Complex wound care by a nurse practitioner in primary care: a quality improvement evaluation on healing rates, costs and patient satisfaction

Complex wounds are a major burden for healthcare professionals. Patients with complex wounds are often referred to hospitals or wound expertise centres. Complex wound care could be organised in primary care, but very little published evidence for this is available. In this study, members of a primary healthcare organisation were interviewed to ascertain how the wound care was organised. Patient characteristics and data regarding wound care, healing rates and costs were collected from medical records. Patients filled in a questionnaire concerning accessibility, communication, medical counselling and the overall experience of their treatment. This study followed 25 patients with a total of 42 wounds. Some 82% of the wounds were healed within a mean treatment duration of 9.7 weeks. Mean treatment costs were calculated at €155 (£130) for healed patients. Patients were generally very satisfied with their treatment, illustrated by an overall 8.7 out of 10 scoring on an amended survey based on the Consumer Quality Index. Treating complex wounds in primary care seemed adequate, with high patient satisfaction and tolerable costs.

Patient-Reported Experience Measures in Stroke Care

Background and Purpose: Patient-reported experience measures (PREMs) assess patients’ perception of health care. We aimed to identify all reported PREMs for stroke care and critically appraise psychometric properties of PREMs validated for patients with stroke. Methods: Studies on the development, validation, or utilization of PREMs for adult patients with stroke were systematically identified. The Consensus-Based Standards for the Selection of Health Measurement Instruments criteria were used to appraise psychometric performance. Results: We included 18 studies, examining 13 PREMs. Two PREMs had been developed for stroke care: Consumer Quality Index: Cerebrovascular Accident and Riksstroke. Consumer Quality Index: Cerebrovascular Accident was given a positive psychometric assessment, but its length and limited language applicability impede clinical implementation. Riksstroke was appraised as doubtful. Eleven PREMs were generic. The psychometric performance of 5 generic PREMS, validated for patients with stroke, received conflicting assessments. Six generic PREMs had not been validated in patients with stroke and were therefore not assessed for instrument performance. Conclusions: Thirteen PREMs have been published for use in stroke care. The stroke-specific Consumer Quality Index: Cerebrovascular Accident has favorable psychometric performance but lacks practical feasibility. Other PREMs have inadequate or unknown psychometric properties. This indicates the need for developing stroke-specific PREMs to support quality improvement and enhance patient-centered care.

Validating a generic cancer consumer quality index in eight European countries, patient reported experiences and the influence of cultural differences

Background Taking patient centeredness into account is important in healthcare. The European Cancer Consumer Quality Index (ECCQI) is a validated tool for international benchmarking of patient experiences and satisfaction. This study aimed to further validate the ECCQI in larger and more uniform groups of high volume tumours such as breast and prostate cancer. A second objective was the verification of the influence of cultural factors of the country to determine its possible use in international benchmarking. Methods Data from two survey studies in eight European countries were combined. Socio-demographic correlations were analysed with Kruskall-Wallis and Mann-Whitney tests. Cronbach’s alpha was calculated to validate internal consistency. Influences of masculinity (MAS), power distance (PD) and uncertainty avoidance (UA) were determined by linear regression analysis in a general model and subgroup models. Results A total of 1322 surveys were included in the analysis (1093 breast- and 348 prostate cancer patients). Cronbach’s alpha was good (α ≥ 0.7) or acceptable (0.5 ≤ α ≤ 0.7) in 8 out of 9 questionnaire categories, except in the category ‘Safety’ (α = 0.305). Overall ECCQI scores ranged from 22.1 to 25.1 between countries on a 1–35 scale (categories had a 1–4 scale). In certain subcategories such as ‘Organisation’ (range 2.2 vs 3.0) and ‘Supervision & Support’ (range 3.0 vs 3.8) a large difference was observed between countries. Differences in ‘Overall opinion’ were however small: mean scores of 3.7 vs 3.9, whereas median scores were all the maximum of 4.0. Power distance was positively associated with higher patient satisfaction scores whereas Uncertainty avoidance was negatively associated with these scores. Masculinity was only associated with patient satisfaction scores in lower educated patients. We found the highest impact of culture on overall scores in Hungary and Portugal and the lowest in Romania. Conclusions The ECCQI shows high internal consistency in all categories except ‘Safety’. Especially in separate categories and overall ECCQI scores the questionnaire showed discriminative value. This study showed a positive correlation of power distance and a negative correlation for uncertainty avoidance in some countries. When using the ECCQI for international benchmarking these two dimensions of culture should be taken into account.

A New Egyptian Validation Tool for Measuring Quality of Nursing Care Using the CQ Index

Background and PurposeMeasuring and monitoring the quality of nursing care are essential for improving quality of nursing care and safety. This study aimed to develop an Egyptian validation tool for measuring the quality of nursing care from the perspectives of patients based on consumer quality index and describe the aspects of quality of nursing care that need improvement.MethodsA cross-sectional descriptive survey using Consumer quality index questionnaire of nursing care aspects was carried on 400 patients.Results44 attributes of care were extracted into nine dimensions accounting for 70.4% of the total variance. The majority of nursing care aspects needed moderate levels of quality improvement.ConclusionsA valid and reliable Egyptian tool was developed for measuring the quality of nursing care built upon consumer quality index.