Value-based dentistry: Putting the patient first

2016 ◽  
Vol 7 (3) ◽  
pp. 126-129 ◽  
Author(s):  
Sreenivas Koka ◽  
Galya Raz
Keyword(s):  
Risk Management ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Dental Care ◽  
Time Cost ◽  
Safety Risk ◽  
The Cost ◽  
Over Time

What does ‘value’ mean? In the context of dental care, it can be defined as the quality of care received by a patient divided by the cost to the patient of receiving that care. In other words: V =Q/C, where Q equals the quality improvement over time, which most patients view in the context of the outcome, the service provided and safety/risk management, and C equals the financial, biological and time cost to the patient. Here, the need for, and implications of, value-based density for clinicians and patients alike are explored.

scholarly journals Improving nursing documentation for surgical patients in a referral hospital in Freetown, Sierra Leone: protocol for assessing feasibility of a pilot multifaceted quality improvement hybrid type project

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Nataliya Brima ◽  
Nick Sevdalis ◽  
K. Daoh ◽  
B. Deen ◽  
T. B. Kamara ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Sierra Leone ◽  
Referral Hospital ◽  
Audit And Feedback ◽  
Health System Strengthening ◽  
Theory Of Change ◽  
Improve Quality ◽  
Nursing Documentation

Abstract Background There is an urgent need to improve quality of care to reduce avoidable mortality and morbidity from surgical diseases in low- and middle-income countries. Currently, there is a lack of knowledge about how evidence-based health system strengthening interventions can be implemented effectively to improve quality of care in these settings. To address this gap, we have developed a multifaceted quality improvement intervention to improve nursing documentation in a low-income country hospital setting. The aim of this pilot project is to test the intervention within the surgical department of a national referral hospital in Freetown, Sierra Leone. Methods This project was co-developed and co-designed by in-country stakeholders and UK-based researchers, after a multiple-methodology assessment of needs (qualitative, quantitative), guided by a participatory ‘Theory of Change’ process. It has a mixed-method, quasi-experimental evaluation design underpinned by implementation and improvement science theoretical approaches. It consists of three distinct phases—(1) pre-implementation(project set up and review of hospital relevant policies and forms), (2) intervention implementation (awareness drive, training package, audit and feedback), and (3) evaluation of (a) the feasibility of delivering the intervention and capturing implementation and process outcomes, (b) the impact of implementation strategies on the adoption, integration, and uptake of the intervention using implementation outcomes, (c) the intervention’s effectiveness For improving nursing in this pilot setting. Discussion We seek to test whether it is possible to deliver and assess a set of theory-driven interventions to improve the quality of nursing documentation using quality improvement and implementation science methods and frameworks in a single facility in Sierra Leone. The results of this study will inform the design of a large-scale effectiveness-implementation study for improving nursing documentation practices for patients throughout hospitals in Sierra Leone. Trial registration Protocol version number 6, date: 24.12.2020, recruitment is planned to begin: January 2021, recruitment will be completed: December 2021.

CQI: Meeting the Mandate for Quality

1995 ◽  
Vol 112 (5) ◽  
pp. P111-P111
Author(s):  
Carl A. Patow
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Continuous Quality Improvement ◽  
Educational Objectives ◽  
Continuous Quality

Educational objectives: To understand the principles of continuous quality improvement and to use these principles to enhance patient satisfaction through increased efficiency and improved quality of care.

scholarly journals Baseline Quality-of-Care Data From a Quality-Improvement Program Implemented by a Network of Diabetes Outpatient Clinics

Diabetes Care ◽  
2008 ◽  
Vol 31 (11) ◽  
pp. 2166-2168 ◽  
Author(s):  
M. C.E. Rossi ◽  
A. Nicolucci ◽  
A. Arcangeli ◽  
A. Cimino ◽  
G. De Bigontina ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Quality Improvement Program ◽  
Outpatient Clinics ◽  
Improvement Program

scholarly journals Vocational Training and Dental Care in the Unique Health System: Experience Report

2021 ◽  
pp. 15
Author(s):  
Keyword(s):  
Quality Of Care ◽  
Dental Care ◽  
Professional Training ◽  
Tertiary Care ◽  
Oral Care ◽  
Family Health ◽  
Experience Report ◽  
University Hospital ◽  
The University

Objective: To report the experience lived during the Integrated Multiprofessional Residency in Family Health at the Faculty of Medical Sciences of the University of Pernambuco – FCM/UPE – at the interface with the Residency in Hospital Dentistry with a focus on Oncology at the University of Pernambuco developed at the Oncology Center at the Oswaldo Cruz University Hospital of the University of Pernambuco – CEON/HUOC/UPE. Methods: This is an experience report of dental practice in the context of professional training, in SUS, both in primary, secondary and tertiary care. Results: It is noticeable the need for greater professional qualification of the graduate, their integration in the Services of the institutionalized network and their performance with efficiency in multiprofissional teams, emphasizing the importance of professional training through Residencies, allowing the dental surgeon to improve in the diferente fields of Dentistry activities and, in particular, rescuing the inter-trans-multidisciplinary performance in both primary and hospital care and in the area of oncology. It was noticed that the integrated performance of the dental surgeon in a multidisciplinar team in low and medium complexity with resolvability in oral care is essential for the quality of care in the hospital context. Conclusion: Dental care directly impacts the quality of care and patient’s lives. The training of the dental surgeon throug the Residencies can provide skills and contribute with the other professions to the patient’s quality of life. In addition to its assistance character, the Dentistry Service – CEON/HUOC/UPE assumes an important education function, serving as a teaching research and extension field.

scholarly journals Using the WHO Safe Childbirth Checklist to Improve Essential Care Delivery as Part of the District -Wide Maternal and Newborn Health Quality Improvement Initiative, a Time Series Study

2020 ◽  
Author(s):  
Befikadu Bitewulign ◽  
Dereje Abdissa ◽  
Zewdie Mulissa ◽  
Abiyou Kiflie ◽  
Mehiret Abate ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Newborn Health ◽  
System Level ◽  
Maternal And Newborn Health ◽  
Safe Childbirth Checklist ◽  
Safe Childbirth ◽  
Over Time ◽  
Maternal And Newborn

Abstract Background: Care bundles are a set of three to five evidence-informed practices which, when performed collectively and reliably, may improve health system performance and patient care. To date, many studies conducted to improve the quality of essential birth care practices (EBPs) have focused primarily on provider- level and have fallen short of the predicted impact on care quality, indicating that a systems approach is needed to improve the delivery of reliable quality care. This study evaluates the effectiveness of integrating the use of the World Health Organization Safe Childbirth Checklist (WHO-SCC) into a district-wide system improvement collaborative program designed to improve and sustain the delivery of EBPs as measured by "clinical bundle" adherence over-time.Methods: The WHO-SCC was introduced in the context of a district-wide Maternal and Newborn Health (MNH) collaborative quality of care improvement program in four agrarian Ethiopia regions. Three "clinical bundles" were created from the WHO-SCC: On Admission, Before Pushing, and Soon After Birth bundles. The outcome of each bundle was measured using all- or- none adherence. Adherence was assessed monthly by reviewing charts of live births.A time-series analysis was employed to assess the effectiveness of system-level interventions on clinical bundle adherence. STATA version 13.1 was used to analyze the trend of each bundle adherence overtime. Autocorrelation was checked to assess if the assumption of independence in observations collected overtime was valid. Prais-Winsten was used to minimize the effect of autocorrelation.Findings: Quality improvement interventions targeting the three clinical bundles resulted in improved adherence over time across the four regions. In Tigray region, adherence to “On Admission” bundle was increased monthly on average by B =1.39 (95% CI; 0.47 - 2.32; P<0.005).Similarly, adherence to the “Before Pushing” bundle in Southern Nations, Nationalities and People’s (SNNP) region increased monthly on average by B = 2.3 (95% CI; 0.89 - 3.74; P<0.005). Conclusion: Use of the WHO-SCC paired with a system-wide quality improvement approach improved and sustained quality of EBPs delivery. Further studies should be conducted to evaluate the impact on patient-level outcomes.

Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis

2021 ◽  
pp. bmjqs-2021-013110
Author(s):  
Sanjay Mahant ◽  
Jun Guan ◽  
Jessie Zhang ◽  
Sima Gandhi ◽  
Evan Jon Propst ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Health System ◽  
Interrupted Time Series ◽  
Improve Quality ◽  
Interrupted Time Series Analysis ◽  
Quality Improvement Programme ◽  
Improvement Programme

BackgroundTonsillectomy is among the most common and cumulatively expensive surgical procedures in children, with known variations in quality of care. However, evidence on health system interventions to improve quality of care is limited. The Quality-Based Procedures (QBP) programme in Ontario, Canada, introduced fixed episode hospital payment per tonsillectomy and disseminated a perioperative care pathway. We determined the association of this payment and quality improvement programme with tonsillectomy quality of care.MethodsInterrupted time series analysis of children undergoing elective tonsillectomy at community and children’s hospitals in Ontario in the QBP period (1 April 2014 to 31 December 2018) and the pre-QBP period (1 January 2009 to 31 January 2014) using health administrative data. We compared the age-standardised and sex-standardised rates for all-cause tonsillectomy-related revisits within 30 days, opioid prescription fills within 30 days and index tonsillectomy inpatient admission.Results111 411 children underwent tonsillectomy: 51 967 in the QBP period and 59 444 in the pre-QBP period (annual median number of hospitals, 86 (range 77–93)). Following QBP programme implementation, revisit rates decreased for all-cause tonsillectomy-related revisits (0.48 to −0.18 revisits per 1000 tonsillectomies per month; difference −0.66 revisits per 1000 tonsillectomies per month (95% CI −0.97 to −0.34); p<0.0001). Codeine prescription fill rate continued to decrease but at a slower rate (−4.81 to −0.11 prescriptions per 1000 tonsillectomies per month; difference 4.69 (95% CI 3.60 to 5.79) prescriptions per 1000 tonsillectomies per month; p<0.0001). The index tonsillectomy inpatient admission rate decreased (1.12 to 0.23 admissions per 1000 tonsillectomies per month; difference −0.89 (95% CI −1.33 to −0.44) admissions per 1000 tonsillectomies per month; p<0.0001).ConclusionsThe payment and quality improvement programme was associated with several improvements in quality of care. These findings may inform jurisdictions planning health system interventions to improve quality of care for tonsillectomy and other paediatric procedures.

Abstract WP237: Improved Thrombolysis Rates and Quality of Care for Stroke Patients Through a Provincial Emergency Department Quality Improvement Initiative

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Devin R Harris ◽  
Robert Stenstrom ◽  
Eric Grafstein ◽  
Mark Collison ◽  
Grant Innes ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measures ◽  
Large Scale ◽  
Primary Outcome ◽  
Baseline Data ◽  
Quality Improvement Initiative ◽  
Stroke Patients

Background: The care of stroke patients in the emergency department (ED) is time sensitive and complex. We sought to improve quality of care for stroke patients in British Columbia (B.C.), Canada, emergency departments. Objectives: To measure the outcomes of a large-scale quality improvement initiative on thrombolysis rates and other ED performance measures. Methods: This was an evaluation of a large-scale stroke quality improvement initiative, within ED’s in B.C., Canada, in a before-after design. Baseline data was derived from a medical records review study performed between December 1, 2005 to January 31, 2007. Adherence to best practice was determined by measuring selected performance indicators. The quality improvement initiative was a collaboration between multidisciplinary clinical leaders within ED’s throughout B.C. in 2007, with a focus on implementing clinical practice guidelines and pre-printed order sets. The post data was derived through an identical methodology as baseline, from March to December 2008. The primary outcome was the thrombolysis rate; secondary outcomes consisted of other ED stroke performance measures. Results: 48 / 81 (59%) eligible hospitals in B.C. were selected for audit in the baseline data; 1258 TIA and stroke charts were audited. For the post data, 46 / 81 (57%) acute care hospitals were selected: 1199 charts were audited. The primary outcome of the thrombolysis rate was 3.9% (23 / 564) before and 9.3% (63 / 676) after, an absolute difference of 5.4% (95% CI: 2.3% - 7.6%; p=0.0005). Other measures showed changes: administration of aspirin to stroke patients in the ED improved from 23.7% (127 / 535) to 77.1% (553 / 717), difference = 53.4% (95% CI: 48.3% - 58.1%; p=0.0005); and, door to imaging time improved from 2.25 hours (IQR = 3.81 hours) to 1.57 hours (IQR 3.0), difference = 0.68 hours (p=0.03). Differences were found in improvements between large and small institutions, and between health regions. Conclusions: Implementation of a provincial emergency department quality improvement initiative showed significant improvement in thrombolysis rates and adherence to other best practices for stroke patients. The specific factors that influenced improvement need to be further explored.

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