scholarly journals A Study of Community and Health Clinic Approaches to Addressing Toxic Stress and Promoting Protective Factors among Families with Infants

2020 ◽  
Author(s):  
Julie S. McCrae ◽  
JoAnn L Robinson ◽  
Angeline K Spain ◽  
Kaela Byers ◽  
Jennifer L Axelrod
Keyword(s):  
Health Care ◽  
Chronic Stress ◽  
Health Care Quality ◽  
Health Care Systems ◽  
Community Services ◽  
Care Quality ◽  
Health Clinic ◽  
Toxic Stress ◽  
Early Life Adversity ◽  
Design Elements

Abstract BackgroundHealth care administrators must promote effective partnerships with community agencies to address social determinants of health, including reducing exposure to chronic stress in early childhood. Important targets for mitigating “toxic” levels of young child exposures are through reducing parents’ experiences of chronic stress as well as protecting children from direct experiences of harm such as physical or sexual abuse. Conducting screening to identify when parents and children are exposed to early life adversity is a first step; bringing in or referring out families to needed support services is an essential component. This paper describes a multi-modal investigation of health care systems innovations to engage and support parents to prevent and mitigate children’s toxic stress exposures through pediatric primary care and community services partnerships.MethodsKey study features include: 1) multi-component, multi-site study in five U.S. communities of pediatric health care clinics and the families they serve, 2) a developmental evaluation approach that describes how systems innovations are experienced over time at three levels (community systems, pediatric providers, and families), and 3) rapid cycle feedback in partnership with communities, clinics and families to co-interpret data and findings. The methodology includes: 1) focus groups and interviews with community stakeholders, clinic staff, and families, 2) electronic health record and Medicaid services data extracted to assess health care quality, and 3) clinic-recruitment of 908 parents of newborns in a longitudinal survey.ResultsThe sample is briefly characterized based on responses to the enrollment phase of the parent survey.ConclusionsWe discuss the study design elements’ contribution to generate evidence needed by innovators, communities, and clinics to modify and sustain investments in these innovations.

Creating Optimal Healing Environments

2014 ◽  
pp. 84-100
Author(s):  
Terri Zborowsky ◽  
Mary Jo Kreitzer
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Built Environment ◽  
Health Care Quality ◽  
Care Quality ◽  
Care Providers ◽  
Design Elements ◽  
Healing Environment ◽  
Care Processes ◽  
Healing Environments

Creating an optimal healing environment requires attentiveness to the built environment as well as care processes, culture, and competencies of care providers and leadership. There are over 1,000 studies that link the physical environment to outcomes such as health care quality, patient safety, reduction of stress and improvements in patient safety. Key design elements highlighted include access to nature, access to daylight, positive distractions, and the ambient environment.

scholarly journals Shifting to Remotely Delivered Mental Health Care: Quality Improvement in the COVID-19 Pandemic

2020 ◽  
Vol 1 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Patrick Daigle ◽  
Abraham Rudnick
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Quality Improvement ◽  
Mental Health Care ◽  
Health Care Quality ◽  
Care Quality ◽  
Health Clinic ◽  
Quality Improvement Initiative ◽  
Service Users ◽  
Specialized Mental Health

This paper presents an organizational (ambulatory) case study of shifting mental health care from in-person to remote service delivery due to the current (COVID-19) pandemic as a rapid quality improvement initiative. Remotely delivered mental health care, particularly using synchronous video and phone, has been shown to be cost-effective, especially for rural service users. Our provincial specialized mental health clinic rapidly shifted to such remote delivery during the current pandemic. We report on processes and outputs of this rapid quality improvement initiative, which serves a purpose beyond pandemic circumstances, such as improving access to such specialized mental health care for rural and other service users at any time. In conclusion, shifting specialized mental health care from in-person to remotely delivered services as much as possible could be beneficial beyond the current pandemic. More research is needed to optimize the implementation of such a shift.

Quality improvement in large healthcare organizations

2016 ◽  
Vol 30 (1) ◽  
pp. 133-153 ◽  
Author(s):  
Elisabet Höög ◽  
Jack Lysholm ◽  
Rickard Garvare ◽  
Lars Weinehall ◽  
Monica Elisabeth Nyström
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Care Quality ◽  
Health Care Systems ◽  
Care Quality ◽  
Care Organization ◽  
Longitudinal Case Study ◽  
Systematic Analysis ◽  
Content Type

Purpose – The purpose of this paper is to investigate the obstacles and challenges associated with organizational monitoring and follow-up (M & F) processes related to health care quality improvement (QI) and development. Design/methodology/approach – A longitudinal case study of a large health care organization during a system-wide QI intervention. Content analysis was conducted of repeated interviews with key actors and archival data collected over a period of four years. Findings – The demand for improved M & F strategies, and what and how to monitor were described by the respondents. Obstacles and challenges for achieving M & F strategies that enables system-wide and coherent development were found in three areas: monitoring, processing, and feedback and communication. Also overarching challenges were found. Practical implications – A model of important aspects of M & F systems is presented that can be used for analysis and planning and contribute to shared cognition of such systems. Approaches for systematic analysis and follow-up of identified problems have to be developed and fully incorporated in the organization’s measurement systems. A systematic M & F needs analytic and process-oriented competence, and this study highlights the potential in an organizational function with capacity and mandate for such tasks. Originality/value – Most health care systems are flooded with a vast amount of registers, records, and measurements. A key issue is how such data can be processed and refined to reflect the needs and the development process of the health care system and how rich data can be used for improvement purposes. This study presents key organizational actor’s view on important factors to consider when building a coherent organizational M & F strategy.

scholarly journals Measuring Regional Performance in the Italian NHS: Are Disparities Decreasing?

2021 ◽  
Author(s):  
Silvia Bruzzi ◽  
Enrico Ivaldi ◽  
Marta Santagata
Keyword(s):  
Health Care ◽  
Health Systems ◽  
Health Care Quality ◽  
Health Care Systems ◽  
Care Quality ◽  
Regional Disparities ◽  
Future Research ◽  
Regional Health ◽  
Regional Health Care ◽  
Composite Indexes

AbstractGiven the regional disparities that historically characterize the Italian context, in this paper we propose a framework to evaluate the regional health care systems’ performance in order to contribute to the debate on the relationship between decentralisation of health care and equity. To investigate the regional health systems performance, we refer to the OECD Health Care Quality Indicators project to construct of a set of five composite indexes. The composite indexes are built on the basis of the non-compensatory Adjusted Mazziotta-Pareto Index, that allows comparability of the data across units and over time. We propose three indexes of health system performance, namely Quality Index, Accessibility Index and Cost-Expenditure Index, along with a Health Status Index and a Lifestyles Index. Our framework highlights that regional disparities still persist. Consistently with the evidence at the institutional level, there are regions, particularly in Southern Italy, which record lower levels of performance with high levels of expenditure. Continuous research is needed to provide policy makers with appropriate data and tools to build a cohesive health care system for the benefit of the whole population. Even if future research is needed to integrate our framework with new indicators for the calculation of the indexes and with the identification of new indexes, the study shows that a scientific reflection on decentralisation of health systems is necessary in order to reduce inequalities.

scholarly journals Semi-Automated Visualization and ANalysis of Trends: A “SAVANT” for Facilitating Antimicrobial Stewardship Using Antistaphylococcal Resistance and Consumption as a Prototype

2018 ◽  
Vol 5 (4) ◽  
Author(s):  
Robert J Clifford ◽  
Uzo Chukwuma ◽  
Michael E Sparks ◽  
Douglas Richesson ◽  
Charlotte V Neumann ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Large Scale ◽  
Moving Average ◽  
Health Care Systems ◽  
Care Quality ◽  
Mandatory Reporting ◽  
Outpatient Prescription ◽  
Care Systems ◽  
Prescription Rates

Abstract Background Governments and health care regulators now require hospitals and nursing homes to establish programs to monitor and report antimicrobial consumption and resistance. However, additional resources were not provided. We sought to develop an approach for monitoring antimicrobial resistance and consumption that health care systems can implement with minimal added costs or modifications to existing diagnostic and informatics infrastructure. Methods Using (1) the electronic laboratory information system of a nationwide managed care network, (2) the 3 most widely used commercial microbiology diagnostic platforms, and (3) Staphylococcus aureus, one of the most common causes of infections worldwide, as a prototype, we validated the approach dubbed “SAVANT” for Semi-Automated Visualization and ANalysis of Trends. SAVANT leverages 3 analytical methods (time series analysis, the autoregressive integrated moving average, and generalized linear regression) on either commercial or open source software to report trends in antistaphylococcal use and resistance. Results All laboratory results from January 2010 through December 2015 from an annual average of 9.2 million health care beneficiaries were queried. Inpatient and outpatient prescription rates were calculated for 8 key antistaphylococcal compounds. Trends and relationships of antistaphylococcal consumption and resistance among 81 840 unique S. aureus isolates from >6.5 million cultures were revealed. Conclusions Using existing or freely available resources, SAVANT was successfully implemented across a complex and geographically dispersed 280-hospital network, bridging a critical gap between medical informatics, large-scale data analytics, and mandatory reporting of health care quality metrics.

scholarly journals Patients With Health-Related Social Needs More Likely to Report Poor Clinic Experiences

2021 ◽  
Vol 8 ◽  
pp. 237437352110083
Author(s):  
Mary Gray ◽  
Kyle G Jones ◽  
Bill J Wright
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Quality ◽  
Health Care Systems ◽  
Care Quality ◽  
Social Needs ◽  
Survey Analysis ◽  
Care Experience ◽  
Primary Care Clinics ◽  
Health Related

Measuring patients’ care experience is necessary to understanding and improving health care quality and is a core component of patient-centered care. In this study, we test whether patient health care experiences differed between patients with and without health-related social needs, above and beyond demographic differences previously studied. This study relies on survey data from 2341 patients who visited 1 of 7 primary care clinics in Portland, Oregon, and surrounding communities during the latter half of 2018. Survey analysis reveal that patients with at least 1 health-related social need had greater odds of reporting staff not always answering questions, not getting all the care they need, not getting the information to manage care, not being treated with respect by their provider, and getting care being a hassle. The findings from this study suggest that patients with health-related social needs are not getting the holistic care they expect in their primary care clinics and find it a hassle to get care regardless of their demographic characteristics and insurance status. This study may help to inform how health care systems and clinics can best serve patients with health-related social needs.

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