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30-Day Survival Probabilities as a Quality Indicator for Norwegian Hospitals: Data Management and Analysis.

https://arctichealth.org/en/permalink/ahliterature273361
Source
PLoS One. 2015;10(9):e0136547
Publication Type
Article
Date
2015
Author
Sahar Hassani
Anja Schou Lindman
Doris Tove Kristoffersen
Oliver Tomic
Jon Helgeland
Source
PLoS One. 2015;10(9):e0136547
Date
2015
Language
English
Publication Type
Article
Keywords
Comorbidity
Diagnosis-Related Groups
Episode of Care
Hospital Mortality
Hospital records
Hospitals - standards - statistics & numerical data
Humans
Length of Stay
Norway - epidemiology
Patient Admission - statistics & numerical data
Patient Discharge - statistics & numerical data
Patient transfer
Probability
Quality Improvement
Quality Indicators, Health Care
Survival Analysis
Abstract
The Norwegian Knowledge Centre for the Health Services (NOKC) reports 30-day survival as a quality indicator for Norwegian hospitals. The indicators have been published annually since 2011 on the website of the Norwegian Directorate of Health (www.helsenorge.no), as part of the Norwegian Quality Indicator System authorized by the Ministry of Health. Openness regarding calculation of quality indicators is important, as it provides the opportunity to critically review and discuss the method. The purpose of this article is to describe the data collection, data pre-processing, and data analyses, as carried out by NOKC, for the calculation of 30-day risk-adjusted survival probability as a quality indicator.
Three diagnosis-specific 30-day survival indicators (first time acute myocardial infarction (AMI), stroke and hip fracture) are estimated based on all-cause deaths, occurring in-hospital or out-of-hospital, within 30 days counting from the first day of hospitalization. Furthermore, a hospital-wide (i.e. overall) 30-day survival indicator is calculated. Patient administrative data from all Norwegian hospitals and information from the Norwegian Population Register are retrieved annually, and linked to datasets for previous years. The outcome (alive/death within 30 days) is attributed to every hospital by the fraction of time spent in each hospital. A logistic regression followed by a hierarchical Bayesian analysis is used for the estimation of risk-adjusted survival probabilities. A multiple testing procedure with a false discovery rate of 5% is used to identify hospitals, hospital trusts and regional health authorities with significantly higher/lower survival than the reference. In addition, estimated risk-adjusted survival probabilities are published per hospital, hospital trust and regional health authority. The variation in risk-adjusted survival probabilities across hospitals for AMI shows a decreasing trend over time: estimated survival probabilities for AMI in 2011 varied from 80.6% (in the hospital with lowest estimated survival) to 91.7% (in the hospital with highest estimated survival), whereas it ranged from 83.8% to 91.2% in 2013.
Since 2011, several hospitals and hospital trusts have initiated quality improvement projects, and some of the hospitals have improved the survival over these years. Public reporting of survival/mortality indicators are increasingly being used as quality measures of health care systems. Openness regarding the methods used to calculate the indicators are important, as it provides the opportunity of critically reviewing and discussing the methods in the literature. In this way, the methods employed for establishing the indicators may be improved.
Notes
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PubMed ID
26352600 View in PubMed
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Accountability in public health units: using a modified nominal group technique to develop a balanced scorecard for performance measurement.

https://arctichealth.org/en/permalink/ahliterature183128
Source
Can J Public Health. 2003 Sep-Oct;94(5):391-6
Publication Type
Article
Author
Victoria A Robinson
Duncan Hunter
Samuel E D Shortt
Author Affiliation
Department of Community Health and Epidemiology, Queen's University, Kingston, ON. Robinson@hip.on.ca
Source
Can J Public Health. 2003 Sep-Oct;94(5):391-6
Language
English
Publication Type
Article
Keywords
Benchmarking - methods - standards
Consensus
Decision Making
Health Care Surveys
Humans
Ontario
Organizational Objectives
Planning Techniques
Process Assessment (Health Care)
Public Health Administration - standards
Quality Indicators, Health Care
Social Responsibility
Abstract
Little attention has been paid to the need for accountability instruments applicable across all health units in the public health system. One tool, the balanced scorecard was created for industry and has been successfully adapted for use in Ontario hospitals. It consists of 4 quadrants: financial performance, outcomes, customer satisfaction and organizational development. The aim of the present study was to determine if a modified nominal group technique could be used to reach consensus among public health unit staff and public health specialists in Ontario about the components of a balanced scorecard for public health units.
A modified nominal group technique consensus method was used with the public health unit staff in 6 Eastern Ontario health units (n=65) and public health specialists (n=18).
73.8% of the public health unit personnel from all six health units in the eastern Ontario region participated in the survey of potential indicators. A total of 74 indicators were identified in each of the 4 quadrants: program performance (n=44); financial performance (n=11); public perceptions (n=11); and organizational performance (n=8).
The modified nominal group technique was a successful method of incorporating the views of public health personnel and specialists in the development of a balanced scorecard for public health.
PubMed ID
14577752 View in PubMed
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Accountability: unpacking the suitcase.

https://arctichealth.org/en/permalink/ahliterature168409
Source
Healthc Q. 2006;9(3):72-5, 4
Publication Type
Article
Date
2006
Author
Adalsteinn D Brown
Christina Porcellato
Jan Barnsley
Author Affiliation
Ontario Ministry of Health and Long-term Care.
Source
Healthc Q. 2006;9(3):72-5, 4
Date
2006
Language
English
Publication Type
Article
Keywords
Canada
Decision Making, Organizational
Health Policy
Health Services Research
Humans
Information Services
Management Audit
National health programs - organization & administration
Program Evaluation
Quality Assurance, Health Care
Quality Indicators, Health Care
Social Responsibility
Abstract
"Accountability" is the suitcase word in Canadian healthcare. As policy-makers, managers, researchers and providers, we pack accountability with meaning, carry it around with us and open it up to explain everything from the quality of our relationships with and expectations of one another, to our requirements for more transparency in the use of resources, to our diagnosis of problems and remedies for improving our healthcare system.
PubMed ID
16826770 View in PubMed
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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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Achieving quality indicator benchmarks and potential impact on coronary heart disease mortality.

https://arctichealth.org/en/permalink/ahliterature131252
Source
Can J Cardiol. 2011 Nov-Dec;27(6):756-62
Publication Type
Article
Author
Harindra C Wijeysundera
Nicholas Mitsakakis
William Witteman
Mike Paulden
Gabrielle van der Velde
Jack V Tu
Douglas S Lee
Shaun G Goodman
Robert Petrella
Martin O'Flaherty
Simon Capewell
Murray Krahn
Author Affiliation
Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. wijeysundera@gmail.com
Source
Can J Cardiol. 2011 Nov-Dec;27(6):756-62
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Benchmarking - methods
Coronary Disease - mortality - therapy
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Revascularization - methods - standards
Ontario - epidemiology
Prognosis
Quality Indicators, Health Care - utilization
Retrospective Studies
Risk Assessment - methods
Risk factors
Abstract
Quality indicators in coronary heart disease (CHD) measure the practice gap between optimal care and current clinical practice. However, the potential impact of achieving quality indicator benchmarks remains unknown.
Using a validated, epidemiologic model of CHD in Ontario, Canada, we estimated the potential impact on mortality of improved utilization on CHD quality indicators from 2005 levels to recommend benchmark utilization of 90%. Eight CHD disease subgroups were evaluated, including inpatients with acute myocardial infarction (AMI), acute coronary syndromes, and heart failure, in addition to ambulatory patients who were post-acute myocardial infarction survivors, or had heart failure, chronic stable angina, hypertension, or hyperlipidemia. The primary outcome was the predicted mortality reduction associated with meeting quality indicator targets for each CHD subgroup-treatment combination.
In 2005, there were 10,060 CHD deaths in Ontario, representing an age-adjusted CHD mortality of 191 per 100,000 people. By meeting quality indicator utilization benchmarks, mortality could be potentially reduced by approximately 20% (95% confidence interval 17.8-21.1), representing approximately 1960 avoidable deaths. The bulk of this potential benefit was in ambulatory patients with chronic stable angina (36% of reduction) and heart failure (31% of reduction). The biggest drivers were optimizing angiotensin-converting enzyme inhibitor use in chronic stable angina patients (approximately 440 avoidable deaths) and ß-blocker use in heart failure (approximately 400 avoidable deaths).
These findings reinforce the importance of quality indicators and could aid policy makers in prioritizing strategies to meet the goals outlined in the Canadian Heart Health Strategy and Action Plan for reducing cardiovascular mortality.
PubMed ID
21920697 View in PubMed
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Adherence to national diabetes guidelines through monitoring quality indicators--A comparison of three types of care for the elderly with special emphasis on HbA1c.

https://arctichealth.org/en/permalink/ahliterature271560
Source
Prim Care Diabetes. 2015 Aug;9(4):253-60
Publication Type
Article
Date
Aug-2015
Author
Ann-Sofie Nilsson Neumark
Lars Brudin
Thomas Neumark
Source
Prim Care Diabetes. 2015 Aug;9(4):253-60
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Biomarkers - blood
Blood Glucose - drug effects - metabolism
Cross-Sectional Studies
Diabetes Mellitus, Type 1 - blood - diagnosis - drug therapy - epidemiology
Diabetes Mellitus, Type 2 - blood - diagnosis - drug therapy - epidemiology
Female
Guideline Adherence - standards
Health Services for the Aged - standards
Hemoglobin A, Glycosylated - metabolism
Home Care Services
Homes for the Aged
Humans
Hypoglycemic Agents - adverse effects - therapeutic use
Independent living
Male
Nursing Homes
Practice Guidelines as Topic - standards
Practice Patterns, Physicians' - standards
Prevalence
Process Assessment (Health Care) - standards
Quality Indicators, Health Care - standards
Sweden - epidemiology
Treatment Outcome
Abstract
To compare adherence to Swedish guidelines for diabetes care between elderly people living at home with or without home health care, and residents of nursing homes.
Medical records of 277 elderly people aged 80 and older, with known diabetes in a Swedish municipality, were monitored using quality indicators to evaluate processes and outcomes.
Monitoring, in accordance to diabetes guidelines, of HbA1c, lipids, blood pressure and foot examinations was lower among residents of nursing homes (p
PubMed ID
25865853 View in PubMed
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Administrative Data Feedback for Effective Cardiac Treatment: AFFECT, a cluster randomized trial.

https://arctichealth.org/en/permalink/ahliterature173735
Source
JAMA. 2005 Jul 20;294(3):309-17
Publication Type
Article
Date
Jul-20-2005
Author
Christine A Beck
Hugues Richard
Jack V Tu
Louise Pilote
Author Affiliation
Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
Source
JAMA. 2005 Jul 20;294(3):309-17
Date
Jul-20-2005
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Benchmarking
Cluster analysis
Hospitals - standards
Humans
Medical Record Linkage
Myocardial Infarction - mortality - therapy
Outcome and Process Assessment (Health Care)
Quality Indicators, Health Care
Quebec
Abstract
Hospital report cards are increasingly being implemented for quality improvement despite lack of strong evidence to support their use.
To determine whether hospital report cards constructed using linked hospital and prescription administrative databases are effective for improving quality of care for acute myocardial infarction (AMI).
The Administrative Data Feedback for Effective Cardiac Treatment (AFFECT) study, a cluster randomized trial.
Patients with AMI who were admitted to 76 acute care hospitals in Quebec that treated at least 30 AMI patients per year between April 1, 1999, and March 31, 2003.
Hospitals were randomly assigned to receive rapid (immediate; n = 38 hospitals and 2533 patients) or delayed (14 months; n = 38 hospitals and 3142 patients) confidential feedback on quality indicators constructed using administrative data.
Quality indicators pertaining to processes of care and outcomes of patients admitted between 4 and 10 months after randomization. The primary indicator was the proportion of elderly survivors of AMI at each study hospital who filled a prescription for a beta-blocker within 30 days after discharge.
At follow-up, adjusted prescription rates within 30 days after discharge were similar in the early vs late groups (for beta-blockers, odds ratio [OR], 1.06; 95% confidence interval [CI], 0.82-1.37; for angiotensin-converting enzyme inhibitors, OR, 1.17; 95% CI, 0.90-1.52; for lipid-lowering drugs, OR, 1.14; 95% CI, 0.86-1.50; and for aspirin, OR, 1.05; 95% CI, 0.84-1.33). In addition, adjusted mortality was similar in both groups, as were length of in-hospital stay, physician visits after discharge, waiting times for invasive cardiac procedures, and readmissions for cardiac complications.
Feedback based on one-time, confidential report cards constructed using administrative data is not an effective strategy for quality improvement regarding care of patients with AMI. A need exists for further studies to rigorously evaluate the effectiveness of more intensive report card interventions.
Notes
Comment In: ACP J Club. 2005 Nov-Dec;143(3):7916262236
Comment In: JAMA. 2005 Jul 20;294(3):369-7116030283
PubMed ID
16030275 View in PubMed
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Adoption of the chronic care model to improve HIV care: in a marginalized, largely aboriginal population.

https://arctichealth.org/en/permalink/ahliterature113082
Source
Can Fam Physician. 2013 Jun;59(6):650-7
Publication Type
Article
Date
Jun-2013
Author
David Tu
Patricia Belda
Doreen Littlejohn
Jeanette Somlak Pedersen
Juan Valle-Rivera
Mark Tyndall
Author Affiliation
Vancouver Native Health Society, 449 Hastings St E, Vancouver, BC V6A 1P5, Canada. davidtu9@gmail.com
Source
Can Fam Physician. 2013 Jun;59(6):650-7
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Adult
Anti-HIV Agents - therapeutic use
Canada
Chronic Disease - therapy
Community Health Centers
Female
HIV Seropositivity - ethnology - therapy
Humans
Indians, North American
Male
Medication Adherence - ethnology
Middle Aged
Outcome and Process Assessment (Health Care)
Patient care team
Pneumococcal Vaccines
Pneumonia, Pneumococcal - prevention & control
Quality Indicators, Health Care
Social Marginalization
Syphilis - diagnosis
Tuberculosis, Pulmonary - diagnosis
Urban Health Services
Viral Load
Abstract
To measure the effectiveness of implementing the chronic care model (CCM) in improving HIV clinical outcomes.
Multisite, prospective, interventional cohort study.
Two urban community health centres in Vancouver and Prince George, BC.
Two hundred sixty-nine HIV-positive patients (18 years of age or older) who received primary care at either of the study sites.
Systematic implementation of the CCM during an 18-month period.
Documented pneumococcal vaccination, documented syphilis screening, documented tuberculosis screening, antiretroviral treatment (ART) status, ART status with undetectable viral load, CD4 cell count of less than 200 cells/mL, and CD4 cell count of less than 200 cells/mL while not taking ART compared during a 36-month period.
Overall, 35% of participants were women and 59% were aboriginal persons. The mean age was 45 years and most participants had a history of injection drug use that was the presumed route of HIV transmission. During the study follow-up period, 39 people died, and 11 transferred to alternate care providers. Compared with their baseline clinical status, study participants showed statistically significant (P
Notes
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PubMed ID
23766052 View in PubMed
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A-FROM in action at the Aphasia Institute.

https://arctichealth.org/en/permalink/ahliterature130778
Source
Semin Speech Lang. 2011 Aug;32(3):216-28
Publication Type
Article
Date
Aug-2011
Author
Aura Kagan
Author Affiliation
Education and Applied Research, Aphasia Institute, Toronto, Canada. akagan@aphasia.ca
Source
Semin Speech Lang. 2011 Aug;32(3):216-28
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Aphasia - psychology - rehabilitation
Awareness
Communication
Delivery of Health Care - trends
Disability Evaluation
Humans
Motivation
Ontario
Outcome Assessment (Health Care) - trends
Patient Acceptance of Health Care - psychology
Patient Care Planning
Power (Psychology)
Professional-Family Relations
Professional-Patient Relations
Quality Indicators, Health Care - trends
Rehabilitation Centers - trends
Treatment Outcome
World Health Organization
Abstract
Aphasia centers are in an excellent position to contribute to the broad definition of health by the World Health Organization: the ability to live life to its full potential. An expansion of this definition by the World Health Organization International Classification of Functioning, Disability and Health (ICF) forms the basis for a user-friendly and ICF-compatible framework for planning interventions that ensure maximum real-life outcome and impact for people with aphasia and their families. This article describes Living with Aphasia: Framework for Outcome Measurement and its practical application to aphasia centers in the areas of direct service, outcome measurement, and advocacy and awareness. Examples will be drawn from the Aphasia Institute in Toronto. A case will be made for all aphasia centers to use the ICF or an adaptation of it to further the work of this sector and strengthen its credibility.
PubMed ID
21968558 View in PubMed
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617 records – page 1 of 62.