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An integrated MUSA to measure health care service quality from a patient's perspective in a resource-constrained setting

Al-Awlaqi MA, Aamer AM

Int J Health Plann Manage, 2020 Jan;35(1):e119-e132.
PMID: 31670407 DOI: 10.1002/hpm.2943

PURPOSE: Although assessing the quality of health services offered in a least developed country such as Yemen is very important, it is not yet given attention. As a result, Yemeni patients started to look for higher quality of health services abroad. Thus, Yemeni health private providers need to know how to link their patients' satisfaction to the quality of the services offered to end up with more satisfied patients and higher health service quality offered.
METHODOLOGY: Data were collected form 5310 patients in 249 private clinics. The patients evaluated their satisfaction on the quality of service on the basis of nine criteria that comprised 31 subcriteria. We used multicriteria satisfaction analysis (MUSA) to analyze the data.
FINDINGS AND CONCLUSION: The data analysis results showed low level of satisfaction on the health care quality services offered by the private clinics in Yemen. The majority of the criteria and subcriteria showed low level of satisfaction, high demand, and high mandate for improvement.

Matched MeSH terms: Quality Assurance, Health Care/methods*
Critical incident monitoring in anaesthesia (2)

Choy CY

Curr Opin Anaesthesiol, 2008 Apr;21(2):183-6.
PMID: 18443485 DOI: 10.1097/ACO.0b013e3282f33592

PURPOSE OF REVIEW: Updates on developments in critical incident monitoring in anaesthesia, and assesses its role in improving patient safety.
RECENT FINDINGS: Critical incident reporting has become more widely accepted as an effective way to improve anaesthetic safety, and has continued to highlight the importance of human errors and system failures. The establishment of an international database also improves critical incident reporting. Experiences from the national reporting and learning system in the UK have provided some solutions to the many problems and criticisms faced by the critical incident reporting technique. Direct observations to detect errors are more accurate than voluntary reporting of critical incidents, and may be a promising new approach.
SUMMARY: Critical incident monitoring is a valuable tool in ensuring patient safety due to its low cost and the ability to provide a comprehensive body of detailed qualitative information. The qualitative information gathered can be used to develop strategies to prevent and manage existing problems, as well as to plan further initiatives for patient safety. Novel approaches should complement existing methods to achieve better results. The development of a culture which emphasises safety should go hand in hand with current audit activities.

Matched MeSH terms: Quality Assurance, Health Care/methods*
An evaluation framework for Health Information Systems: human, organization and technology-fit factors (HOT-fit)

Yusof MM, Kuljis J, Papazafeiropoulou A, Stergioulas LK

Int J Med Inform, 2008 Jun;77(6):386-98.
PMID: 17964851

The realization of Health Information Systems (HIS) requires rigorous evaluation that addresses technology, human and organization issues. Our review indicates that current evaluation methods evaluate different aspects of HIS and they can be improved upon. A new evaluation framework, human, organization and technology-fit (HOT-fit) was developed after having conducted a critical appraisal of the findings of existing HIS evaluation studies. HOT-fit builds on previous models of IS evaluation--in particular, the IS Success Model and the IT-Organization Fit Model. This paper introduces the new framework for HIS evaluation that incorporates comprehensive dimensions and measures of HIS and provides a technological, human and organizational fit.

Matched MeSH terms: Quality Assurance, Health Care/methods*
Fulltext Development and validation of a new Prescription Quality Index

Hassan NB, Ismail HC, Naing L, Conroy RM, Abdul Rahman AR

Br J Clin Pharmacol, 2010 Oct;70(4):500-13.
PMID: 20840442 DOI: 10.1111/j.1365-2125.2009.03597.x

The aims were to develop and validate a new Prescription Quality Index (PQI) for the measurement of prescription quality in chronic diseases.

Matched MeSH terms: Quality Assurance, Health Care/methods*
Fulltext Critical incident monitoring in anaesthesia (1)

Choy YC

Med J Malaysia, 2006 Dec;61(5):577-85.
PMID: 17623959

Critical incident monitoring in anaesthesia is an important tool for quality improvement and maintenance of high safety standards in anaesthetic services. It is now widely accepted as a useful quality improvement technique for reducing morbidity and mortality in anaesthesia and has become part of the many quality assurance programmes of many general hospitals under the Ministry of Health. Despite wide-spread reservations about its value, critical incident monitoring is a classical qualitative research technique which is particularly useful where problems are complex, contextual and influenced by the interaction of physical, psychological and social factors. Thus, it is well suited to be used in probing the complex factors behind human error and system failure. Human error has significant contributions to morbidities and mortalities in anaesthesia. Understanding the relationships between, errors, incidents and accidents is important for prevention and risk management to reduce harm to patients. Cardiac arrests in the operating theatre (OT) and prolonged stay in recovery, constituted the bulk of reported incidents. Cardiac arrests in OT resulted in significant mortality and involved mostly de-compensated patients and those with unstable cardiovascular functions, presenting for emergency operations. Prolonged-stay in the recovery extended period of observation for ill patients. Prolonged stay in recovery was justifiable in some cases, as these patients needed a longer period of post-operative observation until they were stable enough to return to the ward. The advantages of the relatively low cost, and the ability to provide a comprehensive body of detailed qualitative information, which can be used to develop strategies to prevent and manage existing problems and to plan further initiatives for patient safety makes critical incident monitoring a valuable tool in ensuring patient safety. The contribution of critical incident reporting to the issue of patient safety is far from clear and very difficult to study. Efforts to do so have tended to rely on incident reporting, the only practical approach when funding is limited. The heterogeneity of critically ill patients as a group means that huge study populations would be required if other research techniques were to be used. In the era of evidence-based medicine, anaesthetists are looking for alternative evidence-based solutions to problems that we have accepted traditionally when we cannot quantify for good practical reasons. In the quest for patient safety, investment should be made in reliable audit, detection and reporting systems. The growing recognition that human error usually result from a failure of a system rather than an individual should be fostered to allow more lessons to be learnt, an approach that has been successful in other, safety-critical industries. New technology has a great deal to offer and investment is warranted in novel fail-safe drug administration systems. Last but not the least the importance of simple and sensible changes and better education should be remembered.

Matched MeSH terms: Quality Assurance, Health Care/methods*
External quality assurance in Malaysia

Nawawi H, Lim HH, Zakiah I

Southeast Asian J Trop Med Public Health, 1999;30 Suppl 3:39-45.
PMID: 10926257

An activity supportive of the MOH QA Programme, the National EQAS for clinical chemistry monitors for analytical performance in core routine biochemical testing by the pathology laboratories, with unsatisfactory performance scores serving to alert against deficiencies or problems and the scores in subsequent challenges providing the feedback of effectiveness of remedial actions taken. While unacceptable individual analyte performance score (variance index score, VIS) indicated problems in instruments, reagent and calibrators, or the use of inherently poorer methods, repeated occurrence of unsatisfactory OMRVIS was traceable to generally poor laboratory management of usually inadequately-equipment small laboratories. The outcome has been one of slow but gradual improvement in the overall performance of participating laboratories, with a move towards methods upgrading and standardization to achieve greater concordance of results. Presently, the programme is limited to 61 government and 4 private hospital laboratories in the country for 12 commonly assayed clinical biochemistry analytes. It is hoped that the NEQAS could be extended to the other private laboratories and that of academic institutions. However, this is dependent to a large extent on the manpower and financial support obtainable by the organizing body of the programme in the future. Belk and Sunderman, 1947 demonstrated that laboratories participating in an quality assessment scheme could rapidly and dramatically improve their analytical performance. In some countries, participation has become mandatory, and acceptable performance is a requirement in laboratory accreditation. The need and value of the NEQAP is, therefore, evident. While there may be limitations in the national programme. efforts are being made at improving the programme within the means and resources of the organising body. The goals of the NEQAP are not just to monitor performance but also to educate. On this, matters related to and supportive of these goals have also been pursued. The annual workshop/forum on quality controls had allowed exchange of information between representatives of participating laboratories and the organising body. Recently in the 1997 MOH Quality Improvement evaluation, Quality Control has been evaluated together with the other 17 such activities. The study on knowledge, attitude and practice has provided the necessary feedback and will be used for future planning in making efforts at increasing the effectiveness and benefits of the all QC activities including this NEQAP for clinical chemistry. In addition, there is a need to look into areas such as selection of methods and test systems, and improvement of continuing education, training as well as research in quality improvement as suggested by the Quality Improvement evaluation.

Matched MeSH terms: Quality Assurance, Health Care/methods
Improving diabetes care in a public hospital medical clinic: report of a completed audit cycle

Tan F, Liew SF, Chan G, Toh V, Wong SY

J Eval Clin Pract, 2011 Feb;17(1):40-4.
PMID: 20807297 DOI: 10.1111/j.1365-2753.2010.01367.x

RATIONALE, AIMS AND OBJECTIVES: To evaluate the impact of clinical audit on diabetes care provided to type 2 diabetic patients attending our hospital general medical clinics.
METHODS: Performances on diabetes-related process measures and intermediate outcome measures were evaluated through structured review of outpatient medical records. The results were fed back to the doctors and measures were implemented to improve care. The performance indicators were re-evaluated 2 years later to complete the audit cycle.
RESULTS: Annual testing rates improved for HbA1c (68.4% vs. 87.4%; P < 0.001) and lipid profile (91.8% vs. 97%; P = 0.027). Enquiry on smoking improved from 45.9% to 82.3% (P < 0.001), eye screening rates from 68.9% to 78.8% (P = 0.020) and foot examinations from 22.4% to 64.1% (P < 0.001). Prescription rates for insulin increased from 17.3% to 31.8% (P = 0.001) and statin from 83.2% to 94.4% (P < 0.001). The use of aspirin (80.6% vs. 83.8%; P =0.402) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (92.3% vs. 88.9%; P = 0.239) remained high in both cycles. More patients achieved targets for HbA1c < 7% (38% vs. 26%; P = 0.006), blood pressure < 130/80 mmHg (43% vs. 32%; P = 0.071) and low-density lipoprotein cholesterol < 2.6 mmol/L (71% vs. 52%; P <0.001).
CONCLUSION: Clinical audit is a useful tool in improving diabetes care.
Study site: Outpatient clinic, Sarawak General Hospital, Kuching, Sarawak, Malaysia

Matched MeSH terms: Quality Assurance, Health Care/methods*
A thermoluminescent dosimetry postal dose inter-comparison of radiation therapy centres in Malaysia

Rassiah P, Ng KH, DeWerd LA, Kunugi K

Australas Phys Eng Sci Med, 2004 Mar;27(1):25-9.
PMID: 15156705

A thermoluminescent dosimetry (TLD) postal dose inter-comparison was carried out amongst radiotherapy centres in Malaysia. The aim of this TLD inter-comparison was to compare the uniformity involved in the measurement of absorbed dose among the participating centres. A set of 5 TLD chips placed within acrylic trays were mailed to all participating centres for irradiation to an absorbed dose to water of 2 Gy. Measurements were made for 6 MV and 60Co photon beams. Results show an agreement of +/- 5% for all but three radiotherapy centres. The ratios of the TLD readings to that of the reference centre are comparable with other national/regional dose inter-comparisons. The importance of a proper ongoing quality assurance program is essential in maintaining the consistency and uniformity of doses delivered.

Matched MeSH terms: Quality Assurance, Health Care/methods*
Importance-performance analysis of dental satisfaction among three ethnic groups in malaysia

Dewi FD, Gundavarapu KC, Cugati N

Oral Health Prev Dent, 2013;11(2):131-9.
PMID: 23757453 DOI: 10.3290/j.ohpd.a29735

PURPOSE: To find the differences in patient satisfaction related to dental services among three ethnic groups - Chinese, Indian and Malay - at AIMST University Dental Centre and analyse them with an importance-performance grid, identifying the weak and strong points, in order to provide better service.
MATERIALS AND METHODS: This questionnaire-based study consisted of convenience samples of 174 patients of Chinese, Indian and Malay ethnicity. Importance-performance analysis for 20 attributes were compared using Likert's scale. The data obtained were statistically analysed using the Kruskal-Wallis test.
RESULTS: Chinese and Indians both emphasised low performance on the interpersonal relationship attribute in terms of the receptionist's courtesy, whereas the Malay participants were concerned with convenience attributes. All the ethnic groups favoured maintaining existing major attributes towards technical competency, interpersonal relationship and facility factors. This study demonstrated priority differences between the ethnic groups' perception of the quality of dental services, where ethnic Chinese showed the highest gap (measure of dissatisfaction) between importance and performance compared to ethnic Malays, followed by ethnic Indians.
CONCLUSION: The patients from the three major ethnic groups of Malaysia were generally well satisfied. Perhaps more priority should be placed on improving the interpersonal relationship attribute, especially with the receptionists.

Matched MeSH terms: Quality Assurance, Health Care/methods