scholarly journals PO 8504 EFFECT OF INCREASED USER FEES IN ACCESSING NEW TUBERCULOSIS DIAGNOSTIC SERVICES IN TANZANIA

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A47.2-A47
Author(s):  
Esther Ngadaya ◽  
Godfather Kimaro ◽  
Ramadhani Shemtandulo ◽  
Erica Sandi ◽  
Sunday Simsokwe ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Detrimental Effect ◽  
Healthcare Systems ◽  
User Fees ◽  
Service Utilisation ◽  
Before And After ◽  
User Fee ◽  
Us Dollar

BackgroundWhile user fees in healthcare systems have been associated with quality improvement, a substantial increase may have a detrimental effect. This paper reports on the effects of increasing user fees on utilisation of TB diagnostic services in Tanzania.MethodsWe retrospectively analysed data on TB diagnostic services utilisation between July 2013 and June 2015 in Mnazi Mmoja Zanzibar (MMZ), Musoma and Sumbawanga hospitals. In July 2014, user fees in Musoma were increased substantially from 2 to 5 US dollar; Sumbawanga increased the fees stepwise, from 1 to 2 US dollar in July 2014, and from2 to 3 US dollar in January 2015 MMZ did not raise the fees. We compared TB services utilisation before and after introduction of user fees.ResultsOut of 7483 presumptive TB patients registered in all sites, 50.2% were males. Over half (3969) were registered before the user fee was increased. Among 3969, 1579 (39.8%) were from Musoma, 922 (23.2%) from Sumbawanga and 1468 (37.0%) from MMZ. Of the 3514 patients registered after the introduction of user fees, 983 (28%), 952 (27.1%) and 1579 (44.9%) patients were from Musoma, Sumbawanga and MMZ, respectively. The number of presumptive TB patients seeking TB diagnostic services at Musoma decreased significantly by 38% from 1579 to 983 after the increase of user fees (p=0.001). More females (817; 51.8% vs 458, 35.9%) attended Musoma before user fees were increased as compared to males whose attendance did not differ much (761; 48.2% vs 525; 53.4%); (p=0.01). There was no significant decrease of patients at Sumbawanga and MMZ.ConclusionThere was a significant decrease in the number of presumptive TB patients who accessed new TB diagnostic services in Musoma after a substantial increase of user fees, the effect was stronger among women. Although user fees are beneficial, they should be increased stepwise so as not to affect service utilisation.

An Alternative Approach To User Fee Policy In The Primary Health Care Setting Of Bangladesh.

2020 ◽  
Author(s):  
Nazneen Akhter
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Complex Dynamics ◽  
Quality Care ◽  
Secondary Data ◽  
User Fees ◽  
Primary Health ◽  
Alternative Approach ◽  
Benefit Principle ◽  
User Fee

The concept of ascribing user fee in health care settings always remained a policy struggle and countries experienced different learning in this regards while implementing user fee at different tiers of health settings. The most exquisite learning among the many country specific evidences related to user fee are the match and mismatch between the equity principle and benefit principle while considering the client perspective. There is an added dimension of quality care which also add more complex dynamics into this concept since the quality care consideration has a double edged perspective both for clients and providers, where which one will get superiority over whom is a great question in health care, especially in the Primary Health care (PHC) of the country. In this reality the appropriate implementation guideline, followed by an appropriate practice of the administrative and management both service oriented and financial are of great importance in this user fee implementation consideration which always remained a challenge in the health care specially in remote care of PHC. This paper attempted a secondary data searching and scoping the available documents of Bangladesh and across the world to find an alternative approach to user fees policy where equity and benefit principle and quality - these three have to be placed in a well-constructed triad in PHC implementation which has been recommended as an alternative policy imperative in approaching user fees for Bangladesh PHC settings.

scholarly journals Accounting for quality improvement during the conduct of embedded pragmatic clinical trials within healthcare systems: NIH Collaboratory case studies

Healthcare ◽  
2021 ◽  
Vol 8 ◽  
pp. 100432
Author(s):  
Leah Tuzzio ◽  
Catherine M. Meyers ◽  
Laura M. Dember ◽  
Corita R. Grudzen ◽  
Edward R. Melnick ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Quality Improvement ◽  
Case Studies ◽  
Healthcare Systems ◽  
Pragmatic Clinical Trials

Reducing Hospital-acquired Pressure Injuries Among Pediatric Patients Receiving ECMO: A Retrospective Study Examining Quality Improvement Outcomes

2021 ◽  
Vol 67 (9) ◽  
pp. 14-24
Author(s):  
Jordan Jackson ◽  
Holly Kirkland-Kyhn ◽  
Laura Kenny ◽  
Alana Beres ◽  
Stephanie Mateev
Keyword(s):  
Quality Improvement ◽  
Pediatric Patients ◽  
Wound Care ◽  
Occipital Region ◽  
Provider Education ◽  
Before And After ◽  
Prevention Interventions ◽  
Improvement Interventions ◽  
Quality Improvement Interventions ◽  
Hospital Acquired

BACKGROUND: Pediatric patients immobilized for certain procedures, such as extracorporeal membrane oxygenation (ECMO), are at high risk for developing hospital-acquired pressure injuries (HAPIs). PURPOSE: To evaluate the rate of HAPI occurrence in ECMO patients before and after implementation of prevention interventions. METHODS: Patients younger than 18 years of age who were placed on ECMO from January 2012 through March 2020 were identified, and patient data, including the development of a stage 3, 4, or unstageable pressure injuries, were abstracted. From August 2018 through December 2018, HAPI prevention interventions were implemented, which included targeted HAPI prevention and ECMO provider education, fluidized positioner provider education, and the addition of 2 wound care interventions for ECMO patients. RESULTS: Of the 120 ECMO patients identified, 5 (4.2%) developed a HAPI. All patients developed HAPI in the occipital region, and 1 patient developed an additional HAPI on their back. The median age of patients with HAPI was 1 month (interquartile range [IQR], 0.3–6.8 months). The median duration from ECMO cannulation to identification of HAPI was 9.5 days (IQR, 4.8–32.3 days). The median total run time was 4.9 days (IQR, 2.5-7.6 days): 8.5 days for patients who did develop a HAPI and 4.8 days for those who did not develop a HAPI (P = .02). The overall HAPI rate dropped from 4.8% of ECMO patients before quality improvement interventions to 0% of ECMO patients after quality improvement interventions. CONCLUSIONS: The development of stage 3, 4, or unstageable HAPIs in pediatric ECMO patients was low (4.2%) over the period studied (January 2012 through March 2020). As of the time of this writing, no HAPIs occurred after implementation of provider education in 2018.

Abstract 8: Get With The Guidelines-Stroke Program Participation and Clinical Outcomes for Medicare Beneficiaries

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Sarah Song ◽  
Gregg Fonarow ◽  
Wenqin Pan ◽  
DaiWai Olson ◽  
Adrian F Hernandez ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Early Period ◽  
Quality Improvement Program ◽  
Administrative Claims ◽  
Improvement Program ◽  
All Cause Mortality ◽  
Before And After ◽  
Get With The Guidelines

Background: Get With The Guidelines (GWTG)-Stroke is a national, hospital-based quality improvement program developed by the American Heart Association. While studies have shown a beneficial effect of hospital participation in GWTG-Stroke upon processes of care, whether there are associated improvements in clinical outcomes has not been previously investigated. Methods: From among all acute care US hospitals, we matched 366 hospitals that joined the GWTG-Stroke program between April 2004 and December 2007, with 366 hospitals that did not. Matching was based on ischemic stroke case volume, calendar year, baseline hospital post-stroke 1-year all-cause mortality rates, teaching status, and geographic region. Outcomes of all acute ischemic stroke (AIS) patients admitted to the study hospitals were abstracted from the CMS administrative claims database (65 years and older). Outcomes at matched hospitals were compared in the PRE-GWTG-Stroke period (-540 to -181 days before program launch), RUN-UP period (-180- to -1 day), EARLY period (0 to 180 days) and SUSTAINED period (181 to 540 days). Additional analysis was performed of the entire BEFORE (-540 to -1 days) and AFTER periods (0 to 540 days). The main analytical approach was stratified Cox proportional hazard modeling, with matched site ID at stratum. We adjusted for patient characteristics (age, gender, race, medical history) and hospital characteristics (rural vs. urban, # beds, annual IS discharges.) Results: The study analyzed 88,584 AIS admissions at the 366 GWTG-Stroke hospitals and 85,401 admissions at the 366 matched non-GWTG-Stroke hospitals. In adjusted analysis comparing BEFORE and AFTER periods, GWTG-Stroke hospitals achieved reduced 30 day mortality (30M - HR 0.911, p<0.0001), reduced 1 year mortality (1YM - HR 0.902, p<0.0001), reduced 30 day all-cause rehospitalization (HR 0.956, p=0.013), reduced 30 day stroke rehospitalization (HR 0.927, p=0.038), and reduced 1 year all-cause rehospitalization (HR 0.972, p=0.007). Conversely, matched, non-GWTG-Stroke hospitals showed only reduced 30M (HR 0.954, p=0.010) between the BEFORE and AFTER periods. Comparing the degree of change at GWTG-Stroke with non-GWTG Stroke hospitals, there were greater improvements in discharge to home (DCH), 30M, and 1YM at GWTG-Stroke hospitals in each of the intervention periods: EARLY: DCH, HR 1.090, p<0.0001; 30M, HR 0.894, p=0.0006; 1YM, HR 0.889, p<0.0001; SUSTAINED: DCH, HR 1.097, p<0.0001; 30M, HR 0.934, p=0.004; 1YM, HR 0.918, p<0.0001. Conclusions: Hospitals joining the GWTG-Stroke quality improvement program between 2004-2008 achieved significantly greater improvement in stroke patient outcomes than matched hospitals not joining the program, with lower all-cause mortality at 30 days and 1 year and higher rates of discharge directly to home.

Quality improvement in melanoma care: Multidisciplinary quality program development and comparison of care before and after implementation

2019 ◽  
Vol 217 (3) ◽  
pp. 527-531
Author(s):  
Barrett A. Kielhorn ◽  
Jensen B. Jantz ◽  
Mark S. Kosten ◽  
Stephen S. Phillips ◽  
Sarat C. Khandavalli ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Program Development ◽  
Quality Program ◽  
Before And After

Effectiveness of Probiotic for Primary Prevention of Clostridium difficile Infection: A Single-Center Before-and-After Quality Improvement Intervention at a Tertiary-Care Medical Center

2018 ◽  
Vol 39 (07) ◽  
pp. 765-770 ◽  
Author(s):  
William E. Trick ◽  
Stephen J. Sokalski ◽  
Stuart Johnson ◽  
Kristen L. Bunnell ◽  
Joseph Levato ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Primary Prevention ◽  
Clostridium Difficile ◽  
Incidence Rate ◽  
Tertiary Care ◽  
Prophylactic Antibiotic ◽  
Quality Improvement Intervention ◽  
Tertiary Care Medical Center ◽  
Before And After ◽  
Improvement Intervention

OBJECTIVETo evaluate probiotics for the primary prevention of Clostridium difficile infection (CDI) among hospital inpatients.DESIGNA before-and-after quality improvement intervention comparing 12-month baseline and intervention periods.SETTINGA 694-bed teaching hospital.INTERVENTIONWe administered a multispecies probiotic comprising L. acidophilus (CL1285), L. casei (LBC80R), and L. rhamnosus (CLR2) to eligible antibiotic recipients within 12 hours of initial antibiotic receipt through 5 days after final dose. We excluded (1) all patients on neonatal, pediatric and oncology wards; (2) all individuals receiving perioperative prophylactic antibiotic recipients; (3) all those restricted from oral intake; and (4) those with pancreatitis, leukopenia, or posttransplant. We defined CDI by symptoms plus C. difficile toxin detection by polymerase chain reaction. Our primary outcome was hospital-onset CDI incidence on eligible hospital units, analyzed using segmented regression.RESULTSThe study included 251 CDI episodes among 360,016 patient days during the baseline and intervention periods, and the incidence rate was 7.0 per 10,000 patient days. The incidence rate was similar during baseline and intervention periods (6.9 vs 7.0 per 10,000 patient days; P=.95). However, compared to the first 6 months of the intervention, we detected a significant decrease in CDI during the final 6 months (incidence rate ratio, 0.6; 95% confidence interval, 0.4–0.9; P=.009). Testing intensity remained stable between the baseline and intervention periods: 19% versus 20% of stools tested were C. difficile positive by PCR, respectively. From medical record reviews, only 26% of eligible patients received a probiotic per the protocol.CONCLUSIONSDespite poor adherence to the protocol, there was a reduction in the incidence of CDI during the intervention, which was delayed ~6 months after introducing probiotic for primary prevention.Infect Control Hosp Epidemiol 2018;765–770

Reducing the Contamination Rate and the Unnecessary Requesting of Blood Culture Test through Quality Improvement Project

2021 ◽  
Vol 30 (1) ◽  
pp. 87-91
Author(s):  
Tamer Mohamed ◽  
Ashraf A Askar ◽  
Jamila Chahed
Keyword(s):  
Quality Improvement ◽  
Blood Culture ◽  
Armed Forces ◽  
Blood Cultures ◽  
Quality Improvement Project ◽  
Contamination Rate ◽  
Improvement Project ◽  
Culture Test ◽  
Negative Results ◽  
Before And After

Background: Blood stream infections are major leading causes of morbidity and mortality in hospitalized patients. Increasing the awareness of the clinicians and nurses about the proper protocol of blood culture test is very important in reducing the contamination rate and the unnecessary requesting of blood culture. Objectives: to reduce the contamination rate and the unnecessary requesting of blood culture from different departments through implementation of hospital wide Quality Improvement Project (QIP). Methodology: Blood cultures were tested in the Microbiology Laboratory of Najran Armed Forces hospital, Saudi Arabia, in the period from June 2019 to July 2020 and their results were compared before and after the implementation of the QIP. Results: The comparison between the blood cultures results before and after QIP implementation showed statistically significant (19.6%) reduction in the contamination rate, (14%) reduction in the total number of blood culture requests and (11.6%) reduction in the negative results rate. Conclusion: The reduction in the total number, negative results and contamination rate of blood culture test after QIP implementation were considered as performance indicators that the recommendations of QIP were effective and implemented strictly.

Early Mobility for Critically Ill Patients: Building Staff Commitment Through Appreciative Inquiry

2020 ◽  
Vol 40 (4) ◽  
pp. 66-72
Author(s):  
Michelle M. Fernald ◽  
Nicholas A. Smyrnios ◽  
Joan Vitello
Keyword(s):  
Quality Improvement ◽  
Critically Ill ◽  
Appreciative Inquiry ◽  
Critically Ill Patients ◽  
Staff Members ◽  
Before And After ◽  
Trained Facilitator ◽  
Improvement Method ◽  
And Performance ◽  
Staff Commitment

Background Immobility contributes to many adverse effects in critically ill patients. Early progressive mobility can mitigate these negative sequelae but is not widely implemented. Appreciative inquiry is a quality improvement method/change philosophy that builds on what works well in an organization. Objectives To explore whether appreciative inquiry would reinvigorate an early progressive mobility initiative in a medical intensive care unit and improve and sustain staff commitment to providing regular mobility therapy at the bedside. Secondary goals were to add to the literature about appreciative inquiry in health care and to determine whether it can be adapted to critical care. Methods Staff participated in appreciative inquiry workshops, which were conducted by a trained facilitator and structured with the appreciative inquiry 4-D cycle. Staff members’ attitudes toward and knowledge of early progressive mobility were evaluated before and after the workshops. Performance of early progressive mobility activities was recorded before and 3 and 10 months after the workshops. Results Sixty-seven participants completed the program. They rated the workshops as successfully helping them to understand the importance of early progressive mobility (98%), explain their responsibility to improve patient outcomes (98%), and engender a greater commitment to patients and the organization (96%). Regarding mobility treatments, at 3 months orders had improved from 62% to 88%; documentation, from 52% to 89%; and observation, from 39% to 87%. These improvements were maintained at 10 months. Conclusion Participation in the workshops improved the staff’s attitude toward and performance of mobility treatments. Appreciative inquiry may provide an adjunct to problem-based quality improvement techniques.

scholarly journals Evaluation of a mandatory phishing training program for high-risk employees at a US healthcare system

2019 ◽  
Vol 26 (6) ◽  
pp. 547-552 ◽  
Author(s):  
William J Gordon ◽  
Adam Wright ◽  
Robert J Glynn ◽  
Jigar Kadakia ◽  
Christina Mazzone ◽  
...  
Keyword(s):  
High Risk ◽  
Training Program ◽  
Lower Risk ◽  
Healthcare Systems ◽  
Intervention Period ◽  
Substantial Impact ◽  
Hospital Employees ◽  
Mandatory Training ◽  
Before And After ◽  
The Impact

Abstract Objective The study sought to understand the impact of a phishing training program on phishing click rates for employees at a single, anonymous US healthcare institution. Materials and Methods We stratified our population into 2 groups: offenders and nonoffenders. Offenders were defined as those that had clicked on at least 5 simulated phishing emails and nonoffenders were those that had not. We calculated click rates for offenders and nonoffenders, before and after a mandatory training program for offenders was implemented. Results A total of 5416 unique employees received all 20 campaigns during the intervention period; 772 clicked on at least 5 emails and were labeled offenders. Only 975 (17.9%) of our set clicked on 0 phishing emails over the course of the 20 campaigns; 3565 (65.3%) clicked on at least 2 emails. There was a decrease in click rates for each group over the 20 campaigns. The mandatory training program, initiated after campaign 15, did not have a substantial impact on click rates, and the offenders remained more likely to click on a phishing simulation. Discussion Phishing is a common threat vector against hospital employees and an important cybersecurity risk to healthcare systems. Our work suggests that, under simulation, employee click rates decrease with repeated simulation, but a mandatory training program targeted at high-risk employees did not meaningfully decrease the click rates of this population. Conclusions Employee phishing click rates decrease over time, but a mandatory training program for the highest-risk employees did not decrease click rates when compared with lower-risk employees.

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