal of Primary Health ◽

10.1071/py11071 ◽

2013 ◽

Vol 19 (3) ◽

pp. 184 ◽

Cited By ~ 12

Author(s):

D. A. Black ◽

J. Taggart ◽

U. W. Jayasinghe ◽

J. Proudfoot ◽

P. Crookes ◽

...

Keyword(s):

Quality Of Care ◽

Chronic Disease ◽

Chronic Illness ◽

Team Work ◽

Chronic Illness Care ◽

Patient Assessment ◽

Significant Difference ◽

The Impact

There is evidence for a team-based approach in the management of chronic disease in primary health care. However, the standard of care is variable, probably reflecting the limited organisational capacity of health services to provide the necessary structured and organised care for this group of patients. This study aimed to evaluate the impact of a structured intervention involving non-GP staff in GP practices on the quality of care for patients with diabetes or cardiovascular disease. A cluster randomised trial was undertaken across 60 GP practices. The intervention was implemented in 30 practices with staff and patients interviewed at baseline and at 12–15 months follow up. The change in team roles was evaluated using a questionnaire completed by practice staff. The quality of care was evaluated using the Patient Assessment of Chronic Illness Care questionnaire. We found that although the team roles of staff improved in the intervention practices and there were significant differences between practices, there was no significant difference between those in the intervention and control groups in patient-assessed quality of care after adjusting for baseline-level score and covariates at the 12-month follow up. Practice team roles were not significantly associated with change in Patient Assessment of Chronic Illness Care scores. Patients with multiple conditions were more likely to assess their quality of care to be better. Thus, although previous research has shown a cross-sectional association between team work and quality of care, we were unable to replicate these findings in the present study. These results may be indicative of insufficient time for organisational change to result in improved patient-assessed quality of care, or because non-GP staff roles were not sufficiently focussed on the aspects of care assessed. The findings provide important information for researchers when designing similar studies.

Download Full-text

A155 QUALITY OF CARE IN THE INFLAMMATORY BOWEL DISEASES (IBD) CENTER FROM A TERTIARY REFERRAL HOSPITAL: PATIENT ASSESSMENT STRATEGY AT REFERRAL

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwy009.155 ◽

2018 ◽

Vol 1 (suppl_2) ◽

pp. 231-231

Author(s):

S Restellini ◽

L Gonczi ◽

Z Kurti ◽

W Afif ◽

T Bessissow ◽

...

Keyword(s):

Quality Of Care ◽

Inflammatory Bowel Diseases ◽

Hospital Patient ◽

Patient Assessment ◽

Tertiary Referral ◽

Tertiary Referral Hospital ◽

Assessment Strategy ◽

Bowel Diseases ◽

Inflammatory Bowel

Download Full-text

Patients' assessment of care for type 2 diabetes: Results of the Patient Assessment of Chronic Illness Care scale in a Danish population

BMC Health Services Research ◽

10.1186/s12913-021-07051-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anne Frølich ◽

Ann Nielsen ◽

Charlotte Glümer ◽

Christian U Eriksen ◽

Helle Terkildsen Maindal ◽

...

Keyword(s):

Type 2 Diabetes ◽

Quality Of Care ◽

Chronic Illness ◽

Diabetes Care ◽

Descriptive Statistics ◽

Chronic Illness Care ◽

Patient Assessment ◽

Danish Population

Abstract Background The Patient Assessment of Chronic Illness Care (PACIC) scale is the most appropriate for assessing self-reported experience in chronic care. We aimed to validate the PACIC questionnaire by (1) assess patients’ perception of the quality of care for Danish patients with type 2 diabetes, (2) identify which factors are most important to the quality of care designated by the five subscales in PACIC, and (3) the validity of the questionnaire. Methods A survey of 7,745 individuals randomly selected from the National Diabetes Registry. Descriptive statistics inter-item and item-rest correlations and factor analysis assessed the PACIC properties. Quality of care was analysed with descriptive statistics; linear and multiple regression assessed the effect of forty-nine covariates on total and subscale scores. Results In total, 2,696 individuals with type 2 diabetes completed ≥ 50 % of items. The floor effect for individual items was 8.5–74.5 %; the ceiling effect was 4.1–47.8 %. Cronbach’s alpha was 0.73–0.86 for the five subscales. The comparative fit index (CFI) and the Tucker–Lewis index (TLI) were 0,87, and 0,84, respectively. Mean PACIC score was 2.44 (± 0.04). Respondents, who receive diabetes care primarily at general practice and outpatient clinics had higher scores compared to those receiving care at a private specialist. Receiving rehabilitation was followed by higher scores in all subscales. Those 70 years or older had lower mean total and subscale scores compared to younger patient groups. A higher number of diabetes visits were associated with higher total scores; a higher number of emergency department visits were associated with lower total scores. The effects of healthcare utilisation on subscale scores varied. Conclusions These results provide insight into variations in the quality of provided care and can be used for targeting initiatives towards improving diabetes care. Factors important to the quality of perceived care are having a GP or hospital outpatient clinic as the primary organization. Also having a higher number of visits to the two organizations are perceived as higher quality of care as well as participating in a rehabilitation program. Floor and ceiling effects were comparable to an evaluation of the PACIC questionnaire in a Danish population. Yet, floor effects suggest a need for further evaluation and possible improvement of the PACIC questionnaire in a Danish setting. Total PACIC scores were lower than in other healthcare systems, possible being a result of different contexts and cultures, and of a need for improving diabetes care in Denmark.

Download Full-text