Pub Date : 2010-04-01DOI: 10.1136/qshc.2010.041624.81
A. Didier, Davis Eric, C. Richard, M. Franck
Background and objectives Education is a key component of the care of diabetic patients. Back in 1999 we set up a network for the management of diabetics which is centred on an out-of-hospital structured therapeutic patient education (TPE) programme Its main objective is to help improve the patient's state of health. Programme The TPE programme comprises three parts (a total of 27 h) and is implemented by trained professionals (doctors, dieticians, chiropodists, nurses) in an out-of-hospital setting. An external assessment using standards established by the French National Authority for Health (HAS) was performed from 2005 to 2007. Analysis focused on items in the patient's file (blood pressure (BP), glycated haemoglobin (HbA1c), LDL cholesterol), health professional and patient satisfaction surveys, a quality of life questionnaire (DHP 81), and reimbursements by French national health insurance. The data were compared to the results of the 2001 ENTRED study. Results The analysis concerned 268 patients with type 2 diabetes (mean age, 65.2 years; 55.2% male). The disease had been diagnosed on average 12.1 years earlier and 31.4% of patients were on insulin. There was no difference beween our population and the ENTRED population. The satisfaction score was 8.9/10 and 6.9/10 for network patients and professionals, respectively, versus 8.4/10 and 6.4/10, respectively, for ENTRED patients and professionals. The quality of life score was 6.7/81 versus 16.3/81 for ENTRED. Annual eye examinations were performed in 83.3% of network patients versus 66.9% of ENTRED patients. At least three HbA1c measurements were made in 71% of network patients versus 51.5% of ENTRED patients. Over the three parts, an HbA1c of <6.5% was found in an increasing proportion of network patients: 30.1% (part 1), 36.3% (part 2) and 42.6% (part 3), as was an LDL value of <1 g: 44.7% (part 1), 50.9% (part 2) and 62.4% (part 3). However, only 34.6% of network patients had a BP <130/80 that remained unchanged over time. The mean length of hospital stay was 12.1 days/patient in 15.6% of network patients versus 18.4 days/patient in 25.2% of ENTRED patients. The savings made by national health insurance (constant €) were 1088 €/patient/year, of which 252 € related to ambulatory pharmacy costs and 837 € to hospital expenditure. Network costs were 1107 €/patient/part. The cost of one satisfaction point per medical expense was 473.8 € in the network versus 499.8 € for ENTRED. The cost of one quality of life point per expense was 57.5 € in the network versus 64.9 € for ENTRED. Discussion and conclusion The impact of the network was highly positive with regard to patient satisfaction and quality of life but less so with regard to health professional satisfaction. Working within a network helps improve professional practices. The network provides educational value for patients independently of any care they receive and this can be translated into better clinical and biological test results. Th
背景与目的教育是糖尿病患者护理的重要组成部分。早在1999年，我们就建立了一个以院外结构化治疗性患者教育(TPE)项目为中心的糖尿病患者管理网络，其主要目标是帮助改善患者的健康状况。TPE方案包括三部分(共27小时)，由训练有素的专业人员(医生、营养师、足病医生、护士)在院外环境中实施。2005年至2007年，利用法国国家卫生局制定的标准进行了外部评估。分析的重点是患者档案中的项目(血压(BP)、糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇)、卫生专业人员和患者满意度调查、生活质量问卷(DHP 81)以及法国国民健康保险的报销。这些数据与2001年enterd研究的结果进行了比较。结果本组共纳入268例2型糖尿病患者，平均年龄65.2岁;55.2%的男性)。该疾病的平均诊断时间早12.1年，31.4%的患者接受胰岛素治疗。我们的人群和enterd人群之间没有差异。网络患者和专业人员的满意度分别为8.9/10和6.9/10，而ENTRED患者和专业人员的满意度分别为8.4/10和6.4/10。生活质量评分为6.7/81，而enterd组为16.3/81。83.3%的网络患者进行年度眼科检查，而66.9%的ENTRED患者进行年度眼科检查。71%的网络患者进行了至少三次HbA1c测量，而进入red的患者为51.5%。在这三个部分中，HbA1c <6.5%的网络患者比例增加:30.1%(第1部分)、36.3%(第2部分)和42.6%(第3部分)，LDL <1 g的比例增加:44.7%(第1部分)、50.9%(第2部分)和62.4%(第3部分)。然而，只有34.6%的网络患者的血压<130/80，并且随着时间的推移保持不变。15.6%的网络患者的平均住院时间为12.1天/患者，而25.2%的enterd患者的平均住院时间为18.4天/患者。国家健康保险(固定欧元)节省了1088欧元/病人/年，其中252欧元与流动药房费用有关，837欧元与医院支出有关。网络费用为1107欧元/病人/部分。在网络中，每笔医疗费用的一个满意点成本为473.8欧元，而在entre中为499.8欧元。在该网络中，每一笔支出的生活质量点成本为57.5欧元，而在entre中为64.9欧元。讨论和结论网络对患者满意度和生活质量的影响是高度积极的，但对卫生专业人员满意度的影响较小。在社交网络中工作有助于提高专业水平。该网络为患者提供了独立于他们接受的任何护理的教育价值，这可以转化为更好的临床和生物学测试结果。卫生经济学分析证实，该网络产生的支出被直接卫生支出方面的节省所抵消。我们研究的一个局限性是enterd研究有点过时。总之，独立于护理提供的教育支持是有效的。背景、目的对患者进行控制，使其成为多学科的患者，并使其成为必要的患者。dds 1999年的报告指出，“我不知道在什么地方，我的工作是在一个项目结构的中心，我的工作是在一个项目结构的中心，我的工作是在一个项目结构的中心，我的工作是在一个项目结构的中心，我的工作是在一个项目的中心，我的工作是在一个项目的中心，我的工作是在一个项目的中心，我的工作是在一个项目的中心。方案3:在3个周期内(27个周期)，在3个周期内(3个周期内)，在3个周期内(3个周期内)，在3个周期内(3个周期内)，在3个周期内(3个周期内)，在3个周期内(3个周期内)，在3个周期内(3个周期内)。一个评估走读生repondant上有referentiel de l有一个土耳其宫廷里面de fonctionnement 2005 2007 et diabetiques包括268名患者。L'analyse <s:1> port<s:1> sur les parpartres du档案(HTA,HbA1c, LDL)， de enquêtes de satisfaction professionnels et patients, unquestionnaire qualitest de life (DHP 81)， L'analyse des dsames rembourssames at L 'assurance maladie。从2001年开始，所有的薪金薪金都是由薪金薪金和薪金薪金组成的。2型(31.4%)为典型的胰岛素型(31.4%)。年龄最大的是65.2人(55.2%的人是老人)，年龄最大的是12.1人，年龄最大的是糖尿病患者。患者满意度评分为8.9/10，患者满意度为6.9/10，患者满意度为8.4/10，患者满意度为6.4/10。Le score qualit<s:1> de vie分别为6.7/81和16.3/81。71%的患者在接受3个剂量的糖化血红蛋白(hba1c)治疗后恢复正常，而51.5个剂量的患者恢复正常。83.3%对66.9%，而去年为66.9%。L’hba1c在三个周期内均表现良好，第1周期为30.1%，第2和第42周期为36.3%。 6%的人糖化血红蛋白< 6.5%。44. 7%的患者在第1周期LDL < 1 g/l，在第2和第3周期分别为50.9%和62.4%。相比之下，只有34.6%的网络患者ad < 130/80没有随时间变化。从经济角度来看，15.6%的网络患者住院12.1天/例，而糖尿病患者住院18.4天/例的比例为25.2%。与入院患者相比，健康保险节省的固定欧元为1088欧元/患者/年，其中门诊药房费用252欧元，医院费用837欧元。网络费用为1107欧元/患者/周期。在网络中，1个满意度点/医疗费用的成本为473.8欧元，而ENTRED的成本为499.8欧元。在网络中，1点生活质量/医疗费用的成本是57.5欧元，而ENTRED的成本是64.9欧元。讨论/结论网络护理对患者满意度和生活质量的影响非常积极，但对专业人员的影响较小。网络增强了专业实践，并展示了教育护理的价值，包括患者的临床和生物学结果。另一方面，ENTRED研究的比较参考可能有点过时。经济分析证实，该网络产生的支出被直接卫生支出的节省所抵消。独立于护理的教育护理证明了它的效率。
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Pub Date : 2010-04-01DOI: 10.1136/qshc.2010.041624.99
Bourgeois Maryline, C. B. Agnès, Pachot Monique, Galland Roula, Isabelle Shoenfelfer
Background and objectives Haemodialysis centres in France are being converted into “medicalised dialysis units” where the full-time presence of a physician is no longer required. This has prompted managers to ask questions about safety. Dialysis sessions require many nursing skills, in particular at the start of the session which is a critical phase because of the age of the patients (mean age, 73 years) and the number of comorbidities, and because of renal insufficiency symptoms such as hyperkalemia, salt and water overload, and fatigue. The use of a haemodialysis generator and extracorporeal circulation requires technical skills, and decoagulation and care of vascular access add to the risks. Our objective was to introduce a checklist for nurses that would help the nurse decide whether to start the dialysis session or not. Programme The checklist was built from the clinical processes and protocols currently used in the unit, such as those dealing with clinical situations where a physician should be called, patient monitoring during a dialysis session, and patient welcome. The checklist had to be short, simple, easy to use, and unambiguous. It was formatted in order to answer the question: “what must be checked before starting dialysis in order to ensure the safety of a dialysis session?” and included the following sections: reading the medical file and consulting data on earlier dialysis sessions, checking the generator setting and the physician's dialysis order, and clinical assessment of the patient. Each item of each section had to be ticked Yes or No. The presence of certain symptoms (ticked Yes) meant that the session could not start and a physician had to be called. The checklist was validated by all nephrologists and pilot tested for self-care dialysis in a small dialysis unit by experienced nurses. In September 2009, its use was extended to a new set of dialysis centres converted into medicalised dialysis units. The checklist is attached to the patient's monitoring record and signed by the nurse. Results The checklist was rapidly accepted by all the nurses and pleased physicians and patients. The clinical assessment of the patient reassured nurses, physicians and patients with regard to safety. Nurses completely changed their way of managing dialysis sessions, and transformed technical care of the dialysis patient into global care. After 2 months of checklist use, 137 checklists were reviewed. In 7% of cases a physician was called and in 22% of these cases some adaptation was required before the start of dialysis. In the absence of the physician, the nurse became the patient's main contact, thus completely changing the nurse's role throughout the dialysis session. The nurses even asked for checklist use to be extended to dialysis centres (where a nephrologist is on permanent duty). Conclusion The use of a checklist can enhance safety at the start of a dialysis session. Its use can better delineate the roles of physicians with regard to
背景和目的法国的血液透析中心正在转变为“医疗化透析单位”，不再需要医生的全职存在。这促使管理人员提出了有关安全的问题。透析需要许多护理技能，特别是在透析开始时，由于患者的年龄(平均年龄73岁)和合并症的数量，以及肾功能不全症状，如高钾血症、盐和水超载以及疲劳，这是一个关键阶段。使用血液透析发生器和体外循环需要一定的技术技能，而血管通路的解凝和护理也增加了风险。我们的目的是为护士介绍一份检查表，帮助护士决定是否开始透析疗程。该清单是根据该单位目前使用的临床流程和协议构建的，例如处理应该呼叫医生的临床情况，透析期间患者监护以及患者欢迎。检查表必须简短、简单、易于使用和明确。它的格式是为了回答这个问题:“为了确保透析疗程的安全，在开始透析之前必须检查什么?”，内容包括以下几个部分:阅读医疗档案和咨询早期透析疗程的数据，检查发电机设置和医生的透析命令，以及对患者的临床评估。每个部分的每一项都必须打上“是”或“否”。出现某些症状(勾选“是”)意味着会话不能开始，必须呼叫医生。检查表被所有的肾病学家验证，并在一个小的透析单位由经验丰富的护士进行自我护理透析的试点测试。2009年9月，它的使用范围扩大到一组由医疗透析单位改建的新透析中心。检查表附在病人的监护记录上，并由护士签名。结果该检查表很快被所有护士接受，医生和病人都很满意。患者的临床评估使护士、医生和患者对安全性放心。护士完全改变了他们管理透析疗程的方式，并将透析患者的技术护理转变为全球护理。使用检查表2个月后，共审查了137份检查表。在7%的病例中，医生被召唤，其中22%的病例在透析开始前需要进行一些适应。在医生缺席的情况下，护士成为患者的主要联系人，从而完全改变了护士在整个透析过程中的角色。护士们甚至要求将检查表的使用范围扩大到透析中心(那里有一名肾病专家长期值班)。结论在透析开始时使用检查表可以提高安全性。它的使用可以更好地描述医生在各自能力方面的角色，并提高透析的质量。透析患者尤其欣赏这一点。变性，变性，变性，变性，变性，变性，变性，变性，变性，变性，变性，变性，变性，变性，变性。因此，即使是在一个中心，也会有一些重要的变化，例如:在一个中心，也就是在一个中心，也就是在一个中心，也就是在一个中心，也就是在一个中心，也就是在一个中心，也就是在一个中心。L' hsammodialyse requirede nombreuses compacmes。La phase initiale de branicement pet être qualifisamente de psamade critique car - La dialyse address:患者不患有moyenne d'age est de 73 ans, pressiente de nombreuses共发病的samoente de nombreuses合并发病的samoente ' susuffisance ssamenale:高钾型samoise，过量氢氧化钠型samoise，疲劳。利用体外循环，体外注射，体外循环，体外循环，体外循环，体外循环，体外循环，体外循环，体外循环，体外循环，体外循环，体外循环，体外循环，体外循环，体外循环，体外循环D'où la crcrationation D 'une check-list pour l'accueil du patient en UDM，渗透率l' infirmiire D 'autoriser for non - le branch。例如，当一个简单、快速、方便地使用一个简单、快速、方便的使用一个简单、快捷、方便的使用一个简单、快捷、方便的使用一个简单、快捷、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用一个简单、方便的使用。 模型的构建是基于以下问题:“在开始安全透析之前，需要检查哪些重要元素?”因此，我们选择了以下几点:阅读患者传输，检查发电机电路，阅读透析表，检查患者透析处方，患者的临床评估。其中一些项目在不同的地方进行了详细说明。每一个都需要一个复选框:是/否。关于最后一点，根据是否存在某些症状规定了应采取的行动。如果一个项目被选中“是”并提交给医生，连接将被延迟。经过医疗团队的验证，它最初由在UDM和自体透析中工作的护士进行了测试，然后于2009年9月在新的UDM系列中引入。它与患者的透析监测表相关联，并与会话参数一起存档。它是提名的，并由ide签署。检查表很快就被团队整合了。关于病人临床评估的部分从一开始就令人放心。通过这种方式，护士们加强了对病人整体护理的参与。我们评估了该工具使用2个月的情况，发现在137份完成的检查表中，7%的检查表导致医生打电话，22%的检查表导致透析前处方改变。其他症状，特别是消化不良，也被传播，并导致处方的调整。由于医生的缺席，护士成为病人的特权对话者。现在，患者将任何临床进展或会期间事件传递给她。在一个非常技术性的环境中，我们还发现这种评估，在UDM中正式为患者进行，成为所有患者的临床方法。因此，对患者进行系统的临床评估，可以针对以前没有系统分析的重要症状。检查表是确保UDM患者连接安全的一种方法，因为它构建了透析的关键阶段。让病人放心，它重视护士在医生中的作用，并允许优化透析护理。
{"title":"158 The development and implementation of a checklist in dialysis units","authors":"Bourgeois Maryline, C. B. Agnès, Pachot Monique, Galland Roula, Isabelle Shoenfelfer","doi":"10.1136/qshc.2010.041624.99","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.99","url":null,"abstract":"Background and objectives Haemodialysis centres in France are being converted into “medicalised dialysis units” where the full-time presence of a physician is no longer required. This has prompted managers to ask questions about safety. Dialysis sessions require many nursing skills, in particular at the start of the session which is a critical phase because of the age of the patients (mean age, 73 years) and the number of comorbidities, and because of renal insufficiency symptoms such as hyperkalemia, salt and water overload, and fatigue. The use of a haemodialysis generator and extracorporeal circulation requires technical skills, and decoagulation and care of vascular access add to the risks. Our objective was to introduce a checklist for nurses that would help the nurse decide whether to start the dialysis session or not. Programme The checklist was built from the clinical processes and protocols currently used in the unit, such as those dealing with clinical situations where a physician should be called, patient monitoring during a dialysis session, and patient welcome. The checklist had to be short, simple, easy to use, and unambiguous. It was formatted in order to answer the question: “what must be checked before starting dialysis in order to ensure the safety of a dialysis session?” and included the following sections: reading the medical file and consulting data on earlier dialysis sessions, checking the generator setting and the physician's dialysis order, and clinical assessment of the patient. Each item of each section had to be ticked Yes or No. The presence of certain symptoms (ticked Yes) meant that the session could not start and a physician had to be called. The checklist was validated by all nephrologists and pilot tested for self-care dialysis in a small dialysis unit by experienced nurses. In September 2009, its use was extended to a new set of dialysis centres converted into medicalised dialysis units. The checklist is attached to the patient's monitoring record and signed by the nurse. Results The checklist was rapidly accepted by all the nurses and pleased physicians and patients. The clinical assessment of the patient reassured nurses, physicians and patients with regard to safety. Nurses completely changed their way of managing dialysis sessions, and transformed technical care of the dialysis patient into global care. After 2 months of checklist use, 137 checklists were reviewed. In 7% of cases a physician was called and in 22% of these cases some adaptation was required before the start of dialysis. In the absence of the physician, the nurse became the patient's main contact, thus completely changing the nurse's role throughout the dialysis session. The nurses even asked for checklist use to be extended to dialysis centres (where a nephrologist is on permanent duty). Conclusion The use of a checklist can enhance safety at the start of a dialysis session. Its use can better delineate the roles of physicians with regard to ","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"72 6 1","pages":"A145 - A146"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84724047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041624.65
M. Baudet, C. Daugareil, M. Bucau, S. Caspar-Bauguil, P. Hericotte
Background Cardiovascular disease resulting from atherosclerosis is influenced by lifestyle choices including smoking, lack of physical activity, unhealthy diet and obesity. Objectives The global treatment of patients with acute coronary syndrome (ACS) requires modification of their lifestyle. Methods Eight hundred and eighty-six patients exhibiting this syndrome received consultations with a therapeutic education (TE) nurse, aiming to decrease their risk factors and to modify their dietary habits. The initial consultation gathers information on six principal risk factors and 15 dietary habits. Our unit has developed a software program which gives each answer either a positive digital score if those factors lead to increased atherosclerosis or a negative score if those factors protect against the disease. In order to evaluate the biological impact of the TE dietary advises which reproduce the recommendations currently accepted, fatty acid composition in erythrocyte membrane phospholipids was determined in another group of 71 patients with ACS, upon arrival in intensive coronary care and again 1 year after TE. Results Patient outcome was compared for those who were followed regularly in voluntary Therapeutic Education consultations (Group 1, n=285) and those who were not (Group 2, n=593), with a median follow-up of 40 months. Eight patients left the program. The 285 patients of Group I were seen every 6 months in consultation; progress was observed, not only for the control of risk factors (the score decreased from 6.3 to 4.5, p<0.001) but also for their dietary habits (the score decreased from 1.5 to−7.1, p<0.001). Compared to Group 2, Group 1 patients had less cardiovascular events including death (43 patients with event vs 172, p<0.001), or other events linked to atherosclerosis (34 vs 121, p<0.01) with fewer hospitalisations for cardiovascular events (41 vs 161, p<0.001). In reference to total fatty acids, EPE+DHA increased from 6.24%+/-6.51 to 7.67%+/−1.67 (p<0.05), oleic acid increased from 14.45%+/−1.08 to 15.26%+/−1.06 (p<0.05), total saturated acids decreased from 40.68%+/−1.53 to 39.97%+/−1.63 (p<0.05) and pro-inflammation ratios n−6/n−3 and Arachidonic Acid/EPA+DHA decreased respectively from 4.14+/−1 to 3.27+/−0.70 (p<0.05) and from 3.02+/−0.93 to 2.41+/−0.84 (p<0.05). Conclusion In ‘real life’ and in addition to randomised studies: (1) lifestyle, including cardiovascular risk factors and risky dietary habits which participated in the onset of ACS, may be improved by TE (2) prognosis is simultaneously improved (3) the TE dietary recommendations produce erythrocyte membrane modifications which protect against cardiovascular disease. Contexte Les maladies cardiovasculaires secondaires à l'athérosclérose sont influencées par une mauvaise hygiène de vie incluant tabagisme, sédentarité, mauvaises habitudes alimentaires et obésité. Objectifs La prise en charge globale des patients ayant eu un syndrome coronaire aigu (SCA) nécessite
{"title":"240 Lifestyle modification by therapeutic education improves the prognosis of acute coronary syndrome and the distribution of fatty acids in erythrocyte membranes","authors":"M. Baudet, C. Daugareil, M. Bucau, S. Caspar-Bauguil, P. Hericotte","doi":"10.1136/QSHC.2010.041624.65","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.65","url":null,"abstract":"Background Cardiovascular disease resulting from atherosclerosis is influenced by lifestyle choices including smoking, lack of physical activity, unhealthy diet and obesity. Objectives The global treatment of patients with acute coronary syndrome (ACS) requires modification of their lifestyle. Methods Eight hundred and eighty-six patients exhibiting this syndrome received consultations with a therapeutic education (TE) nurse, aiming to decrease their risk factors and to modify their dietary habits. The initial consultation gathers information on six principal risk factors and 15 dietary habits. Our unit has developed a software program which gives each answer either a positive digital score if those factors lead to increased atherosclerosis or a negative score if those factors protect against the disease. In order to evaluate the biological impact of the TE dietary advises which reproduce the recommendations currently accepted, fatty acid composition in erythrocyte membrane phospholipids was determined in another group of 71 patients with ACS, upon arrival in intensive coronary care and again 1 year after TE. Results Patient outcome was compared for those who were followed regularly in voluntary Therapeutic Education consultations (Group 1, n=285) and those who were not (Group 2, n=593), with a median follow-up of 40 months. Eight patients left the program. The 285 patients of Group I were seen every 6 months in consultation; progress was observed, not only for the control of risk factors (the score decreased from 6.3 to 4.5, p<0.001) but also for their dietary habits (the score decreased from 1.5 to−7.1, p<0.001). Compared to Group 2, Group 1 patients had less cardiovascular events including death (43 patients with event vs 172, p<0.001), or other events linked to atherosclerosis (34 vs 121, p<0.01) with fewer hospitalisations for cardiovascular events (41 vs 161, p<0.001). In reference to total fatty acids, EPE+DHA increased from 6.24%+/-6.51 to 7.67%+/−1.67 (p<0.05), oleic acid increased from 14.45%+/−1.08 to 15.26%+/−1.06 (p<0.05), total saturated acids decreased from 40.68%+/−1.53 to 39.97%+/−1.63 (p<0.05) and pro-inflammation ratios n−6/n−3 and Arachidonic Acid/EPA+DHA decreased respectively from 4.14+/−1 to 3.27+/−0.70 (p<0.05) and from 3.02+/−0.93 to 2.41+/−0.84 (p<0.05). Conclusion In ‘real life’ and in addition to randomised studies: (1) lifestyle, including cardiovascular risk factors and risky dietary habits which participated in the onset of ACS, may be improved by TE (2) prognosis is simultaneously improved (3) the TE dietary recommendations produce erythrocyte membrane modifications which protect against cardiovascular disease. Contexte Les maladies cardiovasculaires secondaires à l'athérosclérose sont influencées par une mauvaise hygiène de vie incluant tabagisme, sédentarité, mauvaises habitudes alimentaires et obésité. Objectifs La prise en charge globale des patients ayant eu un syndrome coronaire aigu (SCA) nécessite","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"24 1","pages":"A113 - A113"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81714884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041624.89
Noubel Julien, Mercier Patricia, Dumont François
Objectives The GPSPB a Network of Health Professionals in the Beaune Area is a primary care network created February 2002. It covers a population of over 77,000 people and gathers together 123 health professionals. One of the health priorities of the network concerns diabetes. The aim of the study was to evaluate the overall satisfaction of patients with the diabetes care they receive and to measure the medico-economic impact of coordinated care (GPs, dieticians and podiatrists). Program To follow-up satisfaction questionnaires sent to patients with diabetes who applied to the GPSPB from April 2006 to the end of December 2007 (48 people). To study the evolution of relevant biomedical data (HbA1c, LDL, BMI) to assess the efficacy of care in 52 patients with type 2 diabetes from April 2006 to May 2008. To compare diabetic patients managed by the GPSPB with other diabetic patients in Côte d'Or in terms of quantitative data supplied by the national health insurance system for services provided between June 2008 to May 2009. This comparison includes all costs incurred by these patients. Résults Sixty-two percent of patients responded to the questionnaire, and overall the level of satisfaction was high, particularly regarding the combined dietetics and podiatry consultation. Most diabetic patients were stabilised or had seen improvements in their results over this period of time. There was a significant decrease in LDL (−0.16 g/l), p<0.01. The decreases in BMI (−3.73 kg/m2) and HbA1c (−0.43%), however, were not significant. In the study period, the average cost for a GPSPB diabetic patient was 9,812 Euros while the average cost for a Côte-d'Or diabetic patient was 13,592. The savings of 3780 Euros per patient was mainly due to reduced costs for hospitalisation, transport and income replacement. GPSPB diabetics, however, incur higher costs for paramedical services. Conclusion This study shows that in chronic diseases such as type 2 diabetes, it is possible to improve management of patients thanks to the creation of more efficient patient-centered care networks, with the coordinated intervention of different health professionals; the GPSPB is such a network. Patients seem satisfied with the additional support offered by the network. Even though there were few patients in the study, we observed an improvement in their biomedical data over two years with non-significant decreases in HbA1c and BMI, and a significant decrease in LDL. It has also shown the impact of the network in the reduction of health care costs. More research is necessary to determine whether this type of care organisation modifies the incidence of morbidity and mortality in this population, and whether these results persist in the long term. Prise en charge des patients diabétiques dans un groupement interprofessionnel de santé territorial. Evaluation de 52 patients du Groupement des Professionnels de Santé du Pays Beaunois. Objectif(s), Contexte Le Groupement des Professionnels de
GPSPB -博恩地区保健专业人员网络是2002年2月创建的初级保健网络。它覆盖了7.7万多人口，聚集了123名卫生专业人员。该网络的健康重点之一与糖尿病有关。该研究的目的是评估糖尿病患者对他们接受的护理的总体满意度，并衡量协调护理(全科医生、营养师和足科医生)的医学经济影响。项目对2006年4月至2007年12月底申请GPSPB的糖尿病患者(48人)进行满意度问卷跟踪调查。研究2006年4月~ 2008年5月52例2型糖尿病患者的相关生物医学数据(HbA1c、LDL、BMI)的变化，评价护理效果。比较GPSPB管理的糖尿病患者与Côte d'Or的其他糖尿病患者，根据2008年6月至2009年5月国民健康保险系统提供的服务提供的定量数据。这一比较包括了这些患者所发生的所有费用。调查结果:62%的患者回答了问卷，总体满意度很高，特别是关于营养和足部咨询的综合满意度。在这段时间里，大多数糖尿病患者的病情稳定下来，或者病情有所改善。LDL显著降低(- 0.16 g/l)， p<0.01。然而，BMI (- 3.73 kg/m2)和HbA1c(- 0.43%)的下降并不显著。在研究期间，GPSPB糖尿病患者的平均费用为9812欧元，而Côte-d'Or糖尿病患者的平均费用为13592欧元。每名病人节省了3780欧元，主要是由于住院、交通和替代收入的费用减少。然而，GPSPB糖尿病患者需要支付更高的辅助医疗服务费用。结论本研究表明，在2型糖尿病等慢性疾病中，通过不同卫生专业人员的协调干预，建立更有效的以患者为中心的护理网络，可以改善患者的管理;GPSPB就是这样一个网络。患者似乎对网络提供的额外支持感到满意。尽管研究中的患者很少，但我们观察到他们的生物医学数据在两年内有所改善，HbA1c和BMI无显著下降，LDL显著下降。它还显示了网络在降低保健费用方面的影响。需要更多的研究来确定这种类型的护理组织是否改变了这一人群的发病率和死亡率，以及这些结果是否长期存在。负责病人的组织和组织、跨专业人员和地区人员。博诺瓦圣皮埃尔专业小组对52例患者的评价。目的(5)，2002年3月，在全国范围内，对全国范围内的青年青年和青年青年进行了调查。这将使1万人口加上77000名居民，重新组合123名专业人员。一项关于糖尿病患者的优先事项。它是" agit d' samvaluer cheles patients, diabetacementes, diabetacementes, lesatisfaction global "和" memeer 'impact "，即" sametacementes, disametacementes, disametacementes, codologues "。方案编制了问卷调查、满意度调查、患者和患者的满意度调查(2006年4月)、社会福利和社会福利局(2007年11月)和财务调查(48人)。在2006年4月至2008年5月期间，对52例患有2型糖尿病的患者进行了研究，分析了他们的健康状况。Comparaison de juin 2008梅2009 des数据数字de l 'assurance疾病患者les diabetiques du GPSPB之间的关联性病人diabetiques de科多尔。我们比较了这两种不同的情况。在调查问卷中，有62%的受访者表示，在全球范围内，对个人和企业的满意度保持不变，特别是对个人和企业的满意度保持不变，对个人和企业的满意度保持不变。laplpart des patients, diabetys, diabetys, stabilisys, samsamo, samsamo, samsamo，与leleprise, en charge sur, ette psamade有关。此外，imc (- 3,73 Kg/m2)和hba1c(- 0,43%)均有显著降低。相反，平均p< 0.01，将存在一个显著减少的LDLc (- 0.16 g/l)。苏尔la里面有d 'etude平均cout d一个病人diabetique du GPSPB是德那么9 812欧元,平均cout d一个病人diabetique de科多尔是德13 592欧元。380欧元/病人:所有的医疗、交通和替代收入等部门都恢复了正常工作。 GPSPB糖尿病患者需要更多的医疗辅助费用。缔结这项研究可以证明对2型糖尿病等慢性病,可以有更好的照顾病人,多亏了一个更加出色病人为中心的护理组织和协调与各专业医疗人员:这正是GPSPB所建议的那样。患者似乎对该组织提供的额外护理感到满意。即使在研究中只有少数患者，他们的生物医学数据也有改善，两年内糖化血红蛋白、bmi和LDLc显著下降。此外，还证明了所采用的方法的效率。问题是，这种管理是否会改变这一人群的发病率和死亡率，以及这些结果是否会在更长的时间内恢复。
{"title":"233 Diabetic care in a network of health professionals in the beaune area","authors":"Noubel Julien, Mercier Patricia, Dumont François","doi":"10.1136/QSHC.2010.041624.89","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.89","url":null,"abstract":"Objectives The GPSPB a Network of Health Professionals in the Beaune Area is a primary care network created February 2002. It covers a population of over 77,000 people and gathers together 123 health professionals. One of the health priorities of the network concerns diabetes. The aim of the study was to evaluate the overall satisfaction of patients with the diabetes care they receive and to measure the medico-economic impact of coordinated care (GPs, dieticians and podiatrists). Program To follow-up satisfaction questionnaires sent to patients with diabetes who applied to the GPSPB from April 2006 to the end of December 2007 (48 people). To study the evolution of relevant biomedical data (HbA1c, LDL, BMI) to assess the efficacy of care in 52 patients with type 2 diabetes from April 2006 to May 2008. To compare diabetic patients managed by the GPSPB with other diabetic patients in Côte d'Or in terms of quantitative data supplied by the national health insurance system for services provided between June 2008 to May 2009. This comparison includes all costs incurred by these patients. Résults Sixty-two percent of patients responded to the questionnaire, and overall the level of satisfaction was high, particularly regarding the combined dietetics and podiatry consultation. Most diabetic patients were stabilised or had seen improvements in their results over this period of time. There was a significant decrease in LDL (−0.16 g/l), p<0.01. The decreases in BMI (−3.73 kg/m2) and HbA1c (−0.43%), however, were not significant. In the study period, the average cost for a GPSPB diabetic patient was 9,812 Euros while the average cost for a Côte-d'Or diabetic patient was 13,592. The savings of 3780 Euros per patient was mainly due to reduced costs for hospitalisation, transport and income replacement. GPSPB diabetics, however, incur higher costs for paramedical services. Conclusion This study shows that in chronic diseases such as type 2 diabetes, it is possible to improve management of patients thanks to the creation of more efficient patient-centered care networks, with the coordinated intervention of different health professionals; the GPSPB is such a network. Patients seem satisfied with the additional support offered by the network. Even though there were few patients in the study, we observed an improvement in their biomedical data over two years with non-significant decreases in HbA1c and BMI, and a significant decrease in LDL. It has also shown the impact of the network in the reduction of health care costs. More research is necessary to determine whether this type of care organisation modifies the incidence of morbidity and mortality in this population, and whether these results persist in the long term. Prise en charge des patients diabétiques dans un groupement interprofessionnel de santé territorial. Evaluation de 52 patients du Groupement des Professionnels de Santé du Pays Beaunois. Objectif(s), Contexte Le Groupement des Professionnels de","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"17 1","pages":"A135 - A136"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80554538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041624.40
S. Jerome, Ducloy Jean-Claude, Bailleux Bernard, E. Anne, S. Philippe, D. Anne-sophie
Introduction Post-partum haemorrhage (PPH) remains the leading cause of maternal morbidity and mortality in France and worldwide. PPH can occur in any parturient. Perinatal care network is defined as a practioners’ and women's hospitals’ association organising mother and child management around the birth period. The aim of our medical practice improvement program (MPIP) was to standardise the management of PPH in every women hospital of the network according to the French guidelines.1 The aim of the study was to measure the impact of the MPIP on PPH-related morbidity.2 Program The MPIP created a common management guideline and critical care chart resulting from the chart of each of the 11 low risk women's hospitals. These guidelines included initial aggressive and timed management of the uterine tone, vascular and coagulation resuscitation. The critical care chart included three sections: the first one was the graduated timed common chart (poster and verso of the data collection paper support); the second is the intensive care data collection paper support; the third one is the prevention chart poster for high risk patients. Five training teams performed educational program for midwives, paramedics and medical doctors. Impact of the MPIP was measured by the haemorrhage-related morbidity of the transferred patients in 2006 after MPIP versus 2004 before MPIP. Collected data was the adequacy of the management to the protocol and PPH-related morbidity indicators. Results The results are described in Abstract 041 table 1. Despite the limited number of cases, it can be observed a trend for better detection of PPH (0.88% to 1.25%) and for better and more rapid management of PPH in the primary care units. When PPH became so severe that ICU transfer is indicated, no more hemorrhagic shock had been noted after MPIP. Red blood cells transfusion, procoagulant treatment and embolisation are less required in the tertiary care unit leading to quicker discharge from obstetrics ICU. Abstract 041 Table 1 Comparison of the severe PPH management and related morbidity before and afer MPIP 2004 before MPIP 2006 after MPIP p Deliveries (Low risk) 21373 20 619 NA PPH 189 259 0.26 Transfer to obstetrics ICU 16 13 0.004 Transfer delay (min) 205 (90–300) 158 (60–270) 0.001 Haemorrhagic shock 5 0 0.001 Transfusion 5 2 0.05 Procoagulant complement 9 4 0.10 Uterine A embolisation 7 2 0.26 Discharge after 12 h from the obstetrics ICU 11/16 12/13 NS Improving the obstetrics care at the nearest of the patient could be the new challenge for maternal risk management as suspected in ICM and FIGO joint guidelines3 and in the French perinatal networks study.4 Intractable obstetrics haemorrhage mortality can be reduced by a tertiary care safety programimproving management of patients at high risk of HPP.5 Any delay or indecision in PPH primary care management contributes to the severity of the disease and to maternal morbidity, despite adequate secondary obstetrics ICU. Perinatal netw
产后出血(PPH)仍然是法国和全世界孕产妇发病和死亡的主要原因。PPH可发生于任何产妇。围产期护理网络被定义为医生和妇女医院在分娩期间组织母婴管理的协会。我们的医疗实践改进计划(MPIP)的目的是根据法国指南规范网络中每个妇女医院的PPH管理本研究的目的是测量MPIP对pph相关发病率的影响方案MPIP根据11家低风险妇女医院的图表制定了共同的管理指南和重症监护图表。这些指导方针包括子宫张力的初始积极和定时管理，血管和凝血复苏。重症监护图表包括三部分:第一部分为分级计时公共图表(资料收集纸的海报和反面支持);二是重症监护资料收集论文支持;第三张是高危患者的预防图表海报。五个培训小组为助产士、护理人员和医生执行了教育方案。MPIP的影响是通过2006年MPIP后与2004年MPIP前转移患者的出血相关发病率来衡量的。收集的数据是管理方案的充分性和pph相关的发病率指标。研究结果见摘要041表1。尽管病例数量有限，但可以观察到更好的PPH检测趋势(0.88%至1.25%)，以及在初级保健单位更好和更快速地管理PPH。当PPH严重到需要转至ICU时，MPIP后不再出现失血性休克。在三级护理病房，红细胞输血、促凝剂治疗和栓塞的要求较低，可以更快地从产科ICU出院。文摘041表1比较严重、管理及相关的发病率前和后经过MPIP 2004 2006年MPIP之前MPIP p交付(低风险)21373 189 259 619 NA PPH 0.26转到产科ICU 16 13 0.004传输延迟(min) 205(90 - 300) 158(60 - 270) 0.001出血休克5 0 0.10 0.001输血5 2 0.05促凝血的补9 4子宫embolisation 7 2 0.26放电12 h的产科ICU 11/16 12/13 NS提高产科护理ICM和FIGO联合指南以及法国围产期网络研究都怀疑，离患者最近可能是产妇风险管理的新挑战难治性产科出血死亡率可以通过三级医疗安全计划来降低，该计划改善了PPH高风险患者的管理。5尽管有足够的二级产科ICU，但PPH初级医疗管理的任何延误或优柔寡断都会导致疾病的严重程度和孕产妇发病率。围产期网络培训计划是感兴趣的初级单位。埃及在1990年代实施的全国安全孕产方案扭转了地区护理不达标的局面，使这些地区的产妇死亡率降低了52%在围产期护理网络规模上，医疗实践改进计划导致PPH的初始积极管理可以避免演变为严重的孕产妇发病率。它可以是发达国家和发展中国家的公共卫生项目。导语产后康复(HPP)是法国产后康复的主要原因，也是世界的主要原因。Elle peut survenchez toute parturiente même认为，<s:1> <s:1> risque。Les resimseaux de soins psamintal重组Les professionnels en charge de la santeer de la m<e:1> et de l'enfant。1 .计划的目标和计划的目标和计划的目标和计划的目标和计划的目标和计划的目标、计划的目标和计划的目标、计划的目标和计划的目标、计划的目标和计划的目标、计划的目标和计划的目标、计划的目标、计划的目标、计划的目标、计划的目标、计划的目标、计划的目标、计划的目标、计划的目标、计划的目标、计划的目标和计划的目标综合方案:11个母亲的薪金和三个文件的薪金交换方案:一份薪金、一份薪金和一份薪金交换文件。根据协议规定，所有的人都有自己的生活方式，包括:从个人的生活方式、从母亲的生活方式、从母亲的生活方式、从母亲的生活方式、从母亲的生活方式。五种不同的<s:1> <s:1> <s:2> <s:2> <s:2> <s:2>的<s:1> <s:1> <s:2> <s:2>的- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -L'impact de L' epp的测量，par L' cima de la PEC et de la morbidit<e:1>， chez les patients(患者)，将HPP和HPP之间的<s:1>持续障碍(soins continuous)障碍(USIO)相比较，2006 aprres L' epp与2004 avant epp。恶性肿瘤患者中，未观察到的患者中，有1例患者出现了恶性肿瘤，1例患者出现了恶性肿瘤，1例患者出现了恶性肿瘤，1例患者出现了恶性肿瘤。
{"title":"041 Impact of perinatal care network improvement program on post-partum hemorrhage–related morbidity","authors":"S. Jerome, Ducloy Jean-Claude, Bailleux Bernard, E. Anne, S. Philippe, D. Anne-sophie","doi":"10.1136/QSHC.2010.041624.40","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.40","url":null,"abstract":"Introduction Post-partum haemorrhage (PPH) remains the leading cause of maternal morbidity and mortality in France and worldwide. PPH can occur in any parturient. Perinatal care network is defined as a practioners’ and women's hospitals’ association organising mother and child management around the birth period. The aim of our medical practice improvement program (MPIP) was to standardise the management of PPH in every women hospital of the network according to the French guidelines.1 The aim of the study was to measure the impact of the MPIP on PPH-related morbidity.2 Program The MPIP created a common management guideline and critical care chart resulting from the chart of each of the 11 low risk women's hospitals. These guidelines included initial aggressive and timed management of the uterine tone, vascular and coagulation resuscitation. The critical care chart included three sections: the first one was the graduated timed common chart (poster and verso of the data collection paper support); the second is the intensive care data collection paper support; the third one is the prevention chart poster for high risk patients. Five training teams performed educational program for midwives, paramedics and medical doctors. Impact of the MPIP was measured by the haemorrhage-related morbidity of the transferred patients in 2006 after MPIP versus 2004 before MPIP. Collected data was the adequacy of the management to the protocol and PPH-related morbidity indicators. Results The results are described in Abstract 041 table 1. Despite the limited number of cases, it can be observed a trend for better detection of PPH (0.88% to 1.25%) and for better and more rapid management of PPH in the primary care units. When PPH became so severe that ICU transfer is indicated, no more hemorrhagic shock had been noted after MPIP. Red blood cells transfusion, procoagulant treatment and embolisation are less required in the tertiary care unit leading to quicker discharge from obstetrics ICU. Abstract 041 Table 1 Comparison of the severe PPH management and related morbidity before and afer MPIP 2004 before MPIP 2006 after MPIP p Deliveries (Low risk) 21373 20 619 NA PPH 189 259 0.26 Transfer to obstetrics ICU 16 13 0.004 Transfer delay (min) 205 (90–300) 158 (60–270) 0.001 Haemorrhagic shock 5 0 0.001 Transfusion 5 2 0.05 Procoagulant complement 9 4 0.10 Uterine A embolisation 7 2 0.26 Discharge after 12 h from the obstetrics ICU 11/16 12/13 NS Improving the obstetrics care at the nearest of the patient could be the new challenge for maternal risk management as suspected in ICM and FIGO joint guidelines3 and in the French perinatal networks study.4 Intractable obstetrics haemorrhage mortality can be reduced by a tertiary care safety programimproving management of patients at high risk of HPP.5 Any delay or indecision in PPH primary care management contributes to the severity of the disease and to maternal morbidity, despite adequate secondary obstetrics ICU. Perinatal netw","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"148 1","pages":"A86 - A87"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77830243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/qshc.2010.041624.76
C. Mouchoux, S. Touzet, C. Colin, M. Lépine, C. Goubier-Vial, S. Wesolowski
Background Venous thromboembolism and the prevention of thromboembolic risk during atrial fibrillation are two main indications for vitamin K antagonist (VKA) therapy in elderly patients. Due to the high risk of haemorrhages, prescribing a VKA treatment requires complying with practice guidelines. Furthermore, medical treatment of excess dosage must be adapted in order to minimise the risk of haemorrhage and thrombosis. This study aimed to assess the impact of intervention program on prescription of VKAs and medical treatment of excess dosage at a healthcare facility fir the elderly. Method A ‘before/after’ study was conducted at a 632-bed geriatric. All patients treated with VKAs were included and followed-up for a period of 2 months. The program assessed composed of two interventions. The first intervention, aiming to improve prescription practices, was based on the distribution of a guideline for VKAs treatment adapted to geriatric care and the local context. The three steps in conception these practices guidelines were: 1/in-depth bibliographical research by all physicians at the facility, followed by selection of pertinent references; 2/writing by a pharmacist and a physician; and 3/proofreading, correction and approval by all of the prescribing staff at the facility. After it was approved, the prescribing guidelines for VKA treatment was presented at an institutional meeting and then distributed at each physician and pharmacist and each care unit. The second intervention, aiming to improve treatment of excess dosage, was based on an oral presentation of recommendations for treatment of excess dosage by pharmacist. Results One hundred and ten and 115 patients were enrolled respectively before and after implementation of the intervention program. Implementation of the practices guidelines resulted in a significant increase in the prescription rate of warfarin (8% vs 40%, p<0.001) and a significant decrease rate of acenocoumarol (21% vs 6%, p<0.01). The incidence of excess dosage (6.4% vs 2.6%, p>0.05) decreased between the two phases of the study. Medical treatment of the excess dosage was wrong with recommendations during the first phase of the study and did not change during the second phase. Discussion—conclusion The intervention program implemented at the facility resulted in a concrete, nearly immediate change in prescription practices, primarily concerning the choice of molecule. However, according to our analysis, the two interventions did have not the same impact on prescription practices and treatment of excess dosage. An ‘active’ intervention, such a conception of local guideline for VKAs treatment, has a greater impact than the oral presentation of guidelines for treating excess dosage. In order to improve the safety of VKA treatment in elderly, the improvement in prescription practices must be continued by means of enhancement: Training and awareness programs and tracking changes in practices: implementation of indicators. Context
{"title":"257 Impact of intervention program on vitamin K antagonist prescription practices in elderly patients","authors":"C. Mouchoux, S. Touzet, C. Colin, M. Lépine, C. Goubier-Vial, S. Wesolowski","doi":"10.1136/qshc.2010.041624.76","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.76","url":null,"abstract":"Background Venous thromboembolism and the prevention of thromboembolic risk during atrial fibrillation are two main indications for vitamin K antagonist (VKA) therapy in elderly patients. Due to the high risk of haemorrhages, prescribing a VKA treatment requires complying with practice guidelines. Furthermore, medical treatment of excess dosage must be adapted in order to minimise the risk of haemorrhage and thrombosis. This study aimed to assess the impact of intervention program on prescription of VKAs and medical treatment of excess dosage at a healthcare facility fir the elderly. Method A ‘before/after’ study was conducted at a 632-bed geriatric. All patients treated with VKAs were included and followed-up for a period of 2 months. The program assessed composed of two interventions. The first intervention, aiming to improve prescription practices, was based on the distribution of a guideline for VKAs treatment adapted to geriatric care and the local context. The three steps in conception these practices guidelines were: 1/in-depth bibliographical research by all physicians at the facility, followed by selection of pertinent references; 2/writing by a pharmacist and a physician; and 3/proofreading, correction and approval by all of the prescribing staff at the facility. After it was approved, the prescribing guidelines for VKA treatment was presented at an institutional meeting and then distributed at each physician and pharmacist and each care unit. The second intervention, aiming to improve treatment of excess dosage, was based on an oral presentation of recommendations for treatment of excess dosage by pharmacist. Results One hundred and ten and 115 patients were enrolled respectively before and after implementation of the intervention program. Implementation of the practices guidelines resulted in a significant increase in the prescription rate of warfarin (8% vs 40%, p<0.001) and a significant decrease rate of acenocoumarol (21% vs 6%, p<0.01). The incidence of excess dosage (6.4% vs 2.6%, p>0.05) decreased between the two phases of the study. Medical treatment of the excess dosage was wrong with recommendations during the first phase of the study and did not change during the second phase. Discussion—conclusion The intervention program implemented at the facility resulted in a concrete, nearly immediate change in prescription practices, primarily concerning the choice of molecule. However, according to our analysis, the two interventions did have not the same impact on prescription practices and treatment of excess dosage. An ‘active’ intervention, such a conception of local guideline for VKAs treatment, has a greater impact than the oral presentation of guidelines for treating excess dosage. In order to improve the safety of VKA treatment in elderly, the improvement in prescription practices must be continued by means of enhancement: Training and awareness programs and tracking changes in practices: implementation of indicators. Context","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"63 1","pages":"A123 - A124"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90763660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041608.23
A. Ricard-Hibon, T. Ariski, S. Guéant, J. Borel-Kühner, M. Cauterman, M. Raphael
Background and Objectives The objective is (1) to assess pain management in emergency services (ES) and (2) to assess the impact of quality improvement measures. Program A quality assurance process was developed and implemented by 50 French emergency services (ES) based in teaching, public, private and military hospitals. An initial retrospective audit of medical charts (T0) allowed development of quality initiatives and prospective evaluation of their impact at three monthly intervals (T1 and T2). For each ES, 50 medical charts were randomly selected. Inclusion criteria were: all patients aged ≥15 years old presenting to the ES. There were no exclusion criteria. Data collected included general demographic data, diagnosis, presence of pain as the primary motif for consultation, assessment of the pain intensity (PI) at admission and after the care management, analgesic treatments and times of pain care management. Outcome measures were: time to PI assessment at admission, time to treatment, proportion of patients assessed, proportion of patients with adequate pain relief. Statistical analysis was performed using ANOVA for quantitative data and chi-square test for qualitative data. Results 7516 patients were included during the 3 periods (T0 n=2679, T1 n=2498, T2 n=2339). 4670 patients complained of pain at admission (62% of the studied population). The rate of patients presenting with severe pain and treated by morphine was: T0 n=22 (11%), T1 n=46 (11%), T2 n=36 (8%). Abstract 292 Table 1 n=4670 T0 (n=1580) T1 (n=1598) T2 (n=1492) p Patients with PI assessment (%) 465 (29%) 992 (62%) 1073 (72%) 0.0001 Treated patients (%) 728 (46%) 782 (49%) 801 (54%) 0.001 Assessed patients last period (%) 144 (9%) 329 (21%) 407 (27%) 0.0001 Patients with pain relief (%) 119 (8%) 249 (16%) 333 (22%) 0.0001 Time to assessment (min±SD) 65±159 66±148 61±148 NS Time to treatment (min±SD) 90±137 92±151 85±135 0.05 Discussion and Conclusion This wide scale quality assurance process has led to an improvement in the proportion of appropriately assessed and treated patients. However, delays in pain care management and the proportion of patients with adequate pain relief should be improved. Contexte et objectifs L'objectif est d’évaluer la prise en charge (PEC) de la douleur en médecine d'urgence et d’évaluer l'efficacité des mesures correctrices mise en place. Programme 50 SU volontaires (CHU, CHG, 1 hôpital des armées, 2 structures privées répartis sur le territoire national) se sont engagés dans une procédure d'assurance qualité comprenant une phase de lancement puis un audit de dossier rétrospectif initial (T0) suivi de mesures correctrices évaluées par 2 audits successif à 3 mois d'intervalle (T1 et T2). Chaque SU devait analyser à chaque audit 50 dossiers tirés au sort. Les patients inclus étaient des adultes > 15 ans se présentant au SU, aucun facteur d'exclusion. Etaient recueillis: Les caractéristiques générales du patient, les pathologies, l
{"title":"292 Improvement of pain management in emergency medicine: a multicentric audit of 50 emergency services","authors":"A. Ricard-Hibon, T. Ariski, S. Guéant, J. Borel-Kühner, M. Cauterman, M. Raphael","doi":"10.1136/QSHC.2010.041608.23","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041608.23","url":null,"abstract":"Background and Objectives The objective is (1) to assess pain management in emergency services (ES) and (2) to assess the impact of quality improvement measures. Program A quality assurance process was developed and implemented by 50 French emergency services (ES) based in teaching, public, private and military hospitals. An initial retrospective audit of medical charts (T0) allowed development of quality initiatives and prospective evaluation of their impact at three monthly intervals (T1 and T2). For each ES, 50 medical charts were randomly selected. Inclusion criteria were: all patients aged ≥15 years old presenting to the ES. There were no exclusion criteria. Data collected included general demographic data, diagnosis, presence of pain as the primary motif for consultation, assessment of the pain intensity (PI) at admission and after the care management, analgesic treatments and times of pain care management. Outcome measures were: time to PI assessment at admission, time to treatment, proportion of patients assessed, proportion of patients with adequate pain relief. Statistical analysis was performed using ANOVA for quantitative data and chi-square test for qualitative data. Results 7516 patients were included during the 3 periods (T0 n=2679, T1 n=2498, T2 n=2339). 4670 patients complained of pain at admission (62% of the studied population). The rate of patients presenting with severe pain and treated by morphine was: T0 n=22 (11%), T1 n=46 (11%), T2 n=36 (8%). Abstract 292 Table 1 n=4670 T0 (n=1580) T1 (n=1598) T2 (n=1492) p Patients with PI assessment (%) 465 (29%) 992 (62%) 1073 (72%) 0.0001 Treated patients (%) 728 (46%) 782 (49%) 801 (54%) 0.001 Assessed patients last period (%) 144 (9%) 329 (21%) 407 (27%) 0.0001 Patients with pain relief (%) 119 (8%) 249 (16%) 333 (22%) 0.0001 Time to assessment (min±SD) 65±159 66±148 61±148 NS Time to treatment (min±SD) 90±137 92±151 85±135 0.05 Discussion and Conclusion This wide scale quality assurance process has led to an improvement in the proportion of appropriately assessed and treated patients. However, delays in pain care management and the proportion of patients with adequate pain relief should be improved. Contexte et objectifs L'objectif est d’évaluer la prise en charge (PEC) de la douleur en médecine d'urgence et d’évaluer l'efficacité des mesures correctrices mise en place. Programme 50 SU volontaires (CHU, CHG, 1 hôpital des armées, 2 structures privées répartis sur le territoire national) se sont engagés dans une procédure d'assurance qualité comprenant une phase de lancement puis un audit de dossier rétrospectif initial (T0) suivi de mesures correctrices évaluées par 2 audits successif à 3 mois d'intervalle (T1 et T2). Chaque SU devait analyser à chaque audit 50 dossiers tirés au sort. Les patients inclus étaient des adultes > 15 ans se présentant au SU, aucun facteur d'exclusion. Etaient recueillis: Les caractéristiques générales du patient, les pathologies, l","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"36 1","pages":"A23 - A24"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90800537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041624.70
Jafarbay Jamileh, Bernardou Colette, D. Martine, Poret Françoise, Lombardin Cécile, M. Christine, Arvieu Jean Jacque
Meah [National Mission of Hospital Consulting and Auditing] Introduction The prevalence and incidence of bedsores in the departments for mid- to long-term geriatric hospital are very widespread. The occurrence of bedsores during hospitalisations has major human and financial consequences. The Abondances Gerontology Center is a 310-bed unit and receives poly-pathologic patients. In 2005, a one-day audit concluded that 28 patients had bedsores, of which 22 were acquired in the hospital. Objective Part of the 2007 MeaH* pilot program ‘improve the prevention and the treatment of bedsore’, a quantitative objective for this project was reduce the incidence of bedsore by 50%. Methods The institution set up an organisational project spread out over 18 months, in four phases. From April to July 2007, the first phase was devoted to diagnosis, set up a group project, appointment of a project officer and tracking indicators, such as the incidence and prevalence through monthly reports and quarterly reviews of files. From August to November 2007, the second phase was dedicated to determining the action plan. From December 2007 to September 2008, the third phase was concerned the implementation of the action plan. The last phase, from October to December 2008, was assessment of the actions undertaken and leverage of the pilot program. Results The diagnostic phase enabled identifying strong and weak points. The audit made the teams aware of bedsore prevention upon patient in-take. A decision tree specifying the role of everyone on the staff was developed. The personnel were regularly informed about the project's advancement. At the end of phase four, we achieved our objective. We realised decrease the incidence by 50%. Conclusion Setting an outcome objective, formation, and the best coordination, made possible to decrease the incidence of bedsores by 50%, especially stage 3 and 4(NPUAP Classification). Contexte En juillet 2007, la prévalence des escarres a pu être évaluée à près de 16% des patients au centre de gérontologie Les Abondances. Parmi celles-ci, jusqu'à 69% sont acquises en cours d'hospitalisation. Leurs conséquences notamment pour les patients âgés sont importantes en termes de qualité des soins (souffrance, mise en jeu du pronostic fonctionnel et détérioration du niveau d'autonomie, augmentation du risque relatif de décès, …) et de surcoûts (allongement de la durée de séjour, accroissement de la charge en soins, coût des traitements, …). Objectif l'objectif quantitatif de ce projet, est de diminuer de 50% le taux d'incidence des escarres acquises. Méthode, programme Afin d'améliorer la prévention, le dépistage et le traitement des escarres, l'établissement a conduit, sur l'ensemble des unités, un projet d'organisation institutionnelle, étalé sur 18 mois découpés en 4 phases. La première phase, d'avril à juillet 2007, a été consacrée au diagnostic. La gestion du projet repose notamment sur la création d'un comité
{"title":"214 Strategies to reduce the incidence of bedsores in a Geriatric Institution","authors":"Jafarbay Jamileh, Bernardou Colette, D. Martine, Poret Françoise, Lombardin Cécile, M. Christine, Arvieu Jean Jacque","doi":"10.1136/QSHC.2010.041624.70","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.70","url":null,"abstract":"Meah [National Mission of Hospital Consulting and Auditing] Introduction The prevalence and incidence of bedsores in the departments for mid- to long-term geriatric hospital are very widespread. The occurrence of bedsores during hospitalisations has major human and financial consequences. The Abondances Gerontology Center is a 310-bed unit and receives poly-pathologic patients. In 2005, a one-day audit concluded that 28 patients had bedsores, of which 22 were acquired in the hospital. Objective Part of the 2007 MeaH* pilot program ‘improve the prevention and the treatment of bedsore’, a quantitative objective for this project was reduce the incidence of bedsore by 50%. Methods The institution set up an organisational project spread out over 18 months, in four phases. From April to July 2007, the first phase was devoted to diagnosis, set up a group project, appointment of a project officer and tracking indicators, such as the incidence and prevalence through monthly reports and quarterly reviews of files. From August to November 2007, the second phase was dedicated to determining the action plan. From December 2007 to September 2008, the third phase was concerned the implementation of the action plan. The last phase, from October to December 2008, was assessment of the actions undertaken and leverage of the pilot program. Results The diagnostic phase enabled identifying strong and weak points. The audit made the teams aware of bedsore prevention upon patient in-take. A decision tree specifying the role of everyone on the staff was developed. The personnel were regularly informed about the project's advancement. At the end of phase four, we achieved our objective. We realised decrease the incidence by 50%. Conclusion Setting an outcome objective, formation, and the best coordination, made possible to decrease the incidence of bedsores by 50%, especially stage 3 and 4(NPUAP Classification). Contexte En juillet 2007, la prévalence des escarres a pu être évaluée à près de 16% des patients au centre de gérontologie Les Abondances. Parmi celles-ci, jusqu'à 69% sont acquises en cours d'hospitalisation. Leurs conséquences notamment pour les patients âgés sont importantes en termes de qualité des soins (souffrance, mise en jeu du pronostic fonctionnel et détérioration du niveau d'autonomie, augmentation du risque relatif de décès, …) et de surcoûts (allongement de la durée de séjour, accroissement de la charge en soins, coût des traitements, …). Objectif l'objectif quantitatif de ce projet, est de diminuer de 50% le taux d'incidence des escarres acquises. Méthode, programme Afin d'améliorer la prévention, le dépistage et le traitement des escarres, l'établissement a conduit, sur l'ensemble des unités, un projet d'organisation institutionnelle, étalé sur 18 mois découpés en 4 phases. La première phase, d'avril à juillet 2007, a été consacrée au diagnostic. La gestion du projet repose notamment sur la création d'un comité","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"16 1","pages":"A118 - A118"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90460946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041624.83
M. Julien, Bourgueil Yann, Leboulch Philippe, Yilmaz Engin
Background and objectives The French healthcare system for ambulatory care is a fragmented system rather than an integrated system with formally organized primary care. Most health care professionals in the primary care sector are self-employed, work in solo practice, are paid on a fee-for-service (FFS) basis and, historically, are not subject to constraints due to mandatory and strict quality regulation. As a result, several signs of inefficiency in healthcare delivery have come to light. This has been especially true with regard to the chronically ill who have not benefited from any marked improvement in the delivery of care despite the fact that chronic diseases represent a growing burden and consume an increasing share of the resources within the French healthcare system. At the same time, we are expecting a future shortage of medical doctors and an increase in the supply of nurses. A growing number of stakeholders (sickness funds, health authorities, local representatives…) and professionals' representatives are therefore supporting multidisciplinary group practice and teamwork in the primary care sector in order to improve access to primary care and the quality of the care and services delivered. The objective of our study was to assess the efficacy and cost of teamwork between nurses and general practitioners (GPs) within a project called ASALEE (French acronym for Health Action by Teams of Self-employed Health Professionals). The study concerned the management of patients with type 2 diabetes. Programme ASALEE was launched in 2004 in the Deux-Sèvres department (France). In 2007, 41 GPs and eight nurses were taking part in the project and, at the time, it was the only project with such a skill mix and a primary care focus. The GPs in the project entrusted the nurses with the computerized management of certain patient data and the holding of therapeutic patient education consultations in accordance with a specific protocol. We used a case-control study design to compare the care of type 2 diabetes patients in the teamwork group (intervention group) and in a group delivered ‘standard’ care by the GPs (control group). We measured process indicators (standard follow-up procedures) and outcomes indicators (glycaemic control) and examined cost over two consecutive periods. Results After 11 months of follow-up, patients in the intervention group were more likely than control group patients to be or become correctly followed-up (OR: 2.1 to 6.8, p<5%) and to achieve glycaemic control (OR: 1.8 to 2.7, p≤5%). However, glycaemic control was achieved only when patients had seen the nurse at least once for therapeutic education and counselling. There was no difference in cost between the intervention and control groups. Conclusion Our teamwork project was both effective and efficient. Its findings may have implications for the design of future teamwork experiments launched by the French health authorities at the end of 2009. Their objective is to test
背景和目的法国的门诊医疗系统是一个分散的系统，而不是一个具有正式组织的初级保健的综合系统。初级保健部门的大多数保健专业人员都是自雇人士，单独执业，按服务收费(FFS)领取报酬，而且历来不受强制性和严格的质量管制的限制。因此，医疗保健服务效率低下的几个迹象已经暴露出来。对于慢性病患者来说尤其如此，尽管慢性病负担越来越重，消耗了法国医疗保健系统中越来越多的资源，但他们并没有从医疗服务的提供方面得到任何显著改善。与此同时，我们预计未来医生短缺，护士供应增加。因此，越来越多的利益攸关方(疾病基金、卫生当局、地方代表等)和专业人员的代表正在支持初级保健部门的多学科小组实践和团队合作，以改善获得初级保健的机会以及所提供的护理和服务的质量。我们研究的目的是评估在一个名为ASALEE(法语首字母缩略词，即个体健康专业人员团队的健康行动)的项目中护士和全科医生(gp)之间团队合作的效果和成本。该研究涉及2型糖尿病患者的管理。ASALEE项目于2004年在法国的deux - s<e:1>部门启动。2007年，41名全科医生和8名护士参与了该项目，当时，这是唯一一个拥有如此技能组合和初级保健重点的项目。该项目的全科医生委托护士对某些患者数据进行计算机化管理，并按照特定的方案进行治疗性患者教育咨询。我们采用病例对照研究设计来比较团队合作组(干预组)和全科医生提供“标准”护理组(对照组)对2型糖尿病患者的护理。我们测量了过程指标(标准随访程序)和结果指标(血糖控制)，并检查了连续两个时期的成本。结果随访11个月后，干预组患者较对照组患者更容易得到正确的随访(or: 2.1 ~ 6.8, p<5%)，更容易达到血糖控制(or: 1.8 ~ 2.7, p≤5%)。然而，只有当患者至少见过一次护士进行治疗教育和咨询时，血糖才能得到控制。干预组和对照组之间的成本没有差异。结论我们的团队合作项目既有效又高效。它的发现可能会对法国卫生当局在2009年底发起的未来团队实验的设计产生影响。他们的目标是测试一项基于绩效改进的新财务计划，这将是对目前FFS支付的补充。在法国，“动态变化组织”显然是“系统<e:1>的碎片化”，“系统<e:1>的离散化”是“系统<e:1>的离散化”，“系统的离散化”是“系统的离散化”，“系统的离散化”是“系统的离散化”，“系统的离散化”是“系统的离散化”。职业人员的主要职业是由实践决定的，个人的主要职业是由薪金决定的，个人的主要职业是由薪金决定的，个人的主要职业是由薪金决定的，个人的主要职业是由薪金决定的，个人的主要职业是由薪金决定的。没有人知道，没有人知道，没有人知道，没有问题，没有效率，没有流动，没有记录，没有负担，没有疾病，没有慢性病，没有健康，没有健康，没有健康，没有健康，没有健康，没有健康，没有健康，没有健康，没有健康，没有健康，没有健康，没有健康，没有健康，没有健康。与此同时，我们也要注意到，在减少密度和增加密度的过程中，我们要注意的是，在减少密度和增加密度的过程中，我们要注意的是:在ce contexte过这des装备pluridisciplinaires et travaillant en合作est soutenue par un数量羊角面包d 'acteurs因为它同样像联合国征收捐税的人重要为改良conjointement de参与et l 'attractivite de la质量过en参与de首映式界线。这个练习曲倒目的d 'evaluer l 'efficacite等一个实验德莱斯cout阵痛运动队,欧德合作,之间des infirmieres et des多面手,l 'experimentation ASALEE (Action德桑特Liberale en运动队及其装备),在中科院de la撬en des souffrant德德2型糖尿病患者。2004年6月和2007年6月，共有41个主要的<s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1>和<s:1> - <s:1>。这是一项非常重要的工作，它是一项非常重要的工作，是一项非常重要的工作，是一项非常重要的工作。 医生委托护士根据明确的协议，对某些病人数据和治疗教育会诊进行计算机管理。见证我们的研究是基于设计案例/护理在其中我们业绩趋势比较而言)后续进程(标准程序和最后的结果(血糖)和成本控制,连续两期之间的2型糖尿病患者的随访中(实验)干预组或对照组(control group)。我们展示11月之后,后续ASALEE患者与对照组比较,有更大的概率保持或成为监测指标而言,尽管过程(包括黄金约2.1至6.8,p < 5%)也指出,根据血糖监测(嗯~ 1.8到2.7,p < 5%)。只有当患者接受了至少一次护理教育咨询和健康饮食建议时，才能获得后一种结果。最后，这个实验可以被认为是有效和高效的。我们的研究结果可能会对社会保障理事会正在启动的集体和多学科前线结构的新支付方法的实验建设产生影响，以补充按需支付。
{"title":"208 Assessment of teamwork by self-employed health professionals in the management of type 2 diabetes patients: the ASALEE project","authors":"M. Julien, Bourgueil Yann, Leboulch Philippe, Yilmaz Engin","doi":"10.1136/QSHC.2010.041624.83","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.83","url":null,"abstract":"Background and objectives The French healthcare system for ambulatory care is a fragmented system rather than an integrated system with formally organized primary care. Most health care professionals in the primary care sector are self-employed, work in solo practice, are paid on a fee-for-service (FFS) basis and, historically, are not subject to constraints due to mandatory and strict quality regulation. As a result, several signs of inefficiency in healthcare delivery have come to light. This has been especially true with regard to the chronically ill who have not benefited from any marked improvement in the delivery of care despite the fact that chronic diseases represent a growing burden and consume an increasing share of the resources within the French healthcare system. At the same time, we are expecting a future shortage of medical doctors and an increase in the supply of nurses. A growing number of stakeholders (sickness funds, health authorities, local representatives…) and professionals' representatives are therefore supporting multidisciplinary group practice and teamwork in the primary care sector in order to improve access to primary care and the quality of the care and services delivered. The objective of our study was to assess the efficacy and cost of teamwork between nurses and general practitioners (GPs) within a project called ASALEE (French acronym for Health Action by Teams of Self-employed Health Professionals). The study concerned the management of patients with type 2 diabetes. Programme ASALEE was launched in 2004 in the Deux-Sèvres department (France). In 2007, 41 GPs and eight nurses were taking part in the project and, at the time, it was the only project with such a skill mix and a primary care focus. The GPs in the project entrusted the nurses with the computerized management of certain patient data and the holding of therapeutic patient education consultations in accordance with a specific protocol. We used a case-control study design to compare the care of type 2 diabetes patients in the teamwork group (intervention group) and in a group delivered ‘standard’ care by the GPs (control group). We measured process indicators (standard follow-up procedures) and outcomes indicators (glycaemic control) and examined cost over two consecutive periods. Results After 11 months of follow-up, patients in the intervention group were more likely than control group patients to be or become correctly followed-up (OR: 2.1 to 6.8, p<5%) and to achieve glycaemic control (OR: 1.8 to 2.7, p≤5%). However, glycaemic control was achieved only when patients had seen the nurse at least once for therapeutic education and counselling. There was no difference in cost between the intervention and control groups. Conclusion Our teamwork project was both effective and efficient. Its findings may have implications for the design of future teamwork experiments launched by the French health authorities at the end of 2009. Their objective is to test ","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"41 1","pages":"A129 - A130"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88441241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041624.52
Bodiguel Eric, Thiery Roselyne, Lairy Gérard, M. Catherine, Woimant France
Background and objectives A Cochrane meta-analysis published in 2007 has shown that stroke patients who receive care in a dedicated stroke unit are more likely to survive and become independent than those who are admitted to a non-dedicated unit. The evidence-based practices underlying the better outcomes are given in guidelines such as those produced by the Haute Autorité de Santé (HAS 2002). We used audit criteria derived from these guidelines to assess medical and allied health professional care in different hospital units. Programme Six university hospitals and five general hospitals volunteered to take part in self-auditing of medical and allied health professional care of acute stroke patients. Five hospitals had a dedicated stroke unit and five did not. A stroke unit was opened in one hospital between the two assessments. The study coordinator in each hospital was provided with training in auditing and methodological support by HAS. A first assessment (November 2004) of 290 medical records and 142 allied health professional files led to a tailored quality improvement programme being set up in each hospital. A second assessment (October 2005) of 236 medical records and 102 allied health professional files enabled measurement of the impact of the improvement programmes. A national statitical analysis of the anonymised data was carried out. Results and impact The first audit showed that stroke unit care complied significantly better with guidelines than care in non-dedicated units. The second audit showed an increase in the quality of medical and allied health professional care in both dedicated and non-dedicated units although there was improvement in more items in the non-dedicated units. The main quality improvement actions set up after the first audit concerned staff training, drafting of care protocols, procedures for prompt access to paraclinical exams, check lists, nursing and monitoring documents, and medical order forms. The medical criteria that showed significantly increased compliance between rounds were initial evaluation, blood pressure management, prevention of bronchial obstruction, prescription of speech therapy, and transmission of the hospitalisation report in under 8 days. The allied health professional criteria with significantly increased compliance were admission and initial evaluation, monitoring of swallowing and respiratory frequency, prevention of bronchial obstruction, patient positioning, behavioural monitoring, and preparing for and carrying out hospital discharge. Discussion and conclusion Although we cannot exclude statistical bias, our results indicate that guideline implementation is better in a dedicated setting (stroke units) and that improvement is greater when initial compliance is low (non-dedicated units). We thus advocate that practice improvement strategies be different in dedicated and non-dedicated units. Clinical audits and their simplified versions (mini-audits) are an efficient method of improv
{"title":"075 Audits of in-hospital management of stroke patients in dedicated and non-dedicated units on a national scale in France","authors":"Bodiguel Eric, Thiery Roselyne, Lairy Gérard, M. Catherine, Woimant France","doi":"10.1136/QSHC.2010.041624.52","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.52","url":null,"abstract":"Background and objectives A Cochrane meta-analysis published in 2007 has shown that stroke patients who receive care in a dedicated stroke unit are more likely to survive and become independent than those who are admitted to a non-dedicated unit. The evidence-based practices underlying the better outcomes are given in guidelines such as those produced by the Haute Autorité de Santé (HAS 2002). We used audit criteria derived from these guidelines to assess medical and allied health professional care in different hospital units. Programme Six university hospitals and five general hospitals volunteered to take part in self-auditing of medical and allied health professional care of acute stroke patients. Five hospitals had a dedicated stroke unit and five did not. A stroke unit was opened in one hospital between the two assessments. The study coordinator in each hospital was provided with training in auditing and methodological support by HAS. A first assessment (November 2004) of 290 medical records and 142 allied health professional files led to a tailored quality improvement programme being set up in each hospital. A second assessment (October 2005) of 236 medical records and 102 allied health professional files enabled measurement of the impact of the improvement programmes. A national statitical analysis of the anonymised data was carried out. Results and impact The first audit showed that stroke unit care complied significantly better with guidelines than care in non-dedicated units. The second audit showed an increase in the quality of medical and allied health professional care in both dedicated and non-dedicated units although there was improvement in more items in the non-dedicated units. The main quality improvement actions set up after the first audit concerned staff training, drafting of care protocols, procedures for prompt access to paraclinical exams, check lists, nursing and monitoring documents, and medical order forms. The medical criteria that showed significantly increased compliance between rounds were initial evaluation, blood pressure management, prevention of bronchial obstruction, prescription of speech therapy, and transmission of the hospitalisation report in under 8 days. The allied health professional criteria with significantly increased compliance were admission and initial evaluation, monitoring of swallowing and respiratory frequency, prevention of bronchial obstruction, patient positioning, behavioural monitoring, and preparing for and carrying out hospital discharge. Discussion and conclusion Although we cannot exclude statistical bias, our results indicate that guideline implementation is better in a dedicated setting (stroke units) and that improvement is greater when initial compliance is low (non-dedicated units). We thus advocate that practice improvement strategies be different in dedicated and non-dedicated units. Clinical audits and their simplified versions (mini-audits) are an efficient method of improv","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"1 4","pages":"A100 - A99"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91498089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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