Élaboration et évaluation d’indicateurs de la qualité des soins pharmaceutiques en médecine interne au CHUS
Bibliographic record
Abstract
Resume Objectif : Ce projet avait pour but d’elaborer puis d’evaluer des indicateurs de la qualite des soins pharmaceutiques en medecine interne au Centre hospitalier universitaire de Sherbrooke. Methodologie : Une revue de la litterature medicale a ete effectuee pour determiner des indicateurs de la qualite des soins generaux et specifiques aux pathologies ciblees (diabete, insuffisance cardiaque, maladie pulmonaire obstructive chronique, fibrillation auriculaire et syndrome coronarien aigu). Ensuite, les pharmaciens hospitaliers ont fourni une retroaction sur la pertinence, la mesurabilite et le processus de mesure. Finalement, l’evaluation de certains indicateurs a eu lieu a partir d’un echantillon de sujets hospitalises en medecine interne au Centre hospitalier universitaire de Sherbrooke et de questions adressees au pharmacien en service. Resultats : Parmi les 57 indicateurs developpes, 27 ont ete retenus (47,4 %) pour avoir ete juges les plus pertinents. Les pharmaciens repondants ont propose de mesurer les indicateurs au moyen d’un audit dans 84,2 % des cas. Un sous-ensemble de 16 indicateurs ont ete evalues aupres de 31 sujets hospitalises en medecine interne. La conformite aux indicateurs est d’au moins 80 % dans 63 % des cas. Les taux de conformite les plus bas concernaient les conseils sur la medication de depart et la cessation tabagique. Conclusion : Ce projet nous a permis d’evaluer la qualite de la prise en charge des patients admis a l’unite de medecine interne du Centre hospitalier universitaire de Sherbrooke et de proposer des solutions afin d’accroitre la proportion de sujets qui beneficieront d’un enseignement sur leur medication au depart de l’hopital ainsi que de conseils lies a la cessation tabagique. Abstract Objective: To develop and evaluate the quality indicators for pharmaceutical care in internal medicine at Centre hospitalier universitaire de Sherbrooke. Methods: A review of the medical literature was done to determine the quality indicators used in general care and for specific diseases such as diabetes, congestive heart failure, chronic obstructive pulmonary disease, atrial fibrillation and acute coronary syndrome. Hospital pharmacists provided feedback related to the relevance, measurability, and the performance measurement process. Finally, specific indicators were evaluated using a sample of hospitalized subjects in internal medicine at Centre hospitalier universitaire de Sherbrooke by questioning pharmacists on service. Results: Of the 57 indicators developed, 27 (47.4%) were considered to be the most relevant. Pharmacists suggested to use an audit method to measure these indicators. A subgroup of 16 indicators were used in 31 hospitalized patients in internal medicine. Compliance with indicators was at least 80% in 63% of cases. The lowest compliance rate involved counselling for discharge medication and smoking cessation. Conclusion: This project allowed the authors to evaluate the quality of the management of patients admitted to internal medicine at the Centre hospitalier universitaire de Sherbrooke. It also help identified which subjects would benefit from counselling for their discharge medication as well as from counselling for smoking cessation. Key words: Acute coronary syndrome, atrial fibrillation, chronic obstructive pulmonary disease, congestive heart failure, diabetes, indicators, pharmaceutical care, quality
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Observational | low |
| gpt | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Observational | low |
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.085 | 0.134 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".