QUALITY OF CARE FOR PRESCHOOL CHILDREN WITH ASTHMA: THE ROLE OF SOCIAL FACTORS AND PRACTICE SETTING

Racial minorities admitted for asthma were less likely to have received maximally effective preventive therapy. Marked differences in the quality of care planned after hospital discharge differed significantly when comparing white patients with black and Hispanic patients. In an era of health care reform, attention should focus on the area of high quality care for underserved children who are already at high-risk for asthma-related morbidity. [See table in the PDF file]

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We-care ibd score: assessing high-quality care in the perspective of patients with inflammatory bowel diseases

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa174 ◽

2020 ◽

Author(s):

Serena Barello ◽

Elena Guida ◽

Andrea Bonanomi ◽

Julia Menichetti ◽

Salvatore Leone ◽

...

Keyword(s):

Quality Of Care ◽

Quality Care ◽

Psychometric Evaluation ◽

Healthcare Services ◽

Care Patient ◽

Psychosocial Needs ◽

High Quality ◽

Patient Reported ◽

Inflammatory Bowel

Abstract Background and Aims PREMs are today a core asset to orient healthcare quality improvements. They are particularly relevant in clinical situations requiring frequent interactions between patients and the healthcare system, like inflammatory bowel disease (IBD). Indeed, IBD chronic care requires continuous therapies, psychological interventions and follow-ups. The characteristics of healthcare services play an important role in the life of these patients and in their satisfaction with the care received. The aim of this study was to develop and validate an IBD-specific questionnaire (WE-CARE IBD SCORE) able to capture IBD patients’ needs and priorities for their own healthcare and rooted in patients’ perspectives. Methods The WE-CARE IBD SCORE was developed and validated through a multi-stage process (qualitative and quantitative) and administered to 1176 patients with IBD. Psychometric evaluation included an assessment of internal consistency and factor analysis. Results The WE-CARE IBD SCORE is a short and self-administered questionnaire that includes six items assessing one unique dimension of “IBD patients-rooted high-quality of care” . Psychometric evaluations demonstrate the reliability (Cronbach’s Alpha =0.93) and validity (invariance to gender and diagnosis) of the questionnaire as an instrument able to detect and assess IBD patients’ main psychosocial needs and priorities for receiving healthcare services. Conclusions The WE-CARE IBD SCORE contributes to the panorama of existing quality of care patient-reported measures by providing a patient-rooted, psychosocial perspective in the evaluation of a key aspect for chronic - and particularly for IBD patients - care.

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The Role of Empathy and Wisdom in Medical Practice and Pedagogy: Confronting the Hidden Curriculum

Journal of Biomedical Education ◽

10.1155/2013/923810 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

James A. Marcum

Keyword(s):

Quality Of Care ◽

Clinical Practice ◽

Quality Care ◽

Modern Medicine ◽

Pulitzer Prize ◽

Medicine Quality ◽

Grand Rounds ◽

Synergistic Relationship

The role of the virtues of empathy and wisdom in clinical practice is used to address two crises facing modern medicine—quality of care and professionalism. To that end, these virtues are initially explored individually and then collectively in terms of a synergistic relationship between them. Next, how empathy and wisdom guide and empower clinical practice, especially in terms of their synergistic relationship, is discussed vis-à-vis the two crises. The “Grand Rounds” scene from “W;t”—Margaret Edson’s 1999 Pulitzer prize-winning play—is used to illustrate how these virtues function with respect to providing quality care in a professional manner. The paper concludes with a discussion of the challenges facing the pedagogy of equipping medical students, residents, and even practicing clinicians with virtues like empathy and wisdom.

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Coding for quality? Accountability work in standardised cancer patient pathways (CPPs)

Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine ◽

10.1177/13634593211013882 ◽

2021 ◽

pp. 136345932110138

Author(s):

Erna Håland ◽

Line Melby

Keyword(s):

Quality Of Care ◽

Cancer Patient ◽

Health Personnel ◽

Quality Care ◽

Important Work ◽

High Quality ◽

Patient Pathways ◽

Work Health ◽

Crucial Part

A vital part of standardised care pathways is the possibility to measure performance through different indicators – for example, codes. In this article, based on interviews with health personnel in a project evaluating the introduction of standardised cancer patient pathways (CPPs) in Norway, we explore the specific types of work involved when health personnel produce codes as (intended) signifiers of quality. All the types of work are dimensions of what we define as accountability work – work health personnel do to make the codes signifiers of quality of care in the CPP. Codes and coding practices raise questions of what quality of care represents and how it could and should be measured. Informants in our study advocate for coding as important work for the patient more than for ‘the system’. This shows how organising for quality becomes a crucial part of professional work, expanding what it means to perform high quality care.

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US physicians' perceptions of the effect of practice guidelines and ability to provide high-quality care

Journal of Health Services Research & Policy ◽

10.1258/1355819053559056 ◽

2005 ◽

Vol 10 (2) ◽

pp. 69-76 ◽

Cited By ~ 6

Author(s):

Jessica Bartell ◽

Maureen Smith

Keyword(s):

Health Care ◽

Quality Of Care ◽

Practice Guidelines ◽

Primary Care Physicians ◽

Quality Care ◽

Care Organization ◽

High Quality ◽

High Quality Care ◽

Negative Perceptions

Objectives: In the USA, health care organizations frequently disseminate practice guidelines to physicians, but physicians often resist implementing guidelines when they perceive no improvements in quality of care will result. Greater involvement with a single health care organization may affect physicians' perceptions of guidelines. We examined the relationship between the perceived effect of guidelines on practice and perceived quality of care for US primary care physicians (PCPs) and specialists with varying levels of financial involvement with a single managed care organization. Methods: Data were from the 1996-1997 Community Tracking Study, a nationally representative, cross-sectional survey of 12,528 physicians. Data were adjusted for possible confounders using ordinal logistic regression. Results: Almost half the physicians described a moderate to very large perceived effect of guidelines (46% of PCPs, 46% of specialists). Physicians' financial involvement with a single organization was modest: PCPs received on average 24% of their revenue from their largest contract, while specialists averaged 18%. For specialists, increasing perceived effect of guidelines was associated with increasingly negative perceptions of quality of care [β= –0.16, 95% confidence interval (–0.22, –0.10)]. Similar results were obtained for PCPs with low levels of financial involvement with a single organization. However, this negative association disappeared for PCPs with higher levels of financial involvement. Conclusions: PCPs with substantial financial involvement with a single organization who perceive greater effects of guidelines on practice have less negative perceptions of their ability to provide high-quality care. Although our data cannot confirm a causal relationship, financial involvement with a single organization may be one factor linking practice guidelines to high-quality care.

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Accreditation of oncology education in low-and- middle income countries: Perspectives of African oncologists.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18213 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18213-e18213

Author(s):

Nazik Hammad ◽

Densie Stockley ◽

Thomas Caruso ◽

Amber Hastings

Keyword(s):

Resource Constraints ◽

Training Programs ◽

Quality Care ◽

Quality Of Education ◽

Resource Constrained ◽

High Quality ◽

Internal Medicine Training ◽

Oncology Education

e18213 Background: There is an expansion of postgraduate oncology training programs in LMIC . Locally trained oncologists are expected to deliver high quality care. Accreditation is one of the essential regulatory mechanisms to ensure high-quality education. Accreditation systems are rarely standardized or applied in the majority of LMIC. The purpose of this study is to understand the perspectives of African Oncologists on the role of accreditation and adoption of global standards into oncology training programs Methods: We developed a survey that addressed African Oncologists’ perspectives of the role of accreditation. It included 187 standards from the WFME PGME standards, ACGME-I standards for hematology/oncology, and the Royal College of Physician and Surgeons of Canada medical oncology standards. A 3-point scale was employed for each standard: 1 = not important, 2 = important but not essential, 3 = essential Results: The survey was sent to 79 physicians, 38 responded. 87% agreed that accreditation ensures quality of education. 100% agreed that it should involve an external review. 74% believe that accreditation is feasible in resource-constrained settings. 45% agreed it will not increase emigration of qualified doctors. Data of 22 individuals who completed the survey in its entirety were analyzed for standards. 5 standards received the highest ratings of 3 from all respondents: life-long learning, professionalism and ethical principles, competence in chemotherapy delivery and management of toxicities. One standard (prior internal medicine training) received a low rating of < 2.0. The majority of standards had ratings between 2.6 and 2.94, indicating that African Oncologists believe most standards to be useful. Ratings < 2.6 were related to resource constraints such as having PET scans or exposure to clinical trial patients. Conclusions: Most African oncologists believe that accreditation ensures quality of education. Most of the standards were considered important. This data will be useful for developing and adapting oncology education accreditation standards in resource-constrained settings. Abbreviations: ACGME-I: American Council of Graduate Medical Education-International

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Improving the Quality of Care Following an Acute Cardiac Event—The Role of Cardiac Rehabilitation in the Care Continuum

US Cardiology Review ◽

10.15420/usc.2009.6.2.79 ◽

2009 ◽

Vol 6 (2) ◽

pp. 79-83

Author(s):

Marjorie L King ◽

Keyword(s):

Quality Of Care ◽

Cardiac Rehabilitation ◽

Cardiac Event ◽

Care Continuum ◽

Acute Cardiac Event

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Using Regulatory Flexibility to Address Market Informality in Seed Systems: A Global Study

Agronomy ◽

10.3390/agronomy11020377 ◽

2021 ◽

Vol 11 (2) ◽

pp. 377

Author(s):

Katrin Kuhlmann ◽

Bhramar Dey

Keyword(s):

Seed Quality ◽

Regulatory Environment ◽

Control Mechanisms ◽

Seed Systems ◽

High Quality ◽

Design And Implementation ◽

Key Dimensions ◽

Regulatory Flexibility

Seed rules and regulations determine who can produce and sell seeds, which varieties will be available in the market, the quality of seed for sale, and where seed can be bought and sold. The legal and regulatory environment for seed impacts all stakeholders, including those in the informal sector, through shaping who can participate in the market and the quality and diversity of seed available. This paper addresses a gap in the current literature regarding the role of law and regulation in linking the informal and formal seed sectors and creating more inclusive and better governed seed systems. Drawing upon insights from the literature, global case studies, key expert consultations, and a methodology on the design and implementation of law and regulation, we present a framework that evaluates how regulatory flexibility can be built into seed systems to address farmers’ needs and engage stakeholders of all sizes. Our study focuses on two key dimensions: extending market frontiers and liberalizing seed quality control mechanisms. We find that flexible regulatory approaches and practices play a central role in building bridges between formal and informal seed systems, guaranteeing quality seed in the market, and encouraging market entry for high-quality traditional and farmer-preferred varieties.

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Parental Involvement Policies for Minors Seeking Abortion in the Southeast and Quality of Care

Sexuality Research and Social Policy ◽

10.1007/s13178-021-00539-0 ◽

2021 ◽

Author(s):

Kari White ◽

Subasri Narasimhan ◽

Sophie A. Hartwig ◽

Erin Carroll ◽

Alexandra McBrayer ◽

...

Keyword(s):

Quality Of Care ◽

Parental Involvement ◽

Service Delivery ◽

Quality Care ◽

Health Service Delivery ◽

Policy Implications ◽

Patient Centeredness ◽

Patient Centered ◽

Staff Members

Abstract Introduction Thirty-seven states require minors seeking abortion to involve a parent, either through notification or consent. Little research has examined how implementation of these laws affect service delivery and quality of care for those who involve a parent. Methods Between May 2018 and September 2019, in-depth interviews were conducted with 34 staff members involved in scheduling, counseling, and administration at abortion facilities in three Southeastern states. Interviews explored procedures for documenting parental involvement, minors’ and parents’ reactions to requirements, and challenges with implementation and compliance. Both inductive and deductive codes, informed by the Institute of Medicine’s healthcare quality framework, were used in the thematic analysis. Results Parental involvement laws adversely affected four quality care domains: efficiency, patient-centeredness, timeliness, and equity. Administrative inefficiencies stemmed from the extensive documentation needed to prove an adult’s relationship to a minor, increasing the time and effort needed to comply with state reporting requirements. If parents were not supportive of their minor’s decision, participants felt they had a duty to intervene to ensure the minor’s decision and needs remained centered. Staff further noted that delays to timely care accumulated as minors navigated parental involvement and other state mandates, pushing some beyond gestational age limits. Lower income families and those with complex familial arrangements had greater difficulty meeting state requirements. Conclusions Parental involvement mandates undermine health service delivery and quality for minors seeking abortion services in the Southeast. Policy Implications Removing parental involvement requirements would protect minors’ reproductive autonomy and support the provision of equitable, patient-centered healthcare.

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