Dataset Information

Improving Quality of Care in Hemodialysis: a Content Analysis.

ABSTRACT: Introduction: Hemodialysis is currently the most common alternative treatment in patients with renal failure in the world. Today, despite the support provided by healthcare providers for these patients, they still express dissatisfaction with the quality of care and find it inadequate. However, there have been few studies investigating the needs of in-patients receiving hemodialysis care in Iran. Thus this research was undertaken to study the needs and demands of such patients. Methods: This qualitative research was conducted from June to November 2016 to investigate the view points of the patients, their families and health care providers about improving quality of care in dialysis unit. At first, the sampling was based on a purposeful sampling method. A total of 35 participants (patients, their families and health care providers) were interviewed. The interviews were analyzed via Graneheim & Lundman qualitative content analysis. Results: Data analyses led to the production of 700 primary codes, 54 subcategories and 27 secondary categories out which 4 main categories of modification of physical stressors, requirement of support and the requirement of improved quality of Health Care service and improved facilities and equipment requirement. Conclusion: Planning for modification of physical stressors, improved support of patients, enhancing the quality of care services provided by the treatment team, upgrading the facilities and equipment and the adoption of an interdisciplinary approach are all believed to improve the care services among in-patients receiving hemodialysis treatment.

SUBMITTER: Hashemi MS

PROVIDER: S-EPMC6163156 | biostudies-other | 2018 Sep

REPOSITORIES: biostudies-other

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Improving Quality of Care in Hemodialysis: a Content Analysis.

Hashemi Maryam Sadat MS Irajpour Alireza A Abazari Parvaneh P

Journal of caring sciences 20180901 3

Introduction: Hemodialysis is currently the most common alternative treatment in patients with renal failure in the world. Today, despite the support provided by healthcare providers for these patients, they still express dissatisfaction with the quality of care and find it inadequate. However, there have been few studies investigating the needs of in-patients receiving hemodialysis care in Iran. Thus this research was undertaken to study the needs and demands of such patients. ...[more]

PMID: 30283760

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Project description:BackgroundThe Department of Veterans Affairs (VA) has led the industry in measuring facility performance as a critical element in improving quality of care, investing substantial resources to develop and maintain valid and cost-effective measures. The External Peer Review Program (EPRP) of the VA is the official data source for monitoring facility performance, used to prioritize the quality areas needing most attention. Facility performance measurement has significantly improved preventive and chronic care, as well as overall quality; however, much variability still exists in levels of performance across measures and facilities. Audit and feedback (A&F), an important component of effective performance measurement, can help reduce this variability and improve overall performance. Previous research suggests that VA Medical Centers (VAMCs) with high EPRP performance scores tend to use EPRP data as a feedback source. However, the manner in which EPRP data are used as a feedback source by individual providers as well as service line, facility, and network leadership is not well understood. An in-depth understanding of mental models, strategies, and specific feedback process characteristics adopted by high-performing facilities is thus urgently needed.This research compares how leaders of high, low, and moderately performing VAMCs use clinical performance data from the EPRP as a feedback tool to maintain and improve quality of care.MethodsWe will conduct a qualitative, grounded theory analysis of up to 64 interviews using a novel method of sampling primary care, facility, and Veterans Integrated Service Network (VISN) leadership at high-, moderate-, and low-performing facilities. We will analyze interviews for evidence of cross-facility differences in perceptions of performance data usefulness and strategies for disseminating performance data evaluating performance, with particular attention to timeliness, individualization, and punitiveness of feedback delivery.DiscussionMost research examining feedback to improve provider and facility performance lacks a detailed understanding of the elements of effective feedback. This research will highlight the elements most commonly used at high-performing facilities and identify additional features of their successful feedback strategies not previously identified. Armed with this information, practices can implement more effective A&F interventions to improve quality of care.

Project description:ObjectiveThe prevailing approaches to selecting multiple sclerosis (MS) disease modifying therapies (DMTs) have contributed to exponential increases in societal expenditures and out-of-pocket expenses, without compelling evidence of improved outcomes. Guidance is lacking regarding when and in whom the benefits of preventing MS-related disability likely outweighs the risks of highly effective DMTs (HET) and when it is appropriate to consider DMT costs. Our objective was to develop a standardized approach to improve the quality, affordability and equity of MS care.MethodsMS experts partnered with health plan pharmacists to develop an ethical, risk-stratified, cost-sensitive treatment algorithm. We developed a risk-stratification schema to classify patients with relapsing forms of MS as high, intermediate or low risk of disability based on the best available evidence and, when the evidence was poor or lacking, by consensus. DMTs are grouped as highly, modestly or low/uncertain effectiveness and preferentially ranked within groups by safety based on pre-specified criteria. We reviewed FDA documents and the published literature. When efficacy and safety are equivalent, the lower cost DMT is preferred.ResultsAssignment to the high-risk group prompts treatment with preferred HETs early in the disease course. For persons in the intermediate- or low-risk groups with cost or health care access barriers, we incorporated induction therapy with an affordable B-cell depleting agent. Based on more favorable safety profiles, our preferred approach prioritizes use of rituximab and natalizumab among HETs and interferon-betas or glatiramer acetate among modestly effective agents.InterpretationThe risk-stratified treatment approach we recommend provides clear, measurable guidance in whom and when to prescribe HETs, when to prioritize lower cost DMTs and how to accommodate persons with MS with cost or other barriers to DMT use. It can be adapted to other cost structures and updated quickly as new information emerges. We recommend that physician groups partner with health insurance plans to adapt our approach to their settings, particularly in the United States. Future studies are needed to resolve the considerable uncertainty about how much variability in prognosis specific risk factors explain.

Dataset Information

Improving Quality of Care in Hemodialysis: a Content Analysis.

Publications

Improving Quality of Care in Hemodialysis: a Content Analysis.

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