Sağlık Hizmetlerinin Kalitesi ile Hastane Bilgi Sistemleri İlişkisi

The aim of this study is to determine functional sufficiency of Hospital Information Systems used in Turkey hospitals and to set forth levels of influence of these systems on quality of health care services. The target population of this study is hospitals of Ministry of Health, Private Hospitals and University Hospitals which provide health care services in Turkey. The “Hospital Information System Assessment Survey” which was formed by the investigator and contained 50 specialties was conveyed to “Directors of Quality Departments” of all hospitals. On the other hand, the quality scores used for analyses were provided by Department of Quality and Accreditation in General Directorate of Health Services. 528 hospitals which constituted %36 of the study’s target population participated in the study. Statistically, no meaningful relationship between functional sufficiency of Hospital Information Systems and quality scores of hospitals has been identified at the end of the study. The average quality scores of the hospitals in the study were “0,83 ± 0,16”. The quality scores of university hospitals were lower in comparison to hospitals of Ministry of Health and private hospitals and it was determined that this lowness was statistically meaningful. It was specified that the hospitals in this study had average %65,3 of 50 specialties which figured out functionality of Hospital Information Systems. Directors of Quality Departments thought that each of Hospital Information System features involved in the study survey was considerably effective on the quality of health services. In terms of all specialties, the mean of scores which were graded on importance level of 1 to 9 was identified as “7,91 ± 2,00”. As a result of the study, it was determined that Hospital Information Systems used in Turkey do not have some functional characteristics at the level of their attributed importance although these systems are thought as significant from the viewpoint of affecting quality of healthcare services. It is expected that healthcare institutions which aim at quality vii healthcare services should prefer Hospital Information Systems which have features supporting this goal.Bu araştırmanın amacı, Türkiye’de kullanılan hastane bilgi sistemlerinin işlevsel yeterliliklerini belirlemek ve bu sistemlerin sunulan sağlık hizmetlerinin kalitesini etkileme düzeylerini ortaya koymaktır. Araştırmanın evrenini, Türkiye’de faaliyet yürütmekte olan Sağlık Bakanlığı, Özel ve Üniversite Hastaneleri oluşmaktadır. Analizde anket verisi ve kalite puanları olmak üzere iki tür veri kullanılmıştır. Hastane bilgi sistemlerinin işlevsel yeterliliklerini ve bu işlevlerin sunulan sağlık hizmetinin kalitesine etkisini belirlemek üzere araştırmacı tarafından oluşturulan ve 50 özellikten oluşan “Hastane Bilgi Sistemi Değerlendirme Anketi” tüm hastanelerin “Kalite Yöneticilerine” ulaştırılmıştır. Analizlerde kullanılan kalite puanları da Sağlık Bakanlığı’ndan temin edilmiştir. Araştırmaya, araştırma evreninin %36’sını oluşturan 528 hastaneden katılım olmuştur. Araştırma sonunda, hastane bilgi sistemlerinin işlevsel yeterlilik düzeyi ile hastanelerin kalite denetimlerinden aldıkları kalite puanları arasında istatistiksel olarak anlamlı bir ilişki bulunamamıştır. Araştırmaya katılan hastanelerin aldıkları ortalama kalite puanının “0,83 ± 0,16” olduğu tespit edilmiştir. “Üniversite Hastanelerinin” aldıkları kalite puanlarının “Özel” ve “Sağlık Bakanlığı Hastaneleri”ne nazaran daha düşük olduğu ve bunun istatistiksel olarak anlamlı olduğu tespit edilmiştir. Araştırmaya katılan hastanelerin, araştırma anketinde yer alan ve hastane bilgi sistemlerinin işlevselliğini ifade eden 50 özelliğin ortalama %65,3’üne sahip olduğu belirlenmiştir. Ankete katılan kurumlarda çalışan kalite yöneticilerinin ankette yer alan her bir Hastane Bilgi Sistemi özelliğinin, sağlık hizmetlerinin kalitesini etkileme açısından oldukça etkili olduğunu düşündükleri, önem derecesine 1 ile 9 puan arasında verilen puanların tüm özellikler açısından ortalamasının “7,91 ± 2,00” olduğu tespit edilmiştir. Araştırma sonucunda, sunulan sağlık hizmetlerinin kalitesini etkileme açısından oldukça önemli görüldüğü halde, Türkiye’de kullanılan HBS’lerin bir takım işlevsel özeliklere, önem atfedildikleri oranda sahip olmadıkları tespit v edilmiştir. Kaliteli sağlık hizmeti sunmayı hedefleyen sağlık kurumlarının, bu hedefi destekleyebilecek özelliklere sahip HBS’leri tercih etmeleri beklenmektedir

Functionality of hospital information systems: results from a survey of quality directors at Turkish hospitals

Background: We aimed to determine availability of core Hospital Information Systems (HIS) functions implemented in Turkish hospitals and the perceived importance of these functions on quality and patient safety. Methods: We surveyed quality directors (QDs) at civilian hospitals in the nation of Turkey. Data were collected via web survey using an instrument with 50 items describing core functionality of HIS. We calculated mean availability of each function, mean and median values of perceived impact on quality, and we investigated the relationship between availability and perceived importance. Results: We received responses from 31% of eligible institutions, representing all major geographic regions of Turkey. Mean availability of 50 HIS functions was 65.6%, ranging from 19.6% to 97.4%. Mean importance score was 7.87 (on a 9-point scale) ranging from 7.13 to 8.41. Functions related to result management (89.3%) and decision support systems (52.2%) had the highest and lowest reported availability respectively. Availability and perceived importance were moderately correlated (r = 0.52). Conclusion: QDs report high importance of the HIS functions surveyed as they relate to quality and patient safety. Availability and perceived importance of HIS functions are generally correlated, with some interesting exceptions. These findings may inform future investments and guide policy changes within the Turkish healthcare system. Financial incentives, regulations around certified HIS, revisions to accreditation manuals, and training interventions are all policies which will help integrate HIS functions to support quality and patient safety in Turkish hospitals. Electronic supplementary material The online version of this article (10.1186/s12911-018-0581-2) contains supplementary material, which is available to authorized users

Additional file 1: of Functionality of hospital information systems: results from a survey of quality directors at Turkish hospitals

Survey Items Related to IOM Groups. This table provides classification of survey items within the 8 HIS functionality categories described by IOM. (XLSX 13 kb

Features of acute COVID-19 associated with post-acute sequelae of SARS-CoV-2 phenotypes: results from the IMPACC study

Post-acute sequelae of SARS-CoV-2 (PASC) is a significant public health concern. We describe Patient Reported Outcomes (PROs) on 590 participants prospectively assessed from hospital admission for COVID-19 through one year after discharge. Modeling identified 4 PRO clusters based on reported deficits (minimal, physical, mental/cognitive, and multidomain), supporting heterogenous clinical presentations in PASC, with sub-phenotypes associated with female sex and distinctive comorbidities. During the acute phase of disease, a higher respiratory SARS-CoV-2 viral burden and lower Receptor Binding Domain and Spike antibody titers were associated with both the physical predominant and the multidomain deficit clusters. A lower frequency of circulating B lymphocytes by mass cytometry (CyTOF) was observed in the multidomain deficit cluster. Circulating fibroblast growth factor 21 (FGF21) was significantly elevated in the mental/cognitive predominant and the multidomain clusters. Future efforts to link PASC to acute anti-viral host responses may help to better target treatment and prevention of PASC

IgM N-glycosylation correlates with COVID-19 severity and rate of complement deposition

The glycosylation of IgG plays a critical role during human severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, activating immune cells and inducing cytokine production. However, the role of IgM N-glycosylation has not been studied during human acute viral infection. The analysis of IgM N-glycosylation from healthy controls and hospitalized coronavirus disease 2019 (COVID-19) patients reveals increased high-mannose and sialylation that correlates with COVID-19 severity. These trends are confirmed within SARS-CoV-2-specific immunoglobulin N-glycan profiles. Moreover, the degree of total IgM mannosylation and sialylation correlate significantly with markers of disease severity. We link the changes of IgM N-glycosylation with the expression of Golgi glycosyltransferases. Lastly, we observe antigen-specific IgM antibody-dependent complement deposition is elevated in severe COVID-19 patients and modulated by exoglycosidase digestion. Taken together, this work links the IgM N-glycosylation with COVID-19 severity and highlights the need to understand IgM glycosylation and downstream immune function during human disease