摘要:

The link between payment and quality for nursing care provided in long-term care facilities is an emerging trend for many state Medicaid agencies. This article describes a demonstration project that allows nursing facilities more flexibility in how they can spend funds received from the state for Medicaid residents, but also requires accountability for quality of care outcomes. Nursing facilities are encouraged to move from a quality assurance model to a quality improvement model by developing quality of care and quality of life improvement plans. The processes used by facilities to develop these plans and the follow up on the progress and results of the plan are described.

ISSN:1057-3631    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Because of the complexity and dynamic nature of the health care system, effective communication remains pivotal to the health care process. This article compares nursing time and user friendliness of two nurse call systems in a large metropolitan hospital. Results identify ways to save RN time and acknowledge the importance of unit secretaries in the daily operation of a nurse call system operation on an adult medical-surgical unit.

ISSN:1057-3631    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Clinical pathway development has been an ongoing process at most hospitals for the past decade. Early articles described the development process and the implementation problems encountered. Articles that are more recent have described standard implementation procedures. Discussions of staff educational requirements, organizational structure and responsibilities, the action plan, and the evaluation process are less common. This article describes a complete practical application of clinical pathway development, implementation, and evaluation, with emphasis on organizational and research issues not typically addressed in the literature.

ISSN:1057-3631    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The purpose of this study was to elicit legal definitions and nurse definitions of a late entry. An exploratory study using a 34-item survey was conducted. Participants who attended an advanced fetal monitoring course conducted by the primary author were asked to complete the survey. Two hundred fifty-seven participants completed the survey. The sample included a physician, 13 certified nurse midwives, five nurse practitioners, and a licensed practical nurse. Two hundred and fifty-three participants were registered nurses. The median full-time nursing experience was 14.5 years. Nurses with an average of 14.3 years of experience used descriptive words, such as "out of sequence," to define an entry as late. Nurses with an average of 17.4 years of experience used minutes or hours to define when an entry was late. The average time for an entry to be considered late was 41.53 minutes after an event or action. Nurses who documented using a computer were significantly more likely to use a time frame to define an entry as late. There was no consensus on the definition of a late entry either by nurses or the courts. The majority of nurses define a late entry using qualitative descriptors. A well-accepted definition is needed to define when an entry is timely and valid and when it becomes so late that it lacks credibility.

ISSN:1057-3631    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Randomly selected inpatients with lower respiratory tract infections were selected from April 1, 1995, to September 30, 1996, from 10 pediatric hospitals (n = 804). Those ≤ 90 days of age with bronchiolitis (ICD-9 466.1, n = 303) are included. Medical records were abstracted. Pediatric Comprehensive Severity Index was used for severity scoring. Sepsis evaluation was defined as any culture of blood, urine, or cerebrospinal fluid, or parenteral antibiotic. Growth of any bacterial pathogen defined a serious bacterial infection (SBI). Rate of sepsis evaluations among sites (13% to 84%) was significantly different; mean age (49 days) and severity were not different. Intensive care stay (PICU, 22% to 87%), average length of stay (ALOS, 3-9 days), and mean total costs ($3,490-$16,147) were significantly different among hospitals. Logistic regression predicting sepsis evaluation showed significant predictor variables to be: age, severity, and PICU stay (Odds Ratio [OR] = 3.3). After controlling for these variables, significant variation due to site (OR by site ranged from 0.1 to 4.6) was observed. Total costs were predicted by severity, PICU stay, and sepsis evaluation. There were four infants with SBI (1.3%), all positive for Respiratory Syncytial Virus (RSV). Infants were similar among 10 sites with respect to age and severity; there was a significant difference among sites for sepsis evaluation, ALOS, and costs, after controlling for age, severity, and PICU stay. Risk of SBI was low. Unwarranted variation should be addressed and reduced.

ISSN:1057-3631    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The Health Information Technology Institute (HITI) criteria were used to evaluate ten Internet resources for consumers on quality care. All of the Internet resources met the essential HITI criteria. Consumers (n = 33) then evaluated each document for ease of use, knowledge gained, and value of the information to them. Most of the consumers acquired new knowledge on quality care and information to assess the quality of their own health care from reading AHRQ's Your Guide to Choosing Quality Health Care, even though it was not as easy to use as the other documents. Two resources that should be available to all patients from a consumer point of view were AHRQ's Be Informed: Questions to Ask Your Doctor Before You Have Surgery and Prescription Medicines and You.

ISSN:1057-3631    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Quality is an illusive concept with different meanings to different people. Providers often define quality in terms of patient outcomes, professional standards of practice, predetermined criteria used to measure quality, and even subjective opinion. Patients describe quality in terms of the interpersonal aspects of care, how well they were treated, and the responsiveness of the provider to their needs. This qualitative study using a semi-structured interview defined quality from the perspectives of patients, physicians, nurses, and payers associated with a hospital-based women's service line, and how the attributes of quality varied among the multiple groups. The study also described how stakeholders become aware of quality and how they determined a hospital's quality. From the findings of the study, a conceptual framework of quality in women's health was developed.

ISSN:1057-3631    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1057-3631    

出版商:OVID    

年代:2001

数据来源: OVID