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 · Sep 2006
Selecting indicators for the quality of cardiac care at the health system level in Organization for Economic Co-operation and Development countries.
Cardiovascular (CV) diseases are major causes of morbidity and death in adults in the world. Major differences have been reported in the management strategies and the outcome of CV diseases within and between countries. To better understand and address these differences, there is a need for quantitative information on patient management, outcome, and prognosis. ⋯ The final set of 17 indicators selected by the Cardiac Care Panel constitutes a comprehensive set of measures for the most relevant domains of CV care. Nevertheless, gaps remain in the area of primary prevention and in particular in areas with rapidly changing technology and improving treatment options.
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Int J Qual Health Care · Jun 2006
A multifaceted intervention improves patient satisfaction and perceptions of emergency department care.
. We aimed to evaluate the effectiveness of a multifaceted intervention, targeting staff-patient communication, in improving emergency department patient satisfaction. ⋯ Significant improvements in a variety of patient satisfaction measures were achieved with an intervention comprising staff communication workshops, a patient education film, and a patient liaison nurse.
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Int J Qual Health Care · Jun 2006
Appropriateness of colorectal cancer screening: appraisal of evidence by experts.
. To evaluate how the level of evidence perceived by an international panel of experts was concordant with the level of evidence found in the literature, to compare experts perceived level of evidence to their appropriateness scores, and to compare appropriateness criteria for colonoscopy between experts and an evidence-based approach. ⋯ Experts often overestimated the level of evidence on which they based their decisions. However, rarely did the experts' judgement completely disagree with the literature, although concordance between panel- and literature-based appropriateness was only fair. A more explicit discussion of existing evidence should be undertaken with the experts before they evaluate appropriateness criteria.
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Int J Qual Health Care · Apr 2006
Prevention of perioperative venous thromboembolism and coronary events: differential responsiveness to an intervention program to improve guidelines adherence.
Prevention of venous thromboembolism and coronary events (with beta-blockers) during and after surgery is at the top of a list of safety practices for hospitalized patients, recommended by the Agency for Health Care Research and Quality (AHRQ). We wished to determine and improve adherence to clinical guidelines for these topics in our institution. PATIENTS, MATERIAL, AND METHODS: A prospective survey was conducted over several weeks on operated patients in a 1200-beds medical center (a teaching, community and referral hospital in Jerusalem, Israel). Eligibility for and actual administration of prophylactic treatment with anticoagulant and beta-blockers were determined. Following an intervention program, which included staff meetings, development of local protocols, and academic detailing by a nurse, the survey was repeated. ⋯ Adherence to guidelines for prevention of surgical complications was found to be low in our institution. A multifaceted intervention significantly increased use of prophylaxis for venous thromboembolism but not for coronary events. This differential response suggests that the success of a quality improvement project strongly depends on topic content and its phase of acceptance.
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Int J Qual Health Care · Apr 2006
Process of care and mortality of stroke patients with and without a do not resuscitate order in the West Midlands, UK.
. To compare the process of care of stroke patients with and without a do not resuscitate (DNR) order. ⋯ Stroke patients with a DNR order are not receiving optimum care in that they are not being cared for on stroke units or by specialist teams. This may reflect the inadequate provision of specialist stroke services in the UK.