Incidence of Complicated Appendicitis as a Metric of Health Care Delivery

2020 ◽  
pp. 000313482095376
Author(s):  
Fawaz Araim ◽  
Artem Shmelev ◽  
Gopal C. Kowdley
Keyword(s):  
Health Care ◽  
Acute Appendicitis ◽  
Health Care Delivery ◽  
Health Care Quality ◽  
Care Delivery ◽  
State Level ◽  
Care Quality ◽  
Physician Density ◽  
Multivariable Logistic Regression Model ◽  
Modifiable Factors

Background Complicated acute appendicitis (CAA) has been linked to extremes of age, racial and socioeconomic disparities, public insurance, and remote residency. CAA rate has been used from 2005 to 2018 as a health care quality metric, with the assumption that delay in treatment was a main cause of perforation. We studied factors that could contribute to CAA focusing on modifiable factors which could be altered as part of a health care delivery system. Materials and Methods All primary admissions for acute appendicitis (AA) from the 2010 Nationwide Inpatient Sample were linked to 2010 state-level physician density data. CAA was distinguished by codes for perforation, generalized peritonitis, or intra-abdominal abscess. A multivariable logistic regression model for CAA prediction was built. Results A total of 288 556 patients were admitted with AA and 86 272 (29.9%) had CAA. Independent factors, linked to CAA, included age outside the 10-39 range (odds ratio (OR) = 2.1-2.4 and all P < .001), male gender (OR = 1.2), malnutrition (OR = 6.2), diabetes mellitus (OR = 2.1), chronic anemias (OR = 1.9), nonprivate insurances (OR 1.2-1.5), nonmetropolitan patient’s residence (OR = 1.15), and Midwest region (OR = 1.2). Patient income and physician coverage were not significant factors after adjustment for all other covariates. Highest CAA fraction of 39.6% was noted in rural patients admitted to urban teaching facilities. Discussion Although provider coverage at the state level may seem adequate and not related to increased CAA rates, the distance patients traveled for their definitive surgical care correlated with higher rates of CAA. Adjusting physician distribution into nonurban settings closer to patients could decrease rates of CAA by diminishing time to definitive care.

scholarly journals In patient satisfaction survey- how does it help our health care delivery system (the patient, the health care giver and the organization)?

2017 ◽  
Vol 4 (10) ◽  
pp. 3280
Author(s):  
Priti Prasad Shah
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health Care Delivery ◽  
Health Care Quality ◽  
Care Delivery ◽  
Healthcare Services ◽  
Care Quality ◽  
Survey Study ◽  
Satisfaction Survey ◽  
Patient Satisfaction Survey

Background: Patient satisfaction is a mean of measuring the effectiveness of health care delivery.    It can suggest proportion to the problem areas and a reference point to take management decisions. It can serve as a mean of holding physician accountable. Patient satisfaction data can be used to document health care quality for accrediting organizations and consumer groups. They can also measure specific initiative or changes in service delivery.  They can increase loyalty of patients by demonstrating you care their perceptions and looking for ways to improve. The purpose of our study is to carry out evaluation of hospital services by getting a patient satisfaction survey. Main aim is to identify potential problems in the services.Methods: A hospital based inpatient satisfaction survey study done on 200 patients. A Predesigned structured questionnaire was based on relevance of questions to healthcare services on various aspects of inpatient care.  The interviewer based questionnaires were filled after obtaining verbal informed consent from all subjects. 200 valid responses were analyzed using MS office excel. Data analysis of study is done using the SPSS (Statistical Package for the Social Science) Version 17 for window.Results: Results of our study is very positive and suggest that patients were satisfied with the attitude of doctors, nurses and paramedical staff and it was appreciated. As in D Y Patil Medical College and Hospital most facilities are free for the patients, so we got better feedback for the facilities and satisfaction for this study. Satisfied patients are more likely to continue using the health care services and maintain their relationship with specific health care providers.Conclusions: Patient satisfaction survey can be a driving force for changes in health care delivery with institutions and individuals. These initiatives can promote improvement in practice and also respond to patient expressed needs.

The role of community engagement in building sustainable health-care delivery interventions for Kenya

2018 ◽  
Vol 42 (1/2) ◽  
pp. 35-47
Author(s):  
Elise Catherine Davis ◽  
Elizabeth T. Arana ◽  
John S. Creel ◽  
Stephanie C. Ibarra ◽  
Jesus Lechuga ◽  
...  
Keyword(s):  
Health Care ◽  
Community Engagement ◽  
Health Care Delivery ◽  
Low Income ◽  
Health Care Quality ◽  
Care Delivery ◽  
Care Quality ◽  
Content Type ◽  
Seek Health Care ◽  
Sustainable Health

Purpose The purpose of this article is to provide a general review of the health-care needs in Kenya which focuses on the role of community engagement in facilitating access and diminishing barriers to quality care services. Health-care concerns throughout Kenya and the culture of Kenyan’s health-care practices care are considered. Design/methodology/approach A comprehensive review covered studies of community engagement from 2000 till present. Studies are collected using Google Scholar, PubMed, EBSCOhost and JSTOR and from government and nongovernment agency websites. The approach focuses on why various populations seek health care and how they seek health care, and on some current health-care delivery models. Findings Suggestions for community engagement, including defining the community, are proposed. A model for improved health-care delivery introduces community health workers (CHWs), mHealth technologies and the use of mobile clinics to engage the community and improve health and quality of care in low-income settings. Practical implications The results emphasize the importance of community engagement in building a sustainable health-care delivery model. This model highlights the importance of defining the community, setting goals for the community and integrating CHWs and mobile clinics to improve health status and decrease long-term health-care costs. The implementation of these strategies contributes to an environment that promotes health and wellness for all. Originality/value This paper evaluates health-care quality and access issues in Kenya and provides sustainable solutions that are linked to effective community engagement. In addition, this paper adds to the limited number of studies that explore health-care quality and access alongside community engagement in low-income settings.

scholarly journals Quality of health care in Nigeria: a myth or a reality

2018 ◽  
Vol 6 (9) ◽  
pp. 2875
Author(s):  
Benson Chukwunweike Ephraim-Emmanuel ◽  
Adetutu Adigwe ◽  
Roland Oyeghe ◽  
Daprim S. T. Ogaji
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Health Care Quality ◽  
Care Delivery ◽  
Care Quality ◽  
Quality Systems ◽  
Quality Health Care ◽  
The Poor ◽  
Quality Health

The delivery of high quality health care is crucial to achieving enhanced health benefits, patient safety and a positive patient experience of health care. This article provides insight on the quality of the health care delivery in Nigeria and aim to uncover if quality health care in Nigeria is a reality or a myth. Relevant information was abstracted from included articles and used to provide both descriptive and analytical discourse on the subject. Discussions and reflections were carried out along an established quality framework of treatment effectiveness, acceptability, efficiency, the appropriateness of the means of delivery as well as equity. The slow pace of development of quality systems in health service delivery in Nigeria is evidenced by the poor quality of health services as well as the poor health status of the population. The pace of developing quality systems in health care delivery in Nigeria is unsatisfactory. There is a need to galvanise the efforts of relevant stakeholders including the patient in charting a new agenda for health care quality improvement in Nigeria.

Managed care Medicaid

2017 ◽  
Vol 11 (2) ◽  
pp. 198-210 ◽  
Author(s):  
William Trombetta
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Care Quality ◽  
Market Segment ◽  
Economic Aspects ◽  
Content Type ◽  
The Poor

Purpose Providing health care to the poor is evolving in the new US marketplace. The Affordable Care Act has set goals enhancing access to health care, lowering costs and improving patient outcomes. A key segment in this evolution is the most vulnerable health-care population of all: Medicaid. This paper aims to provide a general review of how providing health care to Medicaid patients is changing including how socio-economic aspects of this vulnerable population affects the quality of the health care provided. Design/methodology/approach The paper is entirely secondary research; no primary research has been conducted. Findings Managed care Medicaid provides a risk-based model to treating a vulnerable health-care market segment. The jury is still out on whether managed care Medicaid (MCM) is improving health-care quality and saving cost, but the provision of health care to the Medicaid segment is definitely shifting from a fee-for-service model to value based payment. Very recent developments of new health-care delivery approaches present a positive outlook for improving quality and containing costs going forward. Research limitations/implications At this stage, whether or not MCM saves money or provides better health-care quality to this vulnerable population is a work in progress. Health-care marketing can impact socio-economic aspects of health care for the poor. There is a need to follow up on the positive results being documented in demonstration health-care delivery models. Practical implications At this point, there has been no long-term study of whether managed care Medicaid offers better quality of health care and cost savings. The research to date suggest that the quality of health-care delivery to the poor is improving at a lower cost to payers. Social implications Medicaid patients are an underserved market segment. Managed care Medicaid offers a new model that has the potential to provide quality care at acceptable cost. Critical to this vulnerable market segment is the need to integrate socio-economic aspects of the population with the delivery of health care. Originality/value There has been very little discussion of Medicaid overall in the marketing literature, much less any discussion of managed care Medicaid.

How Do We Align Health Services Research and Quality Improvement?

2020 ◽  
pp. 282-291
Author(s):  
Devika Das ◽  
Lalan Wilfong ◽  
Katherine Enright ◽  
Gabrielle Rocque
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Services Research ◽  
Health Services ◽  
Health Care Quality ◽  
Care Delivery ◽  
Care Quality ◽  
Health Care Use ◽  
Semistructured Interview ◽  
Services Research

Quality improvement (QI) initiatives and health services research (HSR) are commonly used to target health care quality. These disciplines are increasingly important because of the movement toward value-based health care as alternative payment and care delivery models drive institutions and investigators to focus on reducing unnecessary health care use and improving care coordination. QI efforts frequently target medical error and/or efficiency of care through the Plan-Do-Study-Act methodology. Within the QI framework, strategies for data display (e.g., Pareto charts, run charts, histograms, scatter plots) are leveraged to identify opportunities for intervention and improvement. HSR is a multidisciplinary field of study that seeks to identify the most effective way to organize, deliver, and finance health care to maximize the quality and value of care at both the individual and population levels. HSR uses a diverse set of quantitative and qualitative methodologies, such as case-control studies, cohort studies, randomized control trials, and semistructured interview/focus group evaluations. This manuscript provides examples of methodologic approaches for QI and HSR, discusses potential challenges associated with concurrent quality efforts, and identifies strategies to successfully leverage the strengths of each discipline in care delivery.

Changing health care delivery system and certification at the state level

1972 ◽  
Author(s):  
Nathaniel Wagner ◽  
Cecil P. Peck ◽  
Bernard Borislow ◽  
Henry D. Remple ◽  
Allen V. Williams
Keyword(s):  
Health Care ◽  
Delivery System ◽  
Health Care Delivery ◽  
Care Delivery ◽  
State Level ◽  
Health Care Delivery System ◽  
The State

State Nurse Practitioner Practice Regulations and U.S. Health Care Delivery Outcomes: A Systematic Review

2020 ◽  
pp. 107755871990121 ◽  
Author(s):  
Bo Kyum Yang ◽  
Mary E. Johantgen ◽  
Alison M. Trinkoff ◽  
Shannon R. Idzik ◽  
Jessica Wince ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Access To Care ◽  
Health Care Delivery ◽  
Nurse Practitioner ◽  
Care Delivery ◽  
Care Quality ◽  
Cost Of Care ◽  
Delivery Outcomes ◽  
The Impact

There is a great variation across states in nurse practitioner (NP) scope of practice moderated by state regulations. The purpose of this study was to synthesize the evidence from studies of the impact of state NP practice regulations on U.S. health care delivery outcomes (e.g., health care workforce, access to care, utilization, care quality, or cost of care), guided by Donabedian’s structure, process, and outcomes framework. This systematic review was performed using Medline, CINAHL, PsycINFO, and PubMed according to Preferred Reporting Items for Systematic and Meta-Analysis on the literature from January 2000 to August 2019. The results indicate that expanded state NP practice regulations were associated with greater NP supply and improved access to care among rural and underserved populations without decreasing care quality. This evidence could provide guidance for policy makers in states with more restrictive NP practice regulations when they consider granting greater practice independence to NPs.

scholarly journals Metabolic monitoring in children 5 years of age and younger prescribed second-generation antipsychotic medications

2017 ◽  
Vol 7 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Yardlee S. Kauffman ◽  
Thomas Delate ◽  
Sheila Botts
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Second Generation ◽  
Care Delivery ◽  
Cohort Analysis ◽  
Health Care Delivery System ◽  
Care Quality ◽  
Metabolic Monitoring ◽  
Second Generation Antipsychotic

Abstract Introduction: The objective of this article was to identify the rates of patients ≤5 years of age who received recommended monitoring before and after second-generation antipsychotic (SGA) initiation and had an SGA metabolic adverse effect (MAE). Methods: This was a retrospective cohort analysis conducted at Kaiser Permanente Colorado, an integrated health care delivery system, between January 1, 2002, and June 30, 2011. Commercially insured patients ≤5 years of age newly initiated on an SGA were included. Patients were followed for up to 3 years. Metabolic monitoring included lipid profile, blood glucose, blood pressure, and weight measurements. Patient characteristics and outcomes were described using descriptive statistics. Results: A total of 40 patients were included. Overall, 2 (5.0%) patients received all recommended baseline monitoring, and no (0.0%) patients received all recommended follow-up monitoring. Weight monitoring was completed most frequently with rates of completion of 57.5%, 95.0%, 85.0%, and 76.5% at baseline and years 1, 2, and 3, respectively. At least 1 MAE was identified in 14/40 (35.0%), 5/28 (17.9%), and 2/17 (11.8%) patients during years 1, 2, and 3, respectively. The most frequent MAE identified was weight gain. Among patients identified with at least 1 MAE, 4/14 (28.6%), 2/5 (40.0%), and 2/2 (100%) received a behavioral intervention during years 1, 2, and 3, respectively. Discussion: Overall, baseline and follow-up metabolic monitoring were poor. Future studies should focus on examining barriers to monitoring in order to improve health care quality.

scholarly journals Unintended outcomes of health care delivery and the need for a national risk management approach

1999 ◽  
Vol 22 (1) ◽  
pp. 44
Author(s):  
Carol O'Donnell
Keyword(s):  
Health Care ◽  
Risk Management ◽  
Health Care Quality ◽  
Technology Development ◽  
Care Delivery ◽  
Health And Safety ◽  
Information Provision ◽  
Care Quality ◽  
Management Approach ◽  
Healthcare Provision

Unlike the situation in occupational health and safety, there is no nationally coordinated approach to risk management to prevent unintended outcomes of healthcare provision and improve health care quality. There is a related absence of linkages between quality assurance processes, other programs aimed at patient injury prevention and professional indemnity insurance systems. This article discusses the Australian health policy direction and argues for a coordinated national health risk management approach developed through contract requirements which include duty of care and information provision, nationally approved standards and codes, professional liability requirements, and supporting health education, research and information technology development.

scholarly journals Patient Safety: A Deep Concern to Caregivers

2019 ◽  
Vol 10 (1) ◽  
pp. 7
Author(s):  
AK Mohiuddin
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Safety Culture ◽  
Health Care Professionals ◽  
Health Care Quality ◽  
Care Delivery ◽  
Patient Safety Culture ◽  
Care Quality ◽  
Care Giving ◽  
Essential Components

Patient safety is a global concern and is the most important domains of health-care quality. Medical error is a major patient safety concern, causing increase in health-care cost due to mortality, morbidity, or prolonged hospital stay. A definition for patient safety has emerged from the health care quality movement that is equally abstract, with various approaches to the more concrete essential components. Patient safety was defined by the IOM as “the prevention of harm to patients.” Emphasis is placed on the system of care delivery that prevents errors; learns from the errors that do occur; and is built on a culture of safety that involves health care professionals, organizations, and patients. Patient safety culture is a complex phenomenon. Patient safety culture assessments, required by international accreditation organizations, allow healthcare organizations to obtain a clear view of the patient safety aspects requiring urgent attention, identify the strengths and weaknesses of their safety culture, help care giving units identify their existing patient safety problems, and benchmark their scores with other hospitals.   Article Type: Commentary

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