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The quality of private and public primary health care management of children with diarrhoea and acute respiratory infections in Tlaxcala, Mexico

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HEALTH POLICY AND PLANNING 1998年第3期13卷 323-331页

作者： Bojalil, R Guiscafré, H Espinosa, P Martínez, H Palafox, M Romero, G Gutiérrez, G Cerro Macuiltepec 404 Col Campestre Churubusco Mexico City 04200 DF Mexico

In Tlaxcala, Mexico, 80% of the children who died from diarrhoea or acute respiratory infections (ARI) in 1992-1993 received medical care;in more than 70% of cases it was provided by a private general practitioner (GP). The present study evaluated the quality of case management by private and public GPs to children under Five years of age with diarrhoea and ARI. During the clinical observation, the treatment and counselling given to the mother were assessed with the WHO guidelines as reference standard. A total of 41 private and 40 public GPs were evaluated for the management of diarrhoea, and 59 private and 40 public GPs for the management of ARI. For diarrhoea, half of the private GPs gave inadequate rehydration therapy, 63% gave incorrect advice on diet, 66% and 49% made an incorrect decision in the prescription of antimicrobial and symptomatic drugs, respectively. Public GPs generally performed better in diarrhoea management: 7% gave inadequate rehydration therapy, 13% gave wrong advice on diet, 3% made a wrong decision in the prescription of symptomatic drugs and 28% gave a wrong decision in antimicrobial prescription. In the management of ARI, 66% and 58% of private GPs made a wrong decision in the prescription of antimicrobial and symptomatic drugs, respectively, compared to 30% and 20% of public GPs, respectively. Counselling to the mother given by both private and public GPs was considered inadequate in most cases of diarrhoea and ARI. These results clearly show that private doctors, as important providers of medical care, need to be included in the strategies to improve the quality of care of children with diarrhoea and ARI. Future research needs to address the determinants of the clinical practice of private doctors in countries like Mexico.

关键词：儿童保健服务/标准腹泻/死亡率腹泻/治疗家庭医学/标准家庭医学/统计学和数值数据墨西哥/流行病学私人开业/标准私人开业/统计学和数值数据公共卫生管理/标准公共卫生管理/统计学和数值数据卫生保健质量/统计学和数值数据呼吸道感染/死亡率呼吸道感染/治疗儿童儿童学龄前人类婴儿婴儿新生

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Quality of care for patients hospitalized with heart failure at academic medical centers

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AMERICAN HEART JOURNAL 1999年第6期137卷 1028-1034页

作者： Nohria, A Chen, YT Morton, DJ Walsh, R Vlasses, PH Krumholz, HM Yale Univ Sch Med Yale New Haven Hosp Ctr Outcomes Res & EvaluatSect Cardiovasc Med New Haven CT USA Yale Univ Sch Med Yale New Haven Hosp Ctr Outcomes Res & EvaluatDept Med New Haven CT USA Qualidigm Middletown CT USA Univ Healthsyst Chicago IL USA

Background The purpose of this study was to determine the standard of care provided by academic medical centers For the management of congestive heart failure (CHF). Methods and Results The standard of care was estimated by assessing adherence to the treatment guidelines published by the US Agency for Health Care Policy and Research among 522 patients hospitalized at 7 university hospitals with a diagnosis of CHF. Data were abstracted by retrospective chart review. Of the 522 patients analyzed, 435 (83%) had a left ventricular ejection fraction (LVEF) measured or documented. Among these patients, 192 were considered "ideal" candidates for angiotensin-converting enzyme (ACE) inhibitor therapy tie, with systolic dysfunction [LVEF <40%] and no contraindications to ACE inhibitors). In this cohort of "ideal" candidates, 138 (72%) were receiving ACE inhibitors at hospital discharge, including 60 (44%) who were prescribed doses recommended in large clinical trials. Compliance with patient education guidelines was assessed in all 487 patients who were alive at the time of discharge. Of these patients, 365 (75%) received dietary counseling, 404 (83%) were educated about exercise, 54 (11%) were instructed to follow daily weights, and 468 (96%) were counseled regarding medication compliance. Among the 87 smokers who were alive at time of discharge, 8 (9%) had documented advice to quit smoking. Conclusions This study indicates that academic medical centers performed fairly well on the assessment of LVEF, the prescription of ACE inhibitors at discharge, and on education regarding diet, exercise, and compliance with medications. However, the results suggest opportunities for improvement in ACE inhibitor dosing and patient education regarding the importance of monitoring daily weights and smoking cessation.

关键词：医学科学研究中心/标准医学科学研究中心/统计学和数值数据血管紧张素转换酶抑制药/治疗应用心脏病学科医院/标准心脏病学科医院/统计学和数值数据数据收集/方法住院/统计学和数值数据 Logistic模型质量指标卫生保健卫生保健质量/标准卫生保健质量/统计学和数值数据美国老年人老年人 80以上女(雌)性人类男(雄)性中年人

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How well does chart abstraction measure quality? A prospective comparison of standardized patients with the medical record

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AMERICAN JOURNAL OF MEDICINE 2000年第8期108卷 642-649页

作者： Luck, J Peabody, JW Dresselhaus, TR Lee, M Glassman, P Inst Global Hlth San Francisco Vet Affairs Med Ctr San Francisco CA 94105 USA Vet Affairs Greater Los Angeles Healthcare Syst Los Angeles CA USA Vet Affairs Ctr Study Hlth Care Provider Behav Sepulveda CA USA Univ Calif San Diego Sch Med San Diego CA 92103 USA San Diego Vet Affairs Med Ctr San Diego CA USA Univ Calif San Francisco San Francisco CA 94143 USA Univ Calif Los Angeles Sch Med Los Angeles CA USA Univ Calif Los Angeles Sch Publ Hlth Los Angeles CA 90024 USA RAND Santa Monica CA USA Inst Global Hlth San Francisco CA USA

PURPOSE: Despite widespread reliance on chart abstraction for quality measurement, concerns persist about its reliability and validity. We prospectively evaluated the validity of chart abstraction by directly comparing it with the gold standard of reports by standardized patients. SUBJECTS AND METHODS: Twenty randomly selected general internal medicine residents and attending faculty physicians at the primary care clinics of two Veterans Affairs Medical Centers blindly evaluated and treated actor-patients (standardized patients) who had one of four common diseases: diabetes, chronic obstructive pulmonary disease, coronary artery disease, or low back pain. Charts from the visits were abstracted using explicit quality criteria;standardized patients completed a checklist containing the same criteria. For each physician, quality was measured for two different cases of the four conditions (a total of 160 physician-patient encounters). We compared chart abstraction with standardized;patient reports for four aspects of the encounter: taking the history, examining the patient, making the diagnosis, and prescribing appropriate treat-ment. The sensitivity and specificity of chart abstraction were calculated. RESULTS: The mean (+/- SD) chart abstraction score was 54% +/- 9%, substantially less than the mean score on the standardized-patient checklist of 68% +/- 9% (P <0.001). This finding was similar for all four conditions and at both sites. "False positives"- chart-recorded necessary care actions not reported by the standardized patients-resulted in a specificity of only 81%. The overall sensitivity of chart abstraction for necessary care was only 70%. CONCLUSIONS: Chart abstraction underestimates the quality of care for common outpatient general medical conditions when compared with standardized-patient reports. The medical record is neither sensitive nor specific. Quality measurements derived from chart abstraction may have important shortcomings, particularly as the basis

关键词：门诊医疗/标准规范/方法加利福尼亚全体教工医学院校/标准内科学/标准实习医师和住院医师职务/标准病案/统计学和数值数据结果与过程评价(卫生保健)/方法病人模拟初级卫生保健/标准前瞻性研究卫生保健质量/统计学和数值数据可重复性结果人类

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Effect of a drug supply and cost sharing system on prescribing and utilization: A controlled trial from Nepal

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HEALTH POLICY AND PLANNING 1995年第4期10卷 423-430页

作者： Chalker, J SAVE CHILDREN FUND HANOIVIETNAM

The effect on prescribing habits of a drug supply and cost sharing system was studied in a hill district in Nepal. In this district the inadequate yearly supply of drugs from the government was supplemented by an extra supply from the project. Drugs were sold at a fixed prescription charge which covered all drugs for one episode of illness. The prescribing pattern in this district was compared to a control district with only the yearly government drug supply and no drug scheme. Drugs prescribed were also compared to theoretical needs based on the recorded diagnoses of the same patients and recommended treatment guidelines. Attendance figures were studied before and after the introduction of the drug scheme in the test district. A 25% sample of prescriptions was taken from all health posts in both districts, over a one year period. This was in total 11 772 prescriptions from 22 health posts. The results show that in the drug scheme district health workers prescribed essential drugs excessively. However, the doses that were prescribed were somewhat better than in the control district. Utilization of health facilities dropped by 18% in the drug scheme district and then increased in the second year. A supply of essential drugs does not necessarily improve the quality of care, or increase attendance levels. The WHO indicators designed to assess the quality of drug use at health facilities can give a misleading picture, as they do not include information on dosages. The effect on quality of care of supply and financing mechanisms needs further study.

关键词：费用分担发展中国家药物利用评审/经济学药物利用评审/标准药物利用评审/统计学和数值数据费用药物/统计学和数值数据卫生服务滥用尼泊尔药用制剂/经济学药用制剂/供应和分配医师诊疗模式/统计学和数值数据卫生保健质量/统计学和数值数据回顾性研究世界卫生组织青少年成年人儿童学龄前人类婴儿婴儿新生

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DEATH CONCERN AND ATTITUDES TOWARD THE ELDERLY IN NURSING-HOME PERSONNEL

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DEATH STUDIES 1992年第6期16卷 537-555页

作者： DEPAOLA, SJ NEIMEYER, RA LUPFER, MB FIEDLER, J MEMPHIS STATE UNIV DEPT PSYCHOLMEMPHISTN 38152 USA

The present project investigated the relationship between death fear and threat, attitudes toward the elderly, and personal anxiety toward one's own aging in a group of 145 nursing home employees and a matched comparison group of 130 individuals who worked in non-death related occupations. Contrary to predictions, nursing home personnel did not have higher levels of death threat when compared to controls;in fact, control group subjects had higher levels of death concern on two dimensions of death fear (fear of the dead and fear of significant others dying). However, the results also indicated that increasing levels of death concern were associated with greater anxiety toward aging, especially in the nursing home sample, and nursing personnel displayed significantly fewer positive attitudes toward the elderly than did controls.

关键词：年龄因素焦虑/心理学对死亡的态度队列研究多元分析护士病人关系医护疗养所/人力医护疗养所/统计学和数值数据护理研究护理人员/心理学护理人员/统计学和数值数据卫生保健质量/统计学和数值数据问卷调查田纳西成年人老年人女(雌)性人类男(雄)性

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Patient satisfaction with quality of care in a hospital system in Qatar.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1999年第1期21卷 28-29,32-36,41页

作者： McGivern, S.A. CIGNA Healthcare Seattle WA United States

This article presents the results of a patient satisfaction survey carried out in an acute care hospital complex in Doha, Qatar, in the Middle East. The objectives were to determine the level of patient satisfaction as follows: in general, in 18 different patient areas and services, for Qatar citizens and noncitizens, among patients with different sociodemographic characteristics, and in technical and interpersonal areas of care. The quantitative, descriptive survey design involved two 73-item questionnaires, one in English and one in Arabic. It was given to medical, surgical, and obstetric and gynecologic patients. Satisfaction was rated on a 5-point scale, and univariate statistics and chi-square analysis were used to determine frequencies and statistical differences. The response rate was 77%;84% rated the overall quality of care excellent or very good. Respondents gave nursing services the highest ratings and slightly favored technical over interpersonal care. The results show that patients are willing to participate in the survey process and that the questionnaire is a valuable tool for measuring satisfaction and for obtaining feedback and continuous evaluation of services.

关键词：规范反馈卫生保健调查卫生服务研究医院公立/标准医院公立/统计学和数值数据病人满意度/统计学和数值数据卡塔尔质量指标卫生保健卫生保健质量/分类卫生保健质量/统计学和数值数据问卷调查社会经济因素成年人人类

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THE IMPACT OF PHYSICIAN CHARACTERISTICS IN CONDITIONAL CHOICE MODELS FOR HOSPITAL-CARE

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JOURNAL OF HEALTH ECONOMICS 1992年第1期11卷 43-62页

作者： BURNS, LR WHOLEY, DR UNIV ARIZONA COLL BUSINESS & PUBL ADMSCH PUBL ADMTUCSONAZ 85721 CARNEGIE MELLON UNIV DEPT SOCIAL & DECIS SCIPITTSBURGHPA 15213

Recent research has investigated the determinants of the specific hospitals to which patients are admitted. Data limitations have led researchers to examine the effects of patient and hospital characteristics while ignoring the role of physician characteristics. In this study we analyze the effects of all three sets of factors on hospital choice in the greater Phoenix area during 1989. Our results suggest that physician characteristics are strong determinants of hospital choice, accounting for much of the explained variation. Differences in hospital quality and cost, on the other hand, exert significant effects on hospital choice but explain relatively little variation.

关键词：亚利桑那卫生服务范围/统计学和数值数据选择行为诊断相关患者组/统计学和数值数据费用和收费/统计学和数值数据卫生服务研究/方法医院死亡率医院/分类医院/统计学和数值数据医院/利用模型统计学医师/分类医师/统计学和数值数据医师/利用专业场所/统计学和数值数据卫生保健质量/统计学和数值数据回归分析运输人类

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Human resources management practices and patient satisfaction in home health care

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Home Health Care Services Quarterly 1994年第1期15卷 43-56页

作者： Dansky, Kathryn H. Brannon, Diane Wangsness, Sally Department of Health Policy and Administration The Pennsylvania State University University Park Pennsylvania PA 16802 United States The Pennsylvania State University University Park PA 16802 United States

Patient satisfaction is an important issue for home health providers. This study tested the influence of organizational factors, particularly human resource management practices, on quality of care, as measured by patient satisfaction. Six hundred ninety-six patients of thirteen home health agencies were surveyed to test the influence of organizational factors on five dimensions of patient satisfaction. Organizational variables included size of the agency, staffing characteristics, educational preparation of RNs, continuing education, and compensation. We found that full-time staffing, the number of BSN-prepared RNs, and percent of budget allocated to benefits all predicted high patient satisfaction scores. © 1994 Taylor & Francis Group, LLC.

关键词：数据收集家庭保健机构/组织和管理俄亥俄病人满意度/统计学和数值数据宾夕法尼亚人员管理/标准人员配备和时间安排/标准人员配备和时间安排/统计学和数值数据卫生保健质量/标准卫生保健质量/统计学和数值数据薪金和附加福利/统计学和数值数据人员开发/标准人员开发/统计学和数值数据

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Satisfaction with Medical Care among Elderly People in Fee-for-Service Care and an HMO

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Journal of Aging and Health 1992年第2期4卷 282-302页

作者： Kasper, Judith D. Riley, Gerald Johns Hopkins School of Hygiene and Public Health United States Health Care Financing Administration United States

This study investigates satisfaction with care among elderly Medicare beneficiaries enrolled in a health maintenance organization (HMO) and beneficiaries in fee-for-service (FFS) care in the same geographic area. Satisfaction with two dimensions of care, access/quality and costs, are examined, to investigate differences in enrollee/FFS evaluation of these dimensions of care as well as predictors of satisfaction with care. In addition, satisfaction among healthy and chronically ill elderly people in these two care settings is explored. Results indicate higher satisfaction with access/quality of care among those in FFS and higher satisfaction with costs among HMO enrollees. These relationships hold controlling for other variables and among the chronically ill elderly. Sources of variation in satisfaction are somewhat different among the HMO and FFS elderly. Satisfaction with paperwork and ease of getting to care, however, influences satisfaction with other aspects of care in both populations. © 1992, Sage Publications. All rights reserved.

关键词：数据收集评价研究费用医疗/标准健康维护组织/经济学健康维护组织/标准健康维护组织/利用卫生服务易得程度/标准卫生服务易得程度/统计学和数值数据马萨诸塞 MedicareB部/组织和管理病人满意度/经济学病人满意度/统计学和数值数据试点项目卫生保健质量/标准卫生保健质量/统计学和数值数据回归分析社会经济因素美国老年人女(雌)性人类

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The interactive effects of race and ethnicity and mother's residence on the adequacy of prenatal care

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JOURNAL OF RURAL HEALTH 1996年第1期12卷 6-18页

作者： Miller, MK Clarke, LL Albrecht, SL Farmer, FL UNIV FLORIDA HLTH SCI CTRINST HLTH POLICY RESPOB 100177GAINESVILLEFL 32610 USA

Adequate prenatal care is known to reduce the risks of low birth weight and neonatal death, yet nearly one quarter of all women giving birth in the United States receive delayed, inadequate or no prenatal care. This suboptimal use of prenatal care has contributed to rates of low birth weight and neonatal mortality higher than those in most other industrialized nations. This paper examines the relationships among race/ethnicity, residence, maternal sociodemographic and medical risk characteristics, and use of prenatal care in the United States. Using data from the National Maternal and Infant Health Survey, this study found important differences in prenatal cave use by race/ethnicity and residence, as well as interactive effects of these variables. Single marital status, nonmetropolitan residence, poverty, low level of education, and no insurance were move strongly associated with inadequate prenatal care for whites and Hispanics than for blacks. Nonmetropolitan residents were more likely to receive inadequate care, regardless of race/ethnicity or sociodemographic characteristics. Predicted probabilities of prenatal care use by race/ethnicity and residence showed that, regardless of risk, nonmetropolitan Hispanic women had the highest probability of obtaining inadequate prenatal care. Results highlight the continued importance of race/ethnicity and rural residence in determining prenatal care use and the need to design interventions targeted to these populations.

关键词：非洲裔美国人/统计学和数值数据欧洲大陆世系人群/统计学和数值数据西班牙裔美国人/统计学和数值数据产前保健/标准产前保健/利用卫生保健质量/统计学和数值数据问卷调查回归分析危险因素农村人口抽样研究社会经济因素美国/流行病学市区人口女(雌)性人类妊娠

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