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Satisfaction with maternal and birth services: a survey in public hospitals in Turkey. 对孕产妇和分娩服务的满意度:土耳其公立医院的调查。
IF 1.5 Q4 HEALTH POLICY & SERVICES Pub Date : 2020-07-08 DOI: 10.1108/IJHCQA-08-2019-0146
Şirin Özkan, Chifa Chiang, Gökhan Aba, Yusuf Çelik

Purpose: The purpose of this study was to determine the satisfaction of women who underwent normal delivery and cesarean section (or C-section) with maternal care in five state-run hospitals in Northwestern Turkey.

Design/methodology/approach: This was a cross-sectional study. The sample consisted of 580 women who underwent normal delivery (ND) and 392 who had a C-section (CS). Data were collected using two maternal satisfaction questionnaires, which participants completed right before they were discharged.

Findings: More than half of ND (61.7%) and CS (56.9%) participants were satisfied with maternal care. ND participants who had received antenatal training were more satisfied with maternal care than CS participants who had not received antenatal training. Higher income was a significant predictor for reduced satisfaction with maternal care among CS participants (p = 0.031).

Practical implications: Hospital administrators and decision-makers should meet women's expectations, provide them with comfort, encourage them for skin-to-skin contact and respect their right to privacy in order to increase their satisfaction with maternal care. Pregnant women should also be encouraged to receive antenatal training offered by hospitals before delivery.

Originality/value: The evidence-based results of the study will help hospital administrators to improve healthcare quality and focus on increasing women's satisfaction with maternal care.

目的:本研究的目的是确定在土耳其西北部五家国营医院接受正常分娩和剖宫产(或剖腹产)的妇女对产妇护理的满意度。设计/方法/方法:这是一项横断面研究。样本包括580名正常分娩(ND)和392名剖腹产(CS)的妇女。数据收集使用两份产妇满意度问卷,参与者在出院前完成问卷。结果:半数以上的ND(61.7%)和CS(56.9%)对产妇护理感到满意。接受过产前培训的ND参与者对产妇护理的满意度高于未接受产前培训的CS参与者。高收入是CS参与者对产妇护理满意度降低的显著预测因子(p = 0.031)。实际意义:医院管理者和决策者应满足妇女的期望,为她们提供舒适,鼓励她们进行皮肤接触,尊重她们的隐私权,以提高她们对孕产妇护理的满意度。还应鼓励孕妇在分娩前接受医院提供的产前培训。原创性/价值:本研究的循证结果将有助于医院管理者提高医疗质量,并将重点放在提高妇女对孕产妇护理的满意度上。
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引用次数: 2
A tool to assess the quality perception of healthcare employees. 一个评估医疗保健员工质量感知的工具。
IF 1.5 Q4 HEALTH POLICY & SERVICES Pub Date : 2020-06-16 DOI: 10.1108/IJHCQA-01-2020-0008
Ajayan Kamalasanan, Gurumoorthy Sathiyamurthi, Arun Vijay Subbarayalu

Purpose: The purpose of this project was to determine the validity and reliability of the Healthcare Quality Perception (HQP) questionnaire tool designed to capture employees' perceptions of healthcare quality in Indian hospitals.

Design/methodology/approach: Two hundred employees in private and public sector hospitals in India were randomly selected and given the HQP tool. It consisted of 38 Likert-scale items and six different subscales: (1) Planning and Documentation (n = 7); (2) Employee Participation in Quality Management Activities (n = 5); (3) Existence of Policies/Procedures/Guidelines (n = 5); (4) Quality and Patient Safety Management (n = 9); (5) Perceived Effect of Quality Improvement (n = 7) and (6) Training and Development Opportunities (n = 5). 156 completed questionnaires were received, demonstrating a 78% response rate. HQP tool subjected to statistical analysis to measure its reliability and validity. A p-value of less than 0.05 was considered as "significant."

Findings: Factor analysis pulled out six factors that conjointly demonstrated 66.4 % of the variance in healthcare professionals' (HCPs') perception of healthcare service quality in selected Indian hospitals. The overall Cronbach's alpha coefficient was measured at 0.959 for internal consistency reliability. This study demonstrates that the identified six critical factors are important determinants influencing HCPs' perception of the quality of healthcare services in private and public sector hospitals in India.

Originality/value: This study provides evidence for the reliability and validity of the newly developed HCP Scale for the assessment of employee perception of the quality of services offered in selected hospitals in India, with potential applications in other contexts.

目的:本项目的目的是确定医疗保健质量感知(HQP)问卷工具的效度和可靠性,该工具旨在捕捉员工对印度医院医疗保健质量的感知。设计/方法/方法:随机选择印度私立和公立医院的200名员工,并给予他们健康质量计划工具。它包括38个李克特量表项目和6个不同的子量表:(1)计划和文件(n = 7);(2)员工参与质量管理活动(n = 5);(3)政策/程序/指引的存在(n = 5);(4)质量和患者安全管理(n = 9);(5) Perceived Effect of Quality Improvement (n = 7)和(6)Training and Development Opportunities (n = 5)共收到问卷156份,回复率78%。对HQP工具进行统计分析,衡量其信度和效度。p值小于0.05为“显著”。“结果:因子分析得出六个因素,这些因素共同表明,在选定的印度医院中,医疗保健专业人员(HCPs)对医疗保健服务质量的看法差异占66.4%。内部一致性信度总体Cronbach’s alpha系数为0.959。本研究表明,确定的六个关键因素是影响印度私营和公立医院卫生保健服务质量的重要决定因素。原创性/价值:本研究为新开发的HCP量表的可靠性和有效性提供了证据,该量表用于评估印度选定医院提供的服务质量的员工感知,并具有在其他情况下的潜在应用。
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引用次数: 2
Identifying contextually relevant improvement measures, illustrated by a case of executive walkrounds. 识别上下文相关的改进措施,通过执行巡查的案例来说明。
IF 1.5 Q4 HEALTH POLICY & SERVICES Pub Date : 2020-04-21 DOI: 10.1108/IJHCQA-08-2019-0140
Nick J Reed, Natalie Wilson, Kathryn J Hayes

Purpose: A method to engage salient organisational stakeholders in identifying and ranking measures of healthcare improvement programs is described. The method is illustrated using Executive WalkRounds (EWRs) in a multi-site Australian Health District.

Design/methodology/approach: Subject matter experts (SMEs) conducted document analysis, identified potential EWRs measures, created driver diagrams and then eliminated weak measures. Next, a panel of executives skilled in EWRs ranked and ratified the potential measures using a modified Delphi technique.

Findings: EWRs measurement selection demonstrated the feasibility of the method. Of the total time to complete the method 79% was contributed by SMEs, 14% by administration personnel and 7% by executives. Document analysis revealed three main EWRs aims. Ten of 28 potential measures were eliminated by the SME review. After repeated Delphi rounds the executive panel achieved consensus (75% cut-off) on seven measures. One outcome, one process and one implementation fidelity metric were selected to measure and monitor the impact of EWRs in the health district.

Practical implications: Perceptions of weak relationships between measures and intended improvements can lead to practitioner scepticism. This work offers a structured method to combine the technical expertise of SMEs with the practical knowledge of healthcare staff in selecting improvement measures.

Originality/value: This research describes and demonstrates a novel method to systematically leverage formal and practical types of expertise to select measures that are strongly linked to local quality improvement goals. The method can be applied in diverse healthcare settings.

目的:描述了一种方法,以参与显著的组织利益相关者识别和排名措施的医疗保健改善方案。该方法是用行政巡诊(EWRs)在多站点澳大利亚卫生区说明。设计/方法论/方法:主题专家(sme)进行文档分析,确定潜在的EWRs度量,创建驱动图,然后消除弱度量。接下来,一组在EWRs方面熟练的高管使用改进的德尔菲技术对可能的措施进行排名和批准。结果:EWRs测量选择证明了该方法的可行性。在完成该方法的总时间中,中小企业贡献了79%,管理人员贡献了14%,高管贡献了7%。文献分析揭示了EWRs的三个主要目标。28项潜在措施中的10项在中小企业审查中被淘汰。经过反复的德尔菲轮次,执行小组在七项措施上达成了共识(75%的截止)。选择了一个结果、一个过程和一个实施保真度指标来衡量和监测卫生区EWRs的影响。实际含义:对措施和预期改进之间的弱关系的认识可能导致从业者怀疑。这项工作提供了一种结构化的方法,将中小企业的技术专长与医护人员的实践知识结合起来,选择改进措施。原创性/价值:本研究描述并展示了一种新颖的方法,系统地利用正式和实用类型的专业知识来选择与当地质量改进目标密切相关的措施。该方法可应用于不同的医疗保健环境。
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引用次数: 0
Bureaucracy and the balanced scorecard in health care settings. 卫生保健机构中的官僚主义和平衡计分卡。
IF 1.5 Q4 HEALTH POLICY & SERVICES Pub Date : 2020-04-08 DOI: 10.1108/IJHCQA-07-2019-0121
Helena Costa Oliveira, Lúcia Lima Rodrigues, Russell Craig

Purpose: We explore the relationship between the balanced scorecard (BSC) and neo-bureaucracy by investigating whether the operationalization of the BSC incorporates "neo-bureaucratic" ideas and whether the BSC implemented in a Portuguese Local Health Unit (LHU) demonstrates a neo-bureaucratic approach.

Design/methodology/approach: We conduct semi-structured interviews with LHU staff and analyse documents to assess whether features of bureaucratic organization were evident in the use of a BSC by the LHU.

Findings: We found nine bureaucratic features evident in the LHU's BSC. These were systematization, rationality, authority, jurisdiction, professional qualification, knowledge, discipline, transparency and accountability. The BSC used at the LHU demonstrated a neo-bureaucratic approach.

Originality/value: Our study helps to demystify bureaucracy and overcome prevailing prejudices regarding some of its principles. Health care managers should recognize and endorse neo-bureaucratic principles in developing a BSC. They should recognize the BSC as involving a neo-bureaucratic approach. The BSC is a valuable management tool that hospital managers should find useful in fostering flexibility, collaboration, innovation and adaptation - all of which should help lead to improved healthcare outcomes.

目的:我们探讨平衡计分卡(BSC)与新官僚主义之间的关系,通过调查平衡计分卡的运作是否包含“新官僚主义”思想,以及在葡萄牙地方卫生单位(LHU)实施的平衡计分卡是否体现了新官僚主义方法。设计/方法/方法:我们与LHU员工进行半结构化访谈,并分析文件,以评估LHU在使用平衡计分卡时官僚组织的特征是否明显。结果:我们在LHU的平衡计分卡中发现了九个明显的官僚主义特征。它们是系统化、合理性、权威、管辖权、专业资格、知识、纪律、透明度和问责制。LHU使用的平衡记分卡展示了一种新官僚主义的方法。原创性/价值:我们的研究有助于揭开官僚主义的神秘面纱,并克服有关其某些原则的普遍偏见。在制定平衡记分卡时,卫生保健管理人员应承认并支持新官僚主义原则。他们应该认识到平衡计分卡涉及一种新官僚主义方法。平衡记分卡是一种有价值的管理工具,医院管理者应该发现它在促进灵活性、协作、创新和适应方面很有用——所有这些都应该有助于改善医疗保健结果。
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引用次数: 13
Comparison of two fall-risk assessment tools used in a long-term care facility. 长期护理机构使用的两种跌倒风险评估工具的比较。
IF 1.5 Q4 HEALTH POLICY & SERVICES Pub Date : 2020-03-24 DOI: 10.1108/IJHCQA-03-2019-0065
Anat Glass, Gad Mendelson, Merav Ben Natan

Purpose: The purpose of this paper is to compare the ability of the Morse Fall Scale (MFS) and Farmer's fall-risk assessment tool (FFAT) to identify correlations between risk factors and falls among older adult long-term care (LTC) facility residents.

Design/methodology/approach: This was a correlational retrospective study. 200 medical records of older adults hospitalized in a LTC facility in central Israel, from January 2017 to January 2018, were examined.

Findings: Of all the residents, 75% and 99.5% of the residents were identified as having a high fall risk according to the MFS and FFAT, respectively. Only 12.5% of residents actually fell. MFS score was weakly correlated with actual falls (odds ratio = 1.035). It was also found that all fallers fell during their first week at the facility.

Research limitations/implications: Future research should explore the ability of the tools to capture changes in the fall risk by repeat assessments, as this has not been examined in the present study.

Practical implications: The MFS and FFAT tool may have little value in assessing fall risk in older adult LTC facility residents. Therefore, nurses should perform a clinical evaluation of each individual patient. In addition, nurses should place a particular emphasis on fall risk and prevention during the first week following admission.

Originality/value: The findings of the present study raise doubts regarding the utility of the common practice of assessing fall risk in older adult LTC facility residents using the tools MFS and the FFAT, thus emphasizing the need to adopt a different approach.

目的:比较Morse跌倒量表(MFS)和Farmer跌倒风险评估工具(FFAT)在识别长期护理机构(LTC)老年人跌倒风险因素之间的相关性的能力。设计/方法/方法:这是一项相关回顾性研究。研究人员检查了2017年1月至2018年1月在以色列中部一家LTC设施住院的200名老年人的医疗记录。结果:根据MFS和FFAT,所有居民中分别有75%和99.5%的居民被确定为具有高跌倒风险。只有12.5%的居民实际下降了。MFS评分与实际跌倒呈弱相关(优势比= 1.035)。调查还发现,所有的摔倒者都是在第一周摔倒的。研究局限性/意义:未来的研究应该探索这些工具通过重复评估来捕捉跌倒风险变化的能力,因为这在本研究中尚未得到检验。实际意义:MFS和FFAT工具在评估老年LTC设施居民跌倒风险方面可能没有什么价值。因此,护士应该对每个病人进行临床评估。此外,护士应在入院后的第一周特别强调跌倒风险和预防。独创性/价值:本研究的发现对使用MFS和FFAT工具评估老年LTC设施居民跌倒风险的常见做法的效用提出了质疑,因此强调需要采用不同的方法。
{"title":"Comparison of two fall-risk assessment tools used in a long-term care facility.","authors":"Anat Glass,&nbsp;Gad Mendelson,&nbsp;Merav Ben Natan","doi":"10.1108/IJHCQA-03-2019-0065","DOIUrl":"https://doi.org/10.1108/IJHCQA-03-2019-0065","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this paper is to compare the ability of the Morse Fall Scale (MFS) and Farmer's fall-risk assessment tool (FFAT) to identify correlations between risk factors and falls among older adult long-term care (LTC) facility residents.</p><p><strong>Design/methodology/approach: </strong>This was a correlational retrospective study. 200 medical records of older adults hospitalized in a LTC facility in central Israel, from January 2017 to January 2018, were examined.</p><p><strong>Findings: </strong>Of all the residents, 75% and 99.5% of the residents were identified as having a high fall risk according to the MFS and FFAT, respectively. Only 12.5% of residents actually fell. MFS score was weakly correlated with actual falls (odds ratio = 1.035). It was also found that all fallers fell during their first week at the facility.</p><p><strong>Research limitations/implications: </strong>Future research should explore the ability of the tools to capture changes in the fall risk by repeat assessments, as this has not been examined in the present study.</p><p><strong>Practical implications: </strong>The MFS and FFAT tool may have little value in assessing fall risk in older adult LTC facility residents. Therefore, nurses should perform a clinical evaluation of each individual patient. In addition, nurses should place a particular emphasis on fall risk and prevention during the first week following admission.</p><p><strong>Originality/value: </strong>The findings of the present study raise doubts regarding the utility of the common practice of assessing fall risk in older adult LTC facility residents using the tools MFS and the FFAT, thus emphasizing the need to adopt a different approach.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":1.5,"publicationDate":"2020-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/IJHCQA-03-2019-0065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37762591","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}
引用次数: 2
Standardizing inpatient colonoscopy preparations improves quality and provider satisfaction. 标准化住院患者结肠镜检查准备可提高质量和提供者满意度。
IF 1.5 Q4 HEALTH POLICY & SERVICES Pub Date : 2020-03-09 DOI: 10.1108/IJHCQA-11-2019-0186
Brian Sullivan, Cecelia Zhang, Kara Wegermann, Tzu-Hao Lee, David A Leiman

Purpose: Inpatient colonoscopy bowel preparation quality is frequently suboptimal. This quality improvement (QI) intervention is focused on regimenting this process to impact important outcomes.

Design/methodology/approach: Define, Measure, Analyze, Improve and Control (DMAIC) methodology was employed, including generating a root-cause analysis to identify factors associated with inpatient bowel quality. These findings motivated the creation of a standardized electronic health record (EHR)-based order set with consistent instructions and anticipatory guidance for administering providers.

Findings: There were 264 inpatient colonoscopies evaluated, including 198 procedures pre-intervention and 66 post-intervention. The intervention significantly improved the adequacy of right colon bowel preparations (75.0 percent vs 86.9 percent, p = 0.04) but not overall preparation quality (73.7 percent vs 80.3 percent, p = 0.22). The intervention led to numerical improvement in the proportion of procedures in which the preparation quality interfered with making a diagnosis (10 percent-6 percent, p = 0.29) or resulted in an aborted procedure (3.5 percent-1.5 percent, p = 0.39). After the intervention, provider satisfaction with the ordering process significantly increased (23.3 percent vs 61.1 percent, p < 0.001).

Practical implications: The QI intervention significantly reduced the number of inpatient colonoscopies with inadequate preparation in the right colon, while also modestly improving the diagnostic yield and proportion of aborted procedures. Importantly, the standardized EHR order set substantially improved provider satisfaction, which should justify broader use of such tools.

Originality/value: Novel clinical outcomes such as ability to answer diagnostic questions were improved using this intervention. The results align with strategic goals to enhance provider experience and continuously improve quality of patient care.

目的:住院患者结肠镜检查肠准备质量经常不理想。这种质量改善(QI)干预的重点是控制这一过程,以影响重要的结果。设计/方法学/方法:采用定义、测量、分析、改善和控制(DMAIC)方法学,包括生成根本原因分析以确定与住院患者肠道质量相关的因素。这些发现促使建立了一个标准化的基于电子健康记录(EHR)的订单集,为管理提供者提供一致的指示和预期指导。结果:264例住院患者接受结肠镜检查,其中干预前198例,干预后66例。干预显著提高了右结肠肠道准备的充分性(75.0% vs 86.9%, p = 0.04),但没有改善整体准备质量(73.7% vs 80.3%, p = 0.22)。干预导致制备质量干扰诊断的手术比例(10% - 6%,p = 0.29)或导致手术流产(3.5% - 1.5%,p = 0.39)的数值改善。干预后,提供者对订购过程的满意度显著提高(23.3% vs 61.1%)。实际意义:QI干预显著减少了右结肠准备不足的住院结肠镜检查人数,同时也适度提高了诊断率和流产手术的比例。重要的是,标准化的EHR订单集大大提高了提供者的满意度,这应该证明更广泛地使用此类工具是合理的。独创性/价值:新的临床结果,如回答诊断问题的能力,使用这种干预措施得到改善。结果与战略目标一致,以提高提供者的经验,并不断提高患者护理质量。
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引用次数: 3
Preventing skin staining: an effective iron infusion protocol. 防止皮肤染色:一种有效的铁输注方案。
IF 1.5 Q4 HEALTH POLICY & SERVICES Pub Date : 2020-03-06 DOI: 10.1108/IJHCQA-10-2019-0177
Clare Margaret Crowley, Gabriela McMahon, Joanna Desmond, Mendinaro Imcha

Purpose: To implement a safe and effective intravenous iron infusion protocol to prevent skin staining.

Design/methodology/approach: Mixed methods approach was utilised including education, auditing, self-reported survey, patient information leaflet and patient feedback. In total 25 healthcare professionals completed the survey and 15 patients provided feedback.

Findings: No skin staining or severe adverse reactions were observed over eight weeks. Audit results found 53 per cent of staff were compliant with the recommended IV iron infusion protocol and 46 per cent informed patients of skin staining risk. Self-report surveys indicated 92 per cent flushed the cannula with sodium chloride before starting the infusion, 88 per cent flushed the cannula after the infusion and 76 per cent informed patients of skin staining risk. Patient feedback was largely positive and constructive.

Research limitations: Limitations include self-reported bias, short audit time interval, missing data and discrepancy between audit and survey results.

Originality/value: This quality improvement project was developed following two skin staining incidences at our maternity hospital. Although rare, skin staining after intravenous iron infusion is potentially permanent and may be distressing for some patients. Intravenous iron is considered safe and effective to treat anaemia during pregnancy and is often prescribed for this patient cohort. To avoid medicolegal action and patient dissatisfaction, it is essential that patients are informed of potential skin staining and an evidence-based administration protocol is utilised.

目的:建立一种安全有效的静脉输铁预防皮肤染色的方案。设计/方法/方法:采用混合方法,包括教育、旁听、自述调查、患者信息单张和患者反馈。共有25名医护人员完成了调查,15名患者提供了反馈。结果:8周未见皮肤染色或严重不良反应。审计结果发现,53%的工作人员遵守了推荐的静脉输铁方案,46%的工作人员告知患者皮肤染色的风险。自我报告调查显示,92%的医生在开始输注前用氯化钠冲洗套管,88%的医生在输注后冲洗套管,76%的医生告知患者皮肤染色的风险。病人的反馈基本上是积极和建设性的。研究局限性:局限性包括自我报告偏倚、审计时间间隔短、数据缺失、审计结果与调查结果不一致。原创性/价值:本质量改进项目是在我们妇产医院发生两起皮肤染色事件后制定的。虽然罕见,但静脉输铁后的皮肤染色可能是永久性的,对一些患者来说可能是痛苦的。静脉注射铁被认为是安全有效的治疗妊娠期贫血,经常被用于这一患者群体。为避免医疗法律行动和患者不满,必须告知患者潜在的皮肤染色,并采用循证给药方案。
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引用次数: 3
Maternal health outcomes of socially marginalized groups in India. 印度社会边缘群体的产妇保健结果。
IF 1.5 Q4 HEALTH POLICY & SERVICES Pub Date : 2020-03-01 DOI: 10.1108/IJHCQA-08-2018-0212
Arvind Kumar Yadav, Pabitra Kumar Jena

Purpose: The present study delves into the health inequalities between the two most socially deprived groups namely Scheduled Tribes (STs) and Scheduled Castes (SCs) in rural India.

Design/methodology/approach: This study used health-specific three rounds of National Sample Survey Office (NSSO) unit-level data for analyses. Probit model has been used to predict the differences in access to maternal healthcare services. Blinder-Oaxaca decomposition method is used to explore the inequality in health of rural population in India and assess the estimated relative contribution of socioeconomic and demographic factors to inequalities in maternal health.

Findings: The study establishes that STs women often perform poorly compared to SCs in terms of maternal health such as antenatal care, postnatal care and institutional delivery. Blinder-Oaxaca decomposition method shows that there exist health inequalities between STs and SCs women. Difference in household income contributes 21-34 percent and women's education 19-24 percent in the gap of utilization of maternal healthcare services between SCs and STs women. A substantial part of this difference is contributed by availability of water at home and geographical region. Finally, the study offers some policy suggestions in order to mitigate the health inequalities among socially marginalized groups of SCs and STs women in rural areas.

Originality/value: This study measures and explains inequalities in maternal health variables such as antenatal care, postnatal care and institutional delivery in rural India. Research on access to maternal healthcare facilities is needed to improve the health of deprived sections such as STs and SCs in India. The results of this study pinpoint the need for public health decision-makers in India to concentrate on the most deprived and vulnerable sections of the society. This study thus makes a detailed and tangible contribution to the current knowledge of health inequalities between the two most deprived social groups, i.e., SCs and STs.

目的:本研究探讨了印度农村两个最受社会剥夺的群体,即表列部落(STs)和表列种姓(SCs)之间的健康不平等。设计/方法/方法:本研究使用国家抽样调查办公室(NSSO)三轮健康相关单位数据进行分析。Probit模型已被用于预测获得孕产妇保健服务的差异。使用Blinder-Oaxaca分解方法探讨印度农村人口健康不平等现象,并评估社会经济和人口因素对孕产妇健康不平等的估计相对贡献。研究结果:研究表明,与SCs相比,STs妇女在产前护理、产后护理和机构分娩等孕产妇保健方面的表现往往较差。Blinder-Oaxaca分解方法表明,STs和SCs妇女之间存在健康不平等。家庭收入差异对南南社会主义妇女和南南社会主义妇女利用孕产妇保健服务的差距的影响为21- 34%,妇女受教育程度为19- 24%。这种差异的很大一部分是由家庭和地理区域的水供应造成的。最后,该研究提出了一些政策建议,以减轻农村地区社会边缘化群体中SCs和STs妇女之间的健康不平等。原创性/价值:本研究衡量并解释了印度农村产前护理、产后护理和机构分娩等孕产妇保健变量方面的不平等现象。需要研究获得孕产妇保健设施的机会,以改善印度st和SCs等贫困群体的健康。这项研究的结果明确指出,印度的公共卫生决策者需要关注社会中最贫困和最脆弱的群体。因此,这项研究对目前了解两个最贫困的社会群体,即南南和南南社会群体之间的健康不平等作出了详细和切实的贡献。
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引用次数: 18
Health care expenditure and child mortality in Nigeria. 尼日利亚的保健支出和儿童死亡率。
IF 1.5 Q4 HEALTH POLICY & SERVICES Pub Date : 2020-02-28 DOI: 10.1108/IJHCQA-10-2019-0172
Oluyemi Theophilus Adeosun, Omolara Morounkeji Faboya

Purpose: Health improves the proficiency and output generated by individuals. It also raises physical as well as mental abilities, which are required for the growth and advancement of any economy. Many infant diseases have been recognised via contemporary technology in a bid to tackle these diseases. However, children within the African continent (Including Nigeria) die en masse from diseases. This has made the government of Nigeria allocate sizeable part of the nation's budget to healthcare system. The allocation to health is, however, yet to translate to improved health condition for Nigerians. It does not measure up to the World Health Organization's (WHO) standards for apportioning budget to the health sector. This study also analyses empirically the impact of healthcare expenses on the mortality level of infants as well as Nigeria's neonatal mortality level.

Design/methodology/approach: The paper focuses on Nigeria. Vector auto regression model techniques, unit root tests and cointegration test were carried out using time series date for the period between 1986 and 2016.

Findings: The outcome has revealed that expenditure on healthcare possesses a negative correlation with the mortality of infants and neonates. The study discovers that if the Nigerian government raises and maintains health expenditure specifically on activities focused on minimising infant mortality, it will translate to reduction in infant mortality in Nigeria.

Originality/value: This paper has contributed exhaustively to solution to poor expenditure on healthcare, especially child mortality, in Nigeria.

目的:健康提高个人的熟练程度和产出。它还提高了身体和心理能力,这是任何经济增长和进步所必需的。许多婴儿疾病已经通过现代技术被识别出来,以应对这些疾病。然而,非洲大陆(包括尼日利亚)的儿童大量死于疾病。这使得尼日利亚政府将相当大一部分国家预算分配给医疗保健系统。然而,用于保健的拨款尚未转化为尼日利亚人健康状况的改善。它不符合世界卫生组织(卫生组织)将预算分配给卫生部门的标准。本研究还实证分析了医疗费用对婴儿死亡率水平以及尼日利亚新生儿死亡率水平的影响。设计/方法/方法:本文的重点是尼日利亚。采用向量自回归模型技术、单位根检验和协整检验,采用1986 - 2016年的时间序列数据。结果显示,医疗保健支出与婴儿和新生儿死亡率呈负相关。该研究发现,如果尼日利亚政府提高并维持卫生支出,专门用于降低婴儿死亡率的活动,这将转化为尼日利亚婴儿死亡率的降低。原创性/价值:本文为解决尼日利亚医疗保健支出不足,特别是儿童死亡率问题作出了详尽的贡献。
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引用次数: 6
Reduction of central-line-associated bloodstream infection (CLABSI) in resource limited, nonintensive care unit (ICU) settings. 在资源有限的非重症监护病房(ICU)环境中减少中央静脉相关血流感染(CLABSI)。
IF 1.5 Q4 HEALTH POLICY & SERVICES Pub Date : 2020-02-25 DOI: 10.1108/IJHCQA-11-2019-0195
Kok Wei Poh, Cheng Huong Ngan, Ji Yin Wong, Tiang Koi Ng, Nadiah Mohd Noor

Purpose: There was limited study available on successful intervention for central-line-associated bloodstream infection (CLABSI) done at nonintensive care unit (ICU) and resources-limited setting. The objective of this study was to design, implement and evaluate a strategy to reduce CLABSI rate in non-ICU settings at general medical wards of Hospital Tuanku Ja'afar Seremban.

Design/methodology/approach: Preinterventional study was conducted in one-month period of January 2019, followed by intervention period from February to March 2019. Postintervention study was conducted from April to July 2019. The CLABSI rates were compared between pre and postintervention periods. A multifaceted intervention bundle was implemented, which comprised (1) educational program for healthcare workers, (2) weekly audit and feedback and (3) implementation of central line bundle of care.

Findings: There was a significant overall reduction of CLABSI rate between preintervention and postintervention period [incidence rate ratio (IRR) of 0.06 (95 percent CI, 0.01-0.33; P = 0.001)].

Practical implications: CLABSI rates were reduced by a multifaceted intervention bundle, even in non-ICU and resource-limited setting. This includes a preinterventional study to identify the risk factors followed by a local adaption of the recommended care bundles. This study recommends resources-limited hospitals to design a strategy that is suitable for their own local setting to reduce CLABSI.

Originality/value: This study demonstrated the feasibility of a multifaceted intervention bundle that was locally adapted with an evidence-based approach to reduce CLABSI rate in non-ICU and resource-limited setting.

目的:关于在非重症监护病房(ICU)和资源有限的环境中成功干预中央线相关血流感染(CLABSI)的研究有限。本研究的目的是设计、实施和评估降低Tuanku Ja'afar Seremban医院普通病房非icu病房CLABSI发生率的策略。设计/方法/方法:介入前研究于2019年1月进行,为期一个月,干预期为2019年2月至3月。干预后研究于2019年4月至7月进行。比较干预前后的CLABSI率。实施了多方面的一揽子干预措施,包括(1)卫生保健工作者教育计划,(2)每周审计和反馈,(3)实施中心线一揽子护理。结果:干预前和干预后CLABSI发生率显著降低[发病率比(IRR)为0.06 (95% CI, 0.01-0.33;p = 0.001)]。实际意义:即使在非icu和资源有限的情况下,多方面的干预措施也能降低CLABSI的发生率。这包括一项确定风险因素的介入前研究,然后对推荐的一揽子护理进行地方调整。本研究建议资源有限的医院设计适合其本地环境的策略来减少CLABSI。独创性/价值:本研究证明了在非icu和资源有限的情况下,采用基于证据的方法在当地进行多方面干预的可行性,以降低CLABSI发生率。
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引用次数: 1
期刊
INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE
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