scholarly journals Understanding how and why audits work in improving the quality of hospital care: A systematic realist review

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248677
Author(s):  
Lisanne Hut-Mossel ◽  
Kees Ahaus ◽  
Gera Welker ◽  
Rijk Gans
Keyword(s):  
Research Agenda ◽  
Hospital Care ◽  
Healthcare Professionals ◽  
Realist Review ◽  
Leadership Positions ◽  
Policy Makers ◽  
Audit Data ◽  
Sustained Change ◽  
Over Time

Background Several types of audits have been used to promote quality improvement (QI) in hospital care. However, in-depth studies into the mechanisms responsible for the effectiveness of audits in a given context is scarce. We sought to understand the mechanisms and contextual factors that determine why audits might, or might not, lead to improved quality of hospital care. Methods A realist review was conducted to systematically search and synthesise the literature on audits. Data from individual papers were synthesised by coding, iteratively testing and supplementing initial programme theories, and refining these theories into a set of context–mechanism–outcome configurations (CMOcs). Results From our synthesis of 85 papers, seven CMOcs were identified that explain how audits work: (1) externally initiated audits create QI awareness although their impact on improvement diminishes over time; (2) a sense of urgency felt by healthcare professionals triggers engagement with an audit; (3) champions are vital for an audit to be perceived by healthcare professionals as worth the effort; (4) bottom-up initiated audits are more likely to bring about sustained change; (5) knowledge-sharing within externally mandated audits triggers participation by healthcare professionals; (6) audit data support healthcare professionals in raising issues in their dialogues with those in leadership positions; and (7) audits legitimise the provision of feedback to colleagues, which flattens the perceived hierarchy and encourages constructive collaboration. Conclusions This realist review has identified seven CMOcs that should be taken into account when seeking to optimise the design and usage of audits. These CMOcs can provide policy makers and practice leaders with an adequate conceptual grounding to design contextually sensitive audits in diverse settings and advance the audit research agenda for various contexts. PROSPERO registration CRD42016039882.

scholarly journals Introduction to the special issue: multiple jobholding in Europe

2021 ◽  
Vol 27 (2) ◽  
pp. 141-147
Author(s):  
Wieteke Conen ◽  
Karin Schulze Buschoff
Keyword(s):  
Labour Market ◽  
Social Protection ◽  
Special Issue ◽  
Clear Trend ◽  
Policy Makers ◽  
Quality Of Work ◽  
Labour Market Flexibility ◽  
Employment Situation ◽  
Over Time

In a number of European countries there is a clear trend towards increased multiple jobholding. As things stand, however, little is known about the structure and the potential consequences of this increase, notably in terms of quality of work and social protection. This special issue focuses on contemporary forms of multiple jobholding in Europe. Have the structure, nature and dynamics of multiple jobholding changed over time? What are the roles of labour market flexibility, technological change and work fragmentation in the development of multiple jobholding? And do multiple jobholders benefit from similar and adequate employment terms, conditions and protections compared with single jobholders, or are they worse off as a consequence of their (fragmented) employment situation? What implications do these findings have for unions, policy-makers and the regulation of work? The collection of articles in this special issue adds to the literature on emerging forms of employment in the digital age and challenges for social protection, also in light of the COVID-19 pandemic. This introduction initiates a discussion of central debates on multiple jobholding and presents a synopsis of the articles in this issue.

scholarly journals Impact on Health-Related Quality of Life and Costs of Managing Chronic Neuropathic Pain in Academic Pain Centres: Results from a One-Year Prospective Observational Canadian Study

2015 ◽  
Vol 20 (6) ◽  
pp. 327-333 ◽  
Author(s):  
J-E Tarride ◽  
DE Moulin ◽  
M Lynch ◽  
AJ Clark ◽  
L. Stitt ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Economic Value ◽  
Health Related Quality ◽  
Policy Makers ◽  
Related Quality ◽  
Health Related ◽  
The Mean ◽  
One Year ◽  
Over Time

BACKGROUND: The management of chronic pain, including neuropathic pain (NeP), is a major public health issue. However, there is a paucity of data evaluating pain management strategies in real-life settings.OBJECTIVE: To inform policy makers about the economic value of managing chronic NeP in academic centres by conducting a subeconomic assessment of a Canadian multicentre cohort study aimed at determining the long-term outcomes of the management of chronic NeP in academic pain centres. Specific questions regarding the economic value of this type of program were answered by a subset of patients to provide further information to policy makers.METHODS: Baseline demographic information and several pain-related measurements were collected at baseline, three, six and 12 months in the main study. A resource use questionnaire aimed at determining NeP-related costs and the EuroQoL-5 Dimension were collected in the subset study from consenting patients. Statistical analyses were conducted to compare outcomes over time and according to responder status.RESULTS: A total of 298 patients were evaluated in the present economic evaluation. The mean (± SD) age of the participants was 53.7±14.0 years, and 56% were female. At intake, the mean duration of NeP was >5 years. Statistically significant improvements in all pain and health-related quality of life outcomes were observed between the baseline and one-year visits. Use decreased over time for many health care resources (eg, visits to the emergency room decreased by one-half), which resulted in overall cost savings.CONCLUSION: The results suggest that increased access to academic pain centres should be facilitated in Canada.

scholarly journals Dear policy maker: Have you made up your mind? A discrete choice experiment among policy makers and other health professionals

2010 ◽  
Vol 26 (2) ◽  
pp. 198-204 ◽  
Author(s):  
Marc A. Koopmanschap ◽  
Elly A. Stolk ◽  
Xander Koolman
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Disease Severity ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Healthcare Professionals ◽  
Budget Impact ◽  
Policy Makers

Objectives: The aim of this study was to get insight in what criteria as presented in Health technology assessment (HTA) studies are important for decision makers in healthcare priority setting.Methods: We performed a discrete choice experiment among Dutch healthcare professionals (policy makers, HTA experts, advanced HTA students). In twenty-seven choice sets, we asked respondents to elect reimbursement of one of two different healthcare interventions, which represented unlabeled, curative treatments. Both treatments were incrementally compared with usual care. The results of the interventions were normal outputs of HTA studies with a societal perspective. Results were analyzed using a multinomial logistic regression model. Upon completion of the questionnaire, we discussed the exercise with policy makers.Results: Severity of disease, costs per quality-adjusted life-year gained, individual health gain, and the budget impact were the most decisive decision criteria. A program targeting more severe diseases increased the probability of reimbursement dramatically. Uncertainty related to cost-effectiveness was also important. Respondents preferred health gains that include quality of life improvements over extension of life without improved quality of life. Savings in productivity costs were not crucial in decision making, although these are to be included in Dutch reimbursement dossiers for new drugs. Regarding subgroups, we found that policy makers attached relatively more weight to disease severity than others but less to uncertainty.Conclusions: Dutch policy makers and other healthcare professionals seem to have reasonably well articulated preferences: six of seven attributes were significant. Disease severity, budget impact, and cost-effectiveness were very important. The results are comparable to international studies, but reveal a larger set of important decision criteria.

scholarly journals Measuring Health-Related Quality of Life: General Issues

1997 ◽  
Vol 4 (3) ◽  
pp. 123-130 ◽  
Author(s):  
Gordon H Guyatt
Keyword(s):  
Quality Of Life ◽  
High Ratio ◽  
Health Related Quality ◽  
Policy Decisions ◽  
Cross Sectional ◽  
Policy Makers ◽  
Related Quality ◽  
Health Related ◽  
Over Time

Clinicians and policy makers recognize the importance of measuring health-related quality of life (HRQL) to make informed patient management and policy decisions. Self- or interviewer-administered questionnaires can be used to measure cross-sectional differences in quality of life among patients at a point in time (discriminative instruments) or longitudinal changes in HRQL within patients over time (evaluative instruments). Both discriminative and evaluative instruments must be valid (ie, measure what they are supposed to measure) and have a high ratio of signal to noise (reliability and responsiveness for the two instruments, respectively). Reliable discriminative instruments are able to differentiate reproducibly among persons. Responsive evaluative measures are able to detect important changes in HRQL over time, even if those changes are small. HRQL should also be interpretable B that is, clinicians and policy makers must be able to identify differences in scores that correspond to trivial, small, moderate and large differences.There are two basic approaches to quality of life measurement: generic instruments that attempt to provide a summary of HRQL and specific instruments that focus on problems associated with individual disease states, patient groups or areas of function. Generic instruments include health profiles and instruments that generate health utilities. The approaches are not mutually exclusive. Each approach has its strengths and weaknesses and may be suitable under different circumstances. Investigations of HRQL have led to the development of instruments suitable for detecting minimally important effects in clinical trials, for measuring the health of populations and for providing information for policy decisions.

Evaluating the Quality of Changes in Voter Registration Databases

2019 ◽  
Vol 48 (6) ◽  
pp. 670-676
Author(s):  
Seo-young Silvia Kim ◽  
Spencer Schneider ◽  
R. Michael Alvarez
Keyword(s):  
Record Linkage ◽  
Voter Registration ◽  
Election Administration ◽  
Registration Data ◽  
Detection And Tracking ◽  
Audit Data ◽  
Using Data ◽  
Changes Over Time ◽  
Over Time

The administration of elections depends crucially upon the quality and integrity of voter registration databases. In addition, political scientists are increasingly using these databases in their research. However, these databases are dynamic and may be subject to external manipulation and unintentional errors. In this article, using data from Orange County, California, we develop two methods for evaluating the quality of voter registration data as it changes over time: (a) generating audit data by repeated record linkage across periodic snapshots of a given database and monitoring it for sudden anomalous changes and (b) identifying duplicates via an efficient, automated duplicate detection, and tracking new duplicates and deduplication efforts over time. We show that the generated data can serve not only to evaluate voter file quality and election integrity but also as a novel source of data on election administration practices.

Breaking barriers: Adjunctive use of the Ontario Telemedicine Network (OTN) to reach adolescents with obesity living in remote locations

2018 ◽  
Vol 26 (5) ◽  
pp. 271-277 ◽  
Author(s):  
Nicole Coles ◽  
Barkha P Patel ◽  
Ping Li ◽  
Kristina Cordeiro ◽  
Alissa Steinberg ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Weight Management ◽  
Healthcare Professionals ◽  
Healthcare Providers ◽  
Management Programme ◽  
Comparison Groups ◽  
Group 2 ◽  
Survey Responses ◽  
Over Time

Introduction Implementation of telemedicine has been shown to improve health outcomes, such as body mass index (BMI). However, it is unclear whether telemedicine is useful alongside traditional weight-management programmes for adolescents with complex obesity. The objective was to evaluate implementation of the Ontario Telemedicine Network (OTN), a videoconferencing programme, as an adjunctive tool to face-to-face counselling within the setting of an established interdisciplinary obesity treatment programme. Methods Our observational cohort included two groups of adolescents enrolled in a clinical obesity-management programme over a two year period. Adolescents ( n = 50) in group 1 attended both in-person and virtual visits (OTN group), and adolescents ( n = 50) in group 2 received only in-person visits (comparison group). Within the OTN group, satisfaction survey responses were compared between patients and healthcare professionals. Change in BMI per month, paediatric quality of life scores, session attendance and demographic variables were compared between groups. Results OTN subjects averaged 4.9 telehealth visits per adolescent over the two year programme. Both OTN and comparison groups had similar changes in BMI ( p = 0.757), with increases over time ( p = 0.042). Paediatric quality of life scores in both groups improved over time compared to baseline ( p < 0.001), with higher scores for children compared to parental-reported child scores ( p = 0.008). Both adolescents and healthcare professionals using the OTN were similarly satisfied with their experience. Conclusion Adjunctive use of the OTN within the setting of a weight-management programme is feasible, well accepted by families and healthcare providers, and led to similar outcomes compared to usual care.

Cost Containment in Infection Control: Ethical Problems in Rationing Medical Care

1985 ◽  
Vol 6 (9) ◽  
pp. 375-380 ◽  
Author(s):  
Ruth Macklin
Keyword(s):  
Health Care ◽  
Cost Containment ◽  
Hospital Care ◽  
Moral Imperative ◽  
Policy Makers ◽  
Ethical Problems ◽  
The Us ◽  
The Impact ◽  
Harsh Reality

The era of cost containment is upon us. Bureaucrats and regulators, politicians and insurance administrators have begun to devise schemes for reducing the costs of hospital care and medical services in a country justly proud of the quality of its health care. The term “cost containment” has a neutral ring to it, a tone deliberately chosen by policy makers to soften the impact of its effects. The concept has an aura of virtue, conjuring an image of overflowing expenditures that must be put back into the container. But let us recognize the harsh reality that cost containment is simply another term for rationing, a notion that has somewhat unsavory connotations.The need to embark on rationing arises when a crisis of available goods or services is imminent. We are told that too much money is being spent today on health care in the US. Since spending too much on anything is considered wasteful, and since wastefulness is at least an inefficient, if not an unethical way to treat resources, the conclusion seems inescapable that there is a moral imperative to cut costs in the health care sector. To be sure, the goals of eliminating waste and reducing excessive costs should be pursued by hospitals and physicians alike. But let us not hide behind these noble goals and accept uncritically the idea that to increase efficiency in delivering health care, it is necessary to embark on rationing schemes.

Psychological and Cognitive Aspects of Borderline Intellectual Functioning

2017 ◽  
Vol 22 (3) ◽  
pp. 159-166 ◽  
Author(s):  
Bastianina Contena ◽  
Stefano Taddei
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Intellectual Functioning ◽  
Clinical Impact ◽  
Review Of The Literature ◽  
Borderline Intellectual Functioning ◽  
General Quality ◽  
Meta Analyses ◽  
Over Time

Abstract. Borderline Intellectual Functioning (BIF) refers to a global IQ ranging from 71 to 84, and it represents a condition of clinical attention for its association with other disorders and its influence on the outcomes of treatments and, in general, quality of life and adaptation. Furthermore, its definition has changed over time causing a relevant clinical impact. For this reason, a systematic review of the literature on this topic can promote an understanding of what has been studied, and can differentiate what is currently attributable to BIF from that which cannot be associated with this kind of intellectual functioning. Using Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria, we have conducted a review of the literature about BIF. The results suggest that this condition is still associated with mental retardation, and only a few studies have focused specifically on this condition.

Quality of life over time in a German cohort of breast cancer survivors

2017 ◽  
Author(s):  
K Thöne ◽  
N Obi ◽  
A Jung ◽  
M Schmidt ◽  
J Chang-Claude ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Over Time

The objective assessment of the quality of hospital care: dream or reality?

2007 ◽  
Vol 148 (43) ◽  
pp. 2033-2041
Author(s):  
Éva Belicza ◽  
Erika Takács
Keyword(s):  
Hospital Care ◽  
Objective Assessment

A nemzetközi szakirodalom egyre gyakrabban foglalkozik azzal a kérdéssel, hogy a minőségi indikátorokra támaszkodó nyilvános minőségértékelésnek mi a hatása az ellátás minőségére és az érintettek döntésére vonatkozóan, illetve melyek azok a kritériumok, amelyek mentén nyilvános minőségértékelési rendszereket célszerű kialakítani. A nemzetközi szakirodalom alapján a dolgozat hat témakört mutat be: (1) az indikátorok képessége a szolgáltatók megkülönböztetésére; (2) az eredményindikátorok alkalmassága a szolgáltatók megítélésére; (3) a bajnoki tabellák képessége a szolgáltatók rangsorolására; (4) a lakosság viselkedése a szolgáltatók választása során; (5) az indikátorokra támaszkodó nyilvános minősítések hatásai; (6) ajánlások minősítési rendszerek kidolgozására. A szakirodalmi kutatások szerint elsősorban a kockázatkiegyenlítési problémák miatt az indikátorok képessége a szolgáltatók megkülönböztetésére a nyújtott ellátás minősége szempontjából kérdéses; az elért ellátási eredmények nem feltétlenül utalnak vissza az ellátási folyamatok minőségére; a több indikátorból komponált intézményi sorrendek (bajnoki tabellák) nem megbízhatóak; a lakosság a szolgáltatók kiválasztásakor elsősorban a környezet véleményét és a távolságot veszi figyelembe; és a nyilvános közlések hatására igazoltan romlik az ellátás átfogó minősége. A szolgáltatók értékelésében alkalmazott mérési eredmények közzétételét eszköznek kell tekinteni. A lakosság intézményválasztásának elősegítésére az ő preferenciáik mentén végzett betegelégedettségi vizsgálatok nyilvánossá tétele hozhatja meg a kívánt eredményt. A minőségfejlesztési célokat igazoltan segítik a szolgáltatói körben végzett közvetlen visszajelzések az indikátorok mért értékeiről, illetve pontosabb kép kapható az ellátási és szervezési folyamatok, standardok egységes felülvizsgálatára alapozott eljárások külső értékelési rendszerekbe történő beemelésével.

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