Pressure ulcer prevalence and incidence data are increasingly being used as indicators of quality of care and the efficacy of pressure ulcer prevention protocols. In some health care systems, the occurrence of pressure ulcers is also being linked to reimbursement. The wider use of these epidemiological analyses necessitates that all those involved in pressure ulcer care and prevention have a clear understanding of the definitions and implications of prevalence and incidence rates. In addition, an appreciation of the potential difficulties in conducting prevalence and incidence studies and the possible explanations for differences between studies are important. An international group of experts has worked to produce a consensus document that aims to delineate and discuss the important issues involved, and to provide guidance on approaches to conducting and interpreting pressure ulcer prevalence and incidence studies. The group's main findings are summarised in this paper.

Background: Although racial and ethnic differences in healthcare have been extensively documented in the United States, little attention has been paid to the quality of health care for the foreign-born population in the United States. Objectives: This study examines the association between patient perceptions of the patient-physician interaction and nativity status. Research Design: Cross-sectional telephone survey. Subjects: A total of 6674 individuals (US-born ≤ 5156; foreign-born ≤ 1518) 18 years of age and older. Measures: Seven questions measuring the quality of patient-physician interactions. Results: Of the 7 outcome variables examined in the unadjusted logistic regression model, only 2 remained statistically significant in the fully adjusted model. For both the total sample and for Asians only, compared with US-born, foreign-born individuals were at greater odds [total sample, odds ratio (OR) ≤ 1.43; 95% confidence interval (CI) ≤ 1. 01ĝ€"2.04; Asians, OR ≤ 3.25; 95% CI ≤ 1.18ĝ€"8.95] of reporting that their physician did not involve them in their care as much as they would have liked. Compared with US-born Asians, foreign-born Asians were at greater odds of reporting that their physician did not spend as much time with them as they would have liked (OR ≤ 4.19; 95% CI ≤ 1.68ĝ€"10.46). Discussion: Findings from our study suggest that we should not only track disparities by race and ethnicity but also by nativity status.

Due to an increasingly aging population and long-term care available, the number of older adults seeking long-term care facilities is growing. Resident satisfaction indicators have become essential measurements of service quality. However, few studies have investigated the evidence on prevalent resident satisfaction indicators and associated factors. In order to understand what are the types of resident satisfaction measurements utilized in long-term care facilities in the United States and how these types of care services influence resident satisfaction, the researcher conducted the first study, which consists of a systematic scoping review by summarizing the evidence on the types of resident satisfaction indicators utilized in long-term care settings in the United States. The second study completed a further systematic review to summarize how nursing assistants impact resident satisfaction in long-term care settings.The third study aims to translate and validate a Chinese version of the resident satisfaction assessment based on the Ohio Long-term Care Resident Satisfaction Survey (OLCRSS). The fourth study will apply hierarchical regression to predict older adults' satisfaction with individual factors and care services factors in long-term care settings. The dissertation provided a holistic solution to measure resident satisfaction in long-term care settings, assist health providers in meeting the resident`s needs and improve the quality of the care. These studies are significant because they provide fundamental data for using evidence-based indicators of resident satisfaction to enhance the residents' quality of life. Findings could also add to the existing literature regarding resident satisfaction indicators.

No description available.

In the planning and delivery of services the voice and choice of consumers have appeared as the foremost key factors. For a large number of organisations the received feedback from customers about the quality of services, which are the criteria and indication of their level of satisfaction play a crucial role in the improvement of quality. Although across developed western communities, the importance of customers’ views has gained acceptance, few studies have been dedicated to the exploration of the voice of the residents in care homes. The review of the literature regarding residents’ satisfaction and quality in care homes revealed that the voices of residents in care homes are usually not heard or are absent. Moreover, the adoption of quality improvement tools in health care has lagged behind that in other industries and there is generally a failure to use an appropriate methodology in care homes, one based on residents’ voice, for improving quality. As a result, the main aim of this research is to investigate residents’ voice regarding improving their satisfaction in care homes. Further, the researcher seeks to obtain data by using an appropriate methodology to assist care home managers in enhancing the quality of the services they offer by assigning weights to quality indicators pertaining to improving quality and residents’ levels of satisfaction. For this purpose, this research employs both qualitative and quantitative approaches to develop a research process entailing: (1) a comprehensive literature review to recognise the phenomenon; (2) interviews with fifteen older people who lived in three different care homes in order to discover the most important residents’ needs and requirements in such homes; (3) a resident survey with one hundred and two residents in thirty five care homes. These were conducted to assess their preferences for the importance of demanded qualities; their satisfaction with provided services and the attributes of each demanded quality based on the Kano model, in order to identify the priority of improvement. Next, (4) there was the development of the House of Quality (HoQ) to optimize quality to assure residents’ satisfaction; and finally, (5) an evaluation study was conducted with thirteen service providers, in order to assess the accuracy and appropriateness of the methodology. This research has contributed towards a better understanding of the residents’ voice, and applying it for enhancing quality and residents’ satisfaction in care homes. For the first time residents’ requirements are prioritised and classified in this context through accurate methods. Moreover, an understanding of the attributes of care home residents’ needs in relation to a Kano model has been elicited. The novelty of this proposed methodology is in utilising the Quality Function Deployment (QFD) in care homes to translate the voice of residents’ regarding their requirements into service planning. The research methodology and results facilitate care home managers with a hierarchy for improvement planning at both service and executive management levels.

Magister Public Health - MPH / Long waiting times have, for many years, been synonymous with primary health care in South Africa, and this is evident by the long queues and consistent client dissatisfaction. There are multiple contributing factors that exacerbate waiting time in Primary Health Care (PHC) facilities such as shortage of health care providers, increase in the uninsured population and South Africa’s quadruple burden of diseases. Health establishments have initiated numerous strategies to reduce long waiting times with varying degrees of success. These strategies have mostly been quantified and linked to indicators to measure their level of success in relation to quality healthcare. This research explores the clients’ perception of one such intervention, which is the implementation of an appointment system in primary care facilities in the City of Cape Town. Qualitative, exploratory descriptive methods were used to gain understanding of the impact the appointment system has had on the clients’ experience of attending health care services. The researcher also explored how clients perceive their role with regard to the shaping of their clinic’s appointment system. Semi-structured in-depth interviews were conducted with fifteen purposively sampled clients from five City Health clinics, who have implemented an appointment system through the guidance of the Appointment System Learning Initiative (ASLI). Maximum variation in sampling ensured the inclusion of small, medium and larger facilities within different geographical settings. Data analysis was done using a thematic coding approach, the themes were derived from the emerging data and were used to guide the researcher in gaining a rich picture of the clients’ experiences within the clinics. Ethical approval was requested and received from both the University of the Western Cape (UWC) and City Health prior to engaging any participants.

Thesis advisor: Barbara E. Wolfe / Patient quality outcomes in the United States (U.S.) healthcare system are largely stagnant or making minimal improvements, resulting in unnecessary morbidity, mortality, and costs (AHRQ, 2012 National Healthcare Quality Report). As the US implements the 2010 Patient Protection and Affordability Act, there is fiscal pressure to attain and sustain significant improvements to patient quality outcomes. This necessitates an understanding of how the processes and structures of care influence patient quality outcomes (Donabedian, 1966) in a complex care environment. To begin addressing this gap, this investigation examined the influence of unit-level authentic leadership (AL) and structural empowerment (SE) on staff nurse decisional involvement (DI) and patient quality outcomes on general care units in the acute-care hospital setting. This study used a cross-sectional survey design. Participants were staff nurses working on 105 general care units across eleven US hospitals. The surveys measured staff nurse perceptions of AL, SE, and DI at the care unit level. The patient quality outcomes of interest were falls with injury, hospital acquired pressure ulcers and patient satisfaction. Care unit level AL and SE had a significant influence on actual staff nurse DI (p = .002 and < .001, respectively) and the degree of dissonance between actual and preferred DI (p < .001). AL and SE had a significant inverse relationship with patient falls with injury (p = .017 and .028, respectively), yet a positive relationship with HAPU rates (p = .051 and .026, respectively). While AL did not have a significant relationship with any of the three patient satisfaction metrics, a significant positive relationship with SE was found (p = .002, .001, and .002, respectively). There was no support for a relationship between actual staff nurse DI and any of the patient quality outcomes. This study extends previous research in this area in that it is the first to examine actual patient quality outcomes at the care unit level. These findings provide support for the unique contributions to patient quality outcomes at the care unit level, indicating the need to develop AL among front-line nurse managers and SE in nurse work environments. / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis advisor: Kathleen McInnis-Dittrich / Cancer caregivers are key stakeholders across the cancer trajectory, particularly in the final weeks of life and the bereavement period that follows. Current measures are limited in capturing caregiver assessment of the quality of end-of-life (EOL) care. Because none include caregiver perception of patient suffering or prolongation of death, the author sought to develop and validate a new measure of caregiver-perceived quality of EOL care that includes these dimensions. Data for this study comes from Coping with Cancer (CwC), a multisite, prospective, longitudinal study of advanced cancer patients and their caregivers (N=275 dyads). CwC investigators interviewed cancer patients and caregivers prior to the patient's death, and then caregivers again following the patient's death, on a range of psychosocial issues related to EOL care and bereavement. The present study represents a refinement of the author's previous work in developing and validating the Caregiver Evaluation of Quality of End-of-Life Care (CEQUEL) scale, a comprehensive measure of caregiver-perceived quality of EOL care. Factor analysis revealed four distinct factors: Prolongation of Death, Perceived Suffering, Shared Decision-Making, and Preparation for the Death. Each item loaded strongly on only a single factor. The author examined the new measure's factor structure, and evaluated its reliability (using Cronbach's α) and convergent validity (via associations between CEQUEL and key EOL outcomes). CEQUEL and its subscales showed moderate to acceptable Cronbach's α (range: 0.52-0.78). Higher scores (indicating better perceived quality of care) were positively associated with therapeutic alliance (ρ=.13; p≤.05) and hospice enrollment (z=-2.09; ≤;.05), and negatively associated with bereaved caregiver regret (ρ=-.36, p≤.001) and a diagnosis of Posttraumatic Stress Disorder (z=-2.06; p≤.05). Scores did not vary by caregiver characteristics other than religious affiliation, with Catholics scoring lower than non-Catholics, and those without religious affiliation scoring lower than those with an affiliation. Models predicting CEQUEL scores were compared using multiple regression analysis and AICc values. In unadjusted analyses, dying in a hospital, inpatient hospice length of stay (LOS) < 1 week, patients feeling seen as a whole person by their physician, and caregiver religiosity predicted CEQUEL scores. Only dying in a hospital (B=-1.65, SE=0.42, p=0.000) and inpatient hospice LOS < 1 week (B=-1.87, SE=-.69, p=0.008) remained significant in adjusted analysis. These findings suggest that CEQUEL is a brief, valid measure of quality of EOL care from the caregiver's perspective. This study also identifies key factors that can be modified to improve caregiver evaluation of quality of care and associated bereavement outcomes. CEQUEL is the first scale of its kind to include perceived suffering and prolongation of death. If validated in future work, it may prove a useful quality indicator for the delivery of EOL care and a risk indicator for poor bereavement adjustment. Implications for research, clinical practice and policy are discussed. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

In 2014, Louisiana experienced substantive issues with quality of care in nursing homes. The state had the lowest nurse staffing level among all states, and 7,666 deficiencies for immediate jeopardy violations were recorded from 2011 to 2013. Despite ample research on nurse staffing and quality of care, there is no consensus on how higher nurse staffing relates to quality. The purpose of this quantitative, correlational research was to determine the relationship between nurse staffing levels and quality measures in Louisiana. Donabedian's category structure, process, and outcome was the conceptual framework used to develop the research questions. The data included the quality of care deficiency score and the quality measures found in the Centers for Medicare and Medicaid datasets. The quality measures were the deficiencies and the prevalence of nursing home residents with pressure ulcers, urinary tract infections, and physical restraints. Generalized linear models were used to analyze the relationship between nurse staffing levels and the quality measures. The findings suggested that RNs, nonprofits, chain-affiliated nursing homes, and smaller facilities are important to improve the quality of care in Louisiana nursing homes. These variables were associated with fewer quality of care deficiencies and fewer pressure ulcers. These findings have implications for social change. This information may help inform and direct policy makers in the development and implementation of Medicaid-managed long-term services and supports programs in order to improve the quality of care of a vulnerable population: the elderly and disabled.

The need to address the issue of quality in aged care service provision in Australia has received increasing emphasis in recent decades. Particularly since the 1980s, the federal government has played a key role in ensuring that this is the case through the implementation of various reforms and regulatory strategies. In 1998, the national standards monitoring system which had been in place since the mid 1980s was replaced with a new system based on an accreditation model. In contrast to the former system which was wholly controlled by government and involved one-off inspections by government standards monitors, responsibility for managing the new system has been devolved to an independent body, the Aged Care Standards and Accreditation Agency. One of the Agency's primary functions is to assess compliance with the accreditation standards. A key component of the new system is its emphasis on continuous improvement which has been incorporated into the accreditation standards. As a consequence, the new system requires a much greater level of involvement and commitment by providers than previously. In order to continue receiving government funding all facilities had to be accredited by January 1st 2001. This study represents an evaluation of the accreditation system based on the views and experiences of service providers in Western Australia. It explored a number of issues relating to the basic philosophy and principles underlying the new system, the implementation process, the accreditation standards that are used as a basis for assessing service quality and the overall impact of the system on providers. It also sought providers' views about the strengths and limitations of the system and any areas in need of change or improvement. A descriptive design, using in-depth interviews as the method of data collection, was adopted for the study. / Participants from three levels of service provision, namely, facilities, organisations and peak bodies were selected on a stratified purposive basis. A total of 45 informants were interviewed. The findings indicated that, overall, as a regulatory approach the accreditation system was generally supported by providers and was regarded as having a number of positive features, particularly in comparison to the previous system. At the same time a number of concerns were identified. These related in particular to the assessment process, specifically the lack of consistency amongst assessors and the self assessment tool, and to the extent of information and guidance provided by the Agency. Concerns regarding the latter's role in relation to, and extent of independence from, the federal government were also identified. The study also found that the introduction of the system had impacted on providers in a variety of ways, both positive and negative, but particularly in terms of the demands on staff and financial resources. A number of 'broader' level factors, such as funding, nursing shortages and other often competing demands (e.g. assessing residents according to the Resident Classification Scale) were also felt to be impacting on providers' capacity to meet the requirements of the system. These concerns, along with concerns about the way in which the system would develop in the future, appear to have created a degree of uncertainty and in some cases apprehension amongst many providers. Although this study has focused on the experiences of Western Australian service providers, evidence from other reviews of the accreditation system where providers' views have been sought has indicated a widespread similarity in perceptions. This suggests, therefore, that there is a need for further review and refinement of certain aspects of the system as it moves into the second round.