Journal of Healthcare Quality Research最新文献

Introduction and objective

Healthcare resources optimization is crucial to assume the growing demand of neovascular age-related macular degeneration (nAMD). This work provides guidelines and support so that each hospital can lead its change management.

Methods

The OPTIMUS project (n = 10 hospitals) was based on face-to-face interviews with the key staff of the ophthalmology services, and alignment with the main responsible for each centre (nominal group) to identify potential needs for improving nAMD. The OPTIMUS nominal group was expanded to 12 centres (eVOLUTION). Through different remote work sessions, different guides and tools were defined and developed to implement proactive treatment strategies, one-step treatment administration and potential for remote visits (eConsult) in nAMD.

Results

The information collected from the OPTIMUS interviews and working groups (n = 10 centres) defined roadmaps to promote the development of protocols and proactive treatment strategies, including healthcare workload optimization and one-stop treatment administration in nAMD. With eVOLUTION, processes and tools were developed to promote eConsult: (i) healthcare burden calculator; (ii) definition of potential patients for telematic management; (iii) definition of nAMD management archetypes; (iv) definition of processes for implementation of eConsult by archetype; and (v) key performance indicators for changing evaluation.

Conclusions

Managing change is an internal task that requires an adequate diagnosis of processes and feasible implementation roadmaps. OPTIMUS and eVOLUTION provide the basic tools for an autonomous advance of hospitals in the optimization of AMD management, with the available resources.

Introduction

In 2017, the Joint Commission proposed daily meetings called “huddle” as an indicator of quality of care. They are brief daily meetings of the multidisciplinary team, where security problems of the last 24 h are shared and risks are anticipated. The objectives were to describe the most frequent safety events in Pediatric wards, implement improvements in patient safety, improve team communication, implement international safety protocols, and measure the satisfaction of the staff involved.

Material and methods

Prospective, longitudinal and analytical design (June 2020–February 2022), with previous educational intervention. Safety incidents, data related to unequivocal identification, allergy and pain records, data from the Scale for the Early Detection of Deficiencies (SAPI) and the Scale for the Secure Transmission of Information (SBAR) were collected. The degree of satisfaction of the professionals was evaluated.

Results

Three hundred forty-eight security incidents were recorded. Medication prescription or administration errors stood out (n = 103). Drug prescription or administration errors stood out (n = 103), especially those related to high-risk medication: acetaminophen (n = 14) (×10 doses of acetaminophen; n = 6), insulin (n = 6), potassium (n = 5) and morphic (n = 5). An improvement was observed in the pain record; 5% versus 80% (P<.01), in the SAPI registry 5% versus 70% (P<.01), in SBAER scale 40% vs 100% (P<.01), in unequivocal identification of the patient 80% versus 100%; (P<.01) and in the application of analgesic techniques 60% versus 85% (P=.01). In the survey of professionals, a degree of satisfaction of 8 (7–9.5)/10 was obtained.

Conclusions

Huddles made it possible to learn about security events in our environment and increase the safety of hospitalized patients, and improved communication and the relationship of the multidisciplinary team.

Aim

Severe asthma is a complex, heterogeneous condition that can be difficult to control despite currently available treatments. Multidisciplinary severe asthma units (SAU) improve control in these patients and are cost-effective in our setting; however, their implementation and development can represent an organizational challenge. The aim of this study was to validate a set of quality care indicators in severe asthma for SAU in Spain.

Methods

The Carabela initiative, sponsored by SEPAR, SEAIC, SECA and SEDISA and implemented by leading specialists, analyzed the care processes followed in 6 pilot centers in Spain to describe the ideal care pathway for severe asthma. This analysis, together with clinical guidelines and SEPAR and SEAIC accreditation criteria for asthma units, were used to draw up a set of 11 quality of care indicators, which were validated by a panel of 60 experts (pulmonologists, allergologists, and health-policy decision-makers) using a modified Delphi method.

Results

All 11 indicators achieved a high level of consensus after just one Delphi round.

Conclusions

Experts in severe asthma agree on a series of minimum requirements for the future optimization, standardization, and excellence of current SAUs in Spain. This proposal is well grounded on evidence and professional experience, but the validity of these consensus indicators must be evaluated in clinical practice.

Background

Early defibrillation is one of the interventions that can most influence the prognosis of cardiac arrest. The objectives of this study were to determine the number of automatic external defibrillators outside the healthcare setting in each autonomous community in Spain and to compare the legislation of each autonomous community on the mandatory installation of defibrillators outside the healthcare setting.

Methods

A cross-sectional observational study was carried out between December 2021 and January 2022 by consulting official data in the 17 Spanish autonomous communities.

Results

Complete data on the number of registered defibrillators were obtained from 15 autonomous communities. The number of defibrillators ranged from 35 to 126 per 100,000 inhabitants. At the global level, differences were observed between communities with mandatory defibrillator installation and those without (92.1 vs. 57.8 defibrillators/100,000 inhabitants).

Conclusions

There is heterogeneity in the provision of defibrillators outside the health care setting, which seems to be related to the diversity of legislation on the mandatory installation of defibrillators.

There has been a trend in the clinical literature to reduce patient autonomy to decision-making, perhaps due to the influence of the philosophical-legal tradition and because of its initial hospital and emergency medicine focus. This paper presents a broader model of autonomy, which, in addition to strict medical issues and respect for freedom of choice, pays more attention to the specificities that characterise people in need of health care, i.e., the biological, psychological, and social aspects that allow or impede them a greater degree of autonomy. To that end we identify and describe all the stages or points at which the question arises of the patient's (in)capacity for self-management throughout the care process. This generates a more complex and multidimensional notion of patient autonomy which, in addition to the ability to make free and therapeutically informed decisions —decisional autonomy—, also includes the ability to carry out basic vital functions and tasks that can be performed by a statistical majority of people (such as eating, seeing, walking, understanding complex situations, etc.) —functional autonomy—, the patient's capacity to plan, sequence, and perform tasks related to the management of their chronic diseases, i.e., the capacity to implement the chosen therapeutic plan and maintain it over time—executive autonomy—, the patient's capacity to retain, understand and communicate coherently and understandably for others the principle identifying aspects that have characterised them during their lives—narrative autonomy—, and the ability of patients to access and control information relative to their situation for themselves—informative autonomy—.

Introduction and objectives

The aim of the study was to analyze, which individual characteristics (sociodemographic, attitudinal and political factors) mediates in the choice in Spain in 2022, of a private versus public health care alternative for family doctor, doctor specialist, hospital admissions and emergencies.

Methods

Using the health barometers of the Centro de Investigaciones Sociológicas (CIS), we carried out four logistic regressions (then, average marginal effects [AMEs]) whose dependent variables are the preference for a private choice of family doctor versus a public one, the preference for a private choice of doctor specialist versus a public one; the preference for a private choice of hospital admission versus a public one and the preference for a private choice of emergency admission versus a public one. The dependent variables are binary (1 = private; 0 = public). The sample consisted of more than 4,500 individuals older than 18 years old distributed representatively throughout Spain.

Results

The probability of choosing private rather than public is correlated with the age of the individual: those over 50 years are less likely to opt for a private alternative (P < .01), as well as by ideology and satisfaction with the way that the national health system (NHS) works. Patients with a conservative ideology are more likely to choose private options (P < .01) and individuals with greater satisfaction with the NHS are less likely to choose private ones (P < .01).

Conclusions

Satisfaction with the NHS and patient ideology are the most relevant factors for private versus public choice.

Background

The aim of this study was to determine incidence of COVID-19 in relationship to geographical distribution among Spain.

Method

Cluster analysis taking into consideration the incidence of COVID-19 in the provinces and autonomous cities of Spain in each of the first six waves of the pandemic.

Results

All the provinces of the Canary Islands, Catalonia and Andalusia form independent clusters. In Comunidad Valenciana, Galicia, País Vasco and Aragón two out of three provinces (three out of four in Galicia) were in the same cluster, with no other provinces.

Discussion

The incidence of COVID-19 in Spain in the first six waves forms clusters that reproduce the territorial division of Spain into autonomous communities. Although this could be explained by greater mobility within a community, it cannot be ruled out that this distribution is due to differences in screening, diagnosis, registration or reporting of COVID-19 cases.