Journal of Healthcare Quality Research最新文献

英文中文

Surgical safety checklist in crisis: We do either it right or we do it right 危机中的手术安全清单：我们要么做对，要么做对。

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2026-01-01 Epub Date: 2025-12-24 DOI: 10.1016/j.jhqr.2025.101182

D. Parés

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 : 2026-01-01 Epub 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

A retrospective cohort study of onco-hematologic inpatients with SACT at the end of life in a single cancer institution: Differences between solid tumors and hematological neoplasms 一项回顾性队列研究，在单一癌症机构对SACT晚期肿瘤-血液学住院患者：实体瘤和血液学肿瘤之间的差异

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2026-01-01 Epub Date: 2025-09-09 DOI: 10.1016/j.jhqr.2025.101160

L. Pétriz , A. Vidal , J.R. Germà , E. Loureiro , J. Muniesa , T. Ferro

Background

This study compares mortality indicators in patients with solid tumors (ST) and hematological neoplasms (HN) who died in the hospital during systemic anticancer therapy (SACT) in the last 30 days of life. We used indicators described by Earle: SACT < 30d, SACT < 14d, therapeutic regimen changes, and palliative care referrals. We also analyzed the impact of palliative care availability on patient survival.

Methods

Between 2017 and 2022, we identified, validated, and registered 2285 cases through our institution's Mortality Subcommittee (MS) that met the inclusion criteria for this cohort.

Results

We observed differences in indicators between ST and HN consistent with published literature. These differences occurred both in therapeutic intensity (higher in HN) and in palliative care referrals (higher percentage for ST). When analyzing survival from advanced disease definition to death, no statistically significant differences emerged between patients with HN versus ST, or between those with and without palliative care.

Conclusions

The published differences between subgroups (ST vs HN) persist even in our hospital death cohort, confirming the need for pathology-specific standards.

本研究比较了生命最后30天在医院接受全身抗癌治疗（SACT）期间死亡的实体瘤（ST）和血液肿瘤（HN）患者的死亡率指标。我们使用Earle描述的指标：SACT <； 30d, SACT < 14d，治疗方案改变和姑息治疗转诊。我们还分析了姑息治疗对患者生存的影响。方法：在2017年至2022年期间，我们通过我们机构的死亡率小组委员会（MS）确定、验证并登记了2285例符合该队列纳入标准的病例。结果我们观察到ST和HN在指标上的差异与已发表的文献一致。这些差异发生在治疗强度（HN较高）和姑息治疗转诊（ST较高百分比）。当分析从晚期疾病定义到死亡的生存率时，HN和ST患者之间，或接受和不接受姑息治疗的患者之间没有统计学上的显著差异。结论已发表的亚组（ST与HN）之间的差异即使在我们的医院死亡队列中也存在，这证实了对病理特异性标准的需求。

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引用次数: 0

Estrategia para la mejora del Servicio de Atención a la persona Usuaria de un Sistema Público de Salud [改善公共卫生系统病人和使用者服务的战略]。

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2026-01-01 Epub Date: 2026-01-12 DOI: 10.1016/j.jhqr.2025.101185

Aitziber Echevarria Echevarria

Introduction

The current health situation necessitates a paradigm shift in Patient Care Services to meet societal needs.

The general objective wasto improve the quality and effectiveness of the Patient Care Service and users of a public health system.

Material and methods

A systematic bibliographic review of aspects related to the Patient/User/Citizen Care Service was conducted, and a survey was developed on general and organizational aspects and the strategies followed by different hospitals in various Autonomous Communities.

Results

Significant differences in User Care Services exist between the Autonomous Communities in Spain due to the decentralization of the health system and outdated regulations. These differences include nomenclature, hierarchical dependence, organization and management, services offered, responsibilities, professional training, accessibility, implementation of user rights and duties, and citizen participation in health centers.

Conclusion

The results highlight the need for a comprehensive model that combines personalization, technology, and citizen participation. This approach enhances the efficiency of User Care Services, strengthens equity, and reinforces institutional trust. In the face of the sociodemographic and structural challenges of the healthcare system, it is essential to move towards person-centered models, where the patient's voice is integrated as a driver of quality and transformation.

导言：目前的健康状况需要在病人护理服务范式的转变，以满足社会的需要。总体目标是提高病人护理服务和公共卫生系统用户的质量和有效性。材料和方法：对患者/用户/公民护理服务相关方面进行了系统的书目审查，并对各个自治区不同医院的一般和组织方面以及所遵循的战略进行了调查。结果：由于卫生系统的分散化和过时的法规，西班牙自治区之间存在显著的用户护理服务差异。这些差异包括命名法、等级依赖性、组织和管理、提供的服务、责任、专业培训、可及性、用户权利和义务的实施以及公民在保健中心的参与。结论：研究结果表明，需要建立一个综合模型，将个性化、技术和公民参与结合起来。这种做法提高了用户关怀服务的效率，加强了公平性，并加强了机构信任。面对医疗保健系统的社会人口和结构挑战，必须转向以人为中心的模式，在这种模式中，患者的声音被整合为质量和转型的驱动力。

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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 : 2026-01-01 Epub Date: 2025-10-25 DOI: 10.1016/j.jhqr.2025.101171

R. Allande-Cussó , J. Gómez-Salgado

引用次数: 0

Acknowledgment to the Journal Reviewers for their contributions 感谢期刊审稿人的贡献

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2026-01-01 Epub Date: 2026-01-22 DOI: 10.1016/j.jhqr.2026.101190

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 : 2026-01-01 Epub 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

Improving the quality of emergency care with a risk map 通过风险地图提高急诊护理的质量。

IF 1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2026-01-01 Epub Date: 2025-12-11 DOI: 10.1016/j.jhqr.2025.101180

A. Cuerva Carvajal, I. Osorio González, J.L. Fernández Ropero, A. Quitián Martín

Objective

To describe the process of developing a risk map in a hospital emergency department.

Method

A risk map was developed for the observation area of the emergency department of a secondary-level hospital belonging to the Regional Health Service of Andalusia. The work involved the systematic identification of potential problems, their prioritization, and the proposal of improvement measures, following a structured risk analysis methodology applied to patient safety.

Results

A total of 25 main problems were identified. After prioritization, the following critical areas were highlighted: direct patient monitoring; medication safety during treatment administration; standardization of clinical procedures; continuity of care during night shifts; appropriate management of patient isolation; analysis of previous initiatives; and the implementation and auditing of new improvement proposals.

Conclusions

The use of structured tools aimed at patient safety, such as risk maps, is both feasible and useful for identifying improvement areas in emergency services. Their application allows problems to be prioritized, interventions to be targeted, and a systematic framework to be established for the continuous improvement of healthcare quality.

目的：描述医院急诊科制定风险图的过程。方法：对安达卢西亚地区卫生局下属二级医院急诊科观察区绘制风险图。这项工作包括系统地识别潜在问题，确定其优先次序，并提出改进措施，遵循适用于患者安全的结构化风险分析方法。结果：共发现25个主要问题。在确定优先顺序后，重点强调了以下关键领域：患者直接监测；给药过程中的用药安全；临床程序标准化；夜班期间护理的连续性；适当管理患者隔离；对以往倡议的分析；并对新的改进建议进行实施和审核。结论：针对患者安全使用结构化工具，如风险图，对于确定急诊服务的改进领域既可行又有用。它们的应用可以对问题进行优先排序，有针对性地进行干预，并为持续改进医疗保健质量建立系统框架。

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引用次数: 0

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 : 2026-01-01 Epub 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

Healthcare-associated infections in a long-term care hospital: A three-year point-prevalence study 长期护理医院的医疗保健相关感染：一项为期三年的点流行研究

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-11-01 Epub Date: 2025-06-09 DOI: 10.1016/j.jhqr.2025.101146

P. Cárdenas-Soriano , V.S.H. Múgica , P. Blanco-Hernández , M. Gil-López , G. Rodríguez-Caravaca , A.M. Pedraza-Flechas

Objective

To assess the prevalence of Healthcare-Associated Infections (HAIs) acquired during hospitalization in a long-term care (LTC) hospital during three periods and identify associated factors.

Methods

An observational, cross-sectional study had been conducted in 2019, 2021, and 2023 that included 380 patients. Data collected encompassed demographics, presence of risk factors (pressure sores, catheters, surgery), and HAIs acquired in the current hospitalization. Global and per location HAI was determined, and bivariate and a multiple logistic regression model was constructed to explore the association between the studied variables and infection.

Results

The median age varied depending on the year of the survey between 77 and 80.5 years, and the proportion of female patients increased each edition. Length of stay peaked in 2021 (43.5 days), and risk factors in 2023. HAIs prevalences were 8.4% (2019), 10.7% (2021), and 5.6% (2023). Respiratory tract infection was the most frequent globally (34.4%), in 2019 (35.7%) and 2023 (50.0%), followed by urinary tract infection. Globally, HAI and any risk factor (OR: 3.8, 95% CI: 1.6–8.8), and pressure sores (OR: 2.4, 95% CI: 1.1–5.2) were associated, this last remained after adjustment (OR: 16.0, 95% CI: 2.5–104.9).

Conclusions

LTC hospitals pose a risk for HAI. Further research on associated factors and preventive strategies is crucial to improve care in this sector.

目的评估某长期护理医院住院期间获得性卫生保健相关感染（HAIs）的流行情况，并确定相关因素。方法于2019年、2021年和2023年进行了一项观察性横断面研究，包括380例患者。收集的数据包括人口统计、风险因素（压疮、导尿管、手术）的存在以及当前住院期间获得的卫生保健指数。确定了全球和每个地点的HAI，并构建了双变量和多元逻辑回归模型，以探讨所研究变量与感染之间的关系。结果不同年份患者年龄中位数在77 ~ 80.5岁之间，女性患者所占比例逐年增加。停留时间在2021年达到峰值（43.5天），风险因素在2023年达到峰值。HAIs患病率分别为8.4%（2019年）、10.7%（2021年）和5.6%（2023年）。全球最常见的是呼吸道感染（34.4%），2019年（35.7%）和2023年（50.0%），其次是尿路感染。总体而言，HAI与任何危险因素（OR: 3.8, 95% CI: 1.6-8.8）和压疮（OR: 2.4, 95% CI: 1.1-5.2）相关，最后一个因素在调整后仍然存在（OR: 16.0, 95% CI: 2.5-104.9）。结论sltc医院存在HAI风险。进一步研究相关因素和预防战略对于改善这一部门的护理至关重要。

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