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BACKGROUND: Injury is a major cause of death and disability in Ethiopia. ALERT Hospital, one of only three designated trauma centers in the country, has employed a basic trauma registry since its inception in 2016; however, these data had not been used. In joint efforts with the Federal Ministry of Health, we aimed to understand patient injury characteristics and predictors of mortality, to inform priorities in resource and training investments. METHODS: Data from 12 816 consecutive patients in the first 3 years of the trauma registry were reviewed retrospectively. Modified Early Warning Score was used at triage to indicate injury severity (red=critically injured, green=minor injury). No physiologic data for calculating Injury Severity Scores or in-hospital intervention data were available. Triage groups were compared and multivariate logistic regression conducted to determine predictors of in-emergency department (ED) mortality. RESULTS: Most patients presented with minor injuries with 64.7% triaged as yellow and 16.4% triaged as green, and most (75.9%) referred from another facility. Of those who were critically injured, only 31.0% arrived by ambulance. Most injuries were soft tissue (51.1%) and fractures (23.0%); when stratified by triage category, most critical (red) patients had sustained head injuries (52.7%). Arrival by ambulance (OR 2.20, p=0.017) and head injury (OR 3.11, p

Background Patients provide a unique, irreplaceable, and essential perspective in evaluating patient safety. The suite of Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) tools are a notable exception to the scarcity of patient-reported patient safety measures. Full evaluation of their performance has only been attempted for the English version, thereby limiting its international applicability.Objectives To assess the psychometric performance of the Spanish and Catalan versions of the PREOS-PC-Compact.Methods Cross-sectional validation study. We used Classical Test Theory methods to examine scale score distribution, internal consistency, and construct validity; and Item Response Theory (IRT) methods to further explore construct validity.Results 3287 patients completed the Spanish version, and 1007 the Catalan version. Similar results were obtained for both versions. Confirmatory Factor Analysis supported a single construct for each scale. The correlations between PREOS-PC-Compact scales and known group analysis suggested adequate construct validity (inconclusive for known groups at the provider level). All four multi-item scales demonstrated adequate internal consistency reliability (α > 0.7), which was only confirmed for test-retest reliability for ‘Practice activation.’ A sample between 60–90 patients per practice was estimated sufficient to produce scores with reliability > 0.7 for all scales except for harm scales. IRT models showed disordered thresholds for ‘Practice activation’ and ‘Harm burden’ but showed excellent fit after reducing the response categories.Conclusion The Spanish and Catalan versions of the PREOS-PC-Compact are broadly valid and reliable tools to measure patient safety in Spanish primary care centres; confirmation of lower-than-expected test-rest reliability merits further examination .

Introduction: The growth of innovation in health technologies continues to pose new challenges for pharmaceutical companies and authorities. It requires increasingly complex assessment processes and greater expertise. Recently, the Portuguese authorities updated the Health Technology Assessment framework with new guidelines for the evaluation of Added Therapeutic Value. Purpose: The aim is to provide an overview of the recent updates and discuss the implications for future innovative therapeutics. Methodology: This review compared the new guidelines with earlier versions and was followed by a Think Tank discussion with an expert panel. Results: The new guidelines introduced relevant changes regarding the population(s), comparators, outcomes, meta-analysis, indirect comparisons, research and data sources and final assessment decision(s). Discussion: These changes are likely to affect assessments in Portugal directly and indirectly with implications for: defining the population, indication(s), comparators, and outcomes of future studies; analyzing when evidence is limited and dealing with increasingly complex assessments. Some strategies are suggested to support future assessments. Conclusion: Balancing speed and accuracy in health technology assessments will be key for faster access to innovative medicines for patients. These recent updates should result in timely and more robust assessments, and ultimately pave the way for the future of health technologies.

Building a high-quality and efficient people centered integrated care system with Chinese characteristics crucial for implementing the Healthy China strategy and essential for the high-quality development of the healthcare system. This article proposes that a people centered integrated care system should center on health, with efficient triage of urgent and non-urgent cases, linkage between different healthcare levels, and a synergy of prevention and treatment. The development of medical services requires collaboration between public medical and health institutions and societal forces. To construct such a system, transformation is necessary in seven key areas: service system, service concept, individual service decision-making, doctor-patient relationship, service mode, payment mechanism, and regulatory assessment. The key is to promote the strengthening, extension, and integration of the healthcare system and public health service system. This article highlights the importance of management system reform and the full use of information technology, stating that the core aim of building a peo-ple centered integrated care system is to meet the comprehensive health needs of the population, establish a rational and orderly medical framework, and ultimately support the creation of a robust health system in China.

Abstract Background Prehabilitation aims to improve patients' functional capacity before surgery to reduce perioperative complications, promote recovery and decrease probability of disability. The planned economic evaluation is performed alongside a large German multi-centre pragmatic, two-arm parallel-group, randomized controlled trial on prehabilitation for frail elderly patients before elective surgery compared to standard care (PRAEP-GO RCT). The aim is to determine the cost-effectiveness and cost-utility of prehabilitation for frail elderly before an elective surgery. Methods The planned health economic evaluation comprises cost-effectiveness, and cost-utility analyses. Analyses are conducted in the German context from different perspectives including the payer perspective, i.e. the statutory health insurance, the societal perspective and the health care provider perspective. Data on outcomes and costs, are collected alongside the ongoing PRAEP-GO RCT. The trial population includes frail or pre-frail patients aged ≥70 years with planned elective surgery. The intervention consists of frailty screening (Fried phenotype), a shared decision-making conference determining modality (physiotherapy and unsupervised physical exercises, nutrition counselling, etc.) and setting (inpatient, day care, outpatient etc.) of a 3-week individual multimodal prehabilitation prior to surgery. The control group receives standard preoperative care. Costs include the intervention costs, the costs of the index hospital stay for surgery, and health care resources consumed during a 12-month follow-up. Clinical effectiveness outcomes included in the economic evaluation are the level of care dependency, the degree of disability as measured by the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), quality-adjusted life years (QALY) derived from the EQ-5D-5L and the German utility set, and complications occurring during the index hospital stay. Each adopted perspective considers different types of costs and outcomes as outlined in the protocol. All analyses will feature Intention-To-Treat analysis. To explore methodological and parametric uncertainties, we will conduct probabilistic and deterministic sensitivity analyses. Subgroup analyses will be performed as secondary analyses. Discussion The health economic evaluation will provide insights into the cost-effectiveness of prehabilitation in older frail populations, informing decision-making processes and contributing to the evidence base in this field. Potential limitation includes a highly heterogeneous trial population. Trial registration PRAEP-GO RCT: NCT04418271; economic evaluation: OSF ( https://osf.io/ecm74 ).

Background: Prehabilitation aims to improve patients' functional capacity before surgery to reduce perioperative complications, promote recovery and decrease probability of disability. The planned economic evaluation is performed alongside a large German multi-centre pragmatic, two-arm parallel-group, randomized controlled trial on prehabilitation for frail elderly patients before elective surgery compared to standard care (PRAEP-GO RCT). The aim is to determine the cost-effectiveness and cost-utility of prehabilitation for frail elderly before an elective surgery. Methods: The planned health economic evaluation comprises cost-effectiveness, and cost-utility analyses. Analyses are conducted in the German context from different perspectives including the payer perspective, i.e. the statutory health insurance, the societal perspective and the health care provider perspective. Data on outcomes and costs, are collected alongside the ongoing PRAEP-GO RCT. The trial population includes frail or pre-frail patients aged ≥70 years with planned elective surgery. The intervention consists of frailty screening (Fried phenotype), a shared decision-making conference determining modality (physiotherapy and unsupervised physical exercises, nutrition counselling, etc.) and setting (inpatient, day care, outpatient etc.) of a 3-week individual multimodal prehabilitation prior to surgery. The control group receives standard preoperative care. Costs include the intervention costs, the costs of the index hospital stay for surgery, and health care resources consumed during a 12-month follow-up. Clinical effectiveness outcomes included in the economic evaluation are the level of care dependency, the degree of disability as measured by the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), quality-adjusted life years (QALY) derived from the EQ-5D-5L and the German utility set, and complications occurring during the index hospital stay. Each adopted perspective considers different types of costs and outcomes as outlined in the protocol. All analyses will feature Intention-To-Treat analysis. To explore methodological and parametric uncertainties, we will conduct probabilistic and deterministic sensitivity analyses. Subgroup analyses will be performed as secondary analyses. Discussion: The health economic evaluation will provide insights into the cost-effectiveness of prehabilitation in older frail populations, informing decision-making processes and contributing to the evidence base in this field. Potential limitation includes a highly heterogeneous trial population. Trial registration: PRAEP-GO RCT: NCT04418271; economic evaluation: OSF (https://osf.io/ecm74). [ABSTRACT FROM AUTHOR]

Objectives The use of technology in healthcare to manage patient records, guide diagnosis, and make referrals is termed electronic healthcare. An electronic health record system called Lightwave Health Information Management System (LHIMS) was implemented in 2018 at Cape Coast Teaching Hospital (CCTH). This study evaluated the impact of LHIMS on the quality of healthcare data at CCTH, focusing on the extent to which its use has enhanced the main dimensions of data quality. Methods Structured questionnaires were administered to doctors at CCTH to enquire about their opinions about the present state of LHIMS as measured against the parameters of interest in this study, mainly the dimensions of quality healthcare data and the specific issues plaguing the system as reported by respondents. Results Most doctors found LHIMS convenient to use, mainly because it made access to patient records easier and had to some extent improved the dimensions of quality healthcare data, except for comprehensiveness, at CCTH. Major challenges that impeded the smooth running of the system were erratic power supply, inadequate logistics and technological drive, and poor internet connectivity. Conclusions LHIMS must be upgraded to include more decision support systems and additional add-ons such as patients’ radiological reports, and laboratory results must be readily available on LHIMS to make patient health data more comprehensive.

Abstract Background The Norwegian Trauma Registry (NTR) is designed to monitor and improve the quality and outcome of trauma care delivered by Norwegian trauma hospitals. Patient care is evaluated through specific quality indicators, which are constructed of variables reported to the registry by certified registrars. Having high-quality data recorded in the registry is essential for the validity, trust and use of data. This study aims to perform a data quality check of a subset of core data elements in the registry by assessing agreement between data in the NTR and corresponding data in electronic patient records (EPRs). Methods We validated 49 of the 118 variables registered in the NTR by comparing those with the corresponding ones in electronic patient records for 180 patients with a trauma diagnosis admitted in 2019 at eight public hospitals. Agreement was quantified by calculating observed agreement, Cohen’s Kappa and Gwet’s first agreement coefficient (AC1) with 95% confidence intervals (CIs) for 27 nominal variables, quadratic weighted Cohen’s Kappa and Gwet’s second agreement coefficient (AC2) for five ordinal variables. For nine continuous, one date and seven time variables, we calculated intraclass correlation coefficient (ICC). Results Almost perfect agreement (AC1 /AC2/ ICC > 0.80) was observed for all examined variables. Nominal and ordinal variables showed Gwet’s agreement coefficients ranging from 0.85 (95% CI: 0.79–0.91) to 1.00 (95% CI: 1.00–1.00). For continuous and time variables there were detected high values of intraclass correlation coefficients (ICC) between 0.88 (95% CI: 0.83–0.91) and 1.00 (CI 95%: 1.00–1.00). While missing values in both the NTR and EPRs were in general negligeable, we found a substantial amount of missing registrations for a continuous “Base excess” in the NTR. For some of the time variables missing values both in the NTR and EPRs were high. Conclusion All tested variables in the Norwegian Trauma Registry displayed excellent agreement with the corresponding variables in electronic patient records. Variables in the registry that showed missing data need further examination.

RESUMEN Introducción. La monitorización de la utilización del conocimiento y la evaluación de resultados permiten conocer la aplicación de la evidencia, cambios en los conocimientos y actitudes, el impacto en resultados de salud y la integración y el mantenimiento de las prácticas adoptadas. Existen debilidades relacionadas con la falta de sistematización, limitaciones de los registros y calidad del proceso. El objetivo de este artículo es describir la experiencia en la generación de estrategias de monitorización y evaluación de resultados de implantación de Guías de Buenas Prácticas en España. División de temas tratados. En primer lugar, se revisan los procesos de medición de resultados en la implantación de Guías, en el marco del Programa Best Practice Spotlight Organizations®, cuya herramienta para liderar el cambio incluye la monitorización y evaluación como una de las seis fases del ciclo de acción. En segundo lugar, se analizan las estrategias de monitorización y evaluación propuestas en la literatura, destacando la Asociación Profesional de Enfermeras de Ontario. Finalmente, se analizan las estrategias de monitorización y evaluación generadas por dos instituciones españolas participantes en el programa, centradas en adecuación de registros, explotación y análisis de indicadores, desarrollo de herramientas, procedimientos de evaluación y mecanismos de difusión y retroalimentación. Conclusiones. La definición de estrategias de monitorización y evaluación planificada de forma temprana contribuye a la viabilidad de la evaluación de la implantación y su sostenibilidad. Es necesario adaptarlas al contexto, con estrategias transversales que alcancen a toda la institución, facilitadas por la institución. Palabras clave: Ciencia de la Implementación; Práctica Clínica Basada en la Evidencia; Evaluación de Resultado en la Atención de Salud; Mecanismos de Evaluación de la Atención de Salud; Indicadores de Calidad de la Atención de Salud ABSTRACT Introduction. Monitoring the usage of knowledge and evaluating results permits one to know the application of the evidence, knowledge, and attitude changes, the impact on health results, integration, and maintenance of the adopted practices. There exist weaknesses related to lack of systematization, limitation of the records, and quality of the process. This article’s objective is to describe the experience generating monitoring strategies and evaluation of the results regarding the implementation of good practice guides in Spain. Topics for Reflection. In the first place, the measurement process of the results regarding the implementation of guides are reviewed, in the Best Practice Spotlight Organizations® program frame, whose tool to lead the change includes monitoring and evaluation as one of the sixth phases of the action cycle. In the second place, monitoring and evaluation strategies proposed in the literature are analyzed, highlighting the Professional Nurses Association of Ontario. Finally, the monitoring and evaluation strategies are analyzed by two Spanish institutions participating in the program, focused on the adequation of records, exploitation and indicator analysis, tools development, evaluation procedures, dissemination, and feedback mechanisms. Conclusions: The definition of monitoring and evaluation strategies planned in advance contributes to the viability of the evaluation regarding the implementation and its sustainability. Is necessary to adapt them to the context, with transversal strategies that reach the whole institution, facilitated by the institution. Keywords: Implementation Science; Evidence-Based Practice; Outcome Assessment, Health Care; Health Care Evaluation Mechanisms; Quality Indicators, Health Care RESUMO Introdução. Monitorizar a utilização do conhecimento e avaliar os resultados permite-nos conhecer a aplicação das evidências, as mudanças nos conhecimentos e atitudes, o impacto nos resultados de saúde e a integração e manutenção das práticas adotadas. Existem fragilidades relacionadas à falta de sistematização, limitações de registros e qualidade do processo. O objetivo deste artigo é descrever a experiência na geração de estratégias de monitoramento e avaliação dos resultados da implementação de Manuais de Boas Práticas na Espanha. Divisão dos temas abordados. Em primeiro lugar, são revistos os processos de medição de resultados na implementação dos Manuais, no âmbito do Programa Best Practice Spotlight Organizations®, cuja ferramenta para liderar a mudança inclui a monitorização e avaliação como uma das seis fases do ciclo de ação. Em segundo lugar, são analisadas as estratégias de monitoramento e avaliação propostas na literatura, com destaque para a Associação Profissional de Enfermeiros de Ontário. Por fim, são analisadas as estratégias de monitoramento e avaliação geradas por duas instituições espanholas participantes do programa, focadas na adaptação de registros, exploração e análise de indicadores, desenvolvimento de ferramentas, procedimentos de avaliação e mecanismos de divulgação e feedback. Conclusões. A definição de estratégias de monitoramento e avaliação planeadas antecipadamente contribui para a viabilidade da avaliação da implementação e para a sua sustentabilidade. É necessário adaptá-los ao contexto, com estratégias transversais que alcancem toda a instituição, facilitadas pela instituição. Palavras-chave: Ciência da Implementação; Prática Clínica Baseada em Evidências; Avaliação de Resultados em Cuidados de Saúde; Mecanismos de Avaliação da Assistência à Saúde; Indicadores de Qualidade em Assistência à Saúde

Background: A 2014 SSO-ASTRO guideline on surgical margins aimed to reduce unnecessary reoperation after breast conserving surgery (BCS). We investigate whether publication of the guideline was associated with a reduction in reoperation in Western Australia (WA). Methods: In this retrospective, population-based cohort study, cases of newly-diagnosed breast cancer were identified from the WA Cancer Registry. Linkage to the Hospital Morbidity Data Collection identified index BCS for invasive cancer between January 2009 and June 2018 (N = 8059) and reoperation within 90 days. Pre-guideline (2009–2013) and post-guideline (2014–2018) reoperation proportions were compared, and temporal trends were estimated with generalised linear regression. Results: The pre-guideline reoperation proportion was 25.8% compared with 21.7% post-guideline (difference −4.0% [95% CI —5.9, −2.2, p

Background: The Norwegian Trauma Registry (NTR) is designed to monitor and improve the quality and outcome of trauma care delivered by Norwegian trauma hospitals. Patient care is evaluated through specific quality indicators, which are constructed of variables reported to the registry by certified registrars. Having high-quality data recorded in the registry is essential for the validity, trust and use of data. This study aims to perform a data quality check of a subset of core data elements in the registry by assessing agreement between data in the NTR and corresponding data in electronic patient records (EPRs). Methods: We validated 49 of the 118 variables registered in the NTR by comparing those with the corresponding ones in electronic patient records for 180 patients with a trauma diagnosis admitted in 2019 at eight public hospitals. Agreement was quantified by calculating observed agreement, Cohen's Kappa and Gwet's first agreement coefficient (AC1) with 95% confidence intervals (CIs) for 27 nominal variables, quadratic weighted Cohen's Kappa and Gwet's second agreement coefficient (AC2) for five ordinal variables. For nine continuous, one date and seven time variables, we calculated intraclass correlation coefficient (ICC). Results: Almost perfect agreement (AC1 /AC2/ ICC > 0.80) was observed for all examined variables. Nominal and ordinal variables showed Gwet's agreement coefficients ranging from 0.85 (95% CI: 0.79–0.91) to 1.00 (95% CI: 1.00–1.00). For continuous and time variables there were detected high values of intraclass correlation coefficients (ICC) between 0.88 (95% CI: 0.83–0.91) and 1.00 (CI 95%: 1.00–1.00). While missing values in both the NTR and EPRs were in general negligeable, we found a substantial amount of missing registrations for a continuous "Base excess" in the NTR. For some of the time variables missing values both in the NTR and EPRs were high. Conclusion: All tested variables in the Norwegian Trauma Registry displayed excellent agreement with the corresponding variables in electronic patient records. Variables in the registry that showed missing data need further examination. [ABSTRACT FROM AUTHOR]

A 2014 SSO-ASTRO guideline on surgical margins aimed to reduce unnecessary reoperation after breast conserving surgery (BCS). We investigate whether publication of the guideline was associated with a reduction in reoperation in Western Australia (WA). In this retrospective, population-based cohort study, cases of newly-diagnosed breast cancer were identified from the WA Cancer Registry. Linkage to the Hospital Morbidity Data Collection identified index BCS for invasive cancer between January 2009 and June 2018 (N = 8059) and reoperation within 90 days. Pre-guideline (2009–2013) and post-guideline (2014–2018) reoperation proportions were compared, and temporal trends were estimated with generalised linear regression. The pre-guideline reoperation proportion was 25.8% compared with 21.7% post-guideline (difference −4.0% [95% CI —5.9, −2.2, p < 0.001], odds ratio [OR] 0.80 [95% CI 0.72, 0.89, p < 0.001]). Absolute reductions were similar for repeat BCS (16.3% versus 14.6%; difference −1.8% [95% CI —3.4, −0.2, p = 0.03]) and conversion to mastectomy (9.4% versus 7.2%; difference −2.2% [95% CI —3.4, −1.0, p < 0.001]). Over the study period, there was an annual absolute change in reoperation of −0.8% (95% CI —1.2, −0.5, p < 0.001). Accounting for this linear trend, the difference in reoperation between time periods was −0.5% (95% CI —4.3, 3.3; p = 0.81), reflecting a non-significant reduction in conversion to mastectomy. Comparisons of pre- versus post-guideline time periods in WA showed reductions in reoperation that were similar to international estimates; however, an annual decline in reoperation predated the guideline. Analyses that do not account for temporal trends are likely to overestimate changes in reoperation associated with the guideline. • The reoperation rate was lower after than before the SSO-ASTRO margins guideline. • However, an annual decline in reoperation preceded publication of the guideline. • Accounting for this trend, a smaller reduction was associated with the guideline. [ABSTRACT FROM AUTHOR]

Accurate and efficient data collection is crucial for effective evaluation of quality of care. The objective of this study is to compare two methods of data collection used to score quality indicators for musculoskeletal injury management in Emergency departments: prospective observation, and chart audit. An analysis was undertaken of data collected from 633 patients who presented with a musculoskeletal injury to eight emergency departments in Queensland, Australia in 2016–17. Twenty-two quality indicators were scored using both prospective observation and chart audit data for each occasion of service. Quality indicators were included if they were originally published with both collection methods. Analyses were performed to compare firstly, the quality indicator denominators, and secondly, the quality indicator trigger rates, scored using each collection method. Chi Square statistics were used to identify significant differences. Prospectively collected data scored quality indicator denominators significantly (p value<0.05) more often than chart audit data for five (22.7 %) of the 22 quality indicators. The remaining 17 quality indicators (77.3 %) showed no statistical differences. When comparing quality indicator trigger rates, 16 (72.7 %) had significantly different results between methods with 12 (54.5 %) scoring higher using prospective data and four (18.2 %) with chart audit data. The remaining six quality indicators (27.3 %) in this comparison showed no significant difference between chart and prospective data. Quality indicators including aspects of care associated with patient safety, and those relying on clinician written orders or forms were adequately scored using either prospective observation or chart audit data. Whereas quality indicators relying on time-sensitive information, elements of a social history, general physical exams and patient education and advice scored higher using prospective observation data collection. [ABSTRACT FROM AUTHOR]

INTRODUCTION The safety of patients and property in healthcare settings is directly influenced by security response time, yet this critical aspect is often overlooked. In this article, we aim to address this gap by presenting a proposed key performance indicator (KPI) for security response times. METHODS To develop the proposed KPI, we followed a systematic approach. First, we defined the necessary KPI. We then collected baseline response time data and met with stakeholders to gather their insights. Subsequently, we analysed the response time data from before and after implementation of the proposed KPI, and introduced a levelling method for responses that takes into account the intensity and risk level of each situation. RESULTS The weekly average baseline response time for situations requiring security department intervention was found to be 8 minutes and 1 second. One year after implementing the levelling method, the data comparison revealed a substantial decrease in response times. Specifically, responses to Level 1 incidents averaged 3 minutes and 57 seconds; Level 2 incidents averaged 5 minutes and 47 seconds; and Level 3 incidents averaged 3 minutes and 59 seconds. CONCLUSION The application and testing of this new KPI over the course of one year demonstrated a remarkable impact on security response time. Given the lack of a published benchmark for such response, we propose a benchmark of 5 minutes.

ABSTRACT Objectives: to assess the operationalization of Primary Health Care in the COVID-19 pandemic, according to Primary Care Assessment Tool: PCATool-Brasil attributes, from physicians’ and nurses’ perspective. Methods: a cross-sectional study, carried out with 99 physicians and nurses from Basic Health Units in a state in northeastern Brazil, with the aid of the adapted instrument PCATool-Brasil. Results: Essential Score was classified as high performance (6.6) and General Score as low performance (6.5). First Contact Access, Care Integration, and Community Guidance scores were 6.6). Conclusions: the attributes of Primary Health Care, in general, showed values above or close to the cut-off point in the assessment. These data can support strategies for local and national managers to strengthen Primary Health Care in the COVID-19 pandemic and future public health emergencies.

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Abstract Background The presence of residents in Primary Care health centres may influence their operational results. Aim To examine the relationship between the presence of residents and the results of the evaluation in Portuguese Primary Care Health Centres. Methods We conduct a cross-sectional study, comparing the results achieved by the mainland Portuguese Primary Care Health Centres measured by the Global Performance Index (Índice de desempenho global – IDG) by the presence of General & Family Medicine residents in training. Analysis took into consideration the distribution by region and typology of the health centres. Results We evaluated 906 units, 55.7% involved in the training of General & Family Medicine residence. The presence of residents was associated with higher Global Performance Index values (77.3 vs 57.6; p

Objective: To evaluate and characterize the quality of ophthalmic care offered in an outpatient service unit of the SUS secondary care according to the perception of users and/or those responsible for these users. Methods: A cross-sectional study of analytical prevalence was carried out among users assisted from September 2019 to March 2020, in one of the six ophthalmic care services offered by the SUS, in the municipality of Vitória da Conquista (BA), Brazil. Demographic and socioeconomic conditions, as well as self-perception of health, were evaluated. The characteristics and quality levels of ophthalmic health care were also evaluated. Data collection took place through a telephone interview. Results: A total of 389 users and/or guardians participated in the study. Participants reported high levels of satisfaction, considering the questions that make up the instrument’s construct. Compromised quality levels were observed in relation to the freedom to choose their eye care provider (n=154; 39.7%). Lower levels of satisfaction were associated with the variables male gender (OR=1.66; 95%CI=1.04-2.65; p=0.033) and self-reported white race (OR=6.89; 95%CI=4, 00-11.86; p=0.000). Conclusion: Users reported good levels of satisfaction with eye health care. There were greater chances of lower levels of satisfaction among men and among those with a self-reported white race. [ABSTRACT FROM AUTHOR]

Aim: Pressing oral health care challenges pose prioritization dilemmas for governments. This study aimed to identify key determinants of prioritization in oral health policy in Denmark, Germany, the Netherlands, and the United Kingdom, as part of a series of the DELIVER project., Methods: A literature review based on a search of PubMed and Google Scholar articles related to these countries from January 1, 2000, to October 17, 2023, and key informant interviews with policy makers were conducted to identify key trends in oral health policy choices and determinants of priority setting and resource allocation processes., Results: A total of 249 articles were included, and 6 key informants were interviewed. The overarching focus identified was the accessibility of dental care, primarily characterized by incremental and localized programs for vulnerable groups. Supply-side arrangements consisted of adaptations to population needs, including financial incentives for providers and adjusted service delivery models such as task shifting. Several interventions of quality management were found, particularly in Germany. A funnel was produced to illustrate 3 stages driving oral health policy choices. These were political accountability to address population demand, stakeholder influence through negotiations and lobbying, and bureaucratic justification of policy innovations. While findings highlighted political attention on oral health care through public outcry, complex negotiations and limited data formed bottlenecks of prioritization., Conclusion: Prioritization in oral health policy seems to be dominated by fragmented investments in incremental services of delivery rather than synergized reforms such as granular package designs. While some contexts showed political traction for oral health policy, complex negotiations strained by interests of private professionals and challenges of limited evidence result in difficulties in constraining oral health care within public spending targets. This has placed oral health policy in a state of inertia, where insufficient public resources meet the force of content exerted by the private sector., Knowledge Transfer Statement: This study can inform policy makers and researchers to understand the various stakeholder roles in maintaining the status quo of oral health policy and the processes creating the bottlenecks preventing progression in improving oral health care systems. This understanding could lead to novel approaches to oral health policy making and the appropriate data acquisition and analysis to aid oral health policy., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background/Aim. Health indicators provide comparable in-formation relevant to defining health goals. The aim of this study was to perform a forecasting analysis of the selected indicators, which could help anticipate the future necessities in the health economy and prevent the problems that would predictively grow in the future. Methods. Health indicators are collected from publicly available databases of the World Health Organization and Eurostat. We used the quantitative forecasting technique, commonly used for historical data, to predict several years in the future concerning selected health- and economy-related indicators. Results. Total health expenditures as a percentage of gross domestic product (GDP) by 2025 will increase in most of the 17 surveyed countries. The percentage of direct household budget payments (out-of-pocket) for health services will decrease in half of the countries, while values of GDP expressed in US$ will increase significantly com-pared to the last surveyed year (2017), except in Greece. The infant mortality indicator shows that the numbers will decrease in each surveyed country, while the urban population percent-age will rise almost in each country except Estonia. Life expectancy will increase in each surveyed country. Conclusion. Health- and economy-related indicators must be monitored over time, as they provide significant information concerning the relevant issues in the health care system. Moreover, they may indicate changes that should be made in order to accomplish progress in each individual country.

Abstract Background The present study has been undertaken with the aim to evaluate performance and ranking of various universities of medical sciences that are responsible for providing public health services and primary health care in Iran. Methods Four models; Weighted Factor Analysis (WFA), Equal Weighting (EW), Stochastic Frontier Analysis (SFA), and Data Envelopment Analysis (DEA) have been applied for evaluating the performance of universities of medical sciences. This study was commenced based on the statistical reports of the Ministry of Health and Medical Education (MOHME), census data from the Statistical Center of Iran, indicators of Vital Statistics, results of Multiple Indicator of Demographic and Health Survey 2010, and results of the National Survey of Risk Factors of non-communicable diseases. Results The average performance scores in WFA, EW, SFA, and DEA methods for the universities were 0.611, 0.663, 0.736 and 0.838, respectively. In all 4 models, the performance scores of universities were different (range from 0.56–1, 0.53–1, 0.73–1 and 0.83–1 in WFA, EW, SFA and DEA models, respectively). Gilan and Rafsanjan universities with the average ranking score of 4.75 and 41 had the highest and lowest rank among universities, respectively. The universities of Gilan, Ardabil and Bojnourd in all four models had the highest performance among the top 15 universities, while the universities of Rafsanjan, Ahvaz, Kerman and Jiroft showed poor performance in all models. Conclusions The average performance scores have varied based on different measurement methods, so judging the performance of universities based solely on the results of a model can be misleading. In all models, the performance of universities has been different, which indicates the need for planning to balance the performance improvement of universities based on learning from the experiences of well-performing universities.

Abstract Background In-hospital mortality and short-term mortality are indicators that are commonly used to evaluate the outcome of emergency department (ED) treatment. Although several scoring systems and machine learning-based approaches have been suggested to grade the severity of the condition of ED patients, methods for comparing severity-adjusted mortality in general ED patients between different systems have yet to be developed. The aim of the present study was to develop a scoring system to predict mortality in ED patients using data collected at the initial evaluation and to validate the usefulness of the scoring system for comparing severity-adjusted mortality between institutions with different severity distributions. Methods The study was based on the registry of the National Emergency Department Information System, which is maintained by the National Emergency Medical Center of the Republic of Korea. Data from 2016 were used to construct the prediction model, and data from 2017 were used for validation. Logistic regression was used to build the mortality prediction model. Receiver operating characteristic curves were used to evaluate the performance of the prediction model. We calculated the standardized W statistic and its 95% confidence intervals using the newly developed mortality prediction model. Results The area under the receiver operating characteristic curve of the developed scoring system for the prediction of mortality was 0.883 (95% confidence interval [CI]: 0.882–0.884). The Ws score calculated from the 2016 dataset was 0.000 (95% CI: − 0.021 – 0.021). The Ws score calculated from the 2017 dataset was 0.049 (95% CI: 0.030–0.069). Conclusions The scoring system developed in the present study utilizing the parameters gathered in initial ED evaluations has acceptable performance for the prediction of in-hospital mortality. Standardized W statistics based on this scoring system can be used to compare the performance of an ED with the reference data or with the performance of other institutions.

Background: The presence of residents in Primary Care health centres may influence their operational results. Aim: To examine the relationship between the presence of residents and the results of the evaluation in Portuguese Primary Care Health Centres. Methods: We conduct a cross-sectional study, comparing the results achieved by the mainland Portuguese Primary Care Health Centres measured by the Global Performance Index (Índice de desempenho global – IDG) by the presence of General & Family Medicine residents in training. Analysis took into consideration the distribution by region and typology of the health centres. Results: We evaluated 906 units, 55.7% involved in the training of General & Family Medicine residence. The presence of residents was associated with higher Global Performance Index values (77.3 vs 57.6; p < 0.001). The higher difference was found in the less developed Personalized Health Care Units and in the region of Lisbon and Tagus Valley. Conclusion: The presence of residents in training is a contributing factor in the productivity of the Primary Health Care facilities. It may model the asymmetry in the performance of Portuguese Health Centres. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the satisfaction of users of Dental Specialty Centers (CEO) in Brazil employing the Service Satisfaction Index (SSI) and identify associated factors. Methods: This quantitative, evaluative, and cross‐sectional study used secondary data extracted from the Second External Evaluation of the Program for the Improvement of Access and Quality of Brazilian Dental Specialty Centers (PMAQ‐CEO) held in 2018 in 901 municipalities, accounting for 1097 CEO, of which 1042 were investigated. A total of 10391 users participated in the study. Considering user satisfaction as an aggregate variable, SSI was classified into two categories: Lower Satisfaction (SSI < 20) and Maximum Satisfaction (SSI = 20). Data were analyzed by descriptive and inferential statistics using the SPSS® software. The exploratory factor analysis verified the statistical correlations between attributes and SSI. Results: The maximum satisfaction with the service was 21.1%; factors that expressed the most significant influence on SSI were waiting time (OR = 1.17; CI 95%: 1.05–1.31), feeling that CEO has good conditions of use (OR = 7.05; CI 95%: 5.15–9.65), not wishing to be assisted at another CEO (OR = 4.17; CI 95%: 3.12–5.57), not having treatment interrupted due to lack of material (OR = 2.05; CI 95%: 1.70–2.47), age up to 40 years of users (OR = 1.31; CI 95%: 1.18–1.46) and higher education (OR = 1.30; CI 95%: 1.14–1.49). Conclusions: SSI appropriately described the user's satisfaction with the service. The maximum satisfaction with the service was influenced by age, education, waiting time, not having treatment interrupted, and considering CEO clean and hygienic environment. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between health management and human resource factors on matrix support (MS) in a nationally representative sample of Dental Specialty Centres (DSCs) in Brazil. Methods: This survey included 1042 DSCs (Response rate = 94.99%) in the second cycle of the National Program for the Improvement of the Quality and Access to the Dental Specialty Centres (PMAQ‐CEO, in Portuguese) in 2018. Previously trained interviewers extracted information on MS, health management and human resources of the DSC by using a structured instrument. An MS score was created by adding the number of positive answers to the 10 MS questions. Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios (RR) and corresponding 95% confidence interval (CI). Results: Of all the DSCs (n = 1042), 116 (11.1%) performed all 10 MS procedures. Those DSCs with a manager who had a higher education degree in the area of Public Health or Public Management (RR = 1.01, 95% CI, 1.01–1.02) and with human resources that received incentives, bonuses or financial awards for performance related to the PMAQ‐CEO result (RR = 1.01 95% CI 1.01–1.02) are more likely to perform MS, when compared to the reference categories. The DSCs that are more likely to perform MS include those that developed actions as a result of periodic planning and evaluation with confirmatory documentation (RR = 1.06, 95% CI; 1.01–1.10); those that received support for planning and organizing the work scheme (RR = 1.03, 95% CI; 1.01–1.05); those that monitored and analysed the goals set for each specialty offered at the DSC, with (RR = 1.06, 95% CI; 1.01–1.10) or without confirmatory documentation (RR = 1.06, 95%CI; 1.02–1.11); those whose team periodically performed self‐assessment processes, using the Ministry of Health's formal self‐assessment (AMAQ in Portuguese) (RR = 1.04, 95% CI; 1.02–1.05); those who followed clinical guidelines (with confirmatory documentation) regarding the referral of patients from primary care to the DSC (RR = 1.02, 95% CI; 1.01–1.04). On the contrary, DSCs that did not use the results achieved in previous PMAQ cycles in the organization of the DSC's team work scheme proved to be less likely to perform MS (RR = 0.98, 95% CI; 0.96–0.99). Conclusions: Matrix support is associated with human resources and management factors in secondary oral health care in Brazil. Continuing professional development and some management characteristics are important for secondary dental care quality and could be considered in health policy initiatives. [ABSTRACT FROM AUTHOR]

Innovative health technologies offer much to patients, clinicians, and health systems. Policy makers can, however, be slow to embrace innovation for many reasons, including a less robust body of evidence, perceived high costs, and a fear that once technologies enter the health system, they will be difficult to remove. Health technology funding decisions are usually made after a rigorous health technology assessment (HTA) process, including a cost analysis. However, by focusing on therapeutic value and cost-savings, the traditional HTA framework often fails to capture innovation in the assessment process. How HTA defines, evaluates, and values innovation is currently inconsistent, and it is generally agreed that by explicitly defining innovation would recognize and reward and, in turn, stimulate, encourage, and incentivize future innovation in the system. To foster innovation in health technology, policy needs to be innovative and utilize other HTA tools to inform decision making including horizon scanning, multicriteria decision analysis, and funding mechanisms such as managed agreements and coverage with evidence development. When properly supported and incentivized, and by shifting the focus from cost to investment, innovation in health technology such as genomics, point-of-care testing, and digital health may deliver better patient outcomes. Industry and agency members of the Health Technology Assessment International Asia Policy Forum (APF) met in Taiwan in November 2023 to discuss the potential of HTA to foster innovation, especially in the Asia region. Discussions and presentations during the 2023 APF were informed by a background paper, which forms the basis of this paper.

Background: The present study has been undertaken with the aim to evaluate performance and ranking of various universities of medical sciences that are responsible for providing public health services and primary health care in Iran.Methods: Four models; Weighted Factor Analysis (WFA), Equal Weighting (EW), Stochastic Frontier Analysis (SFA), and Data Envelopment Analysis (DEA) have been applied for evaluating the performance of universities of medical sciences. This study was commenced based on the statistical reports of the Ministry of Health and Medical Education (MOHME), census data from the Statistical Center of Iran, indicators of Vital Statistics, results of Multiple Indicator of Demographic and Health Survey 2010, and results of the National Survey of Risk Factors of non-communicable diseases.Results: The average performance scores in WFA, EW, SFA, and DEA methods for the universities were 0.611, 0.663, 0.736 and 0.838, respectively. In all 4 models, the performance scores of universities were different (range from 0.56-1, 0.53-1, 0.73-1 and 0.83-1 in WFA, EW, SFA and DEA models, respectively). Gilan and Rafsanjan universities with the average ranking score of 4.75 and 41 had the highest and lowest rank among universities, respectively. The universities of Gilan, Ardabil and Bojnourd in all four models had the highest performance among the top 15 universities, while the universities of Rafsanjan, Ahvaz, Kerman and Jiroft showed poor performance in all models.Conclusions: The average performance scores have varied based on different measurement methods, so judging the performance of universities based solely on the results of a model can be misleading. In all models, the performance of universities has been different, which indicates the need for planning to balance the performance improvement of universities based on learning from the experiences of well-performing universities. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify symptom profiles among U.S. military personnel within 1 year after combat injury and assess the relationship between the symptom profiles and long-term quality of life (QoL). Methods: The study sample consisted of 885 military personnel from the Expeditionary Medical Encounter Database who completed (1) a Post-Deployment Health Assessment (PDHA) within 1 year following combat injury in Iraq or Afghanistan, and (2) a survey for the Wounded Warrior Recovery Project (WWRP), a longitudinal study tracking patient-reported outcomes (e.g., QoL) in injured military personnel. Fifteen self-reported symptoms from the PDHA were assessed using latent class analysis to develop symptom profiles. Multivariable linear regression assessed the predictive effect of symptom profiles on QoL using the physical (PCS) and mental (MCS) component summary scores from the 36-Item Short Form Survey included in the WWRP. Time between PDHA and WWRP survey ranged from 4.3 to 10.5 years (M = 6.6, SD = 1.3). Results: Five distinct symptom profiles were identified: low morbidity (50.4%), multimorbidity (15.6%), musculoskeletal (14.0%), psycho-cognitive (11.1%), and auditory (8.9%). Relative to low morbidity, the multimorbidity (β = − 5.45, p < 0.001) and musculoskeletal (β = − 4.23, p < 0.001) profiles were associated with lower PCS, while the multimorbidity (β = − 4.25, p = 0.002) and psycho-cognitive (β = − 3.02, p = 0.042) profiles were associated with lower MCS. Conclusion: Multimorbidity, musculoskeletal, and psycho-cognitive symptom profiles were the strongest predictors of lower QoL. These profiles can be employed during screening to identify at-risk service members and assist with long-term clinical planning, while factoring in patient-specific impairments and preferences. [ABSTRACT FROM AUTHOR]

ObjectivesWe investigated associations between full Electronic Medical Record (EMR) system adoption and drug use in healthcare organizations (HCOs) to explore whether EMR system features such as electronic prescribing, medicines reconciliation, and decision support, might be related to drug use by using the relevant nation-wide data.MethodsThe study design was cross-sectional. Survey data of the level of adoption of EMR systems were collected for the Organization for Economic Co-operation and Development benchmarking information and communication technologies (ICT) study between November 2013 and January 2014, in Korea. Survey respondents were hospital chief information officers and medical practitioners in primary care clinics. From the national health insurance administrative dataset, two outcomes, the rate of antibiotic prescription and polypharmacy with ≥6 drugs, were extracted.ResultsWe found that full EMR adoption showed a 16.1% lower antibiotic drug prescription than partial adoption including paper-based medical charts in the hospital only (p = 0.041). Between EMR adoption status and polypharmacy prescription, only those clinics which fully adopted EMR showed significant associations with higher polypharmacy prescriptions (36.9%, p = 0.001).ConclusionsThe findings suggested that there might be some confounding effects present and sophisticated ICT may provide some benefits to the quality of care even with some mixed results. Although a negative relationship between full EMR system adoption and antibiotic drug use was only significant in hospitals, EMR system functions searching drugs or listing specific patients might facilitate antibiotic drug use reduction. Positive relationships between full EMR system adoption and polypharmacy rate in general hospitals and clinics, but not hospitals, require further research.

Information Systems play a relevant role for primary health care in policy orientation and attention of users needs; therefore, criteria and mechanisms are required to establish whether in a specific strategy implementation, they provide adequate support. In this paper, a characterization of Information Systems that support primary health care, based on the model of community-oriented primary care is presented. A set of essential characteristics that the Information Systems should offer to support the primary health care was identified, with which it is possible to establish the aspects that require intervention to improve their support for strategy implementation . On the basis of the obtained characterization, the development of a methodology which will allow a more formalized evaluation is under construction.

RESUMO Objetivou-se analisar a produção científica sobre a aplicação dos Estudos de Avaliabilidade na área da saúde. Trata-se de uma revisão integrativa da literatura realizada de setembro a outubro de 2017, com busca de pesquisas avaliativas com aplicação de um Estudo de Avaliabilidade, na Biblioteca Virtual em Saúde, Scopus e Web of Science. Analisaram-se 21 artigos, 57,1% publicados nos últimos cinco anos. Os resultados demonstram que há incorporação de aspectos importantes da teoria dos Estudos de Avaliabilidade nos estudos, tais como modelo teórico norteador, uso das etapas próprias de um Estudo de Avaliabilidade, realização da modelagem do programa e associação de fontes de evidências. Conclui-se que o uso do Estudo de Avaliabilidade vem aumentando na área da saúde, entretanto, há necessidade de melhorar sua qualidade, especialmente quanto ao objetivo e questão de pesquisa, descrição do envolvimento dos autores e autorização do local de pesquisa, envolvimento dos stakeholders, descrição dos procedimentos de análise dos dados, estratégias para garantir validade e confiabilidade dos dados, e contribuição para aumento do conhecimento acadêmico, explicitando as contribuições potenciais do Estudo de Avaliabilidade e da avaliação em saúde.

Abstract The Digital Imaging Adoption Model (DIAM), a joint project established in 2016 by the European Society of Radiology (ESR) and the Healthcare Information and Management Systems Society (HIMSS), is designed to assist imaging institutions in implementing increasingly integrated IT systems and improving patient care. The model provides a framework through which existing capacities can be assessed and strategy for future institutional development elaborated. DIAM has already been adopted by 58 leading institutions in 18 countries. This article will first provide an overview of the DIAM framework; subsequently, it will consider what its adoption has revealed so far, both through the analysis of global data and through specific case studies; finally, it will outline the future potential and goals of the project.

Background: In-hospital mortality and short-term mortality are indicators that are commonly used to evaluate the outcome of emergency department (ED) treatment. Although several scoring systems and machine learning-based approaches have been suggested to grade the severity of the condition of ED patients, methods for comparing severity-adjusted mortality in general ED patients between different systems have yet to be developed. The aim of the present study was to develop a scoring system to predict mortality in ED patients using data collected at the initial evaluation and to validate the usefulness of the scoring system for comparing severity-adjusted mortality between institutions with different severity distributions.Methods: The study was based on the registry of the National Emergency Department Information System, which is maintained by the National Emergency Medical Center of the Republic of Korea. Data from 2016 were used to construct the prediction model, and data from 2017 were used for validation. Logistic regression was used to build the mortality prediction model. Receiver operating characteristic curves were used to evaluate the performance of the prediction model. We calculated the standardized W statistic and its 95% confidence intervals using the newly developed mortality prediction model.Results: The area under the receiver operating characteristic curve of the developed scoring system for the prediction of mortality was 0.883 (95% confidence interval [CI]: 0.882-0.884). The Ws score calculated from the 2016 dataset was 0.000 (95% CI: - 0.021 - 0.021). The Ws score calculated from the 2017 dataset was 0.049 (95% CI: 0.030-0.069).Conclusions: The scoring system developed in the present study utilizing the parameters gathered in initial ED evaluations has acceptable performance for the prediction of in-hospital mortality. Standardized W statistics based on this scoring system can be used to compare the performance of an ED with the reference data or with the performance of other institutions. [ABSTRACT FROM AUTHOR]

Background: Injury is a major cause of death and disability in Ethiopia. ALERT Hospital, one of only three designated trauma centers in the country, has employed a basic trauma registry since its inception in 2016; however, these data had not been used. In joint efforts with the Federal Ministry of Health, we aimed to understand patient injury characteristics and predictors of mortality, to inform priorities in resource and training investments., Methods: Data from 12 816 consecutive patients in the first 3 years of the trauma registry were reviewed retrospectively. Modified Early Warning Score was used at triage to indicate injury severity (red=critically injured, green=minor injury). No physiologic data for calculating Injury Severity Scores or in-hospital intervention data were available. Triage groups were compared and multivariate logistic regression conducted to determine predictors of in-emergency department (ED) mortality., Results: Most patients presented with minor injuries with 64.7% triaged as 'yellow' and 16.4% triaged as 'green', and most (75.9%) referred from another facility. Of those who were critically injured, only 31.0% arrived by ambulance. Most injuries were soft tissue (51.1%) and fractures (23.0%); when stratified by triage category, most critical ('red') patients had sustained head injuries (52.7%). Arrival by ambulance (OR 2.20, p=0.017) and head injury (OR 3.11, p<0.001) were independent predictors of death in the ED., Conclusion: This study of injured patients presenting to an Ethiopian trauma center is one of the largest to date, highlighting the need for more accessible and streamlined prehospital trauma care. Opportunities for improvement include staff training in initial trauma management and implementation of a more comprehensive trauma registry containing physiologic, intervention, and outcomes data to support a robust quality improvement program. Efforts by the Federal Ministry of Health are ongoing to support these improvements in care., Level of Evidence: Level 3, observational study., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

ABSTRACT Objective: to describe the stages of construction and content validation of an instrument to assess Primary Health Care Planning workshops. Methods: this methodological study focused on validating the instrument’s content. The instrument developed was assessed by a committee of experts using the Delphi Technique, in two rounds. For the degree of agreement, percentage agreement and Content Validity Index (CVI) were used. Results: in the first round, six experts participated, and the degree of agreement was 87% for clarity and 94% for representativeness. In the second round, five experts participated, the CVI was 0.95 for clarity, 0.97 for representativeness and 0.96 total CVI. The final instrument had 42 items divided into three chunks. Conclusion: the instrument has content validity to assess Primary Health Care Planning workshops, being a tool for the use of state and municipal administrations.

To establish and validate risk models of mortality and morbidity associated with 12 major pediatric surgical procedures using the National Clinical Database-Pediatric (NCD-P) data. We used the NCD-P data for the development and validation datasets. By using multivariate logistic regression to analyze the development dataset, we created a prediction model for 30-day mortality and morbidity in 12 major pediatric surgical procedures, including tracheoplasty, pneumonectomy, fundoplication, total/subtotal excision of malignant tumor, and surgeries for Hirschsprung disease, anorectal malformation, biliary atresia, choledocal cyst, midgut volvulus, funnel chest, gastrointestinal perforation, and intestinal obstruction. We selected variables that were almost identical to those used in the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P). The primary outcomes were 30-day mortality and composite morbidity. We assessed the obtained models using the C-indices of the development and validation datasets. Overall, 10 and 21 variables were identified for mortality and morbidity, respectively. C-indices of mortality were 0.940 and 0.924 in the development and validation datasets, respectively. C-indices of morbidity were 0.832 and 0.830 in the development and validation datasets, respectively. Based on the NCD-P data, we developed satisfactory risk models for mortality and morbidity prediction in major pediatric surgeries. Level I (Prognosis Study). [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quality of nursing care in a population of patients with hemodialysis treatment in the city of Bogotá. Materials and Methods: A cross-sectional descriptive study was carried out, through the application of the Colombian adaptation of the Care-Q instrument that relates attitudes and nursing care activities that were evaluated by the patient through a Likert scale. The universe consisted of all the patients on hemodialysis who belong to a support group of chronic patients, reaching a limit of 100 patients summoned to whom the instrument was applied. Results: It was determined that between 60% and 85% of the population evaluated in a positive way the care provided by the nursing staff. Conclusions: A considerable percentage of satisfaction was found within the participating population, which is contrasted with what is evidenced in the literature where it is stated that the nurse is the most suitable professional for the care of this type of patients. It made evident the need to generate research aimed at the continuous evaluation of nursing care, because it facilitates the creation of actions for improvement in the management of care and allows working for the fulfi llment of quality in health care.

Abstract Background Access to health services is in part defined by the spatial distribution of healthcare equipment. To ensure equity in the provision of health services, it is important to examine availability across different health care providers taking into account population demand. Given the importance of the equitable provision of health equipment, we evaluate its spatial distribution in Brazil. Methods This study is classified as cross-sectional with an ecological design. We evaluate Brazilian data on distance to available health equipment considering: dialysis machines (385), magnetic resonance imaging (MRI) (257), hospital beds (3675) and bone densitometers (429). We define two distance thresholds (50 km and 200 km) from a municipality to the center of services provision. The balance between infrastructure capacity and potential demand was evaluated to identify a lack or surplus of health services. Results The distribution of dialysis equipment and bone densitometers is not balanced across Brazilian states, and unmet demand is high. With respect to MRIs, the large capacity of this equipment results in a large excess of supply. However, this characteristic alone cannot account for excesses of supply of over 700%, as is the case of the Federal District when the range is limited to 50 km. At the same time, four states in the Northeastern region of Brazil show a net excess of demand. Some regions do not meet the standard amount of supply defined by Brazilian Ministry of Health. The quantity and distribution of hospital beds are not sufficient to provide full coverage to the population. Conclusion Our main focus was to evaluate the network of the provision of health equipment in Brazil, considering both private and public sectors conjointly. We take into account two main aspects of a spatially balanced health system: the regional availability of health equipment and the geographic distance between its demand and supply at the municipality level. Some regions do not meet the minimum requirement defined by the Brazilian Ministry of Health regarding the supply of health services.

The evaluation of nutrition programs and policies has traditionally focused on analysing the impact and biological outcomes of their actions. Objective: To examine whether evaluations of nutrition programs include the following sociopolitical categories: (a) the right to food; (b) citizenship building; (c) civil participation in public policies; (d) women’s empowerment; and (e) territoriality in policy planning. Methodology: A comprehensive literature review of articles and documents that evaluate food and nutrition programs carried out in different Latin American countries and published during 2005-2013. Results: It was found that the evaluations carried out generally do not use these categories. In the cases where they are used, the conceptual development applied to the evaluation process is still incipient. Discussion: This study analyzed the sociopolitical categories of: the right to food; citizenship building; civil participation in public policies; women’s empowerment; and territoriality in policy planning, and found that although these categories are not prioritised when nutritional programs in Latin America are assessed, in most cases they form the basis of these programs. Conclusion: Social protection nutrition programs demand new objectives and actions. It is necessary to apply evaluation criteria that account for these new underpinnings in order to establish consistency between government institutions’ discourse, and the reality of their efforts.

The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics. It will enable large-scale evaluations of maternal and perinatal outcomes under different models of care independently of the model's name. To assess the accuracy, repeatability and reproducibility of the Maternity Care Classification System. All 70 public maternity services in New South Wales, Australia, were invited to classify three randomly allocated model case-studies using a web-based survey tool and repeat their classifications 4–6 weeks later. Accuracy of classifications was assessed against the correct values for the case-studies; repeatability (intra-rater reliability) was analysed by percent agreement and McNemar's test between the same participants in both surveys; and reproducibility (inter-rater reliability) was assessed by percent agreement amongst raters of the same case-study combined with Krippendorff's alpha coefficient for a subset of characteristics. The accuracy of the Maternity Care Classification System was high with 90.8% of responses correctly classified; was repeatable, with no statistically significant change in the responses between the two survey instances (mean agreement 91.5%, p > 0.05 for all but one variable); and was reproducible with a mean percent agreement across 9 characteristics of 83.6% and moderate to substantial agreement as assessed by a Krippendorff's alpha coefficient of 0.4–0.8. The results indicate the Maternity Care Classification System is a valid system for classifying models of care in Australia, and will enable the legitimate evaluation of outcomes by different models of care. [ABSTRACT FROM AUTHOR]

The Digital Imaging Adoption Model (DIAM), a joint project established in 2016 by the European Society of Radiology (ESR) and the Healthcare Information and Management Systems Society (HIMSS), is designed to assist imaging institutions in implementing increasingly integrated IT systems and improving patient care. The model provides a framework through which existing capacities can be assessed and strategy for future institutional development elaborated. DIAM has already been adopted by 58 leading institutions in 18 countries. This article will first provide an overview of the DIAM framework; subsequently, it will consider what its adoption has revealed so far, both through the analysis of global data and through specific case studies; finally, it will outline the future potential and goals of the project. [ABSTRACT FROM AUTHOR]

Foundation: organizational climate has been studied since the XX century and its first research started in the corporate area. These results transcended to other fields as the health sector where contextualization has been developed according to its ethical characteristics. Objectives: to redesign an instrument for evaluating nursing organizational climate in hospitals. Methods: development research realized at the University Pediatric Hospital Paquito González Cueto Cienfuegos from January to May 2017 for which a documentary review was done about the instruments: questionnaires of Litwin y Stringer, questionnaires of organizational diagnosis, Model of Meyer and Allen, Wes questionnaire, organizational climate inventory, descriptive questionnaire of organizational climate of Halpin y Crofts, organizational health inventory of Hoy y Feldmany. For the coherence of the characteristics of the health sector and the experiences with the application of this instrument in it, it was decided to take The inventory of Organizational Climate adapted by Vivian Noriega. Once designed the instrument it was submitted to expert valuation. Results: most experts assessed the relation between the instrument and the objectives for its design as favorable, and comprehensible the different items and their contextualization. Conclusion: the proposal presented may constitute a mechanism for periodical measurement and be part of the structural capital of hospital institutions. Its application may improve the assistance to patients on the basis of a favorable organizational climate. [ABSTRACT FROM AUTHOR]

Abstract Objective To develop and test face and content validity, and user interface design of a rehabilitative care patient experience measure. Design Mixed methods, cross-sectional validation study that included subject matter expert input. Cognitive interviewing tested user interface and design. Setting Outpatient rehabilitative care settings. Participants Subject matter experts (n=3), health care providers (n=137), and patients and caregivers (n=5) contributed to the question development. Convenience and snowball sampling were used to recruit rehabilitative care patients postdischarge (n=9) for cognitive interviews to optimize survey design and user interface (N=154). Interventions Not applicable. Main Outcome Measure This novel survey instrument measures 6 concepts previously identified as key to outpatient rehabilitative care patients' experience: ecosystem issues, client and informal caregiver engagement, patient and health care provider relations, pain and functional status, group and individual identity, and open-ended feedback. Results 502 survey questions from psychometrically tested instruments, secondary data from a related ethnographic study, and consultations with health care providers, patients, caregivers, and subject matter experts, were analyzed to create a 10-item questionnaire representing 6 key constructs that influence patient experience quality. Cognitive interviewing with 9 patients (3 rounds of 3 participants each), produced 3 progressively edited versions of the survey instrument. A final version required no further modifications. Discussion Rehabilitative care clients have characteristics that differentiate their experience from that of other sectors and patient groups, warranting a distinct experience measure. The survey instrument includes a parsimonious set of questions that address strategic issues in the ongoing improvement of care delivery and the patient experience in the rehabilitative care sector. Conclusion The rehabilitative care patient experience survey instrument developed has an acceptable user interface, and content and face validity. Psychometric testing of the survey instrument is reported elsewhere. Highlights • We developed the WatLX patient experience measure for the rehabilitative care sector. • The measurement tool includes a parsimonious set of 10 patient experience questions that underwent face and content validation through expert consultations and a card sort activity, and usability testing through cognitive interviews. • The WatLX takes patients approximately 10 minutes to complete, which may contribute to higher completion rates. • Psychometric and feasibility testing is reported elsewhere. Future development includes releasing multi-lingual formats, developing a version for clients with cognitive deficits, and exploring administration via web-based and smartphone applications. [ABSTRACT FROM AUTHOR]

Large financial resources are needed to treat fractures. Surprisingly little is, however, known about actual numbers, treatment methods or outcomes. A large population-based observational study can add valuable knowledge, especially if patient-reported results are included. There is no previous national fracture register with prospectively collected data on fractures of all types, treated surgically as well as non-surgically. With the implementation of the Swedish Fracture Register (SFR), we have shown that this is possible. More than 285,000 fractures have been registered. The database is increasing at a rate of 70,000 fractures a year, i. e. one fracture every 7 min. The aim of this article is to describe the first seven years in the history of the SFR, with opportunities for the future as well as limitations. [ABSTRACT FROM AUTHOR]

Patients with cardiac diseases can achieve the greatest benefit from cardiac rehabilitation through modification of their unhealthy behaviors. This study aimed to develop and examine the psychometric properties of the Cardiac Rehabilitation Adherence Tool (CRAT), which was designed to assess patients’ adherence to cardiac rehabilitation. In this instrument development study, the items of the CRAT were extracted through a comprehensive literature review. The CRAT was assessed in terms of validity and reliability. Exploratory factor analysis was conducted to assess its construct validity, which led to the development of a tool containing 57 items and five dimensions including “acceptance of the rehabilitation center”, “being interested in health”, “feeling a need”, “personal control over the situation”, and “encouragement and advice.” These five factors accounted for 45.23% of the observed variance. The Cronbach’s alpha was 0.935. The test-retest method supported the stability of the instrument (r = 0.95). Health care professionals can use the CRAT to examine factors influencing the patient’s decision to leave cardiac rehabilitation and design strategies for improving their adherence to the rehabilitation program.