International Journal for Quality in Health Care (Int J Qual Health Care )

Publisher: International Society for Quality in Health Care, Oxford University Press


The International Journal for Quality in Health Care makes activities and research related to quality in health care available to a worldwide readership. The Journal publishes papers in all disciplines related to the quality of health care including health services research health care evaluation technology assessment health economics utilization review cost containment and nursing care research as well as clinical research related to quality of care.

Impact factor 1.79

  • 5-year impact
  • Cited half-life
  • Immediacy index
  • Eigenfactor
  • Article influence
  • Website
    International Journal for Quality in Health Care website
  • Other titles
    International journal for quality in health care (Online)
  • ISSN
  • OCLC
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Oxford University Press

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 months embargo on science, technology, medicine articles
    • 2 years embargo on arts and humanities articles
    • Some titles may have different embargoes
  • Conditions
    • Pre-print can only be posted prior to acceptance
    • Pre-print must be accompanied by set statement (see link)
    • Pre-print must not be replaced with post-print, instead a link to published version with amended set statement should be made
    • Pre-print on author's personal website, employer website, free public server or pre-prints in subject area
    • Post-print in Institutional repositories or Central repositories
    • Publisher version cannot be used except for Nucleic Acids Research articles
    • Published source must be acknowledged
    • Must link to publisher version
    • Set phrase to accompany archived copy (see policy)
    • Articles in some journals can be made Open Access on payment of additional charge
    • Eligible UK authors may deposit in OpenDepot
    • Publisher will deposit on behalf of NIH funded authors to PubMed Central, Nucleic Acids Research authors must pay their fee first
    • Some titles may use different policies
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Quality Problem or Issue: The EU has identified Denmark as one of the countries who have to potential to provide leadership and inspiration for other countries eHealth implementation and adoption. However, Denmark has historically struggled to facilitate data exchange between their public hospitals electronic health records (EHRs). Furthermore, state-led projects failed to adequately address the challenges of interoperability after deployment. Choice of solution: Changes in the organisational setup and division of responsibilities concerning the future of eHealth implementations in hospitals took place, which granted the Danish regions with the full responsibility for all hospital systems, specifically the consolidation of EHRs to one system per region. Implementation: The regions reduced the number of different EHRs to six systems by 2014. Additionally, the first version of the National Health Record was launched to provide healthcare practitioners with an overview of a patient’s data stored in all EHRs across the regions and within the various health sectors. Evaluation: The governance of national eHealth implementation plays a crucial role in the development and diffusion of interoperable technologies. Changes in the organizational setup and redistribution of responsibilities between the Danish regions and the state are pivotal role in producing viable and coherent solutions within a timely manner.
    International Journal for Quality in Health Care 01/2015;
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    ABSTRACT: /st>(i) To examine the sustainability of an in-hospital quality improvement (QI) intervention, the American College of Cardiology's Guideline Applied to Practice (GAP) in acute myocardial infarction (AMI). (ii) To determine the predictors of physician adherence to AMI guidelines-recommended medication prescribing. /st>Prospective observational study. /st>Five mid-Michigan community hospitals. /st>516 AMI patients admitted consecutively 1 year after the GAP intervention. These patients were compared with 499 post-GAP patients. /st>The main outcome was adherence to medication use guidelines. Predictors of medication use were determined using multivariable logistic regression analysis. /st>1 year after GAP implementation, adherence to most medications remained high. We found a significant increase in beta-blocker (BB) use in-hospital (87.9 vs. 72.1%, P < 0.001) whereas cholesterol assessment within 24 h (79.5 vs. 83.6%, P > 0.225) did not change significantly. However, discharge aspirin (83 vs. 90%, P < 0.018) and BB prescriptions (84 vs. 92%, P < 0.016) dropped to preintervention rates. Discharge angiotensin-converting enzyme inhibitor and treatment of patients with low-density lipoprotein of ≥100 were unchanged. Predictors of receiving appropriate medications were male gender (for aspirin and BBs) and treatment with percutaneous coronary intervention compared with coronary artery bypass graft. Notably, prescription rates for discharge medications differed significantly by hospital. /st>Early benefits of the Mid-Michigan GAP intervention on guideline use were only partially sustained at 1 year. Differences in guideline adherence by treatment modality and hospital demonstrate challenges for follow-up phases of GAP. Additional strategies to improve sustainability of QI efforts are urgently needed.
    International Journal for Quality in Health Care 05/2014;
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    ABSTRACT: /st>Getting greater levels of evidence into practice is a key problem for health systems, compounded by the volume of research produced. Implementation science aims to improve the adoption and spread of research evidence. A linked problem is how to enhance quality of care and patient safety based on evidence when care settings are complex adaptive systems. Our research question was: according to the implementation science literature, which common implementation factors are associated with improving the quality and safety of care for patients? /st>We conducted a targeted search of key journals to examine implementation science in the quality and safety domain applying PRISMA procedures. Fifty-seven out of 466 references retrieved were considered relevant following the application of exclusion criteria. Included articles were subjected to content analysis. Three reviewers extracted and documented key characteristics of the papers. Grounded theory was used to distil key features of the literature to derive emergent success factors. /st>Eight success factors of implementation emerged: preparing for change, capacity for implementation-people, capacity for implementation-setting, types of implementation, resources, leverage, desirable implementation enabling features, and sustainability. Obstacles in implementation are the mirror image of these: for example, when people fail to prepare, have insufficient capacity for implementation or when the setting is resistant to change, then care quality is at risk, and patient safety can be compromised. /st>This review of key studies in the quality and safety literature discusses the current state-of-play of implementation science applied to these domains.
    International Journal for Quality in Health Care 05/2014;
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    ABSTRACT: /st>To measure the rate of medication incidents associated with the prescription and administration of high-alert medications and to identify patient-, environment- and medication-related factors associated with these incidents. /st>A retrospective chart audit design was conducted of medical records for patient admissions from 1 January 2010 to 31 December 2010. /st>Five practice settings (cardiac care, emergency care, intensive care, oncology care and perioperative care) at a public teaching hospital in Melbourne, Australia. /st>Patients were considered for inclusion if they were prescribed at least one high-alert medication and if they were admitted to one of five practice settings. /st>High-alert prescribing and administering incidents were measured in each of the five practice settings. Generalized linear mixed modeling was used for data analysis. /st>There were 6984 opportunities for high-alert medication incidents across the five clinical settings. The overall medication incident rate was 1934/6984 (27.69%). There were 1176 prescribing incidents (16.84%) and 758 administering incidents (10.85%). Statistical modeling showed that, in each of the five clinical settings, an increased number of ward transfers was associated with increased odds of prescribing incidents. In addition, statistical modeling demonstrated that an increased number of ward transfers was associated with increased odds of administering incidents in emergency care and perioperative care. /st>Complex relationships were found in managing high-alert medications in specialty clinical settings. Employing measures to address patients' movements across ward settings can reduce high-alert medication incidents and improve quality of care.
    International Journal for Quality in Health Care 04/2014;
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    ABSTRACT: /st>Incident reporting is an important component of health care quality improvement. The objective of this investigation was to evaluate the effectiveness of an emergency department (ED) peer review process in promoting incident reporting. /st>An observational, interrupted time-series analysis of health care provider (HCP) incident reporting to the ED during a 30-month study period prior to and following the peer review process implementation and a survey-based assessment of physician perceptions of the peer review process' educational value and its effectiveness in identifying errors. /st>Large, urban, academic ED. and INTERVENTIONS: /st>HCPs were invited to participate in a standardized, non-punitive, non-anonymous peer review process that involved analysis and structured discussion of incident reports submitted to ED physician leadership. /st>Monthly frequency of incident reporting by HCPs and physician perceptions of the peer review process. /st>HCPs submitted 314 incident reports to the ED over the study period. Following the intervention, frequency of reporting by HCPs within the hospital increased over time. The frequencies of self-reporting, reporting by other ED practitioners and reporting by non-ED practitioners within the hospital increased compared with a control group of outside HCPs (P = 0.0019, P = 0.0025 and P < 0.0001). Physicians perceived the peer review process to be educational and highly effective in identifying errors. /st>The implementation of a non-punitive peer review process that provides timely feedback and is perceived as being valuable for error identification and education can lead to increased incident reporting by HCPs.
    International Journal for Quality in Health Care 04/2014;
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    ABSTRACT: /st>To pilot-test the feasibility and preliminary effect of a community health worker (CHW) intervention to reduce hospital readmissions. /st>Patient-level randomized quality improvement intervention. /st>An academic medical center serving a predominantly low-income population in the Boston, Massachusetts area and 10 affiliated primary care practices. /st>Medical service patients with an in-network primary care physician who were discharged to home (n = 423) and had one of five risk factors for readmission within 30 days. /st>Inpatient introductory visit and weekly post-discharge telephonic support for 4 weeks to assist patient in coordinating medical visits, obtaining and using medications, and in self-management. /st>Number of completed CHW contacts; CHW-reported barriers and facilitators to assisting patients; primary care, emergency department and inpatient care use. /st>Roughly 70% of patients received at least one post-discharge CHW call; only 38% of patients received at least four calls as intended. Hospital readmission rates were lower among CHW patients (15.4%) compared with usual care (17.9%); the difference was not statistically significant. /st>Under performance-based payment systems, identifying cost-effective solutions for reducing hospital readmissions will be crucial to the economic survival of all hospitals, especially safety-net systems. This pilot study suggests that with appropriate supportive infrastructure, hospital-based CHWs may represent a feasible strategy for improving transitional care among vulnerable populations. An ongoing, randomized, controlled trial of a CHW intervention, developed according to the lessons of this pilot, will provide further insight into the utility of this approach to reducing readmissions.
    International Journal for Quality in Health Care 04/2014;
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    ABSTRACT: /st>To evaluate whether public reporting of performance data was associated with a change over time in quality indicators for acute myocardial infarction (AMI) in Italian hospitals. /st>Pre-post evaluation of AMI indicators in the Lazio region, before and after disclosure of the Regional Outcome Evaluation Program, and a comparative evaluation versus other Italian regions not participating in the program. /st>Nationwide Hospital Information System and vital status records. /st>24 800 patients treated for AMI in Lazio and 39 350 in the other regions. /st>Public reporting of the Regional Outcome Evaluation Program in the Lazio region. /st>Risk-adjusted indicators for AMI. /st>The proportion of ST-segment elevation myocardial infarction (STEMI) patients treated with percutaneous coronary interventions (PCI) within 48 h in Lazio changed from 31.3 to 48.7%, before and after public reporting, respectively (relative increase 56%; P < 0.001). In the other regions, the proportion increased from 51.5 to 58.4% (relative increase 13%; P < 0.001). Overall 30-day mortality and 30-day mortality for patients treated with PCI did not improve during the study period. The 30-day mortality for STEMI patients not treated with PCI in Lazio was significantly higher in 2009 (29.0%) versus 2006/07 (24.0%) (P = .002). /st>Public reporting may have contributed to increasing the proportion of STEMI patients treated with timely PCI. The mortality outcomes should be interpreted with caution. Changes in AMI diagnostic and coding systems should also be considered. Risk-adjusted quality indicators represent a fundamental instrument for monitoring and potentially enhancing quality of care.
    International Journal for Quality in Health Care 04/2014;
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    ABSTRACT: /st>To better understand the structure of the Patient Assessment of Chronic Illness Care (PACIC) instrument. More specifically to test all published validation models, using one single data set and appropriate statistical tools. /st>Validation study using data from cross-sectional survey. /st>A population-based sample of non-institutionalized adults with diabetes residing in Switzerland (canton of Vaud).Main outcome measureFrench version of the 20-items PACIC instrument (5-point response scale). We conducted validation analyses using confirmatory factor analysis (CFA). The original five-dimension model and other published models were tested with three types of CFA: based on (i) a Pearson estimator of variance-covariance matrix, (ii) a polychoric correlation matrix and (iii) a likelihood estimation with a multinomial distribution for the manifest variables. All models were assessed using loadings and goodness-of-fit measures. /st>The analytical sample included 406 patients. Mean age was 64.4 years and 59% were men. Median of item responses varied between 1 and 4 (range 1-5), and range of missing values was between 5.7 and 12.3%. Strong floor and ceiling effects were present. Even though loadings of the tested models were relatively high, the only model showing acceptable fit was the 11-item single-dimension model. PACIC was associated with the expected variables of the field. /st>Our results showed that the model considering 11 items in a single dimension exhibited the best fit for our data. A single score, in complement to the consideration of single-item results, might be used instead of the five dimensions usually described.
    International Journal for Quality in Health Care 04/2014;
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    ABSTRACT: /st>To investigate whether an accreditation program facilitates healthcare organizations (HCOs) to evolve and maintain high-performance human resource management (HRM) systems. /st>Cross-sectional multimethod study. /st>Healthcare organizations participating in the Australian Council on Healthcare Standards Evaluation and Quality Improvement Program (EQuIP 4) between 2007 and 2011. /st>Ratings across the EQuIP 4 HRM criteria, a clinical performance measure, surveyor reports (HRM information) and interview data (opinions and experiences regarding HRM and accreditation). /st>Healthcare organizations identified as high performing on accreditation HRM criteria seek excellence primarily because of internal motivations linked to best practice. Participation in an accreditation program is a secondary and less significant influence. Notwithstanding, the accreditation program provides the HCO opportunity for internal and external review and assessment of their performance; the accreditation activities are reflective learning and feedback events. /st>This study reveals that HCOs that pursue highly performing HRM systems use participation in an accreditation program as an opportunity. Their organizational mindset is to use the program as a tool by which to reflect and obtain feedback on their performance so to maintain or improve their management of staff and delivery of care.
    International Journal for Quality in Health Care 04/2014;
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    ABSTRACT: /st>To create a simple readmission risk-prediction tool that can be generated easily at the bedside by physicians, nurses, care coordinators and discharge planners. /st>Retrospective cohort study. /st>Tertiary academic medical center. /st>Inpatients aged 18 and older on general internal medicine services.MeasuresPredictor variables included age, prior hospitalization, high-risk diagnoses, high-risk medications, polypharmacy, depression, use of palliative care and a cumulative score summing these factors (readmission risk score-RRS). The main outcome measure was 30-day readmission. Predictive values were calculated. /st>Readmission increased linearly from 4.9% of those whose RRS score was 0-37.5% of those with highest risk scores (P = 0.0002). We derived a simple formula for readmission risk as 8 and 4% more for each additional readmission risk factor. The positive predictive value for RRS >0 was low, while the negative predictive value for this cutoff was 95%. /st>An easily calculated 7-point score can be used to estimate readmission risk. This tool may be particularly useful for identifying lower risk patients who may not require intensive intervention, thus aiding in appropriate targeting of resources.
    International Journal for Quality in Health Care 04/2014;
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    ABSTRACT: /st>Quality improvement (QI) methods have been fashionable in hospitals for decades. Previous studies have discussed the relationships between the implementation of QI methods and various external and internal factors, but there has been no examination to date of whether the neighbourhood effect influences such implementation. The aim of this study was to use a multilevel model to investigate whether and how the neighbourhood effect influences the implementation of QI methods in the hospital setting in Taiwan. /st>This is a retrospective questionnaire-based survey. /st>All medical centres, regional hospitals and district teaching hospitals in Taiwan. /st>Directors or persons in charge of implementing QI methods in hospitals. s)None. s)The breadth and depth of QI method implementation. /st>Seventy-two of the 139 hospitals contacted returned the questionnaire, yielding a 52% response rate. The breadth and depth of QI method implementation increased over the 10-year study period, particularly between 2004 and 2006. The breadth and depth of the QI methods implemented in the participating hospitals were significantly associated with the average breadth and depth of those implemented by their competitors in the same medical area during the previous period. In addition, time was positively associated with the breadth and depth of QI method implementation. /st>In summary, the findings of this study show that hospitals' QI implementation status is influenced by that of their neighbours. Hence, the neighbourhood effect is an important factor in understanding hospital behaviour.
    International Journal for Quality in Health Care 04/2014;