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1.
Int J Environ Res Public Health ; 18(21)2021 10 28.
Article in English | MEDLINE | ID: covidwho-1512287

ABSTRACT

Assisted living (AL) is an emerging model of care in countries where long-term care needs are escalating, with emphasis given to promoting independence and autonomy among the residents to achieve active and healthy ageing. Unlike established nursing homes, the governance of AL is nebulous due to its novelty and diverse nature of operations in many jurisdictions. A comprehensive understanding of how AL is governed globally is important to inform regulatory policies as the adoption of AL increases. A systematic literature review was undertaken to understand the different levels of regulations that need to be instituted to govern AL effectively. A total of 65 studies, conducted between 1990 to 2020, identified from three major databases (PubMed, Medline, and Scopus), were included. Using a thematic synthesis analytical approach, we identified macro-level regulations (operational authorisation, care quality assessment and infrastructural requirements), meso-level regulations (operational management, staff management and distribution, service provision and care monitoring, and crisis management), and micro-level regulations (clear criteria for resident admission and staff hiring) that are important in the governance of AL. Large-scale adoption of AL without compromising the quality, equity and affordability would require clear provisions of micro-, meso- and macro-level regulations.


Subject(s)
Long-Term Care , Nursing Homes , Delivery of Health Care , Humans , Quality of Health Care
6.
Am J Nurs ; 121(11): 7, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1493969

ABSTRACT

Nurses have the opportunity to make a difference for caregivers.


Subject(s)
Caregivers/psychology , Health Facilities , Quality of Health Care , COVID-19 , Humans
7.
Liver Transpl ; 27(10): 1479-1489, 2021 10.
Article in English | MEDLINE | ID: covidwho-1487507

ABSTRACT

Cirrhosis has a significant and growing impact on public health and patient-reported outcomes (PROs). The increasing burden of cirrhosis has led to an emphasis on the quality of care with the goal of improving overall outcomes in this high-risk population. Existing evidence has shown the significant gaps in quality across process measures (eg, hepatocellular carcinoma screening), highlighting the need for consistent measurement and interventions to address the gaps in quality care. This multistep process forms the quality continuum, and it depends on clearly defined process measures, real-time quality measurement, and generalizable evaluative methods. Herein we review the current state of quality care in cirrhosis across the continuum with a focus on process measurement methodologies, developments in PRO evaluation on quality assessment, practical examples of quality improvement initiatives, and the recent emphasis placed on the value of primary prevention.


Subject(s)
Liver Transplantation , Quality Improvement , Humans , Liver Cirrhosis/diagnosis , Liver Cirrhosis/therapy , Patient Reported Outcome Measures , Quality of Health Care
8.
BMC Med Ethics ; 22(1): 144, 2021 10 27.
Article in English | MEDLINE | ID: covidwho-1486575

ABSTRACT

BACKGROUND: The COVID-19 pandemic called for a new ethical climate in the designated hospitals and imposed challenges on care quality for anti-pandemic nurses. Less was known about whether hospital ethical climate and nurses' ethical sensitivity were associated with care quality. This study examined the association between the perceived hospital ethical climate and self-evaluated quality of care for COVID-19 patients among anti-pandemic nurses, and explored the mediating role of ethical sensitivity in this relationship. METHODS: A cross-sectional study was conducted through an online survey. A total of 399 anti-pandemic nurses from ten designated hospitals in three provinces of China were recruited to fill out an online survey. Multiple linear regression analysis and a bootstrap test were used to examine the relationships between ethical climate, ethical sensitivity and care quality. RESULTS: Nurses reported mean scores of 4.43 ± 0.577 (out of 5) for hospital ethical climate, 45.00 ± 7.085 (out of 54) for ethical sensitivity, and 5.35 ± 0.661 (out of 6) for self-evaluated care quality. After controlling for covariates, perceived hospital ethical climate was positively associated with self-evaluated care quality (direct effect = 0.710, 95% confidence interval [CI] 0.628, 0.792), and was partly mediated by ethical sensitivity (indirect effect = 0.078, 95% confidence interval [CI] 0.002, 0.145). CONCLUSIONS: Chinese nurses who cared for COVID-19 patients perceived high levels of hospital ethical climate, ethical sensitivity, and self-evaluated care quality. Positive perceptions of hospital ethical climate were both directly associated with a higher level of self-evaluated care quality and indirectly associated, through the mediation effect of ethical sensitivity among anti-pandemic nurses.


Subject(s)
COVID-19 , Nurses , Attitude of Health Personnel , China , Cross-Sectional Studies , Hospitals , Humans , Job Satisfaction , Pandemics , Quality of Health Care , SARS-CoV-2 , Surveys and Questionnaires
10.
J Healthc Manag ; 66(4): 258-270, 2021.
Article in English | MEDLINE | ID: covidwho-1475897

ABSTRACT

EXECUTIVE SUMMARY: Home hospital care (HHC) is a new and exciting concept that holds the promise of achieving all three components of the Triple Aim and reducing health disparities. As an innovative care delivery model, HHC substitutes traditional inpatient hospital care with hospital care at home for older patients with certain conditions. Studies have shown evidence of reduced cost of care, improved patient satisfaction, and enhanced quality and safety of care for patients treated through this model. The steady growth in Medicare Advantage enrollment and the expansion in 2020 of the Centers for Medicare & Medicaid Services (CMS) Hospitals Without Walls program to include acute hospital care at home creates an opportunity for hospitals to implement such programs and be financially rewarded for reducing costs. Capacity constraints exacerbated by the COVID-19 pandemic suggest that now is the ideal time for healthcare leaders to test and advance the concept of HHC in their communities.


Subject(s)
COVID-19 , Critical Care Nursing/economics , Critical Care Nursing/standards , Healthcare Disparities/standards , Home Care Services/economics , Home Care Services/standards , Quality of Health Care/standards , Adult , Aged , Aged, 80 and over , Female , Healthcare Disparities/economics , Healthcare Disparities/statistics & numerical data , Home Care Services/statistics & numerical data , Humans , Male , Middle Aged , Pandemics , Patient Satisfaction/statistics & numerical data , Practice Guidelines as Topic , Quality of Health Care/economics , Quality of Health Care/statistics & numerical data , SARS-CoV-2 , United States
13.
BMC Cancer ; 21(1): 1094, 2021 Oct 11.
Article in English | MEDLINE | ID: covidwho-1463236

ABSTRACT

BACKGROUND: To ensure safe delivery of oncologic care during the COVID-19 pandemic, telemedicine has been rapidly adopted. However, little data exist on the impact of telemedicine on quality and accessibility of oncologic care. This study assessed whether conducting an office visit for thoracic oncology patients via telemedicine affected time to treatment initiation and accessibility. METHODS: This was a retrospective cohort study of patients with thoracic malignancies seen by a multidisciplinary team during the first surge of COVID-19 cases in Philadelphia (March 1 to June 30, 2020). Patients with an index visit for a new phase of care, defined as a new diagnosis, local recurrence, or newly discovered metastatic disease, were included. RESULTS: 240 distinct patients with thoracic malignancies were seen: 132 patients (55.0%) were seen initially in-person vs 108 (45.0%) via telemedicine. The majority of visits were for a diagnosis of a new thoracic cancer (87.5%). Among newly diagnosed patients referred to the thoracic oncology team, the median time from referral to initial visit was significantly shorter amongst the patients seen via telemedicine vs. in-person (median 5.0 vs. 6.5 days, p < 0.001). Patients received surgery (32.5%), radiation (24.2%), or systemic therapy (30.4%). Time from initial visit to treatment initiation by modality did not differ by telemedicine vs in-person: surgery (22 vs 16 days, p = 0.47), radiation (27.5 vs 27.5 days, p = 0.86, systemic therapy (15 vs 13 days, p = 0.45). CONCLUSIONS: Rapid adoption of telemedicine allowed timely delivery of oncologic care during the initial surge of the COVID19 pandemic by a thoracic oncology multi-disciplinary clinic.


Subject(s)
COVID-19/epidemiology , Health Services Accessibility , Pandemics , Telemedicine/organization & administration , Thoracic Neoplasms/therapy , Time-to-Treatment , Aged , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Patient Care Team , Philadelphia/epidemiology , Quality of Health Care , Referral and Consultation , Retrospective Studies , Telemedicine/standards , Telemedicine/statistics & numerical data , Thoracic Neoplasms/epidemiology , Thoracic Neoplasms/pathology , Time Factors
14.
JAMA Dermatol ; 157(3): 330-337, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1453488

ABSTRACT

Importance: Shared decision-making (SDM) can improve the quality of care for patients. The extent to which this tool has been used and the evidence supporting its use in dermatology have not been systematically examined. Objective: To perform a scoping review of the literature regarding SDM in dermatology. Evidence Review: Searches of Ovid MEDLINE, PsycINFO, PsycARTICLES, Sciverse Scopus, and EBM Reviews were conduced on July 11, 2019, and March 6, 2020. There were no limits on date, type of article, language, or subject for the initial search. A total of 1673 titles and abstracts were screened by 2 independent reviewers in the Covidence mixed-methods platform. Forty-one full-text studies were assessed for eligibility. For inclusion, articles needed to include a dermatologic diagnosis as well as discussion of SDM or patient decision aids. Two independent reviewers screened 29 full-text articles for inclusion and extracted qualitative data using a set of 26 predefined codes. Qualitative coding was applied to excerpts to categorize the article, define and describe advantages and disadvantages of SDM, understand patient and physician requests for SDM, and discuss methods of implementation. Findings: Despite a small number of articles on SDM (n = 29) in dermatology, the selected literature provided consistent messages regarding the importance of SDM for dermatology and a number of strategies and tools for implementation. Medical dermatology was the most common subspecialty studied, with melanoma, psoriasis, and connective tissue diseases most examined. Only 5 publications introduced SDM tools specifically for dermatologic conditions; of these, only 2 tools were validated. Barriers to implementation that were cited included time and a lack of training for clinicians, although the literature also provided potential solutions to these issues. All articles emphasized the value of SDM for both patients and physicians. Conclusions and Relevance: The literature regarding SDM in dermatology consistently suggests that it is a useful tool for providing patient-centered care. Established tools have been proposed since 2012. More research is needed to implement better practices, especially in dermatologic subspecialties. However, there are substantial suggestions from the literature for strategies and tools with which to begin a shared decision-making practice.


Subject(s)
Decision Making, Shared , Dermatology/standards , Quality of Health Care , Humans , Patient-Centered Care/standards , Skin Diseases/therapy
15.
Gerontologist ; 60(3): e200-e217, 2020 04 02.
Article in English | MEDLINE | ID: covidwho-1455299

ABSTRACT

BACKGROUND AND OBJECTIVES: In long-term care (LTC) facilities, nursing staff are important contributors to resident care and well-being. Despite this, the relationships between nursing staff coverage, care hours, and quality of resident care in LTC facilities are not well understood and have implications for policy-makers. This systematic review summarizes current evidence on the relationship between nursing staff coverage, care hours, and quality of resident care in LTC facilities. RESEARCH DESIGN AND METHODS: A structured literature search was conducted using four bibliographic databases and gray literature sources. Abstracts were screened by two independent reviewers using Covidence software. Data from the included studies were summarized using a pretested extraction form. The studies were critically appraised, and their results were synthesized narratively. RESULTS: The systematic searched yielded 15,842 citations, of which 54 studies (all observational) were included for synthesis. Most studies (n = 53, 98%) investigated the effect of nursing staff time on resident care. Eleven studies addressed minimum care hours and quality of care. One study examined the association between different nursing staff coverage models and resident outcomes. Overall, the quality of the included studies was poor. DISCUSSION AND IMPLICATIONS: Because the evidence was inconsistent and of low quality, there is uncertainty about the direction and magnitude of the association between nursing staff time and type of coverage on quality of care. More rigorously designed studies are needed to test the effects of different cutoffs of care hours and different nursing coverage models on the quality of resident care in LTC facilities.


Subject(s)
Homes for the Aged/standards , Nursing Homes/standards , Nursing Staff/statistics & numerical data , Personnel Staffing and Scheduling/statistics & numerical data , Quality of Health Care , Aged , Delivery of Health Care/standards , Humans , Long-Term Care , Workforce
16.
J Med Internet Res ; 23(9): e28869, 2021 09 24.
Article in English | MEDLINE | ID: covidwho-1443965

ABSTRACT

BACKGROUND: Oncological health care services are challenged by the increasing number of cancer survivors, long-term follow-up care, and fragmentation of care. Digital care platforms are potential tools to deliver affordable, patient-centered oncological care. Previous reviews evaluated only one feature of a digital care platform or did not evaluate the effect on enhancement of information, self-efficacy, continuity of care, or patient- and health care provider-reported experiences. Additionally, they have not focused on the barriers and facilitators for implementation of a digital care platform in oncological care. OBJECTIVE: The aim of this systematic review was to collect the best available evidence of the effect of a digital care platform on quality of care parameters such as enhancement of available information, self-efficacy, continuity of care, and patient- and health care provider-reported experiences. Additionally, barriers and facilitators for implementation of digital care platforms were analyzed. METHODS: The PubMed (Medline), Embase, CINAHL, and Cochrane Library databases were searched for the period from January 2000 to May 2020 for studies assessing the effect of a digital care platform on the predefined outcome parameters in oncological patients and studies describing barriers and facilitators for implementation. Synthesis of the results was performed qualitatively. Barriers and facilitators were categorized according to the framework of Grol and Wensing. The Mixed Methods Appraisal Tool was used for critical appraisal of the studies. RESULTS: Seventeen studies were included for final analysis, comprising 8 clinical studies on the effectiveness of the digital care platform and 13 studies describing barriers and facilitators. Usage of a digital care platform appeared to enhance the availability of information and self-efficacy. There were no data available on the effect of a digital care platform on the continuity of care. However, based on focus group interviews, digital care platforms could potentially improve continuity of care by optimizing the exchange of patient information across institutes. Patient-reported experiences such as satisfaction with the platform were considerably positive. Most barriers for implementation were identified at the professional level, such as the concern for increased workload and unattended release of medical information to patients. Most facilitators were found at the patient and innovation levels, such as improved patient-doctor communication and patient empowerment. There were few barriers and facilitators mentioned at the economic and political levels. CONCLUSIONS: The use of digital care platforms is associated with better quality of care through enhancement of availability of information and increased self-efficacy for oncological patients. The numerous facilitators identified at the patient level illustrate that patients are positive toward a digital care platform. However, despite these favorable results, robust evidence concerning the effectiveness of digital care platforms, especially from high-quality studies, is still lacking. Future studies should therefore aim to further investigate the effectiveness of digital care platforms, and the barriers and facilitators to their implementation at the economic and political levels.


Subject(s)
Health Personnel , Patient Participation , Communication , Humans , Qualitative Research , Quality of Health Care
19.
J Nurs Adm ; 51(10): 500-506, 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1434561

ABSTRACT

Like any disaster, the COVID-19 pandemic has presented significant challenges to healthcare systems, especially the threat of insufficient bed capacity and resources. Hospitals have been required to plan for and implement innovative approaches to expand hospital inpatient and intensive care capacity. This article presents how one of the largest healthcare systems in the United States leveraged existing technology infrastructure to create a virtual hospital that extended care beyond the walls of the "brick and mortar" hospital.


Subject(s)
COVID-19 , Delivery of Health Care/organization & administration , Home Care Services, Hospital-Based/organization & administration , Hospitals , Surge Capacity/organization & administration , Telemedicine/organization & administration , Humans , Quality of Health Care , SARS-CoV-2 , Telemedicine/methods , United States/epidemiology
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