Patient-reported outcomes (PROs) provide clinical researchers with a good means to assess patient-based outcomes. Yet there are still some problems to pay attention to while using PROs as an effectiveness assessment index, including the selection of an appropriate scale of PRO, quality control in PRO data collection, and the interpretations and application ranges of the PRO results.
Outcome Assessment (Health Care) ; methods ; Patient Satisfaction ; Psychometrics ; Quality Control

PURPOSE: This study was performed to investigate the preventable death rate (PDR) in Daegu, South Korea, and to assess both its affecting- and preventable-factors to improve the treatment of regional trauma patients. METHODS: All cases of traumatic death that occurred between January 2012 and December 2012 in five hospitals in Daegu were analyzed retrospectively by a panel review. Cases were classified into preventable (P) and non-preventable deaths (NP). We determined the affecting factors of trauma deaths and preventable factors during trauma care. RESULTS: The PDR was 25.2%. Significant differences by mode of arrival, day of injury, cause of death, and time of emergency department (ED) arrival were observed between P and NP groups. According to the logistic regression analysis, preventability was associated with patients transferred from other hospitals, ED arrival at night and dawn, and non-head injuries. A total of 145 preventable factors were discovered in 59 preventable trauma deaths. When we categorized by location, the ED was the most common, with 71 cases, followed by 57 prehospital preventable factors. When we classified the preventable factors by process, 76.8% were process-related and 23.4% were structure-related. CONCLUSION: Our study is valuable to build an adequate trauma system in Daegu as it provides the baseline quality control data. Efforts to mediate the preventable factors were revealed in this study, and continuous reviews to calculate and track the PDR are needed to evaluate the local trauma system and establish a system specific to Daegu.
Cause of Death ; Daegu* ; Emergency Service, Hospital ; Humans ; Korea* ; Logistic Models ; Mortality* ; Outcome and Process Assessment (Health Care) ; Quality Control ; Retrospective Studies

PURPOSE: Patients usually suffer from pain and discomfort after oral surgery and their consumption of food is severely affected. Accordingly, the patients' quality of life reduce significantly. The aim of this study was to analyze patient satisfaction on the nutritional supplement drinks following periodontal surgery. MATERIALS AND METHODS: Total 90 patients who underwent periodontal surgery were recruited and commercially available nutritional drinks were provided. Group I received two bottles per each meal for 2 days, Group II had one bottle per each meal for 3 days, and Group III had no drinks. The survey for the patient-reported outcome measures (PROMs) were given at the next visit for the removal of sutures. RESULTS: The result of PROMs showed the nutrition drink was easy to intake, appeared to help the healing and can be a satisfying supplement for the meals. CONCLUSION: Nutritional drinks appeared to help the healing after periodontal surgeries and supported the food intake. Also, it was helpful for the patients in nutritional supply and psychological stability.
Eating ; Humans ; Meals ; Outcome Assessment (Health Care)* ; Patient Satisfaction ; Quality of Life ; Surgery, Oral ; Sutures ; Wound Healing

Background: In 2008, the Department of Health (DOH) issued Administrative Order 2008-0023 that called for an “effective and efficient monitoring system that will link all patient safety initiatives”. However, there are still no explicit and harmonized targets to measure effectiveness and to provide benchmarks that assess whether previous efforts were helpful. Objective: The study aimed to describe the status of patient safety performance measures and indicators on the international patient safety goals (IPSGs) in select hospitals in the Philippines. Methods: Descriptive, cross-sectional design was used to investigate currently used performance measures and indicators. Data collection included administration of a Hospital Patient Safety Indicators Questionnaire (HPSIQ) that summarized the currently used patient safety measures and indicators in the sampled Level 2 and level 3 hospitals and triangulation by review of documents such as hospital databases, protocols on reporting, and manuals for information gathering regarding patient safety. Performance measures were categorized using the Donabedian framework. Core indicators were identified through review of standards that cut across the six IPSGs and evaluation of overarching processes and concepts in patient safety. Results: Forty-one level 2 and 3 hospitals participated in the study. Most performance indicators were process measures (52%), while structure (31%) and outcome measures (17%) accounted for the rest. There is an obvious lack of structural requirements for patient safety in the hospitals included in this study. Less than half the hospitals surveyed implement risk assessment and management consistently. Reporting of events, near- misses, and patient safety data are widely varied among hospitals. Data utilization for quality improvement is not fully established in many of the hospitals. Patient engagement is not integrated in service delivery and performance measurement but is crucial in promoting patient safety. Conclusion Mechanisms to improve hospitals’ capacity to monitor, anticipate, and reduce risk of patient harm during the provision of healthcare should be provided. Having a unified set of definitions and protocols for measurement will facilitate reliable monitoring and improvement. Leadership and governance, both internal (e.g., hospital administrators) and external (e.g., DOH) that recognize a data-driven approach to policymaking and improvement of service delivery are crucial in promoting patient safety
Patient Safety ; Outcome and Process Assessment, Health Care

PURPOSE: This study was to systematically review the contents and effects of nurse-led transitional care programs for discharged patients from hospital to home. METHODS: Randomized controlled trials published between 2005 and 2015 were searched in Pubmed, Embase, Cochrane(Central Register of Controlled Trials) and CINAHL. Data were analyzed using Cochrane Review Manager(Revman) software 5.3. RESULTS: Nine studies were selected and analyzed. Patient assessment, education and discharge planning were included in pre-discharge phase. Referring, communication and care planning were performed by nurses in transition phase. Home and phone visits, monitoring and multidisciplinary advices were included in post-discharge phase. Various outcome measures such as hospital utilization(30 days readmission and emergency department visit), quality of life, and cost were used to identify effectiveness of nurse-led transitional care programs. 30 days readmission(OR=.73, 95% CI 0.54, 0.98; p=.03) and emergency department visit(OR=.67, 95% CI 0.50, 0.88; p=.005) were statistically significant in meta-analysis. However, participant blinding was not done in seven studies which put at the risk of performance bias. CONCLUSION: The results indicated that nurse-led transitional care program is effective in reducing unnecessary hospital utilization. Nevertheless, small sample size and risk at performance bias are the limitation of this study. Thus, we suggest that well-designed randomized controlled trials need to be conducted.
Bias (Epidemiology) ; Continuity of Patient Care ; Education ; Emergency Service, Hospital ; Humans ; Outcome Assessment (Health Care) ; Patient Discharge ; Quality of Life ; Sample Size ; Transitional Care

BACKGROUND: Gynecomastia is a common condition that can cause severe emotional and physical distress in both young and older men. Patients in whom symptomatic recalcitrant gynecomastia persists for a long time are potential candidates for surgery. METHODS: From January 2014 to January 2016, 15 patients underwent correction of gynecomastia through a single 3-mm incision at our institution. Only patients with true gynecomastia underwent surgery with this new technique. Through the small incision, sharp dissection was performed in a clockwise and counterclockwise direction describing two half-circles. Health-related quality of life and aesthetic outcomes were evaluated using a modified version of the Breast Evaluation Questionnaire (BEQ). RESULTS: The patients’ average age was 23.5 years (range, 18–28 years), and their average body mass index was 23.2 kg/m² (range, 19.2–25.3 kg/m²). One case was unilateral and 14 cases were bilateral. The weight of glandular tissue resected from each breast ranged from 80 to 170 g. No excess skin was excised. Bleeding was minimal. The mean operating time was 25 minutes (range, 21–40 minutes). No complications were recorded. All lesions were histologically benign. The patients’ average score was 3.5 (on a 5-point Likert scale) in all domains of the BEQ for themselves and their partners. CONCLUSIONS: In this study, we demonstrated the safety and reliability of a new technique that allows mastectomy through an imperceptible 3-mm incision. We obtained high patient satisfaction scores using our surgical technique, and patients reported considerable improvement in their social, physical, and psychological well-being after surgery.
Body Mass Index ; Breast ; Gynecomastia ; Hemorrhage ; Humans ; Lipectomy ; Male ; Mastectomy ; Outcome Assessment (Health Care) ; Patient Satisfaction ; Quality of Life ; Skin

INTRODUCTIONThis paper shows the importance and value of external proficiency testing programmes in monitoring and improving a laboratory's diagnostic skills. It reviews and documents the wide variety of inherited metabolic disorders (IMDs) encountered in the programmes organised by the Human Genetics Society of Australasia and the College of American Pathologists.

MATERIALS AND METHODSThe programmes used actual patient specimens to assess a laboratory's ability to provide diagnoses based on laboratory tests results and brief clinical information. Participating laboratory was also required to suggest additional test(s) to confirm diagnoses.

RESULTSThe results of diagnoses on 116 samples were reviewed. Altogether 49 IMDs were encountered, including 26 organic acidurias, 16 aminoacidurias, 3 urea cycle defects, 5 mucopolysaccharidoses, and 1 each of mucolipidosis and purine disorder. Our report for 21 of the 116 samples (18.1%) deviated from the actual diagnoses. Deviations from the final diagnoses were recorded along with the reasons for them. The main reasons for the deviations were: the lack of standards for recognising metabolites of pathognomonic significance, absence of characteristic metabolites in samples collected during treatment, the presence of misleading unusual metabolites, inadequate clinical information, and inability to perform additional tests due to insufficient specimens.

CONCLUSIONSThe programmes provided a wide variety of IMDs, some of which we have yet to encounter in our patients. They also enabled us to learn about the varied biochemical manifestations at different stages of disease and the identity of previously unidentified metabolites. They enhanced our knowledge and experience and improved our diagnostic skills.

Australia ; Humans ; Laboratories ; standards ; Metabolism, Inborn Errors ; diagnosis ; New Zealand ; Pathology, Clinical ; standards ; Professional Competence ; Program Evaluation ; Quality Assurance, Health Care ; Quality Control ; Specimen Handling ; standards

OBJECTIVE: To investigate the comparative treatment effects of ultrasound-guided pulsed radiofrequency treatment (UG-PRF) in the gastrocnemius interfascial space and ultrasound-guided interfascial injection (UG-INJ) on myofascial pain syndrome. METHODS: Forty consecutive patients with myofascial pain syndrome of the gastrocnemius were enrolled and were allocated to one of the two groups. Twenty patients were treated by UG-PRF delivered to the gastrocnemius interfascial space (UG-PRF group) and the other 20 patients were treated by interfascial injection (UG-INJ group). The primary outcome measure was the numeric rating score (NRS) for pain on pressing the tender point in the gastrocnemius, and the secondary outcome measure was health-related quality of life as determined by the Short Form-36 questionnaire (SF-36). NRSs were obtained at the first visit, immediately after treatment, and at 2 and 4 weeks post-treatment, and physical component summary scores (PCS) and mental component summary scores (MCS) of the SF-36 questionnaire were measured at the first visit and at 4 weeks post-treatment. RESULTS: Immediately after treatments, mean NRS in the UG-PRF group was significantly higher than that in the UG-INJ group (p<0.0001). However, at 2 and 4 weeks post-treatment, the mean NRS was significantly lower in the UG-PRF group (both p<0.0001). Similarly, at 4 weeks post-treatment, mean PCS and MCS were significantly higher in the UG-PRF group (p<0.0001 and p=0.002, respectively). CONCLUSION: Based on these results, the authors conclude that ultrasound-guided gastrocnemius interfascial PRF provides an attractive treatment for myofascial pain syndrome of the gastrocnemius.
Humans ; Muscle, Skeletal ; Myofascial Pain Syndromes* ; Outcome Assessment (Health Care) ; Pulsed Radiofrequency Treatment ; Quality of Life

OBJECTIVE: Comprehensive poststroke rehabilitation includes continuum of care after discharge from hospital. Day hospital is a milieu-oriented outpatient rehabilitation program that offers continuous rehabilitation service to promote psychosocial adaptation and quality of life. This study is to evaluate long-term effects of day hospital program in stroke patients. METHOD: Forty-eight stroke patients who received day hospital program for 2 or more months after inpatient rehabilitation program and 42 control stroke patients, who received only inpatient rehabilitation program, responded telephone interview for the study. Outcome measurement included the Korean Activities of Daily Living (K-ADL), the Korean Instrumental Activities of Daily Living (K- IADL) and the Medical Outcome Study 8-item Short Form Survey (SF-8). RESULTS: There was no difference in many item scores of K-ADL between day hospital group and control group, but the item scores of dressing, washing face and hands were significantly higher in control group. Among the item scores of K-IADL, except managing money, most item scores of K-IADL were no significant difference between day hospital group and control group. All item scores of SF-8 were significantly higher in day hospital group than control group. CONCLUSION: Day hospital is an effective rehabilitation program to enhance health-related quality of life for stroke patients.
Activities of Daily Living ; Bandages ; Continuity of Patient Care ; Hand ; Humans ; Inpatients ; Interviews as Topic ; Outcome Assessment (Health Care) ; Outpatients ; Quality of Life ; Rehabilitation* ; Stroke*

OBJECTIVES: Technological advances using telemedicine and telehealth are growing in healthcare fields, but the evaluation framework for them is inconsistent and limited. This paper suggests a comprehensive evaluation framework for telemedicine system implementation and will support related stakeholders' decision-making by promoting general understanding, and resolving arguments and controversies. METHODS: This study focused on developing a comprehensive evaluation framework by summarizing themes across the range of evaluation techniques and organized foundational evaluation frameworks generally applicable through studies and cases of diverse telemedicine. Evaluation factors related to aspects of information technology; the evaluation of satisfaction of service providers and consumers, cost, quality, and information security are organized using the fishbone diagram. RESULTS: It was not easy to develop a monitoring and evaluation framework for telemedicine since evaluation frameworks for telemedicine are very complex with many potential inputs, activities, outputs, outcomes, and stakeholders. A conceptual framework was developed that incorporates the key dimensions that need to be considered in the evaluation of telehealth implementation for a formal structured approach to the evaluation of a service. The suggested framework consists of six major dimensions and the subsequent branches for each dimension. CONCLUSIONS: To implement telemedicine and telehealth services, stakeholders should make decisions based on sufficient evidence in quality and safety measured by the comprehensive evaluation framework. Further work would be valuable in applying more comprehensive evaluations to verify and improve the comprehensive framework across a variety of contexts with more factors and participant group dimensions.
Delivery of Health Care ; Logic* ; Patient Safety ; Program Evaluation ; Quality of Health Care ; Telemedicine*