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1.
PLoS One ; 19(6): e0304165, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38913675

RESUMO

BACKGROUND: There is limited understanding of how social determinants of health (SDOH) impact family decision-making when seeking surgical care for children. Our objectives of this study are to identify key family experiences that contribute to decision-making when accessing surgical care for children, to confirm if family experiences impact delays in care, and to describe differences in family experiences across populations (race, ethnicity, socioeconomic status, rurality). METHODS: We will use a prospective, cross-sectional, mixed methods design to examine family experiences during access to care for children with appendicitis. Participants will include 242 parents of consecutive children (0-17 years) with acute appendicitis over a 15-month period at two academic health systems in North Carolina and Virginia. We will collect demographic and clinical data. Parents will be administered the Adult Responses to Children's Symptoms survey (ARCS), the child and parental forms of the Adverse Childhood Experiences (ACE) survey, the Accountable Health Communities Health-Related Social Needs Screening Tool, and Single Item Literacy Screener. Parallel ARCS data will be collected from child participants (8-17 years). We will use nested concurrent, purposive sampling to select a subset of families for semi-structured interviews. Qualitative data will be analyzed using thematic analysis and integrated with quantitative data to identify emerging themes that inform a conceptual model of family-level decision-making during access to surgical care. Multivariate linear regression will be used to determine association between the appendicitis perforation rate and ARCS responses (primary outcome). Secondary outcomes include comparison of health literacy, ACEs, and SDOH, clinical outcomes, and family experiences across populations. DISCUSSION: We expect to identify key family experiences when accessing care for appendicitis which may impact outcomes and differ across populations. Increased understanding of how SDOH and family experiences influence family decision-making may inform novel strategies to mitigate surgical disparities in children.


Assuntos
Apendicite , Tomada de Decisões , Acessibilidade aos Serviços de Saúde , Humanos , Criança , Estudos Transversais , Adolescente , Pré-Escolar , Masculino , Feminino , Apendicite/cirurgia , Lactente , Estudos Prospectivos , Pais/psicologia , Recém-Nascido , Família/psicologia , North Carolina , Virginia
2.
BMJ Qual Saf ; 31(5): 353-363, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34039747

RESUMO

BACKGROUND: Little is known about factors affecting implementation of patient safety programmes in low and middle-income countries. The goal of our study was to evaluate the implementation of a patient safety programme for paediatric care in Guatemala. METHODS: We used a mixed methods design to examine the implementation of a patient safety programme across 11 paediatric units at the Roosevelt Hospital in Guatemala. The safety programme included: (1) tools to measure and foster safety culture, (2) education of patient safety, (3) local leadership engagement, (4) safety event reporting systems, and (5) quality improvement interventions. Key informant staff (n=82) participated in qualitative interviews and quantitative surveys to identify implementation challenges early during programme deployment from May to July 2018, with follow-up focus group discussions in two units 1 year later to identify opportunities for programme modification. Data were analysed using thematic analysis, and integrated using triangulation, complementarity and expansion to identify emerging themes using the Consolidated Framework for Implementation Research. Salience levels were reported according to coding frequency, with valence levels measured to characterise the degree to which each construct impacted implementation. RESULTS: We found several facilitators to safety programme implementation, including high staff receptivity, orientation towards patient-centredness and a desire for protocols. Key barriers included competing clinical demands, lack of knowledge about patient safety, limited governance, human factors and poor organisational incentives. Modifications included use of tools for staff recognition, integration of education into error reporting mechanisms and designation of trained champions to lead unit-based safety interventions. CONCLUSION: Implementation of safety programmes in low-resource settings requires recognition of facilitators such as staff receptivity and patient-centredness as well as barriers such as lack of training in patient safety and poor organisational incentives. Embedding an implementation analysis during programme deployment allows for programme modification to enhance successful implementation.


Assuntos
Segurança do Paciente , Melhoria de Qualidade , Criança , Grupos Focais , Guatemala , Humanos , Pesquisa Qualitativa
3.
PLOS Glob Public Health ; 2(9): e0000220, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36962482

RESUMO

The financing of surgical care for children in low- and middle-income countries (LMICs) remains challenging and may restrict adherence to universal health coverage (UHC) frameworks. Our aims were to describe Guatemala's national pediatric surgical financing structure, to identify financing challenges, and to develop recommendations to improve the financing of surgical care for children. We conducted a qualitative study of the financing of surgical care for children in Guatemala's public health system with key informant interviews (n = 20) with experts in the medical, financial, and political health sectors. We used this data to generate recommendations to improve surgical care financing for children. We identified several systemic challenges to the financing of surgical care for children, including passive purchasing structures, complex political contexts, health system fragmentation, widespread use of informal fees for surgical services, and lack of earmarked funding for surgical care. Patient and provider challenges include lack of provider input in non-personnel funding decisions, and patients functioning as both financing agents and beneficiaries in the same financing stream. Key recommendations include reducing health finance system fragmentation through resource pooling, increasing earmarked funding for surgical care with quantifiable outcome measures, engagement with clinical providers in non-personnel budgetary decision-making, and use of innovative financing instruments such as resource pooling. Surgical financing for children in Guatemala requires substantial remodeling to increase access to timely, affordable, and safe surgical care and improve alignment with Guatemala's UHC scheme.

4.
World J Surg ; 44(7): 2131-2138, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32236730

RESUMO

BACKGROUND: The implementation of programs to improve patient safety remains challenging in low- and middle-income countries. The goal of our study was to define the barriers and facilitators to implementation of a perioperative patient safety program in Guatemala. MATERIAL AND METHODS: We conducted semi-structured interviews with 16 staff pre-intervention and a follow-up focus group discussion 1 year later in the perioperative department at the Roosevelt Hospital in Guatemala. We performed qualitative thematic analysis to identify barriers and facilitators to the implementation process, with analysis guided by the Consolidated Framework for Implementation Research. RESULTS: We found several dominant themes affecting implementation of a patient safety program. Implementation facilitators included strong prioritization of patient needs, program compatibility with existing workflow, and staff attributes. Barriers included a lack of knowledge about patient safety, limited resources, limited leadership engagement, and lack of formal implementation leaders. Several program modifications were made to enhance successful implementation iteratively during the implementation process. DISCUSSION: Our analysis highlights several dominant themes which affect the implementation of a perioperative safety program in Guatemala. Understanding the barriers and facilitators to implementation during program deployment allows for program modification and improvement of the implementation process itself.


Assuntos
Segurança do Paciente , Assistência Perioperatória , Guatemala , Humanos , Liderança , Pesquisa Qualitativa
5.
Pediatr Blood Cancer ; 67(8)2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37132000

RESUMO

Background: Total splenectomy (TS) and partial splenectomy (PS) are used for children with congenital hemolytic anemia (CHA), although the long-term outcomes of these procedures are poorly defined. This report describes long-term outcomes of children with CHA requiring TS or PS. Procedure: We collected data from children ages 2-17 with hereditary spherocytosis (HS) or sickle cell disease (SCD) requiring TS or PS from 1996 to 2016 from 14 sites in the Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium using a prospective, observational patient registry. We summarized hematologic outcomes, clinical outcomes, and adverse events to 5 years after surgery. Hematologic outcomes were compared using mixed effects modeling. Results: Over the study period, 110 children with HS and 97 children with SCD underwent TS or PS. From preoperatively compared to postoperatively, children with HS increased their mean hemoglobin level by 3.4 g/dL, decreased their mean reticulocyte percentage by 6.7%, and decreased their mean bilirubin by 2.4mg/dL. Hematologic improvements and improved clinical outcomes were sustained over 5 years of follow-up. For children with SCD, there was no change in hemoglobin after PS or TS following surgery, although all clinical outcomes were improved. Over 5 years, there was one child with HS and 5 children with SCD who developed post-splenectomy sepsis. Conclusions: For children with HS, there are excellent long-term hematologic and clinical outcomes following either PS or TS. Although hemoglobin levels do not change after TS or PS in SCD, the long-term clinical outcomes for children with SCD are favorable.

6.
Rev Panam Salud Publica ; 43: e64, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31410088

RESUMO

OBJECTIVE: Patient safety is challenging for health systems around the world, particularly in low-and middleincome countries such as Guatemala. The goal of this report is to summarize a strategic planning process for a national patient safety plan in Guatemala. METHODS: This strategic planning process involved multiple stakeholders, including representatives of the Guatemala Ministry of Health and Social Assistance, medical leadership from across the public health system, and academic experts from Guatemala and the United States of America. We used mixed methods (quantitative and qualitative surveys) and a nominal group technique at a national symposium to prioritize patient safety challenges across Guatemala, and subsequent meetings to develop a national patient safety plan. RESULTS: This national patient safety plan outlines four domains to advance patient safety across the public hospital system over a five-year period in Guatemala: leadership and governance, training and awareness, safety culture, and outcome metrics. For each domain, we developed a set of goals, activities, outputs, and benchmarks to be overseen by the Ministry of Health. CONCLUSIONS: With this national patient safety plan, Guatemala has made a long-term commitment to improving patient safety across the public hospital system of Guatemala. Future efforts will require its extension to all levels of the Guatemalan health system.

7.
Artigo em Inglês | PAHO-IRIS | ID: phr-51394

RESUMO

[ABSTRACT]. Objective. Patient safety is challenging for health systems around the world, particularly in low- and middleincome countries such as Guatemala. The goal of this report is to summarize a strategic planning process for a national patient safety plan in Guatemala. Methods. This strategic planning process involved multiple stakeholders, including representatives of the Guatemala Ministry of Health and Social Assistance, medical leadership from across the public health system, and academic experts from Guatemala and the United States of America. We used mixed methods (quantitative and qualitative surveys) and a nominal group technique at a national symposium to prioritize patient safety challenges across Guatemala, and subsequent meetings to develop a national patient safety plan. Results. This national patient safety plan outlines four domains to advance patient safety across the public hospital system over a five-year period in Guatemala: leadership and governance, training and awareness, safety culture, and outcome metrics. For each domain, we developed a set of goals, activities, outputs, and benchmarks to be overseen by the Ministry of Health. Conclusions. With this national patient safety plan, Guatemala has made a long-term commitment to improving patient safety across the public hospital system of Guatemala. Future efforts will require its extension to all levels of the Guatemalan health system.


[RESUMEN]. Objetivo. La seguridad del paciente constituye un reto para los sistemas de salud de todo el mundo, particularmente en los países de ingresos medianos y bajos como Guatemala. El objetivo del presente informe es resumir el proceso de planificación estratégica para elaborar un plan nacional sobre seguridad del paciente en Guatemala. Métodos. En el proceso de planificación estratégica participaron varios interesados directos, entre los cuales se encontraron representantes del Ministerio de Salud Pública y Asistencia Social de Guatemala, autoridades médicas de todo el sistema de salud pública, así como expertos académicos de Guatemala y Estados Unidos de América. Para establecer las prioridades en cuanto a los retos que deben abordarse en Guatemala en materia de seguridad del paciente se utilizó un método mixto (encuestas cuantitativas y cualitativas) y la técnica de grupo nominal en un simposio nacional, y posteriormente se realizaron reuniones para elaborar un plan nacional sobre la seguridad del paciente. Resultados. En el plan nacional sobre la seguridad del paciente se presentan cuatro ámbitos en los cuales se puede impulsar la seguridad del paciente en todos los hospitales públicos de Guatemala en un período de cinco años: liderazgo y gobernanza, capacitación y concientización, cultura de seguridad y métodos para medir los resultados. Se creó un conjunto de metas, actividades, resultados y puntos de referencia para cada ámbito, que estarán bajo la supervisión del Ministerio de Salud. Conclusiones. Con este plan nacional sobre la seguridad del paciente, Guatemala ha adquirido el compromiso a largo plazo de mejorar la seguridad del paciente en los hospitales públicos del país. Las iniciativas que se emprendan en el futuro requerirán que se extienda a todos los niveles del sistema de salud guatemalteco.


[RESUMO]. Objetivo. A segurança do paciente representa um desafio aos sistemas de saúde em todo o mundo, sobretudo nos países de baixa e média renda como a Guatemala. O presente tem o objetivo de descrever sucintamente o processo de planejamento estratégico para um plano nacional de segurança do paciente na Guatemala. Métodos. Este processo de planejamento estratégico contou com a participação de diversos interessados diretos, como representantes do Ministério da Saúde e Assistência Social da Guatemala, autoridades médicas da área de saúde pública e especialistas acadêmicos da Guatemala e dos Estados Unidos. Métodos combinados (pesquisas quantitativas e qualitativas) e técnica de grupo nominal foram usados em um simpósio nacional para priorizar os desafios em segurança do paciente na Guatemala e reuniões subsequentes foram realizadas para elaborar o plano nacional de segurança do paciente. Resultados. No plano nacional de segurança do paciente, são definidos quatro domínios para fazer avançar o processo de segurança do paciente no sistema hospitalar público em um período de cinco anos: liderança e governança; capacitação e conscientização; cultura de segurança e métricas para mensuração dos resultados. Um conjunto de metas, atividades, resultados e parâmetros de referência foi elaborado para cada domínio, a ser supervisado pelo Ministério da Saúde. Conclusões. Com este plano nacional de segurança do paciente, a Guatemala assumiu um compromisso de longo prazo de melhorar a segurança do paciente no sistema hospitalar público. Esforços devem ser empreendidos para expandir o plano a todos os níveis do sistema de saúde da Guatemala.


Assuntos
Garantia da Qualidade dos Cuidados de Saúde , Segurança do Paciente , Erros Médicos , Planejamento em Saúde , Guatemala , Segurança do Paciente , Erros Médicos , Erros Médicos , Garantia da Qualidade dos Cuidados de Saúde , Planejamento em Saúde , Garantia da Qualidade dos Cuidados de Saúde , Segurança do Paciente , Planejamento em Saúde
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