ABSTRACT
OBJECTIVE: The purpose of this review was to identify quality indicators described in the literature that may be used as quality measures in hospital physical therapy units. METHODS: The following sources were searched for quality indicators or articles: Web of Science, MEDLINE, IBECS, Latin American and Caribbean Health Sciences Literature, Cumulative Index of Nursing and Allied Health, Academic Search Complete, SportDiscus, SciELO, PsychINFO, Consejo Superior de Investigaciones Cientificas, and Scopus databases; the Agency for Healthcare Research and Quality, National Health System Indicator Portal, Joint Commission on Accreditation of Healthcare Organizations, and Organisation for Economic Co-operation and Development websites; and the National Quality Forum's measures inventory tool. Search terms included "quality indicator," "quality measure," "physiotherapy," and "physical therapy." Inclusion criteria were articles written in English, Spanish, French, or Portuguese aimed at measuring the quality of care in hospital physical therapy units. Evidence-based indicators with an explicit formula were extracted by 2 independent reviewers and then classified using the structure-process-outcome model, quality domain, and categories defined by a consensus method. RESULTS: Of the 176 articles identified, only 19 met the criteria. From these articles and from the indicator repository searches, 178 clinical care indicators were included in the qualitative synthesis and presented in this paper. Process and outcome measures were prevalent, and 5 out of the 6 quality domains were represented. No efficiency measures were identified. Moreover, structure indicators, equity and accessibility indicators, and indicators in the cardiovascular and circulatory, mental health, pediatrics, and intensive care categories were underrepresented. CONCLUSIONS: A broad selection of quality indicators was identified from international resources, which can be used to measure the quality of physical therapy care in hospital units. IMPACT: This review identified 178 quality of care indicators that can be used in clinical practice monitoring and quality improvement of hospital physical therapy units. The results highlight a lack of accessibility, equity, and efficiency measures for physical therapy units.
Subject(s)
Hospital Units/standards , Physical Therapy Modalities/standards , Quality Indicators, Health Care , Humans , Quality ImprovementABSTRACT
OBJECTIVE: To develop risk-adjusted models for two quality indicators addressing surgical site infection (SSI) in clean and colorectal surgery, to be used for benchmarking and quality improvement in the Spanish National Health System. STUDY DESIGN: A literature review was undertaken to identify candidate adjustment variables. The candidate variables were revised by clinical experts to confirm their clinical relevance to SSI; experts also offered additional candidate variables that were not identified in the literature review. Two risk-adjustment models were developed using multiple logistic regression thus allowing calculation of the adjusted indicator rates. DATA SOURCE: The two SSI indicators, with their corresponding risk-adjustment models, were calculated from administrative databases obtained from nine public hospitals. A dataset was obtained from a 10-year period (2006-2015), and it included data from 21 571 clean surgery patients and 6325 colorectal surgery patients. ANALYSIS METHODS: Risk-adjustment regression models were constructed using Spanish National Health System data. Models were analysed so as to prevent overfitting, then tested for calibration and discrimination and finally bootstrapped. RESULTS: Ten adjustment variables were identified for clean surgery SSI, and 23 for colorectal surgery SSI. The final adjustment models showed fair calibration (Hosmer-Lemeshow: clean surgery χ2 = 6.56, P = 0.58; colorectal surgery χ2 = 6.69, P = 0.57) and discrimination (area under receiver operating characteristic [ROC] curve: clean surgery 0.72, 95% confidence interval [CI] 0.67-0.77; colorectal surgery 0.62, 95% CI 0.60-0.65). CONCLUSIONS: The proposed risk-adjustment models can be used to explain patient-based differences among healthcare providers. They can be used to adjust the two proposed SSI indicators.
Subject(s)
Colorectal Surgery , Surgical Wound Infection , Colorectal Surgery/adverse effects , Humans , Logistic Models , Retrospective Studies , Risk Adjustment , Risk Factors , Surgical Wound Infection/epidemiologyABSTRACT
OBJECTIVE: Develop and pilot indicators of quality of care to neonates with relevant conditions in Mexico (prematurity, neonatal sepsis, perinatal asphyxia, and intrauterine hypoxia). MATERIALS AND METHODS: Own indicators were built based on key recommendations of national clinical practice guidelines and indicators found in international repositories. With previous search, selection and prioritization, the indicators were piloted within two hospitals. The feasibility of measuring, (kappa index) reliability and usefulness was analyzed to detect quality problems. RESULTS: 23 indicators were selected and piloted, 12 are compounds, of the total, nine were feasible and reliable. The quality of the hospital's information was diverse and often poor, limiting both the feasibility and the reliability of the indicators. Improvement opportunities were identified thorough the compliance levels. CONCLUSIONS: A set of nine indicators valid, reliable, feasible and useful indicators is proposed in order to monitor the quality of care of pathological neonates.
OBJETIVO: Desarrollar y pilotar indicadores de calidad de la atención a neonatos con padecimientos relevantes en México (prematuridad, sepsis neonatal, asfixia perinatal e hipoxia intrauterina). MATERIAL Y MÉTODOS: Se construyeron indicadores propios a partir de recomendaciones clave de las guías de práctica clínica nacionales e indicadores encontrados en repositorios internacionales. Previa búsqueda, selección y priorización, los indicadores fueron pilotados en dos hospitales. Se analizó la factibilidad de medición, fiabilidad (índice kappa) y utilidad para detectar problemas de calidad. RESULTADOS: Se seleccionaron y pilotaron 23 indicadores; 12 eran compuestos. Del total, nueve fueron factibles y fiables. La calidad de la información en los hospitales fue diversa y frecuentemente deficiente, limitando tanto la factibilidad como la fiabilidad de los indicadores. Los niveles de cumplimiento identificaron oportunidades de mejora. CONCLUSIONES: Se propone un set de nueve indicadores válidos, factibles, fiables y útiles para la monitorización de la calidad en la atención a neonatos patológicos.
Subject(s)
Asphyxia Neonatorum/epidemiology , Fetal Hypoxia/epidemiology , Neonatal Sepsis/epidemiology , Quality Indicators, Health Care , Data Accuracy , Female , Humans , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/epidemiology , Male , Mexico/epidemiology , Pilot Projects , Practice Guidelines as Topic , Quality Improvement , Quality of Health Care , Reproducibility of ResultsABSTRACT
Resumen: Objetivo: Desarrollar y pilotar indicadores de calidad de la atención a neonatos con padecimientos relevantes en México (prematuridad, sepsis neonatal, asfixia perinatal e hipoxia intrauterina). Material y métodos: Se construyeron indicadores propios a partir de recomendaciones clave de las guías de práctica clínica nacionales e indicadores encontrados en repositorios internacionales. Previa búsqueda, selección y priorización, los indicadores fueron pilotados en dos hospitales. Se analizó la factibilidad de medición, fiabilidad (índice kappa) y utilidad para detectar problemas de calidad. Resultados: Se seleccionaron y pilotaron 23 indicadores; 12 eran compuestos. Del total, nueve fueron factibles y fiables. La calidad de la información en los hospitales fue diversa y frecuentemente deficiente, limitando tanto la factibilidad como la fiabilidad de los indicadores. Los niveles de cumplimiento identificaron oportunidades de mejora. Conclusiones: Se propone un set de nueve indicadores válidos, factibles, fiables y útiles para la monitorización de la calidad en la atención a neonatos patológicos.
Abstract Objective: Develop and pilot indicators of quality of care to neonates with relevant conditions in Mexico (prematurity, neonatal sepsis, perinatal asphyxia, and intrauterine hypoxia). Materials and methods: Own indicators were built based on key recommendations of national clinical practice guidelines and indicators found in international repositories. With previous search, selection and prioritization, the indicators were piloted within two hospitals. The feasibility of measuring, (kappa index) reliability and usefulness was analyzed to detect quality problems. Results: 23 indicators were selected and piloted, 12 are compounds, of the total, nine were feasible and reliable. The quality of the hospital's information was diverse and often poor, limiting both the feasibility and the reliability of the indicators. Improvement opportunities were identified thorough the compliance levels. Conclusions: A set of nine indicators valid, reliable, feasible and useful indicators is proposed in order to monitor the quality of care of pathological neonates.
Subject(s)
Humans , Male , Female , Infant, Newborn , Asphyxia Neonatorum/epidemiology , Quality Indicators, Health Care , Fetal Hypoxia/epidemiology , Neonatal Sepsis/epidemiology , Quality of Health Care , Infant, Premature , Pilot Projects , Reproducibility of Results , Practice Guidelines as Topic , Quality Improvement , Data Accuracy , Infant, Premature, Diseases/epidemiology , Mexico/epidemiologyABSTRACT
OBJECTIVES: This study was designed to address the current relative void of valid measures by developing evidence-based quality indicators for pain management of chronic nonmalignant pain. METHODS: We performed a 10-year literature search to identify guidelines and review articles on chronic pain management to identify evidence-based recommendations for the different conditions associated to chronic pain. A complementary search of indicators and indicator-related articles was also performed. Then, we built new indicators or adapted existing ones to cover all the evidence-based recommendations we found. The resulting set was pilot tested for feasibility, reliability (kappa), and usefulness to identify quality problems, using the Lot Quality Acceptance method (α ≤ 0.05 and ß ≤ 0.01) for 75% (40% threshold) and 95% (70% threshold) compliance standards, and estimates with binomial exact 95% confidence intervals. We reviewed clinical records from a primary care center, a medium-size hospital (250 beds), and a large hospital (500 beds). RESULTS: Forty-six indicators were developed (6 general and 40 condition specific). Thirty-three were feasible in primary care and/or hospitals. Feasible indicators were also reliable (most kappa > 0.7). Regarding compliance, 4 quality indicators obtained compliance levels over 60%, addressing pharmacological treatment, multimodal approach, and appropriate use of neuro-image tests, while 16 obtained compliance scores under 15% (6 with 0% compliance). CONCLUSIONS: The created set has tested to be feasible, reliable, and useful, with the capacity to serve as the baseline for developing the necessary strategies to improve the management of chronic nonmalignant pain, by monitoring and evaluating quality of care.
Subject(s)
Chronic Pain/therapy , Pain Management/methods , Quality Indicators, Health Care , Evidence-Based Medicine , Female , Humans , Pilot Projects , Reproducibility of ResultsABSTRACT
INTRODUCCIÓN: En la actualidad no se dispone de un conjunto adecuado de indicadores para benchmarking en las unidades de cirugía general del Sistema Nacional de Salud. Este trabajo presenta la selección, el desarrollo y los resultados del estudio piloto de un primer grupo de indicadores para esta finalidad. MÉTODOS: Se realizó una selección y priorización de indicadores mediante un Delphi modificado con un grupo de expertos de la Asociación Española de Cirujanos. Los indicadores priorizados fueron sometidos a un estudio cualitativo de factibilidad y, para aquellos medidos por historia clínica, cuali-cuantitativo de fiabilidad en un hospital público. Se obtuvieron resultados de concordancia simple y estadístico kappa, ajustado y no ajustado por prevalencias y sesgos, para 3 evaluadores con un muestreo aleatorio sistemático de 30 casos por indicador. RESULTADOS: De los 13 indicadores propuestos, 12 resultaron factibles (5 de historia clínica y 7 de bases de datos). De los 5 de historia, 3 resultaron fiables (concordancia interobservador > 95% o índice kappa > 0,6 para compuestos y subindicadores, o bien kappa ajustado por prevalencias y sesgos > 0,6 en presencia de prevalencias extremas) y 2 necesitaron ser redefinidos a partir de los resultados obtenidos. CONCLUSIONES: Los 5 indicadores de historia clínica podrán utilizarse para comparar unidades quirúrgicas, mientras que los 7 indicadores factibles de bases de datos necesitarán mayor validación y ajuste de riesgo para permitir comparaciones entre servicios. Los resultados del centro evaluado muestran áreas de mejora en algunos procesos de la atención
INTRODUCTION:At present there is a lack of appropriate quality measures for benchmarking in general surgery units of Spanish National Health System. The aim of this study is to present the selection, development and pilot-testing of an initial set of surgical quality indicators for this purpose. METHODS: A modified Delphi was performed with experts from the Spanish Surgeons Association in order to prioritize previously selected indicators. Then, a pilot study was carried out in a public hospital encompassing qualitative analysis of feasibility for prioritized indicators and an additional qualitative and quantitative three-rater reliability assessment for medical record-based indicators. Observed inter-rater agreement, prevalence adjusted and bias adjusted kappa and non-adjusted kappa were performed, using a systematic random sample (n = 30) for each of these indicators. RESULTS: Twelve out of 13 proposed indicators were feasible: 5 medical record-based indicators and 7 indicators based on administrative databases. From medical record-based indicators, 3 were reliable (observed agreement > 95%, adjusted kappa index > 0.6 or non adjusted kappa index > 0.6 for composites and its components) and 2 needed further refinement. CONCLUSIONS: Currently, medical record-based indicators could be used for comparison purposes, whilst further research must be done for validation and risk-adjustment of outcome indicators from administrative databases. Compliance results in the adequacy of informed consent, diagnosis-to-treatment delay in colorectal cancer, and antibiotic prophylaxis show room for improvement in the pilot-tested hospital
Subject(s)
Humans , Benchmarking/methods , Quality Indicators, Health Care , Surgery Department, Hospital/organization & administration , Hospital Information Systems/organization & administration , General Surgery/organization & administration , Biomedical Enhancement/methods , Quality Improvement/organization & administrationABSTRACT
INTRODUCTION: At present there is a lack of appropriate quality measures for benchmarking in general surgery units of Spanish National Health System. The aim of this study is to present the selection, development and pilot-testing of an initial set of surgical quality indicators for this purpose. METHODS: A modified Delphi was performed with experts from the Spanish Surgeons Association in order to prioritize previously selected indicators. Then, a pilot study was carried out in a public hospital encompassing qualitative analysis of feasibility for prioritized indicators and an additional qualitative and quantitative three-rater reliability assessment for medical record-based indicators. Observed inter-rater agreement, prevalence adjusted and bias adjusted kappa and non-adjusted kappa were performed, using a systematic random sample (n=30) for each of these indicators. RESULTS: Twelve out of 13 proposed indicators were feasible: 5 medical record-based indicators and 7 indicators based on administrative databases. From medical record-based indicators, 3 were reliable (observed agreement >95%, adjusted kappa index >0.6 or non-adjusted kappa index >0.6 for composites and its components) and 2 needed further refinement. CONCLUSIONS: Currently, medical record-based indicators could be used for comparison purposes, whilst further research must be done for validation and risk-adjustment of outcome indicators from administrative databases. Compliance results in the adequacy of informed consent, diagnosis-to-treatment delay in colorectal cancer, and antibiotic prophylaxis show room for improvement in the pilot-tested hospital.
Subject(s)
Benchmarking , General Surgery/standards , Quality Indicators, Health Care , Surgical Procedures, Operative/standards , Humans , Pilot Projects , Retrospective StudiesABSTRACT
Objetivos. Se han hecho esfuerzos en estandarizar una práctica basada en la evidencia, pero las guías de práctica clínica no siempre siguen métodos rigurosos de desarrollo. El objetivo de esta revisión es identificar las guías actuales, analizar la variabilidad de sus recomendaciones y hacer una síntesis para su uso clínico. Material y método. Se realizó una búsqueda sistemática de guías de práctica clínica en las bases de datos electrónicas y bases de guías; con los términos: «fibromyalgia» AND [«guideline» OR «Clinical Practice guideline»], desde enero de 2003 a julio de 2013. Se seleccionaron las guías según los siguientes criterios: a) dirigidas al tratamiento de la fibromialgia en población adulta, b) basadas en evidencia científica, buscada de forma sistemática, c) incluyen niveles de evidencia y fuerza de recomendación, d) escritas en inglés o español. Resultados. De los 249 resultados, 6 guías cumplieron con los criterios de inclusión. Las guías analizadas en esta revisión muestran gran variabilidad tanto en presencia como en nivel de evidencia y fuerza de recomendación de muchos tratamientos. El ejercicio físico y la terapia cognitivo-conductual son las terapias de primera elección, con alto nivel de evidencia. La amitriptilina, usada por periodos cortos para controlar el dolor, es el tratamiento farmacológico con evidencia más sólida. El abordaje multimodal reporta mejores resultados que la aplicación aislada de cualquier tratamiento. Conclusiones. Las recomendaciones finales identifican los tratamientos óptimos, facilitando la translación de la evidencia a la práctica y permitiendo mayor eficiencia y efectividad en una actividad asistencial de calidad (AU)
Objectives. Efforts have been made to standardise evidence-based practice, but clinical practice guidelines do not always follow strict development methods. The objective of this review is to identify the current guidelines, analyse the variability of its recommendations and make a synthesis for clinical practice. Material and methods. A systematic review of clinical practice guidelines was made in electronic databases and guidelines databases; using 'fibromyalgia' AND ['guideline' OR 'Clinical Practice guideline'] as terms, from January for 2003 to July of 2013. Guidelines were selected according to the following criteria: a) aimed to fibromyalgia treatment in adults; b) based on scientific evidence, systematically searched; c) evidence levels and strength of recommendation included; d) written in English or Spanish. Results. From 249 initial results, six guides fulfilled the inclusion criteria. Clinical practice guidelines analysed in this review show great variability both in the presence and level of evidence and in the strength of recommendation of many treatments. Physical exercise and cognitive-behavioural therapy are first-line treatments, showing high level of evidence. Amitriptyline, used for short periods of time for pain control, is the pharmacologic treatment with the most solid evidence. The multimodal approach reported better results than the isolated application of any treatment. Conclusions. Final recommendations in this review identify optimal treatments, facilitating the translation of evidence into practice and enabling more efficient and effective quality care (AU)
Subject(s)
Humans , Male , Female , Fibromyalgia/epidemiology , Fibromyalgia/prevention & control , Evidence-Based Practice/methods , Evidence-Based Practice/organization & administration , Evidence-Based Practice/standards , Chronic Pain/epidemiology , Chronic Pain/prevention & control , Chronic Pain/therapy , Exercise/physiology , Exercise/psychology , Cognitive Behavioral Therapy/methods , Cognitive Behavioral Therapy/trends , Combined Modality Therapy/instrumentation , Combined Modality Therapy/methods , Evaluation of the Efficacy-Effectiveness of Interventions , Practice Guidelines as TopicABSTRACT
OBJECTIVES: Efforts have been made to standardise evidence-based practice, but clinical practice guidelines do not always follow strict development methods. The objective of this review is to identify the current guidelines, analyse the variability of its recommendations and make a synthesis for clinical practice. MATERIAL AND METHODS: A systematic review of clinical practice guidelines was made in electronic databases and guidelines databases; using "fibromyalgia" AND ["guideline" OR "Clinical Practice guideline"] as terms, from January for 2003 to July of 2013. Guidelines were selected according to the following criteria: a) aimed to fibromyalgia treatment in adults; b) based on scientific evidence, systematically searched; c) evidence levels and strength of recommendation included; d) written in English or Spanish. RESULTS: From 249 initial results, six guides fulfilled the inclusion criteria. Clinical practice guidelines analysed in this review show great variability both in the presence and level of evidence and in the strength of recommendation of many treatments. Physical exercise and cognitive-behavioural therapy are first-line treatments, showing high level of evidence. Amitriptyline, used for short periods of time for pain control, is the pharmacologic treatment with the most solid evidence. The multimodal approach reported better results than the isolated application of any treatment. CONCLUSIONS: Final recommendations in this review identify optimal treatments, facilitating the translation of evidence into practice and enabling more efficient and effective quality care.
