Evaluation of a population-based prevention program against influenza among Swiss elderly people.

Influenza is a major cause of morbidity and mortality and occurs in epidemics in the winter. This study is an evaluation of a population-based prevention program against Influenza, implemented during autumn 2000 by the Health Department of the Canton of Vaud. A pre-intervention/post-intervention design was used. In June 2000 and March 2001, 4007 questionnaires were sent to two different stratified random samples of people aged 65 and over living in the Canton of Vaud, Switzerland. Univariate, bivariate and multivariate analyses were performed. Vaccination coverage among people older than 65 was 58.0% in 1999 (95% CI: 56.2%-59.8%) and 58.4% (95% CI: 56.6%-60.2%) in 2000. A 6.5% significant increase in vaccination coverage was seen in the group of people aged 65 to 69 (p = 0.008). In the pre-intervention survey immunisation rates were 22.6% among people who had not consulted a physician, 59.2% among those who had consulted a physician once, and 73.2% among those who consulted twice or more (p = 0.001). These rates were respectively 30.8%, 58.0% and 75.1% (p = 0.001) in the post-intervention survey. No global increase in Influenza vaccination coverage in the elderly population could be observed following a community based intervention in a Swiss Canton. However, the enhanced vaccination rates noted in the 65-69 years old group and in people who did not receive medical care are compatible with an effect of the campaign. Further increase in vaccination coverage may be obtained by diversification and repetition of such promotion campaigns

Variations in quality of care for heart failure.

BACKGROUND: The objective of our study was to assess hospital-to-hospital variations for the management and treatment of heart failure (HF) patients. METHODS: We performed a cross-sectional study among randomly selected patients with ICD-10 (International Classification of Disease, 10th revision) HF hospitalised in three Swiss university hospitals in 1999. Demographic characteristics, risk factors, symptoms and findings at admission and discharge medications were abstracted. The main outcome measure was the percentage of patients receiving appropriate management and treatment as defined by quality of care indicators derived from evidence-based guidelines. Quality indicators were considered only when they could be applied (no contra-indications). RESULTS: Among 1153 eligible patients with HF the mean age (SD) was 75.3 (12.7), 54.3% were male. Among potential candidates for specific interventions left ventricular function (LVF) was determined in 68.5% of patients; 53.8% received target dose of angiotensin converting enzyme inhibitors (ACEI), 86.0% any dose of angiotensin receptor blockers; 21.9% b-blockers, and 62.1% anticoagulants at discharge. Compared to hospital B (reference), the adjusted odds ratios (OR) (95% CI) for LVF not determined were 3.82 (2.50 to 5.85) in hospital A and 3.25 (1.78 to 5.93) in hospital C. The adjusted OR (95% CI) for not receiving target dose ACEI was 1.76 (0.95 to 3.26) for hospital A and 3.20 (1.34 to 7.65) for hospital C compared to hospital B. CONCLUSIONS: Apparently, important hospital-to-hospital variations in the quality of care given to patients with HF could have existed between three academic medical centers

Quality of health care surveillance systems: review and implementation in the Swiss setting.

Quality of health care has been a subject of attention for many years in the USA and in Europe. Since the introduction of the new federal law on insurance in 1996 it has evolved to a progressively more important issue within the Swiss health care system. In this review, some theoretical concepts of quality of health care, variations, and surveillance systems are explored. Examples of quality of health care surveillance systems that have been developed successfully in the USA, in Canada, in Australia, and in Europe are discussed. They all demonstrate the interest in creating a large range of quality indicators in the surveillance system and in evaluating hospital performance using a benchmark approach. Currently, the measurement of quality with appropriate indicators is a subject of intense debate between the Swiss Hospitals Association (H+) and the Swiss Health Insurance Consortium (Santésuisse). Examples of existing surveillance systems in Switzerland are the Outcome Verein in Zurich and the quality of care program of the Canton of Valais. The FoQual association has also contributed to the debate by reviewing six indicators, which could be used nationally for a healthcare surveillance system. In this debate it is important to stress that ideal quality indicators intended for use as measures of quality in Swiss hospitals need to be both appropriate and valid. Only indicators that fulfil these conditions should be integrated in a Swiss health care surveillance system. Priority needs to be given to quality indicators and methods with the highest level of evidence and with a solid scientific basis

Prevalence of frailty indicators and association with socioeconomic status in middle-aged and older adults in a swiss region with universal health insurance coverage : a population-based cross-sectional study

Frailty prevalence in older adults has been reported but is largely unknown in middle-aged adults. We determined the prevalence of frailty indicators among middle-aged and older adults from a general Swiss population characterized by universal health insurance coverage and assessed the determinants of frailty with a special focus on socioeconomic status. Participants aged 50 and more from the population-based 2006-2010 Bus Santé study were included (N = 2,930). Four frailty indicators (weakness, shrinking, exhaustion, and low activity) were measured according to standard definitions. Multivariate logistic regressions were used to determine associations. Overall, 63.5%, 28.7%, and 7.8% participants presented no frailty indicators, one frailty indicator, and two or more frailty indicators, respectively. Among middle-aged participants (50-65 years), 75.1%, 22.2%, and 2.7% presented 0, 1, and 2 or more frailty indicators. The number of frailty indicators was positively associated with age, hypertension, and current smoking and negatively associated with male gender, body mass index, waist-to-hip ratio, and serum total cholesterol level. Lower income level but not education was associated with higher number of frailty indicators. Frailty indicators are frequently encountered in both older and middle-aged adults from the Swiss general population. Despite universal health insurance coverage, household income is independently associated with frailty

Variations in the quality of care of patients with acute myocardial infarction among Swiss university hospitals.

OBJECTIVE: The objective of our study was to assess hospital variations in the quality of care delivered to acute myocardial infarction (AMI) patients among three Swiss academic medical centres. DESIGN: Cross-sectional study. SETTING: Three Swiss university hospitals. STUDY PARTICIPANTS: We selected 1129 eligible patients discharged from these hospitals from 1 January to 31 December 1999, with a primary or secondary diagnosis code [International Classification of Diseases, 10th revision (ICD-10)] of AMI. We abstracted medical records for information on demographic characteristics, risk factors, symptoms, and findings at admission. We also recorded the main ECG and laboratory findings, as well as hospital and discharge management and treatment. We excluded patients transferred to another hospital and who did not meet the clinical definition of AMI. MAIN OUTCOME MEASURES: Percentage of patients receiving appropriate intervention as defined by six quality of care indicators derived from clinical practical guidelines. RESULTS: Among 577 eligible patients with AMI in this study, the mean (SD) age was 68.2 (13.9), and 65% were male. In the assessment of the quality indicators we excluded patients who were not eligible for the procedure. Among cohorts of 'ideal candidates' for specific interventions, 64% in hospital A and 73% in hospital C had reperfusion within 12 hours either with thrombolytics or percutaneous transluminal coronary angioplasty (P = 0.367). Further, in hospitals A, B, and C, respectively 97, 94, and 84% were prescribed aspirin during the initial hospitalization (P = 0.0002), and respectively 68, 91, and 75% received angiotensin converting enzyme inhibitors at discharge in the case of left ventricular systolic dysfunction (P = 0.003). CONCLUSIONS: Our results showed important hospital-to-hospital variations in the quality of care provided to patients with AMI between these three university hospitals

Processes and outcomes for acute myocardial infarction patients

PURPOSE: The purpose of this paper is to determine whether process quality indicators for acute myocardial infarction (AMI) one associated with outcome indicators (hospital mortality and early readmission). DESIGN/METHODOLOGY/APPROACH: A retrospective cohort study was conducted among patients discharged from three Swiss university hospitals with a primary or secondary International Classification of Diseases, 10th revision (ICD-10) AMI code in 1999. A total of 1,129 patients' records were abstructed. Demographic characteristics and risk factors at admission were recorded. The main ECG and laboratory findings were further abstracted as well as hospital and discharge management and treatment. The main outcome measure was process quality indicators derived from evidence-based guidelines, and hospital mortality and early readmissions. FINDINGS: After exclusions, 577 patients with AMI were eligible for this study. The mean (SD) age was 68.2 (13.9). In the assessment of quality indicators patients with potential contra-indications were excluded. Among cohorts of "ideal candidates" for specific interventions, aspirin was not prescribed within 24 hours after admission in 33 (6.2 percent) patients. Among those, 17 (51.5 percent) died (p<0.0001). The adjusted OR for no aspirin after admission was 3.61 (95 percent CI 1.11-11.77) for hospital mortality. Further, 78 (19.5 percent) patients did not receive ß-blockers at discharge. Among them nine (11.5 percent) were readmitted (p=0.133). The adjusted OR for no ß-blockers at discharge was 2.15 (95 percent CI 0.86-5.41) for readmissions. Among patients with AMI, not prescribing aspirin within 24 hours after admission was associated with hospital mortality. However, process indicators derived from evidence-based guidelines were not related to early readmission in this study. ORIGINALITY/VALUE: The paper stresses the importance of clinicians confronting their decisions with recommendations of evidence-based guidelines for the management and treatment of AMI patients

Pre-ESRD Care and Mortality in Incident ESRD Patients With Multiple Myeloma.

The relationship between mortality and pre-ESRD (end-stage renal disease) nephrology care in incident ESRD patients with multiple myeloma (MM) as the primary cause of renal failure has not been examined. Among 439,206 incident US hemodialysis patients with MM as the primary cause of ESRD (June 1, 2005 to May 31, 2009) identified using the US Renal Data System, adjusted odds ratios (OR) for reported pre-ESRD nephrology care for ESRD due to MM (n=4561) versus other causes (n=434,645) were calculated. The association of pre-ESRD nephrology care with subsequent mortality in MM-ESRD patients was examined. MM-ESRD patients were less likely to have any predialysis nephrology care in the year before initiation of dialysis (34.8% vs. 58.5%; OR=0.38; 95% confidence interval [CI], 0.34-0.43) compared with patients with ESRD due to other causes. MM-ESRD patients compared with others were more likely to have catheters on first dialysis (91.8% vs. 75.6%; OR=4.15; 95% CI, 3.54-4.86). Incident MM-ESRD patients receiving predialysis care for ≥6 months had significantly lower 1-year mortality (hazard ratio 0.89; 95% CI, 0.82-0.97 and 0.88; 95% CI, 0.80-0.96, respectively), relative to those without this care. A catheter for dialysis access was associated with a 1.6-fold increase in 1-year mortality in incident MM-ESRD (hazard ratio 1.55; 95% CI, 1.32-1.83). MM-ESRD patients were less likely to have predialysis nephrology care and more likely to use catheters on first dialysis. However, predialysis care is independently associated with lower mortality in MM-ESRD patients. Predialysis care should be prioritized in MM patients approaching ESRD

The occurrence of percutaneous injuries to health care workers: a cross sectional survey in seven Swiss hospitals.

OBJECTIVES: In 1995, a cross sectional survey was conducted in 7 Swiss hospitals to estimate the incidence of percutaneous injuries among nurses, surgeons, anesthetists and domestic personnel, and to describe the circumstances of these injuries and the reporting process within the hospital. METHODS: An anonymous questionnaire was distributed and filled out on-site in the case of nursing staff and domestic personnel, and was sent by post to physicians (anesthetists and surgeons). Participants were asked to report in detail on percutaneous injuries of the last workday and the last working month (nurses and physicians), and of the last month and the last year for domestic personnel. The overall response rate was 72%, representing a total of 3116 health care workers. RESULTS: The annual incidence rates of percutaneous injury with material contaminated with blood or other biological fluids were calculated by type of worker for the two available units of time. For nurses, the incidence was 0.49 and 2.23, for surgeons 4.28 and 11.05, for anesthetists 2.11 and 3.14, and for domestic personnel 0.11 and 0.17 respectively. Most of the injuries occurred in a "normal" situation (no emergency, no stress, no fatigue) and were described as avoidable. Compliance with universal precautions was not optimal and declaration rates within the hospital rather low (nurses 39.7%, physicians 3.4%, domestic personnel 87.9%). CONCLUSION: Percutaneous injuries with blood-contaminated material are frequent in health care workers, and are not always adequately assessed because of under-reporting of accidents within the hospital. This may result in underestimation of current occupational exposure of health care workers to HIV and other blood-borne viruses