Headache service quality: evaluation of quality indicators in 14 specialist-care centres

Dopaminergic pathways could be involved in the pathophysiology of myofascial temporomandibular disorders (M-TMD). This study investigated plasma levels of dopamine and serotonin (5-HT) in patients with M-TMD and in healthy subjects. Fifteen patients with M-TMD and 15 age- and sex-matched healthy subjects participated. The patients had received an M-TMD diagnosis according to the Research Diagnostic Criteria for TMD. Perceived mental stress, pain intensity (0–100-mm visual analogue scale), and pressure pain thresholds (PPT, kPa) over the masseter muscles were assessed; a venous blood sample was taken. Dopamine in plasma differed significantly between patients with M-TMD (4.98 ± 2.55 nM) and healthy controls (2.73 ± 1.24 nM; P < 0.01). No significant difference in plasma 5-HT was observed between the groups (P = 0.75). Patients reported significantly higher pain intensities (P < 0.001) and had lower PPTs (P < 0.01) compared with the healthy controls. Importantly, dopamine in plasma correlated significantly with present pain intensity (r = 0.53, n = 14, P < 0.05) and perceived mental stress (r = 0.34, n = 28, P < 0.05). The results suggest that peripheral dopamine might be involved in modulating peripheral pain. This finding, in addition to reports in other studies, suggests that dopaminergic pathways could be implicated in the pathophysiology of M-TMD but also in other chronic pain conditions. More research is warranted to elucidate the role of peripheral dopamine in the pathophysiology of chronic pain.     

Headache service quality evaluation: implementation of quality indicators in primary care in Europe

BackgroundLifting The Burden (LTB) and European Headache Federation (EHF) have developed a set of headache service quality indicators, successfully tested in specialist headache centres. Their intended application includes all levels of care. Here we assess their implementation in primary care.MethodsWe included 28 primary-care clinics in Germany (4), Turkey (4), Latvia (5) and Portugal (15). To implement the indicators, we interviewed 111 doctors, 92 nurses and medical assistants, 70 secretaries, 27 service managers and 493 patients, using the questionnaires developed by LTB and EHF. In addition, we evaluated 675 patients’ records. Enquiries were in nine domains: diagnosis, individualized management, referral pathways, patient education and reassurance, convenience and comfort, patient satisfaction, equity and efficiency of headache care, outcome assessment and safety.ResultsThe principal finding was that Implementation proved feasible and practical in primary care. In the process, we identified significant quality deficits. Almost everywhere, histories of headache, especially temporal profiles, were captured and/or assessed inaccurately. A substantial proportion (20%) of patients received non-specific ICD codes such as R51 (“headache”) rather than specific headache diagnoses. Headache-related disability and quality of life were not part of routine clinical enquiry. Headache diaries and calendars were not in use. Waiting times were long (e.g., about 60 min in Germany). Nevertheless, most patients (> 85%) expressed satisfaction with their care. Almost all the participating clinics provided equitable and easy access to treatment, and follow-up for most headache patients, without unnecessary barriers.ConclusionsThe study demonstrated that headache service quality indicators can be used in primary care, proving both practical and fit for purpose. It also uncovered quality deficits leading to suboptimal treatment, often due to a lack of knowledge among the general practitioners. There were failures of process also. These findings signal the need for additional training in headache diagnosis and management in primary care, where most headache patients are necessarily treated. More generally, they underline the importance of headache service quality evaluation in primary care, not only to identify-quality failings but also to guide improvements.This study also demonstrated that patients’ satisfaction is not, on its own, a good indicator of service quality.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-021-01236-4.     

养老机构照护服务质量评价指标的构建及信效度检验

目的 构建养老机构照护服务质量评价指标,并检验其信效度。 方法 以服务质量模型为基础,通过查阅相关文献、专家咨询、小组讨论等方法构建养老机构照护服务质量评价指标暂定版,采用暂定版评价指标对南通市7所养老机构中277例老年人进行问卷调查,对养老机构照护服务质量评价表的信效度进行检验,形成养老机构照护服务质量评价指标。 结果 养老机构照护服务质量评价指标包括4个维度（有形性、可靠性、响应性、移情性）、24个条目。养老机构照护服务质量评价表的Cronbach's α系数为0.945,折半信度为0.904;条目水平的内容效度为1.00,量表水平的内容效度为1.00;探索性因子分析提取4个公因子,方差累积贡献率为61.763%;各维度之间的相关系数为0.509~0.757,各维度与量表总分之间的相关系数为0.760~0.942。 结论 养老机构照护服务质量评价指标具有良好的信效度,可作为养老机构照护服务质量的评价工具。     

HLA-B14 Antigen in Cluster Headache

SYNOPSIS
The relationships of HLA-antigens and Cluster Headache (C.H.) is described.
60 subjects (39 males and 21 females aged between 15 and 75 years - mean age 40.13 years) from Central Italy with Cluster Headache were examined. Three subgroups were identified, 29 Episodic Cluster Headache, 20 Hemicrania Cluster and 11 Chronic Paroxysmal Hemicrania. The 12 alleles of the Iocus-A and the 16 alleles of the Iocus-B were studied in the C.H. group and in 321 subjects, most of whom were blood donors, selected as a control group.
Typing was carried out with the microlymphocyto-toxicity technique used by N.I.H.
Genetic frequency, relative risk (R.R.) and "linkage disequilibrium" calculation were evaluated statistically. The statistical significance was corrected taking into consideration the number of observations carried out. The X² test was used.
The data showed a decreased frequency of antigen HLA-B14 (1.66% vs 11.53% r<0.05) and HLA-Bw21 (5% vs 13.71%) in patients with C.H. compared to the group of controls. The R.R. was 0.19 and 0.33 respectively.     

Combining multiple indicators of clinical quality: an evaluation of different analytic approaches

OBJECTIVE: To compare different methods of combining quality indicators scores to produce composite scores that summarize the overall performance of health care providers. METHODS: Five methods for computing a composite quality score were compared: the "All-or-None," the "70% Standard," the "Overall Percentage," the "Indicator Average," and the "Patient Average." The first 2 "criterion-referenced" methods assess the degree to which a provider has reached a threshold for quality of care for each patient (100% or 70%). The remaining "absolute score" methods produce scores representing the proportion of required care successfully provided. Each method was applied to 2 quality indicator datasets, derived from audits of UK family practitioner records. Dataset A included quality indicator data for 1178 patients from 16 family practices covering 23 acute, chronic, and preventative conditions. Dataset B included data on 3285 patients from 60 family practices, covering 3 chronic conditions. RESULTS: The results varied considerably depending on the method of aggregation used, resulting in substantial differences in how providers scored. The results also varied considerably for the 2 datasets. There was more agreement between methods for dataset B, but for dataset A 6 of the 16 practices moved between the top and bottom quartiles depending upon the method used. CONCLUSIONS: Different methods of computing composite quality scores can lead to different conclusions being drawn about both relative and absolute quality among health care providers. Different methods are suited to different types of application. The main advantages and disadvantages of each method are described and discussed.     

护理质量评价指标筛选方法的研究进展

质量是医院管理的第一要素,护理质量的高低直接影响到医疗质量的优劣。护理质量评价指标体系是护理管理工作中不可或缺的内容,而护理质量评价指标的筛选可以真实客观地反映护理质量的水平,促进医院进一步提高医疗质量。因此,筛选护理质量评价指标,构建完整统一科学的护理质量评价体系,将成为提高整体护理质量管理的一个重要课题。现就目前国内外护理质量评价指标筛选方法的研究进展综述如下。     

优质护理服务在胸腔镜手术中的实施效果评价

目的探讨优质护理服务在胸腔镜手术患者中的临床应用价值。方法选择2011年1月~10月胸腔镜手术患者60例作为对照组。选择2012年1月~10月胸腔镜手术患者60例作为观察组。对照组采用常规的手术室护理。观察组在常规护理基础上采用人性化、个性化的优质护理服务模式。比较手术医生、两组患者对手术室护理工作的满意程度及护理后患者的抑郁、焦虑程度。结果对照组抑郁、焦虑的发生率明显高于观察组(P<0.05)。观察组手术患者对手术室工作的满意度高于对照组(P<0.05)。手术医生对手术室专科护理工作的满意度高于实施前(P<0.05)。结论优质护理是一种人性化及个性化的护理方式,有利于提高患者及手术医生对手术室护理工作的满意度,降低胸腔镜手术给患者带来的负面影响,使患者能够早日康复,有着重要的临床意义。     

Student evaluation of simulation in undergraduate nursing programs in Australia using quality indicators

Student evaluation of the implementation of evidence‐based quality indicators for simulation experiences in undergraduate nursing programs in 2012 was explored in this study. The evaluation instrument used five specific measures derived from quality indicators. Students evaluated 10 simulation learning experiences in the first and second years of undergraduate nursing programs at two universities in Australia. Overall, students (n = 85) reported that simulation contributed to their achievement of objectives, but they did not always feel supported in these sessions. Student preparation and orientation was scored lower than other components of the simulation experience. Students reported very good scores for perceived realism and fidelity of simulation sessions, particularly the silicone mask and high‐fidelity sessions, which implies that learning from simulation is transferable into the clinical practice setting. However, patient charts and other clinical documents were not always considered to be realistic. Debriefing was scored very highly overall and for both approaches used for debriefing. The student‐evaluation instrument was an effective means of measuring student‐related quality indicators across a range of simulation sessions. It identified areas for the improved delivery of simulation sessions.     

Servqual评价调查表在优质护理示范病房服务质量评价中的应用

目的:了解患者对优质护理服务质量的真实感受和评价,为进一步提高护理服务质量提供指导。方法:采用Servqual评价调查表对首都医科大学附属三级甲等医院优质护理示范病房的118位住院患者进行现场调查,了解并评价患者对该病房优质护理服务质量(SQ)的感知与期望。结果:患者对护理服务质量的有形性、可靠性、响应性、保证性、移情性及费用可接受性的期望值(E)分别为4.31、4.50、4.56、4.52、4.49、4.42,感知值(P)分别为4.38、4.57、4.64、4.59、4.55、4.43,服务质量(SQ)值分别为0.0678、0.0678、0.0763、0.0657、0.0610、0.0169。结论:患者对护理服务各个属性的期望值均较高,该病房在服务的有形性、可靠性、响应性、保证性、移情性及费用可接受性几个方面做的均较好。     

优质护理服务在神经外科中的实践及评价

目的:探讨优质护理服务在神经外科中应用,并客观评价优质护理服务的实践效果。方法:2010年对我院神经外科进行优质护理服务模式试行,调查实施优质护理服务一年后患者的满意度情况,正确评价优质护理服务在神经外科护理工作中的实施效果。结果:患者总满意率为99.34%。结论:优质护理服务是提高护理工作水平、加强服务意识的重要保障,可有效提升患者满意度。     

中文版护理服务质量评价量表的编译与评价

目的编译适用于测评我国护理服务质量的中文版量表。方法基于服务质量模型,对原始量表进行翻译、回译和本土化修订。采用中文版问卷对湖北省两所综合性医院的209例住院患者进行测评,并对结果进行信度和效度分析。结果基于服务质量模型研制的护理服务质量评价量表,经因子分析产生5个公因子,总的变异系数为62.85%。问卷总的Cronbach'sα系数为0.852,各个分量表的Cronbach'sα系数分别为0.731、0.809、0.818、0.801和0.812。结论护理服务质量评价量表具有较好的信度和效度,其维度设置适用于我国护理服务工作。     

以患者为中心的居家护理服务质量评价指标的构建

目的 探讨构建以患者为中心的全面、科学、可靠、实用的居家护理服务质量评价指标,为完善居家护理服务模式提供参考。 方法 2021年2月—3月,基于文献检索和半结构访谈结果,拟订评价指标,形成专家咨询问卷,利用德尔菲技术,由19名护理或医学相关工作领域专家对指标（3个一级维度、9个二级维度及61个三级条目）进行咨询并确定各级指标权重。 结果 两轮专家咨询问卷的有效回收率均为100%,专家权威系数（Cr）为0.88,最后形成的居家护理服务质量评价指标包括3个一级维度、10个二级维度和46个三级条目;肯德尔和谐系数（W）一级维度由0.18增至0.32,二级维度由0.11增至0.30,三级指标由0.13增至0.20,均P<0.01。 结论 居家护理服务质量评价指标基本符合我国国情和以患者为中心的理念,具有较好的全面性、科学性、可靠性和实用性。     

互联网+护理服务质量评价指标体系的构建

目的：构建“互联网+护理服务”质量评价指标体系,为进一步安全推动“互联网+护理服务”的开展,建立可量化的指标。方法：以三维质量结构理论为框架拟定指标体系初稿,编制问卷,采用德尔菲法对18名专家进行2轮函询,运用层次分析法确定各级指标权重。结果：2轮专家函询问卷的有效回收率分别为100%、94.44%,专家权威系数分别为0.805,0.818。2轮函询肯德尔和谐系数分别为0.137,0.180(P<0.001)。最终形成“互联网+护理服务”质量评价指标体系包括3个一级指标,15个二级指标,51个三级指标。结论：本研究构建的“互联网+护理服务”质量评价指标体系为安全推动“互联网+护理服务”提供质量评价依据。     

北京市"优质护理服务示范工程"实施效果评价

目的:评价北京市试点医院"优质护理服务示范工程"实施效果.方法:依据<住院患者基础护理服务项目规范>及<北京市"规范护理服务,争创优质护理服务示范标兵"工作方案>自行设计检查表,采用便利抽样的方法,选取了申请参加北京市"优质护理服务示范工程"试点的36家医院,58个病区,一级护理危重症及生活完全不能自理或部分自理的患者174例,进行了评价.结果:"优质护理服务示范工程"实施4个月后,试点医院的总体护理服务质量提高,基础护理到位率明显提高.结论:优质护理服务示范工程活动成效显著,护理人员在提高基础护理质量的同时,还应重视专科疾病的护理及对病人的健康教育.     

疗区实施全程优质服务的效果评估

全程优质服务疗区的创建是我院为了更好地落实“以疗养员为中心”的整体护理，从人文关怀的角度出发提出的一个新概念，旨在增强医护人员服务意识，提高疗养员满意度。我院疗区自2002年3月起，采取系列服务新举措，积极创建全程优质服务疗区，提高了护理服务质量，取得了较大的效果。     

Identification of performance indicators for emergency centres in South Africa: results of a Delphi study

Background

Emergency medicine is a rapidly developing field in South Africa (SA) and other developing nations. There is a need to develop performance indicators that are relevant and easy to measure. This will allow identification of areas for improvement, create standards of care and allow inter-institutional comparisons to be made. There is evidence from the international literature that performance measures do lead to performance improvements.

Aims

To develop a broad-based consensus document detailing quality measures for use in SA Emergency Centres (ECs).

Methods

A three-round modified Delphi study was conducted over e-mail. A panel of experts representing the emergency medicine field in SA was formed. Participants were asked to provide potential performance indicators for use in SA, under subheaders of the various disciplines that are seen in emergency patients. These statements were collated and sent out to the panel for scoring on a 9-point Lickert scale. Statements that did not reach a predefined consensus were sent back to the panellist for reconsideration.

Results

Consensus was reached on 99 out of 153 (65%) of the performance indicators proposed. These were further refined, and a synopsis of the statements is presented, classified as to whether the statements were thought to be feasible or not in the current circumstances.

Conclusions

A synopsis of the useful and feasible performance indicators is presented. The majority are structural and performance-based indicators appropriate to the development of the field in SA. Further refinement and research is needed to implement these indicators.