EFFECT OF SAFE PATIENT HANDLING (SPH) PROGRAM ON REHABILITATION OUTCOMES AND ON SAFETY OF PHYSICAL THERAPISTS IN RURAL HOSPITAL: A RANDOMIZED CLINICAL TRIAL

Patient management and intervention practices are a crucial component of patient treatment in the hospitals. Increase in inpatient mobilization to improve patient treatment raises a physiotherapist’s physical demands and therefore risk of injury. With the context of a patient mobilization program, better work procedures and decrease in physiotherapist’s injuries while working, SPH program was incorporated. The purpose of this study is to assess the impact of the SPH program and mobilization in the context of efforts to improve health care quality and patient safety, as well as the safety of physical therapists. There will be 2 groups, intervention (SPH) and comparison (no-SPH) each group will consist of 30 patients. The intervention group will be consisting the patients admitted in rehabilitation unit for the first three months of the research and the comparison group will consist the patients admitted in rehabilitation unit in the last 3 months of the research. Intervention group will undergo rehabilitation with SPH program which will include equipment like lifts based on ceiling and floors, sit to stand supports, motorized hospital beds and ambulation aids. In this study we found that the SPH program did not impede rehabilitation but also somewhat sped up the recovery process. Patients who had an SPH program during rehabilitation showed similar but better outcomes than those who did not.

Physicians’ Attitude towards Electronic Medical Record Systems: An Input for Future Implementers

Background. Electronic medical record (EMR) systems offer the potential to improve health care quality by allowing physicians real-time access to patient healthcare information. The endorsement and usage of EMRs by physicians have a significant influence on other user groups in the healthcare system. As a result, the purpose of this study was to examine physicians’ attitudes regarding EMRs and identify the elements that may influence their attitudes. Method. An institutional-based cross-sectional study design supplemented with a qualitative study was conducted from March 1 to April 30, 2018, among a total of 403 physicians. A self-administered questionnaire was used to collect quantitative data. The validity of the prediction bounds for the dependent variable and the validity of the confidence intervals and P values for the parameters were measured with a value of less than 0.05 and 95 percent of confidence interval. For the supplementary qualitative study, data were collected using semistructured in-depth interviews from 11 key informants, and the data were analyzed using thematic analysis. Result. Physicians’ computer literacy (CI: 0.264, 0.713; P : 0001) and computer access at work (CI: 0.141, 0.533, P : 0.001) were shown to be favorable predictors of their attitude towards EMR system adoption. Another conclusion from this study was the inverse relationship between physicians’ prior EMR experience and their attitude about the system (CI: -0.517, -0.121; P : 0.002). Conclusion. According to the findings of this study, physicians’ attitudes regarding EMR were found moderate in the studied region. There was a favorable relationship between computer ownership, computer literacy, lack of EMR experience, participation in EMR training, and attitude towards EMR. Improving the aforementioned elements is critical to improving physicians’ attitudes regarding EMR.

A Multimodal Quality Improvement Curriculum for Pediatric GME Program Directors

The 2016 Accreditation Council for Graduate Medical Education Clinical Learning Environment Review report identified knowledge gaps for quality in the clinical environment. It suggested quality improvement (QI) training is necessary to develop skills to improve health care quality. However, at the authors’ institution, there is limited department-level QI mentorship and engagement, thus limiting QI experiences for residents and fellows. The authors developed pediatric graduate medical education program director (PD) proficiency in QI through a fellowship-focused QI project. PDs underwent an 18-month QI curriculum consisting of focused online QI education, a half-day workshop, additional QI didactic sessions, project presentations, and individual QI coaching. QI knowledge in 9 domains and participants’ confidence were assessed. Participants’ self-perceived confidence and skills increased by at least 20% in most domains. Overall, PDs felt prepared to help with their fellows’ future QI projects. Fellowship-focused QI projects and individual coaching were key to course engagement.

Risk Analysis for Patient Safety in Surgical Departments: Cross-Sectional Design Usefulness

(1) Background: Identifying and measuring adverse events (AE) is a priority for patient safety, which allows us to define and prioritise areas for improvement and evaluate and develop solutions to improve health care quality. The aim of this work was to determine the prevalence of AEs in surgical and medical-surgical departments and to know the health impact of these AEs. (2) Methods: A cross-sectional study determining the prevalence of AEs in surgical and medical-surgical departments was conducted and a comparison was made among both clinical areas. A total of 5228 patients were admitted in 58 hospitals in Argentina, Colombia, Costa Rica, Mexico, and Peru, within the Latin American Study of Adverse Events (IBEAS), led by the Spanish Ministry of Health, the Pan American Health Organization, and the WHO Patient Safety programme. (3) Results: The global prevalence of AEs was 10.7%. However, the prevalence of AEs in surgical departments was 11.9%, while in medical-surgical departments it was 8.9%. The causes of these AEs were associated with surgical procedures (38.6%) and nosocomial infections (35.4%). About 60.6% of the AEs extended hospital stays by 30.7 days on average and 25.8% led to readmission with an average hospitalisation of 15 days. About 22.4% resulted in death, disability, or surgical reintervention. (4) Conclusions: Surgical departments were associated with a higher risk of experiencing AEs.

Development and Psychometric Testing of the Implementation Self-efficacy for EBP (ISE4EBP) Scale

There is inadequate research about nurses’ confidence in implementation strategies that foster the application and sustainability of evidence-based practice (EBP). Guided by Bandura’s self-efficacy theory, we propose that self-efficacy (confidence) in EBP implementation strategies can accelerate the uptake of evidence into practice to improve health care quality. The purpose of this study was to develop and test the psychometric properties of the Implementation Self-efficacy for EBP (ISE4EBP) scale as a measure for evaluating self-efficacy in using EBP implementation strategies. In a sample of 65 registered nurses, the 29-item ISE4EBP scale demonstrated adequate content validity (via content validity index), internal consistency reliability (Cronbach's alpha = 0.987), and construct validity indicated by associations with organizational readiness for EBP. Clinicians may use the ISE4EBP scale to identify areas for building implementation confidence to accelerate the uptake of evidence to improve quality care.

Community Efforts to Reduce Racial and Ethnic Health Disparities: Challenges and Facilitators Identified by 16 Multistakeholder Alliances

The Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q) program aimed to improve health care quality and reduce racial and ethnic disparities in 16 diverse communities in the United States from 2006 to 2015; yet most communities failed to make substantive progress toward advancing health care equity by the program’s end. This qualitative analysis of key stakeholder interviews aims to identify the major contributors to success versus failure in addressing local health disparities during AF4Q and identified five major themes. Three themes highlight challenges related to collecting local data on racial and ethnic health disparities and transitioning from data collection to action. Two themes capture the critical contribution of stakeholder engagement and access to technical expertise to successful efforts. The challenges and facilitators experienced by these 16 AF4Q communities may help inform the disparities reduction efforts of other communities and guide state or federal policies to reduce health disparities.

A regional collaborative working to improve health care quality, outcomes, and affordability

Purpose The purpose of this paper is to describe the Bree Collaborative’s background, history, structure, and work. Design/methodology/approach The Bree Collaborative was established by the Washington State Legislature to convene public and private health care stakeholders with the goal of identifying specific mechanisms to improve health care quality, outcomes, and affordability. These members are appointed by the Washington State Governor and represent public health care purchasers for Washington State, private health care purchasers (employers and union trusts), health plans, physicians and other health care providers, hospitals, and quality improvement organizations. Members annually select health care services that show high variation in care delivery, that are highly utilized without leading to better care or patient health, or that have known or suspected patient safety issues and develop recommendations for health care improvement. Findings Recommendations are meant to be implemented by the Washington State Health Care Authority and used to set a community standard across the state. Successful implementation depends on several factors including engaged health care purchasers, support from diverse partners, and a health care community willing to put the patient at the center of care. Originality/value Bottom-up, collective action through the Bree Collaborative can help achieve the triple aim for Washington State and should be used as a model nationally and internationally.

INOVASI JAMINAN KESEHATAN SEMESTA DALAM USAHA MENINGKATKAN KUALITAS PELAYANAN KESEHATAN BAGI PESERTA JAMINAN PENYANGGA DI DAERAH ISTIMEWA YOGYAKARTA

This research aims to know and understand about the implementation of the innovation of Universal Health Insurance (Jamkesta) system in an effort to improve health care quality for participants buffer in Yogyakarta. This reseach used descriptive qualitative method. Data collected by interview and observation. Data validity checking is done through a method of triangulation. The process of data analysis include data reduction, data presentation, and conclusion. The results showed that the element of human resources, processes, financing, location, response to suggestions for improvements innovation, law, and social supports the implementation of Universal Health Insurance for participant buffer and newborns. However, there are still some deficiencies that need to be corrected when viewed from the elements of socialization, culture and technology. Meanwhile, elements of the results showed that as many as 45% of the total number of participants for eligibility letter (SEP) printed out by Bapel Jamkesos is for the class buffer without ID cards and newborns. This indicates that the Jamkesta vision and mandate of the Governor of Yogyakarta has been reached.Keywords: Innovation, Universal Health Insurance, and Health Care.