scholarly journals Widespread gaps in the quality of care for primary biliary cholangitis in UK

2021 ◽  
pp. flgastro-2020-101713
Author(s):  
Mathuri Sivakumar ◽  
Akash Gandhi ◽  
Eathar Shakweh ◽  
Yu Meng Li ◽  
Niloufar Safinia ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Medical Records ◽  
Clinical Symptoms ◽  
Primary Biliary Cholangitis ◽  
Cholestatic Liver Disease ◽  
Patient Demographics ◽  
Risk Patients ◽  
Wide Scale ◽  
The Uk

ObjectivePrimary biliary cholangitis (PBC) is a progressive, autoimmune, cholestatic liver disease affecting approximately 15 000 individuals in the UK. Updated guidelines for the management of PBC were published by The European Association for the Study of the Liver (EASL) in 2017. We report on the first national, pilot audit that assesses the quality of care and adherence to guidelines.DesignData were collected from 11 National Health Service hospitals in England, Wales and Scotland between 2017 and 2020. Data on patient demographics, ursodeoxycholic acid (UDCA) dosing and key guideline recommendations were captured from medical records. Results from each hospital were evaluated for target achievement and underwent χ2 analysis for variation in performance between trusts.Results790 patients’ medical records were reviewed. The data demonstrated that the majority of hospitals did not meet all of the recommended EASL standards. Standards with the lowest likelihood of being met were identified as optimal UDCA dosing, assessment of bone density and assessment of clinical symptoms (pruritus and fatigue). Significant variations in meeting these three standards were observed across UK, in addition to assessment of biochemical response to UDCA (all p<0.0001) and assessment of transplant eligibility in high-risk patients (p=0.0297).ConclusionOur findings identify a broad-based deficiency in ‘real-world’ PBC care, suggesting the need for an intervention to improve guideline adherence, ultimately improving patient outcomes. We developed the PBC Review tool and recommend its incorporation into clinical practice. As the first audit of its kind, it will be used to inform a future wide-scale reaudit.

Electronic medical records: Assessment of recorded cancer stage in support of quality of care.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 129-129
Author(s):  
Gregory P. Hess
Keyword(s):  
Quality Of Care ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Positive Impact ◽  
Significant Proportion ◽  
Malignant Neoplasm ◽  
Cancer Stage ◽  
Underlying Assumption ◽  
Data Field

129 Background: Electronic medical records (EMRs) are being increasingly adopted in part driven by reports of their positive impact on patient’s quality of care. An underlying assumption is that data recorded will be relatively complete. As a field of primary importance, this study assessed the frequency with which cancer stage was recorded within an EMR data field during a historical and recent 12-month period. A random sample of records with missing stage was assessed to identify at a qualitative level reasons that stage may be omitted. Methods: Two datasets were constructed. The first comprised of oncology EMRs from 77 practices covering 476 sites of care across 34 states from 1/1/2000-12/31/2010. The second dataset from 58 practices covering 391 sites of care across 37 states. Inclusion criteria required patients to have a valid visit (i.e., not simply ‘scheduled’) and ≥ 1 diagnosis of a primary, malignant, neoplasm (except brain or spine). All data fields utilized to record stage (stage I, II, etc.) or from which stage could be reliably derived (T, M, N fields) were defined as "recorded." Practices were not required to exist in each dataset. Recorded stage by age, gender, state, and payer type was also assessed. Results: Reasons reported for absent stage within the data field included: consult visit only, written in the progress notes, text present in a scanned report, stage X (insufficient information), continuing treatment initiated elsewhere, and missing entry error. Conclusions: A significant proportion of cancer patients may not have stage recorded in the designated, searchable, data field within an EMR. The frequency of recorded stage is increasing over time. Reasons for unpopulated stage field(s) include use of nonsearchable text entries, scanned reports, and short episodes of care. Further research is needed to validate the observations in this study, determine root causes, and employ appropriate solutions. [Table: see text]

Lung cancer quality of care in Uruguay: First experience in a public hospital.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 231-231
Author(s):  
Maria Clara Rodriguez Palleiro ◽  
Virginia Rodriguez ◽  
Viviana Dominguez ◽  
Siul Salisbury ◽  
Alonzo Rodriguez ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Quality Of Care ◽  
Cancer Care ◽  
Medical Records ◽  
Adherence Rate ◽  
Pathology Report ◽  
Histologic Subtype ◽  
Starting Point ◽  
The Impact

231 Background: Improvement in quality of cancer care is a strategic health objective for the Ministry of Health in Uruguay. Lung cancer is the first cancer in mortality in men and the third in women in our country, there are few reports from Latino America about quality of cancer care, in our knowledge this is the first in lung cancer. Methods: We audit a public reference center in oncology that receive about 8 percent of new cases in the country, our objective was to perform a first study in quality of cancer care in non-small cell lung cancer. We reviewed the compliance with a group of 14 indicators (six general and eight NSCLC specific) selected from literature and used in different quality programs. We performed a retrospective analysis of medical records from 408 new patients seen between January 2011 and July 2016. Results: The median age was 62 years, 72,8% were male and 27,2% females, 76,6% were stage III-IV and 23,6% were stage I-II. The median adherence rate to core indicators were 84,2 (69% to 100%). PS was recorded in 76% of cases. Pathology report was present in 71,8% and stage in 97% of medical records. NSCLC indicators had a lower adherence rate 29,8% (5% to 56,3%). 60% receive adjuvant therapy based in platins but only in 5% of patients receive cisplatin. Histologic subtype was informed in 42% of pathology samples and EGFR mutation test were performed in 56% of patient with non-squamous lung cancer. Patients were treated with chemotherapy or radiotherapy as first treatment in 65,4%, stage IV patients receive as first line platin based chemotherapy in 42,7% of cases . Time between diagnosis and first treatment initiation was 28 days and the time to symptoms initiation to diagnosis was 3 months. Conclusions: This auditory identify a high rate of compliance in general indicators, compliance with lung cancer specific quality indicators is heterogeneous. Time to diagnosis need special attention. This study identify a room to improve in lung cancer quality of care and establish a starting point to evaluate the impact of future improvement efforts.

Anticancer therapy within the last 30 days of life: Results of an audit and re-audit cycle from a regional cancer center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18260-e18260
Author(s):  
Mike Nguyen ◽  
Alysson Wann ◽  
Babak Tamjid ◽  
Arvind Sahu ◽  
Javier Torres
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Retrospective Review ◽  
Medical Records ◽  
Quality Improvement Intervention ◽  
Separate Analysis ◽  
Number Of Patients ◽  
Audit Period ◽  
Improvement Intervention

e18260 Background: The therapeutic landscape in medical oncology continues to expand significantly. Newer therapies, especially immunotherapy, offer the hope of profound and durable responses with more tolerable side effect profiles. Integrating this information into the decision making process is challenging for patients and oncologists. Systemic anticancer treatment within the last thirty days of life is a key quality of care indicator and is one parameter used in the assessment of aggressiveness of care. Methods: A retrospective review of medical records of all patients previously treated at Goulburn Valley Health oncology department who died between 1 January 2015 and 30 June 2018 was conducted. Information collected related to patient demographics, diagnosis, treatment, and hospital care within the last 30 days of life. These results were presented to a hospital meeting and a quality improvement intervention program instituted. A second retrospective review of medical records of all patients who died between 1 July 2018 and 31 December 2018 was conducted in order to measure the effect of this intervention. Results: The initial audit period comprised 440 patients. 120 patients (27%) received treatment within the last 30 days of life. The re-audit period comprised 75 patients. 19 patients (25%) received treatment within the last 30 days of life. Treatment rates of chemotherapy reduced after the intervention in contrast to treatment rates of immunotherapy which increased. A separate analysis calculated the rate of mortality within 30 days of chemotherapy from the total number of patients who received chemotherapy was initially 8% and 2% in the re-audit period. Treatment within the last 30 days of life was associated with higher use of aggressive care such as emergency department presentation, hospitalisation, ICU admission and late hospice referral. Palliative care referral rates improved after the intervention. Conclusions: This audit demonstrated that a quality improvement intervention can impact quality of care indicators with reductions in the use of chemotherapy within the last 30 days of life. However, immunotherapy use increased which may be explained by increased access and perceived better tolerability.

scholarly journals Effectiveness of UK provider financial incentives on quality of care: a systematic review

2017 ◽  
Vol 67 (664) ◽  
pp. e800-e815 ◽  
Author(s):  
Rishi Mandavia ◽  
Nishchay Mehta ◽  
Anne Schilder ◽  
Elias Mossialos
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Quality Of Care ◽  
Quality Of Health Care ◽  
Financial Incentives ◽  
Healthcare Quality ◽  
Standards Of Care ◽  
Positive Effects ◽  
The Uk

BackgroundProvider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency.AimTo review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care.Design and settingSystematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.MethodMEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as ‘positive’, those that were ‘intermediate’ showed improvement in some measures, and those classified as ‘negative’ showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist.ResultsOf the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points.ConclusionThe effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives — if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK.

The need for a National Service Framework for leg ulcers

2010 ◽  
Vol 25 (1_suppl) ◽  
pp. 68-72 ◽  
Author(s):  
R A Bulbulia ◽  
K R Poskitt
Keyword(s):  
Quality Of Care ◽  
Standards Of Care ◽  
Ulcer Recurrence ◽  
Leg Ulcers ◽  
National Service ◽  
National Service Framework ◽  
Assessment And Treatment ◽  
The Uk ◽  
Service Framework

Leg ulcers are common and costly to treat, and the quality of care provided to patients with this condition varies widely across the UK. The introduction of specialized community-based leg ulcer clinics in Gloucestershire has been associated with increased ulcer healing rates and decreased rates of ulcer recurrence, but this model of care has not been widely replicated. One way of ending this ‘postcode lottery’ is to produce a National Service Framework for leg ulcers, with the aim of delivering high-quality evidence-based care via such clinics under the supervision of local consultant vascular surgeons. Existing National Service Frameworks cover a range of common conditions that are, like leg ulceration, associated with significant morbidity, disability and resource use. These documents aim to raise quality and decrease regional variations in health care across the National Health Service, and leg ulceration fulfils all the necessary criteria for inclusion in a National Service Framework. Centrally defined standards of care for patients with leg ulceration, and the reorganization and restructuring of local services to allow the accurate assessment and treatment of such patients are required. Without a National Service Framework to drive up the quality of care across the country, the treatment of patients with leg ulcers will remain suboptimal for the majority of those who suffer from this common and debilitating condition.

scholarly journals The Medical Society’s Role in Assessing Physician’s Performance: An Analysis of Six Years of Grievances Considered by an Urban Medical Society

2006 ◽  
Vol 92 (4) ◽  
pp. 9-15
Author(s):  
Arthur Frank ◽  
Howard A. Hoffman ◽  
Edward H. Stolar
Keyword(s):  
Quality Of Care ◽  
Medical Records ◽  
Ethical Issues ◽  
Professional Standards ◽  
Medical Society ◽  
Legal Authority ◽  
Behavior Issues ◽  
Staff Behavior ◽  
Office Procedures

ABSTRACT Context Although they have no legal authority, medical organizations are frequently asked to assess physician conduct. These organizations have established a variety of procedures to review grievances brought for their consideration. Objective This analysis was conducted to assess the nature and the disposition of the complaints considered by the Professional Standards Committee (Committee) of an urban medical society. Design All cases considered by the Committee (193 complaints) during a six-year period were arbitrarily sorted into categories and the nature of how the case was resolved was tabulated. Results Of all the cases considered 108 (56 percent) were categorized as related to quality of care and physician/staff behavior issues. Of these, 39 (20 percent) dealt with the characteristics of the care provided, 28 (15 percent) with physician and staff behavior, 23 (12 percent) with physician and staff communications and 18 (nine percent) with ethical issues. An additional 85 cases (44 percent) were related to administrative issues and office procedures. Of these, 50 (26 percent) were related to billing, fees and charges, 23 (12 percent) concerned medical records, 10 (five percent) dealt with office practices and procedures and two (one percent) were related to worker’s compensation. Of 141 cases in which a judgment could be made, 48.2 percent were decided in the complainant’s favor and corrective recommendations were made. The grievance appeared to be inappropriate in 51.8 percent of the cases and the reason for this decision was explained to the complainant. In the remaining 22 percent of the cases irreconcilable descriptions of the circumstances made it impossible for the Committee to make a decision or recommendation about the grievance. Conclusion The mechanism of review by the Professional Standards Committee of a medical society does appear to offer a procedure by which there can be some resolution of these complaints. In cases in which a judgment could be made the complaint was decided in favor of the complainant as frequently as in favor of the physician.

scholarly journals EP.FRI.974 NELA 30 day mortality: A single centre experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
M A Gok ◽  
O Shams ◽  
F Ftaieh ◽  
U A Khan
Keyword(s):  
High Risk ◽  
Survival Curve ◽  
Emergency Laparotomy ◽  
Single Centre ◽  
High Risk Patients ◽  
Single Centre Experience ◽  
Risk Patients ◽  
The Uk ◽  
National Emergency

Abstract Aims National emergency laparotomy audit (NELA) developed in 2014 in the UK, aims to improve of quality of care of patients undergoing emergency laparotomy. NELA highlights the importance of identifying high risk patients for potential significant morbidity and mortality. The aim of this study is to review the NELA 30 day mortality at a single centre. Methods This is a retrospective review of all 30 day NELA mortality patients since 2014 carried out at East Cheshire NHS Trust until January 2020. The NELA survivors beyond 30 days were used as controls. Results Conclusion The overall NELA 30 day mortality rate was 9.8 %. NELA deaths occurred in the older, frail, multi-comorbid & high ASA status patients. Most NELA deaths occur within 90 days, whereas patient survival curve appears to plateau out beyond 90 days. P possum can be used to identify high risk patients, where early collaborative senior assessment by consultant surgeons, anaesthetists and intensivists may identify and allocate appropriate surgical intervention. 

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