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BACKGROUND AND AIM: Pervasive disparities characterize sickle cell disease (SCD) care, including limited access to SCD specialists. Rapid deployment of remote healthcare provision and support during the COVID-19 pandemic provides an opportunity to understand telehealth barriers/facilitators for SCD. We aimed to evaluate telehealth experiences and satisfaction for routine visits among adults and caregivers of children with SCD within a US regional collaborative. METHODS: 151 adults ≥ 18 [median (IQR) = 36 (28, 43) years], and 94 caregivers [median child age (IQR) = 12 (7, 14) years] completed a 30-item online survey in 2021 assessing systems issues such as reliable Internet; health information sharing; and consumer focus (e.g., visit started on time). A multivariable logistic regression model was used to evaluate relations between independent variables and the outcome overall satisfaction with telehealth. RESULTS: Patients were primarily diagnosed with sickle cell anemia (60.8%) and prescribed hydroxyurea (57.6%). Satisfaction with telehealth was high (> 90%), but 60.6% of caregivers gave the highest rating compared with 44.9% of adults (p = 0.02). Few accessibility/technical issues were cited, however, caregivers reported more often having home support for telehealth (80.9% vs. 63.6%, p = 0.003). In multivariable analyses, participants seen in large centers (> 200) were more likely to give the highest satisfaction ratings compared with those in smaller centers (

BACKGROUND: The Get With The Guidelines-Stroke program is a quality improvement initiative designed to enhance adherence to evidence-based stroke care. Since its inception in 2003, over 2800 hospitals in the United States have participated in the program. METHODS: We examined patient characteristics, adherence to performance measures, and in-hospital outcomes in patients hospitalized for acute ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and transient ischemic attack in The Get With The Guidelines-Stroke hospitals from 2003 through 2022. We quantified temporal changes in performance measure adherence and clinical outcomes over time. Performance measure denominators consisted of patients who were eligible, excluding those with contraindications. RESULTS: Over the 20 years of the program, a total of 7837 849 stroke cases (median age 71 years, 51.0% female; 69.2% ischemic strokes, 3.9% SAHs, 11.5% ICHs, and 15.3% TIAs) were entered into the registry. Except for antithrombotics at discharge, in which the baseline performance was >92%, there was sustained improvement in all performance metrics regardless of type of cerebrovascular event (P

BACKGROUND: Recent randomized trials have suggested non-operative management to be a safe alternative to appendectomy for acute uncomplicated appendicitis. Yet, there remains significant variability in treatment approach. This study sought to characterize center-level variation in non-operative management within a national cohort of adults presenting with appendicitis. METHODS: The 2016-2020 Nationwide Readmissions Database was queried to identify all adult (≥18 years) hospitalizations for acute uncomplicated appendicitis. Hierarchical, mixed-effects models were developed to ascertain factors linked with non-operative management. Bayesian methodology was applied to predict random effects, which were then used to rank centers by increasing hospital-attributed rate of non-operative management. Institutions with high center-specific rates of non-operative management (>90th percentile) were considered low-operating hospitals (LOH). RESULTS: Of an estimated 447,500 patients, 52,523 (11.7 %) were managed non-operatively. Compared to those undergoing appendectomy, the non-operative cohort was older, more commonly male, and of a higher comorbidity burden. Approximately 30 % in the variability of non-operative management was attributable to hospital effects, with absolute, risk-adjusted rates ranging from 0.5 to 22.5 %. Centers with non-operative management rates ≥90th percentile were considered LOH.Following risk adjustment, among patients undergoing appendectomy, care at LOH was linked with greater odds of postoperative infection, resource utilization, and non-elective readmission. CONCLUSIONS: We identified significant interhospital variation in the utilization of non-operative management for acute uncomplicated appendicitis. Further, we found LOH to be associated with inferior outcomes following surgical management. Future work is needed to assess the care pathways that contribute to increased utilization of non-operative strategies, and disseminate best practices across institutions.

ObjectiveWe describe the experiences and preferences of women who switched from clinic-administered intramuscular depot medroxyprogesterone acetate (DMPA-IM) to self-administered subcutaneous DMPA (DMPA-SC) in the context of the COVID-19 pandemic.MethodsWe conducted interviews with women in California and Washington about their experiences with self-administered DMPA-SC. We interviewed women after their first or second self-administered DMPA-SC injection and conducted follow-up interviews after their third or fourth injection. We performed both thematic and descriptive content analyses.ResultsWe completed 29 interviews with 15 women. Most participants (n = 10) were between the ages of 20 and 39 and the majority (n = 12) used DMPA primarily for contraception. Most (n = 13) described self-administered DMPA-SC as "very easy" or "somewhat easy" to use and reported greater convenience, decreased pain, fewer logistical and financial challenges, increased privacy, and improved comfort with injection compared to DMPA-IM. Participants identified difficulties obtaining DMPA-SC from pharmacies and safe needle disposal as barriers. Most (n = 13) would recommend DMPA-SC to a friend and desired to continue self-administration beyond the COVID-19 pandemic. Participants recommended counseling all patients about this option alongside other contraceptive methods, and offering clinician supervision, if desired.ConclusionWomen who switched from in-clinic DMPA-IM to self-administered DMPA-SC during the COVID-19 pandemic preferred the latter and intended to continue self-administration. Self-administration of DMPA-SC should be routinely offered and easily accessible to patients.

ObjectiveDespite the many advancements made in patient safety over the past decade, combating diagnostic errors (DEs) remains a crucial, yet understudied initiative toward improvement. This study sought to understand the perception of dental patients who have experienced a dental diagnostic failure (DDF) and to identify patient-centered strategies to help reduce future occurrences of DDF.MethodsThrough social media recruitment, we conducted a screening survey, initial assessment, and 67 individual patient interviews to capture the effects of misdiagnosis, missed diagnosis, or delayed diagnosis on patient lives. Audio recordings of patient interviews were transcribed, and a hybrid thematic analysis approach was used to capture details about 4 main domains of interest: the patient's DDF experience, contributing factors, impact, and strategies to mitigate future occurrences.ResultsDental patients endured prolonged suffering, disease progression, unnecessary treatments, and the development of new symptoms as a result of experiencing DE. Poor provider communication, inadequate time with provider, and lack of patient self-advocacy and health literacy were among the top attributes patients believed contributed to the development of a DE. Patients suggested that improvements in provider chairside manners, more detailed patient diagnostic workups, and improving personal self-advocacy; along with enhanced reporting systems, could help mitigate future DE.ConclusionsThis study demonstrates the valuable insight the patient perspective provides in understanding DEs, therefore aiding the development of strategies to help reduce the occurrences of future DDF events. Given the challenges patients expressed, there is a significant need to create an accessible reporting system that fosters constructive clinician learning.

Patient experience is a key aspect of care quality. Since the 2007 release of the Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS) survey, no systematic review of factors associated with CG-CAHPS scores has been reported. We reviewed 52 peer-reviewed English language articles published in the United States using CG-CAHPS data. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and used the Checklist for Analytical Cross-Sectional Studies. We identified several interventions (eg, adding a care coordinator focused on chronic care management) associated with improved overall provider rating and 2 interventions (eg, peer shadow coaching) that improved provider communication scores. Studies evaluating the implementation of patient-centered medical homes or patient-reported outcomes found mixed results. We identified site-level factors (eg, better team communication) and provider-level factors (eg, physician empathy) associated with better patient experience. In contrast, patient-level factors (eg, medication adherence) found mixed associations with patient experience. Policymakers, clinicians, and healthcare leaders can leverage this evidence for quality improvement efforts and interventions supporting patient-centered care.

Hospital quality ratings are widely available to help Medicare beneficiaries make an informed choice about where to receive care. However, how beneficiaries trade-off between different quality domains (clinical outcomes, patient experience, safety, efficiency) and other considerations (out-of-pocket cost, travel distance) is not well understood. We sought to study how beneficiaries make trade-offs when choosing a hypothetical hospital. We administered an online survey that included a discrete choice experiment to a nationally representative sample of 1025 Medicare beneficiaries. On average, beneficiaries were willing to pay $1698 more for a hospital with a 1-star higher rating on clinical outcomes. This was over twice the value of the patient experience ($691) and safety ($615) domains and nearly 8 times the value of the efficiency domain ($218). We also found that the value of a 1-star improvement depends not only on the quality domain but also the baseline level of performance of the hospital. Generally, it is more valuable for low-performing hospitals to achieve average performance than for average hospitals to achieve excellence.

BACKGROUND: Disparities in diabetes care quality may have increased for patients with limited English language proficiency (LEP) compared to non-LEP patients during the COVID-19 pandemic. Changes in diabetes care quality for adult LEP and non-LEP patients of community health centers (CHCs) were examined from 2019 to 2020. METHODS: Adults with Type 2 diabetes (n = 15 965) of 88 CHC sites in California and with 1+ visit/year in 2019 and 2020 from OCHIN electronic health record data were included. Multivariable regression models estimated the association of LEP status and changes in diabetes care quality from 2019 to 2020, controlling for patient sociodemographic and clinical characteristics. Interaction terms (LEP × 2020) were used to estimate differential over time changes in (1) blood pressure screening, (2) blood pressure control (

Background: This study aims to describe the main type 2 diabetes mellitus (T2DM) quality improvement (QI) challenges identified by primary care teams in the province of Quebec who participated in the COMPAS + QI collaborative. Methods: A qualitative descriptive design was used to analyse the results of 8 COMPAS + workshops conducted in 4 regions of the province between 2016 and 2020. Deductive content analysis was performed to classify the reported QI priorities under the Consolidated Framework for Implementation Research domains; and proposed change strategies under the Behavior Change Wheel (BCW) intervention functions. Results: A total of 177 participants attended the T2DM COMPAS + workshops. Three QI priorities were identified: (1) lack of coordination and integration of T2DM care and services; (2) lack of preventive services for pre-diabetes and T2DM; and (3) lack of integration of the patients-as-partners approach to support T2DM self-management. The proposed QI strategies to address those priorities were classified under the education, training, persuasion, habilitation and restructuring BCW intervention functions. Conclusion: This study provides insights on how QI collaboratives can support the identification of QI priorities and strategies to improve T2DM management in primary care. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Quality maternity care is known to improve a range of maternal and neonatal outcomes. The Lancet Series on Midwifery's Quality Maternal and Newborn Care (QMNC) Framework is a high‐level synthesis of the global evidence on quality maternity care. Initial qualitative work demonstrated the Framework's adaptability in evaluating service user and provider perceptions of the quality of maternity care. However, evaluating services at scale requires a survey instrument. This paper reports the validation of the QMNC Framework index (QMNCFi), a five‐part survey for the evaluation of maternity care across diverse settings.International online English language survey of women who had given birth in the previous year in Australia, Ghana, India and the United Kingdom (UK). It was distributed through service user networks (UK and Australia) and at postnatal clinics (Ghana and India). All forms were completed online. Test–retest was conducted to assess reliability.Five hundred and forty mothers completed the survey (Australia 136; Ghana 131; India 153; UK 120). Construct validity: Cronbach's α in 12 of the survey's 13 sections ranged from 0.795 to 0.986; for the remaining section the alpha was 0.594. Reliability: 55 participants completed the QMNCFi a second time. Intraclass correlation coefficient results ranged from 0.657 to 0.939 across the 13 sections. Field researchers in Ghana and India reported that the survey was easily understood and completed.This survey has shown that, across diverse contexts, the QMNCFi is a valid, reliable, and comprehensive tool for measuring service user perceptions of the quality of care over time. [ABSTRACT FROM AUTHOR]

Background: Birth asphyxia remains one of the leading causes of neonatal deaths worldwide with a higher incidence in resource limited countries such as Malawi. At Balaka district hospital, Birth asphyxia is the primary cause of neonatal mortality accounting for 37.3% of the district's neonatal deaths. Although various quality improvement initiatives on birth asphyxia such as Helping Babies Breathe have been documented in Malawi, there is limited information on use of criterion-based audit (CBA) to enhance the care of neonates with birth asphyxia. Criterion-based audit is a systematic and critical analysis that seeks to improve quality of care by reviewing cases against an explicit criterion and using findings to modify practice as necessary. This study aimed to evaluate the effectiveness of CBA in improving the quality of neonatal birth asphyxia care at Balaka district hospital in Malawi. Methods: A CBA on the care of asphyxiated neonates was conducted at Balaka district hospital in Malawi. The care practices were assessed through a retrospective review of 110 cases notes which were selected by systematic random sampling technique. The care practices were compared with locally established standards, by a multidisciplinary team, based on the Malawi guidelines on care of the infant and newborn and World Health Organization documents. The gaps in the current practice were identified, reasons discussed, and recommendations were made and implemented. A re-audit was conducted on 110 case notes, six months after the initial audit. Results: The re-audit showed significant improvements in most of the set criteria for quality care: Checking of vital signs (80% vs. 98.2%; p = 0.000), laboratory investigations done (0.9% vs. 74%; p = 0.000), thermal support (82.7% vs. 91.8%; p = 0.041), correct diagnosis (60% vs. 81%; p = 0.001), correct treatment (18.7% vs. 81%; p = 0.000), correct feeding (12.7% vs. 56.4%; p = 0.000), Clinical officers conducting ward rounds (0% vs. 72%; p = 0.000), and daily weight check (49.1% vs. 93%; p = 0.000). Additionally, neonatal death decreased from 11% in the initial audit to 5% in the re-audit. Conclusion: Criterion-based audit is a low-cost tool that can significantly improve the care of neonates with birth asphyxia in resource-limited countries. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the diagnostic management and follow‐up imaging for glioma patients across Belgian hospitals by calculating process indicators. Methods: Patients with newly diagnosed glioma in Belgium (2016–2019) were selected from the Belgian Cancer Registry. The National Social Security Number served as unique patient identifier, linking the Registry to vital status and reimbursement data. Nine measurable process related to diagnosis and follow‐up imaging were identified, with reformulations for 7 due to data limitations. For each indicator, technical documentation sheets, containing all required details (rationale, numerator and denominator, target, limitations, benchmarking, subgroup analyses) were developed, reviewed by a multidisciplinary expert panel, and validated in six pilot hospitals. Per indicator, patients were assigned to the most relevant hospital per indicator using allocation algorithms. Results: Results for process indicators assessing MRI use in glioma diagnosis and follow‐up aligned with predefined targets (90%), except for early postoperative MRI (48.5% vs. target 90%). Mandatory reporting of the WHO performance status (89.3% vs. target 100%) and performance of full‐spine (43.6% vs. target 90%) and follow‐up MRI (73.5% vs. target 90%) in ependymoma were suboptimal. The largest variability across centers was noted for the indicator on early postoperative MRI. Conclusion: This calculation of process indicators identified opportunities for improvement in diagnosis and follow‐up imaging for glioma patients in Belgium. Monitoring indicator results and providing individual feedback reports to the Belgian hospitals invites neuro‐oncology care teams and hospital managements to reflect on their results and to take measures to continuously improve care for glioma. [ABSTRACT FROM AUTHOR]

Background/Objectives: Preoperative anxiety in cardiac surgery patients can adversely affect mental well-being and postoperative outcomes. Virtual reality (VR) patient education has been proposed as a novel method to enhance patient education and potentially reduce preoperative anxiety. The VR Patient Journey Trial aimed to evaluate the impact of VR patient education on preoperative anxiety and patient satisfaction compared to traditional education methods. Methods: This randomized controlled trial included 121 patients undergoing cardiac surgery. Participants were randomized to receive either VR patient education (intervention group) or traditional education (control group). Preoperative anxiety was measured using the State–Trait Anxiety Inventory (STAI) and the Amsterdam Preoperative Anxiety and Information scale (APAIS). Patient satisfaction was assessed postoperatively through a custom questionnaire. Statistical analyses included linear regression and non-parametric testing. Results: Neither STAI nor APAIS scores showed differences in preoperative anxiety between both groups. However, the intervention group reported significantly higher patient satisfaction with the information provided (median score 9 vs. 8; p < 0.001). Furthermore, women reported higher levels of anxiety than men (p = 0.01), and open-ended feedback from participants indicated a need for more detailed information on postoperative rehabilitation and potential risks. Conclusions: The VR Patient Journey Trial revealed that, although VR patient education did not significantly reduce preoperative anxiety levels, it significantly improved patient satisfaction with the information provided. These results suggest that VR patient education can be a valuable addition to preoperative patient programs. [ABSTRACT FROM AUTHOR]

Background and Objectives English and Welsh laws require "contemporaneous" consent to sexual relations, often precluding "non-capacituos" people living with advanced dementia from these human interactions. Research Design and Methods The views of people living with dementia, carers, professionals, and over-55s were explored on implications of current laws on sexuality in dementia. Thirty-five participants from England were recruited through purposive selective sampling. Audio-taped semistructured interviews were transcribed and thematically analyzed with each stakeholder group coded separately. Results Common themes across stakeholders were (i) law reform needed due to their hammer-like effect ignoring the individual; (ii) dissonant theme of needing the law for protection; (iii) negative impact of denied intimacy on individuals and partners; (iv) support for Advance Decisions on Intimacy with caveats; (v) less support for involvement of Court of Protection and Powers of Attorney; (vi) call for review of capacity concept with support for an assent model. People living with dementia described shame and stigma associated with policing of their sexuality and perception of being singled out for protection and intrusion into their lives. For informal carers (mostly wives), the theme of "what about me" emerged, demonstrating that for the long-term partnered, this is a couple's issue. Discussion and Implications Practical implications of this study include need to address ageism and ableism; human rights education for society and professionals; starting point of presumed capacity for sexual relations with consensus on how and when this should be rebutted; and care homes' certification requirements should incorporate assessment of the relationship health of their residents. [ABSTRACT FROM AUTHOR]

Background Although a significant number of cases of Staphylococcus aureus bacteraemia (SAB) are managed at non-referral community hospitals, the impact of a bundle-of-care intervention in this setting has not yet been explored. Methods We performed a quasi-experimental before–after study with the implementation of a bundle of care for the management of SAB at five non-referral community hospitals and a tertiary care university hospital. Structured recommendations for the five indicators selected to assess quality of care were provided to investigators before the implementation of the bundle and monthly thereafter. Primary endpoints were adherence to the bundle intervention and treatment failure, defined as death or relapse at 90 days of follow-up. Results One hundred and seventy patients were included in the pre-intervention period and 103 in the intervention period. Patient characteristics were similar in both periods. Multivariate analysis controlling for potential confounders showed that performance of echocardiography was the only factor associated with improved adherence to the bundle in the intervention period (adjusted OR 2.13; 95% CI 1.13–4.02). Adherence to the bundle, performance of follow-up blood cultures, and adequate duration of antibiotic therapy for complicated SAB presented non-significant improvements. The intervention was not associated with a lower rate of 90 day treatment failure (OR 1.11; 95% CI 0.70–1.77). Conclusions A bundle-of-care intervention for the management of SAB at non-referral community hospitals increased adherence to quality indicators, but did not significantly reduce rates of 90 day mortality or relapse. [ABSTRACT FROM AUTHOR]

Background: Complex high-precision radiotherapy, such as stereotactic body radiotherapy (SBRT), should only be offered to patients with sufficiently long survival. In the context of bone metastases radiotherapy, low rates of treatment close to the end of life, e.g. last 30 days (RT30), may serve as a quality of care indicator. While traditional, pain-relieving short-course regimens have been studied comprehensively, real-world SBRT results are still limited. Methods: Retrospective analysis (2010–2023, n = 1117 episodes) of patients with bone metastases treated with traditional single-fraction (8 Gy × 1) or multi-fraction regimens (often 4 Gy × 5 or 3 Gy × 10) compared to stereotactic single-fraction (12–16 Gy × 1) or multi-fraction regimens. Results: Except for gender, almost all baseline variables were uneven distributed. Failure to complete fractionated radiotherapy was uncommon in the stereotactic (4%) and non-stereotactic group (3%), p = 1.0. With regard to RT30, relevant differences emerged (19% for 8-Gy single-fraction versus 0% for stereotactic single-fraction, p = 0.01). The corresponding figures were 11% for multi-fraction non-stereotactic and 2% for multi-fraction stereotactic, p = 0.08. Median overall survival was shortest after 8-Gy single-fraction irradiation (4.2 months) and longest after stereotactic multi-fraction treatment (13.9 months). Neither stereotactic radiotherapy nor multi-fraction treatment improved survival in multivariate Cox regression analysis. Factors significantly associated with longer survival included better performance status, lower LabBM score (5 standard blood test results), stable disease outside of irradiated area(s), metachronous distant metastases, longer time interval from metastatic disease to bone irradiation, and outpatient status. Conclusion: The implementation of SBRT for selected patients has resulted in low rates of non-completion and RT30. Optimal selection criteria remain to be determined, but in current clinical practice we exclude patients with poor performance status, unfavorable blood test results (high LabBM score) and progressive disease sites not amenable to SBRT. Established, guideline-endorsed short-course regimens, especially 8-Gy single-fraction treatment, continue to represent an important palliative approach. [ABSTRACT FROM AUTHOR]

Objective: In the present study we aimed to review the evolution and function of the maternal medicine multidisciplinary team (MMMDT) meeting of a maternal medicine service of a tertiary level stand‐alone maternity hospital. Methods: We conducted a retrospective descriptive study of all minutes of MMMDT meetings from 2014 to 2020, with the aim of evaluating meeting characteristics and patient demographics. Results: There were 575 multidisciplinary team (MDT) discussions of 486 women during 43 meetings in the 7 year period. On average, 13 (range 3–23; SD = 5.28) women were discussed at each meeting, attended by 17 (range: 11–27; SD = 4.26) attendees. There were 18 women discussed during successive pregnancies. When analyzing the 2017–2020 data, preconceptual discussions made up 7.3% (n = 42) of patients discussed, with 5.7% (n = 33) being postnatal. The mean maternal age was 32.5 years (range 15–48 years) and women were most likely to be discussed in the mid‐trimester period (21–24 weeks gestation). The top five primary specialities involved were hematology, neurology, rheumatology, neurosurgery and gastroenterology; however, 22 specialities were represented overall when classified by the primary medical condition. When examining the MDT input, hematology input was required in 144 patients (25.0%), radiology in 161 (28.0%) patients, and 117 in anesthesiology (20.3%). When examining the number of teams required to manage the patient, 80 women required the input of three specialities, with 16 women requiring the input of four specialities. Conclusion: We demonstrate the value and role of the MDT in the management of complex patients, providing a forum to discuss care in all phases of the obstetric journey. Synopsis: The maternal medicine MDT has evolved to become an essential part of practice, caring from women throughout the reproductive cycle. [ABSTRACT FROM AUTHOR]

Background: Language barriers have been identified as a key access barrier to healthcare services for immigrants. The aim of this study was twofold: to investigate immigrants' and healthcare professionals' experiences with barriers and facilitators of interpreter services, and to examine the influence of barriers to interpreter services on the quality of care from immigrant and healthcare professional perspectives. Methods: We searched PubMed, Embase, The Cochrane Library, Scopus, SocINDEX and PsycINFO, resulting in 1425 studies. A total of 21 original quantitative, qualitative and mixed methods studies published between 1996 and 2021 were assessed as eligible for inclusion. Results: Identified barriers included: lack of immediately available interpreter services, cost, lack of knowledge about availability, and attitude towards interpreter services. Facilitators included: a high number of interpreters in the requested language, awareness among healthcare professionals and patients of the patient's rights to interpreters, and a positive attitude towards use of interpreter services. Regarding quality of care, language barriers created safety risks for the patients, made patients feel unsafe, or delayed patient contact with the healthcare system. Conclusions: Immigrant patients and healthcare professionals experience barriers in using interpreter services due to restrictive policies regarding user fees and limitations to entitlement to interpreters, a limited number of qualified interpreters and lack of knowledge. Medical encounters with unaddressed language barriers can put patients at risk and reduce quality of care for immigrants, which calls for strengthening formal and informal access to interpreters. [ABSTRACT FROM AUTHOR]

Emergency departments (EDs) face increasing pressure due to overcrowding, long waiting times, and challenges in delivering timely, high-quality care. Rapid triage techniques have been introduced as a solution to streamline patient flow, prioritize care for critically ill patients, and improve overall operational efficiency. This systematic review explores the impact of rapid triage models, such as the Emergency Severity Index (ESI) and Manchester Triage System (MTS), on reducing waiting times and improving the quality of care in EDs. A comprehensive search of relevant databases identified studies examining the effects of rapid triage systems. The review highlights consistent reductions in waiting times, especially for high-acuity patients, along with improved patient outcomes, greater triage accuracy, and enhanced patient satisfaction. However, successful implementation of these systems depends on adequate staffing, proper training, and resource availability. Some challenges, such as extended waiting times for low-acuity patients and resource constraints, were also noted. Overall, rapid triage techniques significantly enhance ED efficiency and care quality, but their success hinges on sufficient support and resources. This review emphasizes the need for further research and careful implementation to optimize the benefits of rapid triage across various healthcare settings. [ABSTRACT FROM AUTHOR]

Introduction: The growing popularity of dietary supplements in Poland raises the need to verify the knowledge and practices of healthcare workers who have a key role in recommending their use. Understanding these issues is important to ensure patient safety and the correct use of dietary supplements. Therefore, the aim of the study was to examine the level of knowledge, practices, and sources of information on dietary supplements among various professional groups of healthcare workers. Material and Methods: The study conducted from September 2023 to June 2024 involved 743 healthcare professionals, including doctors, pharmacists, and nurses. Data were collected online using an original questionnaire. The questionnaire was placed in portals associated with target groups. Results: A total of 73.49% of respondents declared knowledge of dietary supplements. The most common source of information was scientific articles (42.8%), and only 7.00% of respondents used official sources such as the Chief Sanitary Inspectorate. Advertisements had a smaller impact on doctors (p < 0.001), with 46.97% of respondents stating that they did not pay attention to them. In addition, 84.52% of respondents considered the composition of the dietary supplement to be a key factor in their recommendation. Conclusions: Knowledge of dietary supplements among healthcare professionals varies, particularly between different professional groups. The results indicate a need for further education and standardization of information to ensure safe and responsible recommendation of supplements to consumers. [ABSTRACT FROM AUTHOR]

Does higher medical spending improve quality of care? We estimate the effect of changes in regulated reimbursement prices for hospitals on multiple dimensions of hospital quality, including mortality outcomes, surgical complications, process quality and patient satisfaction. We exploit an exogenous variation in reimbursement prices between the years 2006 and 2010 based on a reform of hospital financing in Germany. We find that changes in reimbursement prices do not affect quality of care. This effect is precisely estimated, and we can rule out effect sizes that are large relative to the overall variation in quality indicators across hospitals. [ABSTRACT FROM AUTHOR]

The clinical and economic impact of heart failure (HF) is immense and will continue to rise due to the increasing prevalence of the disease. Despite the availability of guideline-recommended medications that improve mortality, reduce hospitalizations, and enhance quality of life, there are major gaps in the implementation of such care. Quality improvement interventions have generally focused on clinicians. While certain interventions have had modest success in improving the use of heart failure medications, they remain insufficient in optimizing HF care. Here, we discuss how patient-facing interventions can add value and supplement clinician-centered interventions. We discuss how digital health can be leveraged to create patient activation tools that create a larger, sustainable impact. Small studies have suggested the promise of digital tools for patient engagement and self-care, but there are also important barriers to the adoption of such interventions that we describe. We share key principles and strategies around the design and implementation of digital health innovations to maximize patient participation and engagement. By uniquely activating patients in their own care, digital health can unlock the full potential of both existing and new quality improvement initiatives to drive forward high-quality and equitable heart failure care. [ABSTRACT FROM AUTHOR]

The prevalence of dementia is increasing globally, with an estimated 139 million people expected to be living with dementia by 2050. Across numerous countries, substandard care for people with dementia is evident, with quality improvement needed. Recently, a focus on patient-reported experience measures (PREMs) has been utilised in healthcare services as a method of evaluating the care experiences provided and determining areas of improvement. The literature is scarce regarding the feasibility and acceptability of implementing PREMs with people with moderate to advanced dementia. This scoping review aimed to identify PREMs that have been used with vulnerable populations including people with cognitive impairment, mental health concerns, and children, outline dimensions included, and determine adaptions made to the PREMs to improve acceptability of the instruments for vulnerable populations. A database search of Medline was conducted to identify 36 studies including 32 PREMs. The PREMs identified covered a range of dimensions, most frequently care effectiveness, care environment, and patient involvement. The most common adaption to the PREMs was simplification of wording and sentence structure. Several measures conflated patient outcomes and patient satisfaction with patient experience, limiting utility for improving patient experience specifically. While several PREMs have been used with people with dementia, challenges in their implementation and their applicability to specific settings limit their use more broadly. Evidently, there is a need for development of a PREM for people with moderate to advanced dementia that is applicable across healthcare settings and is appropriately adapted for varying cognitive and communicative barriers. [ABSTRACT FROM AUTHOR]

Objective Data Setting and Design Data Sources and Analytic Sample Principal Findings Conclusions To examine the response of community health center (CHC) quality to quality levels at neighboring CHCs in the presence of non‐price competition.A quasi‐experimental study of US community health centers. Outcome variables were indices that measured overall quality of CHC care. Using patient flow data, we constructed CHC‐specific Hirschman–Herfindahl index (HHI) and competitors' composite quality measure. The plausibly exogenous change in characteristics of “competitors' competitors” was exploited to identify the relationship between competition and quality of care, using a generalized two‐stage least square model with instrumental variables.Using the Health Center Program Uniform Data System (2014–2018), linked with American Community Survey and Medical Expenditure Panel Survey, we analyzed 1098 unique federally funded CHCs in 50 states and District of Columbia which had at least one neighboring CHC and had non‐missing data for 2015–2018 (4226 CHC‐years).Most of CHCs served populations in overlapping geographic markets, with median market concentration decreasing during the study period. A one‐percent increase in competitors' quality was associated with a 0.71‐percent increase in an index CHC's composite quality (p < 0.01), consisting of a 0.59‐percent increase in chronic condition control rates (p < 0.01); a 0.68‐percent increase in the screening and assessment rates (p < 0.01); and a 0.78‐percent increase in medication management rates (p < 0.01). The association was stronger at CHCs serving a smaller proportion of uninsured patients. No significant quality reaction was observed at CHCs with a percentage of uninsured patients larger than the 75th percentile. We observed no significant associations between HHI and quality.Increasing competition does not harm quality of care at CHCs. A CHC appears to improve its quality if its competitors improved quality. The beneficial quality effect was less pronounced in CHCs providing a significant proportion of care to uninsured patients, suggesting lack of incentives faced by these CHCs. [ABSTRACT FROM AUTHOR]

Context Methods Findings Conclusions Policy Points What are the facilitators and barriers of physician group participation in a performance‐based financial incentive program aimed at improving equity of care by patient race and ethnicity? Launching financial incentives to improve racial equity has required extensive organizational change management for participating physician groups, including major investments to improve quality management systems. Carefully designing financial incentives to encourage equity improvement while managing unintended consequences, and considering physician groups’ populations served, baseline maturity of quality management systems, and efforts to assess and address patients’ social risk factors have been central to prepare physician groups for financial incentives to improve equity of care. Given the major investments required of physician groups to prepare for financial incentives that reward equity improvement, alignment of equity of care measure specifications and reporting requirements across payers could facilitate physician group engagement. Evidence about how baseline physician group capabilities, including the maturity of their quality management systems, impact equity improvement may help health plans prioritize and target their investments to advance equity of care by patient race and ethnicity. What are the facilitators and barriers of physician group participation in a performance‐based financial incentive program aimed at improving equity of care by patient race and ethnicity? Launching financial incentives to improve racial equity has required extensive organizational change management for participating physician groups, including major investments to improve quality management systems. Carefully designing financial incentives to encourage equity improvement while managing unintended consequences, and considering physician groups’ populations served, baseline maturity of quality management systems, and efforts to assess and address patients’ social risk factors have been central to prepare physician groups for financial incentives to improve equity of care. Given the major investments required of physician groups to prepare for financial incentives that reward equity improvement, alignment of equity of care measure specifications and reporting requirements across payers could facilitate physician group engagement. Evidence about how baseline physician group capabilities, including the maturity of their quality management systems, impact equity improvement may help health plans prioritize and target their investments to advance equity of care by patient race and ethnicity. Blue Cross Blue Shield of Massachusetts (BCBSMA), a large commercial health insurer, is using financial incentives to advance equity of care by patient race and ethnicity. Understanding experiences of this payer and its contracted physician groups can inform efforts elsewhere. We qualitatively assess physician groups’ barriers and facilitators of planning and implementing BCBSMA's financial incentives to improve equity of ambulatory care quality by patient race and ethnicity.Key informant interviews (n = 44) of the physician group, BCBSMA, and external stakeholders were conducted, equity initiative meetings were observed, and documents were analyzed to identify barriers and facilitators of designing and preparing for financial incentives to advance racial equity. Physician group experiences of preparing for and responding to financial incentives for equity improvement were assessed.Analyses revealed 1) the central importance of valid and reliable equity performance measurement and carefully designed equity improvement incentives for physician group buy‐in, 2) that prior to implementing financial incentives for equity improvement, physician groups needed to improve their quality management systems and the accuracy and completeness of patient race and ethnicity data, and 3) physician groups’ populations served, baseline maturity of quality management systems, and efforts to assess and address patients’ social risk factors were central to consider to plan for physician group financial incentives to improve racial equity.Given the major infrastructure investments and organizational change management resources required of physician groups to participate in a financial incentive program designed to reward equity improvement, alignment of equity measurement and performance requirements across payers would facilitate physician groups’ engagement in efforts to improve quality of care for racial and ethnic minority patients. [ABSTRACT FROM AUTHOR]

Background: Few studies describe the use of the Post-Stroke Checklist (PSC) as a tool for longitudinal stroke follow-up in clinical practice. We mapped the prevalence of stroke-related health problems and targeted interventions at 3 and 12 months post-stroke by using the PSC. Methods: Patients with acute stroke discharged home in 2018–2019 at Skåne University Hospital, Sweden, were invited to participate in a comprehensive nurse-led follow-up based on a 14-item PSC 3 and 12 months post-stroke. We measured time consumption, screened for stroke-related health problems, compared the findings, and recorded targeted healthcare interventions. Problems at 12 months were grouped into new, persistent, or none compared to the 3-month evaluation. Results: Of 200 consecutively included patients, 146 (77%) completed both the 3- and 12-month follow-ups. At 12-month follow-up, 36% of patients reported no stroke-related health problems, 24% reported persistent problems, and 40% reported new problems since the 3-month evaluation. New problems at 12 months were most common within the domains: secondary prevention (23%) and life after stroke (10%). Stroke recurrence rate was 7.5%, 43% had high blood pressure, and few smokers had quit smoking. At 12 months, 53% received at least one new healthcare intervention, compared to 84% at 3 months. Conclusions: Stroke-related health problems decreased beyond 3 months but were still present in two-thirds of patients at 1 year. This emphasizes the relevance of continuous structured follow-up using the PCS. However, the follow-up alone was insufficient to adequately achieve treatment targets for secondary prevention, which require intensified focus. Trial registration: ClinicalTrials.gov ID NCT04295226, (04/03/2020) [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Maternal‐neonatal healthcare services were severely disrupted during the COVID‐19 pandemic in even high‐income countries within the World Health Organization (WHO) European Region. The objective of this study was to compare trends in the quality of maternal and neonatal care (QMNC) in Sweden and Norway to 12 other countries from the WHO European Region during the COVID‐19 pandemic, and to identify domains for improvement.This cross‐sectional study included women giving birth in Europe from March 1, 2020 to December 31, 2022. Women answered an online, anonymous questionnaire which included 40 WHO Standard‐based Quality Measures collectively scored as the total QMNC index (0–400) and separately in four subdomains (0–100): provision of care, experience of care, availability of human and physical resources, and reorganizational changes due to COVID‐19. To assess reported QMNC changes over time, we used adjusted quantile regression models. ClinicalTrials.gov Identifier: NCT04847336.Of the 45151 women included in the study, 13 117 (29.1%) were from Sweden and Norway and 32034 (70.9%) from the 12 WHO European countries. The total QMNC index for Sweden and Norway (median: 325, IQR: 285–355) was higher than the 12 WHO European countries (median: 315, IQR: 265–350, p < 0.001) as were trends in QMNC index over time (Sweden and Norway median: 310–345; 12 WHO European countries median: 305–340). Sweden and Norway also had higher scores in three‐of‐four QMNC subdomains, with the 12 WHO European countries scoring higher only for reorganizational changes due to COVID‐19. In adjusted quantile models of the total QMNC index, Sweden and Norway had higher scores, with largest differences in the lower quantiles (p < 0.001 in all percentiles).Across Europe, there are significant gaps in the quality of maternal‐neonatal healthcare services. Although women giving birth in Sweden and Norway reported higher QMNC scores in all subdomains except for “reorganizational changes due to COVID‐19,” there is room for improvement and shared learning across Europe. Policymakers should prioritize long‐term investments in maternal and neonatal healthcare, ensuring that facilities are adequately equipped during public health crises and that all women have access to high‐quality, evidence‐based, equitable, and respectful care. [ABSTRACT FROM AUTHOR]

ObjectiveDesignResultsConclusionThe resident population in nursing homes is increasingly racially diverse. The purpose of this study was to assess racial differences in the quality of care interactions among nursing home residents with dementia.The study utilized baseline data from the Testing the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD), a randomized controlled pragmatic trial. The Quality of Interaction Scale (QuIS) was used to measure quality of staff-resident care interactions. The sample included 531 residents. An analysis of covariance was conducted to address the aim.The majority of interactions were positive social (42%) or positive care (37%). Black residents living with dementia had higher QuIS scores (M = 5.98, SD = 1.66) than White residents with dementia (M = 5.40, SD = 1.75), whereas higher QuIS scores indicating more positive interactions. However, the results of the analysis of covariance indicated that there was not a significant difference in QuIS scores between Black versus White residents living with dementia (p =.203).The findings suggest that care interactions in nursing homes are consistent between Black residents and White residents. Future research should evaluate the impact of staff race on the quality of care interaction among nursing home residents. [ABSTRACT FROM AUTHOR]

Quality measurement plays an increasing role in U.S. health care. Measures inform quality improvement efforts, public reporting of variations in quality of care across providers and hospitals, and high‐stakes financial decisions. To be meaningful in these contexts, measures should be reliable and not heavily impacted by chance variations in sampling or measurement. Several different methods are used in practice by measure developers and endorsers to evaluate reliability; however, there is uncertainty and debate over differences between these methods and their interpretations. We review methods currently used in practice, pointing out differences that can lead to disparate reliability estimates. We compare estimates from 14 different methods in the case of two sets of mental health quality measures within a large health system. We find that estimates can differ substantially and that these discrepancies widen when sample size is reduced. [ABSTRACT FROM AUTHOR]

Background Aim Study Design Results Conclusions Relevance to Clinical Practice Open‐heart surgery patients face many problems because of post‐sternotomy pain. Care protocols can eliminate pain and pain‐related problems by providing holistic care.The aim of this study was to examine the effect of an open‐heart surgery patient care protocol developed in the study on post‐sternotomy pain, anxiety and quality of care.The study was carried out as a double‐blind randomized controlled trial. The sample size was calculated. Considering some attrition, the sample size was increased by 10% for each group, and a total of 68 participants, including 34 in each group, were included in the sample. Data were collected using a ‘Patient Information Form’, a ‘Post‐Sternotomy Pain Follow‐up Form’, the ‘Numeric Rating Scale’, the ‘State Anxiety Inventory’ and the ‘Strategic and Clinical Quality Indicators in Postoperative Pain Management Questionnaire’. The patients in the experimental group were given care in accordance with the protocol, which was developed in the study, on postoperative days 0, 1 and 2.The statistical evaluation showed a significant difference between the mean scores of the experimental (F = 7.28; p < .001) and control groups (F = 2.42; p < .05) on the pain assessment scale. It was determined that the number of analgesics used in the experimental group was statistically significantly lower than in the control group. Intra‐group comparisons showed that there was a difference between the mean pre‐test and post‐test state anxiety scale scores of the groups (p < .001). The experimental group had higher mean scores on the Strategic and Clinical Quality Indicators in Postoperative Pain Management Questionnaire than that of the control group (p < .001).The protocol developed in the study was found to be effective in reducing pain, the use of NSAIDs and opioids, and anxiety levels and increasing the level of quality of care.The protocol was original and feasible in that it included independent nursing interventions to improve the quality of care by reducing pain and anxiety. Particularly, the use of protocols in intensive care units was nurses' strongest resource in patient care management. Thus, the protocol, which was prepared for intensive care patients who most frequently experience pain and anxiety, was promising for nurses in improving the quality of care by reducing pain and anxiety. However, it is necessary to conduct further studies involving longitudinal follow‐up in samples and institutions with similar conditions. [ABSTRACT FROM AUTHOR]

Introduction: Nurse–physician collaboration is a fundamental part of the healthcare information flow, while poor or improper collaboration could result in poor healthcare outcomes and increased medical errors. Objective: This study investigated the relationship between nurse–physician collaboration and the perceived quality of healthcare services offered in Jordanian public hospitals, and associated factors. Methods: A descriptive correlational research design was used. A sample of 385 nurses employed in five Jordanian public hospitals was recruited. Nurse–Physician Collaboration Scale was used to assess collaboration, while the HEALTHQUAL scale was used to evaluate healthcare service quality. The IBM SPSS software (version 26) was used to analyze the data. Results: There was a positive correlation between nurse–physician collaboration and the perceived quality of healthcare services provided to patients (r = 0.778, p <.01). There was variability in the perception of nurse–physician collaboration based on gender, RN-to-patient staffing ratios, age, and income level (p <.05). No association was found between nurses' demographics and their perceptions of the quality of healthcare services provided to patients. Conclusions: Healthcare organizations should implement effective practices to promote nurse–physician collaboration, which could subsequently improve the quality of tangible services provided to patients. [ABSTRACT FROM AUTHOR]

Patient experience is a key aspect of care quality. Since the 2007 release of the Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS) survey, no systematic review of factors associated with CG-CAHPS scores has been reported. We reviewed 52 peer-reviewed English language articles published in the United States using CG-CAHPS data. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and used the Checklist for Analytical Cross-Sectional Studies. We identified several interventions (eg, adding a care coordinator focused on chronic care management) associated with improved overall provider rating and 2 interventions (eg, peer shadow coaching) that improved provider communication scores. Studies evaluating the implementation of patient-centered medical homes or patient-reported outcomes found mixed results. We identified site-level factors (eg, better team communication) and provider-level factors (eg, physician empathy) associated with better patient experience. In contrast, patient-level factors (eg, medication adherence) found mixed associations with patient experience. Policymakers, clinicians, and healthcare leaders can leverage this evidence for quality improvement efforts and interventions supporting patient-centered care. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim(s) Design Methods Data Sources Results Conclusions Implications for the Profession and Patient Care Impact Reporting Method Patient or Public contribution To provide an introduction to the Good Nursing Care Scale (GNCS) and systematically review the application of the scale in health research.Systematic review.Empirical studies published in English or Finnish in peer‐reviewed journals or as a summary of a PhD thesis where the scale was used for data collection amongst patients were included. Analysis was made by using descriptive statistics, narrative analysis, and evaluation of psychometric properties.PubMed, CINAHL, Cochrane, and Scopus in October 2023.A total of 26 full‐text studies and summaries of PhD theses were included in the review. The GNCS has been developed systematically, and the theoretical structure has remained stable. The studies indicate a high level of patient‐centered quality of nursing care. Validity and reliability evaluation and reporting were systematic in the studies and mainly indicate sufficient level. Variations between countries are not large, supporting the international use of the GNCS.Patient‐centered quality of nursing care is predominantly at high levels. However, systematic evaluation is needed to provide longitudinal data. For that purpose, the GNCS is one potential instrument.Support for the use of existing, tested instruments is encouraged to provide critical ideas for the future needs of nurse practitioners, managers, teachers and researchers.This paper impacts researchers interested in systematic evaluation of the patient‐centered quality of nursing care and for practitioners taking care of patients. For researchers, it introduces a relevant instrument, the GNCS, for analysing the quality or for comparing the quality with other instruments. For practitioners, it produces evidence of the usability of the GNCS.PRISMA guided the systematic review, and the COSMIN guideline was used for quality appraisal of included studies.No Patient or Public contribution. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Design Methods Results Conclusion Implications Impact Reporting Method Patient or Public Contribution To explore the care experiences of informal carers of people with chronic conditions in hospitals and identify areas for improvement in the context of comprehensive care delivery.A explanatory sequential mixed‐method study.This study was conducted, involving a survey with 182 carers and interviews with 31 carers of individuals who attended an Australian hospital. Descriptive analysis of quantitative data was performed using RStudio, while thematic analysis of qualitative data was conducted using NVivo.The findings revealed seven overarching components of care that influenced carers' hospital experiences and their perceptions of care quality. Areas requiring improvement were identified within these categories.This review identifies common perspectives of informal carers of people with chronic conditions in hospital settings and highlights important areas that require attention to improve carers' hospital care experiences. Carers should be welcomed, involved, informed and supported during hospital attendance to foster the most positive care experiences.Healthcare professionals should involve carers in assessment, shared decision‐making and the care process and recognise and address carers' needs.The findings revealed the carer's hospital experiences in the context of comprehensive care delivery and identified areas requiring improvement.The CROSS and the COREQ guidelines were followed.The study protocol was presented to stakeholders from two hospitals in Australia, a Patient and Carer Advisory Board (attached to the parent project: evaluating Quality of Care (eQC)) and the Australian Commission on Safety and Quality in Health Care, and discussions were held to assess the relevance and significance of this study to clinical practice and health policy. [ABSTRACT FROM AUTHOR]

Background: Professional nurses are trained to provide quality care. Despite the professional nurses' acquired skill and professionalism attributes, the neonate, infant, and under-5-child mortality rates are high in sub-Saharan Africa. This health care report indicates that sub-Saharan Africa countries face a challenge in reaching the Sustainable Development Goal number 3 by the year 2030 (that is, ensuring healthy lives and reducing the mortality rates of children under 5). It has been reported that professionalism in nursing can improve the quality of care and positively change the health outcomes. Methods: This study employed a qualitative exploratory, descriptive design to explore and describe professional nurses' own professionalism attributes to provide quality care to neonates, infants, and under-5 children in the North West province in South Africa. Eight naïve sketches of an all-inclusive sample of invited professional nurses (N = 25; n = 8) were received. The naïve sketch questions were based on the Registered Nurses' Association of Ontario's professionalism attributes. Tesch's eight steps of data-analysis were used, with an independent coder's assistance. Results: The categories included (1) knowledge, (2) spirit of inquiry, (3) accountability, (4) autonomy, (5) advocacy, (6) collegiality and collaboration, (7) ethics and values, and (8) professional reputation, and each category generated sub-themes. Conclusion: Professional nurses are aware of their own professionalism attributes in quality of care of neonates, infants and under-5 children; the 'innovation and visionary' attribute did not emerge, which should receive more attention to strengthen quality care. However, a new attribute, 'professional reputation', reflecting a South African culture-orientated attribute, emerged from the data collected. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Implications for the Profession and/or Patient Care Reporting Method Patient or Public Contribution To explore and validate an end of shift survey with a low response burden, practical application and generated evidence of related associations between workload, quality of work and patient care, missed care and job satisfaction.A retrospective cross‐sectional survey of the experiences of nursing staff.Data were collected from 265 nurses who responded to a questionnaire at the end of their shift in 2022. Exploratory factor analysis was undertaken using IBM SPSS v.27 and confirmatory factor analysis was undertaken using IBM AMOS v27. Hypotheses testing was undertaken using IBM SPSS v.27 using multiple regression analyses.All of the hypotheses were supported. There was a negative association between workload and quality of work and job satisfaction. Quality of work was negatively associated with workload and missed care and positively associated with job satisfaction. The association between missed care and job satisfaction was negative.The EOSS is a valid and reliable tool with a low response burden. The tool supports previous research which demonstrated there is a negative relationship between level of workload and shift type with satisfaction, quality of work and potentially nurse retention.In the context of a global nursing shortage nursing leaders must ensure that care we provide is of the highest quality. We must take every action to address high workload to reduce the risk that fundamental care is not sacrificed, job satisfaction is improved and nurses remain in the profession. The EOSS gives nurse leaders a reliable, practical, consistent, applied tool that will better enable associations to be observed between resource configuration, workload and critical impacts on nursing and patient care.We have adhered to the relevant EQUATOR guidelines using the STROBE reporting method.No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown the negative impact of institutional care on children's physical and mental health. However, in addition to the form of care, the quality of care is an important factor in children's mental health. This study explored the quality of care and the association between the quality of care and mental health issues among adolescents in Vietnam social support facilities (SSFs). Methods: A cross-sectional study was conducted with 273 institutionalized adolescents who lived in SSFs and 273 adolescents cared for by family. Depressive symptoms, anxiety symptoms, sleep problems, behavioral problems, and quality of care were measured. Descriptive statistics were calculated, and multiple linear regression analysis was performed. Results: The quality of care was rated as quite high by institutionalized adolescents. However, the mean score for quality of care was significantly lower for institutionalized adolescents than for the comparison group. The quality of physical care did not show a significant relationship with mental health risk, except for anxiety. In contrast, emotional care was negatively associated with all common mental health problems including anxiety (beta = –0.40, P <.001), depression (beta = –0.31, P <.01), conduct behavior (beta = –0.30, P <.01) and sleep problems (beta = –0.30, P <.01). An increase in emotional care was therefore associated with a decrease in mental health problems. Conclusions: Emotional care is more important than physical care for adolescents in SSFs. It is necessary to improve the quality of care, particularly emotional care, for adolescents to reduce the risk of mental health problems. [ABSTRACT FROM AUTHOR]

Background: Currently, there are no agreed quality standards for post‐stroke aphasia services. Therefore, it is unknown if care reflects best practices or meets the expectations of people living with aphasia. We aimed to (1) shortlist, (2) operationalise and (3) prioritise best practice recommendations for post‐stroke aphasia care. Methods: Three phases of research were conducted. In Phase 1, recommendations with strong evidence and/or known to be important to people with lived experience of aphasia were identified. People with lived experience and health professionals rated the importance of each recommendation through a two‐round e‐Delphi exercise. Recommendations were then ranked for importance and feasibility and analysed using a graph theory–based voting system. In Phase 2, shortlisted recommendations from Phase 1 were converted into quality indicators for appraisal and voting in consensus meetings. In Phase 3, priorities for implementation were established by people with lived experience and health professionals following discussion and anonymous voting. Findings: In Phase 1, 23 best practice recommendations were identified and rated by people with lived experience (n = 26) and health professionals (n = 81). Ten recommendations were shortlisted. In Phase 2, people with lived experience (n = 4) and health professionals (n = 17) reached a consensus on 11 quality indicators, relating to assessment (n = 2), information provision (n = 3), communication partner training (n = 3), goal setting (n = 1), person and family‐centred care (n = 1) and provision of treatment (n = 1). In Phase 3, people with lived experience (n = 5) and health professionals (n = 7) identified three implementation priorities: assessment of aphasia, provision of aphasia‐friendly information and provision of therapy. Interpretation: Our 11 quality indicators and 3 implementation priorities are the first step to enabling systematic, efficient and person‐centred measurement and quality improvement in post‐stroke aphasia services. Quality indicators will be embedded in routine data collection systems, and strategies will be developed to address implementation priorities. Patient and Public Contribution: Protocol development was informed by our previous research, which explored the perspectives of 23 people living with aphasia about best practice aphasia services. Individuals with lived experience of aphasia participated as expert panel members in our three consensus meetings. We received support from consumer advisory networks associated with the Centre for Research Excellence in Aphasia Rehabilitation and Recovery and the Queensland Aphasia Research Centre. [ABSTRACT FROM AUTHOR]

Objective Nursing care is a unique and indispensable concept for nursing that includes helping to meet the needs of an individual or a group of individuals offered by nurses. This study is aimed to test the validity and reliability of the Turkish version of the Quality Nursing Care Scale (QNCS-T). Materials and Methods The methodological approach employed in this study spanned from April 25, 2021, to May 5, 2021, and enlisted the participation of 347 nurses. Data collection was executed utilizing a "Personal Information Form" and the "Quality Nursing Care Scale (QNCS)." The research comprised two phases: Phase 1 involved the adaptation of the scale, while Phase 2 focused on determining construct validity through confirmatory factor analysis. Reliability was assessed through measures of internal consistency and item-total correlation coefficients. Results and Discussion The adaptation phase yielded affirmative outcomes, affirming the linguistic and content validation of the Turkish version of the scale. Confirmatory factor analysis demonstrated a highly favorable fit for a six-factor model. The Cronbach's alpha coefficient for the entire scale was determined to be 0.93, attesting to its strong internal consistency. Conclusion The Turkish version of the Quality Nursing Scale showed consistently good psychometric properties of reliability and validity. [ABSTRACT FROM AUTHOR]

Background: As the number of people ageing in prison with complex healthcare needs continues to increase, so does the need for palliative care in the restrictive prison context. Palliative care for people in prison is facilitated by correctional officers, and prison- and hospital-based clinicians. A collective analysis of existing research to identify common experiences of these stakeholders globally has not been completed. Aim: To explore the perceptions and experiences of correctional officers and prison- and hospital-based clinicians who facilitate palliative care for people in prison. Design: A systematic review and meta-synthesis. Data sources: Keywords and subject headings related to palliative care and prisons were used to search seven databases with no time limitations. Peer-reviewed research in English, containing qualitative data from stakeholders facilitating palliative care for people in prison were included, and appraised using the CASP tool. Results: Two analytical themes emerged: (i) a prison lens on a palliative approach and (ii) coping complexities. Palliative care is 'translated' into the prison setting according to security and environmental constraints. Stakeholders experienced ethical, personal and professional difficulties, because prison-based palliative care did not align with community norms. Ambiguous policy and expectations regarding prioritising care needs and balancing custodial rules led to role stress. Conclusions: Providing palliative care for people in prison is complex and impacts stakeholders and people in prison with palliative care needs. Supporting person-centred care through a multi-service approach, stakeholder education and standards will improve the quality and accessibility of care. [ABSTRACT FROM AUTHOR]

Purpose: To elucidate the relationship between in-hospital mortality and the institutional factors of intensive care units (ICUs), with a focus on the intensivist-to-bed ratio. Methods: A retrospective cohort study was conducted using a Japanese ICU database, including adult patients admitted between April 1, 2020 and March 31, 2021. We used a multilevel logistic regression model to investigate the associations between in-hospital mortality and the following institutional factors: the intensivist-to-bed ratios on weekdays or over weekends/holidays, different work shifts, hospital-to-ICU-bed ratio, annual-ICU-admission-to-bed ratio, type of hospital, and the presence of other medical staff. Results: The study population comprised 46 503 patients admitted to 65 ICUs. The in-hospital mortality rate was 8.1%. The median numbers of ICU beds and intensivists were 12 (interquartile range [IQR] 8-14) and 4 (IQR 2-9), respectively. In-hospital mortality decreased significantly as the intensivist-to-bed ratio at 10 am on weekdays increased: the average contrast indicated a 20% (95% confidence interval [CI]: 1%-38%) reduction when the ratio increased from 0 to 0.5, and a 38% (95% CI: 9%-67%) reduction when the ratio increased from 0 to 1. The other institutional factors did not present a significant effect. Conclusions: The intensivist-to-bed ratio at 10 am on weekdays had a significant effect on in-hospital mortality. Further investigation is needed to understand the processes leading to improved outcomes. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo evaluate factors associated with a higher completion rate of annual diabetic eye examinations.This retrospective, cross-sectional study included patients diagnosed with diabetes mellitus (DM) who were aged 18–75 years and receiving primary care in a suburban integrated delivery network (IDN). Patient demographic, sociomedical, biometric characteristics, and Healthcare Effectiveness Data and Information Set (HEDIS) measures within the Comprehensive Diabetes Care bundle were extracted from the electronic health record (EHR) and analyzed by using multivariate logistic regression to assess factors associated with completion of an eye exam (retinal) performed during the study year.Among 19,901 primary care patients with DM, 35.15% completed an eye examination in 2021. After adjusting for demographic and biometric characteristics, the two factors most closely associated with completing a diabetic eye examination were having had a primary care office visit (adjusted odds ratio [aOR], 3.525; 95% confidence interval [CI], 3.210–3.871, p < 0.001) or an eye examination in the prior year (aOR, 2.948; 95% CI, 2.752–3.158, p < 0.001). The next most important factor to emerge was having an activated, online patient portal (PP; aOR, 1.737; 95% CI, 1.592–1.896; p < 0.001) or PP recently activated within the prior year (aOR, 1.387; 95% CI, 1.220–1.576, p < 0.001).Surveillance for diabetic retinopathy relies on annual diabetic eye examinations yet adherence to that standard remains unacceptably low. Our study suggests that engagement of patients through an online PP could help increase this rate. [ABSTRACT FROM AUTHOR]

Background Global health care quality improvement efforts have focussed on management practices. However, knowledge in primary care settings, especially in developing countries, such as China, is lacking. Objective To examine the organizational and physician features associated with health care quality in China's community health centres (CHCs). Methods We conducted a cross-sectional survey of 224 primary care physicians (PCPs) in 38 CHCs in Jinan, Tianjin, Shenzhen, and Shanghai. Clinical and prevention care quality with a 5-level scale (1 = never, 5 = always) reported by the PCPs were used to measure the quality of care. Two-level hierarchical linear models were estimated to examine the organization and physician-level variables associated with primary care quality. Results The average clinical care quality score was 4.08 and 3.59 for preventative care out of 5. At the organizational level, organizational culture and organizational support were the strongest predictors of physician-reported quality of care. At the physician level, professional fulfilment, psychological safety, and organizational citizenship behaviour were positively associated with care quality. Conclusions Chinese CHCs clinical quality ranked high by PCPs, but the quality of preventative care provision required improvement. To improve primary care quality, managers of CHCs should implement optimal organizational structures, supportive organizational cultures, and strong organizational support at the organization level and cultivate high professional fulfilment, safe, and trustful relationships with colleagues at the physician level. [ABSTRACT FROM AUTHOR]

Background Many patients present to their family medicine clinic with more than one health concern, placing an increased demand on family physicians. Research into the average number of concerns per regular family medicine visit is limited. Recognition of the frequency that family physicians address more than one concern per visit and adapting practices accordingly is important for improving patient care. Objective To examine whether family physicians routinely address multiple different patient concerns during a single visit and if this is influenced by patient demographics. Methods This study was conducted at a multi-physician family medicine clinic in Regina, Saskatchewan, Canada. Five physicians contributed their 500 most recent charts, extending retrospectively from 1 June 2023, from in-person visits by patients over 18 years of age and billed as regular appointments without billed procedures. Each chart was reviewed for the number of concerns addressed in the visit. Results Fifty percent of visits addressed more than 1 concern (range = 1–8). A generalized linear mixed model using Poisson distribution showed certain physicians (incident rate ratio [IRR]: 1.192, 95% CI: 1.087–1.307, P  < 0.001) and adults older than 65 years compared to adults less than 40 years (IRR 1.151, 95% CI: 1.069–1.239, P  < 0.001) were more likely to present with multiple concerns, but patient sex was not a significant predictor. Conclusions Family physicians routinely address more than one concern per visit. Standard visit length and billing practices should be adapted to reflect this complexity. [ABSTRACT FROM AUTHOR]

Background: Efforts to increase transparency and accountability of nursing homes, and thus improve quality, now include information about changes in nursing home ownership. However, little is known about how change in ownership affects nursing home quality. Methods: We conducted a retrospective cohort study of 15,471 U.S. nursing homes between January 2016 and December 2022, identifying all changes in ownership during that period. We used logistic regression to measure the association between nursing home characteristics and the odds of a change in ownership. A difference‐in‐differences model with multiple time periods was used to examine the impact of a change in ownership on the Medicare Nursing Home Compare 5‐star ratings. Results: One in five (23%) facilities changed ownership between 2016 and 2022. Nursing homes that were urban, for‐profit, part of a chain, located in the South, had >50 beds, lower occupancy, higher percentage of stays covered by Medicaid, higher percentage of residents with non‐white race, or a 1‐star (poor) rating were more likely to undergo a change in ownership. There was a small statistically significant decrease in 5‐star ratings after a change in ownership (−0.09 points on a 5‐point scale; 95% CI −0.13 to −0.04; p < 0.001), driven primarily by a decrease in staffing ratings (−0.19 points; 95% CI −0.24 to −0.14; p < 0.001), and health inspections ratings (−0.07 points; 95% CI −0.11 to −0.03; p = 0.001). This was mitigated by an increase in quality measure ratings (0.15 points; 95% CI 0.10–0.20; p < 0.001). Conclusion: Nursing Home Compare ratings decreased slightly after a change in facility ownership, driven by lower staffing and health inspection ratings and mitigated somewhat by higher quality measure ratings. These conflicting trends underscore the need for transparency around changes in facility ownership and a better understanding of consequences of changes in ownership that are salient to patients and families. [ABSTRACT FROM AUTHOR]

Purpose: Transthyretin amyloid cardiomyopathy (ATTR-CM) is associated with severely impaired health-related quality of life (HRQL). HRQL is an independent predictor of outcome in heart failure (HF), but data on patients with ATTR-CM is scarce. This study therefore aims to evaluate the association of HRQL with outcome in ATTR-CM. Methods: Patients from our prospective ATTR-CM registry were assessed using the Kansas City cardiomyopathy questionnaire (KCCQ), the Minnesota living with HF questionnaire (MLHFQ), and the EuroQol five dimensions questionnaire (EQ-5D). Cox regression analysis was utilised to assess the impact of HRQL on all-cause mortality. Results: 167 patients [80 years; interquartile range (IQR): 76–84; 80.8% male] were followed for a median of 27.6 (IQR: 9.7–41.8) months. The primary endpoint of all-cause mortality was met by 43 (25.7%) patients after a median period of 16.2 (IQR: 9.1–28.1) months. In a univariate Cox regression for mortality, a 10-point change in the KCCQ implied a hazard ratio (HR) of 0.815 [95%-confidence interval (CI): 0.725–0.916; p = 0.001], in the EQ-5D VAS of 0.764 (95%-CI: 0.656–0.889; p < 0.001), and 1.163 (95%-CI: 1.114–1.433; p < 0.001) in the MLHFQ. After adjustment for established biomarkers of HF, all-cause mortality was predicted independently by the EQ-5D VAS (HR: 0.8; 95%-CI: 0.649–0.986; p = 0.037; per 10 points) and the MLHFQ (HR: 1.228; 95%-CI: 1.035–1.458; p = 0.019; per 10 points). Conclusion: HRQL is a predictor of outcome in ATTR-CM. The EQ-5D VAS and the MLHFQ predict survival independent of biomarkers of HF. Plain English Summary: Patients with transthyretin amyloid cardiomyopathy, a condition causing heart failure and mostly seen in the elderly, suffer from shortness of breath and reduced maximum physical performance. Disease assessment is currently based on blood analysis for markers of heart failure. However, standardised patient questionnaires also allow to estimate disease severity. In this study, we analyse different standardised patient questionnaires for their ability to predict adverse events including death and heart failure-related hospitalisations. The analysis demonstrates that an increase of ten points in the Kansas City Cardiomyopathy questionnaire, a tool specifically designed for patients with heart failure, implies a reduction of mortality risk of close to 20%. Interestingly, even the very simple visual analogue scale, a quality-of-life measurement tool which asks the patient to rate their health on a scale from zero (worst) to one hundred (best) has demonstrated remarkable predictive utility. An increase of ten points on this scale resulted in a reduction of risk for death from any cause of almost a quarter. This analysis suggests that standardised patient questionnaires for the assessment of quality of life may play an important role in the evaluation of patients with transthyretin amyloid cardiomyopathy and estimation of prognosis. [ABSTRACT FROM AUTHOR]

Patient-reported outcome measures (PROMs) have emerged as a promising approach to involve patients in their treatment process. Beyond serving as outcome measures, PROMs can be applied to provide feedback to healthcare providers and patients, thereby offering valuable insights that can improve health outcomes and care processes. This overview offers a comprehensive synthesis of the effects of PROM feedback, contributing to the evidence-based discussion on PROMs' potential to enhance patient care. Following Cochrane Collaboration recommendations, this overview included literature reviews across diverse treatment areas, investigating the impact of PROM feedback on patient health outcomes (including quality of life, symptoms, or survival) and care process outcomes (including communication, symptom identification, or clinical practice). The methodological quality of the evidence was assessed with a modified version of A Measurement Tool to Assess Systematic Reviews 2, and the potential overlap of primary studies was quantified. Results were narratively synthesized. Forty reviews grouped into 4 categories of treatment areas were included. Overall, their methodological quality was low. The overall overlap of primary studies was 2.2%, reaching up to 15.7% within specific treatment areas. The results indicate that PROM feedback may enhance the quality-of-care processes, whereas its effects on patient health outcomes remained less conclusive. PROM feedback positively influences the interaction between physicians and patients across the included treatment areas. Further research is needed to comprehend the trickle-down effects of PROM feedback and how to enhance its potential in yielding health benefits for patients. • Primary studies, reviews, and overviews of Patient-Reported Outcome Measure (PROM) feedback are already present, but their research focus is often limited, primarily concentrating on specific treatment areas or individual outcomes. • This comprehensive overview assesses the influence of PROM feedback on both "patient health outcomes," such as quality of life, physical or mental symptoms, and "care process outcomes," such as communication or symptom identification across treatment areas, with no restrictions on single outcome parameters. Additionally, it provides a detailed evaluation of the reviews' methodological quality. • The results indicate that PROM feedback may enhance care process outcomes, whereas its effects on patient health outcomes remained less definitive. For a comprehensive evaluation of effects on treatment quality, clinical parameters should also be considered. Future research should clearly identify the feedback characteristics so that beneficial elements of the feedback system can be identified and PROM feedback interventions continuously improved. [ABSTRACT FROM AUTHOR]

Many Veterans receive Department of Veterans Affairs (VA)-purchased care from non-VA facilities but little is known about factors that Veterans consider for this choice. Between May 2020 and August 2021, we surveyed VA-purchased care-eligible VA patients about barriers and facilitators to choosing where to receive care. We examined the association between travel time to their VA facility and their choice of VA-purchased care (VA-paid health care received in non-VA settings) versus VA facility and whether this association was modified by distrust. We received 1,662 responses and 692 (42%) chose a VA facility. Eighty percent reported quality care was in their top three factors that influenced their decision. Respondents with the highest distrust and who lived >1 hr from the nearest VA facility had the lowest predicted probability (PP) of choosing VA (PP 15%; 95% confidence interval: 10%–20%). Veterans value quality of care. VA and other health care systems should consider patient-centered ways to improve and publicize quality and reduce distrust. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Mental health services report adverse incidents in different ways and the relationship between adverse incidents and the workforce is uncertain. In England, there are national datasets recording all incidents and workforce statistics though there is no peer‐reviewed evidence examining recent trends. What this paper adds to existing knowledge?: Although there has been an overall increase in the number of mental health nurses, more are working in the community and the number of nurses relative to adverse incidents has decreased. There have been service‐provision changes but the role of mental health nurses has not significantly changed in this period, and we can therefore assume that their current practice is saturated with risk or increased reporting. To help understand the relationship between nurses and incidents, we need to transform how incidents are recorded in England. What are the implications for practice?: English mental health services report greater levels of patient‐related factors such as self‐harm or aggression rather than missed or erroneous care. This makes it difficult to understand if a rise in incident frequency is linked to reporting behaviour, patient risk, unsafe/ineffective care or other reasons and therefore planning workforce deployment to improve care quality is problematic. Introduction: There is a paucity of empirical data examining incidents and mental health nurses and the relationship between the two remains uncertain. Aim: Comparison of English national data for incidents and nursing workforce to examine recent trends. Method: Descriptive analysis of two national datasets of incidents and workforce data for England between 2015 and 2022. Results: A 46% increase in incidents was found; the leading causes are self‐harm and aggressive behaviour. Despite the rise in adverse incident reporting, a 6% increase in mental health nurses was found, with more nurses in community settings than hospitals. Discussion: Current services are incident reporting at greater concentrations than in previous years. Patient‐related behaviour continues to be most prominently reported, rather than possible antecedent health services issues that may contribute to reporting. Whilst staffing has increased, this does not seem to have kept pace with the implied workload evident in the increase in incident reports. Implications for Practice: Greater emphasis should be placed on health service behaviour in reporting mechanisms. Self‐harm and aggression should continue to be considered adverse outcomes, but causal health service factors, such as missed care, should be present in pooled reporting to help reduce the occurrence of adverse outcomes. [ABSTRACT FROM AUTHOR]

Objective: The authors sought to update and expand the evidence on the quality of health care and disparities in care among Medicaid beneficiaries with schizophrenia. Methods: Adult beneficiaries of New York State Medicaid with schizophrenia receiving care during 2016–2019 were identified. Composite quality scores were derived from item response theory models by using evidence-based indicators of the quality of mental and general medical health care. Risk-adjusted racial-ethnic differences in quality were estimated and summarized as percentiles relative to White beneficiaries' mean quality scores. Results: The study included 71,013 beneficiaries; 42.8% were Black, 22.9% Latinx, 27.4% White, and 6.9% other race-ethnicity. Overall, 68.8% had a mental health follow-up within 30 days of discharge, and 90.2% had no preventable hospitalizations for chronic obstructive pulmonary disease or asthma. Among beneficiaries receiving antipsychotic medications, medication adherence was adequate for 43.7%. Fourteen indicators for mental and general medical health care quality yielded three composites: two for mental health care (pharmacological and ambulatory) and one for acute mental and general medical health care. Mean quality of pharmacological mental health care for Black and Latinx beneficiaries was lower than for White beneficiaries (39th and 44th percentile, respectively). For Black beneficiaries, mean quality of ambulatory mental health care was also lower (46th percentile). In New York City, Black beneficiaries received lower-quality care in all domains. The only meaningful group difference in the quality of acute mental and general medical health care indicated higher-quality care for individuals with other race-ethnicity. Conclusions: Disparities in the quality of Medicaid-financed health care persist, particularly for Black beneficiaries. Regional differences merit further attention. [ABSTRACT FROM AUTHOR]