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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 Care at Hospitals Identified as Outliers in Publicly Reported Mortality Statistics for Percutaneous Coronary Intervention.
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Quality of Care at Hospitals Identified as Outliers in Publicly Reported Mortality Statistics for Percutaneous Coronary Intervention.

Circulation. 2017 May 16;135(20):1897-1907

Authors: Waldo SW, McCabe JM, Kennedy KF, Zigler CM, Pinto DS, Yeh RW

Abstract
BACKGROUND: Public reporting of percutaneous coronary intervention (PCI) outcomes may create disincentives for physicians to provide care for critically ill patients, particularly at institutions with worse clinical outcomes. We thus sought to evaluate the procedural management and in-hospital outcomes of patients treated for acute myocardial infarction before and after a hospital had been publicly identified as a negative outlier.
METHODS: Using state reports, we identified hospitals that were recognized as negative PCI outliers in 2 states (Massachusetts and New York) from 2002 to 2012. State hospitalization files were used to identify all patients with an acute myocardial infarction within these states. Procedural management and in-hospital outcomes were compared among patients treated at outlier hospitals before and after public report of outlier status. Patients at nonoutlier institutions were used to control for temporal trends.
RESULTS: Among 86 hospitals, 31 were reported as outliers for excess mortality. Outlier facilities were larger, treating more patients with acute myocardial infarction and performing more PCIs than nonoutlier hospitals (P<0.05 for each). Among 507 672 patients with acute myocardial infarction hospitalized at these institutions, 108 428 (21%) were treated at an outlier hospital after public report. The likelihood of PCI at outlier (relative risk [RR], 1.13; 95% confidence interval [CI], 1.12-1.15) and nonoutlier institutions (RR, 1.13; 95% CI, 1.11-1.14) increased in a similar fashion (interaction P=0.50) after public report of outlier status. The likelihood of in-hospital mortality decreased at outlier institutions (RR, 0.83; 95% CI, 0.81-0.85) after public report, and to a lesser degree at nonoutlier institutions (RR, 0.90; 95% CI, 0.87-0.92; interaction P<0.001). Among patients that underwent PCI, in-hospital mortality decreased at outlier institutions after public recognition of outlier status in comparison with prior (RR, 0.72; 9% CI, 0.66-0.79), a decline that exceeded the reduction at nonoutlier institutions (RR, 0.87; 95% CI, 0.80-0.96; interaction P<0.001).
CONCLUSIONS: Large hospitals with higher clinical volume are more likely to be designated as negative outliers. The rates of percutaneous revascularization increased similarly at outlier and nonoutlier institutions after report of outlier status. After outlier designation, in-hospital mortality declined at outlier institutions to a greater extent than was observed at nonoutlier facilities.

PMID: 28249879 [PubMed - indexed for MEDLINE]




Combined Use of the Rationalization of Home Medication by an Adjusted STOPP in Older Patients (RASP) List and a Pharmacist-Led Medication Review in Very Old Inpatients: Impact on Quality of Prescribing and Clinical Outcome.
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Combined Use of the Rationalization of Home Medication by an Adjusted STOPP in Older Patients (RASP) List and a Pharmacist-Led Medication Review in Very Old Inpatients: Impact on Quality of Prescribing and Clinical Outcome.

Drugs Aging. 2017 Feb;34(2):123-133

Authors: Van der Linden L, Decoutere L, Walgraeve K, Milisen K, Flamaing J, Spriet I, Tournoy J

Abstract
BACKGROUND: Polypharmacy and potentially inappropriate drugs have been associated with negative outcomes in older adults which might be reduced by pharmacist interventions.
OBJECTIVES: Our objective was to evaluate the effect of a pharmacist intervention, consisting of the application of the Rationalization of home medication by an Adjusted STOPP in older Patients (RASP) list and a pharmacist-led medication review on polypharmacy, the quality of prescribing, and clinical outcome in geriatric inpatients.
METHODS: A monocentric, prospective controlled trial was undertaken at the geriatric wards of a large university hospital. Pharmacists applied the RASP list to the drugs reconciled on admission and additionally performed an expert-based medication review, upon which recommendations were provided to the treating physicians. The primary outcome was the composite endpoint of drug discontinuation and dose reduction of drugs taken on admission. Secondary outcomes included RASP-identified potentially inappropriate medications (PIMs), the number of Emergency Department (ED) visits and quality of life (QOL) registered up to 3 months after discharge.
RESULTS: On average, patients (n = 172) took 10 drugs on admission and were 84.5 years (standard deviation 4.8) of age. More drugs were discontinued or reduced in dose in the intervention group {control vs.
INTERVENTION: median (interquartile range [IQR]) 3 (2-5) vs. 5 (3-7); p < 0.001}. More PIMs were discontinued in the intervention group, leading to less PIM at discharge [control vs.
INTERVENTION: median (IQR) 2 (1-3) vs. 0.5 (0-1); p < 0.001]. No signal of harm was seen, and a significant improvement of QOL and less ED visits without hospitalization were observed.
CONCLUSIONS: The combined intervention safely reduced drug use in very old inpatients and outperformed usual geriatric care. An increased QOL was seen, as well as a trend towards less ED visits. ClinicalTrials.gov Identifier: NCT01513265.

PMID: 27915457 [PubMed - indexed for MEDLINE]




Does frequency of restless legs syndrome and poor sleep quality increase with age in irritable bowel syndrome?
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Does frequency of restless legs syndrome and poor sleep quality increase with age in irritable bowel syndrome?

Wien Klin Wochenschr. 2016 Dec;128(Suppl 8):604-609

Authors: Acay A, Bal A, Oruc S, Ozkececi T, Sariaydin M, Demirbas H, Acarturk G

Abstract
BACKGROUND: Irritable bowel syndrome (IBS) is a common gastrointestinal disease which leads to a reduction in the quality of life. Restless legs syndrome (RLS) and the incidence of poor sleep quality (PSQ) are known to increase in IBS. In this study, we aimed to investigate the prevalence and association of RLS and PSQ in a young population.
METHODS: A total of 112 IBS patients (46 constipation predominant IBS, 17 diarrhea predominant IBS, 23 mixed IBS and 26 unsubtyped IBS) and 106 healthy controls were included in the study. The Pittsburgh Sleep Quality Index (PSQI) and the 2012 revised diagnostic criteria of the International Restless Legs Syndrome Study Group were used in the groups.
RESULTS: In the patients with IBS and the control group, the respective results obtained were as follows: presence of PSQ 16 (13.4 %) and 5 (4.7 %) and presence of RLS 10 (8.9 %) and 4 (3.7 %), respectively. There were significant differences between the two groups in terms of these values. According to the PSQI, the mean global PSQI scores of patients with IBS and control group were 7.61±3.9 and 4.5±3.7, respectively (P = 0.01). While PSQ was detected in 21 out of 218 participants, RLS was detected in 14. PSQ and RLS coexisted in nine of the participants and all of them were IBS patients.
CONCLUSIONS: Previous studies and our study reveal that the frequency of RLS and PSQ increases in IBS. However, this result is a lower rate compared to previous studies. The controlled and prospective studies with larger numbers of cases which demonstrate the real frequency.

PMID: 27624325 [PubMed - indexed for MEDLINE]