Measuring the Quality of Care using a Large Clinical Database : Lessons learned in Oncology

Abstract Background Safe childbirth remains a daunting challenge, particularly in low-middle income countries, where most pregnancy-related deaths occur. Cameroon’s maternal mortality rate, estimated at 529 per 100,000 live births in 2017, is significantly high. The WHO Safe Childbirth Checklist (SCC) was designed to improve the quality of care provided to pregnant women during childbirth. The SCC was implemented at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital to improve the quality of care during childbirth. Methods This study was a retrospective study to determine the adoption rate of the SCC and its association with maternal (eclampsia, perineal tears, and postpartum haemorrhage) and neonatal (stillbirth, neonatal asphyxia and neonatal death) complications. Data were collected 6 months after the introduction of the SCC. Multivariate binary logistic regression was used to analyse the association between the use of the SCC and maternofoetal complications. Results Out of 1611 deliveries conducted, 1001 records were found, giving a retrieval rate of 62%. Twenty-five records were excluded. During the study period, the checklists were used in 828 of 976 clinical notes, with an adoption rate of 84.8% and a utilization rate of 93.9% at 6 months. Severe preeclampsia/eclampsia was associated with the non-use of the SCC (2.1 vs 5.4%, p = 0.041). Stillbirth, neonatal asphyxia, and neonatal death rates were not significantly different between the checklist and non-checklist groups. However, for all neonatal outcomes, the proportion of complications was lower when the checklist was used. Conclusion The use of the SCC was associated with significantly reduced pregnancy complications, especially for reducing the rates of severe pre-eclampsia/eclampsia. The use of the SCC increased to 93.9% of all deliveries within 6 months. We advocate for the use of the WHO Safe Childbirth Checklist in maternity units.

Download Full-text

Improving quality of care in conflict settings: access and infrastructure are fundamental

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzz128 ◽

2019 ◽

Vol 31 (10) ◽

pp. G187-G190

Author(s):

Dilshad Jaff ◽

Sheila Leatherman ◽

Linda Tawfik

Keyword(s):

Quality Of Care ◽

Health Care Services ◽

Quality Care ◽

Evidence Base ◽

Lessons Learned ◽

Armed Conflicts ◽

Initial Assessment ◽

Quality Health Care ◽

Basic Infrastructure

Abstract Quality problem or issue Armed conflicts pose significant challenges to ensuring timely access to quality health care services for millions around the world. Initial assessment Ensuring access and basic infrastructure for conflict-affected populations are overlooked in the global movement to provide quality of care. Choice of solution This paper identifies strategies and interventions to improve access to good quality care in settings and communities afflicted by conflict. Lessons learned t is crucial to focus more attention on, and develop an evidence base for, ensuring access and basic infrastructure to improve quality of care in conflict-affected regions.

Download Full-text

Lessons Learned from the Quality of Care Project

TEXILA INTERNATIONAL JOURNAL OF MANAGEMENT ◽

10.21522/tijmg.2015.se.21.01.art001 ◽

2021 ◽

pp. 1-10

Author(s):

Roy Chikwem

Keyword(s):

Quality Of Care ◽

Quantitative Data ◽

Lessons Learned ◽

Qualitative And Quantitative ◽

Pregnancy And Childbirth ◽

Care Project ◽

Integrated Project ◽

Save The Children ◽

Document Review

Each year 40,000 women die during pregnancy and childbirth, and over 250,000 babies die in their first month of life in Nigeria. Save the Children International worked to improve the lives and health status of an estimated 435,000 mothers and their babies in Lagos and Jigawa over a period of three years through its Quality of Care (QoC) project in Nigeria. This integrated project drew on existing partnerships with national, state and global experts to strengthen essential training, improve the clinic environment including supervision and monitoring, develop and disseminate communication messages for behaviour change as well as advocate for implementation of transformative policies. A combination of document review, qualitative and quantitative data collection approaches were adopted. These data were then triangulated to respond to the objectives of the evaluation. The findings show that the project has changed the way healthcare is provided in target facilities in Jigawa and Lagos as a result of their participation on the project.

Download Full-text

Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study

PLoS ONE ◽

10.1371/journal.pone.0254781 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254781

Author(s):

Manoja Kumar Das ◽

Narendra Kumar Arora ◽

Suresh Kumar Dalpath ◽

Saket Kumar ◽

Amneet P. Kumar ◽

...

Keyword(s):

Quality Improvement ◽

Patient Satisfaction ◽

Quality Of Care ◽

Newborn Care ◽

Lessons Learned ◽

Essential Newborn Care ◽

Case Record ◽

District Hospitals ◽

Maternal And Newborn

Introduction Improving quality of care (QoC) for childbirth and sick newborns is critical for maternal and neonatal mortality reduction. Information on the process and impact of quality improvement at district and sub-district hospitals in India is limited. This implementation research was prioritized by the Haryana State (India) to improve the QoC for maternal and newborn care at the busy hospitals in districts. Methods This study at nine district and sub-district referral hospitals in three districts (Faridabad, Rewari and Jhajjar) during April 2017-March 2019 adopted pre-post, quasi-experimental study design and plan-do-study-act quality improvement method. During the six quarterly plan-do-study-act cycles, the facility and district quality improvement teams led the gap identification, solution planning and implementation with external facilitation. The external facilitators monitored and collected data on indicators related to maternal and newborn service availability, patient satisfaction, case record quality, provider’s knowledge and skills during the cycles. These indicators were compared between baseline (pre-intervention) and endline (post-intervention) cycles for documenting impact. Results The interventions closed 50% of gaps identified, increased the number of deliveries (1562 to 1631 monthly), improved care of pregnant women in labour with hypertension (1.2% to 3.9%, p<0.01) and essential newborn care services at birth (achieved ≥90% at most facilities). Antenatal identification of high-risk pregnancies increased from 4.1% to 8.8% (p<0.01). Hand hygiene practices improved from 35.7% to 58.7% (p<0.01). The case record completeness improved from 66% to 87% (p<0.01). The time spent in antenatal clinics declined by 19–42 minutes (p<0.01). The pooled patient satisfaction scores improved from 82.5% to 95.5% (p<0.01). Key challenges included manpower shortage, staff transfers, leadership change and limited orientation for QoC. Conclusion This multipronged quality improvement strategy improved the maternal and newborn services, case documentation and patient satisfaction at district and sub-district hospitals. The processes and lessons learned shall be useful for replicating and scaling up.

Download Full-text

Retrospective Assessment of the Standardized Mortality Ratio as a Measure of the Quality of Care in a Major Intensive Care Unit in the Republic of Cyprus

Connect The World of Critical Care Nursing ◽

10.1891/wfccn-d-19-00012 ◽

2019 ◽

Vol 13 (3) ◽

pp. 118-125

Author(s):

Stelios Iordanou ◽

Nicos Middleton ◽

Elizabeth Papathanassoglou ◽

Lakis Palazis ◽

Vasilios Raftopoulos

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Of Care ◽

Lessons Learned ◽

Standardized Mortality Ratio ◽

Surveillance Period ◽

Web Based ◽

Saps Ii Score ◽

Mortality Ratio

IntroductionThe standardized mortality ratio (SMR) is commonly used to assess the overall quality of care by comparing the observed hospital mortality with the mortality predicted by statistical models. If the observed deaths are less than the predicted, the overall quality of care can be considered high; in the opposite case, it is low.AimThe aim of the study was to assess the overall quality of care in an intensive care unit (ICU) during the period of 2012 to 2017. We also reported our experience and lessons learned throughout the surveillance period.MethodsA retrospective study design was adopted. Healthcare-associated infections (HAI–ICU) protocol v1.1 was used in a major ICU for a period of 6 years. All patients admitted to the ICU during the surveillance period were included in the study. The SMR was measured.ResultsDuring the 6-year period, 1067 patients were admitted and remained hospitalized for more than 48 hours; 207 patients' discharge status was reported as “death”, compared to 309 deaths predicted based on the SAPS II score. The overall mean observed mortality rate during the study period was 19.4%, as opposed to 28.95% for the predicted mortality. The overall mean SMR was 0.62 (IQR 0.49-0.82). Difficulties were faced due to the lack of surveillance software, but they were overcome by the use of a freely available web-based form.ConclusionsThe overall quality of ICU care is considered to correspond to high-quality standards, since standardized mortality rates during the study period were lower than one. The use of the web-based form as an alternative solution to the surveillance software performed well in terms of recording data.

Download Full-text

LESSONS LEARNED FROM NURSING HOME CIVIL MONETARY PENALTY PROJECTS

Innovation in Aging ◽

10.1093/geroni/igz038.2832 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S770-S770

Author(s):

Diana L Sturdevant ◽

Kathleen C Buckwalter

Keyword(s):

Nursing Home ◽

Quality Of Care ◽

Nursing Homes ◽

Nursing Home Residents ◽

Lessons Learned ◽

Federal State ◽

Future Research ◽

Term Care ◽

Home Setting

Abstract Nursing homes must comply with numerous federal/state regulations to receive Medicare and Medicaid funding. Failure to comply with these regulations can result in deficiency citations, and depending on the severity of the deficiency, a resulting Civil Monetary Penalty (CMP). Through the Centers for Medicare and Medicaid Services (CMS) Civil Monetary Penalty Reinvestment Program, CMP funds are reinvested to support activities that benefit nursing home residents and that protect or improve their quality of life or quality of care. This symposium presents some of the unique challenges, successes, failures, and surprise findings from CMP-funded nursing home quality improvement projects in two, predominantly rural Midwestern states: Oklahoma and Kansas. Dr. Williams presents findings of a pilot-study testing an adaptation of a successful family caregiver telehealth support intervention in the nursing home setting and implications for future research. Dr. Sturdevant shares successes, challenges, and unanticipated results from the “It’s Not OK to Fall” project, a comprehensive, 3 year fall prevention project implemented in Oklahoma nursing homes. Lastly, Ms. Round’s paper describes the implementation and findings of a Long-term Care Leadership Academy aimed at improving leadership and team building skills of three levels of nursing home staff, including Administrators/Directors’ of Nursing, RN/LPN charge nurses and certified nursing assistants. Discussant, Dr. Kathleen Buckwalter Ph.D., FAAN, RN, will discuss how principles of nursing home culture change provides a common framework for these projects and conclude by offering suggestions on how promotion of these principles might improve the quality of care provided by nursing homes.

Download Full-text

Patient safety, ethics and whistleblowing: a nursing response to the events at the Campbelltown and Camden Hospitals

Australian Health Review ◽

10.1071/ah040013 ◽

2004 ◽

Vol 28 (1) ◽

pp. 13 ◽

Cited By ~ 16

Author(s):

Megan-Jane Johnstone

Keyword(s):

Health Care ◽

At Risk ◽

Patient Safety ◽

Quality Of Care ◽

Code Of Ethics ◽

Codes Of Ethics ◽

Lessons Learned ◽

Professional Conduct ◽

Australian Health

IN NOVEMBER 2002, in what stands as one of the most significant whistle blowing cases in the history of the Australian health care system, four nurses went public with concerns they had about the management of clinical incidents and patient safety at two hospitals in Sydney, New South Wales. The handling of this case and its aftermath raises important moral questions concerning the nature of whistleblowing in health care domains and the possible implications for the patient safety and quality of care movement in Australia. This paper presents an overview of the case, the moral risks associated with whistleblowing, and some lessons learned. The International Council of Nurses (2000) Code of Ethics stipulates that nurses have a stringent responsibility to 'take appropriate action to safeguard individuals when their care is endangered by a co-worker or any other person'. Other local and international nursing codes of ethics and standards of professional conduct likewise obligate nurses to take appropriate action to safeguard individuals when placed at risk by the incompetent, unethical or illegal acts of others ? including the system. Despite these coded moral prescriptions for responsible and accountable professional conduct, taking appropriate action when others are placed at risk (including making reports to appropriate authorities) is never an easy task nor is it free of risk for nurses. As has been amply demonstrated in the literature, taking a moral stance to protect patient safety and quality of care can be extremely hazardous to nurses (Johnstone 1994, 2002, 2004; Ahern & McDonald 2002). In situations where nurses report their concerns to an appropriate authority but nothing is done to either investigate or validate their claims, nurses are faced with the ethical dilemma and 'choice' of whether to: do nothing ('put up and shut up'); leave their current place of employment (and possibly even the profession); or take the matter further ('blow the whistle') by reporting their concerns to an external authority that they perceive as having the power to do something about their concerns. It is rare for nurses to 'blow the whistle' in the public domain. When they do, it is usually because they perceive that something is terribly wrong and, as a matter of conscience, they cannot just look on as morally passive bystanders. For those nurses who do take a stand, the costs to them personally and professionally are almost always devastating, with no guarantees that the situation on which they have taken a public stance will be improved. Nurses who blow the whistle often end up with their careers and lives in tatters (see case studies in Johnstone 1994 & 2004).

Download Full-text

How COVID-19 challenged care for women and their newborns: a qualitative case study of the experience of Belgian midwives during the first wave of the pandemic

10.1101/2021.05.21.21257440 ◽

2021 ◽

Author(s):

Elise Huysmans ◽

Constance Audet ◽

Therese Delvaux ◽

Anna Galle ◽

Aline Semaan ◽

...

Keyword(s):

Quality Of Care ◽

Work Experience ◽

Newborn Care ◽

Lessons Learned ◽

National Guidelines ◽

Health Authorities ◽

The Impact ◽

Maternal And Newborn Care ◽

Maternal And Newborn

In this article, we describe the results of a rapid qualitative study conducted between May 19 and June 25, 2020 on the work experience of midwives during the first wave of the COVID-19 pandemic in Brussels and Wallonia (Belgium). Using semi-structured interviews conducted with fifteen midwives working in hospitals or practicing privately, we investigated the impact of the first COVID-19 wave on their work experience, the woman-midwife relationship, and midwife-perceived changes in quality of care. Findings include high levels of stress and insecurity related to the lack of resources and personal protective equipment, feelings of distrust from midwives towards the Belgian State and public health authorities, as well as structural and organizational challenges within maternity wards which negatively affected quality of care. Moreover, based on the midwives' experiences, we demonstrate the need to recognise the views of all stakeholders involved in maternal and newborn care provision, and share five essential lessons learned from this study: 1) it is crucial to acknowledge the central role of midwives for maintaining maternal and newborn care amidst the pandemic and beyond; 2) creating unified national guidelines could support ensuring best practice; 3) efforts must be put in place to diminish the climate of mistrust towards health authorities and to repair the relationship between midwives and decision-makers which was damaged during the pandemic; 4) caring for front-line healthcare workers' mental health is critical, and 5) quality of maternal care can be improved, even in the midst of a pandemic, through team effort and creative solutions tailored to the needs and demands of each setting.

Download Full-text

6.H. Workshop: Quality strategies in European health systems: assessing their nature, use and effectiveness

European Journal of Public Health ◽

10.1093/eurpub/ckz185.449 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

Keyword(s):

Health Care ◽

Quality Of Care ◽

Cost Effectiveness ◽

Health Systems ◽

Health Care Quality ◽

Care Quality ◽

Lessons Learned ◽

Potential Contribution ◽

Policy Makers

Abstract Quality of care is one of the most frequently quoted principles of health policy, and is currently high up on the agenda of policy-makers at national, European, and international levels. However, the understanding of the term and what it encompasses varies. Many organizations and movements, such as evidence-based medicine, health technology assessment, provider accreditation, clinical practice guidelines and patient safety, play an important role in improving quality of health care. However, this broad field of quality-related initiatives is fragmented, and there is often a lack of awareness about parallel activities because of different labels. Evidence on the effectiveness and cost-effectiveness of different quality strategies is not always readily available for policy-makers, who have to struggle with prioritizing initiatives for investment. To provide a solid foundation for addressing these challenges, the European Observatory on Health Systems and Policies in collaboration with the OECD has put together a comprehensive study on health care quality, its interpretation and the evidence on different strategies aiming to assure or improve it. Drawing on this 2019 study, the workshop has the following objectives: Provide an understanding of the multidimensional concept of quality of care and its relation to health system performance as well as a comprehensive framework for looking at different strategies and their potential contribution to improving health care quality;Introduce key components of international and European governance for quality of care;Highlight the effectiveness, cost-effectiveness and implementation of selected quality strategies, with a focus on the European context:Health professional regulation, including education, licensing and registration, continuous professional development and mechanisms to ensure fitness to practice;External institutional strategies for health care organizations, including accreditation, certification and supervision;“Pay for Quality”, wherein financial incentives are paid to providers or professionals for achieving quality-related targets within a specific timeframe.Discuss and refine lessons learned through audience participation, and identify further areas for research and action. Key messages Quality of care is a political priority and an important contributor to population health. Within an overall strategic framework, understanding the potential of different quality strategies is key. Evidence on the (cost-)effectiveness of different quality strategies is variable but largely inconclu-sive. Maintaining an overview and identifying areas for action is paramount for policy-makers.

Download Full-text