scholarly journals Listening to older voices: results of a cross-sectional survey of older patient-reported experiences of facility-based healthcare in Nouna, Burkina Faso

2021 ◽  
Author(s):  
Ellen Miriam Goldberg ◽  
Mamadou Bountogo ◽  
Guy Harling ◽  
Till Baernighausen ◽  
Justine R Davies ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Burkina Faso ◽  
System Quality ◽  
Cross Sectional ◽  
Quality Outcomes ◽  
Healthcare Needs ◽  
Patient Reported ◽  
Aging Populations ◽  
Health System Quality

Abstract Background: Ensuring responsive healthcare which meets patient expectations and generates trust is important to increase rates of access and retention. This need is important for aging populations where non-communicable diseases (NCDs) are a growing cause of morbidity and mortality. Methods: We performed a cross-sectional household survey including socio-demographic, morbidities, and health system utilization, responsiveness, and quality outcomes in individuals over age 40 in northwestern Burkina Faso. We describe results and use exploratory factor analysis to derive a contextually appropriate grouping of health system responsiveness (HSR) variables. We used linear or logistic regression to explore associations between socio-demographics, morbidities, and the grouped-variable, then between these variables and health system quality outcomes. Results: Of 2,639 eligible respondents, 26.8% had least one NCD, 56.3% were frail or pre-frail and 23.9% had a recent visit, including only 1/3 of those with an NCD. Highest ratings of care experience (excellent/very good) included ease of following instructions (86.1%) and trust in provider skills (81.1%). The HSR grouping with the greatest factor loading included involvement in decision-making, clarity in communication, trust in the provider, and confidence in provider skills, termed as Shared Understanding and Decision Making (SUDM). In multivariable analysis, higher quality of life (OR 1.02,95%CI 1.01-1.04), frailty (OR 1.47,95%CI 1.00-2.16), and SUDM (OR 1.06,95%CI 1.05-1.09) were associated with greater health system trust and confidence. SUDM was associated with overall positive assessment of the healthcare system (OR 1.02,95%CI 1.01-1.03) and met healthcare needs (OR 1.09,95%CI 1.08-1.11). Younger age and highest wealth quintile were also associated with higher met needs. Conclusions: Recent healthcare access was low for people with existing NCDs, and SUDM was the most consistent factor associated with higher health system quality outcomes. Results highlight the need to increase continuity of care for aging populations with NCDs and explore strengthening SUDM to achieve this goal.

scholarly journals Non-fatal injuries in rural Burkina Faso amongst older adults, disease burden and health system responsiveness: a cross-sectional household survey

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045621
Author(s):  
John Whitaker ◽  
Guy Harling ◽  
Ali Sie ◽  
Mamadou Bountogo ◽  
Lisa R Hirschhorn ◽  
...  
Keyword(s):  
Health System ◽  
Burkina Faso ◽  
Disease Burden ◽  
Household Survey ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Patient Reported ◽  
Reported Health ◽  
System Responsiveness ◽  
Health System Responsiveness

ObjectivesThis study aimed to evaluate the epidemiology of injury as well as patient-reported health system responsiveness following injury and how this compares with non-injured patient experience, in older individuals in rural Burkina Faso.DesignCross-sectional household survey. Secondary analysis of the CRSN Heidelberg Ageing Study dataset.SettingRural Burkina Faso.Participants3028 adults, over 40, from multiple ethnic groups, were randomly sampled from the 2015 Nouna Health and Demographic Surveillance Site census.Primary and secondary outcome measuresPrimary outcome was incidence of injury. Secondary outcomes were incidence of injury related disability and patient-reported health system responsiveness following injury.Results7.7% (232/3028) of the population reported injury in the preceding 12 months. In multivariable analyses, younger age, male sex, highest wealth quintile, an abnormal Generalised Anxiety Disorder score and lower Quality of Life score were all associated with injury. The most common mechanism of injury was being struck or hit by an object, 32.8%. In multivariable analysis, only education was significantly negatively associated with odds of disability (OR 0.407, 95% CI 0.17 to 0.997). Across all survey participants, 3.9% (119/3028) reported their most recent care seeking episode was following injury, rather than for another condition. Positive experience and satisfaction with care were reported following injury, with shorter median wait times (10 vs 20 min, p=0.002) and longer consultation times (20 vs 15 min, p=0.002) than care for another reason. Injured patients were also asked to return to health facilities more often than those seeking care for another reason, 81.4% (95% CI 73.1% to 87.9%) vs 54.8% (95% CI 49.9% to 53.6%).ConclusionsInjury is an important disease burden in this older adult rural low-income and middle-income country population. Further research could inform preventative strategies, including safer rural farming methods, explore the association between adverse mental health and injury, and strengthen health system readiness to provide quality care.

Patient Tolerability of Bowel Preparation is Associated with Polyp Detection Rate During Colonoscopy

2014 ◽  
Vol 23 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Edward W. Holt ◽  
Kidist K. Yimam ◽  
Hanley Ma ◽  
Richard E. Shaw ◽  
Richard A. Sundberg ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Polyp Detection ◽  
Cross Sectional ◽  
Quality Outcomes ◽  
Negative Experience ◽  
Polyp Detection Rate ◽  
Patient Reported ◽  
Bowel Prep

Background & Aims: A number of factors have been identified that influence the yield of screeningcolonoscopy. The perceived tolerability of bowel preparation has not been studied as a predictor of quality outcomes in colonoscopy. We aimed to characterize the association between patient-perceived tolerability of bowel preparation and polyp detection during colonoscopy.Methods: We performed a cross-sectional cohort study of 413 consecutive adult patients presenting foroutpatient colonoscopy at two outpatient endoscopy centers at our institution. We developed a standardized questionnaire to assess the patient's experience with bowel preparation. Bowel preparation quality was measured using the validated Ottawa scale and colonoscopic findings were recorded for each patient. The primary outcome was polyp detection and the secondary outcome was the quality of bowel preparation.Results: Patient-reported clarity of effluent during bowel preparation correlated poorly with Ottawa score during colonoscopy, k=0.15. Female gender was an independent risk factor for a poorly tolerated bowel prep (OR 3.93, 95% CI 2.30 - 6.72, p<0.001). Report of a poorly tolerated bowel prep was independently associated with the primary outcome, polyp detection (OR 0.39, 95% CI 0.18 - 0.84, p=0.02) and also with the secondary outcome, lower quality bowel preparation (OR 2.39, 95% CI 1.17 - 4.9, p=0.02).Conclusions: A patient-perceived negative experience with bowel preparation independently predicted both a lower quality bowel preparation and a lower rate of polyp of detection. Assessment of the tolerability of bowel preparation before colonoscopy may be a clinically useful predictor of quality outcomes during colonoscopy.

Trends in Antidepressant Prescribing for New Episodes of Depression and Implications for Health System Quality Measures

Medical Care ◽  
2012 ◽  
Vol 50 (1) ◽  
pp. 86-90 ◽  
Author(s):  
Paul N. Pfeiffer ◽  
Benjamin R. Szymanski ◽  
Marcia Valenstein ◽  
John F. McCarthy ◽  
Kara Zivin
Keyword(s):  
Health System ◽  
Quality Measures ◽  
System Quality ◽  
Health System Quality

scholarly journals Engaging Learners in Health System Quality Improvement Efforts

2017 ◽  
Vol 92 (5) ◽  
pp. 593-597 ◽  
Author(s):  
Karnjit Johl ◽  
R. Kevin Grigsby
Keyword(s):  
Quality Improvement ◽  
Health System ◽  
System Quality ◽  
Health System Quality

Conceptualizing Administrative Databases as Screening Tools for Health System Quality

JAMA Surgery ◽  
2015 ◽  
Vol 150 (1) ◽  
pp. 5 ◽  
Author(s):  
David C. Chang ◽  
Christopher Evans ◽  
Joseph Parker
Keyword(s):  
Health System ◽  
Screening Tools ◽  
Administrative Databases ◽  
System Quality ◽  
Health System Quality

scholarly journals URMC Universal Depression Screening Initiative: Patient Reported Outcome Assessments to Promote a Person-Centered Biopsychosocial Population Health Management Strategy

2022 ◽  
Vol 12 ◽  
Author(s):  
Kimberly A. Van Orden ◽  
Julie Lutz ◽  
Kenneth R. Conner ◽  
Caroline Silva ◽  
Michael J. Hasselberg ◽  
...  
Keyword(s):  
Health System ◽  
Population Health ◽  
Patient Reported Outcomes ◽  
Well Being ◽  
Social Health ◽  
Depression Symptoms ◽  
Healthcare Needs ◽  
Unmet Healthcare Needs ◽  
Number Of Patients ◽  
Patient Reported

Background: Patient-reported outcomes (PROs) can promote person-centered biopsychosocial health care by measuring outcomes that matter to patients, including functioning and well-being. Data support feasibility and acceptability of PRO administration as part of routine clinical care, but less is known about its effects on population health, including detection of unmet healthcare needs. Our objectives were to examine differences in rates of clinically significant depression across sociodemographic groups and clinical settings from universal depression screens in a large health system, estimate the number of patients with untreated depression detected by screenings, and examine associations between biopsychosocial PROs—physical, psychological, and social health.Methods: We analyzed data from over 200,000 adult patients who completed depression screens—either PROMIS (Patient Reported Outcomes Measurement Information System) or PHQ-2/9—as part of routine outpatient care.Results: Depression screens were positive in 14.2% of the sample, with more positive screens among younger vs. older adults, women vs. men, non-White vs. White, and Hispanics vs. non-Hispanics. These same sociodemographic indicators, as well as completing screening in primary care (vs. specialty care) were also associated with greater likelihood of detected depression in the medical record.Discussion: Universal screening for depression symptoms throughout a large health system appears acceptable and has the potential to detect depression in diverse patient populations outside of behavioral health. Expanded delivery of PROs to include physical and social health as well as depression should be explored to develop a clinically-relevant model for addressing patients' biopsychosocial needs in an integrated fashion across the health system.

scholarly journals Use of interrupted time series methods in the evaluation of health system quality improvement interventions: a methodological systematic review

2020 ◽  
Vol 5 (10) ◽  
pp. e003567
Author(s):  
Celestin Hategeka ◽  
Hinda Ruton ◽  
Mohammad Karamouzian ◽  
Larry D Lynd ◽  
Michael R Law
Keyword(s):  
Systematic Review ◽  
Time Series ◽  
Quality Improvement ◽  
Health System ◽  
Robust Design ◽  
Interrupted Time Series ◽  
Risk Of Bias ◽  
Monthly Interval ◽  
System Quality ◽  
Health System Quality

BackgroundWhen randomisation is not possible, interrupted time series (ITS) design has increasingly been advocated as a more robust design to evaluating health system quality improvement (QI) interventions given its ability to control for common biases in healthcare QI. However, there is a potential risk of producing misleading results when this rather robust design is not used appropriately. We performed a methodological systematic review of the literature to investigate the extent to which the use of ITS has followed best practice standards and recommendations in the evaluation of QI interventions.MethodsWe searched multiple databases from inception to June 2018 to identify QI intervention studies that were evaluated using ITS. There was no restriction on date, language and participants. Data were synthesised narratively using appropriate descriptive statistics. The risk of bias for ITS studies was assessed using the Cochrane Effective Practice and Organisation of Care standard criteria. The systematic review protocol was registered in PROSPERO (registration number: CRD42018094427).ResultsOf 4061 potential studies and 2028 unique records screened for inclusion, 120 eligible studies assessed eight QI strategies and were from 25 countries. Most studies were published since 2010 (86.7%), reported data using monthly interval (71.4%), used ITS without a control (81%) and modelled data using segmented regression (62.5%). Autocorrelation was considered in 55% of studies, seasonality in 20.8% and non-stationarity in 8.3%. Only 49.2% of studies specified the ITS impact model. The risk of bias was high or very high in 72.5% of included studies and did not change significantly over time.ConclusionsThe use of ITS in the evaluation of health system QI interventions has increased considerably over the past decade. However, variations in methodological considerations and reporting of ITS in QI remain a concern, warranting a need to develop and reinforce formal reporting guidelines to improve its application in the evaluation of health system QI interventions.

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