27 results on '"de Wet, Carl"'
Search Results
2. Implementing patient decision aids into general practice clinical decision support systems: Feasibility study in cardiovascular disease prevention
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Cornell, Samuel, Doust, Jenny, Morgan, Mark, Greaves, Kim, Hawkes, Anna L., de Wet, Carl, O'Connor, Denise, and Bonner, Carissa
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- 2023
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3. Supporting quality and safety in general practice: 'Response rates to computer decision support'
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Davies, Deborah, Morgan, Mark, and de Wet, Carl
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- 2022
4. A mixed-methods study of the implementation of the Trigger Review Method in general medical practice
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de Wet, Carl
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616 ,R Medicine (General) - Abstract
Introduction : There is now compelling evidence that a significant minority of patients suffer preventable iatrogenic harm during their interactions with health care, including in UK general practice. While our understanding of the extent of the problem and the contributing factors continues to increase, it remains incomplete. Further patient safety research is therefore urgently required, particularly to develop, test and successfully implement effective improvement strategies, methods and tools. Of the main approaches currently available for improving patient safety, the general practice Trigger Review Method (TRM) is of particular interest and the main focus of this study. The TRM is, quite simply, a structured way to rapidly screen samples of random electronic patient records for undetected patient safety incidents (PSIs). It is essentially an adaptation of clinical record review, with the same underlying principles of learning from error and improving care. Development of the TRM commenced in 2007 in Scottish general practice, with subsequent testing in The Health Foundation-funded Safety and Improvement in Primary Care (SIPC) programme. In 2013, the TRM was included as one of the three core components of the Scottish Government’s Patient Safety Programme for Primary Care (SPSP-PC). Scottish general practices were also financially incentivised through the Quality and Outcomes Framework (QOF) to routinely apply the TRM and report their findings. However, despite the increasing and national interest in the TRM, many unanswered questions remained: what is its potential value, how acceptable and feasible is it and to what extent (if any) will, or should, it become part of routine general practice? The aims of this study were therefore to: (i) describe the patient safety perceptions of general practice clinicians and staff; (ii) determine the usefulness of the TRM; (iii) explain how the TRM worked; and (iv) identify the main factors that facilitated or hindered its implementation. Methods: This study has a mixed-methods design. It was undertaken in the West of Scotland region in two NHS Health Boards: Greater Glasgow and Clyde (GGC) and Ayrshire and Arran (A&A). Convenience samples of 12 general practice teams and 25 GP Specialty Trainees (GPST) were recruited. Data were collected through: semi-structured interviews (n=62) with a range of general practice clinicians and staff; and cross-sectional trigger reviews of selected electronic patient records. Normalisation Process Theory (NPT) underpinned all stages of the research. NPT is a socio-technical, middle-range theory about the ‘work’ people do collectively and as individuals to implement and sustain complex health care interventions such as the TRM. The majority of the qualitative data were analyzed thematically and a NPT framework was applied to the remaining data. Quantitative data were analysed using recognised statistical tests. Results: A total of 47 primary care clinicians reviewed 1659 electronic patient records and detected 216 PSIs. A substantial minority of these were considered to have led to moderate or more substantial harm (29.2%), while the majority (54.8%) were rated as being preventable or potentially preventable. The most common type of PSI related to ‘medication’ (40.7%) and the most commonly implicated drug was Warfarin. The participants reported considering or undertaking specific improvement actions during and after approximately two thirds of trigger reviews. The most common action was ‘feedback to colleagues’. More specific actions included: undertaking significant event analyses (SEAs) and clinical audits, designing or redesigning practice protocols and including their findings in their appraisal documentation. The vast majority of participants identified four main factors as being particularly important for the successful implementation of the TRM, and by extension its potential normalisation. The first and most important factor was provision of adequate resources and protected time to conduct trigger reviews. The second factor was whether senior leaders in the practice teams, the government and professional bodies practically demonstrated their support for the TRM through, for example, contextually integrating it into existing general practice processes. The third and fourth factors related to the characteristics of participants. Successful implementation required knowledgeable clinicians to remain engaged with the TRM, and to perceive it as useful, acceptable and feasible – which the vast majority of participants were, and did. Discussion: This study is the first known attempt to investigate how the TRM is implemented and perceived from the perspective of general practice clinicians and staff. The main findings are that most participants experienced the method as acceptable, feasible and useful. It is clear that the TRM is uncovering important patient safety concerns and also driving improvements in related care systems and processes at the individual practice level. The implication is that this is making significant and demonstrable differences to patient care, while impacting positively on local safety culture. On the evidence presented, normalisation of the TRM in general practice can therefore be recommended. However, while the usefulness of an intervention is an important factor in determining whether it is normalised or not, the study findings also clearly indicate – consistent with the international literature – that there are other factors that are at least equally important for normalisation. At the time of writing, there are no formal mandates or financial incentives for general practice clinicians or teams to perform regular trigger reviews. It therefore seems likely that normalisation of the TRM in Scottish general practice will be gradual and piecemeal, if it happens at all. Nevertheless, the lessons learnt from this study can be incorporated in the ongoing efforts to further improve the safety of care in general medical practice. In particular, researchers and policy makers should pro-actively identify and address the main factors that are known to facilitate or hinder the implementation of improvement initiatives; the existing knowledge and ‘engagement’ of clinicians should be recognised and harnessed; and the lessons learnt from PSIs should be more widely disseminated.
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- 2017
5. The accuracy, completeness and timeliness of discharge medication information and implementing medication reconciliation: A cross-sectional survey of general practitioners
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Latimer, Sharon, Hewitt, Jayne, Teasdale, Trudy, de Wet, Carl, and Gillespie, Brigid M
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- 2020
6. ‘The big buzz’: a qualitative study of how safe care is perceived, understood and improved in general practice
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de Wet, Carl, Bowie, Paul, and O’Donnell, Catherine
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- 2018
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7. User redesign, testing and evaluation of the Monitoring Risk and Improving System Safety (MoRISS) checklist for the general practice work environment
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Bowie, Paul, primary, de Wet, Carl, additional, Crickett, Tracey, additional, McCulloch, Jan, additional, Young, Pauline, additional, Freestone, John, additional, Watson, Paul, additional, Houston, Neil, additional, Gillies, Jill, additional, and McNab, Duncan, additional
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- 2020
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8. Training health care professionals in root cause analysis: a cross-sectional study of post-training experiences, benefits and attitudes
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Bowie Paul, Skinner Joe, and de Wet Carl
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Root cause analysis (RCA) originated in the manufacturing engineering sector but has been adapted for routine use in healthcare to investigate patient safety incidents and facilitate organizational learning. Despite the limitations of the RCA evidence base, healthcare authorities and decision makers in NHS Scotland – similar to those internationally - have invested heavily in developing training programmes to build local capacity and capability, and this is a cornerstone of many organizational policies for investigating safety-critical issues. However, to our knowledge there has been no systematic attempt to follow-up and evaluate post-training experiences of RCA-trained staff in Scotland. Given the significant investment in people, time and funding we aimed to capture and learn from the reported experiences, benefits and attitudes of RCA-trained staff and the perceived impact on healthcare systems and safety. Methods We adapted a questionnaire used in a published Australian research study to undertake a cross sectional online survey of health care professionals (e.g. nursing & midwifery, medical doctors and pharmacists) formally trained in RCA by a single territorial health board region in NHS Scotland. Results A total of 228/469 of invited staff completed the survey (48%). A majority of respondents had yet to participate in a post-training RCA investigation (n=127, 55.7%). Of RCA-experience staff, 71 had assumed a lead investigator role (70.3%) on one or more occasions. A clear majority indicated that their improvement recommendations were generally or partly implemented (82%). The top three barriers to RCA success were cited as: lack of time (54.6%), unwilling colleagues (34%) and inter-professional differences (31%). Differences in agreement levels between RCA-experienced and inexperienced respondents were noted on whether a follow-up session would be beneficial after conducting RCA (65.3% v 39.4%) and if peer feedback on RCA reports would be of educational value (83.2% v 37.0%). Comparisons with the previous research highlighted significant differences such as less reported difficulties within RCA teams (P Conclusion This study adds to our knowledge and understanding of the need to improve the effectiveness of RCA training and frontline practices in healthcare settings. The overall evidence points to a potential organisational learning need to provide RCA-trained staff with continuous development opportunities and performance feedback. Healthcare authorities may wish to look more critically at whom they train in RCA, and how this is delivered and supported educationally to maximize cost-benefits, organizational learning and safer patient care.
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- 2013
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9. Combining QOF data with the care bundle approach may provide a more meaningful measure of quality in general practice
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de Wet Carl, McKay John, and Bowie Paul
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background A significant minority of patients do not receive all the evidence-based care recommended for their conditions. Health care quality may be improved by reducing this observed variation. Composite measures offer a different patient-centred perspective on quality and are utilized in acute hospitals via the ‘care bundle’ concept as indicators of the reliability of specific (evidence-based) care delivery tasks and improved outcomes. A care bundle consists of a number of time-specific interventions that should be delivered to every patient every time. We aimed to apply the care bundle concept to selected QOF data to measure the quality of evidence-based care provision. Methods Care bundles and components were selected from QOF indicators according to defined criteria. Five clinical conditions were suitable for care bundles: Secondary Prevention of Coronary Heart Disease (CHD), Stroke & Transient Ischaemic Attack (TIA), Chronic Kidney Disease (CKD), Chronic Obstructive Pulmonary Disease (COPD) and Diabetes Mellitus (DM). Each bundle has 3-8 components. A retrospective audit was undertaken in a convenience sample of nine general medical practices in the West of Scotland. Collected data included delivery (or not) of individual bundle components to all patients included on specific disease registers. Practice level and overall compliance with bundles and components were calculated in SPSS and expressed as a percentage. Results Nine practices (64.3%) with a combined patient population of 56,948 were able to provide data in the format requested. Overall compliance with developed QOF-based care bundles (composite measures) was as follows: CHD 64.0%, range 35.0-71.9%; Stroke/TIA 74.1%, range 51.6-82.8%; CKD 69.0%, range 64.0-81.4%; and COPD 82.0%, range 47.9-95.8%; and DM 58.4%, range 50.3-65.2%. Conclusions In this small study compliance with individual QOF-based care bundle components was high, but overall (‘all or nothing’) compliance was substantially lower. Care bundles may provide a more informed measure of care quality than existing methods. However, the acceptability, feasibility and potential impact on clinical outcomes are unknown.
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- 2012
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10. Computed tomographic pulmonary angiography and pulmonary embolism: predictive value of a d-dimer assay
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Deonarine Patricia, de Wet Carl, and McGhee Alistair
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Pulmonary embolism ,D-dimer ,CTPA (tomography) ,Medicine ,Biology (General) ,QH301-705.5 ,Science (General) ,Q1-390 - Abstract
Abstract Background Computed tomographic pulmonary angiography (CTPA) is increasingly being used as first investigation for suspected pulmonary embolism (PE). The investigation has high predictive value, but is resource and time intensive and exposes patients to considerable radiation. Our aim was to assess the potential value of a negative d-dimer assay to exclude pulmonary emboli and reduce the number of performed CTPAs. Methods All CTPAs performed in a Scottish secondary care hospital for a fourteen month period were retrospectively reviewed. Collected data included the presence or absence of PE, d-dimer results and patient demographics. PE positive CTPAs were reviewed by a specialist panel. Results Pulmonary embolisms were reported for 66/405 (16.3%) CTPAs and d-dimer tests were performed for 216 (53%). 186/216 (86%) patients had a positive and 30 (14%) a negative d-dimer result. The panel agreed 5/66 (7.6%) false positive examinations. The d-dimer assay's negative predictive value was 93.3% (95% CI = 76.5%-98.8%) based on the original number of positive CTPAs and 100% (95% CI = 85.9%-100%) based on expert review. Significant non-PE intrapulmonary pathology was reported for 312/405 (77.0) CTPAs, including 13 new diagnoses of carcinoma. Conclusions We found that a low d-dimer score excluded all pulmonary embolisms, after a further specialist panel review identified initial false positive reports. However, current evidence-based guidelines still recommend that clinicians combine a d-dimer result with a validated clinical risk score when selecting suitable patients for CTPA. This may result in better use of limited resources, prevent patients being exposed to unnecessary irradiation and prevent potential complications as a result of iodinated contrast.
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- 2012
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11. Facilitators and barriers to safer care in Scottish general practice: a qualitative study of the implementation of the trigger review method using normalisation process theory
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de Wet, Carl, primary, Bowie, Paul, additional, and O'Donnell, Catherine A, additional
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- 2019
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12. Never events in general practice: a focus group study exploring the views of English and Scottish general practitioners of ‘never events’
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Morris, Rebecca L, primary, Cheraghi-Sohi, Sudeh, additional, Bowie, Paul, additional, Esmail, Aneez, additional, de Wet, Carl, additional, and Campbell, Stephen M, additional
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- 2019
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13. Implementation of the trigger review method in Scottish general practices: patient safety outcomes and potential for quality improvement
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de Wet, Carl, Black, Chris, Luty, Sarah, McKay, John, O'Donnell, Catherine A., and Bowie, Paul
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Objectives: To report the implementation of a trigger review method (TRM) in primary care, with a particular focus on its impact on patient safety-related findings.\ud \ud Design: Cross-sectional structured review of random samples (n=25) of electronic records of ‘high-risk’ patient groups conducted twice per year (each for a retrospective review period of 3 months).\ud \ud Setting: 274 general practices in two regions of Scotland.\ud \ud Intervention: Contractual incentivisation of TRM implementation.\ud \ud Main outcome measures: Practice participation rate; characteristics of patient safety incidents (PSIs), for example, their prevalence, type, perceived severity and preventability; and actions or intended actions undertaken during and after trigger reviews.\ud \ud Results: 274 of 318 eligible practices (86.2%) returned 536 TRM Summary Reports, which outlined findings from reviews of 13 351 electronic patient records. 1887 (14.1%) PSIs were recorded, with a mean of 3.5 (536/1887) per Summary Report (SD±1.6). Of these, 830 (44.0%) were judged to have caused mild to moderate harm, with 262 (13.9%) cases resulting in more severe harm. A total of 852 PSIs (46.2%) were rated as preventable or potentially preventable. In 459 Summary Reports (85.6%), reviewers indicated implementing one or more improvement actions during the actual TRM process; and 2177 actions after completion of the TRM process (mean 4.1 (SD±3.3) actions per review).\ud \ud Conclusions: The great majority of clinician reviewers ‘successfully’ applied the TRM, uncovering important but previously undetected PSIs, which prompted care teams to take action during and after the trigger reviews. The method and data generated have the potential to drive improvements in related care processes at the practice, regional and national health system level. TRM arguably increased ‘ownership’ of the safety challenge and clinician engagement in implementing their solutions to specific problems identified. Our results suggest that the TRM has potential as a feasible, pragmatic approach to improving primary care safety and quality.
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- 2017
14. Development and psychometric testing of an instrument to measure safety climate perceptions in community pharmacy
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Newham, Rosemary, Bennie, Marion, Maxwell, David, Watson, Anne, de Wet, Carl, and Bowie, Paul
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RS - Abstract
A positive and strong safety culture underpins effective learning from patient safety incidents in health care, including the community pharmacy (CP) setting. To build this culture, perceptions of safety climate must be measured with context-specific and reliable instruments. No pre-existing instruments were specifically designed or suitable for CP within Scotland. We therefore aimed to develop a psychometrically sound instrument to measure perceptions of safety climate within Scottish CPs. The first stage, development of a preliminary instrument, comprised three steps: (i) a literature review; (ii) focus group feedback; and (iii) content validation. The second stage, psychometric testing, consisted of three further steps: (iv) a pilot survey; (v) a survey of all CP staff within a single health board in NHS Scotland; and (vi) application of statistical methods, including principal components analysis and calculation of Cronbach's reliability coefficients, to derive the final instrument. The preliminary questionnaire was developed through a process of literature review and feedback. This questionnaire was completed by staff in 50 CPs from the 131 (38%) sampled. 250 completed questionnaires were suitable for analysis. Psychometric evaluation resulted in a 30-item instrument with five positively correlated safety climate factors: leadership, teamwork, safety systems, communication and working conditions. Reliability coefficients were satisfactory for the safety climate factors (α > 0.7) and overall (α = 0.93). The robust nature of the technical design and testing process has resulted in the development of an instrument with sufficient psychometric properties, which can be implemented in the community pharmacy setting in NHS Scotland.
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- 2014
15. Erratum to: Missed diagnostic opportunities and English general practice: a study to determine their incidence, confounding and contributing factors and potential impact on patients through retrospective review of electronic medical records
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Cheraghi-Sohi, Sudeh, primary, Singh, Hardeep, additional, Reeves, David, additional, Stocks, Jill, additional, Rebecca, Morris, additional, Esmail, Aneez, additional, Campbell, Stephen, additional, and de Wet, Carl, additional
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- 2015
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16. Missed diagnostic opportunities and English general practice: a study to determine their incidence, confounding and contributing factors and potential impact on patients through retrospective review of electronic medical records
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Cheraghi-Sohi, Sudeh, primary, Singh, Hardeep, additional, Reeves, David, additional, Stocks, Jill, additional, Rebecca, Morris, additional, Esmail, Aneez, additional, Campbell, Stephen, additional, and de Wet, Carl, additional
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- 2015
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17. Participatory design of a preliminary safety checklist for general practice
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Bowie, Paul, primary, Ferguson, Julie, additional, MacLeod, Marion, additional, Kennedy, Susan, additional, de Wet, Carl, additional, McNab, Duncan, additional, Kelly, Moya, additional, McKay, John, additional, and Atkinson, Sarah, additional
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- 2015
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18. Patient safety and general practice: traversing the tightrope
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de Wet, Carl, primary and Bowie, Paul, additional
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- 2014
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19. Developing a preliminary ‘never event’ list for general practice using consensus-building methods
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de Wet, Carl, primary, O’Donnell, Catherine, additional, and Bowie, Paul, additional
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- 2014
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20. Applying the trigger review method after a brief educational intervention: potential for teaching and improving safety in GP specialty training?
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McKay, John, primary, de Wet, Carl, additional, Kelly, Moya, additional, and Bowie, Paul, additional
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- 2013
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21. Smoking in Asthma Is Associated with Elevated Levels of Corticosteroid Resistant Sputum Cytokines—An Exploratory Study
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Spears, Mark, primary, McSharry, Charles, additional, Chaudhuri, Rekha, additional, Weir, Christopher J., additional, de Wet, Carl, additional, and Thomson, Neil C., additional
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- 2013
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22. Can we quantify harm in general practice records? An assessment of precision and power using computer simulation
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de Wet, Carl, primary, Johnson, Paul, additional, O’Donnell, Catherine, additional, and Bowie, Paul, additional
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- 2013
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23. Quality improvement and person-centredness: a participatory mixed methods study to develop the 'always event' concept for primary care.
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Bowie, Paul, McNab, Duncan, Ferguson, Julie, de Wet, Carl, Smith, Gregor, MacLeod, Marion, McKay, John, and White, Craig
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Objectives: (1) To ascertain from patients what really matters to them on a personal level of such high importance that it should 'always happen' when they interact with healthcare professionals and staff groups. (2) To critically review existing criteria for selecting 'always events' (AEs) and generate a candidate list of AE examples based on the patient feedback data. Design: Mixed methods study informed by participatory design principles. Subjects and setting: Convenience samples of patients with a long-term clinical condition in Scottish general practices. Results: 195 patients from 13 general practices were interviewed (n=65) or completed questionnaires (n=130). 4 themes of high importance to patients were identified from which examples of potential 'AEs' (n=8) were generated: (1) emotional support, respect and kindness (eg, "I want all practice team members to show genuine concern for me at all times"); (2) clinical care management (eg, "I want the correct treatment for my problem"); (3) communication and information (eg, "I want the clinician who sees me to know my medical history") and (4) access to, and continuity of, healthcare (eg, "I want to arrange appointments around my family and work commitments"). Each 'AE' was linked to a system process or professional behaviour that could be measured to facilitate improvements in the quality of patient care. Conclusions: This study is the first known attempt to develop the AE concept as a person-centred approach to quality improvement in primary care. Practice managers were able to collect data from patients on what they 'always want' in terms of expectations related to care quality from which a list of AE examples was generated that could potentially be used as patient-driven quality improvement (QI) measures. There is strong implementation potential in the Scottish health service. However, further evaluation of the utility of the method is also necessary. [ABSTRACT FROM AUTHOR]
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- 2015
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24. The quality of preventive care for pre-school aged children in Australian general practice.
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Wiles, Louise K., de Wet, Carl, Dalton, Chris, Murphy, Elisabeth, Harris, Mark F., Hibbert, Peter D., Molloy, Charlotte J., Arnolda, Gaston, Ting, Hsuen P., Braithwaite, Jeffrey, and CareTrack Kids Investigative Team
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ELDER care , *MEDICAL records , *MEDICAL practice , *CONFIDENCE intervals - Abstract
Background: Variable and poor care quality are important causes of preventable patient harm. Many patients receive less than recommended care, but the extent of the problem remains largely unknown. The CareTrack Kids (CTK) research programme sought to address this evidence gap by developing a set of indicators to measure the quality of care for common paediatric conditions. In this study, we focus on one clinical area, 'preventive care' for pre-school aged children. Our objectives were two-fold: (i) develop and validate preventive care quality indicators and (ii) apply them in general medical practice to measure adherence.Methods: Clinical experts (n = 6) developed indicator questions (IQs) from clinical practice guideline (CPG) recommendations using a multi-stage modified Delphi process, which were pilot tested in general practice. The medical records of Australian children (n = 976) from general practices (n = 80) in Queensland, New South Wales and South Australia identified as having a consultation for one of 17 CTK conditions of interest were retrospectively reviewed by trained paediatric nurses. Statistical analyses were performed to estimate percentage compliance and its 95% confidence intervals.Results: IQs (n = 43) and eight care 'bundles' were developed and validated. Care was delivered in line with the IQs in 43.3% of eligible healthcare encounters (95% CI 30.5-56.7). The bundles of care with the highest compliance were 'immunisation' (80.1%, 95% CI 65.7-90.4), 'anthropometric measurements' (52.7%, 95% CI 35.6-69.4) and 'nutrition assessments' (38.5%, 95% CI 24.3-54.3), and lowest for 'visual assessment' (17.9%, 95% CI 8.2-31.9), 'musculoskeletal examinations' (24.4%, 95% CI 13.1-39.1) and 'cardiovascular examinations' (30.9%, 95% CI 12.3-55.5).Conclusions: This study is the first known attempt to develop specific preventive care quality indicators and measure their delivery to Australian children in general practice. Our findings that preventive care is not reliably delivered to all Australian children and that there is substantial variation in adherence with the IQs provide a starting point for clinicians, researchers and policy makers when considering how the gap between recommended and actual care may be narrowed. The findings may also help inform the development of specific improvement interventions, incentives and national standards. [ABSTRACT FROM AUTHOR]- Published
- 2019
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25. Quality of care for acute abdominal pain in children
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Peter Hibbert, Gaston Arnolda, Jeffrey Braithwaite, Hsuen P Ting, Charlotte J. Molloy, Yvonne Zurynski, Louise Wiles, Carl de Wet, Kate Churruca, Sarah Dalton, Zurynski, Yvonne, Churruca, Kate, Arnolda, Gaston, Dalton, Sarah, Ting, Hsuen P, Hibbert, Peter Damian, Molloy, Charlotte, Wiles, Louise K, de Wet, Carl, and Braithwaite, Jeffrey
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Male ,medicine.medical_specialty ,Quality management ,Adolescent ,Acute abdominal pain ,Audit ,030204 cardiovascular system & hematology ,quality improvement ,Care setting ,paediatrics ,03 medical and health sciences ,0302 clinical medicine ,children ,Medicine ,Humans ,030212 general & internal medicine ,Quality of care ,Child ,Quality of Health Care ,Original Research ,general practice ,Clinical Audit ,business.industry ,Health Policy ,Medical record ,Outcome measures ,Australia ,abdominal pain ,Infant ,Abdominal Pain ,Child, Preschool ,Emergency medicine ,General practice ,Acute Disease ,Practice Guidelines as Topic ,Female ,Guideline Adherence ,Health Facilities ,business ,Emergency Service, Hospital ,clinical practice guidelines - Abstract
ObjectiveTo assess quality of care for children presenting with acute abdominal pain using validated indicators.DesignAudit of care quality for acute abdominal pain according to 21 care quality indicators developed and validated in four stages.Setting and participantsMedical records of children aged 1–15 years receiving care in 2012–2013 were sampled from 57 general practitioners, 34 emergency departments (ED) and 28 hospitals across three Australian states; 6689 medical records were screened for visits for acute abdominal pain and audited by trained paediatric nurses.Outcome measuresAdherence to 21 care quality indicators and three bundles of indicators: bundle A-History; bundle B-Examination; bundle C-Imaging.ResultsFive hundred and fourteen children had 696 visits for acute abdominal pain and adherence was assessed for 9785 individual indicators. The overall adherence was 69.9% (95% CI 64.8% to 74.6%). Adherence to individual indicators ranged from 21.6% for assessment of dehydration to 91.4% for appropriate ordering of imaging. Adherence was low for bundle A-History (29.4%) and bundle B-Examination (10.2%), and high for bundle C-Imaging (91.4%). Adherence to the 21 indicators overall was significantly lower in general practice (62.7%, 95% CI 57.0% to 68.1%) compared with ED (86.0%, 95% CI 83.4% to 88.4%; pConclusionsThere was considerable variation in care quality for indicator bundles and care settings. Future work should explore how validated care quality indicator assessments can be embedded into clinical workflows to support continuous care quality improvement.
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- 2020
26. The quality of preventive care for pre-school aged children in Australian general practice
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CareTrack Kids Investigative Team, Carl de Wet, Chris Dalton, Jeffrey Braithwaite, Elisabeth Murphy, Louise Wiles, Hsuen P Ting, Charlotte J. Molloy, Peter Hibbert, Mark Harris, Gaston Arnolda, Wiles, Louise K, De Wet, Carl, Dalton, Chris, Murphy, Elisabeth, Harris, Mark F, Hibbert, Peter D, Molloy, Charlotte J, Arnolda, Gaston, Ting, Hsuen P, and Braithwaite, Jeffrey
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medicine.medical_specialty ,Child Health Services ,Psychological intervention ,lcsh:Medicine ,Process assessment (healthcare) ,Quality of healthcare ,preventive medicine ,paediatrics ,03 medical and health sciences ,0302 clinical medicine ,process assessment (healthcare) ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Quality of Health Care ,Retrospective Studies ,Preventive healthcare ,Preventive medicine ,general practice ,Medical records ,business.industry ,Medical record ,lcsh:R ,Australia ,Infant ,Paediatrics ,General Medicine ,Guideline ,Anthropometry ,Confidence interval ,3. Good health ,Incentive ,medical records ,quality of healthcare ,Child, Preschool ,Family medicine ,General practice ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Background: Variable and poor care quality are important causes of preventable patient harm. Many patients receive less than recommended care, but the extent of the problem remains largely unknown. The CareTrack Kids (CTK) research programme sought to address this evidence gap by developing a set of indicators to measure the quality of care for common paediatric conditions. In this study, we focus on one clinical area, 'preventive care' for pre-school aged children. Our objectives were two-fold: (i) develop and validate preventive care quality indicators and (ii) apply them in general medical practice to measure adherence. Methods: Clinical experts (n = 6) developed indicator questions (IQs) from clinical practice guideline (CPG) recommendations using a multi-stage modified Delphi process, which were pilot tested in general practice. The medical records of Australian children (n = 976) from general practices (n = 80) in Queensland, New South Wales and South Australia identified as having a consultation for one of 17 CTK conditions of interest were retrospectively reviewed by trained paediatric nurses. Statistical analyses were performed to estimate percentage compliance and its 95% confidence intervals. Results: IQs (n = 43) and eight care 'bundles' were developed and validated. Care was delivered in line with the IQs in 43.3% of eligible healthcare encounters (95% CI 30.5-56.7). The bundles of care with the highest compliance were 'immunisation' (80.1%, 95% CI 65.7-90.4), 'anthropometric measurements' (52.7%, 95% CI 35.6-69.4) and 'nutrition assessments' (38.5%, 95% CI 24.3-54.3), and lowest for 'visual assessment' (17.9%, 95% CI 8.2-31.9), 'musculoskeletal examinations' (24.4%, 95% CI 13.1-39.1) and 'cardiovascular examinations' (30.9%, 95% CI 12.3-55.5). Conclusions: This study is the first known attempt to develop specific preventive care quality indicators and measure their delivery to Australian children in general practice. Our findings that preventive care is not reliably delivered to all Australian children and that there is substantial variation in adherence with the IQs provide a starting point for clinicians, researchers and policy makers when considering how the gap between recommended and actual care may be narrowed. The findings may also help inform the development of specific improvement interventions, incentives and national standards. Refereed/Peer-reviewed
- Published
- 2019
27. Improving health system responses when patients are harmed: a protocol for a multistage mixed-methods study.
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Hibbert PD, Raggett L, Molloy CJ, Westbrook J, Magrabi F, Mumford V, Clay-Williams R, Lingam R, Salmon PM, Middleton S, Roberts M, Bradd P, Bowden S, Ryan K, Zacka M, Sketcher-Baker K, Phillips A, Birks L, Arya DK, Trevorrow C, Handa S, Swaminathan G, Carson-Stevens A, Wiig S, de Wet C, Austin EE, Nic Giolla Easpaig B, Wang Y, Arnolda G, Peterson GM, and Braithwaite J
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- Humans, Australia, Patient Harm prevention & control, Quality Improvement, Medical Errors prevention & control, Focus Groups, Delivery of Health Care, Patient Safety, Research Design
- Abstract
Introduction: At least 10% of hospital admissions in high-income countries, including Australia, are associated with patient safety incidents, which contribute to patient harm ('adverse events'). When a patient is seriously harmed, an investigation or review is undertaken to reduce the risk of further incidents occurring. Despite 20 years of investigations into adverse events in healthcare, few evaluations provide evidence of their quality and effectiveness in reducing preventable harm.This study aims to develop consistent, informed and robust best practice guidance, at state and national levels, that will improve the response, learning and health system improvements arising from adverse events., Methods and Analysis: The setting will be healthcare organisations in Australian public health systems in the states of New South Wales, Queensland, Victoria and the Australian Capital Territory. We will apply a multistage mixed-methods research design with evaluation and in-situ feasibility testing. This will include literature reviews (stage 1), an assessment of the quality of 300 adverse event investigation reports from participating hospitals (stage 2), and a policy/procedure document review from participating hospitals (stage 3) as well as focus groups and interviews on perspectives and experiences of investigations with healthcare staff and consumers (stage 4). After triangulating results from stages 1-4, we will then codesign tools and guidance for the conduct of investigations with staff and consumers (stage 5) and conduct feasibility testing on the guidance (stage 6). Participants will include healthcare safety systems policymakers and staff (n=120-255) who commission, undertake or review investigations and consumers (n=20-32) who have been impacted by adverse events., Ethics and Dissemination: Ethics approval has been granted by the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH02007 and 2023/ETH02341).The research findings will be incorporated into best practice guidance, published in international and national journals and disseminated through conferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2024
- Full Text
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