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Adopting the Klein Triple Path Model of Insight for Clinical Quality Improvement 采用克莱因三重路径洞察模型改进临床质量
Pub Date : 2024-02-01 DOI: 10.36401/jqsh-23-44
Isaac K. S. Ng
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引用次数: 0
Lomitapide: A Medication Use Evaluation and a Formulary Perspective 洛米他匹:用药评估和处方集视角
Pub Date : 2024-01-20 DOI: 10.36401/jqsh-23-32
Laila Carolina Abu Esba, Hani Alharbi
Lomitapide is approved for lowering low-density lipoprotein cholesterol (LDL-C) in homozygous familial hypercholesterolemia, which is a rare genetic disorder. The evidence regarding its safety and efficacy from a small clinical trial requires further validation for effectiveness and safety in the real world. This study aimed to use institutional data on the effectiveness and safety of lomitapide to assist in formulating a perspective on adding it to the formulary. This was a retrospective review of patients who were actively prescribed lomitapide at King Abdulaziz Medical City, Riyadh, Saudi Arabia, from 2019 to 2022. Data collection included demographics, confirmed gene mutation results, duration of lomitapide therapy, baseline, on-treatment, last LDL-C levels, percent reduction in LDL-C after 1-3 months of therapy (whichever was first available), other LDL-C lowering therapies used, liver function tests, adverse effects, and compliance. Eight adult patients were included in the review, with a mean age of 25.5 years. Approximately 75% were female, and the duration of treatment with lomitapide ranged from 9 months to 3 years. None of the patients were on continuous LDL apheresis. The mean baseline LDL-C at presentation to our facility was 17.2 mmol/L (range, 11.78–21.97 mmol/L), the mean percent drop in LDL-C with lomitapide was 34.1% (range, 0%–87%), gastrointestinal disturbances were documented in 50% of the patients, and no cases of severe liver toxicities or increase in liver enzymes were seen. In our cohort of adult patients, lomitapide showed an overall modest reduction in LDL-C, with no cases of increase in liver enzymes and documented intolerance, indicating that most patients were likely noncompliant. This review revealed important considerations when reimbursing expensive medications for rare diseases. Real-world evidence in real-time can support healthcare systems in price negotiations and reaching mutual agreements that can eventually improve patient access to care.
洛米他匹获准用于降低同卵家族性高胆固醇血症(一种罕见的遗传性疾病)患者的低密度脂蛋白胆固醇(LDL-C)。从一项小型临床试验中获得的有关其安全性和有效性的证据需要在现实世界中进一步验证其有效性和安全性。本研究旨在利用有关洛米他匹的有效性和安全性的机构数据,协助制定将其纳入处方集的观点。 本研究对沙特阿拉伯利雅得阿卜杜勒阿齐兹国王医疗城在2019年至2022年期间积极处方洛米他肽的患者进行了回顾性审查。收集的数据包括人口统计学特征、确诊基因突变结果、洛米他匹治疗持续时间、基线、治疗中、最后LDL-C水平、治疗1-3个月后LDL-C降低百分比(以最先获得的数据为准)、使用的其他降低LDL-C疗法、肝功能检测、不良反应和依从性。 本次研究共纳入了 8 名成年患者,平均年龄为 25.5 岁。约75%的患者为女性,使用洛米他匹治疗的时间从9个月到3年不等。所有患者均未持续进行低密度脂蛋白清除治疗。来我院就诊时的平均基线 LDL-C 为 17.2 mmol/L(范围为 11.78-21.97 mmol/L),使用洛美他肽后 LDL-C 的平均降幅为 34.1%(范围为 0%-87%),50% 的患者出现胃肠道紊乱,未发现严重肝毒性或肝酶升高的病例。 在我们的成年患者队列中,洛米他匹总体上显示出低密度脂蛋白胆固醇的适度降低,没有肝酶升高的病例,也没有不耐受的记录,这表明大多数患者可能没有遵从医嘱。本综述揭示了罕见病昂贵药物报销时的重要注意事项。真实世界的实时证据可以支持医疗系统进行价格谈判并达成相互协议,从而最终改善患者获得护理的机会。
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引用次数: 0
Cause-and-Effect (Fishbone) Diagram: A Tool for Generating and Organizing Quality Improvement Ideas 因果(鱼骨)图:生成和组织质量改进想法的工具
Pub Date : 2024-01-11 DOI: 10.36401/jqsh-23-42
Augustine Kumah, C. N. Nwogu, Abdul-Razak Issah, Emmanuel Obot, Deborah T. Kanamitie, Jerry S. Sifa, L. A. Aidoo
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引用次数: 0
Quality Indicators in Adult Critical Care Medicine 成人重症医学质量指标
Pub Date : 2023-12-19 DOI: 10.36401/jqsh-23-30
H. Al-Dorzi, Y. Arabi
Quality indicators are increasingly used in the intensive care unit (ICU) to compare and improve the quality of delivered healthcare. Numerous indicators have been developed and are related to multiple domains, most importantly patient safety, care timeliness and effectiveness, staff well-being, and patient/family-centered outcomes and satisfaction. In this review, we describe pertinent ICU quality indicators that are related to organizational structure (such as the availability of an intensivist 24/7 and the nurse-to-patient ratio), processes of care (such as ventilator care bundle), and outcomes (such as ICU-acquired infections and standardized mortality rate). We also present an example of a quality improvement project in an ICU indicating the steps taken to attain the desired changes in quality measures.
重症监护病房(ICU)越来越多地使用质量指标来比较和提高医疗质量。目前已经制定了许多指标,这些指标涉及多个领域,其中最重要的是患者安全、护理的及时性和有效性、员工福利以及以患者/家属为中心的结果和满意度。在这篇综述中,我们介绍了与组织结构(如全天候的重症监护医生和护士与患者的比例)、护理流程(如呼吸机护理捆绑包)和结果(如重症监护病房获得性感染和标准化死亡率)相关的重症监护病房质量指标。我们还介绍了一个重症监护室质量改进项目的实例,说明了为实现质量措施的预期变化而采取的步骤。
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引用次数: 0
Quality Measures for Multidisciplinary Tumor Boards and Their Role in Improving Cancer Care 多学科肿瘤委员会的质量措施及其在改善癌症护理中的作用
Pub Date : 2023-12-15 DOI: 10.36401/jqsh-23-22
K. Abuelgasim, Abdul Rahman Jazieh
While multidisciplinary tumor boards (MTBs) are widely used in managing patients with cancer, their impact on patient care and outcome is not routinely measured in different settings. The authors conducted a literature review in Medline, Google Scholar, Embase, and Web of Science using the following keywords: cancer, multidisciplinary, tumor board, quality performance indicator, lung cancer, and lymphoma. Standards from various accreditation and professional organizations were reviewed to compile relevant standards for MTB. A list of quality performance indicators that can be used to improve MTBs’ performance and impact was compiled. Specific examples for non-Hodgkin lymphoma and lung cancer MTBs were presented. Guidance was provided to help MTB team members select implement the appropriate quality measures. The functions and impact of MTBs should be monitored and evaluated by a set of measures that help guide MTBs to improve their performance and provide better care to their patients.
虽然多学科肿瘤委员会(MTB)被广泛应用于癌症患者的管理中,但其对患者护理和治疗效果的影响并未在不同的环境中得到常规衡量。 作者使用以下关键词在 Medline、Google Scholar、Embase 和 Web of Science 中进行了文献综述:癌症、多学科、肿瘤委员会、质量绩效指标、肺癌和淋巴瘤。审查了各种认证和专业组织的标准,以汇编 MTB 的相关标准。 编制了一份质量绩效指标清单,可用于提高 MTB 的绩效和影响力。介绍了非霍奇金淋巴瘤和肺癌 MTB 的具体实例。为帮助 MTB 团队成员选择实施适当的质量措施提供了指导。 MTB 的功能和影响应通过一系列措施进行监测和评估,这些措施有助于指导 MTB 提高绩效,为患者提供更好的治疗。
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引用次数: 0
Abstracts Presented at the 2023 International Pharmacoeconomics ForumDecember 1-2, 2023, Riyadh, Saudi Arabia 2023 年国际药物经济学论坛摘要2023 年 12 月 1-2 日,沙特阿拉伯利雅得
Pub Date : 2023-12-11 DOI: 10.36401/jqsh-23-x7
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引用次数: 0
Assessment of Structural and Process Factors in Delivering Quality Adolescent Sexual and Reproductive Health Services in Ghana 评估加纳提供优质青少年性健康和生殖健康服务的结构和过程因素
Pub Date : 2023-12-02 DOI: 10.36401/jqsh-23-20
Augustine Kumah, Lawrencia Antoinette Aidoo, Vera Edem Amesawu, Abdul-Razak Issah, Hillary Selassi Nutakor
Sexual and reproductive health services are often underserved to adolescents in many societies. For many of these sexually active adolescents, reproductive health services such as the provision of contraception and treatment for sexually transmitted infections, either are not available or are provided in a way that makes adolescents feel unwelcome and embarrassed. This study assessed the structural and process factors available in delivering quality adolescent sexual and reproductive health (ASRH) services in health facilities across three regions in Ghana. A facility-based descriptive cross-sectional study assessed the structural and process factors available for delivering quality adolescent sexual reproductive health services in 158 selected health facilities across three regions (Oti, Eastern, and Volta) of Ghana. A simple random sampling by balloting was used to select the health facilities and a total of 158 adolescents who used ASRH services in the selected facilities were sampled for an existing interview. The Donabedian model of quality assessment was adopted and modified into an assessment tool and a questionnaire to assess the selected health facilities and respondents. The Statistical Package for the Social Sciences (SPSS) version 20.0 was used to analyze the data collected and the findings presented in the tables. The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. A proportion of 85 (53.50%) of the facilities assessed did not have separate spaces for delivering services for adolescents. All 158 health facilities had the National Health Insurance Scheme (NHIS) covering contraceptive/family planning services for adolescents. Most (128, 81.01%) facilities had available educational materials on ASRH but were not made available for take home by adolescents. The findings indicated that most respondents did not require parental, spouse, or guardian consent before using ASRH services. The average waiting time for adolescents to be attended to by service providers was ≤30 minutes. The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. ASRH services, particularly contraceptive/family planning services, were well integrated into NHIS to improve access and utilization by adolescents.
在许多社会中,青少年往往得不到充分的性健康和生殖健康服务。对于许多性生活活跃的青少年来说,提供避孕药具和治疗性传播感染等生殖健康服务要么无法获得,要么提供服务的方式让青少年感到不受欢迎和尴尬。本研究评估了加纳三个地区医疗机构在提供优质青少年性与生殖健康(ASRH)服务方面的结构和流程因素。 这项以医疗机构为基础的描述性横断面研究评估了在加纳三个地区(奥蒂、东部和沃尔特)的 158 家医疗机构中提供优质青少年性与生殖健康服务的结构和过程因素。研究采用了简单随机抽样的方法来选择医疗机构,并对在所选医疗机构中使用过青少年性健康和生殖健康服务的 158 名青少年进行了访谈。采用多纳比德质量评估模型,并将其修改为评估工具和调查问卷,对选定的医疗机构和受访者进行评估。研究使用社会科学统计软件包(SPSS)20.0 版对收集到的数据进行分析,并将结果列于表格中。 研究发现了一些影响加纳提供优质 ASRH 服务的结构性和过程性障碍。在接受评估的机构中,有 85 家(53.50%)没有为青少年提供单独的服务场所。所有 158 家医疗机构都有涵盖青少年避孕/计划生育服务的国家医疗保险计划(NHIS)。大多数(128 家,81.01%)医疗机构都有关于青少年生殖健康和生殖保健的教育材料,但没有提供给青少年带回家。调查结果表明,大多数受访者在使用 ASRH 服务前不需要征得父母、配偶或监护人的同意。青少年等待服务提供者提供服务的平均时间不超过 30 分钟。 研究发现,一些结构性和程序性障碍影响了加纳提供优质的青少年生殖健康服务。ASRH 服务,尤其是避孕/计划生育服务,已被很好地纳入 NHIS,以改善青少年获得和利用服务的情况。
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引用次数: 0
Reducing Unplanned Readmissions in Pediatric Hospitals: Applying Patient and Family-Centered Care 减少儿科医院的计划外再入院:应用以患者和家庭为中心的医疗服务
Pub Date : 2023-11-01 DOI: 10.36401/jqsh-23-x6
Muhammad Hasan Abid
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引用次数: 0
Overview of Procurement and Reimbursement of Pharmaceuticals in Saudi Arabia, United Arab Emirates, Qatar, and Egypt: Challenges and Opportunities 沙特阿拉伯、阿拉伯联合酋长国、卡塔尔和埃及的药品采购与报销概况:挑战与机遇
Pub Date : 2023-11-01 DOI: 10.36401/jqsh-23-1
Anas Hamad, Mai Alsaqa’aby, Yazed Alruthia, Sara Aldallal, G. Elsisi
There is an increased interest in cost consciousness concerning healthcare spending worldwide. In the Arab world, a major transformation is underway in the healthcare sectors to achieve national and government visions to attain better outcomes with optimal value. This article contains expert recommendations on how decision-makers can implement pharmacoeconomic principles at a national level in the Arab world. A multidisciplinary panel of experts was formed of policymakers, clinical pharmacists, health economists, and chronic disease control and public health experts from different countries and healthcare sectors. The panel developed consensus recommendations for different stakeholders using a framework analysis method. The experts discussed the limitations and opportunities of implementing the pharmacoeconomics concept in evaluating new technologies in their respective countries. Common limitations recognized in the included countries were a lack of infrastructure to support the adoption of the concept in practice, challenges in obtaining data to support the decision-making process, and the lack of human resources to raise awareness among decision-makers and the public to use health economics in making informed decisions in reimbursing new technologies. The expert panel recommendations will guide relevant stakeholders at a national level per country. Adapting these recommendations to each setting is essential to accommodate the situation and needs of each country.
在全球范围内,人们越来越关注医疗开支的成本意识。在阿拉伯世界,医疗保健行业正在进行重大转型,以实现国家和政府的愿景,以最佳价值取得更好的成果。本文就阿拉伯世界的决策者如何在国家层面实施药物经济学原则提出了专家建议。 由来自不同国家和医疗保健部门的政策制定者、临床药剂师、卫生经济学家以及慢性病控制和公共卫生专家组成了一个多学科专家小组。专家小组采用框架分析方法为不同的利益相关者制定了协商一致的建议。 专家们讨论了各自国家在评估新技术时实施药物经济学概念的局限性和机遇。这些国家所面临的共同限制包括:缺乏支持在实践中采用这一概念的基础设施;在获取数据以支持决策过程方面面临挑战;缺乏人力资源以提高决策者和公众利用卫生经济学在新技术报销方面做出明智决策的意识。 专家小组的建议将为每个国家的利益相关者提供指导。根据每个国家的国情和需求对这些建议进行调整至关重要。
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引用次数: 0
Identifying the Prevalence and Causes of 30-Day Hospital Readmission in Children: A Case Study from a Tertiary Pediatric Hospital 确定儿童 30 天再住院的流行率和原因:一家三级儿科医院的案例研究
Pub Date : 2023-11-01 DOI: 10.36401/jqsh-23-17
Hamad Alkhalaf, Wejdan A. Alhamdan, S. Kinani, Reema Alzighaibi, Shahd Fallata, Abdullah Al Mutrafy, J. Alqanatish
The objectives of this study were to determine the prevalence of unplanned readmissions in the pediatric population within 30 days of discharge, identify the possible reasons behind them, and develop a predictive model for unplanned admissions. A retrospective chart review study of 25,211 patients was conducted to identify the prevalence of readmissions occurring within 30 days of discharge from the King Abdullah Specialized Children’s Hospital (KASCH) in Riyadh, Saudi Arabia, between Jan 1, 2019, and Dec 31, 2021. The data were collected using the BestCare electronic health records system and analyzed using Jamovi statistical software version 1.6. Among the 25,211 patients admitted to the hospital during the study period, the prevalence of unplanned readmission within 30 days was 1291 (5.12%). Of the 1291 patients, 1.91% had subsequent unplanned readmissions. In 57.8% of the cases, the cause of the first unplanned readmission was related to the cause of the first admission, and in 90.64% of the cases, the cause of the subsequent unplanned readmission was related to the cause of the first unplanned readmission. The most common reason for the first unplanned readmission was postoperative complications (18.75%), whereas pneumonia (10.81%) was the most common reason for subsequent unplanned readmissions. Most patients with subsequent unplanned readmissions were also found to have either isolated central nervous system pathology or chronic complex medical conditions. Internationally, the rate of unplanned readmissions in pediatric patients has been estimated to be 6.5% within 30 days, which is comparable to the results of our study (5.12%). Most of the causes of first and subsequent unplanned readmission were found to be related to primary admission. The diagnosis/causes of readmission vary depending on the patient’s age. A predictive model for pediatric readmission should be established so that preventive measures can be implemented.
本研究的目的是确定儿科患者在出院后 30 天内意外再入院的发生率,找出其背后的可能原因,并建立一个意外入院的预测模型。 该研究对 25211 名患者进行了回顾性病历审查,以确定沙特阿拉伯利雅得的阿卜杜拉国王儿童专科医院(KASCH)在 2019 年 1 月 1 日至 2021 年 12 月 31 日期间出院 30 天内再入院的发生率。数据通过 BestCare 电子健康记录系统收集,并使用 Jamovi 统计软件 1.6 版进行分析。 在研究期间入院的 25211 名患者中,有 1291 人(5.12%)在 30 天内发生了计划外再入院。在这 1291 名患者中,有 1.91% 的患者随后发生了计划外再入院。在 57.8% 的病例中,首次非计划再入院的原因与首次入院的原因有关,而在 90.64% 的病例中,后续非计划再入院的原因与首次非计划再入院的原因有关。首次非计划再入院最常见的原因是术后并发症(18.75%),而肺炎(10.81%)是随后非计划再入院最常见的原因。大多数非计划再入院的患者还患有孤立的中枢神经系统疾病或慢性复杂内科疾病。 据估计,国际上儿科患者 30 天内的意外再入院率为 6.5%,与我们的研究结果(5.12%)相当。研究发现,首次和随后的计划外再入院的原因大多与首次入院有关。再入院的诊断/原因因患者年龄而异。应建立儿科再入院预测模型,以便采取预防措施。
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Global journal on quality and safety in healthcare
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