Journal of evaluation in clinical practice
-
Guidelines recommend inviting family members of intensive care unit (ICU) patients to rounds. We aimed to create a toolkit to support family participation in ICU bedside rounds, based upon evidence from research and in collaboration with ICU family member representatives and healthcare providers. ⋯ There is consensus on general strategies for facilitating family participation in rounds and meaningful communication between family and the healthcare team during rounds as an important element of the continuum of communication in the ICU. The incorporation of these elements should be standardized, though tailored to user needs.
-
The aim of this study was to explore factors that influence individuals' attitudes towards mandatory vaccination in Greece. ⋯ This survey revealed that most Greek citizens support mandatory vaccination, which was critically affected by the utilization of preventive services and trust in healthcare authorities. Our results suggest that healthcare policy interventions should promote mandatory vaccination through multi-level initiatives to improve healthcare providers' and the general public's understanding of the value of vaccination.
-
Prescribed opioids are major contributors to the international public health opioid crisis. Such widespread iatrogenic harms usually result from collective decision failures of healthcare organizations rather than solely of individual organizations or professionals. Findings from a system-wide safety analysis of the iatrogenic opioid crisis that includes roles of pertinent healthcare organizations may help avoid or mitigate similar future iatrogenic consequences. In this retrospective exploratory study, we report such an analysis. ⋯ The iatrogenic crisis has multiple intricately linked roots. The major catalyst: pervasive pharma-linked financial conflicts of interest (CoIs) involving most other healthcare organizations. These extensive financial CoIs were likely triggers for a cascade of erroneous decisions and actions that adversely affected patients. The actions and decisions of pharma ranged from unethical to illegal. The iatrogenic opioid crisis may exemplify 'institutional corruption of pharmaceuticals'.
-
Low-income women disproportionately experience preventable, adverse neonatal outcomes. Prior to the Affordable Care Act (ACA) Medicaid expansion, many low-income women became eligible for coverage only after becoming pregnant, reducing their access to healthcare before pregnancy and creating discontinuities in care that may delay Medicaid enrollment. The objective of this study was to examine the impact of the ACA Medicaid expansion on neonatal outcomes among low-income populations in Oregon. ⋯ This study provides evidence that expanding Medicaid coverage may have positive effects on LBW and preterm birth, which could lead to important long-term impacts on childhood and later-life health outcomes. States that have not expanded their Medicaid programs might improve neonatal outcomes among low-income populations by extending insurance coverage to low-income adults.
-
Review
Improving quality in a complex primary care system-An example of refugee care and literature review.
Applying traditional industrial quality improvement (QI) methodologies to primary care is often inappropriate because primary care and its relationship to the healthcare macrosystem has many features of a complex adaptive system (CAS) that is particularly responsive to bottom-up rather than top-down management approaches. We report on a demonstration case study of improvements made in the Family Health Center (FHC) of the JPS Health Network in a refugee patient population that illustrate features of QI in a CAS framework as opposed to a traditional QI approach. ⋯ Meaningful improvement in primary care is more likely achieved when the impetus to implement change shifts from top-down to bottom-up.