International Journal for Quality in Health Care最新文献

Background: In Taiwan, as the population ages, palliative care services (PCS) have expanded significantly to include comprehensive benefit plans for critically ill individuals, supported by reimbursements from the National Health Insurance program. However, incorporating palliative care into the medical management of these patients presents several challenges. We aim to evaluate the effects of palliative care interventions on medical resources in end-of-life scenarios, to promote earlier palliative care access and provide high-quality healthcare services for patients.

Methods: A total of 2202 patients were included in this study. Primary diagnosis and referral for PCS were assessed using ICD-10 and HNI code. All study subjects were divided into three groups: patients who did not receive PCS (no-PCS), patients who received PCS before their final hospital admission (PCS-before), and patients who received PCS after their final admission (PCS-after). We evaluated (i) the effects of PCS on eight medical resource utilization outcomes within the 30 days preceding death and (ii) the effects of early intervention on two major diseases.

Results: Initiating PCS before a patient's last hospital admission was associated with less aggressive medical interventions in the 30 days before death, including reduced length of intensive care unit (ICU) [odds ratio (OR) = 0.25], and rates of endotracheal intubation (OR = 0.12), respiratory ventilator support (OR = 0.20), cardiopulmonary resuscitation (OR = 0.18), and blood transfusion (OR = 0.65). Among patients with cancer and lung diseases, those who received PCS prior to their final hospitalization of over 14 days experienced reduced hospitalization duration (OR = 0.52 and 0.24, respectively). Patients with lung disease also had significantly lower odds of ICU stays (OR = 0.44) and respiratory ventilation (OR = 0.33).

Conclusion: The timing of palliative care intervention critically impacts on duration of hospitalization and ICU stay and the need for intubation procedures or cardiopulmonary resuscitation. The findings can help the government and medical providers in developing comprehensive palliative care policies and programs to improve care quality and patient rights.

Background: In Taiwan, as the population ages, palliative care services (PCS) have expanded significantly to include comprehensive benefit plans for critically ill individuals, supported by reimbursements from the National Health Insurance program. However, incorporating palliative care into the medical management of these patients presents several challenges. We aim to evaluate the effects of palliative care interventions on medical resources in end-of-life scenarios, to promote earlier palliative care access and provide high-quality healthcare services for patients.

Methods: A total of 2202 patients were included in this study. Primary diagnosis and referral for PCS were assessed using ICD-10 and HNI code. All study subjects were divided into three groups: patients who did not receive PCS (no-PCS), patients who received PCS before their final hospital admission (PCS-before), and patients who received PCS after their final admission (PCS-after). We evaluated (i) the effects of PCS on eight medical resource utilization outcomes within the 30 days preceding death and (ii) the effects of early intervention on two major diseases.

Results: Initiating PCS before a patient's last hospital admission was associated with less aggressive medical interventions in the 30 days before death, including reduced length of intensive care unit (ICU) [odds ratio (OR) = 0.25], and rates of endotracheal intubation (OR = 0.12), respiratory ventilator support (OR = 0.20), cardiopulmonary resuscitation (OR = 0.18), and blood transfusion (OR = 0.65). Among patients with cancer and lung diseases, those who received PCS prior to their final hospitalization of over 14 days experienced reduced hospitalization duration (OR = 0.52 and 0.24, respectively). Patients with lung disease also had significantly lower odds of ICU stays (OR = 0.44) and respiratory ventilation (OR = 0.33).

Conclusion: The timing of palliative care intervention critically impacts on duration of hospitalization and ICU stay and the need for intubation procedures or cardiopulmonary resuscitation. The findings can help the government and medical providers in developing comprehensive palliative care policies and programs to improve care quality and patient rights.

Background: Patient complaint taxonomies strongly support the use of healthcare complaints as a powerful tool to improve the quality and safety of patient care. Hospitals use complaint data at the organizational level to address quality variation across service lines and departments.

Methods: We applied a validated typology method to identify where the complaints occured and gained deeper insights about how they can be more effectively utilized to drive and implement continuous quality and service improvement activities within a tertiary hospital. We included all complaints and opinions from patients and their families over a 5-year period at a large tertiary teaching hospital in Japan. Two analysts categorized the opinions into complaints and gratitude expressions, with complaints classified using Reader et al.'s taxonomy. We performed statistical tabulations and determined the number of complaints across hospital sectors using the chi-squared test, residual analysis, and Cramer's V tests to check for significant correlations between the variables.

Results: A total of 6607 complaints and comments were received. Of these, 5401 related to the Clinical, Administrative, and Human Relations domains, respectively (11.1%, 56.1%, and 32.8%). At the domain level, the most common complaints are related to the Relationships domain in both the Medical and Nursing departments. However, a detailed analysis of the category levels demonstrated that the Medicine department received the most complaints in the Communication and Patient Rights category, whereas in the Nursing department, the Humanness/Caring and Patient Rights categories were the most common sources for complaints. The Administrative department complaints were mostly related to the Management domain, with the largest number of complaints related to the Institutional Issues category.

Conclusions: We used a validated taxonomy to identify and address trends in patient complaints and identified the key hospital departments that required remedial improvement actions. All hospital departments received direct and targeted feedback on how to effectively improve the quality, safety and services of their clinical service lines.

Background: An adverse event (AE) is any undesirable medical manifestation in an individual who has received pharmacological treatment. To be considered serious (SAE), it needs to meet minimally one of the severity criteria by Health Canada. The most recent data (2006) suggested that AEs were underreported (<6%) to health authorities. In Canada, since the implementation of Vanessa's Law (2019), hospitals are required to report SAEs; however, this law remains relatively unknown. The objectives of the study were: (i) to document the incidence of any AE and SAE over time in a 'real' clinical context, (ii) to quantify SAEs reported to Health Canada, and (iii) to assess whether Vanessa's Law has led to an increase in mandatory reporting to Health Canada.

Methods: We carried out a descriptive retrospective study at the Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, including 500 patients hospitalized between 1 January 2018 and 31 December 2021 and randomized into 4 cohorts (125 patients/year). Descriptive and comparative analyses were performed.

Results: The characteristics of the cohorts were: 43.6% women; median age: 69 years (min-max: 21-96 years), number of comorbidities: 4 (1-12). During their hospitalization, patients consumed 18 different drug products (2-56) and the median of observed SAEs/patients was 0 (0-10) (total: 302). The overall percentage of SAEs reported to Health Canada was 0%, before and following the implementation of Vanessa's Law.

Conclusion: According to 500 electronic medical records, SAEs were underreported to Health Canada, even after the implementation of Vanessa's law.

Background: Lean management (LM) provides hospitals with tools to respond to today's rapidly changing healthcare environment. However, evidence of its success is inconclusive. In some cases, well-executed LM supports effective, beneficial, and safe patient care; reduces costs; and increases patient and staff satisfaction. In other cases, however, the desired outcomes have not been achieved. Organizations must acknowledge the maturity level of LM to successfully implement it for continuous development. This study evaluates the maturity of Lean implementation using a structured interview with a framework based on the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) and utilizes findings about Lean adoption to evaluate factors that support and hinder its implementation, with the aim of assisting leaders in maintaining and developing Lean in health care.

Methods: The article describes a case study done at Helsinki University Hospital. A qualitative study was conducted in three sectors (A, B, and C) of the hospital. Fifteen healthcare leaders from the three sectors participated in a semistructured interview based on the dimensions of the LHISI. Qualitative content analyses were based on grounded theory.

Results: We concluded that the five dimensions (leadership, commitment, standard work, communication, and daily management system) of LHISI provide a comprehensive framework for qualitatively evaluating Lean in the hospital. We found that the five dimensions are influenced by other explanatory factors. These explanatory factors, knowledge about Lean, available data, and environmental, psychological, and organizational factors all support and hinder leadership, communication, daily management, and commitment to Lean in the hospital. The results highlight differences in the Lean maturity levels in the hospital. We noticed that 9 of 15 leaders had a misunderstanding of Lean, and all 3 sectors showed a lack of staff commitment to Lean in their units.

Conclusion: To strengthen the organization-wide implementation of Lean, it is necessary to understand that LM is a comprehensive sociotechnical management system, for which it is not enough to mechanically implement Lean with tools and techniques alone. By focusing on and developing the five dimensions and explanatory factors, organizations can achieve a high maturity of Lean and reach their full potential. A good level of competency and commitment to Lean by the leaders and the staff alike are important for achieving goals, engaging the staff, and increasing the quality of patient care in the hospital. The long-term Lean development of a hospital organization can be followed and continuously maintained via easy-to-use maturity tools.

Background: The Finnish public healthcare system aims to ensure equal access to health services for all but faces challenges in meeting the demand for specialized care, such as neurosurgery, due to resource constraints. This study investigates interventions to increase resources at a neurosurgery outpatient clinic to improve patient care without compromising waiting times for diagnoses and treatments, leveraging Finland's unique healthcare landscape.

Methods: The study was conducted at Kuopio University Hospital's Department of Neurosurgery, the sole provider of neurosurgical care in Eastern Finland. Two interventions were designed to optimize clinic operations: one focusing on dynamic resource allocation through continuous monitoring and the other on establishing a fixed additional neurosurgeon slot. Process capability and regression analysis were employed to evaluate the effects of these interventions on the number of outpatient visits and the variability in daily patient numbers.

Results: The preliminary analysis showed an average of 9.3 outpatient visits per day (SD 5.2). The introduction of an additional neurosurgeon led to an increase of 5.014 visits per day, according to the regression analysis performed before the interventions. Following the interventions, the clinic observed an increase in the average number of daily outpatient visits to 9.8 after the first intervention and 11.6 after the second, with corresponding improvements in the number of neurosurgeons present. The second intervention, which established a predictable additional resource, resulted in a more significant improvement in process efficiency and stability. After the interventions, the number of new neurosurgical first patient visits increased by 7% (97 patients).

Conclusion: This study demonstrates the importance of structured and predictable resource allocation in enhancing the efficiency of specialized healthcare services, particularly in neurosurgery. It also underscores the potential of planned interventions to manage and improve patient care in a publicly funded healthcare system, despite the challenges posed by limited resources and the need for prioritization. Moreover, the findings highlight the necessity of ongoing measurement and analysis of development projects to ensure sustained improvement and avoid regression in process quality.

Background: Healthcare quality has long been defined and assessed using different theories that outline care delivery as a product of clinical and non-clinical aspects. The clinical aspect is medicinal in nature, while the non-clinical symbolizes social and technological aspects of care. To the best of our knowledge, the joint effect of the clinical, social, and technological aspects of care on outcome quality of care has not been investigated in the literature. The current study empirically investigates, using the joint effect of the clinical, social, and technological care quality dimensions on mortality rates through analyzing longitudinal data from 3081 US hospitals.

Methods: Six-year data from 3081 acute care hospitals are collected and analyzed using econometric analysis with two-stage least square instrumental variable regression models.

Results: Hospitals that jointly focus on clinical, social, and technological care dimensions realize lower mortality rates. Combining clinical quality (CM) with either patient-caregiver interaction (PCI) or meaningful use of health infomration technology (MUHIT) reduces mortality rates. The lowest mortality rate is realized when hospitals combine CM, PCI, and MUHIT.

Conclusion: Our study provides empirical evidence on the importance of combining clinical and non-clinical care measures to reduce mortality rates in hospitals. Our results indicate that hospitals that combine dual quality dimensions, clinical quality with either PCI or MUHIT, can also realize improvement in mortality rates. However, the best outcome can be realized by focusing on the triple quality dimensions (CM, PCI, and MUHIT). The study provides pointers to healthcare professionals and policymakers on the impact of non-clinical care on the clinical-mortality link in hospitals.