Costs and Quality of Care in Different Types of Hospitals

Inappropriate intake of medications can increase the risk of many morbidities and mortality among the geriatric population. Therefore, assessment of drug underuse, overuse, and inappropriate use has been an area of interest across the different investigations, and according to which, different screening tools were developed to identify these problems and enhance the quality of care to these patients. In the present study, we aim comprehensively discuss the different types of currently reported screening tools that can identify potentially inappropriate medication in the geriatric population. Studies show that assess, review, minimize, optimize, reassess (ARMOR), and medication appropriateness index (MAI) tools are the most commonly reported for this purpose to appropriately evaluate drug administration practices. However, they are time-consuming and need adequately trained personnel, which might not be available within the different settings. Accordingly, we suggest that more than one tool should be used, as we have reviewed all the advantages and disadvantages of the modality within the current study, to adequately facilitate and make the process of evaluation easy and enhance the quality of care for the geriatric population.

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Can quality from a care ethical perspective be assessed? A review

Nursing Ethics ◽

10.1177/0969733013500163 ◽

2013 ◽

Vol 21 (7) ◽

pp. 774-793 ◽

Cited By ~ 8

Author(s):

Esther E Kuis ◽

Gijs Hesselink ◽

Anne Goossensen

Keyword(s):

Quality Of Care ◽

Quality Assessment ◽

Conceptual Framework ◽

Psychometric Properties ◽

Ethics Of Care ◽

Specific Context ◽

Ethical Perspective ◽

Care Theory ◽

Different Types

Background: Ethics-of-care theories contain important notions regarding the quality of care; however, until now, concrete translations of the insights into instruments are lacking. This may be a result of the completely different type of epistemology, theories and concepts used in the field of quality of care research. Objectives: Both the fields of ‘ethics of care’ and ‘quality of care’ aim for improvement of care; therefore; insights could possibly meet by focusing on the following question: How could ethics-of-care theories contribute to better quality in care at a measurement level? This study reviews existing instruments with the aim of bridging this gap and examines the evidence of their psychometric properties, feasibility and responsiveness. Research design: A systematic search of the literature was undertaken using multiple electronic databases covering January 1990 through May 2012. Method and findings: Of the 3427 unique references identified, 55 studies describing 40 instruments were selected. Using a conceptual framework, an attempt was made to distinguish between related concepts and to group available instruments measuring different types of concepts. A total of 13 instruments that reflect essential aspects of ethics-of-care theory were studied in greater detail, and a quality assessment was conducted. Conclusion: Three promising qualitative instruments were found, which follow the logic of the patient and take their specific context into account.

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Validity of the risk adjustment approach to compare outcomes

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2003000100032 ◽

2003 ◽

Vol 19 (1) ◽

pp. 287-295 ◽

Cited By ~ 7

Author(s):

Leticia Krauss Silva

Keyword(s):

Quality Of Care ◽

Predictive Validity ◽

Risk Adjustment ◽

Medical Technologies ◽

Sufficient Cause ◽

Different Types ◽

Risk Patients ◽

Measuring Outcomes ◽

Counterfactual Approach

This paper focuses on the issue of the extent to which the present mainstream risk adjustment (RA) methodology for measuring outcomes is a valid and useful tool for quality-improvement activities. The method's predictive and attributional validity are discussed, considering the confounding and effect modification produced by medical care over risk variables' effect. For this purpose, the sufficient-cause model and the counterfactual approach to effect and interaction are tentatively applied to the relationships between risk (prognostic) variables, medical technology, and quality of care. The main conclusions are that quality of care modifies the antagonistic interaction between medical technologies and risk variables, related to different types of responders, as well as the confounding of the effect of risk variables produced by related medical technologies. Thus, confounding of risk factors in the RA method, which limits the latter's predictive validity, is related to the efficacy and complexity of associated medical technologies and to the quality mix of services. Attributional validity depends on the validity of the probabilities estimated for each subgroup of risk (predictive validity) and the percentage of higher-risk patients at each service.

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