Journal of Healthcare Quality Research最新文献_第2页

Análisis de la relación entre gasto sanitario público y resultados en salud en España (2002-2022) [2002-2022年西班牙公共卫生支出与卫生成果关系分析]。

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-11-13 DOI: 10.1016/j.jhqr.2025.101179

F.M. Escandell Rico , L. Pérez Fernández

Objective

To analyze the relationship between public health expenditure and its possible association with health indicators, particularly life expectancy and infant mortality in Spain during the period 2002-2022.

Method

An ecological, longitudinal, and retrospective study that included the 17 autonomous communities, generating a panel of 340 observations (17 communities × 20 years). Official data from the Public Health Expenditure Statistics and health indicators from the Ministry of Health were used. Time trends in public health expenditure, life expectancy, and infant mortality were analyzed, and correlation analysis, multiple regression, and hierarchical cluster analysis were applied to evaluate patterns and associations.

Results

Public health expenditure per capita increased by 70.6% between 2002 and 2022, mainly concentrated in hospital services, while primary care showed limited growth, and public health only increased significantly after the COVID-19 pandemic. A positive, albeit weak, association was observed between total spending and life expectancy, and a negative correlation approaching significance between spending and infant mortality. Regional inequalities persisted, with regions such as Catalonia and Madrid presenting the highest spending levels and improved indicators, in contrast to regions such as Andalusia and the Valencian Community, which maintained lower and more unstable levels.

Conclusions

Increased public health spending in Spain is associated with improvements in key health indicators, but spending alone does not guarantee better outcomes. Efficiency improvements, strengthening of primary care, reduction of territorial inequalities, and results-oriented strategic planning are required to ensure the sustainability and effectiveness of the health system.

目的：分析2002-2022年期间西班牙公共卫生支出及其与健康指标，特别是预期寿命和婴儿死亡率之间的关系。方法：一项生态、纵向和回顾性研究，包括17个自治区，产生340个观察小组（17个社区×20years）。使用了《公共卫生支出统计》的官方数据和卫生部的卫生指标。分析了公共卫生支出、预期寿命和婴儿死亡率的时间趋势，并应用相关分析、多元回归和分层聚类分析来评估模式和关联。结果：2002 - 2022年，人均公共卫生支出增长70.6%，主要集中在医院服务方面，初级保健支出增长有限，公共卫生支出仅在新冠肺炎大流行后才有明显增长。总体支出与预期寿命之间存在微弱的正相关关系，而支出与婴儿死亡率之间存在接近显著的负相关关系。地区不平等现象依然存在，加泰罗尼亚和马德里等地区的支出水平最高，各项指标也有所改善，而安达卢西亚和瓦伦西亚社区等地区的支出水平较低，也更不稳定。结论：西班牙公共卫生支出的增加与关键健康指标的改善有关，但仅支出并不能保证更好的结果。为了确保卫生系统的可持续性和有效性，需要提高效率、加强初级保健、减少地域不平等和注重结果的战略规划。

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引用次数: 0

Estudio multicéntrico de validez del Sistema Centralizado de Triaje Pediátrico [多中心研究系统的有效性Pediátrico (STPED)]。

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-11-04 DOI: 10.1016/j.jhqr.2025.101173

M.C. Miguez-Navarro , G. Guerrero-Márquez , P. Storch De Gracia Calvo , S. Herranz López , M.A. de la Fuente de la Hoz , M.I. Sainz de la Maza Giménez , Grupo de Triaje Pediátrico-STPED

Introduction

This study was conducted to determine the indirect validity of the Sistema Centralizado de Triaje Pediátrico (STPED) –the computer version of the Sistema de Triaje Pediátrico del Hospital Gregorio Marañón (TRIPED-GM)– in eight pediatric emergency departments of the Community of Madrid.

Patients and methods

It is a retrospective observational multicenter study. A sample of patients (<18 years) attending triaje from October 2021 to October 2022, for any reason, was randomly selected. The validity of STPED was assessed by analyzing the association between priority level (1 [maximum]- 5 [minimum]) and use of resources utilization (number of complementary tests, procedures, or treatments; need for observation or admissions; mean length of stay [LOS]) with a regression model. A subgroup analysis of secondary and tertiary hospitals was performed. The R software version

4.3.3 was used.

Results

A total of 542 patients were analyzed. For each unit increase in priority, the probability of performing a complementary test, procedure or receiving treatment increased 1.83-fold (Incidence Rate Ratio: 1.83; 95% confidence interval (CI): 1.66-2.02; p < 0.001), the need for observation, 6 (Odds Ratio: 6.07; 95% CI: 4.10-9.22; p < 0.001) and the need for admission, almost 5 (Odds Ratio: 4.93; 95% CI: 2.97-8.43; p < 0.001). The LOS increased by 69 minutes (beta: 69; 95% CI: 44-95; p < 0.001). The relationship between resource use and priority was higher in tertiary hospitals.

Conclusions

The results confirm the indirect validity of STPED, especially in tertiary hospitals. Studies in other regions are needed to ratify these findings.

本研究旨在确定马德里社区8个儿科急诊科的Sistema Centralizado de Triaje Pediátrico （STPED）——计算机版Sistema de Triaje Pediátrico del Hospital Gregorio Marañón （TRIPED-GM）的间接有效性。患者和方法：这是一项回顾性观察性多中心研究。结果：共分析542例患者。优先级每增加一个单位，执行补充检查、程序或接受治疗的概率增加1.83倍(发病率比：1.83；95%可信区间（CI）： 1.66-2.02；结论：结果证实了STPED的间接有效性，特别是在三级医院。需要在其他区域进行研究以批准这些发现。

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引用次数: 0

Improving Administrative Processes in a Trauma Centre: Lean and Pareto Approach 改进创伤中心的管理流程：精益和帕累托方法。

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-11-01 DOI: 10.1016/j.jhqr.2025.101172

R. Harsvardhan, A. Jain, S. Singh, M. Suhaib, S. Bose

Background

The Central Control Room (CCR) of hospital plays a pivotal role in the hospital operations by overseeing, coordinating and resolving real-time administrative and operational challenges. Trauma centres operate in high-pressure environment and frequently encounter inefficiently designed workflows that impacts service delivery. Pareto analysis and Gemba Walk, based on Lean Management and Total Quality Management approach, focuses on direct observation by identify high-priority issues and real-time problem solving.

Methods

An interventional study was conducted over seven months (April–October 2024) at a trauma centre. In Phase I (April–June), all complaints reported in CCR were registered, categorized and analysed using Pareto analysis to identify the most frequent and high-impact issues. In Phase II (July), Gemba Walk by multidisciplinary team was introduced. During Phase III (August–October 2024), complaints were re-evaluated using Pareto analysis to measure the impact of the intervention.

Interventions

Introduction of structured complaint tracking using Pareto charts, followed by Gemba Walks involving operations, nursing, engineering, and housekeeping teams to address issues at the point of occurrence.

Results

Pareto analysis done in pre-intervention phase revealed that 69.88% of issues stemmed from 28.6% of the complaints. After targeted Gemba Walk introduction, the post-intervention analysis showed that while 67.77% of issues were still from 28.6% of complaints, however, nature of the problems was different.

Conclusion

Integration of Pareto analysis and Gemba Walk proved to be an effective approach for identifying and resolving key operational challenges in trauma centre. Findings highlight the importance of structured quality improvement approach in enhancing hospital efficiency.

背景：医院中央控制室（CCR）通过监督、协调和解决实时管理和运营挑战，在医院运营中发挥着关键作用。创伤中心在高压环境中运作，经常遇到设计效率低下的工作流程，影响服务的提供。基于精益管理和全面质量管理方法的帕累托分析和Gemba Walk侧重于通过识别高优先级问题和实时解决问题来直接观察。方法：在创伤中心进行为期7个月（2024年4月至10月）的介入研究。在第一阶段（4月至6月），CCR中报告的所有投诉都被登记、分类并使用帕累托分析来确定最频繁和影响最大的问题。在第二阶段（7月），引入了多学科团队的玄叶步行。在第三阶段（2024年8月至10月），使用帕累托分析对投诉进行重新评估，以衡量干预的影响。干预措施：引入使用Pareto图表的结构化投诉跟踪，随后是涉及操作、护理、工程和内务团队的Gemba Walks，以解决发生的问题。结果：干预前阶段的帕累托分析显示，69.88%的问题源于28.6%的投诉。在有针对性地引入玄叶步行后，干预后分析显示，虽然67.77%的问题仍然来自28.6%的投诉，但问题的性质有所不同。结论：将Pareto分析法与Gemba Walk相结合是创伤中心识别和解决关键操作挑战的有效方法。研究结果强调了结构化质量改进方法对提高医院效率的重要性。

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引用次数: 0

Implementación de la vía RICA en cirugía urgente: adherencia, barreras y facilitadores RICA在急诊手术中的应用：依从性、障碍和促进因素

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-10-31 DOI: 10.1016/j.jhqr.2025.101170

S. Postigo-Morales , B. Ugarte-Sierra , M. San-Juan-González , J.M. Ramírez-Rodríguez

Background and objective

The Enhanced Recovery After Surgery (ERAS) clinical pathway has been shown to improve postoperative outcomes in elective surgery but its implementation in emergency settings remains limited and understudied. The aim of the study is to assess the degree of adherence to selected perioperative ERAS items in frequent emergency surgeries (appendectomy, cholecystectomy and non-neoplastic perforated peptic ulcer), as well as to identify barriers and facilitators for its implementation.

Materials and methods

Descriptive, prospective and exploratory observational study including 206 consecutive patients undergoing one of the selected emergency surgeries between November 2021 and July 2022. Adherence to ERAS items was assessed in the preoperative, intraoperative and immediate postoperative phases. Barriers and facilitators were also analysed through literature review, standardised matrix development, unstructured interviews and direct observation.

Results

Overall adherence was over 70% for most items, with greater variability, as expected, in those measures dependent on the complexity of the case, such as the use of drains or tubes. The main barrier was organisational and the previous experience of ERAS in elective surgery acted as a facilitator.

Conclusions

The implementation of certain perioperative ERAS items in emergency surgery is feasible, presenting high adherence in settings with previous experience in elective surgery. The main barrier detected was organisational, while the consolidated institutional culture was a key facilitator. Studies with methodologically robust designs, including evaluation of clinical outcomes, are needed to support its implementation as a standard of care.

背景与目的ERAS临床路径已被证明可改善选择性手术的术后预后，但其在急诊环境中的实施仍然有限且研究不足。本研究的目的是评估在频繁的急诊手术（阑尾切除术、胆囊切除术和非肿瘤性穿孔性消化性溃疡）中选定的围手术期ERAS项目的遵守程度，并确定其实施的障碍和促进因素。材料和方法描述性、前瞻性和探索性观察研究，包括206例连续患者，在2021年11月至2022年7月期间接受了其中一种选定的急诊手术。在术前、术中和术后立即阶段对ERAS项目的依从性进行评估。通过文献综述、标准化矩阵开发、非结构化访谈和直接观察，分析了障碍和促进因素。结果大多数项目的总体依从性超过70%，正如预期的那样，在那些取决于病例复杂性的措施中，如使用引流管或管道，具有更大的可变性。主要的障碍是组织和以前的ERAS在择期手术中的经验起到了促进作用。结论急诊外科围手术期ERAS项目的实施是可行的，在有择期手术经验的机构中具有较高的依从性。发现的主要障碍是组织，而巩固的机构文化是一个关键的促进因素。需要具有方法学稳健设计的研究，包括临床结果评估，以支持其作为标准护理的实施。

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引用次数: 0

Float nurses, patient safety and humanised care: A global challenge 浮动护士、患者安全和人性化护理：一项全球性挑战

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-10-25 DOI: 10.1016/j.jhqr.2025.101171

R. Allande-Cussó , J. Gómez-Salgado

引用次数: 0

AI and neurotechnology: Ethical challenges, human rights, and quality of healthcare 人工智能和神经技术：伦理挑战、人权和医疗保健质量。

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-10-07 DOI: 10.1016/j.jhqr.2025.101169

I. de Lecuona , R.F. Estévez

AI-powered neurotechnologies pose significant challenges due to the sensitive nature of the personal data they process and their potential impact on human behaviour and health. This work adopts an ethical framework that, drawing on scientific evidence, advocates for the promotion and protection of individual rights in the deployment of AI. First, it explores the exponential adoption and diversification of AI systems in healthcare delivery. Second, it explores translational neuroethics to demonstrate its value in enhancing the quality of care. Ultimately, ensuring high-quality healthcare requires rethinking the human–technology relationship.

人工智能驱动的神经技术由于其处理的个人数据的敏感性及其对人类行为和健康的潜在影响，构成了重大挑战。这项工作采用了一个伦理框架，根据科学证据，倡导在部署人工智能时促进和保护个人权利。首先，它探讨了人工智能系统在医疗保健服务中的指数级采用和多样化。其次，探讨转化神经伦理学，以证明其在提高护理质量方面的价值。最终，确保高质量的医疗保健需要重新思考人与技术的关系。

引用次数: 0

Habilidades no técnicas en cuidados intensivos. Importantes, pero aún desconocidas [重症监护的非技术技能。很重要，但仍然未知]。

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-10-06 DOI: 10.1016/j.jhqr.2025.101162

E. Chicote-Álvarez, E. Cervantes-Marrodán, A. Sáenz-Pinillos, M. Macías-Pascual, A. Calvo-Martínez

引用次数: 0

[Impact of clinical simulation on improving compliance with the surgical safety checklist]. [临床模拟对提高手术安全检查表依从性的影响]。

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-10-01 DOI: 10.1016/j.jhqr.2025.101166

M Corominas Iglesias, M Blasco Afonso, J Piqué-Buisan

Introduction: Surgery is a fundamental component of healthcare, with over 300 million procedures performed annually. At least half of adverse events are considered preventable through tools such as the Surgical Safety Checklist (SSC). However, adherence to the SSC is often incomplete. Simulation-based training offers a meaningful learning methodology that can effectively improve compliance. This study aims to evaluate the use of simulation as a strategy to increase SSC adherence at our hospital.

Methods: We conducted a retrospective, quasi-experimental quantitative intervention study, analyzing pre- and post-simulation data collected between the second half of 2021 and the second half of 2023. The target population included operating room healthcare professionals, and the SSC endorsed by the WHO was used. Clinical simulations were carried out that had been previously designed to imitate real situations in operating rooms with natural equipment and their respective post-debriefings as guided reflection for learning.

Results: Simulation participation rates by department were as follows: 40% for Anesthesiology, 55.5% for Surgery, 75% for Orthopedics, and 76.5% for surgical nurses. The impact of the intervention was assessed by retrospectively reviewing SSC compliance before and after the simulation training. The results showed a significant increase in SSC compliance at the entry phase and during the surgical pause (P=.000), while no significant change was observed at the surgical exit phase.

Conclusion: The findings suggest that implementing simulation-based interventions in the operating room can enhance compliance with the Surgical Safety Checklist, thereby contributing to improved patient safety.

手术是医疗保健的基本组成部分，每年有超过3亿例手术。通过手术安全检查表（SSC）等工具，至少有一半的不良事件被认为是可以预防的。然而，对SSC的遵守往往是不完整的。基于模拟的培训提供了一种有意义的学习方法，可以有效地提高依从性。本研究旨在评估在我院使用模拟作为一种策略来提高SSC的依从性。方法：我们进行了一项回顾性、准实验性的定量干预研究，分析了2021年下半年至2023年下半年收集的模拟前后数据。目标人群包括手术室医护专业人员，使用世界卫生组织认可的SSC。临床模拟进行了之前的设计，以模仿手术室的真实情况，使用自然设备和各自的事后汇报，作为指导学习的反思。结果：科室模拟参与率分别为麻醉科40%、外科55.5%、骨科75%、外科护士76.5%。通过回顾模拟训练前后的SSC依从性来评估干预的影响。结果显示，进入期和手术暂停期间SSC依从性显著增加（P= 0.000），而在手术结束期未观察到显著变化。结论：研究结果表明，在手术室实施基于模拟的干预措施可以提高对《手术安全检查表》的依从性，从而有助于提高患者的安全性。

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引用次数: 0

Cataract care process: Systematic review of clinical guidelines and synthesis of recommendations 白内障护理过程：临床指南的系统回顾和建议的综合。

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-09-29 DOI: 10.1016/j.jhqr.2025.101161

M. García Anguas , A.M. Seva-Llor , R. Cabrera Beyrouti

Introduction

In 2020, 94 million people worldwide had moderate to severe visual impairment or blindness due to cataracts, particularly among older adults. The allocation of resources and appropriate strategies are essential for effective healthcare management that can control costs and improve patients’ quality of life. Clinical Practice Guidelines (CPGs) help reduce variability in care.

Objective

To analyze, compare, and synthesize recommendations from multiple guidelines on the same topic in order to identify consistencies, discrepancies, and opportunities for improvement.

Methods

Websites of international organizations, scientific societies, and various databases such as PubMed, WoS, and Cinahl were reviewed. A systematic review identified five high-quality CPGs for cataract management, with recommendations covering diagnosis, treatment, and postoperative follow-up.

Results

Although some variability was found, common recommendations were identified. Two widely agreed upon recommendations stood out: avoiding routine preoperative medical tests for local anesthesia, as they do not reduce complications, and using intracameral antibiotics (cefuroxime/moxifloxacin) for infection prevention, supported by high-level evidence, among others. The guideline developed by the American Academy of Ophthalmology – Cataract in the Adult Eye Preferred Practice Pattern – was found to be the most valid and useful.

Conclusion

Standardizing high-evidence recommendations can improve clinical decision-making, reduce variability, and enhance patient outcomes. This study highlights the need for better implementation strategies and patient-centered education to improve adherence to care.

2020年，全世界有9400万人因白内障出现中度至重度视力障碍或失明，尤其是老年人。资源分配和适当的策略对于有效的医疗保健管理至关重要，可以控制成本并改善患者的生活质量。临床实践指南（CPGs）有助于减少护理的可变性。目的：分析、比较和综合来自同一主题的多个指南的建议，以确定一致性、差异和改进机会。方法：查阅国际组织网站、科学学会网站以及PubMed、WoS、china等数据库。一项系统综述确定了5种用于白内障治疗的高质量cpg，并提供了包括诊断、治疗和术后随访的建议。结果：虽然发现了一些差异，但确定了共同的建议。其中有两项得到广泛同意的建议：避免术前常规的局部麻醉医学检查，因为它们不能减少并发症；以及使用内源性抗生素（头孢呋辛/莫西沙星）预防感染，这得到了高水平证据的支持。由美国眼科学会制定的指南——成人眼科首选实践模式中的白内障——被认为是最有效和有用的。结论：标准化高证据推荐可以改善临床决策，减少可变性，提高患者预后。本研究强调需要更好的实施策略和以患者为中心的教育，以提高对护理的依从性。

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引用次数: 0

Análisis de las hospitalizaciones potencialmente evitables en las enfermedades crónicas [潜在可避免的慢性疾病住院分析]。

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-09-27 DOI: 10.1016/j.jhqr.2025.101168

F.M. Escandell Rico , L. Pérez Fernández

Objective

To analyze indicators of potentially avoidable hospitalizations obtained through the minimum basic data set for chronic disease management and improving the quality of care.

Method

A descriptive retrospective study evaluating gender differences included hospital discharge records from 342 hospitals in the National Health System. The indicators and axes of analysis were from 2021, and the information included the following general data: total discharges, mean stay, mean age, and mortality rate. Four groups of indicators of potentially avoidable hospitalizations were analyzed: diabetes and its complications, cardiovascular disease and hypertension, respiratory and pulmonary diseases, and other acute and chronic conditions.

Results

Women have a higher risk of mortality in congestive heart failure (RR = 1.35) and diabetes with acute complications. Men have higher mortality rates in respiratory diseases such as COPD and asthma. In acute conditions, there are no significant differences in mortality, but in chronic conditions, women have a higher risk. In diabetes, women have higher mortality from acute complications (RR = 1.42), while men face a higher risk of chronic complications.

Conclusions

The study reveals variations in mortality and hospitalization associated with cardiovascular and respiratory diseases, and diabetes, with significant differences by gender. Women have higher mortality from acute complications of diabetes, while men have higher mortality from chronic diseases. These findings support the need for a personalized approach to treatment and prevention, considering the specificities of each gender.

目的：分析通过最低基本数据集获得的潜在可避免住院的指标，为慢性病管理和提高护理质量提供依据。方法：对全国卫生系统342家医院的出院记录进行描述性回顾性研究，评估性别差异。分析指标和轴自2021年起，信息包括以下一般数据：总出院人数、平均住院时间、平均年龄和死亡率。分析了四组潜在可避免住院的指标：糖尿病及其并发症、心血管疾病和高血压、呼吸和肺部疾病以及其他急性和慢性疾病。结果：女性在充血性心力衰竭（RR=1.35）和糖尿病合并急性并发症时有较高的死亡风险。男性患慢性阻塞性肺病和哮喘等呼吸系统疾病的死亡率更高。在急性疾病中，死亡率没有显著差异，但在慢性疾病中，妇女的风险更高。在糖尿病中，女性的急性并发症死亡率更高（RR=1.42），而男性的慢性并发症风险更高。结论：该研究揭示了与心血管和呼吸系统疾病以及糖尿病相关的死亡率和住院率的差异，性别差异显著。妇女因糖尿病的急性并发症死亡率较高，而男子因慢性病死亡率较高。这些发现支持了个性化治疗和预防方法的必要性，考虑到每个性别的特殊性。

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引用次数: 0