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1.
O Bayley T Colbourn B Nambiar A Costello F Kachale T Meguid C Mwansambo 《Malawi medical journal : the journal of Medical Association of Malawi》2013,25(4):105-108
Aim
Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers'' knowledge of management of routine labour, emergency obstetric care and emergency newborn care; correlated knowledge with reported confidence and previous study or training; and measured perception of the care they provided.Methods
This study formed part of a large-scale quality of care assessment in three districts (Kasungu, Lilongwe and Salima) of Malawi. Subjects were selected purposively by their role as providers of obstetric and newborn care during routine visits to health facilities by a research assistant. Research assistants introduced and supervised the self-completed questionnaire by the service providers. Respondents included 42 nurse midwives, 1 clinical officer, 4 medical assistants and 5 other staff. Of these, 37 were staff working in facilities providing Basic Emergency Obstetric Care (BEMoC) and 15 were from staff working in facilities providing Comprehensive Emergency Obstetric Care (CEMoC).Results
Knowledge regarding management of routine labour was good (80% correct responses), but knowledge of correct monitoring during routine labour (35% correct) was not in keeping with internationally recognized good practice. Questions regarding emergency obstetric care were answered correctly by 70% of respondents with significant variation depending on clinicians'' place of work. Knowledge of emergency newborn care was poor across all groups surveyed with 58% correct responses and high rates of potentially life-threatening responses from BEmOC facilities. Reported confidence and training had little impact on levels of knowledge. Staff in general reported perception of poor quality of care.Conclusion
Serious deficiencies in providers'' knowledge regarding monitoring during routine labour and management of emergency newborn care were documented. These may contribute to maternal and neonatal deaths in Malawi. The knowledge gap cannot be overcome by simply providing more training. 相似文献2.
J Roberts D Sealy H Hopp Marshak L Manda-Taylor P Gleason R Mataya 《Malawi medical journal : the journal of Medical Association of Malawi》2015,27(4):145-150
Background
Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization''s recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake.Methods
A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites.Results
Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve.Conclusions
The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed. 相似文献3.
Background
Since 2007, New York City''s primary care information project has assisted over 3000 providers to adopt and use a prevention-oriented electronic health record (EHR). Participating practices were taught to re-adjust their workflows to use the EHR built-in population health monitoring tools, including automated quality measures, patient registries and a clinical decision support system. Practices received a comprehensive suite of technical assistance, which included quality improvement, EHR customization and configuration, privacy and security training, and revenue cycle optimization. These services were aimed at helping providers understand how to use their EHR to track and improve the quality of care delivered to patients.Materials and Methods
Retrospective electronic chart reviews of 4081 patient records across 57 practices were analyzed to determine the validity of EHR-derived quality measures and documented preventive services.Results
Results from this study show that workflow and documentation habits have a profound impact on EHR-derived quality measures. Compared with the manual review of electronic charts, EHR-derived measures can undercount practice performance, with a disproportionately negative impact on the number of patients captured as receiving a clinical preventive service or meeting a recommended treatment goal.Conclusion
This study provides a cautionary note in using EHR-derived measurement for public reporting of provider performance or use for payment. 相似文献4.
Calvin K L Or Ben-Tzion Karsh Dolores J Severtson Laura J Burke Roger L Brown Patricia Flatley Brennan 《J Am Med Inform Assoc》2011,18(1):51-59
Objective
With the advent of personal health records and other patient-focused health technologies, there is a growing need to better understand factors that contribute to acceptance and use of such innovations. In this study, we employed the Unified Theory of Acceptance and Use of Technology as the basis for determining what predicts patients'' acceptance (measured by behavioral intention) and perceived effective use of a web-based, interactive self-management innovation among home care patients.Design
Cross-sectional secondary analysis of data from a randomized field study evaluating a technology-assisted home care nursing practice with adults with chronic cardiac disease.Measurement and analysis
A questionnaire was designed based on validated measurement scales from prior research and was completed by 101 participants for measuring the acceptance constructs as part of the parent study protocol. Latent variable modeling with item parceling guided assessment of patients'' acceptance.Results
Perceived usefulness accounted for 53.9% of the variability in behavioral intention, the measure of acceptance. Together, perceived usefulness, health care knowledge, and behavioral intention accounted for 68.5% of the variance in perceived effective use. Perceived ease of use and subjective norm indirectly influenced behavioral intention, through perceived usefulness. Perceived ease of use and subjective norm explained 48% of the total variance in perceived usefulness.Conclusion
The study demonstrates that perceived usefulness, perceived ease of use, subjective norm, and healthcare knowledge together predict most of the variance in patients'' acceptance and self-reported use of the web-based self-management technology. 相似文献5.
Ibrahim Taiwo Adeleke Adedeji Olugbenga Adekanye Kayode Abiodun Onawola Alaba George Okuku Samuel Adebowale Adefemi Sunday Adesubomi Erinle AbdurRahman Alhaji Shehu Olubunmi Edith Yahaya AbdulLateef Adisa Adebisi John Adeniran James Oloundare Olanrewaju AbdulGhaney Lateef Mosebolatan Ogundiran Abdullahi Daniyan Jibril Moses Esimy Atakere Moses Achinbee Oluwaseun Ayoade Abodunrin Muhammad Wasagi Hassan 《J Am Med Inform Assoc》2012,19(6):1039-1042
Background
Health records are essential for good health care. Their quality depends on accurate and prompt documentation of the care provided and regular analysis of content. This study assessed the quantitative properties of inpatient health records at the Federal Medical Centre, Bida, Nigeria.Method
A retrospective study was carried out to assess the documentation of 780 paper-based health records of inpatients discharged in 2009.Results
732 patient records were reviewed from the departments of obstetrics (45.90%), pediatrics (24.32%), and other specialties (29.78%). Documentation performance was very good (98.49%) for promptness recording care within the first 24 h of admission, fair (58.80%) for proper entry of patient unit number (unique identifier), and very poor (12.84%) for utilization of discharge summary forms. Overall, surgery records were nearly always (100%) prompt regarding care documentation, obstetrics records were consistent (80.65%) in entering patients'' names in notes, and the principal diagnosis was properly documented in all (100%) completed discharge summary forms in medicine. 454 (62.02%) folders were chronologically arranged, 456 (62.29%) were properly held together with file tags, and most (80.60%) discharged folders reviewed, analyzed and appropriate code numbers were assigned.Conclusions
Inadequacies were found in clinical documentation, especially gross underutilization of discharge summary forms. However, some forms were properly documented, suggesting that hospital healthcare providers possess the necessary skills for quality clinical documentation but lack the will. There is a need to institute a clinical documentation improvement program and promote quality clinical documentation among staff. 相似文献6.
7.
Sushil Chawla M. Nakra S. Mohan B.C. Nambiar Raju Agarwal A. Marwaha 《Medical Journal Armed Forces India》2013,69(2):134-137
Background
Pregnant women are at risk to develop complications due to illness related to pregnancy or due to aggravation of pre-existing disease. These patients also require critical care and ICU admissions in some cases. To determine the current spectrum of diseases in an obstetric population resulting in admission to the intensive care unit (ICU) at a tertiary care hospital.Methods
A retrospective case series study and analysis of data from obstetric patients admitted for critical care management.Results
0.26% of the total obstetric patients admitted to the hospital required ICU admissions. 46% of patients were admitted to ICU for ventilator support. Pre-eclampsia and obstetrical hemorrhage were the common diagnosis for these patients.Conclusion
Critically ill obstetric patients require a team approach of the obstetrician, anesthesiologist and intensive care specialist for the optimal care of these patients. 相似文献8.
K Lungu YEC Ratsma 《Malawi medical journal : the journal of Medical Association of Malawi》2007,19(1):1-8
Setting
Mwanza, Phalombe and Zomba districts in the Southern Region of Malawi.Background
Radios have been installed in many health centers in the Southern Region of Malawi but communication is often indirect. Messages get re-channeled from one health center to another before reaching district hospitals. In an attempt to strengthen the obstetric referral system, the Safe Motherhood Project installed a repeater-based VHF radio communication system in three pilot districts. The overall goal of the new network was to enable the health centers to communicate directly to their district health offices (DHOs) for an ambulance when they have an emergency obstetric complication for referral to the hospital.Aim
This study aimed to determine whether or not improving the radio communications system reduces the delay in referral of obstetric emergencies from health center to hospital.Materials and methods
Data collection was conducted between 2001 and 2003 using a range of data collection methods. Radio communications register books were placed at each participating health center to record information on all women with emergency obstetric complications referred to the hospital for further management. An obstetric referral form was completed on each woman referred to the hospital. And using the same referral form, the referral hospital was required to give feedback to the health centers on discharge of the patient. Existing maternity registers or HMIS registers were reviewed to obtain additional information not captured in radio communication registers. Interviews with health center staff were conducted to obtain their communication experiences before and after the new network was installed.Results
The average number of obstetric admissions per month and the proportion of referrals in the participating health centers significantly increased during the post-intervention period. Significantly more emergency obstetric referrals were collected under 1 hour between decision to refer by the midwife at the health center and arrival of transport from the DHO or base station in the post-intervention period than pre-intervention period (p<0.02). However, some patients still waited for more than 13 hours for transportation in the post-intervention period. The median time interval between decision to refer and arrival of transport was 3 h. versus 2 h. 3 min. in the pre- and post-intervention periods respectively.Conclusion
This study has demonstrated that the new VHF radio network system has, without doubt, improved the radio communication system in the three pilot districts. However, although the time interval between the decision to refer and arrival of transport significantly improved after the intervention, the majority of transportation still took too long, particularly for someone with postpartum hemorrhage. It is very important to improve the management/control of obstetric ambulances at district level so as to complement efforts of an improved radio communication system in reducing delays in the referral of obstetric emergencies.Open in a separate window 相似文献9.
David W Baker Stephen D Persell Abel N Kho Jason A Thompson Darren Kaiser 《J Am Med Inform Assoc》2011,18(6):805-811
Objective
We have reported that implementation of an electronic health record (EHR) based quality improvement system that included point-of-care electronic reminders accelerated improvement in performance for multiple measures of chronic disease care and preventive care during a 1-year period. This study examined whether providing pre-visit paper quality reminders could further improve performance, especially for physicians whose performance had not improved much during the first year.Design
Time-series analysis at a large internal medicine practice using a commercial EHR. All patients eligible for each measure were included (range approximately 100–7500).Measurements
The proportion of eligible patients in the practice who satisfied each of 15 quality measures after removing those with exceptions from the denominator. To analyze changes in performance for individual physicians, two composite measures were used: prescribing seven essential medications and completion of five preventive services.Results
During the year after implementing pre-encounter reminders, performance continued to improve for eight measures, remained stable for four, and declined for three. Physicians with the worst performance at the start of the pre-encounter reminders showed little absolute improvement over the next year, and most remained below the median performance for physicians in the practice.Conclusions
Paper pre-encounter reminders did not appear to improve performance beyond electronic point-of-care reminders in the EHR alone. Lagging performance is likely not due to providers'' EHR workflow alone, and trying to step backwards and use paper reminders in addition to point-of-care reminders in the EHR may not be an effective strategy for engaging slow adopters. 相似文献10.
Eyob Tadesse Bogale Worku 《Malawi medical journal : the journal of Medical Association of Malawi》2003,15(3):102-104
Objectives
To determine the prevalence and causes of perinatal mortality rates at Tikure Anbessa hospital, Ethiopia, 1995–96Design
A cross-sectional review of hospital records of all women who delivered at Tikure Anbessa Hospital. Data were collected prospectively.Setting
Teaching Hospital of Tikure Anbessa, Addis Ababa, EthiopiaSubjects
Women and neonates from 8986 deliveries. Deliveries exceeding 28 weeks of gestation or birth weight of 1000 grams were considered.Materials and Methods
All deliveries were included for infants whose gestational age exceeded 28 completed weeks. When the gestational age was unknown, the birth weight of 1000 grams or more was considered. All perinatal deaths and obstetric complications were identified. Labour chart, mode of delivery and summary of delivery had been recorded by the responsible resident at a monthly combined obstetric and paediatric perinatal mortality meeting. Age of the mother, parity, booking status for antenatal care, obstetric complications, labour, mode of delivery, birth weight, gestational age, one and five minutes Apgar scores were collected.Results
A total of 8986 deliveries were conducted during the study period. Of these 6933 (77.2%) were booked for antenatal care while the remaining 2053 (22.8%) were not booked in any health institution. The perinatal mortality rate of the hospital was 71.6 per 1000 live births. The risk of perinatal mortality was more than doubled among mothers who failed to book for antenatal care follow-up and no laboratory investigations was done were birth asphyxia followed by premature birth 15.4% and 12% respectively.Conclusions
Perinatal mortality rates are high at Tikure Anbessa Hospital, Ethiopia. There is need to ensure that pregnant women are booked for antenatal care so as to provide adequate antenatal and perinatal health care. 相似文献11.
C Kambala T Morse S Masangwi P Mitunda 《Malawi medical journal : the journal of Medical Association of Malawi》2011,23(1):1-5
Introduction
Research was conducted to get a community''s perspective on the factors contributing to continued maternal and neonatal deaths. The aim of the study was to identify and understand experiences, perceptions and needs of the community on maternal health service utilization.Methods
Qualitative data was obtained through focus group discussions with community leaders, women, men and youth in the catchment areas of three remote health centres. A total of fourteen focus groups were held: three each with community leaders, men, women, boys and two with girls.Data was transcribed and analyzed manually through the use of thematic analysis.Results
The discussions revealed the following as barriers to maternal health service utilization: walking long distances to access health facilities, lack of midwives, lack of or insufficient items to be used during delivery, long stay and rude health personnel. Seeking help from Traditional Birth Attendants (TBAs) during delivery was a common option because TBAs are within reach, do not demand many items for delivery, and treat the women with respect.Conclusion
This study suggests some factors that are contributing to the high burden of maternal deaths in Malawi. Interventions should be developed and implemented to improve the barriers reported. 相似文献12.
Objective
To determine doctors'' and nurses'' attitudes and beliefs about treating patients with type 2 diabetes with less than ideal glycaemic control while receiving maximal oral treatment in primary care.Design
Focus groups.Setting
Primary care.Participants
Four focus groups of 23 GPs and practice nurses.Results
General practice was thought to be the best setting for managing all patients with type 2 diabetes but there were concerns about a lack of resources and unfamiliarity with starting insulin. Issues around compliance were extensively discussed; the “failing diabetic” had dual meanings of failing glycaemic control and failing compliance and effort by both patient and doctor. Although views about insulin therapy differed, patients were understood to be resistant to starting insulin, representing for them a more serious stage of diabetes, with fears of needles and hypoglycaemia.Conclusion
The role of diabetes specialist nurses working in primary care will be crucial in managing such patients to improve knowledge, for extra resources, for their experience of insulin use, and to change attitudes. 相似文献13.
Thomas D. Sequist Theresa Cullen Howard Hays Maile M. Taualii Steven R. Simon David W. Bates 《J Am Med Inform Assoc》2007,14(2):191-197
Objectives
There are limited data regarding implementing electronic health records (EHR) in underserved settings. We evaluated the implementation of an EHR within the Indian Health Service (IHS), a federally funded health system for Native Americans.Design
We surveyed 223 primary care clinicians practicing at 26 IHS health centers that implemented an EHR between 2003 and 2005.Methods
The survey instrument assessed clinician attitudes regarding EHR implementation, current utilization of individual EHR functions, and attitudes regarding the use of information technology to improve quality of care in underserved settings. We fit a multivariable logistic regression model to identify correlates of increased utilization of the EHR.Results
The overall response rate was 56%. Of responding clinicians, 66% felt that the EHR implementation process was positive. One-third (35%) believed that the EHR improved overall quality of care, with many (39%) feeling that it decreased the quality of the patient–doctor interaction. One-third of clinicians (34%) reported consistent use of electronic reminders, and self-report that EHRs improve quality was strongly associated with increased utilization of the EHR (odds ratio 3.03, 95% confidence interval 1.05–8.8). The majority (87%) of clinicians felt that information technology could potentially improve quality of care in rural and underserved settings through the use of tools such as online information sources, telemedicine programs, and electronic health records.Conclusions
Clinicians support the use of information technology to improve quality in underserved settings, but many felt that it was not currently fulfilling its potential in the IHS, potentially due to limited use of key functions within the EHR. 相似文献14.
Objectives
This study aimed to determine the quality of life of pregnant adolescents aged < 20 years and pregnant adults aged between 20–29 years, to evaluate the effects of gestational periods on the quality of life, and to compare the quality of life scores of pregnant adolescents and adults.Methods
This study was performed in Turkey in 2007. Totally, 147 pregnant adolescents aged < 20 years and 156 pregnant adults aged between 20 and 29 years were included. A questionnaire on socio-demographic and obstetric characteristics was administered by face-to-face interviewing method, and Short Form-36 scale was applied.Results
The mean quality of life scores ranged between 44.2 and 56.1 points for the adolescents and between 44.6 and 59.9 points for the adults. All quality of life scores, except bodily pain, were lower for adolescents than for adults. It was determined that the quality of life scores in pregnancy were generally lower in the first trimester, significantly increased in the second trimester, and decreased to the lowest level in the third trimester.Conclusions
Quality of life scores of the pregnant adolescents were significantly lower than the pregnant adults. Physical care, support, and education programs may be beneficial to increase the quality of life levels in pregnancy. 相似文献15.
Objective
To determine the effect of the introduction of an acute medical admissions unit (AMAU) on key quality efficiency and outcome indicator comparisons between medical teams as assessed by funnel plots.Methods
A retrospective analysis was performed of data relating to emergency medical patients admitted to St James'' Hospital, Dublin between 1 January 2002 and 31 December 2004, using data on discharges from hospital recorded in the hospital in‐patient enquiry system. The base year was 2002 during which patients were admitted to a variety of wards under the care of a named consultant physician. In 2003, two centrally located wards were reconfigured to function as an AMAU, and all emergency patients were admitted directly to this unit. The quality indicators examined between teams were length of stay (LOS) <30 days, LOS >30 days, and readmission rates.Results
The impact of the AMAU reduced overall hospital LOS from 7 days in 2002 to 5 days in 2003/04 (p<0.0001). There was no change in readmission rates between teams over the 3 year period, with all teams displaying expected variability within control (95%) limits. Overall, the performance in LOS, both short term and long term, was significantly improved (p<0.0001), and was less varied between medical teams between 2002 and 2003/04.Conclusions
Introduction of the AMAU improved performance among medical teams in LOS, both short term and long term, with no change in readmissions. Funnel plots are a powerful graphical technique for presenting quality performance indicator variation between teams over time. 相似文献16.
Shane R Reti Henry J Feldman Stephen E Ross Charles Safran 《J Am Med Inform Assoc》2010,17(2):192-195
Objective
To assess the patient-centeredness of personal health records (PHR) and offer recommendations for best practice guidelines.Design
Semi-structured interviews were conducted in seven large early PHR adopter organizations in 2007. Organizations were purposively selected to represent a variety of US settings, including medium and large hospitals, ambulatory care facilities, insurers and health plans, government departments, and commercial sectors.Measurements
Patient-centeredness was assessed against a framework of care that includes: (1) respect for patient values, preferences, and expressed needs; (2) information and education; (3) access to care; (4) emotional support to relieve fear and anxiety; (5) involvement of family and friends; (6) continuity and secure transition between healthcare providers; (7) physical comfort; (8) coordination of care. Within this framework we used evidence for patient preferences (where it exists) to compare existing PHR policies, and propose a best practice model.Results
Most organizations enable many patient-centered functions such as data access for proxies and minors. No organization allows patient views of clinical progress notes, and turnaround times for PHR reporting of normal laboratory results can be up to 7 days.Conclusion
Findings suggest patient-centeredness for personal health records can be improved, and recommendations are made for best practice guidelines. 相似文献17.
Objective
Individual users’ attitudes and opinions help predict successful adoption of health information technology (HIT) into practice; however, little is known about pediatric users’ acceptance of HIT for medical decision-making at the point of care.Materials and methods
We wished to examine the attitudes and opinions of pediatric users’ toward the Child Health Improvement through Computer Automation (CHICA) system, a computer decision support system linked to an electronic health record in four community pediatric clinics. Surveys were administered in 2011 and 2012 to all users to measure CHICA''s acceptability and users’ satisfaction with it. Free text comments were analyzed for themes to understand areas of potential technical refinement.Results
70 participants completed the survey in 2011 (100% response rate) and 64 of 66 (97% response rate) in 2012. Initially, satisfaction with CHICA was mixed. In general, users felt the system held promise; however various critiques reflected difficulties understanding integrated technical aspects of how CHICA worked, as well as concern with the format and wording on generated forms for families and users. In the subsequent year, users’ ratings reflected improved satisfaction and acceptance. Comments also reflected a deeper understanding of the system''s logic, often accompanied by suggestions on potential refinements to make CHICA more useful at the point of care.Conclusions
Pediatric users appreciate the system''s automation and enhancements that allow relevant and meaningful clinical data to be accessible at point of care. Understanding users’ acceptability and satisfaction is critical for ongoing refinement of HIT to ensure successful adoption into practice. 相似文献18.
Background
A study was carried out to assess the job satisfaction of medical officers of the Armed Forces.Methods
Medical officers having a minimum of five years service, stationed in a large cantonment having a tertiary care service hospital were administered anonymously the scale developed by Brayfield and Rothe to assess job satisfaction. A total of 64 medical officers (22 administrative cadre, 26 specialists and 16 superspecialists), participated in the study.Results
Overall there was a low level of job satisfaction among the medical officers. There was no significant difference in the level of job satisfaction in the three groups. Only 3 each of administrative cadre and specialist officers were in the higher satisfied group. The most common factor stated (91.5% of the respondents), as contributing towards job satisfaction was an opportunity for self-development. Others in decreasing frequency were job security (51.6%), prestige of organization (38.5%), nature of work (28.8%) and opportunity for promotion (21.6%). Factors for dissatisfaction were poor utilization of skills (80.8%), poor promotional prospects (78.4%), inadequate redressal of grievances (72.7%), organizational policy (68.7%) and inadequate pay and allowances (48.7%).Conclusion
It was concluded that job satisfaction is a multi-dimensional phenomenon where it is not easy to assign one factor as the sole determinant of satisfaction/dissatisfaction with the job.Key Words: Correlates, Determinant, Job satisfaction, Medical 相似文献19.
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