International Journal for Quality in Health Care最新文献

Kidney cancer (KC) is a prevalent cancer worldwide. The incidence and mortality rates of KC have risen in recent decades. The quality of care provided to KC patients is a concern for public health. Considering the importance of KC, in this study, we aim to assess the burden of the disease, gender and age disparities globally, regionally, and nationally to evaluate the quality and inequities of KC care. The 2019 Global Burden of Disease study provides data on the burden of the KC. The secondary indices, including mortality-to-incidence ratio, disability-adjusted life years -to-prevalence ratio, prevalence-to-incidence ratio, and years of life lost-to-years lived with disability ratio, were utilized. These four newly merged indices were converted to the quality-of-care index (QCI) as a summary measure using principal component analysis. QCI ranged between 0 and 100, and higher amounts of QCI indicate higher quality of care. Gender disparity ratio was calculated by dividing QCI for females by males to show gender inequity. The global age-standardized incidence and mortality rates of KC increased by 29.1% (95% uncertainty interval 18.7-40.7) and 11.6% (4.6-20.0) between 1990 and 2019, respectively. Globally, the QCI score for KC increased by 14.6% during 30 years, from 71.3 to 81.6. From 1990 to 2019, the QCI score has increased in all socio-demographic index (SDI) quintiles. By 2019, the highest QCI score was in regions with a high SDI (93.0), and the lowest was in low SDI quintiles (38.2). Based on the World Health Organization regions, the QCI score was highest in the region of America, with Canada having the highest score (99.6) and the lowest in the African Region, where the Central African Republic scored the lowest (17.2). In 1990, the gender disparity ratio was 0.98, and in 2019, it was 0.97 showing an almost similar QCI score for females and males. Although the quality of care for KC has improved from 1990 to 2019, there is a significant gap between nations and different socioeconomic levels. This study provides clinicians and health authorities with a global perspective on the quality of care for KC and identifies the existing disparities.

China's population is ageing, affecting trends in social development and basic national conditions. More attention must be paid to the lack of care needs assessments for the elderly in China's pension institutions. This paper discusses a systematic evaluation of the care needs of the elderly in China's elderly care institutions. Literature was collected and synthesized after a search of the Web of Science, PubMed, and other databases for works published up to August 2021. Relevant content is proposed, including the name of the first author, publication date, study area, and sample size. Exactly 18 articles were included in the literature, documents that reported on a total of 7277 elderly people. The results showed a combined demand rate of primary care needs ≥50%. The top five needs included mental/psychological (76%), tranquillity/care (73%), living/environmental (71%), medical treatment (64%), and preventive healthcare (64%). The combined demand rate of secondary care needs was  ≥50%. The top five needs included 79% for room/laundry/cleaning, 77% for psychological comfort and nursing, 73% for end-of-life care, 70% for disease diagnosis and treatment, and 69% for physical examination. The health needs of older people are diverse and focus mainly on mental/psychological, tranquility/care, living/environmental (71%), pharmacotherapy, and preventive healthcare.

Cancer patients have a high incidence of intraoperative acquired pressure injury (IAPI). Constructing IAPI quality indicators can reduce the incidence of pressure injury, but there are a lack of these indicators targeting cancer patients. Based on this, this study develops a system of quality indicators for IAPI. Thirty-four potential indicators were included based on the literature review. The 26 experts were asked to rate the importance and feasibility of each indicator using three rounds of email survey. The authoritative coefficient ranged from 0.92 to 0.94. After three rounds of Delphi expert consultation, nine nursing quality indicators were identified for IAPI in cancer patients. The mean importance or feasibility ratings ranged from 4.77 to 5.81 on a six-point scale, with variation coefficients ranging from 0.07 to 0.26. The percentage of full score for potential indicators ranged from 23.10% to 80.80%. Over three rounds, the Kendall's W coefficients ranged from 0.157 to 0.354 (P < .01). The absolute and relative importance and feasibility of the nine indicators were identified as potentially valid measures of nursing quality indicators for IAPI in cancer patients. This instrument is the first set of IAPI quality indicators developed specifically for cancer patients, and it should be useful for evaluating and improving the quality of IAPI in this population.

Increased family physician workloads have strained primary care. The objective of this study was to describe the frequency and types of quality concerns identified among Saskatchewan's family physicians, changes in these concerns over time, associated physician characteristics, and recommendations made for improvement. In this repeated cross-sectional study (1997-2020), we examined family physician assessment reports from the Saskatchewan Practice Enhancement Program, a mandatory practice review strategy, for quality concerns on three outcomes: care, medical record, and facility. We recorded demographic and practice characteristics, the presence or absence of quality concerns, and the type of recommendations made. Concern incidence was calculated both overall and across subperiods, and three outcome-specific multiple logistic regression models were developed. Recommendations made were quantified, and their nature was evaluated using thematic analysis. Among 824 assessments, 20.8% identified concerns, with a statistically significant increase in 2015-20 over earlier years (14.2% versus 43.4%, P < .001). Corresponding proportions also significantly increased within each quality outcome (6.0%-37.1%, P < .001 for care concerns; 12.7%-19.6%, P = .03 for medical record concerns; 3.9%-21.0%, P < .001 for facility concerns). We found statistically significant adjusted associations between care concerns and both urban location [odds ratio (OR): 2.2; 95% confidence interval (CI): 1.30, 3.8] and international medical training (OR: 2.4; 95% CI: 1.34, 4.2); facility concerns and solo practice (OR: 2.5 95% CI: 1.10, 5.7); and medical record concerns and male gender (OR: 1.88; 95% CI: 1.09, 3.3), solo practice (OR: 1.67; 95% CI: 1.01, 2.7), and increased age. Reflecting a statistically significant interaction found between age as a continuous covariate and time period, older physicians were more likely to have a medical record concern in later years (OR: 1.072; 95% CI: 1.026, 1.120) compared to earlier ones (OR: 1.021; 95% CI: 1.001, 1.043). Among physicians where a concern was identified, recommendations most frequently pertained to documentation (91.2%), chronic disease management (78.2%), cumulative patient profiles (62.9%), laboratory investigations (53.5%), medications (51.8%), and emergency preparedness (51.2%). A concerning and increasing proportion of family physicians have quality gaps, with identifiable factors and recurring recommendations. These findings provide direction for strategic support development.

Daycare infusion therapy is an integral aspect of oncology, but increased waiting time raises concerns for patients. Patient-reported experience measures prompted the need to evaluate reasons for prolonged appointment delays. This study seeks to analyze and address patients' concerns, to streamline the process flow and reduce waiting time for daycare infusion therapy thereby enhancing patient experience. The define, measure, analyze, improve, and control methodology was implemented, and its impact on reducing waiting times was evaluated. The objective is to ensure that >85% of patients enter the daycare infusion unit within an hour of their appointment time in 6 months. The baseline data for patient waiting times was measured for a period of 2 months, and the average waiting time was determined. Potential causes contributing to prolonged waiting times were identified through time-motion analysis, with a fishbone diagram categorizing potential causes and a Pareto chart prioritizing them. Plan, do, study, and act cycles were conducted for implementing the changes, and a new process flow mapped. Baseline data showed 32% average adherence to the defined turnaround time of 1 hour, with an average waiting time of 108 minutes. Forty causes were identified for increased waiting time, of which eight were key. Adherence to waiting time turnaround time improved from 32% to 89% and the average waiting time decreased by 59 minutes from 108 minutes, increasing patient satisfaction index by 7.5%. The balancing measures include an increase in operational efficiency and throughput of the unit and the inventory levels of oncology medicine were decreased, leading to a 50% reduction in inventory value, while medication error declined by 0.62%, improving patient safety. The project gained tangible and intangible benefits impacting staff, patients, and relatives while improving operational efficiency. This study, with its scientific and systematic approach, enhanced patient satisfaction, patient safety, and better utilization of resources.

Identifying the risk and predicting complaints and misconduct against health practitioners are essential for healthcare regulators to implement early interventions and develop long-term prevention strategies to improve professional practice and enhance patient safety. This scoping review aims to map out existing literature on the risk identification and prediction of complaints and misconduct against health practitioners. This scoping review followed Arksey and O'Malley's five-stage methodological framework. A comprehensive literature search was conducted on MEDLINE, EMBASE, and CINAHL databases and finished on the same day (6 September 2021). Articles meeting the eligibility criteria were charted and descriptively analysed through a narrative analysis method. The initial search generated 5473 articles. After the identification, screening, and inclusion process, 81 eligible studies were included for data charting. Three key themes were reported: methods used for identifying risk factors and predictors of the complaints and misconduct, synthesis of identified risk factors and predictors in eligible studies, and predictive tools developed for complaints and misconduct against health practitioners. The findings reveal that risk identification and prediction of complaints and misconduct are complex issues influenced by multiple factors, exhibiting non-linear patterns and being context specific. Further efforts are needed to understand the characteristics and interactions of risk factors, develop systematic risk prediction tools, and facilitate the application in the regulatory environment.

In today's complex healthcare landscape, exacerbated by resource constraints at various levels, optimization of health professionals' roles is becoming increasingly paramount. Interprofessional collaboration, underpinned by role recognition and teamwork, leads to improved patient and organizational outcomes. Hospital pharmacists play a pivotal role in multidisciplinary teams, and it is imperative to understand multidisciplinary viewpoints on hospital pharmacists' roles to guide role prioritization and organizational efficiency. However, no study extensively investigated multidisciplinary views on values of diverse pharmacist roles in tertiary settings. This study aims to address this gap by examining non-pharmacist health professionals' views on hospital pharmacists' roles, recognizing their specialized niches as a crucial step towards optimizing their roles and services in Australia and internationally. Multiple focus group discussions and interviews were held via a virtual conferencing platform. Study participants were recruited using the study investigators' professional networks who were non-pharmacist health professionals with experience working with pharmacists in hospital settings. Data were collected from transcripts of the focus group recordings, which were later summarized using descriptive statistics and thematic analysis. Overarching themes were categorized and mapped against work system models to conceptualize organizational implications of multidisciplinary feedback, linking them to patient and organizational outcomes. Twenty-seven health professionals participated across focus groups and interviews, with the majority of professions being doctors and nurses. Three major themes were identified as follows: (i) overarching perceptions regarding hospital pharmacists; (ii) professional niches of hospital pharmacists; and (iii) future opportunities to optimize hospital pharmacy services. Valued professional niches included patient and health professional educators, transition-of-care facilitators, and quality use of medicines analysts. The study highlights critical insights into hospital pharmacists' roles in Australia, identifying their niche expertise as vital to healthcare efficiency and success. Based on multidisciplinary feedback, the study advocates for strategic role optimization and targeted research for enhanced clinical, economic, and organizational outcomes.