International journal for quality in health care : journal of the International Society for Quality in Health Care
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Int J Qual Health Care · Aug 2002
Comparative StudyHospital in the home is cost saving for appropriately selected patients: a comparison with in-hospital care.
As the cost of acute care in hospitals increases, there is an increasing need to find alternative means of providing acute care. Hospital in the home (HITH) has developed in response to this challenge. Current evidence is conflicting as to whether HITH provides cost savings compared with in-hospital care (IHC). The heterogeneous nature of HITH and the clinical complexity of patients is the greatest obstacle to making valid comparisons between the two modes of care. ⋯ In our study the adjusted cost of HITH was significantly cheaper than IHC, particularly as total episode substitution. The cost needs to be adjusted because many factors other than HITH or IHC can influence crude costs. There may be potential for wider use of HITH for appropriately selected patients.
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Int J Qual Health Care · Aug 2002
Use of home health services covered by new public long-term care insurance in Japan: impact of the presence and kinship of family caregivers.
In April 2000, the system for caring for the elderly in Japan was changed drastically with the launch of new long-term care insurance. Unlike the previous system, the maximum monthly amount of insured services is now decided solely by an applicant's physical condition, regardless of family support. We investigated whether the presence and kinship of a family caregiver still affect service use under the new system. ⋯ The use of major services may be decided more by the needs of caregivers than by the care level of the applicant. To successfully implement the new system, consideration of the caregiver situation should be included in policy making.
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To determine the adverse event (AE) rate for surgical patients in Australia. ⋯ The high AE rate for surgical procedures supports the need for monitoring and intervention strategies. The 18 screening criteria provide a tool to identify admissions with a greater risk of a surgical AE. Risk factors for an AE were age and procedure, and these should be assessed prior to surgery. Prophylactic interventions for infection and deep vein thrombosis could reduce the occurrence of AEs in hospitals.
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Int J Qual Health Care · Aug 2002
Impact of end user involvement in implementing guidelines on routine pre-operative tests.
To assess the impact of health professionals' involvement in the implementation of practice guidelines aimed at reducing the use of pre-operative tests in patients at low anaesthetic risk undergoing elective surgery. ⋯ This study indicates that an implementation strategy based upon direct involvement of end users in the identification of possible barriers to change can be successful in promoting the use of practice guidelines.
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The use of rigorous qualitative research methods can enhance the development of quality measures, the development and dissemination of comparative quality reports, as well as quality improvement efforts. This paper describes how such methods have been and can be used, and identifies how to improve the use of such methods in studying quality of care. Focus groups and cognitive interviews are now a standard part of the development of valid and reliable survey instruments. ⋯ The design and conduct of rigorous qualitative research takes a skilled and experienced team. Issues commonly faced in quantitative work must also be addressed in qualitative studies, including study design, specification of the unit of analysis, sampling, instrument design and administration, and, in particular, data analysis. It is especially critical that the analysis and interpretation process be deliberate and thorough to avoid the use of initial impression rather than detailed examination of the raw data.