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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


Voice quality in patients suffering from bipolar disease.
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Voice quality in patients suffering from bipolar disease.

Conf Proc IEEE Eng Med Biol Soc. 2015;2015:6106-9

Authors: Guidi A, Schoentgen J, Bertschy G, Gentili C, Landini L, Scilingo EP, Vanello N

People suffering from bipolar disease are more and more common. Such pathology can severely affect patients' lifestyle by wide, and sometimes extreme, mood swings. Biosignals can be very useful to understand this disease. Specifically, speech-related features have been seen to vary in depressed people with respect to healthy subjects. Usually prosodic, spectral and energy-related features are studied. Some further information, instead, can be provided studying voice quality. According to Laver's model, voice quality is sensitive and depends on both anatomic/physiologic issues and long-term muscular adjustments of the larynx or the supraglottal vocal tract. A pilot study on both bipolar patients and healthy control subjects, performed by means of the Long-Term Average Spectrum (LTAS) is presented. The effects on LTAS estimation of a F0-correction procedure are discussed. Pairwise statistical comparisons between subjects in euthymic and depressed states and euthymic and hypomanic states were performed. Significant differences were found in some frequency intervals in both cases. The F0-correction procedure modified the values of the significant frequency intervals in the euthymic/depressed comparison, that also was characterized by a change of F0. Noticeably, no statistically significant differences were found in control subjects acquired in the same mood state. Though the number of subjects is small, the results are encouraging given their coherence across patients and the lack of differences in the control group. Finally, this work suggests that particular vocal settings might be involved in different mood states.

PMID: 26737685 [PubMed - indexed for MEDLINE]

Tailored expectant management in couples with unexplained infertility does not influence their experiences with the quality of fertility care.
Related Articles Tailored expectant management in couples with unexplained infertility does not influence their experiences with the quality of fertility care. Hum Reprod. 2016 Jan;31(1):108-16 Authors: Kersten FA, Hermens RP, Braat DD, Tepe E, Sluijmer A, Kuchenbecker WK, Van den Boogaard N, Mol BW, Goddijn M, Nelen WL, Improvement study Group Abstract STUDY QUESTION: Do couples who were eligible for tailored expectant management (TEM) and did not start treatment within 6 months after the fertility work-up, have different experiences with the quality of care than couples that were also eligible for TEM but started treatment right after the fertility work-up? SUMMARY ANSWER: Tailored expectant management of at least 6 months in couples with unexplained infertility is not associated with the experiences with quality of care or trust in their physician. WHAT IS KNOWN ALREADY: In couples with unexplained infertility and a good prognosis of natural conception within 1 year, expectant management for 6-12 months does not compromise ongoing birth rates and is equally as effective as starting medically assisted reproduction immediately. Therefore, TEM is recommended by various international clinical guidelines. Implementation of TEM is still not optimal because of existing barriers on both patient and professional level. An important barrier is the hesitance of professionals to counsel their patients for TEM because they fear that patients will be dissatisfied with care. However, if and how adherence to TEM actually affects the couples' experience with care is unknown. Experiences with the quality care can be measured by evaluating the patient-centredness of care and the patients' trust in their physician. STUDY DESIGN, SIZE, DURATION: This is a retrospective cross-sectional study. A survey with written questionnaires was performed among all couples who participated in the retrospective audit of guideline adherence on TEM in 25 Dutch clinics. PARTICIPANTS/MATERIALS, SETTING, METHODS: Couples were eligible to participate if they were diagnosed with unexplained infertility and had a good prognosis (>30%) of natural conception within 1 year based on the Hunault prediction model. We used patient's questionnaires to collect data on the couples' experience with the quality of care and possible confounders for their experiences other than having undergone TEM or not. Multilevel regression analyses were performed to investigate case-mix adjusted association of TEM with the patient-centredness of care (PCQ-Infertility) and the patients' trust in their physician (Wake Forest Trust Scale). MAIN RESULTS AND THE ROLE OF CHANCE: Couples who adhered to TEM experienced the quality of care on the same level as couples who were exposed to early treatment, i.e. started fertility treatment within 6 months after fertility work-up. There were no associations between adherence to TEM and the patient-centredness of care or the patients' trust in their physician. LIMITATIONS, REASONS FOR CAUTION: Because this study is retrospective, recall bias might occur. Furthermore, we were unable to measure the difference in experience with care over time. Therefore, our results have to be interpreted carefully. WIDER IMPLICATIONS OF THE FINDINGS: Prospective research on couples undergoing TEM have to be performed to provide more detailed insight in the patients' experiences with the decision making process and subsequently the expectant period. Tackling the barriers surrounding TEM, i.e. better counselling and more patient information material, could further improve patient experiences with the quality of care for couples who are advised TEM. STUDY FUNDING/COMPETING INTERESTS: Supported by Netherlands Organisation for Health Research and Development (ZonMW). ZonMW had no role in designing the study, data collection, analysis and interpretation of data or writing of the report. Competing interests: none. TRIAL [...]

The use of a global trigger tool to inform quality and safety in Australian general practice: a pilot study.
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The use of a global trigger tool to inform quality and safety in Australian general practice: a pilot study.

Aust Fam Physician. 2014 Oct;43(10):723-6

Authors: Hibbert P, Williams H

BACKGROUND: Systems to identify risks and adverse events (AEs) in Australia are limited. This study aims to explore whether general practice records contain information on AEs, and to conduct a pilot study on the type and frequency of AEs in general practice in Australia, using a global trigger tool (GTT).
METHODS: Five practices were recruited and consented to collect data. Practice nurses were trained to collect data at their practices. Rec-ords from randomly sampled patients aged 75 years or older were reviewed.
RESULTS: A total of 428 patient records were reviewed. A total of 44 AEs were detected in 41 records. The percentage of patients with an AE was 9.6%. Most low preventability AEs (21/29) were medication incidents.
DISCUSSION: The study found that significant levels of information about AEs exist in general practice medical records and rates of harm are broadly in line with a similar study in Scotland.

PMID: 25286432 [PubMed - indexed for MEDLINE]

Quality of end-of-life care among rural Medicare beneficiaries with colorectal cancer.
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Quality of end-of-life care among rural Medicare beneficiaries with colorectal cancer.

J Rural Health. 2014;30(4):397-405

Authors: Watanabe-Galloway S, Zhang W, Watkins K, Islam KM, Nayar P, Boilesen E, Lander L, Wang H, Qiu F

BACKGROUND: Although previous research has documented rural disparities in hospice use, limited data exist on the roles of geographic access in different types of end-of-life indicators among cancer survivors.
METHODS: Medicare claims data were used to identify beneficiaries with colorectal cancer who died in 2008 (N = 34,975). We evaluated rural-urban differences in ER visits 90 days before death, inpatient hospital admissions ≤90 days before death, intensive care unit (ICU) use ≤90 days before death, hospice care use at any time, and hospice enrollment <3 days before death.
RESULTS: About 60% of beneficiaries in rural areas lived in counties with the 2 lowest socioecomonic levels compared to only 5.3% of beneficiaries in metropolitan areas. After adjusting for demographic factors and comorbidities, beneficiaries in rural counties had a lower number of ICU days (RR = 0.65) and were less likely to ever use hospice (OR = 0.78) compared to those in metropolitan counties. Beneficiaries from racial/ethnic minority groups, those with lower socioeconomic status, and those with a higher comorbidity index were less likely to ever use hospice but they tended to use ER, inpatient care, and ICU.
CONCLUSIONS: Evidence for disparities due to geographic access and socioeconomic factors warrant increased efforts to remove systemic and structural barriers. Future research should focus on exploring and evaluating potential policy and practice interventions to improve the quality of life among elderly cancer survivors living in rural communities and those from socioeconomically disadvantaged backgrounds.

PMID: 24803384 [PubMed - indexed for MEDLINE]

Birth volume and the quality of obstetric care in rural hospitals.
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Birth volume and the quality of obstetric care in rural hospitals.

J Rural Health. 2014;30(4):335-43

Authors: Kozhimannil KB, Hung P, Prasad S, Casey M, McClellan M, Moscovice IS

BACKGROUND: Childbirth is the most common reason for hospitalization in the United States. Assessing obstetric care quality is critically important for patients, clinicians, and hospitals in rural areas.
METHODS: The study used hospital discharge data from the Statewide Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, for 9 states (Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin) to identify all births in rural hospitals with 10 or more births/year in 2002 (N = 94,356) and 2010 (N = 103,880). Multivariate logistic regression was used to assess the relationship between hospital annual birth volume, measured as low (10-110), medium (111-240), medium-high (241-460) or high (>460), and 3 measures of obstetric care quality (low-risk cesarean rates for term, vertex, and singleton pregnancies with no prior cesarean; nonindicated cesarean; and nonindicated induction) and 2 patient safety measures (episiotomy and perineal laceration).
RESULTS: The odds of low-risk and nonindicated cesarean were lower in medium-high and high-volume rural hospitals compared with low-volume hospitals after controlling for maternal demographic and clinical factors. In low-volume hospitals, odds of labor induction without medical indication were higher than in medium-volume hospitals, but not significantly different from medium-high or high-volume hospitals. Odds of episiotomy were greater in medium-high or high-volume hospitals than in low-volume hospitals. The likelihood of perineal laceration did not differ significantly by birth volume.
CONCLUSIONS: Obstetric quality and safety outcomes vary significantly across rural hospitals by birth volume. Better performance is not consistently associated with either lower or higher volume facilities.

PMID: 24483138 [PubMed - indexed for MEDLINE]