ABSTRACT
No disponible
Subject(s)
Humans , Chronic Disease/epidemiology , Health Services/trends , Continuity of Patient Care/trends , Systems Integration , Sustainable Development , Health Promotion/trendsABSTRACT
Las técnicas de gestión de calidad total han sido introducidas recientemente en la práctica clínica. Este artículo describe la aplicación de la gestión de procesos en la unidad de atención al usuario de un hospital tipo. Material y método: Se constituyó un equipo de trabajo con experiencia en gestión de procesos y de gestión de las unidades de atención al usuario hospitalarias. El equipo desarrolló el trabajo de campo (revisión bibliográfica, dibujo de los diagramas, selección y definición de indicadores, etc.) junto a un grupo de personal de varias unidades de atención al usuario. Resultados: Se han definido el propietario y los límites del proceso con un diagrama de flujo en el que aparecen todas las actividades del proceso, los indicadores para su monitorización y sus estándares (AU)
Subject(s)
Organization and Administration , Outcome and Process Assessment, Health Care/standards , Outcome and Process Assessment, Health Care/organization & administration , Outcome and Process Assessment, Health Care , Quality of Health Care/organization & administration , Total Quality Management/organization & administration , Patient Advocacy/standards , Indicators of Quality of Life , Indicators of Health Services/organization & administration , Health Services Needs and Demand/organization & administration , Total Quality Management/standards , Total Quality Management/organization & administration , Total Quality Management/trends , Total Quality ManagementABSTRACT
We tested an appropriateness of indications tool for total hip joint replacement in patients with osteoarthritis. Criteria were developed using a modified Delphi panel judgment process. Ratings were analyzed regarding level of agreement among panelists. Another panel rated the same indications; results were compared with the main panel. Test-retest of the main panel was performed. Regression models were used to assess the contribution of each algorithm variable. Appropriateness indication judgment was applied to 84 patients and compared to health-related quality-of-life improvement before and 3 months following intervention. Main panel ratings compared to those of a second panel resulted in a kappa statistic of 0.77. Test-retest kappa for the main panel was 0.81. Patients considered appropriate candidates for surgery, based on their composite indication scores, showed more improvement in health-related quality of life after 3 months than those considered inappropriately by composite indication scores. The previous parameters tested showed acceptable results for an evaluation tool. These results support the use of this indications algorithm as a screening tool for assessing the appropriateness of hip replacement surgery in osteoarthritis.
Subject(s)
Arthroplasty, Replacement, Hip/statistics & numerical data , Osteoarthritis, Hip/surgery , Practice Guidelines as Topic , Algorithms , Arthroplasty, Replacement, Hip/standards , Decision Trees , Delphi Technique , Humans , Models, Statistical , Quality of Life , Regression Analysis , Reproducibility of Results , Spain/epidemiology , Utilization ReviewABSTRACT
The Basque Country Public Health Service has moved in the last years from considering quality as an attribute of patient care to thinking that all management can be subject to improvement. Consequently, its general management team has promoted and supported a self-assessment experience of all their centres by means of the European Quality Model. This strategy has been facilitated by the Basque Country Government, which has strongly encouraged total quality management in companies, and has created the Basque Foundation for Quality Promotion, a key institution in this whole process. A total of 26 centres of the Public Health Service concluded a self-assessment process. As the main result of this, different improvement areas were detected, and various necessary actions were implemented in the centres assessed. Advantages, troubles and future work lines to extend and improve the use of the EFQM model in the health sector are discussed.
Subject(s)
Management Audit , Models, Organizational , Public Health Administration/standards , Total Quality Management/organization & administration , Health Status Indicators , Humans , Outcome and Process Assessment, Health Care , Program Evaluation , Public Health Administration/economics , Public Health Administration/statistics & numerical data , Self-Assessment , Spain/epidemiology , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To describe patient satisfaction with emergency care of different hospitals. METHODS: patients attended in emergency departments of nine acute hospitals. A patient satisfaction questionnaire was used which includes relevant areas for patients and emergency departments workers 1,940 patients were selected to be surveyed by phone, by previously trained interviewers. RESULTS: 1, 423 patients were interviewed. They reported that mean waiting time until were seeing by the physician ranged from 20 to 60 minutes and total time at the emergency room from 60 to 170 minutes. Interviewees negative ratings for both were of 38% and 36% respectively. Information given about the problem of the patient was negatively rated by 6 to 17%, and about the treatment to follow by 8 to 16% of them. 5% referred not getting information on the latest. Up to 30% of patients said not were clearly informed of the results of the test performed Interpersonal care was positively rated in 55% of cases in some hospitals. Global evaluation gave positive ratings of 58% and negatives of 14%. CONCLUSIONS: This survey detect significant differences among all the centers in the study. Waiting time area showed the greater differences among them. Also the worst qualifications, followed by information to patient. Patient satisfaction questionnaires may work as aid in detecting health care problems.
Subject(s)
Emergency Service, Hospital/statistics & numerical data , Patient Satisfaction/statistics & numerical data , Adult , Female , Humans , Male , Middle Aged , Quality of Health Care/statistics & numerical data , Surveys and QuestionnairesABSTRACT
GOAL: To analyze variation in length of stay in acute hospitals by using a large administrative data base based on CMBD. SUBJECTS AND METHODS: Surgical patients admitted from 93 to 95 in the seven hospital with the largest volume of admissions from the Servicio Vasco de Salud--Osakidetza with a discharge diagnosis of inguinal hernia (IH), benign prostatic hyperplasia (BPH) and total hip joint replacement (THJR). We used data generated by a Patient Management Categories (PMC) data base. We present median length of stay result adjusted by age, sex, type of admission and Risk Intensity Score (RIS). We employed Analysis of Covariance (ANCOVA) for the multivariate analysis including the relevant interaction terms. RESULT: Adjusted median length of stay went from 2 to 6 days for IH patients, from 7 to 18 for BPH patients, from 5 to 18 for THJR patients; depending upon the different hospital and patient attributable considered confounders. By year, we saw a general decrease on length of stay. CONCLUSIONS: We found important differences by hospital though there is a decrease in length of stay in the last years. The administrative data bases, in spite of presenting validity problems, are a cheap and quick way of analyzing certain indicators to help in care management; given their limitations, cautious interpretation of the results is necessary.
