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We established a program of research to improve the development, reporting and evaluation of practice guidelines. We assessed the construct validity of the items and user's manual in the β version of the AGREE II. We designed guideline excerpts reflecting high- and low-quality guideline content for 21 of the 23 items in the tool. We designed two study packages so that one low-quality and one high-quality version of each item were randomly assigned to each package. We randomly assigned 30 participants to one of the two packages. Participants reviewed and rated the guideline content according to the instructions of the user's manual and completed a survey assessing the manual. In all cases, content designed to be of high quality was rated higher than low-quality content; in 18 of 21 cases, the differences were significant (p < 0.05). The manual was rated by participants as appropriate, easy to use, and helpful in differentiating guidelines of varying quality, with all scores above the mid-point of the seven-point scale. Considerable feedback was offered on how the items and manual of the β-AGREE II could be improved. The validity of the items was established and the user's manual was rated as highly useful by users. We used these results and those of our study presented in part 1 to modify the items and user's manual. We recommend AGREE II (available at www.agreetrust.org) as the revised standard for guideline development, reporting and evaluation.

\"Although depression is a major cause of illness and disability, the quality of care offered is often poor. Research evidence demonstrating how the quality of primary care can be improved is dispersed in different academic journals and written in technical jargon. Depression in Primary Care: Evidence and Practice summarizes this research in a clear and useable format. This collection of high quality reviews of research evidence takes the form of a series of clinical and economic evaluations. Each provides a clear summary of the best evidence from trials and an accessible 'how to do it' guide, written by international experts. Global approaches towards the organization and delivery of primary care for depression are presented, from the UK, North America, Europe and the developing world. An important source of practical guidance about how to implement quality improvement programs in clinical practice, this book will assist practitioners, researchers and policy makers alike. - Combines clear evidence summaries with a simple and practical guide about how to implement quality improvement programmes in practice - Prepared by international experts and of interest and relevance in all countries and healthcare settings - Addresses a major healthcare priority identified by the World Health Organization, US Agency for Healthcare Research and UK National Institute for Clinical Excellence\"--Provided by publisher.

In some low-income countries such as Cambodia and Rwanda, experimental performance-based payment systems have led to rapid improvements in access to health care and the quality of that care. Under this type of payment scheme, funders-including foreign governments and international aid programs-subsidize local health care providers for achieving certain benchmarks. The benchmarks can include such measures as child immunizations or childbirth in a health facility. In this article we report the results of a performance-based payment experiment conducted in the Democratic Republic of Congo, which is one of the poorest countries in the world and has an extremely high level of child and maternal mortality. We found that providing performance-based subsidies resulted in lower direct payments to health facilities for patients, who received comparable or better services and quality of care than those provided at a control group of facilities that were not financed in this way. The disparity occurred despite the fact that the districts receiving performance-based subsidies received external foreign assistance of approximately $2 per capita per year, compared to the $9-$12 in external assistance received by the control districts. The experiment also revealed that performance-based financing mechanisms can be effective even in a troubled nation such as the Democratic Republic of Congo. Adapted from the source document.

\"Quality Management and Managerialism in Healthcare creates a comprehensive and systematic international survey of various perspectives on healthcare quality management together with some of their most pertinent critiques. Chapter one starts with a general discussion of the factors that drove the introduction of management paradigms into public sector and health management contexts in the mid to late 1980s. Chapter two explores the rise of risk awareness in medicine; which, prior to the 1980s, stood largely in isolation to the implementation of managerial performance targets. Chapter three investigates the widespread adoption of performance management and clinical governance frameworks during the 1980s and 1990s. This is followed by Chapters four and five which examine systems based models of patient safety and the evidence-based medicine movement as exemplars of managerial perspectives on healthcare quality. Chapter six discusses potential future avenues for the development of alternative perspectives on quality of care which emphasise workforce involvement. The book concludes by reviewing the factors which have underpinned the managerialist trajectory of healthcare management over the past decades and explores the potential impact of nascent technologies such as 'connected health' and 'telehealth' on future developments\"-- Provided by publisher.

Objectives: To describe a new, rigorous, comprehensive practicebased evidence for clinical practice improvement (PBE-CPI) study methodology, and compare its features, advantages, and disadvantages to those of randomized controlled trials and sophisticated statistical methods for comparative effectiveness research. Research Design: PBE-CPI incorporates natural variation within data from routine clinical practice to determine what works, for whom, when, and at what cost. It uses the knowledge of front-line caregivers, who develop study questions and define variables as part of a transdisciplinary team. Its comprehensive measurement framework provides a basis for analyses of significant bivariate and multivariate associations between treatments and outcomes, controlling for patient differences, such as severity of illness. Results: PBE-CPI studies can uncover better practices more quickly than randomized controlled trials or sophisticated statistical methods, while achieving many of the same advantages. We present examples of actionable findings from PBE-CPI studies in postacute care settings related to comparative effectiveness of medications, nutritional support approaches, incontinence products, physical therapy activities, and other services. Conclusions: Outcomes improved when practices associated with better outcomes in PBE-CPI analyses were adopted in practice.

\"The same Lean principles that are helping hospitals eliminate waste and improve efficiencies are applicable to individuals working in healthcare. This book not only provides the tools to alleviate the obvious symptoms of inefficiency but also demonstrates how to find the root causes underlying that inefficiency. It presents a practical, step-by-step approach to applying Lean principles to individuals, including real-world examples that illustrate how these principles have been applied in the healthcare industry\"-- Provided by publisher.

ObjectivesThe objective was to assess the possibility of using a combination of official and unofficial Facebook ratings and comments as a basis for nation-wide hospital quality assessments in Norway.MethodsAll hospitals from a national cross-sectional patient experience survey in 2015 were matched with corresponding Facebook ratings. Facebook ratings were correlated with both case-mix adjusted and unadjusted patient-reported experience scores, with separate analysis for hospitals with official site ratings and hospitals with unofficial site ratings. Facebook ratings were also correlated with patient-reported incident scores, hospital size, 30-day mortality and 30-day readmission. Facebook comments from 20 randomly selected hospitals were analysed, contrasting the content and sentiments of official versus unofficial Facebook pages.ResultsFacebook ratings were significantly correlated with most patient-reported indicators, with the highest correlations relating to unadjusted scores for organisation (0.60, p<0.000) and nursing services (0.57, p<0.000). Facebook ratings were significantly correlated with hospital size (−0.40, p=0.003) and 30-day mortality (0.31, p=0.040). Sentiment analysis showed that 84.7% of the comments from unofficial Facebook sites included neutral comments that did not give any specific description of experiences of the quality of care at the hospital. Content analysis identified common themes on official and unofficial Facebook pages.ConclusionsFacebook ratings were associated with patient-reported indicators, hospital size, and 30-day mortality. Qualitative comments from official Facebook are more relevant for hospital evaluation than unofficial sites. More research is needed on using Facebook ratings as a standalone indicator of patient experiences in national quality measurement, and such ratings should be reported together with research-based patient experience indicators and with explicit criteria for the inclusion of unofficial sites.

To increase the effective use of thrombolytics for acute stroke, the expertise of vascular neurologists must be disseminated more widely. We prospectively assessed whether telemedicine (real-time, two-way audio and video, and digital imaging and communications in medicine [DICOM] interpretation) or telephone was superior for decision making in acute telemedicine consultations. From January, 2004, to August, 2007, patients older than 18 years who presented with acute stroke symptoms at one of four remote spoke sites were randomly assigned, through a web-based, permuted blocks system, to telemedicine or telephone consultation to assess their suitability for treatment with thrombolytics, on the basis of standard criteria. The primary outcome measure was whether the decision to give thrombolytic treatment was correct, as determined by central adjudication. Secondary outcomes were the rate of thrombolytic use, 90-day functional outcomes (Barthel index [BI] and modified Rankin scale [mRS]), the incidence of intracerebral haemorrhages, and technical observations. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00283868. 234 patients were assessed prospectively. 111 patients were randomised to telemedicine, and 111 patients were randomised to telephone consultation; 207 completed the study. Mean National Institutes of Health stroke scale score at presentation was 9·5 (SD 8·1) points (11·4 [8·7] points in the telemedicine group versus 7·7 [7·0] points in the telephone group; p=0·002). One telemedicine consultation was aborted for technical reasons, although it was included in the analyses. Correct treatment decisions were made more often in the telemedicine group than in the telephone group (108 [98%] vs 91 [82%], odds ratio [OR] 10·9, 95% CI 2·7–44·6; p=0·0009). Intravenous thrombolytics were used at an overall rate of 25% (31 [28%] telemedicine vs 25 [23%] telephone, 1·3, 0·7–2·5; p=0·43). 90-day functional outcomes were not different for BI (95–100) (0·6, 0·4–1·1; p=0·13) or for mRS score (0·6, 0·3–1·1; p=0·09). There was no difference in mortality (1·6, 0·8–3·4; p=0·27) or rates of intracerebral haemorrhage after treatment with thrombolytics (2 [7%] telemedicine vs 2 [8%] telephone, 0·8, 0·1–6·3; p=1·0). However, there were more incomplete data in the telephone group than in the telemedicine group (12% vs 3%, 0·2, 0·1–0·3; p=0·0001). The authors of this trial report that stroke telemedicine consultations result in more accurate decision making compared with telephone consultations and can serve as a model for the effectiveness of telemedicine in other medical specialties. The more appropriate decisions, high rates of thrombolysis use, improved data collection, low rate of intracerebral haemorrhage, low technical complications, and favourable time requirements all support the efficacy of telemedicine for making treatment decisions, and might enable more practitioners to use this medium in daily stroke care. National Institute of Neurological Disorders and Stroke; California Institute of Telecommunications Technology; Department of Veterens' Affairs Research Division.