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AGRASS Questionnaire: Assessment of Risk Management in Health Care.

ABSTRACT: OBJECTIVE:This study aims to assess the development and the validity analysis of the Assessment of Risk Management in Health Care Questionnaire (AGRASS). METHODS:This is a validation study of a measurement instrument following the stages: 1) Development of conceptual model and items; 2) Formal multidisciplinary assessment; 3) Nominal group for validity analysis with national specialists; 4) Development of software and national pilot study in 62 Brazilian hospitals 5) Delphi for validity analysis with the users of the questionnaire. In stages 3 and 5, the items were judged based on face validity, content validity, and utility and viability, by a 1-7 Likert scale (cut-off point: median < 6). Accuracy and reliability of the questionnaire were analyzed with the Confirmatory Factor Analysis and the Cronbach's alpha. RESULTS:The initial version of the instrument (98 items) was adapted during stages 1 to 3 for the final version with 40 items, which were considered relevant, of adequate content, useful, and viable. The instrument has 2 dimensions and 9 subdimensions, and the items have closed-ended questions (yes or no). The software for the automatic collection and analysis generates indicators, tables, and automatic graphs for the assessed institution and aggregated data. The adjustment indices confirmed a bi-dimensional model composed of structure and process (X2/gl = 1.070, RMSEA ? 0.05 = 0.847, TLI = 0.972), with high reliability for the AGRASS Questionnaire (? = 0.94) and process dimension (? = 0.93), and adequate for the structural dimension (? = 0.70). CONCLUSIONS:The AGRASS Questionnaire is a potentially useful instrument for the surveillance and monitoring of the risk management and patient safety in health services.

SUBMITTER: Gama ZADS

PROVIDER: S-EPMC7006914 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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AGRASS Questionnaire: Assessment of Risk Management in Health Care.

Gama Zenewton André da Silva ZADS Saturno-Hernandez Pedro Jesus PJ Caldas Anna Claudia Sales Gomes ACSG Freitas Marise Reis de MR Mendonça Ana Elza Oliveira de AEO Medeiros Carlos Alexandre de Souza CAS Medeiros Wilton Rodrigues WR Kessler Oliver O Soares Diogo Penha DP

Revista de saude publica 20200210

<h4>Objective</h4>This study aims to assess the development and the validity analysis of the Assessment of Risk Management in Health Care Questionnaire (AGRASS).<h4>Methods</h4>This is a validation study of a measurement instrument following the stages: 1) Development of conceptual model and items; 2) Formal multidisciplinary assessment; 3) Nominal group for validity analysis with national specialists; 4) Development of software and national pilot study in 62 Brazilian hospitals 5) Delphi for va ...[more]

PMID: 32049211

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Project description:BackgroundWorking with eHealth requires health care organizations to make structural changes in the way they work. Organizational structure and process must be adjusted to provide high-quality care. This study is a follow-up study of a systematic literature review on optimally organizing hybrid health care (eHealth and face to face) using the Donabedian Structure-Process-Outcome (SPO) framework to translate the findings into a modus operandi for health care organizations.ObjectiveThis study aimed to develop an SPO-based quality assessment model for organizing hybrid health care using an accompanying self-assessment questionnaire. Health care organizations can use this model and a questionnaire to manage and improve their hybrid health care.MethodsConcept mapping was used to enrich and validate evidence-based knowledge from a literature review using practice-based knowledge from experts. First, brainstorming was conducted. The participants listed all the factors that contributed to the effective organization of hybrid health care and the associated outcomes. Data from the brainstorming phase were combined with data from the literature study, and duplicates were removed. Next, the participants rated the factors on importance and measurability and grouped them into clusters. Finally, using multivariate statistical analysis (multidimensional scaling and hierarchical cluster analysis) and group interpretation, an SPO-based quality management model and an accompanying questionnaire were constructed.ResultsAll participants (n=39) were familiar with eHealth and were health care professionals, managers, researchers, patients, or eHealth suppliers. The brainstorming and literature review resulted in a list of 314 factors. After removing the duplicates, 78 factors remained. Using multivariate statistical analyses and group interpretations, a quality management model and questionnaire incorporating 8 clusters and 33 factors were developed. The 8 clusters included the following: Vision, strategy, and organization; Quality information technology infrastructure and systems; Quality eHealth application; Providing support to health care professionals; Skills, knowledge, and attitude of health care professionals; Attentiveness to the patient; Patient outcomes; and Learning system. The SPO categories were positioned as overarching themes to emphasize the interrelations between the clusters. Finally, a proposal was made to use the self-assessment questionnaire in practice, allowing measurement of the quality of each factor.ConclusionsThe quality of hybrid care is determined by organizational, technological, process, and personal factors. The 33 most important factors were clustered in a quality management model and self-assessment questionnaire called the Hybrid Health Care Quality Assessment. The model visualizes the interrelations between the factors. Using a questionnaire, each factor can be assessed to determine how effectively it is organized and developed over time. Health care organizations can use the Hybrid Health Care Quality Assessment to identify improvement opportunities for solid and sustainable hybrid health care.

Project description:BACKGROUND:The Health And Self-Management In Diabetes (HASMIDv1) questionnaire consists of 8 attributes, 4 about quality of life, and 4 about self-management. The overall aim of this study was to rigorously examine the psychometric properties of the HASMIDv1 questionnaire. METHODS:The study comprised two phases. Phase 1 identified items of the HASMIDv1 questionnaire that potentially required rewording through consultation with a patient involvement panel and two focus groups of people with diabetes. Phase 2 involved a cross-sectional longitudinal survey where HASMID, EQ-5D-5L, health, treatment and sociodemographic questions were administered using both paper and online versions to people with diabetes. Participants were asked to complete the survey again approximately 3?months later. Psychometric analyses were undertaken to examine floor and ceiling effects, item distributions, known group differences and internal consistency. Rasch analysis was undertaken to assess differential item functioning and disordered thresholds. RESULTS:Phase 1 derived five alternative wordings to items: Irritable, Affects Mealtimes, Daily Routine, Social Activities and Problem. Phase 2 achieved 2835 responses at time point 1 (n?=?1944 online, n?=?891 paper version) and 1243 at time point 2 (n?=?533 online, n?=?710 paper version). Overall the HASMID items performed well, though two alternative worded items (Irritable and Social Activities) provided additional information not fully captured by the original HASMID items. CONCLUSION:Psychometric evaluation and Rasch analysis were used in conjunction with expert opinion to determine the final questionnaire. The application of psychometric analyses or Rasch analysis alone to inform item selection would have resulted in different items being selected for the final instrument. The benefit of a combined approach has produced an instrument which has a broader evaluation of self-management. The final validated HASMID-10 is a short self-report PRO that can be used to evaluate the impact of self-management for people living with diabetes. HASMID-10 can be scored using total summative scores, with utility and monetary values also available for use in cost-utility and cost-benefit analyses.

Project description:BACKGROUND AND HYPOTHESIS: Heterogeneity in clinical manifestations and disease progression in Chronic Obstructive Pulmonary Disease (COPD) lead to consequences for patient health risk assessment, stratification and management. Implicit with the classical "spill over" hypothesis is that COPD heterogeneity is driven by the pulmonary events of the disease. Alternatively, we hypothesized that COPD heterogeneities result from the interplay of mechanisms governing three conceptually different phenomena: 1) pulmonary disease, 2) systemic effects of COPD and 3) co-morbidity clustering, each of them with their own dynamics. OBJECTIVE AND METHOD: To explore the potential of a systems analysis of COPD heterogeneity focused on skeletal muscle dysfunction and on co-morbidity clustering aiming at generating predictive modeling with impact on patient management. To this end, strategies combining deterministic modeling and network medicine analyses of the Biobridge dataset were used to investigate the mechanisms of skeletal muscle dysfunction. An independent data driven analysis of co-morbidity clustering examining associated genes and pathways was performed using a large dataset (ICD9-CM data from Medicare, 13 million people). Finally, a targeted network analysis using the outcomes of the two approaches (skeletal muscle dysfunction and co-morbidity clustering) explored shared pathways between these phenomena. RESULTS: (1) Evidence of abnormal regulation of skeletal muscle bioenergetics and skeletal muscle remodeling showing a significant association with nitroso-redox disequilibrium was observed in COPD; (2) COPD patients presented higher risk for co-morbidity clustering than non-COPD patients increasing with ageing; and, (3) the on-going targeted network analyses suggests shared pathways between skeletal muscle dysfunction and co-morbidity clustering. CONCLUSIONS: The results indicate the high potential of a systems approach to address COPD heterogeneity. Significant knowledge gaps were identified that are relevant to shape strategies aiming at fostering 4P Medicine for patients with COPD.

Project description:BACKGROUND: The valid and reliable measurement of health service utilization, productivity losses and consequently total disease-related costs is a prerequisite for health services research and for health economic analysis. Although administrative data sources are usually considered to be the most accurate, their use is limited as some components of utilization are not systematically captured and, especially in decentralized health care systems, no single source exists for comprehensive utilization and cost data. The aim of this study was to develop and test a questionnaire for the measurement of disease-related costs for patients after an acute cardiac event (ACE). METHODS: To design the questionnaire, the literature was searched for contributions to the assessment of utilization of health care resources by patient-administered questionnaires. Based on these findings, we developed a retrospective questionnaire appropriate for the measurement of disease-related costs over a period of 3 months in ACE patients. Items were generated by reviewing existing guidelines and by interviewing medical specialists and patients. In this study, the questionnaire was tested on 106 patients, aging 35-65 who were admitted for rehabilitation after ACE. It was compared with prospectively measured data; selected items were compared with administrative data from sickness funds. RESULTS: The questionnaire was accepted well (response rate = 88%), and respondents completed the questionnaire in an average time of 27 minutes. Concordance between retrospective and prospective data showed an intraclass correlation (ICC) ranging between 0.57 (cost of medical intake) and 0.9 (hospital days) with the other main items (physician visits, days off work, medication) clustering around 0.7. Comparison between self-reported and administrative data for days off work and hospitalized days were possible for n = 48. Respective ICCs ranged between 0.92 and 0.94, although differences in mean levels were observed. CONCLUSION: The questionnaire was accepted favorably and correlated well with alternative measurement approaches. This first assessment showed promising characteristics of this questionnaire in different aspects of validity for patients with ACE. However, additional research and more extensive tests in other patient groups would be worthwhile.

Project description:BackgroundPatient safety is a universal issue which affects countries at all stages of health system development. Patient safety research in primary care reveals that globally millions of people suffer disabilities, injuries, or death due to unsafe medical practices. This study aims to explore the understanding of frontline primary health care professionals regarding patient safety culture in health care facilities in Oman.MethodsA questionnaire-based survey was conducted using a validated Hospital Survey of Patient Safety Culture tool. Invitations were sent to all 198 health professionals from each occupational category from each primary care center in Muscat, Oman.ResultsThe total number of respondents was 186 participants out of 198 (response rate: 94%). Overall, the staff had a strong sense of teamwork within the units (85%), they reported organization learning for continuous improvement (84%) and teamwork across the units (82%). However, the four dimensions which received the lowest scores were related to communication problems between the staff (23%), non-punitive response to errors (27%), frequency of event reporting (40%), and errors occurring when transferring patients to higher levels of health care during handoffs and transitions (46%).ConclusionsOverall, the participants rated patient safety in the primary health care setting as excellent or very good and the perception of patient safety was moderately positive. The core areas of strength were teamwork within the units with positivity and organization learning and continuous improvement. The weaknesses were non-punitive response to errors, inadequate staffing and hand offs and transition. The results of this study will provide policy makers and health care professionals with a detailed understanding of the current patient safety culture in primary care in Muscat, Oman. The results will be used by the Ministry of Health to inform policy and strategies to strengthen patient safety within primary health care in Oman.

Project description:BACKGROUND:Successfully implementing eMental health (eMH) interventions in routine mental health care constitutes a major challenge. Reliable instruments to assess implementation progress are essential. The Normalization MeAsure Development (NoMAD) study developed a brief self-report questionnaire that could be helpful in measuring implementation progress. Based on the Normalization Process Theory, this instrument focuses on 4 generative mechanisms involved in implementation processes: coherence, cognitive participation, collective action, and reflexive monitoring. OBJECTIVE:The aim of this study was to translate the NoMAD questionnaire to Dutch and to confirm the factor structure in Dutch mental health care settings. METHODS:Dutch mental health care professionals involved in eMH implementation were invited to complete the translated NoMAD questionnaire. Confirmatory factor analysis (CFA) was conducted to verify interpretability of scale scores for 3 models: (1) the theoretical 4-factor structure, (2) a unidimensional model, and (3) a hierarchical model. Potential improvements were explored, and correlated scale scores with 3 control questions were used to assess convergent validity. RESULTS:A total of 262 professionals from mental health care settings in the Netherlands completed the questionnaire (female: 81.7%; mean age: 45 [SD=11]). The internal consistency of the 20-item questionnaire was acceptable (.62≤alpha≤.85). The theorized 4-factor model fitted the data slightly better in the CFA than the hierarchical model (Comparative Fit Index=0.90, Tucker Lewis Index=0.88, Root Mean Square Error of Approximation=0.10, Standardized Root Mean Square Residual=0.12, χ22=22.5, P≤.05). However, the difference is small and possibly not outweighing the practical relevance of a total score and subscale scores combined in one hierarchical model. One item was identified as weak (λCA.2=0.10). A moderate-to-strong convergent validity with 3 control questions was found for the Collective Participation scale (.47≤r≤.54, P≤.05). CONCLUSIONS:NoMAD's theoretical factor structure was confirmed in Dutch mental health settings to acceptable standards but with room for improvement. The hierarchical model might prove useful in increasing the practical utility of the NoMAD questionnaire by combining a total score with information on the 4 generative mechanisms. Future research should assess the predictive value and responsiveness over time and elucidate the conceptual interpretability of NoMAD in eMH implementation practices.

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AGRASS Questionnaire: Assessment of Risk Management in Health Care.

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AGRASS Questionnaire: Assessment of Risk Management in Health Care.

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