Effects of Government Supervision on Quality of Integrated Diabetes Care

Wesselink, Sandra F. Oude; Lingsma, Hester F.; Ketelaars, Corry A.J.; Mackenbach, Johan P.; Robben, Paul

doi:10.1097/mlr.0000000000000399

Cited by 11 publications

(7 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast to previous studies, which were unable to detect association between external inspections and improvement in quality of care, 11–13 we found improvements in key measures of care delivery, including time to treatment. The lack of significant associations between inspection and the outcome measures when adjusting for time might be due to the heterogeneity of the patient group included in the study.…”

Section: Discussioncontrasting

confidence: 99%

“…External assessments are contemporary, real-world events that involve autonomous actors, including healthcare providers, inspecting organs and policy-makers. The complexity of the settings in which external assessments take place may explain why only three randomised controlled studies have been performed to evaluate their effect on quality of care: two small-scale studies 11 12 and one study 13 whose methods have been criticised for leading to unreliable conclusions. 10 None of these studies found improvements in patient care resulting from external assessments.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of external inspections on sepsis detection and treatment: a stepped-wedge study with cluster-level randomisation

et al. 2020

View full text Add to dashboard Cite

ObjectiveTo evaluate the effects of external inspections on (1) hospital emergency departments’ clinical processes for detecting and treating sepsis and (2) length of hospital stay and 30-day mortality.DesignIncomplete cluster-randomised stepped-wedge design using data from patient records and patient registries. We compared care processes and patient outcomes before and after the intervention using regression analysis.SettingNationwide inspections of sepsis care in emergency departments in Norwegian hospitals.Participants7407 patients presenting to hospital emergency departments with sepsis.InterventionExternal inspections of sepsis detection and treatment led by a public supervisory institution.Main outcome measuresProcess measures for sepsis diagnostics and treatment, length of hospital stay and 30-day all-cause mortality.ResultsAfter the inspections, there were significant improvements in the proportions of patients examined by a physician within the time frame set in triage (OR 1.28, 95% CI 1.07 to 1.53), undergoing a complete set of vital measurements within 1 hour (OR 1.78, 95% CI 1.10 to 2.87), having lactate measured within 1 hour (OR 2.75, 95% CI 1.83 to 4.15), having an adequate observation regimen (OR 2.20, 95% CI 1.51 to 3.20) and receiving antibiotics within 1 hour (OR 2.16, 95% CI 1.83 to 2.55). There was also significant reduction in mortality and length of stay, but these findings were no longer significant when controlling for time.ConclusionsExternal inspections were associated with improvement of sepsis detection and treatment. These findings suggest that policy-makers and regulatory agencies should prioritise assessing the effects of their inspections and pay attention to the mechanisms by which the inspections might contribute to improve care for patients.Trial registrationNCT02747121.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of external inspections on sepsis detection and treatment: a stepped-wedge study with cluster-level randomisation

et al. 2020

View full text Add to dashboard Cite

show abstract

“…1 2 The expectation is that inspections will impact positively on the quality and safety of care, although there is little direct evidence of the effectiveness of external inspections on quality of care within organisations. [3][4][5][6] A recent report from the King's Fund explored the impact of regulation and identified ways in which regulation might impact provider performance before, during and after inspection: for example, healthcare providers might anticipate an upcoming inspection and make changes in practice, become aware of specific quality and safety concerns raised during inspections, and might initiate broader organisational developments, reflection and analysis following the inspection. 7 Such reactions might positively affect healthcare quality but can also have unintended effects.…”

Section: Introductionmentioning

confidence: 99%

Publication of inspection frameworks: a qualitative study exploring the impact on quality improvement and regulation in three healthcare settings

2020

View full text Add to dashboard Cite

BackgroundThe Dutch healthcare inspectorate publishes its inspection frameworks to inform both the public and healthcare providers about regulatory procedures and in the hope that publication will motivate healthcare providers to improve quality and comply with standards. This study explores the consequences of publishing these frameworks for the regulation of quality and safety in healthcare.MethodsWe selected recently published inspection frameworks used in three healthcare settings: nursing home care, dental care and hospital care. We conducted 37 interviews with 39 respondents (healthcare professionals, managers, quality officers, policy advisers and inspectors) and explored their awareness of and experiences with these frameworks. We held a group interview with three inspectors to reflect on our findings. All data underwent thematic content analysis.ResultsWe found that the institutional infrastructure of a sector plays an important role in how an inspection framework is used after publication; particularly the presence and maturity of quality improvement work in the sector and the inspectorate’s grip on a sector matter. Respondents mentioned differences in framework use in organisational contexts, particularly relating to scale. In some organisations, the framework served as an accountability mechanism to check if quality meets basic standards, while in other organisations professionals adopted it to stimulate discussion and learning across teams.ConclusionPublication of inspection frameworks might result in quality improvement work, and in particular contexts could be used as a regulatory strategy to target quality improvement in a healthcare sector. For this, it is important that regulators consider the capabilities and possibilities for learning and improving within a sector.

show abstract

“… 11 14 15 Research suggests that there is an association between inspections and different quality outcomes, for example, reduced incidence of pressure ulcer and suicides 16–18 ; however, randomised controlled studies have not been able to find evidence of impact of inspections on the quality of care. 19 20 …”

Section: Introductionmentioning

confidence: 99%

Effects of external inspection on sepsis detection and treatment: a study protocol for a quasiexperimental study with a stepped-wedge design

et al. 2017

View full text Add to dashboard Cite

IntroductionInspections are widely used in health care as a means to improve the health services delivered to patients. Despite their widespread use, there is little evidence of their effect. The mechanisms for how inspections can promote change are poorly understood. In this study, we use a national inspection campaign of sepsis detection and initial treatment in hospitals as case to: (1) Explore how inspections affect the involved organizations. (2) Evaluate what effect external inspections have on the process of delivering care to patients, measured by change in indicators reflecting how sepsis detection and treatment is carried out. (3) Evaluate whether external inspections affect patient outcomes, measured as change in the 30-day mortality rate and length of hospital stay.Methods and analysisThe intervention that we study is inspections of sepsis detection and treatment in hospitals. The intervention will be rolled out sequentially during 12 months to 24 hospitals. Our effect measures are change on indicators related to the detection and treatment of sepsis, the 30-day mortality rate and length of hospital stay. We collect data from patient records at baseline, before the inspections, and at 8 and 14 months after the inspections. We use logistic regression models and linear regression models to compare the various effect measurements between the intervention and control periods. All the models will include time as a covariate to adjust for potential secular changes in the effect measurements during the study period. We collect qualitative data before and after the inspections, and we will conduct a thematic content analysis to explore how inspections affect the involved organisations.Ethics and disseminationThe study has obtained ethical approval by the Regional Ethics Committee of Norway Nord and the Norwegian Data Protection Authority. It is registered at www.clinicaltrials.gov (Identifier: NCT02747121). Results will be reported in international peer-reviewed journals.Trial RegistrationNCT02747121; Pre-results.

show abstract

Effects of Government Supervision on Quality of Integrated Diabetes Care

Cited by 11 publications

References 11 publications

Effects of external inspections on sepsis detection and treatment: a stepped-wedge study with cluster-level randomisation

Effects of external inspections on sepsis detection and treatment: a stepped-wedge study with cluster-level randomisation

Publication of inspection frameworks: a qualitative study exploring the impact on quality improvement and regulation in three healthcare settings

Effects of external inspection on sepsis detection and treatment: a study protocol for a quasiexperimental study with a stepped-wedge design

Contact Info

Product

Resources

About