Journal of Healthcare Quality Research最新文献

英文中文

Textbook outcome in thyroid surgery: A new approach to assess quality in an endocrine surgery unit 教科书结果在甲状腺手术：一个新的方法来评估质量在内分泌外科单位

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-03 DOI: 10.1016/j.jhqr.2025.101120

D. Costa Navarro , J.J. Rubio-García , A. Gomis-Martín , T. Viñas Martínez , J. López-Noguera , M. Franco-Campello , A. Carrion-Tomás , J.M. Ramia

Background

Thyroidectomy is a term encompassing various surgical procedures involving the thyroid gland. Assessing quality is imperative for patient safety and clinical auditing and textbook outcome (TO) offers more comprehensive information on overall quality than single indicators. This study aims to define the parameters constituting TO in thyroid surgery, evaluate the outcomes based on TO criteria within an endocrine surgery unit at a tertiary hospital, and identify factors associated with failure to achieve TO in these cases.

Methods

A retrospective observational study of consecutive patients undergoing thyroid surgery at the Endocrine Surgery Unit in Spain between January 2020 and December 2022. The analyzed variables included, among others, age and sex, comorbidities, diagnosis, intrathoracic goiter, type of thyroidectomy, and several postoperative complications. The first TO definition in thyroid surgery was made.

Results

A total of 244 patients were included in the study. TOTS was achieved in 153 patients (62.7%), and there were no reported mortalities. Diabetes (18% vs 8.61%) and endothoracic goiter (40% vs 22%) were statistically associated with textbook outcome non-achievement. Also, the endothoracic goiter parameter was identified as a statistically significant predictor of textbook outcome non-achievement.

Conclusion

The implementation of the TO concept in thyroid surgery offers a comprehensive method for assessing surgical quality, encapsulating a range of critical postoperative outcomes. The rate of TO in our serie was 62.7%, identifying that endothoracic goiter is the main parameter of textbook outcome non-achievement.

甲状腺切除术是一个包含涉及甲状腺的各种外科手术的术语。评估质量对于患者安全和临床审计是必不可少的，教科书结果（TO）提供了比单一指标更全面的总体质量信息。本研究旨在确定甲状腺手术中to的构成参数，根据三级医院内分泌外科的to标准评估结果，并确定这些病例中未能达到to的相关因素。方法对2020年1月至2022年12月在西班牙内分泌外科连续接受甲状腺手术的患者进行回顾性观察研究。分析的变量包括年龄和性别、合并症、诊断、胸内甲状腺肿、甲状腺切除术类型和一些术后并发症。甲状腺手术中第一个TO定义被提出。结果共纳入244例患者。153例患者（62.7%）获得TOTS，无死亡报告。糖尿病（18% vs 8.61%）和胸内甲状腺肿（40% vs 22%）与教科书结局不达标有统计学关联。此外，胸内甲状腺肿参数被确定为教科书结果未达到的统计显著预测因子。结论在甲状腺手术中实施TO概念提供了一种评估手术质量的综合方法，包含了一系列关键的术后结果。本组患者的甲状腺肿率为62.7%，表明胸内甲状腺肿是教科书预后不达标的主要参数。

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引用次数: 0

Análisis de los indicadores de seguridad del paciente en las complicaciones por cuidados durante la hospitalización 【住院期间护理并发症患者安全指标分析】。

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-02 DOI: 10.1016/j.jhqr.2025.01.001

F.M. Escandell Rico , L. Pérez Fernández

Objective

To Analyze AHRQ Patient Safety Indicators (PSI) obtained through the Minimum Basic Data Set (MBDS) in improving patient safety.

Method

Observational descriptive and retroprective study. The CMBD hospital discharge registry of 342 hospitals of the National Health System was included. The MBDS indicators and analysis axes were from 2021 and the hospitalization MBDS information included the following general data: total discharges, average stay, average age and % mortality. Four patient safety indicators were analyzed: Pressure ulcers (PSI 03), Iatrogenic pneumothorax (PSI 06), Accidental puncture or tear in adults (PSI 15) and CVC-related to bloodstream infection (PSI 07).

Results

The PSI 06 and PSI 07 categories not only have a higher number of discharges, but also a longer average stay and mortality. In comparison, PSI 03 and PSI 15 categories show a much lower number of discharges, and a lower mortality and average stay. Conditions associated with PSI 06 and PSI 07 categories could be more severe or complex, leading to a longer hospital stay and a higher risk of mortality. According to relative risk analyses, all indicators show a slightly higher mortality risk in men than in women.

Conclusions

Advanced age and serious diagnoses, such as circulatory diseases or neoplasia, are associated with higher mortality and hospital stay. In relation to hospital size, smaller ones show higher risks and worse mortality outcomes. Therefore, these results could guide strategies to optimize resources and focus interventions on the most vulnerable groups.

目的分析通过最低基本数据集（MBDS）获得的 AHRQ 患者安全指标（PSI）在改善患者安全方面的作用：观察性描述和追溯研究。方法：观察性描述和回顾性研究。研究对象包括全国卫生系统 342 家医院的 CMBD 出院登记。MBDS指标和分析轴来自2021年，住院MBDS信息包括以下一般数据：出院总人数、平均住院日、平均年龄和死亡率。对四项患者安全指标进行了分析：压疮（PSI 03）、先天性气胸（PSI 06）、成人意外穿刺或撕裂（PSI 15）和CVC相关血流感染（PSI 07）：结果：PSI 06 和 PSI 07 类别不仅出院人数较多，而且平均住院时间和死亡率也较长。相比之下，PSI 03 和 PSI 15 类别的出院人数要少得多，死亡率和平均住院时间也较短。与 PSI 06 和 PSI 07 类别相关的情况可能更加严重或复杂，导致住院时间更长，死亡风险更高。根据相对风险分析，所有指标均显示男性的死亡风险略高于女性：结论：高龄和严重诊断（如循环系统疾病或肿瘤）与较高的死亡率和住院时间有关。就医院规模而言，规模较小的医院风险较高，死亡率较低。因此，这些结果可以指导优化资源的战略，并将干预重点放在最脆弱的群体上。

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引用次数: 0

Optimización del reprocesado de materiales sanitarios en centros de atención primaria 在初级保健设施中优化卫生材料的后处理

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-02 DOI: 10.1016/j.jhqr.2025.101124

E.A. Sabuco Tébar , Á.R. Sáez Soto , M. Culiañez Alenda , Y. López Benavente , R. López Alegría , F.J. Campayo Rojas

Introduction and objetive

Reprocessing of medical devices in Primary Care Centers (PCC) can be a source of infections. The aim of this study was to improve the quality of reprocessing devices in the PCCs of Area VII-Murcia/Este through an improvement cycle.

Methods

This prospective intervention study. was carried out in 12 PCC, 14 Local Clinics (LC), 4 Oral Health Units (OHU) and the professionals involved in the reprocessing. Between 09/2022-03/2023, a working group was created, and a situation analysis was carried out: inventory of autoclaves, consumption of materials, and visits to the PCCs. Between 04/2023-03/2024, improvement actions were implemented: purchasing plan, use of Chemical Indicators (CHI) and Biological Indicators (BI), training with prior knowledge surveys, work procedure, and processes traceability.

Results

In total 11 autoclaves were acquired. The percentage of BI completion was ≥ 45%, and 80% of professionals were trained. The following improvements were obtained: detergent technical data sheet in the washing Area (45% to 73%), sterilization dates traceability (10% to 78%), sterilization cycles traceability (11% to 66%), use of instrument brush (55% to 74%), bag labeling (45% to 68%), correct storage (45% to 78%), and use of tap water to generate steam (2% to 0%).

Conclusions

The implementation of an improvement cycle, through the training of professionals, standardization of procedures, and traceability of processes, in addition to having an expert nurse as a reference, increases the quality in the reprocessing of medical devices.

初级保健中心（PCC）医疗器械的引入和处理可能是感染的一个来源。本研究的目的是通过一个改进周期来提高第七区穆尔西亚/埃斯特的PCCs的再处理设备的质量。方法前瞻性干预研究。在12个PCC、14个地方诊所、4个口腔保健单位和参与再处理的专业人员中进行。在2022年9月至2023年3月期间，成立了一个工作组，并进行了情况分析：热压灭菌器的库存，材料的消耗，以及对PCCs的访问。在204/04 - 2024 / 03期间，实施了改进措施：采购计划，化学指标（CHI）和生物指标（BI）的使用，预先知识调查培训，工作程序和过程可追溯性。结果共获得11台高压灭菌器。BI完成率≥45%，80%的专业人员接受过培训。取得了以下改进：洗涤区域的洗涤剂技术数据表（45%至73%），灭菌日期可追溯性（10%至78%），灭菌周期可追溯性（11%至66%），使用仪器刷（55%至74%），袋装标签（45%至68%），正确储存（45%至78%），使用自来水产生蒸汽（2%至0%）。结论通过专业人员的培训、流程的标准化和流程的可追溯性，以及有专家护士作为参考，实施改进周期，提高了医疗器械再加工的质量。

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引用次数: 0

Experiencias, percepciones y emociones de los pacientes crónicos hospitalizados tras un programa de intervencion musical 音乐干预方案后住院的慢性病患者的经历、感受和情绪

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-02 DOI: 10.1016/j.jhqr.2025.101121

L. Ortiz de Villacián-Fernández , I. Apraiz-Sánchez , N. Martínez-Domínguez , A. Picón-Santamaría , S. Ballesteros-Peña

Aim

Musical interventions for hospitalized patients have shown benefits such as improved mood and reduced stress, but their impact from a qualitative perspective is under-explored. This study aimed to understand the experiences, perceptions, and emotions of chronically ill hospitalized patients who participated in a program of individual micro-concerts during their hospital stay.

Methodology

A qualitative study was conducted in a hospital in Bilbao, Spain, in 2024. Hospitalized patients were offered 20-minute micro-concerts three times a week. Semi-structured interviews were conducted with 21 patients selected through purposive sampling. The interviews were transcribed and analyzed inductively to identify thematic patterns.

Results

The analysis identified four categories. The first was emotional and cognitive well-being, where patients reported improvements in mood and cognitive stimulation. The second category, the operational aspects of the intervention, highlighted the positive perception of the frequency, duration, and personalization of the sessions. The third category was personal evaluation, where the role of the music therapist was highlighted as a key factor in the success of the intervention. Finally, suggestions for improvement included recommendations to extend the program to other areas of the hospital and combine musical interventions with complementary activities.

Conclusions

Personalized musical interventions have a positive impact on the emotional and cognitive well-being of patients. It is essential to design flexible interventions that adapt to individual needs and promote integrated care models.

AimMusical对住院患者的干预已经显示出改善情绪和减轻压力等益处，但从定性角度来看，它们的影响尚未得到充分探讨。本研究旨在了解慢性疾病住院患者在住院期间参加个人微音乐会的体验、感知和情绪。方法于2024年在西班牙毕尔巴鄂的一家医院进行定性研究。住院患者每周有三次20分钟的微音乐会。采用目的抽样法对21例患者进行半结构化访谈。对访谈进行转录和归纳分析，以确定主题模式。结果分析确定了四类。第一个是情绪和认知健康，患者报告情绪和认知刺激有所改善。第二类，即干预的操作方面，强调了对会议频率、持续时间和个性化的积极看法。第三类是个人评估，其中音乐治疗师的作用被强调为干预成功的关键因素。最后，改进建议包括将该项目扩展到医院的其他领域，并将音乐干预与补充活动结合起来。结论个性化音乐干预对患者的情绪和认知健康有积极影响。必须设计适应个人需要的灵活干预措施，并促进综合护理模式。

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引用次数: 0

Influencia de la adherencia en el valor de persistencia dentro de la Medicina 6P 依从性对医学中持久性值的影响6P

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-02 DOI: 10.1016/j.jhqr.2025.101123

J. Borrás-Blasco , E. Ramírez-Herráiz , A. Navarro-Ruiz

引用次数: 0

El modelo MUFACE: un anacronismo contrario a la equidad ciudadana y la congruencia normativa del Sistema Nacional de Salud [MUFACE模式：与公民的公平和国家卫生系统的监管一致性背道而驰的时代错误]。

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-01 DOI: 10.1016/j.jhqr.2025.101127

R. Urbanos-Garrido , B. González López-Valcárcel

引用次数: 0

MUFACE: un buen modelo para un sistema basado en la coexistencia de lo público y lo privado [MUFACE：一个基于公私共存的系统的好模型]。

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-03-31 DOI: 10.1016/j.jhqr.2025.101119

J. Abarca Cidón

引用次数: 0

Elaboración de un checklist para la transferencia en UCIP del paciente pediátrico quirúrgico [PICU中儿科手术患者交接清单的制定]。

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-03-01 DOI: 10.1016/j.jhqr.2024.12.004

M.Á. Rivas Paterna , M. Abelaira García , D. Ortega Martínez , B. Joyanes Abancens , A.I. Alguacil Pau , E. Aleo Luján

引用次数: 0

Adecuación del consentimiento informado en la investigación clínica: estudio descriptivo transversal 临床研究中知情同意的充分性：一项描述性横断面研究。

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-03-01 DOI: 10.1016/j.jhqr.2024.12.001

M.D. Monge-Muñoz , G. Rodríguez-Caravaca , J.L. del-Barrio-Fernández

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.

前言和目标：病人自主参与和将其健康数据纳入研究项目的原则是一项必须履行的法律和道义义务。本研究旨在了解某大学医院临床研究项目中知情同意的遵守程度和充分性。材料和方法：通过本横断面研究，分析了在提交给某大学医院研究委员会的研究项目中获取患者数据的方式是否充分。在研究项目中获得患者数据的方式的充分性，处理知情同意和豁免的原因，描述了它们的频率分布。通过回溯逻辑回归模型，包括先前在单变量分析中分析的可预测的显著变量，通过调整的优势比进行评估。结果：共纳入565个方案。最常见的研究类型是观察性回顾性研究（49.6%）和年终项目（28.1%）。获取患者数据最常见的方式是请求豁免知情同意（48.3%）。51.1%的项目认为获得患者数据过程是适当的。充足性较高的项目是由学生征集的项目(OR=4.2；CI95%=2.0-8.8)，居民OR=3.0；CI95% = 1.2 - -2.4)。结论：大多数被评估的项目是回顾性观察性研究，在这些研究中，要求受试者豁免知情同意。由学生及居民征集适当度较高的项目。

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引用次数: 0

Calidad de la asistencia sanitaria y salud del sistema en perspectiva 卫生保健质量和系统健康前景

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-03-01 DOI: 10.1016/j.jhqr.2025.02.001

R. Meneu

引用次数: 0

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