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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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Assessing the performance of rural hospitals.

https://arctichealth.org/en/permalink/ahliterature186289
Source
Healthc Manage Forum. 2002;Suppl:27-34
Publication Type
Article
Date
2002
Author
Patricia J Martens
David K Stewart
Lori Mitchell
Charlyn Black
Author Affiliation
Manitoba Centre for Health Policy.
Source
Healthc Manage Forum. 2002;Suppl:27-34
Date
2002
Language
English
Publication Type
Article
Keywords
Bed Occupancy
Efficiency, Organizational
Health services needs and demand
Hospitals, Rural - organization & administration - standards - statistics & numerical data
Humans
Manitoba
Patient Admission
Patient Discharge
Quality Indicators, Health Care - statistics & numerical data
Abstract
This study developed population-based and hospital-based indicators to examine the performance of Manitoba's 68 rural hospitals. Analyses of the indicators revealed considerable differences in the populations served and their use of rural hospital services. Hospital type was also an important factor for performance. The rural hospital indicators would be useful to hospital planners and regional policy makers for comparison purposes and for highlighting issues that need to be addressed.
PubMed ID
12632679 View in PubMed
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The association between quality of care and technical efficiency in long-term care.

https://arctichealth.org/en/permalink/ahliterature175583
Source
Int J Qual Health Care. 2005 Jun;17(3):259-67
Publication Type
Article
Date
Jun-2005
Author
Juha Laine
U Harriet Finne-Soveri
Magnus Björkgren
Miika Linna
Anja Noro
Unto Häkkinen
Author Affiliation
Chydenius Institute, University of Jyväskylä, Kokkola, Finland. juha.laine@stakes.fi
Source
Int J Qual Health Care. 2005 Jun;17(3):259-67
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Aged
Cross-Sectional Studies
Diagnosis-Related Groups - classification
Efficiency, Organizational - statistics & numerical data
Finland
Health Care Costs
Homes for the Aged - standards
Hospital Units - standards
Hospitals, Public - standards
Humans
Long-Term Care - classification - organization & administration - standards
Quality Indicators, Health Care - statistics & numerical data
Questionnaires
Risk factors
Abstract
To analyse the association between quality of care and technical (productive) efficiency in institutional long-term care wards for the elderly.
One hundred and fourteen public health centre hospitals and residential homes in Finland.
Wards were divided into two categories according to their rank in the quality distribution, considering 41 quality variables separately. The technical efficiency scores of the good- and poor-quality groups were compared using cross-sectional data.
Data envelopment analysis was used for calculating technical efficiency. The Mann-Whitney test and correlation coefficients were used to explore the association between quality and efficiency.
The wards where quality indicators indicated less pro-active (passive) nursing practice and more dependent patients-for instance, in terms of very high prevalence of bedfast residents or very high prevalence of daily physical restraints-performed more efficiently than the comparison group.
The results suggest that an association may exist between technical efficiency and unwanted dimensions of quality. Hence, the efficiency and quality of care are essential aspects of management and performance measurement in elderly care.
PubMed ID
15788463 View in PubMed
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Canadian Association of Gastroenterology Indicators of Safety Compromise following Colonoscopy in Clinical Practice.

https://arctichealth.org/en/permalink/ahliterature281167
Source
Can J Gastroenterol Hepatol. 2016;2016:2729871
Publication Type
Article
Date
2016
Author
Mark R Borgaonkar
David Pace
Muna Lougheed
Curtis Marcoux
Bradley Evans
Nikita Hickey
Meghan O'Leary
Jerry McGrath
Source
Can J Gastroenterol Hepatol. 2016;2016:2729871
Date
2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Colonoscopy - adverse effects - standards - statistics & numerical data
Conscious Sedation - adverse effects - statistics & numerical data
Female
Fentanyl - therapeutic use
Humans
Hypnotics and Sedatives - therapeutic use
Incidence
Male
Midazolam - therapeutic use
Middle Aged
Newfoundland and Labrador - epidemiology
Postoperative Complications - epidemiology - etiology
Quality Indicators, Health Care - statistics & numerical data
Safety - statistics & numerical data
Abstract
In 2012 the Canadian Association of Gastroenterology published 19 indicators of safety compromise. We studied the incidence of these indicators by reviewing all colonoscopies performed in St. John's, NL, between January 1, 2012, and June 30, 2012. Results. A total of 3235 colonoscopies were included. Adverse events are as follows. Medication-related includes use of reversal agents 0.1%, hypoxia 9.9%, hypotension 15.4%, and hypertension 0.9%. No patients required CPR or experienced allergic reactions or laryngospasm/bronchospasm. The indicator, "sedation dosages in patients older than 70," showed lower usage of fentanyl and midazolam in elderly patients. Procedure-related immediate includes perforation 0.2%, immediate postpolypectomy bleeding 0.3%, need for hospital admission or transfer to the emergency department 0.1%, and severe persistent abdominal pain proven not to be perforation 0.4%. Instrument impaction was not seen. Procedure-related delayed includes death within 14 days 0.1%, unplanned health care visit within 14 days of the colonoscopy 1.8%, unplanned hospitalization within 14 days of the colonoscopy 0.6%, bleeding within 14 days of colonoscopy 0.2%, infection 0.03%, and metabolic complication 0.03%. Conclusions. The most common adverse events were mild and sedation related. Rates of serious adverse events were in keeping with published reports.
Notes
Cites: Am Surg. 1988 Feb;54(2):61-33341645
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Cites: Can J Gastroenterol Hepatol. 2014 Dec;28(11):595-925575107
Cites: Can J Gastroenterol. 2013 Feb;27(2):74-8223472242
Cites: Ann Intern Med. 2006 Dec 19;145(12):880-617179057
Cites: Am J Gastroenterol. 2006 Jun;101(6):1333-4116771958
Cites: Gastrointest Endosc. 2009 Mar;69(3 Pt 2):665-7119251007
Cites: Gastrointest Endosc. 2007 Jul;66(1):27-3417591470
PubMed ID
27446832 View in PubMed
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Chartbook: shining a light on the quality of healthcare in Canada: what can be learned to catalyze improvements in healthcare quality?

https://arctichealth.org/en/permalink/ahliterature124841
Source
Healthc Pap. 2012;12(1):10-24
Publication Type
Article
Date
2012
Author
Kim Sutherland
Sheila Leatherman
Susan Law
Jennifer Verma
Stephen Petersen
Author Affiliation
Judge Business School, University of Cambridge.
Source
Healthc Pap. 2012;12(1):10-24
Date
2012
Language
English
Publication Type
Article
Keywords
Canada
Chronic Disease
Delivery of Health Care - organization & administration - statistics & numerical data
Health Expenditures - statistics & numerical data
Health Services Accessibility - organization & administration - statistics & numerical data
Health Services Research - statistics & numerical data
Humans
Information Systems - organization & administration - statistics & numerical data
National Health Programs - organization & administration - statistics & numerical data
Patient Safety
Primary Health Care - organization & administration - statistics & numerical data
Quality Indicators, Health Care - statistics & numerical data
Quality of Health Care - organization & administration - statistics & numerical data
Vital statistics
Waiting Lists
Abstract
This paper provides a reflection on the findings of Canada's first-ever chartbook on the quality of healthcare in Canada. Quality of Healthcare in Canada: A Chartbook was published in 2010 by the Canadian Health Services Research Foundation in partnership with the Canadian Institute for Health Information and the Canadian Patient Safety Institute, and with support from Statistics Canada. This paper, by the chartbook authors (Sutherland and Leatherman) and colleagues (Law, Verma and Petersen), presents selected key findings and lessons from the chartbook and aims to serve as a catalyst for ideas and discussion in the papers that follow. The chartbook identified a lack of common language and indicators on quality across Canada's provinces and territories, underscoring the need to create and coordinate core measures. The Canadian chartbook and this issue of Healthcare Papers provide an update on the existing quality measures and the state of healthcare quality in Canada, and create the opportunity for jurisdictions to learn from one another and to contemplate the steps required to improve quality across the country.
Notes
Comment In: Healthc Pap. 2012;12(1):32-7; discussion 50-722543328
Comment In: Healthc Pap. 2012;12(1):26-31; discussion 50-722543327
Comment In: Healthc Pap. 2012;12(1):38-43; discussion 50-722543329
Comment In: Healthc Pap. 2012;12(1):44-8; discussion 50-722543330
Comment In: Healthc Pap. 2012;12(1):5-722543325
PubMed ID
22543326 View in PubMed
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A comparison of home care quality indicator rates in two Canadian provinces.

https://arctichealth.org/en/permalink/ahliterature256841
Source
BMC Health Serv Res. 2014;14:37
Publication Type
Article
Date
2014
Author
Amanda M Mofina
Dawn M Guthrie
Author Affiliation
Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Ave, W, Waterloo, ON N2L 3C5, Canada. dguthrie@wlu.ca.
Source
BMC Health Serv Res. 2014;14:37
Date
2014
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Chronic Pain - therapy
Cognition Disorders - therapy
Female
Home Care Services - standards - statistics & numerical data
Humans
Male
Manitoba - epidemiology
Ontario - epidemiology
Quality Indicators, Health Care - statistics & numerical data
Risk Adjustment
Abstract
Home care is becoming an increasingly vital sector in the health care system yet very little is known about the characteristics of home care clients and the quality of care provided in Canada. We describe these clients and evaluate home care quality indicator rates in two regions.
A cross-sectional analysis of assessments completed for older (age 65+) home care clients in both Ontario (n = 102,504) and the Winnipeg Regional Health Authority (n = 9,250) of Manitoba, using the Resident Assessment Instrument for Home Care (RAI-HC). This assessment has been mandated for use in these two regions and the indicators are generated directly from items within the assessment. The indicators are expressed as rates of negative outcomes (e.g., falls, dehydration). Client-level risk adjustment of the indicator rates was used to enable fair comparisons between the regions.
Clients had a mean age of 83.2 years, the majority were female (68.6%) and the regions were very similar on these demographic characteristics. Nearly all clients (92.4%) required full assistance with instrumental activities of daily living (IADLs), approximately 35% had activities of daily living (ADL) impairments, and nearly 50% had some degree of cognitive impairment, which was higher among clients in Ontario (48.8% vs. 37.0%). The highest quality indicator rates were related to clients who had ADL/rehabilitation potential but were not receiving therapy (range: 66.8%-91.6%) and the rate of cognitive decline (65.4%-76.3%). Ontario clients had higher unadjusted rates across 18 of the 22 indicators and the unadjusted differences between the two provinces ranged from 0.6% to 28.4%. For 13 of the 19 indicators that have risk adjustment, after applying the risk adjustment methodology, the difference between the adjusted rates in the two regions was reduced.
Home care clients in these two regions are experiencing a significant level of functional and cognitive impairment, health instability and daily pain. The quality indicators provide some important insight into variations between the two regions and can serve as an important decision-support tool for flagging potential quality issues and isolating areas for improvement.
Notes
Cites: Home Health Care Serv Q. 2008;27(1):59-7418510199
Cites: BMJ Qual Saf. 2013 Dec;22(12):989-9723828878
Cites: Aging Clin Exp Res. 2007 Aug;19(4):323-917726364
Cites: Healthc Q. 2007;10(3):63-917626548
Cites: Home Healthc Nurse. 2007 Mar;25(3):191-717353712
Cites: BMC Health Serv Res. 2005 Jan 18;5(1):715656901
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Cites: J Gerontol. 1994 Jul;49(4):M174-828014392
Cites: Gerontologist. 2004 Oct;44(5):665-7915498842
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Cites: Gerontologist. 2001 Apr;41(2):173-911327482
Cites: Age Ageing. 2000 Mar;29(2):165-7210791452
Cites: J Gerontol A Biol Sci Med Sci. 1999 Nov;54(11):M546-5310619316
Cites: BMC Health Serv Res. 2013;13:22723800280
Cites: Age Ageing. 2010 Nov;39(6):755-820858672
Cites: J Nurs Manag. 2009 Mar;17(2):165-7419416419
Cites: Age Ageing. 2008 Jan;37(1):51-618033777
PubMed ID
24460732 View in PubMed
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A comparison of methods to obtain a composite performance indicator for evaluating clinical processes in trauma care.

https://arctichealth.org/en/permalink/ahliterature114539
Source
J Trauma Acute Care Surg. 2013 May;74(5):1344-50
Publication Type
Article
Date
May-2013
Author
Lynne Moore
André Lavoie
Marie-Josée Sirois
Amina Belcaid
Gilles Bourgeois
Jean Lapointe
John S Sampalis
Natalie Le Sage
Marcel Émond
Author Affiliation
Department of Social and Preventative Medicine, Centre de Recherche du CHU (Hôpital de l'Enfant- Jésus), Université Laval, Québec City, Québec, Canada. lynne.moore.cha@ssss.gouv.qc.ca
Source
J Trauma Acute Care Surg. 2013 May;74(5):1344-50
Date
May-2013
Language
English
Publication Type
Article
Keywords
Aged
Canada
Female
Hospital Mortality
Humans
Injury Severity Score
Male
Middle Aged
Quality Indicators, Health Care - statistics & numerical data
Quality of Health Care - standards
Registries
Reproducibility of Results
Retrospective Studies
Trauma Centers - standards
Traumatology - standards
Abstract
Process performance indicators that evaluate trauma centers in clinical case management provide information essential to the improvement of trauma care. However, multiple indicators are needed to adequately evaluate process performance, which renders comparisons cumbersome. Several methods are available for generating composite indicators that measure global performance. The goal of this study was to compare three composite methods that are widely used in other health care domains to identify the most appropriate for trauma care process performance evaluation.
In this retrospective, multicenter cohort study, 15 process performance indicators were implemented using data from a Canadian provincial trauma registry (19,853 patients; 59 centers) on patients with an Injury Severity Score (ISS) greater than 15. Composite scores were derived using three methods as follows: the indicator average, the opportunity model, and a latent variable model. Composite scores were evaluated in terms of discrimination, construct validity (association with an indicator of trauma center structural performance), criterion predictive validity (association with clinical outcomes), and forecasting (correlation over time).
All composite scores discriminated well between trauma centers. Only the average indicator score was correlated with improved structure (r = 0.29; 95% confidence interval [CI], 0.07-0.53), lower risk-adjusted mortality (r = -0.22; 95% CI, -0.46 to 0.04), and lower risk-adjusted complication rate (r = -0.48; 95% CI, -0.65 to -0.25). Composite scores calculated with 1999 to 2002 data all correlated with those calculated with 2003 to 2006 data (r = 0.49, 0.87, and 0.84 for the indicator average, the opportunity model, and the latent variable model, respectively).
Results suggest that of the three composite scores evaluated, only the indicator average demonstrates content and predictive criterion validity, discriminates between centers, and has good forecasting properties. In addition, this score is simple and intuitive and not subject to variation in weights over trauma systems and time. The observed association between higher indicator average scores and lower risk-adjusted mortality and complication rates suggests that improving process performance may improve patient outcome.
PubMed ID
23609288 View in PubMed
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The concept of patient satisfaction in adolescent psychiatric care: a qualitative study.

https://arctichealth.org/en/permalink/ahliterature137546
Source
J Child Adolesc Psychiatr Nurs. 2011 Feb;24(1):3-10
Publication Type
Article
Date
Feb-2011
Author
Páll Biering
Valgerõur H Jensen
Author Affiliation
School of Health Science, Faculty of Nursing, University of Iceland, Reykjavik, Iceland. pb@hi.is
Source
J Child Adolesc Psychiatr Nurs. 2011 Feb;24(1):3-10
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adolescent Psychiatry - standards
Child
Clinical Competence
Female
Guidelines as Topic
Humans
Iceland
Interviews as Topic
Male
Patient Satisfaction - statistics & numerical data
Professional-Patient Relations
Psychiatric Department, Hospital
Qualitative Research
Quality Assurance, Health Care - standards
Quality Indicators, Health Care - statistics & numerical data
Safety
Social Isolation
Social Participation
Trust - psychology
Abstract
Few studies have asked how adolescents perceive the quality of psychiatric care. Therefore, the aim of the study was to explore adolescents' perception of quality of care and of satisfying treatment outcomes.
Fourteen adolescents participated in this hermeneutic study.
Several concepts describing adolescents' perspective of quality of care were found: secure place, tough love, peer solidarity, self-expression, and person not patient. Concepts describing satisfying treatment outcomes fell into four categories: improved mental health, personal development, strengthening of the self, and improved family relations.
By casting light on users' perspectives, the study offers guidance for improvement of quality of care and for the development of patient satisfaction instruments.
PubMed ID
21272109 View in PubMed
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Conformance to evidence-based treatment recommendations in schizophrenia treatment services.

https://arctichealth.org/en/permalink/ahliterature124807
Source
Can J Psychiatry. 2012 May;57(5):317-23
Publication Type
Article
Date
May-2012
Author
Donald Addington
Emily McKenzie
Harvey Smith
Henry Chuang
Stephen Boucher
Beverly Adams
Zahinoor Ismail
Author Affiliation
Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. addingto@ucalgary.ca
Source
Can J Psychiatry. 2012 May;57(5):317-23
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antipsychotic Agents - therapeutic use
Canada
Cohort Studies
Community Mental Health Services - statistics & numerical data
Cross-Sectional Studies
Evidence-Based Medicine
Female
Guideline Adherence - statistics & numerical data
Humans
Male
Middle Aged
Process Assessment (Health Care) - statistics & numerical data
Psychotherapy - statistics & numerical data
Quality Indicators, Health Care - statistics & numerical data
Rehabilitation, Vocational - statistics & numerical data
Schizophrenia - therapy
Abstract
To assess quality of health care provided in a representative Canadian mental health service using conformance to evidence-based treatment recommendations, and to examine differences from published US results.
We used a cross-sectional cohort design involving a randomly selected sample of patients diagnosed with schizophrenia attending 1 of 3 mental health clinics in 1 Canadian regional health system. The sample size was calculated to detect differences with the US sample. Conformance criteria were based on a published protocol. Data were collected using patient interviews and a structured review of health records. Conformance to 9 key Schizophrenia Patient Outcomes Research Team recommendations was assessed.
Conformance ranged between 58% and 90% for pharmacological recommendations, and 0% to 81% for psychosocial recommendations. No patients who met criteria for assertive case management had been referred to an assertive case management team. Significant differences in conformance rates to some treatment recommendations were found between Canadian and published US results.
It proved possible to assess health care quality using process measures of conformance to treatment recommendations. Conformance to clinical recommendations for pharmacotherapy is higher than for psychosocial therapies. The absence of barriers to access for pharmacological therapies likely enhances the higher conformance to these recommendations. Limited or variable access to psychosocial services, specifically assertive community treatment, likely negatively affects conformance to psychosocial treatment recommendations. Methodological limitations preclude drawing conclusions on comparisons between Canadian and US services.
Notes
Comment In: Can J Psychiatry. 2012 Sep;57(9):583; author reply 583-423073036
PubMed ID
22546064 View in PubMed
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Death in low-risk cardiac surgery: Stockholm experience.

https://arctichealth.org/en/permalink/ahliterature141427
Source
Interact Cardiovasc Thorac Surg. 2010 Nov;11(5):547-9
Publication Type
Article
Date
Nov-2010
Author
Mikael Janiec
Ulrik Sartipy
Author Affiliation
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
Source
Interact Cardiovasc Thorac Surg. 2010 Nov;11(5):547-9
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Cardiac Surgical Procedures - mortality
Hospital Mortality
Humans
Medical Errors - mortality - prevention & control
Outcome and Process Assessment (Health Care) - statistics & numerical data
Patient Discharge - statistics & numerical data
Quality Indicators, Health Care - statistics & numerical data
Registries
Risk assessment
Risk factors
Sweden - epidemiology
Time Factors
Abstract
In cardiac surgery, perioperative death in low-risk patients is uncommon, but does occur. Reports on the incidence, cause and circumstances of death in this population are rare. We analyzed the early mortality and cause of death in patients with an additive EuroSCORE=3 who underwent cardiac surgery between 2001 and August 2009 in Stockholm. We also investigated if death could be considered preventable, and in that case, if it was due to a technical or a system error. Among 3924 low-risk patients, 15 died within 30 days of surgery, and early mortality was 0.38%. Cause of death was mostly cardiac related (11 of 15). Death occurred after hospital discharge in three patients, and was classified as non-preventable in 13 patients. In the remaining two patients, the circumstances leading to death were categorized as due to a system error. A systematic and structured analysis of the circumstances resulting in death in low-risk patients, in addition to traditional morbidity and mortality conferences, have the potential to identify problems and offer improvements in the quality of care.
PubMed ID
20724423 View in PubMed
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