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482 results for “quality of care”
What drives poor quality of care for child diarrhea? Experimental evidence from India
<p>Most healthcare providers in developing countries know that oral rehydration salts (ORS) is a lifesaving treatment for child diarrhea, yet few prescribe it. This know-do gap has puzzled experts for decades and has cost millions of lives. Using several randomized controlled trials among private providers in 253 towns in India, we estimated the extent to which ORS under-prescription is driven by financial incentives to sell more lucrative medicines, stock-outs of ORS, and provider perceptions that patients do not want ORS. We found that patients expressing a preference for ORS increased ORS prescribing by 27 percentage points. Eliminating stock-outs increased ORS provision by 6.8 percentage points. Eliminating financial incentives to sell medicines had no effect on average but increased ORS prescribing at pharmacies by 9 percentage points. Our findings, combined with patient exit surveys suggest that provider perceptions that patients do not want ORS explain 42% of under-prescribing, while stock-outs and financial incentives explain only 6% and 5% respectively.</p>
Can we collect health-related quality of life information from anticoagulated atrial fibrillation participants who have recently experienced a bleed? An observational feasibility study in primary, and secondary care and through an online forum
<p>The purpose of the study was to evaluate the feasibility of recruiting participants diagnosed with atrial fibrillation (AF) taking oral anticoagulation therapies (OACs) and recently experiencing a bleed to collect health-related quality of life (HRQoL) information.</p> <p><strong>Design</strong></p> <p>Observational feasibility study. The study aimed to determine the feasibility of recruiting participants with minor and major bleeds, the most appropriate route for recruitment and the appropriateness of the Patient Reported Outcome Measures (PROMs) selected for collecting HRQoL information in AF patients, and the preferred format of the surveys.</p> <p><strong>Setting</strong></p> <p>Primary care, secondary care, and via an online patient forum.</p> <p><strong>Participants</strong></p> <p>The study population was adult patients (≥ 18) with Atrial Fibrillation (AF) taking oral anticoagulation therapies (OATs) who had experienced a recent major or minor bleed within the last four weeks.</p> <p><strong>Primary and Secondary outcome measures</strong></p> <p>Primary outcome:</p> <p>Patient reported outcome measures (PROMs): EuroQol 5 dimensions-5 levels (EQ-5D-5L); Perception of anticoagulant treatment questionnaire, part 2 only (PACT-Q, part 2); Atrial fibrillation effect on quality of life (AFEQT)</p> <p>Secondary outcomes:</p> <p>Location of bleed; bleed severity; current treatment; patient perceptions of HRQoLin relation to bleeding events.</p> <p><strong>Results</strong></p> <p>We received initial expressions of interest from 103 participants. We subsequently recruited 32 participants to the study- 14 from primary care and 18 through the AF forum. No participants were recruited through secondary care. Despite 32 participants consenting, only 26 initial surveys were completed. We received follow-up surveys from 11 participants (8 primary care and 3 AF forum). COVID-19 had a major impact on the study. </p> <p><strong>Conclusions</strong></p> <p>Primary care was the most successful route for recruitment. Most participants recruited to the study experienced a minor bleed. Further ways to recruit in secondary care should be explored, especially to capture more serious bleeds. </p> <p><strong>Registration</strong></p> <p>The study was adopted onto the NIHR Portfolio (I.D. #47771) and registered with www.ClinicalTrials.gov (#NCT04921176) in February 2021.</p> <p>Dataset contains all anonymised data for the participants who completed the survey including demographics, details of bleeds, co-morbidities and completed patient reported outcomes</p>
What drives poor quality of care for child diarrhea? Experimental evidence from India
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Assessing the Nature and Quality of Emergency Obstetric Care for Preventing Maternal and Perinatal Mortality in 8 Secondary and Tertiary Hospitals in Nigeria: Results of a Formative Research Study
<p>Nigeria suffers some of the highest rates of maternal and perinatal mortality in the world. Poor quality of obstetric care is a key factor, and although not quantified at a national level, local studies suggest that high rates of maternal and perinatal deaths are due to clinical management errors in hospitals. This project therefore explored the nature of existing practices and quality of clinical management of three leading causes of maternal and perinatal deaths (primary postpartum haemorrhage, eclampsia, and obstructed labour); implement an intervention package aimed at improving the quality of clinical management of these causes of deaths; and test the effectiveness of this package on quality of care indicators and maternal and perinatal outcomes. </p> <p>The study follows a quasi-experimental research design, using interrupted time series analysis for assessment over a three year period. Six public secondary care hospitals and two public tertiary care hospitals in both north and south of Nigeria were selected randomly. Formative research was conducted in all eight hospitals, and thereafter the intervention will be carried out in four hospitals, with the remaining four hospitals functioning as control sites. </p> <p>Clinical outcomes will be compared between intervention and control sites in a total of 2334 cases of PPH, preeclampsia/eclampsia and obstructed labour (based on an anticipated 50% reduction in case fatality rates, significance level of 0.05 and 80% power). This will consist of 1167 cases in the intervention sites and 1167 in the control sites. Maternal and perinatal mortality rates will serve as primary outcome measures. Secondary outcomes involve quality of care drawn from United Nations process indicators, skilled attendance index and data derived from this formative audit phase of the project.</p> <p>The results will enable the identification of a system-wide quality of care framework for improving the delivery of emergency obstetric care for the prevention of maternal and perinatal morbidity and mortality in Nigeria.</p>
Assessing the Nature and Quality of Emergency Obstetric Care for Preventing Maternal and Perinatal Mortality in 8 Secondary and Tertiary Hospitals in Nigeria: Results of a Formative Research Study
<p>Nigeria suffers some of the highest rates of maternal and perinatal mortality in the world. Poor quality of obstetric care is a key factor, and although not quantified at a national level, local studies suggest that high rates of maternal and perinatal deaths are due to clinical management errors in hospitals. This project therefore explored the nature of existing practices and quality of clinical management of three leading causes of maternal and perinatal deaths (primary postpartum haemorrhage, eclampsia, and obstructed labour); implement an intervention package aimed at improving the quality of clinical management of these causes of deaths; and test the effectiveness of this package on quality of care indicators and maternal and perinatal outcomes. </p> <p>The study follows a quasi-experimental research design, using interrupted time series analysis for assessment over a three year period. Six public secondary care hospitals and two public tertiary care hospitals in both north and south of Nigeria were selected randomly. Formative research was conducted in all eight hospitals, and thereafter the intervention will be carried out in four hospitals, with the remaining four hospitals functioning as control sites.</p> <p>Clinical outcomes will be compared between intervention and control sites in a total of 2334 cases of PPH, preeclampsia/eclampsia and obstructed labour (based on an anticipated 50% reduction in case fatality rates, significance level of 0.05 and 80% power). This will consist of 1167 cases in the intervention sites and 1167 in the control sites. Maternal and perinatal mortality rates will serve as primary outcome measures. Secondary outcomes involve quality of care drawn from United Nations process indicators, skilled attendance index and data derived from this formative audit phase of the project.</p> <p>The results will enable the identification of a system-wide quality of care framework for improving the delivery of emergency obstetric care for the prevention of maternal and perinatal morbidity and mortality in Nigeria</p>
Assessing the Impact of an Intervention to Improve the Quality of Emergency Obstetric Care on Maternal Health in Nigeria
<p>Nigeria suffers some of the highest rates of maternal and perinatal mortality in the world. Poor quality of obstetric care is a key factor, and although not quantified at a national level, local studies suggest that high rates of maternal and perinatal deaths are due to clinical management errors in hospitals. This project therefore explored the nature of existing practices and quality of clinical management of three leading causes of maternal and perinatal deaths (primary postpartum haemorrhage, eclampsia, and obstructed labour); implement an intervention package aimed at improving the quality of clinical management of these causes of deaths; and test the effectiveness of this package on quality of care indicators and maternal and perinatal outcomes. </p> <p> </p> <p>The study follows a quasi-experimental research design, using interrupted time series analysis for assessment over a three year period. Six public secondary care hospitals and two public tertiary care hospitals in both north and south of Nigeria were selected randomly. Formative research was conducted in all eight hospitals, and thereafter the intervention will be carried out in four hospitals, with the remaining four hospitals functioning as control sites. The package consists of training in use of evidence-based clinical protocols on postpartum haemorrhage (PPH), preeclampsia/eclampsia and obstructed labour, audit and feedback, reminders, commodity supply monitoring and replenishments and patients’ education. </p> <p> </p> <p>Clinical outcomes will be compared between intervention and control sites in a total of 2334 cases of PPH, preeclampsia/eclampsia and obstructed labour (based on an anticipated 50% reduction in case fatality rates, significance level of 0.05 and 80% power). This will consist of 1167 cases in the intervention sites and 1167 in the control sites. Maternal and perinatal mortality rates will serve as primary outcome measures. Secondary outcomes involve quality of care drawn from United Nations process indicators, skilled attendance index and data derived from the formative audit phase of the project.</p> <p> </p> <p>The results will enable the identification of a system-wide quality of care framework for improving the delivery of emergency obstetric care for the prevention of maternal and perinatal morbidity and mortality in Nigeria.</p>
Dataset_Scoping review_Changes in quality of cancer care assessed through performance indicators
<p>Data on which the conclusions of the study "<em>Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a Scoping Review</em>" rely, namely: articles included in the Scoping Review and performance indicators extracted and collated.</p>
Quality of care and performance indicators of mental health supported accommodation services in England
<p class="MsoNormal"><span>This dataset includes data from Mental Health supporting accommodation services in England. It includes information on resources (inputs) and outcomes (outputs) of care, which are described in the manuscript published in Plos One: "Almeda, N., García-Alonso, C. R., Killaspy, H., Gutiérrez-Colosía, M. R., & Salvador-Carulla, L. (2022). The critical factor: The role of quality in the performance of supported accommodation services for complex mental illness in England. Plos One, 17(3), e0265319. https://doi.org/10.1371/journal.pone.0265319"</span></p> <p class="MsoNormal"><span>The research associated with the present data focused on developing an analytical process for assessing the performance of the Mental health (MH) supporting accommodation services from 14 different regions of England considering the effect of the quality-of-care indicators in the performance. For doing so every service was classified in Residential Care (move on and non-move on oriented), Supported Housing or Floating Outreach. Then, information about the quality-of-care was collected from each domain of the instrument QuIRC-SA. Finally, a decision support system that integrated data envelopment analysis, Monte Carlo simulation and artificial intelligence was used.</span></p> <p class="MsoNormal"><span>The main results of the analyses pointed out that the incorporation of quality domains as variables (outputs) in DEA had a neutral-positive or positive global impact on the performance of MH-supported accommodation services.</span></p>
Utility index and vision related quality of life in patients awaiting specialist eye care
<p>Objectives:</p> <p>This study aimed to ascertain utility and vision-related quality of life in patients awaiting access to specialist eye care. A secondary aim was to evaluate the association of utility indices with demographic profile and waiting time.</p> <p>Methods:</p> <p>Consecutive patients that had been waiting for ophthalmology care answered the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). The questionnaire was administered when patients arrived at the clinics for their first visit. We derived a utility index (VFQ-UI) from the patients' responses, then calculated the correlation between this index and waiting time and compared utility across demographic subgroups stratified by age, sex, and care setting.</p> <p>Results:</p> <p>536 individuals participated in the study (mean age 52.9±16.6 years; 370 women, 69% women). The median utility index was 0.85 (interquartile range [IQR] 0.70–0.92; minimum 0.40, maximum 0.97). The mean VFQ-25 score was 70.88±14.59. Utility correlated weakly and nonsignificantly with waiting time (-0.05, <em>P </em>= 0.24). It did not vary across age groups (<em>P </em>= 0.85) or care settings (<em>P </em>= 0.77). Utility was significantly lower for women (0.84, IQR 0.70–0.92) than men (0.87, IQR 0.73–0.93, <em>P </em>= 0.03), but the magnitude of this difference was small (Cohen's d = 0.13).</p> <p>Conclusion:</p> <p>Patients awaiting access to ophthalmology care had a utility index of 0.85 on a scale of 0 to 1. This measurement was not previously reported in the literature. Utility measures can provide insight into patients' perspectives and support economic health analyses and inform health policies.</p>
Data from: Novel methods to define invasive procedures at the end-of-life were developed to improve quality of end of life care research: A population-based cohort study in colorectal cancer
<p><strong>Background</strong></p> <p>Understanding the use of invasive procedures (IPs) at the end-of-life (EoL) is important to avoid under- and overtreatment, but epidemiologic analysis is hampered by limited methods to define treatment intent and EoL phase. This study applied novel methods to report IPs at the EoL using a colorectal cancer (CRC) case study.</p> <p><strong>Methods</strong></p> <p>An English population-based cohort of adult patients diagnosed between 2013 and 2015 was used with follow-up to 2018. Procedure intent (curative, non-curative, diagnostic) by cancer site and stage at diagnosis was classified by two surgeons independently. Joinpoint regression modelled weekly rates of IPs for 36 sub-cohorts of patients with incremental survival of 0-36 months. EoL phase was defined by a significant IP rate change before death. Zero-inflated Poisson regression explored associations between IP rates and clinical/sociodemographic variables.</p> <p><strong>Results</strong></p> <p>Of 87,731 patients included, 41,972 (48%) died. 9,492 procedures were classified by intent (interrater agreement 99.8%). Patients received 502,895 IPs (1.39 and 3.36 per person year for survivors and decedents). Joinpoint regression identified significant increases in IPs four weeks before death in those living 3-6 months, and eight weeks before death in those living 7–36 months from diagnosis. 7,908 (18.8%) patients underwent IPs at the EoL, with stoma formation the most common major procedure. Younger age, early-stage disease, men, lower comorbidity, those receiving chemotherapy and living longer from diagnosis were associated with IPs.</p> <p><strong>Conclusions</strong></p> <p>Methods to identify and classify IPs at the EoL were developed and tested within a CRC population. This approach can be now extended and validated to identify potential under- and overtreatment. </p>
Prospective cohort study of a community-based primary care program's effects on pharmacotherapy quality in low-income Peruvians with type 2 diabetes and hypertension
<p>A door-to-door survey was conducted to enumerate all household members by age and sex in a low-income community in Peru. 856 adults 35 years and older were eligible to participate in screening for type 2 diabetes and hypertension. 709 (83%) participated in screening. 130 (18.3%) were diagnosed with hypertension and/or type 2 diabetes of which 109 (84%) participated at program onset and 22 were added later from earlier non-participants in screening or program onset to form the cohort of 131 patients with diabetes and/or hypertension. The primary care program had components of the Chronic Care Model, community health workers, and freely accessible visits and medications. The program operated between September 2011 and May 2014, and consisted of two care periods (separated by a six-month hiatus), first a 10-month home-care period, then a 17-month clinic-care period. The dataset is two files corresponding to two exposures: the 27-month program overall (post- versus pre-) (N=262 observations, 131 pairs with patients as self-controls) and care period (clinic versus home), N=211 (109 home and 102 clinic observations, >131 because 80 patients participated in both care periods). Exposures were evaluated for their effects on guidelines-based pharmacotherapy standards: hypoglycemic and antihypertensive medications, low-dose aspirin, and first-line angiotensin converting enzyme inhibitor (ACEi) treatment of diabetes with elevated blood pressure.</p>
Reverse Innovation and Patient Engagement to Improve Quality of Care and Patient Outcomes
ClinicalTrials.gov study NCT02222909. IPD Sharing: NO. Countries: 1. Publications: 3.
Understanding Disparities in Healthcare and Primary Care Provider Quality
ClinicalTrials.gov study NCT02626910. IPD Sharing: NO. Countries: 1. Publications: 2.
Early Palliative Care With Standard Care or Standard Care Alone in Improving Quality of Life of Patients With Incurable Lung or Non-colorectal Gastrointestinal Cancer and Their Family Caregivers
ClinicalTrials.gov study NCT02349412. IPD Sharing: Not stated. Countries: 1. Publications: 2.
Multidisciplinary Care for Lifestyle Change for Metabolic Control and Quality of Life in Prediabetes (PreCPro)
ClinicalTrials.gov study NCT06468553. IPD Sharing: UNDECIDED. Countries: 1. Publications: 3.
Dyadic Interventions to Boost Quality of Life Among Stroke Survivors and Care Partners in Pakistan.
ClinicalTrials.gov study NCT06827093. IPD Sharing: YES. Countries: 1. Publications: 15.
Evaluating Evidence-Based Quality Improvement of Comprehensive Women's Health Care Implementation in Low-Performing VAs
ClinicalTrials.gov study NCT03238417. IPD Sharing: NO. Countries: 1. Publications: 1.
Development of an Osteoarthritis (OA) Care Plan to Improve Process and Quality of OA Treatment Decisions
ClinicalTrials.gov study NCT03102580. IPD Sharing: NO. Countries: 1. Publications: 10.
An Observational Study to Evaluate Physical Activity, Bleeding Incidence and Health Related Quality of Life, in Participants With Haemophilia A Without Inhibitors Receiving Standard of Care Treatment
ClinicalTrials.gov study NCT04165135. IPD Sharing: NO. Countries: 1. Publications: 1.
Severe Acquired Brain Injuries: Prognostic Factors and Quality of Care
ClinicalTrials.gov study NCT04905264. IPD Sharing: UNDECIDED. Countries: 1. Publications: 1.
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International Brain Laboratory public data
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OpenNeuro
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