Journal of Healthcare Quality Research最新文献

Introduction and objectives: The medicine development demonstrates that the traditional bioethical medical care model is not the most adequate. On the other hand, the person-centered clinical method has been winning more space in the medical practice, since it is a humanized method of care that allows best results. In pediatrics, the patient-centered care works a little bit different, since it requires not only the physician-patient relation, but also the integration of the physician-family-patient relation. Thus, the patient-centered care in the pediatric area is understudied, as well as little practiced. In this context, this review has the objective to exposure the actual scenario of the patient-centered care in pediatrics.

Materials and methods: This is a scoping review carried out from the standards of Jonna Briggs Institute (JBI). The database PubMed, Science Direct and BVS were used to search studies between 2012 until 2024. The research was performed with the descriptors "Medicine", "Shared DecisionMaking", "Pediatrics", "Physician-PatientRelations" and "Patient-CenteredCare".

Results: The research identified 27,272 articles, along with 79 met the criteria and were included. Each article was analyzed and allocated in the four pillars of the patient-centered care, which was described and related with the pediatric clinic.

Conclusions: The patient-centered care brings benefits to medical care, especially in the pediatric area. Among them, stands out the increased adherence to treatment, the lowest rates of medical errors, the greater integration of the interprofessional team, the more individual and patient-sensitive investigation, as well as the respect of beliefs and desires, making the results obtained better.

Background and aim: Measuring patient-reported experience measures (PREMs) is essential for the continuous improvement of quality. This study aims to assess the quality perceived by patients in the key care processes of an integrated health area measuring PREM elements, with the goal of identifying opportunities for improvement.

Methods: The research was conducted in the first half of 2023 within a Spanish integrated health area, analysing five key healthcare processes: Primary Care, Emergency Services, Hospitalisation, Consultations, and Surgery. To assess perceived quality, PREM elements such as accessibility, information, and professionalism were measured using the Net Promoter Score (NPS). The Lot Quality Assurance Sampling (LQAS) method was employed to identify specific areas for improvement by detecting rejected lots and optimising sample sizes.

Results: Although the perceived quality was generally high, with good or excellent NPS scores, significant variability was observed between processes. A total of 104 rejected lots (21%) were identified across the processes evaluated. The highest number of rejections occurred in and Emergency Services (67%), with notable issues in accessibility and information.

Conclusions: The study underscores the need for targeted interventions in accessibility and information to enhance the patient experience, particularly in Primary Care and Emergency Services. The measurement of PREM elements using NPS, in conjunction with the LQAS method, proves to be an effective tool for identifying and prioritising areas for improvement, especially when applied on a regular basis.

Objective: To evaluate levels of humanization, professional quality of life, resilience, communication skills, and the use of silence among healthcare professionals in these areas.

Methods: Observational, cross-sectional, and descriptive study conducted in a referral hospital. Data were collected from 152 healthcare professionals through questionnaires assessing professional quality of life (ProQOL), resilience (CD-RISC), humanization (HUMAS), communication skills (EHC-PS), and the use of silence (Q-SPS).

Results: The median age of the professionals was 42 years. They showed moderate levels of compassion satisfaction and resilience (means=23.47 and 29.96) but low levels of humanization (mean=66.09). Emotional exhaustion was significant among physicians (mean=19.19, P=.022), while radiotherapy technicians excelled in empathy (mean=27.33). Significant correlations were observed between compassion satisfaction and optimism (Rho=0.2017, P=.0127), and between productive silence and communication skills (Rho=0.3131, P=.0001).

Conclusions: Strengthening emotional and communication competencies is essential. Interventions should focus on reducing compassion fatigue and enhancing the well-being of healthcare professionals, improving care quality for oncohematology and radiotherapy patients.

Objective: This quasi-experimental, non-randomized study described the process of implementing ISO 7101 subclause 8.10.5 Health literacy in specialty consultations, then determined the effects of implementation on patient general health literacy scores and perceptions of quality of care.

Method: Implementation steps were outlined, nurses were trained and used a standardized health literacy checklist with patients. The HLS₁₉-Q12 was used to calculate patients' general health literacy scores pre- and post-implementation of subclause 8.10.5. Paired samples t-test and Wilcoxon signed-rank test determined relationships between implementation, health literacy score, and quality of care perceived.

Results: Mean general health literacy scores increased post-implementation from 66.35 to 76.29, as did the mean score of perception of quality of care received (M=3.87 to M=3.99). Wilcoxon test for both variables was significant (P<.001), and effect size was large (d≥0.8).

Conclusions: Implementation of ISO 7101, subclause 8.10.5 Health literacy had a positive, statistically significant impact on patient general health literacy scores and perceptions of quality of care. This is valuable information for healthcare management decision makers as they implement new standards and seek to improve patient health outcomes.

Introduction and objectives: Despite the importance of length of stay (LOS) following spinal cord injury, it remains underexplored in the literature. This study aims to bridge this gap by investigating the association between rehabilitation LOS and functional gains among patients with traumatic (TSCI) or non-traumatic (NTSCI) spinal cord injuries.

Methods: We conducted a retrospective observational cohort study assessing functional gains using the motor Functional Independence Measure (mFIM) and the Spinal Cord Independence Measure (SCIM III) from rehabilitation admission to discharge. Outcomes were analyzed across four neurological categories based on the American Spinal Injury Association Impairment Scale (AIS): C1-C4 AIS A-C; C5-8 AIS A-C; T1-S5 AIS A-C; and AIS D. Linear regression models estimated changes across rehabilitation LOS quarters (Q1-Q4), adjusting for covariates.

Results: We included 1036 patients admitted for rehabilitation between 2007 and 2023 (46.3% TSCI, 53.7% NTSCI). TSCI: age 42.7, 80.2% male, 41.8% AIS A, LOS 90.5. NTSCI: age 55.7, 54.2% male, 14.2% AIS A, LOS 69.6. For TSCI, mFIM and SCIM III gains increased significantly from Q1 to Q2 (T1-S5-ABC, n=214) and Q2 to Q3 (AIS D, n=129). For NTSCI, gains increased from Q2 to Q3 (T1-S5-ABC, n=195) and from Q1 to Q2 as well as from Q2 to Q3 (AIS D, n=304). Adjusted models showed decreasing gains for Q2 and Q3 vs. Q1 (TSCI) but increasing gains for Q2-Q4 vs. Q1 (NTSCI) for both measures. No significant gains were observed from Q3 to Q4.

Conclusions: We identified specific neurological categories and LOS quarters yielding to significant functional gains.

Introduction and objectives: The principle of patient autonomy in the participation and incorporation of their health data in research projects is a legal and deontological obligation that must be fulfilled. The aim of this study was to know the degree of compliance and adequacy of informed consent in clinical research projects in a university hospital.

Material and methods: Through this cross-sectional study, the adequacy of the way patient data are obtained in the research projects presented to the Research Committee of a university hospital was analyzed. The adequacy of the way patient data were obtained in the research projects, dealing with informed consent and causes of exemption, was described with their frequencies distributions. It was assessed by means of the adjusted odds ratio through a backstep logistic regression model, including the predictable significant variables previously analyzed in the univariant analysis.

Results: A total of 565 protocols were included. The most frequent type of studies assessed were observational retrospectives (49.6%) and end-of-year projects (28.1%). The most frequent way of obtaining the patient data were by means of soliciting exemption of informed consent (48.3%). Obtaining the patient data process was considered appropriated in 51.1% of the projects. Projects with higher adequacy were those solicited by students (OR=4.2; CI_95%=2.0-8.8) and residents OR=3.0; CI_95%=1.2-2.4).

Conclusions: The majority of the projects assessed was retrospective observational studies in which exemption of informed consent was solicited. Projects with higher adequacy were solicited by students and residents.

Objetive: To know the perception of primary care professionals about the frequency with which interventions that should not be done at this level of care are carried out.

Material and methods: Three questionnaires were developed to evaluate 9 interventions in family medicine, 2 in pediatrics and 6 in nursing. The percentage of professionals who stated that they always or almost always carried out these interventions was calculated, considering acceptable percentages of less than 5%. A descriptive analysis of the barriers identified to reduce these interventions was also carried out.

Results: Five of the 9 interventions evaluated in family medicine, 2 in pediatrics, and 4 of the 6 in nursing were always or almost always performed by 5% or more of the professionals. Among the barriers identified to stop doing unnecessary interventions, the first was lack of time in the consultation, followed by lack of training.

Conclusions: The results obtained have made it possible to identify which of the primary care interventions evaluated have the greatest room for improvement, as well as the main barriers to their deimplementation. Surveys of professionals make it possible to assess recommendations that cannot be measured from clinical records. Knowing their perception of their clinical practice can be very useful for designing the intervention plan.

Objective: Nurses and their leaders are known for actively using incident reporting systems. However, information sharing about lessons learned from incidents has rarely been reported in previous studies. This study aimed to describe nurses' and nursing managers' experiences with incident reporting system information sharing and their perceptions of patient safety development needs.

Material and methods: Semi-structured individual and group interviews were conducted with nursing staff in Estonia (n=26). Collected data was analyzed using the inductive content analysis method. The COREQ checklist was used for study report.

Results: Nursing staff considered information sharing of lessons learned crucial. First, it was necessary to raise patient safety awareness among employees. Second, the importance of learning from mistakes to protect themselves from legal consequences and improve public trust was highlighted. Nursing staff had traditional ways of sharing information about lessons learned. However, because of the lack of organized strategies, nurses resorted to private discussions or self-initiated investigations. Nursing staff reported a need to develop patient safety by supporting nurses' patient safety competencies and training, and to establish the use of a reporting system in daily care. The precondition was a positive patient safety culture, which would be improved by open communication among nursing staff and sufficient resources.

Conclusions: Information sharing from safety incident reports should rely on organized strategies to avoid self-initiated practices and misinformation. Awareness of the complexity of implementing patient safety initiatives and adequate responsiveness from hospital executives can help establish practices supporting staff to feel secure when discussing safety issues.

Introduction and objectives: The EQ-5D VAS is a widely used measure for health-related quality of life (HRQol). The EQ-5D health states often weighted using the time trade-off (TTO). The assessment of the EQ-5D, VAS, TTO psychometric properties is necessary to inform adaption across countries and populations due to cross-cultural and language diversity. The objective of the study is to evaluate validity, reliability, and feasibility of the Arabic version of the EQ-5D-3L, VAS, and TTO among a broad sample of Arabic-speaking Jordanians.

Methods: A cross-sectional study was conducted using structured face-to-face interviews with 1007 participants attending outpatient clinics at a central university affiliated hospital. The participants completed the EQ-5D-3L, described own health via VAS and in words (excellent, very good, good, fair, and poor). Additionally, participants requested to answer a TTO question. Validity was assessed using correlation analysis, while test-retest methods were used to evaluate reliability. Perspectives of participants on how easy to complete or understand the study measures were investigated.

Results: Completion rates were 100% for the EQ-5D, 98% for VAS and 77% for TTO. The construct validity of EQ-5D, VAS, and TTO was supported by significant correlation across each other and participants' characteristics. Higher severity of EQ-5D health states was significantly associated with lower VAS scores (r_s=-0.38, p<0.01). Usual activity and pain/discomfort had the strongest correlations with VAS scores (-0.40 and -0.39, respectively, p<0.001). A higher willingness to trade years was observed with more severe EQ-5D states (r_s=0.32, p<0.001), with usual activity, and pain/discomfort showing the strongest associations. Self-reported health via VAS and words was highly correlated (r_s=0.76, p<0.001). Reliability of the weighted Cohen's k for EQ-5D dimension ranged between 0.3 and .72. Intraclass correlation coefficients for VAS were 0.80 and 0.92 for TTO, all p value <0.001. VAS showed substantial test-retest reliability (ICC=0.80), and TTO showed excellent reliability (ICC=0.92). However, only 62.3% and 54.6% found EQ-5D and TTO easy to understand, respectively, while 89.4% found the VAS easy to use.

Conclusion: The Arabic EQ-5D-3L, VAS, and TTO demonstrated validity and reliability for measuring HRQoL among Jordanians. The study highlights the importance of cultural and linguistic contexts in HRQoL measures adaption. Future research should focus on refining TTO to improve cultural appropriateness and understanding among Arabic-speaking populations.