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Quality of Health Care clinical trials

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NCT ID: NCT01059942 Completed - Communication Clinical Trials

Development and Validation of a Tool to Measure Hand-off Quality

Start date: January 2010
Phase: N/A
Study type: Observational

The aim of this project is to develop and validate a simple, flexible, reliable, real-time observation tool to evaluate hand-off practices. The Hand-off CEX is a paper-based instrument that can be used to evaluate either the sender or the receiver of hand-off communication. This tool is based on a previously-validated, widely-used, real-time educational evaluation tool (the Mini-CEX); published expert opinion; and our prior research . The investigators' tool incorporates unique role-based anchors for both senders and receivers that refer to verbal communication, professionalism and environment, hand-off domains informed by preliminary work and expert opinion. The Hand-off CEX(Clinical Evaluation Exercise) will be used by academic hospitalists and house-staff physicians to assess feasibility. We, the investigators, will also assess the construct validity and inter-rater reliability of the tool through the use of standardized, videotaped hand-off scenarios depicting various levels of performance of a hand-off scenario. We hypothesize that the Hand-off CEX will arm educators with an innovative, necessary, valid and feasible method for training health professionals to conduct safe and effective hand-offs. Finally, the Hand-off CEX will be a useful tool to assist hospitals in improving patient safety.

NCT ID: NCT00939419 Completed - Clinical trials for Tuberculosis, Pulmonary

The Effectiveness of Health Facility-based and Community-based Care for Tuberculosis

Start date: January 2005
Phase: Phase 4
Study type: Interventional

The purpose of the study is whether the provision of tuberculosis care using volunteer community health workers or self-administered treatment for 7 months is equally effective with the existing 8 months of TB care in public health facilities by health workers. Patient care by volunteer community health workers and 7 months of self-administered treatment are more patient-convenient delivery options than the ongoing TB care in health facility.

NCT ID: NCT00893672 Completed - Clinical trials for Intensive Care Units

Comparison of Two Chest Radiograph Prescription Strategies in Intensive Care Unit

RARE
Start date: December 2006
Phase: N/A
Study type: Observational

Current guidelines recommend Routine daily chest radiographs (CXRs) for mechanically ventilated patients in intensive care units (ICUs). However, some ICUs have shifted to an On-demand strategy, in which this CXR is only prescribed if warranted by the patient's status at the morning physical examination. Here the investigators compared Routine and On-demand strategies in 21 French ICUs. The working hypothesis was that CXR prescriptions would fall by at least 20% with the On-demand strategy, with no reduction in quality of care.

NCT ID: NCT00793065 Completed - Clinical trials for Quality of Health Care

Evaluating the Effects of EHRs, P4P and Medical Home Redesign in the Hudson Valley

Start date: January 2008
Phase: N/A
Study type: Observational

The investigators will conduct a longitudinal cohort study with concurrent controls. The investigators will include all primary care physicians in the Hudson Valley including family practitioners, internists, and pediatricians. The purpose of this study is to determine the effects of implementing electronic health records (EHRs), pay-for-performance incentives for physicians (P4P), and Medical Home redesign on health care quality, cost and patient experience in the Hudson Valley.

NCT ID: NCT00571376 Completed - Clinical trials for Quality of Health Care

Evaluating the Impact on Quality and Costs of Regional Clinical Data Exchange Programs in New York State

Start date: January 2009
Phase: N/A
Study type: Observational

The purpose of this study is to measure the financial effects of health information technology and health information exchange in regional health information organizations in New York State.

NCT ID: NCT00188032 Completed - Pulmonary Embolism Clinical Trials

Strategies for Suspected Pulmonary Embolism in Emergency Departments

Start date: June 2005
Phase: N/A
Study type: Interventional

Aims: 1) To evaluate the effectiveness of two interventions aimed at improving the management of patients with suspected pulmonary embolism: Written guidelines and Computer-Assisted Decision Support (CADS). 2) To evaluate the impact of electronic reminders on the appropriateness of the treatment of patients with suspected PE Design: Pragmatic, unblinded, cluster randomised controlled study. Setting: 20 French Emergency Departments Patients: Out patients suspected of having pulmonary embolism Methods: Emergency physicians will prospectively complete a standardized electronic form on Personal Data Assistant (PDA), including patients' characteristics, the clinical probability if assessed, the diagnostic tests performed, the treatments initiated and the final diagnostic and therapeutic decisions. Patients will be interviewed at the end of a 3-month follow-up period using a standardized questionnaire. The reference rate of appropriateness of the diagnostic management before intervention will be assessed in each centre. At the end of this preliminary period, the centres will be randomized in two fold two groups according to a factorial design with stratification on their reference level of appropriateness. Half of the centres will have written guidelines and half a Computer-Assisted Decision Support for the diagnosis of PE on the PDA. In each of these two main groups, half of the centres will have electronic reminders on their PDA concerning the treatment of PE. Judgment criteria Main : Rate of strategies considered as validated according to the results of the systematic review and meta-analysis.3 Secondary judgment criteria (diagnosis): - Rate of strategies considered as validated or acceptable according to the opinion of international advisors. - Rate of thromboembolic-events during a 3-month follow-up period in patients for whom pulmonary embolism will be ruled out - Costs of the diagnostic management Secondary judgment criteria (treatment): - Delay between Emergency Department admission and the first dose of antithrombotic treatment in patients with high clinical probability of PE according to the Revised Geneva Score - Rate of inappropriate treatment according to international recommendations for patients with confirmed PE. Number of patients: By estimating that the rate of appropriateness would be 55% in the "written guidelines" group, 1331 patients are necessary to highlight an absolute superiority of 15% in the "CADS" group (rate of conformity of 70%). The number of patients will be adjusted at the end of the preliminary period according to the level of appropriateness before interventions considering that it will improve less than 5% in the "written guidelines" group.