CPQA Sounding Board

The authors sought to update and expand the evidence on the quality of health care and disparities in care among Medicaid beneficiaries with schizophrenia. Adult beneficiaries of New York State Medicaid with schizophrenia receiving care during 2016-2019 were identified. Composite quality scores were derived from item response theory models by using evidence-based indicators of the quality of mental and general medical health care. Risk-adjusted racial-ethnic differences in quality were estimated and summarized as percentiles relative to White beneficiaries' mean quality scores. The study included 71,013 beneficiaries; 42.8% were Black, 22.9% Latinx, 27.4% White, and 6.9% other race-ethnicity. Overall, 68.8% had a mental health follow-up within 30 days of discharge, and 90.2% had no preventable hospitalizations for chronic obstructive pulmonary disease or asthma. Among beneficiaries receiving antipsychotic medications, medication adherence was adequate for 43.7%. Fourteen indicators for mental and general medical health care quality yielded three composites: two for mental health care (pharmacological and ambulatory) and one for acute mental and general medical health care. Mean quality of pharmacological mental health care for Black and Latinx beneficiaries was lower than for White beneficiaries (39th and 44th percentile, respectively). For Black beneficiaries, mean quality of ambulatory mental health care was also lower (46th percentile). In New York City, Black beneficiaries received lower-quality care in all domains. The only meaningful group difference in the quality of acute mental and general medical health care indicated higher-quality care for individuals with other race-ethnicity. Disparities in the quality of Medicaid-financed health care persist, particularly for Black beneficiaries. Regional differences merit further attention.

SummaryBackgroundNational levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.MethodsWe mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time.FindingsBetween 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015.InterpretationThis novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world.FundingBill & Melinda Gates Foundation.

Racial and ethnic disparities in health care quality are indicative of relatively poorer quality of care for racial/ethnic minority groups. They represent critical injustices when provisions of health care are unexplained by the patient's clinical needs and other determinants of health care delivery, and the benefits of health care services are not equitably realized. While health care remains suboptimal in the United States, improvement in health care quality is observed for all population subgroups. Yet, racial and ethnic disparities in health care access and quality have not shown any significant improvement. Health care disparities have discernible patterns and different putative explanatory pathways. Extricating these patterns and pathways will help to better understand why race/ethnic disparities are observed for some measures of health care quality (e.g., invasive cardiac care), but not others (e.g., cancer screening); and why health care access and quality are suboptimal for all Americans. Evidence‐based health care quality improvement, which integrates the elimination of defined racial/ethnic disparities, is the paradigm for achieving equitable best care.

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

Significant percentage of health care services for rural Nigerians is being provided in rural health facilities by rurally based doctors, nurses, midwifes and other categories of health professionals. These services include general medical and obstetric care as well elective and urgent surgeries. As a result of these, there is likelihood of a decrease in the need for rural people to travel to major centres to seek health care service except for referral purposes. Medical education and health service management policy appear to support the location of tertiary and secondary health facilities in urban areas to the detriment of rural community health care. Hence there is an assumption, without much evidence, that the quality of care in rural hospitals' is lower than that provided in larger urban hospitals. Also there is dearth of literature on the aspects of heath care to be measured to indicate quality. This article reports an exploration of multiple perspectives on what constitutes quality of care in rural community medical practice. This is a multiple perspective analytical study. Data were obtained from a series of 134 individual patient cases involving internal medicine, obstetric and surgical procedures in small to large rural hospitals. Interviews were conducted with several participants in each case and these include doctors; nurses; midwives; patients; and family members of the patients. The interviews also explored the perspectives of individuals in each group on the broader question of what constitutes quality of care in a general sense. Their comments were subjected to qualitative analysis using SPSS software package. The different groups produced different views on what might determine the quality of health care in rural community hospitals. The health professionals tended to focus on technical aspects of care, although the doctors and nurses had some different emphases, while the patients and their families were more concerned with access, interpersonal communication, convenience and cost. These factors appeared to be consistent with previous literature from general healthcare settings. Some indicators were suggested for measuring the quality of rural health care. The contribution of this study to knowledge is in area of improvement of understanding of the differing views held by rural health professionals, patients and patients' families in thinking about the quality of care provided in rural community health facilities. Consideration of the quality of procedural rural medical care should include the needs and expectations of those living and working in a smaller, more familiar environment. This has implications for health planners, and suggests that there is a continuing need for rural health professionals to be trained to provide procedural medical services in rural hospitals, and for rural hospitals to be maintained at a standard necessary to support quality service provision.Keywords: Nigeria; quality of health care; experiences; perspectives; rural community Nigerian Medical Practitioner Vol. 50 (2) 2006: pp 48-53

Objective(s): To evaluate the family physicians' practices and to measure its impact upon the quality of familymedicine health care in Baghdad City model primary health care centers.Methodology: A descriptive study, using the evaluation approach, has evaluated the impact of family physicians'practices upon quality of healthcare in Baghdad's Model Primary Health Care Centers of Family Medicine. It iscarried out during 15th of May – 20th of August 2017. The study is conducted at five model primary health carecenters of family medicine from two districts; AL-Rusafa and AL-Kurkh. Sample size is calculated to be (76)family physicians. Convenient sample of (124) patients who are attending these primary health care centers to seekfamily health care services. Adopted structured self-administered questionnaire is used to collect data from theFamily physicians. The list of dual-forced items obtained through the Delphi process, which include "Do" or "Don'tdo". Inpatient care is clarified with (25) statements, urgent care and minor procedures tested in (27) statements andambulatory care includes (16) statements. The quality of health care questionnaire is developed for the purpose ofthe study. The overall number of items included in the questionnaire is (18) items. Internal consistency "split-half"reliability is obtained through computation of Cronbach's alpha correlation coefficient. Content validity of thequestionnaire is determined through panel of (10) experts. Data are collected through the utilization of thequestionnaire and the interview technique as means of data collection. Data of both stages is entered to computerusing Statistical Package of Social Science, Version (23.00) for windows(10) (SPSS-23) and are handled usingdescriptive statistical data analysis approach (frequencies, percentages, mean of scores, total scores and Cronbach'salpha correlation coefficient) and inferential statistical data analysis approach (simple linear regression).Results: The study reveals that the majority of the family physicians has performance experienced inadequate offamily health care practices. The quality of family medicine health care services in Baghdad's primary health carecenters of the patients' perspectives is poor (82.30%).The impact of family physicians' practices upon the quality offamily medicine health care services in Baghdad City model primary health care centers presents that familyphysicians' practices have not made noteworthy change on the quality of family medicine health care services.Recommendations: Family physicians can follow the family medicine practices' standards to provide quality offamily medicine health care services. The Ministry of Health Department of Primary Health Care can periodicallymonitor the implementation of family physicians' practices standards for the benefit of better quality of familymedicine health care services. The family medicine quality of health care services can be valued on a regular basefor the benefits of the patients who are attending the primary health care centers to seek such care

Primary healthcare quality of migraine in China: a study using unannounced standardized patients

In recent years, many studies have emerged in economics on various topics in the area of health; however, conspicuously absent from the literature is an investigation of the relationship of the quality of human health to city size and urban growth. The possible existence of a functional relationship between health quality and urban size has importance to a large set of economic issues. For instance, discussions concerning optimum city size, welfare policies, national health insurance programs, wage contracts, and the advantages and disadvantages of urban growth would be clarified by additional knowledge of systematic variations in the quality of health with urban size. One normally conjures up ghastly images of poor health conditions in large cities. Since the time of Friedrich Engels' horrifying descriptions of the conditions of working class Manchester in 1844 which [Engels, 1978, p. 584] "undermine(d) the health of thousands" to present day reports of harmful externalities, one is left with the impression the quality of human health and urban size are inversely related. Recent studies have shown that negative externalities, such as air and water pollution, traffic congestion, and noise, tend to increase with city size [i.e., Mazek and Laird, 1972]. Empirical tests on quantifiable measures of these externalities have also revealed their significant associations with the incidence of specific disease and death rates) Since urban

Severe job stress has adverse effects on the health of Chinese healthcare workers. We investigated associations between job stress, health, and quality of health care among Chinese healthcare workers. To analyze associations between stress, health, and quality of health care among healthcare workers in 74 Chinese hospitals, we surveyed 2426 healthcare workers of primary, secondary, and tertiary hospitals in Western, Central, and Eastern China in 2017. Structural equation modelling was used to examine relationships between job stress, health, and quality of health care. The mediating effect of health on the association between job stress and quality of health care was examined with the Sobel test. In the final model, health had a moderate direct positive effect on the quality of health care (β = 0.24; p < 0.001). Challenge stress had a direct inverse effect on health (β = −0.05; p < 0.05) and a significant direct positive effect on the quality of health care (β = 0.26; p < 0.001). Hindrance stress had a significant inverse effect on health (β = −0.37; p < 0.001) and a moderate inverse effect on the quality of health care (β = −0.19; p < 0.001). The correlation between challenge stress and hindrance stress was significant and positive (β = 0.59; p < 0.001). A partial mediation effect was in the final model. The health status of healthcare workers is an important concern at all levels of Chinese hospitals. To improve quality of healthcare, appropriate challenge stress is recommended among young staff, and interventions targeting hindrance stress should be developed and implemented in all hospital departments.

Abstract: The South African healthcare system has been plagued by challenges that impede access to affordable and quality healthcare. To count the few, the racial fragmentation imposed by apartheid policies, the two-tier healthcare system, which exacerbates inequality between the affluent and the underprivileged, and, most recently, COVID-19, which exposed the vulnerability of citizens under the current system. This paper aims to provide a comprehensive critique of the South African National Health Insurance Act 60 of 2023 and assess its feasibility in delivering affordable and quality healthcare. The issue of access to quality healthcare has been highly contentious and has sparked debates across all sectors of society. The Medical Aid schemes want further clarity on the implementation of the National Health Insurance Act. Whereas the poor aspire to access such quality and affordable healthcare. Wherefore, the paper aims to provide clarity on several crucial issues, such as the constitutionality of the Act, the pooling of funds, and the convincing roadmap towards the implementation of the NHI scheme. By addressing these aspects, the paper seeks to contribute to a comprehensive understanding of the NHI's impact on society at large. This paper employs the theories of social exclusion and social justice to show that there is unequal treatment of citizens regarding access to healthcare, and to further advocate for the inclusion of the downtrodden masses into the flourishing healthcare system. It is argued that access to healthcare is a right and not a privilege, regardless of one’s financial status. In the current two-tier system, it is an injustice for South Africa to witness such inequality. It is submitted that the National Health Insurance Act presents a marvelous opportunity to improve the quality of life and to free the potential of each person. The study finds that the introduction of the National Health Insurance Act seeks to achieve the aspirations of the Constitution, and therefore, it should be supported across the spectrum. Moreover, the Act seeks to achieve the United Nations Sustainable Development Goals (SDG), particularly goals 3,8, which envisage Universal Health Coverage. This paper finds that there is disconcerting conduct from the medical aid schemes, which tend to contest the eligibility of the NHI Act. It is submitted that there is an urgent need for the spirit of cooperation. It becomes the collective responsibility of both the government and the private healthcare sector to collaborate and foster the implementation of the NHI scheme to achieve universal health coverage. Internal resistance and court battles delay the implementation of the NHI Act and continue to inhibit access to quality healthcare.

Aligning Healthcare Safety and Quality Competencies: Quality and Safety Education for Nurses (QSEN), The Joint Commission, and American Nurses Credentialing Center (ANCC) Magnet® Standards Crosswalk

Patient Safety: Grantmakers Join The Effort To Reduce Medical Errors

This paper evaluates the service quality of rural health care and hospital based on different levels of customers’ perception regarding service quality. The researchers applied SERVPERF (Cronin, 1992) scale to measure the perception of rural people towards the health care and hospital services in rural area. EFA test is applied through factor analysis and reliability test with SPSS 16.0. The results indicate that SERVPERF Scale is highly reliable (0.944) than expected range 0.70. Normality test also approved that the scale was reliable. This study found that rural health care and hospital provide very poor services in all their dimensions. The mean score was not even 3.00. The rural health care and hospital provide very poor services in tangible, assurance and responsiveness compared to others.

Background: Hospital health service quality is a fundamental component of the health system. Hospital accreditation is a key approach to enhancing this quality, necessitating the correct implementation of processes. Objectives: This study aims to investigate the compliance of the executive processes of Iran’s hospital accreditation program with the requirements of the International Society for Quality in Health Care and to provide corrective solutions. Methods: This qualitative study uses an inductive content analysis technique. A checklist with seven axes was established by extracting and interpreting the requirements of the executive processes from the International Society for Quality in Health Care. By examining existing documents at the Ministry of Health’s Accreditation Office and conducting interviews with managers and experts in the field, challenges in the domain of the executive processes of Iran’s hospital accreditation program were identified using the relevant checklist. Corrective solutions were then gathered through semi-structured interviews with 19 experts, managers, and accreditation field specialists, categorized inductively, and presented using MAXQDA software. Results: Challenges in seven areas were identified, including governance; strategic, operational and financial management; risk management; human resources management; information management; survey and client management; and the granting of accreditation approval. Subsequently, solutions were categorized into five groups encompassing 26 concepts, focusing on reforming macro policies, addressing implementation challenges, fostering appropriate interactions, improving human resource management, and promoting evidence-based decision-making. Conclusions: The Iran hospital accreditation program’s adherence to International Society for Quality in Health Care standards is inadequate. Establishing a semi-autonomous, non-profit accreditation body that operates under government control and ensuring the independence of the accreditation office is essential for achieving higher compliance and receiving certification from International Society for Quality in Health Care.

BackgroundMeasuring the quality and performance of health care is a major challenge in improving the efficiency of a health system. Patient experience is one important measure of the quality of health care, and the use of patient-reported experience measures (PREMs) is recommended. The aims of this project are 1) to develop item banks of PREMs that assess the quality of health care for adult patients with psychiatric disorders (schizophrenia, bipolar disorder, and depression) and to validate computerized adaptive testing (CAT) to support the routine use of PREMs; and 2) to analyze the implementation and acceptability of the CAT among patients, professionals, and health authorities.MethodsThis multicenter and cross-sectional study is based on a mixed method approach, integrating qualitative and quantitative methodologies in two main phases: 1) item bank and CAT development based on a standardized procedure, including conceptual work and definition of the domain mapping, item selection, calibration of the item bank and CAT simulations to elaborate the administration algorithm, and CAT validation; and 2) a qualitative study exploring the implementation and acceptability of the CAT among patients, professionals, and health authorities.DiscussionThe development of a set of PREMs on quality of care in mental health that overcomes the limitations of previous works (ie, allowing national comparisons regardless of the characteristics of patients and care and based on modern testing using item banks and CAT) could help health care professionals and health system policymakers to identify strategies to improve the quality and efficiency of mental health care.Trial registrationNCT02491866.