scholarly journals ISQUA17-2286IS HIGH QUALITY OF CARE ASSOCIATED WITH HIGHER COSTS? - A NATIONWIDE COHORT STUDY AMONG HIP FRACTURE PATIENTS

2017 ◽  
Vol 29 (suppl_1) ◽  
pp. 19-19
Author(s):  
P K Kristensen ◽  
R Søgaard ◽  
T M Thillemann ◽  
S P Johnsen
Keyword(s):  
Cohort Study ◽  
Quality Of Care ◽  
Hip Fracture ◽  
High Quality

High quality of care did not imply increased hospital spending— nationwide cohort study among hip fracture patients

2018 ◽  
Vol 31 (7) ◽  
pp. 22-29
Author(s):  
Pia Kjær Kristensen ◽  
Rikke Søgaard ◽  
Theis Muncholm Thillemann ◽  
Kjeld Søballe ◽  
Søren Paaske Johnsen
Keyword(s):  
Quality Of Care ◽  
Hip Fracture ◽  
Performance Measures ◽  
Hospital Costs ◽  
Public Hospitals ◽  
Process Performance ◽  
National Guidelines ◽  
High Quality ◽  
Cost Differences

Abstract Objective To examine whether fulfilment of process performance measures reflecting national guidelines is associated with in-hospital costs among hip fracture patients. Design Nationwide, population-based follow-up study. Setting Public hospitals in Denmark. Participants A total of 20 458 patients 65 years or older admitted with a hip fracture between 2010 and 2013. Intervention Quality of care defined as fulfilment of process performance measures reflecting recommendations from national clinical guidelines, which previously have been shown to be associated with lower mortality and readmission risk. The measures included systematic pain assessment; mobilisation within 24 h post-operatively; assessment of basic mobility before admission and discharge; and receiving a rehabilitation programme before discharge, anti-osteoporotic medication and fall prevention. Main outcome measures Total costs defined as the sum of hospital costs used for treating the individual patients according to the Danish Reference Cost Database. Results Within the index admission, fulfilling 50 to >75% of the performance measures was associated with lower adjusted costs (EUR 2643) than was fulfilling 0–50% of these measures (EUR 3544). The lower costs were mainly due to savings on further treatment and fewer bed days. Mobilisation within 24 h after surgery and assessment for need of anti-osteoporotic medication were associated with the largest cost differences, corresponding to adjusted cost differences of EUR 3030 and EUR 3538, respectively. The cost difference was lower when all costs related to hospitalisation within the first year were considered. Conclusions These findings indicate that high quality of care does not imply higher hospital spending and may be associated with cost savings.

scholarly journals Quality of care and 30 day mortality among patients with hip fractures: a nationwide cohort study

2009 ◽  
Vol 9 (1) ◽  
Author(s):  
Katrine A Nielsen ◽  
Niels C Jensen ◽  
Claus M Jensen ◽  
Marianne Thomsen ◽  
Lars Pedersen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Quality Of Care ◽  
Hip Fractures

scholarly journals Effect of Inpatient Quality of Care on Functional Outcomes in Patients With Hip Fracture

Medical Care ◽  
2006 ◽  
Vol 44 (9) ◽  
pp. 862-869 ◽  
Author(s):  
Albert L. Siu ◽  
Kenneth S. Boockvar ◽  
Joan D. Penrod ◽  
R Sean Morrison ◽  
Ethan A. Halm ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Hip Fracture ◽  
Functional Outcomes

scholarly journals Implementing Technology That Disrupts Health Systems but not Quality of Care: The Pocket Colposcope in Lima, Peru

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 34-34
Author(s):  
Marlee Krieger ◽  
Nimmi Ramanujam ◽  
Mary Elizabeth Dotson Libby
Keyword(s):  
Quality Of Care ◽  
Low Income ◽  
Value Chain ◽  
Ease Of Use ◽  
Patient Acceptance ◽  
Disruptive Technology ◽  
Global Value Chain ◽  
High Quality ◽  
Iron Triangle

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.

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

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)

PP30 ‘I can’t remember’ – patients views of receiving pain management from paramedics for suspected hip fracture

2019 ◽  
Vol 36 (1) ◽  
pp. e12.1-e12
Author(s):  
Bridie Evans ◽  
Alan Brown ◽  
Jenna Bulger ◽  
Greg Fegan ◽  
Simon Ford ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Hip Fracture ◽  
Pain Management ◽  
Prehospital Care ◽  
Face To Face ◽  
Experience Of Care ◽  
Ambulance Transport ◽  
Fascia Iliaca Compartment Block ◽  
To Receive

BackgroundUp to 40% of patients with suspected hip fracture report inadequate or no pre-hospital pain management. Morphine may raise risk of complications and may be avoided by paramedics. Fascia Iliaca Compartment Block (FICB) is used in Emergency Department and orthopaedic wards. The RAPID trial tested feasibility of paramedics administering FICB to patients with suspected hip fracture.ObjectiveTo explore patients’ views and experience of care received for suspected hip fracture and in particular FICB before ambulance transport to hospital.MethodWe interviewed six patients and the daughter of a patient who received FICB to manage their suspected hip fracture. Interviews, by telephone or face-to-face, were audio-recorded with consent. We conducted thematic analysis of transcripts. Two researchers, one paramedic and one lay member were in the analysis teamResultsRespondents’ memory of prehospital care was dominated by their experience of extreme pain. While they recalled events before falling, they only had partial memory of care prior to hip surgery. Although they recalled paramedics’ arrival, which they reported was up to six hours after their injury, respondents said they remembered little else. Just one recalled consenting to receiving FICB and could describe the process. Other respondents said they were in too much pain to comprehend what occurred or respond coherently. They explained their priority was to receive pain management and they expected the paramedics to treat them safely and effectively. Respondents appeared to be a stoical and trusting group who accepted the treatment they were offered. They did recall high quality of care and praised paramedics for their reassuring and calm manner.ConclusionsHip fracture patients’ overwhelming memory of injury and treatment was of pain and their priority was to receive pain relief. The quality of care, reassurance and administration of pain management was more important to patients than the mechanism of delivering the intervention.

Telestroke and Teleneurology

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.

scholarly journals Can the adherence to quality of care indicators for early rheumatoid arthritis in clinical practice reduce risk of hospitalisation? Retrospective cohort study based on the Record Linkage of Rheumatic Disease study of the Italian Society for Rheumatology

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038295
Author(s):  
Anna Zanetti ◽  
Carlo Alberto Scirè ◽  
Lisa Argnani ◽  
Greta Carrara ◽  
Antonella Zambon
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Quality Of Care ◽  
Retrospective Cohort Study ◽  
Lower Risk ◽  
Retrospective Cohort ◽  
Quality Standards ◽  
Standards Of Care ◽  
Adherence Score

ObjectiveTo describe the adherence to quality of care indicators in early rheumatoid arthritis (RA) and to evaluate its impact on the risk of hospitalisation in a real-world setting.DesignRetrospective cohort study.SettingPatients with early-onset RA identified from healthcare regional administrative databases by means of a validated algorithm between 2006 and 2012 in the Lombardy region (Italy).ParticipantsThe study cohort included 14 203 early-onset RA (71% female, mean age 60 years).Outcome measuresFor each patient, a summary adherence score was calculated starting from the compliance to six quality indicators: (1–2) methotrexate or sulfasalazine or leflunomide with/without glucocorticoids, (3–4) other disease-modifying antirheumatic drugs (DMARDs) with/without glucocorticoids, (5) early interruption of glucocorticoids, (6) early clinical assessment.The relationship between low, intermediate and high categories of the summary score and the 12-month risk of hospitalisation for all causes and for RA was assessed.ResultsDuring a follow-up of 1 year, 2609 hospitalisations occurred, of which 704 were for RA (main or secondary diagnosis) and 252 primarily for RA. In a 7-year period (2006–2012), early DMARDs and timely clinical monitoring treatment increased (from 52% to 62% p trend <0.001 and from 25% to 30% p trend 0.009, respectively).Intermediate and high summary adherence score categories (compared with the low category) were related significantly with a lower risk of hospitalisation (adjusted HR 0.85 (95% CI 0.77 to 0.93), p<0.001 and HR 0.76 (95% CI 0.69 to 0.84), p<0.001, respectively). Among the indicators of the adherence score, early DMARD prescription showed the strongest positive impact, while long-term use of glucocorticoids was the worst negative one.ConclusionIn early RA, adherence to quality standards of care is associated with a lower risk of hospitalisation. Future interventions to improve the adherence to quality standards of care in this setting should decrease the risk of hospitalisation with a significant impact on individual and population health.

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