Delays in treatment for colorectal cancer patients in an NCI-designated cancer center serving a Hispanic majority community.

e18233 Background: Timeliness of cancer treatment is an important aspect of health care quality. Colorectal cancer (CRC) care requires the coordinated multidisciplinary effort of various aspects of the health care system, which can lead to delays between initial diagnoses to definitive therapy. Little is known about the time from diagnosis to cancer-directed treatment, neither about the factors that cause delays or its effect on patient outcomes. Delays to curative surgery beyond 12 weeks are associated with increased mortality in CRC. Longer time to adjuvant chemotherapy is associated with worse survival among patients with resected CRC. The objective of our study is to identify delays in initiation of CRC treatment and its causative factors. Methods: We retrospectively reviewed the medical records of CRC patients who were either initially diagnosed or had initial surgical resection at University Hospital and had further treatment at Cancer Therapy and Research Center, between 7/1/2010 and 12/22/2014. Data were collected on patient and disease characteristics, treatment timelines and outcomes, till pre-specified data cut-off date of 8/1/16. Results: Of 256 patients treated for CRC, majority were males (59 %), Hispanic (59 % ) and uninsured (34 %). Most had non-metastatic disease (70%). 72 % were still alive at the time of data cut-off. The median time from diagnosis to treatment (TDT) was 21 days, with most of te patients getting first treatment between 0-30 days of diagnosis (60 %). Median time from first treatment to first progression or recurrence was 12 months (range 0.9- 42 mos.). Median overall survival (OS) was 17 months (0.1- 51 months). There were no statistically significant difference between the progression or recurrence free survival and OS in patients with TDT < 30 days, 30-89 days and > 90 days. Compared to non-Hispanics, Hispanic patients were more likely to have a TDT of 31-89 days (31% vs 37%, p = 0.0003) and > / = 90 days (3% vs 7%, p = 0.0001). Conclusions: Hispanic patients were more likely to have a longer time from diagnosis to treatment compared to non-Hispanic patients. The factors for such disparities in health care quality and their effect on survival needs to be explored further.

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Delays in treatment for colorectal cancer patients in an NCI-designated cancer center serving a Hispanic majority community.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.178 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 178-178

Author(s):

Tamna Wangjam ◽

Sherri L. Rauenzahn ◽

Praveena Iruku ◽

Stephanie Purkat Lindauer ◽

Matthew James Butler ◽

...

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Cancer Patients ◽

Median Time ◽

Health Care Quality ◽

Care Quality ◽

Definitive Therapy ◽

Significant Difference ◽

Hispanic Patients ◽

Colorectal Cancer Patients

178 Background: Timeliness of cancer treatment is an important aspect of health care quality. Colorectal cancer (CRC) care requires the coordinated multidisciplinary effort of various aspects of the health care system, which can lead to delays between initial diagnoses to definitive therapy. Little is known about the time from diagnosis to cancer-directed treatment, neither about the factors that cause delays or its effect on patient outcomes. Delays to curative surgery beyond 12 weeks are associated with increased mortality in CRC. Longer time to adjuvant chemotherapy is associated with worse survival among patients with resected CRC. The objective of our study is to identify delays in initiation of CRC treatment and its causative factors. Methods: We retrospectively reviewed the medical records of colorectal cancer patients who were either initially diagnosed or had initial surgical resection at University Hospital and had further treatment at Cancer Therapy and Research Center, between 7/1/2010 and 12/22/2014. Data were collected on patient and disease characteristics, treatment timelines and outcomes, till pre-specified data cut-off date of 8/1/16. Results: Of 256 patients treated for CRC, 59 % were males, 59 % Hispanic, and 34 % were uninsured. Most had non-metastatic disease (70%). 72 % were still alive at the time of data cut-off. The median time from diagnosis to treatment (TDT) was 21 days, with 60 % between 0-30 days and 59 % between 31-89 days. Median time from first treatment to first progression or recurrence was 12 months (range 0.9- 42 mos.). Median overall survival (OS) was 17 months (0.1- 51 months). There were no statistically significant difference between the progression or recurrence free survival and OS in patients with TDT <30 days, 30-89 days and >90 days. Compared to non-Hispanics, Hispanic patients were more likely to have a TDT of 31-89 days (31% vs 37%, p= 0.0003) and >/= 90 days (3% vs 7%, p= 0.0001). Conclusions: Hispanic patients were more likely to have a longer time from diagnosis to treatment compared to non-Hispanic patients. The various factors for such disparities in health care quality and their effect on survival needs to be explored further.

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Investigation of the Gap Between Patients’ Perceptions and Expectations of Hospital Service Quality

Journal of Client-centered Nursing Care ◽

10.32598/jccnc.6.2.286.1 ◽

2020 ◽

Vol 6 (2) ◽

pp. 117-124

Author(s):

Haniyeh Nazem ◽

◽

Hadi Raeis Abdollahi ◽

Abasat Mirzaei ◽

◽

...

Keyword(s):

Health Care ◽

Service Quality ◽

Health Care Quality ◽

Simple Random Sampling ◽

Care Quality ◽

T Test ◽

Hospital Service ◽

Cross Sectional ◽

Significant Difference

Background: Health care services are costly and complex and provide facilities that significantly affect the economy and quality of life of individuals. In this study, we determined the gap between patients’ expectations and perceptions of hospital service quality to provide reference data for creating strategies to improve health care quality. Methods: In this descriptive cross-sectional study, five private hospitals in Tehran were selected. Using a simple random sampling method, 110 patients were recruited and voluntarily responded to the standard service quality (SERVQUAL) model questionnaire. Data were analyzed by the K-S test, t-test, and paired t-test using SPSS V. 23. Results: The results showed that among the quality of health care components, the highest mean was related to the responsiveness (M=3.89) and the least was related to the tangible dimension (M=3.11). The lowest average quality gap (perceived service and expected service) was seen in the responsiveness dimension (2.96 and 3.28) and followed by reliability (2.66 and 3.90), tangible (2.53 and 3.91), empathy (1.36, 3.19), and assurance dimensions (2.39 and 4.75). Conclusion: The findings revealed a significant difference between the patients’ perceived and expected services, which indicates that the quality of services as perceived by patients was lower than their expectations. According to the findings, the assurance dimension had the greatest gap. To reduce or eliminate the existing gap, it is suggested that hospitals consider strategic and operational planning to improve hospitalization experience‏, quality of medical services, and hospital resources.

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Musculoskeletal healthcare at a Swiss university hospital chiropractic medicine outpatient clinic in 2019: a health services research study

10.21203/rs.3.rs-885731/v1 ◽

2021 ◽

Author(s):

Léonie Hofstetter ◽

Melanie Häusler ◽

Malin Mühlemann ◽

Luana Nyirö ◽

Daniel Mühlemann ◽

...

Keyword(s):

Health Care ◽

Quality Assurance ◽

Health Services Research ◽

Health Services ◽

Health Care Quality ◽

Research Study ◽

Clinical Care ◽

Care Quality ◽

University Hospital ◽

Services Research

Abstract Background The Balgrist University Hospital in Zurich, Switzerland, is an academic hospital focused on musculoskeletal (MSK) disorders. An integrated chiropractic medicine clinic provides chiropractic care to a broad patient population. Our health services research study aims to advance understanding of chiropractic health care service for quality assurance and health care quality improvement. Methods An observational clinical cohort study at the Balgrist chiropractic medicine clinic in 2019 was performed. The records of all patients with initial visits or returning initial visits (> 3 months since last visit) and their subsequent visits from January 1, 2019 to December 31, 2019, were used to create the study dataset. Data collected included demographic characteristics, diagnoses, imaging data, conservative treatments, surgeries, and other clinical care data. Descriptive statistics were used to summarize data. Results 1844 distinct patients (52% female, mean age 48 ± 17 years) were eligible and included in the study. 1742 patients had a single initial visit, 101 had 2 initial visits, and 1 patient had 3 initial visits during the study period. The most common main diagnoses were: low back pain (41%; 95% CI, 39–43%), neck pain (21%; 19–23%), and thoracic pain (8%; 7–9%). 29% had an acute (< 4 weeks) symptom duration, 10% subacute (4 to 12 weeks), and 52% chronic (> 12 weeks). Patients had a median number of 5 chiropractic visits during their episode of care, with a median care episode duration of 28 days. Only 49% (95% CI, 47–52%) of patient records had a clinical outcome that was extractable from routine clinical practice documentation retrievable from the hospital system. Conclusion Our health services research study provides an initial understanding of the patient characteristics and MSK clinical care delivered in a Swiss outpatient hospital setting and areas for clinical data quality assurance. Deeper insights into health care services and outcomes will help to facilitate a health quality improvement initiative by identifying clinical data and health care quality gaps, and establishing overall aims and targets for improvement.

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Internações por condições sensíveis à atenção primária decorrentes das doenças cardiovasculares

Revista Recien - Revista Científica de Enfermagem ◽

10.24276/rrecien2021.11.33.222-232 ◽

2021 ◽

Vol 11 (33) ◽

pp. 222-232

Author(s):

Eliane Santos Cavalcante ◽

Micael Pyerre Martins Duarte ◽

Viviane Peixoto dos Santos Pennafort ◽

Roberval Edson Pinheiro de Lima ◽

Juliana Jales Menescal Pinto ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Cardiovascular Diseases ◽

Health Care Quality ◽

Secondary Data ◽

Care Quality ◽

University Hospital ◽

Cross Sectional ◽

Insuficiencia Cardiaca ◽

Quality Health

Objetivou-se identificar as principais internações por Condições Sensíveis à Atenção Primária decorrente de Doença Cardiovascular em hospital público universitário. Estudo transversal, descritivo com dados secundários de internações ocorridas de agosto a dezembro de 2017. Das 1266 internações por Causa Sensível à Atenção Primária, as doenças cardiovasculares emergem com maior percentual (49,38%) dos diagnósticos, sendo as quatro principais causas que mais contribuíram para o total de internações: Infarto agudo do miocárdio não especificado (19,92%), Hipertensão essencial (primária) (10,37%), Angina instável (9,96%) e Insuficiência cardíaca (9,13%). Identificou-se predomínio em homens (55,92%), maiores de 60 anos (67,28%), com baixa escolaridade (24,17%), em sua maioria aposentados, casados (58,76%) e católicos. Os achados proporcionaram uma análise que aponta para a necessidade de qualificação dos serviços e dos sistemas de saúde, com ênfase nos territórios locais, considerando sua responsabilização para o desenvolvimento de ações e serviços no âmbito da Atenção Primária.Descritores: Doenças Cardiovasculares, Atenção Primária à Saúde, Hospitalização, Qualidade, Acesso e Avaliação da Assistência à Saúde. Hospitalizations for conditions sensitive to primary care due to cardiovascular diseasesAbstract: The objective was to identify the main hospitalizations for Conditions Sensitive to Primary Care resulting from Cardiovascular Disease in a public university hospital. A cross-sectional, descriptive study with secondary data on hospitalizations that took place from August to December 2017. Of the 1266 hospitalizations for a Cause Sensitive to Primary Care, cardiovascular diseases emerge with a higher percentage (49.38%) of the diagnoses, being the four main causes that contributed most to the total number of hospitalizations: Unspecified acute myocardial infarction (19.92%), Essential hypertension (primary) (10.37%), Unstable angina (9.96%) and Heart failure (9, 13%). There was a predominance of men (55.92%), older than 60 years (67.28%), with low education (24.17%), mostly retired, married (58.76%), and Catholics. The findings provide an analysis that points to the need for quality health services and systems, with an emphasis on local territories, considering their responsibility for the development of actions and services within the scope of Primary Care.Descriptors: Cardiovascular Diseases, Primary Health Care, Hospitalization, Health Care Quality, Access and Evaluation. Ingresos por afecciones sensibles a la atención primaria derivadas de enfermedades cardiovascularesResumen: El objetivo fue identificar las principales hospitalizaciones por afecciones sensibles a la atención primaria derivadas de la enfermedad cardiovascular en hospital universitario público. Estudio descriptivo transversal con datos secundarios sobre hospitalizaciones que tuvieron lugar de agosto a diciembre de 2017. De las 1266 hospitalizaciones por una causa sensible a la atención primaria, las enfermedades cardiovasculares surgen con un mayor porcentaje (49.38%) de los diagnósticos, siendo las cuatro causas principales que más contribuyeron al número total de hospitalizaciones: infarto agudo de miocardio no especificado (19,92%), hipertensión esencial (primaria) (10,37%), angina inestable (9,96%) e insuficiencia cardíaca (9, 13%). Predominaron los hombres (55,92%), mayores de 60 años (67,28%), con baja educación (24,17%), en su mayoría jubilados, casados (58,76%) y católicos. Los resultados proporcionan un análisis que señala la necesidad de calificar los servicios y sistemas de salud, con énfasis en los territorios locales, considerando su responsabilidad para el desarrollo de acciones y servicios dentro del alcance de la Atención Primaria.Descriptores: Enfermedades Cardiovasculares, Atención Primaria de Salud, Hospitalización, Calidad, Acceso y Evaluación de la Atención de Salud.

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