According to the ACOVE indicators and the studies identified by our review, it appears that the qualityofcare for the elderly is low. However, we can only draw limited conclusions from these studies, for several reasons. First, although the QIs are generally evidence–based and have been developed in multiple Delphi rounds using expert panels, it is still possible that individual physicians will debate the content of specific QIs. Although the QIs are conjectured to represent minimal care, it is possible that low pass rates may represent legitimate differences of medical opinion. Second, undocumented patient refusal of the offered care could lead to a lower measured pass rate. Various studies, however, have taken this aspect into account and counted an indicator as passed when a patient refused the indicated care or when a contraindication existed. Third, identifying the vulnerable elderly (VE) is difficult and, probably due to this difficulty, the majority of the studies did not distinguish between the vulnerable elderly and the general elderly population. Since ACOVE was designed for a vulnerable elderly population, this can lead to a biased score. Fourth, the reason for selecting a certain number and type of QIs for the assessment ofcare for a specific condition was not always clearly described in the studies. Difficulty in the assessment of some of the QIs could have lead to omitting these QIs from the assessment of that condition and consequently to selection bias. This can result in an incomplete picture of the qualityofcareof patients for the specific condition. Poor record- keeping can influence, positively or negatively, the pass rates of various QIs. It is plausible that correct care was performed but not documented, which can lead to lower pass rates. On the other hand, poor-record keeping for the ‘‘IF’’ part of a rule renders the rule as inapplicable and hence failure to provide the correct care will go undetected. Irrespective of the ability to measure QI pass rates, lack of documentation can be an indicator of poor quality because it hampers continuity ofcare and contributes to miscommunication . Fifth, variation in scores ofqualityofcare could be caused by either variation in the number of QIs used per study or by the fact that QIs focused on different aspects ofcare for a specific condition. Moreover, variation in the study sample sizes can cause differences in the pass rates per condition. A smaller study population gives more opportunity for chance findings. We suggest that future studies should explicitly mention and discuss these factors.
6. Mehta RH, Montoye CK, Faul J, Nagle DJ, Kure J, Raj E, Fattal P, Sharrif S, Amlani M, Changezi HU, Skorcz S, Bailey N, Bourque T, LaTarte M, McLean D, Savoy S, Werner P, Baker PL, DeFranco A, Eagle KA; American College of Cardiology Guidelines Applied in Practice Steering Committee. Enhancing qualityofcare for acute myocardial infarction: shifting the focus of improvement from key indicators to process ofcare and tool use: the American College of Cardiology Acute Myocardial Infarction Guidelines Applied in Practice Project in Mich. J Am Coll Cardiol. 2004;43(12):2166-73. 7. Evidence-based care: 1. Setting priorities: how important is the problem?
Despite adequate results in the qualityindicators, there was no signiicant impact on the clinical outcomes. Although it was possible to improve the physiotherapy care, an impact on global clinical outcomes is less likely to occur considering the importance of the multidisciplinary treatment of patients. he indicators assessed in this study concerned only the assistance of intensive physiotherapy and were not designed to assess the impact of actions taken by other teams working in the ICU, which could also inluence these outcomes. Moreover, many of the indicators already had high compliance at baseline, and even a signiicant improvement would likely not impact the clinical outcomes. However, demonstrating this impact would be easier in services with lower compliance rates.
Objective: To evaluate the care prenatal low risk carried out by nurses in the municipality of Lagarto/Se. Method: A descriptive, qualitative study, conducted with 11 nurses who make a prenatal appointment. The data collection instrument includes information about the professional profile of the strategies that they use to achieve the qualityindicatorsof prenatal care and its operations in the face of pregnant women. Data were analyzed using descriptive statistics, whereas qualitative data were analyzed according to Bardin, emerging three analytical categories. Results: It became clear that the prenatal low risk in Lizard municipality performed by nurses is done satisfactorily, and there is still need for strategies to improve the careof pregnant women. Conclusions: professional qualifications are necessary and continuing education for nurses facing the prenatal performance, with the main objective to improve prognosis, reduce risk and provide the best care to pregnant women.
Resumo As Instituições de Longa Permanência para Idosos (ILPI) são uma importante alterna- tiva de cuidado no mundo, porém o Brasil ainda não dispõe de instrumento válido para monitorar a qualidade dessas instituições. Portanto, o obje- tivo do presente artigo é descrever as etapas ini- ciais da adaptação transcultural do Observable Indicatorsof Nursing Home CareQuality Ins- trument (IOQ) usado para avaliar a qualidade do cuidado nas ILPI. Realizou-se a equivalência conceitual e de itens para avaliar a pertinência e a viabilidade do IOQ à realidade nacional através do Índice de Validade do Conteúdo (IVC). Em se- guida, cumpriu-se a equivalência operacional, a idiomática e a semântica. Esta última tem 5 fases: (1) duas traduções e (2) duas respectivas retra- duções; (3) apreciação formal; (4) revisão; e (5) aplicação do pré-teste em três ILPI. Modificações importantes foram realizadas para garantir a va- lidade do IOQ. O IVC do instrumento referentes ao contexto brasileiro foi de 94,3% (viabilidade) e 95,3% (relevância). O IOQ mostrou-se compre- ensível e de fácil aplicação no pré-teste. A adapta- ção transcultural do IOQ contribui para avalia- ção e melhoria da qualidade nas ILPI brasileiras, mas os resultados devem ser complementados me- diante avaliação psicométrica.
The ACOVE QIs are constructed in an IF/THEN format. The "IF" portion of the QI defines the eligible patient for a specific process ofcare, and the "THEN" portion defines the recom- mended care. So, "IF" in the patient’s medical record that specific clinical characteristic was reported (eg. that NH resident had diabetes), "THEN" it was necessary to check whether the procedure described by the QI had been performed or not (eg. his or her glycosylated hemoglobin levels had been measured at least every 12 month). Therefore, each NH resident has been considered eligible in relation to one or more clinical conditions reported in the medical record. Whenever the condition described by one of the QI appeared in the medical record, a score of 1 was assigned if the process ofcare had been performed in adherence to the indicator, otherwise a score of 0 was attributed. For each patient the same indicator could be measured several times according to the recurrence of the condition in the medical record. If the patient had an identified contraindication to a process ofcare, the related indicator was not included in the scoring process. If feasibility of any indicator was questionable, it was not considered [12,13]. For each clinical condition, scores were calculated at the patient level as the percentage of adherence to the recommended process ofcare. For example, a patient who had 1 medical conditions (hypertension), and 1 geriatric syndrome (dementia), might have been eligible for all 13 hypertension QIs, and for 11 of the 13 dementia QIs. If 7, and 4 QIs, respectively, were satisfied, the patient’s mean quality score for hypertension would be calculated as 7:13 = 54%, and for dementia as 4:11 = 36%. Moreover, the scores were also calculated by domain ofcare, categorized into three groups: screening and prevention, diagnosis and treatment. For instance, of the 13 indicators related to hypertension 3 belonged to the screening and prevention domain ofcare, 4 to the diagnosis, and 6 to the therapy. If the 7 QIs satisfied were divided as the following: 1 QI in screening and prevention, 2 QIs in diagnosis and 4 QIs of therapy, the patient’s mean quality score for each domain ofcare related to hypertension would be calculated as 1:3 = 33% for screening and prevention, as 2:4 = 50% for diagnosis, and as 4:6 = 67% for therapy.
and established a computerized control system (SisPreNatal) for proper follow-up of pregnant women registered in the PHNP, which is part of the Single Health System (SUS). The program registers pregnant women upon their first visit and follows them until the puerperal pregnancy. Municipalization of health services is part of a process of political, technical, and administrative decentralization, translated into the introduction, organization, and management of resources – in São Paulo, this process started in 2001. An assessment of prenatal carequality and the problems resulting in newborns with congenital syphilis in 41 Basic Health Units (BHU) in the city of São Paulo (3) in 2000 concluded, among other points, that the care delivered to pregnant women in most units under study does not meet the Ministry of Health requirements (4). The creation ofqualityindicators in this survey enabled us to identify problems, to assess the introduction of public policies in health, to organize services to monitor preventive actions in prenatal care, and to attempt to eradicate and/or control the possible adverse outcomes for pregnant women and their children (3) .
The objective of this quantitative, correlational and descriptive study was to analyze the time the nursing staff spends to assist patients in Adult Intensive Care Units, as well as to verify its correlation with qualitycareindicators. The average length of time spent on care and the qualitycareindicators were identified by consulting management instruments the nursing head of the Unit employs. The average hours of nursing care delivered to patients remained stable, but lower than official Brazilian agencies’ indications. The correlation between time of nursing care and the incidence of accidental extubation indicator indicated that it decreases with increasing nursing care delivered by nurses. The results of this investigation showed the influence of nursing care time, provided by nurses, in the outcome ofcare delivery.
This raises the question why was qualityofcare higher in the intervention homes compared to the control homes? It is possible the qualityindicators in the control homes did not improve to the same extent as in the intervention homes because intervention participants were receiving increased attention from the residential home staff as well as increased referrals to secondary care. The increase in secondary care may have induced the need for the informal caregiver to attend and help transport patients to the secondary care appointments which may explain the increased informal care costs. If there was unmet care, then the use of the interRAI and the multidisciplinary meetings addressed this gap in care. However, a trade-off needs to be made whether the additional effects are worth the additional costs.
Criteria for inclusion were as follows: being 18 years of age or older and having received enteral nutrition therapy (ENT), parenteral nutrition therapy (PNP), or both. Data collection was carried out by a trained researcher and entered in a semi-structured form. The variables investigated were age, sex, diagnosis, clinical outcome, and length of hospital stay, supplemented with information required for the evaluation ofqualityindicators. Statistical analysis was performed using SPSS software, version 22.0, adopting a significance level of 5%. Target quality rates and the formula for calculating indicators were those proposed by Waitzberg (2008). NTQIs were expressed as percent or per mil target rates, as recommended by ILSI-Brasil.
Choosing a good indicator requires a trade off between several features: the scope of the indicator, the target to be reached, its value in terms of ﬁ nancial reward and when it will be retired or replaced. This process is a politico-institutional one in the QOF and whilst NICE, York University, NHS Information and NHS Evidence work hard to create fair yet relevant indicators, based on the best available evidence, professional lobbying groups inﬂ uence which indicators get adopted and which do not. Care needs to be taken to ensure that there is consensus around indicator development. The legitimacy of P4P Table. Quality and Outcomes Framework indicators for diabetes. United Kingdom, 2009-2010.
The variable satisfaction with care, a crucial pillar in the normative guidelines for health care, has been identified as one of the best ways to evaluate the contribution of each professional group for health results achieved by people. This research was intended to contribute to the consolida- tion of the continuous improvement of systems ofquality in the practice of nurses. Several crucial indicators emerged for the qualityofcare, or that were key to better care and better health outcomes achieved by people: the need to invest in graduate training in mental health and the need for attention to the qualityof working conditions, for when they are lower, they impact the qualityofcare that leads to lower patient satisfaction. Surprisingly, the older, more pro- fessional experience and working with dependents, were related to lower satisfaction with nursing care. The data showed that the variables associated with greater experi- ence of nurses, were conditioned by the lower perception of working conditions and the lower nurse/user ratio. These data highlighted the importance of resource management and labor conditions for obtaining better health outcomes.
Objective: this study sought to test the interexaminer agreement and reliability of 15 indicatorsof nursing carequality. Methods: this was a quantitative, methodological, experimental, and applied study conducted at a large, tertiary, public teaching hospital in the state of Paraná. For data analysis, the Kappa (k) statistic was applied to the categorical variables – indicators 1 to 11 and 15 – and the interclass correlation coefficient (ICC) to the continuous variables – indicators 12, 13, and 14, with the corresponding 95% confidence intervals. The categorical data were analyzed using the Lee software, elaborated by the Laboratory of Epidemiology and Statistics of Dante Pazzanese Institute of Cardiology – Brazil, and the continuous data were assessed using BioEstat 5.0. Results: the k-statistic results indicated excellent agreement, which was statistically significant, and the values of the ICC denoted excellent and statistically significant reproducibility/agreement relative to the investigated indicators. Conclusion: the investigated indicators exhibited excellent reliability and reproducibility, thus showing that it is possible to formulate valid and reliable assessment instruments for the management of nursing care.
Objective: to describe drug prescription indicators in a primary health care facility with different models of health care. Methods: this was a descriptive study using secondary data of prescriptions with regard to qualityindicators in a health facility that has three health care models: Outpatient Medical Care (OMC), Primary Health Care Unit (PHU) and Family Health Strategy (FHS) in Vila Nova Jaguaré OMC/PHU in São Paulo-SP, Brazil, from July to October 2011. Results: 16,720 prescriptions were studied; the proportion of drugs provided through the Municipal List of Essential Drugs (Remume) was higher for FHS prescriptions (98.9%), compared to PHU (95.6%) and OMC (95.7%); similarly, both the use of the generic name of the drugs and the proportion of drugs provided was higher among ESF prescriptions (98.9% and 96.1%, respectively), compared with PHU (94.4 % and 92.9%) and OMC (94.0% and 92.7 %). Conclusion: all the prescription indicators show better results for FHS. Key words: Pharmaceutical Services; Primary Health Care; Health Service Indicators; Drug Prescription; National Health System.
The Scale of Predisposition for the Occurrence of Adverse Events (EPEA) proposed the discussion ofcarequality as a balance between risks and beneits, in view of human beings’ fallibility, besides proposing the use of adverse events as outcome indicators. Thus, ICU Nursing carequality becomes the product of the combination between ideal work conditions (structure and process), deriving from Brazilian and international recommendations to promote ICU patient safety and carequality, and intensive care nurses’ attitudes towards the conditions that can predispose to the occurrence of the adverse event (outcome indicator).
A maioria dos autores considerou a deterioração cognitiva e a perceção da realidade dos pacientes com demência na decisão da aplicação do questionário. Nos casos ligeiros de demência, o questionário é apli- cado aos doentes, podendo também ser aplicado em simultâneo aos cuidadores. Casos de demência grave deverão ser avaliados pelas escalas Activity and Affect IndicatorsofQualityof Life, QUALID (The Qualityof Life in Late-Stage Dementia Scale), DCM (Dementia Care Maping), DEMQOL e QUALIDEM, com informa- ções dadas pelo cuidador. No entanto, ao ser o cuida- dor a dar a informação, poderá haver uma compo- nente pessoal na sua avaliação e deturpar de forma não intencional a avaliação da QoL do indivíduo em estudo.
The proposed panel ofindicators improves the management of dysphagia in a hospital setting. It is essential to introduce qualityindicators in order to clearly understand and manage the qualityof health care. Using qualityindicators in hospital units improves the analysis of performance over time as new procedures and technology are introduced. In addition, it allows hospital units to be compared with other providers in the area. The management of hospital units using qualityindicators also measures the effectiveness and eficiency of SRPs.
In this sense, it is understood that the PN assess- ment by the service must be a continuous process in the gestational period for each woman. For this to occur, it is suggested that managers establish check- points that serve as PN careindicators observing the attendance of the PHPN indicators and the Rede Cegonha (Stork Network) at the end of each gesta- tional trimester,which would allow a more targeted active search in order to remedy the flaws found at that moment, reversing this situation before giving birth, which would give the PN care a higher quality and effectiveness and would favor more favorable maternal and child outcomes.
Table 3 shows the average intervals of time between the onset of AMI symptoms, admission to the emergency and coronary reperfusion, where hospital delay was analyzed until reperfusion. This table included an additional case of coronary angioplasty performed outside the referent in the pre-CG group, because the purpose is to analyze the in- hospital logistics of using resources for coronary reperfusion. This case was excluded from Table 2, which only examined reperfusion in candidates with indication for that. Although the number of cases is small, there was a reduction in the average in-hospital delay until the beginning of reperfusion post-CG after 112 minutes (95% CI=27.9; 196.0). The use of mechanical reperfusion was exceptional, and with a delay greater than that observed for streptokinase.
it is a specific sample of PHC nurses, it shows the contrary, the average frequency of feelings related to burnout was 24.6% for emotional exhaustion, 9, 4% for depersonalization and 30.4% for reduced professional accomplishment. It may be due to the low autonomy, poor control over the work environment and poor organizational support, which may be related to the expansion and consolidation of the Family Health Strategy (FHS) focused on family and social relations, oriented SUS principles and technological innovation. Given that, in 2006, the Política Nacional de Atenção Básica (freely translated as National Basic Care Policy- PNAB) emerged to define strategies for operationalization and consolidation of PHC actions, since the discussions and tendencies in the health area were and are focused on improvements in the models management (34) . On