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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 of working life of cancer survivors: development of a cancer-specific questionnaire.
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Quality of working life of cancer survivors: development of a cancer-specific questionnaire.

J Cancer Surviv. 2016 Apr;10(2):394-405

Authors: de Jong M, Tamminga SJ, de Boer AG, Frings-Dresen MH

Abstract
PURPOSE: The aim of this study was to generate, and select quality of working life issues for the development of an initial version of the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS).
METHODS: Quality of working life issues were generated through focus groups with cancer survivors and oncological occupational physicians, and interviews with employers, supervisors, and organization officers. A selection of these quality of working life issues was made based on relevance and importance by conducting an online questionnaire among the cancer survivors and oncological occupational physicians. Researchers formulated the issues into items for the QWLQ-CS.
RESULTS: A total of 24 cancer survivors, six oncological occupational physicians and 11 employers, supervisors, and organization officers participated. The 222 quality of working life issues identified through the focus groups, interviews, and literature were converted into an online questionnaire. Cancer survivors (N = 20) found 44 issues not relevant or important with respect to their quality of working life. The researchers reviewed the remaining 178 issues and formulated them into 102 items classified by five categories: work perception, job characteristics, the social structure and environment, organizational characteristics, and the effect of the disease and treatment.
CONCLUSIONS: The initial version of the QWLQ-CS exists out of 102 items which cover the experiences and perceptions of cancer survivors in the work environment. All items were indicated by working cancer survivors as relevant and important.
IMPLICATIONS FOR CANCER SURVIVORS: This initial version of the QWLQ-CS may increase awareness of the potential problems or emotional difficulties working cancer survivors face during the work continuation process.

PMID: 26370284 [PubMed - indexed for MEDLINE]




Better life quality and sexual function in men and their female partners with short-segment posterior fixation in the treatment of thoracolumbar junction burst fractures.
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Better life quality and sexual function in men and their female partners with short-segment posterior fixation in the treatment of thoracolumbar junction burst fractures.

Eur Spine J. 2016 Apr;25(4):1128-34

Authors: Cankaya D, Balci M, Deveci A, Yoldas B, Tuncel A, Tabak Y

Abstract
PURPOSE: Thoracolumbar junction burst fractures remain a challenging problem due to controversy over the treatment choice of short- or long-segment posterior fixation. The aim of the present study was to compare life quality and sexual function of patients after short- and long-segment posterior fixations in the treatment of thoracolumbar junction burst fractures.
METHODS: In this prospective, randomized study, 24 sexually active male patients diagnosed with thoracolumbar junction burst fractures were randomly assigned to either the short-segment posterior fixation (SSPF) group or the long-segment posterior fixation group (LLPF). The exclusion criteria were rheumatological disease and spinal surgery history. There were no significant differences in age, body mass index or smoking habits between the groups. The life quality score of EQ-5D and the International Index of erectile function (IIEF-5) score of male patients and the Female Sexual Function Index (FSFI) score of female partners were recorded preoperatively and 1 year after surgery.
RESULTS: The mean age of patients in the SSPF and LSPF groups was 44.58 and 42.92 years, respectively. There were no statistically significant differences between the groups in the preoperative EQ-5D and IIEF-5 scores of male patients and the FSFI score of their partners. Postoperatively, the EQ-5D scores (p = 0.011) and IIEF-5 scores (p = 0.000) of male patients and the FSFI score of their partners (p = 0.001) were better in the short-segment group.
CONCLUSIONS: Patients treated with SSPF have better sexual function and life quality with their partners compared to those treated with LSPF. The main clinical relevance of this study is that the impact of the choice of short or long-segment treatment on postoperative sexual function and life quality should be considered by surgeons when performing posterior fixation after thoracolumbar junction burst fractures.

PMID: 26202101 [PubMed - indexed for MEDLINE]




Usability and Acceptability of the QDACT-PC, an Electronic Point-of-Care System for Standardized Quality Monitoring in Palliative Care.
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Usability and Acceptability of the QDACT-PC, an Electronic Point-of-Care System for Standardized Quality Monitoring in Palliative Care.

J Pain Symptom Manage. 2015 Nov;50(5):615-21

Authors: Kamal AH, Kavalieratos D, Bull J, Stinson CS, Nicolla J, Abernethy AP

Abstract
CONTEXT: Few resources exist to support collaborative quality monitoring in palliative care. These tools, if proven efficient through technology-enabled methods, may begin to routinize data collection on quality during usual palliative care delivery. Usability testing is a common approach to assess how easily and effectively users can interact with a newly developed tool.
OBJECTIVES: We performed usability testing of the Quality Data Collection Tool for Palliative Care (QDACT-PC) a novel, point-of-care quality monitoring tool for palliative care.
METHODS: We used a mixed methods approach to assess community palliative care clinicians' evaluations of five domains of usability. These approaches included clinician surveys after recording mock patient data to assess satisfaction; review of entered data for accuracy and time to completion; and thematic review of "think aloud" protocols to determine issues, barriers, and advantages to the electronic system.
RESULTS: We enrolled 14 palliative care clinicians for the study. Testing the electronic system vs. paper-based methods demonstrated similar error rates and time to completion. Overall, 68% of the participants believed that the electronic interface would not pose a moderate or major burden during usual clinical activities, and 65% thought it would improve the care they provided. Thematic analysis revealed significant issues with paper-based methods alongside training needs for future participants on using novel technologies that support the QDACT-PC.
CONCLUSION: The QDACT-PC is a usable electronic system for quality monitoring in palliative care. Testing reveals equivalence with paper for data collection time, but with less burden overall for electronic methods across other domains of usability.

PMID: 26166184 [PubMed - indexed for MEDLINE]




Increasing the Number of Outpatients Receiving Spiritual Assessment: A Pain and Palliative Care Service Quality Improvement Project.
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Increasing the Number of Outpatients Receiving Spiritual Assessment: A Pain and Palliative Care Service Quality Improvement Project.

J Pain Symptom Manage. 2015 Nov;50(5):724-9

Authors: Gomez-Castillo BJ, Hirsch R, Groninger H, Baker K, Cheng MJ, Phillips J, Pollack J, Berger AM

Abstract
BACKGROUND: Spirituality is a patient need that requires special attention from the Pain and Palliative Care Service team. This quality improvement project aimed to provide spiritual assessment for all new outpatients with serious life-altering illnesses.
MEASURES: Percentage of new outpatients receiving spiritual assessment (Faith, Importance/Influence, Community, Address/Action in care, psychosocial evaluation, chaplain consults) at baseline and postinterventions.
INTERVENTION: Interventions included encouraging clinicians to incorporate adequate spiritual assessment into patient care and implementing chaplain covisits for all initial outpatient visits.
OUTCOMES: The quality improvement interventions increased spiritual assessment (baseline vs. postinterventions): chaplain covisits (25.5% vs. 50%), Faith, Importance/Influence, Community, Address/Action in care completion (49% vs. 72%), and psychosocial evaluation (89% vs. 94%).
CONCLUSIONS/LESSONS LEARNED: Improved spiritual assessment in an outpatient palliative care clinic setting can occur with a multidisciplinary approach. This project also identifies data collection and documentation processes that can be targeted for improvement.

PMID: 26166183 [PubMed - indexed for MEDLINE]




Validation of the German Version of the Quality of Dying and Death Questionnaire for Informal Caregivers (QODD-D-Ang).
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Validation of the German Version of the Quality of Dying and Death Questionnaire for Informal Caregivers (QODD-D-Ang).

J Pain Symptom Manage. 2015 Sep;50(3):402-13

Authors: Heckel M, Bussmann S, Stiel S, Weber M, Ostgathe C

Abstract
CONTEXT: The quality of dying and death (QOD) influences end-of-life care for patients and their relatives. To the best of our knowledge, there are currently no validated standard instruments for evaluating the QOD of patients in palliative care units (PCUs) in Germany.
OBJECTIVES: This study aimed to validate the German version of the multidimensional questionnaire "Quality of Dying and Death" for informal caregivers (QODD-Deutsch-Angehörige [QODD-D-Ang]) and provide a detailed report on its validity and reliability.
METHODS: The QODD was forward/backward translated following the European Organization for Research and Treatment of Cancer guidelines. Data collected in two German palliative care units (N = 226) with the QODD-D-Ang were used to calculate the QODD-D-Ang total score (TS) and to define reliability and validity, as well as acceptance and burden for informal caregivers. Frequencies, means, and SDs of various patient data related to care and disease were calculated to describe the study population and to look at group differences.
RESULTS: The mean TS of 175 participants was 75.72 (range 38-99; minimum 0 to maximum 100; higher scores indicate better QOD). The QODD-D-Ang showed good internal consistency for 27 items (Cronbach's alpha 0.852). Factors extracted by factor analysis could not be usefully interpreted. The TS of the QODD-D-Ang correlated substantially with the Palliative care Outcome Scale (r = 0.540), indicating good convergent validity. The QODD-D-Ang TS was stable for various demographic and clinical dimensions except for the amount of days on which informal caregivers visited patients, and, therefore, provided good discriminant validity.
CONCLUSION: Analyses of validity and reliability of the QODD-D-Ang showed satisfactory to good psychometric properties, meaning that the QODD can be recommended for standard implementation in German hospices and palliative care institutions to measure the QOD. Feasibility could be improved by adapting the instrument so that it may be administered with minimal demands on staff. When interpreting the results, it should be kept in mind that the QODD-D-Ang does not measure quality of care but the quality of the dying process as estimated by bereaved relatives.

PMID: 26079825 [PubMed - indexed for MEDLINE]




Assessing the Quality of Death and Dying in an Integrated Health Care System in Rural Pennsylvania.
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Assessing the Quality of Death and Dying in an Integrated Health Care System in Rural Pennsylvania.

J Pain Symptom Manage. 2015 Sep;50(3):343-349.e6

Authors: Darer JD, Clarke DN, Sees AC, Berger AL, Kirchner HL, Stametz RA, Davis D

Abstract
CONTEXT: With growing emphasis on improving the value of health care, there is increased scrutiny of quality outcomes and high health expenditures during the final months of life.
OBJECTIVES: The purpose of this project is to answer 1) how do next of kin (NOK) perceive the quality of their loved ones' dying and death; 2) are there patient and NOK characteristics that predict lower quality; and 3) are there structural aspects of care associated with lower quality?
METHODS: A mailed survey was administered to a stratified random sample of NOK of Geisinger Health System patients who had died in the past year. The Quality of Death and Dying, the General Anxiety Disorder seven-item scale, the Patient Health Questionnaire eight-item depression scale, and selected questions from the Toolkit of Instruments to Measure End of Life Care were used.
RESULTS: There were 672 respondents. Significant predictors of Quality of Death and Dying score were number of doctors involved in care (P = 0.0415), location of death (P < 0.0001), frequency of receiving confusing or contradictory information (P < 0.0001), illness progression (P = 0.0343), Patient Health Questionnaire-2 score (P = 0.0148), and General Anxiety Disorder seven-item scale score (P < 0.0070).
CONCLUSION: Several findings suggest that factors such as NOK depression and anxiety, prolonged illness, dying in the hospital, receipt of conflicting information, and confusion around the doctor in charge are associated with lower quality of the dying and death experience for NOK. Further investigation is warranted to facilitate high-quality measurement and the use of measurement results to improve care.

PMID: 25982156 [PubMed - indexed for MEDLINE]




Correlation between quality of cardiopulmonary resuscitation and self-efficacy measured during in-hospital cardiac arrest simulation; preliminary results.
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Correlation between quality of cardiopulmonary resuscitation and self-efficacy measured during in-hospital cardiac arrest simulation; preliminary results.

Acta Biomed. 2015 Mar 13;86 Suppl 1:40-5

Authors: Gonzi G, Sestigiani F, D'errico A, Vezzani A, Bonfanti L, Noto G, Artioli G

Abstract
BACKGROUND: The concept of self-assess it's a central mechanism in human agency for behavior change and should translate to desirable practice patterns. There are no many studies that have investigated the relationship between the perception of the ability to perform cardiopulmonary resuscitation (CPR) and the quality of the same. The aim of this work is to investigate the relation between physiological and psychosocial variables in cardiac resuscitation in order to improve the involvement and motivation of professionals in training courses.
METHODS: During the year 2012, 322 medical staff of Ospedale-Universitario of Parma were trained to basic life support defibrillation (BLSD). Before started the course the partecipants were randomly selected among the staff working in the same department to create a team of two persons and involved in a simulation that reproduced the first five minutes that occurs for a cardiac arrest in a medical or surgical department in our hospital before the intervention of the hospital emergency team. Before and after simulation to each participant was asked to answer a self-efficacy questionnaire on a 10-point scale on the management of cardiac. During simulation were registered the activation time of the emergency response system, hands-on time, defibrillation time, number of compression and correct compression rate.
RESULTS: Activation time of the emergency response system was 70.52 ± 78.77 seconds. In 55 teams was not made the allert. The defibrillation time was 148.63 ± 58.43 seconds. In 44 teams the defibrillator were used within 120 seconds, in 36 (22.1%) it was not used. Hands-on time average was of 166.20 ± 62.9 seconds. The mean number of compression was 216.22 ± 115.57. The percentage of satisfactory compression was 9.97 ± 21.23 %. The level of self-efficacy was under the average for the 35.6%, while the 26.8% of the participants had a medium level of 5 and the 38.5% of the sample declared to feel an efficacy level included in 6-10. The sense of self efficacy after the simulation was constant in the 38.3% of the sample, while increased in the 30.5% and decreased in the 31.2%. We found no significant correlations between self-efficacy levels and specific results in scenario acting before simulation, instead, after the simulation the skills performances are much more correlated with self-efficacy.
CONCLUSIONS: The medical staff reported an individual's perception of good efficacy in the management of simulation of cardiac arrest, but it does not correspond to a high skills. An open question is if and how these psychosocial variables may play a role in improving the quality of CPR and if knowledge of the low capacity to manage a cardiac arrest can be translated into the need for the medical staff to be regularly engaged in BLSD retraining.

PMID: 25835764 [PubMed - indexed for MEDLINE]




Evaluation of sleep disorders in cancer patients based on Pittsburgh Sleep Quality Index.
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Evaluation of sleep disorders in cancer patients based on Pittsburgh Sleep Quality Index.

Eur J Cancer Care (Engl). 2015 Jul;24(4):553-9

Authors: Akman T, Yavuzsen T, Sevgen Z, Ellidokuz H, Yilmaz AU

Abstract
Insomnia, poor sleep quality and short sleep durations are the most common problems seen in cancer patients. More studies are needed about sleep disorders in cancer patients. In our study, we aimed to investigate the prevalence of sleep disorders and the impact of these problems on the quality of life in cancer patients. Pittsburgh Sleep Quality Index (PSQI) was given to a total of 314 patients. The psychometric evaluation of the Turkish version of PSQI in cancer patients revealed that 127 (40.4%) patients had global PSQI scores >5, indicating poor sleep quality. There was no statistically significant relationship between PSQI scores and sexuality, marital status, cancer stage and chemotherapy type (P > 0.05); while the patients with bone and visceral metastasis had much lower PSQI scores (P = 0.006). Patients with Eastern Cooperative Oncology Group performance scores of 3 or more had also significantly lower PSQI scores (P = 0.02). In conclusion, PSQI questionnaire may be used to evaluate the sleep disorders in cancer patients. Consistent use of multi-item measures such as PSQI with established reliability and validity would improve our understanding of difficulties experienced by cancer patients with chronic insomnia.

PMID: 25727241 [PubMed - indexed for MEDLINE]




Impact of an EHR-based diabetes management form on quality and outcomes of diabetes care in primary care practices.
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Impact of an EHR-based diabetes management form on quality and outcomes of diabetes care in primary care practices.

Am J Med Qual. 2015 Jan-Feb;30(1):14-22

Authors: Herrin J, da Graca B, Aponte P, Stanek HG, Cowling T, Fullerton C, Hollander P, Ballard DJ

Abstract
Health information technology shows promise for improving chronic disease care. This study assessed the impact of a diabetes management form (DMF), accessible within an electronic health record. From 2007 to 2009, 2108 diabetes patients were seen in 20 primary care practices; 1103 visits involved use of the DMF in 2008. The primary outcome was "optimal care": HbA1c ≤8%, low-density lipoprotein (LDL) cholesterol <100 mg/dL, blood pressure <130/80 mm Hg, not smoking, and aspirin prescription in patients ≥40 years. After adjusting for number of visits, age, sex, and insulin use, DMF-exposed patients showed less improvement in attaining "optimal care" (estimated difference-in-difference [DID] = -2.06 percentage points; P < .001), LDL cholesterol (DID = -2.30; P = .023), blood pressure (DID = -3.05; P < .001), and total cholesterol (DID = -0.47; P = .004) targets. Documented microalbumin tests, aspirin prescription, and eye and foot exams increased more. Thus, DMF use was associated with smaller gains in achieving evidence-based targets, but greater improvement in documented delivery of care.

PMID: 24399633 [PubMed - indexed for MEDLINE]




Reliability and utility of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII) for auditing and quality development in services for adults with intellectual disability and challenging behaviour.
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Reliability and utility of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII) for auditing and quality development in services for adults with intellectual disability and challenging behaviour.

J Intellect Disabil Res. 2013 Aug;57(8):716-27

Authors: McVilly K, Webber L, Paris M, Sharp G

Abstract
BACKGROUND: Having an objective means of evaluating the quality of behaviour support plans (BSPs) could assist service providers and statutory authorities to monitor and improve the quality of support provided to people with intellectual disability (ID) who exhibit challenging behaviour. The Behaviour Support Plan Quality Evaluation Guide II (BSP-QEII) was developed to monitor and assess BSPs prepared by teachers to support children with disability in the school system. This study investigated the application of the BSP-QEII to the assessment of BSPs for adults with ID in community support services.
METHOD: The inter-rater reliability of the BSP-QEII was assessed. The utility of the BPS-QEII was then investigated with reference to a time series study of matched pairs of BSPs, developed for the same clients over a period of approximately 3 years. Differences in plan quality measured across a number of service and systemic variables were also investigated.
RESULTS: The BSP-QEII was found to have good inter-rater reliability and good utility for audit purposes. It was able to discriminate changes in plan quality over time. Differences in plan quality were also evident across different service types, where specialist staff had or had not been involved, and in some instances where a statutory format for the plan had or had not been used. There were no differences between plans developed by government and community sector agencies, nor were there any regional differences across the jurisdiction.
CONCLUSIONS: The BSP-QEII could usefully be adopted as an audit tool for measuring the quality of BSPs for adults with ID. In addition to being used for research and administrative auditing, the principles underpinning the BSP-QEII could also be useful to guide policy and educational activities for staff in community based services for adults with ID.

PMID: 22845772 [PubMed - indexed for MEDLINE]




The content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII) and its potential application in accommodation and day-support services for adults with intellectual disability.
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The content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII) and its potential application in accommodation and day-support services for adults with intellectual disability.

J Intellect Disabil Res. 2013 Aug;57(8):703-15

Authors: McVilly K, Webber L, Sharp G, Paris M

Abstract
BACKGROUND: The quality of support provided to people with disability who show challenging behaviour could be influenced by the quality of the behaviour support plans (BSPs) on which staff rely for direction. This study investigated the content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII), originally developed to guide the development of BSPs for children in school settings, and evaluated its application for use in accommodation and day-support services for adults with intellectual disability.
METHOD: A three-round Delphi study involving a purposive sample of experienced behaviour support practitioners (n = 30) was conducted over an 8-week period. The analyses included deductive content analysis and descriptive statistics.
RESULTS: The 12 quality domains of the BSP-QEII were affirmed as valid for application in adult accommodation and day-support service settings. Two additional quality domains were suggested, relating to the provision of detailed background on the client and the need for plans to reflect contemporary service philosophy. Furthermore, the results suggest that some issues previously identified in the literature as being important for inclusion in BSPs might not currently be a priority for practitioners. These included: the importance of specifying replacement or alternative behaviours to be taught, descriptions of teaching strategies to be used, reinforcers, and the specification of objective goals against which to evaluate the success of the intervention programme.
CONCLUSIONS: The BSP-QEII provides a potentially useful framework to guide and evaluate the development of BSPs in services for adults with intellectual disability. Further research is warranted to investigate why practitioners are potentially giving greater attention to some areas of intervention practice than others, even where research has demonstrated these others areas of practice could be important to achieving quality outcomes.

PMID: 22845742 [PubMed - indexed for MEDLINE]