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Screening for Cystic Fibrosis Related Complications in the Context of a Pandemic and Altered Models of Care. 在大流行病和改变护理模式的背景下筛查囊性纤维化相关并发症。
IF 2.8 Q2 Medicine Pub Date : 2023-10-16 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231205145
Michael Doumit, Roxanne Strachan, Raynuka Lazarus, Peter Middleton, Ruth Dentice, Jessica Marouvo, Laura Jeffrey, Hiran Selvadurai, Sheila Sivam, Verity Pacey, Adam Jaffe, Kelly Gray

Background: Standard of care recommend that patients with cystic fibrosis (CF) require screening investigations to assess for complications. Changing models of care due to the COVID19 pandemic may have impacted completion of recommended screening.

Objective: To compare the frequency of screening investigations completed in people with CF before and after the onset of the COVID19 pandemic.

Methods: Medical records were reviewed at 4 CF-specialist centers to identify screening investigations completed in the 12-months before and after pandemic onset.

Results: Records of 625 patients were reviewed. Prior to pandemic onset, there was between center variability in completion of screening investigations. There was greatest baseline variation between centers in performing oral glucose tolerance test (OGTT); range 38%-69%, exercise tests; 3%-51% and sputum screening for non-tuberculous mycobacteria; 53%-81%. Following pandemic onset, blood tests, and sputum cultures were maintained at the highest rates. Exercise testing, CXR and OGTT exhibited the greatest declines, with reductions at individual centers ranging between 10%-24%, 22%-43%, and 20%-26%, respectively. Return to in-person visits following pandemic onset was variable, ranging from 16% to 74% between centers.

Conclusion: Completion of screening investigations varies between CF centers and changes in models of care, such as increased virtual care in response to COVID19 pandemic was associated with reduction in completion of investigations. Centers would benefit from auditing their adherence to standards of care, particularly considering recent changes in care delivery.

背景:护理标准建议囊性纤维化(CF)患者需要进行筛查以评估并发症。新冠肺炎疫情导致的护理模式变化可能影响了建议筛查的完成。目的:比较新冠肺炎疫情爆发前后CF患者完成筛查调查的频率。方法:对4个CF专家中心的医疗记录进行审查,以确定在大流行爆发前后12个月内完成的筛查调查。结果:回顾了625例患者的病历。在新冠疫情爆发之前,在完成筛查调查方面存在中心之间的变异性。在进行口服葡萄糖耐量试验(OGTT)时,各中心之间的基线差异最大;范围38%-69%,运动测试;3%-51%,痰中非结核分枝杆菌筛查;53%~81%。疫情爆发后,血液检测和痰培养保持在最高水平。运动测试、CXR和OGTT的下降幅度最大,单个中心的下降幅度分别在10%-24%、22%-43%和20%-26%之间。在新冠疫情爆发后,亲自就诊的比例各不相同,各中心之间的比例从16%到74%不等。结论:CF中心的筛查调查完成情况各不相同,护理模式的变化,如应对新冠肺炎疫情而增加的虚拟护理19,与调查完成情况的减少有关。中心将从审计其对护理标准的遵守情况中受益,特别是考虑到最近护理服务的变化。
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引用次数: 0
Multidisciplinary Team Meeting in the Core of Nasopharyngeal Cancer Management Improved Quality of Care and Survival of Patients. 癌症管理核心多学科团队会议提高了患者的护理质量和生存率。
IF 2.8 Q2 Medicine Pub Date : 2023-10-16 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231204757
Kartika W Taroeno-Hariadi, Camelia Herdini, Aulia S Briliant, Henry K Husodoputro, Wigati Dhamiyati, Sagung Rai Indrasari, Setiyani P Lestari, Yulestrina Widyastuti, Herindita Puspitaningtyas, Risa Rahmasari, Innayah Nur Rachmawati, Ibnu Purwanto, Nurhuda H Setyawan, Ericko Ekaputra, Susanna H Hutajulu, Sri R Dwidanarti, Torana Kurniawan, Lidya Meidania, Seize E Yanuarta, Mardiah S Hardianti, Johan Kurnianda

Nasopharyngeal cancer (NPC) cases are often diagnosed in advanced stages. The complexity of clinical management for advanced-stage NPC requires thorough communication and shared decisions between medical professionals and allied teams. Incorporating a multidisciplinary team meeting (MDTM) for newly diagnosed NPC patients was chosen to facilitate collaboration and communication between physicians. This retrospective study aimed to compare the quality of care, clinical responses and survival between NPC patients treated with and without MDTM. Data on clinical responses, assessment visits, date of progression and death with progression-free survival (PFS), overall survival (OS), and hazard ratio (HR) were collected and analyzed with 95% confidence interval (CI) and significance set as P < .05. There were 87 of 178 NPC patients treated with MDTM. Revisions of diagnosis and stage occurred in 5.7% and 52.9% of cases during the MDTM. More clinical responses were achieved by patients treated with MDTM (69.0%vs 32.0%, P < .00). NPC patients who received MDTM treatment recommendation had a lower risk for progression (median PFS 59.89 months vs 12.68 months; HR 0.267, 95% CI: 0.17-0.40, P < .00) and mortality (median OS was not reached vs 13.44 months; HR 0.134, 95% CI: 0.08-0.24, P < .00) compared to patients without MDTM. Incorporating the MDTM approach into NPC management improves patients' clinical responses and survival.

癌症病例通常诊断为晚期。晚期鼻咽癌临床管理的复杂性要求医疗专业人员和联合团队之间进行彻底的沟通和共享决策。选择为新诊断的NPC患者举办多学科团队会议(MDTM),以促进医生之间的合作和沟通。这项回顾性研究旨在比较使用和不使用MDTM治疗的NPC患者的护理质量、临床反应和生存率。收集并分析临床反应、评估访视、无进展生存期(PFS)、总生存期(OS)和危险比(HR)的进展和死亡数据,95%置信区间(CI)和显著性设置为P P P P
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引用次数: 0
Tracking Needs-Based Community and Specialized Services of Young Adults and Their Parents Before and During a First Episode of Psychosis (FEP): Highlighting Intervention Trajectories in FEP. 在首次精神病发作之前和期间跟踪年轻人及其父母基于需求的社区和专业服务:强调精神病发作的干预轨迹。
IF 2.8 Q2 Medicine Pub Date : 2023-09-30 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231200707
Marie-Hélène Morin, Maryse Proulx

Aim: This article aims to document 10 service trajectories of young adults (YA) and their parents, informed by healthcare professionals (HP), before and during a first episode of psychosis (FEP).

Design: Based on a crisis model perspective of the Life Course Theory (Elder; Elder and Shanahan) developed by Carpentier and White, and adapted to the current context to track community and specialized services trajectories. Thematic analysis was used to code responses to open-ended questions around the need for help and accessing services by young adults affected by a psychotic disorder, and their parents.

Setting: In collaboration with FEP clinics, setting of choice by YA and their parents.

Participants: 5 YA, 12 parents, and 6 HP.

Results: 10 individual service trajectories grouped into 3 distinct types of trajectories (optimal, typical, and complex) based on grouping 5 similar characteristics, highlighting service access complexity and early intervention in FEP.

Conclusion: This study is the first of its kind to examine the experiences of those who seek needs-based community and specialized services leading up to and during a FEP. Findings provide key insights related to early intervention in FEP and recommendations on improving access to such services in Quebec.

目的:本文旨在记录年轻人(YA)及其父母在精神病(FEP)第一次发作前和发作期间的10条服务轨迹。设计:基于Carpentier和White开发的生命历程理论(Elder;Elder和Shanahan)的危机模型视角,并适应当前环境,以跟踪社区和专业服务的轨迹。主题分析用于编码对受精神障碍影响的年轻人及其父母对帮助和获得服务的需求等开放式问题的回答。设置:与FEP诊所合作,由YA及其父母选择设置。参与者:5名YA、12名父母和6名HP。结果:10个个体服务轨迹基于5个相似特征分组,分为3种不同类型的轨迹(最优、典型和复杂),强调了FEP中服务获取的复杂性和早期干预。结论:本研究首次考察了那些在FEP之前和期间寻求基于需求的社区和专业服务的人的经历。研究结果提供了与FEP早期干预相关的关键见解,并就改善魁北克获得此类服务的机会提出了建议。
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引用次数: 0
The Patient as an Actor in His Care Pathway: Insights From the French Case. 患者在其护理路径中扮演的角色:法国案例的启示。
IF 2.8 Q2 Medicine Pub Date : 2023-09-28 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231196029
Isabelle Aubert, Frédéric Kletz, Jean-Claude Sardas

In France, patients' right to take part in decisions regarding their health has been recognized by law since 2002. This legal recognition was the outcome of a long-standing call to allow all individuals to be "actors in their own health" and to co-develop their care pathway with the professionals involved. In practice, care pathways simultaneously intertwine both standardization and personalization dynamics, which involve different forms of professional-patient interaction. This article analyses the links between the organizational variables of care pathways, and the ways in which patients are involved in the management of their own pathway. To date, these links have received little attention in the management science and health literatures. We draw on material from a case study carried out in 2 French territories, combining the analysis of patient pathways with interviews conducted with professionals and carers. Building on this analysis, we propose a typology of patient profiles which distinguishes between their different forms of involvement in the development of their care pathway, based on its organizational characteristics.

在法国,自2002年以来,法律承认患者参与健康决策的权利。这一法律承认是一项长期呼吁的结果,即允许所有人都成为“自己健康的参与者”,并与相关专业人员共同发展他们的护理途径。在实践中,护理途径同时交织着标准化和个性化动态,这涉及不同形式的专业患者互动。本文分析了护理路径的组织变量与患者参与自身路径管理的方式之间的联系。到目前为止,这些链接在管理科学和健康文献中很少受到关注。我们借鉴了在2 法国领土,将对患者路径的分析与对专业人员和护理人员进行的访谈相结合。基于这一分析,我们提出了一种患者档案类型,根据其组织特征,区分他们参与护理途径发展的不同形式。
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引用次数: 0
Integrating Digital Innovation Mechanisms in Digital Infrastructures: The Case of Digital Remote Care. 在数字基础设施中整合数字创新机制:以数字远程护理为例。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-09-26 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231200704
Anne Ks Ajer, Egil Øvrelid

Digital innovation (DIN) is crucial for managing the growth of resource use in the hospital sector and for providing citizens with services aligned with the requirements of the modern world. DIN includes the co-creation of novel services, such as digital remote care (DRC) solutions. The healthcare sector, with a plethora of applications, is an example of a large digital infrastructure. Our study aims to explore how DRC initiatives can be integrated in large-scale digital infrastructures. Our in-depth case study, which explores 72 different DRC trajectories at 9 hospital health trusts in Norway, reveals the dynamic interplay among 3 key mechanisms - idealistic entrepreneurship, anchoring and remote infrastructure. Our contribution to the DIN literature is a model that shows the interplay among these key mechanisms, which increases the innovation pace, improves the innovations' scalability and provides a robust organisation that constantly implements innovations. As a contributions to DRC practice, lessons learned to speed up the innovation pace are offered: (1) Create a DRC organisational structure. (2) Ensure financial predictability. (3) secure anchoring upward in the governance structure. (4) Make the remote infrastructure appropriate for integration with the current digital infrastructure. (5) Advocate the success across the organisation to spur others to innovate.

数字创新(DIN)对于管理医院部门资源使用的增长以及为公民提供符合现代世界要求的服务至关重要。DIN包括共同创建新型服务,如数字远程护理(DRC)解决方案。拥有大量应用程序的医疗保健部门是大型数字基础设施的一个例子。我们的研究旨在探索如何将DRC举措整合到大规模数字基础设施中。我们的深入案例研究探索了挪威9家医院健康信托基金的72种不同的DRC轨迹,揭示了理想主义创业、锚定和远程基础设施这三种关键机制之间的动态相互作用。我们对DIN文献的贡献是一个模型,它显示了这些关键机制之间的相互作用,从而加快了创新步伐,提高了创新的可扩展性,并提供了一个不断实施创新的强大组织。作为对DRC实践的贡献,我们提供了加快创新步伐的经验教训:(1)创建DRC组织结构。(2) 确保财务可预测性。(3) 在治理结构中向上稳固锚定。(4) 使远程基础架构适合与当前数字基础架构集成。(5) 倡导整个组织的成功,以激励其他人创新。
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引用次数: 0
Adolescent and Caregiver Perspectives on Family Navigation to Improve Healthcare Access and Use for Managing Pediatric Obesity. 青少年和护理人员对家庭导航的看法,以改善儿童肥胖的医疗保健机会和使用。
IF 2.8 Q2 Medicine Pub Date : 2023-09-26 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231200863
Geoff Dc Ball, Marcus G O'Neill, Mitchell Rath, Maryam Kebbe, Arnaldo Perez, Ian Zenlea, Josephine Ho

We interviewed families to explore their views on the role of family navigation (FN) to improve access to and use of health services for managing pediatric obesity. From March to December, 2020, we conducted individual, structured telephone interviews with adolescents with obesity (13-17 years old) and their caregivers from Edmonton and Calgary, Canada. Among our 37 participants (14 adolescents, 23 caregivers), most (n = 27; 73.0%) reported FN could improve their access to obesity management. Participants recommended several activities to support healthcare access and use, including appointment reminders, evening/weekend appointments, parking/transportation support, and in-clinic childcare, all of which help families to attend appointments over an extended period to support obesity management. Most participants preferred FN be offered by healthcare professional 'navigators' who were approachable, empathic, and compassionate since issues regarding health and obesity can be sensitive, emotional topics to discuss. Overall, families supported integrating FN into multidisciplinary pediatric obesity management to improve healthcare access and use by navigators who apply a range of practical strategies and relational skills to enhance long-term access and adherence to care.

我们采访了家庭,探讨他们对家庭导航(FN)在改善儿童肥胖管理中获得和使用医疗服务的作用的看法。2020年3月至12月,我们对肥胖青少年(13-17 岁)及其来自加拿大埃德蒙顿和卡尔加里的照顾者。在我们的37名参与者(14名青少年,23名护理人员)中,大多数(n = 27;73.0%)报告FN可以改善他们获得肥胖管理的机会。参与者推荐了一些支持医疗保健获取和使用的活动,包括预约提醒、晚间/周末预约、停车/交通支持和诊所儿童保育,所有这些都有助于家庭长期参加预约,以支持肥胖管理。大多数参与者更喜欢由平易近人、富有同情心的医疗专业“导航员”提供FN,因为与健康和肥胖有关的问题可能是需要讨论的敏感、情绪化的话题。总的来说,家庭支持将FN纳入多学科儿科肥胖管理,以改善导航仪获得医疗保健的机会和使用情况,导航仪应用一系列实用策略和关系技能来提高长期获得和坚持护理的能力。
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引用次数: 0
Healthcare Professionals' Resilience During the COVID-19 and Organizational Factors That Improve Individual Resilience: A Mixed-Method Study. 新冠肺炎期间医疗保健专业人员的复原力和提高个人复原力的组织因素:一项混合方法研究。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-09-19 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231198991
Raquel Simões de Almeida, Ana Costa, Inês Teixeira, Maria João Trigueiro, Artemisa Rocha Dores, António Marques

Healthcare workers are a susceptible population to be psychologically affected during health crises, such as the recent COVID-19 pandemic. Resilience has been pointed out in the literature as a possible protective factor against psychological distress in crisis situations. This can be influenced by internal and external factors, such as individual characteristics and organizational factors. Thus, this study aims to characterize the overall resilience levels among healthcare professionals in Portugal and to understand the perspectives of this healthcare workers regarding organizational factors that improve individual resilience. This is a mixed-method study: a first quantitative study using a cross-sectional design to administer the Resilience Scale for Adults (RSA) to 271 healthcare professionals (Mage 33.90, SD = 9.59 years, 90.80% female), followed by a qualitative study through 10 in-depth interviews. The mean score for the total RSA was 178.17 (SD = 22.44) out of a total of 231. Qualitative analysis showed 4 major themes on factors that enhance resilience: "Professional's Training," "Support and Wellbeing Measures," "Reorganization of Services" and "Professional Acknowledgment." The findings may contribute to the development of targeted interventions and support systems to enhance resilience and well-being among healthcare workers.

在最近的新冠肺炎大流行等健康危机期间,医护人员是易受心理影响的人群。文献中指出,在危机情况下,韧性可能是抵御心理困扰的一个保护因素。这可能受到内部和外部因素的影响,如个人特征和组织因素。因此,本研究旨在描述葡萄牙医疗保健专业人员的总体恢复力水平,并了解这些医疗保健工作者对提高个人恢复力的组织因素的看法。这是一项混合方法研究:首次使用横断面设计对271名医疗保健专业人员(Mage 33.90,SD = 9.59 年,90.80%为女性),然后通过10次深入访谈进行定性研究。总RSA的平均得分为178.17(SD = 22.44)。定性分析显示了关于增强复原力因素的4个主要主题:“专业人员培训”、“支持和福利措施”、“服务重组”和“专业认可”。这些发现可能有助于制定有针对性的干预措施和支持系统,以增强医护人员的复原力和幸福感。
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引用次数: 0
Acknowledging the Complexity of Antipsychotic Use in Long-Term Care During the COVID-19 Pandemic. 承认新冠肺炎大流行期间长期护理中抗精神病药物使用的复杂性。
IF 2.8 Q2 Medicine Pub Date : 2023-09-19 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231195211
Luke Andrew Turcotte, Caitlin McArthur, Jeff W Poss, George Heckman, Lori Mitchell, John Morris, Andrea D Foebel, John P Hirdes
that an increase in administration also occurred in the previous year among Alberta residents. Our analysis was a comparison of the pandemic period against the 2 most recent historical years and did not test for year-over-year trends. Interrupted time series analysis by Hoben et al 3 supports Dr. Quail’s argument that the inappropriate use of antipsychotic medications increased in the years leading up to the pandemic in Alberta. However, in alignment with our own findings, the rate of that increase accelerated significantly during the pandemic period. We offer supplemental analysis of pairwise comparisons back to 2013/2014 when Alberta was first included in the annual CIHI “Quick Stats” report (Figure 1). This illustrates that (1) the increase during the pandemic period was significant relative to all years since 2014/2015 and (2) the magnitude of the increase observed in recent years was largest during the pandemic period. Without question, a greater percentage of residents received inappropriate antipsychotic medications during the pandemic period.
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引用次数: 0
Evaluation of the Response Rates of Hospitals in the Prevention and Control of COVID-19 in Hamadan Province of Iran. 伊朗哈马丹省医院对预防和控制 COVID-19 的响应率评估。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-07-21 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231187825
Mohammad Ali Seif Rabiei, Fariba Keramat, Iraj Sedighi, Ebrahim Jalili, Mahshid Nikooseresht, Seyed Saman Talebi, Seyedeh Melika Kharghani Moghadam

The COVID-19 pandemic has challenged the capacity of health systems in various countries. This study was designed to evaluate the response rates of hospitals in the prevention and control of COVID-19 in Hamadan province, Iran. In this cross-sectional study, all 20 hospitals in Hamadan province were monitored in February 2020. The instrument used in this study was the WHO checklist, entitled "Infection prevention and control health-care facility response for COVID-19." In each hospital, the hospital infection control officials completed the checklists under the supervision of the hospital managers and were then provided to the project manager. Data analyzed by SPSS 22 software. There were 3482 hospital beds (the average beds of each hospital was 174) in the studied hospitals. Of 15 055 patients admitted to all hospitals, 2196 (14.6%) individuals were COVID-19 patients. The total average score obtained from the checklist was 62.25. Among 7 domains studied, the lowest scores belonged to 2 domains of "infrastructure and equipment" and "patient screening and triage." The scores of domains "IPC programs" and "visitors" were significantly higher in hospitals with ICU beds than other hospitals (P-value = .03 in both domains). A comparison between university-teaching hospitals with other hospitals and those in Hamadan city with other cities revealed no significant differences in any of the domains. The mean response rate (62.25) of hospitals in terms of COVID-19 in Hamadan province indicates their relative readiness to prevent and control the COVID19 pandemic. The shortage of infrastructure and equipment and screening and triage problems of patients were the main challenges of hospitals in managing the COVID-19 pandemic in Hamadan province, Iran.

COVID-19 大流行对各国卫生系统的能力提出了挑战。本研究旨在评估伊朗哈马丹省各医院在预防和控制 COVID-19 方面的响应率。在这项横断面研究中,于 2020 年 2 月对哈马丹省所有 20 家医院进行了监测。本研究使用的工具是世界卫生组织题为 "感染预防和控制医疗机构对 COVID-19 的反应 "的核对表。在每家医院,医院感染控制官员在医院经理的监督下填写核对表,然后将核对表提供给项目经理。数据由 SPSS 22 软件进行分析。研究医院共有 3482 张病床(每家医院的平均病床数为 174 张)。在所有医院收治的 15 055 名患者中,有 2196 人(14.6%)是 COVID-19 患者。核对表得出的总平均分为 62.25 分。在研究的 7 个领域中,得分最低的是 "基础设施与设备 "和 "患者筛查与分流 "两个领域。拥有重症监护病房床位的医院在 "IPC计划 "和 "访客 "两个领域的得分明显高于其他医院(两个领域的P值均为0.03)。将大学教学医院与其他医院以及哈马丹市的医院与其他城市的医院进行比较后发现,在任何领域都没有明显差异。哈马丹省各医院对 COVID-19 的平均回复率(62.25)表明,它们已做好预防和控制 COVID19 大流行的相对准备。基础设施和设备短缺以及病人筛查和分流问题是伊朗哈马丹省医院在管理 COVID-19 大流行方面面临的主要挑战。
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引用次数: 0
Quality of Municipal Long-Term Care in Different Models of Care: A Cross-Sectional Study From Norway. 不同护理模式下的市政长期护理质量:挪威的一项横断面研究。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-07-17 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231185537
Hanne Marie Rostad, Lisa Victoria Burrell, Marianne Sundlisæter Skinner, Ragnhild Hellesø, Maren Kristine Raknes Sogstad

The quality of care remains a critical concern for health systems around the globe, especially in an era of unprecedented financial challenges and rising demands. Previous research indicates large variation in several indicators of quality in the long-term care setting, highlighting the need for further investigation into the factors contributing to such disparities. As different ways of delivering long-term care services likely affect quality of care, the objectives of our study is to investigate (1) variation in structure, process and outcome quality between municipalities, and (2) to what extent variation in quality is associated with municipal models of care and structural characteristics. The study had a cross-sectional approach and we utilized data on the municipal level from 3 sources: (1) a survey for models of care (2) Statistics Norway for municipal structural characteristics and (3) the National Health Care Quality Indicator System. Descriptive statistics showed that the Norwegian long-term care sector performs better (measured as percentage or probability) on structure (85.53) and outcome (84.86) quality than process (37.85) quality. Hierarchical linear regressions indicated that municipal structural characteristics and model of care had very limited effect on the quality of long-term care. A deeper understanding of variation in service quality may be found at the micro level in healthcare workers' day-to-day practice.

医疗质量仍然是全球医疗系统关注的一个重要问题,尤其是在面临前所未有的财政挑战和需求不断增长的时代。以往的研究表明,在长期护理环境中,几项质量指标的差异很大,这凸显了进一步调查造成这种差异的因素的必要性。由于提供长期护理服务的不同方式可能会影响护理质量,我们的研究目标是调查:(1)不同城市之间在结构、过程和结果质量方面的差异;(2)质量差异在多大程度上与城市护理模式和结构特征有关。研究采用横截面方法,我们利用了来自三个方面的市级数据:(1)护理模式调查;(2)挪威统计局的市政结构特征;(3)国家医疗质量指标系统。描述性统计显示,挪威长期护理行业在结构质量(85.53)和结果质量(84.86)方面的表现(以百分比或概率衡量)优于过程质量(37.85)。层次线性回归表明,市政结构特征和护理模式对长期护理质量的影响非常有限。要更深入地了解服务质量的差异,可以从医护人员的日常实践这一微观层面入手。
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引用次数: 0
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