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    ABSTRACT: Quality continues to be placed at the heart of discussions about healthcare. This raises important questions about precisely what quality care is, and how it should be measured. An overall measure of subjective well-being (SWB) that assesses and joins up different stages of the treatment process, and the different people affected, could potentially be used to capture the full impact of quality care throughout the entire treatment process. This article presents a temporal model through which SWB links all stages in the treatment and care process, thus allowing the overall quality of care to be determined and valued according to its direct effect on people's lives. Drawing on existing medical and behavioural studies, we populate this model with evidence that demonstrates how SWB is affected at different points along the patient pathway. SWB is shown to have an effect on outcomes at all stages of the treatment experience and improved health and quality outcomes are shown to consistently enhance SWB. Furthermore, SWB measures are shown to be a suitable method to value the impact of healthcare on the families and carers of patients and, in this way, can join up health outcomes to show wider effects of treatment on patients' lives. Measuring an individual's SWB throughout his or her treatment experience can enable a full appraisal of the quality of care that they receive. This will facilitate service improvements at the micro level and help value treatments for resource allocation purposes at the macro level.
    No preview · Article · Dec 2013 · Social Science [?] Medicine

  • No preview · Article · Nov 2013 · BMJ (online)
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    ABSTRACT: Poorly performing doctors are a source of harm but do not commonly feature in discussions of patient safety. Few countries have national mechanisms to deal with these doctors; most opt for suspension and/or exclusion from clinical practice. This study reports on the 11-year experience of dealing with concerns about doctors' performance in the UK National Health Service (NHS). The aim of this study was to describe the frequency with which doctors were referred due to performance-related concerns, examine demographic and specialty differences, and identify the nature of the concerns prompting referral. This observational study uses data collected by the National Clinical Assessment Service for each referral (n=6179 doctors) over an 11-year period (April 2001-March 2012) in England to examine the rate at which concerns about doctors' performance occur, understand differences in rates between practitioner groups, and changes over time. The annual referral rate was five per 1000 doctors (95% CI 4.6 to 5.4). Doctors whose first medical qualification was gained outside the UK were more than twice as likely to be referred as UK-qualified doctors; male doctors were more than twice as likely to be referred as women doctors; and doctors in the late stages of their career were nearly six times as likely to be referred as early career doctors. The UK holds a consistently collected national dataset on performance concerns about doctors. This allows risk groups to be identified so that preventive action and early intervention can be targeted most effectively to reduce harm to patients. A feature of past handling of poor clinical performance has been late presentation and a lack of thematic study of causation.
    No preview · Article · Oct 2013 · BMJ quality & safety
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