scholarly journals Patient-related healthcare disparities in the quality of acute hip fracture care: a 10-year nationwide population-based cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e051424
Author(s):  
Pia Kjær Kristensen ◽  
Anne Mette Falstie-Jensen ◽  
Morten Madsen ◽  
Søren Paaske Johnsen
Keyword(s):  
Hip Fracture ◽  
Quality Care ◽  
Population Based ◽  
Nutritional Risk ◽  
High Quality ◽  
Process Measures ◽  
Fracture Care ◽  
The Individual ◽  
Over Time

ObjectivesTo characterise and quantify possible patient-related disparities in hip fracture care including temporal changes.DesignPopulation-based cohort study.SettingAll Danish hospitals treating patients with hip fracture.Participants60 275 hip fracture patients from 2007 to 2016.InterventionsQuality of care was defined as fulfilment of eligible care process measures for the individual patient recommended by an expert panel. Using yearly logistic regression models, we predicted the individual patient’s probability for receiving high-quality care, resulting in a distribution of adjusted probabilities based on age, sex, comorbidity, fracture type, education, family mean income, migration status, cohabitation status, employment status, nursing home residence and type of municipality. Based on the distribution, we identified best-off patients (ie, the 10% of patients with the highest probability) and worst-off patients (ie, the 10% of patients with the lowest probability). We evaluated disparities in quality of care by measuring the distance in fulfilment of outcomes between the best-off and worst-off patients.Primary and secondary outcome measuresThe primary outcome was fulfilment of all-or-none, defined as receiving all relevant process measures. Secondary outcomes were fulfilment of the individual process measures including preoperative optimisation, early surgery, early mobilisation, assessment of pain, basic mobility, nutritional risk and need for antiosteoporotic medication, fall prevention and a postdischarge rehabilitation programme.ResultsThe proportion of patients receiving high-quality care varied over time for both best-off and worst-off patients. The absolute difference in percentage points between the best-off and worst-off patients for receiving all-or-none of the eligible process measures was 12 (95% CI 6 to 18) in 2007 and 23 (95% CI 19 to 28) in 2016. Disparities were consistent for a range of care processes, including assessment of pain, mobilisation within 24 hours, assessment of need for antiosteoporotic medication and nutritional risk assessment.ConclusionsDisparity of care between best-off and worst-off patients remained substantial over time.

scholarly journals Is the higher mortality among men with hip fracture explained by sex-related differences in quality of in-hospital care? A population-based cohort study

2016 ◽  
Vol 46 (2) ◽  
pp. 193-199 ◽  
Author(s):  
Pia Kjær Kristensen ◽  
Søren Paaske Johnsen ◽  
Anil Mor ◽  
Theis Muncholm Thillemann ◽  
Alma Becic Pedersen
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Hospital Care ◽  
Length Of Hospital Stay ◽  
Population Based ◽  
Performance Measure ◽  
Process Performance ◽  
Discharge Data ◽  
The Individual

Abstract Background mortality after hip fracture is two-fold higher in men compared with women. It is unknown whether sex-related differences in the quality of in-hospital care contribute to the higher mortality among men. Objective to examine sex-related differences in quality of in-hospital care, 30-day mortality, length of hospital stay and readmission among patients with hip fracture. Design population-based cohort study. Measures using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry, we identified 25,354 patients ≥65 years (29% were men). Outcome measures included quality of in-hospital care as reflected by seven process performance measures, 30-day mortality, length of stay (LOS) and readmission within 30 days after discharge. Data were analysed using multivariable regression techniques. Results in general, there were no substantial sex-related differences in quality of in-hospital care. The relative risk for receiving the individual process performance measure ranged from 0.91 (95% confidence interval (CI) 0.85–0.97) to 0.97 (95% CI 0.94–0.99) for men compared with women. The 30-day mortality was 15.9% for men and 9.3% for women corresponding to an adjusted odds ratio (OR) of 2.30 (95% CI 2.09–2.54). The overall readmission risk within 30 days after discharge was 21.6% for men and 16.4% for women (adjusted OR of 1.38 (95% CI 1.29–1.47)). No difference in LOS was observed between men and women. Conclusions sex differences in the quality of in-hospital care appeared not to explain the higher mortality and risk of readmission among men hospitalised with hip fracture.

scholarly journals Dynamic Signaling with Dropout Risk

2016 ◽  
Vol 8 (1) ◽  
pp. 57-82 ◽  
Author(s):  
Francesc Dilmé ◽  
Fei Li
Keyword(s):  
Time Varying ◽  
High Quality ◽  
Indivisible Good ◽  
Initial Belief ◽  
Costly Delay ◽  
Over Time

We study the role of dropout risk in dynamic signaling. A seller privately knows the quality of an indivisible good and decides when to trade. In each period, he may draw a dropout shock that forces him to trade immediately. To avoid costly delay, the seller with a low-quality good voluntarily pools with early dropouts, implying that the expected quality of the good increases over time. We characterize the time-varying equilibrium trading dynamics. It is demonstrated that the maximum equilibrium delay of trade is decreasing in the initial belief that the good is of high quality. (JEL C73, D82, D83)

scholarly journals REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE): protocol for a mixed-methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e049763
Author(s):  
Rita Patel ◽  
Sarah Drew ◽  
Antony Johansen ◽  
Tim Chesser ◽  
Muhammad K Javaid ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Hip Fracture ◽  
Patient Outcomes ◽  
Ethics Committee ◽  
High Quality ◽  
England And Wales ◽  
Fracture Care ◽  
Unwarranted Variation ◽  
Organisational Factors ◽  
Organisational Level

IntroductionSubstantial variation in the delivery of hip fracture care, and patient outcomes persists between hospitals, despite established UK national standards and guidelines. Patients’ outcomes are partly explained by patient-level risk factors, but it is hypothesised that organisational-level factors account for the persistence of unwarranted variation in outcomes. The mixed-methods REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE) study, aims to determine key organisational factors to target to improve patient care.Methods and analysisQuantitative analysis will assess the outcomes of patients treated at 172 hospitals in England and Wales (2016–2019) using National Hip Fracture Database data combined with English Hospital Episodes Statistics; Patient Episode Database for Wales; Civil Registration (deaths) and multiple organisational-level audits to characterise each service provider. Statistical analyses will identify which organisational factors explain variation in patient outcomes, and typify care pathways with high-quality consistent patient outcomes. Documentary analysis of 20 anonymised British Orthopaedic Association hospital-initiated peer-review reports, and qualitative interviews with staff from four diverse UK hospitals providing hip fracture care, will identify barriers and facilitators to care delivery. The COVID-19 pandemic has posed a major challenge to the resilience of services and interviews will explore strategies used to adapt and innovate. This system-wide understanding will inform the development, in partnership with key national stakeholders, of an ‘Implementation Toolkit’ to inform and improve commissioning and delivery of hip fracture services.Ethics and disseminationThis study was approved: quantitative study by London, City and East Research Ethics Committee (20/LO/0101); and qualitative study by Faculty of Health Sciences University of Bristol Research Ethics Committee (Ref: 108284), National Health Service (NHS) Health Research Authority (20/HRA/71) and each NHS Trust provided Research and Development approval. Findings will be disseminated through scientific conferences, peer-reviewed journals and online workshops.

scholarly journals Gambaran Kebutuhan Orangtua Dengan Bayi Yang Sakit Kritis di RSUD Prof.dr. Margono Soekarjo Purwokerto

2019 ◽  
Vol 11 (02) ◽  
pp. 64-76
Author(s):  
ADIRATNA SEKAR SIWI
Keyword(s):  
Care Setting ◽  
Quality Care ◽  
Total Sample ◽  
Descriptive Study ◽  
Psychological Problem ◽  
Family Needs ◽  
High Quality ◽  
Cross Sectional ◽  
Consecutive Sampling

Patient’s parent is an essential part of holistically care treatment, especially when the patients are still too young to responsible for their own. Nurse have to understand regarding parents need to deliver high quality care for patients and their family. Parents’ needs during accompanying their children could be very specific and unique. The knowledge regarding this issue is crucial to increase the quality of care and prevent parents’ psychological problem. This is a descriptive study with cross sectional approach. Total sample in this study are respondent who are chosen by using consecutive sampling. The NICU Family Needs Inventory (NFNI) was used in this study. This study shows that the parents’ needs during accompanying their children in critical care setting are need for closeness with their children, Certainty regarding patient condition, comfort, information, and the needs of support.

Pitfalls of Using Performance Measures to Evaluate the Quality of Hip Fracture Care

Orthopedics ◽  
2009 ◽  
Vol 32 (2) ◽  
pp. 84-85 ◽  
Author(s):  
Nelson F SooHoo ◽  
Bryan Correa ◽  
Rajeev Pandarinath
Keyword(s):  
Hip Fracture ◽  
Performance Measures ◽  
Fracture Care

Preparing for an Epidemic: Cancer Care in an Aging Population

2014 ◽  
pp. 133-137 ◽  
Author(s):  
Ya-Chen Tina Shih ◽  
Arti Hurria
Keyword(s):  
Older Adults ◽  
Cancer Care ◽  
Care Delivery ◽  
Quality Care ◽  
Aging Population ◽  
Population Based ◽  
Cancer Drug ◽  
Evidence Based ◽  
Evidence Based Care

The Institute of Medicine's (IOM) Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population was charged with evaluating and proposing recommendations on how to improve the quality of cancer care, with a specific focus on the aging population. Based on their findings, the IOM committee recently released a report highlighting their 10 recommendations for improving the quality of cancer care. Based on those recommendations, this article highlights ways to improve evidence-based care and addresses rising costs in health care for older adults with cancer. The IOM highlighted three recommendations to address the current research gaps in providing evidence-based care in older adults with cancer, which included (1) studying populations which match the age and health-risk profile of the population with the disease, (2) legislative incentives for companies to include patients that are older or with multiple morbidities in new cancer drug trials, and (3) expansion of research that contributes to the depth and breadth of data available for assessing interventions. The recommendations also highlighted the need to maintain affordable and accessible care for older adults with cancer, with an emphasis on finding creative solutions within both the care delivery system and payment models in order to balance costs while preserving quality of care. The implementation of the IOM's recommendations will be a key step in moving closer to the goal of providing accessible, affordable, evidence-based, high-quality care to all patients with cancer.

scholarly journals Using Multivariate Statistical Methods to Analyze High-Quality Bicycle Path Service Systems: A Case Study of Popular Bicycle Paths in Taiwan

2020 ◽  
Vol 12 (17) ◽  
pp. 7185
Author(s):  
Shinn-Jou Lin ◽  
Guey-Shin Shyu ◽  
Wei-Ta Fang ◽  
Bai-You Cheng
Keyword(s):  
Explanatory Power ◽  
Value Added ◽  
Service Systems ◽  
Image Management ◽  
High Quality ◽  
Multivariate Statistical ◽  
The Individual ◽  
Quantitative Indicators

Taiwan has promoted bicycle tourism for nearly 20 years, and the bicycle paths it has constructed throughout the island are diverse in design. In the present study, an evaluation scale for bicycle path sightseeing potential was devised with a focus on the overall service quality of the paths; 30 popular bicycle paths were analyzed using a field survey, with expert consultation on quantitative indicators, and a qualitative analysis entailing interviews with people regarding the bicycle paths. A multivariate statistical analysis was performed on the quality of the service systems for these paths. The results revealed that the quality of these service systems is influenced by four principal components, namely, landscape attractiveness, image management, bicycle-specific paths, and accessibility, for a total explanatory power of 76.21%; the individual explanatory power of these components was 25.89%, 21.49%, 16.81%, and 12.03%, respectively. Bicycle path conditions, service maintenance, and cleanliness and bicycle specificity are required for future high-quality bicycle paths; diverse bicycle rental services and bicycle types, entrance visibility, and ecological introduction boards along paths are value-added factors to bicycle path quality.

scholarly journals Pearls for Interpreting Neurosurgical Systematic Reviews and Meta-Analyses: Lessons From a Collaborative Effort

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 435-441 ◽  
Author(s):  
Victor M Lu ◽  
Christopher S Graffeo ◽  
Avital Perry ◽  
Michael J Link ◽  
Fredric B Meyer ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Evidence Based Medicine ◽  
Lessons Learned ◽  
Evidence Based ◽  
Cranial Neuralgia ◽  
The Individual ◽  
Meta Analyses ◽  
Based Medicine ◽  
Over Time

Abstract Systematic reviews and meta-analyses in the neurosurgical literature have surged in popularity over the last decade. It is our concern that, without a renewed effort to critically interpret and appraise these studies as high or low quality, we run the risk of the quality and value of evidence-based medicine in neurosurgery being misinterpreted. Correspondingly, we have outlined 4 major domains to target in interpreting neurosurgical systematic reviews and meta-analyses based on the lessons learned by a collaboration of clinicians and academics summarized as 4 pearls. The domains of (1) heterogeneity, (2) modeling, (3) certainty, and (4) bias in neurosurgical systematic reviews and meta-analyses were identified as aspects in which the authors’ approaches have changed over time to improve robustness and transparency. Examples of how and why these pearls were adapted were provided in areas of cranial neuralgia, spine, pediatric, and neuro-oncology to demonstrate how neurosurgical readers and writers may improve their interpretation of these domains. The incorporation of these pearls into practice will empower neurosurgical academics to effectively interpret systematic reviews and meta-analyses, enhancing the quality of our evidence-based medicine literature while maintaining a critical focus on the needs of the individual patients in neurosurgery.

Comorbid cognitive impairment and depression is a significant predictor of poor outcomes in hip fracture rehabilitation

2009 ◽  
Vol 22 (2) ◽  
pp. 246-253 ◽  
Author(s):  
Liang Feng ◽  
Samuel C Scherer ◽  
Boon Yeow Tan ◽  
Gribson Chan ◽  
Ngan Phoon Fong ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Hip Fracture ◽  
Life Outcomes ◽  
Ambulatory Status ◽  
Quality Of Life Outcomes ◽  
Mood And Cognition ◽  
Over Time

ABSTRACTBackground: The effects of depression and cognitive impairment on hip fracture rehabilitation outcomes are not well established. We aimed to evaluate the associations of depressive symptoms and cognitive impairment (individually and combined) with ambulatory, living activities and quality of life outcomes in hip fracture rehabilitation patients.Methods: A cohort of 146 patients were assessed on depressive symptoms (Geriatric Depression Scale, GDS ≥ 5), cognitive impairment (Mini-mental State Examination, MMSE ≤ 23), and other variables at baseline, and on ambulatory status, Modified Barthel Index (MBI), and SF-12 PCS and MCS quality of life on follow ups at discharge, 6 months and 12 months post fracture.Results: In these patients (mean age 70.8 years, SD 10.8), 7.5% had depressive symptoms alone, 28.8% had cognitive impairment alone, 50% had both, and 13.7% had neither (reference). Ambulatory status showed improvement over time in all mood and cognition groups ((β = 0.008, P = 0.0001). Patients who had cognitive impairment alone (β = −0.060, P = 0.001) and patients who had combined cognitive impairment with depressive symptoms β = −0.62, P = 0.0003), showed significantly less improvement in ambulatory status than reference patients. In the latter group, the relative differences in ambulatory scores from the reference group were disproportionately greater over time (β = −0.003, SE = 0.001, P = 0.021). Patients with combined depressive symptoms and cognitive impairment also showed a significantly lower MBI score, (β = −10.92, SE = 4.01, P = 0.007) and SF-12 MCS (β = −8.35, SE = 2.37, P = 0.0006). Mood and cognition status did not significantly predict mortality during the follow-up.Conclusion: Depression and cognitive impairment comorbidity is common in hip fracture rehabilitation patients and significantly predicts poor functional and quality of life outcomes.

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