Search

Introduction and Objective: This paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework and methods applied, highlighting the novel features of this study., Design: DUQuE was designed as a multi-level cross-sectional study with data collection at hospital, pathway, professional and patient level in eight countries., Setting and Participants: We aimed to collect data for the assessment of hospital-wide constructs from up to 30 randomly selected hospitals in each country, and additional data at pathway and patient level in 12 of these 30., Main Outcome Measures: A comprehensive conceptual framework was developed to account for the multiple levels that influence hospital performance and patient outcomes. We assessed hospital-specific constructs (organizational culture and professional involvement), clinical pathway constructs (the organization of care processes for acute myocardial infarction, stroke, hip fracture and deliveries), patient-specific processes and outcomes (clinical effectiveness, patient safety and patient experience) and external constructs that could modify hospital quality (external assessment and perceived external pressure)., Results: Data was gathered from 188 hospitals in 7 participating countries. The overall participation and response rate were between 75% and 100% for the assessed measures., Conclusions: This is the first study assessing relation between quality management and patient outcomes at EU level. The study involved a large number of respondents and achieved high response rates. This work will serve to develop guidance in how to assess quality management and makes recommendations on the best ways to improve quality in healthcare for hospital stakeholders, payers, researchers, and policy makers throughout the EU.

Purpose: Quantitative instruments to assess patient safety culture have been developed recently and a few review articles have been published. Measuring safety culture enables healthcare managers and staff to improve safety behaviours and outcomes for patients and staff. The study aims to determine the AHRQ Hospital Survey on Patient Safety Culture (HSPSC) Portuguese version's validity and reliability., Design/methodology/approach: A missing-value analysis and item analysis was performed to identify problematic items. Reliability analysis, inter-item correlations and inter-scale correlations were done to check internal consistency, composite scores. Inter-correlations were examined to assess construct validity. A confirmatory factor analysis was performed to investigate the observed data's fit to the dimensional structure proposed in the AHRQ HSPSC Portuguese version. To analyse differences between hospitals concerning composites scores, an ANOVA analysis and multiple comparisons were done., Findings: Eight of 12 dimensions had Cronbach's alphas higher than 0.7. The instrument as a whole achieved a high Cronbach's alpha (0.91). Inter-correlations showed that there is no dimension with redundant items, however dimension 10 increased its internal consistency when one item is removed., Originality/value: This study is the first to evaluate an American patient safety culture survey using Portuguese data. The survey has satisfactory reliability and construct validity.

Introduction: Due to their morbidity and mortality, cardiovascular diseases are one of the most significant public health problems in industrialized countries, including Portugal. The appropriate use of lipid-lowering drugs to prevent and treat these diseases is therefore of major and increasing importance in therapy today, in terms of both public health and allocation of financial resources by the health system., Objectives: The present study aims to characterize use and expenditure for lipid-lowering drugs in Portugal, and the impact of current policies on their consumption and cost., Methods: The analysis refers to lipid-lowering drugs prescribed and dispensed to outpatients in mainland Portugal covered by the National Health Service (NHS) between January 1, 1995 and June 30, 2004. The Anatomical Therapeutic Chemical classification index recommended by the World Health Organization was used in order to calculate various utilization and expenditure indicators., Results: The use of lipid-lowering drugs in Portugal showed a large increase in terms of defined daily doses per 1000 inhabitants per day (DID), from 10.21 DID in 1995 to 67.93 DID in 2004, mainly due to increased use of statins (an average annual growth of 34.5%). Expenditure on lipid-lowering drugs reached around 123 million euros in 2003, representing. 5% of total NHS expenditure on outpatient medicines. However, the daily treatment cost of these medicines has decreased, particularly in the case of statins and more markedly following increased availability of generic medicines., Conclusions: The study indicates a change in the pattern of lipid-lowering drug utilization and a more rational use of these medicines with the introduction of statins. The increased use of statins follows changes in clinical guidelines for the treatment of dyslipidemia and suggests a favorable evolution in the number of individuals taking statins, although this has had a significant impact on pharmaceutical expenditure, representing a major expense for patients and the NHS. In conclusion, the measures studied for expenditure containment have been successful in the case of statins, with significant development of the generics market (31% market share in 2004), reduction of costs (35% between 1995 and 2004) and hence increased access of patients to such therapy.