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Background: Women Veterans with co-morbid medical and mental health conditions face persistent barriers accessing high-quality health care. Evidence-based quality improvement (EBQI) offers a systematic approach to implementing new care models that can address care gaps for women Veterans. Objective: This study examines factors associated with the successful deployment of EBQI within integrated health systems to improve primary care for women Veterans with complex mental health needs. Design: Following a 12-site (8 EBQI, 4 control) cluster randomized study to evaluate EBQI effectiveness, we conducted an in-depth case study analysis of one women's health clinic that used EBQI to improve integrated primary care–mental health services for women Veterans. Participants: Our study sample included providers, program managers, and clinic staff at a women Veteran's health clinic that, at the time of the study, had one Primary Care and Mental Health Integration team and one women's health primary care provider serving 800 women. We analyzed interviews conducted 12 months, 24 months, and 4 years post-implementation and call summaries between the clinic and support team. Main Measures: We conducted qualitative thematic analysis of interview and call summary data to identify EBQI elements, clinic characteristics, and reported challenges and successes within project development and execution. Key Results: The clinic harnessed core EBQI elements (multi-level stakeholder engagement, data-driven progress-monitoring, PDSA cycles, sharing results) to accomplish pre-defined project goals, strengthen inter-disciplinary partnerships, and bolster team confidence. Clinic characteristics that facilitated implementation success included prior QI experience and an organizational culture responsive to innovation, while lack of pre-existing guidelines and limited access to centralized databases posed implementation challenges. Conclusions: Successful practice transformation emerges through the interaction of evidence-based methods and site-specific characteristics. Examining how clinic characteristics support or impede EBQI adaptation can facilitate efforts to improve care within integrated health systems. [ABSTRACT FROM AUTHOR]

Objective: In the current study we evaluated the impact of the number of examination subjects and the length of teaching duration on student performance in the fourth professional examination. Study Design: Comparative cross-sectional study. Place and duration of Study: Shifa College of Medicine, Islamabad from 1 Jan 2021 to 30 June 2022. Materials and Methods: The study enrolled 220 students from the batches of year 2021 and 2022. We analysed the effect of duration of the clinical teaching (2 years vs. 3 years) and the effect of number of examining subjects in professional examination (3 subjects vs. 4 subjects) on the students' final scores. The data was analysed by SPSS version 23.0. The mean scores and standard deviation for theory and objectively structured clinical exam (OSCE) were compared using independent sample t-test. The results were also compared for the number of failing students and high scores (> 80 %) between two study cohorts. The p value of ≤ 0.05 was considered statistically significant. Results: No statistically significant difference was found in the scores of ophthalmology theory /OSCE, gynaecology & obstetrics (OB/GYN), ENT theory and pediatric OSCE. The mean scores were significantly better in OB/GYN OSCE (p value < 0.015) and ENT OSCE (p value

This research aims to explore the potential of online service innovations in the public sector in Indonesia to improve the quality of public services. The study employs a mixed-methods approach, including surveys, interviews, and case studies, to gather data from various public sector organizations in Indonesia. The results indicate that the development of online service innovations has the potential to improve the quality of public services, particularly in terms of accessibility, efficiency, and effectiveness. The study also identifies several challenges in implementing online service innovations, including technical issues, limited resources, and resistance to change. The findings suggest that public sector organizations in Indonesia should prioritize the development of online service innovations as part of their efforts to improve the quality of public services. This research provides valuable insights for policymakers and practitioners who are interested in enhancing public service delivery through the use of technology.

Screening significantly decreases the severity and incidence of conditions, as well as mortality, and therefore can improve the health of the population. Screening in Poland falls below the acceptable level of 45% of organised screening uptake and the recommended level of 65%. Multidimensional factors have been implicated as barriers and facilitators of screening uptake in the primary care setting. This paper summarises the existing evidence on factors influencing screening uptake in a Pap smear for cervical cancer (CC), mammography screening for breast cancer and faecal occult blood test (FOBT) for colorectal cancer (CRC). We performed a literature search in the MEDLINE (PubMed) and EMBASE databases and included articles of any study design published between 2010 and 2020. We also demonstrate the original concept of ‘Ugly Value’, which describes factors that may reduce screening uptake. Primary care practitioners play a vital role in increasing screening rates in the populations and can improve these rates through a variety of systematically implemented strategies and interventions. We determine four areas to improve cancer screening uptake in primary healthcare institutions: data gathering and data use (IT systems, meaningful use of Electronic Health Records to generate reminders, prompting healthcare professionals to refer patients for screening), cost effectiveness (avoiding overuse of screening in low-risk populations), innovative efficient management (use of effective interventions and thoughtful allocation of resources, e.g. engaging nurses into patient navigation instead of assigning them to answer patient concerns about screening by telephone), organisational system (team based, integrated care and patient navigation are ways to improve screening rates).

Objective: To investigate demographics, clinical patterns and outcomes of rapid response reviews in hospital, reviewing indications for and outcomes of rapid response reviews initiated for clinical concern and to understand the role of clinical concern in identifying the deteriorating patient and at-risk patient populations. Method: This was a retrospective analysis of General Medical inpatients at Alfred Hospital from 1 January 2018 to 31 July 2020. Data extraction from electronic medical records identified patients who had a rapid response review during admission. Demographic and clinical data, investigations and clinical outcomes from rapid response reviews were investigated. Comparisons were performed using χ 2 or Fisher's exact test where appropriate. Odds ratios and 95% confidence intervals were calculated for factors associated with rapid response reviews for clinical concern and clinical outcomes. Results: There were 10 797 admissions of 7409 individual patients. There were 2359 rapid response reviews during the study period, occurring in 13% of admissions. Patients were majority female (50.4%), and the median age was 79 ± 17.6 years. Rapid response reviews were for cardiovascular (46.8%), respiratory (25.3%) and neurological (14.3%) indications. A total of 11% of rapid response reviews (n = 258) were for clinical concern. Inpatient falls accounted for a significant proportion of rapid response reviews for clinical concern. Reviews were more common in older patients, those admitted after-hours, and patients with disabilities. The latter group were more likely to have rapid response reviews for clinical concern. Rapid response reviews initiated for clinical concern were more likely than those initiated for standard criteria to change patients' clinical status, particularly the withdrawal of active management. Conclusions: Rapid response reviews for clinical concern are important triggers to identify clinical deterioration in vulnerable patients. Reviews were initiated for clinical concern were more likely than those initiated for standard criteria to result in a change in patients' resuscitation status and care trajectory. Clinician concern, even when prompting review for parameters outside of standard clinical review criteria, remains an important factor in recognising the deteriorating patient. What is known about the topic? Rapid response reviews, including those initiated for clinician gestalt for clinical concern, are important tools to identify deteriorating patients in the inpatient setting. What does this paper add? Rapid response reviews for clinical concern are of particular relevance in vulnerable populations and may be important in identifying deteriorating patients and reassessing care trajectory. What are the implications for practitioners? Clinical concern may be just as clinically relevant as rapid response reviews prompted by standard criteria, especially in vulnerable populations. This might prompt investigation of better identifiers and tools for escalation of concerns for vulnerable patients, which may improve outcomes in this patient group. [ABSTRACT FROM AUTHOR]

Claudia Zemmrich,1 Peter Bramlage,2 Philipp Hillmeister,3 Mesud Sacirovic,3 Ivo Buschmann3 1Deutsche Angiologie-CRO, Berlin, Germany; 2Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany; 3Department of Angiology, Medical University Brandenburg, Brandenburg, GermanyCorrespondence: Claudia ZemmrichDeutsche Angiologie CRO (DA-CRO), Straubinger Strasse 20, Berlin, 12683, GermanyTel +49 178 7152405Email claudia.zemmrich@da-cro.deIntroduction: Coronary artery disease (CAD) and peripheral arterial disease (PAD) account for significant morbidity and mortality in Germany and are more prevalent in rural, non-metropolitan areas. The goal of this study is to screen patients for their current atherosclerotic status, initiate treatment according to the latest scientific findings using a standardised multimodal approach and track their atherosclerotic status over one year.Methods and Analysis: This manuscript describes the study protocol of a prospective, multicentre registry of 500 sequential patients with CAD and/or PAD in rural, non-metropolitan regions of Germany. Patients, who visit the “WalkByLab” at the Brandenburg Medical School, Brandenburg, Germany, will be assessed by using our structured, multimodal risk factor management (SMART) tool to evaluate cardiovascular morbidity data, collect information on care and deliver multimodal therapy. The study’s primary objective is a cross-sectional examination of the risk profile, diagnostic and therapeutic status in this patient group. Secondary objectives include the assessment of risk factor correlations as well as changes in risk-factor profile and therapy adherence. Patients will be examined at baseline and followed up at three-monthly intervals for one year. Over this time, atherosclerotic risk factors and patient adherence to defined therapeutic strategies will be evaluated. Study completion is estimated to be December 2021. An expansion of this concept into other rural, non-metropolitan neighbouring regions is planned.Ethics and Dissemination: This registry was assessed and approved by the ethics committee of the Brandenburg State Medical Association, Brandenburg, Germany, and conducted in accordance with the Declaration of Helsinki. The study findings will be disseminated through usual academic channels including meeting presentations and peer-reviewed publications.Protocol Version: 1.0.Keywords: coronary artery disease, peripheral arterial disease, atherosclerosis, rural, risk factor, quality improvement

Poor quality records management in Sri Lankan Hospital offices is a major dissatisfaction and demotivation for healthcare staff. An intervention research project to improve the record management of selected Human Resource (HR) records of nurses in an Office of a Tertiary Care Hospital in Sri Lanka was carried out to identify the gaps, implement improvements and to test the outcome. Grade promotion and annual increment HR processes considered for the improvements. Qualitative and quantitative techniques used for gap identification, planning of interventions and assessment of the effectiveness. A package of quality improvements initiatives implemented following literature review and stakeholder participation. Absence of instructions/sample filled-forms and issues in the document flow were the inconsistencies noted. The record processing time was 30.83 days with an SD of ±4.84 for completion of annual increments and 24.33 days with an SD of ±4.21 for authorisation of grade promotions. The package of interventions included e-based/ paper-based guides and specimen request forms and a document movement register to track the records. Increased accessibility, accuracy, improved quality, timeliness and improved traceability of submitted forms and improvements in the average time spent for annual increments and grade promotions noted; 17.52 days (SD ±3.39) and 12.13 days (SD ±2.33) respectively, a statistically significant reduction (p

RESUMO Introdução: O acompanhamento e a avaliação continuada das ações desenvolvidas na Assistência Farmacêutica são estratégias para a busca da qualidade, especialmente no âmbito hospitalar. Uma boa avaliação visa reduzir incertezas, melhorar a efetividade das ações e propiciar a tomada de decisões relevantes auxiliando na gestão dos serviços. Objetivos: Elaborar uma matriz de avaliação e monitoramento da farmácia de uma instituição hospitalar. Método: Trata-se de um estudo avaliativo. Para a elaboração e validação de conteúdo foram desenvolvidas as seguintes etapas: revisão bibliográfica, proposição das dimensões e elaboração de indicadores, grupo focal com especialistas para validação e priorização das dimensões e aplicação da técnica delphi aos indicadores para relevância e valoração. O coeficiente alfa de Cronbach foi utilizado para medir a confiabilidade dos indicadores. O estudo foi desenvolvido no contexto da farmácia de um hospital de grande porte no Estado do Rio Grande do Sul. Resultados: Foram identificadas cinco dimensões para a avaliação da Farmácia Hospitalar e 70 indicadores, distribuídos da seguinte maneira: Gestão da Assistência (n=15), Gestão dos Recursos Humanos (n=13), Gestão do Medicamento (n=13), Gestão Financeira (n=12) e Gestão da Clínica dos Pacientes (n=17). A dimensão Gestão do Medicamento foi priorizada pelos especialistas, finalizada com nove indicadores. Conclusão: O estudo evidenciou a importância da avaliação para a gestão da Farmácia Hospitalar e a capacidade de execução de métodos de consenso para indicadores de qualidade em serviços de alto nível de complexidade. O instrumento com os indicadores desenvolvidos para dimensão Gestão do Medicamento mostrou evidência de validade e uma boa confiabilidade.

Background and Objectives: Safety and health of employees is one of the top priorities of human resource managers in every organization. In the meantime, hospital staffs are exposed to various occupational hazards, including different types of infections, stressors, allergen materials, and so on. Therefore, the need for a health care and monitoring plan is one of the most important management programs. The present study was performed with the purpose of designing a staff health management process in hospitals. Methods: This qualitative study was carried out as a grounded theory study by purposeful sampling among the experts of healthcare management, occupational health, and HSE group in Tohid Hospital in Bushehr province. Data were collercted using in-depth interview questions. The number of participants with theoretical saturation of interview data was considered 15 subjects, but for sure, 20 interviews were performed. The duration of each interview was 40 to 50 minutes. The validation was performed using reliability, portability, reliability, and verifiability methods. The data were analyzed using Straus Corbin method. Results: In this study, 135 primary codes and 6 main categories, including interfering factors, causal factors, pivotal phenomenon, performance strategies, contextual requirements, and functional outcomes, were extracted. The components of employee health consisted of rules and requirements management, management of environmental hazards identification, accident management, employees’ safety management, and preventive measures. Conclusion: The proposed model can be used as a tool for the hospital staff health management. Management of the hospital staff health requires a coherent and efficient plan, which must be continuously and consistently implemented, controlled, and monitored to lead to improvement and effectiveness of the quality of staff health.

Introduction: Action research is one of the important methods in medical education quality improvement. This study aims to improve quality of 'health service management' student’s clerkship course using action research. Methods: This action research study used mix method approach and was conducted in Tabriz University of Medical Science in 2018 year using Simon’s six stage model. Qualitative data was collected through in deapth interviews and focus group discussions (FGDs). Quantitative data was collected through a reliable and validated questionnaire. The participants were 17 health service management students (enrolled in 2015-2016) and the control group were 28 health service management students enrolled in 2014-2015). Qualitative data were analysed using content-analysis and quantitative data were analysed using T-test by SPSS-16 software. Result: Overall, 14 problems were identified and for 11 problems interventions were designed. The most important strengths of clerkship were;a)regular planning, b) appropriate assessment, c)scoring, high level of tutor attendance and d)more attention to management issues. Coordination problems and inappropriate headline of portfolio in some cases were weakness of this action research. The results of quantitative evaluation show that all items of questionnaire were improved. After reseach, %20.6 increase was observed in students' satisfactions level in the intervention groupcompared with the control group (80.7 vs. 60.1) (p>0.05). Conclusion: This action research significantly improved quality of clerkship course, it’s recommended that in future years same studies with aim to more quality improvement implemented. Keywords: Action research, Medical education, Clerkship, Quality improvement.

Although quality improvement interventions for acute heart failure have been studied in high-income countries, none have been studied in low- or middle-income country settings where quality of care can be lower. We evaluated the effect of a quality improvement toolkit on process of care measures and clinical outcomes in patients hospitalized for acute heart failure in 8 hospitals in Kerala, India utilizing an interrupted time series design from February 2018 to August 2018. The quality improvement toolkit included checklists, audit-and-feedback reports, and patient education materials. The primary outcome was rate of discharge guideline-directed medical therapy for patients with heart failure with reduced ejection fraction. We used mixed effect logistic regression and interrupted time series models for analysis. Among 1400 participants, mean (SD) age was 66.6 (12.2) years, and 38% were female. Mean (SD) left ventricular ejection fraction was 35.2% (9.7%). The primary outcome was observed in 41.3% of participants in the intervention period and 28.1% of participants in the control period (difference 13.2%; 95% CI 6.8, 19.0; adjusted OR = 1.70; 95% CI 1.17, 2.48). Interrupted time series model demonstrated highest rate of guideline-directed medical therapy at discharge in the initial weeks following intervention delivery with a concomitant decline over time. Improvements were observed in discharge process of care measures, including diet counseling, weight monitoring instructions, and scheduling of outpatient clinic follow-up but not hospital length of stay nor inpatient mortality. Higher rates of guideline-directed medical therapy at discharge were observed in Kerala. Broader implementation of this quality improvement intervention may improve heart failure care in low- and middle-income countries. • No quality improvement interventions for acute heart failure have been studied in low- or middle-income country settings. • A quality improvement toolkit increased rates of guideline-directed medical therapy in patients with heart failure in Kerala. • Broader implementation of this quality improvement toolkit may improve heart failure care in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Optimal primary care sector performance is vital for ensuring the delivery of quality health services and effective clinical management of populations. The Primary Care Practice Improvement Tool (PC-PIT) incorporates subjective staff input and objective indicators to measure 13 elements of organisational performance. This study aimed to measure change in organisational performance for general practices using the PC-PIT with Primary Health Network (PHN) support. A pre-post design was used for changes in PC-PIT subjective and objective scores. Practices used results with PHN support to complete two Plan Do Study Act initiatives and were reassessed 9-months later. PC-PIT scales were dichotomised into lower and higher scores, with odds ratios used to determine effect size. Staff survey response rates were 55.4% at baseline and 50.1% at follow up. There were modest increases in the likelihood of staff rating several elements higher at follow up. When implemented with PHN support staff, the PC-PIT has the potential for effective, focussed and sustained quality improvement, with capacity to support Health Care Home model transition and implementation. Optimising primary care practice performance presents an important national challenge. This paper demonstrates the positive effect of the Primary Care Practice Improvement Tool (PC-PIT), supported by a Primary Health Network practice support team, in building practice quality and performance. [ABSTRACT FROM AUTHOR]

Background: This second harvest of the Congenital Heart Surgery Database intended to compare current results with international databases., Methods: This retrospective study examined a total of 4007 congenital heart surgery procedures from 15 centers in the Congenital Heart Surgery Database between January 2018 and January 2023. International diagnostic and procedural codes were used for data entry. STAT (Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery) mortality scores and categories were used for comparison of the data. Surgical priority status was modified from American Society of Anesthesiologist guidelines. Centers that sent more than 5 cases to the database were included to the study., Results: Cardiopulmonary bypass and cardioplegic arrest were performed in 2,983 (74.4%) procedures. General risk factors were present in 22.6% of the patients, such as genetic anomaly, syndrome, or prematurity. Overall, 18.9% of the patients had preoperative risk factors (e.g., mechanical ventilation, renal failure, and sepsis). Of the procedures, 610 (15.2%) were performed on neonates, 1,450 (36.2%) on infants, 1,803 (45%) on children, and 144 (3.6%) on adults. The operative timing was elective in 56.5% of the patients, 34.4% were urgent, 8% were emergent, and 1.1% were rescue procedures. Extracorporeal membrane oxygenation support was used in 163 (4%) patients, with a 34.3% survival rate. Overall mortality in this series was 6.7% (n=271). Risk for mortality was higher in patients with general risk factors, such as prematurity, low birth weight neonates, and heterotaxy syndrome. Mortality for patients with preoperative mechanical ventilation was 17.5%. Pulmonary hypertension and preoperative circulatory shock had 11.6% and 10% mortality rates, respectively. Mortality for patients who had no preoperative risk factor was 3.9%. Neonates had the highest mortality rate (20.5%). Intensive care unit and hospital stay time for neonates (median of 17.8 days and 24.8 days, respectively) were also higher than the other age groups. Infants had 6.2% mortality. Hospital mortality was 2.8% for children and 3.5% for adults. Mortality rate was 2.8% for elective cases. Observed mortality rates were higher than expected in the fourth and fifth categories of the STAT system (observed, 14.8% and 51.9%; expected, 9.9% and 23.1%; respectively)., Conclusion: For the first time, outcomes of congenital heart surgery in Türkiye could be compared to the current world experience with this multicenter database study. Increased mortality rate of neonatal and complex heart operations could be delineated as areas that need improvement. The Congenital Heart Surgery Database has great potential for quality improvement of congenital heart surgery in Türkiye. In the long term, participation of more centers in the database may allow more accurate risk adjustment., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2024, Turkish Society of Cardiovascular Surgery.)

Purpose: The article reviews the literature on the concept of Global 8 Disciplines method in the context of root cause analysis of the quality issue. Design/methodology/approach: In this paper the objective was set to prevent quality issues regarding the surface of wire rod coils. In order to achieve this, the G8D problem solving method was applied to analyze and solve the problem. Findings: G8D does improve the efficiency of quality issue problem-solving. Originality/value: G8D method application allows reducing problem analysis time and costs in the manufacturing companies. [ABSTRACT FROM AUTHOR]

Hans Friis-Andersen1,2, Thue Bisgaard2,3 1Surgical Department, Horsens Regional Hospital, Horsens, Denmark; 2Steering Committee, Danish Hernia Database, 3Surgical Gastroenterological Department 235, Copenhagen University Hospital, Hvidovre, Denmark Aim of database: To monitor and improve nation-wide surgical outcome after groin hernia repair based on scientific evidence-based surgical strategies for the national and international surgical community. Study population: Patients ≥18 years operated for groin hernia. Main variables: Type and size of hernia, primary or recurrent, type of surgical repair procedure, mesh and mesh fixation methods. Descriptive data: According to the Danish National Health Act, surgeons are obliged to register all hernia repairs immediately after surgery (3 minute registration time). All institutions have continuous access to their own data stratified on individual surgeons. Registrations are based on a closed, protected Internet system requiring personal codes also identifying the operating institution. A national steering committee consisting of 13 voluntary and dedicated surgeons, 11 of whom are unpaid, handles the medical management of the database. Results: The Danish Inguinal Hernia Database comprises intraoperative data from >130,000 repairs (May 2015). A total of 49 peer-reviewed national and international publications have been published from the database (June 2015). Conclusion: The Danish Inguinal Hernia Database is fully active monitoring surgical quality and contributes to the national and international surgical society to improve outcome after groin hernia repair. Keywords: nation-wide, recurrence, chronic pain, femoral hernia, surgery, quality improvement

Ann-Dorthe Zwisler,1 Henriette Knold Rossau,1 Anne Nakano,2,3 Sussie Foghmar,4 Regina Eichhorst,5 Eva Prescott,6 Charlotte Cerqueira,7 Anne Merete Boas Soja,4 Gunnar H Gislason,8–10 Mogens Lytken Larsen,5 Ulla Overgaard Andersen,11 Ida Gustafsson,4 Kristian K Thomsen,12 Lene Boye Hansen,13 Signe Hammer,14 Lone Viggers,15 Bo Christensen,16 Birgitte Kvist,17 Cecilie Lindström Egholm,18 Ole May19 On behalf of the Working Group of Preventive Cardiology and Rehabilitation, Danish Society of Cardiology, and the Working Group of Cardiac Clinical Registries, Danish Society of Cardiology 1Danish Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, 2Department of Clinical Epidemiology, Aarhus University Hospital, 3Registry Support Centre (West) – Clinical Quality Improvement & Health Informatics, Aarhus, 4Department of Cardiology, Copenhagen University Hospital, Hvidovre, 5Department of Cardiology, Aalborg University Hospital, Aalborg, 6Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, 7Registry Support Centre (East) – Epidemiology and Biostatistics, Research Centre for Prevention and Health, the Capital Region of Denmark, Glostrup, 8Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, 9The Danish Heart Foundation, Copenhagen, 10The National Institute of Public Health, University of Southern Denmark, 11Department of Cardiology, Holbaek Hospital, University of Copenhagen, Copenhagen, 12Department of Cardiology, Hospital of Southwest Jutland, Esbjerg, 13Department of Cardiology, Gentofte Hospital, Gentofte, 14Department of Occupational Therapy and Physiotherapy, Herlev Hospital, Herlev, 15Department of Nutrition, Regional Hospital West Jutland, Holstebro, 16Department of General Medicine, School of Public Health, Aarhus University, Aarhus, 17Department of Health Care and Prevention, Municipality of Frederikshavn, Frederikshavn, 18The Regional Research Unit, Region Zealand, Roskilde, 19Department of Medicine, Cardiovascular Research Unit, Regional Hospital Herning, Herning, Denmark Aim of database: The Danish Cardiac Rehabilitation Database (DHRD) aims to improve the quality of cardiac rehabilitation (CR) to the benefit of patients with coronary heart disease (CHD).Study population: Hospitalized patients with CHD with stenosis on coronary angiography treated with percutaneous coronary intervention, coronary artery bypass grafting, or medication alone. Reporting is mandatory for all hospitals in Denmark delivering CR. The database was initially implemented in 2013 and was fully running from August 14, 2015, thus comprising data at a patient level from the latter date onward.Main variables: Patient-level data are registered by clinicians at the time of entry to CR directly into an online system with simultaneous linkage to other central patient registers. Follow-up data are entered after 6 months. The main variables collected are related to key outcome and performance indicators of CR: referral and adherence, lifestyle, patient-related outcome measures, risk factor control, and medication. Program-level online data are collected every third year.Descriptive data: Based on administrative data, approximately 14,000 patients with CHD are hospitalized at 35 hospitals annually, with 75% receiving one or more outpatient rehabilitation services by 2015. The database has not yet been running for a full year, which explains the use of approximations.Conclusion: The DHRD is an online, national quality improvement database on CR, aimed at patients with CHD. Mandatory registration of data at both patient level as well as program level is done on the database. DHRD aims to systematically monitor the quality of CR over time, in order to improve the quality of CR throughout Denmark to benefit patients. Keywords: secondary prevention, coronary heart disease, cardiovascular prevention, clinical quality registry, clinical database, quality improvement

The Primary Care Practice Improvement Tool (PC-PIT) is an organisational performance improvement tool recently implemented by two Primary Health Networks (PHNs). This study explored barriers and facilitators to implementing the PC-PIT process at scale, from the initial introduction of the tool to completion of Plan-Do-Study-Act cycles with general practices. Using a qualitative design, in-depth, semi-structured interviews were conducted with 10 PHN staff to seek feedback on the delivery of the PC-PIT to general practices. Interview results were analysed using a grounded theory approach. The identification of barriers such as difficulty engaging practices and lack of report sharing with the PHNs will help streamline future implementation. The PC-PIT was highly compatible with existing quality improvement programs and offers enhanced opportunity to support capacity building and implementation of the Health Care Home model. [ABSTRACT FROM AUTHOR]

Introduction: Evaluation of the effects of health information systems enable health care policy and decisions makers to better invest on and utilize health information applications. The objective of this systematic review is to consolidate existing evidence from published studies on the effect of health information systems in Iran. Methods: The aim of this study is systematic review of articles about effects of health information systems in Iran. In this study all papers relevant to the research objective were retrieved from SID, Magira, Irandoc, Medlib and Iran Medex databases until July 2013, and finally 18 out of 861 retrieved articles were identified as relevant and reviewed by the authors. Results:This study shows that approximately more than half of the studies indicated the positive effects of these systems on costs and less than half of them had negative on costs.The results also demonstrate other major effects of these systems: decreased medication errors, increased accuracy and timeliness of activities, increased accessibility of information and improved quality of services. Conclusion:Theresults of this study provide a good insights concerning the effects of health information systems for policymakers and researchers. This study mainly highlighted the positive effects of these systems on health care procedures Key Words: Health Information Systems; Hospital Information Systems; Quality Improvement.

Nowadays many companies focus on various kinds of quality improvement techniques to carry the service quality beyond costumer expectations. The selected quality technique should be appropriate to the company's culture and should be sufficient for carry out targeted improvement; this will enhance the company’s superiority in market place.For this purpose, Lean Six Sigma methods are one of the important methods being used today as an intensive use of statistical tools and techniques. Lean Six Sigma methods can be implemented in almost all sectors and successful gains can be obtained. Lean Six Sigma has wide range application in the world. Most applications are successful, while some of them are failed. In this study, reasons for unsuccessful Lean Six Sigma projects are examined. The way to convert unsuccessful project into successful project are suggested. Some solutions are carried out for this purpose.

Introduction: Diabetes Prevention and Control has become among the nation's health system priorities in recent decade. Meanwhile, educational programs for executives have been designed and implemented. Tha aim of this study was to describe the situation of training of general practitioners who care diabetiv patients under National Diabetes Prevention and Control Program. Methods: This study is a qualitative content analysis (the conventional type). Data gathering was done through unstructured interviews with eight of diabetes management planners in the Ministry of Health and Medical Education as well as officials of the health system in Isfahan, and six general practitioners working in diabetes centers in Isfahan province. Observations and several field notes as well as existing records, documents, and technical notes were other sources of data collection. After manuscript analysis, meaning units, codes, categories, and key themes were achieved. The strategies for results validation included triangulation of data collection sources and methods, continuous observations in the field, and supervision and review of the analysis process by research team. Results: Three major themes and six sub-themes were emerged through qualitative data analysis. Major themes were (1) unstructured education including sub-themes of lack of continuous primary training among freshmen and lack of retraining for physicians (2) inadequate physician's competence including sub-themes of inadequate knowledge, and lack of success in earning patients and colleagues' trust (3) barriers to effective education including sub-themes of planning-related challenges, inadequate supervision on physician training process. Conclusion: Despite the importance of physician roles in diabetes management in health care centers, findings showed their education is faced with significant shortcomings.

Background: Echocardiography is routinely ordered in acute ischemic stroke workup. No standardized or structured criteria is used to select or exclude echocardiography in such settings. Moreover, the diagnostic yield of echocardiography in stroke is low in our medical center. This article presents newly proposed selection criteria for echocardiography in ischemic stroke workup., Methods: A quality improvement project was implemented in a 385-bed community hospital in Maryland, USA. A computerized decision support tool consisting of new criteria for selecting echocardiography in ischemic stroke workup was created. 639 patients hospitalized with ischemic stroke were followed-up over 12 months after intervention, and 686 matched-controls with ischemic stroke were retrospectively analyzed from the 12 months prior to intervention. Cost-effectiveness and diagnostic yield of echocardiography in ischemic stroke were measured before and after intervention., Results: Following intervention, the diagnostic yield of echocardiography in ischemic stroke workup significantly increased by 51% (from 3.8% to 7.8%, odds ratio (OR) 2.1, P= 0.01 ). The number of echocardiography studies needed to detect and treat one patient with a cardiac source of embolism was reduced from 50 to 25 studies. The overall use of echocardiography in stroke workup significantly decreased (OR 0.4, p < 0.001). Patients with lacunar infarcts or atrial fibrillation had significant reduction in echocardiography (OR 0.2, p < 0.001 and OR 0.4, p < 0.001, respectively)., Conclusion: The new criteria for echocardiography selection in hospitalized patients with ischemic stroke significantly improved the cost-effectiveness and the diagnostic yield of echocardiography and reduced unnecessary echocardiography in lacunar infarcts or atrial fibrillation., Competing Interests: None declared.

Background. Evidence for pay-for-performance (P4P) has been searched for in the last decade as financial incentives increased to influence behaviour of health care professionals to improve quality of care. The effectiveness of P4P is inconclusive, though some reviews reported significant effects. Objective. To assess changes in performance after introducing a participatory P4P program. Design. An observational study with a pre- and post-measurement. Setting and subjects. Sixty-five general practices in the south of the Netherlands. Intervention. A P4P program designed by target users containing indicators for chronic care, prevention, practice management and patient experience (general practitioner’s [GP] functioning and organization of care). Quality indicators were calculated for each practice. A bonus with a maximum of 6890 Euros per 1000 patients was determined by comparing practice performance with a benchmark. Main outcome measures. Quality indicators for clinical care (process and outcome) and patient experience. Results. We included 60 practices. After 1 year, significant improvement was shown for the process indicators for all chronic conditions ranging from +7.9% improvement for cardiovascular risk management to +11.5% for asthma. Five outcome indicators significantly improved as well as patients’ experiences with GP’s functioning and organization of care. No significant improvements were seen for influenza vaccination rate and the cervical cancer screening uptake. The clinical process and outcome indicators, as well as patient experience indicators were affected by baseline measures. Smaller practices showed more improvement. Conclusions. A participatory P4P program might stimulate quality improvement in clinical care and improve patient experiences with GP’s functioning and the organization of care. [ABSTRACT FROM PUBLISHER]

Depression is a very common reason that individuals seek treatment in the primary care setting. However, advances in depression management are often not integrated into care for ethnic and racial minorities. This supplement summarizes evidence in six key areas—current practices in diagnosis and treatment, disparities, treatment in managed care settings, quality improvement, physician learning, and community-based participatory research—used to develop an intervention concept described in the concluding article. Evidence of gaps in the care for minorities, while discouraging, presents unique opportunities for medical educators to develop interventions with the potential to change physician behavior and thereby reduce disparities and enhance patient outcomes. [ABSTRACT FROM AUTHOR]

The quality of depression care, especially care received by minorities, needs improvement. Several interventions have been developed for the purpose of improving the quality of depression management in primary care, including quality improvement strategies employing disease management approaches, the chronic care model, and the Breakthrough Collaborative Series developed by the Institute for Healthcare Improvement. This article reviews these interventions and examines their potential to contribute to the improvement of depression care. [ABSTRACT FROM AUTHOR]

Systematic procedures for quality assurance and improvement through evaluation have been in place in Western Europe since the mid 1980s and in Germany since the mid 1990s. As studies in Europe and beyond show that multi-stage evaluation procedures as the main quality assurance instrument for evaluation of teaching and learning in higher education institutions have proved reliable and have gained acceptance, in Germany (as well as in other countries) the evaluation of teaching and learning through internal and external evaluations has long come under the fire of criticism. Our results of the first comprehensive and representative investigation of procedures for the evaluation of teaching and learning in Germany show that former participants in the evaluations (reviewers and those reviewed) are satisfied all in all with the multi-stage procedure. They are convinced that the goals of quality assurance and improvement were achieved. Suggestions for improving the procedures target individual aspects, such as, for example, the composition of the review panel. Against this background, it makes sense to perform regular quality assessments of the procedures for quality assurance and improvement. [ABSTRACT FROM AUTHOR]

The article presents an evaluation of an integrated primary care depression treatment program. Collaborative Care is recommended for moderate depression. Routine care is needed to treat mild depression. Key stakeholders and executive decision makers in healthcare system require clear and convincing data of the value of chronic illness care models for the primary care treatment of depression. Intermountain Health Care is a nonprofit health care system that aims to serve the healthcare needs of Utah and Idaho residents.

The article presents information on a research study which focuses on the role of clinical information technology in depression care management. The article authors say that the study was focused on medical care issues related to the Robert Wood Johnson Foundation's national program. The study was focused on key issues including implementation of medical registries and avoiding violations of patient privacy with the advent of more advanced information technologies. The study also discussed some implications of clinical information technology for healthcare practices and policy makers.

The article presents information on the program Depression in Primary Care: Linking Clinical and Systems Strategies, of the Robert Wood Johnson Foundation (RWJF) in the U.S. This program functions synergistically with RWJF's other national quality improvement programs. The program attempts to address the barriers to chronic illness primary care for depression through a "6P" strategy that considers the multiple perspectives of six key groups of stakeholders-- patients/consumers, providers, practices, health plans/payers, public and private purchasers, and local populations/policies. The program consists of three primary program components--demonstration projects on incentives, research projects on the value of improved care for depression in primary care settings, and physician leadership development.

We designed, implemented, and evaluated a 4-week practicebased learning and improvement (PBLI) elective. Eleven internal medicine residents from 2 separate residency programs participated in the PBLI elective and 22 other residents comprised a comparison group. Residents in each group had similar pretest Quality Improvement Knowledge Application Tool scores; but after the PBLI elective, participant scores were significantly higher. Also, participants' self-assessed ratings of PBLI skills increased after the rotation and remained elevated 6 months afterward. In this curriculum, residents completed a project to improve patient care and demonstrated their knowledge on an evaluation tool in a way that was superior to nonparticipants. [ABSTRACT FROM AUTHOR]

Objective: To determine the root causes of patient safety events in a high-volume intravitreal injection clinic and to assess the effect of interventions to reduce the rate of events., Design: Quality improvement study., Subjects: All cases of intravitreal injection in a designated injection clinic between January 1, 2016, and December 31, 2019., Methods: The injection clinic model involved an injecting physician, who usually differed from a prescribing physician. The procedural injection area was also physically separate from the retina outpatient clinic. A root cause analysis was used to determine the factors that contributed to possible patient safety events in an institutional quality improvement project. Specific interventions were implemented to address each specific root cause. The rates of patient safety events (never events and near misses), whether associated with patient harm or not, were compared before and after the intervention., Main Outcome Measures: Frequency (%) of patient-safety-related intravitreal injection events before (January 1, 2016, to December 31, 2018) and after (January 1, 2019, to December 31, 2019) intervention., Results: The root cause analysis included complex treatment plans that could be difficult to interpret, insufficient time to adequately review the designated treatment plans, and the risk of human error given the pace and volume of scheduled injections. Quality improvement strategies included revising the standardized treatment plan documentation template, scheduling block time for injecting physicians to review treatment plans within 24 hours of the injection clinic, and requiring agreement between dual, independent, site, and medication verifications of the treatment plan by the injecting physician and an allied health coordinator before site marking. The rate of events was 0.1% (28 in 27 400, or 9.3 events per year) before intervention and decreased to 0.01% (1 in 9375, or 1 event per year) after intervention (P = 0.01). Most events were classified as near misses, and there were no instances of patient harm., Conclusions: A high level of patient safety can be achieved in a complex, high-volume intravitreal injection practice by recognizing potential safety issues and root causes and implementing relevant quality improvements. Although most events were near misses and no patients were harmed, reducing near misses can reduce the likelihood of harm associated with never events., (Copyright © 2022 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

To improve the quality of health care, the PHC strategy can be linked to continuous quality improvement (CQI)-also referred to as total quality management (TQM). The linkup-with emphasis on consumer participation is explained below. INSETS: Major Assumptions of CQI;Continuous Quality Improvement: A History;Principles of CQI.

Community pharmacies provide the convenience and ease of administrating vaccinations outside traditional settings. Vaccinations are health initiatives that protect communities and improve health outcomes in all populations. Despite their accessibility and supporting clinical data, various influential factors contribute to the current suboptimal rates of vaccine administration. Given the common barriers to vaccine administration, this research narrows down to address a specific barrier and attempts to implement a method that focuses on improving vaccine rates in community pharmacies. This research is a case study that utilizes the Define, Measure, Analyze, Improve, Control (DMAIC) model of Lean Six Sigma and aims to use this quality improvement process to identify, measure, analyze, and implement a training program to facilitate pharmacists in high-quality vaccine recommendations to promote higher rates of pneumococcal vaccinations in community settings., (Copyright © 2022 by the American Health Information Management Association.)

Objective To undertake a pilot project to determine how clinical and non-clinical staff perceive feedback given to them following clinical incident reviews. Methods An online survey was devised and sent as a link to staff across the Murrumbidgee Local Health District who would be likely to submit patient-related adverse incidents into the NSW Health Incident Information Management System. Results Two hundred and twenty-eight responses were received. Feedback was viewed as constructive and helpful. Medical staff were less enthusiastic about feedback and preferred formal feedback processes. Conclusions Feedback from clinical incident reviews closes the loop of the review process and creates a platform for necessary changes to be undertaken. [ABSTRACT FROM AUTHOR]

The Choosing Wisely campaign has stimulated many clinicians to think about the appropriateness of various tests and treatments. Most of the recommendations published thus far are adult-focused. In this commentary, we discuss the development and early implementation of a Choosing Wisely 'top 5' list specifically aimed at children being cared for at our tertiary care children's hospital. We hope that this will encourage others involved in the health care of infants and children to engage in further thought and discussion about the appropriateness of current tests and therapies. Despite often focusing on the deficiencies, we are privileged to have a highly developed and well-resourced health care system in Canada which allows us tremendous freedom to order tests and treatments. It is incumbent on us as health care providers to exercise that privilege with the utmost responsibility and strive to choose wisely and thoughtfully when selecting tests and therapies for our patients.

Background: United States guidelines recommend that all adolescents and adults be tested for human immunodeficiency virus (HIV) and that persons born between 1945 and 1965 be tested for hepatitis C virus (HCV)., Methods: We used electronic medical record (EMR) data to identify patients in 3 primary care clinics in Seattle, Washington who met national criteria for routine HCV or HIV testing and had no documented history of prior testing. Clinic staff received daily lists of untested patients with scheduled appointments. We used generalized linear models to compare the percentage of patients tested and newly diagnosed with HIV and HCV in the 18 months before and during the intervention., Results: A total of 16784 patients aged 18-64 and 9370 patients born between 1945 and 1965 received care from January 2011 to December 2015. Comparing the preintervention and intervention periods, the percentage of previously untested patients tested for HIV and HCV increased from 14.9% to 30.8% and from 18.0% to 35.5%, respectively ( P < .0001 for both). Despite this increase in testing, there was no change in the percentage of patients newly diagnosed with HIV (0.7% in both periods, P = .96) or HCV (3.6% vs 3.7%, P = .81). We estimate that 1.2%-15% of HCV-infected primary care patients in our medical center are undiagnosed., Conclusions: EMR-based HCV/HIV testing promotion increased testing but not case finding among primary care patients in our medical center. In our institution, most HCV-infected patients are already diagnosed, primarily through risk-based and clinical screening, highlighting the need to concentrate future efforts on increasing HCV treatment., (© The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background: Type II diabetes continues to be a major health problem in USA, particularly in minority populations. The Diabetes Equity Project (DEP), a clinic-based diabetes self-management and education program led by community health workers (CHWs), was designed to reduce observed disparities in diabetes care and outcomes in medically underserved, predominantly Hispanic communities., Objective: The purpose of this study was to evaluate the impact of the DEP on patients' clinical outcomes, diabetes knowledge, self-management skills, and quality of life., Methods: The DEP was implemented in five community clinics from 2009 to 2013 and 885 patients completed at least two visits with the CHW. Student's paired t-tests were used to compare baseline clinical indicators with indicators obtained from patients' last recorded visit with the CHW and to assess differences in diabetes knowledge, perceived competence in managing diabetes, and quality of life. A mixed-effects model for repeated measures was used to examine the effect of DEP visits on blood glucose (HbA1c), controlling for patient demographics, clinic and enrolment date., Results: DEP patients experienced significant (P < 0.0001) improvements in HbA1c control, blood pressure, diabetes knowledge, perceived competence in managing diabetes, and quality of life. Mean HbA1c for all DEP patients decreased from 8.3% to 7.4%., Conclusion: Given the increasing prevalence of diabetes in USA and documented disparities in diabetes care and outcomes for minorities, particularly Hispanic patients, new models of care such as the DEP are needed to expand access to and improve the delivery of diabetes care and help patients achieve improved outcomes., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Patient experience and satisfaction are important indicators of quality in health care. Little is known about where to prioritize efforts to improve patient satisfaction., Objectives: To investigate patient satisfaction with primary care, as part of the Quality and Costs of Primary Care in Europe study in England, identifying areas where improvements could be made from patients' perspectives., Methods: We conducted a questionnaire survey of general practice patients in three English regions. Patient Values questionnaires assessed what patients thought was important, and Patient Experience questionnaires rated performance of primary care. Fifteen attributes of care were compared using Importance Performance Analysis, a method that simultaneously represents data on importance and performance of a service, enabling identification of its strengths and weaknesses., Results: Patients rated both 'relational' and 'functional' aspects of care as important. Satisfaction with general practice could be improved by concentrating on specific aspects of access (ensuring that patients know how to access out-of-hours services and find it easy to get an appointment), and one aspect of empowerment (after their visit, patients feel able to cope better with their health problem/illness). However, for other attributes (e.g. proximity of the practice to a patient's house or, a short waiting time when contacting the practice), investing additional resources is not likely to increase patient satisfaction., Conclusion: Attributes needing most improvement concerned access to primary care and patient empowerment. More research is needed to identify how to improve access without generating unnecessary additional demand or compromising continuity of care., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: This paper examines the development of treatment guidelines, medication algorithms and clinical pathway guides for depression in countries participating in the SEBoD Initiative.Methods: A systematic review of the extent of development of treatment guidelines, medication algorithms or clinical pathway guides for depression in participating countries.Results: Most countries in the Asia Pacific region have commenced the development of treatment guidelines, medication algorithms or clinical pathway guides. The promoters of such efforts have included a range of professional and government bodies. Most efforts have borrowed heavily on existing international guidelines. There is a significant emphasis on medication practices in most countries, with less emphasis on the role of psychological or other non-pharmacological approaches. There has been insufficient emphasis on integrating local classification, assessment and cultural practices into the provision of high quality care. Important additional measures, including practice surveys and consensus judgements, have been undertaken in some countries.Conclusions: The development of a genuine quality improvement movement for depression treatments is in its infancy in the Asia Pacific region. However, there is now the capacity to bring together such efforts at a regional level and, in doing so, promote standards for best care, more community and professional involvement and the uptake of a wider variety of treatment approaches. [ABSTRACT FROM AUTHOR]

Unlabelled: Healthcare is becoming more complex and costly in both European (Slovak) and American models. Healthcare in the United States (U.S.) is undergoing a particularly dramatic change. Physician and hospital reimbursement are becoming less procedure focused and increasingly outcome focused. Efforts at Mercy Hospital have shown promise in terms of collaborative team based care improving performance on glucose control outcome metrics, linked to reimbursement. Our performance on the Centers for Medicare and Medicaid Services (CMS) post-operative glucose control metric for cardiac surgery patients increased from a 63.6% pass rate to a 95.1% pass rate after implementing interventions involving physician-pharmacist team based care.Having a multidisciplinary team that is able to adapt quickly to changing expectations in the healthcare environment has aided our institution. As healthcare becomes increasingly saturated with technology, data and quality metrics, collaborative efforts resulting in increased quality and physician efficiency are desirable., Conclusion: Multidisciplinary collaboration (including physician-pharmacist collaboration) appears to be a viable route to improved performance in an outcome based healthcare system (Fig. 2, Ref. 12).