This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ http://www.biomedcentral.com/bmchealthservres/mostviewed/ Most viewed articles in last 30 days from BMC Health Services Research (ISSN 1472-6963) published by BioMed Central Background: Short-term medical missions (STMMs) are a well-established means of providing health care to the developing world. Despite over 250 million dollars and thousands of volunteer hours dedicated to STMMs, there is a lack of standardized evaluation to assess patient safety, quality control, and mission impact. The objective of this project is to design and implement an assessment tool that defines objective parameters of quality of care as identified by STMMs. Methods: The study was conducted in 3 phases: 1) Base-need analysis to determine factors critical to the quality of STMMs, 2) Design of 5 surveys for mission personnel and patients to enable 360-degree evaluation based on factors from phase 1, and 3) Field testing of the surveys with 5 STMMs. Results: An evaluation tool was created assessing 6 major and 30 minor factors identified as important to the quality of STMMs. 5 mission directors, 43 personnel, 10 local hosts, and 55 patients completed the surveys. Of the 6 major measures of quality, missions performed best in Cost (mean score 86%), and Impact (84%). The poorest performance was in Education (64%). Efficiency, Sustainability, and Preparedness showed mean scores of 76%, 77%, and 73%, respectively. Conclusion: Our study provides a novel standardized tool for STMM evaluation. Use of the assessment instrument identified areas of strength and weakness of a particular mission, and delineated general trends in performance compared to other STMMs. We anticipate that the use of this tool may improve the quality of care provided by missions, and stimulate solution-sharing and scholarly discussion among missions. http://www.biomedcentral.com/1472-6963/8/121 Jesse Maki, Munirih Qualls, Benjamin White, Sharon Kleefield and Robert Crone BMC Health Services Research 2008, 8:121 Number of accesses: 525 2008-06-02 doi:10.1186/1472-6963-8-121 BMC Health Services Research 1472-6963 8 121 2008-06-02 Background: In quality improvement collaboratives (QICs) teams of practitioners from different health care organizations are brought together to systematically improve an aspect of patient care. Teams take part in a series of meetings to learn about relevant best practices, quality methods and change ideas, and share experiences in making changes in their own local setting. The purpose of this study was to develop an instrument for measuring team organization, external change agent support and support from the team's home institution in a Dutch national improvement and dissemination programme for hospital based on several QICs. Methods: The exploratory methodological design included two phases: a) content development and assessment, resulting in an instrument with 15 items, and b) field testing (N = 165). Internal consistency reliability was tested via Cronbach's alpha coefficient. Principal component analyses were used to identify underlying constructs. Tests of scaling assumptions according to the multi trait/multi-item matrix, were used to confirm the component structure. Results: Three components were revealed, explaining 65% of the variability. The components were labelled 'organizational support', 'team organization' and 'external change agent support'. One item not meeting item-scale criteria was removed. This resulted in a 14 item instrument. Scale reliability ranged from 0.77 to 0.91. Internal item consistency and divergent validity were satisfactory. Conclusion: On the whole, the instrument appears to be a promising tool for assessing team organization and internal and external support during QIC implementation. The psychometric properties were good and warrant application of the instrument for the evaluation of the national programme and similar improvement programmes. http://www.biomedcentral.com/1472-6963/8/172 Michel LA Duckers, Cordula Wagner and Peter P Groenewegen BMC Health Services Research 2008, 8:172 Number of accesses: 522 2008-08-11 doi:10.1186/1472-6963-8-172 BMC Health Services Research 1472-6963 8 172 2008-08-11 Background: There is widespread interest in measuring healthcare provider attitudes about issues relevant to patient safety (often called safety climate or safety culture). Here we report the psychometric properties, establish benchmarking data, and discuss emerging areas of research with the University of Texas Safety Attitudes Questionnaire. Methods: Six cross-sectional surveys of health care providers (n = 10,843) in 203 clinical areas (including critical care units, operating rooms, inpatient settings, and ambulatory clinics) in three countries (USA, UK, New Zealand). Multilevel factor analyses yielded results at the clinical area level and the respondent nested within clinical area level. We report scale reliability, floor/ceiling effects, item factor loadings, inter-factor correlations, and percentage of respondents who agree with each item and scale. Results: A six factor model of provider attitudes fit to the data at both the clinical area and respondent nested within clinical area levels. The factors were: Teamwork Climate, Safety Climate, Perceptions of Management, Job Satisfaction, Working Conditions, and Stress Recognition. Scale reliability was 0.9. Provider attitudes varied greatly both within and among organizations. Results are presented to allow benchmarking among organizations and emerging research is discussed. Conclusion: The Safety Attitudes Questionnaire demonstrated good psychometric properties. Healthcare organizations can use the survey to measure caregiver attitudes about six patient safety-related domains, to compare themselves with other organizations, to prompt interventions to improve safety attitudes and to measure the effectiveness of these interventions. http://www.biomedcentral.com/1472-6963/6/44 John B Sexton, Robert L Helmreich, Torsten B Neilands, Kathy Rowan, Keryn Vella, James Boyden, Peter R Roberts and Eric J Thomas BMC Health Services Research 2006, 6:44 Number of accesses: 518 2006-04-03 doi:10.1186/1472-6963-6-44 BMC Health Services Research 1472-6963 6 44 2006-04-03 Background: Redesigning care has been proposed as a lever for improving chronic illness care. Within primary care, diabetes care is the most widespread example of restructured integrated care. Our goal was to assess to what extent important aspects of restructured care such as multidisciplinary teamwork and different types of organizational culture are associated with high quality diabetes care in small office-based general practices. Methods: We conducted cross-sectional analyses of data from 83 health care professionals involved in diabetes care from 30 primary care practices in the Netherlands, with a total of 752 diabetes mellitus type II patients participating in an improvement study. We used self-reported measures of team climate (Team Climate Inventory) and organizational culture (Competing Values Framework), and measures of quality of diabetes care and clinical patient characteristics from medical records and self-report. We conducted multivariate analyses of the relationship between culture, climate and HbA1c, total cholesterol, systolic blood pressure and a sum score on process indicators for the quality of diabetes care, adjusting for potential patient- and practice level confounders and practice-level clustering. Results: A strong group culture was negatively associated to the quality of diabetes care provided to patients (β = -0.04; p = 0.04), whereas a more 'balanced culture' was positively associated to diabetes care quality (β = 5.97; p = 0.03). No associations were found between organizational culture, team climate and clinical patient outcomes. Conclusion: Although some significant associations were found between high quality diabetes care in general practice and different organizational cultures, relations were rather marginal. Variation in clinical patient outcomes could not be attributed to organizational culture or teamwork. This study therefore contributes to the discussion about the legitimacy of the widespread idea that aspects of redesigning care such as teamwork and culture can contribute to higher quality of care. Future research should preferably combine quantitative and qualitative methods, focus on possible mediating or moderating factors and explore the use of instruments more sensitive to measure such complex constructs in small office-based practices. http://www.biomedcentral.com/1472-6963/8/180 Marije Bosch, Rob Dijkstra, Michel Wensing, Trudy van der Weijden and Richard Grol BMC Health Services Research 2008, 8:180 Number of accesses: 466 2008-08-21 doi:10.1186/1472-6963-8-180 BMC Health Services Research 1472-6963 8 180 2008-08-21 Background: The performance of separate Intensive Care Unit (ICU) status scoring systems vis-à-vis prediction of outcome is not satisfactory. Computer-based predictive modeling techniques may yield good results but their performance has seldom been extensively compared to that of other mature or emerging predictive models. The objective of the present study was twofold: to propose a prototype meta-level predicting approach concerning Intensive Care Unit (ICU) survival and to evaluate the effectiveness of typical mining models in this context. Methods: Data on 158 men and 46 women, were used retrospectively (75% of the patients survived). We used Glasgow Coma Scale (GCS), Acute Physiology And Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Injury Severity Score (ISS) values to structure a decision tree (DTM), a neural network (NNM) and a logistic regression (LRM) model and we evaluated the assessment indicators implementing Receiver Operating Characteristics (ROC) plot analysis. Results: Our findings indicate that regarding the assessment of indicators' capacity there are specific discrete limits that should be taken into account. The Az score ± SE was 0.8773± 0.0376 for the DTM, 0.8061± 0.0427 for the NNM and 0.8204± 0.0376 for the LRM, suggesting that the proposed DTM achieved a near optimal Az score. Conclusion: The predicting processes of ICU survival may go "one step forward", by using classic composite assessment indicators as variables. http://www.biomedcentral.com/1472-6963/8/157 Lefteris G Gortzis, Filippos Sakellaropoulos, Ioannis Ilias, Konstantinos Stamoulis and Ioanna Dimopoulou BMC Health Services Research 2008, 8:157 Number of accesses: 464 2008-07-26 doi:10.1186/1472-6963-8-157 BMC Health Services Research 1472-6963 8 157 2008-07-26 Background: Provision of complementary therapy services within the NHS is scarce and contested. However, their adoption may be more likely in a service model that is designed to the specifications of clinicians and Primary Care Trust (PCT) managers. Our objective was to identify the features of a 'NHS friendly' service to inform service designers who wish to develop NHS complementary therapy services. Methods: Using a case study approach, two sites offering complementary therapies on NHS premises were studied using interview and documentary data. We conducted interviews with 20 NHS professionals, including PCT managers and clinicians. We used descriptive content analysis to analyse interview data. We collected and analysed documentation, such as referral data, funding bids and evaluations, to compare reported and documented behaviour. Results: Ideally, a 'NHS friendly' complementary therapy service should offer a limited number of therapies for a specific condition for high priority patient populations (e.g. acupuncture for addictions). In this service model, the therapies should be perceived to have 'good' evidence for conditions where there are 'effectiveness gaps' (i.e. current treatments are limited). The service should be evaluated and regularly promoted. Inter-professional relationships would flourish through opportunities for informal contact and formal interactions, such as observations of consultations. However, the service should include gatekeeper mechanisms to control demand and avoid picking up 'unmet need' (i.e. individuals currently not accessing NHS services). The complementary therapy service should pay for itself and reduce NHS costs elsewhere, such as hospital admissions. Conclusion: The service design model identified in this study is problematic. For example, it is contradictory to provide specific interventions for specific conditions within a holistic healthcare framework. It is difficult to avoid providing for 'unmet need' while concurrently filling 'effectiveness gaps'. In addition, demonstrating the impact of a community service on reducing hospital admissions is challenging. Those seeking to establish a NHS complementary therapy service might be well-advised to meet as many of the criteria of a 'NHS friendly' model as possible, recognising that its full realisation may be impossible. However, during periods of innovation and financial security, some relaxation of expectations may occur. http://www.biomedcentral.com/1472-6963/8/173 Lesley Wye, Alison Shaw and Debbie Sharp BMC Health Services Research 2008, 8:173 Number of accesses: 434 2008-08-12 doi:10.1186/1472-6963-8-173 BMC Health Services Research 1472-6963 8 173 2008-08-12 Background: This study investigated the costs and outcomes of implementing cognitive behavior therapy (CBT) for chronic fatigue syndrome (CFS) in a mental health center (MHC). CBT is an evidence-based treatment for CFS that was scarcely available until now. To investigate the possibilities for wider implementation, a pilot implementation project was set up. MethodCosts and effects were evaluated in a non-controlled before- and after study with an eight months time-horizon. Both the costs of performing the treatments and the costs of implementing the treatment program were included in the analysis. The implementation interventions included: informing general practitioners (GPs) and CFS patients, training therapists, and instructing the MHC employees. Given the non-controlled design, cost outcome ratio's (CORs) and their acceptability curves were analyzed. Analyses were done from a health care perspective and from a societal perspective. Bootstrap analyses were performed to estimate the uncertainty around the cost and outcome results. Results: 125 CFS patients were included in the study. After treatment 37% had recovered from CFS and the mean gained QALY was 0.03. Costs of patients' health care and productivity losses had decreased significantly. From the societal perspective the implementation led to cost savings and to higher health states for patients, indicating dominancy. From the health care perspective the implementation revealed overall costs of E5.320 per recovered patient, with an acceptability curve showing a 100% probability for a positive COR at a willingness to pay threshold of E6.500 per recovered patient. Conclusions: Implementing CBT for CFS in a MHC appeared to have a favorable cost outcome ratio (COR) from a societal perspective. From a health care perspective the COR depended on how much a recovered CFS patient is being valued. The strength of the evidence was limited by the non-controlled design. The outcomes of this study might facilitate health care providers when confronted with the decision whether or not to adopt CBT for CFS in their institution. http://www.biomedcentral.com/1472-6963/8/175 Korine Scheeres, Michel Wensing, Gijs Bleijenberg and Johan L Severens BMC Health Services Research 2008, 8:175 Number of accesses: 432 2008-08-13 doi:10.1186/1472-6963-8-175 BMC Health Services Research 1472-6963 8 175 2008-08-13 Background: Few studies have examined empowerment interventions as they actually unfold in home care in the context of chronic health problems. This study aims to document the empowerment process as it plays out in interventions with adults receiving home care services.Methods/designThe qualitative design chosen is a fourth generation evaluation combined with case studies. A home care team of a health and social services center situated in the Eastern Townships (Québec, Canada) will be involved at every step in the study. A sample will be formed of 15 health care professionals and 30 of their home care clients and caregiver. Semi-structured interviews, observations of home care interventions and socio-demographic questionnaires will be used to collect the data. Nine instruments used by the team in prior studies will be adapted and reviewed. A personal log will document the observers' perspectives in order to foster objectivity and the focus on the intervention. The in-depth qualitative analysis of the data will illustrate profiles of enabling interventions and individual empowerment.DiscussionThe ongoing process to transform the health care and social services network creates a growing need to examine intervention practices of health care professionals working with clients receiving home care services. This study will provide the opportunity to examine how the intervention process plays out in real-life situations and how health care professionals, clients and caregivers experience it. The intervention process and individual empowerment examined in this study will enhance the growing body of knowledge about empowerment. http://www.biomedcentral.com/1472-6963/8/177 Denise St-Cyr Tribble, Frances Gallagher, Linda Bell, Chantal Caron, Pierre Godbout, Jeannette Leblanc, Pascale Morin, Marianne Xhignesse, Louis Voyer and Mélanie Couture BMC Health Services Research 2008, 8:177 Number of accesses: 415 2008-08-20 doi:10.1186/1472-6963-8-177 BMC Health Services Research 1472-6963 8 177 2008-08-20 Background: While the majority of dental care in Australia is provided in the private sector those patients who attend for public care remain a public health focus due to their socioeconomic disadvantage. The aims of this study were to compare dental service profiles provided to patients at private and public clinics, controlling for age, sex, reason for visit and income. Methods: Data were collected in 2004–06, using a three-stage, stratified clustered sample of Australians aged 15+ years, involving a computer-assisted telephone interview (CATI), oral examination and mailed questionnaire. Analysis was restricted to those who responded to the CATI. Results: A total of 14,123 adults responded to the CATI (49% response) of whom 5,505 (44% of those interviewed) agreed to undergo an oral epidemiological examination. Multivariate analysis controlling for age, sex, reason for visit and income showed that persons attending public clinics had higher odds [Odds ratio, 95%CI] of extraction (1.69, 1.26–2.28), but lower odds of receiving oral prophylaxis (0.50, 0.38–0.66) and crown/bridge services (0.34, 0.13–0.91) compared to the reference category of private clinics. Conclusion: Socio-economically disadvantaged persons who face barriers to accessing dental care in the private sector suffer further oral health disadvantage from a pattern of services received at public clinics that has more emphasis on extraction of teeth and less emphasis on preventive and maintenance care. http://www.biomedcentral.com/1472-6963/8/1 David S Brennan, Liana Luzzi and Kaye F Roberts-Thomson BMC Health Services Research 2008, 8:1 Number of accesses: 410 2008-01-03 doi:10.1186/1472-6963-8-1 BMC Health Services Research 1472-6963 8 1 2008-01-03 Background: A number of approaches have been used to grade levels of evidence and the strength of recommendations. The use of many different approaches detracts from one of the main reasons for having explicit approaches: to concisely characterise and communicate this information so that it can easily be understood and thereby help people make well-informed decisions. Our objective was to critically appraise six prominent systems for grading levels of evidence and the strength of recommendations as a basis for agreeing on characteristics of a common, sensible approach to grading levels of evidence and the strength of recommendations. Methods: Six prominent systems for grading levels of evidence and strength of recommendations were selected and someone familiar with each system prepared a description of each of these. Twelve assessors independently evaluated each system based on twelve criteria to assess the sensibility of the different approaches. Systems used by 51 organisations were compared with these six approaches. Results: There was poor agreement about the sensibility of the six systems. Only one of the systems was suitable for all four types of questions we considered (effectiveness, harm, diagnosis and prognosis). None of the systems was considered usable for all of the target groups we considered (professionals, patients and policy makers). The raters found low reproducibility of judgements made using all six systems. Systems used by 51 organisations that sponsor clinical practice guidelines included a number of minor variations of the six systems that we critically appraised. Conclusions: All of the currently used approaches to grading levels of evidence and the strength of recommendations have important shortcomings. http://www.biomedcentral.com/1472-6963/4/38 David Atkins, Martin Eccles, Signe Flottorp, Gordon H Guyatt, David Henry, Suzanne Hill, Alessandro Liberati, Dianne O'Connell, Andrew D Oxman, Bob Phillips, Holger Schünemann, Tessa Tan-Torres Edejer, Gunn E Vist, John W Williams and The GRADE Working Group BMC Health Services Research 2004, 4:38 Number of accesses: 403 2004-12-22 doi:10.1186/1472-6963-4-38 BMC Health Services Research 1472-6963 4 38 2004-12-22