Patient reported experience measures – A Quality Indicator from the Patient Perspective

Praćenje kvalitete zdravstvene skrbi stalni je proces koji zahtijeva i slušanje glasa „korisnika“, odnosno pacijenta. Mjere iskustva koje navodi pacijent (PREM) jedan su od alata kojim mjerimo kvalitetu pružene zdravstvene skrbi iz perspektive pacijenta, a koji pruža uvid u aspekte zdravstvene skrbi nedostupne drugim alatima. Ovaj rad daje pregled saznanja o mjerama iskustva pacijenta i predstavlja najčešće korištene alate za mjerenje iskustva o pruženoj zdravstvenoj skrbi iz perspektive pacijenta te predstavlja način primjene i svrhu mjerenja iskustva pruženom skrbi u zdravstvenim sustavima članica OECD-a. Iskustvo pacijenta predstavlja jedno od temeljnih načela kvalitete u zdravstvu. Mjerenjem iskustva pacijenata različitim metodama pruža se uvid u aspekte zdravstvenoga sustava nevidljive tradicionalnim metrikama. Najčešće korišten alat jest upitnik, a mogu se koristiti i strukturirani intervjui, intervjui s fokus-grupama te ocjenjivanje snimljenih konzultacija s pacijentom. Mjerenje iskustva koje navodi pacijent danas predstavljaju stalnu praksu u razvijenim zemljama, a inicijative su rezultirale i s nekoliko međunarodnih projekata. Praćenje PREM-a u zemljama OECD-a utječe i na akreditaciju i financiranje ustanova, a pozitivna praksa praćenja mjera iskustva rezultirala je i proširenjem uporabe PREM-a i novim međunarodnim projektima. Stalnim razvojem kvalitete i procedura razvoja i praćenja, PREM je postao pouzdan alat koji mora biti jedan od elemenata praćenja kvalitete u modernim zdravstvenim sustavima.Healthcare quality monitoring is a constant process which necessitates tracking end-user’s, or patient’s, opinion. Patient reported experience measures (PREM) are one of the tools used to measure healthcare quality from the patient’s perspective which allow measurement of healthcare aspects not available to other tools. This thesis shows the latest findings regarding patient reported experience measures and displays the most frequently used tools for measuring patient experience. Additionally, this thesis displays the utilization of patientreported experience measures in OECD member states. Patient experience is one of the main principles in healthcare quality. Measuring patient experience through different methods allows insight into healthcare system segments invisible to traditional metrics. Questionnaires are the most widely used tool for evaluating patient reported experience measures. Other methods include structured interviews, focus-groups and graded videorecorded patient consultations. The role of PREM will expand to healthcare technology assessment. Patient reported experience measures represent an integral part of daily activities in developed countries and several initiatives have resulted in international projects. Monitoring PREM affects accreditation and financing in OECD countries, and the positive experiences with PREM have resulted in expanding the areas of their use as well as new international projects. With ongoing development of PREM quality and the methods of their development and monitoring, PREM have become a reliable tool and one of crucial elements of health care quality monitoring in modern health systems

Red cell distribution width is a potent prognostic parameter for in-hospital and post-discharge mortality in hospitalized coronavirus disease 2019 patients: a registry-based cohort study on 3941 patients

Aim To investigate clinical and prognostic associations of red cell distribution width (RDW) in hospitalized coronavi - rus disease 2019 (COVID-19) patients. Methods We retrospectively analyzed the records of 3941 consecutive COVID-19 patients admitted to a tertiary-level institution from March 2020 to March 2021 who had avail - able RDW on admission. Results The median age was 74 years. The median Charl - son comorbidity index (CCI) was 4. The majority of pa - tients (84.1%) on admission presented with severe or criti - cal COVID-19. Patients with higher RDW were significantly more likely to be older and female, to present earlier dur - ing infection, and to have higher comorbidity burden, worse functional status, and critical presentation of COVID-19 on admission. RDW was not significantly associated with C-re - active protein, occurrence of pneumonia, or need for oxy - gen supplementation on admission. During hospital stay, patients with higher RDW were significantly more likely to require high-flow oxygen therapy, mechanical ventilation, intensive care unit, and to experience prolonged immobi - lization, venous thromboembolism, bleeding, and bacte - rial sepsis. Thirty-day and post-hospital discharge mortality gradually increased with each rising RDW percent-point. In a series of multivariate Cox-regression models, RDW demon - strated robust prognostic properties at >14% cut-off level. This cut-off was associated with inferior 30-day and postdischarge survival independently of COVID-19 severity, age, and CCI; and with 30-day survival independently of COVID severity and established prognostic scores (CURB-65, 4Cmortality, COVID-gram and VACO-index). Conclusion RDW has a complex relationship with COVID19-associated inflammatory state and is affected by prior comorbidities. RDW can improve the prognostication in hospitalized COVID-19 patients

The associations of age, sex, and comorbidities with survival of hospitalized patients with coronavirus disease 2019: data from 4014 patients from a tertiary-center registry

Aim To investigate how age, sex, and comorbidities affect the survival of hospitalized coronavirus disease 2019 (COVID-19) patients. Methods We retrospectively analyzed the records of 4014 consecutive adults hospitalized for COVID-19 in a tertiarylevel institution from March 2020 to March 2021. Results The median age was 74 years. A total of 2256 (56.2%) patients were men. The median Charlson-comor - bidity-index (CCI) was 4 points; 3359 (82.7%) patients had severe or critical COVID-19. A significant interaction be - tween age, sex, and survival ( P <0.05) persisted after ad - justment for CCI. In patients <57 years, male sex was re - lated to a favorable (odds ration [OR] 0.50, 95% confidence interval [CI] 0.29-0.86), whereas in patients ≥57 years it was related to an unfavorable prognosis (OR 1.19, 95% CI 1.04- 1.37). Comorbidities associated with inferior survival inde - pendently of age, sex, and severe/critical COVID-19 on ad - mission were chronic heart failure, atrial fibrillation, acute myocardial infarction, acute cerebrovascular insult, history of venous thromboembolism, chronic kidney disease, ma - jor bleeding, liver cirrhosis, mental retardation, dementia, active malignant disease, metastatic malignant disease, autoimmune/rheumatic disease, bilateral pneumonia, and other infections on admission. Conclusion Among younger patients, female sex might lead to an adverse prognosis due to undisclosed reasons (differences in fat tissue distribution, hormonal status, and other mechanisms). Patient subgroups with specific co - morbidities require additional considerations during hos - pital stay for COVID-19. Future studies focusing on sex differences and potential interactions are warranted

Patohistološki nalazi u pacijenata umrlih tijekom liječenja veno-venskom ekstrakorporealnom membranskom oksigenacijom

ECMO is a life-support intervention allowing for oxygenation of blood independent of the function of lungs and/or heart. Developed and enhanced for decades, its use has peaked in the previous decade, particularly with the 2009 H1N1 pandemics. Invasive procedures involving severely ill patients carry a large risk of complications, which have to be weighed when choosing to perform the procedure. Majority of complications are related to the delicate coagulation status, with procoagulant and anticoagulant effects in interplay at the same time. Monitoring of anticoagulation during ECMO is difficult, and many different tests are required to paint the full coagulation status picture. Despite the array of tests available, no test is available to predict bleeding complications and adequately guide anticoagulation therapy during treatment. Hemorrhagic complications ranging in severity are the most common, and they greatly influence treatment length and mortality in VV ECMO patients. Case series presented in this thesis depicts patients in which hemorrhage was only diagnosed at autopsy, and serves as a reminder to include severe hemorrhage in the differential diagnosis in deteriorating patients on VV ECMO support.ECMO je intervencija koja omogućuje oksigenaciju krvi neovisno o funkciji pluća i/ili srca. Razvijana i poboljšavana desetljećima, uporaba ECMO tehnologije je dosegla svoj vrhunac u prethodnom desetljeću, naročito tijekom H1N1 pandemije. Invazivne procedure, naročito u teško bolesnih pacijenata, nose visok rizik komplikacija na koje treba misliti tijekom donošenja odluke za vršenje procedure. Većina komplikacija je vezana za delikatni koagulacijski status jer su zbog naravi bolesti i procedure prokoagulantni i antikoagulantni učinci u stalnom međudjelovanju. Praćenje stanja koagulacije tijekom ECMO-a je komplicirano i potrebni su brojni testovi kako bi se prikazala cijela slika koagulacijskog stanja. Unatoč širokom izboru testova, niti jedan test se nije pokazao savršenim za predviđanje i procjenu krvarenja te precizno navođenje antikoagulacijske terapije. Komplikacije u vidu krvarenja svih stupnjeva su najčešće, a značajne su jer znatno utječu na duljinu liječenja i stopu smrtnih ishoda. Prikaz serije u ovom radu sadrži pacijente kod kojih je krvarenje dijagnosticirano tek na autopsiji i služi kao podsjetnik da se ozbiljno krvarenje uvijek treba naći u diferencijalnoj dijagnozi kod naglog pogoršanja stanja u pacijenata na VV ECMO potpori

Patohistološki nalazi u pacijenata umrlih tijekom liječenja veno-venskom ekstrakorporealnom membranskom oksigenacijom

ECMO is a life-support intervention allowing for oxygenation of blood independent of the function of lungs and/or heart. Developed and enhanced for decades, its use has peaked in the previous decade, particularly with the 2009 H1N1 pandemics. Invasive procedures involving severely ill patients carry a large risk of complications, which have to be weighed when choosing to perform the procedure. Majority of complications are related to the delicate coagulation status, with procoagulant and anticoagulant effects in interplay at the same time. Monitoring of anticoagulation during ECMO is difficult, and many different tests are required to paint the full coagulation status picture. Despite the array of tests available, no test is available to predict bleeding complications and adequately guide anticoagulation therapy during treatment. Hemorrhagic complications ranging in severity are the most common, and they greatly influence treatment length and mortality in VV ECMO patients. Case series presented in this thesis depicts patients in which hemorrhage was only diagnosed at autopsy, and serves as a reminder to include severe hemorrhage in the differential diagnosis in deteriorating patients on VV ECMO support.ECMO je intervencija koja omogućuje oksigenaciju krvi neovisno o funkciji pluća i/ili srca. Razvijana i poboljšavana desetljećima, uporaba ECMO tehnologije je dosegla svoj vrhunac u prethodnom desetljeću, naročito tijekom H1N1 pandemije. Invazivne procedure, naročito u teško bolesnih pacijenata, nose visok rizik komplikacija na koje treba misliti tijekom donošenja odluke za vršenje procedure. Većina komplikacija je vezana za delikatni koagulacijski status jer su zbog naravi bolesti i procedure prokoagulantni i antikoagulantni učinci u stalnom međudjelovanju. Praćenje stanja koagulacije tijekom ECMO-a je komplicirano i potrebni su brojni testovi kako bi se prikazala cijela slika koagulacijskog stanja. Unatoč širokom izboru testova, niti jedan test se nije pokazao savršenim za predviđanje i procjenu krvarenja te precizno navođenje antikoagulacijske terapije. Komplikacije u vidu krvarenja svih stupnjeva su najčešće, a značajne su jer znatno utječu na duljinu liječenja i stopu smrtnih ishoda. Prikaz serije u ovom radu sadrži pacijente kod kojih je krvarenje dijagnosticirano tek na autopsiji i služi kao podsjetnik da se ozbiljno krvarenje uvijek treba naći u diferencijalnoj dijagnozi kod naglog pogoršanja stanja u pacijenata na VV ECMO potpori

Mjere iskustva koje navodi pacijent – pokazatelj kvalitete pružene zdravstvene skrbi iz perspektive pacijenta

Praćenje kvalitete zdravstvene skrbi stalni je proces koji zahtijeva i slušanje glasa „korisnika“, odnosno pacijenta. Mjere iskustva koje navodi pacijent (PREM) jedan su od alata kojim mjerimo kvalitetu pružene zdravstvene skrbi iz perspektive pacijenta, a koji pruža uvid u aspekte zdravstvene skrbi nedostupne drugim alatima. Ovaj rad daje pregled saznanja o mjerama iskustva pacijenta i predstavlja najčešće korištene alate za mjerenje iskustva o pruženoj zdravstvenoj skrbi iz perspektive pacijenta te predstavlja način primjene i svrhu mjerenja iskustva pruženom skrbi u zdravstvenim sustavima članica OECD-a. Iskustvo pacijenta predstavlja jedno od temeljnih načela kvalitete u zdravstvu. Mjerenjem iskustva pacijenata različitim metodama pruža se uvid u aspekte zdravstvenoga sustava nevidljive tradicionalnim metrikama. Najčešće korišten alat jest upitnik, a mogu se koristiti i strukturirani intervjui, intervjui s fokus-grupama te ocjenjivanje snimljenih konzultacija s pacijentom. Mjerenje iskustva koje navodi pacijent danas predstavljaju stalnu praksu u razvijenim zemljama, a inicijative su rezultirale i s nekoliko međunarodnih projekata. Praćenje PREM-a u zemljama OECD-a utječe i na akreditaciju i financiranje ustanova, a pozitivna praksa praćenja mjera iskustva rezultirala je i proširenjem uporabe PREM-a i novim međunarodnim projektima. Stalnim razvojem kvalitete i procedura razvoja i praćenja, PREM je postao pouzdan alat koji mora biti jedan od elemenata praćenja kvalitete u modernim zdravstvenim sustavima

The effect of outpatient antibiotic treatment of coronavirus disease 2019 on the outcomes in the emergency department: a propensity score matching study

Aim To determine the effect of outpatient oral antibiotics on coronavirus disease 2019 (COVID-19) in patients presenting to the emergency department. Methods This retrospective cohort study with propensity score matching conducted at University Hospital Dubrava collected data on all emergency department visits due to COVID-19 in November 2020. The primary outcome was hospital admission. The secondary outcomes were pneumonia development, respiratory failure, and required level of respiratory support. Results Overall, 1217 visits were evaluated and 525 patients were included in the analysis. After propensity score matching, 126 pairs of treated patients and controls were identified. Patients and controls did not differ in physical examination findings, laboratory test results, radiographic findings, or defined outcomes before and after matching. Conclusion This study suggests no benefit of empirical oral antibiotics for outpatient treatment of COVID-19. In patients presenting to the emergency department, prior oral antibiotic treatment did not affect hospital admission rates or the level of respiratory support required

Patterns of anticoagulation therapy in atrial fibrillation: results from a large real-life single-center registry

Aim: To investigate the differences in the characteristics and clinical outcomes of recently diagnosed patients with atrial fibrillation (AF) receiving different types of anticoagulants in a real-life setting. ----- Methods: We retrospectively analyzed the charts of 1000 consecutive patients with non-valvular AF diagnosed at our institution or referred it to from 2013 to 2018. ----- Results: Over the observed period, the frequency of direct oral anticoagulation (DOAC) therapy use significantly increased (P = 0.002). Patients receiving warfarin had more unfavorable thromboembolic and bleeding risk factors than patients receiving DOAC. Predetermined stroke and major bleeding risks were similarly distributed among the dabigatran, rivaroxaban, and apixaban groups. Patients receiving warfarin had shorter time-to-major bleeding (TTB), time to thrombosis (TTT), and overall survival (OS) than patients receiving DOACs. After adjustment for factors unbalanced at baseline, the warfarin group showed significantly shorter OS (hazard ratio 2.27, 95% confidence interval 1.44-3.57, P<0.001], while TTB and TTT did not significantly differ between the groups. Only 37% of patients on warfarin had optimal dosing control, and they did not differ significantly in TTB, TTT, and OS from patients on DOACs. ----- Conclusion: Warfarin and DOACs are administered to different target populations, possibly due to socio-economic reasons. Patients receiving warfarin rarely obtain optimal dosing control, and experience significantly shorter survival compared with patients receiving DOACs