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Preview: PubMed: Quality of care

pubmed: Quality of care



NCBI: db=pubmed; Term=(("quality assurance, health care"[MeSH Terms] OR "quality indicators, health care"[MeSH Terms] OR "quality of health care"[MeSH Terms] OR "total quality management"[MeSH Terms]) AND quality[TI]) AND English[Lang] AND "adult"[MeSH Te



 



Quality improvement intervention to increase adherence to ART prescription policy at HIV treatment clinics in Lusaka, Zambia: A cluster randomized trial.
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Quality improvement intervention to increase adherence to ART prescription policy at HIV treatment clinics in Lusaka, Zambia: A cluster randomized trial.

PLoS One. 2017;12(4):e0175534

Authors: McCarthy EA, Subramaniam HL, Prust ML, Prescott MR, Mpasela F, Mwango A, Namonje L, Moyo C, Chibuye B, van den Broek JW, Hehman L, Moberley S

Abstract
INTRODUCTION: In urban areas, crowded HIV treatment facilities with long patient wait times can deter patients from attending their clinical appointments and picking up their medications, ultimately disrupting patient care and compromising patient retention and adherence.
METHODS: Formative research at eight facilities in Lusaka revealed that only 46% of stable HIV treatment patients were receiving a three-month refill supply of antiretroviral drugs, despite it being national policy for stable adult patients. We designed a quality improvement intervention to improve the operationalization of this policy. We conducted a cluster-randomized controlled trial in sixteen facilities in Lusaka with the primary objective of examining the intervention's impact on the proportion of stable patients receiving three-month refills. The secondary objective was examining whether the quality improvement intervention reduced facility congestion measured through two proxy indicators: daily volume of clinic visits and average clinic wait times for services.
RESULTS: The mean change in the proportion of three-month refills among control facilities from baseline to endline was 10% (from 38% to 48%), compared to a 25% mean change (an increase from 44% to 69%) among intervention facilities. This represents a significant 15% mean difference (95% CI: 2%-29%; P = 0.03) in the change in proportion of patients receiving three-month refills. On average, control facilities had 15 more visits per day in the endline than in the baseline, while intervention facilities had 20 fewer visits per day in endline than in baseline, a mean difference of 35 fewer visits per day (P = 0.1). The change in the mean facility total wait time for intervention facilities dropped 19 minutes between baseline and endline when compared to control facilities (95% CI: -10.2-48.5; P = 0.2).
CONCLUSION: A more patient-centred service delivery schedule of three-month prescription refills for stable patients is viable. We encourage the expansion of this sustainable intervention in Zambia's urban clinics.

PMID: 28419106 [PubMed - indexed for MEDLINE]




Longitudinal study of diet quality and change in asthma symptoms in adults, according to smoking status.
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Longitudinal study of diet quality and change in asthma symptoms in adults, according to smoking status.

Br J Nutr. 2017 Feb;117(4):562-571

Authors: Li Z, Kesse-Guyot E, Dumas O, Garcia-Aymerich J, Leynaert B, Pison C, Le Moual N, Romieu I, Siroux V, Camargo CA, Nadif R, Varraso R

Abstract
It has been hypothesised that increased asthma prevalence in westernised countries is associated with changes in lifestyle factors, including a poorer diet. However, little is known regarding the association between diet quality and asthma. In the diet-asthma association, the role of BMI as a potential mediator needs clarification; moreover, potential effect modification by non-diet sources of oxidants, such as smoking, merits investigation. We investigated the association between diet quality and change in asthma symptoms, as well as assessed effect modification by smoking, while accounting for BMI as a potential mediator. Using data from the French prospective Epidemiological study on the Genetics and Environment of Asthma study, we assessed diet quality using the Alternate Healthy Eating Index 2010 (AHEI-2010) at baseline and change in asthma symptoms (stable (reference), worsening, improved; mean follow-up time: 7 years). Mediation analysis was used to disentangle total and direct effects and the indirect effect mediated by BMI. The analyses included 969 adults (mean age 43 years; 49 % men; 42 % ever asthma). We observed a significant interaction between smoking and AHEI-2010 on change in asthma symptoms (P for interaction=0·04). Among never smokers (n 499), we observed a positive total effect (multivariable OR 1·39; 95 % CI 1·07, 1·80) and a positive direct effect (OR 1·41; 95 % CI 1·09, 1·80) of the AHEI-2010 (per ten-point increment) on improved symptoms. No indirect effect mediated through BMI was observed (OR 0·99; 95 % CI 0·91, 1·07). Among former and current smokers, all effects were statistically non-significant. Better diet quality was associated with improved asthma symptoms over time in never smokers, independently of BMI.

PMID: 28382891 [PubMed - indexed for MEDLINE]




Health providers' perception of quality of care for neonates in health facilities in a municipality in Southern Ghana.
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Health providers' perception of quality of care for neonates in health facilities in a municipality in Southern Ghana.

Int J Health Care Qual Assur. 2016 Oct 10;29(8):907-20

Authors: Elikplim Pomevor K, Adomah-Afari A

Abstract
Purpose The purpose of this paper is to assess available human resources for neonatal care and their skills, in order to explore health providers' perceptions of quality of neonatal care in health facilities in Ghana. Design/methodology/approach Data were gathered using qualitative interviews with health providers working in the maternity and paediatric wards and midwives; direct observation; and documentary review at a regional hospital, a municipal hospital and four health centres in a municipality in a region in Southern Ghana. Data were analysed using thematic framework through the process of coding in six phases to create and establish meaningful patterns. Findings The study revealed that health providers were concerned about the number of staff available, their competence and also equipment available for them to work more efficiently. Some essential equipment for neonatal care was either not available or was non-functional where it was available, while aseptic procedures were not adhered to. Moreover, personal protective equipment such as facemask, caps, aprons were not used except in the labour wards where staff had to change their footwear before entering. Research limitations/implications Limited number of health providers and facilities used, lack of exploration of parents of neonates' perspective of quality of neonatal care in this study and other settings, including the teaching hospitals. The authors did not examine issues related to the ineffective use of IV cannulation for neonates by nurses as well as referral of neonates. Additionally, the authors did not explore the perspectives of management of the municipal and regional health directorates or policy makers of the Ministry of Health and Ghana Health Service regarding the shortage of staff, inadequate provision of medical equipment and infrastructure. Practical implications This paper suggests the need for policy makers to redirect their attention to the issues that would improve the quality of neonatal health care in health facilities in Ghana and in countries with similar challenges. Social implications The study found that the majority of nursing staff catering for sick newborns were not trained in neonatal nursing. Babies were found sleeping in separate cots but were mixed with older children. The study suggests that babies should be provided with a separate room and not mixed with older babies. Originality/value There seemed to be no defined policy framework for management of neonatal care in the country's health care facilities. The study recommends the adoption of paediatric and neonatal care nursing as a specialty in the curricula of health training institutions. In-service trainings should encompass issues related to management of sick babies, care of preterm babies, neonatal resuscitation and intravenouscannulation, among others.

PMID: 27671425 [PubMed - indexed for MEDLINE]




Quality of care received and patient-reported regret in prostate cancer: Analysis of a population-based prospective cohort.
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Quality of care received and patient-reported regret in prostate cancer: Analysis of a population-based prospective cohort.

Cancer. 2017 Jan 01;123(1):138-143

Authors: Holmes JA, Bensen JT, Mohler JL, Song L, Mishel MH, Chen RC

Abstract
BACKGROUND: Meeting quality of care standards in oncology is recognized as important by physicians, professional organizations, and payers. Data from a population-based cohort of patients with prostate cancer were used to examine whether receipt of care was consistent with published consensus metrics and whether receiving high-quality care was associated with less patient-reported treatment decisional regret.
METHODS: Patients with incident prostate cancer were enrolled in collaboration with the North Carolina Central Cancer Registry, with an oversampling of minority patients. Medical record abstraction was used to determine whether participants received high-quality care based on 5 standards: 1) discussion of all treatment options; 2) complete workup (prostate-specific antigen, Gleason grade, and clinical stage); 3) low-risk participants did not undergo a bone scan; 4) high-risk participants treated with radiotherapy (RT) received androgen deprivation therapy; and 5) participants treated with RT received conformal or intensity-modulated RT. Treatment decisional regret was assessed using a validated instrument.
RESULTS: A total of 804 participants were analyzed. Overall, 66% of African American and 73% of white participants received care that met all standards (P = .03); this racial difference was confirmed by multivariable analysis. Care that included "discussion of all treatment options" was found to be associated with less patient-reported regret on univariable analysis (P = .03) and multivariable analysis (odds ratio, 0.59; 95% confidence interval, 0.37-0.95).
CONCLUSIONS: The majority of participants received high-quality care, but racial disparity existed. Participants who discussed all treatment options appeared to have less treatment decisional regret. To the authors' knowledge, this is the first study to demonstrate an association between a quality of care metric and patient-reported outcome. Cancer 2017;138-143. © 2016 American Cancer Society.

PMID: 27622730 [PubMed - indexed for MEDLINE]




Work Environment and Its Relationship to Quality Improvement: Health Care Providers' Perspectives.
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Work Environment and Its Relationship to Quality Improvement: Health Care Providers' Perspectives.

J Nurs Care Qual. 2016 Jul-Sep;31(3):290-8

Authors: Hussein AH, Abou Hashish EA

Abstract
There is a gap in understanding how work environment contributes to hospitals' readiness for quality improvement (QI) in developing countries; thus, diagnosing work environment problems in health care organizations is the initial step in designing strategies for QI in organizations. This study examines the relationship between nurses' and physicians' perspectives of the work environments and hospitals' climate for QI. Study results indicate that work environment is positively associated with hospitals' readiness for QI.

PMID: 27191372 [PubMed - indexed for MEDLINE]




Examining IV Insulin Practice Guidelines in the Cardiac Surgery Patient: Nurses Evaluating Quality Outcomes.
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Examining IV Insulin Practice Guidelines in the Cardiac Surgery Patient: Nurses Evaluating Quality Outcomes.

J Nurs Care Qual. 2016 Oct-Dec;31(4):344-9

Authors: Westbrook A, Sherry D, McDermott M, Gobber M, Pabst M

Abstract
Recent changes in the Surgical Care Improvement Project guideline require blood glucose values be less than 180 mg/dL 18 to 24 hours after anesthesia end time after cardiac surgery. Our study compares the first group of patients transitioned off IV insulin on postoperative day 1, 24 hours after anesthesia end time, whereas the second group was transitioned off IV insulin on the second day, 48 hours after anesthesia end time. Results show no statistical difference in outcomes between groups.

PMID: 27164170 [PubMed - indexed for MEDLINE]




The effect of forage type on lamb carcass traits, meat quality and sensory traits.
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The effect of forage type on lamb carcass traits, meat quality and sensory traits.

Meat Sci. 2016 Sep;119:95-101

Authors: De Brito GF, McGrath SR, Holman BW, Friend MA, Fowler SM, van de Ven RJ, Hopkins DL

Abstract
The aim of this study was to evaluate the effect of different forage-types on lamb carcass, meat quality and sensory attributes. Sixty-two, White Dorper lambs finished on bladder clover, brassica, chicory+arrowleaf clover, lucerne+phalaris or lucerne, were slaughtered at a commercial abattoir. At 24h post-mortem, the m. longissimus thoracis et lumborum (LL) was removed from the left side and sliced into three equal sub-samples, vacuum packaged and randomly assigned to ageing periods (5, 12 or 40days) and the right side was aged for 5days. The m. semimembranosus and m. adductor femoris were removed and, the former was then aged for 40days. Lambs fed chicory+arrowleaf clover or lucerne had a higher dressing percentage and fat depth. Bladder clover gave the highest level of glycogen in the LL. No sensory or other meat quality trait differences were found between the treatments. In general, no treatments showed any unfavourable effect on the traits examined.

PMID: 27155319 [PubMed - indexed for MEDLINE]




Physical activity, diet quality, and mortality among sarcopenic older adults.
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Physical activity, diet quality, and mortality among sarcopenic older adults.

Aging Clin Exp Res. 2017 Apr;29(2):257-263

Authors: Brown JC, Harhay MO, Harhay MN

Abstract
BACKGROUND: It is unknown if physical activity and good diet quality modify the risk of poor outcomes, such as mortality, among older adults with sarcopenia.
AIM: To examine if physical activity and good diet quality modify the risk of poor outcomes, such as mortality, among older adults with sarcopenia.
METHODS: A population-based cohort study among 1618 older adults with sarcopenia from the Third National Health and Nutrition Survey (NHANES III; 1988-1994). Sarcopenia was defined by the European Working Group on Sarcopenia in Older People. Physical activity was self-reported, and classified as sedentary (0 bouts per week), physically inactive (1-4 bouts per week), and physically active (≥5 bouts per week). Diet quality was assessed with the healthy eating index (a scale of 0-100 representing adherence to federal dietary recommendations), and classified as poor (<51), fair (51-80), and good (>80) diet quality.
RESULTS: Compared to participants who were sedentary, those who were physically inactive were 16 % less likely to die [HR 0.84 (95 % CI 0.64-1.09)], and those who were physically active were 25 % less likely to die [HR 0.75 (95 % CI 0.59-0.97); P trend = 0.026]. Compared to participants with poor diet quality, those with fair diet quality were 37 % less likely to die [HR 0.63 (95 % CI 0.47-0.86)], and those with good diet quality were 45 % less likely to die [HR 0.55 (95 % CI 0.37-0.80); P trend = 0.002].
CONCLUSIONS: Participation in physical activity and consumption of a healthy diet correspond with a lower risk of mortality among older adults with sarcopenia. Randomized trials are needed in this population.

PMID: 27020695 [PubMed - indexed for MEDLINE]




Health System Quality Improvement: Impact of Prompt Nutrition Care on Patient Outcomes and Health Care Costs.
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Health System Quality Improvement: Impact of Prompt Nutrition Care on Patient Outcomes and Health Care Costs.

J Nurs Care Qual. 2016 Jul-Sep;31(3):217-23

Authors: Meehan A, Loose C, Bell J, Partridge J, Nelson J, Goates S

Abstract
Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. We implemented a quality improvement program that positioned early nutritional care into the nursing workflow. Nurses screened for malnutrition risk at patient admission and then immediately ordered oral nutritional supplements for those at risk. Supplements were given as regular medications, guided and monitored by medication administration records. Post-quality improvement program, pressure ulcer incidence, length of stay, 30-day readmissions, and costs of care were reduced.

PMID: 26910129 [PubMed - indexed for MEDLINE]




Effects of Work Environment on Quality of Care in ICUs: A Multisite Survey in China.
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Effects of Work Environment on Quality of Care in ICUs: A Multisite Survey in China.

J Nurs Care Qual. 2016 Jul-Sep;31(3):E1-8

Authors: Liu J, You L, Zheng J, Ross AM, Liu K

Abstract
This study estimated the effects of the work environment on the quality of care in intensive care units (ICUs). Nurses in ICUs with good work environments or high nurse staffing were significantly less likely to report poor or fair quality of care (odds ratio [OR] = 0.37-0.47), rationing of nursing care (OR = 0.38-0.76), and health care-associated infections (OR = 0.28-0.68). Favorable ICU work environments and adequate nurse staffing can predict better quality of care.

PMID: 26796973 [PubMed - indexed for MEDLINE]




Depression and infrequent participation in social activities among older adults: the moderating role of high-quality familial ties.
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Depression and infrequent participation in social activities among older adults: the moderating role of high-quality familial ties.

Aging Ment Health. 2017 Apr;21(4):379-388

Authors: Holtfreter K, Reisig MD, Turanovic JJ

Abstract
OBJECTIVES: The primary objective of this study is to investigate whether depression is associated with reduced participation in social activities among older adults. Additionally, this study assesses whether high-quality familial ties diminish the negative association between depression and social activities.
METHODS: Using cross-sectional telephone interview data from a sample of individuals 60 years of age and older in Arizona and Florida (N = 2000), this study estimates a series of linear regression models to assess the relationship between depression and social activities, and test whether this association is conditioned by high-quality familial ties using multiplicative interaction terms.
RESULTS: As expected, an inverse relationship between depression and social activities is observed. Delving deeper, the regression models reveal that the depression-inactivity association is weaker among older individuals with strong, positive ties to spouses and children. Additional tests demonstrate the mere of existence of familial bonds provides no meaningful benefit - the quality of such ties matters.
CONCLUSION: Findings support the theoretical argument that high-quality familial ties provide supportive coping resources that buffer individuals from the undesirable consequences associated with depression. Moving forward, longitudinal research on the causal links between depression and infrequent participation in social and leisure activities among older adults is warranted.

PMID: 26471453 [PubMed - indexed for MEDLINE]