Quality of care for women presenting with benign breast conditions

The aim of the study was to investigate the management of women with benign breast problems. A consecutive sample of women (n = 194) was assessed who presented to public or private sector providers. The main reasons for referral were breast lumps (62%); 56% of women who attended the public sector did not receive any recommendation compared to 40% who attended the private sector and clinical/general practitioner reviews were recommended to more women in the private sector (54%). Reasons for the discrepancy between public and private patients require further investigation. (Intern Med J 2005; 35: 357–358)

Public reporting of nursing home quality of care : Lessons from the United States experience for Canadian policy discussion

While the demand for continuing care services in Canada grows, the quality of such services has come under increasing scrutiny. Consideration has been given to the use of public reporting of quality data as a mechanism to stimulate quality improvement and promote public accountability for and transparency in service quality. The recent adoption of the Resident Assessment Instrument (RAI) throughout a number of Canadian jurisdictions means that standardized quality data are available for comparisons among facilities across regions, provinces and nationally. In this paper, we explore current knowledge on public reporting in nursing homes in the United States to identify what lessons may inform policy discussion regarding potential use of public reporting in Canada. Based on these findings, we make recommendations regarding how public reporting should be progressed and managed if Canadian jurisdictions were to implement this strategy.

Using hospital standardised mortality ratios to assess quality of care--proceed with extreme caution

Australian Health Ministers have endorsed the hospital standardised mortality ratio (HSMR) as a key indicator of quality and safety, and efforts are currently underway towards its national implementation. In the United Kingdom, Canada, the Netherlands and the United States, the HSMR has been used for several years within organisations to monitor performance and response to various quality and safety programs. In the UK and Canada, the HSMR is also publicly reported and used to compare performance between hospitals. The validity and reliability of the HSMR as a screening tool for distinguishing low-quality from high-quality hospitals remain in doubt, and it has not yet been proven that HSMR reporting necessarily leads to worthwhile improvement in quality of care and patient outcomes.

Does self-efficacy mediate the cross-sectional relationship between perceived quality of health care and self-management of diabetes? Results from Diabetes MILES - Australia

OBJECTIVE: Quality of health care (QoC) and self-efficacy may affect self-management of diabetes, but such effects are not well understood. We examined the indirect role of diabetes-specific self-efficacy (DSE) and generalised self-efficacy (GSE) in mediating the cross-sectional relationship between self-reported QoC and diabetes self-management.

DESIGN: Diabetes MILES-Australia was a national survey of 3,338 adults with diabetes. We analysed data from 1,624 respondents (Age: M=52.1, SD=13.9) with type 1 (T1D; n=680) or type 2 diabetes (T2D; n=944), who responded to a version of the survey containing key measures.

MAIN OUTCOME MEASURES: Self-reported healthy eating, physical activity, self-monitoring of blood glucose frequency, HbA1c, medication/insulin adherence. RESULTS: We used Preacher and Hayes' bootstrapping method, controlling for age, gender and diabetes duration, to test mediation of DSE and GSE on the relationship of QoC with each self-management variable. We found statistically significant but trivial mediation effects of DSE and of GSE on most, but not all, variables (all effect sizes <0.06).

CONCLUSION: Support for mediation was weak, suggesting that relationships amongst these variables are small and that future research might explore other aspects of self-management in diabetes.

An improved model of care for inflammatory bowel disease (IBD).

Recommendations from the 3rd round of the Report of the results for the national clinical audit of adult inflammatory bowel disease (IBD) inpatient care in the UK published earlier this year by UK's Royal College of Physicians and mentioned in the Lancet in March 20121 report improvements in the quality of care (QoC) of patients with IBD since audits began in 2006 but also list improvements yet to be achieved. Importantly, optimising the quality of life (QoL) of sufferers was indicated as deserving greater attention as part of the global approach to improved QoC.

Improving the quality of life for patients' with co-morbidities requiring acute care

Reduced mortality rates in the Western world have created an increase in people with co-morbidities who have the potential to require acute care hospital services. These patients' chronic conditions often require complex needs that may not always be met by an acute care focus. This has created a precedent for nurses concerned with the holistic care and quality of life for these patients. This paper aims to describe the experiences of patients with co-morbidities who were admitted to hospital with an acute illness. This exploratory descriptive design selected patients in acute care who had more than one co-morbidity for approximately five years. Data was obtained from a purposive sample of twelve patients within two weeks of being discharged home using a semi-structured interview approach. Data analysis was conducted utilising Nvivo software to process the Colaizzi [1978] method. The theme clusters revealed a lack of continuity and co-ordinated care of the patients' co-morbidities during the acute admission and in discharge planning. It was seen that combinations of chronic conditions and treatments affected these patients' experience of acute care and thereafter, where conceptualisations of co-morbidity failed to accurately capture the underlying health care needs of these patients. These findings have implications for a comprehensive and considered approach to these patients' health care needs and quality of life whilst developing an improved understanding of co-morbidity for nursing. Recommendations for further research conclude this paper.

Nutrition screening in long-term care facilities : an evaluation of the methodological quality of available instruments

A variety of nutrition screening instruments have been developed and implemented for identifying the risk of undernutrition among community and hospitalized older adults. Despite the high prevalence of undernutrition amongst older adults in long-term care, few screening instruments have been developed or evaluated in this setting. This review aims to evaluate the validity, reproducibility and feasibility of nutrition screening instruments developed for use, or described as being used, with older adults in long-term care. Ten publications encompassing nine independent nutrition screening tools were identified using electronic databases and manual searches of reference lists. The Mini Nutritional Assessment-Short Form (MNA-SF) was the most widely evaluated nutrition screening instrument and met the requirements for a valid instrument (sensitivity and specificity >0.9) for use in the long-term care setting. Modified versions of the MNA for use in China and South Africa also demonstrated acceptable levels of sensitivity and specificity. Other nutrition screening instruments were found to have variable levels of sensitivity and specificity and while some demonstrated levels consistent with the MNA-SF, only two were evaluated across more than one study population, Body Mass Index (BMI)+weight loss and BMI+albumin. These same instruments reported the highest levels of inter-rater and test-retest reproducibility, although this was only tested in one other instrument (Chinese Nutrition Screen -modified MNA). In conclusion, it is evident from this review that further work in this area is needed. Based on validity, reproducibility and feasibility it appears that BMI+weight loss is the most suitable nutrition screening instrument for use in the long-term care setting at this time. MNA-SF is promising; however, there is currently no data for inter-rater or test-retest reproducibility in the long-term care setting.

Improving the quality of diabetes care in general practice

Objective: The evidence treatment gap for patients with type 2 diabetes.
Design: A summary of convenience sample of seven general practices.
Setting: Metropolitan and rural Victoria, Australia.
Participants: 561 patients of general practices (75% from rural general practices).
Main outcome measures: Demographic data, duration of diabetes, diabetes complications, HbA1c and lipid levels, blood pressure and score on PHQ-9.
Results: Patients with depression show more severe, progressive and intensively treated diabetes. The prevalence of depression in diabetes is about twice that of the general population.
Conclusion: Australian guidelines for diabetes should recommend screening for depression.

Assessing the impact of diabetes on the quality of life of older adults living in a care home : validation of the ADDQoL senior

Aims  Around a quarter of UK care-home residents have diabetes. Diabetes is known to impact quality of life but existing diabetes-specific quality of life measures are unsuitable for elderly care-home residents. We aimed to develop and evaluate a new measure for use with older adults, to be particularly suitable for use with care-home residents: the Audit of Diabetes-Dependent Quality of Life (ADDQoL) Senior†.

Methods  Content and format changes were made to the 19-domain ADDQoL, informed by related measures for people with visual impairments (12 domain-specific items were retained, four items were revised/added and three items were removed). This revision was modified further following cognitive debriefing interviews with three older adults living in a care home. Psychometric evaluation of the newly developed 17-domain ADDQoL Senior was conducted using data from 90 care-home residents with diabetes who took part in a broader intervention study.

Results  The life domains most impacted by diabetes were ‘independence’ and ‘freedom to eat as I wish’. The ADDQoL Senior demonstrated good factor structure and internal consistency (Cronbach’s alpha = 0.924). Domain scores were, as expected, significantly intercorrelated.

Conclusions  The ADDQoL Senior measures the perceived impact of diabetes on quality of life in older adults, and has been found to be suitable for those living in care homes if administered by interview. The scale has demonstrated acceptability and excellent psychometric properties. It is anticipated that the number of items may be reduced in the future if our current findings can be replicated.