Quality of Care for Children Under Five with Malaria Using IMCI Approach at Public Health Centre: Literature Review

Integrated Management of Childhood Illness is one of the strategies in health care services for infants and children under five at primary health care facilities. Children with fever in high malaria endemic areas must have a blood test done to check whether the children have malaria or not. IMCI is one of the interventions recommended by WHO to screen and also ensure that children receive proper initial treatment at first-level health facilities. This article aims to discuss the quality of care for children under five with malaria using IMCI approach. This is a systematic review by searching 4 databases including Scopus, Web of Science, SAGE and Proquest. Health care services for children under five with an integrated management of childhood illness are intended to provide immediate and appropriate treatment. The guideline for treating children under five with malaria using IMCI approach is very helpful for nurses both in assessing, classifying, treating/curing and making decisions for pre-referral measures for severe cases. Several factors to support quality of care are trained officers, supervision and procurement of essential medicines, RDT and malaria microscopy. Enforcement of the right diagnosis will improve the quality of life of children and prevent death in children under five. Keywords: IMCI, Malaria, Children under five

Anxiety Profile of PWD and Caregiver During COVID-19 Pandemic in ALZI Surabaya Community, Indonesia

The consequence of COVID-19 pandemic conditions in vulnerable groups such as Patients with Dementia (PWD) and their caregivers are required to be urgently addressed. This study was conducted to collect data on PWD and caregiver characteristics, also concluding the profile of anxiety during the COVID-19 pandemic in Alzi Surabaya Community. This research is an observational descriptive cross-sectional study using the Beck Anxiety Inventory and Rating Anxiety in Dementia questionnaire to apprehend the profile of anxiety in PWD and caregivers in the Alzi Surabaya Community during the COVID-19 pandemic. PWD in this community experience significant anxiety (82.35%) with symptoms such as sleep disturbance (100%) worry over trifles (92.85%), complaints of headache and body aches or pains (92.85%) also sweating, flushes or chills, tingling or numbness of extremities (42.85%) and insignificant anxiety (17.65%) with symptoms such as fatigue and tiredness (100%), worry about physical health (66.57%), irritability (66.57%), heart racing or thumping (33.33%). Caregivers of PWD in this community all experience low anxiety with symptoms such as fear of something worst happening (80%), unable to relax (65%), indigestion and dizziness or lightheadedness (55%). Intervention, in order to reduce anxiety in PWD and caregiver during and post-pandemic, is substantial as establishing a good quality of life is important for PWD to increase fulfilment in life and also important for caregivers in order to maintain quality of care.

Characteristics and outcome of COVID-19 patients admitted to the ICU: a nationwide cohort study on the comparison between the first and the consecutive upsurges of the second wave of the COVID-19 pandemic in the Netherlands

Background To assess trends in the quality of care for COVID-19 patients at the ICU over the course of time in the Netherlands. Methods Data from the National Intensive Care Evaluation (NICE)-registry of all COVID-19 patients admitted to an ICU in the Netherlands were used. Patient characteristics and indicators of quality of care during the first two upsurges (N = 4215: October 5, 2020–January 31, 2021) and the final upsurge of the second wave, called the ‘third wave’ (N = 4602: February 1, 2021–June 30, 2021) were compared with those during the first wave (N = 2733, February–May 24, 2020). Results During the second and third wave, there were less patients treated with mechanical ventilation (58.1 and 58.2%) and vasoactive drugs (48.0 and 44.7%) compared to the first wave (79.1% and 67.2%, respectively). The occupancy rates as fraction of occupancy in 2019 (1.68 and 1.55 vs. 1.83), the numbers of ICU relocations (23.8 and 27.6 vs. 32.3%) and the mean length of stay at the ICU (HRs of ICU discharge = 1.26 and 1.42) were lower during the second and third wave. No difference in adjusted hospital mortality between the second wave and the first wave was found, whereas the mortality during the third wave was considerably lower (OR = 0.80, 95% CI [0.71–0.90]). Conclusions These data show favorable shifts in the treatment of COVID-19 patients at the ICU over time. The adjusted mortality decreased in the third wave. The high ICU occupancy rate early in the pandemic does probably not explain the high mortality associated with COVID-19.

From Discipline to Quality of Care: How Neurologists Can Learn from Decisions of Disciplinary Tribunals

<b><i>Background:</i></b> One of the primary aims of medical disciplinary law is to improve the quality of care. However, the decisions of disciplinary tribunals are not sufficiently analysed to identify the learning elements. <b><i>Aim:</i></b> This study aimed to investigate the frequency and nature of complaints for the specialty neurology which were upheld by the disciplinary tribunals and to learn from disciplinary law through an analysis of which factors contributed to complaints being upheld. <b><i>Design:</i></b> This is a retrospective, observational study. <b><i>Methods:</i></b> All upheld complaints in the field of neurology were collected for the period of January 1, 2010, to January 1, 2020. A qualitative analysis of the decisions was conducted using the usual characteristics set out by disciplinary tribunals in their annual reports. The relevant factors which potentially played a role in the complaint being upheld were identified for more detailed analysis. <b><i>Results:</i></b> In the 10-year period, a complaint was submitted to the disciplinary tribunals against 299 neurologists. Forty-four complaints were upheld (15%). The most common sanction was a warning (70%). A large majority of cases were directly related to patient care, such as decisions about the patient’s diagnosis and the treatment. Recordkeeping (50%), interpretation and discussion of imaging (30%), and involvement of several consultants of one or more specialties (34%) frequently played a role in the successful complaints. <b><i>Conclusion:</i></b> Medical disciplinary cases in the field of neurology are usually about diagnosis- and treatment-related aspects. Recordkeeping, interpretation of neuroimaging, and involvement of several consultants frequently play a role in a complaint being upheld. It is important that specialties evaluate disciplinary decisions on a structural and continuous basis.

Leveraging value-based care principles in developing eHealth systems: A teaching case

Recently, many countries, including developing countries, have struggled to manage rising healthcare costs and challenges around decreasing quality of care. Previous studies suggest that electronic health systems could significantly improve the quality of care and facilitate better access to care. However, there is still a lack of studies providing sufficient evidence around how this can be achieved. This case study examines how a hospital uses its electronic health (eHealth) systems to offer better access, quality, and value by leveraging the principles of value-based care for its patients. This case study provides critical insights for healthcare stakeholders, public hospitals, especially in developing countries, healthcare providers and policymakers and proffers an approach to leverage the principles of value-based care when developing eHealth systems to offer better overall health and well-being services to their patients.

Can competition improve hospital quality of care? A difference-in-differences approach to evaluate the effect of increasing quality transparency on hospital quality

Public reporting on the quality of care is intended to guide patients to the provider with the highest quality and to stimulate a fair competition on quality. We apply a difference-in-differences design to test whether hospital quality has improved more in markets that are more competitive after the first public release of performance data in Germany in 2008. Panel data from 947 hospitals from 2006 to 2010 are used. Due to the high complexity of the treatment of stroke patients, we approximate general hospital quality by the 30-day risk-adjusted mortality rate for stroke treatment. Market structure is measured (comparatively) by the Herfindahl–Hirschman index (HHI) and by the number of hospitals in the relevant market. Predicted market shares based on exogenous variables only are used to compute the HHI to allow a causal interpretation of the reform effect. A homogenous positive effect of competition on quality of care is found. This effect is mainly driven by the response of non-profit hospitals that have a narrow range of services and private for-profit hospitals with a medium range of services. The results highlight the relevance of outcome transparency to enhance hospital quality competition.

Development and Operationalization of a Data Framework to Assess Quality of Integrated Diabetes Care in the Fragmented Data Landscape of Belgium

Background. To assess the quality of integrated diabetes care, we should be able to follow the patient throughout the care path, monitor his/her care process and link them to his/her health outcomes, while simultaneously link this information to the primary care system and its performance on the structure and organization related quality indicators. However the development process of such a data framework is challenging, even in period of increasing and improving health data storage and management. This study aims to develop an integrated multi-level data framework for quality of diabetes care and to operationalize this framework in the fragmented Belgium health care and data landscape.Methods. Based on document reviews and iterative expert consultations, theoretical approaches and quality indicators were identified and assessed. After mapping and assessing the validity of existing health information systems and available data sources through expert consultations, the theoretical framework was translated in a data framework with measurable quality indicators. The construction of the data base included sampling procedures, data-collection, and several technical and privacy-related aspects of linking and accessing Belgian datasets.Results. To address three dimensions of quality of care, we integrated the chronic care model and cascade of care approach, addressing respectively the structure related quality indicators and the process and outcome related indicators. The corresponding data framework is based on self-collected data at the primary care practice level (using the Assessment of quality of integrated care tool), and linked health insurance data with lab data at the patient level. Conclusion. In this study, we have described the transition of a theoretical quality of care framework to a unique multilevel database, which allows assessing the quality of diabetes care, by considering the complete care continuum (process and outcomes) as well as organizational characteristics of primary care practices.