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Accreditation and improvement in process quality of care: a nationwide study.

https://arctichealth.org/en/permalink/ahliterature274471
Source
Int J Qual Health Care. 2015 Oct;27(5):336-43
Publication Type
Article
Date
Oct-2015
Author
Søren Bie Bogh
Anne Mette Falstie-Jensen
Paul Bartels
Erik Hollnagel
Søren Paaske Johnsen
Source
Int J Qual Health Care. 2015 Oct;27(5):336-43
Date
Oct-2015
Language
English
Publication Type
Article
Keywords
Accreditation - statistics & numerical data
Denmark
Follow-Up Studies
Guideline Adherence - statistics & numerical data
Heart Failure - therapy
Hospital Bed Capacity
Hospitals, Public - statistics & numerical data
Humans
Peptic Ulcer - therapy
Practice Guidelines as Topic
Quality Improvement - statistics & numerical data
Quality Indicators, Health Care - statistics & numerical data
Residence Characteristics
Stroke - therapy
Abstract
To examine whether performance measures improve more in accredited hospitals than in non-accredited hospital.
A historical follow-up study was performed using process of care data from all public Danish hospitals in order to examine the development over time in performance measures according to participation in accreditation programs.
All patients admitted for acute stroke, heart failure or ulcer at Danish hospitals.
Hospital accreditation by either The Joint Commission International or The Health Quality Service.
The primary outcome was a change in opportunity-based composite score and the secondary outcome was a change in all-or-none scores, both measures were based on the individual processes of care. These processes included seven processes related to stroke, six processes to heart failure, four to bleeding ulcer and four to perforated ulcer.
A total of 27 273 patients were included. The overall opportunity-based composite score improved for both non-accredited and accredited hospitals (13.7% [95% CI 10.6; 16.8] and 9.9% [95% 5.4; 14.4], respectively), but the improvements were significantly higher for non-accredited hospitals (absolute difference: 3.8% [95% 0.8; 8.3]). No significant differences were found at disease level. The overall all-or-none score increased significantly for non-accredited hospitals, but not for accredited hospitals. The absolute difference between improvements in the all-or-none score at non-accredited and accredited hospitals was not significant (3.2% [95% -3.6:9.9]).
Participating in accreditation was not associated with larger improvement in performance measures for acute stroke, heart failure or ulcer.
PubMed ID
26239473 View in PubMed
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Adherence to a Healthy Nordic Diet and Risk of Stroke: A Danish Cohort Study.

https://arctichealth.org/en/permalink/ahliterature282576
Source
Stroke. 2017 Feb;48(2):259-264
Publication Type
Article
Date
Feb-2017
Author
Camilla Plambeck Hansen
Kim Overvad
Cecilie Kyrø
Anja Olsen
Anne Tjønneland
Søren Paaske Johnsen
Marianne Uhre Jakobsen
Christina Catherine Dahm
Source
Stroke. 2017 Feb;48(2):259-264
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Animals
Cohort Studies
Denmark - epidemiology
Diet, Mediterranean
Female
Fishes
Fruit
Health Promotion - methods
Healthy Diet - methods
Humans
Male
Middle Aged
Registries
Risk factors
Scandinavian and Nordic Countries - epidemiology
Stroke - diet therapy - epidemiology - prevention & control
Vegetables
Whole Grains
Abstract
Specific dietary patterns, including the Mediterranean diet, have been associated with stroke prevention. Our aim was to investigate whether adherence to a healthy Nordic diet, including fish, apples and pears, cabbages, root vegetables, rye bread, and oatmeal, was associated with risk of stroke.
Incident cases of stroke among 55?338 men and women from the Danish Diet, Cancer and Health cohort were identified from the Danish National Patient Register and verified by review of records. Cases of ischemic stroke were further subclassified based on etiology according to the TOAST classification system (Trial of Org 10172 in Acute Stroke Treatment). Information on diet was collected at baseline (1993-1997) using a semiquantitative food-frequency questionnaire. Cox proportional hazards models were used to estimate hazards ratios of total stroke and subtypes of ischemic and hemorrhagic stroke.
During a median follow-up of 13.5 years, 2283 cases of incident stroke were verified, including 1879 ischemic strokes. Adherence to a healthy Nordic diet, as reflected by a higher Healthy Nordic Food Index score, was associated with a lower risk of stroke. The hazards ratio comparing an index score of 4 to 6 (high adherence) with an index score of 0 to 1 (low adherence) was 0.86 (95% confidence interval 0.76-0.98) for total stroke. Inverse associations were observed for ischemic stroke, including large-artery atherosclerosis. No trend was observed for hemorrhagic stroke; however, a statistically insignificant trend was observed for intracerebral hemorrhage.
Our findings suggest that a healthy Nordic diet may be recommended for the prevention of stroke.
PubMed ID
28049735 View in PubMed
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Age- and sex-related differences in use of guideline-recommended care and mortality among patients with incident heart failure in Denmark.

https://arctichealth.org/en/permalink/ahliterature287055
Source
Age Ageing. 2016 Sep;45(5):635-42
Publication Type
Article
Date
Sep-2016
Author
Anne Nakano
Kenneth Egstrup
Marie Louise Svendsen
Inge Schjødt
Lars Jakobsen
Frank Mehnert
Søren Paaske Johnsen
Source
Age Ageing. 2016 Sep;45(5):635-42
Date
Sep-2016
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Denmark - epidemiology
Echocardiography
Female
Guideline Adherence - statistics & numerical data
Heart Failure - diagnosis - mortality - therapy
Humans
Male
Middle Aged
Registries
Sex Factors
Abstract
data are sparse on age- and sex-related differences in use of guideline-recommended care and subsequent mortality among patients with heart failure (HF).
we identified 24,308 incident patients with a verified primary diagnosis of HF recorded during 2003-2010 in the Danish Heart Failure Registry. The registry monitors guideline-recommended processes of care: echocardiography, New York Heart Association Classification, treatment with angiotensin converting enzyme inhibitors/angiotensin II receptor blockers, betablockers, physical training and patient education.
older age was associated with lower use of recommended processes of care. Relative risk (RR) for receiving processes of care varied for men >80 years from 0.52 to 0.91 compared with men =65 years. Corresponding RRs among women >80 years varied from 0.55 to 0.89 compared with women =65 years. Older age was as expected associated with higher 1 year mortality (32.6% among men >80 years versus 5.4% among men =65 years and 33.8% among women >80 years versus 6.6% among women =65 years). The corresponding hazard ratios (HRs) were 4.54 (95% CI 3.93-5.25) and 4.08 (95% CI 3.51-4.75) for the oldest versus youngest men and women, after adjustment for patient characteristics. Adjustment for differences in care lowered HRs among the oldest age groups (adjusted HR 3.87 for men and 3.48 for women, respectively). The findings were also confirmed when stratifying the patients according to left ventricular ejection fraction =40% and >40%.
older patients with HF were less likely to receive guideline-recommended processes of care, irrespective of sex. Lower level of care may contribute to an excess mortality observed among the older patients.
PubMed ID
27496924 View in PubMed
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Anthropometry, body fat, and venous thromboembolism: a Danish follow-up study.

https://arctichealth.org/en/permalink/ahliterature147736
Source
Circulation. 2009 Nov 10;120(19):1850-7
Publication Type
Article
Date
Nov-10-2009
Author
Marianne Tang Severinsen
Søren Risom Kristensen
Søren Paaske Johnsen
Claus Dethlefsen
Anne Tjønneland
Kim Overvad
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg Hospital, Sdr. Skovvej 15, DK-9000 Aalborg, Denmark. m.severinsen@rn.dk
Source
Circulation. 2009 Nov 10;120(19):1850-7
Date
Nov-10-2009
Language
English
Publication Type
Article
Keywords
Adipose Tissue - pathology
Anthropometry
Body mass index
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Predictive value of tests
Proportional Hazards Models
Prospective Studies
Registries
Risk factors
Sex Distribution
Venous Thromboembolism - epidemiology - pathology - prevention & control
Waist Circumference
Waist-Hip Ratio
Abstract
Obesity, measured as body mass index, is associated with venous thromboembolism (VTE). Body mass index is a marker of excess weight and correlates well with body fat content in adults; however, it fails to consider the distribution of body fat. We assessed the association between anthropometric variables and VTE.
From 1993 to 1997, 27 178 men and 29 876 women 50 to 64 years of age were recruited into a Danish prospective study (Diet, Cancer, and Health). During 10 years of follow-up, the outcome of VTE events was identified in the Danish National Patient Registry and verified by review of medical records. Body weight, body mass index, waist circumference, hip circumference, and total body fat were measured at baseline. We used Cox proportional hazard models to assess the association between anthropometry and VTE. Age was used as a time axis, with further adjustment for smoking, physical activity, height, hypertension, diabetes mellitus, cholesterol, and, among women, use of hormone replacement therapy. We verified 641 incident VTE events and found monotonic dose-response relationships between VTE and all anthropometric measurements in both sexes. In mutually adjusted analyses of waist and hip circumference, we found that hip circumference was positively associated with VTE in women but not in men, whereas waist circumference was positively associated with VTE in men but not in women.
All measurements of obesity are predictors of the risk for VTE. Positive associations were found between VTE and body weight, body mass index, waist circumference, hip circumference, and total body fat mass.
PubMed ID
19858417 View in PubMed
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Body height and sex-related differences in incidence of venous thromboembolism: a Danish follow-up study.

https://arctichealth.org/en/permalink/ahliterature142410
Source
Eur J Intern Med. 2010 Aug;21(4):268-72
Publication Type
Article
Date
Aug-2010
Author
Marianne Tang Severinsen
Søren Paaske Johnsen
Anne Tjønneland
Kim Overvad
Claus Dethlefsen
Søren Risom Kristensen
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg and Aarhus, Denmark. m.severinsen@rn.dk
Source
Eur J Intern Med. 2010 Aug;21(4):268-72
Date
Aug-2010
Language
English
Publication Type
Article
Keywords
Body Height
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Proportional Hazards Models
Pulmonary Embolism - epidemiology
Sex Factors
Venous Thromboembolism - epidemiology
Venous Thrombosis - epidemiology
Abstract
Sex-related differences in incidence rate of venous thromboembolism (VTE) have been reported. It is unclear whether these differences reflect sex-related differences in the incidence of deep venous thrombosis (DVT), pulmonary embolism (PE) or both and to which extent the differences are mediated by known risk factors for VTE.
To compare the incidence of DVT and PE between middle-aged men and women.
We computed sex-specific incidences of VTE, DVT and PE and estimated the crude and adjusted incidence rate ratios (IRR) of VTE, DVT and PE using Cox regression for men versus women participating in the prospective study Diet, Cancer and Health. We controlled for body mass index, body height, leisure-time physical activity and smoking dose.
We verified 641 VTE events during a median follow-up time of 10 years. The overall incidence of VTE was 1.15 [95%CI: 1.07-1.25] per thousand person years; it was higher for men than women (crude IRR: 1.55 [95%CI: 1.32-1.82]). The adjusted IRR for DVT was 1.06 [95%CI: 0.75-1.50] and for PE 0.60 [95%CI: 0.41-1.18] for men versus women. The higher rate among men appeared to be mediated mainly by body height.
In this middle-aged population, men experienced a higher incidence of VTE due to a higher incidence of DVT. The higher incidence among men appeared to be mediated by body height. Adjusted for body height, male sex was not associated with an excess risk of either VTE or DVT but the risk of PE was notably lower compared with women.
PubMed ID
20603033 View in PubMed
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Can improved quality of care explain the success of orthogeriatric units? A population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature277031
Source
Age Ageing. 2016 Jan;45(1):66-71
Publication Type
Article
Date
Jan-2016
Author
Pia Kjær Kristensen
Theis Muncholm Thillemann
Kjeld Søballe
Søren Paaske Johnsen
Source
Age Ageing. 2016 Jan;45(1):66-71
Date
Jan-2016
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Delivery of Health Care, Integrated - organization & administration - standards
Denmark
Female
Fracture Fixation - adverse effects - mortality - standards
Geriatrics - organization & administration - standards
Hip Fractures - diagnosis - mortality - surgery
Humans
Length of Stay
Linear Models
Logistic Models
Male
Multivariate Analysis
Odds Ratio
Orthopedics - organization & administration - standards
Patient Admission
Process Assessment (Health Care) - organization & administration - standards
Prospective Studies
Quality Improvement - organization & administration - standards
Quality Indicators, Health Care - organization & administration - standards
Registries
Risk factors
Time Factors
Time-to-Treatment
Treatment Outcome
Abstract
admission to orthogeriatric units improves clinical outcomes for patients with hip fracture; however, little is known about the underlying mechanisms.
to compare quality of in-hospital care, 30-day mortality, time to surgery (TTS) and length of hospital stay (LOS) among patients with hip fracture admitted to orthogeriatric and ordinary orthopaedic units, respectively.
population-based cohort study.
using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry, we identified 11,461 patients aged =65 years admitted with a hip fracture between 1 March 2010 and 30 November 2011. The patients were divided into two groups: (i) those treated at an orthogeriatric unit, where the geriatrician is an integrated part of the multidisciplinary team, and (ii) those treated at an ordinary orthopaedic unit, where geriatric or medical consultant service are available on request. Outcome measures were the quality of care as reflected by six process performance measures, 30-day mortality, the TTS and the LOS. Data were analysed using log-binomial, linear and logistic regression controlling for potential confounders.
admittance to orthogeriatric units was associated with a higher chance for fulfilling five out of six process performance measures. Patients who were admitted to an orthogeriatric unit experienced a lower 30-day mortality (adjusted odds ratio (aOR) 0.69; 95% CI 0.54-0.88), whereas the LOS (adjusted relative time (aRT) of 1.18; 95% CI 0.92-1.52) and the TTS (aRT 1.06; 95% CI 0.89-1.26) were similar.
admittance to an orthogeriatric unit was associated with improved quality of care and lower 30-day mortality among patients with hip fracture.
PubMed ID
26582757 View in PubMed
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Clinical outcome after primary percutaneous coronary intervention with drug-eluting and bare metal stents in patients with ST-segment elevation myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature98528
Source
Circ Cardiovasc Interv. 2008 Dec;1(3):176-84
Publication Type
Article
Date
Dec-2008
Author
Lisette Okkels Jensen
Michael Maeng
Per Thayssen
Anne Kaltoft
Hans Henrik Tilsted
Morten Bøttcher
Jens Flensted Lassen
Knud Nørregaard Hansen
Lars Romer Krusell
Klaus Rasmussen
Knud Erik Pedersen
Lars Pedersen
Søren Paaske Johnsen
Henrik Toft Sørensen
Leif Thuesen
Author Affiliation
Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, Odense, Denmark. okkels@dadlnet.dk
Source
Circ Cardiovasc Interv. 2008 Dec;1(3):176-84
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Cohort Studies
Coronary Thrombosis - epidemiology
Diabetes Mellitus - epidemiology
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Myocardial Infarction - mortality - therapy
Prosthesis Design
Registries
Retreatment - statistics & numerical data
Stents - adverse effects
Abstract
BACKGROUND: The use of drug-eluting stents (DESs) versus bare metal stents (BMSs) in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction is a matter of debate. Therefore, we examined the risk of target lesion revascularization (TLR), stent thrombosis, myocardial infarction, and death after the implantation of DES or BMS in primary PCI patients in Western Denmark. METHODS AND RESULTS: A total of 3756 consecutive patients with ST-segment elevation myocardial infarction treated with primary PCI and stent implantation, recorded in the Western Denmark Heart Registry from January 2002 through June 2005, were followed up for 2 years. We used Cox regression analysis to control for confounding. The 2-year incidence of definite stent thrombosis was 1.9% in the DES group and 1.1% in the BMS group (adjusted relative risk [RR]=1.53; 95% CI=0.84 to 2.78; P=0.17). Very late definite stent thrombosis (> or =12 months) was seen in 0.4% in the DES group and 0.06% in the BMS group (adjusted RR=6.74; 95% CI=1.23 to 37.00; P=0.03). The 2-year incidence of myocardial infarction was similar in the 2 groups, 5.2% in the DES group versus 6.3% in the BMS group (P=0.28; adjusted RR=1.13; 95% CI=0.81 to 1.59; P=0.47). All-cause 2-year mortality was 7.8% in the DES group and 11.4% in BMS group (P
Notes
RefSource: Circ Cardiovasc Interv. 2008 Dec;1(3):161-3
PubMed ID
20031676 View in PubMed
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Compliance with hospital accreditation and patient mortality: a Danish nationwide population-based study.

https://arctichealth.org/en/permalink/ahliterature270828
Source
Int J Qual Health Care. 2015 Jun;27(3):165-74
Publication Type
Article
Date
Jun-2015
Author
Anne Mette Falstie-Jensen
Heidi Larsson
Erik Hollnagel
Mette Nørgaard
Marie Louise Overgaard Svendsen
Søren Paaske Johnsen
Source
Int J Qual Health Care. 2015 Jun;27(3):165-74
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Accreditation - standards - statistics & numerical data
Aged
Aged, 80 and over
Denmark
Female
Guideline Adherence - statistics & numerical data
Hospital Mortality
Hospitals, Public - standards - statistics & numerical data
Humans
Male
Middle Aged
Mortality
Quality of Health Care - standards - statistics & numerical data
Risk Management
Abstract
To examine the association between compliance with hospital accreditation and 30-day mortality.
A nationwide population-based, follow-up study with data from national, public registries.
Public, non-psychiatric Danish hospitals.
In-patients diagnosed with one of the 80 primary diagnoses.
Accreditation by the first version of The Danish Healthcare Quality Programme for hospitals from 2010 to 2012. Compliance were assessed by surveyors on an on-site survey and awarded the hospital as a whole; fully (n = 11) or partially accredited (n = 20). A follow-up activity was requested for partially accredited hospitals; submitting additional documentation (n = 11) or by having a return-visit (n = 9).
All-cause mortality within 30-days after admission. Multivariable logistic regression was used to compute odds ratios (ORs) for 30-day mortality adjusted for six confounding factors and for cluster effect at hospital level.
A total of 276 980 in-patients were identified. Thirty-day mortality risk for in-patients at fully (n = 76 518) and partially accredited hospitals (n = 200 462) was 4.14% (95% confidence interval (CI):4.00-4.28) and 4.28% (95% CI: 4.20-4.37), respectively. In-patients at fully accredited hospitals had a lower risk of dying within 30-days after admission than in-patients at partially accredited hospitals (adjusted OR of 0.83; 95% CI: 0.72-0.96). A lower risk of 30-day mortality was observed among in-patients at partially accredited hospitals required to submit additional documentation compared with in-patients at partially accredited hospitals requiring a return-visit (adjusted OR 0.83; 95% CI: 0.67-1.02).
Admissions at fully accredited hospitals were associated with a lower 30-day mortality risk than admissions at partially accredited hospitals.
PubMed ID
25921337 View in PubMed
Less detail
Source
Ugeskr Laeger. 2012 Oct 15;174(42):2554
Publication Type
Article
Date
Oct-15-2012
Author
Søren Paaske Johnsen
Annette Ingeman
Susanne Zielke
Palle Petersen
Author Affiliation
Klinisk Epidemiologisk Afdeling, Aarhus Universitetshospital, Olof Palmes Alle 43, Aarhus. spj@dce.dk
Source
Ugeskr Laeger. 2012 Oct 15;174(42):2554
Date
Oct-15-2012
Language
Danish
Publication Type
Article
Keywords
Databases, Factual
Denmark - epidemiology
Humans
Quality Assurance, Health Care
Registries
Stroke - epidemiology
PubMed ID
23079457 View in PubMed
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The Danish Register of Congenital Heart Disease.

https://arctichealth.org/en/permalink/ahliterature131552
Source
Scand J Public Health. 2011 Jul;39(7 Suppl):50-3
Publication Type
Article
Date
Jul-2011
Author
Morten Olsen
Jørgen Videbæk
Søren Paaske Johnsen
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. mo@dce.au.dk
Source
Scand J Public Health. 2011 Jul;39(7 Suppl):50-3
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adult
Biomedical research
Child
Denmark - epidemiology
Follow-Up Studies
Heart Defects, Congenital - classification - diagnosis - epidemiology
Humans
Prognosis
Registries - standards
Abstract
Congenital heart defects (CHD) constitute the largest group of congenital defects with a prevalence at birth of 5-11 per 1000 live births, and the population of adults with CHD is increasing. However, few population-based long-term outcome data exist.
The Danish Register of Congenital Heart Disease holds data on patients diagnosed with CHD since 1963 and patients below 25 years of age with other types of heart disease.
Overall and defect specific validation is ongoing.
Together with other Danish registers, the Danish Register of Congenital Heart Disease provides extensive research possibilities.
PubMed ID
21898918 View in PubMed
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69 records – page 1 of 7.