Implementation of departmental quality strategies is positively associated with clinical practice : Results of a multicenter study in 73 hospitals in 7 European countries
Suñol Sala, Rosa (Universitat Autònoma de Barcelona. Institut Universitari Avedis Donabedian)
Wagner, Cordula (Department of Public and Occupational Health,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam)
Arah, Onyebuchi A. (University of California Los Angeles. Department of Epidemiology)
Kristensen, Solvejg (Aalborg University. Department of Health Science and Technology)
Pfaff, Holger (Center for Health Services Research Cologne, University of Cologne)
Klazinga, Niek (University of Amsterdam. Department of Public Health, Academic Medical Center)
Thompson, Caroline A. (Palo Alto Medical Foundation Research Institute (PAMFRI), Palo Alto, California)
Wang, Aolin (University of California Los Angeles. Department of Epidemiology)
Dersarkissian, Maral (University of California Los Angeles. Department of Epidemiology)
Bartels, Paul (Aalborg University. Department of Health Science and Technology)
Michel, Philippe (Hospices Civils de Lyon, Université Claude Bernard Lyon 1)
Groene, Oliver (London School of Hygiene and Tropical Medicine. Department of Health Services Research and Policy)
DUQuE Project Consortium

Data:	2015
Resum:	Given the amount of time and resources invested in implementing quality programs in hospitals, few studies have investigated their clinical impact and what strategies could be recommended to enhance its effectiveness. To assess variations in clinical practice and explore associations with hospital- and department-level quality management systems. Multicenter, multilevel cross-sectional study. Seventy-three acute care hospitals with 276 departments managing acute myocardial infarction, deliveries, hip fracture, and stroke in seven countries. None. Predictor variables included 3 hospital- and 4 department-level quality measures. Six measures were collected through direct observation by an external surveyor and one was assessed through a questionnaire completed by hospital quality managers. Dependent variables included 24 clinical practice indicators based on case note reviews covering the 4 conditions (acute myocardial infarction, deliveries, hip fracture and stroke). A directed acyclic graph was used to encode relationships between predictors, outcomes, and covariates and to guide the choice of covariates to control for confounding. Data were provided on 9021 clinical records by 276 departments in 73 hospitals. There were substantial variations in compliance with the 24 clinical practice indicators. Weak associations were observed between hospital quality systems and 4 of the 24 indicators, but on analyzing department-level quality systems, strong associations were observed for 8 of the 11 indicators for acute myocardial infarction and stroke. Clinical indicators supported by higher levels of evidence were more frequently associated with quality systems and activities. There are significant gaps between recommended standards of care and clinical practice in a large sample of hospitals. Implementation of department-level quality strategies was significantly associated with good clinical practice. Further research should aim to develop clinically relevant quality standards for hospital departments, which appear to be more effective than generic hospital-wide quality systems.
Ajuts:	European Commission 241822
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	PloS one, Vol. 10 (november 2015) , ISSN 1932-6203

DOI: 10.1371/journal.pone.0141157
PMID: 26588842

16 p, 1007.2 KB

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