Pub Date : 2023-11-01DOI: 10.1016/j.jhqr.2023.09.004
G. Garzón González, L.M. Parra Ramírez
Aim
To validate a reduced and applicable to distinct location version of the only validated questionnaire of patient safety culture in managers in Spanish language.
Method
Questionnaire validation study. Community of Madrid 2022. Reduction/adaptation of the original questionnaire: Giménez-Aibar-Gutiérrez, 2013 Questionnaire was reduced from 85 items to 25; those local or not applicable were removed. Pre-test: Semi-structured survey on comprehension and response scale. There was no need to modify the questionnaire. Validation: It was tested in 39 primary care managers without care activity. Internal consistency (α Cronbach), content validity (experts) and construct validity (factor analysis) were analysed. Usability analysis: Survey on time spent and non-response rate.
Results
α Cronbach = 0.894. Content validity: Experts deemed questionnaire was complete. Factor analysis: five factors explain 68% of variance. The factors corresponded to the dimensions of the theoretical construct. Factors, internal consistency of each and correlation with global score were: commitment with patient safety: α Cronbach = 0.793, r = 0.778; P < .001; procedures/reporting: α Cronbach = 0.83, r = 0.806; P < .001; attitudes with patient safety: α Cronbach = 0.766, r = 0.596; P < .001; clinicians involving: α Cronbach = 0.773, r = 0.798; P < .001; patient safety communication: α Cronbach = 0.615, r = 0.518; P = .001; usability survey: 95% thought spent time was adequate. Non-response rate was 0%, except one item.
Conclusion
In this work, a reduced and adapted version of questionnaire of Giménez-Aibar-Gutiérrez was validated at distinct location (Madrid region). Psychometric properties and usability, which were found, suggest that the reduced questionnaire is a reliable, valid and usable instrument to assess patient safety culture in managers of any place.
{"title":"Validación de un cuestionario para evaluar la cultura de seguridad del paciente en directivos de la salud: propiedades psicométricas y usabilidad","authors":"G. Garzón González, L.M. Parra Ramírez","doi":"10.1016/j.jhqr.2023.09.004","DOIUrl":"https://doi.org/10.1016/j.jhqr.2023.09.004","url":null,"abstract":"<div><h3>Aim</h3><p>To validate a reduced and applicable to distinct location version of the only validated questionnaire of patient safety culture in managers in Spanish language.</p></div><div><h3>Method</h3><p>Questionnaire validation study. Community of Madrid 2022. Reduction/adaptation of the original questionnaire: Giménez-Aibar-Gutiérrez, 2013 Questionnaire was reduced from 85 items to 25; those local or not applicable were removed. Pre-test: Semi-structured survey on comprehension and response scale. There was no need to modify the questionnaire. Validation: It was tested in 39 primary care managers without care activity. Internal consistency (α Cronbach), content validity (experts) and construct validity (factor analysis) were analysed. Usability analysis: Survey on time spent and non-response rate.</p></div><div><h3>Results</h3><p>α Cronbach<!--> <!-->=<!--> <!-->0.894. Content validity: Experts deemed questionnaire was complete. Factor analysis: five factors explain 68% of variance. The factors corresponded to the dimensions of the theoretical construct. Factors, internal consistency of each and correlation with global score were: commitment with patient safety: α Cronbach<!--> <!-->=<!--> <!-->0.793, <em>r</em> <!-->=<!--> <!-->0.778; <em>P</em> <!--><<!--> <!-->.001; procedures/reporting: α Cronbach<!--> <!-->=<!--> <!-->0.83, <em>r</em> <!-->=<!--> <!-->0.806; <em>P</em> <!--><<!--> <!-->.001; attitudes with patient safety: α Cronbach<!--> <!-->=<!--> <!-->0.766, <em>r</em> <!-->=<!--> <!-->0.596; <em>P</em> <!--><<!--> <!-->.001; clinicians involving: α Cronbach<!--> <!-->=<!--> <!-->0.773, <em>r</em> <!-->=<!--> <!-->0.798; <em>P</em> <!--><<!--> <!-->.001; patient safety communication: α Cronbach<!--> <!-->=<!--> <!-->0.615, <em>r</em> <!-->=<!--> <!-->0.518; <em>P</em> <!-->=<!--> <!-->.001; usability survey: 95% thought spent time was adequate. Non-response rate was 0%, except one item.</p></div><div><h3>Conclusion</h3><p>In this work, a reduced and adapted version of questionnaire of Giménez-Aibar-Gutiérrez was validated at distinct location (Madrid region). Psychometric properties and usability, which were found, suggest that the reduced questionnaire is a reliable, valid and usable instrument to assess patient safety culture in managers of any place.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72116810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-26DOI: 10.1016/j.jhqr.2023.09.005
E. Gimenez , C. Watson , Y. Cossio-Gil
{"title":"Decoding patient-reported measures (PRMs) use in clinical practice: How and for what? The MATRICS framework","authors":"E. Gimenez , C. Watson , Y. Cossio-Gil","doi":"10.1016/j.jhqr.2023.09.005","DOIUrl":"10.1016/j.jhqr.2023.09.005","url":null,"abstract":"","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136159981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.jhqr.2022.09.006
L.D. Ferreira , D. McCants , S. Velamuri
Introduction
In the U.S., sepsis afflicts 1.7 million adults, causing 270,000 deaths each year. Early detection of sepsis could decrease the number of deaths by 92,000 annually and decrease hospital expenditures by 1.5 billion USD. Few prior studies and reviews have presented a holistic understanding of the relationship between machine learning and existing process improvement measures. This study, in addition to discussing machine learning and existing process improvements measures, elaborates on the disadvantages and the barriers to integrating machine learning into the clinic. This article synthesizes previous studies to educate healthcare professionals on effectively managing sepsis by leveraging the benefits of machine learning.
Methods
This study used the PubMed database. Search terms include sepsis antibiotics, sepsis process improvement, sepsis machine learning. Our search criteria included previous studies published between January 1, 2017, and February 1, 2022.
Results/discussion
Although machine learning algorithms have better predictive capabilities, their effectiveness in the clinical setting is limited as studies show mixed results because the medical staff often fails to intervene. To overcome poor interventional response, clinicians need to work with the facility's IT department to ensure integration into clinical workflow and minimize alert-fatigue. Algorithms should enhance the productivity of clinical teams, not attempt to replace them entirely.
Conclusion
Hospitals can employ process improvement measures that effectively utilize machine learning algorithms to ensure integration into clinical workflows. Healthcare professionals can utilize workflow tools in addition to the predictive capabilities of machine learning to enhance clinical decisions in sepsis.
{"title":"Using machine learning for process improvement in sepsis management","authors":"L.D. Ferreira , D. McCants , S. Velamuri","doi":"10.1016/j.jhqr.2022.09.006","DOIUrl":"10.1016/j.jhqr.2022.09.006","url":null,"abstract":"<div><h3>Introduction</h3><p>In the U.S., sepsis afflicts 1.7 million adults, causing 270,000 deaths each year. Early detection of sepsis could decrease the number of deaths by 92,000 annually and decrease hospital expenditures by 1.5 billion USD. Few prior studies and reviews have presented a holistic understanding of the relationship between machine learning and existing process improvement measures. This study, in addition to discussing machine learning and existing process improvements measures, elaborates on the disadvantages and the barriers to integrating machine learning into the clinic. This article synthesizes previous studies to educate healthcare professionals on effectively managing sepsis by leveraging the benefits of machine learning.</p></div><div><h3>Methods</h3><p>This study used the PubMed database. Search terms include <em>sepsis antibiotics</em>, <em>sepsis process improvement</em>, <em>sepsis machine learning</em>. Our search criteria included previous studies published between January 1, 2017, and February 1, 2022.</p></div><div><h3>Results/discussion</h3><p>Although machine learning algorithms have better predictive capabilities, their effectiveness in the clinical setting is limited as studies show mixed results because the medical staff often fails to intervene. To overcome poor interventional response, clinicians need to work with the facility's IT department to ensure integration into clinical workflow and minimize alert-fatigue. Algorithms should enhance the productivity of clinical teams, not attempt to replace them entirely.</p></div><div><h3>Conclusion</h3><p>Hospitals can employ process improvement measures that effectively utilize machine learning algorithms to ensure integration into clinical workflows. Healthcare professionals can utilize workflow tools in addition to the predictive capabilities of machine learning to enhance clinical decisions in sepsis.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10506678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.jhqr.2023.03.001
J. Moya-Salazar , V. Rojas-Zumaran , C.R. Salazar , H. Contreras-Pulache
{"title":"Transformando las instituciones en respuesta a las necesidades de atención en salud: comentarios sobre una experiencia peruana","authors":"J. Moya-Salazar , V. Rojas-Zumaran , C.R. Salazar , H. Contreras-Pulache","doi":"10.1016/j.jhqr.2023.03.001","DOIUrl":"https://doi.org/10.1016/j.jhqr.2023.03.001","url":null,"abstract":"","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49876243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.jhqr.2023.04.002
D. Montserrat Capella, P. Cazallo Navarro, C. Ruiz Entrecanales, J. García Pondal
{"title":"Adaptación de un modelo de transformación hospitalaria en relación al proceso de excelencia de la EFQM","authors":"D. Montserrat Capella, P. Cazallo Navarro, C. Ruiz Entrecanales, J. García Pondal","doi":"10.1016/j.jhqr.2023.04.002","DOIUrl":"https://doi.org/10.1016/j.jhqr.2023.04.002","url":null,"abstract":"","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49876237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.jhqr.2023.02.007
J. Mondéjar, G. Pellico, T. Sallén, P. Núñez, M. Puigcerver, I. Pallàs
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.
{"title":"Optimización del manejo de la degeneración macular asociada a la edad neovascular en España: evolución hacia modelos proactivos de tratamiento","authors":"J. Mondéjar, G. Pellico, T. Sallén, P. Núñez, M. Puigcerver, I. Pallàs","doi":"10.1016/j.jhqr.2023.02.007","DOIUrl":"https://doi.org/10.1016/j.jhqr.2023.02.007","url":null,"abstract":"<div><h3>Introduction and objective</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>The information collected from the OPTIMUS interviews and working groups (<em>n</em> <!-->=<!--> <!-->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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49876244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.jhqr.2023.03.002
R. Rodríguez-Fernández , L. Sánchez-Barriopedro , A. Merino-Hernández , M.I. González-Sánchez , J. Pérez-Moreno , B. Toledo del Castillo , F. González Martínez , C. Díaz de Mera Aranda , T. Eizaguirre Fernández-Palacios , A. Dominguez Rodríguez , E. Tierraseca Serrano , M. Sánchez Jiménez , O. Sanchez Lloreda , M. Carballo Nuria
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.
{"title":"Impacto de los «daily huddle» en la seguridad del paciente pediátrico hospitalizado","authors":"R. Rodríguez-Fernández , L. Sánchez-Barriopedro , A. Merino-Hernández , M.I. González-Sánchez , J. Pérez-Moreno , B. Toledo del Castillo , F. González Martínez , C. Díaz de Mera Aranda , T. Eizaguirre Fernández-Palacios , A. Dominguez Rodríguez , E. Tierraseca Serrano , M. Sánchez Jiménez , O. Sanchez Lloreda , M. Carballo Nuria","doi":"10.1016/j.jhqr.2023.03.002","DOIUrl":"https://doi.org/10.1016/j.jhqr.2023.03.002","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Material and methods</h3><p>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.</p></div><div><h3>Results</h3><p>Three hundred forty-eight security incidents were recorded. Medication prescription or administration errors stood out (<em>n</em> <!-->=<!--> <!-->103). Drug prescription or administration errors stood out (<em>n</em> <!-->=<!--> <!-->103), especially those related to high-risk medication: acetaminophen (<em>n</em> <!-->=<!--> <!-->14) (×10 doses of acetaminophen; <em>n</em> <!-->=<!--> <!-->6), insulin (<em>n</em> <!-->=<!--> <!-->6), potassium (<em>n</em> <!-->=<!--> <!-->5) and morphic (<em>n</em> <!-->=<!--> <!-->5). An improvement was observed in the pain record; 5% versus 80% (<em>P</em><.01), in the SAPI registry 5% versus 70% (<em>P</em><.01), in SBAER scale 40% vs 100% (<em>P</em><.01), in unequivocal identification of the patient 80% versus 100%; (<em>P</em><.01) and in the application of analgesic techniques 60% versus 85% (<em>P</em>=.01). In the survey of professionals, a degree of satisfaction of 8 (7–9.5)/10 was obtained.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49876247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.jhqr.2023.03.003
A. Crespo-Lessmann , J.A. Marqués-Espi , J. Dominguez-Ortega , L. Perez de Llano , M. Blanco-Aparicio , M. Santiñá , M. Palop-Cervera , F.J. Álvarez , J. Fraj
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.
{"title":"Quality indicators in the rational management of severe asthma: A Spanish multidisciplinary consensus","authors":"A. Crespo-Lessmann , J.A. Marqués-Espi , J. Dominguez-Ortega , L. Perez de Llano , M. Blanco-Aparicio , M. Santiñá , M. Palop-Cervera , F.J. Álvarez , J. Fraj","doi":"10.1016/j.jhqr.2023.03.003","DOIUrl":"10.1016/j.jhqr.2023.03.003","url":null,"abstract":"<div><h3>Aim</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>All 11 indicators achieved a high level of consensus after just one Delphi round.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10488852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.jhqr.2023.02.004
S. Ballesteros-Peña , I. Fernández-Aedo , G. Vallejo de la Hoz
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.
{"title":"Diferencias entre comunidades autónomas de España en la dotación de desfibriladores externos semiautomáticos fuera del ámbito sanitario","authors":"S. Ballesteros-Peña , I. Fernández-Aedo , G. Vallejo de la Hoz","doi":"10.1016/j.jhqr.2023.02.004","DOIUrl":"https://doi.org/10.1016/j.jhqr.2023.02.004","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>A cross-sectional observational study was carried out between December 2021 and January 2022 by consulting official data in the 17 Spanish autonomous communities.</p></div><div><h3>Results</h3><p>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).</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49876245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.jhqr.2022.11.002
I. Arrieta Valero
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—.
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