Indicators for monitoring maternal and neonatal quality care: a systematic review.
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ABSTRACT:
SUBMITTER: Saturno-Hernandez PJ
PROVIDER: S-EPMC6330388 | biostudies-literature | 2019 Jan
REPOSITORIES: biostudies-literature
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Project description:ObjectivesWe evaluated breast cancer (BC) care quality indicators (QIs) in clinical pathways and integrated health care processes.MethodsFollowing protocol registration (Prospero no: CRD42021228867), relevant documents were identified, without language restrictions, through a systematic search of bibliographic databases (EMBASE, Scopus, Web of Science, MEDLINE), health care valuable representatives and the World Wide Web in April 2021. Data concerning QIs, measurement tools and compliance standards were extracted from European and North American sources in duplicate with 98% reviewer agreement.ResultsThere were 89 QIs found from 22 selected documents (QI per document mean 13.5 with standard deviation 11.9). The Belgian (38 QIs) and the EUSOMA (European Society of Breast Cancer Specialists) (34 QIs) documents were the ones that best reported the QIs. No identical QI was identified in all the documents analysed. There were 67/89 QIs covering processes (75.3%) and 11/89 (12.4%) for each structure and outcomes QIs. There were 21/89 QIs for diagnosis (30.3%), 43/89 for treatment (48.3%), and 19/89 for staging, counselling, follow-up and rehabilitation (21.4%). Of 67 process QIs and 11 outcome QIs, 20/78 (26%) did not report a minimum standard of care. Shared decision making was only included as a QI in the Italian document.ConclusionMore than half of countries have not established a national clinical pathway or integrated breast cancer care process to achieve the excellence of BC care. There was heterogeneity in QIs for the evaluation of BC care quality. Over two-thirds of the clinical pathways and integrated health care processes did not provide a minimum auditable standard of care for compliance, leaving open the definition of best practice. There is a need for harmonisation of BC care QIs.
| S-EPMC8322135 | biostudies-literature
Project description:BackgroundDespite the growing interest in assessing the quality of care for depression, there is little evidence to support measurement of the quality of primary care for depression. This study identified evidence-based quality indicators for monitoring, evaluating and improving the quality of care for depression in primary care settings.MethodsOvid MEDLINE and Ovid PsycINFO databases, and grey literature, including relevant organizational websites, were searched from 2000 to 2015. Two reviewers independently selected studies if (1) the study methodology combined a systematic literature search with assessment of quality indicators by an expert panel and (2) quality indicators were applicable to assessment of care for adults with depression in primary care settings. Included studies were appraised using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument, which contains four domains and 20 items. A narrative synthesis was used to combine the indicators within themes. Quality indicators applicable to care for adults with depression in primary care settings were extracted using a structured form. The extracted quality indicators were categorized according to Donabedian's 'structure-process-outcome' framework.ResultsThe search revealed 3838 studies. Four additional publications were identified through grey literature searching. Thirty-nine articles were reviewed in detail and seven met the inclusion criteria. According to the AIRE domains, all studies were clear on purpose and stakeholder involvement, while formal endorsement and usage of indicators in practice were scarcely described. A total of 53 quality indicators were identified from the included studies, many of which overlap conceptually or in content: 15 structure, 33 process and four outcome indicators. This study identified quality indicators for evaluating primary care for depression among adult patients.ConclusionsThe identified set of indicators address multiple dimensions of depression care and provide an excellent starting point for further development and use in primary care settings.
| S-EPMC5496323 | biostudies-literature
Project description:BackgroundHealth care systems that succeed in preventing long term care and hospital admissions of frail older people may substantially save on their public spending. The key might be found in high-quality care in the community. Quality Indicators (QIs) of a sufficient methodological level are a prerequisite to monitor, compare, and improve care quality. This systematic review identified existing QIs for community care for older people and assessed their methodological quality.MethodsRelevant studies were identified by searches in electronic reference databases and selected by two reviewers independently. Eligible publications described the development or application of QIs to assess the quality of community care for older people. Information about the QIs, the study sample, and specific setting was extracted. The methodological quality of the QI sets was assessed with the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. A score of 50% or higher on a domain was considered to indicate high methodological quality.ResultsSearches resulted in 25 included articles, describing 17 QI sets with 567 QIs. Most indicators referred to care processes (80%) and measured clinical issues (63%), mainly about follow-up, monitoring, examinations and treatment. About two-third of the QIs focussed on specific disease groups. The methodological quality of the indicator sets varied considerably. The highest overall level was achieved on the domain 'Additional evidence, formulation and usage' (51%), followed by 'Scientific evidence' (39%) and 'Stakeholder involvement' (28%).ConclusionA substantial number of QIs is available to assess the quality of community care for older people. However, generic QIs, measuring care outcomes and non-clinical aspects are relatively scarce and most QI sets do not meet standards of high methodological quality. This study can support policy makers and clinicians to navigate through a large number of QIs and select QIs for their purposes. PROSPERO Registration: 2014:CRD42014007199.
| S-EPMC5760020 | biostudies-literature
Project description:ObjectiveTo identify valid and feasible quality indicators for the primary care of osteoarthritis (OA).DesignSystematic review and narrative synthesis.Data sourcesElectronic reference databases (MEDLINE, EMBASE, CINAHL, HMIC, PsychINFO), quality indicator repositories, subject experts.Eligibility criteriaEligible articles referred to adults with OA, focused on development or implementation of quality indicators, and relevant to UK primary care. An English language restriction was used. The date range for the search was January 2000 to August 2013. The majority of OA management guidance has been published within this time frame.Data extractionRelevant studies were quality assessed using previous quality indicator methodology. Two reviewers independently extracted data. Articles were assessed through the Outcome Measures in Rheumatology filter; indicators were mapped to management guidance for OA in adults. A narrative synthesis was used to combine the indicators within themes.Results10,853 articles were identified from the search; 32 were included in the review. Fifteen indicators were considered valid and feasible for implementation in primary care; these related to assessment non-pharmacological and pharmacological management. Another 10 indicators were considered less feasible, in various aspects of assessment and management. A small number of recommendations had no published corresponding quality indicator, such as use of topical non-steroidal anti-inflammatory drugs. No negative ('do not do') indicators were identified.Conclusions and implications of key findingsThere are well-developed, feasible indicators of quality of care for OA which could be implemented in primary care. Their use would assist the audit and quality improvement for this common and frequently disabling condition.
| S-EPMC4345981 | biostudies-literature
Project description:BackgroundDespite the high prevalence of osteoarthritis and the prominence of primary care in managing this condition, there is no systematic summary of quality indicators applicable for osteoarthritis care in primary care settings.ObjectivesThis systematic review aimed to identify evidence-based quality indicators for monitoring, evaluating and improving the quality of care for adults with osteoarthritis in primary care settings.MethodsOvid MEDLINE and Ovid EMBASE databases and grey literature, including relevant organizational websites, were searched from 2000 to 2015. Two reviewers independently selected studies if (i) the study methodology combined a systematic literature search with assessment of quality indicators by an expert panel and (ii) quality indicators were applicable to assessment of care for adults with osteoarthritis in primary care settings. Included studies were appraised using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. A narrative synthesis was used to combine the indicators within themes. Applicable quality indicators were categorized according to Donabedian's 'structure-process-outcome' framework.ResultsThe search revealed 4526 studies, of which 32 studies were reviewed in detail and 4 studies met the inclusion criteria. According to the AIRE domains, all studies were clear on purpose and stakeholder involvement, while formal endorsement and use of indicators in practice were scarcely described. A total of 20 quality indicators were identified from the included studies, many of which overlapped conceptually or in content.ConclusionsThe process of developing quality indicators was methodologically suboptimal in most cases. There is a need to develop specific process, structure and outcome measures for adults with osteoarthritis using appropriate methodology.
| S-EPMC5892173 | biostudies-literature
Project description:Nowadays, evaluating the quality of health services, especially in primary health care (PHC), is increasingly important. In a historical perspective, the Department of Health (United Kingdom) developed and proposed a range of indicators in 1998, and lately several health, social and political organizations have defined and implemented different sets of PHC quality indicators. Some systematic reviews in PHC quality indicators are reported but only in specific contexts and conditions. The aim of this study is to characterize and provide a list of indicators discussed in the literature to support managers and clinicians in decision-making processes, through an umbrella review on PHC quality indicators. The methodology was performed according to PRISMA Statement. Indicators from 33 eligible systematic reviews were categorized according to the dimensions of care, function, type of care, domains and condition contexts. Of a total of 727 indicators or groups of indicators, 74.5% (n = 542) were classified in process category and 89.5% (n = 537) with chronic type of care (n = 428; 58.8%) and effective domain (n = 423; 58.1%) with the most frequent values in categorizations by dimensions. The results of this overview of reviews are valuable and imply the need for future research and practice regarding primary health care quality indicators in the most varied conditions and contexts to generate new discussions about their use, comparison and implementation.
| S-EPMC6697344 | biostudies-literature
Project description:BACKGROUND:One way of measuring the quality of home care are quality indicators (QIs) derived from data collected with the Resident Assessment Instrument-Home Care (RAI-HC). In order to produce meaningful results for quality improvement and quality comparisons across home care organizations (HCOs) and over time, RAI-HC QIs must be valid and reliable. The aim of this systematic review was to identify currently existing RAI-HC QIs and to summarize the scientific knowledge on the validity and reliability of these QIs. METHODS:A systematic review was performed using the electronic databases PubMed, CINAHL, Embase, PsycINFO and Cochrane Library. Studies describing the development process or the psychometric characteristics of RAI-HC QIs were eligible. The data extraction involved a general description of the included studies as well as the identified RAI-HC QIs and information on validity and reliability. The methodological quality of the identified RAI-HC QI sets was assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. RESULTS:Four studies out of 659 initial hits met the inclusion criteria. The included studies described the development and validation process of three RAI-HC QI sets comprising 48 unique RAI-HC QIs, which predominantly refer to outcome of care. Overall, the validity and reliability of the identified RAI-HC QIs were not sufficiently tested. The methodological quality of the three identified RAI-HC QI sets varied across the four AIRE instrument domains. None of the QI sets reached high methodological quality, defined as scores of 50% and higher in all four AIRE instrument domains. CONCLUSIONS:This is the first review that systematically summarized and appraised the available scientific evidence on the validity and reliability of RAI-HC QIs. It identified insufficient reporting of RAI-HC QIs validation processes and reliability as well as missing state-of-the-art methodologies. The review provides guidance as to what additional validity and reliability testing are needed to strengthen the scientific soundness of RAI-HC QIs. Considering that RAI-HC QIs are already implemented and used to measure and compare quality of home care, further investigations on RAI-HC QIs reliability and validity is recommended.
| S-EPMC7191714 | biostudies-literature
Project description:Strained intensive care unit (ICU) capacity represents a fundamental supply-demand mismatch in ICU resources. Strain is likely to be influenced by a range of factors; however, there has been no systematic evaluation of the spectrum of measures that may indicate strain on ICU capacity.We performed a systematic review to identify indicators of strained capacity. A comprehensive peer-reviewed search of MEDLINE, EMBASE, CINAHL, Cochrane Library, and Web of Science Core Collection was performed along with selected grey literature sources. We included studies published in English after 1990. We included studies that: (1) focused on ICU settings; (2) included description of a quality or performance measure; and (3) described strained capacity. Retrieved studies were screened, selected and extracted in duplicate. Quality was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). Analysis was descriptive.Of 5297 studies identified in our search; 51 fulfilled eligibility. Most were cohort studies (n = 39; 76.5%), five (9.8%) were case-control, three (5.8%) were cross-sectional, two (3.9%) were modeling studies, one (2%) was a correlational study, and one (2%) was a quality improvement project. Most observational studies were high quality. Sixteen measures designed to indicate strain were identified 110 times, and classified as structure (n = 4, 25%), process (n = 7, 44%) and outcome (n = 5, 31%) indicators, respectively. The most commonly identified indicators of strain were ICU acuity (n = 21; 19.1% [process]), ICU readmission (n = 18; 16.4% [outcome]), after-hours discharge (n = 15; 13.6% [process]) and ICU census (n = 13; 11.8% [structure]). There was substantial heterogeneity in the operational definitions used to define strain indicators across studies.We identified and characterized 16 indicators of strained ICU capacity across the spectrum of healthcare quality domains. Future work should aim to evaluate their implementation into practice and assess their value for evaluating strategies to mitigate strain.This systematic review was registered at PROSPERO (March 27, 2015; CRD42015017931 ).
| S-EPMC5870068 | biostudies-other
Project description:BackgroundOffshore industries operate all around the world in diverse and remote environments. The use of telemedicine to ensure up-to-date medical care for thousands of people offshore has been common practice for decades. Thus, in this setting, extensive experiences with this type of health care delivery have already been gathered, while in other settings this is just beginning. However, the quality of telemedical care on offshore installations is rarely reported yet. The objective of this review was to explore published literature with regards to the following questions: Have any Quality Indicators (QIs) been published for measuring the quality of telemedical care on offshore installations or are there identifiable items that could be used as such QIs?MethodsWe conducted a comprehensive Scoping Review (PRISMA-ScR) of the published literature using the databases MEDLINE, Cochrane Library, Web of Science (Core Collection), and Google Scholar. Search results were read and QIs or findings from which QIs could be derived were classified according to the dimensions of quality established by Donabedian (structure, process, or outcome QIs).ResultsThe search returned 10,236 non-recurring articles, 45 of which were full-text screened and 15 of which were included in this review. Types of publications were heterogenous. No QIs for the quality of telemedical care offshore have been published yet. Findings that could be the basis for QIs focused on structure quality (11 QIs) followed by process quality (11 QIs), while outcome quality was less common (1 QI).ConclusionCurrently, although years of experience with telemedical care on offshore installations exist, there is a paucity of research on a solid data base regarding the quality of telemedical care offshore. The authors derived a list of 24 possible QIs from the findings of the publications for further validation. This could be the basis for implementation and definition of QIs in this and in similar remote settings.
| S-EPMC8638379 | biostudies-literature
Project description:BackgroundNeonatal morbidity is associated with lifelong impairments, but the absence of a consensual definition and the need for large data sets limit research.ObjectivesTo inform initiatives to define standard outcomes for research, we reviewed composite neonatal morbidity indicators derived from routine hospital discharge data.Data sourcesPubMed (updated on October 12, 2018). The search algorithm was based on three components: "morbidity," "neonatal," and "hospital discharge data."Study selection and data extractionStudies investigating neonatal morbidity using a composite indicator based on hospital discharge data were included. Indicators defined for specific conditions (eg congenital anomalies, maternal addictions) were excluded. The target population, objectives, component morbidities, diagnosis and procedure codes, validation methods, and prevalence of morbidity were extracted.SynthesisFor each study, we assessed construct validity by describing the methods used to select the indicator components and evaluated whether the authors assessed internal and external validity. We also calculated confidence intervals for the prevalence of the morbidity composite.ResultsSeventeen studies fulfilled inclusion criteria. Indicators targeted all (n = 4), low-/moderate-risk (n = 9), and very preterm (VPT, n = 4) infants. Components were similar for VPT infants, but domains and diagnosis codes within domains varied widely for all and low-/moderate-risk infants. Component selection was described for 8/17 indicators and some form of validation reported for 12/17. Neonatal morbidity prevalence ranged from 4.6% to 9.0% of all infants, 0.4% to 8.0% of low-/moderate-risk infants, and 17.8% to 61.0% of VPT infants.ConclusionsMultiple neonatal morbidity indicators based on hospital discharge data have been used for research, but their heterogeneity limits comparisons between studies. Standard neonatal outcome measures are needed for benchmarking and synthesis of research results.
| S-EPMC7418783 | biostudies-literature