scholarly journals Metabolic monitoring in children 5 years of age and younger prescribed second-generation antipsychotic medications

2017 ◽  
Vol 7 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Yardlee S. Kauffman ◽  
Thomas Delate ◽  
Sheila Botts
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Second Generation ◽  
Care Delivery ◽  
Cohort Analysis ◽  
Health Care Delivery System ◽  
Care Quality ◽  
Metabolic Monitoring ◽  
Second Generation Antipsychotic

Abstract Introduction: The objective of this article was to identify the rates of patients ≤5 years of age who received recommended monitoring before and after second-generation antipsychotic (SGA) initiation and had an SGA metabolic adverse effect (MAE). Methods: This was a retrospective cohort analysis conducted at Kaiser Permanente Colorado, an integrated health care delivery system, between January 1, 2002, and June 30, 2011. Commercially insured patients ≤5 years of age newly initiated on an SGA were included. Patients were followed for up to 3 years. Metabolic monitoring included lipid profile, blood glucose, blood pressure, and weight measurements. Patient characteristics and outcomes were described using descriptive statistics. Results: A total of 40 patients were included. Overall, 2 (5.0%) patients received all recommended baseline monitoring, and no (0.0%) patients received all recommended follow-up monitoring. Weight monitoring was completed most frequently with rates of completion of 57.5%, 95.0%, 85.0%, and 76.5% at baseline and years 1, 2, and 3, respectively. At least 1 MAE was identified in 14/40 (35.0%), 5/28 (17.9%), and 2/17 (11.8%) patients during years 1, 2, and 3, respectively. The most frequent MAE identified was weight gain. Among patients identified with at least 1 MAE, 4/14 (28.6%), 2/5 (40.0%), and 2/2 (100%) received a behavioral intervention during years 1, 2, and 3, respectively. Discussion: Overall, baseline and follow-up metabolic monitoring were poor. Future studies should focus on examining barriers to monitoring in order to improve health care quality.

scholarly journals Follow-up of Abnormal Estimated GFR Results Within a Large Integrated Health Care Delivery System: A Mixed-Methods Study

2019 ◽  
Vol 74 (5) ◽  
pp. 589-600 ◽  
Author(s):  
Kim N. Danforth ◽  
Erin E. Hahn ◽  
Jeffrey M. Slezak ◽  
Lie Hong Chen ◽  
Bonnie H. Li ◽  
...  
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Delivery System ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Mixed Methods Study ◽  
Estimated Gfr ◽  
System A

Incidence of Complicated Appendicitis as a Metric of Health Care Delivery

2020 ◽  
pp. 000313482095376
Author(s):  
Fawaz Araim ◽  
Artem Shmelev ◽  
Gopal C. Kowdley
Keyword(s):  
Health Care ◽  
Acute Appendicitis ◽  
Health Care Delivery ◽  
Health Care Quality ◽  
Care Delivery ◽  
State Level ◽  
Care Quality ◽  
Physician Density ◽  
Multivariable Logistic Regression Model ◽  
Modifiable Factors

Background Complicated acute appendicitis (CAA) has been linked to extremes of age, racial and socioeconomic disparities, public insurance, and remote residency. CAA rate has been used from 2005 to 2018 as a health care quality metric, with the assumption that delay in treatment was a main cause of perforation. We studied factors that could contribute to CAA focusing on modifiable factors which could be altered as part of a health care delivery system. Materials and Methods All primary admissions for acute appendicitis (AA) from the 2010 Nationwide Inpatient Sample were linked to 2010 state-level physician density data. CAA was distinguished by codes for perforation, generalized peritonitis, or intra-abdominal abscess. A multivariable logistic regression model for CAA prediction was built. Results A total of 288 556 patients were admitted with AA and 86 272 (29.9%) had CAA. Independent factors, linked to CAA, included age outside the 10-39 range (odds ratio (OR) = 2.1-2.4 and all P < .001), male gender (OR = 1.2), malnutrition (OR = 6.2), diabetes mellitus (OR = 2.1), chronic anemias (OR = 1.9), nonprivate insurances (OR 1.2-1.5), nonmetropolitan patient’s residence (OR = 1.15), and Midwest region (OR = 1.2). Patient income and physician coverage were not significant factors after adjustment for all other covariates. Highest CAA fraction of 39.6% was noted in rural patients admitted to urban teaching facilities. Discussion Although provider coverage at the state level may seem adequate and not related to increased CAA rates, the distance patients traveled for their definitive surgical care correlated with higher rates of CAA. Adjusting physician distribution into nonurban settings closer to patients could decrease rates of CAA by diminishing time to definitive care.

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 In patient satisfaction survey- how does it help our health care delivery system (the patient, the health care giver and the organization)?

2017 ◽  
Vol 4 (10) ◽  
pp. 3280
Author(s):  
Priti Prasad Shah
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health Care Delivery ◽  
Health Care Quality ◽  
Care Delivery ◽  
Healthcare Services ◽  
Care Quality ◽  
Survey Study ◽  
Satisfaction Survey ◽  
Patient Satisfaction Survey

Background: Patient satisfaction is a mean of measuring the effectiveness of health care delivery.    It can suggest proportion to the problem areas and a reference point to take management decisions. It can serve as a mean of holding physician accountable. Patient satisfaction data can be used to document health care quality for accrediting organizations and consumer groups. They can also measure specific initiative or changes in service delivery.  They can increase loyalty of patients by demonstrating you care their perceptions and looking for ways to improve. The purpose of our study is to carry out evaluation of hospital services by getting a patient satisfaction survey. Main aim is to identify potential problems in the services.Methods: A hospital based inpatient satisfaction survey study done on 200 patients. A Predesigned structured questionnaire was based on relevance of questions to healthcare services on various aspects of inpatient care.  The interviewer based questionnaires were filled after obtaining verbal informed consent from all subjects. 200 valid responses were analyzed using MS office excel. Data analysis of study is done using the SPSS (Statistical Package for the Social Science) Version 17 for window.Results: Results of our study is very positive and suggest that patients were satisfied with the attitude of doctors, nurses and paramedical staff and it was appreciated. As in D Y Patil Medical College and Hospital most facilities are free for the patients, so we got better feedback for the facilities and satisfaction for this study. Satisfied patients are more likely to continue using the health care services and maintain their relationship with specific health care providers.Conclusions: Patient satisfaction survey can be a driving force for changes in health care delivery with institutions and individuals. These initiatives can promote improvement in practice and also respond to patient expressed needs.

How Do We Align Health Services Research and Quality Improvement?

2020 ◽  
pp. 282-291
Author(s):  
Devika Das ◽  
Lalan Wilfong ◽  
Katherine Enright ◽  
Gabrielle Rocque
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Services Research ◽  
Health Services ◽  
Health Care Quality ◽  
Care Delivery ◽  
Care Quality ◽  
Health Care Use ◽  
Semistructured Interview ◽  
Services Research

Quality improvement (QI) initiatives and health services research (HSR) are commonly used to target health care quality. These disciplines are increasingly important because of the movement toward value-based health care as alternative payment and care delivery models drive institutions and investigators to focus on reducing unnecessary health care use and improving care coordination. QI efforts frequently target medical error and/or efficiency of care through the Plan-Do-Study-Act methodology. Within the QI framework, strategies for data display (e.g., Pareto charts, run charts, histograms, scatter plots) are leveraged to identify opportunities for intervention and improvement. HSR is a multidisciplinary field of study that seeks to identify the most effective way to organize, deliver, and finance health care to maximize the quality and value of care at both the individual and population levels. HSR uses a diverse set of quantitative and qualitative methodologies, such as case-control studies, cohort studies, randomized control trials, and semistructured interview/focus group evaluations. This manuscript provides examples of methodologic approaches for QI and HSR, discusses potential challenges associated with concurrent quality efforts, and identifies strategies to successfully leverage the strengths of each discipline in care delivery.

scholarly journals Unintended outcomes of health care delivery and the need for a national risk management approach

1999 ◽  
Vol 22 (1) ◽  
pp. 44
Author(s):  
Carol O'Donnell
Keyword(s):  
Health Care ◽  
Risk Management ◽  
Health Care Quality ◽  
Technology Development ◽  
Care Delivery ◽  
Health And Safety ◽  
Information Provision ◽  
Care Quality ◽  
Management Approach ◽  
Healthcare Provision

Unlike the situation in occupational health and safety, there is no nationally coordinated approach to risk management to prevent unintended outcomes of healthcare provision and improve health care quality. There is a related absence of linkages between quality assurance processes, other programs aimed at patient injury prevention and professional indemnity insurance systems. This article discusses the Australian health policy direction and argues for a coordinated national health risk management approach developed through contract requirements which include duty of care and information provision, nationally approved standards and codes, professional liability requirements, and supporting health education, research and information technology development.

scholarly journals Patient Safety: A Deep Concern to Caregivers

2019 ◽  
Vol 10 (1) ◽  
pp. 7
Author(s):  
AK Mohiuddin
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Safety Culture ◽  
Health Care Professionals ◽  
Health Care Quality ◽  
Care Delivery ◽  
Patient Safety Culture ◽  
Care Quality ◽  
Care Giving ◽  
Essential Components

Patient safety is a global concern and is the most important domains of health-care quality. Medical error is a major patient safety concern, causing increase in health-care cost due to mortality, morbidity, or prolonged hospital stay. A definition for patient safety has emerged from the health care quality movement that is equally abstract, with various approaches to the more concrete essential components. Patient safety was defined by the IOM as “the prevention of harm to patients.” Emphasis is placed on the system of care delivery that prevents errors; learns from the errors that do occur; and is built on a culture of safety that involves health care professionals, organizations, and patients. Patient safety culture is a complex phenomenon. Patient safety culture assessments, required by international accreditation organizations, allow healthcare organizations to obtain a clear view of the patient safety aspects requiring urgent attention, identify the strengths and weaknesses of their safety culture, help care giving units identify their existing patient safety problems, and benchmark their scores with other hospitals.   Article Type: Commentary

scholarly journals Total Quality Management in Healthcare

2009 ◽  
Author(s):  
Gunjan Patel ◽  
G P
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Care Delivery ◽  
Quality Of Healthcare ◽  
Care Quality ◽  
Total Quality ◽  
Multiple Sources ◽  
True Nature ◽  
Error Prevention

This paper presents the description on Healthcare organizations are required to focus on Total quality improve:- Rendering acceptable, quality health services to patients at affordable price within reasonable price, within in a reasonable time; Applying zero errors to all patients services; maintaining a continuous error prevention program; Training employees in medical care on such aspects as error prevention,reducing delay time and providing prompt reasonable to patients needs; management system have always improvement in such systems to realize the true nature of the quality of healthcare and to be motivated towards improving this quality.In spite of billions of dollars of money spent worldwide, most of the healthcare is seen to be ineffective, inefficient and inadequate. Therefore there is a crying need to bring about a paradigm shift in the quality of health care delivery and to monitor and sustain it. It is obvious that those institutions, which are quality conscious and are committed to continuous quality improvement, will gain the highest consumer acceptance and will flourish at the expense of others. The ‘Quality Revolution’, as it is sometimes referred to, is nothing but putting the patient at the heart of health care and wrapping the care around it, rather than the other way around. Quality Measuring and assessing service is important, particularly when multiple sources of variation are present. Analyzing all medical processes to remove rework and waste could build health care quality and lead to significant reductions in patient cost. The use of quality-assurance programs and statistical tools can be directly applied to health-care organizations with improved quality of patient’s objectives and the results of care from the patient’s viewpoint.

scholarly journals Quality and Accountability in Health Care Delivery: Audit-Study Evidence from Primary Care in India

2016 ◽  
Vol 106 (12) ◽  
pp. 3765-3799 ◽  
Author(s):  
Jishnu Das ◽  
Alaka Holla ◽  
Aakash Mohpal ◽  
Karthik Muralidharan
Keyword(s):  
Health Care ◽  
Public Sector ◽  
Health Care Quality ◽  
Care Delivery ◽  
Care Quality ◽  
Rural India ◽  
Correct Treatment ◽  
Public And Private ◽  
Market Prices ◽  
Private Providers

We present unique audit-study evidence on health care quality in rural India, and find that most private providers lacked medical qualifications, but completed more checklist items than public providers and recommended correct treatments equally often. Among doctors with public and private practices, all quality metrics were higher in their private clinics. Market prices are positively correlated with checklist completion and correct treatment, but also with unnecessary treatments. However, public sector salaries are uncorrelated with quality. A simple model helps interpret our findings: Where public-sector effort is low, the benefits of higher diagnostic effort among private providers may outweigh costs of potential overtreatment. (JEL H42, I11, I18, O15)

The role of community engagement in building sustainable health-care delivery interventions for Kenya

2018 ◽  
Vol 42 (1/2) ◽  
pp. 35-47
Author(s):  
Elise Catherine Davis ◽  
Elizabeth T. Arana ◽  
John S. Creel ◽  
Stephanie C. Ibarra ◽  
Jesus Lechuga ◽  
...  
Keyword(s):  
Health Care ◽  
Community Engagement ◽  
Health Care Delivery ◽  
Low Income ◽  
Health Care Quality ◽  
Care Delivery ◽  
Care Quality ◽  
Content Type ◽  
Seek Health Care ◽  
Sustainable Health

Purpose The purpose of this article is to provide a general review of the health-care needs in Kenya which focuses on the role of community engagement in facilitating access and diminishing barriers to quality care services. Health-care concerns throughout Kenya and the culture of Kenyan’s health-care practices care are considered. Design/methodology/approach A comprehensive review covered studies of community engagement from 2000 till present. Studies are collected using Google Scholar, PubMed, EBSCOhost and JSTOR and from government and nongovernment agency websites. The approach focuses on why various populations seek health care and how they seek health care, and on some current health-care delivery models. Findings Suggestions for community engagement, including defining the community, are proposed. A model for improved health-care delivery introduces community health workers (CHWs), mHealth technologies and the use of mobile clinics to engage the community and improve health and quality of care in low-income settings. Practical implications The results emphasize the importance of community engagement in building a sustainable health-care delivery model. This model highlights the importance of defining the community, setting goals for the community and integrating CHWs and mobile clinics to improve health status and decrease long-term health-care costs. The implementation of these strategies contributes to an environment that promotes health and wellness for all. Originality/value This paper evaluates health-care quality and access issues in Kenya and provides sustainable solutions that are linked to effective community engagement. In addition, this paper adds to the limited number of studies that explore health-care quality and access alongside community engagement in low-income settings.

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