scholarly journals Predictive factors of diagnostic and therapeutic divergence in a nationwide cohort of patients seeking second medical opinion

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stéphane Sanchez ◽  
Isabelle Adamowicz ◽  
Jan Chrusciel ◽  
Philippe Denormandie ◽  
Pierre Denys ◽  
...  
Keyword(s):  
Public Funding ◽  
Patient Characteristics ◽  
Diagnostic Strategy ◽  
Medical Opinion ◽  
Improvement Programs ◽  
French Overseas Territories ◽  
Overseas Territories ◽  
New Research ◽  
Physician Network ◽  
Quality Improvement Programs

Abstract Objectives The aim of this study was to describe the profile of patients who sought a second medical opinion (SMO) on their therapeutic or diagnostic strategy using nationwide data from a French physician network dedicated to SMOs. Methods An observational cohort study was conducted and the study population consisted of patients residing in France or in the French overseas territories who submitted a request for an SMO through a dedicated platform between January 2016 and October 2020. Patient characteristics were compared between convergent and divergent SMOs. The divergent rate for all patients excluding those with mental diseases were described. Logistic regression was used to estimate the probability of a divergent SMO according to patient characteristics. Results and discussion In total, 1,552 adult patients over several French regions were included. The divergence rate was 32.3 % (n = 502 patients). Gynecological [Odds Ratio (OR) and 95 % CI: 5.176 (3.154 to 8.494)], urological [OR 4.246 (2.053 to 8.782)] and respiratory diseases [OR 3.639 (1.357 to 9.758)] had the highest probability of a divergent SMO. Complex cases were also associated with a significantly higher risk of a divergent opinion [OR 2.78 (2.16 to 3.59)]. Age, sex, region and profession were not found to be predictive of a divergent second opinion. Conclusions Policymakers should encourage new research on patient outcomes such as mortality and hospitalization rates after a SMO. When proven effective, SMO networks will have the potential to benefit from specific public funding or even play a key role in national healthcare quality improvement programs.

Addressing Communication Breakdowns during Emergency Care Transitions of Older Adults: Evaluation of a Standardized Inter-Facility Health Care Communication Form

2021 ◽  
pp. 1-11
Author(s):  
Patrick McLane ◽  
Kaitlyn Tate ◽  
R. Colin Reid ◽  
Brian H. Rowe ◽  
Carole Estabrooks ◽  
...  
Keyword(s):  
Older Persons ◽  
Chart Review ◽  
Care Transitions ◽  
Unintended Consequences ◽  
Term Care ◽  
Usual Practice ◽  
Improvement Programs ◽  
Quality Improvement Programs ◽  
Communication Breakdowns

Abstract Transitions for older persons from long-term care (LTC) to the emergency department (ED) and back, can result in adverse events. Effective communication among care settings is required to ensure continuity of care. We implemented a standardized form for improving consistency of documentation during LTC to ED transitions of residents 65 years of age or older, via emergency medical services (EMS), and back. Data on form use and form completion were collected through chart review. Practitioners’ perspectives were collected using surveys. The form was used in 90/244 (37%) LTC to ED transitions, with large variation in data element completion. EMS and ED reported improved identification of resident information. LTC personnel preferred usual practice to the new form and twice reported prioritizing form completion before calling 911. To minimize risk of harmful unintended consequences, communication forms should be implemented as part of broader quality improvement programs, rather than as stand-alone interventions.

Austria before Austria: The Medieval Past of Polities to Come

2007 ◽  
Vol 38 ◽  
pp. 1-12 ◽  
Author(s):  
Herwig Wolfram
Keyword(s):  
History Textbooks ◽  
German History ◽  
French History ◽  
The World ◽  
History Of ◽  
To Come ◽  
First Dynasty ◽  
People Search ◽  
French Overseas Territories ◽  
Overseas Territories

Throughout the world, historians expand the history of their nations and states into periods when these polities did not yet exist. The French speak of their first dynasty and mean the Frankish Merovingians. Until recently French history textbooks even for students in the French overseas territories started with “Nos ancêtres, les Gaulois.” In the German Kaiserreich between 1871 and 1918, let us say, little Jan Kowalski in Poznan had to accept the Germanic peoples as his forefathers, as every textbook on German history dealt with them at length. Needless to say, not only German medievalists speak of Germans long before theodiscus or teutonicus came to mean deutsch. All over the world people search for the roots of their identity. Take, for instance, the present preoccupation with Celtic ancestors. Not only the Irish, Welsh, Scots, and Bretons, but a great many other Europeans also want to be Celts by origin. “Their successors in Brittany, Wales, or Ireland do not threaten anybody with Anschluss or war. The Celtic origins, therefore, fit the Austrian neutrality perfectly well,” as Erich Zöllner ironically put it in 1976 after Chancellor Bruno Kreisky had openly declared that the Celts and not the Germans were our forefathers.

Effectiveness of Multifaceted Hospitalwide Quality Improvement Programs Featuring an Intervention to Remove Unnecessary Urinary Catheters at a Tertiary Care Center in Thailand

2007 ◽  
Vol 28 (7) ◽  
pp. 791-798 ◽  
Author(s):  
Anucha Apisarnthanarak ◽  
Kanokporn Thongphubeth ◽  
Sirinaj Sirinvaravong ◽  
Danai Kitkangvan ◽  
Chananart Yuekyen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Costs ◽  
Urinary Catheterization ◽  
Urinary Catheters ◽  
Improvement Program ◽  
Improvement Programs ◽  
Intervention Team ◽  
Quality Improvement Programs

Objective.To evaluate the efficacy of a multifaceted hospitalwide quality improvement program that featured an intervention to remind physicians to remove unnecessary urinary catheters.Methods.A hospitalwide preintervention-postintervention study was conducted over 2 years (July 1, 2004, through June 30, 2006). The intervention consisted of nurse-generated daily reminders that were used by an intervention team to remind physicians to remove unnecessary urinary catheters, beginning 3 days after insertion. Clinical, microbiological, pharmaceutical, and cost data were collected.Results.A total of 2,412 patients were enrolled in the study. No differences were found in the demographic and/or clinical characteristics of patients between the preintervention and postintervention periods. After the intervention, reductions were found in the rate of inappropriate urinary catheterization (mean rate, preintervention vs postintervention, 20.4% vs 11% [P = .04]), the rate of catheter-associated urinary tract infection (CA-UTI) (mean rate, 21.5 vs 5.2 infections per 1,000 catheter-days [P <.001]), the duration of urinary catheterization (mean, 11 vs 3 days [P < .001]), and the total length of hospitalization (mean, 16 vs 5 days [P < .001]). A linear relationship was seen between the monthly average duration of catheterization and the rate of CA-UTI (r = 0.89; P < .001). The intervention had the greatest impact on the rate of CA-UTI in the intensive care units (mean rate, preintervention vs postintervention, 23.4 vs 3.5 infections per 1,000 catheter-days [P = .01]). The monthly hospital costs for antibiotics to treat CA-UTI were reduced by 63% (mean, $3,739 vs $1,378 [P < .001]), and the hospitalization cost for each patient during the intervention was reduced by 58% (mean, $366 vs $154 [P < .001]).Conclusions.This study suggests that a multifaceted intervention to remind physicians to remove unnecessary urinary catheters can significantly reduced the duration of urinary catheterization and the CA-UTI rate in a hospital in a developing country.

scholarly journals BIAYA KUALITAS DAN KOMPQNENNYA PADA BAD AN USAHA PERAIH ISO 9000 DI KAWASAN INDUSTRI SIER DAN PIER

2005 ◽  
Vol 4 (1) ◽  
Author(s):  
Stefanus Budy Widjaja Subali ◽  
Yie Ke Feliana
Keyword(s):  
Quality Improvement ◽  
Iso 9000 ◽  
Cost Driver ◽  
Quality Costs ◽  
Activity Cost ◽  
Improvement Programs ◽  
Quality Improvement Programs

Quality has become an important competitive dimension for all organization. Recently, -the emphasis on quality has shifted from a source of strategic advantage to a compepetive necessity As the companies implement quality-improvement programs,one of those is. ISO 9000, a need arises to monitor and report on the progress of these programs. Managers r need to know about the quality costs and the component of quality costs. The component of quality costs include prevention, appraisal, internal failure and external failure costs. This article describes how the companies that were awarded ISO 9000 define the quality costs, what items to be included in the each component of quality costs and how the composition of each component of quality activity cost driver is.

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