Assessing the quality of care for paediatric depression and anxiety in Australia: A population-based sample survey

2019 ◽  
Vol 53 (10) ◽  
pp. 1013-1025
Author(s):  
Louise A Ellis ◽  
Louise K Wiles ◽  
Ruth Selig ◽  
Kate Churruca ◽  
Raghu Lingam ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Medical Records ◽  
Quality Care ◽  
Quality Of Healthcare ◽  
Population Based ◽  
Sample Survey ◽  
Additional Information ◽  
Stratified Sample ◽  
Using Data

Objective: We examine the prevalence of quality care (as measured by adherence to recommendations in clinical practice guidelines) for Australian paediatric patients (⩽15 years) with depression and/or anxiety, using data from the CareTrack Kids study; a population-based study of the quality of healthcare practice in inpatient and ambulatory healthcare settings. Methods: A multistage stratified sample identified records of 6689 children. Of these, 156 records were identified for depression and 356 for anxiety. These were assessed for adherence to 15 depression and 13 anxiety indicators, respectively, using a review of medical records. Results: Adherence to assessment and management guidelines was low for both conditions: assessment bundle (depression = 33%, 95% confidence interval = [20, 48]; anxiety = 54%, 95% confidence interval = [43, 64] and depression management bundle = 35%, 95% confidence interval = [15, 60]). Across both conditions, the highest adherence was recorded for indicators that addressed prescription of medications (e.g. venlafaxine, 100%; benzodiazepines, 100%; selective serotonin reuptake inhibitor, 94% and antidepressants, 91%), while compliance was the lowest for ensuring children with depression had an emergency safety plan (44%), informing parents of the risks and benefits of prescribed anxiety medication (51%) and assessment for other causes (59% for depression; 68% for anxiety). Conclusion: These findings suggest that strategies are needed to improve guideline adherence for mental health disorders in children and adolescents, particularly among general practitioners. Learning from these indicators could inform clinical prompts in electronic medical records, as well as links to additional information, to assist in decision-making and streamline work practices.

scholarly journals Infection-associated hospitalizations of women in labour

2020 ◽  
Vol 30 (4) ◽  
pp. 739-743 ◽  
Author(s):  
Katarzyna Kopeć-Godlewska ◽  
Agnieszka Pac ◽  
Anna Różańska ◽  
Paweł Żbikowski ◽  
Jerzy Rosiński ◽  
...  
Keyword(s):  
Infection Control ◽  
Postpartum Period ◽  
Quality Of Healthcare ◽  
Population Based ◽  
Healthcare Provision ◽  
Referral Hospitals ◽  
Using Data ◽  
The One ◽  
And Control

Abstract Background The article analyzes hospitalizations of women in the postpartum period in the Małopolska Province. Re-hospitalization of women as a result of puerperal complications may be used as an infection control quality measure in this patient population. Methods It was a population-based, retrospective analysis using data obtained from the Polish National Health Fund (paying for medical services, financed by all Polish employees contributing 9% of their salaries), collected routinely in 2013–14. The analysis encompassed 29 hospitals and 68 894 childbirths. Results In total, 1.7% of women were re-hospitalized and 563 of these re-hospitalizations (0.8%) were due to infection. Re-hospitalizations due to infections were significantly more often recorded among women who lived in villages compared with inhabitants of towns (OR 1.6, 95% CI 1.23–1.98; P < 0.001) and in women giving birth in primary referral hospitals in comparison with the second referral or clinical hospitals (OR 2.8, 95% CI 1.69–4.65; P < 0.001). On the one hand, the results of the study indicate that, in patients giving birth, the infection control system is not sensitive enough, and on the other hand, more detailed studies need to cover primary referral hospitals, specifically. Conclusions The problem of the infection-associated hospitalizations in the postpartum period is not reliably assessed by infection control professionals and constitutes a challenge for surveillance, including prevention and control. Complications associated with childbirth should be an indication of the quality of healthcare provision and knowledge of the scale of the problem should be the basis for its evaluation and prevention. This is especially true for infections in puerperas.

scholarly journals Quantitative Trait Loci: A Meta-analysis

Genetics ◽  
2000 ◽  
Vol 155 (1) ◽  
pp. 463-473
Author(s):  
Bruno Goffinet ◽  
Sophie Gerber
Keyword(s):  
Quantitative Trait Loci ◽  
Confidence Interval ◽  
Quantitative Trait ◽  
Meta Analysis ◽  
Trait Loci ◽  
Akaike Criterion ◽  
Using Data

Abstract This article presents a method to combine QTL results from different independent analyses. This method provides a modified Akaike criterion that can be used to decide how many QTL are actually represented by the QTL detected in different experiments. This criterion is computed to choose between models with one, two, three, etc., QTL. Simulations are carried out to investigate the quality of the model obtained with this method in various situations. It appears that the method allows the length of the confidence interval of QTL location to be consistently reduced when there are only very few “actual” QTL locations. An application of the method is given using data from the maize database available online at http://www.agron.missouri.edu/.

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 Assessing the quality of health care in the management of bronchiolitis in Australian children: a population-based sample survey

2019 ◽  
Vol 28 (10) ◽  
pp. 817-825
Author(s):  
Nusrat Homaira ◽  
Louise K Wiles ◽  
Claire Gardner ◽  
Charlotte J Molloy ◽  
Gaston Arnolda ◽  
...  
Keyword(s):  
Medical Record ◽  
Guideline Adherence ◽  
Healthcare Setting ◽  
Population Based ◽  
Sample Survey ◽  
Hospital Inpatient ◽  
History Taking ◽  
Ambulatory Services ◽  
Record Review

BackgroundBronchiolitis is the most common cause of respiratory hospitalisation in children aged <2 years. Clinical practice guidelines (CPGs) suggest only supportive management of bronchiolitis. However, the availability of CPGs do not guarantee that they are used appropriately and marked variation in the clinical management exists. We conducted an assessment of guideline adherence in the management of bronchiolitis in children at a subnationally representative level including inpatient and ambulatory services in Australia.MethodsWe searched for national and international CPGs relating to management of bronchiolitis in children and identified 16 recommendations which were formatted into 40 medical record audit indicator questions. A retrospective medical record review assessing compliance with the CPGs was conducted across three types of healthcare setting: hospital inpatient admissions, emergency department (ED) presentations and general practice (GP) consultations in three Australian states for children aged <2 years receiving care in 2012 and 2013.ResultsPurpose-trained surveyors conducted 13 979 eligible indicator assessments across 796 visits for bronchiolitis at 119 sites. Guideline adherence for management of bronchiolitis was 77.3% (95% CI 72.6 to 81.5) for children attending EDs, 81.6% (95% CI 78.0 to 84.9) for inpatients and 52.3% (95% CI 44.8 to 59.7) for children attending GP consultations. While adherence to some individual indicators was high, overall adherence to documentation of 10 indicators relating to history taking and examination was poorest and estimated at 2.7% (95% CI 1.5 to 4.4).ConclusionsThe study is the first to assess guideline-adherence in both hospital (ED and inpatient) and GP settings. Our study demonstrated that while the quality of care for bronchiolitis was generally adherent to CPG indicators, specific aspects of management were deficient, especially documentation of history taking.

scholarly journals Improving Search Quality in Crowdsourced Bib Number Tagging Systems Using Data Fusion

Information ◽  
2020 ◽  
Vol 11 (8) ◽  
pp. 385
Author(s):  
Andrew Ponomarev
Keyword(s):  
Data Fusion ◽  
Graphical Models ◽  
Field Experiments ◽  
Fusion Model ◽  
Human Errors ◽  
Additional Information ◽  
Gps Tracks ◽  
Reasonable Choice ◽  
Using Data

Today, crowd computing is successfully applied for many information processing problems in a variety of domains. One of the most acute issues with crowd-powered systems is the quality of results (as humans can make errors). Therefore, a number of methods have been proposed to process the results obtained from the crowd in order to compensate human errors. Most of the existing methods of processing contributions are constructed based on a (natural) assumption that the only information available is unreliable data obtained from the crowd. However, in some cases, additional information is available, and it can be utilized in order to improve the overall quality of the result. The paper describes a crowd computing application for community tagging of running race photos. It presents a utility analysis to identify situations in which community photo tagging is a reasonable choice. It also proposes a data fusion model making use of runners’ location information recorded in their Global Positioning System (GPS) tracks. Field experiments with the applications show that community-based tagging can collect enough contributors to process photosets from medium-sized running events. Simulation results confirm, that the use of data fusion in processing the results of crowd computing is a promising technique, and the use of probabilistic graphical models (e.g., Bayesian networks) for data fusion allows one to smoothly increase the quality of the results with an increase of the available information.

Prevalence of multiple sclerosis in Denmark 1950—2005

2010 ◽  
Vol 16 (5) ◽  
pp. 520-525 ◽  
Author(s):  
Joan Bentzen ◽  
Esben Meulengracht Flachs ◽  
Egon Stenager ◽  
Henrik Brønnum-Hansen ◽  
Nils Koch-Henriksen
Keyword(s):  
Multiple Sclerosis ◽  
Confidence Interval ◽  
Environmental Changes ◽  
Population Based ◽  
National Registry ◽  
Age At First Birth ◽  
Genetic Changes ◽  
Increased Risk ◽  
Using Data ◽  
Multiple Sclerosis Patients

Multiple sclerosis is an inflammatory disease of the central nervous system of unknown aetiology. Its prevalence varies by ethnicity and place: persons of northern European descent are at increased risk while persons living at lower latitudes appear to be protected against the disease. The Danish Multiple Sclerosis Registry is a national registry established in 1956 after a population-based survey which receives information from numerous sources. It is considered to be more than 90% complete, with a validity of 94%. Using data from the Registry, we calculated prevalences per 100,000 inhabitants. The standardized prevalence of multiple sclerosis increased from 58.8 (95% confidence interval: 54.9—62.7) in 1950 to 154.5 per 100,000 (95% confidence interval: 148.8—160.2) in 2005, and the female to male ratio increased from 1.31 in 1950 to 2.02 in 2005. The increase in prevalence is due to both increased survival of multiple sclerosis patients and an increased incidence rate. The rise in prevalence in the past 50 years is probably due more to environmental factors than to genetic changes in the Danish population. Among women, environmental changes could include older age at first birth, use of oral contraceptives, or changes in sun behaviour and/or vitamin D status.

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.

Assessing the Quality of the Management of Tonsillitis among Australian Children: A Population-Based Sample Survey

2018 ◽  
Vol 160 (1) ◽  
pp. 137-144 ◽  
Author(s):  
Peter Hibbert ◽  
Jacqueline H. Stephens ◽  
Carl de Wet ◽  
Helena Williams ◽  
Andrew Hallahan ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Population Based ◽  
Sample Survey ◽  
Future Research ◽  
Patient Records ◽  
Clinical Indicators ◽  
Appropriate Care ◽  
General Practices ◽  
Current Guidelines

Objective The aims of this study were twofold: (1) to design and validate a set of clinical indicators of appropriate care for tonsillitis and (2) to measure the level of tonsillitis care that is in line with guideline recommendations in a sample of Australian children. Study Design A set of tonsillitis care indicators was developed from available national and international guidelines and validated in 4 stages. This research used the same design as the CareTrack Kids study, which was described in detail elsewhere. Setting Samples of patient records from general practices, emergency departments, and hospital admissions were assessed. Subjects and Methods Patient records of children aged 0 to 15 years were assessed for the presence of, and adherence to, the indicators for care delivered in 2012 and 2013. Results Eleven indicators were developed. The records of 821 children (mean age, 5.0 years; SD, 4.0) with tonsillitis were screened. The reviewers conducted 2354 eligible indicator assessments across 1127 visits. Adherence to 6 indicators could be assessed and ranged from 14.3% to 73.2% (interquartile range 31.5% to 72.2%). Conclusion Our main findings are consistent with the international literature: the treatment of many children who present with confirmed or suspected tonsillitis is inconsistent with current guidelines. Future research should consider how the indicators could be applied in a structured and automated manner to increase the reliability and efficiency of record reviews and help raise clinicians’ awareness of appropriate tonsillitis management.

Health Insurance and Determinants of Perceived Healthcare Service Quality in Jordan

2021 ◽  
Vol 5 (1) ◽  
pp. 1-17
Author(s):  
Wajd R. Hammad ◽  
Rozaleen B. Abedrabbo ◽  
Diala Mazen Khoury ◽  
Nadia J. Sweis
Keyword(s):  
Health Insurance ◽  
Healthcare Workers ◽  
Quality Care ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Specialist Care ◽  
Cross Sectional ◽  
Perception Of Quality

This study demonstrates the determinants that affect the perception of quality of healthcare services in Jordan. A cross-sectional study was conducted in order to determine the perception of quality of healthcare services and relating variables including availability of health insurance and quality of health insurance. This study supports the findings of other studies that health insurance influences the perception of quality of healthcare services provided. However, it is also clear that Jordanians consider the availability of doctors, ability to obtain specialist care, accessibility to health services, and cooperation of healthcare workers as significant determinants when conceptualizing the quality of healthcare and its services. The amount of premium paid had a significant association, which could reflect on valuing the money they pay and expecting high-quality care in return. Being insured increases the likelihood of perceiving higher quality of healthcare.

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