Comparative analysis of patients' satisfaction level, hospitalized before and during the COVID-19 pandemic

Introduction and aim. Measurement of the satisfaction level with health services is the most frequently used indicator, mainly because of its importance for determining the quality of the care offered. It is the key to succeed in achieving high-quality healthcare. The purpose of this study was to create a retrospective comparative analysis of the satisfaction level amongst patients hospitalized before and during the COVID-19 pandemic. Material and methods. The study covered a total of 966 patients in 19 hospital wards, in the fourth quarter of 2019 (before the pandemic) and in the second quarter of 2021 (during the pandemic) at the Masovian Specialist Hospital in Radom. The level of patient satisfaction was assessed based on the questionnaire prepared and approved by the Quality Assurance Team in the Masovian Specialist Hospital. The statistical analysis was carried out on the basis of the STATISTICA 10.1 program, using the Pearson's chi square test, for the significance level at p<0.05. Results. The high level of satisfaction of patients staying in the hospital during the pandemic applied to the widely understood medical and nursing care as well as sanitary conditions in wards, especially the cleanness of rooms, bed linens and sanitary facilities. Conclusion. The biggest dissatisfaction of hospitalized patients during the COVID-19 pandemic involved certain restrictions of visitations and using pastoral services. © 2022 Publishing Office of the University of Rzeszow. All Rights Reserved.

REFERRAL BEHAVIOUR OF PRIMARY CARE DOCTORS TO RHEUMATOLOGY CLINIC IN MALAYSIA

BackgroundThe workload at rheumatology clinics have been growing relentlessly and an audit on new.referrals helps to identify referral behaviour of primary care doctors and improvement can be done by providing further training.ObjectivesTo audit on new referral cases to rheumatology clinic from 2020-2022 and to identify new cases with misdiagnosis for future training purpose.MethodsThis was a retrospective study. The medical records of all new referral to rheumatology clinic Hospital Sultan Ismail and Hospital Pakar Sultanah Fatimah from 1st January 2020 to 31th November 2022 were reviewed. The referral diagnosis and final diagnosis were identified and analysed.ResultsThere were total of 927 new cases referral throughout the 35 months during Covid-19pandemic. Majority of them were diagnosed to have rheumatoid arthritis (217/927)followed by systemic lupus erythematosus (190/927), psoriatic arthritis (147/927),gout (62/927), osteoarthritis (58/927), systemic sclerosis (25/927), ankylosing spondylitis (25/927), soft tissue rheumatism (24/927), Sjogren syndrome (24/927),mixed connective tissue disease (14/927), vasculitis (11/927), fibromyalgia (10/927),polymyositis (7/927) and miscellaneous (39/927).45 out of the new cases were diagnosed as unlikely rheumatic diseases. There were 29pending cases awaiting final diagnosis.212 of the referrals were identified as misdiagnosis with the highest as nodal osteoarthritis.(55/212) followed by unlikely rheumatic disease (43/212), soft tissue rheumatism (24/212),psoriatic arthritis (20/212), Sjogren syndrome (14/212), gout (8/212), rheumatoid arthritis (7/212), fibromyalgia (6/212), systemic lupus erythematosus (5/212), ankylosing spondylitis (4/212), mixed connective tissue disease (3/212), systemic sclerosis (2/212), polymyositis (2/212) and others (19/212): diffuse idiopathic skeletal hyperostosis, hypermobility syndrome, RS3PE syndrome, idiopathic uveitis, graft versus host disease, juvenile idiopathic arthritis, antiphospholipid syndrome, hypothyroidism, post streptococcal arthritis, prolapsed intervertebral disc, cerebrovascular disease, traumatic sternoclavicular joint subluxation, ledderhose disease, paraspinal muscle spasm and viral myalgia).ConclusionNodal osteoarthritis and soft tissue rheumatism can be great mimicker for inflammatory.arthritis and if wrongly diagnosed will lead to unnecessary anxiety or wrong treatment. More training is needed to improve clinical skills amongst primary care doctors.ReferencesNA.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Nurses' experiences caring for patients with opioid use disorders

The purpose of this study was to examine nurses' experience of quality care for hospitalized patients with a history of opioid use disorder or self-injection of opioids and whether hospital, unit, or nurse characteristics impacted experiences of quality care. A secondary aim of the study was to understand how nurses' experiences of quality care for this population have been impacted by the COVID-19 pandemic. The Institute of Medicine's Six Domains of Health Care Quality were used to define quality care in this study. A national sample of 179 nurses completed an online survey regarding their experiences caring for patients with opioid use disorders. The majority of the participants were staff nurses who worked in emergency departments, critical care units, or mother baby units. Only 41.9% of the participants had received education regarding substance use disorders from their employers, and even less had participated in harm reduction education. Only 45% of the nurses had knowledge regarding harm reduction strategies for this population. The participants experienced a low number of restrictive safety measures and an average number of adverse events and effective care interventions when caring for patients with opioid use disorders. The nurses rated quality care and satisfaction as average. Correlation and linear regression analysis suggested trends in nurse, hospital and unit characteristics that are associated with nurses' experiences caring for this population;substance use disorder education, harm reduction education, and unit type were most often associated with nurses' experiences. Content analysis of open-ended questions regarding equity, patient-centeredness, timeliness and the impact of COVID-19 on experiences of quality care supported quantitative findings in the study and provided insight into the nurses' experiences. The findings in this study contribute to current evidence regarding the need for standardized hospital policies and practices aimed at improving quality care for patients with opioid use disorders. These policies and practices should incorporate harm reduction strategies that are patient-centered and evidence-based. Hospitals and nursing schools should provide education aimed at reducing stigma and improving care for this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Construction of a quality evaluation system for emergency pre-examination and triage under the normalization of COVID-19 epidemic based on the Servqual model

Objective: To build a quality evaluation system for emergency pre-test and triage under a normal COVID-19 epidemic, based on the Servqual model, and to improve the effect of emergency epidemic prevention and control and the quality of emergency pre-testing and triage under the normalization of COVID-19 epidemics. Methods: Based on the Servqual model, a quality evaluation system of emergency pre-examination and triage under the normalization of COVID-19 epidemic was developed. Two rounds of expert consultation were conducted by the Delphi method, involving 15 experts. Results: The recovery rates for the two rounds of expert consultation were 100%, the expert authority coefficient was 0.954, and the Kendall coordination coefficients were 0.273 and 0.182 . The coefficients of variation of the three-level indicators of the two rounds of expert consultation were 0.003-0.275 and 0.052-0.125, respectively. An evaluation system including 5 first-level indicators, 14 second-level indicators and 42 third-level indicators of 5 dimensions (feasibility, reliability, responsiveness, security, empathy) of the Servqual model was established. Conclusion: Based on the Servqual model, a quality evaluation system for emergency pre-examination and triage under the normalization of the COVID-19 epidemic situation was completed. It reflects the medical services, triage and epidemic prevention and control required to provide the requisite quality of emergency pre-examination and triage under the normalization of the COVID-19 epidemic situation. It provides a reference for the quality supervision of emergency pre-examination and triage under the normalization of the COVID-19 epidemic situation.

HELLENIC LEAGUE'S AGAINST RHEUMATISM'S SCHOOL OF HEALTH EDUCATION

BackgroundThe more time healthcare professionals spend with patients the better the health outcomes become. Therefore, education seems to play a crucial role for the quality of life not only for the patients but also for the health care costs and the future cost projections that depend on the health outcomes of everyone.ObjectivesAim of the School of Health Education is to give the opportunity to participants to familiarize themselves with frequently used terminology in everyday clinical practice, to become accustomed in using the common medical language when describing their symptoms to their doctors so that they will have a common ground. Basic goal of this education is for every patient to understand a bit more about concepts such as medications, adverse events, pharmacovigilance etc.MethodsInteractive live events, of approximately 2hour duration, have already take place in 15 cities of Greece. In the year 2020 COVID restrictions did not allow for such events to be organized. The project will start again during 2023. Speakers in the events were: rheumatologists, general physicians, anesthesiologists, psychiatrists, psychologists, gynecologists, clinical pharmacologists and others.ResultsOver 1800 patients, caregivers, members of the public, stakeholders, members of the local authorities, healthcare professional and others participated in the live events. Handouts and printed material from HELAR/ELEANA were given to participants as well an evaluation form to complete. The events generated a lot of press locally and nationally, with 4 press conferences, 25 press releases, 18 TV interviews and 10 radio interviews.ConclusionPublicity and participation in the events showed that patient education is quite important for the patients and the local communities. Since 2020 and the COVID pandemic there has been a shift towards public health issues and health education creating a unique opportunity for HELAR/ELEANA's School of Health Education to be adapted and become once more available for the patients living with an RMD. This time the new version could be either a virtual version or a live version for many more patients, caregivers and the public to be able to attend.AcknowledgementsHellenic League Against Rheumatism is grateful to Dimitrios Kouvelas, MD, BPharm, PhD, Professor of Pharmacology and Clinical Pharmacology, Head of the Dept of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki for his precious scientific contribution, implementation and for being the main speaker voluntarily.The School of Health Education was awarded the bronze prize by the Health Care Business Awards in 2019.Disclosure of InterestsKATY ANTONOPOULOU: None declared, ATHANASIA PAPPA: None declared, DIMITRIOS KOUVELAS Consultant of: DEMO, STILVI, Nadia Malliou: None declared, Katerina Tsekoura: None declared, MACHI SALAMALIKI: None declared, EVANGELIA OIKONOMOULA: None declared, KATERINA ROUSTA: None declared.

Calling all nurses-Now is the time to take action on improving the quality of care in nursing homes.

For a number of decades, nurses have raised concerns about nursing-related issues in nursing homes (NH) such as inadequate registered nurse (RN) staffing, insufficient RN and advanced practice registered nurse (APRN) gerontological expertise, and lack of RN leadership competencies. The NASEM Committee on the Quality of Care in Nursing Homes illuminated the long-standing issues and concerns affecting the quality of care in nursing homes and proposed seven goals and associated recommendations intended to achieve the Committee's vision: Nursing home residents receive care in a safe environment that honors their values and preferences, addresses goals of care, promotes equity, and assesses the benefits and risks of care and treatments. This paper outlines concrete and specific actions nurses and nursing organizations can take to ensure the recommendations are implemented.

Randomized regulation: the impact of minimum quality standards on health markets

We report results from the first randomization of a regulatory reform in the health sector. The reform established minimum quality standards for patient safety, an issue that has become increasingly salient following the Ebola and COVID-19 epidemics. In our experiment, all 1348 health facilities in three Kenyan counties were classified into 273 markets, and the markets were then randomly allocated to treatment and control groups. Government inspectors visited health facilities and, depending on the results of their inspection, recommended closure or a timeline for improvements. The intervention increased compliance with patient safety measures in both public and private facilities (more so in the latter) and reallocated patients from private to public facilities without increasing out-of-pocket payments or decreasing facility use. In treated markets, improvements were equally marked throughout the quality distribution, consistent with a simple model of vertical differentiation in oligopolies. Our paper thus establishes the use of experimental techniques to study regulatory reforms and, in doing so, shows that minimum standards can improve quality across the board without adversely affecting utilization.

The relationship between nurse burnout, missed nursing care, and care quality following COVID-19 pandemic.

OBJECTIVES: To determine the relationship between nurse burnout, missed nursing care, and care quality following the COVID-19 pandemic. BACKGROUND: Quality of care and missed nursing care can be consequences of nurse burnout. Little is known about how these factors related to nurse burnout following the COVID-19 pandemic. DESIGN: This study used a cross-sectional correlational design and was conducted in 12 general hospitals across Thailand from August to October 2022. METHODS: 394 nurses providing direct nursing care to patients during the COVID-19 pandemic completed the survey. The Emotional Exhaustion (EE) subscale of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), MISSCARE survey, and quality of care reported by nurses were used to collect data. Descriptive statistics and logistic regression models were used to analyse the data. RESULTS: Approximately thirty-six percent of nurses had burnout following the COVID-19 pandemic. Missed nursing care was higher among nurses with burnout. Most participants reported illness/symptoms such as anxiety, fatigue, a lack of concentration, and sleeping problems. After adjusting for demographic characteristics, every additional unit of emotional exhaustion was associated with 1.61 times higher odds of missed nursing care, 3.37 times higher odds of poor quality of nurse care, and 2.62 times higher odds of poor quality of care for the overall unit. CONCLUSION: The study findings demonstrate that burnout is associated with missed nursing care and poor quality of care following the COVID-19 pandemic. RELEVANCE TO CLINICAL PRACTICE: Policymakers, hospital administrators, and nurse managers should invest in strategies to reduce nurse burnout, which can increase patient safety and quality of care.

The association between nurse managers' transformational leadership and quality of patient care: A systematic review.

AIM: To examine and summarize the reported association of nurse managers' transformational leadership and quality of patient care based on the perceptions of registered nurses. BACKGROUND: Transformational leadership behaviors of nurse managers result in staff nurses' satisfaction and retention and patient satisfaction. Patient safety and quality of care are vital to high-performing healthcare organizations. Perceptions of registered nurses are important because nurses are frontline healthcare providers fundamental to patient safety and quality of care and are considered the final line of defense in preventing adverse events and errors and improving the safety of patients. MATERIALS AND METHODS: We  searched the CINAHL, ProQuest, PubMed, Science Direct, and Web of Science databases for evidence published between 2018 and 2022 in the English language. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in carrying out this meta-analysis. RESULTS: Nine quantitative studies were appraised using the Joanna Briggs Institute checklists and were included in the final review that involved a total sample of 3633 registered nurses. The included studies were reported across Asian, Middle East, and European countries within the past five years. The association between the transformational leadership behaviors of nurse managers and the quality of patient care was found in varying degrees (i.e., insignificant, weak, indirect, and strong direct association) based on the perceptions of registered nurses. CONCLUSIONS: There is a direct and indirect association between the transformational leadership behaviors of nurse managers and the quality of patient care internationally. This association is influenced by confounding and mediating factors, including gender, organizational culture, structural empowerment, and job satisfaction. IMPLICATIONS FOR NURSING AND HEALTH POLICIES: Healthcare organizations need to support nursing leaders to have a stronger transformational leadership style by considering several factors that influence their leadership to improve the quality of patient care their staff nurses provide at the bedside.

Long-Term Care Resident Health and Quality of Care During the COVID-19 Pandemic: A Synthesis Analysis of Canadian Institute for Health Information Data Tables.

Objective: Long-term care (LTC) homes ("nursing homes") were challenged during the first year of the COVID-19 pandemic in Canada. The objective of this study was to measure the impact of the COVID-19 pandemic on resident admission and discharge rates, resident health attributes, treatments, and quality of care. Design: Synthesis analysis of "Quick Stats" standardized data table reports published yearly by the Canadian Institute for Health Information. These reports are a pan-Canadian scorecard of LTC services rendered, resident health characteristics, and quality indicator performance. Setting and participants: LTC home residents in Alberta, British Columbia, Manitoba, and Ontario, Canada that were assessed with the interRAI Minimum Data Set 2.0 comprehensive health assessment in fiscal years 2018/2019, 2019/2020 (pre-pandemic period), and 2020/2021 (pandemic period). Methods: Risk ratio statistics were calculated to compare admission and discharge rates, validated interRAI clinical summary scale scores, medication, therapy and treatment provision, and seventeen risk-adjusted quality indicator rates from the pandemic period relative to prior fiscal years. Results: Risk of dying in the LTC home was greater in all provinces (risk ratio [RR] range 1.06-1.18) during the pandemic. Quality of care worsened substantially on 6 of 17 quality indicators in British Columbia and Ontario, and 2 quality indicators in Manitoba and Alberta. The only quality indicator where performance worsened during the pandemic in all provinces was the percentage of residents that received antipsychotic medications without a diagnosis of psychosis (RR range 1.01-1.09). Conclusions and implications: The COVID-19 pandemic has unveiled numerous areas to strengthen LTC and ensure that resident's physical, social, and psychological needs are addressed during public health emergencies. Except an increase in potentially inappropriate antipsychotic use, this provincial-level analysis indicates that most aspects of resident care were maintained during the first year of the COVID-19 pandemic.

Examining the level of satisfaction of hospitalized patients with a definite or suspected diagnosis of COVID-19 from the care staff of COVID-19 wards

Introduction: Patient satisfaction with services is generally considered the main component of quality of care and can be described as the subjective perception of service quality resulting from the matching of expectations about services with actual experience and results. Therefore, the purpose of this study is to investigate the level of satisfaction of hospitalized patients with a definite or suspected diagnosis of covid-19 from the care staff of covid-19 wards. Methods: In this cross-sectional descriptive study, 172 patients with covid-19 who were admitted to Peymaniyeh Hospital in Jahrom city in 2019 with the diagnosis of corona virus disease were examined. The data collection tool in this study included two questionnaires for demographic information (age, sex, underlying disease, duration of hospitalization, etc.) and a satisfaction questionnaire for the medical staff. Data analysis was done using spss software version 21 and descriptive and inferential statistical tests. Results: The most frequent age was 31-40 years old (22.1%). The satisfaction level of the majority of hospitalized patients from the treatment staff was high, 133 patients (77.3%), the satisfaction level of 37 patients (21.5%) was average, and the satisfaction level of only 2 patients (1.2%) was low. Conclusion: Based on the results of the present study, the level of satisfaction of the majority of patients was reported at a high level. However, the demographic variables (age, sex, marriage, education, occupation, economic status, etc.) of the patients did not have a statistically significant relationship with the level of satisfaction of hospitalized patients with a definite or suspected diagnosis of Covid-19 from the medical staff. Therefore, by implementing continuous training programs and investigating cases of dissatisfaction, we can try to improve the satisfaction of patients as much as possible.

Impact of telehealth versus traditional visits on pain management patients utilizing medical cannabis during the COVID-19 pandemic

Alternatives to traditional office visits have become a necessity with the recent COVID-19 outbreak, resulting in an unmatched surge in telehealth adoption. The present study was an investigation of the impact of telehealth versus traditional office visits in medical cannabis clinics treating patients for chronic pain. With 50,000,000 American adults experiencing pain and over 750,000 overdoses attributed to opioid usage, collecting research-driven evidence to increase the availability of safe, effective, and nonopioid treatment options will create positive social change. The Donabedian model was applied to measure the quality of care, focusing on structure (cannabis clinics), process (telehealth vs. traditional office visits), and outcome (visual analog scale [VAS]). The study utilized a quasi-experimental, retrospective analysis of data using multiple linear regression comparing the impact of telemedicine visits versus traditional office visits on treating five pain types in a medical cannabis clinic during a pandemic. The main finding of this study indicated that telemedicine visits were as effective as traditional office visits in treating pain. However, there was not statistically significant data to suggest that cannabis-derived medicines resulted in improved outcomes in the five pain types studied (general, back, arthritic, cancer, and migraine). Across all pain types and subjects there was an overall decrease in pain from initial visit (7.44) to follow-up visit (6.29) a decrease of 15.4% on the VAS. Expanding healthcare service treatment options that are safe, effective, and accessible in caring for chronic pain will prevent disease, improve health outcomes, and improve quality of care all leading to positive social change. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Impact of the COVID-19 pandemic on the quality of diabetes care: Insights from longitudinal data in Switzerland.

In this population-based cohort study on diabetes care, self-reported quality indicators measured just before (2019) and during (2021) the COVID-19 pandemic were comparable, apart from a modest increase in seasonal influenza immunization and a small decline in patient-centeredness of care in 2021.

"You knew you had to be there, it had to be done": Experiences of health professionals who faced the COVID-19 pandemic in one public hospital in Spain.

Introduction: The COVID-19 pandemic highlighted the lack of a government contingency plan for an effective response to an unexpected health crisis. This study uses a phenomenological approach to explore the experience of healthcare professionals during the first three waves of the COVID-19 pandemic in a public health hospital in the Valencia region, Spain. It assesses the impact on their health, coping strategies, institutional support, organizational changes, quality of care, and lessons learned. Methods: We carried out a qualitative study with semi-structured interviews with doctors and nurses from the Preventive Medicine, Emergency, and Internal Medicine Services and the Intensive Care Unit, using the Colaizzi's 7-step data analysis method. Results: During the first wave, lack of information and leadership led to feelings of uncertainty, fear of infection, and transmission to family members. Continuous organizational changes and lack of material and human resources brought limited results. The lack of space to accommodate patients, along with insufficient training in treating critical patients, and the frequent moving around of healthcare workers, reduced the quality of care. Despite the high levels of emotional stress reported, no sick leave was taken; the high levels of commitment and professional vocation helped in adapting to the intense work rhythms. Healthcare professionals in the medical services and support units reported higher levels of stress, and a greater sense of neglect by their institution than their colleagues in managerial roles. Family, social support, and camaraderie at work were effective coping strategies. Health professionals showed a strong collective spirit and sense of solidarity. This helped them cope with the additional stress and workload that accompanied the pandemic. Conclusion: In the wake of this experience, they highlight the need for a contingency plan adapted to each organizational context. Such a plan should include psychological counseling and continuous training in critical patient care. Above all, it needs to take advantage of the hard-won knowledge born of the COVID-19 pandemic.

Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic disproportionately affected racial and ethnic minorities among the general population in the United States; however, little is known regarding its impact on U.S. military Veterans. In this study, our objectives were to identify the extent to which Veterans experienced increased all-cause mortality during the COVID-19 pandemic, stratified by race and ethnicity. DATA SOURCES: Administrative data from the Veterans Health Administration's Corporate Data Warehouse. STUDY DESIGN: We use pre-pandemic data to estimate mortality risk models using five-fold cross-validation and quasi-Poisson regression. Models were stratified by a combined race-ethnicity variable and included controls for major comorbidities, demographic characteristics, and county fixed effects. DATA COLLECTION: We queried data for all Veterans residing in the 50 states plus Washington D.C. during 2016-2020. Veterans were excluded from analyses if they were missing county of residence or race-ethnicity data. Data were then aggregated to the county-year level and stratified by race-ethnicity. PRINCIPAL FINDINGS: Overall, Veterans' mortality rates were 16% above normal during March-December 2020 which equates to 42,348 excess deaths. However, there was substantial variation by racial and ethnic group. Non-Hispanic White Veterans experienced the smallest relative increase in mortality (17%, 95% CI 11%-24%), while Native American Veterans had the highest increase (40%, 95% CI 17%-73%). Black Veterans (32%, 95% CI 27%-39%) and Hispanic Veterans (26%, 95% CI 17%-36%) had somewhat lower excess mortality, although these changes were significantly higher compared to White Veterans. Disparities were smaller than in the general population. CONCLUSIONS: Minoritized Veterans experienced higher rates excess of mortality during the COVID-19 pandemic compared to White Veterans, though with smaller differences than the general population. This is likely due in part to the long-standing history of structural racism in the United States that has negatively affected the health of minoritized communities via several pathways including health care access, economic, and occupational inequities.

A National Audit of Pancreatic Enzyme Prescribing in Pancreatic Cancer from 2015 to 2023 in England Using OpenSAFELY-TPP.

OBJECTIVES: Cancer treatments were variably disrupted during the coronavirus disease 2019 (COVID-19) pandemic. UK guidelines recommend pancreatic enzyme replacement therapy (PERT) to all people with unresectable pancreatic cancer. The aim was to investigate the impact of the COVID-19 pandemic on PERT prescribing to people with unresectable pancreatic cancer and to investigate the national and regional rates from January 2015 to January 2023. DATA SOURCES: With the approval of NHS England, we conducted this study using 24 million electronic health records of people within the OpenSAFELY-TPP research platform. There were 22,860 people diagnosed with pancreatic cancer in the study cohort. We visualized the trends over time and modeled the effect of the COVID-19 pandemic with the interrupted time-series analysis. CONCLUSION: In contrast to many other treatments, prescribing of PERT was not affected during the pandemic. Overall, since 2015, the rates increased steadily over time by 1% every year. The national rates ranged from 41% in 2015 to 48% in early 2023. There was substantial regional variation, with the highest rates of 50% to 60% in West Midlands. IMPLICATIONS FOR NURSING PRACTICE: In pancreatic cancer, if PERT is prescribed, it is usually initiated in hospitals by clinical nurse specialists and continued after discharge by primary care practitioners. At just under 50% in early 2023, the rates were still below the recommended 100% standard. More research is needed to understand barriers to prescribing of PERT and geographic variation to improve quality of care. Prior work relied on manual audits. With OpenSAFELY, we developed an automated audit that allows for regular updates (https://doi.org/10.53764/rpt.a0b1b51c7a).

Quality of facility-based maternal and newborn care around the time of childbirth during the COVID-19 pandemic: online survey investigating maternal perspectives in 12 countries of the WHO European Region.

BACKGROUND: Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic, as defined by WHO Standards, are lacking. METHODS: Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 - March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures. FINDINGS: 21,027 mothers were included in the analysis. Among those who experienced labour (N=18,063), 41·8% (26·1%- 63·5%) experienced difficulties in accessing antenatal care, 62% (12·6%-99·0%) were not allowed a companion of choice, 31·1% (16·5%-56·9%) received inadequate breastfeeding support, 34·4% (5·2%-64·8%) reported that health workers were not always using protective personal equipment, and 31·8% (17·8%-53·1%) rated the health workers' number as "insufficient". Episiotomy was performed in 20·1% (6·1%-66·0%) of spontaneous vaginal births and fundal pressure applied in 41·2% (11·5% -100%) of instrumental vaginal births. In addition, 23·9% women felt they were not treated with dignity (12·8%-59·8%), 12·5% (7·0%-23·4%) suffered abuse, and 2·4% (0·1%-26·2%) made informal payments. Most findings were significantly worse among women with prelabour caesarean birth (N=2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significant lower QMNC Indexes and Luxemburg showing a significantly higher QMNC Index than the total sample. Younger women and those with operative births also reported significantly lower QMNC Indexes. INTERPRETATION: Mothers reports revealed large inequities in QMNC across countries of the WHO European Region. Quality improvement initiatives to reduce these inequities and promote evidence-based, patient-centred respectful care for all mothers and newborns during the COVID-19 pandemic and beyond are urgently needed. FUNDING: The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy. STUDY REGISTRATION: ClinicalTrials.gov Identifier: NCT04847336.

Advancing patient safety governance in the COVID-19 response

In the backdrop of the COVID-19 pandemic, ensuring the safety of health care services remains a serious, ongoing challenge. This once-in-a-century global health crisis exposed the vulnerability of healthcare delivery systems and the subsequent risks of patient harm. Given the scale of the occurrence and costs of preventable patient safety events, intervention and investment are still relatively modest. Good patient safety governance focuses on what leaders and policy makers can do to improve system performance and reduce the financial burden of avoidable care. Moreover, it is essential in driving progress in improving safety outcomes. This report examines how patient safety governance mechanisms in OECD countries have withstood the test of COVID-19 and provides recommendations for countries in further improving patient safety governance and strengthening health system resilience.

The impact of expanded tele-mental health on quality-of-care indicators: A three-pronged regression analysis at Los Angeles county's department of mental health

Background: The use of Tele-Mental Health (TMH) skyrocketed after the COVID-19 pandemic led to the announcement of a public health emergency in March 2020. This rise coincided with soaring rates of mental health issues and increasing demand for accessible and sustainable treatment, all while meeting physical distancing requirements. TMH use is theorized to improve timely access to care and provide opportunities to improve quality of care indicators in individuals and at the health systems level.Research Question: How has the widespread adoption of Tele-Mental Health changed quality of care (QoC) indicators among patients of LA County Department of Mental Health's (LAC DMH) Directly Operated (DO) clinics?Methods: The study design for this analysis is a multivariate quasi-experimental study with a pseudo-control. A three-pronged approach to the analysis was used to tackle the research question and two QoC indicators are defined as the binary "Timely" variable and the continuous "Appointment Adherence" variable. All the models adjusted for covariates (demographic variables and the ratio of patients to providers) and mediators (the Request Type, which determines the timely standards of care). A "Pandemic Time" variable referred to if the data point took place before March 19, 2020, which referred to the date that the Safer-at-Home Order (SHO) was announced, or after. The first prong, approach A, used a logistic regression for the Timely variable and an OLS regression for Appointment Adherence;it compared users of TMH to those receiving in-person care and included the pandemic time variable. Approach B did the same but accounted for crowding effects over time by adding an offset variable for the ratio of appointment requests to providers. An ANOVA for the first two approaches determined the effect size of the variables and those that had an effect size over 0.01 were used to build a parsimonious model for Approach C. Approach C used Interrupted Time Series models to compare the actual changes in QoC indicators from March 2017 to February 2021 with the expansion of TMH taking place post-SHO (March 2020-February 2021) to a pseudo-control for the whole health system. Approach C transformed the "Timely" and "TMH" variables to be continuous by transforming them to the percent of the total patients that received timely care and the percent of services delivered via TMH. Results: Approach A found that TMH use was significantly associated (p=0.00) with a 15% reduced probability of receiving a timely appointment compared to those that received in-person care, though the probability of receiving a timely appointment increased 10% post-SHO compared to pre-SHO (p=0.00). Approach A also found that TMH use was significantly associated with a 2.5% increase in Appointment Adherence (p=0.00) compared to those receiving in-person care, but that post-SHO there was a 4% decrease in Appointment Adherence as compared to pre-SHO (p=0.00). Approach B found that TMH use was significantly associated (p=0.00) with a 6% decrease in the probability to receive a timely appointment when accounting for the crowding effect;TMH use was not significantly associated with Appointment Adherence. Approach C used Interrupted Time Series regression to find that there was no significant association between TMH use and receiving a timely appointment and that the fluctuations in timely care both exceeded and fell short of the pseudo-control. TMH adoption did however have a significant relationship at a 10% level (p=0.09) with appointment adherence, in which every additional percent of TMH adoption by DMH was associated with a 7% increase in appointment adherence compared to the pseudo-control. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Satisfaction of Patients Other Than COVID-19 During the Pandemic at a Multidisciplinary Centre with COVID-19 Services

Background: The services rendered by hospitals during the pandemic may not be efficient. This might impact the satisfaction of patients seeking healthcare. The aim of this study is to assess the satisfaction level of patients other than those with COVID-19 during the pandemic with different services provided by the hospital. Method: A quantitative, analytical and cross-sectional study was carried out in a multidisciplinary hospital. Valid questionnaire, derived from PSQ III and PSQ 18, was used for data collection from 250 outpatients. Ethical approval was obtained. Systematic random sampling was done to enrol patients into the study after taking their consent. Descriptive analysis was performed using frequency, proportion, median and inter-quartile range. Mann–Whitney U test and Kruskal–Wallis test were carried out to find the association between overall satisfaction and different socio-demographic and other variables. Statistical significance was set at p-value < 0.05. Result: Almost two-thirds of the respondents visiting the hospital during the pandemic were female (male: 35.6% and female: 64.4%). More than half (50.4%) of the patients reported that access to the hospital was feasible. Of the patients reporting dissatisfaction, most of them (86.4%) considered the establishment of separate COVID-19 hospitals as the best option. The median satisfaction score for the overall satisfaction of patients towards different service domains was 54.0 (45–60). Almost all respondents (95.6%) found that services were easily available. Patient satisfaction score was significantly associated with expenditure (p < 0.001). Satisfaction score was also significantly associated with the time spent in the hospital by the patients (p < 0.001). Conclusion: Majority of the patients reporting to the multidisciplinary hospital were satisfied with the provisioning of treatment and different services during the COVID-19 pandemic. Relatively lesser satisfaction was reported for the provision of maintenance of social distance, availability of hand washing/sanitisation, overall hospital cleanliness and cost of treatment. Moreover, satisfaction among patients was associated with their perceived fear of the pandemic. © 2023 Indian Institute of Health Management Research.