| 1. |
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| 2. |
- Abrahamsson, Birgitta, et al.
(författare)
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To recommend the local primary health-care centre or not : What importance do patients attach to initial contact quality, staff continuity and responsive staff encounters?
- 2015
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 27:3, s. 196-200
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objective: This study aims to examine the circumstances associated with patients’ tendencies to recommend a primary care centre, based on four hypotheses, the initial contact’s quality, care relationship continuity, treatment encounter responsiveness and whether the significance of encounter responsiveness differs depending on whether the patient has been seeing a nurse or physician. Design: The study is based on the patient’ self-reported responses, retrieved from the Swedish National Patient Survey. The design is cross-sectional, and data were analysed using a binary logistic regression. Setting: Data were collected from three primary healthcare centres in the region of Västra Götaland, Sweden. Participants: A total of 362 patients (62% females) having visited any of three publicly run healthcare centres in September 2010 constitute the analytical sample. Participants were fairly evenly distributed across all age groups. Main Outcome Measures: Recommendation was captured by patients’ binary responses to the question: Would you recommend the visited primary healthcare centre? Results: The hypotheses involving initial contact quality, care relationship continuity and treatment encounter responsiveness were supported by the analyses. The latter was strongly associated with patient tendency to recommend the primary healthcare centre. However, the profession (nurse or physician) involved in the treatment encounter made no difference for the predictive significance of encounter responsiveness for a patient’s tendency to recommend the healthcare centre. Conclusions: Striving for stable and responsive patient/staff relationships and an open approach towards patients are potentially successful strategies for primary healthcare centres seeking to attract new patients and maintain current ones. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)
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| 3. |
- Ahnquist, Johanna, et al.
(författare)
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What has trust in the health-care system got to do with psychological distress? Analyses from the national Swedish survey of public health
- 2010
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1464-3677 .- 1353-4505. ; 22:4, s. 250-258
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Tidskriftsartikel (refereegranskat)abstract
- Mental health disorders are a rapidly growing public health problem. Despite the fact that lack of trust in the health-care system is considered to be an important determinant of health, there is scarcity of empirical evidence demonstrating its associations with health outcomes. This is the first study which aims to evaluate the association between trust in the health-care system and psychological distress. Cross-sectional study. The association between trust in the health-care system and psychological distress was analysed with multiple logistic regression analysis adjusting for other factors. A randomly selected representative sample of women and men aged 16-84 years from the Swedish population who responded to the 2006 Swedish National Survey of Public Health. A total of 26 305 men and 30 584 women participated in the study. None. The main outcome measure was psychological distress measured by the General Health Questionnaire. Very low trust in health-care services was associated with an increased risk for psychological distress among men (odds ratio = 1.59, 95% confidence intervals 1.25-2.02) and among women (odds ratio = 1.83, 95% confidence intervals 1.47-2.27) after controlling for age, country of birth, socioeconomic circumstances, long-term illness and interpersonal trust. Our results suggest that health-care system mistrust is associated with an increased likelihood of psychological distress. Although causal relationships cannot be established, patient mistrust of health-care providers may have detrimental implications on health. Public health policies should include strategies aimed at increasing access to health-care services, where trust plays a substantial role.
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| 4. |
- Algurén, Beatrix, 1977, et al.
(författare)
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Quality indicators and their regular use in clinical practice: results from a survey among users of two cardiovascular National Registries in Sweden
- 2018
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 30:10, s. 786-792
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Tidskriftsartikel (refereegranskat)abstract
- Objective To examine the regular use of quality indicators from Swedish cardiovascular National Quality Registries (NQRs) by clinical staff; particularly differences in use between the two NQRs and between nurses and physicians. Design Cross-sectional online survey study. Setting Two Swedish cardiovascular NQRs: (a) Swedish Heart Failure Registry and (b) Swedeheart. Participants Clinicians (n =185; 70% nurses, 26% physicians) via the NQRs’ email networks. Main Outcome Measures Frequency of NQR use for (a) producing healthcare activity statistics; (b) comparing results between similar departments; (c) sharing results with colleagues; (d) identifying areas for quality improvement (QI); (e) surveilling the impact of QI efforts; (f) monitoring effects of implementation of new treatment methods; (g) doing research and (h) educating and informing healthcare professionals and patients. Results Median use of NQRs was 10 times a year (25th and 75th percentiles range: 3–23 times/year). Quality indicators from the NQRs were used mainly for producing healthcare activity statistics. Median use of Swedeheart was six times greater than Swedish Heart Failure Registry (SwedeHF; P < 0.000). Physicians used the NQRs more than twice as often as nurses (18 vs. 7.5 times/year; P < 0.000) and perceived NQR work more often as meaningful. Around twice as many Swedeheart users had the role to participate in data analysis and in QI efforts compared to SwedeHF users. Conclusions Most respondents used quality indicators from the two cardiovascular NQRs infrequently (<3 times/year). The results indicate that linking registration of quality indicators to using them for QI activities increases their routine use and makes them meaningful tools for professionals.
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| 5. |
- Anchalia, Manju M, et al.
(författare)
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Seeking solutions : scaling-up audit as a quality improvement tool for infection control in Gujarat, India
- 2011
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 23:4, s. 464-470
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Tidskriftsartikel (refereegranskat)abstract
- QUALITY PROBLEM OR ISSUE: Surgical-site infections (SSIs) give rise to significant demands on the health systems as well as economic and social sequelae for patients. This article describes an audit for infection control developed in a surgical unit of a tertiary care setting in Gujarat state, India that was scaled-up to all state-owned hospitals in the district.IMPLEMENTATION: Surveillance and hospital epidemiology were established and practice reforms implemented. Monthly and annual meetings to review implementation were held.EVALUATION: After 12 months, an 88% decrease in the infection rate in the surgical unit was demonstrated. Thereafter, the process was replicated across the surgical department and for all cases undergoing surgery. After 12 months, a 67% reduction in the infection rate was detected. The process has since been applied across the state.LESSONS LEARNED: A locally owned and team-led process embedded within routine working conditions can challenge widely held perceptions, inform low-cost and no-cost remedial actions, and improve cultures of practice, quality of care and health outcomes. As urban populations grow, methods that are capable of continuously identifying, and responding to, problems and sustaining quality of care in facilities are necessary. SSIs may be largely preventable. With careful implementation, audit has the potential to be a major contributor to their reduction.
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| 6. |
- Anderson, Janet E., et al.
(författare)
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Translating research on quality improvement in five European countries into a reflective guide for hospital leaders : the ‘QUASER Hospital Guide’
- 2019
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 31:8, s. G87-G96
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim was to translate the findings of the QUASER study into a reflective, dialogic guide to help senior hospital leaders develop an organization wide QI strategy.Design: The QUASER study involved in depth ethnographic research into QI work and practices in two hospitals in each of five European countries. Three translational stakeholder workshops were held to review research findings and advise on the design of the Guide. An extended iterative process involving researchers from each participant country was then used to populate the Guide.Setting: The research was carried out in two hospitals in each of five European countries.Participants: In total, 389 interviews with healthcare practitioners and 803 hours of observations.Intervention: None.Main outcome measure: None.Results: The QUASER Hospital Guide was designed for leadership teams to diagnose their organization’s strengths and weaknesses in the eight QI challenges. The Guide supports organizational dialogue about QI challenges, enables leaders to share perspectives, and helps teams to develop solutions to their situated problems. The Guide includes extensive examples of QI strategies drawn from the data and is published online and on paper.Conclusion: The QUASER Hospital Guide is empirically based, draws on a dialogical approach to Organizational Development and complexity science and can facilitate hospital leadership teams to identify the best solutions for their organization.
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| 7. |
- Anell, Anders, et al.
(författare)
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A randomized comparison between league tables and funnel plots as an aid to health care decision-making
- 2017
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1464-3677 .- 1353-4505. ; 28:6, s. 816-823
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Tidskriftsartikel (refereegranskat)abstract
- Objective Comparison of provider performance is commonly used to inform health care decision-making. Little attention has been paid to how data presentations influence decisions. This study analyzes differences in suggested actions by decision-makers informed by league tables or funnel plots.Design Decision-makers were invited to a survey and randomized to compare hospital performance using either league tables or funnel plots for four different measures within the area of cancer care. For each measure, decision-makers were asked to suggest actions towards 12–16 hospitals (no action, ask for more information, intervene) and provide feedback related to whether the information provided had been useful.Setting Swedish health care.Participants Two hundred and twenty-one decision-makers at administrative and clinical levels.Intervention Data presentations in the form of league tables or funnel plots.Main outcome measures Number of actions suggested by participants. Proportion of appropriate actions.Results For all four measures, decision-makers tended to suggest more actions based on the information provided in league tables compared to funnel plots (44% vs. 21%, P < 0.001). Actions were on average more appropriate for funnel plots. However, when using funnel plots, decision-makers more often missed to react even when appropriate.Conclusions The form of data presentation had an influence on decision-making. With league tables, decision-makers tended to suggest more actions compared to funnel plots. A difference in sensitivity and specificity conditioned by the form of presentation could also be identified, with different implications depending on the purpose of comparisons. Explanations and visualization aids are needed to support appropriate actions.
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| 8. |
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| 9. |
- Arakelian, Erebouni, et al.
(författare)
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How operating room efficiency is understood in a surgical team : a qualitative study
- 2011
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 23:1, s. 100-106
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Building surgical teams is one attempt to ensure the health-care system becomes more efficient, but how is 'efficiency'understood or interpreted? The aim was to study how organized surgical team members and their leaders understood operating room efficiency. Design. Qualitative study. Settings. A 1100-bed Swedish university hospital. Participants. Eleven participants, nine team members from the same team and their two leaders were interviewed. Methods. The analysis was performed according to phenomenography, a research approach that aims to discover variationsin peoples' understanding of a henomenon. Results. Seven ways of understanding operating room efficiency were identified: doing one's best from one's prerequisites,enjoying work and adjusting it to the situation, interacting group performing parallel tasks, working with minimal resources to produce desired results, fast work with preserved quality, long-term effects for patient care and a relative concept. When talking about the quality and benefits of delivered care, most team members invoked the patient as the central focus. Despite seven ways of understanding efficiency between the team members, they described their team as efficient. The nurses and assistant nurses were involved in the production and discussed working in a timely manner more than the leaders. Conclusions. The seven ways of understanding operating room efficiency appear to represent both organization-oriented andindividual-oriented understanding of that concept in surgical teams. The patient is in focus and efficiency is understood as maintaining quality of care and measuring benefits of care for the patients.
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| 10. |
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| 11. |
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| 12. |
- Axelsson, Johan, et al.
(författare)
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Home care aides in the administration of medication.
- 2004
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1464-3677 .- 1353-4505. ; 16:3, s. 237-243
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Tidskriftsartikel (refereegranskat)
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| 13. |
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| 14. |
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| 15. |
- Batalden, P., et al.
(författare)
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From assurance to coproduction : A century of improving the quality of health-care service
- 2021
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 33, s. II10-II14
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Tidskriftsartikel (refereegranskat)abstract
- Background: Over the last century, the invitation to improve health-care service quality has taken many different forms: questions, observations, methods, tools and actions have emerged and evolved to create relevant 'improvement work.' In this paper we present three phases of this work. The basic frameworks used in these phases have not supplanted each other, but they have been layered one upon the next over time. Each brought important new thinking, new change opportunities and a new set of limits. The important messages of each need to be carried together into the future, as must the sense of curiosity and possibility about the commonalities that has driven this evolution. Methods: Literature, personal experience and other artifacts were reviewed to develop this description of how the focus on quality work has evolved (and continues to evolve) over the last century. Results: We describe three phases. Quality 1.0 seeks to answer the question 'How might we establish thresholds for good healthcare services?' It described certain 'basic' standards that should be used to certify acceptable performance and capability. This led to the formation of formal processes for review, documentation and external audits and a system for public notice and recognition. Over time, the limits and risks of this approach also became more visible: A 'micro-Accounting compliance' sometimes triumphed over what might be of even greater strategic importance in the development and operations of effective systems of disease prevention and management to improve outcomes for patients and families. Quality 2.0 asked 'How might we use enterprise-wide systems for disease management?' It added a focus on the processes and systems of production, reduction of unwanted variation, the intrinsic motivation to take pride in work, outcome measurement and collaborative work practices as ways to improve quality, modeled on experiences in other industries. Quality 3.0 asks 'How might we improve the value of the contribution that healthcare service makes to health?' It requires careful consideration of the meaning of 'service' and 'value', service-creating logic, and prompts us to consider both relationships and activities in the context of the coproduction of health-care services. Conclusion: Efforts to improve the quality and value of health-care services have evolved over the last century. With each success have come new challenges and questions, requiring the addition of new frames and approaches.
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| 16. |
- Bouchet, B, et al.
(författare)
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The Zambia quality assurance program: successes and challenges
- 2002
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Ingår i: International journal for quality in health care : journal of the International Society for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505. ; 1414 Suppl 1, s. 89-95
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Tidskriftsartikel (refereegranskat)
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| 17. |
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| 18. |
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| 19. |
- Flink, Maria, et al.
(författare)
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Measuring care transitions in Sweden : validation of the care transitions measure
- 2018
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 30:4, s. 291-297
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To translate and assess the validity and reliability of the original American Care Transitions Measure, both the 15-item and the shortened 3-item versions, in a sample of people in transition from hospital to home within Sweden.Design: Translation of survey items, evaluation of psychometric properties.Setting: Ten surgical and medical wards at five hospitals in Sweden.Participants: Patients discharged from surgical and medical wards.Main outcome measure: Psychometric properties of the Swedish versions of the 15-item (CTM-15) and the 3-item (CTM-3) Care Transition Measure.Results: We compared the fit of nine models among a sample of 194 Swedish patients. Cronbach's alpha was 0.946 for CTM-15 and 0.74 for CTM-3. The model indices for CTM-15 and CTM-3 were strongly indicative of inferior goodness-of-fit between the hypothesized one-factor model and the sample data. A multidimensional three-factor model revealed a better fit compared with CTM-15 and CTM-3 one factor models. The one-factor solution, representing 4 items (CTM-4), showed an acceptable fit of the data, and was far superior to the one-factor CTM-15 and CTM-3 and the three-factor multidimensional models. The Cronbach's alpha for CTM-4 was 0.85.Conclusions: CTM-15 with multidimensional three-factor model was a better model than both CTM-15 and CTM-3 one-factor models. CTM-4 is a valid and reliable measure of care transfer among patients in medical and surgical wards in Sweden. It seems the Swedish CTM is best represented by the short Swedish version (CTM-4) unidimensional construct.
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| 20. |
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| 21. |
- Fredriksson, Mio, 1976-, et al.
(författare)
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Are data from national quality registries used in quality improvement at Swedish hospital clinics?
- 2017
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 29:7, s. 909-915
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the use of data from national quality registries (NQRs) in local quality improvement as well as purported key factors for effective clinical use in Sweden. Comparative descriptive: a web survey of all Swedish hospitals participating in three NQRs with different levels of development (certification level). Heads of the clinics and physician(s) at clinics participating in the Swedish Stroke Register (Riksstroke), the Swedish National Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Lung Cancer Registry (NLCR). Individual and unit level use of NQRs in local quality improvement, and perceptions on data quality, organizational conditions and user motivation. Riksstroke data were reported as most extensively used at individual and unit levels ((x) over bar 17.97 of 24 and (x) over bar 27.06 of 35). Data quality and usefulness was considered high for the two most developed NQRs ((x) over bar 19.86 for Riksstroke and (x) over bar 19.89 for GallRiks of 25). Organizational conditions were estimated at the same level for Riksstroke and GallRiks ((x) over bar 12.90 and (x) over bar 13.28 of 20) while the least developed registry, the NLCR, had lower estimates (x 10.32). In Riksstroke, the managers requested registry data more often ((x) over bar 15.17 of 20). While there were significant differences between registries in key factors such as management interest, use of NQR data in local quality improvement seems rather prevalent, at least for Riksstroke. The link between the registry's level of development and factors important for routinization of innovations such as NQRs needs investigation.
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| 22. |
- Gremyr, Andreas, et al.
(författare)
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The role of co-production in Learning Health Systems
- 2021
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 33:Supplement 2, s. ii26-ii32
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Co-production of health is defined as 'the interdependent work of users and professionals who are creating, designing, producing, delivering, assessing, and evaluating the relationships and actions that contribute to the health of individuals and populations'. It can assume many forms and include multiple stakeholders in pursuit of continuous improvement, as in Learning Health Systems (LHSs). There is increasing interest in how the LHS concept allows integration of different knowledge domains to support and achieve better health. Even if definitions of LHSs include engaging users and their family as active participants in aspects of enabling better health for individuals and populations, LHS descriptions emphasize technological solutions, such as the use of information systems. Fewer LHS texts address how interpersonal interactions contribute to the design and improvement of healthcare services.OBJECTIVE: We examined the literature on LHS to clarify the role and contributions of co-production in LHS conceptualizations and applications.METHOD: First, we undertook a scoping review of LHS conceptualizations. Second, we compared those conceptualizations to the characteristics of LHSs first described by the US Institute of Medicine. Third, we examined the LHS conceptualizations to assess how they bring four types of value co-creation in public services into play: co-production, co-design, co-construction and co-innovation. These were used to describe core ideas, as principles, to guide development.RESULT: Among 17 identified LHS conceptualizations, 3 qualified as most comprehensive regarding fidelity to LHS characteristics and their use in multiple settings: (i) the Cincinnati Collaborative LHS Model, (ii) the Dartmouth Coproduction LHS Model and (iii) the Michigan Learning Cycle Model. These conceptualizations exhibit all four types of value co-creation, provide examples of how LHSs can harness co-production and are used to identify principles that can enhance value co-creation: (i) use a shared aim, (ii) navigate towards improved outcomes, (iii) tailor feedback with and for users, (iv) distribute leadership, (v) facilitate interactions, (vi) co-design services and (vii) support self-organization.CONCLUSIONS: The LHS conceptualizations have common features and harness co-production to generate value for individual patients as well as for health systems. They facilitate learning and improvement by integrating supportive technologies into the sociotechnical systems that make up healthcare. Further research on LHS applications in real-world complex settings is needed to unpack how LHSs are grown through coproduction and other types of value co-creation.
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| 23. |
- Gunningberg, Lena, 1954-, et al.
(författare)
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Reduced incidence of pressure ulcers in patients with hip fractures : a 2-year follow-up of quality indicators
- 2001
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 13:5, s. 399-407
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Tidskriftsartikel (refereegranskat)abstract
- In the framework of a quality improvement project, where research activities were integrated with practice-based developmental work, the incidence of pressure ulcers was reduced significantly in patients with hip fractures. The best predictor of pressure ulcer development was increased age.
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| 24. |
- Gunningberg, Lena, et al.
(författare)
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Tracking quality over time : what do pressure ulcer data show?
- 2008
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 20:4, s. 246-253
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To compare the prevalence of pressure ulcers and prevention before and after a quality improvement program, determine whether patient characteristics differed for those who did and did not develop pressure ulcers, identify pressure ulcer prevention implemented at admission and whether prevention and risk factors varied by pressure ulcer severity. Design. Descriptive comparative study based on two cross-sectional pressure ulcer surveys conducted in 2002 and 2006, complemented with a retrospective audit of the electronic health record and administrative system for patients identified with pressure ulcers. Setting. 1100-bed Swedish university hospital. Participants. 612 hospitalized patients in 2002 and 632 in 2006. Main outcome measures. Prevalence of pressure ulcers and prevention (pressure-reducing mattresses, planned repositioning, chair, heel and 30 degrees lateral positioning cushions). Results. Pressure ulcer prevalence was 23.9% in 2002 and 22.9% in 2006. When non-blanchable erythema was excluded, the prevalence was 8.0 and 12.0%, respectively. The use of pressure-reducing mattresses increased while planned repositioning decreased. Those who developed ulcers were older, at-risk for ulcers, incontinent and had longer length of stay. Little prevention was documented at admission. Some prevention strategies and risk factors were related to severity of ulcers. Conclusions. Pressure ulcer prevalence did not decrease, despite a comprehensive quality improvement program. Special attention is needed to provide prevention to older patients with acute admission. Skin and risk assessment, as well as prevention, should start early in the hospitalization. Identifying those persons with community-acquired versus hospital-acquired ulcers will strengthen pressure ulcers as an accurate marker of quality of care for hospitalized patients. If possible, data should be reported by ward level for comparison over time.
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| 25. |
- Gustavsson, Catharina, 1961-, et al.
(författare)
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General practitioners' use of sickness certification guidelines in Sweden at introduction and four years later : a survey study
- 2018
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Ingår i: International Journal for Quality in Health Care. - : OXFORD UNIV PRESS. - 1353-4505 .- 1464-3677. ; 30:6, s. 429-436
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Tidskriftsartikel (refereegranskat)abstract
- Objective: National sickness certification guidelines were introduced in Sweden in 2007, comprising both overarching and diagnoses-specific recommendations. This study aimed to investigate how general practitioners (GP) used and perceived the usefulness of these guidelines in the sickness certification process close after introduction and 4 years later. Design: Two nationwide cross-sectional surveys in 2008 and 2012. Setting: Swedish healthcare. Participants: Physicians working in primary healthcare and having sickness certification consultations at least a few times per year (n = 4214 in 2008, and n = 4067 in 2012). Main Outcome Measures: Frequency of use and perceived usefulness of the sickness certification guidelines. Results: Most GPs used the guidelines at least a few times per year (in 2008 74.6%; in 2012 85.2%). In 2008, 44.1% reported a need to develop competence in using the guidelines, compared with 23.3% in 2012. Of those using the guidelines, 36.7% in 2008 and 44.6% in 2012 reported it problematic to write sickness certificates in accordance with the guidelines. Most GPs (89.2% in 2008 and 88.8% in 2012) valued the guidelines beneficial to ensure quality in sickness certification consultations. A larger proportion in 2012 compared with 2008 reported that the guidelines facilitated contacts with patients (61.2%, respectively, 55.6%), as well as with other stakeholders. Conclusions: The guidelines were perceived as useful and beneficial to ensure high quality in sickness certification consultations, and facilitated contacts with patients as well as other stakeholders. In 2012, still one-fourth reported a need to develop more competence in using the sickness certification guidelines.
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| 26. |
- Hallgren Elfgren, Ing-Marie, et al.
(författare)
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The process of implementation of the diabetes register in Primary Health Care
- 2012
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 24:4, s. 419-424
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Tidskriftsartikel (refereegranskat)abstract
- Quality problem or issue According to Swedish law, all health care units must have a system for quality improvement. The aim of this study was to follow an implementation process of a uniform routine for quality control of diabetes care in Primary Health Care in one county. Initial assessment Primary Health Care had a decentralized organization and patients with type 2 diabetes were served at 42 different Primary Health Care Centres. Choice of solution As the Swedish Diabetes Register (National Diabetes Register, NDR) holds the most important quality indicators, implementation of the NDR registration at all centres was chosen to be the best way to follow up quality in diabetes care. Implementation The process of implementing the NDR went through different phases and the main way to encourage commitment to the process was to reward performance in a progressively more differentiated way. Evaluation During the implementation process (2001–05) there was an increasing rate of registration. When the programme ceased, the registration rate had reached a level of 75%, which has remained stable and was still in 2010 one of the highest rates in Sweden. Lessons learned Important factors for success were the initiative taken by the profession itself and strong support from the leaders of the county council. It was also important to let the process develop gradually in order to get all staff involved. Among the outcomes was an increase in computer use in clinical practice among the diabetes nurse specialists and a structured way of encouraging the patients' participation in self-care.
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| 27. |
- Harris, JK, et al.
(författare)
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The appropriateness of colonoscopy: a multi-center, international, observational study
- 2007
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1464-3677 .- 1353-4505. ; 19:3, s. 150-157
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To examine the appropriateness and necessity of colonoscopy across Europe. Design. Prospective observational study. Setting. A total of 21 gastrointestinal centers from 11 countries. Participants. Consecutive patients referred for colonoscopy at each center. Intervention. Appropriateness criteria developed by the European Panel on the Appropriateness of Gastrointestinal Endoscopy, using the RAND appropriateness method, were used to assess the appropriateness of colonoscopy. Main outcome measure. Appropriateness of colonoscopy. Results. A total of 5213 of 6004 (86.8%) patients who underwent diagnostic colonoscopy and had an appropriateness rating were included in this study. According to the criteria, 20, 26, 27, or 27% of colonoscopies were judged to be necessary, appropriate, uncertain, or inappropriate, respectively. Older patients and those with a major illness were more likely to have an appropriate or necessary indication for colonoscopy as compared to healthy patients or patients who were 45–54 years old. As compared to screening patients, patients who underwent colonoscopy for iron-deficiency anemia [OR: 30.84, 95% CI: 19.79–48.06] or change in bowel habits [OR: 3.69, 95% CI: 2.74–4.96] were more likely to have an appropriate or necessary indication, whereas patients who underwent colonoscopy for abdominal pain [OR: 0.64, 95% CI: 0.49–0.83] or chronic diarrhea [OR: 0.54, 95% CI: 0.40–0.75] were less likely to have an appropriate or necessary indication. Conclusions. This study identified significant proportions of inappropriate colonoscopies. Prospective use of the criteria by physicians referring for or performing colonoscopies may improve appropriateness and quality of care, especially in younger patients and in patients with nonspecific symptoms.
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| 28. |
- Heiwe, Susanne, et al.
(författare)
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Evidence-based practice : attitudes, knowledge and behaviour among allied health care professionals
- 2011
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 23:2, s. 198-209
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore dieticians', occupational therapists' and physical therapists' attitudes, beliefs, knowledge and behaviour concerning evidence-based practice within a university hospital setting. Design: Cross-sectional survey. Setting. University hospital. Participants: All dieticians, occupational therapists and physical therapists employed at a Swedish university hospital (n = 306) of whom 227 (74%) responded. Main Outcome Measures: Attitudes towards, perceived benefits and limitations of evidence-based practice, use and understanding of clinical practice guidelines, availability of resources to access information and skills in using these resources. Results: Findings showed positive attitudes towards evidence-based practice and the use of evidence to support clinical decision-making. It was seen as necessary. Literature and research findings were perceived as useful in clinical practice. The majority indicated having the necessary skills to be able to interpret and understand the evidence, and that clinical practice guidelines were available and used. Evidence-based practice was not perceived as taking into account the patient preferences. Lack of time was perceived as the major barrier to evidence-based practice. Conclusions: The prerequisites for evidence-based practice were assessed as good, but ways to make evidence-based practice time efficient, easy to access and relevant to clinical practice need to be continuously supported at the management level, so that research evidence becomes linked to work-flow in a way that does not adversely affect productivity and the flow of patients. © The Author 2011. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
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| 29. |
- Holmberg, Leif, 1943-
(författare)
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Task uncertainty and rationality in medical problem solving
- 2006
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Ingår i: International Journal for Quality in Health Care. - 1353-4505 .- 1464-3677. ; 18:6, s. 458-462
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Tidskriftsartikel (refereegranskat)abstract
- ISSUE: Medical problem-solving situations are characterized by various degrees of 'task uncertainty'--i.e. uncertainty related to the definition of a problem, the effect of a technology, the value of a solution, and so on. The need for professional discretion varies and depends on the degree of perceived task uncertainty. SUGGESTED SOLUTION: In this report it is argued that, in order to obtain rationality in problem-solving processes, differences in the degree of task uncertainty need to be met by variation in the structure of the health care organization. IMPLICATIONS: The main implications of this view are that (under norms of rationality) problem-solving processes with low task uncertainty must be organized in one way and processes with high task uncertainty in another. Furthermore, processes with high and low task uncertainty also need to be evaluated according to different standards. Some hypotheses regarding the different organizational requirements are presented.
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| 30. |
- Holmberg, Leif
(författare)
-
Task uncertainty and rationality in medical problem solving
- 2006
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 18:6, s. 458-462
-
Tidskriftsartikel (refereegranskat)abstract
- ISSUE: Medical problem-solving situations are characterized by various degrees of 'task uncertainty'--i.e. uncertainty related to the definition of a problem, the effect of a technology, the value of a solution, and so on. The need for professional discretion varies and depends on the degree of perceived task uncertainty. SUGGESTED SOLUTION: In this report it is argued that, in order to obtain rationality in problem-solving processes, differences in the degree of task uncertainty need to be met by variation in the structure of the health care organization. IMPLICATIONS: The main implications of this view are that (under norms of rationality) problem-solving processes with low task uncertainty must be organized in one way and processes with high task uncertainty in another. Furthermore, processes with high and low task uncertainty also need to be evaluated according to different standards. Some hypotheses regarding the different organizational requirements are presented.
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| 31. |
- Jakobsson, Liselotte, 1953-, et al.
(författare)
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Patient satisfaction with nursing care : evaluation before and after expenditure cutback and intervention at a surgical clinic
- 1994
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Ingår i: International Journal for Quality in Health Care. - 1353-4505 .- 1464-3677. ; 6:4, s. 361-369
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Tidskriftsartikel (refereegranskat)abstract
- After a major cutback in the budget and staffing of a surgical clinic in southern Sweden there was intervention to improve the quality of nursing care and to evaluate the outcome. The intervention consisted of the implementation of: (1) nursing care organized in such a way that it would secure continuity of the nurse—patient relationship, (2) individually planned care by means of diagnostic reasoning, and (3) quality assurance for aspects believed to be connected with quality of care. Patient satisfaction before and after the intervention was assessed by means of a patient questionnaire survey (May 1991; n = 105 and May 1992; n = 137). Patient satisfaction improved significantly in variables related to nursing care viz. overall satisfaction and satisfaction with information and decision making; satisfaction with contact and staff-patient relationship; ward facilities and physical treatment or examinations; and satisfaction with physical nursing care. The results were interpreted to mean that the intervention may have counteracted any negative impact the reduced budget might have had such as the higher patient turn-over and the shorter in-patient periods, and thus seemed to have improved the quality of the nursing care in terms of patient satisfaction.
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| 32. |
- Johnson, Julie K., et al.
(författare)
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A starter's guide to learning and teaching how to coproduce healthcare services
- 2021
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 33:Supplement 2, s. II55-II62
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Tidskriftsartikel (refereegranskat)abstract
- Background: There has been insufficient attention paid to the role of learning in co-production-both how service users and professional service providers learn to co-produce effectively and how the lessons of co-production are captured at a service level.Objective: We aimed to develop and test a curriculum to support healthcare professionals' interest in learning how to co-produce health and healthcare services with patients.Methods: We developed a co-production curriculum that was tested iteratively in multiple in-person and virtual teaching sessions and short courses. We conducted a formative evaluation of the co-production curriculum and teaching tools to tailor the curriculum.Results: Several theories underpin our approach to learning and teaching how to co-produce healthcare services. The co-production curriculum is grounded in systems theory and shares elements of educational theories, namely, the postmodern curriculum matrix, the actor network theory and situated learning in communities of practice. Learning participants valued the sense of community, the experiential learning environment, and the practical methods to support their exploration of co-production.Conclusion: This paper summarizes the educational theories that underpin our efforts to develop and implement the curriculum, reports on a formative assessment conducted with learners, and makes recommendations for creating an environment for learning how health professionals can co-produce health and healthcare with patients.
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| 33. |
- Kiadaliri, Ali, et al.
(författare)
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Impact of a national guideline on use of knee arthroscopy : An interrupted time-series analysis
- 2019
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1464-3677 .- 1353-4505. ; 31:9, s. 113-118
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the impact of the Swedish health authority recommendation against the use of knee arthroscopy in patients aged ≥40 years with knee osteoarthritis (OA).DESIGN: Interrupted time series analysis.SETTING: Public health care in Skåne region.PARTICIPANTS: Patients aged ≥40 years who underwent knee arthroscopy from January 2010 to December 2015.INTERVENTION(S): National guideline's recommendation against the use of knee arthroscopy in patients with knee OA.MAIN OUTCOME MEASURE(S): 1) proportion of patients aged ≥40 years with a main diagnosis of Knee OA and/or degenerative meniscal lesions (DML) who underwent knee arthroscopy, and 2) overall knee arthroscopy rate per 100,000 Skåne population aged ≥40 years.RESULTS: A total of 6,155 knee arthroscopy were performed among people aged ≥40 years during study period. Of 42,044 patients with Knee OA/DML, 3,728 had knee arthroscopy. The recommendation was associated with reductions in the use of knee arthroscopy and two years after the recommendation, there was a reduction of 28.6% (95% CI: 9.3, 47.8) and 34.7% (23.9, 45.4) in proportion of Knee OA/DML patients with knee arthroscopy and the overall knee arthroscopy rate, respectively, relative to that expected if pre-recommendation trend continued. Our sensitivity analysis showed that the use of total knee replacement was stable over the study period.CONCLUSION: The national recommendation was associated with reduction in use of knee arthroscopy in public health care in southern Sweden. However, still 4.5% of these patients underwent knee arthroscopy in 2015 implying that more efforts are required to achieve the recommended target.
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| 34. |
- Kredo, Tamara, et al.
(författare)
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Guide to clinical practice guidelines: the current state of play
- 2016
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Ingår i: International Journal for Quality in Health Care. - : OXFORD UNIV PRESS. - 1353-4505 .- 1464-3677. ; 28:1, s. 122-128
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Extensive research has been undertaken over the last 30 years on the methods underpinning clinical practice guidelines (CPGs), including their development, updating, reporting, tailoring for specific purposes, implementation and evaluation. This has resulted in an increasing number of terms, tools and acronyms. Over time, CPGs have shifted from opinion-based to evidence-informed, including increasingly sophisticated methodologies and implementation strategies, and thus keeping abreast of evolution in this field of research can be challenging. Methods: This article collates findings from an extensive document search, to provide a guide describing standards, methods and systems reported in the current CPG methodology and implementation literature. This guide is targeted at those working in health care quality and safety and responsible for either commissioning, researching or delivering health care. It is presented in a way that can be updated as the field expands. Conclusion: CPG development and implementation have attracted the most international interest and activity, whilst CPG updating, adopting (with or without contextualization), adapting and impact evaluation are less well addressed.
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| 35. |
- Lindberg, Malou, et al.
(författare)
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Asthma care and factors affecting medication compliance : the patient's point of view
- 2001
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 13:5, s. 375-383
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To identify important factors that can influence patient compliance with prescribed medication and to elucidate aspects of asthma care from the patient's point of view.Design. Field investigation; the interviewer used a semi‐structured questionnaire.Setting. Patients with asthma in primary health care settings in Sweden.Study participants. A sample of 77 patients was randomly selected from 11 primary health care centres in southern Sweden; 63 of these patients participated in the study.Conclusion. The factors of importance for self‐reported compliance with prescribed medication were age, gender, duration of the disease, the attitude of the staff and information/education about asthma. The patients expressed important aspects of care, and these are in accordance with how an asthma nurse practice functions in Sweden.
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| 36. |
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| 37. |
- Lindberg, Malou, et al.
(författare)
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Patient questionnaires in primary health care : Validation of items used in asthma care
- 2000
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 12:1, s. 19-24
-
Tidskriftsartikel (refereegranskat)abstract
- Objective.To evaluate each item in a patient questionnaire for the purpose of investigating whether the validity of each item is acceptable.Design.The questionnaire was completed by the patients at an ordinary follow-up visit for their asthma, and within 1 week a nurse interviewed them by telephone with the aim of analysing the validity of each item through the use of predetermined criteria.Settings.Patients with asthma in primary health care settings in Sweden.Study participants.Fifty-one patients were consecutively included from three different primary health care units.Results.Nine of 13 items had an acceptable validity. The four items that were not found to have acceptable validity were developed further.Conclusion.Evaluating each item in a questionnaire by means of interviews with the specific patient population is a useful method of assuring that the intention of the patient questionnaire has been met.
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| 38. |
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| 39. |
- Lindgren, Margareta, et al.
(författare)
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The Karen instruments for measuring quality of nursing care: construct validity and internal consistency.
- 2011
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 23:3, s. 292-301
-
Tidskriftsartikel (refereegranskat)abstract
- Background Valid and reliable instruments for measuring the quality of care are needed for evaluation and improvement of nursing care. Previously developed and evaluated instruments, the Karen-patient and the Karen-personnel based on Donabedian's Structure–Process–Outcome triad (S–P–O triad) had promising content validity, discriminative power and internal consistency. Objective The objective of this study was to further develop the instruments with regard to construct validity and internal consistency. Design and Settings This prospective study was carried out in medical and surgical wards at a hospital in Sweden. A total of 95 patients and 120 personnel were included. Methods The instruments were tested for construct validity by performing factor analyses in two steps and for internal consistency using Cronbach's alpha coefficient. Results The first confirmatory factor analyses, with a pre-determined three-factor solution did not load well according to the S–P–O triad, but the second exploratory factor analysis with a six-factor solution appeared to be more coherent and the distribution of variables seemed to be logical. The reliability, i.e. internal consistency, was good in both factor analyses. Conclusions The Karen-patient and the Karen-personnel instruments have achieved acceptable levels of construct validity. The internal consistency of the instruments is good. This indicates that the instruments may be suitable to use in clinical practice for measuring the quality of nursing care.
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| 40. |
- Lofvendahl, S, et al.
(författare)
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Waiting for orthopaedic surgery: factors associated with waiting times and patients' opinion
- 2005
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1464-3677 .- 1353-4505. ; 17:2, s. 133-140
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To assess waiting times for three groups of orthopaedic patients in Sweden and to identify factors explaining variations in waiting time. Also examined were factors associated with patients' perceptions that waiting times were too long. Design. Retrospective study. Setting and study participants. Patients from orthopaedic units at 10 Swedish hospitals participated in the study. A questionnaire was sent to 1336 surgical patients (517 hip replacement, 321 back surgery, and 498 arthroscopic knee surgery) 3 months after surgery. Information extracted from the hospitals' patient administrative systems was also used. Outcome measures. Length of waiting time, socio-economic variables, hospital type, health-related quality of life, and opinion about waiting time. The data were analysed mainly using regression analyses. Results. The overall response rate was 79%. In all pre-operative stages, waiting times were longest in the hip replacement group. Socio-economic variables were not consistent determinants of variation in waiting times except for working status in the back surgery group where. working patients had shorter waiting times than non-working patients irrespective of phase of waiting time. Admission to a county/district county hospital, compared with a university/regional hospital, was associated with shorter time on the waiting fist. Patients with better health-related quality of life had significantly longer waiting times for arthroscopic knee surgery by all waiting time measures. The length of wait was a significant predictor of the patients' acceptance of waiting time. Patients' influence over the date of surgery also appeared to affect their opinion about the waiting time. Conclusions. Hospital-related factors are more important than patient characteristics as explanations of variations in waiting times for orthopaedic surgery. Patients value short waiting times and the possibility of influencing the date of surgery.
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| 41. |
- Lögde, Ann, et al.
(författare)
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I am quitting my job : Specialist nurses in perioperative context and their experiences of the process and reasons to quit their job
- 2018
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 30:4, s. 313-320
-
Tidskriftsartikel (refereegranskat)abstract
- The lack of specialist nurses in operating theatres is a serious problem. The aim of this study was to describe reasons why specialist nurses in perioperative care chose to leave their workplaces and to describe the process from the thought to the decision. Twenty specialist nurses (i.e. anaesthesia, NA, and operating room nurses) from seven university- and county hospitals in Sweden participated in qualitative individual in-depth interviews. Data were analysed by systematic text condensation. We identified four themes of reasons why specialist nurses quitted their jobs: the head nurses' betrayal and dismissive attitude, and not feeling needed; inhumane working conditions leading to the negative health effects; not being free to decide about one's life and family life being more important than work; and, colleagues' diminishing behaviour. Leaving one's job was described as a process and specialist nurses had thought about it for some time. Two main reasons were described; the head nurse manager's dismissive attitude and treatment of their employees and colleagues' mistreatment and colleagues' diminishing behaviour. Increasing knowledge on the role of the head nurse managers in specialist nurses' decision making for leaving their workplace, and creating a friendly, non-violent workplace, may give the opportunity for them to take action before it is too late.
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| 42. |
- Löve, Jesper, 1974, et al.
(författare)
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Balancing extensive ambition and a context overflowing with opportunities and demands : A grounded theory on stress and recovery among highly educated working young women entering male-dominated occupational areas
- 2011
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 6:3
-
Tidskriftsartikel (refereegranskat)abstract
- Several factors underline the issue of stress-related health among young highly educated women. Major societal changes might provide more new challenges with considerably changed and expanded roles than were expected by earlier generations, especially among women. The quantity of young women with higher education has also increased threefold in Sweden in less than two decades and there are a growing number of young women that hereby break with traditional gender positions and enter new occupational areas traditionally dominated by men. The research questions in the present study were: ‘‘What is the main concern, regarding stress and recovery, among young highly educated working women breaking with traditional gender positions and entering male-dominated occupational areas?’’ and ‘‘How do they handle this concern?’’ We conducted open-ended interviews with 20 informants, aged 23-29 years. The results showed that the synergy between highly ambitious individuals and a context overflowing with opportunities and demands ended up in the informants’ constantly striving to find a balance in daily life (main concern). This concern refers to the respondents experiencing a constant overload of ambiguity and that they easily became entangled in a loop of stress and dysfunctional coping behavior, threatening the balance between stress and sufficient recovery. In order to handle this concern, the respondents used different strategies in balancing extensive ambition and a context overflowing with opportunities and demands (core category). This preliminary theoretical model deepens our understanding of how the increasing numbers of highly educated young women face complex living conditions endangering their possibility of maintaining health and work ability.
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| 43. |
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| 44. |
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| 45. |
- Mesterton, J., et al.
(författare)
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Inter-hospital variations in health outcomes in childbirth care in Sweden: A register-based study
- 2019
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 31:4, s. 276-282
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The objective of this study was to estimate case mix adjusted variations in central indicators of health outcomes in childbirth care and to assess whether hospitals who perform well on one indicator also perform well on others. Design: Register-based study using regional administrative data, linked to clinical data and population data. Setting: Twenty-one hospitals in seven Swedish regions covering 67% of deliveries in Sweden. Participants: The study included 139 756 women who gave birth in 2011 and 2012. Intervention(s): N/A. Main Outcome Measure(s): Four indicators of health outcomes were studied: obstetric anal sphincter injuries (OASIS), haemorrhage >1000 ml, postpartum infection and Apgar <4 at 5 min. Variations between hospitals were estimated using fixed effects logistic regression, adjusted for numerous sociodemographic and clinical characteristics. Results: Significant variations after case mix adjustment were observed for all four indicators. If all hospitals had performed as the average of the top five hospitals for each indicator, a total of 890 OASIS, 2700 haemorrhages, 1500 postpartum infections and 180 instances of low Apgar would have been avoided. A certain degree of correlation was observed between different indicators of outcomes. However, no hospital had a statistically significant higher or lower rate across all four indicators of health outcomes. Conclusions: The significant variations in all four indicators demonstrate a potential for improvement in performance at all studied hospitals. Hospital performance was not consistent across different indicators of outcomes and all hospitals have potential for improvement in certain aspects of labour management. © The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved.
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| 46. |
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| 47. |
- Nilsson, Erik, 1939-, et al.
(författare)
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Cholecystectomy : costs and health-related quality of life: a comparison of two techniques
- 2004
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 16:6, s. 473-482
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Tidskriftsartikel (refereegranskat)abstract
- Background. Outcomes of previous health economic evaluations comparing minilaparotomy cholecystectomy and laparoscopic cholecystectomy have been inconsistent.Objective. To compare costs for minilaparotomy cholecystectomy and laparoscopic cholecystectomy and to study changes in quality of life induced by these operations.Design. Single-blind, randomized controlled trial, run from 1 March 1997 to 30 April 1999.Setting. One university hospital and four non-university hospitals in Sweden.Main measures. Cost and perceived health estimation according to the global quality of life instrument EuroQol-5D.Results. Of 1719 cholecystectomy patients at five centres, 724 entered the trial and were treated with minilaparotomy cholecystectomy or laparoscopic cholecystectomy, 362 in each group. Total health care costs were less for minilaparotomy cholecystectomy than for laparoscopic cholecystectomy (median values US$2428 for minilaparotomy cholecystectomy versus US$2613 or US$3006 for laparoscopic cholecystectomy with 100 operations per year and reusable trocars or 50 operations per year and disposable trocars, respectively). There was no significant difference in total costs (including costs due to loss of production) between minilaparotomy cholecystectomy and laparoscopic cholecystectomy with 100 operations per year and reusable trocars in laparoscopic cholecystectomy (US$3731 versus US$3649, respectively). However, in calculations assuming 50 operations per year and disposable trocars in laparoscopic cholecystectomy, this technique was more expensive than minilaparotomy cholecystectomy (US$4042 versus US$3731). Health-related quality of life was slightly but significantly lower for the minilaparotomy cholecystectomy group 1 week after surgery. One month and 1 year postoperatively no difference between the randomized groups was found.Conclusion. Total costs did not differ between minilaparotomy cholecystectomy and laparoscopic cholecystectomy with high-volume surgery and disposable trocars, whereas laparoscopic cholecystectomy was more expensive with fewer operations and disposable trocars. The gain in health-related quality of life with laparoscopic cholecystectomy compared with minilaparotomy cholecystectomy was small and of limited duration.
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| 48. |
- Nordberg, E, et al.
(författare)
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Patient attitudes to major surgery in rural Kenya
- 1996
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Ingår i: International journal for quality in health care : journal of the International Society for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505. ; 8:3, s. 265-269
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Tidskriftsartikel (refereegranskat)
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| 49. |
- Ogink, H., et al.
(författare)
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A strategic tool to improve long-term health outcomes in clinical practice: SHOR driver and association diagram
- 2020
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 32:1, s. 20-27
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Tidskriftsartikel (refereegranskat)abstract
- Quality problem or issue: An over-arching principle of healthcare governance in Sweden is to achieve as much health for as many patients as possible given the available resources. With high life expectancy and increased years lived with non-communicable diseases, more effective interventions in prevention and control of non-communicable diseases are needed in order to ensure high-quality healthcare. Initial assessment: Few publications have described a generic and resource-effective method of implementing the perspective of health outcomes in relation to costs in a clinical Swedish university hospital context. To fill this gap, a generic method was developed at Sahlgrenska University hospital in Gothenburg, Sweden. Choice of solution: A System-based driver and association diagram of Health Outcomes in relation to available Resources (SHOR) was developed. The SHOR driver and association diagram comprised different perspectives: health, patient, process, research and cost perspectives. It enabled the translation from long-term health outcomes to applications in clinical practice. Implementation: Three patient groups exemplify the use and implementation of the method of SHOR association and driver diagram; bipolar disorder (psychiatry), primiparous women with spontaneous onset of labour, (obstetric care) and chronic obstructive pulmonary disease (somatic care). Evaluation:The SHOR driver and association diagram enabled a structure to monitor and support quality development towards maximised health outcomes in relation to available resources and associated total costs for a specific patient group. Lessons learned :This method has connected clinical practice, management and research and has been used for both strategic and operational purposes.
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| 50. |
- Oliver, Brant J., et al.
(författare)
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Initial development of a self-assessment approach for coproduction value creation by an international community of practice
- 2021
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 33:Supplement 2, s. ii48-ii54
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Coproduction offers a new way of conceptualizing healthcare as a service that is co-created by people (health professionals and people seeking health services) rather than a product that is generated by providers or health systems and delivered to patients. This offers new possibilities for those introducing and testing changes, and it enables additional ways of creating value. Fjeldstad and colleagues describe the architecture of several kinds of value creating systems: (i) Chain; (ii) Shop; (iii) Network and (iv) Access. An international Value Creating Business Model Community of practice (VCBM CoP) was formed by the International Coproduction of Health Network and explored these types of systems and developed a self-assessment guide for health systems to use to assess value.METHODS: An international community of practice comprising leaders, clinicians, patients and finance specialists representing 12 health systems from four countries (USA, UK, Israel and Sweden) met monthly for 1 year and used a semi-structured process to iteratively refine and adapt Fjeldstad's model for use in healthcare and develop a draft self-assessment guide. The process concluded with initial focus group user experience sessions with six health systems.RESULTS: The community of practice successfully completed a 1-year journey of discovery, development and learning, resulting in two products: (1) a full-version self-assessment guide (detailed) and (2) an abbreviated 'short-form' of the guide. Initial focus-group results suggest that there is initial perceived feasibility, acceptability and utility of the guides and that further development and research is reasonable to pursue. Results suggest significant variation and context specificity in the use of the guide, simple and complex knowledge transfer applications in use, and the need for the development of simple and technology supported versions for use in the future.CONCLUSION: The VCBM CoP has successfully completed a 1-year collaborative learning cycle, resulting in the development of a self-assessment guide that is now ready for additional investigation using formal research methods. The CO-VALUE study has been designed to build on the work of the CoP and includes qualitative and quantitative assessment phases and a concept mapping study.
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