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Background: The consolidation of acute care surgery (ACS) services at 3 of 6 hospitals in a Canadian health region sought to alleviate a relative shortage of surgeons able to take emergency call. We examined how this affected patient access and outcomes. Methods: Using the generalized linear model and statistical process control, we analyzed ACS-related episodes that occurred between 39 months prior to and 17 months after the model's implementation (n = 14 713). Results: Time to surgery increased after the consolidation. Wait times increased primarily for patients presenting at nonreferral hospitals who were likely to require transfer to a referral hospital. Although ACS teams enabled referral hospitals to handle a much higher volume of patients without increasing within-hospital wait times, overall system wait times were lengthened by the growing frequency of patient transfers. Wait times for inpatient admission were difficult to interpret because there was a trend toward admitting patients directly to the ACS service, bypassing the emergency department (ED). For patients who did go through the ED, wait times for inpatient admission increased after the consolidation; however, this trend was cancelled out by the apparently zero waits of patients who bypassed the ED. Regionalization showed no impact on length of stay, readmissions, mortality or complications. Conclusion: Consolidation enabled the region to ensure adequate surgical coverage without harming patients. The need to transfer patients who presented at nonreferral hospitals led to longer waits. Contexte : Le regroupement des services chirurgicaux d'urgence (SCU) dans 3 hopitaux sur 6 d'une region sanitaire canadienne visait a contrer une relative penurie de chirurgiens capables d'effectuer les interventions d'urgence. Nous en avons analyse l'impact sur l'accessibilite des services et sur les resultats chez les patients. Methodes : A l'aide du modele lineaire generalise et d'un controle statistique des procedes, nous avons analyse les cas adresses aux SCU entre 39 mois precedant et 17 mois suivant l'entree en vigueur du regroupement des services (n = 14 713). Resultats : L'intervalle avant l'intervention chirurgicale s'est allonge apres le regroupement des services. Les temps d'attente ont principalement augmente pour les patients qui consultaient dans un hopital de premier recours d'oU ils etaient susceptibles d'etre reorientes vers un hopital de reference. Meme si les equipes des SCU ont permis aux hopitaux de reference de gerer un volume beaucoup plus important de patients sans augmentation du temps d'attente a l'hopital meme, le temps d'attente dans son ensemble s'est prolonge a l'echelle du systeme en raison de l'accroissement du nombre de transferts. Les temps d'attente pour les hospitalisations ont ete difficiles a interpreter parce qu'on avait tendance a admettre les patients directement aux SCU, en contournant les services d'urgences. Pour les patients qui passaient par les urgences, les temps d'attente pour une hospitalisation ont augmente apres le regroupement; toutefois, cette tendance a ete compensee par l'attente pour ainsi dire nulle des patients qui contournaient les services d'urgence. La regionalisation n'a exerce aucun impact sur la duree du sejour, les readmissions, la mortalite ou les complications. Conclusion : Le regroupement a permis a la region d'assurer une couverture chirurgicale adequate sans nuire aux patients. La necessite de reorienter des patients vers les hopitaux de reference a contribue a prolonger les temps d'attente., Access to emergency or urgent surgery has become a serious concern across North America and beyond. (1,2) With the evolution of surgical subspecialties there has been a relative decline in [...]

A retrospective study is conducted in many hospitals to improve patient safety. The studies have shown that harms remain common, with little evidence of widespread improvement, but further efforts are required to translate effective safety interventions into routine practice and to monitor health care safety over time.

The existing Users' Guides addressing the effects of interventions, including therapy, harm, clinical decision support systems, and summarizing the evidence guides, are complemented and enhanced by emphasizing on issues specific to quality improvement (QI) studies. The analysis has shown that robust study methods are required in QI research, given the potential for the widespread implementation of QI interventions.

Objectives. We sought to examine the utilization and impact of enabling services, such as interpretation and eligibility assistance, among underserved Asian American, Native Hawaiian, and other Pacific Islander (AANHOPI) patients served at 4 community health centers. Methods. For this project, we developed a uniform model for collecting data on enabling services and implemented it across 4 health centers that served primarily AANHOPI patients. We also examined differences in patient characteristics between users and nonusers of enabling services. Results. Health center patients used many enabling services, with eligibility assistance being the most used service. In addition, compared with nonusers, users of enabling services were more likely to be older, female, AANHOPI, and uninsured (P Conclusions. For underserved AANHOPI patients at community health centers, enabling services are critical for access to appropriate care. We were the first to examine uniform data on enabling services across multiple health centers serving underserved AANHOPI patients. More data on enabling services and evaluation are needed to develop interventions to improve the quality of care for underserved AANHOPI patients. (Am J Public Health. 2010;100:2199-2205. doi: 10.2105/AJPH.2009.172270)

A study was conducted to evaluate the association if any, between patient panel characteristics and primary care physician clinical performance rankings. Results indicated that patient panels with greater underinsured, minority and non-English speaking patients had lower physician quality rankings.

Purpose: Guided Care (GC) is a model of health care for multimorbid older adults that is provided by a registered nurse who works with the patients' primary care physician (PCP). The purpose of this study was to determine whether GC improves patients' primary caregivers' depressive symptoms, strain, productivity, and perceptions of the quality of care recipients' chronic illness care. Design and Methods: A cluster-randomized controlled trial of GC was conducted within 14 PCP teams. The study sample included 196 primary caregivers who completed baseline and 18-month surveys and whose care recipients remained alive and enrolled in the GC study for 18 months. Caregiver outcomes included the following: depressive symptoms (Center for Epidemiological Studies-Depression scale), strain (Modified Caregiver Strain Index), the quality of care recipients' chronic illness care [Patient Assessment of Chronic Illness Care (PACIC)], and personal productivity (Work Productivity and Activity Impairment questionnaire, adapted for caregiving). Results: In multivariate regression models, between-group differences in depression, strain, work productivity, and regular activity productivity were not statistically significant after 18 months, but GC caregivers reported the overall quality of their recipients' chronic illness care to be significantly higher (adjusted beta = 0.40, 95% confidence interval : 0.14-0.67). Quality was significantly higher in 4 of 5 PACIC subscales, reflecting the dimensions of goal setting, coordination of care, decision support, and patient activation. Implications: GC improved the quality of chronic illness care received by multimorbid care recipients but did not improve caregivers' depressive symptoms, affect, or productivity. Key Words: Caregiving, Chronic disease, Nursing, Primary care, Guided Care doi: 10.1093/geront/gnp124

Purpose: In this commentary, we examine nursing home quality and indicators that have been used to measure nursing home quality. Design and Methods: A brief review of the history of nursing home quality is presented that provides some context and insight into currently used quality indicators. Donabedian's structure, process, and outcome (SPO) model is used to frame the discussion. Current quality indicators and quality initiatives ate discussed, including those included in the Facility Quality Indicator Profile Report, Nursing Home Compare, deficiency citations included as part of Medicare/Medicaid certification, and the Advancing Excellence Campaign. Results: Current quality indicators are presented as a mix of structural, process, and outcome measures, each of which has noted advantages and disadvantages. We speculate on steps that need to be taken in the future to address and potentially improve the quality of care provided by nursing homes, including report cards, pay for performance, market-based incentives, and policy developments in the certification process. Areas for future research are identified throughout the review. Implications: We conclude that improvements in nursing home quality have likely occurred, but improvements are still needed. Key Words: Quality of care, Nursing homes, Longterm Care doi: 10.1093/geront/gnq052

Quality assessment in dental care is in a relatively primitive state. The limitations of dentistry's quality assessment methods and the reasons behind the limitations are discussed along with suggestions on how to improve quality assessment in dentistry.

Objective To study trends in the quality of the healthcare provided to children aged less than 5 years in Afghanistan between 2004 and 2006. In particular, to determine the effect on such quality of a basic package of health services (BPHS), including Integrated Management of Childhood Illness (IMCI), introduced in 2003. Methods In each year of the study, 500-600 health facilities providing the BPHS were selected by stratified random sampling in 29 provinces of Afghanistan. We observed consultations for children aged less than 5 years, interviewed their caretakers, interviewed health-care providers and measured adherence to case management standards for assessment and counselling in a random sample. Findings The quality of the assessment and counselling provided to sick children aged less than 5 years improved significantly between 2004 and 2006. A 43.4% increase in the assessment index and a 28.7% increase in the counselling index (P< 0.001) were noted. Assessment quality improved significantly every year and was statistically associated with certain characteristics of the provider (being a doctor, having a higher knowledge score, being trained in IMCI, being part of a "contracting-in" mechanism and providing a longer consultation time) and the child (being younger and having a female caretaker). Counselling quality was also significantly associated with these characteristics, except for provider cadre and child age. The presence of clinical guidelines and the frequency of supervision were significantly associated with improved quality scores in 2006 (P < 0.05 and< 0.01, respectively). Conclusion Quality of care improved over the study period, but performance remained suboptimal in some areas. Continued investments in Afghanistan&apos;s health system capacity are needed. Objectif Etudier les tendances de la qualite des soins de sante delivres aux enfants de moins de 5 ans en Afghanistan entre 2004 et 2006. Determiner en particulier les offets sur cette qualite d&apos;un ensemble de services de sante essentiels (BPHS), incluant ia Prise en charge integree des maladies de l&apos;enfant (PCIME), introduite en 2003. Methodes Pour chaque annee d&apos;etude, 500 a 600 etablissements de soins delivrant le BPHS ont ete seiectionnes par sondage aleatoire stratifie dans 29 provinces d&apos;Afghanistan. Nous avons observe ies consultations dont ont benoficie les enfants de moins de 5 ans, interroge les personnes s&apos;occupant de ces enfants et les prestateurs de soins et mesure sur un echantillon aleatoire l&apos;observance des normes de prise en charge des cas pour ce qui concerne l&apos;evaluation et les conseils. Resultats La qualite de l&apos;evaluation et des conseils delivres aux enfants maiades de moins de 5 ans s&apos;est amelioree significativement entre 2004 et 2006. On a ainsi note une augmentation de 43,4 % de l&apos;indice d&apos;evaluation de l&apos;evaluation medicale et de 28,7 % de l&apos;indice d&apos;evaluation des conseils (p < 0,001). La qualite de l&apos;evaluation a progresse significativement chaque annee et etait statistiquement associee a certaines caracteristiques du prestateur (etre medecin, obtenir un score de connaissances plus eleve, etre formee a la PCIME, travailler sous contrat pour le gouvernement et assurer une consultation plus longue) et de l&apos;enfant (jeune age et prise en charge par une femme dans la vie courante). La qualite des conseils presentait egalement une association statistique avec ces caracteristiques, excepte le niveau de qualification du prestateur et l&apos;age de l&apos;enfant. L&apos;existence de directives cliniques et la frequence de la supervision etaient significativement associees a une amelioration des scores de qualite en 2006 (p < 0,05 et p < 0,01, respectivement). Conclusion La qualite des soins s&apos;est amelioree sur la periode etudiee, mais les performances sont restees sous-optimales dans certaines zones. Il faut continuer a investir dans le renforcement des capacites du systeme de sante afghan. Objetivo Estudiar las tendencias de la calidad de la atencion sanitaria proporcionada a los menores de cinco anos en Afganistan entre 2004 y 2006. En particular, determinar el ofecto de la calidad de un paquete basico de servicios de salud (PBSS) que incluia la atencion Integrada a las Enfermedades Prevalentes de la Infancia (AIEPI), introducida en 2003. Metodos Mediante muestreo aleatorio estratificado, cada ano dei estudio se seleccionaron 500-600 centros de salud que empleaban el PBSS en 29 provincias de Afganistan. Observamos las consultas de atencion a menores de cinco anos, entrevistamos a sus cuidadores y a los profesionales que los atendieron, y medimos su cumplimiento de las normas de manejo de casos para evaluacion y asesoramiento en una muestra aleatoria. Resultados La calidad de la evaluacion y de los consejos proporcionados para los ninos enfermos de menos de 5 anos de edad mejoro significativamente entre 2004 y 2006. Se observo un aumento del 43,4% del indice de evaluacion y un aumento dei 28,7% del indice de asesoramiento (p < 0,001). La calidad de la evaluacion mejoro considerablemente cada ano y demostro estar relacionada de forma significativa con determinadas caracteristicas del proveedor (condicion de medico, mayor puntuacion de sus conocimientos, capacitacion en la AIEPI, participacion en un mecanismo de contratacion de la Administracion, y mayor duracion de la consulta) y dei nino (una menor edad, y el hecho de tener a una mujer como cuidadora). Se observo que la calidad del asesoramiento tambien estaba asociada significativamente a esos factores, exceptuando la profesion del trabajador sanitario y la edad dei nino. La existencia de directrices clinicas y la frecuencia de la supervision se asociaron significativamente a mejores puntuaciones de la calidad en 2006 (p < 0,05 y p < 0,01, respectivamente). Conclusion La calidad de la atencion mejoro a lo largo del periodo de estudio, pero el desempeno seguia siendo suboptimo en algunas zonas. Es preciso seguir invirtiendo de forma continuada en la capacidad del sistema de salud de Afganistan., Une traduction en francais de ce resume figure a la fin de l'article. Al final del articulo se facilita una traduccion al espanol. Introduction Afghanistan has some of the poorest [...]

The article puts forth the reasons for changes to be made in the health care system being followed in the U.S. to achieve universal coverage and subsequently lower costs. A plan should be formulated that will be able to address rising costs due to an aging population besides giving better value for money.

This study assesses the administrative data compiled on residential care facilities for the elderly (RCFEs) by the state of California and considers the feasibility of their adaptation into a comprehensive information system. Required state RCFE reporting forms were reviewed for potential data elements. Recording and reporting variation was evaluated using a stratified probability sample of 340 facilities licensed in Northern and Central California. Stratification was by facility size and state district office. Data collection included a 5-year retrospective review of forms and documents in each facility's public file. Little of the information required from RCFEs is computerized. Most of it is maintained at the individual facility and not included in public files. Basic information, while included in the public file, is commonly either not available or not current. Resident characteristics and outcomes are not compiled, except indirectly in citations. The information required from RCFEs, if appropriately compiled and maintained, would produce a comprehensive quality assurance system and more effectively support consumer information and policy needs. KEYWORDS quality of care, quality assurance, residential care, long-term care, assisted living

The article discusses how effective primary care can result in a number of benefits like improving the quality of health outcomes and care as well as save costs, however, this only be done if there are enough primary care physicians present for it. The different steps that could be undertaken to reduce the adult primary care shortages are highlighted.

Kathleen Barry, MD, couldn't believe what she saw on an evaluation of one of her physicians. "The young woman took a cell phone call in the exam room with the [...]

The article discusses the current trend in which patients are considered by medical practitioners as icons, or "iPatients" on the electronic medical record (EMR). It is suggested that residents should be trained for conducting bedside examinations of patients for accurate diagnosis and to gain their trust.