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 · Oct 2004
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialComparing cost effects of two quality strategies to improve test ordering in primary care: a randomized trial.
To determine the costs and cost reductions of an innovative strategy aimed at improving test ordering routines of primary care physicians, compared with a traditional strategy. ⋯ On the basis of our findings, including the expected non-monetary benefits, we recommend further long-term effect and cost-effect studies on the implementation of the quality strategy.
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Int J Qual Health Care · Oct 2004
Impact of medical practice guidelines on the assessment of patients with acute coronary syndrome without persistent ST segment elevation.
To assess the impact of introducing clinical practice guidelines on acute coronary syndrome without persistent ST segment elevation (ACS) on patient initial assessment. ⋯ Guidelines implementation, along with availability of a cardiology consultant in the emergency room had a positive impact on initial assessment of patients evaluated for suspicion of ACS. It led to increased confidence in diagnosis and stratification by risk, which are the first steps in initiating effective treatment for this common condition.
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Int J Qual Health Care · Oct 2004
A qualitative study of the intra-hospital variations in incident reporting.
To determine the relationship between variations in hospital incident reporting and the corresponding attitudes and participation of medical professionals. ⋯ The qualitative data revealed significant variations in the intra-hospital organization of incident reporting between medical specialities that corresponded with the attitudes and participation of medical staff. Specifically, it was found that medical doctors were more inclined to report incidents where the process of reporting was localized and integrated within medical rather than managerial systems of quality improvement. Underlying these variations, it is suggested that medical reporting is more likely when physicians have greater control or ownership of incident reporting, as this fosters confidence in the purpose of reporting, in particular its capacity to make meaningful service improvements whilst maintaining a sense of collegiality and professionalism.
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Int J Qual Health Care · Aug 2004
What makes an error unacceptable? A factorial survey on the disclosure of medical errors.
Although the importance of disclosing medical errors to patients has been argued, little is known about the relative effect of different attributes of error handling and communication on patients' judgments about errors. ⋯ The handling of errors strongly contributes to citizens' choice of actions to be taken, and they are sensitive to failures to name the incident as an 'error'. For the success of de-individualized, systems-oriented approaches to errors, communication of clear accountability to patients will be crucial.
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Int J Qual Health Care · Jun 2004
Physician knowledge and adherence to prescribing antibiotic prophylaxis for sickle cell disease.
The purpose of this research was to examine how physician characteristics were associated with: (i). physician knowledge of and adherence to sickle cell guidelines; and (ii). the types of educational programs about sickle cell disease desired by physicians. ⋯ The majority of physicians surveyed were relatively knowledgeable about sickle cell guidelines, however there may be a need for continuing education programs that focus on the issues of prescribing antibiotics to a child with unconfirmed sickle cell disease and penicillin dosage.