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While patient-reported outcomes measures (PROMs) are used in many practice settings as a standardized system of outcome measures, various factors may impact the meaningful use of PROMs by clinicians operating in various settings. Very limited research exists that focused on examining the use of FOTO® in outpatient rehabilitation settings. This study aimed to explore the barriers and facilitators in achieving FOTO® treatment completion rates and patient functional outcomes among physical therapists. Additionally, the study aimed to explore the internal acceptance of FOTO as a useful tool in rehabilitation from the perspectives of physical therapists. Qualitative data were collected through four focus group interviews with physical therapists at outpatient rehabilitation clinics. The interviews were audio-recorded and transcribed, and transcribed, and qualitative content analysis was applied for data analysis. Four major themes emerged from qualitative data analyses including (a) use of FOTO® in clinical practice, (b) reasons why the FOTO® process may not be followed, (c), therapists' perceptions of FOTO®, and (d) perceived barriers and enablers related to FOTO®. The study concluded that multi-level determinants impact the successful use of FOTO® by therapists in outpatient rehabilitation settings. The findings have important implications for clinical practice, organizational leaders, and PROM developers.
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Fisioterapeutas , Humanos , Investigación Cualitativa , Grupos Focales , Instituciones de Atención Ambulatoria , Resultado del TratamientoRESUMEN
OBJECTIVE: The objective of this study was to explore perceptions of senior leadership in hospitals on the motivations, cost, benefits, barriers, and facilitators of investment in emergency preparedness. STUDY DESIGN: This is a qualitative study which used a grounded theory approach to develop a theory of hospital emergency preparedness. SETTING AND STUDY PARTICIPANTS: A purposive sample of hospital leaders (n = 11) in the US state of Nebraska were interviewed. RESULTS: Results showed that the environmental risk associated with the hospital location, the hospital's position in the community, and the preparedness requirements of the Centers for Medicare and Medicaid Services contribute to investment decisions. Rural hospitals face unique challenges in preparing for disasters, for example, lack of trained personnel. Facilitators of disaster preparedness include the availability of federal funds, the commitment of leadership, and an organizational mission aligned toward emergency preparedness. Hospitals invest in hazard vulnerability assessments; partnerships with other organizations in the community; staff trainings and infrastructure. CONCLUSIONS: The authors concluded that hospitals in Nebraska are committed toward investing in preparedness activities. The theory of hospital emergency preparedness developed will be used in a subsequent study to develop a decision-support framework for hospital investment in preparedness.
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Defensa Civil , Planificación en Desastres , Anciano , Humanos , Liderazgo , Medicare , Nebraska , Estados UnidosRESUMEN
OBJECTIVE: The objective of this article is to trace the hospital emergency preparedness movement in the United States, strengthen the case for hospital investments in emergency preparedness, and make recommendations to ensure sustainability of the program. Design/Approach: This article is a narrative review. Main themes from the literature about the US Hospital Preparedness Program (HPP) are discussed, beginning with the trends in funding levels of the HPP, the rise of regional healthcare coalitions, preparedness performance measures, and the challenges faced over the past 15 years of HPP activities. Finally, recommendations are made about ways to sustain the program. FINDINGS: The HPP was established in 2002 and funding for the program has seen a 56 percent decrease over the last 16 years. Beyond the initial investment in supplies and equipment, hospitals have received very little of the healthcare preparedness funding. Disaster drills and exercises to test emergency plans in hospitals are perceived as a costly distraction from daily work. The biggest challenge is the lack of engagement and support from hospital leadership. CONCLUSIONS: To ensure the sustainability of the HPP, the positive impact of preparedness activities on the hospital's day-to-day operations must be demonstrated.
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Defensa Civil/organización & administración , Planificación en Desastres/organización & administración , Desastres , Hospitales , Federación para Atención de Salud , Administración Hospitalaria , Humanos , Estados UnidosRESUMEN
OBJECTIVE: To compare local health department (LHD) accreditation readiness (AR) and quality improvement (QI) maturity in 3 states, between LHDs with varying levels of rurality, and across an LHD staffing-level continuum. DESIGN: This was a cross-sectional comparative study that included an online survey administered to LHD directors in Colorado, Kansas, and Nebraska. The survey included 10 questions assessed on a 5-point Likert scale covering 3 QI domains and 13 questions covering 5 AR domains. The median score for both QI maturity and AR was calculated by each state, by the number of full-time equivalent staff employed at the LHD, and by a measure of rurality and population density. SETTING AND PARTICIPANTS: A total of 156 LHDs from the states of Colorado, Kansas, and Nebraska. MAIN OUTCOME MEASURE(S): QI maturity and AR scores. RESULTS: A majority (59%) of the surveyed LHDs plan to apply or have already applied for Public Health Accreditation Board (PHAB) accreditation. The overall QI maturity and AR scores were highest in Nebraska, as was the intent to seek PHAB accreditation and current use of PHAB standards. Across levels of rurality and staffing, LHD QI maturity scores were similar; however, AR scores improved as LHD staffing levels increased and rurality decreased. CONCLUSIONS: Small LHDs and rural LHDs have QI maturity levels that are comparable to larger, less rural LHDs, but their AR is much lower. As accreditation has been found to have positive benefits, it is important that all LHDs have the capacity and resources to meet the performance standards required of accredited LHDs. Small, rural LHDs may need additional resources and support in order to improve their ability to be accredited and/or certain accreditation requirements may need modification to make accreditation more accessible to small LHDs.
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Gobierno Local , Salud Pública/normas , Mejoramiento de la Calidad/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Acreditación/estadística & datos numéricos , Colorado , Estudios Transversales , Humanos , Kansas , Nebraska , Salud Pública/métodos , Salud Pública/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To demonstrate an approach to measuring the cost and value of quality improvement (QI) implementation in local health departments (LHDs). DESIGN: We conducted cost estimation for 4 LHD QI projects and return-on-investment (ROI) analysis for 2 selected LHD QI projects. SETTING AND PARTICIPANTS: Four Nebraska LHDs varying in rurality and jurisdiction size. MAIN OUTCOME MEASURES: Total costs, unit costs, incremental cost-effectiveness ratios, and ROI. RESULTS: The 4 QI projects vary significantly in their cost estimates. Estimated ROI ratios for 2 QI projects predicted significant savings in health care utilization for respective program participants. A QI project focused on improving breastfeeding rates in WIC (women, infants, and children) clients had a predicted ROI ratio of 3230% and a QI project for improving participation in a Chronic Disease Self-Management Program would need only 34 new participants to have a positive ROI. CONCLUSIONS: We demonstrated how data can be collected and analyzed for cost estimation and ROI analysis to quantify the economic value of QI for LHDs. Our ROI analysis shows that QI initiatives have great potential to enhance the value of LHDs' public health services. A better understanding of the costs and value of QI will enable LHDs to appropriately allocate and utilize their limited resources for suitable QI initiatives.
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Salud Pública/economía , Salud Pública/normas , Mejoramiento de la Calidad/clasificación , Mejoramiento de la Calidad/economía , Análisis Costo-Beneficio , Humanos , Gobierno Local , Nebraska , Salud Pública/tendencias , Mejoramiento de la Calidad/tendenciasRESUMEN
INTRODUCTION: Despite the known benefits of colorectal cancer (CRC) screening, rural areas have consistently reported lower screening rates than their urban counterparts. Alternative healthcare delivery models, such as accountable care organizations (ACOs), have the potential to increase CRC rates through collaboration among healthcare providers with the aim of improving quality and decreasing cost. However, researchers have not sufficiently explored how this innovative model could influence the promotion of cancer screening. The purpose of the study was to explore the mechanism of how CRC screening can be promoted in ACO-participating rural primary care clinics. METHODS: The study collected qualitative data from in-depth interviews with 21 healthcare professionals employed in ACO-participating primary care clinics in rural Nebraska. Participants were asked about their views on opportunities and challenges to promote CRC screening in an ACO context. Data were analyzed using a grounded theory approach. RESULTS: The study found that the new healthcare delivery model can offer opportunities to promote cancer screening in rural areas through enhanced electronic health record use, information sharing and collaborative learning within ACO networks, use of standardized quality measures and performance feedback, a shift to preventive/comprehensive care, adoption of team-based care, and empowered care coordinators. The perceived challenges were found in financial instability, increased staff workload, lack of provider training/education, and lack of resources in rural areas. CONCLUSIONS: This study found that the innovative care delivery model, ACO, could provide a well-designed platform for promoting CRC screening in rural areas, if sustainable resources (eg finance, health providers, and education) are provided. This study provides 'practical' information to identify effective and sustainable intervention programs to promote preventive screening. Further efforts are needed to facilitate delivery system reforms in rural primary care, such as improving performance evaluation measures and methods.
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Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/estadística & datos numéricos , Modelos Estadísticos , Servicios de Salud Rural/organización & administración , Población Rural/estadística & datos numéricos , Organizaciones Responsables por la Atención , Anciano , Neoplasias Colorrectales/prevención & control , Detección Precoz del Cáncer/economía , Femenino , Humanos , Masculino , Área sin Atención Médica , Persona de Mediana Edad , Nebraska , Investigación Cualitativa , Servicios de Salud Rural/economíaRESUMEN
OBJECTIVES: We examined the relationship between quality improvement (QI) maturity and accreditation attributes of US local health departments (LHDs), specifically those in Nebraska. METHODS: Using 2011 Nebraska LHD QI survey data, we conducted Spearman correlation analyses between QI maturity domains and accreditation attributes. Using the 2010 National Association of County and City Health Officials' National Profile of LHDs, we conducted logistic regression analyses to examine the relationships between specific QI strategies and attitude toward seeking accreditation. RESULTS: Leaders' commitment to and length of time engaged in QI were positively associated with LHDs' general attitude toward seeking accreditation. Use of QI strategies and integration of QI policies and practices were positively associated with LHDs' confidence in their capacity to obtain accreditation. LHDs that had used at least 1 QI framework and at least 1 QI technique in the past year were more likely to agree that they would seek accreditation within 2 years of the national accreditation program. CONCLUSIONS: Experience with and expertise in QI implementation play an important role in LHDs' decision to seek accreditation, and their accreditation-seeking efforts may benefit from prior implementation of systematic QI strategies.