AIMS AND BACKGROUND: A number of documents assess the need for quality assurance in radiotherapy, which must be constantly monitored and possibly improved. In this regard, a system that confirms the quality of a department has been suggested and quality indicators have been used to improve the quality of the service. The National Health Service (Istituto Superiore di Sanità) approved a National Research Project to increase the quality of radiotherapy. The aim of the present study was to analyze the practical feasibility and efficacy of the quality indicators elaborated by the National Health Service study group in a radiotherapy unit.
PATIENTS AND METHODS: The voluntary accredited program was carried out by the Radiotherapy Department of IRCC in Candiolo from June to August 2002. We analyzed 8 of the 13 indicators according to the National Health Service Project. For this purpose, 133 consecutive patients treated in our Unit were analyzed, and the results are reported according to the appropriate indicator (number of staff related to patients treated, waiting list, case history accuracy, multidisciplinary approach, number of treatment plans performed by CT, number of fields per fraction, number of portal imaging performed per overall treatment, and patient satisfaction).
RESULTS: The number of professional staff related to the number of patients treated was easy to calculate and it could be the basis for further evaluation. The overall waiting time was 55.4 days, and it changed for different radiotherapy goals. We obtained 80% conformity in case-history accuracy. The number of multidisciplinary consultations performed ranged between 50% and 100%. The number of CT plans was about 1.6 +/- 0.9 plans per patient. The mean number of fields performed per day and per patient is 3.5 +/- 1.7 and was in agreement with the fact that more than 50% of treatments in our Center were performed with conformal radiotherapy. An average of 16.7 +/- 10.0 portal imaging per case was performed. The percentage of patient satisfaction with the staff obtained a very high compliance.
CONCLUSIONS: The self evaluation promoted by the National Health Service Project allows the monitoring of the activities of the service in order to asses critical factors and it can be the starting point to improve the quality of the service and to compare national and international quality assurance results.
BACKGROUND: Most nationally standardised quality measures use widely accepted evidence-based processes as their foundation, but the discharge instruction component of the United States standards of Joint Commission on Accreditation of Healthcare Organizations heart failure core measure appears to be based on expert opinion alone.
OBJECTIVE: To determine whether documentation of compliance with any or all of the six required discharge instructions is correlated with readmissions to hospital or mortality.
RESEARCH DESIGN: A retrospective study at a single tertiary care hospital was conducted on randomly sampled patients hospitalised for heart failure from July 2002 to September 2003.
PARTICIPANTS: Applying the Joint Commission on Accreditation of Healthcare Organizations criteria, 782 of 1121 patients were found eligible to receive discharge instructions. Eligibility was determined by age, principal diagnosis codes and discharge status codes.
MEASURES: The primary outcome measures are time to death and time to readmission for heart failure or readmission for any cause and time to death.
RESULTS: In all, 68% of patients received all instructions, whereas 6% received no instructions. Patients who received all instructions were significantly less likely to be readmitted for any cause (p = 0.003) and for heart failure (p = 0.035) than those who missed at least one type of instruction. Documentation of discharge instructions is correlated with reduced readmission rates. However, there was no association between documentation of discharge instructions and mortality (p = 0.521).
CONCLUSIONS: Including discharge instructions among other evidence-based heart failure core measures appears justified.
In order to assess the efficacy of inspection and accreditation by the Specialist Advisory Committee for higher surgical training in orthopaedic surgery and trauma, seven training regions with 109 hospitals and 433 Specialist Registrars were studied over a period of two years. There were initial deficiencies in a mean of 14.8% of required standards (10.3% to 19.2%). This improved following completion of the inspection, with a mean residual deficiency in 8.9% (6.5% to 12.7%.) Overall, 84% of standards were checked, 68% of the units improved and training was withdrawn in 4%. Most units (97%) were deficient on initial assessment. Moderately good rectification was achieved but the process of follow-up and collection of data require improvement. There is an imbalance between the setting of standards and their implementation. Any major revision of the process of accreditation by the new Post-graduate Medical Education and Training Board should recognise the importance of assessment of training by direct inspection on site, of the relationship between service and training, and the advantage of defining mandatory and developmental standards.
OBJETIVO: explorar los problemas y obstáculos de los hospitales de Tailandia implementación de sistemas de gestión de calidad según el hospital de acreditación (HA) las normas.
Diseño: encuesta por cuestionario.
Escenario: Treinta y nueve hospitales en las 13 regiones de Tailandia.
Participantes: Un total de 728 profesionales de la salud y 41 inspectores del programa nacional de acreditación.
Principales medidas de resultado: Salud de los profesionales y peritos de opiniones sobre los problemas y obstáculos en las 24 unidades, que representan las normas HA Tailandia.
RESULTADOS: Las tasas de respuesta fueron 94,9 y 73,2% en profesionales de la salud y agrimensores, respectivamente. Más del 90% de ambos grupos pensaban que no había habido problemas en los artículos tales como 'mejora de la calidad (QI)' y 'actividades de integración y la utilización de la información ". Los temas examinados por profesionales de la salud como los principales obstáculos incluyen "la adecuación del personal" (34,6%) y "la integración y la utilización de la información" (26,6%), por ejemplo. Para los topógrafos, "la integración y la utilización de la información" se ocupó el primer lugar de presentar un obstáculo importante (43,9%), seguido de 'proceso de alta y de referencia "(31,7%) y el' proceso de grabación médica" (29,3%). Las órdenes de rango de los 24 temas como los problemas y obstáculos principales fueron similares en ambos grupos (correlación de Spearman 0,436, P = 0,033 y 0,583, P = 0,003, respectivamente). Los inspectores tenían un mayor grado de preocupación y prestar más atención a la atención relacionados con elementos de los que profesionales de la salud.
CONCLUSIONES: Los profesionales sanitarios se han enfrentado a muchos problemas con multidisciplinarios relacionados con el proceso cuestiones de la norma de acreditación, mientras que los inspectores podrían haber tenido algunas dificultades en la transmisión de los conceptos centrales de MC a ellos. Los hallazgos podrían explicarse por los efectos de la reforma de salud en los principios subyacentes de acreditación. Una de las estrategias para responder a la situación se presentó.
Revista»Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
OBJECTIVES: Program accreditation is used to ensure the delivery of quality education and training for allied health providers. However, accreditation is not mandated for paramedic education programs. This study examined if there is a relationship between completion of an accredited paramedic education program and achieving a passing score on the National Registry Paramedic Certification Examination.
METHODS: We used data from the National Registry Paramedic Certification Examination for calendar year 2002. Successful completion (passing) of the examination was defined as correctly answering a minimum of 126 out of 180 (70%) of the questions and meeting or exceeding the individual subtest passing scores. Accredited paramedic training programs were certified by the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) on or before January 1, 2002. Candidates reported demographic characteristics including age, gender, self-reported race and ethnicity, education, and employer type. We examined the relationship between passing the examination and attendance at an accredited paramedic training program.
RESULTS: A total of 12,773 students completed the examination. Students who attended an accredited program were more likely to pass the examination (OR = 1.65, 95% CI: 1.51-1.81). Attendance at an accredited training program was independently associated with passing the examination (OR = 1.58, 95% CI = 1.43-1.74) even after accounting for confounding demographic factors.
CONCLUSION: Students who attended an accredited paramedic program were more likely to achieve a passing score on a national paramedic credentialing examination. Additional studies are needed to identify the aspects of program accreditation that lead to improved examination success.
El uso de la acreditación se ha generalizado entre los proveedores de atención médica, pero la acreditación es relativamente nuevo en el campo de las drogas tratamiento para el abuso. Este estudio presenta las estimaciones de los costos de tramitación de la acreditación de los centros de tratamiento con metadona. Los datos provienen de 102 centros de tratamiento con metadona que se sometieron a la acreditación como parte del Centro para la evaluación de Tratamiento del Abuso de Sustancias del Proyecto de Acreditación de tratamiento con opioides Programa. El análisis representa el análisis más exhaustivo de los costos de tramitación de la acreditación por un proveedor de cuidado de la salud. Es importante destacar, es el primer análisis de los costos de tramitación de la acreditación de los proveedores de tratamiento de drogas. Los responsables políticos y los proveedores de tratamiento de drogas puede utilizar este análisis para planificar las necesidades de mano de obra y los costos de las iniciativas de acreditación en el futuro.
OBJECTIVE: . To investigate the reliability of self-reported standardized performance indicators introduced by the Joint Commission on Accreditation of Healthcare Organizations in July 2002 and implemented in approximately 3400 accredited US hospitals. The study sought to identify the most common data quality problems and determine causes and possible strategies for resolution.
DESIGN: Data were independently reabstracted from a random sample of 30 hospitals. Reabstracted data were compared with data originally abstracted, and discrepancies were adjudicated with hospital staff. Structured interviews were used to probe possible reasons for abstraction discrepancies.
RESULTS: The mean data element agreement rate for the 61 data elements evaluated was 91.9%, and the mean kappa statistic for binary data elements was 0.68. The rate of agreement for individual data elements ranged from 100 to 62.4%. The mean difference between calculated indicator rates was 4.88% (absolute value) and the range of differences was 0.0-13.3%. Symmetry of disagreement among original abstractors and reabstractors identified eight indicators whose differences in calculated rates were statistically unlikely to have occurred through random chance (P < 0.05).
CONCLUSION: Although improvement in the accuracy and completeness of the self-reported data is possible and desirable, the baseline level of data reliability appears to be acceptable for indicators used to assess and improve hospital performance on selected clinical topics.
La investigación en la última década ha identificado errores de medicación como la causa más frecuente de daño accidental que previamente se pensaba. Errores de medicación de pacientes hospitalizados y el uso de medicación propensos a errores se detectan internamente por informes de errores de medicación y externamente a través de encuestas de licencias y acreditación de hospital. Tasa de un hospital de errores de medicación es una de varias medidas de seguridad personal del paciente. Sin embargo, pacientes potenciales y otras partes interesadas deben confiar en partituras de licencias y acreditación, junto con diverso acceso a datos de los resultados, como sus únicos medidas de seguridad del paciente. Hemos previamente informado que tasas mucho más elevadas de errores de medicación se encontraron cuando se usó una auditoría independiente en comparación con las tasas determinadas por el proceso habitual de Autoinforme. En este estudio, nos resumir estos hallazgos anteriores y, a continuación, comparar la sensibilidad de detección de error de licencias y acreditación de estudios con el de una auditoría independiente. Cuando los inspectores experimentados no detectará un gran error propenso a medicamentos uso sistema, plantea cuestiones acerca de la validez de los resultados de la encuesta como una medida de seguridad (es decir, la falta de errores de medicación). Es necesaria la replicación de nuestros hallazgos en otros lugares del hospital. También recomendamos medidas para mejorar la seguridad del paciente por la reducción de las tasas de error y aumentar la detección de errores.
Este estudio examinó la asociación entre la Comisión Conjunta para la Acreditación de Organizaciones de Salud (JCAHO) resultados de acreditación y de la Agencia para la Investigación y los indicadores de calidad de la hospitalización de Calidad e Indicadores de Seguridad del Paciente (IQIs / PSI). JCAHO los datos de acreditación de 1997 a 1999 fueron comparados con instituciones ICI / ISP rendimiento de 24 estados del Healthcare Cost and Utilization Project. La mayoría de las instituciones de elevadas puntuaciones en las medidas de JCAHO pesar de la variación de rendimiento ICI / PSI con una relación significativa entre ellos. Análisis de componentes principales encontrado un factor de cada uno de los IQIs o PSIS que explican la mayor parte de la varianza en las IQIs o PSIS. Peor rendimiento en el factor PSI se asoció con un peor rendimiento en las calificaciones de la JCAHO (p = 0,02). No hay relaciones significativas existentes entre las decisiones de acreditación JCAHO categóricas y IQI o rendimiento PSI. Pocas relaciones existen entre los puntajes de la JCAHO y IQI / rendimiento PSI. Hay una necesidad de reevaluar continuamente todas las herramientas de medición para asegurar que se proporciona al público información fiable, coherente sobre la calidad del cuidado de la salud y la seguridad.
OBJECTIVE: To examine the association between accreditation scores and the disclosure of accreditation reports.
DESIGN: A cross sectional study.
SETTING: Hospitals participating in an accreditation programme in Japan.
PARTICIPANTS: 547 of the 817 hospitals accredited by the Japan Council for Quality Health Care (JCQHC) by January 2003.
MAIN OUTCOME MEASURES: Data on participation in public disclosure of accreditation reports through the JCQHC website were obtained from the JCQHC database. Comments on the disclosure were obtained using a questionnaire based survey.
RESULTS: A total of 508 (93%) of the participating hospitals disclosed their accreditation reports on the JCQHC website. Public hospitals were significantly more committed to public disclosure than private hospitals, and larger hospitals were significantly more likely to participate in public disclosure than smaller hospitals. Accreditation scores were positively related to the public disclosure of hospital accreditation reports. Scores for patient focused care and efforts to meet community needs were significantly higher in actively disclosing hospitals than in non-disclosing hospitals. Among the large hospitals, scores for safety management were significantly higher in hospitals advocating disclosure than in non-disclosing hospitals.
CONCLUSIONS: There was a positive correlation between accreditation scores and public disclosure. Our results suggest that the public disclosure of accreditation reports should be encouraged to improve public accountability and the quality of care. Future studies should investigate the interaction between public disclosure, processes and outcomes.
A number of documents assess the need for quality assurance in radiotherapy, which must be constantly monitored and possibly improved. In this regard, a system that confirms the quality of a department has been suggested and quality indicators have been used to improve the quality of the service. The National Health Service (Istituto Superiore di Sanità) approved a National Research Project to increase the quality of radiotherapy. The aim of the present study was to analyze the practical feasibility and efficacy of the quality indicators elaborated by the National Health Service study group in a radiotherapy unit.
PATIENTS AND METHODS:
The voluntary accredited program was carried out by the Radiotherapy Department of IRCC in Candiolo from June to August 2002. We analyzed 8 of the 13 indicators according to the National Health Service Project. For this purpose, 133 consecutive patients treated in our Unit were analyzed, and the results are reported according to the appropriate indicator (number of staff related to patients treated, waiting list, case history accuracy, multidisciplinary approach, number of treatment plans performed by CT, number of fields per fraction, number of portal imaging performed per overall treatment, and patient satisfaction).
RESULTS:
The number of professional staff related to the number of patients treated was easy to calculate and it could be the basis for further evaluation. The overall waiting time was 55.4 days, and it changed for different radiotherapy goals. We obtained 80% conformity in case-history accuracy. The number of multidisciplinary consultations performed ranged between 50% and 100%. The number of CT plans was about 1.6 +/- 0.9 plans per patient. The mean number of fields performed per day and per patient is 3.5 +/- 1.7 and was in agreement with the fact that more than 50% of treatments in our Center were performed with conformal radiotherapy. An average of 16.7 +/- 10.0 portal imaging per case was performed. The percentage of patient satisfaction with the staff obtained a very high compliance.
CONCLUSIONS:
The self evaluation promoted by the National Health Service Project allows the monitoring of the activities of the service in order to asses critical factors and it can be the starting point to improve the quality of the service and to compare national and international quality assurance results.
