Nationwide Acute Stroke Care Quality and Disparity in Korea: Focusing on the Type of Healthcare Facilities and the Socioeconomic Status of Patients

Background: The quality ofstroke care has a significantimpact onmortality and complications. The purpose ofthisstudy wasto investigate the difference in the quality of acute stroke treatment according to the type of healthcare facility and the socioeconomic status of patients.Methods: Thisstudy used Health Insurance Review and Assessment Service’s Healthcare Quality Assessment for Stroke 2013 data and included 10,399 cases from 201 healthcare facilities. Quality of care was categorized from grade 1 (best group) to grade 5 (worst group) according to performance scores using 10 processindicators.Results: The mean performance score was 91.5. Only 31% of all patients received treatment at grade 1 hospitals while 10% received treatment at grade 3 or lower hospitals. The difference in performance score by the type of healthcare facility existed (tertiary hospitals: 94.3, general hospitals: 88.7).Ofthe 159 general hospitals, 66 hospitals provided grade 3 orlower quality care.NHI patients used more tertiary hospitalsthan MA patients(51% vs. 38%), and MA patientswere more likely to use general hospitals providing grade 3 or lower quality care (11% vs. 21%).Conclusions: This study showed that some general hospitals provided low quality stroke care, and MA patients were more likely to use those hospitals. In order to increase the quality and equity of stroke treatment, a strategy to gather patients at healthcare facilitiesthat provide appropriate medicalservices will be needed.

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Patients’ satisfaction with quality of care in general hospitals in Ebonyi State, Nigeria, using SERVQUAL theory

SAGE Open Medicine ◽

10.1177/2050312120945129 ◽

2020 ◽

Vol 8 ◽

pp. 205031212094512

Author(s):

MaryJoy Umoke ◽

Prince Christian Ifeanachor Umoke ◽

Ignatius O Nwimo ◽

Chioma Adaora Nwalieji ◽

Rosemary N Onwe ◽

...

Keyword(s):

Quality Of Care ◽

Health Workers ◽

Health Sector ◽

Sampling Technique ◽

Healthcare Facility ◽

Cluster Sampling ◽

Cross Sectional ◽

General Hospitals ◽

Patients Satisfaction

Background: Patient satisfaction is an essential parameter in the assessment of quality of care and healthcare facility performance. Objective: To investigate patients’ satisfaction with quality of care in general hospitals in Ebonyi State, South East, Nigeria, using the SERVQUAL. Methods: A cross-sectional descriptive study design was employed on a sample of 400 patients using a 27-item structured open-ended patients’ satisfaction questionnaire with a multi-stage cluster sampling technique. Patients included in the study were those who must have come for an outpatient clinic within the period, be 18 years and above, and those who gave consent to participate. Of 400 questionnaires administered, 396 (99%) were retrieved. SPSS version 20 was used for data analysis. Descriptive statistics, such as frequencies, percentages, mean score ( x), and standard deviation, were employed for interpretation. Results: Out of 396 patients, 156 (39.4%) were male and 240 (60.6%) were females. Most patients were 18–39 years (233 (58.8%)), had secondary education (139 (35.1%)), married (221 (55.8%)), earned <18,000 (170(42.9%)), and were traders (136 (34.3%)). Patients were satisfied with tangibility (2.57 ± 0.99) and reliability (2.84 ± 0.95) and very satisfied with responsiveness (3.06 ± 0.63), assurance (3.07 ± 0.63), and empathy (3.12 ± 0.57). Conclusions: Patients were satisfied with the quality of care. However, satisfaction was highest with empathy and lowest with tangibility. Thus, managers should focus their quality improvement efforts on areas of the neat appearance of health workers, waiting facilities for attendants and patients, and hygienic conditions at the hospital. Also, biannual assessment of patients’ satisfaction should be done and the results generated use judiciously to provide a platform for health sector reform.

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A phase Ib/IIa study of combination therapy with gemcitabine and Atu027 in patients with locally advanced or metastatic pancreatic adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.385 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 385-385 ◽

Cited By ~ 17

Author(s):

Beate Schultheis ◽

Dirk Strumberg ◽

Jan Kuhlmann ◽

Martin Wolf ◽

Karin Link ◽

...

Keyword(s):

Quality Of Life ◽

Combination Therapy ◽

Statistical Significance ◽

Locally Advanced ◽

Progression Free Survival ◽

Standard Of Care ◽

Small Patient Number ◽

The Difference ◽

Grade 3

385 Background: Atu027 is a liposomally formulated short interfering RNA with anti-metastatic activity, which silences expression of protein kinase N3 (PKN3) in the vascular endothelium. PKN3 acts as a Rho effector downstream of PI3K. This trial was designed to assess safety, pharmacokinetics and efficacy of Atu027 in combination with gemcitabine in advanced pancreatic carcinoma (APC). Methods: 23 patients (pts) with APC stage 3 or 4 were enrolled and randomly assigned to different Atu027 dosing schedules (arm 1: 0.253mg/kg once weekly, n = 11; arm 2: 0.253mg/kg twice-weekly, n = 12) but identical gemcitabine regimen. Response was evaluated according to RECIST 1.1. Quality of life was assessed with EORTC questionnaire QLQ-C30. Results: Combination therapy with Atu027 and gemcitabine was given up to 7.8 months until progression. Grade 3 adverse events (AEs) were reported by 9/11 pts (82%) in arm 1 and 11/12 pts (92%) in arm 2. Grade 4 AEs were reported by two pts in each arm. Interestingly, there was a difference in median progression free survival (mPFS) between the two treatment arms. Arm 1 showed an mPFS of 1.8 [95%CI: 0.4-5.5] months vs. 5.3 [95%CI: 1.5-6.0] months in arm 2, p= 0.399. In a post-hoc analysis of metastatic disease only, the difference in mPFS between the two arms reached statistical significance (1.6 [95%CI:0.4-2.1] vs 2.9 [95%CI:1.0-7.3] months, n = 9 vs 10, p= 0.025). Disease control during treatment was achieved in 4/11 (36%) pts in arm 1 and in 7/12 (58%) pts in arm 2. New lesions occurred in all (6/6) pts in arm 1 who had at least one RECIST re-evaluation but only 5/10 pts (50%) in arm 2. In quality of life analysis, pts in the once-weekly arm showed a stable global health status while pts in the twice-weekly arm reported an improvement (0-100 score change from baseline: -2.3 vs +21.6 after one cycle, N = 7 vs 7). Conclusions: Combination of Atu027 with gemcitabine for the treatment of APC is safe and was well tolerated. Despite the small patient number, there is a clear signal that twice-weekly Atu027 dosing might be superior to the once-weekly regimen. These results suggest efficacy of Atu027 and warrant further investigation with Atu027 added to standard of care in APC. Clinical trial information: NCT01808638.

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Post-Stroke Quality of Life Outcomes After Instituting New Stroke Care Quality Indicators

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.1.641 ◽

2021 ◽

Vol 3 (1) ◽

pp. 9-15

Author(s):

Khaled Awawdi ◽

Carmel Armon ◽

Itzhak Kimiagar ◽

Mahdi Tarabeih ◽

Riad Abu Rakia

Keyword(s):

Quality Of Life ◽

Quality Indicators ◽

Stroke Care ◽

Care Quality ◽

Care Process ◽

Life Outcomes ◽

Post Discharge ◽

Stroke Treatment ◽

Quality Of Life Outcomes

Background: In 2013 the Israel Ministry of Health identified the care and treatment of acute cerebral ischemic stroke as failing to achieve expected standards. The Ministry decided to raise standards by defining and instituting, nationwide, a battery of linked care quality indicators to be applied across all relevant facilities and contexts. Five indicators were selected for five key junctures in the AIS care process. Methods: This paper presents and analyses the effects of the implementation of these new care quality indicators on the post-discharge quality of life outcomes of Israeli stroke sufferers. The patient sample comprises patients from Israel’s Central region, where stroke care provision and access is relatively high, and from the peripheral North region, where provision and access are limited. Results: Those who were not treated with thrombolytic treatment and/or cerebral blood vessel catheterization, those who suffered severer strokes, women, the older age groups, non-Jews and North region residents display significantly worse physical functioning outcomes and worse quality of life outcomes on all indicators. Conclusions: Stroke care access and provision disparities translate into significantly higher rates of post-discharge disability, impaired physical and social functioning, and a lower quality of life. The effectiveness of healthcare improvement by the deployment of care indicators is closely associated with the lifestyle, socio-demographic and socioeconomic status of different population groups. The effective implementation of quality care indicators also relies heavily on closing the access and provision gaps between the populations living in central and peripheral areas. Two obvious directions for action are to expand and improve the rehabilitation care network and to combat the age discrimination in hospital stroke treatment.

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Socioeconomic Status and the Quality of Acute Stroke Care

Stroke ◽

10.1161/strokeaha.116.013292 ◽

2016 ◽

Vol 47 (11) ◽

pp. 2836-2842 ◽

Cited By ~ 4

Author(s):

Yuesong Pan ◽

Ruoling Chen ◽

Zixiao Li ◽

Hao Li ◽

Xingquan Zhao ◽

...

Keyword(s):

Socioeconomic Status ◽

Acute Stroke ◽

Stroke Care ◽

Acute Stroke Care

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The experience, results, and possible perspectives of organizing the optimally accessible primary medical care for the rural population of Zaporizhzhia region

Current issues in pharmacy and medicine science and practice ◽

10.14739/2409-2932.2021.3.241818 ◽

2021 ◽

Vol 14 (3) ◽

pp. 369-373

Author(s):

O. H. Aleksieiev ◽

V. V. Taranov ◽

V. P. Petrykhin

Keyword(s):

Primary Care ◽

Medical Care ◽

Primary Healthcare ◽

Rural Areas ◽

Rural Population ◽

Healthcare Facility ◽

Service Area ◽

Healthcare Facilities ◽

Care Facilities

Nowadays, the assessment of the activity of the domestic healthcare system is an important and actual issue, especially against the background the active reformation of this industry. One of the important elements of the assessment is studying the availability of primary healthcare to the rural population. The aim of this work is to study the territorial accessibility of primary healthcare, the adequacy and effectiveness of the principles of forming a network of primary care facilities in the rural areas of Zaporizhzhia region that enables to address issues and optimize the location of primary care facilities in the rural areas. Materials and methods. The materials of the research were the data of the official statistical reports for the past 20 years, which characterize the state of health and the degree of medical care accessibility to the rural population. During the research, the technique of complex social and hygienic research was applied, with the use of historical, sociological, sanitary and statistical methods, organizational experiment and others. Results. The article presents the main results of studying the current state of primary healthcare organization for the rural population of Zaporіzhzhia region against the background of active reforming processes. According to the research results, the main elements forming the system of accessibility are territorial, medical, social and economic. The main factors of impact on territorial accessibility are identified. These are: the nature of the settlement of rural residents (density, compactness, service-area radius, the proportion of the rural population, the distance between villages, the distance from a household to a healthcare facility); quality of roads; transport connections between settlements and healthcare facilities; availability of communication means. Conclusions. As a result of the research, the following conclusions were drawn. Such factors as population density, compactness of its location, service-area radius, distance between villages, distance from a household to a healthcare facility, condition and quality of roads, transport connections between settlements and healthcare facilities are important during forming or improving the network of healthcare facilities in rural areas. These factors must be considered for the rational placement of primary care facilities in rural areas.

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Equal Opportunities in Learning in Diverse Groups in Nepal in the Pre-COVID Realm: Socioeconomic Status, Mathematics Learning, and the Diverse Groups

10.31219/osf.io/wtyj2 ◽

2021 ◽

Author(s):

Sunita Shakya ◽

Jari Metsämuuronen

Keyword(s):

Socioeconomic Status ◽

Mathematics Achievement ◽

Mathematics Learning ◽

National Assessment ◽

Equity Issues ◽

The Difference ◽

Grade 3 ◽

And Mathematics ◽

Diverse Groups ◽

Grade 8

The article discusses the diversity and equity issues behind the learning outcomes of mathematics in the pre-COVID context in Nepal. The article intends to give a baseline for the further studies on the effect of COVID-19 pandemic in the educational realm. Datasets from the national assessment of student achievement in Nepal at grades 3 and 5 and grade 8 are reanalyzed based on socioeconomic status (SES), gender, caste-ethnicity, language, and geographical variables. In Nepal, where the society is customarily highly structured, gender-biased, and poverty-driven, SES influences remarkably in mathematics achievement. The datasets show notable relationships between SES and mathematics achievement (r = 0.35, 0.27 and 0.30 in grade 3, 5 and 8, respectively). In lower grades, the difference between the highest and lowest SES in the achievement of girls is wider than boys and it is reverse in grade 8. Nepali speakers had high scores when they had high SES but, when SES was very low, the non-Nepali speakers performed better in all grades. The advantageous castes tended to always perform higher irrespective of their level of SES. Nevertheless, it is difficult to know with certainty when average and marginalized caste/ethnic groups perform better.

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Modeling the impact of hospital logistics on quality of care and patient satisfaction: Results of a survey in three public healthcare facilities in Fez, Morocco

Journal of Industrial Engineering and Management ◽

10.3926/jiem.3143 ◽

2020 ◽

Vol 13 (2) ◽

pp. 296

Author(s):

Youness Frichi ◽

Fouad Jawab ◽

Said Boutahari

Keyword(s):

Patient Satisfaction ◽

Quality Of Care ◽

Large Scale ◽

Scale Validation ◽

Healthcare Facility ◽

Public Healthcare ◽

Healthcare Facilities ◽

The Impact ◽

Physical Accessibility

Purpose: The objective of this research is to examine the role of hospital logistics in improving quality of care and patient satisfaction. Thus, the paper focuses on modeling and evaluating the relationship between these three constructs.Design/methodology/approach: In the present study, hospital logistics was specified as a second-order construct composed of five first-order constructs: physical accessibility, waiting time, consultation time, hospital hotel services, and administrative procedures. A questionnaire was developed and administered face-to-face to 384 hospitalized patients in three public healthcare facilities in Fez-Morocco. Collected data were processed and analyzed deploying the PLS-SEM method and using SmartPLS3 software. Data analysis was carried out by considering two types of patient circuits according to the admission modes in the healthcare facility: Urgent Patients Circuit and Scheduled Patients Circuit. Thus, two PLS-SEM models were evaluated and validated.Findings: Results highlighted the significant impact of hospital logistics on quality and satisfaction. In particular, the results of the two models showed that the most preponderant hospital logistics component is physical accessibility which consists of the availability and accessibility of ambulances, medical and nursing staff, support and guidance staff, technical facilities and equipment, etc. Thus, hospital managers and health system stakeholders should pay particular attention to hospital logistics activities in general and specifically to the physical accessibility to improve the quality of care and patient satisfaction.Research limitations/implications: This study only included patients from three public healthcare facilities in Fez-Morocco. Also, the model variables of hospital logistics construct are restricted and were applied in a specific context. Besides, the sample size was relatively reduced. Thus, results generalization might be limited. Further studies including more patients from other territories and including other logistics components are needed for large-scale validation of the proposed model. Originality/value: The results of this study contribute to the scientific literature on hospital logistics and its role as a lever for quality of care and patient satisfaction.

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Equal Opportunities in Learning in Diverse Groups in Nepal in the Pre-COVID Realm: Socioeconomic Status, Mathematics Learning, and the Diverse Groups

Education Quarterly Reviews ◽

10.31014/aior.1993.04.04.370 ◽

2021 ◽

Vol 4 (4) ◽

Author(s):

Sunita Shakya ◽

◽

Jari Metsämuuronen ◽

Keyword(s):

Socioeconomic Status ◽

Mathematics Achievement ◽

Mathematics Learning ◽

National Assessment ◽

Equity Issues ◽

The Difference ◽

Grade 3 ◽

And Mathematics ◽

Diverse Groups ◽

Grade 8

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Letter to the Editor: The Continuing Challenge of Evaluating RSD Impairment and Disability

Guides Newsletter ◽

10.1001/amaguidesnewsletters.1998.sepoct05 ◽

1998 ◽

Vol 3 (5) ◽

pp. 8-10

Author(s):

Robert L. Knobler ◽

Charles N. Brooks ◽

Leon H. Ensalada ◽

James B. Talmage ◽

Christopher R. Brigham

Keyword(s):

Disability Evaluation ◽

Body Part ◽

Loss Of Function ◽

Regulatory Requirements ◽

Major Cardiac Event ◽

Clinical Scenarios ◽

Impairment Score ◽

Occupational Activities ◽

The Difference

Abstract The author of the two-part article about evaluating reflex sympathetic dystrophy (RSD) responds to criticisms that a percentage impairment score may not adequately reflect the disability of an individual with RSD. The author highlights the importance of recognizing the difference between impairment and disability in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides): impairment is the loss, loss of use, or derangement of any body part, system, or function; disability is a decrease in or the loss or absence of the capacity to meet personal, social, or occupational demands or to meet statutory or regulatory requirements because of an impairment. The disparity between impairment and disability can be encountered in diverse clinical scenarios. For example, a person's ability to resume occupational activities following a major cardiac event depends on medical, social, and psychological factors, but nonmedical factors appear to present the greatest impediment and many persons do not resume work despite significant improvements in functional capacity. A key requirement according to the AMA Guides is objective documentation, and the author agrees that when physicians consider the disability evaluation of people, more issues than those relating to the percentage loss of function should be considered. More study of the relationships among impairment, disability, and quality of life in patients with RSD are required.

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COMBINATORIAL POLYNOMIALLY COMPUTABLE CHARACTERISTICS OF SUBSTITUTIONS AND THEIR PROPERTIES

Computational nanotechnology ◽

10.33693/2313-223x-2020-7-2-34-41 ◽

2020 ◽

Vol 7 (2) ◽

pp. 34-41

Author(s):

VLADIMIR NIKONOV ◽

◽

ANTON ZOBOV ◽

Keyword(s):

Mathematical Expectation ◽

Point Of View ◽

Small Range ◽

Computational Point ◽

Wide Range ◽

Bijective Function ◽

The Difference ◽

Element Base ◽

Selection Of

The construction and selection of a suitable bijective function, that is, substitution, is now becoming an important applied task, particularly for building block encryption systems. Many articles have suggested using different approaches to determining the quality of substitution, but most of them are highly computationally complex. The solution of this problem will significantly expand the range of methods for constructing and analyzing scheme in information protection systems. The purpose of research is to find easily measurable characteristics of substitutions, allowing to evaluate their quality, and also measures of the proximity of a particular substitutions to a random one, or its distance from it. For this purpose, several characteristics were proposed in this work: difference and polynomial, and their mathematical expectation was found, as well as variance for the difference characteristic. This allows us to make a conclusion about its quality by comparing the result of calculating the characteristic for a particular substitution with the calculated mathematical expectation. From a computational point of view, the thesises of the article are of exceptional interest due to the simplicity of the algorithm for quantifying the quality of bijective function substitutions. By its nature, the operation of calculating the difference characteristic carries out a simple summation of integer terms in a fixed and small range. Such an operation, both in the modern and in the prospective element base, is embedded in the logic of a wide range of functional elements, especially when implementing computational actions in the optical range, or on other carriers related to the field of nanotechnology.

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