BMJ quality & safety
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BMJ quality & safety · Jan 2013
Comparative StudyVariation in safety culture dimensions within and between US and Swiss Hospital Units: an exploratory study.
The purpose of this study was to explore the variability in safety culture dimensions within and between Swiss and US clinical areas. ⋯ The authors found differences in SAQ dimensions at the country, hospital and unit levels. The general emphases placed on teamwork and safety climate in quality and safety efforts appear to be highlighting dimensions that vary more at the unit than hospital level. They suggest that patient safety improvement interventions target unit level changes, and they support the emphasis being placed on teamwork and safety climate, as these vary significantly at the unit level across countries.
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BMJ quality & safety · Jan 2013
Recorded quality of primary care for patients with diabetes in England before and after the introduction of a financial incentive scheme: a longitudinal observational study.
The UK's Quality and Outcomes Framework (QOF) was introduced in 2004/5, linking remuneration for general practices to recorded quality of care for chronic conditions, including diabetes mellitus. We assessed the effect of the incentives on recorded quality of care for diabetes patients and its variation by patient and practice characteristics. ⋯ The introduction of financial incentives was associated with improvements in the recorded quality of diabetes care in the first year. These improvements included some measures of disease control, but most captured only documentation of recommended aspects of clinical assessment, not patient management or outcomes of care. Improvements in subsequent years were more modest. Variation in care between population groups diminished under the incentives, but remained substantial in some cases.
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BMJ quality & safety · Jan 2013
Editorial CommentSafety climate research: taking stock and looking forward.
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BMJ quality & safety · Dec 2012
Multicenter StudyStakeholder perspectives on handovers between hospital staff and general practitioners: an evaluation through the microsystems lens.
Much of the research on improving patient handovers has focused on enhancing communication within the hospital system, but there have been relatively few efforts aimed at addressing the challenges at the interface between the hospital and the primary care setting. ⋯ The microsystem approach offers an innovative organisational construct and approach to assess the gaps in 'hospital to community' patient handovers, by viewing the hospital to the community interface as a clinical microsystem continuum. Our application of the microsystem approach confirms and extends earlier findings about the impact of barriers on the continuity and safety of patient transitions and their impact on the quality of patient care.