scholarly journals Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process

Author(s):  
Michelle Sweidan ◽  
Margaret Williamson ◽  
James F Reeve ◽  
Ken Harvey ◽  
Jennifer A O'Neill ◽  
...  
2006 ◽  
Vol 67 (S1) ◽  
pp. S14-S29 ◽  
Author(s):  
Paula Brauer ◽  
Linda Dietrich ◽  
Bridget Davidson ◽  

Purpose: A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. Methods: Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. Results: An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers’ nutrition services. Conclusions: The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.


2015 ◽  
Vol 25 (4) ◽  
pp. 273-280 ◽  
Author(s):  
Andrea L Hernan ◽  
Sally J Giles ◽  
Jane K O'Hara ◽  
Jeffrey Fuller ◽  
Julie K Johnson ◽  
...  

2021 ◽  
Author(s):  
Melinda A. Bell ◽  
Martin A. Cake ◽  
Laura T. King ◽  
Caroline F. Mansfield

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Huanyu Zhang ◽  
Eliza LY Wong ◽  
Eng-kiong Yeoh ◽  
Bosco HM Ma

Abstract Background Potentially inappropriate medication (PIM) use has adverse effects on health, particularly in elder patients. Various country-specific explicit criteria have been developed to measure the appropriateness of prescribing worldwide. However, it is difficult to apply the criteria developed from other regions to measure and guide the local prescribing practice in Hong Kong. This study aims to develop a Hong Kong-specific PIM assessing tool from previously published criteria and validate this tool using the modified Delphi method. Methods A disease-oriented Hong Kong-specific preliminary PIM list was developed based on nine sets of reference criteria selected from a literature review. Any medication or medication class appeared in at least two sets of the reference criteria as well as its related medical conditions were selected as PIM candidates. After examining the availability of PIM candidates by the Hong Kong Hospital Authority drug formulary, the Hong Kong-specific preliminary PIM list was validated by a two-round of modified Delphi process. Eight experts from different specialties were invited to rate the degree of inappropriateness of each PIM candidate using a five-point Likert scale. The experts were also encouraged to propose therapeutic alternatives and new PIM candidates not covered by the preliminary PIM list. The PIM candidates that the expert panel didn’t reach consensus on were excluded from the final Hong Kong-specific PIM list. Results After two rounds of the Delphi process, eight PIM candidates remained questionable and thus were excluded from the PIM list. The final Hong Kong-specific PIM list included a total of 164 statements applicable to older adults aged 65 years or above, among which 77 were under PIMs independent of diagnoses, and 87 were under PIMs considering specific medical conditions. Conclusions The Hong Kong-specific PIM list can be used as a quality measure and an educational tool to improve the local prescribing quality. Further studies should validate its association with adverse health outcomes in clinical and research settings.


2020 ◽  
pp. archdischild-2020-320345
Author(s):  
Beatrix Algurén ◽  
Jessily P Ramirez ◽  
Matthew Salt ◽  
Nick Sillett ◽  
Stacie N Myers ◽  
...  

ObjectiveTo develop an Overall Pediatric Health Standard Set (OPH-SS) of outcome measures that captures what matters to young people and their families and recognising the biopsychosocial aspects of health for all children and adolescents regardless of health condition.DesignA modified Delphi process.SettingThe International Consortium for Health Outcomes Measurement convened an international Working Group (WG) comprised of 23 international experts from 12 countries in the field of paediatrics, family medicine, psychometrics as well as patient advisors. The WG participated in 11 video-conferences, through a modified Delphi process and 9 surveys between March 2018 and January 2020 consensus was reached on a final recommended health outcome standard set. By a literature review conducted in March 2018, 1136 articles were screened for clinician and patient-reported or proxy-reported outcomes. Further, 4315 clinical trials and 12 paediatric health surveys were scanned. Between November 2019 and January 2020, the final standard set was endorsed by a patient validation (n=270) and a health professional (n=51) survey.ResultsFrom a total of 63 identified outcomes, consensus was formed on a standard set of outcome measures that comprises 10 patient-reported outcomes, 5 clinician-reported measures, and 6 case-mix variables. The four developmental age-specific packages (ie, 0–5, 6–12, 13–17, 18–24 years) include either five or six measures with an average time for completion of 20 min.ConclusionsThe OPH-SS is a starting point to drive value-based paediatric healthcare delivery from a global perspective for enhancing child and adolescent physical health and psychosocial well-being.


2018 ◽  
Vol 32 (8) ◽  
pp. 1002-1012
Author(s):  
Stuart Barson ◽  
Robin Gauld ◽  
Jonathon Gray ◽  
Goran Henriks ◽  
Christina Krause ◽  
...  

Purpose The purpose of this paper is to identify five quality improvement initiatives for healthcare system leaders, produced by such leaders themselves, and to provide some guidance on how these could be implemented. Design/methodology/approach A multi-stage modified-Delphi process was used, blending the Delphi approach of iterative information collection, analysis and feedback, with the option for participants to revise their judgments. Findings The process reached consensus on five initiatives: change information privacy laws; overhaul professional training and work in the workplace; use co-design methods; contract for value and outcomes across health and social care; and use data from across the public and private sectors to improve equity for vulnerable populations and the sickest people. Research limitations/implications Information could not be gathered from all participants at each stage of the modified-Delphi process, and the participants did not include patients and families, potentially limiting the scope and nature of input. Practical implications The practical implications are a set of findings based on what leaders would bring to a decision-making table in an ideal world if given broad scope and capacity to make policy and organisational changes to improve healthcare systems. Originality/value This study adds to the literature a suite of recommendations for healthcare quality improvement, produced by a group of experienced healthcare system leaders from a range of contexts.


F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1634 ◽  
Author(s):  
James Galipeau ◽  
Kelly D. Cobey ◽  
Virginia Barbour ◽  
Patricia Baskin ◽  
Sally Bell-Syer ◽  
...  

Background: Scientific editors (i.e., those who make decisions on the content and policies of a journal) have a central role in the editorial process at biomedical journals. However, very little is known about the training needs of these editors or what competencies are required to perform effectively in this role. Methods: We conducted a survey of perceptions and training needs among scientific editors from major editorial organizations around the world, followed by a modified Delphi process in which we invited the same scientific editors to rate the importance of competency-related statements obtained from a previous scoping review. Results: A total of 148 participants completed the survey of perceptions and training needs. At least 80% of participants agreed on six of the 38 skill and expertise-related statements presented to them as being important or very important to their role as scientific editors. At least 80% agreed on three of the 38 statements as necessary skills they perceived themselves as possessing (well or very well).  The top five items on participants’ list of top training needs were training in statistics, research methods, publication ethics, recruiting and dealing with peer reviewers, and indexing of journals. The three rounds of the Delphi were completed by 83, 83, and 73 participants, respectively, which ultimately produced a list of 23 “highly rated” competency-related statements and another 86 “included” items. Conclusion: Both the survey and the modified Delphi process will be critical for understanding knowledge and training gaps among scientific editors when designing curriculum around core competencies in the future.


BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e040779
Author(s):  
Harry B Burke ◽  
Heidi B King

ObjectiveFor physicians to practice safe high quality medicine they must have sufficient safety and quality knowledge. Although a great deal is known about the safety and quality perceptions, attitudes and beliefs of physicians, little is known about their safety and quality knowledge. This study tested the objective safety and quality knowledge of practicing US primary care physicians.DesignCross-sectional objective test of safety and quality knowledge.SettingPrimary care physicians practicing in the USA.ParticipantsStudy consisted of 518 US practicing primary care physicians who answered an email invitation. Fifty-four percent were family medicine and 46% were internal medicine physicians.The response rate was 66%.InterventionThe physicians took a 24-question multiple-choice test over the internet.OutcomeThe outcome was the percent correct.ResultsThe average number of correct answers was 11.4 (SD, 2.69), 48% correct. Three common clinical vignettes questions were answered correctly by 45% of the physicians. Five common radiation exposures questions were answered correctly by 40% of the physicians. Seven common healthcare quality and safety questions were answered correctly by 43% of the physicians. Seven Donabedian’s model of structure, process and outcome measure questions were answered correctly by 67% of the physicians. Two Institute of Medicine’s definitions of quality and safety questions were answered correctly by 19.5% of the physicians.ConclusionForty-eight per cent of the physicians’ answers to the objective safety and quality questions were correct. To our knowledge, this is the first assessment of the objective safety and quality knowledge of practicing US primary care physicians.


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