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Best practices in scleroderma: an analysis of practice variability in SSc centres within the Canadian Scleroderma Research Group (CSRG).

https://arctichealth.org/en/permalink/ahliterature122345
Source
Clin Exp Rheumatol. 2012 Mar-Apr;30(2 Suppl 71):S38-43
Publication Type
Article
Author
Sarah Harding
Sarit Khimdas
Ashley Bonner
Murray Baron
Janet Pope
Author Affiliation
University of Western Ontario, London, ON, Canada. sarahharding@rcsi.ie
Source
Clin Exp Rheumatol. 2012 Mar-Apr;30(2 Suppl 71):S38-43
Language
English
Publication Type
Article
Keywords
Benchmarking - standards
Canada
Consensus
Databases, Factual
Diagnostic Tests, Routine - standards
Evidence-Based Medicine - standards
Female
Guideline Adherence - standards
Humans
Male
Middle Aged
Outcome and Process Assessment (Health Care) - standards
Physician's Practice Patterns - standards
Practice Guidelines as Topic - standards
Predictive value of tests
Prospective Studies
Quality Indicators, Health Care - standards
Rheumatology - standards
Scleroderma, Systemic - complications - diagnosis - therapy
Severity of Illness Index
Time Factors
Treatment Outcome
Abstract
There is currently no consensus on best practice in systemic sclerosis (SSc). To determine if variability in treatment and investigations exists, practices among Canadian Sclerodermia Research Group (CSRG) centres were compared.
Prospective clinical and demographic data from adult SSc patients are collected annually from 15 CSRG treatment centres. Laboratory parameters, self-reported socio-demographic questionnaires, current and past medications and disease outcome measures are recorded. For centres with >50 patients enrolled, treatment practices were analysed to determine practice variability.
Data from 640 of 938 patients within the CSRG database met inclusion criteria, where 87.3% were female, the mean ± SEM age was 55.3±0.5, 48.9% had limited SSc and 47.8% had diffuse SSc (and 3.3% uncharacterised). Some investigation and treatment practices were inconsistent among 6 centres including proportion receiving: PDE5 (phosphodiesterase type 5) inhibitors for Raynaud's phenomenon (p=0.036); cyclophosphamide (p=0.037) and azathioprine (p=0.037) for treatment of ILD; and current use of D-penicillamine, although uncommon, varied among sites. Annual echocardiograms and PFTs were frequently done and did not vary among sites but the rate of pulmonary arterial hypertension (PAH) was directly related to site size and this was not the case for other organ involvement.
Despite routine tests within a database, site variation in SSc with respect to investigations and management among CSRG centres exists suggesting a need for a standardised approach to the investigation and treatment of SSc. One can speculate that larger centres are more export in detecting PAH.
PubMed ID
22691207 View in PubMed
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Beyond self-assessment--assessing organizational cultural responsiveness.

https://arctichealth.org/en/permalink/ahliterature152943
Source
J Cult Divers. 2008;15(1):7-15
Publication Type
Article
Date
2008
Author
Sarah Bowen
Author Affiliation
Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. sbowen@wrha.mb.ca
Source
J Cult Divers. 2008;15(1):7-15
Date
2008
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Benchmarking - standards
Community-Institutional Relations
Cultural Competency - education - organization & administration
Documentation - standards
Feedback, Psychological
Focus Groups
Guideline Adherence - standards
Health Services Accessibility - standards
Humans
Manitoba
Needs Assessment - organization & administration
Nursing Evaluation Research
Nursing Methodology Research
Organizational Culture
Patient satisfaction
Pilot Projects
Practice Guidelines as Topic
Prejudice
Questionnaires - standards
Research Design
Abstract
While there is growing recognition of the need for health care organizations to provide culturally responsive care, appropriate strategies for assessing organizational responsiveness have not been determined. A document review assessment instrument was designed to assess best practice within eight domains, and along seven dimensions of organizational approach to diversity. Results obtained from the pilot of the instrument were congruent with data collected from key informant interviews, a focus group, observational methods and organizational feedback session; however, they were not consistent with self-assessment results at the same site. A larger pilot is required to determine generalizability of results.
PubMed ID
19172974 View in PubMed
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Current clinical practices in Aphasia Therapy in Finland: challenges in moving towards national best practice.

https://arctichealth.org/en/permalink/ahliterature119377
Source
Folia Phoniatr Logop. 2012;64(4):169-78
Publication Type
Article
Date
2012
Author
A. Klippi
J. Sellman
P. Heikkinen
M. Laine
Author Affiliation
Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland. anu.klippi @ helsinki.fi
Source
Folia Phoniatr Logop. 2012;64(4):169-78
Date
2012
Language
English
Publication Type
Article
Keywords
Aphasia - diagnosis - therapy
Benchmarking - standards
Chronic Disease
Cross-Cultural Comparison
Evidence-Based Practice - standards
Finland
Health Services Research
Humans
Language Therapy - standards
Neuropsychological Tests - standards
Physician's Practice Patterns - standards
Practice Guidelines as Topic
Quality Assurance, Health Care - standards
Questionnaires
Speech Therapy - standards
Stroke - complications
Abstract
The objective of this article is to discover and document the state of clinical practices for aphasia therapy in Finland and to gather information for developing national best practice.
Two surveys were administered in Finland that explored current clinical practices in aphasia rehabilitation and the resources available to speech and language therapists (SLTs). We integrated and compared the results of these surveys. The results are based on the responses of the 88 (45 + 43) returned questionnaires from SLTs.
Four principle themes were identified: planning the aphasia therapy, measures and assessment methods, current therapy service provision, and development suggestions and barriers to change. The results of this study showed considerable consistency in clinical practices among the respondents to the surveys. However, we noticed that there are some discrepancies between the recent research findings and present clinical practices.
The findings from this study indicate that there are many challenges in clinical decision-making at the moment in Finland. The article helps clinicians to evaluate the practices they use and to execute justified modifications in order to implement more effective models of practice. It is evident that national best practice guidelines for aphasia therapy would support SLTs in clinical decision-making.
PubMed ID
23108446 View in PubMed
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Development and validation of a derived measure of research utilization by nurses.

https://arctichealth.org/en/permalink/ahliterature169239
Source
Nurs Res. 2006 May-Jun;55(3):149-60
Publication Type
Article
Author
Lars Wallin
Carole A Estabrooks
William K Midodzi
Greta G Cummings
Author Affiliation
Faculty of Nursing and Knowledge Utilization Studies Program, University of Alberta, Edmonton, Canada.
Source
Nurs Res. 2006 May-Jun;55(3):149-60
Language
English
Publication Type
Article
Keywords
Adult
Alberta - epidemiology
Benchmarking - standards
Clinical Competence - standards
Diffusion of Innovation
Evidence-Based Medicine
Female
Health Care Surveys
Humans
Linear Models
Male
Models, Nursing
Nursing - standards
Nursing Staff, Hospital - statistics & numerical data
Questionnaires
Abstract
Theoretical models are needed to guide strategies for the implementation of research into clinical practice. To develop and test such models, including analyses of complex theoretical constructs and causal relationships, rich datasets are needed. Working with existing datasets may mean that important variables are lacking.
The aim of this study was to derive a nursing research utilization variable and validate it using the Promoting Action on Research Implementation in Health Services (PARIHS) conceptual framework on research implementation.
This study was based on data from two surveys of registered nurses. The first survey (1996; N = 600) contained robust research utilization variables but few organizational variables. The second (1998; N = 6,526) was rich in organizational variables but contained no research utilization variables. A linear regression model with predictors common to both datasets was used to derive a research utilization variable in the 1998 dataset. To validate these scores, four separate procedures based on the hypothesis of a positive relationship between context and research utilization were completed. Mutually exclusive groups reflecting various levels of context were created to accomplish these procedures.
The derived research utilization variable was successfully mapped onto the cases in the 1998 dataset. The derived scores ranged from 0.21 to 21.40, with a mean of 10.85 (SD = 3.23). The mean score per subgroup ranged from 8.28 for the lowest context group to 12.75 for the highest context group. One of the validation procedures showed that significant differences in mean research utilization existed only among four conceptually unique context groups (p
Notes
Comment In: Nurs Res. 2007 Jul-Aug;56(4 Suppl):S47-5217625474
PubMed ID
16708039 View in PubMed
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The development of a national pediatric trauma curriculum.

https://arctichealth.org/en/permalink/ahliterature144960
Source
Med Teach. 2010;32(3):e115-9
Publication Type
Article
Date
2010
Author
Rahim A Valani
Natalie Yanchar
Vince Grant
B J Hancock
Author Affiliation
University of Toronto, Toronto, Ontario, Canada. Rahim.valani@sunnybrook.ca
Source
Med Teach. 2010;32(3):e115-9
Date
2010
Language
English
Publication Type
Article
Keywords
Benchmarking - standards
Canada
Clinical Competence - standards
Curriculum
Delphi Technique
Health Knowledge, Attitudes, Practice
Humans
Pediatrics - education - standards
Program Development
Traumatology - education - standards
Wounds and Injuries - surgery
Abstract
Educational programs dedicated to pediatric trauma are either not available or comprehensive. Pediatric trauma is thus managed by a range of specialists with training in a variety of related fields. Post-certification fellowships in pediatric medicine all mandate education in the assessment and management of the injured child. The purpose of this study was to develop a blueprint for a national pediatric trauma training curriculum.
A team of four experts developed content for a national pediatric trauma curriculum and disseminated it to 11 pediatric trauma sites across Canada. The objectives contained both knowledge and skill sets related to the management of the pediatric trauma patients. A multi-tiered Delphi process was used to develop the final content.
All the 11 pediatric teaching centers across the country participated. A final list, representing a consensus of views, was developed in 10 domains through the iterative process of the Delphi technique. The domains for the curriculum included introduction to pediatric trauma and epidemiology, initial management, pediatric airway, shock, thoracic injuries, abdominal and pelvic injuries, spinal and neurological injuries, pediatric head injuries, burns and electrical injuries, and orthopedic injuries.
The Delphi process is an invaluable tool in developing curricula. The pediatric trauma curriculum can be used in teaching hospitals for house staff education and meeting core competencies. The blueprint can be validated further in the future.
PubMed ID
20218826 View in PubMed
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Education and benchmarking among physicians may facilitate sick-listing practice.

https://arctichealth.org/en/permalink/ahliterature132867
Source
J Occup Rehabil. 2012 Mar;22(1):78-87
Publication Type
Article
Date
Mar-2012
Author
A B Bremander
J. Hubertsson
I F Petersson
B. Grahn
Author Affiliation
Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden. ann.bremander@morse.nu
Source
J Occup Rehabil. 2012 Mar;22(1):78-87
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adult
Benchmarking - standards
Clinical Competence
Cross-Sectional Studies
Delivery of Health Care - standards
Education, Medical, Continuing - methods
Female
Guidelines as Topic
Humans
Male
Middle Aged
Physician's Practice Patterns
Physicians
Questionnaires
Regression Analysis
Sick Leave
Sweden
Work Capacity Evaluation
Abstract
Assessing work ability and sickness certification are considered problematic by many physicians and education and implementation of guidelines to improve knowledge and skills has been requested. Our aim was to study the association between such interventions and physicians' sick-listing practices.
A web-based questionnaire was sent to all physicians working in primary care, psychiatry, orthopedics/rheumatology in the southern region of Sweden before (in 2007 to 1,063 physicians) and after (in 2009 to 1,164 physicians) educational interventions in insurance medicine were offered.
With a response rate of 58%, half of the physicians (51%) reported to work at a clinic with a sick-listing policy in 2009 compared with 31% in 2007. Primary care physicians (OR 12.4) and physicians who had participated in educational interventions in insurance medicine (OR 2.4) more often had a sick-listing policy at the clinic. Physicians with a longer medical experience (OR 0.7) and those with support at the clinic (OR 0.3) and the possibility to extend time if needed (OR 0.4) were less likely to report of problematic cases while primary care physicians were (OR 2.9). On the contrary, physicians who reported to rarely have the possibility to extend time when handling problematic cases were more likely to issue a higher number of sickness certificates.
The sick-listing process is often viewed as problematic and more often by primary care physicians. Benchmarking and education in insurance medicine together with the possibility to allocate extra time if encountering problematic cases may facilitate sick-listing practice.
PubMed ID
21769594 View in PubMed
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Evaluating hospital performance based on excess cause-specific incidence.

https://arctichealth.org/en/permalink/ahliterature269309
Source
Stat Med. 2015 Apr 15;34(8):1334-50
Publication Type
Article
Date
Apr-15-2015
Author
Bart Van Rompaye
Marie Eriksson
Els Goetghebeur
Source
Stat Med. 2015 Apr 15;34(8):1334-50
Date
Apr-15-2015
Language
English
Publication Type
Article
Keywords
Benchmarking - standards - statistics & numerical data
Cause of Death
Clinical Audit - methods - standards
Data Interpretation, Statistical
Hospital Mortality
Hospitals - standards - statistics & numerical data
Humans
Incidence
Logistic Models
Proportional Hazards Models
Quality Assurance, Health Care - methods - standards
Registries - statistics & numerical data
Risk Adjustment - methods - standards
Stroke - mortality
Sweden - epidemiology
Abstract
Formal evaluation of hospital performance in specific types of care is becoming an indispensable tool for quality assurance in the health care system. When the prime concern lies in reducing the risk of a cause-specific event, we propose to evaluate performance in terms of an average excess cumulative incidence, referring to the center's observed patient mix. Its intuitive interpretation helps give meaning to the evaluation results and facilitates the determination of important benchmarks for hospital performance. We apply it to the evaluation of cerebrovascular deaths after stroke in Swedish stroke centers, using data from Riksstroke, the Swedish stroke registry.
PubMed ID
25640288 View in PubMed
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Source
J Emerg Nurs. 2008 Apr;34(2):180-2
Publication Type
Article
Date
Apr-2008
Author
Paula Funderburke
Author Affiliation
Emergency Services, Emory University Hospital, Atlanta, GA 30322, USA. paula.funderburk@emoryhealthcare.org
Source
J Emerg Nurs. 2008 Apr;34(2):180-2
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Benchmarking - standards
Canada
Clinical Competence
Decision Making, Computer-Assisted
Emergency Nursing - standards
Emergency Service, Hospital - organization & administration
Humans
Total Quality Management
Triage - standards
United States
PubMed ID
18358367 View in PubMed
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Health care providers' and patients' perspectives on care in HIV ambulatory clinics across Ontario.

https://arctichealth.org/en/permalink/ahliterature174733
Source
J Assoc Nurses AIDS Care. 2005 Jan-Feb;16(1):37-48
Publication Type
Article
Author
Susan Jane Laschinger
Lori Van Manen
Tracey Stevenson
Frances Fothergill-Bourbonnais
Author Affiliation
Queen's University School of Nursing, Kingston, Ontario, Canada.
Source
J Assoc Nurses AIDS Care. 2005 Jan-Feb;16(1):37-48
Language
English
Publication Type
Article
Keywords
Ambulatory Care Facilities - standards
Appointments and Schedules
Attitude of Health Personnel
Attitude to Health
Benchmarking - standards
Case Management - standards
Communication
Cooperative Behavior
Empathy
Focus Groups
HIV Infections - psychology - therapy
Health Care Surveys
Health Services Accessibility - standards
Humans
Needs Assessment
Nursing Methodology Research
Ontario
Outcome Assessment (Health Care)
Patient Care Team - standards
Patient Education as Topic - standards
Patient-Centered Care - standards
Professional-Patient Relations
Questionnaires
Social Support
Abstract
This descriptive study represents one component of a larger project that examined the perceptions of current and best-care practices in HIV ambulatory clinics across Ontario by health care providers and patients living with HIV/AIDS. Focus groups were held with providers and patients at eight clinics. Results showed that providers' and patients' perceptions were similar. Participants were able to describe current care practices and identify two elements of best care: patient-focused care and access to care. However, both health care providers and patients acknowledged that financial constraints, appointment scheduling, and distance to clinics were some of the barriers to achieving best care. Case management and shared-care schemes are two strategies that are proposed to meet the challenge of providing collaborative integrated care that is accessible and equal to all, while still maintaining positive patient outcomes.
PubMed ID
15903277 View in PubMed
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Length of stay benchmarks for inpatient rehabilitation after stroke.

https://arctichealth.org/en/permalink/ahliterature129023
Source
Disabil Rehabil. 2012;34(13):1077-81
Publication Type
Article
Date
2012
Author
Matthew Meyer
Eileen Britt
Heather A McHale
Robert Teasell
Author Affiliation
Aging, Rehabilitation and Geriatric Care Research Center, Lawson Health Research Institute, UWO, Ontario, Canada. Matthew.Meyer@sjhc.london.on.ca
Source
Disabil Rehabil. 2012;34(13):1077-81
Date
2012
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adult
Aged
Benchmarking - standards
Canada
Humans
Inpatients - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Middle Aged
Outcome Assessment (Health Care) - methods
Patient Discharge
Recovery of Function
Rehabilitation Centers - statistics & numerical data
Retrospective Studies
Severity of Illness Index
Stroke - rehabilitation
Abstract
In Canada, no standardized benchmarks for length of stay (LOS) have been established for post-stroke inpatient rehabilitation. This paper describes the development of a severity specific median length of stay benchmarking strategy, assessment of its impact after one year of implementation in a Canadian rehabilitation hospital, and establishment of updated benchmarks that may be useful for comparison with other facilities across Canada.
Patient data were retrospectively assessed for all patients admitted to a single post-acute stroke rehabilitation unit in Ontario, Canada between April 2005 and March 2008. Rehabilitation Patient Groups (RPGs) were used to establish stratified median length of stay benchmarks for each group that were incorporated into team rounds beginning in October 2009. Benchmark impact was assessed using mean LOS, FIM(®) gain, and discharge destination for each RPG group, collected prospectively for one year, compared against similar information from the previous calendar year. Benchmarks were then adjusted accordingly for future use.
Between October 2009 and September 2010, a significant reduction in average LOS was noted compared to the previous year (35.3 vs. 41.2 days; p
PubMed ID
22149936 View in PubMed
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17 records – page 1 of 2.