Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care最新文献

Objective: To improve continuity of care and appropriateness of plain chest film orders in patients suffering from chronic diseases (hypertension, chronic obstructive pulmonary disease (COPD) and lung tuberculosis.

Design: Retrospective evaluation study using explicit and normative consensued criteria.

Setting: Urban health center.

Results: Compliance with the continuity criteria was 48%, 65% and 76% in three successive evaluations. Compliance with the appropriateness criteria was 52% and 62%. Orders from patients with COPD were responsible for most of the lack of compliance. Causes of non-compliance with the continuity criteria were attitude and organizational problems; with regard to appropriateness, the main cause was external to the Health Center.

Conclusions: (1) Difficulty in improving registers, reflecting a defect in the continuity of care. (2) Usefulness of evaluation in discovering the causes of the problems, in these cases an external one. (3) Difficulty of improvement when the cause of the problem is external to our own setting. (4) Partial effectiveness of continuing education measures because of professional changes in the Health Center.

The purpose of this study was to develop a data set consisting of measures of treatment outcome and cost, capable of standardization across radiation oncology facilities in Australia. Using a detailed consultative process involving representatives of a wide variety of professional organizations including the Royal Australasian College of Radiologists, the study identified the items necessary for inclusion in a data collection instrument to allow assessment of treatment modalities, quality of care, comparative efficiency and cost-effectiveness of radiation oncology services. The instrument has been tested by a pilot study and the results indicate that the items included in the instrument have received acceptance amongst health care providers.

The Life Ingredient Profile (LIP)--a new instrument for iterated quality of life assessments in patients with haematological malignancies--is presented. It is intended to reflect the patient's estimation of the symptoms of disease as well as the side-effects of treatment and is designed for comparing different regimens of chemotherapy. In a pilot study of 35 patients with myeloma, lymphoma and acute leukaemia, the LIP showed good validity, reliability and sensitivity to change. It was easy to apply and the structured interviews took only 10-20 min. LIP appears to assess important dimensions of quality of life without being a burden to the patient or the nursing staff.

Nursing education in Sweden is in a changing phase and the aim of this study is to describe a group of nurse preceptors and explore some of the factors that are believed to be of importance to clinical teaching according to the current model. Staff nurses (N = 86) who served as preceptors to students during their main clinical training in the areas of surgical, medical and long-term care participated in the study. Data were collected by means of a questionnaire designed for the study and the Nurse Self Description Form (NSDF). The results revealed that 39% of the preceptors had less than two years experience as Registered Nurses and 30% were less than 26 years old. These less experienced preceptors evaluated the amount of education they had received concerning the nursing process and related subjects as significantly higher when compared to the more experienced nurses. Approximately one fourth of the preceptors (N = 23) were using care planning in their ordinary work and another 29 had prior experience, but many preceptors (N = 34, 39%) had no direct experience of individualized care planning. Although there was a great deal of variance, the preceptors' estimation of their own professionalism such as in teaching, leadership and knowledge mastery as measured by the NSDF did not reveal any significant differences from ordinary nurses in a reference group. It is concluded that the quality of the important clinical part of nurse education may vary according to individual experience and knowledge of the preceptors.

Impediments to and progress toward valid and reliable international quality comparisons at the diagnosis or case type level are identified and discussed. The need for uniformity in each of the following is established: (1) international clinical data set, (2) definitions of clinical data elements and (3) data collection practices. The need to establish a clinically adequate international data base is discussed and action steps are identified.

In short, quality assurance in UK healthcare has developed since the mid-1980s driven by a series of national policy initiatives in the NHS, by increasing determination of the clinical professions to maintain standards, and by a general consumer movement to know more about public and professional services. Much has been achieved but there remains substantial debate about quality assurance leadership, coordination, funding and evaluation--or even what to call it.

This study examined the interface between emergency departments and community general practice in terms of their delivery of primary care services. Through the collection of casemix and treatment data, and interviews with patients, information was gathered relating to the extent of primary care delivery in emergency departments, problems managed and treatments provided in the two settings and patients' characteristics and reasons for choosing to seek primary care in the emergency department. The results indicate a high proportion of primary care delivery is in emergency departments, and that there is a need for delivery in this setting to continue. The results are discussed in terms of such quality assurance issues as monitoring primary care in emergency departments and addressing patient needs.

At the Emergency Department of Udine General Hospital (Italy) a programme to reduce admissions to the Internal Medicine Department was introduced in 1991. The majority of these admissions come from the Emergency Department, where many people, often without acute conditions, claim medical care. The programme consisted in organizational, professional and economic changes. At the end of 1991, the overall number of admissions to Udine General Hospital, as compared to 1990, decreased by 7.1%, but admissions to the Internal Medicine Department showed an 11.2% reduction. Finally, examinations for internal medical complaints in the emergency ward, not followed by hospitalization, increased by 15.5%. These results showed a reduction in admissions to the Internal Medicine Department greater than previously planned, with an increase in the number of outpatient examinations in the emergency room not followed by admission. Further targets were planned for 1992 to increase the quality of the service.