共查询到20条相似文献,搜索用时 0 毫秒
1.
2.
3.
Continuous Quality Improvement: Does It Make a Difference? 总被引:1,自引:0,他引:1
Helen Darling 《The Milbank quarterly》1998,76(4):755-757
A corporate benefits consultant suggests that dynamic leadership is needed to bring about a serious commitment to continuous quality improvement in the health care field. 相似文献
4.
Patrício Fernando Lemes dos Santos Poliana Rodrigues dos Santos Graziele Souza Lira Ferrari Gisele Almeida Amaral Fonseca Carlos Kusano Bucalen Ferrari 《Osong Public Health and Research Perspectives》2014,5(4):199-203
Objective
Diabetes mellitus (DM) is a chronic disease considered an important public health problem. In recent years, its prevalence has been exponentially rising in many developing countries. Chronic complications of DM are important causes of morbidity and mortality among patients, which impair their health and quality of life. Knowledge on disease prevention, etiology, and management is essential to deal with parents, patients, and caregivers. The aim of this study was to evaluate the knowledge regarding DM in an adult population from a Middle-western Brazilian city.Methods
This was a cross-sectional study covering 178 adults, aged 18–64 years, who answered a diabetes knowledge questionnaire. In order to identify the difference between groups, analysis of variance was used.Results
Higher knowledge scores were found regarding the role of sugars on DM causality, diabetic foot care, and the effects of DM on patients (blindness, impaired wound healing, and male sexual dysfunction). However, lower scores were found amongst types of DM, hyperglycemic symptoms, and normal blood glucose levels. Females tended to achieve better knowledge scores than males.Conclusion
Women had better knowledge regarding types of DM, normal blood glucose values, and consequences of hyperglycemia revealed that diabetes education should be improved. 相似文献5.
6.
7.
Sundaram S Harman JS Peoples-Sheps MD Hall AG Simpson SH 《Maternal and child health journal》2012,16(3):656-667
To identify (1) the association between pre-pregnancy BMI (PP-BMI) and PPD symptoms, and (2) the association between PP-BMI
and PPD symptoms after considering PNC utilization as a moderating variable. Data from the 2004 and 2005 Pregnancy Risk Assessment
Monitoring System (PRAMS) were analyzed from 15 states. The study design utilized two risk-adjustment approaches. One approach
included all women in the dataset and used statistical analyses to risk-adjust for pregnancy risk status, and the other approach,
through a sensitivity analysis, modified the design of the study by truncating the sample to include only women with healthy
pregnancies. An initial association was seen between obesity and PPD symptoms, and PNC and PPD symptoms in the multivariate
analyses. However, the inclusion of case-mix variables into the multivariate models removed these associations. Overall, for
both approaches, there was no indication of a moderating effect of PNC utilization. Results also revealed that many of the
women were significantly affected by a variety of high-risk maternal morbidity (case-mix) variables. Although PNC is important
for the health of mothers and babies, it does not appear to moderate the association of PP-BMI and PPD symptoms. However,
since this study revealed associations between several high-risk maternal morbidities (included as case-mix variables), and
PPD symptoms, it is recommended that future research further investigate the possible association of these morbidities with
PPD symptoms. For practice, it is suggested that PNC providers focus on their patients, and establish suitable interventions
accordingly. 相似文献
8.
Smith ML Sosa ET Hochhalter AK Covin J Ory MG McKyer EL 《The journal of primary prevention》2011,32(5-6):311-322
Effective communication between young adults and their healthcare providers can contribute to early detection of risk for developing cancer and establishment of lifelong habits for engagement in healthcare and health promotion behaviors. Our objectives were to examine factors influencing family health history discussions between college students and physicians and factors associated with perceptions about who is responsible for initiating such discussions. Data from an internet-based study of 632 college students were analyzed. Approximately 60% of college student participants reported they had discussed their family health history with a physician. The perception that physicians are responsible for initiating family health history discussions was associated with being non-White and less than completely knowledgeable about cancer. Having a discussion with a physician was associated with being female, having a regular physician, perceiving genetics as a risk for developing cancer, and having a family member diagnosed with cancer. Understanding variation among college students' perceptions about their role in initiating health-history-related discussions and characteristics of those who have or have not discussed family health issues with physicians can inform healthcare practice to foster optimal healthcare interactions in early adulthood. 相似文献
9.
Dana L Alden John Friend Maria BJ Chun 《Hawai'i Journal of Medicine & Public Health》2013,72(11):396-400
Background: As the health care field moves toward patient-centered care (PCC), increasing emphasis has been placed on the benefits of patient decision aids for promoting shared decision making (SDM). This study provides a baseline measure of knowledge, attitudes, and practices (KAP) among Hawai‘i''s physicians with respect to patient decision aids (DAs). Physicians throughout the State of Hawai‘i were invited to complete a survey assessing their knowledge, attitudes, and practices with respect to the clinical use of DAs.One hundred and seventy four valid surveys were analyzed. Reported awareness and use of DAs were low, but recognition of the benefits of SDM and openness to the use of DAs were very high. The leading perceived barriers to the implementation of DAs were lack of awareness, lack of resources, and limited physician time to learn about DA technology. However, a significant majority of the respondents reported that DAs could empower patients by improving knowledge (88%), increasing satisfaction with the consultation process (81%), and increasing compliance (74%). Among physicians currently employing DAs, use of brochures or options matrix sheets was the most common aid tool. However, leading recommended DA formats were paper-based brochures for clinic use (75%) and interactive online website programs for outside clinic use (73.5%). Given growing emphasis on the PCC model and the recognized desire of many patients to participate in the medical decision making process, positive responses toward SDM and the use of DAs by Hawai‘i physicians are promising. 相似文献
10.
Laura C. Plantinga Delphine S. Tuot Vanessa Grubbs Chi-yuan Hsu Neil R. Powe 《Journal of urban health》2012,89(6):965-976
Whether automated estimated glomerular filtration rate (eGFR) reporting for patients is associated with improved provider recognition of chronic kidney disease (CKD), as measured by diagnostic coding of CKD in those with laboratory evidence of the disease, has not been explored in a poor, ethnically diverse, high-risk urban patient population. A retrospective cohort of 237 adult patients (≥20 years) with incident CKD (≥1 eGFR ≥60 ml/min/1.73 m2, followed by ≥2 eGFRs <60 ml/min/1.73 m2 ≥3 months apart)—pre- or postautomated eGFR reporting—was identified within the San Francisco Department of Public Health Community Health Network (January 2005–July 2009). Patients were considered coded if any ICD-9-CM diagnostic codes for CKD (585.x), other kidney disease (580.x–581.x, 586.x), or diabetes (250.4) or hypertension (403.x, 404.x) CKD were present in the medical record within 6 months of incident CKD. Multivariable logistic regression was used to obtain adjusted odds ratios (ORs) for CKD coding. We found that, pre-eGFR reporting, 42.5 % of incident CKD patients were coded for CKD. Female gender, increased age, and non-Black race were associated with lower serum creatinine and lower prevalence of coding but comparable eGFR. Prevalence of coding was not statistically significantly higher overall (49.6 %, P = 0.27) or in subgroups after the institution of automated eGFR reporting. However, gaps in coding by age and gender were narrowed post-eGFR, even after adjustment for sociodemographic and clinical characteristics: 47.9 % of those <65 and 30.3 % of those ≥65 were coded pre-eGFR, compared to 49.0 % and 52.0 % post-eGFR (OR = 0.43 and 1.16); similarly, 53.2 % of males and 25.4 % of females were coded pre-eGFR compared to 52.8 % and 44.0 % post-eGFR (OR 0.28 vs. 0.64). Blacks were more likely to be coded in the post-eGFR period: OR = 1.08 and 1.43 (Pinteraction > 0.05). Automated eGFR reporting may help improve CKD recognition, but it is not sufficient to resolve underidentification of CKD by safety net providers. 相似文献
11.
Daniella Germain Melanie A. Wakefield Sarah J. Durkin 《The Journal of adolescent health》2010,46(4):385-392
PurposeTo examine the effect of plain packaging on adolescents' perceptions of cigarette packs, attributes of smokers, and expectations of cigarette taste, and to identify the effect of increasing the size of pictorial health warnings on appraisal of plain packs.MethodsWe used a 5 (degree of plain packaging and graphic health warning)× 3 (brand type) between-subjects experimental design, using a Web-based methodology to expose adolescents to one randomly selected cigarette pack, during which respondents completed ratings.ResultsWhen brand elements such as color, branded fonts, and imagery were progressively removed from cigarette packs, adolescents perceived packs to be less appealing, rated attributes of a typical smoker of the pack less positively, and had more negative expectations of cigarette taste. Pack appeal was reduced even further when the size of the pictorial health warning on the most plain pack was increased from 30% to 80% of the pack face, with this effect apparent among susceptible nonsmokers, experimenters, and established smokers.ConclusionsRemoving as much brand information from cigarette packs as possible is likely to reduce positive cigarette brand image associations among adolescents. By additionally increasing the size of pictorial health warnings, positive pack perceptions of those who are at greater risk of becoming regular addicted adult smokers are most likely to be reduced. 相似文献
12.
Janice McHugh 《Journal of health communication》2013,18(3):278-293
Overweight and obesity are directly associated with heart disease, cancer, and diabetes and pose a serious cost-related challenge to employers. As most of the rise in health care spending is traced to the rise in population risk factors, maintaining or reducing the prevalence of disease represents a strategy with large potential payoffs. Tailored communication is a promising communication strategy for influencing health behavior change, including behaviors for weight management. Much of the tailored communication research is based on communication developed for research purposes, yet access to commercially available tailored health programs for worksites is growing. As health risk assessments are increasingly used for setting health programming and insurance priorities in U.S. workplaces and worksites have opportunities to purchase tailored programs, it is important to understand the effect of tailored communication on health risk assessment data. The purpose of this study was to evaluate the long-term effects of a commercially available web-based tailored weight management program on employee weight, body mass index, blood pressure, cholesterol, and blood glucose. The authors compared health risk assessment data at baseline and 2 years later from 101 overweight and obese employees who participated in the tailored weight management program and 137 overweight and obese employees who did not participate in the program. Results show that there were significant mean differences in systolic blood pressure, HDL cholesterol, and blood sugar levels, but each in a clinically undesirable direction. More research is needed to understand the effect of tailored programs used in worksite health promotion. 相似文献
13.
Andreia Fernandes Azevedo Maria João Seabra-Santos Maria Filomena Gaspar Tatiana Carvalho Homem 《Child & youth care forum》2013,42(5):403-424
Background
Evidence-based psychosocial interventions such as parent training programs are strongly recommended as first-line treatment for preschool-age children with or at-risk of attention deficit/hyperactivity disorder (AD/HD).Objective
Evaluate the effectiveness of the Incredible Years Basic Parent Training (IY) in hyperactive and inattentive behaviors of Portuguese preschoolers.Methods
One hundred children, between three and six years-old, with AD/HD behaviors, who were part of a larger randomized controlled trial in which participants were allocated to either an intervention or control group. In this subsample analysis, there were 52 participants in the intervention condition (IYC) and 48 in the waiting-list control condition (WLC). Multi-informants and multi-measures of child and parenting behaviors were taken before and after the 14-week intervention.Results
Medium-to-large intervention effects were found in primary caregivers’ reported measures of children’s AD/HD behaviors and on self-reported parenting practices. Independent observations indicated significant short-term effects on positive parenting and coaching. Primary caregivers had a high attendance rate and reported high satisfaction with the program. Additionally, 43 % of children in the IYC clinically improved in the primary AD/HD outcome measure, compared with 11 % in the WLC.Conclusions
Preliminary results suggest that IY parent training seems to be an effective tool, making the difference in the behavior of Portuguese preschoolers with early signs of AD/HD and their mothers. 相似文献14.
《Value in health》2020,23(12):1613-1621
ObjectivesPartitioned survival models (PSMs) are routinely used to inform reimbursement decisions for oncology drugs. We discuss the appropriateness of PSMs compared to the most common alternative, state transition models (STMs).MethodsIn 2017, we published a National Institute for Health and Care Excellence (NICE) Technical Support Document (TSD 19) describing and critically reviewing PSMs. This article summarizes findings from TSD 19, reviews new evidence comparing PSMs and STMs, and reviews recent NICE appraisals to understand current practice.ResultsPSMs evaluate state membership differently from STMs and do not include a structural link between intermediate clinical endpoints (eg, disease progression) and survival. PSMs directly consider clinical trial endpoints and can be developed without access to individual patient data, but limit the scope for sensitivity analyses to explore clinical uncertainties in the extrapolation period. STMs facilitate these sensitivity analyses but require development of robust survival models for individual health-state transitions. Recent work has shown PSMs and STMs can produce substantively different survival extrapolations and that extrapolations from STMs are heavily influenced by specification of the underlying survival models. Recent NICE appraisals have not generally included both model types, reviewed individual clinical event data, or scrutinized life-years accrued in individual health states.ConclusionsThe credibility of survival predictions from PSMs and STMs, including life-years accrued in individual health states, should be assessed using trial data on individual clinical events, external data, and expert opinion. STMs should be used alongside PSMs to support assessment of clinical uncertainties in the extrapolation period, such as uncertainty in post-progression survival. 相似文献
15.
16.
Kanoe-Lehua de Silva Pai-Jong Stacy Tsai Leanne M Kon Mark Hiraoka Bruce Kessel Todd Seto Bliss Kaneshiro 《Hawai'i Journal of Medicine & Public Health》2014,73(3):80-83
Severe perineal injury (third and fourth degree laceration) at the time of vaginal delivery increases the risk of fecal incontinence, chronic perineal pain, and dyspareunia.1–5 Studies suggest the prevalence of severe perineal injury may vary by racial group.6 The purpose of the current study was to examine rates of severe perineal injury in different Asian and Pacific Islander subgroups. A retrospective cohort study was performed among all patients who had a vaginal delivery at Queens Medical Center in Honolulu, Hawai‘i between January 1, 2002 and December 31, 2003. Demographic and health related variables were obtained for each participant. Maternal race/ethnicity (Japanese, Filipino, Chinese, other Asian, Part-Hawaiian/Hawaiian, Micronesian, other Pacific Islander, Caucasian, multiracial [non-Hawaiian], and other) was self-reported by the patient at the time admission. The significance of associations between racial/ethnic groups and demographic and health related variables was determined using chi-square tests for categorical variables and analysis of variance for continuous factors. Multiple logistic regression was performed to adjust for potential confounders when examining severe laceration rates. A total of 1842 subjects met inclusion criteria. The proportion of severe perineal lacerations did not differ significantly between racial groups. In the multiple logistic regression analysis, operative vaginal delivery was related to both race and severe perineal laceration. However, despite adjusting for this variable, race was not associated with an increased risk of having a severe laceration (P = .70). The results of this study indicate the risk of severe perineal laceration does not differ based on maternal race/ethnicity. 相似文献
17.
Anjana E. Sharma Beatrice Huang Margae Knox Rachel Willard-Grace Michael B. Potter 《Journal of community health》2018,43(6):1069-1074
Patient engagement in primary care leadership is an important means to involve community voices at community health centers. Federally qualified health centers (FQHCs) are mandated to have patient representation within their governing boards, while practices seeking patient-centered medical home certification receive credit for implementing patient advisory councils (PACs). Our objective was to compare and contrast how community health centers engage patients in clinic management, decision-making and planning within governing boards versus PACs. Qualitative study conducted from August 2016 to June 2017 at community health centers in California, Arizona and Hawaii. We interviewed practice leaders of patient engagement programs at their site. Eligible clinics had patient representatives within their governing board, PAC, or both. We assessed patient demographics, roles and responsibilities of patients participating, and extent of involvement in quality improvement among governing boards versus PACs. We interviewed 19 sites, of which 17 were FQHCs that had governing boards. Of the 17 FQHCs, 11 had also implemented PACs. Two non-FQHC safety-net sites had PACs but did not have governing boards. Governing board members had formal, structured membership responsibilities such as finances and hiring personnel. PAC roles were more flexible, focusing on day-to-day clinic operations. Clinics tended to recruit governing board patient members for their skill set and professional experience; PAC member recruitment focused more on demographic representation of the clinic’s patient population. Both groups worked on quality improvement, but governing boards tended to review clinic performance metrics, while PAC members were involved in specific project planning and implementation to improve clinical outcomes and patient experience. Patient involvement in clinic improvement in CHCs includes higher-level decision-making and governance through mechanisms such as governing boards, as well as engagement in day-to-day practice improvement through PACs. These roles offer differing, but valuable insights to clinic programs and policies. 相似文献
18.
Anne Jolivet Emmanuelle Cadot Olivier Angénieux Sophie Florence Sophie Lesieur Jacques Lebas Pierre Chauvin 《Journal of immigrant and minority health / Center for Minority Public Health》2014,16(4):586-594
Few data exist on the health status and heath care utilization of the undocumented migrants in France. Data are particularly scarce in French overseas territories where this population is numerous. We aimed to describe the characteristics of undocumented patients who use the emergency department of Saint-Laurent du Maroni Hospital (SLMH) in French Guiana, and to identify factors associated with their subsequent hospitalization. In a random sample of 177 patients, we used logistic regression models to test the mediational role of health-care system utilization and medical characteristics at admission in the association between residency status and hospitalization. More than a quarter of patients (27.7 %) were undocumented migrants, who were subsequently hospitalized more often than the others [OR 3.11, 95 % CI (1.32–7.34)]. More-severe symptoms at admission, a poorer access to health insurance, a greater distance between their home and SLMH, and poorer French language skills partially explained this higher hospitalization rate. Despite the fact that France has instituted a specific insurance program for the undocumented, an increasing number of barriers to accessing health care is being reported for these people. Our results suggest that these obstacles have some impacts in the utilization of hospital care. 相似文献
19.
Sandra K. Plach 《Health care for women international》2013,34(1):54-75
I performed this study to examine whether the quality of women's social roles influences the impact of heart failure (HF) on their psychological well-being. Survey questionnaires measuring social role quality, physical health, and psychological well-being were completed by 169 midlife, older, and late-life women. Hierarchical multiple regression indicated that, after controlling for age, income, and physical health, social role quality accounted for a significant proportion of variance in multiple well-being outcomes. The quality of women's social roles may be an important consideration in the development of interventions to help women with HF live satisfying and productive lives. 相似文献
20.