Quality improvement in chronic care by self-audit, benchmarking and networking in general practices in South Tyrol, Italy: results from an interventional study

2020 ◽  
Author(s):  
Giuliano Piccoliori ◽  
Angelika Mahlknecht ◽  
Muna E Abuzahra ◽  
Adolf Engl ◽  
Vera Breitenberger ◽  
...  
Keyword(s):  
General Practice ◽  
Quality Of Care ◽  
Quality Indicators ◽  
Quality Score ◽  
Interventional Study ◽  
South Tyrol ◽  
Electronic Health ◽  
The Impact

Abstract Background Systematic strategies promoting quality of care in general practice are yet under-represented in several European countries. Objective This interventional study assessed whether a combined intervention (self-audit, benchmarking, quality circles) improved quality of care in Salzburg, Austria and South Tyrol, Italy. The present publication reports the Italian results. Methods We developed quality indicators for general practice in a consensus process based on pre-existing quality programmes. The indicators addressed diagnosis and treatment regarding eight common chronic conditions. A quality score comprising 91 indicators was calculated (0–5 points per indicator depending on fulfilment, maximum 455 points). We collected anonymous data from the electronic health records of the participating physicians in 2012, 2013 and 2014. Wilcoxon signed-rank tests were used for pre-post analysis. Results Thirty-six GPs participated in the study. The median quality score increased significantly from 177.0 points at baseline to 272.0 points at the second follow-up (P = 0.000). Improvements concerned process and intermediate outcome indicators particularly between baseline and the first follow-up. Conclusion Performance was relatively low at baseline and improved considerably, mainly in the first study period. The intervention investigated in this study can serve as a model for future quality programmes. A customized electronic health record for the implementation of this intervention as well as standardized and consistent documentation by GPs is a prerequisite. Use of a limited set of quality indicators (QIs) and regular QI modification is probably advisable to increase the benefits. Long-term prospective studies should investigate the impact of QI-based interventions on end-result outcomes.

The impact of leadership churn on quality management in Australian hospitals

2019 ◽  
Vol 33 (7/8) ◽  
pp. 809-820
Author(s):  
Sandra Leggat ◽  
Cathy Balding
Keyword(s):  
Quality Of Care ◽  
Quality Management ◽  
Quality Indicators ◽  
Health Sector ◽  
Quality System ◽  
Board Members ◽  
Governing Board ◽  
Content Type ◽  
The Impact

Purpose The purpose of this paper is to explore the relationship between frequent turnover (churn) of the chief executive officer (CEO), quality manager and members of the governing board with the management of quality in eight Australian hospitals. Design/methodology/approach A mixed method three-year longitudinal study was conducted using validated quality system scales, quality indicators and focus groups involving over 800 board members, managers and clinical staff. Findings There were unexpected high levels of both governance and management churn over the three years. Churn among CEOs and quality managers was negatively associated with compliance in aspects of the quality system used to plan, monitor and improve quality of care. There was no relationship with the quality of care indicators. Staff identified lack of vision and changing priorities with high levels of churn, which they described as confusing and demotivating. There was no relationship with quality processes or quality indicators detected for churn among governing board members. Practical implications Governing boards must recognise the risks associated with management change and minimise these risks with robust clinical governance processes. Originality/value This research is the first that we are aware of that identifies the impact of frequent leadership turnover in the health sector on quality management.

Using a disease pathway management approach to improve the quality of breast cancer care in Ontario.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 109-109
Author(s):  
Andrea Eisen ◽  
Jasmin Soobrian ◽  
Ashley Tyrrell ◽  
Clement Li ◽  
Derek Muradali ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Quality Indicators ◽  
Cancer Care ◽  
Evidence Based ◽  
Breast Cancer Care ◽  
Patient Journey ◽  
The Impact

109 Background: Disease Pathway Management (DPM) is used by Cancer Care Ontario (CCO) to set priorities for cancer control, plan cancer services, and improve the quality of care in Ontario by promoting standardization. The DPM approach applies a framework to examine the performance of the entire system from prevention to end of life care, and to identify any gaps within the system. In 2014, DPM began its breast cancer pathway initiative by mapping the patient journey, depicting evidence-based best practice along the breast cancer care continuum, identifying where further guidance is needed for clinical decision making, and identifying gaps in quality of care and performance measurement indicators. Objective: To evaluate the impact of DPM on quality assessment of breast cancer care in Ontario. Methods: DPM convened a multidisciplinary breast cancer working group (WG) of 40 experts from across Ontario. The WG held 12 meetings and used guidelines developed by CCO’s Program in Evidence Based Care (or other sources as needed) to generate pathways for the prevention, screening and diagnosis, treatment, and follow-up care for breast cancer. The pathways were used as a framework to review the existing inventory of provincial breast cancer quality indicators, and to identify areas where evidence based guidance is needed. The pathways were subjected to an extensive review process before publication. Results: The expert WG identified 28 priority areas, including opportunities to develop guidance in areas where it is lacking (e.g. role of perioperative breast MRI; indications for contralateral prophylactic mastectomy) and system barriers that may hinder optimal care (e.g. biomarker assessment). The WG also used the pathways as a framework for evaluating performance measurement indicators by mapping 48 existing quality indicators for breast cancer to the pathway. Conclusions: The CCO DPM Breast Cancer pathways facilitated a province-wide, multidisciplinary process to promote quality standards, to identify gaps and overlaps in performance and quality measurement, and to recommend additional indicators more relevant to the quality of breast cancer care in Ontario.

scholarly journals Inequalities in general practice remote consultations: A systematic review

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0040
Author(s):  
Ruth Parker ◽  
Emma Figures ◽  
Charlotte Paddison ◽  
James Matheson ◽  
David Blane ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
General Practice ◽  
Quality Of Care ◽  
Clinical Outcomes ◽  
The Elderly ◽  
Face To Face ◽  
The Impact ◽  
Remote Consultations

BackgroundCOVID-19 has led to rapid and widespread use of remote consultations in general practice, but the health inequalities impact remains unknown.AimTo explore the impact of remote consultations in general practice compared to face-to-face consultations on utilisation and clinical outcomes across socio-economic and disadvantaged groups.Design & settingSystematic reviewMethodWe undertook an electronic search of MEDLINE, EMBASE and Web of Science from inception to June 2020. We included studies which compared remote consultations to face-to-face consultations in primary care and reported outcomes by PROGRESS Plus criteria. Risk of bias was assessed using ROBINS-I. Data was synthesised narratively.ResultsBased on 13 studies, exploring telephone and internet-based consultations, we found that telephone consultations were used by younger working age people, the very old and non-immigrants, with internet-based consultations more likely to be used by younger people. Women consistently used more remote forms of consulting than men. Socio-economic and ethnicity findings were mixed, with weak evidence that patients from more affluent areas were more likely to use internet-based communication. Remote consultations appeared to help patients with opioid dependence remain engaged with primary care. No studies reported on the impact on quality of care or clinical outcomes.ConclusionRemote consultations in general practice are likely to be used more by younger working people, non-immigrants, the elderly and women, with internet-based consultations more by younger, affluent and educated groups. Wide-spread use of remote consultations should be treated with caution until the inequalities impact on clinical outcomes and quality of care is known.

Intensive multidisciplinary care programme for frail patients

2014 ◽  
Vol 2 (3) ◽  
pp. 274
Author(s):  
I Urreta ◽  
P Aranegi ◽  
J Artetxe ◽  
X Zubeldia ◽  
I Huerta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Multidisciplinary Care ◽  
Perceived Quality ◽  
Easy Access ◽  
Care Programme ◽  
Perceived Quality Of Care ◽  
The Impact

Rationale and Objectives: Patients with chronic diseases re-admitted for acute events are associated with a high use of hospital resources and represent a challenge for healthcare systems. In such cases, follow-up interventions at discharge can be effective. The widespread adoption of follow-up procedures not involving telemonitoring may greatly decrease re-admissions rates without the costs associated with telemedicine. To assess the impact of a structured follow-up programme on patient-perceived healthcare quality, treatment adherence, re-admissions and Emergency Department attendances.Methods: This was a before and after study of 242 patients at risk of re-admission for chronic obstructive pulmonary disease (COPD) or heart failure (HF), recruited between 1st July 2009 and 30th June 2010 at Donostia Tertiary University Hospital (Gipuzkoa, Spain). The follow-up ended on 30th December 2010. The intervention involved identifying independent re-admitted patients, providing personalised information and a direct number to call in the event of clinical worsening, assigning specialists and liaison nurses, structured follow-up by telephone and appointments and contact with general practitioners. Patient perceived quality of care estimated was analyzed using a focus group technique. To assess the number of re-admissions and the Emergency Department attendances we estimated the relative risk reduction as a percentage and corresponding 95% confidence intervals.Results: In terms of perceived quality of care, the most valued elements were related to having an assigned doctor/nurse and easy access in the event of worsening. Overall, 97.9% of patients reported full adherence to treatment (95% CI: 95.4-98.83).Hospital bed days and Emergency Department attendances decreased by 60.7% (95% CI: 58.7-62.7) and 77% (95% CI: 73.2-80.3), respectively.Conclusions: The intensive multidisciplinary care programme can reduce Emergency Department attendances and improve perceived quality of care in patients with HF and COPD.

Development of quality indicators for non-Hodgkin lymphoma

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17017-17017
Author(s):  
L. Wennekes ◽  
P. B. Ottevanger ◽  
J. M. Raemaekers ◽  
H. C. Schouten ◽  
P. H. De Mulder ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Quality Indicators ◽  
International Prognostic Index ◽  
B Cell Lymphoma ◽  
Flow Chart ◽  
World Health ◽  
Care Process ◽  
Organization Of Care

17017 Background: Indicator development to monitor quality of care for non-Hodgkin lymphoma's (NHL) is difficult because NHL represents variable disorders with different and fast changing treatment policies. This study aimed to generate a set of valid indicators for NHL, using a systematic consensus method. Methods: Recommendations from evidence-based guidelines were collected as potential indicators. A multidisciplinary panel of 14 experts rated and discussed these recommendations on the usefulness as an indicator in three rounds using the Rand-modified Delphi procedure. This procedure was innovated with a flow chart from diagnostics to follow-up that showed which recommendations were crucial for the continuation of the care process. Experts were enforced to develop indicators for diagnostics, treatment and follow-up and the organization of care. Results: From a list of 99 recommendations 10 potential indicators for diagnostics, 10 for treatment and follow-up and 8 for the organization of care were selected. All potential indicators for diagnostics and treatment were crucial according to the flow chart. Six indicators were relevant for only a few patients and were rejected. Another six were merged into two. For diagnostics 8 indicators remained including taking a biopsy, evaluation of morphology and immune phenotype, the World Health Organization- classification, staging with CT-scanning of neck, thorax and abdomen, bone marrow aspirate and crista biopsy according to Ann Arbor, blood counts and the International Prognostic Index. For treatment 3 indicators remained regarding treatment with R-CHOP in optimal dose intensity for diffuse large B-cell lymphoma and response evaluation according to Cheson. For organization of care 7 indicators remained including waiting times, multidisciplinary consultations, adequate reporting and accredited expertise and facilities. Conclusions: This study showed that relevant quality indicators can be developed for a complex malignancy like NHL. Our innovations with the flow chart made a relevant contribution to the selection method and we managed to develop indicators for each part of the care process. They are currently tested for validity and feasibility. The use of these indicators makes it possible to monitor and improve the quality of care for NHL. No significant financial relationships to disclose.

The Teamwork Study: enhancing the role of non-GP staff in chronic disease management in general practice

2013 ◽  
Vol 19 (3) ◽  
pp. 184 ◽  
Author(s):  
D. A. Black ◽  
J. Taggart ◽  
U. W. Jayasinghe ◽  
J. Proudfoot ◽  
P. Crookes ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Chronic Disease ◽  
Chronic Illness ◽  
Team Work ◽  
Chronic Illness Care ◽  
Patient Assessment ◽  
Significant Difference ◽  
The Impact

There is evidence for a team-based approach in the management of chronic disease in primary health care. However, the standard of care is variable, probably reflecting the limited organisational capacity of health services to provide the necessary structured and organised care for this group of patients. This study aimed to evaluate the impact of a structured intervention involving non-GP staff in GP practices on the quality of care for patients with diabetes or cardiovascular disease. A cluster randomised trial was undertaken across 60 GP practices. The intervention was implemented in 30 practices with staff and patients interviewed at baseline and at 12–15 months follow up. The change in team roles was evaluated using a questionnaire completed by practice staff. The quality of care was evaluated using the Patient Assessment of Chronic Illness Care questionnaire. We found that although the team roles of staff improved in the intervention practices and there were significant differences between practices, there was no significant difference between those in the intervention and control groups in patient-assessed quality of care after adjusting for baseline-level score and covariates at the 12-month follow up. Practice team roles were not significantly associated with change in Patient Assessment of Chronic Illness Care scores. Patients with multiple conditions were more likely to assess their quality of care to be better. Thus, although previous research has shown a cross-sectional association between team work and quality of care, we were unable to replicate these findings in the present study. These results may be indicative of insufficient time for organisational change to result in improved patient-assessed quality of care, or because non-GP staff roles were not sufficiently focussed on the aspects of care assessed. The findings provide important information for researchers when designing similar studies.

Improving Breast Cancer Quality of Care with the Use of Patient Navigators

2010 ◽  
Vol 76 (10) ◽  
pp. 1043-1046 ◽  
Author(s):  
Formosa Chen ◽  
Cheryl Mercado ◽  
Irina Yermilov ◽  
Melissa Puig ◽  
Clifford Y. Ko ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
Quality Indicators ◽  
Cancer Care ◽  
Public Hospital ◽  
Patient Navigator ◽  
Financial Barriers ◽  
Patient Navigators ◽  
The Impact

The continuum of breast cancer care requires multidisciplinary efforts. Patient navigators, who perform outreach, coordination, and education, have been shown to improve some areas of care. However, little research has assessed the impact of navigators on breast cancer treatment in uninsured populations. Our objective is to report on the impact of a patient navigator program on breast cancer quality of care at a public hospital. One hundred consecutive newly diagnosed patients with breast cancer (Stages I to III) were identified (2005 to 2007). Forty-nine patients were treated before the use of navigators and 51 after program implementation. Nine breast cancer quality indicators were used to evaluate quality of care. Overall adherence to the quality indicators improved from 69 to 86 per cent with the use of patient navigators ( P < 0.01). Only one individual indicator, use of surveillance mammography, improved significantly (52 to 76%, P < 0.05). All nine indicators reached 75 per cent or greater adherence rates after implementation of the navigator program compared with only four before implementation. Patient navigators appear to improve breast cancer quality of care in a public hospital. In populations in which cultural, linguistic, and financial barriers are prevalent, navigator programs can be effective in narrowing the observed gaps in the quality of cancer care.

scholarly journals Data Quality of General Practice Electronic Health Records: The Impact of a Program of Assessments, Feedback, and Training

2004 ◽  
Vol 11 (1) ◽  
pp. 78-86 ◽  
Author(s):  
Mark Porcheret ◽  
Rhian Hughes ◽  
Dai Evans ◽  
Kelvin Jordan ◽  
Tracy Whitehurst ◽  
...  
Keyword(s):  
General Practice ◽  
Electronic Health Records ◽  
Data Quality ◽  
Health Records ◽  
Electronic Health ◽  
The Impact ◽  
And Training
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