Factors associated with quality of care for patients with pancreatic cancer in Australia

OBJECTIVEReadmission to the hospital within 30 days of discharge is used as a surrogate marker for quality and value of care in the United States (US) healthcare system. Concern exists regarding the value of 30-day readmission as a quality of care metric in neurosurgical patients. Few studies have assessed 30-day readmission rates in neurosurgical patients outside the US. The authors performed a retrospective review of all adult neurosurgical patients admitted to a single Canadian neurosurgical academic center and who were discharged to home to assess for the all-cause 30-day readmission rate, unplanned 30-day readmission rate, and avoidable 30-day readmission rate.METHODSA retrospective review was performed assessing 30-day readmission rates after discharge to home in all neurosurgical patients admitted to a single academic neurosurgical center from January 1, 2011, to December 31, 2011. The primary outcomes included rates of all-cause, unplanned, and avoidable readmissions within 30 days of discharge. Secondary outcomes included factors associated with unplanned and avoidable 30-day readmissions.RESULTSA total of 184 of 950 patients (19.4%) were readmitted to the hospital within 30 days of discharge. One-hundred three patients (10.8%) were readmitted for an unplanned reason and 81 (8.5%) were readmitted for a planned or rescheduled operation. Only 19 readmissions (10%) were for a potentially avoidable reason. Univariate analysis identified factors associated with readmission for a complication or persistent/worsening symptom, including age (p = 0.009), length of stay (p = 0.007), general neurosurgery diagnosis (p < 0.001), cranial pathology (p < 0.001), intensive care unit (ICU) admission (p < 0.001), number of initial admission operations (p = 0.01), and shunt procedures (p < 0.001). Multivariate analysis identified predictive factors of readmission, including diagnosis (p = 0.002, OR 2.4, 95% CI 1.4–5.3), cranial pathology (p = 0.002, OR 2.7, 95% CI 1.4–5.3), ICU admission (p = 0.004, OR 2.4, 95% CI 1.3–4.2), and number of first admission operations (p = 0.01, OR 0.51, 95% CI 0.3–0.87). Univariate analysis performed to identify factors associated with potentially avoidable readmissions included length of stay (p = 0.03), diagnosis (p < 0.001), cranial pathology (p = 0.02), and shunt procedures (p < 0.001). Multivariate analysis identified only shunt procedures as a predictive factor for avoidable readmission (p = 0.02, OR 5.6, 95% CI 1.4–22.8).CONCLUSIONSAlmost one-fifth of neurosurgical patients were readmitted within 30 days of discharge. However, only about half of these patients were admitted for an unplanned reason, and only 10% of all readmissions were potentially avoidable. This study demonstrates unique challenges encountered in a publicly funded healthcare setting and supports the growing literature suggesting 30-day readmission rates may serve as an inappropriate quality of care metric in neurosurgical patients. Potentially avoidable readmissions can be predicted, and further research assessing predictors of avoidable readmissions is warranted.

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Adults’ use of electronic communication (e-communication) with providers: Evidence on the prevalence, factors, and its effect on perceived quality of care from the HINTS survey (Preprint)

10.2196/preprints.27167 ◽

2021 ◽

Author(s):

Rumei Yang ◽

Kai Zeng ◽

Yun Jiang

Keyword(s):

Quality Of Care ◽

Rural Area ◽

Perceived Quality ◽

Self Report ◽

Current Status ◽

Patient Portal ◽

Provider Communication ◽

Factors Associated ◽

Perceived Quality Of Care

BACKGROUND Effective patient-provider communication is the core of high-quality patient-centered care. Communication through electronic platforms such as web, patient portal, or mobile phone (referring as e-communication) has become increasingly important as it extends traditional in-person communication with less limitation of timing and locations, and has the potential to facilitate more effective interactions between patients and providers. However, little is known about the current status of patients’ use of e-communication with healthcare providers and whether the use is related to better perceived quality of care at the population level. OBJECTIVE This study was designed to explore the prevalence of, and factors associated with e-communication and effect of e-communication on patient perceived quality of care, using the nationally representative sample of the 2019 Health Information National Trends Survey 5 (HINTS 5)-Cycle 3. METHODS Data from 5,438 survey responders aged 18 years+ (mean=49.04 years, range=18-98) were included in the analysis. All variables were measured using self-report surveys. Logistic and linear regression analyses were used to explore responders’ profile characteristics related to use of e-communication and that use related quality of care. Descriptive sub-analyses for e-communication according to age groups were also performed. All analyses considered the complex design using the jackknife replication method. RESULTS The overall prevalence of the use of e-communication was 60%, with the lowest prevalence in older adults aged 65 years or above (17%), significantly lower than adults younger than 45 years old (41%) and adults aged between 45-65 years (42%) (p<.001). American adults who had some college (OR=3.14, 95% CI 1.52–6.48, p=.003) or college graduate+ (OR=4.14, 95% CI 2.04–8.39, p<.001), household income at or greater than $50,000 (OR=1.75, 95% CI 1.25–2.46, p=.002), or a regular provider (OR=1.93, 95% CI 1.43–2.61, p<.001) were more likely to use e-communication. In contrast, those who reside in rural area (OR=0.59, 95% CI 0.39–0.89, p=.014) were less likely to use e-communication. After controlling for demographic (e.g., age, gender, education, income, and comorbidity) and relationship factors (e.g., regular provider, communication quality, and trust a doctor), the use of e-communication was statistically significantly associated with better quality of care (β=0.13, 95% CI 0.01-0.25, p=.039). CONCLUSIONS Our findings on factors associated with e-communication and the positive association between e-communication and quality of care suggest that policy-level attention is needed to engage the socially disadvantaged (i.e., those with lower levels of education and income, without a regular provider, and living rural area) to maximize the use of e-communication and to support better quality of care among American adults. CLINICALTRIAL NOT APPLICABLE

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Patient and Provider Factors Associated with Selected Measures of Quality of Care

PEDIATRICS ◽

10.1542/peds.65.2.307 ◽

1980 ◽

Vol 65 (2) ◽

pp. 307-313 ◽

Cited By ~ 8

Author(s):

Howard R. Spivak ◽

Janice C. Levy ◽

Rosemary A. Bonanno ◽

Minette Cracknell

Keyword(s):

Quality Of Care ◽

Factors Associated

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Factors associated with the quality of care at the end of life in children with cancer

Journal of Clinical Oncology ◽

10.1200/jco.2004.22.90140.8529 ◽

2004 ◽

Vol 22 (14_suppl) ◽

pp. 8529-8529

Author(s):

J. W. Mack ◽

J. M. Hilden ◽

J. Watterson ◽

H. E. Grier ◽

J. C. Weeks ◽

...

Keyword(s):

Quality Of Care ◽

End Of Life ◽

Children With Cancer ◽

Factors Associated

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Ambulatory health service users' experience of waiting time and expenditure and factors associated with the perception of low quality of care in Mexico

BMC Health Services Research ◽

10.1186/1472-6963-10-178 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 8

Author(s):

Alma Lucila Sauceda-Valenzuela ◽

Veronika J Wirtz ◽

Yared Santa-Ana-Téllez ◽

Maria de la Luz Kageyama-Escobar

Keyword(s):

Quality Of Care ◽

Health Service ◽

Waiting Time ◽

Service Users ◽

Factors Associated

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Use of an electronic integral monitoring system for patients with diabetes to identify factors associated with an adequate glycemic goal and to measure quality of care

Primary Care Diabetes ◽

10.1016/j.pcd.2020.07.009 ◽

2021 ◽

Vol 15 (1) ◽

pp. 162-168

Author(s):

Neftali Eduardo Antonio-Villa ◽

B. Geovani Palma-Moreno ◽

Fátima M. Rodríguez-Dávila ◽

Francisco J. Gómez-Pérez ◽

Carlos A. Aguilar-Salinas ◽

...

Keyword(s):

Quality Of Care ◽

Monitoring System ◽

Factors Associated ◽

Patients With Diabetes

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Intrinsic and extrinsic factors associated with phlebitis in hospitalized patients: Systematic Review [Factores intrínsecos y extrínsecos asociados a flebitis en pacientes hospitalizados: Revisión Sistemática]

Journal of Global Health and Medicine ◽

10.32829/ghmj.v5i2.147 ◽

2021 ◽

Vol 5 (2) ◽

pp. 26-30

Author(s):

Abigail Joaquin-Apaza ◽

Mónica Cárdenas Vásquez ◽

Silvia Patricia Oyola Díaz

Keyword(s):

Quality Of Care ◽

Scientific Evidence ◽

Venous Access ◽

Hospitalized Patients ◽

Extrinsic Factors ◽

Factors Associated ◽

Revisión Sistemática ◽

Peripheral Venous Access ◽

Intrinsic And Extrinsic Factors

Nursing care in central and peripheral venous access is part of nursing work, and the quality of care is affected by the presence of phlebitis in various hospitalization areas. Therefore, factors related to phlebitis are identified. Objective: To analyze the development of scientific evidence on intrinsic and extrinsic factors associated with phlebitis in hospitalized patients. Methodology: A literature search was carried out in databases over the last ten years. There was no language restriction, studies in English, Spanish and Portuguese published in full-text indexed journals were included. A critical analysis of each selected article was carried out, creating a matrix for ordering and categorizing. Results: From a total of 64 articles, 9 were included of which 2 were English and 7 in Portuguese, whose results were that there are intrinsic factors specific to the patient, extrinsic factors that correspond to factors that can be avoidable by the nursing professional when identified. Conclusions: Phlebitis is considered an indicator of nursing service quality. In the course of the article reviews, multiple factors related to phlebitis have been identified, with which preventive, corrective and educational measures should be taken in the areas where venous accesses are manipulated, avoiding future complications, as well as improving the quality of care reflected in the indicators of phlebitis with a zero result as a goal.

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Primary care management for isolated limb injury: Referral to orthopedic surgery in a trauma center

Clinical & Investigative Medicine ◽

10.25011/cim.v33i2.12348 ◽

2010 ◽

Vol 33 (2) ◽

pp. 99

Author(s):

Dominique M Rouleau ◽

Stefan Parent ◽

Debbie Ehrmann Feldman

Keyword(s):

Primary Care ◽

Quality Of Care ◽

Care Center ◽

Related Factors ◽

Lower Limb Injury ◽

Health Care Center ◽

Factors Associated ◽

Limb Injury ◽

Quality Of Primary Care

Introduction: Musculoskeletal injuries affect up to 13% of adults annually. Despite this high incidence, quality of primary care, including analgesia, may be sub-optimal. The goal of this study is to describe the quality of primary care for ambulatory patients with isolated limb injury and to identify related factors. Methods: A cross sectional study was undertaken prospectively on 166 consecutive ambulatory adult patients with isolated limb injury who presented to orthopedics service in a Level one Trauma Centre. Quality of care was assessed by evaluating analgesia, walking aids, immobilization, and quality of referral diagnosis according to actual expert recommendations. Results: This study revealed low quality of primary care for 82 (53.2%) of injured patients. Seventy-three patients (50.3%) had pain level over 5/10 and 45 cases (28.5%) had insufficient/absent analgesia prescriptions. Fifty-one (32.3%) had unacceptable immobilization and 21/59 (35.6%) patients with a lower limb injury did not receive a walking aid prescription. A total of 61 patients (36.7%) had an absent or inadequate referral diagnosis. Factors associated with lower quality depended on the specific quality indicator and included: living further away from the hospital, younger age, initially consulting at another health care center, having a fracture, and being a smoker. Conclusion: The high frequency of low quality of care underlines the necessity for orthopedic surgeons to be involved in primary care education. Identifying factors associated with lower quality of care will orient efforts to improve medical care of patients with isolated traumatic injury.

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Clinical, Behavioral and Social Factors Associated with Racial Disparities in Hospitalized and Ambulatory COVID-19 Patients from an Integrated Health Care System in Georgia

10.1101/2020.07.08.20148973 ◽

2020 ◽

Author(s):

Felipe Lobelo ◽

Alan X Bienvenida ◽

Serena Leung ◽

Armand N Mbanya ◽

Elizabeth J. Leslie ◽

...

Keyword(s):

Health Care ◽

Quality Of Care ◽

Health Care System ◽

Integrated Health Care ◽

Community Level ◽

Factors Associated ◽

Integrated Health ◽

Integrated Health Care System ◽

Care System

Introduction: Racial and ethnic minorities have shouldered a disproportioned burden of coronavirus disease 2019 (COVID-19) infection to date in the US, but data on the various drivers of these disparities is limited. Objectives: To describe the characteristics and outcomes of COVID-19 patients and explore factors associated with hospitalization risk by race. Methods: Case series of 448 consecutive patients with confirmed COVID-19 seen at Kaiser Permanente Georgia (KPGA), an integrated health care system serving the Atlanta metropolitan area, from March 3 to May 12, 2020. KPGA members with laboratory-confirmed COVID-19. Multivariable analyses for hospitalization risk also included an additional 3489 persons under investigation (PUI) with suspected infection. COVID-19 treatment and outcomes, underlying comorbidities and quality of care management metrics, socio-demographic and other individual and community-level social determinants of health (SDOH) indicators. Results: Of 448 COVID-19 positive members, 68,3% was non-Hispanic Black (n=306), 18% non-Hispanic White (n=81) and 13,7% Other race (n=61). Median age was 54 [IQR 43-63) years. Overall, 224 patients were hospitalized, median age 60 (50-69) years. Black race was a significant factor in the Confirmed + PUI, female and male models (ORs from 1.98 to 2.19). Obesity was associated with higher hospitalization odds in the confirmed, confirmed + PUI, Black and male models (ORs from 1.78 to 2.77). Chronic disease control metrics (diabetes, hypertension, hyperlipidemia) were associated with lower odds of hospitalization ranging from 48% to 35% in the confirmed + PUI and Black models. Self-reported physical inactivity was associated with 50% higher hospitalization odds in the Black and Female models. Residence in the Northeast region of Atlanta was associated with lower hospitalization odds in the Confirmed + PUI, White and female models (ORs from 0.22 to 0.64) Conclusions: We found that non-Hispanic Black KPGA members had a disproportionately higher risk of infection and, after adjusting for covariates, twice the risk of hospitalization compared to other race groups. We found no significant differences in clinical outcomes or mortality across race/ethnicity groups. In addition to age, sex and comorbidity burden, pre-pandemic self-reported exercise, metrics on quality of care and control of underlying cardio-metabolic diseases, and location of residence in Atlanta were significantly associated with hospitalization risk by race groups. Beyond well-known physiologic and clinical factors, individual and community-level social indicators and health behaviors must be considered as interventions designed to reduce COVID-19 disparities and the systemic effects of racism are implemented.

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