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Background: The barriers to providing high-quality inflammatory bowel disease (IBD) care go beyond educational needs alone to include access to IBD-related resources such as medications, laboratory testing, and multidisciplinary teams. We assessed the needs and resource constraints of physicians caring for Veterans with IBD to inform efforts to improve access to high-quality care. Methods: We conducted a national observational survey study in July 2021 of gastroenterologists (GIs) and primary care providers (PCPs) caring for Veterans with IBD within the Veterans Health Administration with the intent of including physicians from all 18 Veterans Integrated Service Networks (VISN). We reported descriptive statistics and compared responses between gastroenterologists (GIs) and primary care providers (PCPs), practice locations, and years of experience using χ2 tests. Results: Overall, 173 of 2241 eligible physicians completed the survey, representing an individual physician response rate of 7.7% and VISN response rate of 18 out of 18 (100%). We identified several areas of IBD care where GIs and PCPs reported discomfort including medication prescribing, treatment strategies, and special populations. Further, variability in access to IBD services and awareness of the availability of IBD-targeted medications and laboratory tests was common. This survey also highlights the frequency with which PCPs were identified among the highest volume IBD providers in their facility. Conclusions: Variation in GIs' and PCPs' comfort with IBD treatment and access to IBD resources is common and needs to be considered in leveraging virtual care and educational programs and managing the expansion of IBD support and resources within VA. [ABSTRACT FROM AUTHOR]

Context: Providing high-quality care to older people living in long-term care homes requires consideration of their cultural backgrounds and spiritual beliefs. Objective: To ascertain the views of key informants from Australian culturally and linguistically diverse (CALD), Aboriginal and Torres Strait Islander (ATSI), and spiritual care organisations about providing high-quality cultural and spiritual care in long-term care homes. Method: Semi-structured interviews were undertaken with seven representatives of these Australian organisations. Interview transcripts were thematically analysed. Findings: The importance of cultural and spiritual care to older people living in long-term care was acknowledged. However, it was noted that this care for older people from diverse CALD, ATSI, and spiritual backgrounds was often absent due to staff ignorance, lack of awareness, and assumptions. Staff need further education to provide culturally and spiritually appropriate care; long-term care homes need to incorporate an organizational approach to providing culturally and spirituality appropriate care; and staff should be encouraged to consult experts in cultural and spiritual care when the care they provide is insufficient. Cultural and spiritual care champions may be an appropriate way of disseminating knowledge and establishing a culturally and spiritually aware workforce. Limitations: The small number of existing Australian cultural and spiritual care organisations, and the smaller number of representatives within these organisations who have experience with older people living in long-term care homes, limited the number of eligible participants. Implications for practice • Long-term care homes must invest in comprehensive education to better equip staff to provide high-quality cultural and spiritual care to older people. • Education should assist staff in identifying the range of life areas to which culture and spiritual care have relevance and how to apply appropriate knowledge. Staff should be aware of the available guidelines about culturally and spiritually informed care; and recognise when to consult experts. • Workplace champions can provide and encourage an ethos where culture and spirituality are considered in everyday care.

Abstract Background Home-based healthcare is considered crucial for the sustainability of healthcare systems worldwide. In the homecare context, however, adverse events may occur due to error-prone medication management processes and prevalent healthcare-associated infections, falls, and pressure ulcers. When dealing with risks in any form, it is fundamental for leaders to build a shared situational awareness of what is going on and what is at stake to achieve a good outcome. The overall aim of this study was to gain empirical knowledge of leaders’ risk perception and adaptive capacity in homecare services. Methods The study applied a multiple case study research design. We investigated risk perception, leadership, sensemaking, and decision-making in the homecare services context in three Norwegian municipalities. Twenty-three leaders were interviewed. The data material was analyzed using thematic analysis and interpreted in a resilience perspective of work-as-imagined versus work-as-done. Results There is an increased demand on homecare services and workers’ struggle to meet society’s high expectations regarding homecare’s responsibilities. The leaders find themselves trying to maneuver in these pressing conditions in alignment with the perceived risks. The themes emerging from analyzed data were: ‘Risk and quality are conceptualized as integral to professional work’, ‘Perceiving and assessing risk imply discussing and consulting each other– no one can do it alone’ and ‘Leaders keep calm and look beyond the budget and quality measures by maneuvering within and around the system’. Different perspectives on patients’ well-being revealed that the leaders have a large responsibility for organizing the healthcare soundly and adequately for each home-dwelling patient. Although the leaders did not use the term risk, discussing concerns and consulting each other was a profound part of the homecare leaders’ sense of professionalism. Conclusions The leaders’ construction of a risk picture is based on using multiple signals, such as measurable vital signs and patients’ verbal and nonverbal expressions of their experience of health status. The findings imply a need for more research on how national guidelines and quality measures can be implemented better in a resilience perspective, where adaptive capacity to better align work-as-imagined and work-as-done is crucial for high quality homecare service provision.

Abstract Background The COVID-19 pandemic is one of the worst health catastrophes of the last century, which caused severe economic, political, and social consequences worldwide. Despite these devastating consequences, lessons learned provide a great opportunity that can drive the reform of health systems to become high-performing, effective, equitable, accessible, and sustainable organisations. This work identifies areas in which changes must be encouraged that will enable health systems to deal effectively with current and future challenges, beyond COVID-19. Methods A realist design was chosen, based on qualitative data collection techniques, content analysis and triangulation to identify key domains of organizational interventions behind the changes implemented to react to the COVID-19 pandemic in the Basque Country. Twenty key informants were used as an expert source of information. Thematic analysis was done using the Framework Method. Results The analysis of the interviews resulted in the identification of 116 codes, which were reviewed and agreed upon by the researchers. Following the process of methodological analysis, these codes were grouped into domains: seven themes and 23 sub-themes. Specifically, the themes are: responsiveness, telehealth, integration, knowledge management, professional roles, digitisation, and organisational communication. The detailed description of each theme and subtheme is presented. Conclusions The findings of this work pretend to guide the transformation of health systems into organisations that can improve the health of their populations and provide high quality care. Such a multidimensional and comprehensive reform encompasses both strategic and operational actions in diverse areas and requires a broad and sustained political, technical, and financial commitment.

Background: The COVID-19 pandemic is one of the worst health catastrophes of the last century, which caused severe economic, political, and social consequences worldwide. Despite these devastating consequences, lessons learned provide a great opportunity that can drive the reform of health systems to become high-performing, effective, equitable, accessible, and sustainable organisations. This work identifies areas in which changes must be encouraged that will enable health systems to deal effectively with current and future challenges, beyond COVID-19. Methods: A realist design was chosen, based on qualitative data collection techniques, content analysis and triangulation to identify key domains of organizational interventions behind the changes implemented to react to the COVID-19 pandemic in the Basque Country. Twenty key informants were used as an expert source of information. Thematic analysis was done using the Framework Method. Results: The analysis of the interviews resulted in the identification of 116 codes, which were reviewed and agreed upon by the researchers. Following the process of methodological analysis, these codes were grouped into domains: seven themes and 23 sub-themes. Specifically, the themes are: responsiveness, telehealth, integration, knowledge management, professional roles, digitisation, and organisational communication. The detailed description of each theme and subtheme is presented. Conclusions: The findings of this work pretend to guide the transformation of health systems into organisations that can improve the health of their populations and provide high quality care. Such a multidimensional and comprehensive reform encompasses both strategic and operational actions in diverse areas and requires a broad and sustained political, technical, and financial commitment. [ABSTRACT FROM AUTHOR]

Background: Home-based healthcare is considered crucial for the sustainability of healthcare systems worldwide. In the homecare context, however, adverse events may occur due to error-prone medication management processes and prevalent healthcare-associated infections, falls, and pressure ulcers. When dealing with risks in any form, it is fundamental for leaders to build a shared situational awareness of what is going on and what is at stake to achieve a good outcome. The overall aim of this study was to gain empirical knowledge of leaders’ risk perception and adaptive capacity in homecare services. Methods: The study applied a multiple case study research design. We investigated risk perception, leadership, sensemaking, and decision-making in the homecare services context in three Norwegian municipalities. Twenty-three leaders were interviewed. The data material was analyzed using thematic analysis and interpreted in a resilience perspective of work-as-imagined versus work-as-done. Results: There is an increased demand on homecare services and workers’ struggle to meet society’s high expectations regarding homecare’s responsibilities. The leaders find themselves trying to maneuver in these pressing conditions in alignment with the perceived risks. The themes emerging from analyzed data were: ‘Risk and quality are conceptualized as integral to professional work’, ‘Perceiving and assessing risk imply discussing and consulting each other– no one can do it alone’ and ‘Leaders keep calm and look beyond the budget and quality measures by maneuvering within and around the system’. Different perspectives on patients’ well-being revealed that the leaders have a large responsibility for organizing the healthcare soundly and adequately for each home-dwelling patient. Although the leaders did not use the term risk, discussing concerns and consulting each other was a profound part of the homecare leaders’ sense of professionalism. Conclusions: The leaders’ construction of a risk picture is based on using multiple signals, such as measurable vital signs and patients’ verbal and nonverbal expressions of their experience of health status. The findings imply a need for more research on how national guidelines and quality measures can be implemented better in a resilience perspective, where adaptive capacity to better align work-as-imagined and work-as-done is crucial for high quality homecare service provision. [ABSTRACT FROM AUTHOR]

Coordination across healthcare system levels is a global imperative to ensure efficient resource utilization and provide high‐quality care. The substantial body of research on coordination in healthcare mainly concerns coordination across professional and organizational domains. Consequently, there is a dearth of empirical research aimed at delineating the determinants of coordination across healthcare system levels. This paper describes and analyses the barriers and enablers of healthcare coordination across national, regional, and local system levels in a populous Swedish region. Individual interviews and focus group discussions, encompassing a total of 63 individuals, were conducted with managers, administrators, and politicians. The findings of the paper underscore that the barriers identified were most often of a structural or institutional character, whereas the enablers of the studied cross‐level coordination were mostly relational. Therefore, we propose that future research should aim to further delineate the prerequisites for personal relationships to emerge, as well as how they may act as enablers of coordination across healthcare system levels. [ABSTRACT FROM AUTHOR]

Objective: To determine the feasibility of a flexible visitation system in the intensive care unit (ICU). Methods: A randomized, open-label, parallel group clinical trial was conducted. All patients admitted to the ICU of the Lanzhou University Second Hospital from April to June 2022 were enrolled. The enrolled patients were randomly divided into an experimental group and a control group according to a computer-generated random sequence table. Results: A total of 410 patients were admitted. According to the inclusion and exclusion criteria, 140 patients were included in the experimental group (flexible visitation group) and 140 in the control group (normal visitation group). The average number of visitation minutes per day between the experimental group and the control group was 24.7 versus 23.9 min (p > 0.05).Among the outcome indicators, delirium occurred in 8 (5.7%) patients in the intervention group and in 24 (17.1%) patients in the control group (p = 0.003). Five complaints (mainly pressure ulcers) were received, with one in the experimental group and the others in the control group. There were 28 cases of nosocomial infection in the experimental group and 29 cases in the control group; therefore, the incidence of nosocomial infection was 20% versus 20.7% (p = 0.882). A total of 280 questionnaires were collected, with a retrieval rate of 100%. The satisfaction of patients in the experimental group and the control group was 98.6% and 92.1%, respectively (p = 0.011). The flexible visiting system reduced the ICU length of stay (LOS). The ICU LOS of the experimental group was 6 versus 8 days for the control group (p = 0.041). However, the flexible visiting system did not reduce the hospital stay (17 vs. 19 days, p = 0.923). Conclusion: Conducting a flexible visitation system in ICUs could reduce the incidence of delirium in critically ill patients and improve the quality of nursing care; furthermore, the rate of nosocomial infections was not increased. These findings need to be further verified by a multicentre, large-scale clinical trial. [ABSTRACT FROM AUTHOR]

Background: To explore the effect of high-quality nursing model based on hope theory in endometrial cancer patients. Methods: The patients (n = 120) with endometrial cancer who underwent surgical treatment in hospital from October 2017 to October 2019 were divided into the study group and control group using the random number table method. The patients received usual care in the control group, and received high-quality nursing based on hope theory in the study group. Then, the degree of pain, fatigue, anxiety and depression were evaluated using visual analogue scale (VAS), chronic pain self-efficacy scale (CPSS), cancer fatigue scale (RPFS), self-rating anxiety scale (SAS) and self-rating depression scale (SDS). The hope level and coping style were assessed using Herth hope scale (HHI) and summary coping style questionnaire (SCSQ). The quality of life was assessed using Medical Outcomes Study item short from health survey (SF-36). Moreover, nursing satisfaction was compared using homemade questionnaire. Results: The results showed that VAS score, RPFS score, SDS score and passive coping score of SCSQ questionnaire in the study group were lower than those in the control group (p < 0.05). CPSS score, HHI score, positive coping score of SCSQ questionnaire, nursing satisfaction and SF-36 scores in all dimensions in the study group were higher than those in the control group (p < 0.05). Discussion: The high-quality nursing model based on hope theory could ameliorate patients’ pain and fatigue, enhance their self-efficacy, guide patients to face problems positively, improve their life quality and hope level. Conclusion: It has higher nursing satisfaction in endometrial cancer.

Background. Rising health costs and health inequity are major challenges in Australia, as internationally. Strong primary health care is well evidenced to address these challenges. Primary Health Networks (PHNs) work with general practices to collect data and support quality improvement; however, there is no consensus regarding what defines high quality. This paper describes the development of an evidence-based suite of indicators and measures of high-quality general practice for the Australian context. Methods. We reviewed the literature to develop a suitable framework and revise quality assurance measures currently in use, then reviewed these in three workshops with general practitioners, practice managers, nurses, consumers and PHN staff in western Sydney. We used a descriptive qualitative research approach to analyse the data. Results. A total of 125 evidence-based indicators were agreed to be relevant, and 80 were deemed both relevant and feasible. These were arranged across a framework based on the Quadruple Aim, and include structure, process and outcome measures. Conclusions. The agreed suite of indicators and measures will be further validated in collaboration with PHNs across Australia. This work has the potential to inform health systems innovation both nationally and internationally. [ABSTRACT FROM AUTHOR]

When dementia is diagnosed or when a person with dementia is admitted to hospital as an emergency, the first thought of many families is that the person with dementia will not be able to remain at home. This is not necessarily the case, as some people will be able to stay in their familiar surroundings. This article explores ways to support people with dementia to do that. [ABSTRACT FROM AUTHOR]

There are several interlocking elements integral to the delivery of safe patient care, including clinical governance, efficient communication, teamwork, risk assessment, inter-professional education and effective leadership. Each element can be challenging to understand, develop, or act on, but it is essential that nurses use these as opportunities to ensure their specialty or service delivers safe and high-quality care. This article discusses each of these elements and its relationship to quality patient care, with specific reference to the role of children's nurses. [ABSTRACT FROM AUTHOR]

Congenital heart disease (CHD) is the most common birth defect. About two-thirds of those individuals living with CHD are now adults. If you do not have in-depth knowledge of CHD, knowing what questions to ask and what resources to use can improve patient outcomes and satisfaction with care. [ABSTRACT FROM AUTHOR]

Through focus groups and a written activity, this study explores and compares 41 low-income Maryland parents' childcare priorities and definitions of ideal high-quality care. Features of ideal high-quality care identified by parents align with professional standards and with descriptions found in existing literature, though parents' operationalized definitions of quality varied, and their expectations were lower than most professional standards. There was also strong alignment between identified features of high-quality care and parents' priorities in their most recent childcare searches, though parents focused less on structured learning opportunities when discussing childcare priorities and more on practical features of care. Most features of care discussed by parents are included in Maryland's Quality Rating and Improvement System (QRIS), though some of the specific elements parents cited are not included. Findings from this study could be used to inform marketing and design of consumer-education campaigns, QRIS, and survey development. [ABSTRACT FROM PUBLISHER]

The article presents the viewpoint of the author on the risks associated with rewards in health care system of the U.S. He talks about "Pay-for-performance" incentive program and discusses how it could threaten or support, medical professionalism. He informs that pay-for-performance, aims to pay doctors more when they deliver higher-quality care. Also he infers that health-care professionals should be paid in such a manner so that they can feel motivated to provide high-quality care.

Simple Summary: We conducted a review to identify important symptoms reported by patients on questionnaires (e.g., pain) that can be used to compare cancer centers on how well they provide care. For example, cancer centers could be compared on the percentage of patients with controlled pain after adjusting for demographic and clinical characteristics. Standard review methods were used to identify studies through August 2020. Searches generated 1813 articles and 1779 were coded as not relevant. The remaining 34 studies showed that patients, caregivers, clinicians, and healthcare administrators identify psychosocial care (e.g., distress) and symptom management as critical parts of high-quality care. Patients and caregivers also perceive that maintaining physical function and daily activities are important. Clinicians and healthcare administrators perceive control of specific symptoms to be important (e.g., pain, poor sleep, diarrhea). Results were used to inform testing of symptom questionnaires to compare the quality of care provided by six cancer centers. Performance measurement is the process of collecting, analyzing, and reporting standardized measures of clinical performance that can be compared across practices to evaluate how well care was provided. We conducted a systematic review to identify stakeholder perceptions of key symptoms and health domains to test as patient-reported performance measures in oncology. Stakeholders included cancer patients, caregivers, clinicians, and healthcare administrators. Standard review methodology was used, consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). MEDLINE/PubMed, EMBASE, and the Cochrane Library were searched to identify relevant studies through August 2020. Four coders independently reviewed entries and conflicts were resolved by a fifth coder. Efficacy and effectiveness studies, and studies focused exclusively on patient experiences of care (e.g., communication skills of providers) were excluded. Searches generated 1813 articles and 1779 were coded as not relevant, leaving 34 international articles for extraction. Patients, caregivers, clinicians, and healthcare administrators prioritize psychosocial care (e.g., distress) and symptom management for patient-reported performance measures. Patients and caregivers also perceive that maintaining physical function and daily activities are critical. Clinicians and administrators perceive control of specific symptoms to be critical (gastrointestinal symptoms, pain, poor sleep). Results were used to inform testing at six US cancer centers. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the influence of high-quality care on the psychological well-being, the postoperative complications, and patient satisfaction following a radical mastectomy., Methods: One hundred and eighteen breast cancer patients who underwent radical mastectomies from February, 2017 to May, 2019 in the Cancer Hospital of China Medical University were enrolled. Among them, 56 patients treated with regular care were included in the regular group, while the other 62 patients who underwent high-quality care were included in the high-quality group. The postoperative recoveries and complications were compared between the two groups. The visual analogue scale (VAS), the disabilities of the arm, shoulder and hand (DASH) questionnaire, the self-rating anxiety scale (SAS), the self-rating depression scale (SDS), the quality of life (QOL) assessment scale, and a patient satisfaction questionnaire were used to evaluate the degrees of pain, the upper limb recovery, the negative emotions, the QOL, the patient satisfaction and the two-year survival rate, respectively., Results: The ambulation times, the regression times of upper limb swelling, and the hospital stays in the high-quality group were remarkably shorter than they were in the regular group (P<0.05). The postoperative complications were less frequent in the high-quality group (P<0.05). The VAS scores in the high-quality group were lower than they were in the regular group at 1, 3, and 5 days after surgery, and the DASH scores in the high-quality group were lower at 1 month after discharge (P<0.05). The high-quality group showed lower SAS and SDS scores and higher QOL and patient satisfaction than the regular group (all P<0.05). There was no difference in the two-year survival rates between the two groups after the intervention (P>0.05)., Conclusion: High-quality care following a radical mastectomy contributes to postoperative recovery, the relief of negative emotions, the reduction of complications, as well as the enhancement of QOL and patient satisfaction, so it is worthy of clinical promotion., Competing Interests: None., (AJTR Copyright © 2021.)

Reliable venous access should be part of the clinical-therapeutic path of all cancer patients. A correct preliminary ultrasound evaluation of the patient's veins and the choice of the suitable vein are the fundamental requirements to guarantee a stable and long-lasting venous access.

Objectives: To evaluate the effect of high-quality care on limb function recovery and quality of life (QOL) after osteoporotic hip fracture (OHF) surgery in the elderly., Methods: 116 elderly patients with OHF enrolled in our hospital from January 2017 to December 2019 were assigned into observation group (high-quality care, n=58) and control group (routine care, n=58). After one month of intervention, Harris Hip Score (HHS) and Barthel Index (BI) were used to evaluating limb function and self-care ability, pain intensity numerical rating scale (PINRS) for pain assessment, self-rating anxiety scale (SAS), and self-rating depression scale (SDS) for emotion assessment. Besides, postsurgical complications, QOL and patient satisfaction were examined., Results: HHS and BI were higher in observation group (P<0.05); PINRS, SAS and SDS were lower in observation group (P<0.05); incidence of postsurgical complications in the observation group was significantly lower than that in the control group (P<0.05); QOL and patient satisfaction in the observation group were higher than those in the control group (P<0.05)., Conclusion: High-quality care promotes the recovery of limb function, the QOL and the satisfaction of elderly patients., Competing Interests: The authors have no conflict of interest.

Objective: To explore the effect of high-quality care on the recovery of joint function and quality of life (QOL) for patients who were treated using Mongolian medicine to treat their clavicle fractures., Methods: A total of 167 patients with clavicle fractures who were treated using Mongolian manual reduction in our hospital were placed into a study group (n = 84, high-quality care) or a control group (n = 83, routine care). The two groups' joint function recoveries, their QOL, and their related indicators were compared., Results: After the nursing intervention, the patients in the study group had complete control over their health education, and their Minnesota Job Satisfaction Questionnaire (MSQ) scores, their shoulder joint function effective recovery rates, and their patient satisfaction scores were significantly higher than they were in the control group (P < 0.05). The patients in the study group had a higher demand for the nursing staff' s knowledge and skills and health guidance, rather than service attitude, care and communication and patient feelings (P < 0.05). After the nursing intervention, the quality of life improved in the two groups (P < 0.05), and the improvement in the study group was greater (P < 0.05). The nursing error rate s and the patient complaint rate in the study group were significantly lower than they were in the control group (P < 0.05)., Conclusion: High-quality care can effectively improve the quality of life and nursing satisfaction of patients with clavicle fractures who are treated using Mongolian medical techniques, and it can significantly promote the recovery of their joint function., Competing Interests: None., (AJTR Copyright © 2021.)