National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care

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Darko Gvozdanovi_

2007-09-01

Full Text Available In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1 to provide efficient healthcare-related data management in support of decision-making processes; (2 to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution.

Quality Improvement in Athletic Health Care.

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Lopes Sauers, Andrea D; Sauers, Eric L; Valier, Alison R Snyder

2017-11-01

  Quality improvement (QI) is a health care concept that ensures patients receive high-quality (safe, timely, effective, efficient, equitable, patient-centered) and affordable care. Despite its importance, the application of QI in athletic health care has been limited.   To describe the need for and define QI in health care, to describe how to measure quality in health care, and to present a QI case in athletic training.   As the athletic training profession continues to grow, a widespread engagement in QI efforts is necessary to establish the value of athletic training services for the patients that we serve. A review of the importance of QI in health care, historical perspectives of QI, tools to drive QI efforts, and examples of common QI initiatives is presented to assist clinicians in better understanding the value of QI for advancing athletic health care and the profession. Clinical and Research Advantages:  By engaging clinicians in strategies to measure outcomes and improve their patient care services, QI practice can help athletic trainers provide high-quality and affordable care to patients.

Efficiency of primary care in rural Burkina Faso. A two-stage DEA analysis.

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Marschall, Paul; Flessa, Steffen

2011-07-20

Providing health care services in Africa is hampered by severe scarcity of personnel, medical supplies and financial funds. Consequently, managers of health care institutions are called to measure and improve the efficiency of their facilities in order to provide the best possible services with their resources. However, very little is known about the efficiency of health care facilities in Africa and instruments of performance measurement are hardly applied in this context. This study determines the relative efficiency of primary care facilities in Nouna, a rural health district in Burkina Faso. Furthermore, it analyses the factors influencing the efficiency of these institutions. We apply a two-stage Data Envelopment Analysis (DEA) based on data from a comprehensive provider and household information system. In the first stage, the relative efficiency of each institution is calculated by a traditional DEA model. In the second stage, we identify the reasons for being inefficient by regression technique. The DEA projections suggest that inefficiency is mainly a result of poor utilization of health care facilities as they were either too big or the demand was too low. Regression results showed that distance is an important factor influencing the efficiency of a health care institution Compared to the findings of existing one-stage DEA analyses of health facilities in Africa, the share of relatively efficient units is slightly higher. The difference might be explained by a rather homogenous structure of the primary care facilities in the Burkina Faso sample. The study also indicates that improving the accessibility of primary care facilities will have a major impact on the efficiency of these institutions. Thus, health decision-makers are called to overcome the demand-side barriers in accessing health care.

Integration of quality improvement and cost-efficiency through industrial improvement techniques

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Vink JP

2016-06-01

Full Text Available Jasper P Vink,1 Maxime T Rigaudy,1,2 Karl O Elmqvist11Imperial College Business School, Imperial College London, London, 2Hull York Medical School, York, UKIn this journal, Crema and Verbano1 discussed the importance of defining quality of health care and how quality can be improved through various industrial instruments and techniques. Quality of health care is a heavily debated topic that requires a wide scope of considerations across the many stakeholders of the health system. We acknowledge Crema and Verbano’s arguments that patient safety is a basic pillar of quality, upon which we would like to expand by highlighting the clinical effectiveness and patient-reported outcomes, which are the two further crucial components of quality. The arguments made regarding quality improvement techniques and cost efficiency in health care provision are insightful, yet appear to make a distinction between efforts to improve quality, eliminate waste from processes, and cut costs in health care provision. We would argue that in fact these achievements are all closely related and can be achieved simultaneously, if the industrial techniques of quality management are applied adequately.View the original paper by Crema and Verbano.

Medical Care Provided Under California's Workers' Compensation Program: Effects of the Reforms and Additional Opportunities to Improve the Quality and Efficiency of Care.

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Wynn, Barbara O; Timbie, Justin W; Sorbero, Melony E

2011-01-01

Since 2004, significant changes have been made to the California workers' compensation (WC) system. The Commission on Health and Safety and Workers' Compensation (CHSWC) asked the RAND Corporation to examine the impact that these changes have on the medical care provided to injured workers. This study synthesizes findings from interviews and available information regarding the implementation of the changes affecting WC medical care and identifies areas in which additional changes might increase the quality and efficiency of care delivered under the WC system. To improve incentives for efficiently providing medically appropriate care, California should revise its fee schedule allowances for services provided by hospitals to inpatients, freestanding ambulatory surgery centers, and physicians, create nonmonetary incentives for providing medically appropriate care in the medical provider network (MPN) context through more-selective contracting with providers and reducing medical review requirements for high-performing physicians; reduce incentives for inappropriate prescribing practices by curtailing in-office physician dispensing; and implement pharmacy benefit network regulations. To increase accountability for performance, California should revise the MPN certification process to place accountability for meeting MPN standards on the entity contracting with the physician network; strengthen Division of Workers' Compensation (DWC) authorities to provide intermediate sanctions for failure to comply with MPN requirements; and modify the Labor Code to remove payers and MPNs from the definition of individually identifiable data so that performance on key measures can be publicly available. To facilitate monitoring and oversight, California should provide DWC with more flexibility to add needed data elements to medical data reporting and provide penalties for a claim administrator failing to comply with the data-reporting requirements; require that medical cost

Achieving palliative care research efficiency through defining and benchmarking performance metrics.

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Lodato, Jordan E; Aziz, Noreen; Bennett, Rachael E; Abernethy, Amy P; Kutner, Jean S

2012-12-01

Research efficiency is gaining increasing attention in the research enterprise, including palliative care research. The importance of generating meaningful findings and translating these scientific advances to improved patient care creates urgency in the field to address well documented system inefficiencies. The Palliative Care Research Cooperative Group (PCRC) provides useful examples for ensuring research efficiency in palliative care. Literature on maximizing research efficiency focuses on the importance of clearly delineated process maps, working instructions, and standard operating procedures in creating synchronicity in expectations across research sites. Examples from the PCRC support these objectives and suggest that early creation and employment of performance metrics aligned with these processes are essential to generate clear expectations and identify benchmarks. These benchmarks are critical in effective monitoring and ultimately the generation of high-quality findings that are translatable to clinical populations. Prioritization of measurable goals and tasks to ensure that activities align with programmatic aims is critical. Examples from the PCRC affirm and expand the existing literature on research efficiency, providing a palliative care focus. Operating procedures, performance metrics, prioritization, and monitoring for success should all be informed by and inform the process map to achieve maximum research efficiency.

Health Care Efficiencies: Consolidation and Alternative Models vs. Health Care and Antitrust Regulation - Irreconcilable Differences?

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King, Michael W

2017-11-01

Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation. Fundamentally, what is the best way to reduce U.S. health care spending, while improving the patient experience of care in terms of quality and satisfaction, and driving better patient health outcomes? Mergers, partnerships, and consolidation in the health care industry, new care delivery models like Accountable Care Organizations and integrated care systems, bundled payments, information technology, innovation through new drugs and new medical devices, or some combination of the foregoing? More importantly, recent ambitious reform efforts fall short of a cohesive approach, leaving fundamental internal inconsistencies across divergent arms of the federal government, raising the issue of whether the U.S. health care system can drive sufficient efficiencies within the current health care and antitrust regulatory environments. While debate rages on Capitol Hill over "repeal and replace," only limited attention has been directed toward reforming the current "fee-for-service" model pursuant to which providers are paid for volume of care rather than quality or outcomes. Indeed, both the Patient Protection and Affordable Care Act ("ACA") 3 and proposals for its replacement focus primarily on the reach and cost of providing coverage for

Orthogeriatric care: improving patient outcomes

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Tarazona-Santabalbina FJ

2016-06-01

Full Text Available Francisco José Tarazona-Santabalbina,1,2 Ángel Belenguer-Varea,1,2 Eduardo Rovira,1,2 David Cuesta-Peredó1,21Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera, 2Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, SpainAbstract: Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. Keywords: hip fractures, geriatric assessment, orthogeriatric care, recovery of function, mortality

Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management.

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Kuupiel, Desmond; Bawontuo, Vitalis; Mashamba-Thompson, Tivani P

2017-11-29

Access to point-of-care (POC) diagnostics services is essential for ensuring rapid disease diagnosis, management, control, and surveillance. POC testing services can improve access to healthcare especially where healthcare infrastructure is weak and access to quality and timely medical care is a challenge. Improving the accessibility and efficiency of POC diagnostics services, particularly in resource-limited settings, may be a promising route to improving healthcare outcomes. In this review, the accessibility of POC testing is defined as the distance/proximity to the nearest healthcare facility for POC diagnostics service. This review provides an overview of the impact of POC diagnostics on healthcare outcomes in low- and middle-income countries (LMICs) and factors contributing to the accessibility of POC testing services in LMICs, focusing on characteristics of the supply chain management and quality systems management, characteristics of the geographical location, health infrastructure, and an enabling policy framework for POC diagnostics services. Barriers and challenges related to the accessibility of POC diagnostics in LMICs were also discussed. Bearing in mind the reported barriers and challenges as well as the disease epidemiology in LMICs, we propose a lean and agile supply chain management framework for improving the accessibility and efficiency of POC diagnostics services in these settings.

Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management

Directory of Open Access Journals (Sweden)

Desmond Kuupiel

2017-11-01

Full Text Available Access to point-of-care (POC diagnostics services is essential for ensuring rapid disease diagnosis, management, control, and surveillance. POC testing services can improve access to healthcare especially where healthcare infrastructure is weak and access to quality and timely medical care is a challenge. Improving the accessibility and efficiency of POC diagnostics services, particularly in resource-limited settings, may be a promising route to improving healthcare outcomes. In this review, the accessibility of POC testing is defined as the distance/proximity to the nearest healthcare facility for POC diagnostics service. This review provides an overview of the impact of POC diagnostics on healthcare outcomes in low- and middle-income countries (LMICs and factors contributing to the accessibility of POC testing services in LMICs, focusing on characteristics of the supply chain management and quality systems management, characteristics of the geographical location, health infrastructure, and an enabling policy framework for POC diagnostics services. Barriers and challenges related to the accessibility of POC diagnostics in LMICs were also discussed. Bearing in mind the reported barriers and challenges as well as the disease epidemiology in LMICs, we propose a lean and agile supply chain management framework for improving the accessibility and efficiency of POC diagnostics services in these settings.

Practical strategies for increasing efficiency and effectiveness in critical care education.

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Joyce, Maurice F; Berg, Sheri; Bittner, Edward A

2017-02-04

Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.

[Technical efficiency assessment of public primary care providers in the Basque Country (Spain), 2010-2013].

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Cordero, José Manuel; Nuño-Solinís, Roberto; Orueta, Juan F; Polo, Cristina; Del Río-Cámara, Mario; Alonso-Morán, Edurne

2016-01-01

To evaluate the technical efficiency of primary care units operating in the Basque Health Service during the period 2010-2013, corresponding to the implementation of a care integration strategy by health authorities. This study included 11 of the 12 primary care units in the Basque Health Service during the period 2010-2013. Data envelopment analysis (DEA) was used to assess the technical efficiency of the units. In particular, we applied the extension DEA windows to analyse all units as if they were in a single period (33 observations) as well as a conditional model, which allowed incorporation of the effect of the characteristics of the population covered. The outputs considered were a quality index based on fulfilment of different requirements related to primary care delivery and the rate of avoidable hospitalizations (treated as an undesirable output). The inputs used were the number of physicians, the number of nurses and the costs of prescriptions. The morbidity index was included as an exogenous variable. The results showed that the efficiency of all the units improved during the study period. However, this improvement was not greater in the units incorporated in the integrated healthcare organisation. In a context of global transformation of care delivery in the Basque country in the study period, primary care units increased their efficiency. However, this effect was not larger in vertically integrated primary care providers. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

Improving client-centred care and services : the role of front/back-office configurations

NARCIS (Netherlands)

Broekhuis, Manda; de Blok, C.; Meijboom, B.

Improving client-centred care and services: the role of front/back-officeconfigurations. This paper is a report of a study conducted to explore the application of designing front- and back-office work resulting in efficient client-centred care in healthcare organizations that supply home care,

Improving cardiovascular care through outpatient cardiac rehabilitation: an analysis of payment models that would improve quality and promote use.

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Mead, Holly; Grantham, Sarah; Siegel, Bruce

2014-01-01

Much attention has been paid to improving the care of patients with cardiovascular disease by focusing attention on delivery system redesign and payment reforms that encompass the healthcare spectrum, from an acute episode to maintenance of care. However, 1 area of cardiovascular disease care that has received little attention in the advancement of quality is cardiac rehabilitation (CR), a comprehensive secondary prevention program that is significantly underused despite evidence-based guidelines that recommending its use. The purpose of this article was to analyze the applicability of 2 payment and reimbursement models-pay-for-performance and bundled payments for episodes of care--that can promote the use of CR. We conclude that a payment model combining elements of both pay-for-performance and episodes of care would increase the use of CR, which would both improve quality and increase efficiency in cardiac care. Specific elements would need to be clearly defined, however, including: (a) how an episode is defined, (b) how to hold providers accountable for the care they provider, (c) how to encourage participation among CR providers, and (d) how to determine an equitable distribution of payment. Demonstrations testing new payment models must be implemented to generate empirical evidence that a melded pay-for-performance and episode-based care payment model will improve quality and efficiency.

Process Evaluation: Standard, Effectiveness, Efficiency and Sustainability of Maternity Nursing Care

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Laili Rahayuwati

2017-09-01

Full Text Available Although globally there is a change in the trend of epidemiology from infectious diseases to chronic diseases, the prevalence and incidence of infectious diseases as well as MMR (Maternal Mortality Rate and IMR (infant mortality rate in Indonesia is still high. In year 2000, Faculty of Nursing of the Universitas Padjadjaran in collaboration with Hasan Sadikin Hospital built a model of treatment room, which was affiliated with obstetric gynecology room for improving integrated quality of health care services and education. The model built in this room aimed to : 1 Improve the quality of health care service; 2 to develop the student’s experiences with patients; 3 Provide quality nurse education to support students; 4 encourage students to improve the results of clinical prctice. The objective of process evaluation in this study was to give an insight to an appropriate model for maternity nursing service. This results showed on the one hand , there are some records not yet achieved an ideal standard , lack of effectiveness and efficiency of care delivery, namely: 1 the ratio of midwives and patients are not ideal ; 2 No one consultant obstetrician gynecologist and one doctor for every room . As well as challenges to sustainability care that meets the standards of maternity care. Conclusion: this study recommends to take a comprehensive strategic planning for improving nursing and midwifery services that involve all relevant stakeholders in the government, civil society, service delivery, education, and professional organizations.

Diagnosing and improving functioning in interdisciplinary health care teams.

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Blackmore, Gail; Persaud, D David

2012-01-01

Interdisciplinary teams play a key role in the delivery of health care. Team functioning can positively or negatively impact the effective and efficient delivery of health care services as well as the personal well-being of group members. Additionally, teams must be able and willing to work together to achieve team goals within a climate that reflects commitment to team goals, accountability, respect, and trust. Not surprisingly, dysfunctional team functioning can limit the success of interdisciplinary health care teams. The first step in improving dysfunctional team function is to conduct an analysis based on criteria necessary for team success, and this article provides meaningful criteria for doing such an analysis. These are the following: a common team goal, the ability and willingness to work together to achieve team goals, decision making, communication, and team member relationships. High-functioning interdisciplinary teams must exhibit features of good team function in all key domains. If a team functions well in some domains and needs to improve in others, targeted strategies are described that can be used to improve team functioning.

Improving care by understanding the way we work: human factors and behavioural science in the context of intensive care

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Sevdalis, Nick; Brett, Stephen J

2009-01-01

Effectiveness and efficiency of care of the critically ill patient are subject to a number of systemic influences, including skills of individual physicians/nurses (technical and non-technical), team-working in the intensive care unit (ICU), and the ICU environment. We first discuss the paper of Fackler and colleagues as a contribution to the systems approach to clinical performance in the context of intensive care. We then highlight features of care delivery that are unique to intensive care and discuss the need for better understanding of human and non-human elements of the system of care of the critically ill patient as a driver for improvement of care delivery. PMID:19439048

An electronic dashboard to improve nursing care.

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Tan, Yung-Ming; Hii, Joshua; Chan, Katherine; Sardual, Robert; Mah, Benjamin

2013-01-01

With the introduction of CPOE systems, nurses in a Singapore hospital were facing difficulties monitoring key patient information such as critical tasks and alerts. Issues include unfriendly user interfaces of clinical systems, information overload, and the loss of visual cues for action due to paperless workflows. The hospital decided to implement an interactive electronic dashboard on top of their CPOE system to improve visibility of vital patient data. A post-implementation survey was performed to gather end-user feedback and evaluate factors that influence user satisfaction of the dashboard. Questionnaires were sent to all nurses of five pilot wards. 106 valid responses were received. User adoption was good with 86% of nurses using the dashboard every shift. Mean satisfaction score was 3.6 out of 5. User satisfaction was strongly and positively correlated to the system's perceived impact on work efficiency and care quality. From qualitative feedback, nurses generally agreed that the dashboard had improved their awareness of critical patient issues without the hassle of navigating a CPOE system. This study shows that an interactive clinical dashboard when properly integrated with a CPOE system could be a useful tool to improve daily patient care.

Improving primary health care to increase efficiency

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V. M. Kornatsky

2017-02-01

Full Text Available Thus, the convergence of medicine, psychiatry and psychology is the reality of today to eliminate the imbalance, psychosomatic health. The role of medical practice in the correction of psychosomatic disorders is large, but insufficient. Complementary medical becomes a psychological resource in decision psychosomatic problems. A study of the leading role of psychogenic factors and mechanisms of somatic response to stressful situations, underlying the formation of the most common and socially significant diseases, is a current trend psychosomatic direction in the PC. The data obtained may become the basis for developing measures for the identification, treatment, and prevention of psychosomatic disorders in conditions of emotional stress and their prevention. Successful interdisciplinary interaction fosters the following principles: collegiality in matters of surveillance, social functioning capabilities; continuity in matters of treatment and preventive care; adherence to the principles of medical ethics and deontology; implementation of accounting volume of medical care. The formation of a new system will bring to the population high-tech methods of diagnostics and treatment, strengthen the development of the system of prevention of socially significant diseases and expand the possibilities of rehabilitation.

CFD Analysis of The Hydraulic Turbine Draft Tube to Improve System Efficiency

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Chakrabarty Spandan

2016-01-01

Full Text Available Demand of the power is increasing day by day with the development of the science and technology. Development of the renewable energy sector has become essential issue at the present situation due to the limited source of the non-renewable energy. Hydro energy power generation sector is superior over the other renewable sector due to the high efficiency, ability to continuous generation and low generation cost. In India a great amount of the power generation is taken care by the hydro power system but still some more potential have unexplored. The efficiency improvement of the hydro turbine system can be done for the new installation or installed system by the improvement in component level. The system can be installed by the state of the art equipment, like modern inlet guide vane (IGV control system, improved design of the runner, IGV system, draft tube, penstock to reduce the loss, hence improve the efficiency. The energy recovery in the draft tube depends on the design of draft tube. In the present work the optimized design of the draft tube shape through computational fluid dynamics (CFD simulation has been carried out in ANSYS FLUENT platform. The design objective of the draft tube is to reduce the flow loss and improve the energy recovery, hence to improve the efficiency.

The Effects of Simulation-based Transvaginal Ultrasound Training on Quality and Efficiency of Care

DEFF Research Database (Denmark)

Tolsgaard, Martin Grønnebæk; Ringsted, Charlotte; Rosthøj, Susanne

2017-01-01

, but no studies have examined its effects on quality and efficiency of care. METHODS: Trainees from 4 University Hospitals in East Denmark were included (N = 54). Participants were randomized to either simulation-based ultrasound training and clinical training (intervention group, n = 28), or to clinical training......, 33.5-55.1) and 19.8% (95% CI, 4.1-32.9) in the intervention and control group, respectively (P = 0.005). CONCLUSIONS: Simulation-based ultrasound training improved quality of care and reduced the need for repeated patient examination and trainee supervision.......OBJECTIVE: To explore the effect of adding simulation-based transvaginal ultrasound training to trainees' clinical training compared with only clinical training on quality of and efficiency of care. BACKGROUND: Simulation-based ultrasound training may be an effective adjunct to clinical training...

Impacts of market and organizational characteristics on hospital efficiency and uncompensated care.

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Hsieh, Hui-Min; Clement, Dolores G; Bazzoli, Gloria J

2010-01-01

Hospitals have confronted a difficult financial environment given many factors, including expansion of managed care, changes in public policy, growing market competition for certain services, and growth in the number of uninsured. Policy makers have expressed concern that hospitals may forgo providing care to the indigent as a means to reduce costs and become more efficient when faced with financial pressures. This article examined the effects of environmental pressures on two dimensions of hospital performance: hospital efficiency and uncompensated care provision. Longitudinal data for the Commonwealth of Virginia from 1998 to 2004 were analyzed. Data Envelopment Analysis and bivariate probit were used to examine the factors associated with efficiency and uncompensated care. The results indicated that a positive relationship between hospital efficiency and uncompensated care provision exists. That is, hospitals that are categorized as efficient are likely to provide more uncompensated care. We also found that hospitals tended to provide more uncompensated care when increased demand for these services occurred in a market. Increases in Medicare or Medicaid patient share reduced the provision of uncompensated care. In relation to hospital efficiency, the results indicated that HMO penetration and Medicaid patient share reduced hospital efficiency. This study found that efficient hospitals tend to provide more uncompensated care over time. The findings also suggest that hospitals alter their efficiency and provision of uncompensated care in response to a number of environmental pressures, but it may depend on the type of pressures or uncertainties encountered.

Impact of Medicare Advantage penetration and hospital competition on technical efficiency of nursing care in US intensive care units.

Science.gov (United States)

Min, Ari; Scott, Linda D; Park, Chang; Vincent, Catherine; Ryan, Catherine J; Lee, Taewha

2018-04-10

This study aimed to evaluate technical efficiency of US intensive care units and determine the effects of environmental factors on technical efficiency in providing quality of nursing care. Data were obtained from the 2014 National Database of Nursing Quality Indicators and the Centers for Medicare and Medicaid Services. Data envelopment analysis was used to estimate technical efficiency for each intensive care unit. Multilevel modeling was used to determine the effects of environmental factors on technical efficiency. Overall, Medicare Advantage penetration and hospital competition in a market did not create pressure for intensive care units to become more efficient by reducing their inputs. However, these 2 environmental factors showed positive influences on technical efficiency in intensive care units with certain levels of technical efficiency. The implications of the study results for management strategies and health policy may vary according to the levels of technical efficiency in intensive care units. Further studies are needed to examine why and how intensive care units with particular levels of technical efficiency are differently affected by certain environmental factors. Copyright © 2018 John Wiley & Sons, Ltd.

Cost-Effectiveness of Improving Health Care to People with HIV in Nicaragua

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Edward Broughton

2014-01-01

Full Text Available Background. A 2010 evaluation found generally poor outcomes among HIV patients on antiretroviral therapy in Nicaragua. We evaluated an intervention to improve HIV nursing services in hospital outpatient departments to improve patient treatment and retention in care. The intervention included improving patient tracking, extending clinic hours, caring for children of HIV+ mothers, ensuring medication availability, promoting self-help groups and family involvement, and coordinating multidisciplinary care. Methods. This pre/postintervention study examined opportunistic infections and clinical status of HIV patients before and after implementation of changes to the system of nursing care. Hospital expenditure data were collected by auditors and hospital teams tracked intervention expenses. Decision tree analysis determined incremental cost-effectiveness from the implementers’ perspective. Results. Opportunistic infections decreased by 24% (95% CI: 14%–34% and 11.3% of patients improved in CDC clinical stage. Average per-patient costs decreased by $133/patient/year (95% CI: $29–$249. The intervention, compared to business-as-usual strategy, saved money while improving outcomes. Conclusions. Improved efficiency of services can allow more ART-eligible patients to receive therapy. We recommended the intervention be implemented in all HIV service facilities in Nicaragua.

The Gains from Improved Market Efficiency

DEFF Research Database (Denmark)

Persson, Karl Gunnar; Ejrnæs, Mette

faster, violations of the law of one price become smaller and hence less persistent. There were also significant gains from improved market efficiency but that improvement took place after the information ‘regime’ shifted from pre-telegraphic communication to a regime with swift transmission...... of information in an era which developed a sophisticated commercial press and telegraphic communication. Improved market efficiency probably stimulated trade more than falling transport costs......This paper looks at the gains from improved market efficiency in long-distance grain trade in the second half of the 19th century when violations of the law of one price were reduced due to improved information transmission. Two markets, a major export centre, Chicago, and a major importer...

Shared governance: a way to improve the care in an inpatient rehabilitation facility.

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Torres, Audrey; Kunishige, Nalani; Morimoto, Denise; Hanzawa, Tracie; Ebesu, Mike; Fernandez, John; Nohara, Lynne; SanAgustin, Eliseo; Borg, Stephanie

2015-01-01

Rehabilitation care is specialized and individualized requiring effective and efficient communication to achieve optimal patient outcomes. To examine how effective implementation of shared governance could improve care delivery, promote patient-centered care, and improve patient outcomes. The shared governance approach included all members of the rehabilitation team (i.e., physical therapist, occupational therapist, speech therapist, registered nurse and nurse aide) and was implemented over 6 months. The major end products of this shared governance effort were improved staff communication, problem solving, patient outcomes, and staff satisfaction on our stroke and brain injury unit. When effectively implemented and sustained, shared governance between all rehabilitation team stakeholders can increase the effectiveness of communication along with more positive patient and staff outcomes. © 2014 Association of Rehabilitation Nurses.

[Improving the continuous care process in primary care during weekends and holidays: redesigning and FMEA].

Science.gov (United States)

Cañada Dorado, A; Cárdenas Valladolid, J; Espejo Matorrales, F; García Ferradal, I; Sastre Páez, S; Vicente Martín, I

2010-01-01

To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.

Improving palliative care.

LENUS (Irish Health Repository)

Moran, Sue

2009-05-01

Any service improvement project requires planning, action and evaluation. Using a recognised quality improvement framework can offer a structured approach to implementing and assessing changes to patient care. This article describes how use of the Deming Cycle has helped to identify nurses\\' learning needs.

Improved particle swarm optimization algorithm for android medical care IOT using modified parameters.

Science.gov (United States)

Sung, Wen-Tsai; Chiang, Yen-Chun

2012-12-01

This study examines wireless sensor network with real-time remote identification using the Android study of things (HCIOT) platform in community healthcare. An improved particle swarm optimization (PSO) method is proposed to efficiently enhance physiological multi-sensors data fusion measurement precision in the Internet of Things (IOT) system. Improved PSO (IPSO) includes: inertia weight factor design, shrinkage factor adjustment to allow improved PSO algorithm data fusion performance. The Android platform is employed to build multi-physiological signal processing and timely medical care of things analysis. Wireless sensor network signal transmission and Internet links allow community or family members to have timely medical care network services.

An improvement project within urological care.

Science.gov (United States)

Khatami, Annelie; Rosengren, Kristina

2015-01-01

The purpose of this paper is to describe staff experiences in an on-going improvement project regarding patients with ureteral stones. A qualitative descriptive study based on eight group interviews and 48 narratives, was performed. Data were analysed using qualitative content analysis. Trustworthiness was ensured by using a well-documented improvement process method during six months. The results formed three categories: an absent comprehensive view; complexity; and vulnerability within the organisation. A holistic perspective regarding urological care at the micro-, meso- and macro-levels is needed to improve planning and caring processes. This study includes one team (six members, different health professionals) within the same urology department. Results show that staff need information, such as guidelines and support throughout the improvement work to deliver high-quality care. Moreover, there is a need for evidence-based guidelines at national level to support improvement work. Healthcare staff need to pay attention to all team member needs to improve urological care. Organisational and managerial aspect are needed to support clear and common goals regarding healthcare improvement work. Urological improvement projects, generally, are lacking, which is why this study is important to improve nephrolithiasis patient care.

From coordinated care trials to medicare locals: what difference does changing the policy driver from efficiency to quality make for coordinating care?

Science.gov (United States)

Gardner, Karen; Yen, Laurann; Banfield, Michelle; Gillespie, James; McRae, Ian; Wells, Robert

2013-02-01

The terms coordination and integration refer to a wide range of interventions, from strategies aimed at coordinating clinical care for individuals to organizational and system interventions such as managed care, which contract medical and support services. Ongoing debate about whether financial and organizational integration are needed to achieve clinical integration is evident in policy debates over several decades, from a focus through the 1990s on improving coordination through structural reform and the use of market mechanisms to achieve allocative efficiencies (better overall service mix) to more recent attention on system performance to improve coordination and quality. We examine this shift in Australia and ask how has changing the policy driver affected efforts to achieve coordination? Care planning, fund pooling and purchasing are still important planks in coordination. Evidence suggests that financial strategies can be used to drive improvements for particular patient groups, but these are unlikely to improve outcomes without being linked to clinical strategies that support coordination through multidisciplinary teamwork, IT, disease management guidelines and audit and feedback. Meso level organizational strategies might align the various elements to improve coordination. Changing the policy driver has refocused research and policy over the last two decades from a focus on achieving allocative efficiencies to achieving quality and value for money. Research is yet to develop theoretical approaches that can deal with the implications for assessing effectiveness. Efforts need to identify intervention mechanisms, plausible relationships between these and their measurable outcomes and the components of contexts that support the emergence of intervention attributes.

Validation of Surgical Intensive Care-Infection Registry: a medical informatics system for intensive care unit research, quality of care improvement, and daily patient care.

Science.gov (United States)

Golob, Joseph F; Fadlalla, Adam M A; Kan, Justin A; Patel, Nilam P; Yowler, Charles J; Claridge, Jeffrey A

2008-08-01

We developed a prototype electronic clinical information system called the Surgical Intensive Care-Infection Registry (SIC-IR) to prospectively study infectious complications and monitor quality of care improvement programs in the surgical and trauma intensive care unit. The objective of this study was to validate SIC-IR as a successful health information technology with an accurate clinical data repository. Using the DeLone and McLean Model of Information Systems Success as a framework, we evaluated SIC-IR in a 3-month prospective crossover study of physician use in one of our two surgical and trauma intensive care units (SIC-IR unit versus non SIC-IR unit). Three simultaneous research methodologies were used: a user survey study, a pair of time-motion studies, and an accuracy study of SIC-IR's clinical data repository. The SIC-IR user survey results were positive for system reliability, graphic user interface, efficiency, and overall benefit to patient care. There was a significant decrease in prerounding time of nearly 4 minutes per patient on the SIC-IR unit compared with the non SIC-IR unit. The SIC-IR documentation and data archiving was accurate 74% to 100% of the time depending on the data entry method used. This accuracy was significantly improved compared with normal hand-written documentation on the non SIC-IR unit. SIC-IR proved to be a useful application both at individual user and organizational levels and will serve as an accurate tool to conduct prospective research and monitor quality of care improvement programs.

Improving timeliness and efficiency in the referral process for safety net providers: application of the Lean Six Sigma methodology.

Science.gov (United States)

Deckard, Gloria J; Borkowski, Nancy; Diaz, Deisell; Sanchez, Carlos; Boisette, Serge A

2010-01-01

Designated primary care clinics largely serve low-income and uninsured patients who present a disproportionate number of chronic illnesses and face great difficulty in obtaining the medical care they need, particularly the access to specialty physicians. With limited capacity for providing specialty care, these primary care clinics generally refer patients to safety net hospitals' specialty ambulatory care clinics. A large public safety net health system successfully improved the effectiveness and efficiency of the specialty clinic referral process through application of Lean Six Sigma, an advanced process-improvement methodology and set of tools driven by statistics and engineering concepts.

Improving efficiency in stereology

DEFF Research Database (Denmark)

Keller, Kresten Krarup; Andersen, Ina Trolle; Andersen, Johnnie Bremholm

2013-01-01

of the study was to investigate the time efficiency of the proportionator and the autodisector on virtual slides compared with traditional methods in a practical application, namely the estimation of osteoclast numbers in paws from mice with experimental arthritis and control mice. Tissue slides were scanned......, a proportionator sampling and a systematic, uniform random sampling were simulated. We found that the proportionator was 50% to 90% more time efficient than systematic, uniform random sampling. The time efficiency of the autodisector on virtual slides was 60% to 100% better than the disector on tissue slides. We...... conclude that both the proportionator and the autodisector on virtual slides may improve efficiency of cell counting in stereology....

Improving care in care homes: a qualitative evaluation of the Croydon care home support team.

Science.gov (United States)

Lawrence, Vanessa; Banerjee, Sube

2010-05-01

The Croydon care home support team (CHST) was developed in response to reports of patient abuse within long-term care. It presents a novel strategy for improving standards of care within care homes. A qualitative methodology was used to assess the perceived impact of the CHST. In-depth interviews were conducted with 14 care home managers and 24 members of care home staff across 14 care homes. Grounded theory principles guided the collection and analysis of the data. Reports of improved communication between staff, improved staff development and confidence, and improved quality of care point towards the effectiveness of the CHST model. The collaborative approach of the CHST was considered pivotal to its success and presented as an effective method of engaging care home managers and staff. The CHST adopted a systemic approach that placed an equal emphasis on the social, mental health and nursing needs of residents and aimed to address the whole culture of care within the individual homes. The data demonstrate the potential for specialist multi-disciplinary teams to raise standards of care across long-term care settings. Increased awareness of safeguarding issues, improved staff morale and communication and ongoing opportunities for discussion and problem solving promised to sustain improvements. Such services could be instrumental in meeting the government priority of preventing abuse among vulnerable adults.

Kaizen: a process improvement model for the business of health care and perioperative nursing professionals.

Science.gov (United States)

Tetteh, Hassan A

2012-01-01

Kaizen is a proven management technique that has a practical application for health care in the context of health care reform and the 2010 Institute of Medicine landmark report on the future of nursing. Compounded productivity is the unique benefit of kaizen, and its principles are change, efficiency, performance of key essential steps, and the elimination of waste through small and continuous process improvements. The kaizen model offers specific instruction for perioperative nurses to achieve process improvement in a five-step framework that includes teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement. Published by Elsevier Inc.

Last Mile Towards Efficient Healthcare Delivery in Switzerland: eHealth Enabled Applications Could Speed Up the Care Process.

Science.gov (United States)

Deng, Yihan; Bürkle, Thomas; Holm, Jürgen; Zetz, Erwin; Denecke, Kerstin

2018-01-01

A precise and timely care delivery depends on an efficient triage performed by primary care providers and smooth collaboration with other medical specialities. In recent years telemedicine gained increasing importance for efficient care delivery. It's use, however, has been limited by legal issues, missing digital infrastructures, restricted support from health insurances and the digital divide in the population. A new era towards eHealth and telemedicine starts with the establishment of national eHealth regulations and laws. In Switzerland, a nation-wide digital infrastructure and electronic health record will be established. But appropriate healthcare apps to improve patient care based on this infrastructure remain rare. In this paper, we present two applications (self-anamnesis and eMedication assistant) for eHealth enabled care delivery which have the potential to speed up diagnosis and treatment.

Common challenge in resource efficiency improvement

International Nuclear Information System (INIS)

La Motta, Sergio; Peronaci, Marcello

2015-01-01

Energy efficiency and technology improvements on their own will not achieve the Low Carbon Societies (LCS) goals. Thus, resource efficiency and a circular economy are keys to a low carbon society. Resource efficiency improvement potential has been analysed from the industrial and territorial management perspectives. Exploring synergies between LCS and the larger area of sustainable development and green economy, highlighting co-benefits and trade-offs, is of utmost importance to pave the way to a more equitable and largely participated low carbon transition.

Intensive care nurses' perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care-A quality improvement project.

Science.gov (United States)

Jennings, Fiona L; Mitchell, Marion

2017-06-01

Trauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses' knowledge. The purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement. The project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients' care. The rounds were evaluated to assess the nurse's perception of improvement. There were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues. Inter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge. Copyright © 2017 Elsevier Ltd. All rights reserved.

Creating a Professional Ladder for Interpreters for Improvement of Care.

Science.gov (United States)

Marshall, Lori; Fischer, Anna; Noyes Soeller, Allison; Cordova, Richard; Gutierrez, Yvonne R; Alford, Luis

2016-01-01

Children's Hospital Los Angeles (CHLA), a metropolitan academic medical center, recognized limitations in how the professional interpreters from the Diversity Services Department were used to support effective patient-provider communication across the organization. Given the importance of mitigating language and communication barriers, CHLA sought to minimize clinical and structural barriers to health care for limited English proficiency populations through a comprehensive restructuring of the Diversity Services Department. This approach entailed a new delivery model for hospital language assistance and cultural consultancy resources. The intervention focused on restructuring the Diversity Services Department, redefining priorities, reallocating resources, and redefining the roles of the language staff positions in the department. The language staff role was redesigned to fit a four-level professional career ladder modeled after the professional career ladders commonly used in hospitals for the RN role and other professional disciplines. The approach involved creating new levels of language specialist, each with progressive requirements for performance, leadership, and accountability for patient care outcomes. Language staff in the inpatient, clinic, and emergency department settings worked alongside nurses, physicians, and other disciplines to care for a specific set of patients. The result of this work was a positive culture change resulting in service efficiencies, care improvements, and improved access to language services. A professional career ladder for language staff contributed to improving the quality and access of language services and advancing the interpreting profession by incorporating care coordination support, vital document translation, and cultural consultancy.

Improving performance management for delivering appropriate care for patients no longer needing acute hospital care.

Science.gov (United States)

Penney, Christine; Henry, Effie

2008-01-01

The public, providers and policy-makers are interested in a service continuum where care is provided in the appropriate place. Alternate level of care is used to define patients who no longer need acute care but remain in an acute care bed. Our aims were to determine how subacute care and convalescent care should be defined in British Columbia (BC); how these care levels should be aligned with existing legislation to provide more consistent service standards to patients and what reporting requirements were needed for system planning and performance management. A literature review was conducted to understand the international trends in performance management, care delivery models and change management. A Canada-wide survey was carried out to determine the directions of other provinces on the defined issues and a BC survey provided a current state analysis of programming within the five regional health authorities (HAs). A provincial policy framework for subacute and convalescent care has been developed to begin to address the concerns raised and provide a base for performance measurement. The policy has been approved and disseminated to BC HAs for implementation. An implementation plan has been developed and implementation activities have been integrated into the work of existing provincial committees. Evaluation will occur through performance measurement. The benefits anticipated include: clear policy guidance for programme development; improved comparability of performance information for system monitoring, planning and integrity of the national acute care Discharge Abstracting Database; improved efficiency in acute care bed use; and improved equity of access, insurability and quality for patients requiring subacute and convalescent care. While a national reporting system exists for acute care in Canada, this project raises questions about the implications for this system, given the shifting definition of acute care as other care levels emerge. Questions are also

Complementary effect of patient volume and quality of care on hospital cost efficiency.

Science.gov (United States)

Choi, Jeong Hoon; Park, Imsu; Jung, Ilyoung; Dey, Asoke

2017-06-01

This study explores the direct effect of an increase in patient volume in a hospital and the complementary effect of quality of care on the cost efficiency of U.S. hospitals in terms of patient volume. The simultaneous equation model with three-stage least squares is used to measure the direct effect of patient volume and the complementary effect of quality of care and volume. Cost efficiency is measured with a data envelopment analysis method. Patient volume has a U-shaped relationship with hospital cost efficiency and an inverted U-shaped relationship with quality of care. Quality of care functions as a moderator for the relationship between patient volume and efficiency. This paper addresses the economically important question of the relationship of volume with quality of care and hospital cost efficiency. The three-stage least square simultaneous equation model captures the simultaneous effects of patient volume on hospital quality of care and cost efficiency.

Improving Customer Service in Elderly Care

OpenAIRE

Nielsen, Chris

2015-01-01

The elderly care sector is increasingly facing more competition and demanding customers. This leads to a growing pressure on elderly care home providers to find new and improved solutions that will enhance their level of customer service. The will ensure that the elderly service provider is remaining competitive in the elderly care service marketplace. The purpose of this thesis is to identify areas for improvements and propose implementable solutions for enhancing the elderly care custom...

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

Science.gov (United States)

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

Improving the efficiency of a chemotherapy day unit: applying a business approach to oncology.

Science.gov (United States)

van Lent, Wineke A M; Goedbloed, N; van Harten, W H

2009-03-01

To improve the efficiency of a hospital-based chemotherapy day unit (CDU). The CDU was benchmarked with two other CDUs to identify their attainable performance levels for efficiency, and causes for differences. Furthermore, an in-depth analysis using a business approach, called lean thinking, was performed. An integrated set of interventions was implemented, among them a new planning system. The results were evaluated using pre- and post-measurements. We observed 24% growth of treatments and bed utilisation, a 12% increase of staff member productivity and an 81% reduction of overtime. The used method improved process design and led to increased efficiency and a more timely delivery of care. Thus, the business approaches, which were adapted for healthcare, were successfully applied. The method may serve as an example for other oncology settings with problems concerning waiting times, patient flow or lack of beds.

Improving Family Meetings in Intensive Care Units: A Quality Improvement Curriculum.

Science.gov (United States)

Gruenewald, David A; Gabriel, Michelle; Rizzo, Dorothy; Luhrs, Carol A

2017-07-01

Family meetings in the intensive care unit are associated with beneficial outcomes for patients, their families, and health care systems, yet these meetings often do not occur in a timely, effective, reliable way. The Department of Veterans Affairs Comprehensive End-of-Life Care Implementation Center sponsored a national initiative to improve family meetings in Veterans Affairs intensive care units across the United States. Process measures of success for the initiative were identified, including development of a curriculum to support facility-based quality improvement projects to implement high-quality family meetings. Identified curriculum requirements included suitability for distance learning and applicability to many clinical intensive care units. Curriculum modules were cross-mapped to the "Plan-Do-Study-Act" model to aid in planning quality improvement projects. A questionnaire was e-mailed to users to evaluate the curriculum's effectiveness. Users rated the curriculum's effectiveness in supporting and achieving aims of the initiative as 3.6 on a scale of 0 (not effective) to 4 (very effective). Users adapted the curriculum to meet local needs. The number of users increased from 6 to 17 quality improvement teams in 2 years. All but 3 teams progressed to implementation of an action plan. Users were satisfied with the effectiveness and adaptability of a family-meeting quality improvement curriculum to support implementation of a quality improvement project in Veterans Affairs intensive care units. This tool may be useful in facilitating projects to improve the quality of family meetings in other intensive care units. ©2017 American Association of Critical-Care Nurses.

A systematic review of vertical integration and quality of care, efficiency, and patient-centered outcomes.

Science.gov (United States)

Machta, Rachel M; Maurer, Kristin A; Jones, David J; Furukawa, Michael F; Rich, Eugene C

2018-04-02

Small independent practices are increasingly giving way to more complex affiliations between provider organizations and hospital systems. There are several ways in which vertically integrated health systems could improve quality and lower the costs of care. But there are also concerns that integrated systems may increase the price and costs of care without commensurate improvements in quality and outcomes. Despite a growing body of research on vertically integrated health systems, no systematic review that we know of compares vertically integrated health systems (defined as shared ownership or joint management of hospitals and physician practices) to nonintegrated hospitals or physician practices. We conducted a systematic search of the literature published from January 1996 to November 2016. We considered articles for review if they compared the performance of a vertically integrated health system and examined an outcome related to quality of care, efficiency, or patient-centered outcomes. Database searches generated 7,559 articles, with 29 articles included in this review. Vertical integration was associated with better quality, often measured as optimal care for specific conditions, but showed either no differences or lower efficiency as measured by utilization, spending, and prices. Few studies evaluated a patient-centered outcome; among those, most examined mortality and did not identify any effects. Across domains, most studies were observational and did not address the issue of selection bias. Recent evidence suggests the trend toward vertical integration will likely continue as providers respond to changing payment models and market factors. A growing body of research on comparative health system performance suggests that integration of physician practices with hospitals might not be enough to achieve higher-value care. More information is needed to identify the health system attributes that contribute to improved outcomes, as well as which policy levers

Spreading improvements for advanced COPD care through a Canadian Collaborative

Directory of Open Access Journals (Sweden)

Rocker GM

2017-07-01

Full Text Available Graeme M Rocker,1 Claudia Amar,2 Wendy L Laframboise,3 Jane Burns,4 Jennifer Y Verma2 1Division of Respirology, Nova Scotia Health Authority/Dalhousie University, Halifax, NS, 2Canadian Foundation for Healthcare Improvement, 3The Ottawa Hospital COPD Outreach Program, Ottawa, ON, 4Providence COPD Outreach Program, Vancouver, BC, Canada Background: A year-long pan-Canadian quality improvement collaborative (QIC led by the Canadian Foundation for Healthcare Improvement (CFHI supported the spread of the successful Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ to 19 teams in the 10 Canadian provinces. We describe QIC results, addressing two main questions: 1 Can the results of the Nova Scotia INSPIRED model be replicated elsewhere in Canada? 2 How did the teams implement and evaluate their versions of the INSPIRED program?Methods: Collaborative faculty selected measures that were evidence-based, relatively simple to collect, and relevant to local context. Chosen process and outcome measures are related to four quality domains: 1 patient- and family-centeredness, 2 coordination, 3 efficiency, and 4 appropriateness. Evaluation of a complex intervention followed a mixed-methods approach.Results: Most participants were nurse managers and/or COPD educators. Only 8% were physicians. Fifteen teams incorporated all core INSPIRED interventions. All teams carried out evaluation. Thirteen teams actively involved patients and families in customized, direct care planning, eg, asking them to complete evaluative surveys and/or conducting interviews. Patients consistently reported greater self-confidence in symptom management, a return to daily activities, and improvements to quality of life. Twelve teams collected data on care transitions using the validated three-item Care Transitions Measure (CTM-3. Twelve teams used the Lung Information Needs Questionnaire (LINQ. Admissions, emergency room visits, and patient-related costs fell substantially for

Implementing electronic handover: interventions to improve efficiency, safety and sustainability.

Science.gov (United States)

Alhamid, Sharifah Munirah; Lee, Desmond Xue-Yuan; Wong, Hei Man; Chuah, Matthew Bingfeng; Wong, Yu Jun; Narasimhalu, Kaavya; Tan, Thuan Tong; Low, Su Ying

2016-10-01

Effective handovers are critical for patient care and safety. Electronic handover tools are increasingly used today to provide an effective and standardized platform for information exchange. The implementation of an electronic handover system in tertiary hospitals can be a major challenge. Previous efforts in implementing an electronic handover tool failed due to poor compliance and buy-in from end-users. A new electronic handover tool was developed and incorporated into the existing electronic medical records (EMRs) for medical patients in Singapore General Hospital (SGH). There was poor compliance by on-call doctors in acknowledging electronic handovers, and lack of adherence to safety rules, raising concerns about the safety and efficiency of the electronic handover tool. Urgent measures were needed to ensure its safe and sustained use. A quality improvement group comprising stakeholders, including end-users, developed multi-faceted interventions using rapid PDSA (P-Plan, D-Do, S-Study, A-Act ) cycles to address these issues. Innovative solutions using media and online software provided cost-efficient measures to improve compliance. The percentage of unacknowledged handovers per day was used as the main outcome measure throughout all PDSA cycles. Doctors were also assessed for improvement in their knowledge of safety rules and their perception of the electronic handover tool. An electronic handover tool complementing daily clinical practice can be successfully implemented using solutions devised through close collaboration with end-users supported by the senior leadership. A combined 'bottom-up' and 'top-down' approach with regular process evaluations is crucial for its long-term sustainability. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Interdependence in decision-making by medical consultants: implications for improving the efficiency of inpatient physician services.

Science.gov (United States)

Wilk, Adam S; Chen, Lena M

2017-12-01

Hospital administrators are seeking to improve efficiency in medical consultation services, yet whether consultants make decisions to provide more or less care is unknown. We examined how medical consultants account for prior consultants' care when determining whether to provide intensive consulting care or sign off in the treatment of complex surgical inpatients. We applied three distinct theoretical frameworks in the interpretation of our results. We performed a retrospective cohort study of consultants' care intensity, measured alternately using a dummy variable for providing two or more days consulting (versus one) and a continuous measure of total days consulting, with 100% Medicare claims data from 2007-2010. Our analytic samples included consults for beneficiaries undergoing coronary artery bypass grafting (n = 61,785) or colectomy (n = 33,460) in general acute care hospitals. We compared the care intensity of consultants who observed different patterns of consulting care before their initial consults using ordinary least squares regression models at the patient-physician dyad level, controlling for patient comorbidity and many other patient- and physician-level factors as well as hospital region and year fixed effects. Consultants were less likely to provide intensive consulting care with each additional prior consultant on the case (1.2-1.7 percent) or if a prior consultant rendered intensive consulting care (20.6-21.5 percent) but more likely when prior consults were more concentrated across consultants (2.9-3.1 percent). Effects on consultants' total days consulting were similar. On average, consultants appeared to calibrate their care intensity for individual patients to maximize their value to all patients. Interventions for improving consulting care efficiency should seek to facilitate (not constrain) consultants' decision-making processes.

Improving care at cystic fibrosis centers through quality improvement.

Science.gov (United States)

Kraynack, Nathan C; McBride, John T

2009-10-01

Quality improvement (QI) using a clinical microsystems approach provides cystic fibrosis (CF) centers the opportunity to make a significant positive impact on the health of their patients. The availability of center-specific outcomes data and the support of the Cystic Fibrosis Foundation are important advantages for these quality improvement efforts. This article illustrates how the clinical microsystems methodology can improve care delivery and outcomes by describing the gradual application of quality improvement principles over the past 5 years by the CF team at the Lewis Walker Cystic Fibrosis Center at Akron Children's Hospital in Akron, Ohio. Using the example of a project to improve the pulmonary function of the pediatric patients at our center as a framework, we describe the QI process from the initial team-building phase, through the assessment of care processes, standardization of care, and developing a culture of continuous improvement. We outline how enthusiastic commitment from physician leadership, clinical managers and central administration, the availability of coaches, and an appreciation of the importance of measurement, patient involvement, communication, and standardization are critical components for successful process improvement. Copyright Thieme Medical Publishers.

Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services.

Science.gov (United States)

Stoneman, Alice; Atkinson, David; Davey, Maureen; Marley, Julia V

2014-10-07

Management of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. We have previously demonstrated that diabetes monitoring and outcomes can be improved and maintained over a 10-year period at Derby Aboriginal Health Service (DAHS). While continuous quality improvement (CQI) has been shown to improve service delivery rates and clinical outcome measures, the process of interpreting audit results and developing strategies for improvement is less well described. This paper describes the evaluation of care of patients with type 2 diabetes mellitus (T2DM) and features of effective CQI in ACCHSs in the remote Kimberley region of north Western Australia. Retrospective audit of records for Aboriginal and Torres Strait Islander primary care patients aged ≥15 years with a confirmed diagnosis of T2DM at four Kimberley ACCHSs from 1 July 2011 to 30 June 2012. Interviews with health service staff and focus group discussions with patients post audit. diabetes care related activities, clinical outcome measures and factors influencing good diabetes related care and effective CQI. A total of 348 patients from the four ACCHSs were included in the study. Clinical care activities were generally high across three of the four health services (at least 71% of patients had cholesterol recorded, 89% blood pressure, 84% HbA1c). Patients from DAHS had lower median cholesterol levels (4.4 mmol/L) and the highest proportion of patients meeting clinical targets for HbA1c (31% v 16% ACCHS-3; P = 0.02). Features that facilitated good care included clearly defined staff roles for diabetes management, support and involvement of Aboriginal Health Workers, efficient recall systems, and well-coordinated allied health services. Effective CQI features included seamless and timely data collection, local ownership of the process, openness to admitting deficiencies and willingness to embrace change. Well

Frontier technologies to improve efficiency

International Nuclear Information System (INIS)

Kalhammer, F.R.

1992-01-01

The author discusses conservation technology to improve the efficiency of energy production. Although coal is seen as the largest source of fuel for producing electricity until the year 2040, the heating value of coal is expected to be increased by using Integrated Gasification Combined Cycle (IGCC) technology. Use of fuel cells to produce electricity will be a viable option only if costs can be reduced to make the technology competitive. By coupling IGCC with fuel cells it may be possible to increase total conversion efficiency of coal to electricity at 50%. Photovoltaics technology is more likely to be used in developing countries. Electric utilities target power electronics, lighting fixtures, heat pumps, plasma processing, freeze concentration and application of superconductivity as electricity end use technologies that have the most potential for efficiency improvement. The impact of these technologies in coping with the greenhouse effect was not addressed

GATE: Improving the computational efficiency

International Nuclear Information System (INIS)

Staelens, S.; De Beenhouwer, J.; Kruecker, D.; Maigne, L.; Rannou, F.; Ferrer, L.; D'Asseler, Y.; Buvat, I.; Lemahieu, I.

2006-01-01

GATE is a software dedicated to Monte Carlo simulations in Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET). An important disadvantage of those simulations is the fundamental burden of computation time. This manuscript describes three different techniques in order to improve the efficiency of those simulations. Firstly, the implementation of variance reduction techniques (VRTs), more specifically the incorporation of geometrical importance sampling, is discussed. After this, the newly designed cluster version of the GATE software is described. The experiments have shown that GATE simulations scale very well on a cluster of homogeneous computers. Finally, an elaboration on the deployment of GATE on the Enabling Grids for E-Science in Europe (EGEE) grid will conclude the description of efficiency enhancement efforts. The three aforementioned methods improve the efficiency of GATE to a large extent and make realistic patient-specific overnight Monte Carlo simulations achievable

The SUSTAIN Project: A European Study on Improving Integrated Care for Older People Living at Home

Science.gov (United States)

Stoop, Annerieke; Billings, Jenny; Leichsenring, Kai; Ruppe, Georg; Tram, Nhu; Barbaglia, María Gabriela; Ambugo, Eliva A.; Zonneveld, Nick; Paat-Ahi, Gerli; Hoffmann, Henrik; Khan, Usman; Stein, Viktoria; Wistow, Gerald; Lette, Manon; Jansen, Aaltje P.D.; Nijpels, Giel; Baan, Caroline A.

2018-01-01

Introduction: Integrated care programmes are increasingly being put in place to provide care to older people who live at home. Knowledge of how to further develop integrated care and how to transfer successful initiatives to other contexts is still limited. Therefore, a cross-European research project, called Sustainable Tailored Integrated Care for Older People in Europe (SUSTAIN), has been initiated with a twofold objective: 1. to collaborate with local stakeholders to support and monitor improvements to established integrated care initiatives for older people with multiple health and social care needs. Improvements focus on person-centredness, prevention orientation, safety and efficiency; 2. to make these improvements applicable and adaptable to other health and social care systems, and regions in Europe. This paper presents the overall structure and approach of the SUSTAIN project. Methods: SUSTAIN uses a multiple embedded case study design. In three phases, SUSTAIN partners: (i) conduct interviews and workshops with stakeholders from fourteen established integrated care initiatives to understand where they would prefer improvements to existing ways of working; (ii) collaborate with local stakeholders to support the design and implementation of improvement plans, evaluate implementation progress and outcomes per initiative, and carry out overarching analyses to compare the different initiatives, and; (iii) translate knowledge and experience to an online roadmap. Discussion: SUSTAIN aims to generate evidence on how to improve integrated care, and apply and transfer the knowledge gained to other health and social care systems, and regions. Lessons learned will be brought together in practical tools to inform and support policy-makers and decision-makers, as well as other stakeholders involved in integrated care, to manage and improve care for older people living at home. PMID:29632456

Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review.

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Kruse, Florien M; Stadhouders, Niek W; Adang, Eddy M; Groenewoud, Stef; Jeurissen, Patrick P T

2018-03-02

European countries have enhanced the scope of private provision within their health care systems. Privatizing services have been suggested as a means to improve access, quality, and efficiency in health care. This raises questions about the relative performance of private hospitals compared with public hospitals. Most systematic reviews that scrutinize the performance of the private hospitals originate from the United States. A systematic overview for Europe is nonexisting. We fill this gap with a systematic realist review comparing the performance of public hospitals to private hospitals on efficiency, accessibility, and quality of care in the European Union. This review synthesizes evidence from Italy, Germany, the United Kingdom, France, Greece, Austria, Spain, and Portugal. Most evidence suggests that public hospitals are at least as efficient as or are more efficient than private hospitals. Accessibility to broader populations is often a matter of concern in private provision: Patients with higher social-economic backgrounds hold better access to private hospital provision, especially in private parallel systems such as the United Kingdom and Greece. The existing evidence on quality of care is often too diverse to make a conclusive statement. In conclusion, the growth in private hospital provision seems not related to improvements in performance in Europe. Our evidence further suggests that the private (for-profit) hospital sector seems to react more strongly to (financial) incentives than other provider types. In such cases, policymakers either should very carefully develop adequate incentive structures or be hesitant to accommodate the growth of the private hospital sector. Copyright © 2018 John Wiley & Sons, Ltd.

Care Plan Improvement in Nursing Homes: An Integrative Review.

Science.gov (United States)

Mariani, Elena; Chattat, Rabih; Vernooij-Dassen, Myrra; Koopmans, Raymond; Engels, Yvonne

2017-01-01

Care planning nowadays is a key activity in the provision of services to nursing home residents. A care plan describes the residents' needs and the actions to address them, providing both individualized and standardized interventions and should be updated as changes in the residents' conditions occur. The aim of this review was to identify the core elements of the implementation of changes in nursing homes' care plans, by providing an overview of the type of stakeholders involved, describing the implementation strategies used, and exploring how care plans changed. An integrative literature review was used to evaluate intervention studies taking place in nursing homes. Data were collected from PubMed, CINHAL-EBSCO, and PsycINFO. English language articles published between 1995 and April 2015 were included. Data analysis followed the strategy of Knafl and Whittemore. Twenty-six articles were included. The stakeholders involved were professionals, family caregivers, and patients. Only a few studies directly involved residents and family caregivers in the quality improvement process. The implementation strategies used were technology implementation, audit, training, feedback, and supervision. The majority of interventions changed the residents' care plans in terms of developing a more standardized care documentation that primarily focuses on its quality. Only some interventions developed more tailored care plans that focus on individualized needs. Care plans generally failed in providing both standardized and personalized interventions. Efforts should be made to directly involve residents in care planning and provide professionals with efficient tools to report care goals and actions in care plans.

New directions for hospital strategic management: the market for efficient care.

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Chilingerian, J A

1992-01-01

An analysis of current trends in the health care industry points to buyers seeking high quality, yet efficient, care as an emerging market segment. To target this market segment, hospitals must be prepared to market the efficient physicians. In the coming years, hospitals that can identify and market their best practicing providers will achieve a competitive advantage.

Superefficient Refrigerators: Opportunities and Challenges for Efficiency Improvement Globally

Energy Technology Data Exchange (ETDEWEB)

Shah, Nihar; Park, Won Young; Bojda, Nicholas; McNeil, Michael A.

2014-08-01

As an energy-intensive mainstream product, residential refrigerators present a significant opportunity to reduce electricity consumption through energy efficiency improvements. Refrigerators expend a considerable amount of electricity during normal use, typically consuming between 100 to 1,000 kWh of electricity per annum. This paper presents the results of a technical analysis done for refrigerators in support of the Super-efficient Equipment and Appliance Deployment (SEAD) initiative. Beginning from a base case representative of the average unit sold in India, we analyze efficiency improvement options and their corresponding costs to build a cost-versus-efficiency relationship. We then consider design improvement options that are known to be the most cost effective and that can improve efficiency given current design configurations. We also analyze and present additional super-efficient options, such as vacuum-insulated panels. We estimate the cost of conserved electricity for the various options, allowing flexible program design for market transformation programs toward higher efficiency. We estimate ~;;160TWh/year of energy savings are cost effective in 2030, indicating significant potential for efficiency improvement in refrigerators in SEAD economies and China.

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

OpenAIRE

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...

Using standardized insulin orders to improve patient safety in a tertiary care centre.

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Doyle, Mary-Anne; Brez, Sharon; Sicoli, Silvana; De Sousa, Filomena; Keely, Erin; Malcom, Janine C

2014-04-01

To standardize insulin prescribing practices for inpatients, improve management of hypoglycemia, reduce reliance on sliding scales, increase use of basal-bolus insulin and improve patient safety. Patients with diabetes were admitted to 2 pilot inpatient units followed by corporate spread to all insulin-treated patients on noncritical care units in a Canadian tertiary care multicampus teaching hospital. Standardized preprinted insulin and hypoglycemia management orders, decision support tools and multidisciplinary education strategies were developed, tested and implemented by way of the Model for Improvement and The Ottawa Model for Research Process. Clinical and balance measures were evaluated through statistical process control. Patient safety was improved through a reduction in hypoglycemia and decreased dependence on correctional scales. Utilization of the preprinted orders approached the target of 70% at the end of the test period and was sustained at 89% corporately 3 years post-implementation. The implementation of a standardized, preprinted insulin order set facilitates best practices for insulin therapy, improves patient safety and is highly supported by treating practitioners. The utilization of formal quality-improvement methodology promoted efficiency, enhanced sustainability, increased support among clinicians and senior administrators, and was effective in instituting sustained practice change in a complex care centre. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

Generic project definitions for improvement of health care delivery: a case-based approach.

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Niemeijer, Gerard C; Does, Ronald J M M; de Mast, Jeroen; Trip, Albert; van den Heuvel, Jaap

2011-01-01

The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning approach to project definition. Data sources were project documentation and hospital-performance statistics of 271 Lean Six Sigma health care projects from 2002 to 2009 of general, teaching, and academic hospitals in the Netherlands and Belgium. Objectives and operational definitions of improvement projects in the sample, analyzed and structured in a uniform format and terminology. Extraction of reusable elements of earlier project definitions, presented in the form of 9 templates called generic project definitions. These templates function as exemplars for future process improvement projects, making the selection, definition, and operationalization of similar projects more efficient. Each template includes an explicated rationale, an operationalization in the form of metrics, and a prototypical example. Thus, a process of incremental and sustained learning based on case-based reasoning is facilitated. The quality of project definitions is a crucial success factor in pursuits to improve health care delivery. We offer 9 tried and tested improvement themes related to patient safety, patient satisfaction, and business-economic performance of hospitals.

Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care.

Directory of Open Access Journals (Sweden)

Henry T Stelfox

Full Text Available Large amounts of scientific evidence are generated, but not implemented into patient care (the 'knowledge-to-care' gap. We identified and prioritized knowledge-to-care gaps in critical care as opportunities to improve the quality and value of healthcare.We used a multi-method community-based participatory research approach to engage a Network of all adult (n = 14 and pediatric (n = 2 medical-surgical intensive care units (ICUs in a fully integrated geographically defined healthcare system serving 4 million residents. Participants included Network oversight committee members (n = 38 and frontline providers (n = 1,790. Network committee members used a modified RAND/University of California Appropriateness Methodology, to serially propose, rate (validated 9 point scale and revise potential knowledge-to-care gaps as priorities for improvement. The priorities were sent to frontline providers for evaluation. Results were relayed back to all frontline providers for feedback.Initially, 68 knowledge-to-care gaps were proposed, rated and revised by the committee (n = 32 participants over 3 rounds of review and resulted in 13 proposed priorities for improvement. Then, 1,103 providers (62% response rate evaluated the priorities, and rated 9 as 'necessary' (median score 7-9. Several factors were associated with rating priorities as necessary in multivariable logistic regression, related to the provider (experience, teaching status of ICU and topic (strength of supporting evidence, potential to benefit the patient, potential to improve patient/family experience, potential to decrease costs.A community-based participatory research approach engaged a diverse group of stakeholders to identify 9 priorities for improving the quality and value of critical care. The approach was time and cost efficient and could serve as a model to prioritize areas for research quality improvement across other settings.

Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care.

Science.gov (United States)

Stelfox, Henry T; Niven, Daniel J; Clement, Fiona M; Bagshaw, Sean M; Cook, Deborah J; McKenzie, Emily; Potestio, Melissa L; Doig, Christopher J; O'Neill, Barbara; Zygun, David

2015-01-01

Large amounts of scientific evidence are generated, but not implemented into patient care (the 'knowledge-to-care' gap). We identified and prioritized knowledge-to-care gaps in critical care as opportunities to improve the quality and value of healthcare. We used a multi-method community-based participatory research approach to engage a Network of all adult (n = 14) and pediatric (n = 2) medical-surgical intensive care units (ICUs) in a fully integrated geographically defined healthcare system serving 4 million residents. Participants included Network oversight committee members (n = 38) and frontline providers (n = 1,790). Network committee members used a modified RAND/University of California Appropriateness Methodology, to serially propose, rate (validated 9 point scale) and revise potential knowledge-to-care gaps as priorities for improvement. The priorities were sent to frontline providers for evaluation. Results were relayed back to all frontline providers for feedback. Initially, 68 knowledge-to-care gaps were proposed, rated and revised by the committee (n = 32 participants) over 3 rounds of review and resulted in 13 proposed priorities for improvement. Then, 1,103 providers (62% response rate) evaluated the priorities, and rated 9 as 'necessary' (median score 7-9). Several factors were associated with rating priorities as necessary in multivariable logistic regression, related to the provider (experience, teaching status of ICU) and topic (strength of supporting evidence, potential to benefit the patient, potential to improve patient/family experience, potential to decrease costs). A community-based participatory research approach engaged a diverse group of stakeholders to identify 9 priorities for improving the quality and value of critical care. The approach was time and cost efficient and could serve as a model to prioritize areas for research quality improvement across other settings.

The new health-care quality: value, outcomes, and continuous improvement.

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O'Connor, S J; Lanning, J A

1991-01-01

No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa.

The Determinants of the Technical Efficiency of Acute Inpatient Care in Canada.

Science.gov (United States)

Wang, Li; Grignon, Michel; Perry, Sheril; Chen, Xi-Kuan; Ytsma, Alison; Allin, Sara; Gapanenko, Katerina

2018-04-17

To evaluate the technical efficiency of acute inpatient care at the pan-Canadian level and to explore the factors associated with inefficiency-why hospitals are not on their production frontier. Canadian Management Information System (MIS) database (CMDB) and Discharge Abstract Database (DAD) for the fiscal year of 2012-2013. We use a nonparametric approach (data envelopment analysis) applied to three peer groups (teaching, large, and medium hospitals, focusing on their acute inpatient care only). The double bootstrap procedure (Simar and Wilson 2007) is adopted in the regression. Information on inpatient episodes of care (number and quality of outcomes) was extracted from the DAD. The cost of the inpatient care was extracted from the CMDB. On average, acute hospitals in Canada are operating at about 75 percent efficiency, and this could thus potentially increase their level of outcomes (quantity and quality) by addressing inefficiencies. In some cases, such as for teaching hospitals, the factors significantly correlated with efficiency scores were not related to management but to the social composition of the caseload. In contrast, for large and medium nonteaching hospitals, efficiency related more to the ability to discharge patients to postacute care facilities. The efficiency of medium hospitals is also positively related to treating more clinically noncomplex patients. The main drivers of efficiency of acute inpatient care vary by hospital peer groups. Thus, the results provide different policy and managerial implications for teaching, large, and medium hospitals to achieve efficiency gains. © Health Research and Educational Trust.

The use of data for process and quality improvement in long term care and home care: a systematic review of the literature.

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Sales, Anne E; Bostrom, Anne-Marie; Bucknall, Tracey; Draper, Kellie; Fraser, Kimberly; Schalm, Corinne; Warren, Sharon

2012-02-01

Standardized resident or client assessments, including the Resident Assessment Instrument (RAI), have been available in long term care and home care settings (continuing care sector) in many jurisdictions for a number of years. Although using these data can make quality improvement activities more efficient and less costly, there has not been a review of the literature reporting quality improvement interventions using standardized data. To address 2 questions: (1) How have RAI and other standardized data been used in process or quality improvement activities in the continuing care sector? and (2) Has the use of RAI and similar data resulted in improvements to resident or other outcomes? Searches using a combination of keyword and controlled vocabulary term searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Cochrane Library, and PsychINFO. ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: English language publications from database inception to October 2008 were included. Eligibility criteria included the following: (1) set in continuing care (long-term care facility or home care), (2) involved some form of intervention designed to improve quality or process of care, and (3) used standardized data in the quality or process improvement intervention. After reviewing the articles, we grouped the studies according to the type of intervention used to initiate process improvement. Four different intervention types were identified. We organized the results and discussion by these 4 intervention types. Key word searches identified 713 articles, of which we excluded 639 on abstract review because they did not meet inclusion criteria. A further 50 articles were excluded on full-text review, leaving a total of 24 articles. Of the 24 studies, 10 used a defined process improvement model, 8 used a combination of interventions (multimodal), 5 implemented new guidelines or protocols, and 1 used an education

Productivity and quality improvements in health care through airboss mobile messaging services.

Science.gov (United States)

Shah, P J; Martinez, R; Cooney, E

1997-01-01

The US health care industry is in the midst of revolutionary changes. Under tremendous pressures from third-party payers and managed care programs to control costs while providing high quality medical services, health care entities are now looking at information technologies to help them achieve their goals. These goals typically include improved productivity, efficiency and decision-making capabilities among staff members. Moreover, hospitals and other health care facilities that provide a broad and integrated range of inpatient and outpatient care, wellness and home care services are in the best position to offer comprehensive packages to managed care and private insurers. Many health care providers and administrators are considered mobile employees. This mobility can range from intra-building and intra-campus to multi-site and metropolitan areas. This group often relies on a variety of information technologies such as personal computers, communicating laptops, pagers, cellular phones, wireline phones, cordless phones and fax machines to stay in touch and handle information needs. These health care professionals require mobile information access and messaging tools to improve communications, control accessibility and enhance decision-making capabilities. AirBoss mobile messaging services could address the health care industry's need for improved messaging capabilities for its mobile employees. The AirBoss family of services supports integrated voice services, data messaging, mobile facsimile and customized information delivery. This paper describes overview of the current mobile data networking capability, the AirBoss architecture, the health care-related applications it addresses and long-term benefits. In addition, a prototype application for mobile home health care workers is illustrated. This prototype application provides integrated e-mail, information services, web access, real-time access and update of patient records from wireline or wireless networks

Ontario's primary care reforms have transformed the local care landscape, but a plan is needed for ongoing improvement.

Science.gov (United States)

Hutchison, Brian; Glazier, Richard

2013-04-01

Primary care in Ontario, Canada, has undergone a series of reforms designed to improve access to care, patient and provider satisfaction, care quality, and health system efficiency and sustainability. We highlight key features of the reforms, which included patient enrollment with a primary care provider; funding for interprofessional primary care organizations; and physician reimbursement based on varying blends of fee-for-service, capitation, and pay-for-performance. With nearly 75 percent of Ontario's population now enrolled in these new models, total payments to primary care physicians increased by 32 percent between 2006 and 2010, and the proportion of Ontario primary care physicians who reported overall satisfaction with the practice of medicine rose from 76 percent in 2009 to 84 percent in 2012. However, primary care in Ontario also faces challenges. There is no meaningful performance measurement system that tracks the impact of these innovations, for example. A better system of risk adjustment is also needed in capitated plans so that groups have the incentive to take on high-need patients. Ongoing investment in these models is required despite fiscal constraints. We recommend a clearly articulated policy road map to continue the transformation.

Another link to improving the working environment in acute care hospitals: registered nurses' spirit at work.

Science.gov (United States)

Urban, Ann-Marie; Wagner, Joan I

2013-12-01

Hospitals are situated within historical and socio-political contexts; these influence the provision of patient care and the work of registered nurses (RNs). Since the early 1990s, restructuring and the increasing pressure to save money and improve efficiency have plagued acute care hospitals. These changes have affected both the work environment and the work of nurses. After recognizing this impact, healthcare leaders have dedicated many efforts to improving the work environment in hospitals. Admirable in their intent, these initiatives have made little change for RNs and their work environment, and thus, an opportunity exists for other efforts. Research indicates that spirit at work (SAW) not only improves the work environment but also strengthens the nurse's power to improve patient outcomes and contribute to a high-quality workplace. In this paper, we present findings from our research that suggest SAW be considered an important component in improving the work environment in acute care hospitals.

Bringing quality improvement into the intensive care unit.

Science.gov (United States)

McMillan, Tracy R; Hyzy, Robert C

2007-02-01

During the last several years, many governmental and nongovernmental organizations have championed the application of the principles of quality improvement to the practice of medicine, particularly in the area of critical care. To review the breadth of approaches to quality improvement in the intensive care unit, including measures such as mortality and length of stay, and the use of protocols, bundles, and the role of large, multiple-hospital collaboratives. Several agencies have participated in the application of the quality movement to medicine, culminating in the development of standards such as the intensive care unit core measures of the Joint Commission on Accreditation of Healthcare Organizations. Although "zero defects" may not be possible in all measurable variables of quality in the intensive care unit, several measures, such as catheter-related bloodstream infections, can be significantly reduced through the implementation of improved processes of care, such as care bundles. Large, multiple-center, quality improvement collaboratives, such as the Michigan Keystone Intensive Care Unit Project, may be particularly effective in improving the quality of care by creating a "bandwagon effect" within a geographic region. The quality revolution is having a significant effect in the critical care unit and is likely to be facilitated by the transition to the electronic medical record.

Incentives to improve energy efficiency in EU Grids

Energy Technology Data Exchange (ETDEWEB)

Papaefthymiou, G.; Beestermoeller, C.; Gardiner, A.

2013-04-15

The Energy Efficiency Directive (2012/27/EU) includes provisions related to network tariffs and regulation. It is timely therefore to revisit the potential options for energy efficiency in grids, the treatment of energy efficiency in network tariffs and alternative policies for improving energy efficiency. This project builds on work done previously for the European Copper Institute in this area. In this paper, we concentrate on energy efficiency in electricity network design and operation. Other articles in the Directive relate to the role of the network tariffs and regulations in enabling or incentivising the provision of energy efficiency to end users. In section 2, we describe technical efficiency measures to reduce losses (improve energy efficiency) in the grid. Section 3 reviews grid tariffs in three countries to identify whether they provide incentives or disincentives for energy efficiency in the grid. Section 4 discusses and evaluates alternative regulations for energy efficiency in grids. Section 5 concludes and discusses the main components of the optimal policy framework.

The ReACH Collaborative--improving quality home care.

Science.gov (United States)

Boyce, Patricia Simino; Pace, Karen B; Lauder, Bonnie; Solomon, Debra A

2007-08-01

Research on quality of care has shown that vigorous leadership, clear goals, and compatible incentive systems are critical factors in influencing successful change (Institute of Medicine, 2001). Quality improvement is a complex process, and clinical quality improvement applications are more likely to be effective in organizations that are ready for change and have strong leaders, who are committed to creating and reinforcing a work environment that supports quality goals (Shortell, 1998). Key leadership roles include providing clear and sustained direction, articulating a coherent set of values and incentives to guide group and individual activities, aligning and integrating improvement efforts into organizational priorities, obtaining or freeing up resources to implement improvement activities, and creating a culture of "continuous improvement" that encourages and rewards the pursuit and achievement of shared quality aims (Institute of Medicine, 2001, 70-71). In summary, home health care is a significant and growing sector of the health care system that provides care to millions of vulnerable patients. There seems little doubt that home health agencies want to focus on quality of care issues and provide optimal care to home-based patients. Furthermore, there is a growing awareness of the value for adapting innovative, effective models for improving the culture of home care practice. This awareness stems from the notion that some agencies see quality improvement activities as a way for them to distinguish themselves not only to regulators and customers, but also to meet the cultural and transformational needs to remain viable in a constantly evolving and competitive health care industry.

A Novel Design for Drug-Drug Interaction Alerts Improves Prescribing Efficiency.

Science.gov (United States)

Russ, Alissa L; Chen, Siying; Melton, Brittany L; Johnson, Elizabette G; Spina, Jeffrey R; Weiner, Michael; Zillich, Alan J

2015-09-01

Drug-drug interactions (DDIs) are common in clinical care and pose serious risks for patients. Electronic health records display DDI alerts that can influence prescribers, but the interface design of DDI alerts has largely been unstudied. In this study, the objective was to apply human factors engineering principles to alert design. It was hypothesized that redesigned DDI alerts would significantly improve prescribers' efficiency and reduce prescribing errors. In a counterbalanced, crossover study with prescribers, two DDI alert designs were evaluated. Department of Veterans Affairs (VA) prescribers were video recorded as they completed fictitious patient scenarios, which included DDI alerts of varying severity. Efficiency was measured from time-stamped recordings. Prescribing errors were evaluated against predefined criteria. Efficiency and prescribing errors were analyzed with the Wilcoxon signed-rank test. Other usability data were collected on the adequacy of alert content, prescribers' use of the DDI monograph, and alert navigation. Twenty prescribers completed patient scenarios for both designs. Prescribers resolved redesigned alerts in about half the time (redesign: 52 seconds versus original design: 97 seconds; p<.001). Prescribing errors were not significantly different between the two designs. Usability results indicate that DDI alerts might be enhanced by facilitating easier access to laboratory data and dosing information and by allowing prescribers to cancel either interacting medication directly from the alert. Results also suggest that neither design provided adequate information for decision making via the primary interface. Applying human factors principles to DDI alerts improved overall efficiency. Aspects of DDI alert design that could be further enhanced prior to implementation were also identified.

Health care in China: improvement, challenges, and reform.

Science.gov (United States)

Wang, Chen; Rao, Keqin; Wu, Sinan; Liu, Qian

2013-02-01

Over the past 2 decades, significant progress has been made in improving the health-care system and people's health conditions in China. Following rapid economic growth and social development, China's health-care system is facing new challenges, such as increased health-care demands and expenditure, inefficient use of health-care resources, unsatisfying implementation of disease management guidelines, and inadequate health-care insurance. Facing these challenges, the Chinese government carried out a national health-care reform in 2009. A series of policies were developed and implemented to improve the health-care insurance system, the medical care system, the public health service system, the pharmaceutical supply system, and the health-care institution management system in China. Although these measures have shown promising results, further efforts are needed to achieve the ultimate goal of providing affordable and high-quality care for both urban and rural residents in China. This article not only covers the improvement, challenges, and reform of health care in general in China, but also highlights the status of respiratory medicine-related issues.

Improving the quality of care of patients with rheumatic disease using patient-centric electronic redesign software.

Science.gov (United States)

Newman, Eric D; Lerch, Virginia; Billet, Jon; Berger, Andrea; Kirchner, H Lester

2015-04-01

Electronic health records (EHRs) are not optimized for chronic disease management. To improve the quality of care for patients with rheumatic disease, we developed electronic data capture, aggregation, display, and documentation software. The software integrated and reassembled information from the patient (via a touchscreen questionnaire), nurse, physician, and EHR into a series of actionable views. Core functions included trends over time, rheumatology-related demographics, and documentation for patient and provider. Quality measures collected included patient-reported outcomes, disease activity, and function. The software was tested and implemented in 3 rheumatology departments, and integrated into routine care delivery. Post-implementation evaluation measured adoption, efficiency, productivity, and patient perception. Over 2 years, 6,725 patients completed 19,786 touchscreen questionnaires. The software was adopted for use by 86% of patients and rheumatologists. Chart review and documentation time trended downward, and productivity increased by 26%. Patient satisfaction, activation, and adherence remained unchanged, although pre-implementation values were high. A strong correlation was seen between use of the software and disease control (weighted Pearson's correlation coefficient 0.5927, P = 0.0095), and a relative increase in patients with low disease activity of 3% per quarter was noted. We describe innovative software that aggregates, stores, and displays information vital to improving the quality of care for patients with chronic rheumatic disease. The software was well-adopted by patients and providers. Post-implementation, significant improvements in quality of care, efficiency of care, and productivity were demonstrated. Copyright © 2015 by the American College of Rheumatology.

Improving Integrated Care: Modelling the performance of an online community of practice

Directory of Open Access Journals (Sweden)

Ángel Díaz-Chao

2014-03-01

Full Text Available Introduction: This article aims to confirm the following core hypothesis: a Community of Practice’s use of a Web 2.0 platform for communication between primary and hospital care leads to improved primary care and fewer hospital referrals. This core hypothesis will be corroborated by testing a further five partial hypotheses that complete the main hypothesis being estimated.Methods: An ad-hoc questionnaire was designed and sent to a sample group of 357 professionals from the Badalona-Sant Adrià de Besòs Primary Care Service in Catalonia, Spain, which includes nine primary care centres and three specialist care centres. The study sample was formed by 159 respondents. The partial least squares methodology was used to estimate the model of the causal relationship and the proposed hypotheses.Results: It was found that when healthcare staff used social networks and information and communication technologies professionally, and the more contact hours they have with patients, the more a Web 2.0 platform was likely to be used for communication between primary and hospital care professionals. Such use led to improved primary care and fewer hospital referrals according to the opinions of health professionals on its use.Conclusions: The research suggests that the efficiency of medical practice is explained by the intensity of Web 2.0 platform use for communication between primary and specialist care professionals. Public policies promoting the use of information and communication technologies in communities of practice should go beyond the technological dimension and consider other professional, organisational and social determinants.

Restructuring primary care for performance improvement.

Science.gov (United States)

Fawcett, Kenneth J; Brummel, Stacy; Byrnes, John J

2009-01-01

Primary care practices can no longer consider ongoing quality assessment and management processes to be optional. There are ever-increasing demands from any number of interested parties for objectively measured proof of outcomes and quality of care. Primary Care Partners (PCP), a 16-site ambulatory affiliate of the Spectrum Health system in Grand Rapids, Michigan, began such a continuous quality improvement (CQI) effort in 2005. The intent was to develop an ongoing systematic process that would raise its performance potential and improve patient outcomes in the areas of chronic disease management and preventive services. This article describes the partnerships PCP established, specific benchmarks and measurements used, processes utilized, and results to date. This could be used as a roadmap for other primary care systems that are working to establish CQI in their daily operations.

Improving recovery time following heart transplantation: the role of the multidisciplinary health care team

Directory of Open Access Journals (Sweden)

Roussel MG

2013-08-01

Full Text Available Maureen G Roussel,1 Noreen Gorham,2 Lynn Wilson,2 Abeel A Mangi2 1Heart and Vascular Center, Yale-New Haven Hospital, New Haven, CT, USA; 2Center for Advanced Heart Failure, Mechanical Circulatory Support and Cardiac Transplantation, Yale New Haven Heart and Vascular Institute, Yale-New Haven Hospital, New Haven, CT, USA Background: The care of cardiac transplant patients is complex requiring a finely orchestrated endeavor to save a patient’s life. Given the chronic and complex nature of these patients, multiple disciplines are involved in their care. Recognizing difficulties with communication among team members and striving for improved efficiencies in our pretransplant listing process and in our inpatient care, our team was prompted to change the existing approach to patient care related to heart transplantation. Methods: Daily multidisciplinary rounds were instituted and the format of the weekly Multidisciplinary Review Committee (MDRC meetings was modified with the list of attendees broadened to include a larger interdisciplinary team. Additionally, the approach to patient care was analyzed for process improvement. Results: The quality improvements are improved communication and throughput, quantified in an 85% decrease in time to complete transplant evaluation, a 37% decrease in median length of stay posttransplantation, and a 33% reduction in the 30 day readmission rate. In addition, pre- and posttransplant caregivers now participate in MDRC in person or via an electronic meeting platform to support the continuum of care. Quality metrics were chosen and tracked via a transparent electronic platform allowing all involved to assess progress toward agreed upon goals. These were achieved in an 18 month time period following the recruitment of new leadership and invested team members working together as a multidisciplinary team to improve the quality of cardiac transplant care. Discussion: Implementation of daily multidisciplinary rounds and

ACO model should encourage efficient care delivery.

Science.gov (United States)

Toussaint, John; Krueger, David; Shortell, Stephen M; Milstein, Arnold; Cutler, David M

2015-09-01

The independent Office of the Actuary for CMS certified that the Pioneer ACO model has met the stringent criteria for expansion to a larger population. Significant savings have accrued and quality targets have been met, so the program as a whole appears to be working. Ironically, 13 of the initial 32 enrollees have left. We attribute this to the design of the ACO models which inadequately support efficient care delivery. Using Bellin-ThedaCare Healthcare Partners as an example, we will focus on correctible flaws in four core elements of the ACO payment model: finance spending and targets, attribution, and quality performance. Copyright © 2015 Elsevier Inc. All rights reserved.

Evaluating Technical Efficiency of Nursing Care Using Data Envelopment Analysis and Multilevel Modeling.

Science.gov (United States)

Min, Ari; Park, Chang Gi; Scott, Linda D

2016-05-23

Data envelopment analysis (DEA) is an advantageous non-parametric technique for evaluating relative efficiency of performance. This article describes use of DEA to estimate technical efficiency of nursing care and demonstrates the benefits of using multilevel modeling to identify characteristics of efficient facilities in the second stage of analysis. Data were drawn from LTCFocUS.org, a secondary database including nursing home data from the Online Survey Certification and Reporting System and Minimum Data Set. In this example, 2,267 non-hospital-based nursing homes were evaluated. Use of DEA with nurse staffing levels as inputs and quality of care as outputs allowed estimation of the relative technical efficiency of nursing care in these facilities. In the second stage, multilevel modeling was applied to identify organizational factors contributing to technical efficiency. Use of multilevel modeling avoided biased estimation of findings for nested data and provided comprehensive information on differences in technical efficiency among counties and states. © The Author(s) 2016.

Using Value Stream Mapping to improve quality of care in low-resource facility settings.

Science.gov (United States)

Ramaswamy, Rohit; Rothschild, Claire; Alabi, Funmi; Wachira, Eric; Muigai, Faith; Pearson, Nick

2017-11-01

Jacaranda Health (JH) is a Kenya-based organization that attempts to provide affordable, high-quality maternal and newborn healthcare through a chain of private health facilities in Nairobi. JH needed to adopted quality improvement as an organization-wide strategy to optimize effectiveness and efficiency. Value Stream Mapping, a Lean Management tool, was used to engage staff in prioritizing opportunities to improve clinical outcomes and patient-centered quality of care. Implementation was accomplished through a five-step process: (i) leadership engagement and commitment; (ii) staff training; (iii) team formation; (iv) process walkthrough; and (v) construction and validation. The Value Stream Map allowed the organization to come together and develop an end-to-end view of the process of care at JH and to select improvement opportunities for the entire system. The Value Stream Map is a simple visual tool that allows organizations to engage staff at all levels to gain commitment around quality improvement efforts. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Using data to improve medical practice by measuring processes and outcomes of care.

Science.gov (United States)

Nelson, E C; Splaine, M E; Godfrey, M M; Kahn, V; Hess, A; Batalden, P; Plume, S K

2000-12-01

The purpose of this article is to help clinicians expand their use of data to improve medical practice performance and to do improvement research. Clinical practices can be viewed as small, complex organizations (microsystems) that produce services for specific patient populations. These services can be greatly improved by embedding measurement into the flow of daily work in the practice. WHY DO IT?: Four good reasons to build measures into daily medical practice are to (1) diagnose strengths and weaknesses in practice performance; (2) improve and innovate in providing care and services using improvement research; (3) manage patients and the practice; and (4) evaluate changes in results over time. It is helpful to have a "physiological" model of a medical practice to analyze the practice, to manage it, and to improve it. One model views clinical practices as microsystems that are designed to generate desired health outcomes for specific subsets of patients and to use resources efficiently. This article provides case study examples to show what an office-based practice might look like if it were using front-line measurement to improve care and services most of the time and to conduct clinical improvement research some of the time. WHAT ARE THE PRINCIPLES FOR USING DATA TO IMPROVE PROCESSES AND OUTCOMES OF CARE?: Principles reflected in the case study examples--such as "Keep Measurement Simple. Think Big and Start Small" and "More Data Is Not Necessarily Better Data. Seek Usefulness, Not Perfection, in Your Measures"--may help guide the development of data to study and improve practice. HOW CAN A PRACTICE START TO USE DATA TO IMPROVE CARE AND CONDUCT IMPROVEMENT RESEARCH?: Practical challenges are involved in starting to use data for enhancing care and improvement research. To increase the odds for success, it would be wise to use a change management strategy to launch the startup plan. Other recommendations include "Establish a Sense of Urgency. (Survival Is Not

Thermal efficiency improvements - an imperative for nuclear generating stations

International Nuclear Information System (INIS)

Hassanien, S.; Rouse, S.

1997-01-01

A one and a half percent thermal performance improvement of Ontario Hydro's operating nuclear units (Bruce B, Pickering B, and Darlington) means almost 980 GWh are available to the transmission system (assuming an 80% capacity factor). This is equivalent to the energy consumption of 34,000 electrically-heated homes in Ontario, and worth more than $39 million in revenue to Ontario Hydro Nuclear Generation. Improving nuclear plant thermal efficiency improves profitability (more GWh per unit of fuel) and competitiveness (cost of unit energy), and reduces environmental impact (less spent fuel and nuclear waste). Thermal performance will naturally decrease due to the age of the units unless corrective action is taken. Most Ontario Hydro nuclear units are ten to twenty years old. Some common causes for loss of thermal efficiency are: fouling and tube plugging of steam generators, condensers, and heat exchangers; steam leaks in the condenser due to valve wear, steam trap and drain leaks; deposition, pitting, cracking, corrosion, etc., of turbine blades; inadequate feedwater metering resulting from corrosion and deposition. This paper stresses the importance of improving the nuclear units' thermal efficiency. Ontario Hydro Nuclear has demonstrated energy savings results are achievable and affordable. Between 1994 and 1996, Nuclear reduced its energy use and improved thermal efficiency by over 430,000 MWh. Efficiency improvement is not automatic - strategies are needed to be effective. This paper suggests practical strategies to systematically improve thermal efficiency. (author)

Efficient rehabilitation care for joint replacement patients: skilled nursing facility or inpatient rehabilitation facility?

Science.gov (United States)

Tian, Wenqiang; DeJong, Gerben; Horn, Susan D; Putman, Koen; Hsieh, Ching-Hui; DaVanzo, Joan E

2012-01-01

There has been lengthy debate as to which setting, skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF), is more efficient in treating joint replacement patients. This study aims to determine the efficiency of rehabilitation care provided by SNF and IRF to joint replacement patients with respect to both payment and length of stay (LOS). This study used a prospective multisite observational cohort design. Tobit models were used to examine the association between setting of care and efficiency. The study enrolled 948 knee replacement patients and 618 hip replacement patients from 11 IRFs and 7 SNFs between February 2006 and February 2007. Output was measured by motor functional independence measure (FIM) score at discharge. Efficiency was measured in 3 ways: payment efficiency, LOS efficiency, and stochastic frontier analysis efficiency. IRF patients incurred higher expenditures per case but also achieved larger motor FIM gains in shorter LOS than did SNF patients. Setting of care was not a strong predictor of overall efficiency of rehabilitation care. Great variation in characteristics existed within IRFs or SNFs and severity groups. Medium-volume facilities among both SNFs and IRFs were most efficient. Early rehabilitation was consistently predictive of efficient treatment. The advantage of either setting is not clear-cut. Definition of efficiency depends in part on preference between cost and time. SNFs are more payment efficient; IRFs are more LOS efficient. Variation within SNFs and IRFs blurred setting differences; a simple comparison between SNF and IRF may not be appropriate.

Improving plasmonic waveguides coupling efficiency using nanoantennas

DEFF Research Database (Denmark)

Andryieuski, Andrei; Malureanu, Radu; Bouillard, Jean-Sebastien

2012-01-01

. The classical dipole antenna scheme can be improved by changing the nanoantenna geometry, adding constructive elements such as reflecting bars and mirrors and using arrays of antennas. The modelling designates that the coupling efficiency from a vertical fiber to a plasmonic waveguide can be improved more than......Plasmonic waveguides bear a lot of potential for photonic applications. However, one of the challenges for implementing them in devices is the low coupling efficiency to and from optical fibers. We report on our approach to facilitate the coupling efficiency with the use of metallic nanoantennas...... in 180 times in comparison with a direct fiber-waveguide coupling. Pros and cons of each configuration are discussed. Fabrication and characterisation results are reported....

LEAN SIX SIGMA TECHNIQUES TO IMPROVE OPHTHALMOLOGY CLINIC EFFICIENCY.

Science.gov (United States)

Ciulla, Thomas A; Tatikonda, Mohan V; ElMaraghi, Yehya A; Hussain, Rehan M; Hill, Amanda L; Clary, Julie M; Hattab, Eyas

2017-07-18

Ophthalmologists serve an increasing volume of a growing elderly population undergoing increasingly complex outpatient medical care, including extensive diagnostic testing and treatment. The resulting prolonged patient visit times ("patient flow times") limit quality, patient and employee satisfaction, and represent waste. Lean Six Sigma process improvement was used in a vitreoretinal practice to decrease patient flow time, demonstrating that this approach can yield significant improvement in health care. Process flow maps were created to determine the most common care pathways within clinic. Three months' visits from the electronic medical record system, which tracks patient task times at each process step in the office were collected. Care tasks and care pathways consuming the greatest time and variation were identified and modified. Follow-up analysis from 6 weeks' visits was conducted to assess improvement. Nearly all patients took one of five paths through the office. Patient flow was redesigned to reduce waiting room time by having staff members immediately start patients into one of those five paths; staffing was adjusted to address high demand tasks, and scheduling was optimized around derived predictors of patient flow times. Follow-up analysis revealed a statistically significant decline in mean patient flow time by 18% and inpatient flow time SD by 4.6%. Patient and employee satisfaction scores improved. Manufacturing industry techniques, such as Lean and Six Sigma, can be used to improve patient care, minimize waste, and enhance patient and staff satisfaction in outpatient clinics.

Hospital medicine (Part 2): what would improve acute hospital care?

LENUS (Irish Health Repository)

Kellett, John

2009-09-01

There are so many obvious delays and inefficiencies in our traditional system of acute hospital care; it is clear that if outcomes are to be improved prompt accurate assessment immediately followed by competent and efficient treatment is essential. Early warning scores (EWS) help detect acutely ill patients who are seriously ill and likely to deteriorate. However, it is not known if any EWS has universal applicability to all patient populations. The benefit of Rapid Response Systems (RRS) such as Medical Emergency Teams has yet to be proven, possibly because doctors and nurses are reluctant to call the RRS for help. Reconfiguration of care delivery in an Acute Medical Assessment Unit has been suggested as a "proactive" alternative to the "reactive" approach of RRS. This method ensures every patient is in an appropriate and safe environment from the moment of first contact with the hospital. Further research is needed into what interventions are most effective in preventing the deterioration and\\/or resuscitating seriously ill patients. Although physicians expert in hospital care decrease the cost and length of hospitalization without compromising outcomes hospital care will continue to be both expensive and potentially dangerous.

The productivity and cost-efficiency of models for involving nurse practitioners in primary care: a perspective from queueing analysis.

Science.gov (United States)

Liu, Nan; D'Aunno, Thomas

2012-04-01

To develop simple stylized models for evaluating the productivity and cost-efficiencies of different practice models to involve nurse practitioners (NPs) in primary care, and in particular to generate insights on what affects the performance of these models and how. The productivity of a practice model is defined as the maximum number of patients that can be accounted for by the model under a given timeliness-to-care requirement; cost-efficiency is measured by the corresponding annual cost per patient in that model. Appropriate queueing analysis is conducted to generate formulas and values for these two performance measures. Model parameters for the analysis are extracted from the previous literature and survey reports. Sensitivity analysis is conducted to investigate the model performance under different scenarios and to verify the robustness of findings. Employing an NP, whose salary is usually lower than a primary care physician, may not be cost-efficient, in particular when the NP's capacity is underutilized. Besides provider service rates, workload allocation among providers is one of the most important determinants for the cost-efficiency of a practice model involving NPs. Capacity pooling among providers could be a helpful strategy to improve efficiency in care delivery. The productivity and cost-efficiency of a practice model depend heavily on how providers organize their work and a variety of other factors related to the practice environment. Queueing theory provides useful tools to take into account these factors in making strategic decisions on staffing and panel size selection for a practice model. © Health Research and Educational Trust.

Improving aspects of palliative care for children

NARCIS (Netherlands)

Jagt, C.T.

2017-01-01

This thesis is about improving aspects of palliative care for children, and covers three different areas of quality of care. First of all, palliative care should be anticipating. To be able to deliver this anticipating care, caregivers should know what to expect. The first two chapters of the thesis

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges.

Science.gov (United States)

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System-AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

Low Impedance Voice Coils for Improved Loudspeaker Efficiency

DEFF Research Database (Denmark)

Iversen, Niels Elkjær; Knott, Arnold; Andersen, Michael A. E.

2015-01-01

In modern audio systems utilizing switch-mode amplifiers the total efficiency is dominated by the rather poor efficiency of the loudspeaker. For decades voice coils have been designed so that nominal resistances of 4 to 8 Ohms is obtained, despite modern audio amplifiers, using switch-mode techno...... responses are estimated. For this woofer it is shown that the sensitivity can be improved approximately 1 dB, corresponding to a 30% efficiency improvement, just by increasing the fill factor using a low impedance voice coil with rectangular wire....

Wastewater treatment facilities: Energy efficient improvements and cogeneration

International Nuclear Information System (INIS)

Kunkle, R.; Gray, R.; Delzel, D.

1992-10-01

The Washington State Energy Office (WSEO) has worked with both the Bonneville Power Administration (BPA) and the US Department of Energy to provide technical and financial assistance to local governments. Based on a recent study conducted by Ecotope for WSEO, local governments spend an estimated $45 million on utility bills statewide. Water and wastewater facilities account for almost a third of this cost. As a result, WSEO decided to focus its efforts on the energy intensive water and wastewater sector. The ultimate goal of this project was to develop mechanisms to incorporate energy efficiency improvements into wastewater treatment facilities in retrofits and during upgrades, remodels, and new construction. Project activities included the following: The review of the existing regulatory environment for treatment system construction, A summary of financing options for efficiency improvements in treatment facilities, A literature review of energy efficiency opportunities in treatment plants, Survey and site visits to characterize existing facilities in Washington State, Estimates of the energy efficiency and cogeneration potential in the sector, and A case study to illustrate the implementation of an efficiency improvement in a treatment facility

Improved Efficient Routing Strategy on Scale-Free Networks

Science.gov (United States)

Jiang, Zhong-Yuan; Liang, Man-Gui

Since the betweenness of nodes in complex networks can theoretically represent the traffic load of nodes under the currently used routing strategy, we propose an improved efficient (IE) routing strategy to enhance to the network traffic capacity based on the betweenness centrality. Any node with the highest betweenness is susceptible to traffic congestion. An efficient way to improve the network traffic capacity is to redistribute the heavy traffic load from these central nodes to non-central nodes, so in this paper, we firstly give a path cost function by considering the sum of node betweenness with a tunable parameter β along the actual path. Then, by minimizing the path cost, our IE routing strategy achieved obvious improvement on the network transport efficiency. Simulations on scale-free Barabási-Albert (BA) networks confirmed the effectiveness of our strategy, when compared with the efficient routing (ER) and the shortest path (SP) routing.

The gain from improved market efficiency

DEFF Research Database (Denmark)

Ejrnæs, Mette; Persson, Karl Gunnar

2010-01-01

demand as well as excess supply, which triggered off the tâtonnement process. Over time, adjustments to equilibrium, as measured by the half-life of a shock, became faster and violations of the law of one price become smaller. There were significant gains from improved market efficiency, which took place......This article looks at the gains from improved market efficiency in long-distance grain trade in the second half of the nineteenth century, when violations of the law of one price were reduced due to improved information transmission. Two markets, a major export centre, Chicago, and a major importer......, Liverpool, are analysed. We show that the law of one price equilibrium was an ‘attractor equilibrium'. The implication is that prices converged to that equilibrium in a tâtonnement process. Because of asymmetrically timed information between markets separated by long distances there were periods of excess...

Patient-centered medical homes improve care for adults with chronic conditions.

Science.gov (United States)

Pourat, Nadereh; Lavarreda, Shana Alex; Snyder, Sophie

2013-05-01

The success of health care reform implementation in 2014 partly depends on more efficient delivery of care to the millions of California residents eligible to gain insurance. Emerging evidence supports the effectiveness of the patient-centered medical home (PCMH) as a potential model of care delivery, which improves health outcomes and reduces costs. Among other principles, PCMH entails receipt of care from a personal doctor, who coordinates the patient's care and develops an individualized treatment plan for the patient. These principles are particularly essential in delivery of care to those with chronic conditions who require more intensive care management. Using the 2009 California Health Interview Survey (CHIS 2009), this policy brief indicates that patients who reported meeting these fundamental PCMH principles were more likely to have visited the doctor and to have received flu shots, and they also had better communication with providers than those who did not report meeting these PCMH principles. The data also showed that uninsured individuals, Medi-Cal beneficiaries, those at or below 133% of the federal poverty level, Latinos, and Asian-Americans were less likely to report meeting all three PCMH principles. These findings highlight the population groups that would most benefit from the PCMH care delivery model, particularly Medi-Cal beneficiaries and those eligible for Covered California, the California health benefits exchange.

Nine-point plan to improve care of the injured patient: A case study from Kenya.

Science.gov (United States)

Bachani, Abdulgafoor M; Botchey, Isaac; Paruk, Fatima; Wako, Daniel; Saidi, Hassan; Aliwa, Bethuel; Kibias, Simon; Hyder, Adnan A

2017-12-01

Injury rates in low- and middle-income countries are among the greatest in the world, with >90% of unintentional injury occurring in low- or middle-income countries. The risk of death from injuries is 6 times more in low- and middle-income countries than in high-income countries. This increased rate of injury is partly due to the lack of availability and access to timely and appropriate medical care for injured individuals. Kenya, like most low- and middle-income countries, has seen a 5-fold increase in injury fatalities throughout the past 4 decades, in large part related to the absence of a coordinated, integrated system of trauma care. We aimed to assess the trauma-care system in Kenya and to develop and implement a plan to improve it. A trauma system profile was performed to understand the landscape for the care of the injured patient in Kenya. This process helped identify key gaps in care ranging from prehospital to hospital-based care. In response to this observation, a 9-point plan to improve trauma care in Kenya was developed and implemented in close collaboration with local stakeholders. The 9-point plan was centered on engagement of the stakeholders, generation of key data to guide and improve services, capacity development for prehospital and hospital care, and strengthening policy and legislation. There is an urgent need for coordinated strategies to provide appropriate and timely medical care to injured individuals in low- or middle-income countries to decrease the burden of injuries and related fatalities. Our work in Kenya shows that such an integrated system of trauma care could be achieved through a step-by-step integrated and multifaceted approach that emphasizes engagement of local stakeholders and evidence-based approaches to ensure effectiveness, efficiency, and sustainability of system-wide improvements. This plan and lessons learned in its development and implementation could be adaptable to other similar settings to improve the care of the

Discontinuous interleaving of parallel inverters for efficiency improvement

DEFF Research Database (Denmark)

Rannestad, Bjørn; Munk-Nielsen, Stig; Gadgaard, Kristian

2017-01-01

Interleaved switching of parallel inverters has previously been proposed for efficiency/size improvements of grid connected three-phase inverters. This paper proposes a novel interleaving method which practically eliminates insulated gate bipolar transistor (IGBT) turn-on losses and drastically...... overall power module losses are reduced. The modulation strategy is suited for converters with doubly fed induction generators (DFIG) for wind turbines, but are not limited hereto. Improvement of switching performance are measured and operational efficiency improvements are calculated and verified...

Physician education programme improves quality of diabetes care

African Journals Online (AJOL)

diabetes have been compiled and circulated to health care workers, but ... studied and attempted to improve the quality of diabetes care in primary care ..... project indicators in the Indian Health Service primary care setting. Diabetes Care ...

A framework for improving access and customer service times in health care: application and analysis at the UCLA Medical Center.

Science.gov (United States)

Duda, Catherine; Rajaram, Kumar; Barz, Christiane; Rosenthal, J Thomas

2013-01-01

There has been an increasing emphasis on health care efficiency and costs and on improving quality in health care settings such as hospitals or clinics. However, there has not been sufficient work on methods of improving access and customer service times in health care settings. The study develops a framework for improving access and customer service time for health care settings. In the framework, the operational concept of the bottleneck is synthesized with queuing theory to improve access and reduce customer service times without reduction in clinical quality. The framework is applied at the Ronald Reagan UCLA Medical Center to determine the drivers for access and customer service times and then provides guidelines on how to improve these drivers. Validation using simulation techniques shows significant potential for reducing customer service times and increasing access at this institution. Finally, the study provides several practice implications that could be used to improve access and customer service times without reduction in clinical quality across a range of health care settings from large hospitals to small community clinics.

Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center.

Science.gov (United States)

Cima, Robert R; Brown, Michael J; Hebl, James R; Moore, Robin; Rogers, James C; Kollengode, Anantha; Amstutz, Gwendolyn J; Weisbrod, Cheryl A; Narr, Bradly J; Deschamps, Claude

2011-07-01

Operating rooms (ORs) are resource-intense and costly hospital units. Maximizing OR efficiency is essential to maintaining an economically viable institution. OR efficiency projects often focus on a limited number of ORs or cases. Efforts across an entire OR suite have not been reported. Lean and Six Sigma methodologies were developed in the manufacturing industry to increase efficiency by eliminating non-value-added steps. We applied Lean and Six Sigma methodologies across an entire surgical suite to improve efficiency. A multidisciplinary surgical process improvement team constructed a value stream map of the entire surgical process from the decision for surgery to discharge. Each process step was analyzed in 3 domains, ie, personnel, information processed, and time. Multidisciplinary teams addressed 5 work streams to increase value at each step: minimizing volume variation; streamlining the preoperative process; reducing nonoperative time; eliminating redundant information; and promoting employee engagement. Process improvements were implemented sequentially in surgical specialties. Key performance metrics were collected before and after implementation. Across 3 surgical specialties, process redesign resulted in substantial improvements in on-time starts and reduction in number of cases past 5 pm. Substantial gains were achieved in nonoperative time, staff overtime, and ORs saved. These changes resulted in substantial increases in margin/OR/day. Use of Lean and Six Sigma methodologies increased OR efficiency and financial performance across an entire operating suite. Process mapping, leadership support, staff engagement, and sharing performance metrics are keys to enhancing OR efficiency. The performance gains were substantial, sustainable, positive financially, and transferrable to other specialties. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Point-of-care technology: integration for improved delivery of care.

Science.gov (United States)

Gregory, Debbie; Buckner, Martha

2014-01-01

The growing complexity of technology, equipment, and devices involved in patient care delivery can be staggering and overwhelming. Technology is intended to be a tool to help clinicians, but it can also be a frustrating hindrance if not thoughtfully planned and strategically aligned. Critical care nurses are key partners in the collaborations needed to improve safety and quality through health information technology (IT). Nurses must advocate for systems that are interoperable and adapted to the context of care experiences. The involvement and collaboration between clinicians, information technology specialists, biomedical engineers, and vendors has never been more relevant and applicable. Working together strategically with a shared vision can effectively provide a seamless clinical workflow, maximize technology investments, and ultimately improve patient care delivery and outcomes. Developing a strategic integrated clinical and IT roadmap is a critical component of today's health care environment. How can technology strategy be aligned from the executive suite to the bedside caregiver? What is the model for using clinical workflows to drive technology adoption? How can the voice of the critical care nurse strengthen this process? How can success be assured from the initial assessment and selection of technology to a sustainable support model? What is the vendor's role as a strategic partner and "co-caregiver"?

Recovery Act--Class 8 Truck Freight Efficiency Improvement Project

Energy Technology Data Exchange (ETDEWEB)

Trucks, Daimler [Daimler Trucks North America Llc, Portland, OR (United States)

2015-07-26

Daimler Trucks North America completed a five year, $79.6M project to develop and demonstrate a concept vehicle with at least 50% freight efficiency improvement over a weighted average of several drive cycles relative to a 2009 best-in-class baseline vehicle. DTNA chose a very fuel efficient baseline vehicle, the 2009 Freightliner Cascadia with a DD15 engine, yet successfully demonstrated a 115% freight efficiency improvement. DTNA learned a great deal about the various technologies that were incorporated into Super Truck and those that, through down-selection, were discarded. Some of the technologies competed with each other for efficiency, and notably some of the technologies complemented each other. For example, we found that Super Truck’s improved aerodynamic drag resulted in improved fuel savings from eCoast, relative to a similar vehicle with worse aerodynamic drag. However, some technologies were in direct competition with each other, namely the predictive technologies which use GPS and 3D digital maps to efficiently manage the vehicles kinetic energy through controls and software, versus hybrid which is a much costlier technology that essentially targets the same inefficiency. Furthermore, the benefits of a comprehensive, integrated powertrain/vehicle approach was proven, in which vast improvements in vehicle efficiency (e.g. lower aero drag and driveline losses) enabled engine strategies such as downrating and downspeeding. The joint engine and vehicle developments proved to be a multiplier-effect which resulted in large freight efficiency improvements. Although a large number of technologies made the selection process and were used on the Super Truck demonstrator vehicle, some of the technologies proved not feasible for series production.

A treatment of thermal efficiency improvement in the Brayton cycle

International Nuclear Information System (INIS)

Fujii, Terushige; Akagawa, Koji; Nakanishi, Shigeyasu; Inoue, Kiyoshi; Ishigai, Seikan.

1982-01-01

So far, as the working fluid for power-generating plants, mainly water and air (combustion gas) have been used. In this study, in regeneration and isothermal compression processes being considered as the means for the efficiency improvement in Brayton cycle, the investigation of equivalent graphical presentation method with T-S diagrams, the introduction of the new characteristic number expressing the possibility of thermal efficiency improvement by regeneration, and the investigation of the effect of the difference of working fluid on thermal efficiency were carried out. Next, as the cycle approximately realizing isothermal compression process with condensation process, the super-critical pressure cycle with liquid phase compression was rated, and four working fluids, NH 3 , SO 2 , CO 2 and H 2 O were examined as perfect gas and real gas. The advantage of CO 2 regeneration for the thermal efficiency improvement was clarified by using the dimensionless characteristic number. The graphical presentation of effective work, the thermal efficiency improvement by regeneration, the thermal efficiency improvement by making compression process isothermal, the effect on thermal efficiency due to various factors and working fluids, the characteristic number by regeneration, and the application to real working fluids are reported. (Kako, I.)

The impact of managed care penetration and hospital quality on efficiency in hospital staffing.

Science.gov (United States)

Mobley, Lee R; Magnussen, Jon

2002-01-01

The state of California has recently mandated minimum nurse-staffing ratios, raising concerns about possible affects on hospital efficiency. In this study, we examine how market factors and quality were related to staffing levels in California hospitals in 1995 (prior to implementation of the new law). We are particularly interested in the affect of managed care penetration on this aspect of hospital efficiency because the call to legislative action was predicated on fears that hospitals were reducing staffing below optimal levels in response to managed care pressures. We derive a unique measure of excess staffing in hospitals based on a data envelopment analysis (DEA) production function model, which explicitly includes ancillary care among the inputs and outputs. This careful specification of production is important because ancillary care use has risen relative to daily hospital services, with the spread of managed care and advances in medical technology. We find that market share (adjusted for size) and market concentration are the major determinants of excess staffing while managed care penetration is insignificant. We also find that poor quality (outcomes worse than expected) is associated with less efficient staffing. These findings suggest that the larger, more efficient urban hospitals will be penalized more heavily under binding staffing ratios than smaller, less-urban hospitals.

Evidence or eminence in abdominal surgery: Recent improvements in perioperative care

Science.gov (United States)

Segelman, Josefin; Nygren, Jonas

2014-01-01

Repeated surveys from Europe, the United States, Australia, and New Zealand have shown that adherence to an evidence-based perioperative care protocol, such as Enhanced Recovery After Surgery (ERAS), has been generally low. It is of great importance to support the implementation of the ERAS protocol as it has been shown to improve outcomes after a number of surgical procedures, including major abdominal surgery. However, despite an increasing awareness of the importance of structured perioperative management, the implementation of this complex protocol has been slow. Barriers to implementation involve both patient- and staff-related factors as well as practice-related issues and resources. To support efficient and successful implementation, further educational and structural measures have to be made on a national or regional level to improve the standard of general health care. Besides postoperative morbidity, biological and physiological variables have been quite commonly reported in previous ERAS studies. Little information, however, has been obtained on cost-effectiveness, long-term outcomes, quality of life and patient-related outcomes, and these issues remain important areas of research for future studies. PMID:25469030

SAGD CO2 mitigation through energy efficiency improvements

International Nuclear Information System (INIS)

Plessis du, D.

2010-01-01

An evaluation of the carbon dioxide (CO 2 ) emissions reductions achieved using energy efficiency measures in steam assisted gravity drainage (SAGD) operations was presented. The efficiency of a typical SAGD operation was analyzed using an indexing tool based on the Carnot cycle efficiency to develop an ideal SAGD heat cycle. The benefits of using an organic Rankine cycle (ORC) technology to convert waste heat to electrical power were also investigated. A CO 2 abatement curve was used to identify the economic benefits and costs of various greenhouse gas (GHG) reductions. The level of recovered energy was determined in relation to energy prices, capital costs, and carbon penalties in order to determine the most efficient means of decreasing energy usage. The study demonstrated that energy efficiency can be improved by up to 20 percent, and water loss reductions of up to 50 percent can be achieved using cost-effective energy efficiency measures. Results of the study can be used to guide government policy and provide industry with practical tools to benchmark performance and improve efficiencies. 4 refs., 1 tab., 10 figs.

Improving patients' and staff's experiences of acute care.

Science.gov (United States)

Chaplin, Rob; Crawshaw, Jacob; Hood, Chloe

2015-03-01

The aim of this audit was to assess the effect of the Quality Mark programme on the quality of acute care received by older patients by comparing the experiences of staff and older adults before and after the programme. Data from 31 wards in 12 acute hospitals were collected over two stages. Patients and staff completed questionnaires on the perceived quality of care on the ward. Patients rated improved experiences of nutrition, staff availability and dignity. Staff received an increase in training and reported better access to support, increased time and skill to deliver care and improved morale, leadership and teamwork. Problems remained with ward comfort and mealtimes. Overall, results indicated an improvement in ratings of care quality in most domains during Quality Mark data collection. Further audits need to explore ways of improving ward comfort and mealtime experience.

Standardizing Care and Improving Quality under a Bundled Payment Initiative for Total Joint Arthroplasty.

Science.gov (United States)

Froemke, Cecily C; Wang, Lian; DeHart, Matthew L; Williamson, Ronda K; Ko, Laura Matsen; Duwelius, Paul J

2015-10-01

Increasing demands for episodic bundled payments in total hip and knee arthroplasty are motivating providers to wring out inefficiencies and coordinate services. This study describes a care pathway and gainshare arrangement as the mechanism by which improvements in efficiency were realized under a bundled payment pilot. Analysis of cut-to-close time, LOS, discharge destination, implant cost, and total allowed claims between pre-pilot and pilot cohorts showed an 18% reduction in average LOS (70.8 to 58.2 hours) and a shift from home health and skilled nursing facility discharge to home self-care (54.1% to 63.7%). No significant differences were observed for cut-to-close time and implant cost. Improvements resulted in a 6% reduction in the average total allowed claims per case. Copyright © 2015 Elsevier Inc. All rights reserved.

[Benefits of nursing care service in the assisted reproduction clinic to self-cycle-management and self-efficiency of infertility patients].

Science.gov (United States)

Li, Xiao-Qin; Sun, Chao-Feng; Guo, Mei

2017-06-01

To investigate the benefits of nursing care service in the assisted reproduction clinic to self-cycle-management and self-efficiency of the outpatients with infertility. We randomly divided 600 females preliminarily diagnosed with infertility into a control and an experimental group, 288 in the former and 285 in the latter group excluding those whose husbands had azoospermia. For the women patients of the experimental group, we conducted nursing care intervention concerning related knowledge, skills, diet, excise, medication, and psychology, by one-to-one consultation, individualized or group communication, establishing files, telephone follow-up, and wechat guidance. After 3 months of intervention, we compared the compliance of medical visits, effectiveness of cycle management, sense of self-efficiency, satisfaction, and anxiety score between the two groups of patients. In comparison with the controls, the patients of the experimental group showed significantly better knowledge about assisted reproduction and higher effectiveness of self-cycle-management, self-efficiency, and satisfaction (P <0.05), but a markedly lower degree of anxiety (P <0.05). Nursing care service in the assisted reproduction clinic can improve the compliance of medical visits, effectiveness of self-cycle-management, self-efficiency, and satisfaction and reduce the anxiety of the patients.

Initial Steps for Quality Improvement of Obesity Care Across Divisions at a Tertiary Care Pediatric Hospital

Directory of Open Access Journals (Sweden)

Sheila Z. Chang

2014-09-01

Full Text Available Background: Pediatric subspecialists can participate in the care of obese children. Objective: To describe steps to help subspecialty providers initiate quality improvement efforts in obesity care. Methods: An anonymous patient data download, provider surveys and interviews assessed subspecialty providers’ identification and perspectives of childhood obesity and gathered information on perceived roles and care strategies. Participating divisions received summary analyses of quantitative and qualitative data and met with study leaders to develop visions for division/service-specific care improvement. Results: Among 13 divisions/services, subspecialists’ perceived role varied by specialty; many expressed the need for cross-collaboration. All survey informants agreed that identification was the first step, and expressed interest in obtaining additional resources to improve care. Conclusions: Subspecialists were interested in improving the quality and coordination of obesity care for patients across our tertiary care setting. Developing quality improvement projects to achieve greater pediatric obesity care goals starts with engagement of providers toward better identifying and managing childhood obesity.

Global Lessons In Frugal Innovation To Improve Health Care Delivery In The United States.

Science.gov (United States)

Bhatti, Yasser; Taylor, Andrea; Harris, Matthew; Wadge, Hester; Escobar, Erin; Prime, Matt; Patel, Hannah; Carter, Alexander W; Parston, Greg; Darzi, Ara W; Udayakumar, Krishna

2017-11-01

In a 2015 global study of low-cost or frugal innovations, we identified five leading innovations that scaled successfully in their original contexts and that may provide insights for scaling such innovations in the United States. We describe common themes among these diverse innovations, critical factors for their translation to the United States to improve the efficiency and quality of health care, and lessons for the implementation and scaling of other innovations. We highlight promising trends in the United States that support adapting these innovations, including growing interest in moving care out of health care facilities and into community and home settings; the growth of alternative payment models and incentives to experiment with new approaches to population health and care delivery; and the increasing use of diverse health professionals, such as community health workers and advanced practice providers. Our findings should inspire policy makers and health care professionals and inform them about the potential for globally sourced frugal innovations to benefit US health care.

EFFICIENT USE OF BIOMASS IN IMPROVED COOKSTOVES

Directory of Open Access Journals (Sweden)

R. K. PAL

2016-12-01

Full Text Available Traditional biomass cookstoves have very low efficiency. The improved cookstoves have very high efficiency. These improved cookstoves with high efficiency saves biomass fuels. Biomass can be saved in case of rocket elbow cookstoves. The amount of biomass which can be saved in case of rocket elbow cookstoves is 65.88 MT. More biomass can be saved in case of gasifier fan cookstoves. The amount of biomass which can be saved is 155.71 MT. The pollutants like particulate matter, black carbon, carbon mono-oxide and carbon dioxide emission is lesser in case of rocket elbow cookstoves. The pollutants are least in case of gasifier fan cookstoves. The reduction in particulate matter, black carbon, carbon mono-oxide and carbon dioxide emission in gasifier fan cookstoves is 1.77 MT, 0.24 MT, 0.71 MT & 151.64 MT respectively in comparison to traditional cookstoves. Therefore indoor air pollution is greatly reduced in case of improved cookstoves especially in case of gasifier fan cookstoves as compared to traditional cookstoves.

A time-driven activity-based costing model to improve health-care resource use in Mirebalais, Haiti.

Science.gov (United States)

Mandigo, Morgan; O'Neill, Kathleen; Mistry, Bipin; Mundy, Bryan; Millien, Christophe; Nazaire, Yolande; Damuse, Ruth; Pierre, Claire; Mugunga, Jean Claude; Gillies, Rowan; Lucien, Franciscka; Bertrand, Karla; Luo, Eva; Costas, Ainhoa; Greenberg, Sarah L M; Meara, John G; Kaplan, Robert

2015-04-27

In resource-limited settings, efficiency is crucial to maximise resources available for patient care. Time driven activity-based costing (TDABC) estimates costs directly from clinical and administrative processes used in patient care, thereby providing valuable information for process improvements. TDABC is more accurate and simpler than traditional activity-based costing because it assigns resource costs to patients based on the amount of time clinical and staff resources are used in patient encounters. Other costing approaches use somewhat arbitrary allocations that provide little transparency into the actual clinical processes used to treat medical conditions. TDABC has been successfully applied in European and US health-care settings to facilitate process improvements and new reimbursement approaches, but it has not been used in resource-limited settings. We aimed to optimise TDABC for use in a resource-limited setting to provide accurate procedure and service costs, reliably predict financing needs, inform quality improvement initiatives, and maximise efficiency. A multidisciplinary team used TDABC to map clinical processes for obstetric care (vaginal and caesarean deliveries, from triage to post-partum discharge) and breast cancer care (diagnosis, chemotherapy, surgery, and support services, such as pharmacy, radiology, laboratory, and counselling) at Hôpital Universitaire de Mirebalais (HUM) in Haiti. The team estimated the direct costs of personnel, equipment, and facilities used in patient care based on the amount of time each of these resources was used. We calculated inpatient personnel costs by allocating provider costs per staffed bed, and assigned indirect costs (administration, facility maintenance and operations, education, procurement and warehouse, bloodbank, and morgue) to various subgroups of the patient population. This study was approved by the Partners in Health/Zanmi Lasante Research Committee. The direct cost of an uncomplicated vaginal

Barriers to improvements in energy efficiency

Energy Technology Data Exchange (ETDEWEB)

Reddy, A.K.N.

1991-10-01

To promote energy-efficiency improvements, actions may be required at one or more levels -- from the lowest level of the consumer (residential, commercial, industrial, etc.) through the highest level of the global agencies. But barriers to the implementation of energy-efficiency improvements exist or can arise at all these levels. Taking up each one of these barriers in turn, the paper discusses specific measures that can contribute to overcoming the barriers. However, a one-barrier-one-measure approach must be avoided. Single barriers may in fact involve several sub-barriers. Also, combinations of measures are much more effective in overcoming barriers. In particular, combinations of measures that simultaneously overcome several barriers are most successful. The paper discusses the typology of barriers, explores their origin and suggests measures that by themselves or in combination with other measures, will overcome these barriers. Since most of the barriers dealt with can be found in the barriers'' literature, any originality in the paper lies in its systematic organization, synoptic view and holistic treatment of this issue. This paper is intended to initiate a comprehensive treatment of barriers, their origins and the measures that contribute to overcoming them. Hopefully, such a treatment will facilitate the implementation of energy-efficiency improvements involving a wide diversity of ever-changing energy end uses and consumer preferences.

Barriers to improvements in energy efficiency

Energy Technology Data Exchange (ETDEWEB)

Reddy, A.K.N.

1991-10-01

To promote energy-efficiency improvements, actions may be required at one or more levels -- from the lowest level of the consumer (residential, commercial, industrial, etc.) through the highest level of the global agencies. But barriers to the implementation of energy-efficiency improvements exist or can arise at all these levels. Taking up each one of these barriers in turn, the paper discusses specific measures that can contribute to overcoming the barriers. However, a one-barrier-one-measure approach must be avoided. Single barriers may in fact involve several sub-barriers. Also, combinations of measures are much more effective in overcoming barriers. In particular, combinations of measures that simultaneously overcome several barriers are most successful. The paper discusses the typology of barriers, explores their origin and suggests measures that by themselves or in combination with other measures, will overcome these barriers. Since most of the barriers dealt with can be found in the ``barriers`` literature, any originality in the paper lies in its systematic organization, synoptic view and holistic treatment of this issue. This paper is intended to initiate a comprehensive treatment of barriers, their origins and the measures that contribute to overcoming them. Hopefully, such a treatment will facilitate the implementation of energy-efficiency improvements involving a wide diversity of ever-changing energy end uses and consumer preferences.

Structuring diabetes care in general practices: many improvements, remaining challenges.

LENUS (Irish Health Repository)

Jennings, S

2009-08-07

BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.

Applicability of the 5S management method for quality improvement in health-care facilities: a review.

Science.gov (United States)

Kanamori, Shogo; Shibanuma, Akira; Jimba, Masamine

2016-01-01

The 5S management method (where 5S stands for sort, set in order, shine, standardize, and sustain) was originally implemented by manufacturing enterprises in Japan. It was then introduced to the manufacturing sector in the West and eventually applied to the health sector for organizing and standardizing the workplace. 5S has recently received attention as a potential solution for improving government health-care services in low- and middle-income countries. We conducted a narrative literature review to explore its applicability to health-care facilities globally, with a focus on three aspects: (a) the context of its application, (b) its impacts, and (c) its adoption as part of government initiatives. To identify relevant research articles, we researched public health databases in English, including CINAHL, PubMed, ScienceDirect, and Web of Science. We found 15 of the 114 articles obtained from the search results to be relevant for full-text analysis of the context and impacts of the 5S application. To identify additional information particularly on its adoption as part of government initiatives, we also examined other types of resources including reference books, reports, didactic materials, government documents, and websites. The 15 empirical studies highlighted its application in primary health-care facilities and a wide range of hospital areas in Brazil, India, Jordan, Senegal, Sri Lanka, Tanzania, the UK, and the USA. The review also found that 5S was considered to be the starting point for health-care quality improvement. Ten studies presented its impacts on quality improvements; the changes resulting from the 5S application were classified into the three dimensions of safety, efficiency, and patient-centeredness. Furthermore, 5S was adopted as part of government quality improvement strategies in India, Senegal, Sri Lanka, and Tanzania. 5S could be applied to health-care facilities regardless of locations. It could be not only a tool for health workers and

Measures for energy efficiency improvement of buildings

Directory of Open Access Journals (Sweden)

Vukadinović Ana V.

2015-01-01

Full Text Available The increase in energy consumption in buildings causes the need to propose energy efficiency improvement measures. Urban planning in accordance with micro location conditions can lead to energy consumption reduction in buildings through the passive solar design. While satisfying the thermal comfort to the user space purpose, energy efficiency can be achieved by optimizing the architectural and construction parameters such as shape of the building, envelope structure and the percentage of glazing. The improvement of the proposed measures, including the use of renewable energy sources, can meet requirements of Directive 2010/31 / EU of 'nearly zero energy buildings'.

Involving patients in care decisions improves satisfaction: an outcomes-based quality improvement project.

Science.gov (United States)

Leff, Ellen W

2004-05-01

A home care agency used quality improvement processes to improve patient satisfaction survey ratings. The focus was on involving patients in decisions about their care. A multidisciplinary team developed creative strategies to increase staff awareness and enhance customer service skills, which had dramatic results.

Attending Unintended Transformations of Health Care Infrastructure

DEFF Research Database (Denmark)

Wentzer, Helle; Bygholm, Ann

2007-01-01

Introduction: Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods: Against a background of theor......Introduction: Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods: Against a background...

Potential Global Benefits of Improved Ceiling Fan Energy Efficiency

Energy Technology Data Exchange (ETDEWEB)

Sathaye, Nakul [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Phadke, Amol [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Shah, Nihar [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Letschert, Virginie [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2012-10-31

Ceiling fans contribute significantly to residential electricity consumption, both in an absolute sense and as a proportion of household consumption in many locations, especially in developing countries in warm climates. However, there has been little detailed assessment of the costs and benefits of efficiency improvement options for ceiling fans and the potential resulting electricity consumption and greenhouse gas (GHG) emissions reductions. We analyze the costs and benefits of several options to improve the efficiency of ceiling fans and assess the global potential for electricity savings and GHG emission reductions with more detailed assessments for India, China, and the U.S. We find that ceiling fan efficiency can be cost-effectively improved by at least 50% using commercially available technology. If these efficiency improvements are implemented in all ceiling fans sold by 2020, 70 terrawatt hours per year (TWh/year) could be saved and 25 million metric tons of carbon dioxide (CO2) emissions per year could be avoided, globally. We assess how policies and programs such as standards, labels, and financial incentives can be used to accelerate the adoption of efficient ceiling fans in order to realize this savings potential.

Information management for aged care provision in Australia: development of an aged care minimum dataset and strategies to improve quality and continuity of care.

Science.gov (United States)

Davis, Jenny; Morgans, Amee; Burgess, Stephen

2016-04-01

Efficient information systems support the provision of multi-disciplinary aged care and a variety of organisational purposes, including quality, funding, communication and continuity of care. Agreed minimum data sets enable accurate communication across multiple care settings. However, in aged care multiple and poorly integrated data collection frameworks are commonly used for client assessment, government reporting and funding purposes. To determine key information needs in aged care settings to improve information quality, information transfer, safety, quality and continuity of care to meet the complex needs of aged care clients. Modified Delphi methods involving five stages were employed by one aged care provider in Victoria, Australia, to establish stakeholder consensus for a derived minimum data set and address barriers to data quality. Eleven different aged care programs were identified; with five related data dictionaries, three minimum data sets, five program standards or quality frameworks. The remaining data collection frameworks related to diseases classification, funding, service activity reporting, and statistical standards and classifications. A total of 170 different data items collected across seven internal information systems were consolidated to a derived set of 60 core data items and aligned with nationally consistent data collection frameworks. Barriers to data quality related to inconsistencies in data items, staff knowledge, workflow, system access and configuration. The development an internal aged care minimum data set highlighted the critical role of primary data quality in the upstream and downstream use of client information; and presents a platform to build national consistency across the sector.

Quality and Efficiency Improvement Tools for Every Radiologist.

Science.gov (United States)

Kudla, Alexei U; Brook, Olga R

2018-03-20

In an era of value-based medicine, data-driven quality improvement is more important than ever to ensure safe and efficient imaging services. Familiarity with high-value tools enables all radiologists to successfully engage in quality and efficiency improvement. In this article, we review the model for improvement, strategies for measurement, and common practical tools with real-life examples that include Run chart, Control chart (Shewhart chart), Fishbone (Cause-and-Effect or Ishikawa) diagram, Pareto chart, 5 Whys, and Root Cause Analysis. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Improving quality in Medicaid: the use of care management processes for chronic illness and preventive care.

Science.gov (United States)

Rittenhouse, Diane R; Robinson, James C

2006-01-01

Care management processes (CMPs), tools to improve the efficiency and quality of primary care delivery, are particularly important for low-income patients facing substantial barriers to care. To measure the adoption of CMPs by medical groups, Independent Practice Associations, community clinics, and hospital-based clinics in California's Medicaid program and the factors associated with CMP adoption. Telephone survey of every provider organization with at least 6 primary care physicians and at least 1 Medi-Cal HMO contract, Spring 2003. One hundred twenty-three organizations participated, accounting for 64% of provider organizations serving Medicaid managed care in California. We surveyed 30 measures of CMP use for asthma and diabetes, and for child and adolescent preventive services. The mean number of CMPs used by each organization was 4.5 for asthma and 4.9 for diabetes (of a possible 8). The mean number of CMPs for preventive services was 4.0 for children and 3.5 for adolescents (of a possible 7). Organizations with more extensive involvement in Medi-Cal managed care used more CMPs for chronic illness and preventive service. Community clinics and hospital-based clinics used more CMPs for asthma and diabetes than did Independent Practice Associations (IPAs), and profitable organizations used more CMPs for child and adolescent preventive services than did entities facing severe financial constraints. The use of CMPs by Medicaid HMOs and the presence of external (financial and nonfinancial) incentives for clinical performance were strongly associated with use of care management by provider organizations. Physician and provider organizations heavily involved in California's Medicaid program are extensively engaged in preventive and chronic care management programs.

Wound Care Center of Excellence: A Process for Continuous Monitoring and Improvement of Wound Care Quality.

Science.gov (United States)

Howell, Raelina S; Kohan, Lauren S; Woods, Jon S; Criscitelli, Theresa; Gillette, Brian M; Donovan, Virginia; Gorenstein, Scott

2018-05-01

To provide information about a study using a new process for continuous monitoring to improve chronic wound care quality.This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After completing this continuing education activity, you should be better able to:1. Recognize problems associated with chronic wound care.2. Identify methods used in this project to improve care.3. Illustrate the findings from this and similar projects and implications for providing improved wound care.Patients with chronic wounds require complex care because of comorbidities that can affect healing. Therefore, the goal of this project was to develop a system of reviewing all hospitalized patients seen by the study authors' wound care service on a weekly basis to decrease readmissions, morbidity, and mortality. Weekly multidisciplinary conferences were conducted to evaluate patient data and systematically assess for adherence to wound care protocols, as well as to create and modify patient care plans. This review of pathology and the performance of root-cause analyses often led to improved patient care.

Retaining caregivers, improving care.

Science.gov (United States)

Bodwell, Wendy; Dent, Sara; Grant, Tracie; Hammerly, Milt; Mamula, Jeanie

2006-01-01

Text Summary In 2004, Centura Health's long-term care centers took part in a pilot project, sponsored by the Centers for Medicare & Medicaid Services, called "Improving Nursing Home Culture through Workforce Retention." A 30-member team comprising Centura leaders and long-term facility staff looked at Centura's eight participating facilities through residents' and employees' eyes. The goal of the team's reflection and subsequent changes was to create a culture in which decisions are focused on resident care and organizational policies are based on respect for employees. At the end of the first year, residents seemed happier and employee satisfaction and involvement increased at all eight Centura facilities.

Payment reform to finance a medical home: comment on "Achieving cost control, care coordination, and quality improvement through incremental payment system reform".

Science.gov (United States)

McGuire, Thomas G

2010-01-01

This commentary on R. F. Averill et al. (2010) addresses their idea of risk and quality adjusting fee-for-service payments to primary care physicians in order to improve the efficiency of primary care and take a step toward financing a "medical home"for patients. I show how their idea can create incentives for efficient practice styles. Pairing this with an active beneficiary choice of primary care physician with an enrollment fee would make the idea easier to implement and provide an incentive and the financing for elements of service not covered by procedure-based fees.

Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change.

Science.gov (United States)

McAlearney, Ann Scheck; Terris, Darcey; Hardacre, Jeanne; Spurgeon, Peter; Brown, Claire; Baumgart, Andre; Nyström, Monica E

2014-01-01

We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations. We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model. We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

Quality Improvement in Critical Care: Selection and Development of Quality Indicators

Science.gov (United States)

Martin, Claudio M.; Project, The Quality Improvement in Critical Care

2016-01-01

Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts. PMID:27493476

Pulmonary Hypertension Care Center Network: Improving Care and Outcomes in Pulmonary Hypertension.

Science.gov (United States)

Sahay, Sandeep; Melendres-Groves, Lana; Pawar, Leena; Cajigas, Hector R

2017-04-01

Pulmonary hypertension (PH) is a chronic, progressive, life-threatening disease that requires expert multidisciplinary care. To facilitate this level of care, the Pulmonary Hypertension Association established across the United States a network of pulmonary hypertension care centers (PHCCs) with special expertise in PH, particularly pulmonary arterial hypertension, to raise the overall quality of care and outcomes for patients with this life-threatening disease. Since the inception of PHCCs in September 2014, to date 35 centers have been accredited in the United States. This model of care brings together physicians and specialists from other disciplines to provide care, facilitate basic and clinical research, and educate the next generation of providers. PHCCs also offer additional opportunities for improvements in PH care. The patient registry offered through the PHCCs is an organized system by which data are collected to evaluate the outcomes of patients with PH. This registry helps in detecting variations in outcomes across centers, thus identifying opportunities for improvement. Multiple tactics were undertaken to implement the strategic plan, training, and tools throughout the PHCC network. In addition, strategies to foster collaboration between care center staff and individuals with PH and their families are the cornerstone of the PHCCs. The Pulmonary Vascular Network of the American College of Chest Physicians believes this to be a positive step that will improve the quality of care delivered in the United States to patients with PH. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Tariff-based incentives for improving coal-power-plant efficiencies in India

International Nuclear Information System (INIS)

Chikkatur, Ananth P.; Sagar, Ambuj D.; Abhyankar, Nikit; Sreekumar, N.

2007-01-01

Improving the efficiency of coal-based power plants plays an important role in improving the performance of India's power sector. It allows for increased consumer benefits through cost reduction, while enhancing energy security and helping reduce local and global pollution through more efficient coal use. A focus on supply-side efficiency also complements other ongoing efforts on end-use efficiency. The recent restructuring of the Indian electricity sector offers an important route to improving power plant efficiency, through regulatory mechanisms that allow for an independent tariff setting process for bulk purchases of electricity from generators. Current tariffs based on normative benchmarks for performance norms are hobbled by information asymmetry (where regulators do not have access to detailed performance data). Hence, we propose a new incentive scheme that gets around the asymmetry problem by setting performance benchmarks based on actual efficiency data, rather than on a normative basis. The scheme provides direct tariff-based incentives for efficiency improvements, while benefiting consumers by reducing electricity costs in the long run. This proposal might also be useful for regulators in other countries to incorporate similar incentives for efficiency improvement in power generation

Diabetic and Obese Patient Clinical Outcomes Improve During a Care Management Implementation in Primary Care.

Science.gov (United States)

Holtrop, Jodi Summers; Luo, Zhehui; Piatt, Gretchen; Green, Lee A; Chen, Qiaoling; Piette, John

2017-10-01

To address the increasing burden of chronic disease, many primary care practices are turning to care management and the hiring of care managers to help patients coordinate their care and self-manage their conditions. Care management is often, but not always, proving effective at improving patient outcomes, but more evidence is needed. In this pair-matched cluster randomized trial, 5 practices implemented care management and were compared with 5 comparison practices within the same practice organization. Targeted patients included diabetic patients with a hemoglobin A1c >9% and nondiabetic obese patients. Clinical values tracked were A1c, blood pressure, low-density lipoprotein, microalbumin, and weight. Clinically important improvements were demonstrated in the intervention versus comparison practices, with diabetic patients improving A1c control and obese patients experiencing weight loss. There was a 12% relative increase in the proportion of patients meeting the clinical target of A1c management practices lost 5% or more of their body weight as compared with 10% of comparison patients (adjusted relative improvement, 15%; CI, 2%-28%). These findings add to the growing evidence-base for the effectiveness of care management as an effective clinical practice with regard to improving diabetes- and obesity-related outcomes.

The Multiple Benefits of Measures to Improve Energy Efficiency

DEFF Research Database (Denmark)

Puig, Daniel; Farrell, Timothy Clifford

Understanding the barriers to, and enablers for, energy efficiency requires targeted information and analysis. This report is a summary of four detailed studies providing new insights on how to promote efficiency in selected priority areas. It complements initiatives such as the so-called energy...... efficiency accelerators, which seek to increase the uptake of selected technologies, as well as the work of many other institutions committed to improving energy efficiency. The modelling estimates and the case studies presented in this report illustrate that, while significant progress has already been...... achieved, the case for accelerating energy efficiency action is strong. Key highlights include: • At the global level, energy efficiency improvements would account for between 2.6 and 3.3 Gt CO2e of the reductions in 2030, equivalent to between 23 and 26 percent of the overall reductions achieved...

Potentials and policy implications of energy and material efficiency improvement

Energy Technology Data Exchange (ETDEWEB)

Worrell, Ernst; Levine, Mark; Price, Lynn; Martin, Nathan; van den Broek, Richard; Block, Kornelis

1997-01-01

There is a growing awareness of the serious problems associated with the provision of sufficient energy to meet human needs and to fuel economic growth world-wide. This has pointed to the need for energy and material efficiency, which would reduce air, water and thermal pollution, as well as waste production. Increasing energy and material efficiency also have the benefits of increased employment, improved balance of imports and exports, increased security of energy supply, and adopting environmentally advantageous energy supply. A large potential exists for energy savings through energy and material efficiency improvements. Technologies are not now, nor will they be, in the foreseeable future, the limiting factors with regard to continuing energy efficiency improvements. There are serious barriers to energy efficiency improvement, including unwillingness to invest, lack of available and accessible information, economic disincentives and organizational barriers. A wide range of policy instruments, as well as innovative approaches have been tried in some countries in order to achieve the desired energy efficiency approaches. These include: regulation and guidelines; economic instruments and incentives; voluntary agreements and actions, information, education and training; and research, development and demonstration. An area that requires particular attention is that of improved international co-operation to develop policy instruments and technologies to meet the needs of developing countries. Material efficiency has not received the attention that it deserves. Consequently, there is a dearth of data on the qualities and quantities for final consumption, thus, making it difficult to formulate policies. Available data, however, suggest that there is a large potential for improved use of many materials in industrialized countries.

Improving the Efficiency of Medical Services Systems: A New Integrated Mathematical Modeling Approach

Directory of Open Access Journals (Sweden)

Davood Shishebori

2013-01-01

Full Text Available Nowadays, the efficient design of medical service systems plays a critical role in improving the performance and efficiency of medical services provided by governments. Accordingly, health care planners in countries especially with a system based on a National Health Service (NHS try to make decisions on where to locate and how to organize medical services regarding several conditions in different residence areas, so as to improve the geographic equity of comfortable access in the delivery of medical services while accounting for efficiency and cost issues especially in crucial situations. Therefore, optimally locating of such services and also suitable allocating demands them, can help to enhance the performance and responsiveness of medical services system. In this paper, a multiobjective mixed integer nonlinear programming model is proposed to decide locations of new medical system centers, link roads that should be constructed or improved, and also urban residence centers covered by these medical service centers and link roads under investment budget constraint in order to both minimize the total transportation cost of the overall system and minimize the total failure cost (i.e., maximize the system reliability of medical service centers under unforeseen situations. Then, the proposed model is linearized by suitable techniques. Moreover, a practical case study is presented in detail to illustrate the application of the proposed mathematical model. Finally, a sensitivity analysis is done to provide an insight into the behavior of the proposed model in response to changes of key parameters of the problem.

Centers for medicare and medicaid services: using an episode-based payment model to improve oncology care.

Science.gov (United States)

Kline, Ronald M; Bazell, Carol; Smith, Erin; Schumacher, Heidi; Rajkumar, Rahul; Conway, Patrick H

2015-03-01

Cancer is a medically complex and expensive disease with costs projected to rise further as new treatment options increase and the United States population ages. Studies showing significant regional variation in oncology quality and costs and model tests demonstrating cost savings without adverse outcomes suggest there are opportunities to create a system of oncology care in the US that delivers higher quality care at lower cost. The Centers for Medicare and Medicaid Services (CMS) have designed an episode-based payment model centered around 6 month periods of chemotherapy treatment. Monthly per-patient care management payments will be made to practices to support practice transformation, including additional patient services and specific infrastructure enhancements. Quarterly reporting of quality metrics will drive continuous quality improvement and the adoption of best practices among participants. Practices achieving cost savings will also be eligible for performance-based payments. Savings are expected through improved care coordination and appropriately aligned payment incentives, resulting in decreased avoidable emergency department visits and hospitalizations and more efficient and evidence-based use of imaging, laboratory tests, and therapeutic agents, as well as improved end of life care. New therapies and better supportive care have significantly improved cancer survival in recent decades. This has come at a high cost, with cancer therapy consuming $124 billion in 2010. CMS has designed an episode-based model of oncology care that incorporates elements from several successful model tests. By providing care management and performance based payments in conjunction with quality metrics and a rapid learning environment, it is hoped that this model will demonstrate how oncology care in the US can transform into a high value, high quality system. Copyright © 2015 by American Society of Clinical Oncology.

The improving efficiency frontier of religious not-for-profit hospitals.

Science.gov (United States)

Harrison, Jeffrey P; Sexton, Christopher

2006-01-01

By using data-envelopment analysis (DEA), this study evaluates the efficiency of religious not-for-profit hospitals. Hospital executives, healthcare policy makers, taxpayers, and other stakeholders benefit from studies that improve hospital efficiency. Results indicate that overall efficiency in religious hospitals improved from 72% in 1998 to 74% in 2001. What is more important is that the number of religious hospitals operating on the efficiency frontier increased from 40 in 1998 to 47 in 2001. This clearly documents that religious hospitals are becoming more efficient in the management of resources. From a policy perspective, this study highlights the economic importance of encouraging increased efficiency throughout the healthcare industry.

[Initiatives to increase the efficiency of dermatological patient care

NARCIS (Netherlands)

Kerkhof, P.C.M. van de

2006-01-01

The number of tasks required of dermatologists has increased in the last decade. This article discusses potential ways to enhance the efficiency ofdermatological patient care and prevent problems of capacity. A study conducted in the UK found that, for the top 10 skin disorders, the accessibility of

Improved efficiency in OLEDs with a thin Alq3 interlayer

International Nuclear Information System (INIS)

Lian Jiarong; Yuan Yongbo; Cao Lingfang; Zhang Jie; Pang Hongqi; Zhou Yunfei; Zhou Xiang

2007-01-01

We demonstrate an improved efficiency in OLEDs with a thin Alq 3 interlayer, which is inserted into the hole-transport layer for adjusting the hole-injection and transport, and improving the hole-electron balance. The thin Alq 3 interlayer can effectively influence the electrical performance and electroluminescence (EL) efficiency of the devices. The devices with an optimum Alq 3 interlayer exhibit a maximum EL efficiency of around 3.3 cd/A, which is improved by a factor of two over the conventional devices (1.6 cd/A) without the interlayer

Health care managers' views on and approaches to implementing models for improving care processes.

Science.gov (United States)

Andreasson, Jörgen; Eriksson, Andrea; Dellve, Lotta

2016-03-01

To develop a deeper understanding of health-care managers' views on and approaches to the implementation of models for improving care processes. In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome. In-depth interviews with first- and second-line managers in Swedish hospitals were conducted and analysed using grounded theory. 'Coaching for participation' emerged as a central theme for managers in handling top-down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work. Implementation models for improving care processes require a coaching leadership built on close manager-employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process-oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management. © 2015 John Wiley & Sons Ltd.

Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries.

Science.gov (United States)

Seidman, Gabriel; Atun, Rifat

2017-04-13

Task shifting has become an increasingly popular way to increase access to health services, especially in low-resource settings. Research has demonstrated that task shifting, including the use of community health workers (CHWs) to deliver care, can improve population health. This systematic review investigates whether task shifting in low-income and middle-income countries (LMICs) results in efficiency improvements by achieving cost savings. Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL, and the Health Economic Evaluation Database on March 22, 2016. We included any original peer-review articles that demonstrated cost impact of a task shifting program in an LMIC. We identified 794 articles, of which 34 were included in our study. We found that substantial evidence exists for achieving cost savings and efficiency improvements from task shifting activities related to tuberculosis and HIV/AIDS, and additional evidence exists for the potential to achieve cost savings from activities related to malaria, NCDs, NTDs, childhood illness, and other disease areas, especially at the primary health care and community levels. Task shifting presents a viable option for health system cost savings in LMICs. Going forward, program planners should carefully consider whether task shifting can improve population health and health systems efficiency in their countries, and researchers should investigate whether task shifting can also achieve cost savings for activities related to emerging global health priorities and health systems strengthening activities such as supply chain management or monitoring and evaluation.

Improving STEM Undergraduate Education with Efficient Learning Design

DEFF Research Database (Denmark)

Godsk, Mikkel

2018-01-01

The project investigates the potential of Learning Design for efficiently improving STEM undergraduate education with technology. In order to investigate this potential, the project consists of two main studies at Aarhus University: a study of the perspectives of the main stakeholders on Learning...... Design uptake. The project concludes that it is possible to improve STEM undergraduate education with Learning Design for technology-enhanced learning efficiently and that Efficient Learning Design provides a useful concept for qualifying educational decisions....... provided by technology-enhanced learning based on Learning Design, and in particular students’ learning was of a high common interest. However, only the educators were directly interested in Learning Design and its support for design, reuse in their practice and to inform pedagogy. A holistic concept...

Improving care of post-infarct patients: effects of disease management programmes and care according to international guidelines.

Science.gov (United States)

Stark, Renee; Kirchberger, Inge; Hunger, Matthias; Heier, Margit; Leidl, Reiner; von Scheidt, Wolfgang; Meisinger, Christa; Holle, Rolf

2014-03-01

Cardiac disease management programmes (CHD-DMPs) and secondary cardiovascular prevention guidelines aim to improve complex care of post-myocardial infarction (MI) patients. In Germany, CHD-DMPs, in addition to incorporating medical care according to guidelines (guideline-care), also ensure regular quarterly follow-up. Thus, our aim was to examine whether CHD-DMPs increase the frequency of guideline-care and whether CHD-DMPs and guideline-care improve survival over 4 years. The study included 975 post-MI patients, registered by the KORA-MI Registry (Augsburg, Germany), who completed a questionnaire in 2006. CHD-DMP enrolment was reported by physicians. Guideline-care was based on patient reports regarding medical advice (smoking, diet, or exercise) and prescribed medications (statins and platelet aggregation inhibitors plus beta-blockers or renin-angiotensin inhibitors). All-cause mortality until December 31, 2010 was based on municipal registration data. Cox regression analyses were adjusted for age, sex, education, years since last MI, and smoking and diabetes. Physicians reported that 495 patients were CHD-DMP participants. CHD-DMP participation increased the likelihood of receiving guideline-care (odds ratio 1.55, 95% CI 1.20; 2.02) but did not significantly improve survival (hazard rate 0.90, 95% CI 0.64-1.27). Guideline-care significantly improved survival (HR 0.41, 95% CI 0.28; 0.59). Individual guideline-care components, which significantly improved survival, were beta-blockers, statins and platelet aggregation inhibitors. However, these improved survival less than guideline-care. This study shows that CHD-DMPs increase the likelihood of guideline care and that guideline care is the important component of CHD-DMPs for increasing survival. A relatively high percentage of usual care patients receiving guideline-care indicate high quality of care of post-MI patients. Reasons for not implementing guideline-care should be investigated.

Steam Pressure-Reducing Station Safety and Energy Efficiency Improvement Project

Energy Technology Data Exchange (ETDEWEB)

Lower, Mark D [ORNL; Christopher, Timothy W [ORNL; Oland, C Barry [ORNL

2011-06-01

The Facilities and Operations (F&O) Directorate is sponsoring a continuous process improvement (CPI) program. Its purpose is to stimulate, promote, and sustain a culture of improvement throughout all levels of the organization. The CPI program ensures that a scientific and repeatable process exists for improving the delivery of F&O products and services in support of Oak Ridge National Laboratory (ORNL) Management Systems. Strategic objectives of the CPI program include achieving excellence in laboratory operations in the areas of safety, health, and the environment. Identifying and promoting opportunities for achieving the following critical outcomes are important business goals of the CPI program: improved safety performance; process focused on consumer needs; modern and secure campus; flexibility to respond to changing laboratory needs; bench strength for the future; and elimination of legacy issues. The Steam Pressure-Reducing Station (SPRS) Safety and Energy Efficiency Improvement Project, which is under the CPI program, focuses on maintaining and upgrading SPRSs that are part of the ORNL steam distribution network. This steam pipe network transports steam produced at the ORNL steam plant to many buildings in the main campus site. The SPRS Safety and Energy Efficiency Improvement Project promotes excellence in laboratory operations by (1) improving personnel safety, (2) decreasing fuel consumption through improved steam system energy efficiency, and (3) achieving compliance with applicable worker health and safety requirements. The SPRS Safety and Energy Efficiency Improvement Project being performed by F&O is helping ORNL improve both energy efficiency and worker safety by modifying, maintaining, and repairing SPRSs. Since work began in 2006, numerous energy-wasting steam leaks have been eliminated, heat losses from uninsulated steam pipe surfaces have been reduced, and deficient pressure retaining components have been replaced. These improvements helped ORNL

Delivering Cost-Efficient Public Services in Health Care, Education and Housing in Chile. OECD Economics Department Working Papers, No. 606

Science.gov (United States)

Moccero, D.

2008-01-01

The Chilean authorities plan to raise budgetary allocations over the medium term for a variety of social programmes, including education, health care and housing. This incremental spending will need to be carried out in a cost-efficient manner to make sure that it yields commensurate improvements in social outcomes. Chile's health indicators show…

Developing evidence-based maternity care in Iran: a quality improvement study

Directory of Open Access Journals (Sweden)

Mohammad Kazem

2008-06-01

Full Text Available Abstract Background Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. Methods The major steps of the study were to (1 identify women's needs, values and preferences via interviews, (2 select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3 redesign care based on the selected evidence-based recommendations and women's views, and (4 implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model. Results Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p Conclusion The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.

Nationwide quality improvement in lung cancer care

DEFF Research Database (Denmark)

Jakobsen, Erik Winther; Green, Anders; Oesterlind, Kell

2013-01-01

To improve prognosis and quality of lung cancer care the Danish Lung Cancer Group has developed a strategy consisting of national clinical guidelines and a clinical quality and research database. The first edition of our guidelines was published in 1998 and our national lung cancer registry...... was opened for registrations in 2000. This article describes methods and results obtained by multidisciplinary collaboration and illustrates how quality of lung cancer care can be improved by establishing and monitoring result and process indicators....

Nurses improve migraine management in primary care

NARCIS (Netherlands)

Veenstra, Petra; Kollen, Boudewijn J.; de Jong, Gosse; Baarveld, Frans; van den Berg, J. S. Peter

Introduction Migraine is a common disorder with a high burden. Adequate treatment results in improvement of quality of life. Migraine patients are mainly treated by general practitioners (GPs), but there is still room for improvement. This study investigated whether primary care nurses could improve

DTU International Energy Report 2012: Energy efficiency improvements

DEFF Research Database (Denmark)

Increased energy efficiency can reduce global CO2 emissions over the period to 2050 with up to 25%. On the top of that large profits can be gained for very little investment. Energy efficiency improvements can save investment in new energy infrastructure, cut fuel costs, increase competitiveness...... and increase consumer welfare. Thus, it is natural for DTU International Energy Report 2012 to take up this issue and analyze the global, regional and national challenges in exploiting energy efficiency and promote research and development in energy efficiency....

Context in Quality of Care: Improving Teamwork and Resilience.

Science.gov (United States)

Tawfik, Daniel S; Sexton, John Bryan; Adair, Kathryn C; Kaplan, Heather C; Profit, Jochen

2017-09-01

Quality improvement in health care is an ongoing challenge. Consideration of the context of the health care system is of paramount importance. Staff resilience and teamwork climate are key aspects of context that drive quality. Teamwork climate is dynamic, with well-established tools available to improve teamwork for specific tasks or global applications. Similarly, burnout and resilience can be modified with interventions such as cultivating gratitude, positivity, and awe. A growing body of literature has shown that teamwork and burnout relate to quality of care, with improved teamwork and decreased burnout expected to produce improved patient quality and safety. Copyright © 2017 Elsevier Inc. All rights reserved.

Critical Care Nurses' Suggestions to Improve End-of-Life Care Obstacles: Minimal Change Over 17 Years.

Science.gov (United States)

Beckstrand, Renea L; Hadley, Kacie Hart; Luthy, Karlen E; Macintosh, Janelle L B

Critical-care nurses (CCNs) provide end-of-life (EOL) care on a daily basis as 1 in 5 patients dies while in intensive care units. Critical-care nurses overcome many obstacles to perform quality EOL care for dying patients. The purposes of this study were to collect CCNs' current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998. A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2000 members of the American Association of Critical-Care Nurses. One of 3 qualitative questions asked CCNs for suggestions to improve EOL care. Comparative obstacle size (quantitative) data were previously published. Of the 509 returned questionnaires, 322 (63.3%) had 385 written suggestions for improving EOL care. Major themes identified were ensuring characteristics of a good death, improving physician communication with patients and families, adjusting nurse-to-patient ratios to 1:1, recognizing and avoiding futile care, increasing EOL education, physicians who are present and "on the same page," not allowing families to override patients' wishes, and the need for more support staff. When compared with data gathered 17 years previously, major themes remained the same but in a few cases changed in order and possible causation. Critical-care nurses' suggestions were similar to those recommendations from 17 years ago. Although the order of importance changed minimally, the number of similar themes indicated that obstacles to providing EOL care to dying intensive care unit patients continue to exist over time.

Strategies to improve quality of childbirth care

Directory of Open Access Journals (Sweden)

farahnaz Changaee

2015-01-01

Full Text Available Background: Access to affordable and quality health care is one of the most important ways for reducing maternal and child mortality. The purpose of this study was to provide strategies to promote the quality of care during childbirth in Lorestan province in 2011. Materials and Methods: This research was a mixed method (quantitative, qualitative, study in which quality of 200 care during childbirth in hospitals of Lorestan Province were evaluated. Data gathered through self-made tools (Checklists prepared according to the guidelines of the ministry of health. Descriptive statistics and SPSS software were used to data analysis.In the second part of the study which was qualitative, interview with service providers, hospital officials and high-ranking officials of Lorestan university of medical sciences (decision makers was used to discuss strategies to improve the quality of care. Results: The results showed that the care of the first stage delivery in %54.5, second stage %57 and third stage 66% were in accordance with the desired status and care in this three stages was of moderate quality. Based on the interviews, the officials who are in charge of Lorestan university of medical sciences, proposed strategies such as financial incentives and in-service training of midwives as suitable strategies to improve quality of services. Conclusion: According to the results, strategies such as financial incentives, increased use of private sector services to reduce the workload of the public sector and increase of quality and use of more in-service training, to improve the quality of services, are recommended.

Implementing Family Meetings Into a Respiratory Care Unit: A Care and Communication Quality Improvement Project.

Science.gov (United States)

Loeslie, Vicki; Abcejo, Ma Sunnimpha; Anderson, Claudia; Leibenguth, Emily; Mielke, Cathy; Rabatin, Jeffrey

Substantial evidence in critical care literature identifies a lack of quality and quantity of communication between patients, families, and clinicians while in the intensive care unit. Barriers include time, multiple caregivers, communication skills, culture, language, stress, and optimal meeting space. For patients who are chronically critically ill, the need for a structured method of communication is paramount for discussion of goals of care. The objective of this quality improvement project was to identify barriers to communication, then develop, implement, and evaluate a process for semistructured family meetings in a 9-bed respiratory care unit. Using set dates and times, family meetings were offered to patients and families admitted to the respiratory care unit. Multiple avenues of communication were utilized to facilitate attendance. Utilizing evidence-based family meeting literature, a guide for family meetings was developed. Templates were developed for documentation of the family meeting in the electronic medical record. Multiple communication barriers were identified. Frequency of family meeting occurrence rose from 31% to 88%. Staff satisfaction with meeting frequency, meeting length, and discussion of congruent goals of care between patient/family and health care providers improved. Patient/family satisfaction with consistency of message between team members; understanding of medications, tests, and dismissal plan; and efficacy to address their concerns with the medical team improved. This quality improvement project was implemented to address the communication gap in the care of complex patients who require prolonged hospitalizations. By identifying this need, engaging stakeholders, and developing a family meeting plan to meet to address these needs, communication between all members of the patient's care team has improved.

Crossing boundaries : improving communication in cerebral palsy care

NARCIS (Netherlands)

Gulmans-Weitenberg, Jitske

2012-01-01

The aim of the present thesis was to contribute to the improvement of patient care communication across the integrated care setting of children with cerebral palsy. Hereto, we followed two subsequent phases: 1) obtaining a better understanding of the experienced quality of patient care communication

A quality improvement management model for renal care.

Science.gov (United States)

Vlchek, D L; Day, L M

1991-04-01

The purpose of this article is to explore the potential for applying the theory and tools of quality improvement (total quality management) in the renal care setting. We believe that the coupling of the statistical techniques used in the Deming method of quality improvement, with modern approaches to outcome and process analysis, will provide the renal care community with powerful tools, not only for improved quality (i.e., reduced morbidity and mortality), but also for technology evaluation and resource allocation.

Improving Reliability, Security, and Efficiency of Reconfigurable Hardware Systems (Habilitation)

NARCIS (Netherlands)

Ziener, Daniel

2017-01-01

In this treatise,  my research on methods to improve efficiency, reliability, and security of reconfigurable hardware systems, i.e., FPGAs, through partial dynamic reconfiguration is outlined. The efficiency of reconfigurable systems can be improved by loading optimized data paths on-the-fly on an

Efficiency improvement opportunities in TVs: Implications for market transformation programs

International Nuclear Information System (INIS)

Park, Won Young; Phadke, Amol; Shah, Nihar; Letschert, Virginie

2013-01-01

Televisions (TVs) account for a significant portion of residential electricity consumption and global TV shipments are expected to continue to increase. We assess the market trends in the energy efficiency of TVs that are likely to occur without any additional policy intervention and estimate that TV efficiency will likely improve by over 60% by 2015 with savings potential of 45 terawatt-hours [TW h] per year in 2015, compared to today’s technology. We discuss various energy-efficiency improvement options and evaluate the cost effectiveness of three of them. At least one of these options improves efficiency by at least 20% cost effectively beyond ongoing market trends. We provide insights for policies and programs that can be used to accelerate the adoption of efficient technologies to further capture global energy savings potential from TVs which we estimate to be up to 23 TW h per year in 2015. - Highlights: • We analyze the impact of the recent TV market transition on TV energy consumption. • We review TV technology options that could be realized in the near future. • We assess the cost-effectiveness of selected energy-efficiency improvement options. • We estimate global electricity savings potential in selected scenarios. • We discuss possible directions of market transformation programs

Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples

Directory of Open Access Journals (Sweden)

McDermott Robyn

2010-05-01

health care and fostering effective and efficient exchange and use of data and information among service providers and policy makers to achieve evidence-based resource allocation, service planning, system development, and improvements of service delivery and Indigenous health outcomes.

Improving crop nutrient efficiency through root architecture modifications.

Science.gov (United States)

Li, Xinxin; Zeng, Rensen; Liao, Hong

2016-03-01

Improving crop nutrient efficiency becomes an essential consideration for environmentally friendly and sustainable agriculture. Plant growth and development is dependent on 17 essential nutrient elements, among them, nitrogen (N) and phosphorus (P) are the two most important mineral nutrients. Hence it is not surprising that low N and/or low P availability in soils severely constrains crop growth and productivity, and thereby have become high priority targets for improving nutrient efficiency in crops. Root exploration largely determines the ability of plants to acquire mineral nutrients from soils. Therefore, root architecture, the 3-dimensional configuration of the plant's root system in the soil, is of great importance for improving crop nutrient efficiency. Furthermore, the symbiotic associations between host plants and arbuscular mycorrhiza fungi/rhizobial bacteria, are additional important strategies to enhance nutrient acquisition. In this review, we summarize the recent advances in the current understanding of crop species control of root architecture alterations in response to nutrient availability and root/microbe symbioses, through gene or QTL regulation, which results in enhanced nutrient acquisition. © 2015 Institute of Botany, Chinese Academy of Sciences.

Electric motor systems in developing countries: Opportunities for efficiency improvement

Energy Technology Data Exchange (ETDEWEB)

Meyers, S.; Monahan, P.; Lewis, P.; Greenberg, S. [Lawrence Berkeley Lab., CA (United States); Nadel, S. [American Council for an Energy-Efficient Economy, Washington, DC (United States)

1993-08-01

This report presents an overview of the current status and efficiency improvement potential of industrial motor systems in developing countries. Better management of electric motor systems is of particular relevance in developing countries, where improved efficiency can lead to increased productivity and slower growth in electricity demand. Motor systems currently consume some 65--80% of the industrial electricity in developing countries. Drawing on studies from Thailand, India, Brazil, China, Pakistan, and Costa Rica, we describe potential efficiency gains in various parts of the motor system, from the electricity delivery system through the motor to the point where useful work is performed. We report evidence of a significant electricity conservation potential. Most of the efficiency improvement methods we examine are very cost-effective from a societal viewpoint, but are generally not implemented due to various barriers that deter their adoption. Drawing on experiences in North America, we discuss a range of policies to overcome these barriers, including education, training, minimum efficiency standards, motor efficiency testing protocols, technical assistance programs, and financial incentives.

Idaho Chemical Processing Plant Process Efficiency improvements

International Nuclear Information System (INIS)

Griebenow, B.

1996-03-01

In response to decreasing funding levels available to support activities at the Idaho Chemical Processing Plant (ICPP) and a desire to be cost competitive, the Department of Energy Idaho Operations Office (DOE-ID) and Lockheed Idaho Technologies Company have increased their emphasis on cost-saving measures. The ICPP Effectiveness Improvement Initiative involves many activities to improve cost effectiveness and competitiveness. This report documents the methodology and results of one of those cost cutting measures, the Process Efficiency Improvement Activity. The Process Efficiency Improvement Activity performed a systematic review of major work processes at the ICPP to increase productivity and to identify nonvalue-added requirements. A two-phase approach was selected for the activity to allow for near-term implementation of relatively easy process modifications in the first phase while obtaining long-term continuous improvement in the second phase and beyond. Phase I of the initiative included a concentrated review of processes that had a high potential for cost savings with the intent of realizing savings in Fiscal Year 1996 (FY-96.) Phase II consists of implementing long-term strategies too complex for Phase I implementation and evaluation of processes not targeted for Phase I review. The Phase II effort is targeted for realizing cost savings in FY-97 and beyond

Big data analytics to improve cardiovascular care: promise and challenges.

Science.gov (United States)

Rumsfeld, John S; Joynt, Karen E; Maddox, Thomas M

2016-06-01

The potential for big data analytics to improve cardiovascular quality of care and patient outcomes is tremendous. However, the application of big data in health care is at a nascent stage, and the evidence to date demonstrating that big data analytics will improve care and outcomes is scant. This Review provides an overview of the data sources and methods that comprise big data analytics, and describes eight areas of application of big data analytics to improve cardiovascular care, including predictive modelling for risk and resource use, population management, drug and medical device safety surveillance, disease and treatment heterogeneity, precision medicine and clinical decision support, quality of care and performance measurement, and public health and research applications. We also delineate the important challenges for big data applications in cardiovascular care, including the need for evidence of effectiveness and safety, the methodological issues such as data quality and validation, and the critical importance of clinical integration and proof of clinical utility. If big data analytics are shown to improve quality of care and patient outcomes, and can be successfully implemented in cardiovascular practice, big data will fulfil its potential as an important component of a learning health-care system.

Costs and benefits of energy efficiency improvements in ceiling fans

Energy Technology Data Exchange (ETDEWEB)

Shah, Nihar; Sathaye, Nakul; Phadke, Amol; Letschert, Virginie [Lawrence Berkeley National Lab., CA (United States). Environmental Energy Technology Division

2013-10-15

Ceiling fans contribute significantly to residential electricity consumption, especially in developing countries with warm climates. The paper provides analysis of costs and benefits of several options to improve the efficiency of ceiling fans to assess the global potential for electricity savings and green house gas (GHG) emission reductions. Ceiling fan efficiency can be cost-effectively improved by at least 50% using commercially available technology. If these efficiency improvements are implemented in all ceiling fans sold by 2020, 70 terawatt hours per year could be saved and 25 million metric tons of carbon dioxide equivalent (CO2-e) emissions per year could be avoided, globally. We assess how policies and programs such as standards, labels, and financial incentives can be used to accelerate the adoption of efficient ceiling fans in order to realize potential savings.

Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping

Directory of Open Access Journals (Sweden)

Tara Sampalli

2015-07-01

Full Text Available Background Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely – an adaptation of Value Stream Mapping (VSM to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. Methods Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. Results The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. Conclusion Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions.

Managing Quality in Health Care: Involving Patient Care Information Systems and Healthcare Professionals in Quality Monitoring and Improvement

NARCIS (Netherlands)

M. de Mul (Marleen)

2009-01-01

textabstractIt is no longer possible to ignore the issue of quality in health care. Care institutions strive to provide all patients with effective, efficient, safe, timely, patient-centered care. Increased attention for quality is also found in discussions regarding use of information

Women's Suggestions for Improving Midwifery Care in The Netherlands.

Science.gov (United States)

Baas, Carien I; Erwich, Jan Jaap H M; Wiegers, Therese A; de Cock, T Paul; Hutton, Eileen K

2015-12-01

The experience of the care a woman receives during pregnancy and childbirth has an immediate and long-lasting effect on her well being. The involvement of patients and clients in health care has increased over the last decades. The Dutch maternity care system offers an excellent opportunity to explore and involve women's suggestions for the improvement of midwifery care in the current maternity care model. This qualitative study is part of the "DELIVER" study. Clients were recruited from 20 midwifery practices. Purposive sampling was used to select the practices. The clients received up to three questionnaires, in which they could respond to the question; "Do you have any suggestions on how your midwife could improve his/her provision of care?" The answers were analyzed with a qualitative thematic content analysis, using the software program MAXQDA. Altogether, 3,499 answers were provided. One overarching concept emerged: clients' desire for individualized care. Within this concept, suggestions could be clustered around 1) provider characteristics: interpersonal skills, communication, and competence, and 2) service characteristics: content and quantity of care, guidance and support, continuity of care provider, continuity of care, information, and coordination of care. Informed by the suggestions of women, care to women and their families could be improved by the following: 1) more continuity of the care provider during the prenatal, natal, and postnatal periods, 2) more information and information specifically tailored for the person, 3) client-centered communication, and 4) a personal approach with 5) enough time spent per client. © 2015 Wiley Periodicals, Inc.

Enhancing systems to improve the management of acute, unscheduled care.

Science.gov (United States)

Braithwaite, Sabina A; Pines, Jesse M; Asplin, Brent R; Epstein, Stephen K

2011-06-01

For acutely ill patients, health care services are available in many different settings, including hospital-based emergency departments (EDs), retail clinics, federally qualified health centers, and outpatient clinics. Certain conditions are the sole domain of particular settings: stabilization of critically ill patients can typically only be provided in EDs. By contrast, many conditions that do not require hospital resources, such as advanced radiography, admission, and same-day consultation can often be managed in clinic settings. Because clinics are generally not open nights, and often not on weekends or holidays, the ED remains the only option for face-to-face medical care during these times. For patients who can be managed in either setting, there are many open research questions about which is the best setting, because these venues differ in terms of access, costs of care, and potentially, quality. Consideration of these patients must be risk-adjusted, as patients may self-select a venue for care based upon perceived acuity. We present a research agenda for acute, unscheduled care in the United States developed in conjunction with an Agency for Healthcare Research and Quality-funded conference hosted by the American College of Emergency Physicians in October 2009, titled "Improving the Quality and Efficiency of Emergency Care Across the Continuum: A Systems Approach." Given the possible increase in ED utilization over the next several years as more people become insured, understanding differences in cost, quality, and access for conditions that may be treated in EDs or clinic settings will be vital in guiding national health policy. © 2011 by the Society for Academic Emergency Medicine.

[Improvement in the efficiency of a rehabilitation service using Lean Healthcare methodology].

Science.gov (United States)

Pineda Dávila, S; Tinoco González, J

2015-01-01

The aim of this study was to evaluate the reduction in costs and the increase in time devoted to the patient, by applying Lean Healthcare methodology. A multidisciplinary team was formed, setting up three potential areas for improvement by performing a diagnostic process, including the storage and standardization of materials, and professional tasks in the therapeutic areas, by implementing three Lean tools: kanban, 5S and 2P. Stored material costs decreased by 43%, the cost of consumables per patient treated by 19%, and time dedicated to patient treatment increased by 7%. The processes were standardized and "muda" (wastefulness) was eliminated, thus reducing costs and increasing the value to the patient. All this demonstrates that it is possible to apply tools of industrial origin to the health sector, with the aim of improving the quality of care and achieve maximum efficiency. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

New raw materials improve packing sealing efficiency

International Nuclear Information System (INIS)

Igel, B.; McKeague, L.

2012-01-01

End-users and OEM's using or manufacturing on/off and control valves expect a permanent and effective increase in service life together with an increased sealing capability while at the same time minimizing maintenance concerns. Developing materials which provide consistency and repeatability are essential characteristics to optimizing valve performance. “New Generation” materials and yarn allow us to meet this growing demand while complying with the requirements related to chemical purity and an increased level of safety to both plant workers and equipment in the nuclear environment. Through R&D initiatives and developments in new and improved raw materials; a new mechanical packing generation which optimizes friction coefficients and extended life cycle has been introduced to the industry. Lower friction values drastically optimize actuator effort and size improving efficiency for stem operation with significant improvements in flow control of fluids. Combined with new and improved procedures (installation, torque levels and consolidation recommendations), this new packing generation has provided significant improvement in the mechanical behavior of packing materials (independent tests carried out in collaboration with AECL and CETIM) this has provided the opportunity to develop successful Valve Enhancement Programs which offer improved efficiency, valve operation and repeatability. These NEW generation yarns are available with or without wire reinforcement depending on specific operating parameters and conditions. The purpose of this presentation is to demonstrate that new generation material(s). Which are available to the industry for AOV, MOV and Manual valves? - To highlight the steps taken in R&D and manufacturing contributing to the much improved yarns and finished packing products. - Comply and are designed to meet the stringent requirements in the nuclear industry - Simplify valve maintenance without risk to safety or performance - Increase service

Applying Bureaucratic Caring Theory and the Chronic Care Model to Improve Staff and Patient Self-Efficacy.

Science.gov (United States)

Potter, Marcia A; Wilson, Candy

Patient activation and engagement can be powerful enablers for health outcomes that are just as important as staff engagement and satisfaction. The authors applied the Bureaucratic Caring Theory and the Chronic Care Model to a process improvement project designed to link activation, engagement, satisfaction, and health outcomes. Twenty-two adults with diabetes and 7 staff members caring for them participated in a 12-week process improvement project that incorporated a time-based element of longitudinal care with skill-based competencies to provide collaborative, team-based care to patients with type 2 diabetes. Patients completed satisfaction surveys at the end of their clinical encounters. Staff members completed satisfaction surveys pre- and postimplementation. The authors analyzed hemoglobin A1C levels pre- and postimplementation. As engagement and activation increased for both staff and patients, hemoglobin A1C levels decreased. The clinical implication is that the use of Bureaucratic Caring Theory may foster caring while broad application of the Chronic Care Model may improve self-efficacy, create healthier populations, and reduce health care costs.

Efficiency improvements in transport

Energy Technology Data Exchange (ETDEWEB)

Schramm, J. [Technical Univ. of Denmark. DTU Mechanical Engineering, Kgs. Lyngby (Denmark); Christensen, Linda; Jensen, Thomas C. [Technical Univ. of Denmark. DTU Transport, Kgs. Lyngby (Denmark)

2012-11-15

Transport of people, personal belongings and goods in private cars is fundamental to our modern welfare society and economic growth, and has grown steadily over many decades. Motor fuels have been based almost entirely on crude oil for the last century. During the last couple of decades engines built for traditional fuels have become more advanced and efficient; this has reduced fuel consumption by around 40% and emissions by more than 90%. Only in the same time span have we begun to look at alternatives to fossil fuels. Biofuels such as biodiesel, bioethanol, biomethanol and biogas can replace petrol and diesel, and in recent years algae have shown a new potential for diesel fuel. Natural gas is also becoming an interesting fuel due to its large resources worldwide. GTL, CTL and BTL are liquid fuels produced from solid or gaseous sources. GTL and CTL are expensive to produce and not very CO{sub 2}-friendly, but they are easily introduced and need little investment in infrastructure and vehicles. DME is an excellent fuel for diesel engines. Methanol and DME produced from biomass are among the most CO{sub 2}-reducing fuels and at the same time the most energy-efficient renewable fuels. Fuel cell vehicles (FCVs) are currently fuelled by hydrogen, but other fuels are also possible. There are, however, several barriers to the implementation of fuel cell vehicles. In particular, a hydrogen infrastructure needs to be developed. Electric vehicles (EVs) have the advantage that energy conversion is centralised at the power plant where it can be done at optimum efficiency and emissions. EVs have to be charged at home, and also away from home when travelling longer distances. With an acceptable fast charging infrastructure at least 85% of the one-car families in Denmark could be potential EV customers. Range improvements resulting from better batteries are expected to create a large increase in the number of EVs in Denmark between 2020 and 2030. The hybrid electric vehicle

Upgrading and efficiency improvement in coal-fired power plants

Energy Technology Data Exchange (ETDEWEB)

NONE

2013-08-01

Improving the efficiencies of the large number of older coal-fired power plants operating around the world would give major savings in CO2 emissions together with significant other benefits. This report begins with a summary of the ways efficiency can become degraded and of the means available to combat the decrease in performance. These include improvements to operating and maintenance practices and more major techniques that are available, including boiler and turbine retrofits. There is also an update on fuel drying developments as a route to higher efficiency in plants firing high moisture lignites. The largest chapter of the report contains a number of descriptions of case study improvement projects, to illustrate measures that have been applied, benefits that have been achieved and identify best practices, which are summarised. Major national and international upgrading programmes are described.

Improvement of the Dehulling Efficiency of Sorghum and Millet using ...

African Journals Online (AJOL)

Conditioning of grain with heat and moisture is known to loosen the adhesion of the seed coat from the endosperm and therefore improve the dehulling efficiency of some grains such as beans, cowpea and canola. This study investigated the effect of hydrothermal treatment on the improvement of dehulling efficiency of ...

The efficiency frontier approach to economic evaluation of health-care interventions.

Science.gov (United States)

Caro, J Jaime; Nord, Erik; Siebert, Uwe; McGuire, Alistair; McGregor, Maurice; Henry, David; de Pouvourville, Gérard; Atella, Vincenzo; Kolominsky-Rabas, Peter

2010-10-01

IQWiG commissioned an international panel of experts to develop methods for the assessment of the relation of benefits to costs in the German statutory health-care system. The panel recommended that IQWiG inform German decision makers of the net costs and value of additional benefits of an intervention in the context of relevant other interventions in that indication. To facilitate guidance regarding maximum reimbursement, this information is presented in an efficiency plot with costs on the horizontal axis and value of benefits on the vertical. The efficiency frontier links the interventions that are not dominated and provides guidance. A technology that places on the frontier or to the left is reasonably efficient, while one falling to the right requires further justification for reimbursement at that price. This information does not automatically give the maximum reimbursement, as other considerations may be relevant. Given that the estimates are for a specific indication, they do not address priority setting across the health-care system. This approach informs decision makers about efficiency of interventions, conforms to the mandate and is consistent with basic economic principles. Empirical testing of its feasibility and usefulness is required.

Association of medical home team-based care functions and perceived improvements in patient-centered care at VHA primary care clinics.

Science.gov (United States)

Helfrich, Christian D; Dolan, Emily D; Fihn, Stephan D; Rodriguez, Hector P; Meredith, Lisa S; Rosland, Ann-Marie; Lempa, Michele; Wakefield, Bonnie J; Joos, Sandra; Lawler, Lauren H; Harvey, Henry B; Stark, Richard; Schectman, Gordon; Nelson, Karin M

2014-12-01

Team-based care is central to the patient-centered medical home (PCMH), but most PCMH evaluations measure team structure exclusively. We assessed team-based care in terms of team structure, process and effectiveness, and the association with improvements in teams׳ abilities to deliver patient-centered care. We fielded a cross-sectional survey among 913 VA primary care clinics implementing a PCMH model in 2012. The dependent variable was clinic-level respondent-reported improvements in delivery of patient-centered care. Independent variables included three sets of measures: (1) team structure, (2) team process, and (3) team effectiveness. We adjusted for clinic workload and patient comorbidity. 4819 surveys were returned (25% estimated response rate). The highest ratings were for team structure (median of 89% of respondents being assigned to a teamlet, i.e., a PCP working with the same clinical associate, nurse care manager and clerk) and lowest for team process (median of 10% of respondents reporting the lowest level of stress/chaos). In multivariable regression, perceived improvements in patient-centered care were most strongly associated with participatory decision making (β=32, Pteam processes). A stressful/chaotic clinic environment was associated with higher barriers to patient centered care (β=0.16-0.34, P=Team process and effectiveness measures, often omitted from PCMH evaluations, had stronger associations with perceived improvements in patient-centered care than team structure measures. Team process and effectiveness measures may facilitate synthesis of evaluation findings and help identify positive outlier clinics. Published by Elsevier Inc.

Improving care for patients whose recovery is uncertain. The AMBER care bundle: design and implementation.

Science.gov (United States)

Carey, Irene; Shouls, Susanna; Bristowe, Katherine; Morris, Michelle; Briant, Linda; Robinson, Carole; Caulkin, Ruth; Griffiths, Mathew; Clark, Kieron; Koffman, Jonathan; Hopper, Adrian

2015-12-01

Despite preferences to the contrary, 53% of deaths in England occur in hospital. Difficulties in managing clinical uncertainty can result in delayed recognition that a person may be approaching the end of life, and a failure to address his/her preferences. Planning and shared decision-making for hospital patients need to improve where an underlying condition responds poorly to acute medical treatment and there is a risk of dying in the next 1-2 months. This paper suggests an approach to improve this care. A care bundle (the AMBER care bundle) was designed by a multiprofessional development team, which included service users, utilising the model for improvement following an initial scoping exercise. The care bundle includes two identification questions, four subsequent time restricted actions and systematic daily follow-up. This paper describes the development and implementation of a care bundle. From August 2011 to July 2012, 638 patients received care supported by the AMBER care bundle. In total 42.8% died in hospital and a further 14.5% were readmitted as emergencies within 30 days of discharge. Clinical outcome measures are in development. It has been possible to develop a care bundle addressing a complex area of care which can be a lever for cultural change. The implementation of the AMBER care bundle has the potential to improve care of clinically uncertain hospital patients who may be approaching the end of life by supporting their recognition and prompting discussion of their preferences. Outcomes associated with its use are currently being formally evaluated. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial.

NARCIS (Netherlands)

Ven, G. van de; Draskovic, I.; Adang, E.M.M.; Donders, R.; Post, A.; Zuidema, S.U.; Koopmans, R.T.C.M.; Vernooij-Dassen, M.J.F.J.

2012-01-01

BACKGROUND: The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the

Does automation improve stock market efficiency in Ghana ...

African Journals Online (AJOL)

The automation of the Ghana Stock Exchange (GSE) in 2008, among other reforms, was expected to improve the efficiency of the market. The extent of this truism has, however, not been empirically established for the GSE. In this study, we attempt to assess the impact of the automation on the efficiency of the GSE within the ...

Towards more efficient burn care: Identifying factors associated with good quality of life post-burn.

Science.gov (United States)

Finlay, V; Phillips, M; Allison, G T; Wood, F M; Ching, D; Wicaksono, D; Plowman, S; Hendrie, D; Edgar, D W

2015-11-01

As minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quality of life (QoL) post-burn is a valid way to optimise patient selection and risk management when applying a streamlined model of care. A sample of 224 burn patients managed by the Burn Service of Western Australia who provided both short and long-term outcomes was used to estimate the probability of achieving a good QoL defined as 150 out of a possible 160 points on the Burn Specific Health Scale-Brief (BSHS-B) at least six months from injury. A multivariate logistic regression analysis produced a predictive model provisioned as a nomogram for clinical application. A second, independent cohort of consecutive patients (n=106) was used to validate the predictive merit of the nomogram. Male gender (p=0.02), conservative management (p=0.03), upper limb burn (p=0.04) and high BSHS-B score within one month of burn (pburns were excluded due to loss to follow up. For clinicians managing comparable burn populations, the BSWA burns nomogram is an effective tool to assist the selection of patients to a streamlined care pathway with the aim of improving efficiency of service delivery. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

An Integrative Behavioral Health Care Model Using Automated SBIRT and Care Coordination in Community Health Care.

Science.gov (United States)

Dwinnells, Ronald; Misik, Lauren

2017-10-01

Efficient and effective integration of behavioral health programs in a community health care practice emphasizes patient-centered medical home principles to improve quality of care. A prospective, 3-period, interrupted time series study was used to explore which of 3 different integrative behavioral health care screening and management processes were the most efficient and effective in prompting behavioral health screening, identification, interventions, and referrals in a community health practice. A total of 99.5% ( P < .001) of medical patients completed behavioral health screenings; brief intervention rates nearly doubled to 83% ( P < .001) and 100% ( P < .001) of identified at-risk patients had referrals made using a combination of electronic tablets, electronic medical record, and behavioral health care coordination.

Improving coverage of postnatal care in rural Ethiopia using a community-based, collaborative quality improvement approach.

Science.gov (United States)

Tesfaye, Solomon; Barry, Danika; Gobezayehu, Abebe Gebremariam; Frew, Aynalem Hailemichael; Stover, Kim Ethier; Tessema, Hana; Alamineh, Lamesgin; Sibley, Lynn M

2014-01-01

Ethiopia has high maternal and neonatal mortality and low use of skilled maternity care. The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP), a 3.5-year learning project, used a community collaborative quality improvement approach to improve maternal and newborn health care during the birth-to-48-hour period. This study examines how the promotion of community maternal and newborn health (CMNH) family meetings and labor and birth notification contributed to increased postnatal care within 48 hours by skilled providers or health extension workers. Baseline and endline surveys, monthly quality improvement data, and MaNHEP's CMNH change package, a compendium of the most effective changes developed and tested by communities, were reviewed. Logistic regression assessed factors associated with postnatal care receipt. Monthly postnatal care receipt was plotted with control charts. The baseline (n = 1027) and endline (n = 1019) surveys showed significant increases in postnatal care, from 5% to 51% and from 15% to 47% in the Amhara and Oromiya regions, respectively (both P care. Women with any antenatal care were 1.7 times more likely to have had a postnatal care visit (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.10-2.54; P care (OR, 4.86; 95% CI, 2.67-8.86; P care far exceeds the 7% postnatal care coverage rate reported in the 2011 Ethiopian Demographic and Health Survey (EDHS). This result was linked to ideas generated by community quality improvement teams for labor and birth notification and cooperation with community-level health workers to promote antenatal care and CMNH family meetings. © 2014 by the American College of Nurse-Midwives.

Energy efficiency improvements in ammonia production--perspectives and uncertainties

International Nuclear Information System (INIS)

Rafiqul, Islam; Weber, Christoph; Lehmann, Bianca; Voss, Alfred

2005-01-01

The paper discusses the energy consumption and energy saving potential for a major energy-intensive product in the chemical industry-ammonia, based on technologies currently in use and possible process improvements. The paper consists of four parts. In the first part, mainly references to various ammonia production technologies are given. Energy consumption, emissions and saving potentials are discussed in the second part. Thereby, the situation in Europe, the US and India is highlighted and various data sources are compared. In the third part of the paper, a novel approach for modeling energy efficiency improvements is described that accounts for uncertainties and unobserved heterogeneity in the production processes. Besides new investments, revamping investments are also included in the modeling and the development of the production stock is accounted for. Finally, in the fourth part, this approach is applied to the modeling of energy efficiency improvements and CO 2 emission reductions in ammonia production. Thereby, considerable improvements in specific energy use and CO 2 emissions are found in the reference scenario, yet under the assumption of high oil and gas prices, a partial switch to coal based technologies is expected which lowers notably the CO 2 efficiency. Introduction of a CO 2 penalty under a certificate trading or other regime is on contrary found to foster energy efficiency and the use of low carbon technologies

Improving Communication About Serious Illness in Primary Care: A Review.

Science.gov (United States)

Lakin, Joshua R; Block, Susan D; Billings, J Andrew; Koritsanszky, Luca A; Cunningham, Rebecca; Wichmann, Lisa; Harvey, Doreen; Lamey, Jan; Bernacki, Rachelle E

2016-09-01

The Institute of Medicine recently called for systematic improvements in clinician-led conversations about goals, values, and care preferences for patients with serious and life-threatening illnesses. Studies suggest that these conversations are associated with improved outcomes for patients and their families, enhanced clinician satisfaction, and lower health care costs; however, the role of primary care clinicians in driving conversations about goals and priorities in serious illness is not well defined. To present a review of a structured search of the evidence base about communication in serious illness in primary care. MEDLINE was searched, via PubMed, on January 19, 2016, finding 911 articles; 126 articles were reviewed and selected titles were added from bibliography searches. Review of the literature informed 2 major topic areas: the role of primary care in communication about serious illness and clinician barriers and system failures that interfere with effective communication. Literature regarding the role that primary care plays in communication focused primarily on the ambiguity about whether primary care clinicians or specialists are responsible for initiating conversations, the benefits of primary care clinicians and specialists conducting conversations, and the quantity and quality of discussions. Timely and effective communication about serious illness in primary care is hampered by key clinician barriers, which include deficits in knowledge, skills, and attitudes; discomfort with prognostication; and lack of clarity about the appropriate timing and initiation of conversations. Finally, system failures in coordination, documentation, feedback, and quality improvement contribute to lack of conversations. Clinician and system barriers will challenge primary care clinicians and institutions to meet the needs of patients with serious illness. Ensuring that conversations about goals and values occur at the appropriate time for seriously ill patients will

Spreading The Net: The Multiple Benefits Of Energy Efficiency Improvements

Energy Technology Data Exchange (ETDEWEB)

NONE

2012-07-01

Improving energy efficiency can deliver a range of benefits to the economy and society. However energy efficiency programmes are often evaluated only on the basis of the energy savings they deliver. As a result, the full value of energy efficiency improvements in both national and global economies may be significantly underestimated. This also means that energy efficiency policy may not be optimised to target the potential of the full range of outcomes possible. Moreover, when the merit of energy efficiency programmes is judged solely on reductions in energy demand, programmes are susceptible to criticisms related to the rebound effect when the energy savings are less than expected due to other welfare gains. There are several reasons why the full range of outcomes from energy efficiency policy is not generally evaluated. First, it is due to the non-market, somewhat intangible, nature of the socioeconomic benefits, which makes them difficult to quantify. Second, the effects due to energy efficiency alone can be complex to isolate and to determine causality. Third, evaluators and policy makers working in the energy efficiency sphere are usually energy professionals, working for an energy agency or ministry, with little experience of how energy efficiency might impact other non-energy sectors. The result is an under-appreciation – and related underinvestment – in energy efficiency, and as a consequence, missed opportunities and benefits. These foregone benefits represent the ‘opportunity cost’ of failing to adequately evaluate and prioritize energy efficiency investments. The objective of this report is to fully outline the array of different benefits from improved energy efficiency and investigate their implications for policy design. By better understanding the different benefits arising from energy efficiency it should be easier for policy makers to prioritise the most significant outcomes, in addition to energy savings, in optimising energy efficiency

Does open access improve the process and outcome of podiatric care?

Science.gov (United States)

Wrobel, James S; Davies, Michael L; Robbins, Jeffrey M

2011-05-19

Open access to clinics is a management strategy to improve healthcare delivery. Providers are sometimes hesitant to adopt open access because of fear of increased visits for potentially trivial complaints. We hypothesized open access clinics would result in decreased wait times, increased number of podiatry visits, fewer no shows, higher rates of acute care visits, and lower minor amputation rates over control clinics without open access. This study was a national retrospective case-control study of VHA (Veterans Hospital Administration) podiatry clinics in 2008. Eight case facilities reported to have open podiatry clinic access for at least one year were identified from an email survey. Sixteen control facilities with similar structural features (e.g., full time podiatrists, health tech, residency program, reconstructive foot surgery, vascular, and orthopedic surgery) were identified in the same geographic region as the case facilities. Twenty-two percent of facilities responded to the survey. Fifty-four percent reported open access and 46% did not. There were no differences in facility or podiatry panel size, podiatry visits, or visit frequency between the cases and controls. Podiatry visits trended higher for control facilities but didn't reach statistical significance. Case facilities had more new consults seen within 30 days (96%, 89%; P = 0.050) and lower minor amputation rates (0.62/1,000, 1.0/1,000; P = 0.041). The VHA is the worlds largest managed care organization and it relies on clinical efficiencies as one mechanism to improve the quality of care. Open access clinics had more timely access for new patients and lower rates of minor amputations.

Does Medical Malpractice Law Improve Health Care Quality?

Science.gov (United States)

Frakes, Michael; Jena, Anupam B.

2016-01-01

We assess the potential for medical liability forces to deter medical errors and improve health care treatment quality, identifying liability’s influence by drawing on variations in the manner by which states formulate the negligence standard facing physicians. Using hospital discharge records from the National Hospital Discharge Survey and clinically-validated quality metrics inspired by the Agency for Health Care Research and Quality, we find evidence suggesting that treatment quality may improve upon reforms that expect physicians to adhere to higher quality clinical standards. We do not find evidence, however, suggesting that treatment quality may deteriorate following reforms to liability standards that arguably condone the delivery of lower quality care. Similarly, we do not find evidence of deterioration in health care quality following remedy-focused liability reforms such as caps on non-economic damages awards. PMID:28479642

Measuring efficiency in health care: analytic techniques and health policy

National Research Council Canada - National Science Library

Smith, Peter C; Street, Andrew; Jacobs, Rowena

2006-01-01

... the efficiency of systems and organisations, including data envelopment analysis and stochastic frontier analysis, and also presents some promising new methodological approaches. Such techniques offer the prospect of many new and fruitful insights into health care performance. Nevertheless, they also pose many practical and methodological c...

Improving the rate and quality of medicaid well child care exams in primary care practices.

Science.gov (United States)

Smith, Katy Duncan; Merchen, Eileen; Turner, Crystal D; Vaught, Cara; Fritz, Terrie; Mold, Jim

2010-07-01

Providing recommended well child care to children insured bythe Medicaid Program can be challenging. Members of the Department of Family and Preventive Medicine (DFPM) at the University of Oklahoma Health Sciences Center contracted to help practices improve the rates and quality of well child care visits within the Oklahoma Medicaid Program. Sixteen pediatric and family medicine practices in three Oklahoma counties chose to participate in this quality improvement initiative. The records of Sooner Care-insured children age 0-20 were reviewed for both rate and quality of well child care visits made during the previous twelve months. Performance feedback was provided. Practice guidelines, Sooner Care requirements, and tips from exemplary practices were provided. In two of the counties, a case manager helped practices with challenging patients. Practice Enhancement Assistants (PEAs) then helped practices implement a variety of strategies to increase visit rates and improve the quality of early and periodic screening, diagnosis, and treatment (EPSDT) visits. Information technology (IT) support was provided when needed. The average rates of visits, for all counties combined, increased. Visit rates increased more in the younger age groups (birth to two years). There was significant improvement in quality of visits. Rates and quality improved much more in some practices than in others. A combination of academic detailing, performance feedback, practice facilitation, case management, and IT support produced increases in the quality and rates of EPSDT exams.

Improving biological efficiency of Oyster mushroom, Pleurotus ...

African Journals Online (AJOL)

International Journal of Biological and Chemical Sciences ... Yield improvement were observed in both pigeon pea and sunflower seed cake supplemented treatments with the highest mycelium vigor (91.65%) and biological ... Keywords: biological efficiency, compost, mycelium vigor, pigeon pea, sunflower seed cake

Improving immediate newborn care practices in Philippine hospitals: impact of a national quality of care initiative 2008-2015.

Science.gov (United States)

Silvestre, Maria Asuncion A; Mannava, Priya; Corsino, Marie Ann; Capili, Donna S; Calibo, Anthony P; Tan, Cynthia Fernandez; Murray, John C S; Kitong, Jacqueline; Sobel, Howard L

2018-03-31

To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Eleven large government hospitals from five regions in the Philippines. One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Sixteen intrapartum and newborn care practices. Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.

Applying Toyota production system techniques for medication delivery: improving hospital safety and efficiency.

Science.gov (United States)

Newell, Terry L; Steinmetz-Malato, Laura L; Van Dyke, Deborah L

2011-01-01

The inpatient medication delivery system used at a large regional acute care hospital in the Midwest had become antiquated and inefficient. The existing 24-hr medication cart-fill exchange process with delivery to the patients' bedside did not always provide ordered medications to the nursing units when they were needed. In 2007 the principles of the Toyota Production System (TPS) were applied to the system. Project objectives were to improve medication safety and reduce the time needed for nurses to retrieve patient medications. A multidisciplinary team was formed that included representatives from nursing, pharmacy, informatics, quality, and various operational support departments. Team members were educated and trained in the tools and techniques of TPS, and then designed and implemented a new pull system benchmarking the TPS Ideal State model. The newly installed process, providing just-in-time medication availability, has measurably improved delivery processes as well as patient safety and satisfaction. Other positive outcomes have included improved nursing satisfaction, reduced nursing wait time for delivered medications, and improved efficiency in the pharmacy. After a successful pilot on two nursing units, the system is being extended to the rest of the hospital. © 2010 National Association for Healthcare Quality.

How improving practice relationships among clinicians and nonclinicians can improve quality in primary care.

Science.gov (United States)

Lanham, Holly J; McDaniel, Reuben R; Crabtree, Benjamin F; Miller, William L; Stange, Kurt C; Tallia, Alfred F; Nutting, Paula

2009-09-01

Understanding the role of relationships health care organizations (HCOs) offers opportunities for shaping health care delivery. When quality is treated as a property arising from the relationships within HCOs, then different contributors of quality can be investigated and more effective strategies for improvement can be developed. Data were drawn from four large National Institutes of Health (NIH)-funded studies, and an iterative analytic strategy and a grounded theory approach were used to understand the characteristics of relationships within primary care practices. This multimethod approach amassed rich and comparable data sets in all four studies, which were all aimed at primary care practice improvement. The broad range of data included direct observation of practices during work activities and of patient-clinician interactions, in-depth interviews with physicians and other key staff members, surveys, structured checklists of office environments, and chart reviews. Analyses focused on characteristics of relationships in practices that exhibited a range of success in achieving practice improvement. Complex adaptive systems theory informed these analyses. Trust, mindfulness, heedfulness, respectful interaction, diversity, social/task relatedness, and rich/lean communication were identified as important in practice improvement. A model of practice relationships was developed to describe how these characteristics work together and interact with reflection, sensemaking, and learning to influence practice-level quality outcomes. Although this model of practice relationships was developed from data collected in primary care practices, which differ from other HCOs in some important ways, the ideas that quality is emergent and that relationships influence quality of care are universally important for all HCOs and all medical specialties.

Energy Efficiency Improvement and Cost Saving Oportunities for the Concrete Industry

Energy Technology Data Exchange (ETDEWEB)

Kermeli, Katerina; Worrell, Ernst; Masanet, Eric

2011-12-01

The U.S. concrete industry is the main consumer of U.S.-produced cement. The manufacturing of ready mixed concrete accounts for more than 75% of the U.S. concrete production following the manufacturing of precast concrete and masonry units. The most significant expenditure is the cost of materials accounting for more than 50% of total concrete production costs - cement only accounts for nearly 24%. In 2009, energy costs of the U.S. concrete industry were over $610 million. Hence, energy efficiency improvements along with efficient use of materials without negatively affecting product quality and yield, especially in times of increased fuel and material costs, can significantly reduce production costs and increase competitiveness. The Energy Guide starts with an overview of the U.S. concrete industry’s structure and energy use, a description of the various manufacturing processes, and identification of the major energy consuming areas in the different industry segments. This is followed by a description of general and process related energy- and cost-efficiency measures applicable to the concrete industry. Specific energy and cost savings and a typical payback period are included based on literature and case studies, when available. The Energy Guide intends to provide information on cost reduction opportunities to energy and plant managers in the U.S. concrete industry. Every cost saving opportunity should be assessed carefully prior to implementation in individual plants, as the economics and the potential energy and material savings may differ.

Options to improve energy efficiency for educational building

Science.gov (United States)

Jahan, Mafruha

The cost of energy is a major factor that must be considered for educational facility budget planning purpose. The analysis of energy related issues and options can be complex and requires significant time and detailed effort. One way to facilitate the inclusion of energy option planning in facility planning efforts is to utilize a tool that allows for quick appraisal of the facility energy profile. Once such an appraisal is accomplished, it is then possible to rank energy improvement options consistently with other facility needs and requirements. After an energy efficiency option has been determined to have meaningful value in comparison with other facility planning options, it is then possible to utilize the initial appraisal as the basis for an expanded consideration of additional facility and energy use detail using the same analytic system used for the initial appraisal. This thesis has developed a methodology and an associated analytic model to assist in these tasks and thereby improve the energy efficiency of educational facilities. A detailed energy efficiency and analysis tool is described that utilizes specific university building characteristics such as size, architecture, envelop, lighting, occupancy, thermal design which allows reducing the annual energy consumption. Improving the energy efficiency of various aspects of an educational building's energy performance can be complex and can require significant time and experience to make decisions. The approach developed in this thesis initially assesses the energy design for a university building. This initial appraisal is intended to assist administrators in assessing the potential value of energy efficiency options for their particular facility. Subsequently this scoping design can then be extended as another stage of the model by local facility or planning personnel to add more details and engineering aspects to the initial screening model. This approach can assist university planning efforts to

IMPROVING TACONITE PROCESSING PLANT EFFICIENCY BY COMPUTER SIMULATION, Final Report

Energy Technology Data Exchange (ETDEWEB)

William M. Bond; Salih Ersayin

2007-03-30

This project involved industrial scale testing of a mineral processing simulator to improve the efficiency of a taconite processing plant, namely the Minorca mine. The Concentrator Modeling Center at the Coleraine Minerals Research Laboratory, University of Minnesota Duluth, enhanced the capabilities of available software, Usim Pac, by developing mathematical models needed for accurate simulation of taconite plants. This project provided funding for this technology to prove itself in the industrial environment. As the first step, data representing existing plant conditions were collected by sampling and sample analysis. Data were then balanced and provided a basis for assessing the efficiency of individual devices and the plant, and also for performing simulations aimed at improving plant efficiency. Performance evaluation served as a guide in developing alternative process strategies for more efficient production. A large number of computer simulations were then performed to quantify the benefits and effects of implementing these alternative schemes. Modification of makeup ball size was selected as the most feasible option for the target performance improvement. This was combined with replacement of existing hydrocyclones with more efficient ones. After plant implementation of these modifications, plant sampling surveys were carried out to validate findings of the simulation-based study. Plant data showed very good agreement with the simulated data, confirming results of simulation. After the implementation of modifications in the plant, several upstream bottlenecks became visible. Despite these bottlenecks limiting full capacity, concentrator energy improvement of 7% was obtained. Further improvements in energy efficiency are expected in the near future. The success of this project demonstrated the feasibility of a simulation-based approach. Currently, the Center provides simulation-based service to all the iron ore mining companies operating in northern

Improving the Efficiency of Solid State Light Sources

International Nuclear Information System (INIS)

Joanna McKittrick

2003-01-01

This proposal addresses the national need to develop a high efficiency light source for general illumination applications. The goal is to perform research that would lead to the fabrication of a unique solid state, white-emitting light source. This source is based on an InGaN/GaN UV-emitting chip that activates a luminescent material (phosphor) to produce white light. White-light LEDs are commercially available which use UV from a GaN chip to excite a phosphor suspended in epoxy around the chip. Currently, these devices are relatively inefficient. This research will target one technical barrier that presently limits the efficiency of GaN based devices. Improvements in efficiencies will be achieved by improving the internal conversion efficiency of the LED die, by improving the coupling between the die and phosphor(s) to reduce losses at the surfaces, and by selecting phosphors to maximize the emissions from the LEDs in conversion to white light. The UCSD research team proposes for this project to develop new phosphors that have high quantum efficiencies that can be activated by the UV-blue (360-410 nm) light emitted by the GaN device. The main goal for the UCSD team was to develop new phosphor materials with a very specific property: phosphors that could be excited at long UV-wavelengths (λ=350-410 nm). The photoluminescence of these new phosphors must be activated with photons emitted from GaN based dies. The GaN diodes can be designed to emit UV-light in the same range (λ=350-410 nm). A second objective, which is also very important, is to search for alternate methods to fabricate these phosphors with special emphasis in saving energy and time and reduce pollution

Method for calculating annual energy efficiency improvement of TV sets

International Nuclear Information System (INIS)

Varman, M.; Mahlia, T.M.I.; Masjuki, H.H.

2006-01-01

The popularization of 24 h pay-TV, interactive video games, web-TV, VCD and DVD are poised to have a large impact on overall TV electricity consumption in the Malaysia. Following this increased consumption, energy efficiency standard present a highly effective measure for decreasing electricity consumption in the residential sector. The main problem in setting energy efficiency standard is identifying annual efficiency improvement, due to the lack of time series statistical data available in developing countries. This study attempts to present a method of calculating annual energy efficiency improvement for TV set, which can be used for implementing energy efficiency standard for TV sets in Malaysia and other developing countries. Although the presented result is only an approximation, definitely it is one of the ways of accomplishing energy standard. Furthermore, the method can be used for other appliances without any major modification

Method for calculating annual energy efficiency improvement of TV sets

Energy Technology Data Exchange (ETDEWEB)

Varman, M. [Department of Mechanical Engineering, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur (Malaysia); Mahlia, T.M.I. [Department of Mechanical Engineering, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur (Malaysia)]. E-mail: indra@um.edu.my; Masjuki, H.H. [Department of Mechanical Engineering, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur (Malaysia)

2006-10-15

The popularization of 24 h pay-TV, interactive video games, web-TV, VCD and DVD are poised to have a large impact on overall TV electricity consumption in the Malaysia. Following this increased consumption, energy efficiency standard present a highly effective measure for decreasing electricity consumption in the residential sector. The main problem in setting energy efficiency standard is identifying annual efficiency improvement, due to the lack of time series statistical data available in developing countries. This study attempts to present a method of calculating annual energy efficiency improvement for TV set, which can be used for implementing energy efficiency standard for TV sets in Malaysia and other developing countries. Although the presented result is only an approximation, definitely it is one of the ways of accomplishing energy standard. Furthermore, the method can be used for other appliances without any major modification.

Improved nurse-parent communication in neonatal intensive care unit

DEFF Research Database (Denmark)

Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid

2014-01-01

of a busy neonatal care unit. Promoting practice uptake was initially underestimated, but nurse guided family-centred care training was improved by increasing the visibility of the study in the unit, demonstrating intervention progress to the nurses and assuring a sense of ownership among nurse leaders...... and adjustment of nurse adherence to guided family-centred care was conducted by monitoring (1) knowledge, (2) delivery, (3) practice uptake and (4) certification. RESULTS: Implementation was improved by the development of a strategic framework and by adjusting the framework according to the real-life context...

Variable cross-section windings for efficiency improvement of electric machines

Science.gov (United States)

Grachev, P. Yu; Bazarov, A. A.; Tabachinskiy, A. S.

2018-02-01

Implementation of energy-saving technologies in industry is impossible without efficiency improvement of electric machines. The article considers the ways of efficiency improvement and mass and dimensions reduction of electric machines with electronic control. Features of compact winding design for stators and armatures are described. Influence of compact winding on thermal and electrical process is given. Finite element method was used in computer simulation.

Scaling production and improving efficiency in DEA: an interactive approach

Science.gov (United States)

Rödder, Wilhelm; Kleine, Andreas; Dellnitz, Andreas

2017-10-01

DEA models help a DMU to detect its (in-)efficiency and to improve activities, if necessary. Efficiency is only one economic aim for a decision-maker; however, up- or downsizing might be a second one. Improving efficiency is the main topic in DEA; the long-term strategy towards the right production size should attract our attention as well. Not always the management of a DMU primarily focuses on technical efficiency but rather is interested in gaining scale effects. In this paper, a formula for returns to scale (RTS) is developed, and this formula is even applicable for interior points of technology. Particularly, technical and scale inefficient DMUs need sophisticated instruments to improve their situation. Considering RTS as well as efficiency, in this paper, we give an advice for each DMU to find an economically reliable path from its actual situation to better activities and finally to most productive scale size (mpss), perhaps. For realizing this path, we propose an interactive algorithm, thus harmonizing the scientific findings and the interests of the management. Small numerical examples illustrate such paths for selected DMUs; an empirical application in theatre management completes the contribution.

Depression Care Management: Can Employers Purchase Improved Outcomes?

Directory of Open Access Journals (Sweden)

Kathryn Rost

2011-01-01

Full Text Available Fourteen vendors are currently selling depression care management products to US employers after randomized trials demonstrate improved work outcomes. The research team interviewed 10 (71.4% of these vendors to compare their products to four key components of interventions demonstrated to improve work outcomes. Five of 10 depression products incorporate all four key components, three of which are sold by health maintenance organizations (HMOs; however, HMOs did not deliver these components at the recommended intensity and/or duration. Only one product delivered by a disease management company delivered all four components of care at the recommended intensity and duration. This “voltage drop,” which we anticipate will increase with product implementation, suggests that every delivery system should carefully evaluate the design of its depression product before implementation for its capacity to deliver evidence-based care, repeating these evaluations as new evidence emerges.

Interprofessional simulation to improve patient participation in transitional care.

Science.gov (United States)

Dyrstad, Dagrunn Nåden; Storm, Marianne

2017-06-01

Educating and training healthcare professionals is known to improve the quality of transitional care for older adults. Arranging interprofessional meetings for healthcare professionals might be useful to improve patient participation skills in transitional care. To describe the learning activities used in The Meeting Point programme, focusing on patient participation in transitional care, and assess whether they increase healthcare professionals' awareness of and competencies relating to patient participation in the transitional care of older patients. Data were collected as part of an educational intervention programme, The Meeting Point, including three seminars on 'Patient participation in the transitional care of older patients' and four follow-up meetings. Participants were nurses, care assistants, doctors, physiotherapists, patient coordinators and administrative personnel from hospital, nursing homes and home-based care services. The Meeting Point was organised around four pillars: introduction, teaching session, group work activity and plenary discussion. Qualitative data included log reports, summaries of meetings, notes from group work activities, and reports from participants and from follow-up meetings. Feedback from participants shows that they were satisfied with meeting healthcare professionals from other units of care. A film scenario was perceived relevant for group work activity and useful in focusing participants' attention to patient participation. Follow-up meetings show that some nursing home wards, the emergency department and one medical ward at the hospital continued with ongoing work to improve quality of care. Efforts included implementation of an observational waiting room with comfortable chairs, planning for discharge in hospital admission, a daily patient flow registration system and motivational interviewing during admission to nursing home. The description of the learning activities used at The Meeting Point seminars shows that they

Face-to-face handoff: improving transfer to the pediatric intensive care unit after cardiac surgery.

Science.gov (United States)

Vergales, Jeffrey; Addison, Nancy; Vendittelli, Analise; Nicholson, Evelyn; Carver, D Jeannean; Stemland, Christopher; Hoke, Tracey; Gangemi, James

2015-01-01

The goal was to develop and implement a comprehensive, primarily face-to-face handoff process that begins in the operating room and concludes at the bedside in the intensive care unit (ICU) for pediatric patients undergoing congenital heart surgery. Involving all stakeholders in the planning phase, the framework of the handoff system encompassed a combination of a formalized handoff tool, focused process steps that occurred prior to patient arrival in the ICU, and an emphasis on face-to-face communication at the conclusion of the handoff. The final process was evaluated by the use of observer checklists to examine quality metrics and timing for all patients admitted to the ICU following cardiac surgery. The process was found to improve how various providers view the efficiency of handoff, the ease of asking questions at each step, and the overall capability to improve patient care regardless of overall surgical complexity. © 2014 by the American College of Medical Quality.

Workarounds Emerging From Electronic Health Record System Usage: Consequences for Patient Safety, Effectiveness of Care, and Efficiency of Care.

Science.gov (United States)

Blijleven, Vincent; Koelemeijer, Kitty; Wetzels, Marijntje; Jaspers, Monique

2017-10-05

Health care providers resort to informal temporary practices known as workarounds for handling exceptions to normal workflow unintendedly imposed by electronic health record systems (EHRs). Although workarounds may seem favorable at first sight, they are generally suboptimal and may jeopardize patient safety, effectiveness of care, and efficiency of care. Research into the scope and impact of EHR workarounds on patient care processes is scarce. This paper provides insight into the effects of EHR workarounds on organizational workflows and outcomes of care services by identifying EHR workarounds and determining their rationales, scope, and impact on health care providers' workflows, patient safety, effectiveness of care, and efficiency of care. Knowing the rationale of a workaround provides valuable clues about the source of origin of each workaround and how each workaround could most effectively be resolved. Knowing the scope and impact a workaround has on EHR-related safety, effectiveness, and efficiency provides insight into how to address related concerns. Direct observations and follow-up semistructured interviews with 31 physicians, 13 nurses, and 3 clerks and qualitative bottom-up coding techniques was used to identify, analyze, and classify EHR workarounds. The research was conducted within 3 specialties and settings at a large university hospital. Rationales were associated with work system components (persons, technology and tools, tasks, organization, and physical environment) of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to reveal their source of origin as well as to determine the scope and the impact of each EHR workaround from a structure-process-outcome perspective. A total of 15 rationales for EHR workarounds were identified of which 5 were associated with persons, 4 with technology and tools, 4 with the organization, and 2 with the tasks. Three of these 15 rationales for EHR workarounds have not been identified in prior

Efficiency Improvement and Quality Initiatives Application in Financial Institutions

Directory of Open Access Journals (Sweden)

MSc. Ajtene Avdullahi

2015-06-01

Full Text Available Financial institutions in today’s economy have no longer the luxury to improve profit simply by increasing revenue. These firms, due to the significant measuring reductions in the financial services industry needed to improve operational efficiencies and merely support existing processes with fewer resources. This paper explains the benefits of Lean, Six Sigma, Total Quality Management and Lean Six Sigma that have improved organization's performance, by cutting costs and waste, improving their products or services, increasing profitability as well as enhancing customer satisfaction. The applicability of quality management practices in financial institutions in Kosovo is presented and also their efficiency and effectiveness. By analyzing data from Raiffeisen Bank Kosovo, this paper highlights the benefits of Individual and Micro companies customer segment as the result of organizational change and successful application of quality initiatives from financial institutions in Kosovo.

Improving the delivery of preventive care services.

Science.gov (United States)

Hung, Dorothy Y

2007-05-01

Performance of preventive services is an important indicator of high-quality health care, but many recommended services are not regularly offered in primary care practices. Health risk assessments, counseling, and referral to community-based programs help address risk behaviors, many of which are leading causes of preventable death and disability in the United States. This study examined various influences on the delivery of preventive services designed to address smoking, excessive consumption of alcohol, unhealthy diets, and sedentary lifestyles. More than 300 health care providers in 52 practices nationwide have contributed data to this study. Staff participation in quality improvement enhanced work relationships and also diminished the effect of practice size on the performance of preventive care. The use of nurse practitioners, allied health professionals, clinician reminders, and patient registries were positively associated with care delivery.

Physician education programme improves quality of diabetes care ...

African Journals Online (AJOL)

Objectives. To determine if a physician education programme and a structured consultation schedule would improve the quality of diabetes patient care in a diabetes clinic. Setting. Two tertiary care diabetes clinics at Kalafong Hospital, Pretoria. Study design. Quasi-experimental controlled before-and-after study. Methods.

Observational study using the tools of lean six sigma to improve the efficiency of the resident rounding process.

Science.gov (United States)

Chand, David V

2011-06-01

Recent focus on resident work hours has challenged residency programs to modify their curricula to meet established duty hour restrictions and fulfill their mission to develop the next generation of clinicians. Simultaneously, health care systems strive to deliver efficient, high-quality care to patients and families. The primary goal of this observational study was to use a data-driven approach to eliminate examples of waste and variation identified in resident rounding using Lean Six Sigma methodology. A secondary goal was to improve the efficiency of the rounding process, as measured by the reduction in nonvalue-added time. We used the "DMAIC" methodology: define, measure, analyze, improve, and control. Pediatric and family medicine residents rotating on the pediatric hospitalist team participated in the observation phase. Residents, nurses, hospitalists, and parents of patients completed surveys to gauge their attitudes toward rounds. The Mann-Whitney test was used to test for differences in the median times measured during the preimprovement and postimprovement phases, and the Student t test was used for comparison of survey data. Collaborative, family-centered rounding with elimination of the "prerounding" process, as well as standard work instructions and pacing the process to meet customer demand (takt time), were implemented. Nonvalue-added time per patient was reduced by 64% (P  =  .005). Survey data suggested that team members preferred the collaborative, family-centered approach to the traditional model of rounding. Lean Six Sigma provides tools, a philosophy, and a structured, data-driven approach to address a problem. In our case this facilitated an effort to adhere to duty hour restrictions while promoting education and quality care. Such approaches will become increasingly useful as health care delivery and education continue to transform.

Improving quality of care among COPD outpatients in Denmark 2008-2011

DEFF Research Database (Denmark)

Tøttenborg, Sandra Søgaard; Lange, P.; Thomsen, R.W.

2013-01-01

OBJECTIVE: To examine whether the quality of care among Danish patients with chronic obstructive pulmonary disease (COPD) has improved since the initiation of a national multidisciplinary quality improvement program. METHODS: We conducted a nationwide, population-based prospective cohort study...... a substantial improvement in the quality of care of COPD in Danish hospitals following the initiation of a national multidisciplinary quality improvement program in 2008. In the forthcoming years, it will be interesting to observe if this will translate into a better prognosis of Danish patients with COPD....... using data from the Danish Clinical Register of COPD (DrCOPD). Since 2008 the register has systematically monitored and audited the use of recommended processes of COPD care. RESULTS: Substantial improvements were observed for all processes of care and registration fulfillment increased to well above 85...

Taxing energy to improve the environment : Efficiency and distributional effects

NARCIS (Netherlands)

Heijdra, BJ; van der Horst, A

We study the effects of environmental tax policy in a dynamic overlapping generations model of a small open economy with environmental quality incorporated as a durable consumption good. Raising the energy tax may yield an efficiency gain if agents care enough about the environment. The benefits are

Mobile phones improve antenatal care attendance in Zanzibar

DEFF Research Database (Denmark)

Lund, Stine; Nielsen, Birgitte B; Hemed, Maryam

2014-01-01

BACKGROUND: Applying mobile phones in healthcare is increasingly prioritized to strengthen healthcare systems. Antenatal care has the potential to reduce maternal morbidity and improve newborns' survival but this benefit may not be realized in sub-Saharan Africa where the attendance and quality...... of care is declining. We evaluated the association between a mobile phone intervention and antenatal care in a resource-limited setting. We aimed to assess antenatal care in a comprehensive way taking into consideration utilisation of antenatal care as well as content and timing of interventions during...... included at their first antenatal care visit and followed until 42 days after delivery. 24 primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text-message and voucher component. Primary outcome...

Lean Six Sigma in Health Care: Improving Utilization and Reducing Waste.

Science.gov (United States)

Almorsy, Lamia; Khalifa, Mohamed

2016-01-01

Healthcare costs have been increasing worldwide mainly due to over utilization of resources. The savings potentially achievable from systematic, comprehensive, and cooperative reduction in waste are far higher than from more direct and blunter cuts in care and coverage. At King Faisal Specialist Hospital and Research Center inappropriate and over utilization of the glucose test strips used for whole blood glucose determination using glucometers was observed. The hospital implemented a project to improve its utilization. Using the Six Sigma DMAIC approach (Define, Measure, Analyze, Improve and Control), an efficient practice was put in place including updating the related internal policies and procedures and the proper implementation of an effective users' training and competency check off program. That resulted in decreasing the unnecessary Quality Control (QC) runs from 13% to 4%, decreasing the failed QC runs from 14% to 7%, lowering the QC to patient testing ratio from 24/76 to 19/81.

Use of automated rendezvous trajectory planning to improve spacecraft operations efficiency

Science.gov (United States)

Mulder, Tom A.

1991-01-01

The current planning process for space shuttle rendezvous with a second Earth-orbiting vehicle is time consuming and costly. It is a labor-intensive, manual process performed pre-mission with the aid of specialized maneuver processing tools. Real-time execution of a rendezvous plan must closely follow a predicted trajectory, and targeted solutions leading up to the terminal phase are computed on the ground. Despite over 25 years of Gemini, Apollo, Skylab, and shuttle vehicle-to-vehicle rendezvous missions flown to date, rendezvous in Earth orbit still requires careful monitoring and cannot be taken for granted. For example, a significant trajectory offset was experienced during terminal phase rendezvous of the STS-32 Long Duration Exposure Facility retrieval mission. Several improvements can be introduced to the present rendezvous planning process to reduce costs, produce more fuel-efficient profiles, and increase the probability of mission success.

Utilization of information and communications technology (ICT) to improve workface efficiency

Energy Technology Data Exchange (ETDEWEB)

Haines, A.; Rasmussen, J. [Industrial Audit Corp., Toronto, Ontario (Canada)

2010-07-01

Improving the efficiency of personnel at the workface is a key objective for executing construction, maintenance, quality, engineering and human performance activities. Schedule and cost overruns have a significant impact on the bottom line and on future business efficiency in execution of tasks is paramount to success. Leveraging information and communications technology (ICT) in construction, maintenance and operation environments can create a mobile workforce where personnel efficiency is improved, significant gains are made on schedule and cost, and the overall quality of work is raised. This paper will discuss the impact of mobile technology specifically on workface efficiency and productivity. (author)

Utilization of information and communications technology (ICT) to improve workface efficiency

International Nuclear Information System (INIS)

Haines, A.; Rasmussen, J.

2010-01-01

Improving the efficiency of personnel at the workface is a key objective for executing construction, maintenance, quality, engineering and human performance activities. Schedule and cost overruns have a significant impact on the bottom line and on future business efficiency in execution of tasks is paramount to success. Leveraging information and communications technology (ICT) in construction, maintenance and operation environments can create a mobile workforce where personnel efficiency is improved, significant gains are made on schedule and cost, and the overall quality of work is raised. This paper will discuss the impact of mobile technology specifically on workface efficiency and productivity. (author)

Improvement in light-extraction efficiency of light emitting diode ...

Indian Academy of Sciences (India)

The effect of various microlens parameters such as diameter and area fraction on light-extraction efficiency was systematically studied. Improvement of 4% in extraction efficiency was obtained by employing it on white light emitting diode. The area fraction of microlenses was increased up to 0.34 by reducing the spin speed.

Refractories for Industrial Processing. Opportunities for Improved Energy Efficiency

Energy Technology Data Exchange (ETDEWEB)

Hemrick, James G. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Hayden, H. Wayne [Metals Manufacture Process and Controls Technology, Inc., Oak Ridge, TN (United States); Angelini, Peter [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Moore, Robert E. [R.E. Moore Associates, Maricopa, AZ (United States); Headrick, William L. [R.E. Moore Associates, Maricopa, AZ (United States)

2005-01-01

Refractories are a class of materials of critical importance to manufacturing industries with high-temperature unit processes. This study describes industrial refractory applications and identifies refractory performance barriers to energy efficiency for processing. The report provides recommendations for R&D pathways leading to improved refractories for energy-efficient manufacturing and processing.

Improving Primary Care with Human-Centered Design and Partnership-Based Leadership

Directory of Open Access Journals (Sweden)

May-Lynn Andresen

2017-06-01

Full Text Available Objective: The purpose of this quality improvement project was to empower and activate first-line staff (FLS to improve the six-month depression remission rate in a primary care clinic. Background: Lack of workforce engagement has been identified as an emerging national problem in health care and health care leaders have urged practice redesign to foster the Triple Aim of improved population health, improved care experience, and reduced cost of care (Berwick et al., 2008. Depression is difficult to manage and often exacerbates chronic illnesses and shortens lifespans, yet despite known effective treatments, six-month remission rates are low and care practices are often inadequate. Engaging in empowering leadership behaviors has demonstrated improvement in motivation, work outcomes, and empowerment in various industry settings across the world. Core approaches include: enhancing staff self-determination, encouraging participation in decision-making, and ensuring that staff have the knowledge and tools to achieve their performance goals, in addition to leadership communications that increase confidence in staff’s potential to perform at high levels, and their recognition that their efforts have an impact on improving organizational effectiveness. Methods: In this outpatient setting, care was siloed, staff were disengaged and a hierarchical paradigm was evident. Human-centered design principles were employed to intensively explore stakeholders’ experiences and to deeply engage end users in improving depression remission rates by creating, participating, and partnering in solutions. Leadership was educated in and deployed empowering leadership behaviors, which were synergistic with design thinking, and fostered empowerment. Results: Pre- and post-surveys demonstrated statistically significant improvement in empowerment. The six-month depression remission rate increased 167%, from 7.3% (N=261 to 19.4% (N=247. Conclusion: The convergence of

Improving the quality of depression and pain care in multiple sclerosis using collaborative care: The MS-care trial protocol.

Science.gov (United States)

Ehde, Dawn M; Alschuler, Kevin N; Sullivan, Mark D; Molton, Ivan P; Ciol, Marcia A; Bombardier, Charles H; Curran, Mary C; Gertz, Kevin J; Wundes, Annette; Fann, Jesse R

2018-01-01

Evidence-based pharmacological and behavioral interventions are often underutilized or inaccessible to persons with multiple sclerosis (MS) who have chronic pain and/or depression. Collaborative care is an evidence-based patient-centered, integrated, system-level approach to improving the quality and outcomes of depression care. We describe the development of and randomized controlled trial testing a novel intervention, MS Care, which uses a collaborative care model to improve the care of depression and chronic pain in a MS specialty care setting. We describe a 16-week randomized controlled trial comparing the MS Care collaborative care intervention to usual care in an outpatient MS specialty center. Eligible participants with chronic pain of at least moderate intensity (≥3/10) and/or major depressive disorder are randomly assigned to MS Care or usual care. MS Care utilizes a care manager to implement and coordinate guideline-based medical and behavioral treatments with the patient, clinic providers, and pain/depression treatment experts. We will compare outcomes at post-treatment and 6-month follow up. We hypothesize that participants randomly assigned to MS Care will demonstrate significantly greater control of both pain and depression at post-treatment (primary endpoint) relative to those assigned to usual care. Secondary analyses will examine quality of care, patient satisfaction, adherence to MS care, and quality of life. Study findings will aid patients, clinicians, healthcare system leaders, and policy makers in making decisions about effective care for pain and depression in MS healthcare systems. (PCORI- IH-1304-6379; clinicaltrials.gov: NCT02137044). This trial is registered at ClinicalTrials.gov, protocol NCT02137044. Copyright © 2017 Elsevier Inc. All rights reserved.

Improving quality of care among patients hospitalised with schizophrenia

DEFF Research Database (Denmark)

Jørgensen, Mette; Mainz, Jan; Svendsen, Marie Louise

2015-01-01

BACKGROUND: The effectiveness of systematic quality improvement initiatives in psychiatric care remains unclear. AIMS: To examine whether quality of care has changed following implementation of a systematic monitoring programme of hospital performance measures. METHOD: In a nationwide population.......27-1.62), psychoeducation (RR: 1.33, 95% CI: 1.19-1.48), psychiatric aftercare (RR: 1.06, 95% CI: 1.01-1.11) and suicide risk assessment (RR: 1.31, 95% CI: 1.21-1.42). CONCLUSIONS: Quality of care improved from 2004 to 2011 among patients hospitalised with schizophrenia in Denmark. DECLARATION OF INTEREST: None. COPYRIGHT...

Efficiency improvement of nuclear power plant operation: the significant role of advanced nuclear fuel technologies

International Nuclear Information System (INIS)

Velde Van de, A.; Burtak, F.

2001-01-01

Due to the increased liberalisation of the power markets, nuclear power generation is being exposed to high cost reduction pressure. In this paper we highlight the role of advanced nuclear fuel technologies to reduce the fuel cycle costs and therefore increase the efficiency of nuclear power plant operation. The key factor is a more efficient utilisation of the fuel and present developments at Siemens are consequently directed at (i) further increase of batch average burnup, (ii) improvement of fuel reliability, (iii) enlargement of fuel operation margins and (iv) improvement of methods for fuel design and core analysis. As a result, the nuclear fuel cycle costs for a typical LWR have been reduced during the past decades by about US$ 35 million per year. The estimated impact of further burnup increases on the fuel cycle costs is expected to be an additional saving of US$10 - 15 million per year. Due to the fact that the fuel will operate closer to design limits, a careful approach is required when introducing advanced fuel features in reload quantities. Trust and co-operation between the fuel vendors and the utilities is a prerequisite for the common success. (authors)

Case-mix tool, costs and effectiveness in improving primary care mental health and substance abuse services.

Science.gov (United States)

Riihimäki, Kirsi; Heiska-Johansson, Ainomaija; Ketola, Eeva

2018-02-01

Despite its importance in improving care and developing services, high-quality data evaluating cost-effectiveness and services in different case-mix populations is scarce in primary care. The objective was to investigate the service use of those mental health and substance abuse patients, who use lots of services. Primary health care diagnosis-related groups (pDRG) is a tool to evaluate service provider system and improve efficiency, productivity and quality. We viewed all pDRG results available from the year 2015 concerning municipal mental health and substance abuse services. In primary care mental health and substance abuse services, the most common ICD-10-codes were depression and substance abuse. One-fifth of patients produced 57% of costs. Their medium of appointments was 16 per year versus 6 per year of all patients. Only 54% of their diagnoses were recorded in the electronic health records versus 75% of all patients. They made 5.7 different pDRG episodes, including 1.8 episodes of depression, per patient. The average episode cost for this patient group was 301€. pDRG makes health care production transparent also in mental health and substance abuse services. It is easy to identify patients, who use a lot of services and thus induce the majority of costs, and focus on their needs in managing and developing services.

Leading quality improvement in primary care: recommendations for success.

Science.gov (United States)

Van Hoof, Thomas J; Bisognano, Maureen; Reinertsen, James L; Meehan, Thomas P

2012-09-01

Leadership is increasingly recognized as a potential factor in the success of primary care quality improvement efforts, yet little is definitively known about which specific leadership behaviors are most important. Until more research is available, the authors suggest that primary care clinicians who are committed to developing their leadership skills should commit to a series of actions. These actions include embracing a theory of leadership, modeling the approach for others, focusing on the goal of improving patient outcomes, encouraging teamwork, utilizing available sources of power, and reflecting on one's approach in order to improve it. Primary care clinicians who commit themselves to such actions will be more effective leaders and will be more prepared as new research becomes available on this important factor. Copyright © 2012 Elsevier Inc. All rights reserved.

Barriers to efficiency improvement and fuel switching in Karnataka, India

International Nuclear Information System (INIS)

Reddy, A.

1991-01-01

Implementing energy efficiency changes requires a wide range measures. Improvements, therefore, require actions at the lowest level of the consumer, through the highest level of the global agencies. Due to the multiplicity of participants, however, barriers to achieving these improvements can arise at every level. The major barriers to improving energy efficiency in developing countries are defined and paths to overcome these challenges are identified. Topics of discussion include: energy consumers; end-use equipment manufacturers; end-use equipment providers; energy carrier producers and distributors; actual/potential cogenerators; financial institutions; government; and international, multilateral and industrialized country funding/aid agencies

[Emergency care of vertigo patients: suggestions for efficient management].

Science.gov (United States)

Kogashiwa, Yasunao; Takei, Yasuhiko; Matsuda, Takeaki; Karaho, Takehiro; Morita, Masahiro; Kohno, Naoyuki

2009-10-01

Some diseases in which persons show vertigo or dizziness may be life-threatening, regardless of symptom severity, and require careful attention. These include diseases of the inner ear, central nervous system, and cardiovascular manifestation. In May 2006, a group in charge of primary emergency consultation began work enabling physicians to treat vertigo patients more efficiently and safely, as detailed in this report. Of the 173 persons with vertigo hospitalized from January 2004 to March 2008, six had cerebrovascular manifestations clarified only after hospitalization, underscoring the importance of careful examination, especially of those 75 years of age older, having continuous headache, having severe trunk ataxia despite apparently mild eye nystagmus, or reporting a history of high blood pressure, diabetes mellitus, hyperlipidemia, or ischemic heart disease.

Deployment of lean six sigma in care coordination: an improved discharge process.

Science.gov (United States)

Breslin, Susan Ellen; Hamilton, Karen Marie; Paynter, Jacquelyn

2014-01-01

This article presents a quality improvement project to reduce readmissions in the Medicare population related to heart failure, acute myocardial infarction, and pneumonia. The article describes a systematic approach to the discharge process aimed at improving transitions of care from hospital to post-acute care, utilizing Lean Six Sigma methodology. Inpatient acute care hospital. A coordinated discharge process, which includes postdischarge follow-up, can reduce avoidable readmissions. Implications for The quality improvement project demonstrated the significant role case management plays in preventing costly readmissions and improving outcomes for patients through better transitions of care from the hospital to the community. By utilizing Lean Six Sigma methodology, hospitals can focus on eliminating waste in their current processes and build more sustainable improvements to deliver a safe, quality, discharge process for their patients. Case managers are leading this effort to improve care transitions and assure a smoother transition into the community postdischarge..

Improving Energy Efficiency In Thermal Oil Recovery Surface Facilities

Energy Technology Data Exchange (ETDEWEB)

Murthy Nadella, Narayana

2010-09-15

Thermal oil recovery methods such as Cyclic Steam Stimulation (CSS), Steam Assisted Gravity Drainage (SAGD) and In-situ Combustion are being used for recovering heavy oil and bitumen. These processes expend energy to recover oil. The process design of the surface facilities requires optimization to improve the efficiency of oil recovery by minimizing the energy consumption per barrel of oil produced. Optimization involves minimizing external energy use by heat integration. This paper discusses the unit processes and design methodology considering thermodynamic energy requirements and heat integration methods to improve energy efficiency in the surface facilities. A design case study is presented.

Chronic care model in primary care: can it improve health-related quality of life?

Directory of Open Access Journals (Sweden)

Aryani FMY

2016-01-01

Full Text Available Faridah Md Yusof Aryani,1 Shaun Wen Huey Lee,2 Siew Siang Chua,3 Li Ching Kok,4 Benny Efendie,2 Thomas Paraidathathu5 1Pharmaceutical Services Division, Ministry of Health Malaysia, Petaling Jaya, 2School of Pharmacy, Monash University Malaysia, Bandar Sunway, 3Department of Pharmacy, Faculty of Medicine, University of Malaya, 4Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur, 5School of Pharmacy, Taylor’s University, Subang Jaya, Selangor, Malaysia Purpose: Chronic diseases such as hypertension, diabetes mellitus, and hyperlipidemia are public health concerns. However, little is known about how these affect patient-level health measures. The aim of the study was to examine the impact of a chronic care model (CCM on the participant’s health-related quality of life (QoL. Patients and methods: Participants received either usual care or CCM by a team of health care professionals including pharmacists, nurses, dietitians, and general practitioners. The participants in the intervention group received medication counseling, adherence, and dietary advice from the health care team. The QoL was measured using the EQ-5D (EuroQoL-five dimension, health-related quality of life questionnaire and comparison was made between usual care and intervention groups at the beginning and end of the study at 6 months. Results: Mean (standard deviation EQ-5D index scores improved significantly in the intervention group (0.92±0.10 vs 0.95±0.08; P≤0.01, but not in the usual care group (0.94±0.09 vs 0.95±0.09; P=0.084. Similarly, more participants in the intervention group reported improvements in their QoL compared with the usual care group, especially in the pain/discomfort and anxiety/depression dimensions. Conclusion: The implementation of the CCM resulted in significant improvement in QoL. An interdisciplinary team CCM approach should be encouraged, to ultimately result in behavior changes and improve the QoL of the patients. Keywords: diabetes

Energy-Efficiency Improvement Opportunities for the Textile Industry

Energy Technology Data Exchange (ETDEWEB)

China Energy Group; Hasanbeigi, Ali

2010-09-29

The textile industry is one of the most complicated manufacturing industries because it is a fragmented and heterogeneous sector dominated by small and medium enterprises (SMEs). Energy is one of the main cost factors in the textile industry. Especially in times of high energy price volatility, improving energy efficiency should be a primary concern for textile plants. There are various energy-efficiency opportunities that exist in every textile plant, many of which are cost-effective. However, even cost-effective options often are not implemented in textile plants mostly because of limited information on how to implement energy-efficiency measures, especially given the fact that a majority of textile plants are categorized as SMEs and hence they have limited resources to acquire this information. Know-how on energy-efficiency technologies and practices should, therefore, be prepared and disseminated to textile plants. This guidebook provides information on energy-efficiency technologies and measures applicable to the textile industry. The guidebook includes case studies from textile plants around the world and includes energy savings and cost information when available. First, the guidebook gives a brief overview of the textile industry around the world, with an explanation of major textile processes. An analysis of the type and the share of energy used in different textile processes is also included in the guidebook. Subsequently, energy-efficiency improvement opportunities available within some of the major textile sub-sectors are given with a brief explanation of each measure. The conclusion includes a short section dedicated to highlighting a few emerging technologies in the textile industry as well as the potential for the use of renewable energy in the textile industry.

Improving health and energy efficiency through community-based housing interventions.

Science.gov (United States)

Howden-Chapman, Philippa; Crane, Julian; Chapman, Ralph; Fougere, Geoff

2011-12-01

Houses designed for one climate and cultural group may not be appropriate for other places and people. Our aim is to find cost-effective ways to improve the characteristics of older homes, ill-fitted for New Zealand's climate, in order to improve the occupants' health. We have carried out two community randomised trials, in partnership with local communities, which have focused on retrofitted insulation and more effective heating and have two other studies under way, one which focuses on electricity vouchers and the other on housing hazard remediation. The Housing, Insulation and Health Study showed that insulating 1,350 houses, built before insulation was required, improved the occupants' health and well being as well as household energy efficiency. In the Housing, Heating and Health Study we investigated the impact of installing more effective heating in insulated houses for 409 households, where there was a child with doctor-diagnosed asthma. Again, the study showed significant results in the intervention group; indoor temperatures increased and levels of NO(2) were halved. Children reported less poor health, lower levels of asthma symptoms and sleep disturbances by wheeze and dry cough. Children also had fewer days off school. Improving the energy efficiency of older housing leads to health improvements and energy efficiency improvements. Multidisciplinary studies of housing interventions can create compelling evidence to support policies for sustainable housing developments which improve health.

Improving the energy efficiency of mine fan assemblages

International Nuclear Information System (INIS)

De Souza, Euler

2015-01-01

Energy associated with ventilating an underground operation comprises a significant portion of a mine operation's base energy demand and is consequently responsible for a large percentage of the total operating costs. Ventilation systems may account from 25 to 40% of the total energy costs and 40–50% of the energy consumption of a mine operation. Fans are the most important mechanical devices used to ventilate underground mines and the total fan power installed in a single mine operation can easily exceed 10,000 kW. Investigations of a number of mine main fan installations have determined their assemblage to be, in general, very energy inefficient. The author has found that 40–80% of the energy consumed by a main fan is used to overcome the resistance of fan assemblage components. This paper presents how engineering design principles can be applied to improve the performance and efficiency of fan installations, resulting in substantial reductions in power consumption, operating cost and greenhouse gas emissions. A detailed case study is presented to demonstrate that, by designing fan assemblages using proper engineering concepts of fluid physics and industrial ventilation design, main fan systems will operate at efficiencies well above 80–90% (compared to common operating efficiencies of between 20 and 65%), resulting in a drastic reduction in a mine's overall costs and base electrical and energy loads. - Highlights: • Increases in fan assemblage efficiencies with minimum capital investment. • Improved designs for substantial fan power and operating cost savings. • General solutions and tactics for improving existing main fan installations. • Case study presented to demonstrate proper design of fan assemblages.

Efficiency Improvement of HIT Solar Cells on p-Type Si Wafers.

Science.gov (United States)

Wei, Chun-You; Lin, Chu-Hsuan; Hsiao, Hao-Tse; Yang, Po-Chuan; Wang, Chih-Ming; Pan, Yen-Chih

2013-11-22

Single crystal silicon solar cells are still predominant in the market due to the abundance of silicon on earth and their acceptable efficiency. Different solar-cell structures of single crystalline Si have been investigated to boost efficiency; the heterojunction with intrinsic thin layer (HIT) structure is currently the leading technology. The record efficiency values of state-of-the art HIT solar cells have always been based on n-type single-crystalline Si wafers. Improving the efficiency of cells based on p-type single-crystalline Si wafers could provide broader options for the development of HIT solar cells. In this study, we varied the thickness of intrinsic hydrogenated amorphous Si layer to improve the efficiency of HIT solar cells on p-type Si wafers.

RESEARCH Improving access and quality of care in a TB control ...

African Journals Online (AJOL)

or treatment. Improving access and quality of care in a. TB control programme. Vera Scott, Virginia Azevedo, Judy Caldwell. Objectives. To use a quality improvement approach to improve access to and quality of tuberculosis (TB) diagnosis and care in. Cape Town. Methods. Five HIV/AIDS/sexually transmitted infections/TB.

Improvement attributes in healthcare: implications for integrated care.

Science.gov (United States)

Harnett, Patrick John

2018-04-16

Purpose Healthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that integrated care represents a means to substantially improve service outcomes, progress has been slow. Difficulties achieving sustained improvement at scale imply that methods employed are not sufficient and that healthcare improvement attributes may be different when compared to prior reference domains. The purpose of this paper is to examine and synthesise key improvement attributes relevant to a complex healthcare change process, specifically integrated care. Design/methodology/approach This study is based on an integrative literature review on systemic improvement in healthcare. Findings A central theme emerging from the literature review indicates that implementing systemic change needs to address the relationship between vision, methods and participant social dynamics. Practical implications Accommodating personal and professional network dynamics is required for systemic improvement, especially among high autonomy individuals. This reinforces the need to recognise the change process as taking place in a complex adaptive system where personal/professional purpose/meaning is central to the process. Originality/value Shared personal/professional narratives are insufficiently recognised as a powerful change force, under-represented in linear and rational empirical improvement approaches.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes.

Science.gov (United States)

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10-20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

Residential carbon dioxide emissions in Canada. Impact of efficiency improvements and fuel substitution

International Nuclear Information System (INIS)

Ugursal, V.I.; FUng, A.S.

1998-01-01

The effect of improving house envelope, heating system and appliance efficiencies, and fuel substitution on the atmospheric emissions of carbon dioxide in the Canadian residential sector is studied based on simulation studies. The findings clearly indicate that improving appliance efficiency reduces the overall end-use energy consumption in the residential sector as well as the associated carbon dioxide emissions. However, the magnitude of the reduction in carbon dioxide emissions as a result of improving only appliance efficiencies is quite small. Significantly larger reductions can be obtained by improving house envelopes and heating/cooling systems in addition to improving appliance efficiencies. Fuel substitution for space and domestic hot water heating can also present a potential to reduce carbon dioxide emissions depending on the fuel substitution scenario adopted. (author)

Does Automation Improve Stock Market Efficiency? Evidence from Ghana

OpenAIRE

Mensah, Justice T.; Pomaa-Berko, Maame; Adom, Philip Kofi

2012-01-01

As a burgeoning capital market in an emerging economy, automation of the stock market is regarded as a major step towards integrating the financial market as a conduit for economic growth. The automation of the Ghana Stock Exchange (GSE) in 2008 is expected among other things to improve the efficiency of the market. This paper therefore investigates the impact of the automation on the efficiency of the GSE within the framework of the weak-form Efficient Market Hypothesis (EMH) using daily mar...

Prior-knowledge-independent equalization to improve battery uniformity with energy efficiency and time efficiency for lithium-ion battery

International Nuclear Information System (INIS)

Zhang, Shumei; Qiang, Jiaxi; Yang, Lin; Zhao, Xiaowei

2016-01-01

To improve battery uniformity as well as energy efficiency and time efficiency, a SOC (state of charge)-based equalization by AGA (adaptive genetic algorithm) is proposed on basis of two-stage DC/DC converters. The simulation results indicate that compared with FLC (fuzzy logic controller) equalization, the standard deviation of final SOC is improved by 78.7% while energy efficiency is improved by 6.01% and equalization time is decreased by 20% for AGA equalization of extreme dispersion. Additionally, AGA improves the battery uniformity by 30.77% with shortening equalization time by 16.29% and saving energy loss by 1.51% compared with FLC for equalization of regular dispersion. For further validation, the equalization optimization is verified by experiment based on the data-driven parameter identification method which is used to enhance the real-time capability of AGA. For AGA equalization of extreme dispersion, the standard deviation of final SOC is just 0.41% while equalization time prolongs only 14 min and energy efficiency is decreased by 0.81% compared with simulation results. Moreover, not only the standard deviation of final SOC is just 0.28% but also the energy efficiency is decreased by 0.69% and equalization time prolongs by 10.4 min compared with the simulation results for equalization of regular dispersion. - Highlights: • Issues of over equalization, time consumption and energy loss are addressed. • A SOC-based equalization is proposed based on adaptive genetic algorithm. • The equalization aims to improve battery uniformity, efficiency of energy and time. • Data-driven parameter identification is used to enhance the real-time capability.

Improving the Efficiency of Organic Solar Cells upon Addition of Polyvinylpyridine

Directory of Open Access Journals (Sweden)

Rita Rodrigues

2014-12-01

Full Text Available We report on the efficiency improvement of organic solar cells (OPVs based on the low energy gap polyfluorene derivative, APFO-3, and the soluble C60 fullerene PCBM, upon addition of a residual amount of poly (4-vinylpyridine (PVP. We find that the addition of 1% by weight of PVP with respect to the APFO-3 content leads to an increase of efficiency from 2.4% to 2.9%. Modifications in the phase separation details of the active layer were investigated as a possible origin of the efficiency increase. At high concentrations of PVP, the blend morphology is radically altered as observed by Atomic Force Microscopy. Although the use of low molecular weight additives is a routine method to improve OPVs efficiency, this report shows that inert polymers, in terms of optical and charge transport properties, may also improve the performance of polymer-based solar cells.

Improving the quality of care for patients with hypertension in Moshupa District, Botswana: Quality improvement cycle

Directory of Open Access Journals (Sweden)

Cathy Kande

2014-01-01

Full Text Available Background: Although there are no prevalence studies on hypertension in Botswana, this condition is thought to be common and the quality of care to be poor.Aim: The aim of this project was to assess and improve the quality of primary care forhypertension.Setting: Moshupa clinic and catchment area, Botswana.Methods: Quality improvement cycle.Results: Two hundred participants were included in the audit. Sixty-eight per cent were women with a mean age of 55 years. In the baseline audit none of the target standards were met. During the re-audit six months later, six out of nine structural target standards, five out of 11 process target standards and one out of two outcome target standards were achieved. Statistically-significant improvement in performance (p < 0.05 was shown in 10 criteria although the target standard was not always met. In the re-audit, the target of achieving blood pressure control (< 140/90 in 70% of patients was achieved.Conclusion: The quality of care for hypertension was suboptimal in our setting. Simple interventions were designed and implemented to improve the quality of care. These interventions led to significant improvement in structural and process criteria. A corresponding significant improvement in the control of blood pressure was also seen.

Health information systems to improve health care: A telemedicine case study

Directory of Open Access Journals (Sweden)

Liezel Cilliers

2013-03-01

Full Text Available Background: E-health has been identified as an integral part of the future of South African public healthcare. Telemedicine was first introduced in South Africa in 1997 and since then the cost of running the Telemedicine projects has increased substantially. Despite these efforts to introduce the system, only 34% of the Telemedicine sites in South Africa are functional at present. Objectives: Literature has suggested that one of the barriers to the successful implementation of health information systems is the user acceptance by health care workers of systems such as Telemedicine. This study investigated the user acceptance of Telemedicine in the public health care system in the Eastern Cape Province, making use of the Unified Theory of the Use and Acceptance of Technology. Method: The study employed a quantitative survey approach. A questionnaire was developed making use of existing literature and was distributed to various clinics around the province where Telemedicine has been implemented. Statistics were produced making use of Statistical Package for the Social Sciences (SPSS. Results: In general, the health care workers did understand the value and benefit of health information systems to improve the effectiveness and efficiency of the health care system. The barriers to the effective implementation of a health information system include the lack of knowledge and the lack of awareness regarding the Telemedicine system. This in turn means that the user is apprehensive when making use of the system thus contributing to less frequent usage. Conclusion: Health care workers do acknowledge that information systems can help to increase the effectiveness of the health care system. In general, the acceptance of Telemedicine in the Eastern Cape Department of Health is positive, but in order to integrate it into standard work practices, more must be done with regards to the promotion and education of telemedicine.

Improving pain care through implementation of the Stepped Care Model at a multisite community health center

Directory of Open Access Journals (Sweden)

Anderson DR

2016-11-01

Full Text Available Daren R Anderson,1 Ianita Zlateva,1 Emil N Coman,2 Khushbu Khatri,1 Terrence Tian,1 Robert D Kerns3 1Weitzman Institute, Community Health Center, Inc., Middletown, 2UCONN Health Disparities Institute, University of Connecticut, Farmington, 3VA Connecticut Healthcare System, West Haven, CT, USA Purpose: Treating pain in primary care is challenging. Primary care providers (PCPs receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM at a large, multisite Federally Qualified Health Center. Methods: The Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence. Results: Providers’ pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009. There was no

Antenatal care strengthening for improved quality of care in Jimma, Ethiopia

DEFF Research Database (Denmark)

Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe

2015-01-01

and assess the implementation process and effectiveness on quality of ANC in Jimma, Ethiopia. METHODS: The intervention comprised trainings, supervisions, equipment, development of health education material, and adaption of guidelines. It was implemented at public facilities and control sites were included...... in the evaluation. Improved content of care (physical examinations, laboratory testing, tetanus toxoid (TT)-immunization, health education, conduct of health professionals, and waiting time) were defined as proximal project outcomes and increased quality of care (better identification of health problems....... The effect of the intervention was assessed by comparing the change in quality of care from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression. RESULTS: The continued attention to the ANC provision during implementation stimulated...

Improving patient care through student leadership in team quality improvement projects.

Science.gov (United States)

Tschannen, Dana; Aebersold, Michelle; Kocan, Mary Jo; Lundy, Francene; Potempa, Kathleen

2015-01-01

In partnership with a major medical center, senior-level nursing students completed a root cause analysis and implementation plan to address a unit-specific quality issue. To evaluate the project, unit leaders were asked their perceptions of the value of the projects and impact on patient care, as well as to provide exemplars depicting how the student root cause analysis work resulted in improved patient outcome and/or unit processes. Liaisons noted benefits of having an RCA team, with positive impact on patient outcomes and care processes.

Scope for improved eco-efficiency varies among diverse cropping systems.

Science.gov (United States)

Carberry, Peter S; Liang, Wei-li; Twomlow, Stephen; Holzworth, Dean P; Dimes, John P; McClelland, Tim; Huth, Neil I; Chen, Fu; Hochman, Zvi; Keating, Brian A

2013-05-21

Global food security requires eco-efficient agriculture to produce the required food and fiber products concomitant with ecologically efficient use of resources. This eco-efficiency concept is used to diagnose the state of agricultural production in China (irrigated wheat-maize double-cropping systems), Zimbabwe (rainfed maize systems), and Australia (rainfed wheat systems). More than 3,000 surveyed crop yields in these three countries were compared against simulated grain yields at farmer-specified levels of nitrogen (N) input. Many Australian commercial wheat farmers are both close to existing production frontiers and gain little prospective return from increasing their N input. Significant losses of N from their systems, either as nitrous oxide emissions or as nitrate leached from the soil profile, are infrequent and at low intensities relative to their level of grain production. These Australian farmers operate close to eco-efficient frontiers in regard to N, and so innovations in technologies and practices are essential to increasing their production without added economic or environmental risks. In contrast, many Chinese farmers can reduce N input without sacrificing production through more efficient use of their fertilizer input. In fact, there are real prospects for the double-cropping systems on the North China Plain to achieve both production increases and reduced environmental risks. Zimbabwean farmers have the opportunity for significant production increases by both improving their technical efficiency and increasing their level of input; however, doing so will require improved management expertise and greater access to institutional support for addressing the higher risks. This paper shows that pathways for achieving improved eco-efficiency will differ among diverse cropping systems.

Quality Improvement Process in a Large Intensive Care Unit: Structure and Outcomes.

Science.gov (United States)

Reddy, Anita J; Guzman, Jorge A

2016-11-01

Quality improvement in the health care setting is a complex process, and even more so in the critical care environment. The development of intensive care unit process measures and quality improvement strategies are associated with improved outcomes, but should be individualized to each medical center as structure and culture can differ from institution to institution. The purpose of this report is to describe the structure of quality improvement processes within a large medical intensive care unit while using examples of the study institution's successes and challenges in the areas of stat antibiotic administration, reduction in blood product waste, central line-associated bloodstream infections, and medication errors. © The Author(s) 2015.

Effectiveness of a quality-improvement program in improving management of primary care practices

Science.gov (United States)

Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja

2011-01-01

Background: The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. Methods: In a before–after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group’s second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. Results: We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Interpretation: Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the

Improving radiation use efficiency in greenhouse production systems

OpenAIRE

Li, Tao

2015-01-01

SUMMARY A large increase in agricultural production is needed to feed the increasing world population with their increasing demand per capita. However, growing competition for arable land, water, energy, and the degradation of the environment impose challenges to improve crop production. Hence agricultural production efficiency needs to increase. Greenhouses provide the possibility to create optimal growth conditions for crops, thereby improving production and product quality. Light is the dr...

Improving organizational climate for excellence in patient care.

Science.gov (United States)

Arnold, Edwin

2013-01-01

Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance.

Quality Improvement in Health Care: The Role of Psychologists and Psychology.

Science.gov (United States)

Bonin, Liza

2018-02-21

Quality Improvement (QI) is a health care interprofessional team activity wherein psychology as a field and individual psychologists in health care settings can and should adopt a more robust presence. The current article makes the argument for why psychology's participation in QI is good for health care, is good for our profession, and is the right thing to do for the patients and families we serve. It reviews the varied ways individual psychologists and our profession can integrate quality processes and improve health care through: (1) our approach to our daily work; (2) our roles on health care teams and involvement in organizational initiatives; (3) opportunities for teaching and scholarship; and (4) system redesign and advocacy within our health care organizations and health care environment.

Energy efficiency improvement and environment in China

International Nuclear Information System (INIS)

Rouhier, Stephane

2010-01-01

Massive reliance on polluting sources of energy (coal, traditional biomass and oil) has damaged the environment in China over years. Now, China is the world's first carbon dioxide emitter and air pollution represents between 2 and 7 percent of loss of Gross Domestic Product per year, depending on the studies chosen. In order to reduce the level of pollution, one can either enhance the technology in use or reduce the share of polluting fuels in the energy mix. Indeed, current Chinese technologies are far less efficient than those of developed countries and the energy mix is massively composed of polluting sources of energy. So, they both represent huge potential savings. This article enquires the link between diversification, efficiency in the power sector and the per capita emissions and shows that emissions are negatively correlated to a diversification of the energy mix as well as an improvement of power generating technologies. Hence, it justifies the diversification of the energy mix and technology improvement as viable strategies to tackle pollution

Workflow standardization of a novel team care model to improve chronic care: a quasi-experimental study.

Science.gov (United States)

Panattoni, Laura; Hurlimann, Lily; Wilson, Caroline; Durbin, Meg; Tai-Seale, Ming

2017-04-19

Team-based chronic care models have not been widely adopted in community settings, partly due to their varying effectiveness in randomized control trials, implementation challenges, and concerns about physician acceptance. The Palo Alto Medical Foundation designed and implemented "Champion," a novel team-based model that includes new standard work (e.g. proactive patient outreach, pre-visit schedule grooming, depression screening, care planning, health coaching) to support patients' self-management of hypertension and diabetes. We investigated whether Champion improved clinical outcomes. We conducted a quasi-experimental study comparing the Champion clinic-level intervention (n = 38 physicians) with a usual care clinic (n = 37 physicians) in Northern California. The primary outcomes, blood pressure and glycohemoglobin (A1c), were analyzed using a piecewise linear growth curve model for patients exposed to a Champion physician visit (n = 3156) or usual care visit (n = 8034) in the two years prior and one year post implementation. Secondary outcomes were provider experience, compared at baseline and 12 months in both the intervention and usual care clinics using multi-level ordered logistic modeling, and electronic health record based fidelity measures. Compared to usual care, in the first 6 months after a Champion physician visit, diabetes patients aged 18-75 experienced an additional -1.13 mm Hg (95% CI: -2.23 to -0.04) decline in diastolic blood pressure and -0.47 (95% CI: -0.61 to -0.33) decline in A1c. There were no additional improvements in blood pressure or A1c 6 to 12 months post physician visit. At 12 months, Champion physicians reported improved experience with managing chronic care patients in 6 of 7 survey items (p work was uneven; depression screening was the most commonly documented element (85% of patients), while care plans were the least (30.8% of patients). Champion standard work improved glycemic control over the first 6�

A scoping review of patient discharge from intensive care: opportunities and tools to improve care.

Science.gov (United States)

Stelfox, Henry T; Lane, Dan; Boyd, Jamie M; Taylor, Simon; Perrier, Laure; Straus, Sharon; Zygun, David; Zuege, Danny J

2015-02-01

We conducted a scoping review to systematically review the literature reporting patient discharge from ICUs, identify facilitators and barriers to high-quality care, and describe tools developed to improve care. We searched Medline, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Data were extracted on the article type, study details for research articles, patient population, phase of care during discharge, and dimensions of health-care quality. From 8,154 unique publications we included 224 articles. Of these, 131 articles (58%) were original research, predominantly case series (23%) and cohort (16%) studies; 12% were narrative reviews; and 11% were guidelines/policies. Common themes included patient and family needs/experiences (29% of articles) and the importance of complete and accurate information (26%). Facilitators of high-quality care included provider-patient communication (30%), provider-provider communication (25%), and the use of guidelines/policies (29%). Patient and family anxiety (21%) and limited availability of ICU and ward resources (26%) were reported barriers to high-quality care. A total of 47 tools to facilitate patient discharge from the ICU were identified and focused on patient evaluation for discharge (29%), discharge planning and teaching (47%), and optimized discharge summaries (23%). Common themes, facilitators and barriers related to patient and family needs/experiences, communication, and the use of guidelines/policies to standardize patient discharge from ICU transcend the literature. Candidate tools to improve care are available; comparative evaluation is needed prior to broad implementation and could be tested through local quality-improvement programs.

Improving stroke care for patients at Cavan hospital [poster

LENUS (Irish Health Repository)

Murugasu, G Dr.

2013-07-01

Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.

Improvement of Engineering Work Efficiency through System Integration

International Nuclear Information System (INIS)

Lee, Sangdae; Jo, Sunghan; Hyun, Jinwoo

2016-01-01

This paper presents the concept of developing an integrated engineering system for ER to improve efficiency and utilization of engineering system. Each process including computer system and database was introduced separately by each department at that different time. Each engineering process has a close relation with other engineering processes. The introduction of processes in a different time has caused the several problems such as lack of interrelationship between engineering processes, lack of integration fleet-wide statistical data, lack of the function of data comparison among plants and increase of access time by different access location on internet. These problems have caused inefficiency of engineering system utilization to get proper information and degraded engineering system utilization. KHNP has introduced and conducted advanced engineering processes to maintain equipment effectively in a highly reliable condition since 2000s. But engineering systems for process implementation have been developed in each department at a different time. This has caused the problems of process inefficiency and data discordance. Integrated Engineering System(IES) to integrate dispersed engineering processes will improve work efficiency and utilization of engineering system because integration system would enable engineer to get total engineering information easily and do engineering work efficiently

Improvement of Engineering Work Efficiency through System Integration

Energy Technology Data Exchange (ETDEWEB)

Lee, Sangdae; Jo, Sunghan; Hyun, Jinwoo [KHNP CRI, Daejeon (Korea, Republic of)

2016-10-15

This paper presents the concept of developing an integrated engineering system for ER to improve efficiency and utilization of engineering system. Each process including computer system and database was introduced separately by each department at that different time. Each engineering process has a close relation with other engineering processes. The introduction of processes in a different time has caused the several problems such as lack of interrelationship between engineering processes, lack of integration fleet-wide statistical data, lack of the function of data comparison among plants and increase of access time by different access location on internet. These problems have caused inefficiency of engineering system utilization to get proper information and degraded engineering system utilization. KHNP has introduced and conducted advanced engineering processes to maintain equipment effectively in a highly reliable condition since 2000s. But engineering systems for process implementation have been developed in each department at a different time. This has caused the problems of process inefficiency and data discordance. Integrated Engineering System(IES) to integrate dispersed engineering processes will improve work efficiency and utilization of engineering system because integration system would enable engineer to get total engineering information easily and do engineering work efficiently.

[Integrated health care organizations: guideline for analysis].

Science.gov (United States)

Vázquez Navarrete, M Luisa; Vargas Lorenzo, Ingrid; Farré Calpe, Joan; Terraza Núñez, Rebeca

2005-01-01

There has been a tendency recently to abandon competition and to introduce policies that promote collaboration between health providers as a means of improving the efficiency of the system and the continuity of care. A number of countries, most notably the United States, have experienced the integration of health care providers to cover the continuum of care of a defined population. Catalonia has witnessed the steady emergence of increasing numbers of integrated health organisations (IHO) but, unlike the United States, studies on health providers' integration are scarce. As part of a research project currently underway, a guide was developed to study Catalan IHOs, based on a classical literature review and the development of a theoretical framework. The guide proposes analysing the IHO's performance in relation to their final objectives of improving the efficiency and continuity of health care by an analysis of the integration type (based on key characteristics); external elements (existence of other suppliers, type of services' payment mechanisms); and internal elements (model of government, organization and management) that influence integration. Evaluation of the IHO's performance focuses on global strategies and results on coordination of care and efficiency. Two types of coordination are evaluated: information coordination and coordination of care management. Evaluation of the efficiency of the IHO refers to technical and allocative efficiency. This guide may have to be modified for use in the Catalan context.

Improving outcomes in lung cancer: the value of the multidisciplinary health care team

Directory of Open Access Journals (Sweden)

Denton E

2016-03-01

Full Text Available Eve Denton,1 Matthew Conron2 1Allergy, Immunology and Respiratory Department, Alfred Hospital, 2Department of Respiratory and Sleep Medicine, St Vincent's Hospital, Melbourne, VIC, Australia Abstract: Lung cancer is a major worldwide health burden, with high disease-related morbidity and mortality. Unlike other major cancers, there has been little improvement in lung cancer outcomes over the past few decades, and survival remains disturbingly low. Multidisciplinary care is the cornerstone of lung cancer treatment in the developed world, despite a relative lack of evidence that this model of care improves outcomes. In this article, the available literature concerning the impact of multidisciplinary care on key measures of lung cancer outcomes is reviewed. This includes the limited observational data supporting improved survival with multidisciplinary care. The impact of multidisciplinary care on other benchmark measures of quality lung cancer treatment is also examined, including staging accuracy, access to diagnostic investigations, improvements in clinical decision making, better utilization of radiotherapy and palliative care services, and improved quality of life for patients. Health service research suggests that multidisciplinary care improves care coordination, leading to a better patient experience, and reduces variation in care, a problem in lung cancer management that has been identified worldwide. Furthermore, evidence suggests that the multidisciplinary model of care overcomes barriers to treatment, promotes standardized treatment through adherence to guidelines, and allows audit of clinical services and for these reasons is more likely to provide quality care for lung cancer patients. While there is strengthening evidence suggesting that the multidisciplinary model of care contributes to improvements in lung cancer outcomes, more quality studies are needed. Keywords: lung cancer, multidisciplinary care, mortality, tumor board

Continuous quality improvement program for hip and knee replacement.

Science.gov (United States)

Marshall, Deborah A; Christiansen, Tanya; Smith, Christopher; Squire Howden, Jane; Werle, Jason; Faris, Peter; Frank, Cy

2015-01-01

Improving quality of care and maximizing efficiency are priorities in hip and knee replacement, where surgical demand and costs increase as the population ages. The authors describe the integrated structure and processes from the Continuous Quality Improvement (CQI) Program for Hip and Knee Replacement Surgical Care and summarize lessons learned from implementation. The Triple Aim framework and 6 dimensions of quality care are overarching constructs of the CQI program. A validated, evidence-based clinical pathway that measures quality across the continuum of care was adopted. Working collaboratively, multidisciplinary experts embedded the CQI program into everyday practices in clinics across Alberta. Currently, 83% of surgeons participate in the CQI program, representing 95% of the total volume of hip and knee surgeries. Biannual reports provide feedback to improve care processes, infrastructure planning, and patient outcomes. CQI programs evaluating health care services inform choices to optimize care and improve efficiencies through continuous knowledge translation. © The Author(s) 2014.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

Directory of Open Access Journals (Sweden)

Janya McCalman

2018-03-01

Full Text Available Continuous quality improvement (CQI processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

Science.gov (United States)

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally. PMID:29623271

Effect of improved glycemic control on health care costs and utilization.

Science.gov (United States)

Wagner, E H; Sandhu, N; Newton, K M; McCulloch, D K; Ramsey, S D; Grothaus, L C

2001-01-10

Because of the additional costs associated with improving diabetes management, there is interest in whether improved glycemic control leads to reductions in health care costs, and, if so, when such cost savings occur. To determine whether sustained improvements in hemoglobin A(1c) (HbA(1c)) levels among diabetic patients are followed by reductions in health care utilization and costs. Historical cohort study conducted in 1992-1997 in a staff-model health maintenance organization (HMO) in western Washington State. All diabetic patients aged 18 years or older who were continuously enrolled between January 1992 and March 1996 and had HbA(1c) measured at least once per year in 1992-1994 (n = 4744). Patients whose HbA(1c) decreased 1% or more between 1992 and 1993 and sustained the decline through 1994 were considered to be improved (n = 732). All others were classified as unimproved (n = 4012). Total health care costs, percentage hospitalized, and number of primary care and specialty visits among the improved vs unimproved cohorts in 1992-1997. Diabetic patients whose HbA(1c) measurements improved were similar demographically to those whose levels did not improve but had higher baseline HbA(1c) measurements (10.0% vs 7.7%; Pcosts were $685 to $950 less each year in the improved cohort for 1994 (P =.09), 1995 (P =.003), 1996 (P =.002), and 1997 (P =.01). Cost savings in the improved cohort were statistically significant only among those with the highest baseline HbA(1c) levels (>/=10%) for these years but appeared to be unaffected by presence of complications at baseline. Beginning in the year following improvement (1994), utilization was consistently lower in the improved cohort, reaching statistical significance for primary care visits in 1994 (P =.001), 1995 (Pcost savings within 1 to 2 years of improvement.

Improvement of pressure ulcer prevention care in private for-profit residential care homes: an action research study.

Science.gov (United States)

Kwong, Enid Wy; Hung, Maria Sy; Woo, Kevin

2016-11-25

A need exits to develop a protocol for preventing pressure ulcers (PUs) in private for-profit nursing homes in Hong Kong, where the incidence of PUs is relatively high and which have high proportion of non-professional care staff. The implementation of such protocol would involve changes in the practice of care, likely evoking feelings of fear and uncertainty that may become a barrier to staff adherence. We thus adopted the Systems Model of Action Research in this study to manage the process of change for improving PU prevention care and to develop a pressure ulcer prevention protocol for private for-profit nursing homes. A total of 474 residents and care staff who were health workers, personal care workers, and/or nurses from four private, for-profit nursing homes in Hong Kong participated in this study. Three cyclic stages and steps, namely, unfreezing (planning), changing (action), and refreezing (results) were carried out. During each cycle, focus group interviews, field observations of the care staff's practices and inspections of the skin of the residents for pressure ulcers were conducted to evaluate the implementation of the protocol. Qualitative content analysis was adopted to analyse the data. The data and methodological triangulation used in this study increased the credibility and validity of the results. The following nine themes emerged from this study: prevention practices after the occurrence of PUs, the improper use of pressure ulcer prevention materials, non-compliance with several prevention practices, improper prevention practices, the perception that the preventive care was being performed correctly, inadequate readiness to use the risk assessment tool, an undesirable environment, the supplying of unfavorable resources, and various management styles in the homes with or without nurses. At the end of the third cycle, the changes that were identified included improved compliance with the revised risk assessment method, the timely and appropriate

SafeCare: An Innovative Approach for Improving Quality Through Standards, Benchmarking, and Improvement in Low- and Middle- Income Countries.

Science.gov (United States)

Johnson, Michael C; Schellekens, Onno; Stewart, Jacqui; van Ostenberg, Paul; de Wit, Tobias Rinke; Spieker, Nicole

2016-08-01

In low- and middle-income countries (LMICs), patients often have limited access to high-quality care because of a shortage of facilities and human resources, inefficiency of resource allocation, and limited health insurance. SafeCare was developed to provide innovative health care standards; surveyor training; a grading system for quality of care; a quality improvement process that is broken down into achievable, measurable steps to facilitate incremental improvement; and a private sector-supported health financing model. Three organizations-PharmAccess Foundation, Joint Commission International, and the Council for Health Service Accreditation of Southern Africa-launched SafeCare in 2011 as a formal partnership. Five SafeCare levels of improvement are allocated on the basis of an algorithm that incorporates both the overall score and weighted criteria, so that certain high-risk criteria need to be in place before a facility can move to the next SafeCare certification level. A customized quality improvement plan based on the SafeCare assessment results lists the specific, measurable activities that should be undertaken to address gaps in quality found during the initial assessment and to meet the nextlevel SafeCare certificate. The standards have been implemented in more than 800 primary and secondary facilities by qualified local surveyors, in partnership with various local public and private partner organizations, in six sub-Saharan African countries (Ghana, Kenya, Nigeria, Namibia, Tanzania, and Zambia). Expanding access to care and improving health care quality in LMICs will require a coordinated effort between institutions and other stakeholders. SafeCare's standards and assessment methodology can help build trust between stakeholders and lay the foundation for country-led quality monitoring systems.

The National Heart Failure Project: a health care financing administration initiative to improve the care of Medicare beneficiaries with heart failure.

Science.gov (United States)

Masoudi, F A; Ordin, D L; Delaney, R J; Krumholz, H M; Havranek, E P

2000-01-01

This is the second in a series describing Health Care Financing Administration (HCFA) initiatives to improve care for Medicare beneficiaries with heart failure. The first article outlined the history of HCFA quality-improvement projects and current initiatives to improve care in six priority areas: heart failure, acute myocardial infarction, stroke, pneumonia, diabetes, and breast cancer. This article details the objectives and design of the Medicare National Heart Failure Quality Improvement Project (NHF), which has as its goal the improvement of inpatient heart failure care. (c)2000 by CHF, Inc.

Efficiency improvement opportunities for personal computer monitors. Implications for market transformation programs

Energy Technology Data Exchange (ETDEWEB)

Park, Won Young; Phadke, Amol; Shah, Nihar [Environmental Energy Technologies Division, Lawrence Berkeley National Laboratory, Berkeley, CA (United States)

2013-08-15

Displays account for a significant portion of electricity consumed in personal computer (PC) use, and global PC monitor shipments are expected to continue to increase. We assess the market trends in the energy efficiency of PC monitors that are likely to occur without any additional policy intervention and estimate that PC monitor efficiency will likely improve by over 40 % by 2015 with saving potential of 4.5 TWh per year in 2015, compared to today's technology. We discuss various energy-efficiency improvement options and evaluate the cost-effectiveness of three of them, at least one of which improves efficiency by at least 20 % cost effectively beyond the ongoing market trends. We assess the potential for further improving efficiency taking into account the recent development of universal serial bus-powered liquid crystal display monitors and find that the current technology available and deployed in them has the potential to deeply and cost effectively reduce energy consumption by as much as 50 %. We provide insights for policies and programs that can be used to accelerate the adoption of efficient technologies to further capture global energy saving potential from PC monitors which we estimate to be 9.2 TWh per year in 2015.

Assessing organizational readiness for depression care quality improvement: relative commitment and implementation capability.

Science.gov (United States)

Rubenstein, Lisa V; Danz, Marjorie S; Crain, A Lauren; Glasgow, Russell E; Whitebird, Robin R; Solberg, Leif I

2014-12-02

Depression is a major cause of morbidity and cost in primary care patient populations. Successful depression improvement models, however, are complex. Based on organizational readiness theory, a practice's commitment to change and its capability to carry out the change are both important predictors of initiating improvement. We empirically explored the links between relative commitment (i.e., the intention to move forward within the following year) and implementation capability. The DIAMOND initiative administered organizational surveys to medical and quality improvement leaders from each of 83 primary care practices in Minnesota. Surveys preceded initiation of activities directed at implementation of a collaborative care model for improving depression care. To assess implementation capability, we developed composites of survey items for five types of organizational factors postulated to be collaborative care barriers and facilitators. To assess relative commitment for each practice, we averaged leader ratings on an identical survey question assessing practice priorities. We used multivariable regression analyses to assess the extent to which implementation capability predicted relative commitment. We explored whether relative commitment or implementation capability measures were associated with earlier initiation of DIAMOND improvements. All five implementation capability measures independently predicted practice leaders' relative commitment to improving depression care in the following year. These included the following: quality improvement culture and attitudes (p = 0.003), depression culture and attitudes (p commitment (p = 0.002) and prior depression quality improvement activities appeared to be associated with earlier participation in the DIAMOND initiative. The study supports the concept of organizational readiness to improve quality of care and the use of practice leader surveys to assess it. Practice leaders' relative commitment to depression care

Studying and Incorporating Efficiency into Gastrointestinal Endoscopy Centers

Directory of Open Access Journals (Sweden)

Lukejohn W. Day

2015-01-01

Full Text Available Efficiency is defined as the use of resources in such a way as to maximize the production of goods and services. Improving efficiency has been the focus of management in many industries; however, it has not been until recently that incorporating efficiency models into healthcare has occurred. In particular, the study and development of improvement projects aimed at enhancing efficiency in GI have been growing rapidly in recent years. This focus on improving efficiency in GI has been spurred by the dramatic rise in the demand for endoscopic procedures as well as the rising number of insured patients requiring GI care coupled at the same time with limited resources in terms of staffing and space in endoscopy centers. This paper will critically review the history of efficiency in endoscopy centers, first by looking at other healthcare industries that have extensively studied and improved efficiency in their fields, examine a number of proposed efficiency metrics and benchmarks in endoscopy centers, and finally discuss opportunities where endoscopy centers could improve their efficiency.

Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care

DEFF Research Database (Denmark)

Nørgaard, Birgitte; Kofoed, Poul-Erik; Ohm Kyvik, Kirsten

2012-01-01

Scand J Caring Sci; 2012; Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care Rationale:  Despite the fact that communication has become a core topic in health care, patients still experience the information provided...... as insufficient or incorrect and a lack of involvement. Objective:  To investigate whether adult orthopaedic patients' evaluation of the quality of care had improved after a communication skills training course for healthcare professionals. Design and methods:  The study was designed as an intervention study...... offering professionals training in communicating with patients and colleagues. The outcome was measured by assessing patients' experience of quality of care. Data were collected by means of a questionnaire and analysed using a linear regression model. Approval was obtained from the Danish Data Protection...

Efficient Adoption and Assessment of Multiple Process Improvement Reference Models

Directory of Open Access Journals (Sweden)

Simona Jeners

2013-06-01

Full Text Available A variety of reference models such as CMMI, COBIT or ITIL support IT organizations to improve their processes. These process improvement reference models (IRMs cover different domains such as IT development, IT Services or IT Governance but also share some similarities. As there are organizations that address multiple domains and need to coordinate their processes in their improvement we present MoSaIC, an approach to support organizations to efficiently adopt and conform to multiple IRMs. Our solution realizes a semantic integration of IRMs based on common meta-models. The resulting IRM integration model enables organizations to efficiently implement and asses multiple IRMs and to benefit from synergy effects.

Improving client-centred care and services: the role of front/back-office configurations.

Science.gov (United States)

Broekhuis, Manda; de Blok, Carolien; Meijboom, Bert

2009-05-01

This paper is a report of a study conducted to explore the application of designing front- and back-office work resulting in efficient client-centred care in healthcare organizations that supply home care, welfare and domestic services. Front/back-office configurations reflect a neglected domain of design decisions in the development of more client-centred processes and structures without incurring major cost increases. Based on a literature search, a framework of four front/back-office configurations was constructed. To illustrate the usefulness of this framework, a single, longitudinal case study was performed in a large organization, which provides home care, welfare and domestic services for a sustained period (2005-2006). The case study illustrates how front/back-office design decisions are related to the complexity of the clients' demands and the strategic objectives of an organization. The constructed framework guides the practical development of front/back-office designs, and shows how each design contributes differently to such performance objectives as quality, speed and efficiency. The front/back-office configurations presented comprise an important first step in elaborating client-centred care and service provision to the operational level. It helps healthcare organizations to become more responsive and to provide efficient client-centred care and services when approaching demand in a well-tuned manner. In addition to its applicability in home care, we believe that a deliberate front/back-office configuration also has potential in other fields of health care.

Research in action: using positive deviance to improve quality of health care

Directory of Open Access Journals (Sweden)

Nembhard Ingrid M

2009-05-01

Full Text Available Abstract Background Despite decades of efforts to improve quality of health care, poor performance persists in many aspects of care. Less than 1% of the enormous national investment in medical research is focused on improving health care delivery. Furthermore, when effective innovations in clinical care are discovered, uptake of these innovations is often delayed and incomplete. In this paper, we build on the established principle of 'positive deviance' to propose an approach to identifying practices that improve health care quality. Methods We synthesize existing literature on positive deviance, describe major alternative approaches, propose benefits and limitations of a positive deviance approach for research directed toward improving quality of health care, and describe an application of this approach in improving hospital care for patients with acute myocardial infarction. Results The positive deviance approach, as adapted for use in health care, presumes that the knowledge about 'what works' is available in existing organizations that demonstrate consistently exceptional performance. Steps in this approach: identify 'positive deviants,' i.e., organizations that consistently demonstrate exceptionally high performance in the area of interest (e.g., proper medication use, timeliness of care; study the organizations in-depth using qualitative methods to generate hypotheses about practices that allow organizations to achieve top performance; test hypotheses statistically in larger, representative samples of organizations; and work in partnership with key stakeholders, including potential adopters, to disseminate the evidence about newly characterized best practices. The approach is particularly appropriate in situations where organizations can be ranked reliably based on valid performance measures, where there is substantial natural variation in performance within an industry, when openness about practices to achieve exceptional performance

Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial

Science.gov (United States)

2012-01-01

Background The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the staff problems. The main objective of this study is to evaluate the effectiveness and cost-effectiveness of dementia-care mapping in nursing-home dementia care. Methods/Design The study is a cluster-randomised controlled trial, with nursing homes grouped in clusters. Studywise minimisation is the allocation method. Nursing homes in the intervention group will receive a dementia-care-mapping intervention, while the control group will receive usual care. The primary outcome measure is resident agitation, to be assessed with the Cohen-Mansfield Agitation Inventory. The secondary outcomes are resident neuropsychiatric symptoms, assessed with the Neuropsychiatric Inventory - Nursing Homes and quality of life, assessed with Qualidem and the EQ-5D. The staff outcomes are stress reactions, job satisfaction and job-stress-related absenteeism, and staff turnover rate, assessed with the Questionnaire about Experience and Assessment of Work, the General Health Questionnaire-12, and the Maastricht Job Satisfaction Scale for Health Care, respectively. We will collect the data from the questionnaires and electronic registration systems. We will employ linear mixed-effect models and cost-effectiveness analyses to evaluate the outcomes. We will use structural equation modelling in the secondary analysis to evaluate the plausibility of a theoretical model regarding the effectiveness of the dementia-care mapping intervention. We will set up process analyses, including focus groups with staff, to determine the relevant facilitators of and barriers to implementing dementia-care mapping broadly. Discussion A novelty of dementia-care mapping is that it offers an integral person

Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial

Directory of Open Access Journals (Sweden)

van de Ven Geertje

2012-01-01

Full Text Available Abstract Background The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the staff problems. The main objective of this study is to evaluate the effectiveness and cost-effectiveness of dementia-care mapping in nursing-home dementia care. Methods/Design The study is a cluster-randomised controlled trial, with nursing homes grouped in clusters. Studywise minimisation is the allocation method. Nursing homes in the intervention group will receive a dementia-care-mapping intervention, while the control group will receive usual care. The primary outcome measure is resident agitation, to be assessed with the Cohen-Mansfield Agitation Inventory. The secondary outcomes are resident neuropsychiatric symptoms, assessed with the Neuropsychiatric Inventory - Nursing Homes and quality of life, assessed with Qualidem and the EQ-5D. The staff outcomes are stress reactions, job satisfaction and job-stress-related absenteeism, and staff turnover rate, assessed with the Questionnaire about Experience and Assessment of Work, the General Health Questionnaire-12, and the Maastricht Job Satisfaction Scale for Health Care, respectively. We will collect the data from the questionnaires and electronic registration systems. We will employ linear mixed-effect models and cost-effectiveness analyses to evaluate the outcomes. We will use structural equation modelling in the secondary analysis to evaluate the plausibility of a theoretical model regarding the effectiveness of the dementia-care mapping intervention. We will set up process analyses, including focus groups with staff, to determine the relevant facilitators of and barriers to implementing dementia-care mapping broadly. Discussion A novelty of dementia-care mapping is that it offers an

Practice-level quality improvement interventions in primary care: a review of systematic reviews.

Science.gov (United States)

Irwin, Ryan; Stokes, Tim; Marshall, Tom

2015-11-01

To present an overview of effective interventions for quality improvement in primary care at the practice level utilising existing systematic reviews. Quality improvement in primary care involves a range of approaches from the system-level to patient-level improvement. One key setting in which quality improvement needs to occur is at the level of the basic unit of primary care--the individual general practice. Therefore, there is a need for practitioners to have access to an overview of the effectiveness of quality improvement interventions available in this setting. A tertiary evidence synthesis was conducted (a review of systematic reviews). A systematic approach was used to identify and summarise published literature relevant to understanding primary-care quality improvement at the practice level. Quality assessment was via the Critical Appraisal Skills Programme tool for systematic reviews, with data extraction identifying evidence of effect for the examined interventions. Included reviews had to be relevant to quality improvement at the practice level and relevant to the UK primary-care context. Reviews were excluded if describing system-level interventions. A range of measures across care structure, process and outcomes were defined and interpreted across the quality improvement interventions. Audit and feedback, computerised advice, point-of-care reminders, practice facilitation, educational outreach and processes for patient review and follow-up all demonstrated evidence of a quality improvement effect. Evidence of an improvement effect was higher where baseline performance was low and was particularly demonstrated across process measures and measures related to prescribing. Evidence was not sufficient to suggest that multifaceted approaches were more effective than single interventions. Evidence exists for a range of quality improvement interventions at the primary-care practice level. More research is required to determine the use and impact of quality

Palliative Care: Improving Nursing Knowledge, Attitudes, and Behaviors
.

Science.gov (United States)

Harden, Karen; Price, Deborah; Duffy, Elizabeth; Galunas, Laura; Rodgers, Cheryl

2017-10-01

Oncology nurses affect patient care at every point along the cancer journey. This creates the perfect opportunity to educate patients and caregivers about palliative care early and often throughout treatment. However, healthcare providers frequently do not have the knowledge and confidence to engage in meaningful conversations about palliative care.
. The specific aims were to improve oncology nurses' palliative care knowledge, attitudes, and behaviors by providing a palliative care nursing education program. An additional aim was to increase the number of conversations with patients and families about palliative care.
. This project had a pre-/post-test design to assess knowledge, attitudes, and behaviors at baseline and one month after implementation of an established education curriculum. The teaching strategy included one four-hour class for oncology RNs with topics about the definition of palliative care, pain and symptom management, and how to have palliative care conversations.
. Results showed a statistically significant difference after the educational intervention for knowledge, attitudes, and behaviors. The number of conversations with patients and caregivers about palliative and end-of-life care increased significantly.

Home Care Nursing Improves Cancer Symptom Management

Science.gov (United States)

Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.

[Strategies for improving care of oncologic patients: SHARE Project results].

Science.gov (United States)

Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

2016-01-01

Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Towards Improving the Transfer of Care of Kidney Transplant Recipients.

Science.gov (United States)

Gill, J S; Wright, A J; Delmonico, F L; Newell, K A

2017-01-01

Kidney transplant recipients require specialized medical care and may be at risk for adverse health outcomes when their care is transferred. This document provides opinion-based recommendations to facilitate safe and efficient transfers of care for kidney transplant recipients including minimizing the risk of rejection, avoidance of medication errors, ensuring patient access to immunosuppressant medications, avoidance of lapses in health insurance coverage, and communication of risks of donor disease transmission. The document summarizes information to be included in a medical transfer document and includes suggestions to help the patient establish an optimal therapeutic relationship with their new transplant care team. The document is intended as a starting point towards standardization of transfers of care involving kidney transplant recipients. © Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

Improving Care Teams' Functioning: Recommendations from Team Science.

Science.gov (United States)

Fiscella, Kevin; Mauksch, Larry; Bodenheimer, Thomas; Salas, Eduardo

2017-07-01

Team science has been applied to many sectors including health care. Yet there has been relatively little attention paid to the application of team science to developing and sustaining primary care teams. Application of team science to primary care requires adaptation of core team elements to different types of primary care teams. Six elements of teams are particularly relevant to primary care: practice conditions that support or hinder effective teamwork; team cognition, including shared understanding of team goals, roles, and how members will work together as a team; leadership and coaching, including mutual feedback among members that promotes teamwork and moves the team closer to achieving its goals; cooperation supported by an emotionally safe climate that supports expression and resolution of conflict and builds team trust and cohesion; coordination, including adoption of processes that optimize efficient performance of interdependent activities among team members; and communication, particularly regular, recursive team cycles involving planning, action, and debriefing. These six core elements are adapted to three prototypical primary care teams: teamlets, health coaching, and complex care coordination. Implementation of effective team-based models in primary care requires adaptation of core team science elements coupled with relevant, practical training and organizational support, including adequate time to train, plan, and debrief. Training should be based on assessment of needs and tasks and the use of simulations and feedback, and it should extend to live action. Teamlets represent a potential launch point for team development and diffusion of teamwork principles within primary care practices. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

The right care, every time: improving adherence to evidence-based guidelines.

Science.gov (United States)

Runnacles, Jane; Roueché, Alice; Lachman, Peter

2018-02-01

Guidelines are integral to reducing variation in paediatric care by ensuring that children receive the right care, every time. However, for reasons discussed in this paper, clinicians do not always follow evidence-based guidelines. Strategies to improve guideline usage tend to focus on dissemination and education. These approaches, however, do not address some of the more complex factors that influence whether a guideline is used in clinical practice. In this article, part of the Equipped Quality Improvement series, we outline the literature on barriers to guideline adherence and present practical solutions to address these barriers. Examples outlined include the use of care bundles, integrated care pathways and quality improvement collaboratives. A sophisticated information technology system can improve the use of evidence-based guidelines and provide organisations with valuable data for learning and improvement. Key to success is the support of an organisation that places reliability of service delivery as the way business is done. To do this requires leadership from clinicians in multidisciplinary teams and a system of continual improvement. By learning from successful approaches, we believe that all healthcare organisations can ensure the right care for each patient, every time. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Efficiency improvement for a sustainable agriculture : the integration of agronomic and farm economics approaches

OpenAIRE

Koeijer, de, T.J.

2002-01-01

Keywords: Sustainable farming systems, Agronomic efficiency, Economic efficiency, Environmental efficiency, Sustainability index, Interdisciplinary analysis.

The objective of the research described in this thesis was to determine what role improved agronomic efficiency can play in the transition towards more sustainable production systems. Agronomic efficiency measures the technical performance. If it could be improved, environmental damage could be reduced while, at the sam...

Social efficiency of hospital care delivery: frontier analysis from the consumer's perspective.

Science.gov (United States)

Bernet, Patrick M; Moises, James; Valdmanis, Vivian Grace

2011-02-01

The efficiency of hospital services and patients' access to hospitals are both important health care policy issues. In the past, research has relied on studying these topics separately. In this article, we measure both efficiency and access at the same time using data envelopment analysis (DEA). By including both the technically efficient use of resources, as well as the patients' travel distances, we found increases in social efficiency when patients' travel distances were taken into account. When compared with patients with nonurgent conditions, we found that patients suffering from conditions requiring urgent attention were treated at closer hospitals, increasing the social efficiency. Insurance coverage and hospital ownership were also examined. Our findings corroborated past literature in the hospital and travel distance literature and set out a framework for future research. Perhaps most important, we demonstrate the techniques needed to incorporate broader measures of social costs into studies of hospital efficiency.

Stimulation of Efficient Employee Performance through Human Resource Management Practices: A Study on the Health Care Sector of Bangladesh

Directory of Open Access Journals (Sweden)

Fatema Nusrat

2018-01-01

Full Text Available As the world is becoming more competitive and unstable than ever before; health care sector, especially in a developing country like Bangladesh, is seeking to gain competitive advantage through the performance of its employees and is turning to be more innovative in this perspective through human resource management (HRM practices. Experts view HRM practices as a set of internally consistent policies and practices designed and implemented to ensure that the human capital of the organization contributes to the achievement of its objectives. This paper examined the effects of human resource management (HRM practices on stimulating or enhancing efficient employee performance in the health care sector of Bangladesh. Ten dimensions and 43 item statements of human resource management (HRM practices and efficient employee performance have been adopted to undertake this study. Data have been gathered following a quantitative survey by a structured questionnaire conducted among a diverse group of employees (N = 240 working in 20 different health care service providing organizations of Bangladesh following simple random sampling method. Several statistical techniques consisting of descriptive analysis, Pearson correlations, ANOVA, Coefficient and regression analysis have been applied using SPSS software to analyze the collected data for taking decisions regarding the hypotheses. The results of the statistical analysis reveal that human resource management (HRM practices positively stimulates efficient employee performance. This study therefore recommends among others: enhancement of motivation among employees, improvement in the reward system, establishment of strong organizational culture, training and re-training of employees,  and employees participation in decision making.

A diabetes dashboard and physician efficiency and accuracy in accessing data needed for high-quality diabetes care.

Science.gov (United States)

Koopman, Richelle J; Kochendorfer, Karl M; Moore, Joi L; Mehr, David R; Wakefield, Douglas S; Yadamsuren, Borchuluun; Coberly, Jared S; Kruse, Robin L; Wakefield, Bonnie J; Belden, Jeffery L

2011-01-01

We compared use of a new diabetes dashboard screen with use of a conventional approach of viewing multiple electronic health record (EHR) screens to find data needed for ambulatory diabetes care. We performed a usability study, including a quantitative time study and qualitative analysis of information-seeking behaviors. While being recorded with Morae Recorder software and "think-aloud" interview methods, 10 primary care physicians first searched their EHR for 10 diabetes data elements using a conventional approach for a simulated patient, and then using a new diabetes dashboard for another. We measured time, number of mouse clicks, and accuracy. Two coders analyzed think-aloud and interview data using grounded theory methodology. The mean time needed to find all data elements was 5.5 minutes using the conventional approach vs 1.3 minutes using the diabetes dashboard (P dashboard (P dashboard (P dashboard improves both the efficiency and accuracy of acquiring data needed for high-quality diabetes care. Usability analysis tools can provide important insights into the value of optimizing physician use of health information technologies.

45 CFR 98.51 - Activities to improve the quality of child care.

Science.gov (United States)

2010-10-01

... health and safety, nutrition, first aid, the recognition of communicable diseases, child abuse detection... 45 Public Welfare 1 2010-10-01 2010-10-01 false Activities to improve the quality of child care... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve...

Improving long-term care provision: towards demand-based care by means of modularity

Directory of Open Access Journals (Sweden)

Meijboom Bert

2010-09-01

Full Text Available Abstract Background As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes. Methods Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software. Results Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services. Conclusion The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to

Improving long-term care provision: towards demand-based care by means of modularity

Science.gov (United States)

2010-01-01

Background As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes. Methods Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software. Results Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services. Conclusion The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to elaborate on how to further

Improving building energy efficiency in India: State-level analysis of building energy efficiency policies

Energy Technology Data Exchange (ETDEWEB)

Yu, Sha; Tan, Qing; Evans, Meredydd; Kyle, Page; Vu, Linh; Patel, Pralit L.

2017-11-01

India is expected to add 40 billion m2 of new buildings till 2050. Buildings are responsible for one third of India’s total energy consumption today and building energy use is expected to continue growing driven by rapid income and population growth. The implementation of the Energy Conservation Building Code (ECBC) is one of the measures to improve building energy efficiency. Using the Global Change Assessment Model, this study assesses growth in the buildings sector and impacts of building energy policies in Gujarat, which would help the state adopt ECBC and expand building energy efficiency programs. Without building energy policies, building energy use in Gujarat would grow by 15 times in commercial buildings and 4 times in urban residential buildings between 2010 and 2050. ECBC improves energy efficiency in commercial buildings and could reduce building electricity use in Gujarat by 20% in 2050, compared to the no policy scenario. Having energy codes for both commercial and residential buildings could result in additional 10% savings in electricity use. To achieve these intended savings, it is critical to build capacity and institution for robust code implementation.

IMPROVING HOSPITAL LOGISTICS BY RETHINKING TECHNOLOGY ASSESSMENT

DEFF Research Database (Denmark)

Jacobsen, Peter; Jørgensen, Pelle Morten Thomas

2011-01-01

In order to cope with the future challenges of the health care sector, there is an urging need for improving efficiency at hospitals. The study presents a framework enabling health care managers of improving the in-house logistics. The distinctiveness of the framework is the way in which it relates...... technology, logistics, structure and procedures to efficiency. Changing one factor e.g. technology, initiates an iterative loop focusing on change in the related factors in order to obtain the optimal efficiency. The search for an optimal efficient solution is the driving force of the framework...... at a Danish hospital. The framework is tested on the blood sample logistics between the emergency department and laboratory with the goal of enhancing the efficiency of the emergency department....

Shifting Landscapes: The Impact of Centralized and Decentralized Nursing Station Models on the Efficiency of Care.

Science.gov (United States)

Fay, Lindsey; Carll-White, Allison; Schadler, Aric; Isaacs, Kathy B; Real, Kevin

2017-10-01

The focus of this research was to analyze the impact of decentralized and centralized hospital design layouts on the delivery of efficient care and the resultant level of caregiver satisfaction. An interdisciplinary team conducted a multiphased pre- and postoccupancy evaluation of a cardiovascular service line in an academic hospital that moved from a centralized to decentralized model. This study examined the impact of walkability, room usage, allocation of time, and visibility to better understand efficiency in the care environment. A mixed-methods data collection approach was utilized, which included pedometer measurements of staff walking distances, room usage data, time studies in patient rooms and nurses' stations, visibility counts, and staff questionnaires yielding qualitative and quantitative results. Overall, the data comparing the centralized and decentralized models yielded mixed results. This study's centralized design was rated significantly higher in its ability to support teamwork and efficient patient care with decreased staff walking distances. The decentralized unit design was found to positively influence proximity to patients in a larger design footprint and contribute to increased visits to and time spent in patient rooms. Among the factors contributing to caregiver efficiency and satisfaction are nursing station design, an integrated team approach, and the overall physical layout of the space on walkability, allocation of caregiver time, and visibility. However, unit design alone does not solely impact efficiency, suggesting that designers must consider the broader implications of a culture of care and processes.

Innovative use of technologies and methods to redesign care: the problem of care transitions.

Science.gov (United States)

Richman, Mark; Sklaroff, Laura Myerchin; Hoang, Khathy; Wasson, Elijah; Gross-Schulman, Sandra

2014-01-01

Organizations are redesigning models of care in today's rapidly changing health care environment. Using proven innovation techniques maximizes likelihood of effective change. Our safety-net hospital aims to reduce high emergency department visit, admission, and readmission rates, key components to health care cost control. Twenty-five clinical stakeholders participated in mixed-methods innovation exercises to understand stakeholders, frame problems, and explore solutions. We identified existing barriers and means to improve post-emergency department/post-inpatient discharge care coordination/communication among patient-centered medical home care team members, including patients. Physicians and staff preferred automated e-mail notifications, including patient identifiers, medical home/primary care provider information, and relevant clinical documentation, to improve communication efficiency/efficacy.

Improving the efficiency of aerodynamic shape optimization

Science.gov (United States)

Burgreen, Greg W.; Baysal, Oktay; Eleshaky, Mohamed E.

1994-01-01

The computational efficiency of an aerodynamic shape optimization procedure that is based on discrete sensitivity analysis is increased through the implementation of two improvements. The first improvement involves replacing a grid-point-based approach for surface representation with a Bezier-Bernstein polynomial parameterization of the surface. Explicit analytical expressions for the grid sensitivity terms are developed for both approaches. The second improvement proposes the use of Newton's method in lieu of an alternating direction implicit methodology to calculate the highly converged flow solutions that are required to compute the sensitivity coefficients. The modified design procedure is demonstrated by optimizing the shape of an internal-external nozzle configuration. Practically identical optimization results are obtained that are independent of the method used to represent the surface. A substantial factor of 8 decrease in computational time for the optimization process is achieved by implementing both of the design procedure improvements.

Evaluating fundamentals of care: The development of a unit-level quality measurement and improvement programme.

Science.gov (United States)

Parr, Jenny M; Bell, Jeanette; Koziol-McLain, Jane

2018-06-01

The project aimed to develop a unit-level quality measurement and improvement programme using evidence-based fundamentals of care. Feedback from patients, families, whānau, staff and audit data in 2014 indicated variability in the delivery of fundamental aspects of care such as monitoring, nutrition, pain management and environmental cleanliness at a New Zealand District Health Board. A general inductive approach was used to explore the fundamentals of care and design a measurement and improvement programme, the Patient and Whānau Centred Care Standards (PWCCS), focused on fundamental care. Five phases were used to explore the evidence, and design and test a measurement and improvement framework. Nine identified fundamental elements of care were used to define expected standards of care and develop and test a measurement and improvement framework. Four six-monthly peer reviews have been undertaken since June 2015. Charge Nurse Managers used results to identify quality improvements. Significant improvement was demonstrated overall, in six of the 27 units, in seven of the nine standards and three of the four measures. In all, 89% (n = 24) of units improved their overall result. The PWCCS measurement and improvement framework make visible nursing fundamentals of care in line with continuous quality improvement to increase quality of care. Delivering fundamentals of care is described by nurses as getting ?back to basics'. Patient and family feedback supports the centrality of fundamentals of care to their hospital experience. Implementing a unit-level fundamentals of care quality measurement and improvement programme clarifies expected standards of care, highlights the contribution of fundamentals of care to quality and provides a mechanism for ongoing improvements. © 2018 John Wiley & Sons Ltd.

IMPROVING CO2 EFFICIENCY FOR RECOVERING OIL IN HETEROGENEOUS RESERVOIRS

International Nuclear Information System (INIS)

Grigg, Reid B.

2002-01-01

A three-year contract, DOE Contract No. DE-FG26-01BC15364 ''Improving CO 2 Efficiency for Recovering Oil in Heterogeneous Reservoirs,'' was started on September 28, 2001. This project examines three major areas in which CO 2 flooding can be improved: fluid and matrix interactions, conformance control/sweep efficiency, and reservoir simulation for improved oil recovery. This report discusses the activity during the six-month period covering January 1, 2002 through June 30, 2002 that covers the second and third fiscal quarters of the project's first year. Paper SPE 75178, ''Cost Reduction and Injectivity Improvements for CO 2 Foams for Mobility Control,'' has been presented and included in the proceedings of the SPE/DOE Thirteenth Symposium on Improved Oil Recovery, Tulsa, OK, April 13-17, 2002. During these two quarters of the project we have been working in several areas: reservoir fluid/rock interactions and their relationships to changing injectivity, producer survey on injectivity, and surfactant adsorption on quarried and reservoir core

Quantum entanglement helps in improving economic efficiency

International Nuclear Information System (INIS)

Du Jiangfeng; Ju Chenyong; Li Hui

2005-01-01

We propose an economic regulation approach based on quantum game theory for the government to reduce the abuses of oligopolistic competition. Theoretical analysis shows that this approach can help government improve the economic efficiency of the oligopolistic market, and help prevent monopoly due to incorrect information. These advantages are completely attributed to the quantum entanglement, a unique quantum mechanical character

Quantum entanglement helps in improving economic efficiency

Science.gov (United States)

Du, Jiangfeng; Ju, Chenyong; Li, Hui

2005-02-01

We propose an economic regulation approach based on quantum game theory for the government to reduce the abuses of oligopolistic competition. Theoretical analysis shows that this approach can help government improve the economic efficiency of the oligopolistic market, and help prevent monopoly due to incorrect information. These advantages are completely attributed to the quantum entanglement, a unique quantum mechanical character.

Impact of the Local Public Hospital Reform on the Efficiency of Medium-Sized Hospitals in Japan: An Improved Slacks-Based Measure Data Envelopment Analysis Approach.

Science.gov (United States)

Zhang, Xing; Tone, Kaoru; Lu, Yingzhe

2018-04-01

To assess the change in efficiency and total factor productivity (TFP) of the local public hospitals in Japan after the local public hospital reform launched in late 2007, which was aimed at improving the financial capability and operational efficiency of hospitals. Secondary data were collected from the Ministry of Internal Affairs and Communications on 213 eligible medium-sized hospitals, each operating 100-400 beds from FY2006 to FY2011. The improved slacks-based measure nonoriented data envelopment analysis models (Quasi-Max SBM nonoriented DEA models) were used to estimate dynamic efficiency score and Malmquist Index. The dynamic efficiency measure indicated an efficiency gain in the first several years of the reform and then was followed by a decrease. Malmquist Index analysis showed a significant decline in the TFP between 2006 and 2011. The financial improvement of medium-sized hospitals was not associated with enhancement of efficiency. Hospital efficiency was not significantly different among ownership structure and law-application system groups, but it was significantly affected by hospital location. The results indicate a need for region-tailored health care policies and for a more comprehensive reform to overcome the systemic constraints that might contribute to the decline of the TFP. © Health Research and Educational Trust.

Implementing practice management strategies to improve patient care: the EPIC project.

Science.gov (United States)

Attwell, David; Rogers-Warnock, Leslie; Nemis-White, Joanna

2012-01-01

Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.

Improving the health care experiences of lesbian, gay, bisexual and transgender patients

International Nuclear Information System (INIS)

Bolderston, A.; Ralph, S.

2016-01-01

Systematic discrimination against lesbian, gay, bisexual and transgender people (LGBT) persists across most contemporary societies and institutions such as health care despite increasing social tolerance and legislative progress. This article explores discrimination against LGBT people, and examines LGBT health and social issues. The implications this has for health care access and quality of care delivered by patient-facing health care professionals such as radiographers are explored. Finally, three categories of suggestions to improve the care of LGBT patients are suggested; changes to the physical environment, improvement in health forms and awareness training. Some of these suggestions can be taken up directly by radiographers, particular accessing training. Others (such as positive changes in the physical space) could be championed by department managers. There is a need to promote better culturally competent training for radiographers to be able to sensitively respond to their LGBT patients' specific health and social needs. - Highlights: • Lesbian, gay, bisexual and trans people can encounter health care discrimination. • Patient-facing professionals like radiographers routinely work with LGBT patients. • Positive changes can be made to improve patient care and access. • These include changes to the environment, health form improvement and training.

High Performance Healthcare Buildings: A Roadmap to Improved Energy Efficiency

Energy Technology Data Exchange (ETDEWEB)

Singer, Brett C.; Tschudi, William F.

2009-09-08

This document presents a road map for improving the energy efficiency of hospitals and other healthcare facilities. The report compiles input from a broad array of experts in healthcare facility design and operations. The initial section lists challenges and barriers to efficiency improvements in healthcare. Opportunities are organized around the following ten themes: understanding and benchmarking energy use; best practices and training; codes and standards; improved utilization of existing HVAC designs and technology; innovation in HVAC design and technology; electrical system design; lighting; medical equipment and process loads; economic and organizational issues; and the design of next generation sustainable hospitals. Achieving energy efficiency will require a broad set of activities including research, development, deployment, demonstration, training, etc., organized around 48 specific objectives. Specific activities are prioritized in consideration of potential impact, likelihood of near- or mid-term feasibility and anticipated cost-effectiveness. This document is intended to be broad in consideration though not exhaustive. Opportunities and needs are identified and described with the goal of focusing efforts and resources.

Relationship-centered health care as a Lean intervention.

Science.gov (United States)

Dunsford, Jennifer; Reimer, Laura E

2017-12-01

Continuous improvement efforts, recognized in much literature as Lean management techniques have been used in efforts to improve efficiency in democratic health care contexts for some time to varying degrees of success. The complexity of the health care system is magnified by the sheer number of processes and sub processes required to deliver value within a bureaucratic environment, while maintaining some level of compassionate and personalized care. There is inherent tension between what is required to be efficient and what is required to be caring and this conflict presses against Lean practice at the level of delivery.Administration and care intersect at the point of the patient's experience. In order to achieve the dual goals of improved value and lower costs, the application of Lean thinking for meaningful health care reform must acknowledge the fundamental dichotomy between the impersonal tasks required to provide health services, and human interactions. Meaningful health care reform requires an acknowledgement of this distinction, currently not recognized in literature. While administrative process improvements are necessary, they are insufficient to achieve a sustainable and caring health care system. Lean thinking must be applied differently for administrative processes and patient care encounters, because these are fundamentally different processes. In this way, Lean principles will effectively contribute to sustainable health system improvements. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

An Employee-Centered Care Model Responds to the Triple Aim: Improving Employee Health.

Science.gov (United States)

Fox, Kelly; McCorkle, Ruth

2018-01-01

Health care expenditures, patient satisfaction, and timely access to care will remain problematic if dramatic changes in health care delivery models are not developed and implemented. To combat this challenge, a Triple Aim approach is essential; Innovation in payment and health care delivery models is required. Using the Donabedian framework of structure, process, and outcome, this article describes a nurse-led employee-centered care model designed to improve consumers' health care experiences, improve employee health, and increase access to care while reducing health care costs for employees, age 18 and older, in a corporate environment.

[Professional's expectations to improve quality of care and social services utilization in geriatric oncology].

Science.gov (United States)

Antoine, Valéry; de Wazières, Benoît; Houédé, Nadine

2015-02-01

Coordination of a multidisciplinary and multi-professional intervention is a key issue in the management of elderly cancer patients to improve health status and quality of life. Optimizing the links between professionals is needed to improve care planning, health and social services utilization. Descriptive study in a French University Hospital. A 6-item structured questionnaire was addressed to professionals involved in global and supportive cares of elderly cancer patients (name, location, effective health care and services offered, needs to improve the quality of their intervention). After the analysis of answers, definition of propositions to improve cares and services utilization. The 37 respondents identified a total of 166 needs to improve quality of care in geriatric oncology. Major expectations were concerning improvement of global/supportive cares and health care services utilization, a better coordination between geriatric teams and oncologists. Ten propositions, including a model of in-hospital health care planning, were defined to answer to professional's needs with the aim of optimizing cancer treatment and global cares. Identification of effective services and needs can represent a first step in a continuous program to improve quality of cares, according to the French national cancer plan 2014-2019. It allows federating professionals for a coordination effort, a better organization of the clinical activity in geriatric oncology, to optimize clinical practice and global cares. Copyright © 2014 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Improvement of pressure ulcer prevention care in private for-profit residential care homes: an action research study

Directory of Open Access Journals (Sweden)

Enid WY Kwong

2016-11-01

Full Text Available Abstract Background A need exits to develop a protocol for preventing pressure ulcers (PUs in private for-profit nursing homes in Hong Kong, where the incidence of PUs is relatively high and which have high proportion of non-professional care staff. The implementation of such protocol would involve changes in the practice of care, likely evoking feelings of fear and uncertainty that may become a barrier to staff adherence. We thus adopted the Systems Model of Action Research in this study to manage the process of change for improving PU prevention care and to develop a pressure ulcer prevention protocol for private for-profit nursing homes. Methods A total of 474 residents and care staff who were health workers, personal care workers, and/or nurses from four private, for-profit nursing homes in Hong Kong participated in this study. Three cyclic stages and steps, namely, unfreezing (planning, changing (action, and refreezing (results were carried out. During each cycle, focus group interviews, field observations of the care staff’s practices and inspections of the skin of the residents for pressure ulcers were conducted to evaluate the implementation of the protocol. Qualitative content analysis was adopted to analyse the data. The data and methodological triangulation used in this study increased the credibility and validity of the results. Results The following nine themes emerged from this study: prevention practices after the occurrence of PUs, the improper use of pressure ulcer prevention materials, non-compliance with several prevention practices, improper prevention practices, the perception that the preventive care was being performed correctly, inadequate readiness to use the risk assessment tool, an undesirable environment, the supplying of unfavorable resources, and various management styles in the homes with or without nurses. At the end of the third cycle, the changes that were identified included improved compliance with the

Efficient Work Team Scheduling: Using Psychological Models of Knowledge Retention to Improve Code Writing Efficiency

Directory of Open Access Journals (Sweden)

Michael J. Pelosi

2014-12-01

Full Text Available Development teams and programmers must retain critical information about their work during work intervals and gaps in order to improve future performance when work resumes. Despite time lapses, project managers want to maximize coding efficiency and effectiveness. By developing a mathematically justified, practically useful, and computationally tractable quantitative and cognitive model of learning and memory retention, this study establishes calculations designed to maximize scheduling payoff and optimize developer efficiency and effectiveness.

Prerequisites for sustainable care improvement using the reflective team as a work model.

Science.gov (United States)

Jonasson, Lise-Lotte; Carlsson, Gunilla; Nyström, Maria

2014-01-01

Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT). The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL) encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental process leading to research-based caring actions within the team. In order to maintain focus, it is important that the RTL has a clear idea of what sustainable care improvement means, and what the prerequisites are for such improvement. The aim of the present study is, therefore, to explore the prerequisites for improving sustainable care, seeking to answer how RTLs perceive these and use RTs for concrete planning. Nine RTLs were interviewed, and their statements were phenomenographically analysed. The analysis revealed three separate qualitative categories, which describe personal, interpersonal, and structural aspects of the prerequisites. In the discussion, these categories are compared with previous research on reflection, and the conclusion is reached that the optimal conditions for RTs to work, when focussed on sustainable care improvement, occur when the various aspects of the prerequisites are intertwined and become a natural part of the reflective work.

Cost-Benefit of Improving the Efficiency of Room Air Conditioners (Inverter and Fixed Speed) in India

Energy Technology Data Exchange (ETDEWEB)

Phadke, Amol [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Shah, Nihar [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Abhyankar, Nikit [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Park, Won Young [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Diddi, Saurabh [Bureau of Energy Efficiency, Government of India (India); Ahuja, Deepanshu [Collaborative Labeling and Appliance Standards Program (CLASP), Washington, DC (United States); Mukherjee, P. K. [Collaborative Labeling and Appliance Standards Program (CLASP), Washington, DC (United States); Walia, Archana [Collaborative Labeling and Appliance Standards Program (CLASP), Washington, DC (United States)

2016-06-01

Improving efficiency of air conditioners (ACs) typically involves improving the efficiency of various components such as compressors, heat exchangers, expansion valves, refrigerant,and fans. We estimate the incremental cost of improving the efficiency of room ACs based on the cost of improving the efficiency of its key components. Further, we estimate the retail price increase required to cover the cost of efficiency improvement, compare it with electricity bill savings, and calculate the payback period for consumers to recover the additional price of a more efficient AC. The finding that significant efficiency improvement is cost effective from a consumer perspective is robust over a wide range of assumptions. If we assume a 50% higher incremental price compared to our baseline estimate, the payback period for the efficiency level of 3.5 ISEER is 1.1 years. Given the findings of this study, establishing more stringent minimum efficiency performance criteria (one-star level) should be evaluated rigorously considering significant benefits to consumers, energy security, and environment

Development of a Medical Care Terminal for Efficient Monitoring of Bedridden Subjects

OpenAIRE

Pereira, Filipe; Carvalho, Vítor; Soares, Filomena; Machado, José; Bezerra, Karolina; Silva, Rui; Matos, Demétrio

2016-01-01

This work is developed in the context of Ambient Assisted Living (AAL) and has as main objective the development of a mechatronic system that allows the care of bedridden patients with ongoing medical care handled by a single person. The developed Medical Care Terminal (MCT) improves autonomy in home care, safety, comfort, and hygiene of bedridden patients. The MCT has six biomedical sensors and four environmental sensors. Data acquisition and processing is performed using Arduino and Lab VIE...

Improving work environments in health care: test of a theoretical framework.

Science.gov (United States)

Rathert, Cheryl; Ishqaidef, Ghadir; May, Douglas R

2009-01-01

In light of high levels of staff turnover and variability in the quality of health care, much attention is currently being paid to the health care work environment and how it potentially relates to staff, patient, and organizational outcomes. Although some attention has been paid to staffing variables, more attention must be paid to improving the work environment for patient care. The purpose of this study was to empirically explore a theoretical model linking the work environment in the health care setting and how it might relate to work engagement, organizational commitment, and patient safety. This study also explored how the work environment influences staff psychological safety, which has been show to influence several variables important in health care. Clinical care providers at a large metropolitan hospital were surveyed using a mail methodology. The overall response rate was 42%. This study analyzed perceptions of staff who provided direct care to patients. Using structural equation modeling, we found that different dimensions of the work environment were related to different outcome variables. For example, a climate for continuous quality improvement was positively related to organizational commitment and patient safety, and psychological safety partially mediated these relationships. Patient-centered care was positively related to commitment but negatively related to engagement. Health care managers need to examine how organizational policies and practices are translated into the work environment and how these influence practices on the front lines of care. It appears that care provider perceptions of their work environments may be useful to consider for improvement efforts.

MEDICARE PAYMENTS AND SYSTEM-LEVEL HEALTH-CARE USE

Science.gov (United States)

ROBBINS, JACOB A.

2015-01-01

The rapid growth of Medicare managed care over the past decade has the potential to increase the efficiency of health-care delivery. Improvements in care management for some may improve efficiency system-wide, with implications for optimal payment policy in public insurance programs. These system-level effects may depend on local health-care market structure and vary based on patient characteristics. We use exogenous variation in the Medicare payment schedule to isolate the effects of market-level managed care enrollment on the quantity and quality of care delivered. We find that in areas with greater enrollment of Medicare beneficiaries in managed care, the non–managed care beneficiaries have fewer days in the hospital but more outpatient visits, consistent with a substitution of less expensive outpatient care for more expensive inpatient care, particularly at high levels of managed care. We find no evidence that care is of lower quality. Optimal payment policies for Medicare managed care enrollees that account for system-level spillovers may thus be higher than those that do not. PMID:27042687

Scotland's Knowledge Network: translating knowledge into action to improve quality of care.

Science.gov (United States)

Wales, A; Graham, S; Rooney, K; Crawford, A

2012-11-01

The Knowledge Network (www.knowledge.scot.nhs.uk) is Scotland's online knowledge service for health and social care. It is designed to support practitioners to apply knowledge in frontline delivery of care, helping to translate knowledge into better health-care outcomes through safe, effective, person-centred care. The Knowledge Network helps to combine the worlds of evidence-based practice and quality improvement by providing access to knowledge about the effectiveness of clinical interventions ('know-what') and knowledge about how to implement this knowledge to support individual patients in working health-care environments ('know-how'). An 'evidence and guidance' search enables clinicians to quickly access quality-assured evidence and best practice, while point of care and mobile solutions provide knowledge in actionable formats to embed in clinical workflow. This research-based knowledge is complemented by social networking services and improvement tools which support the capture and exchange of knowledge from experience, facilitating practice change and systems improvement. In these cases, the Knowledge Network supports key components of the knowledge-to-action cycle--acquiring, creating, sharing and disseminating knowledge to improve performance and innovate. It provides a vehicle for implementing the recommendations of the national Knowledge into Action review, which outlines a new national approach to embedding knowledge in frontline practice and systems improvement.

SU-F-T-163: Improve Proton Therapy Efficiency: Report of a Workshop

Energy Technology Data Exchange (ETDEWEB)

Zheng, Y [Procure Proton Therapy Center, Oklahoma City, OK (United States); Flanz, J [Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Mah, D [Procure Treatment Center, Somerset, NJ (United States); Pankuch, M; Kreydick, B [Northwestern Medicine Proton Center, Warrenville, IL (United States); Beltran, C [Mayo Clinic, Rochester, MN (United States); Robison, B; Schreuder, A [Provision Healthcare Partners, Knoxville, TN (United States)

2016-06-15

Purpose: The technology of proton therapy, especially the pencil beam scanning technique, is evolving very quickly. However, the efficiency of proton therapy seems to lag behind conventional photon therapy. The purpose of the abstract is to report on the findings of a workshop on improvement of QA, planning and treatment efficiency in proton therapy. Methods: A panel of physicists, clinicians, and vendor representatives from over 18 institutions in the United States and internationally were convened in Knoxville, Tennessee in November, 2015. The panel discussed several topics on how to improve proton therapy efficiency, including 1) lean principle and failure mode and effects analysis, 2) commissioning and machine QA, 3) treatment planning, optimization and evaluation, 4) patient positioning and IGRT, 5) vendor liaison and machine availability, and 6) staffing, education and training. Results: The relative time needed for machine QA, treatment planning & check in proton therapy was found to range from 1 to 2.5 times of that in photon therapy. Current status in proton QA, planning and treatment was assessed. Key areas for efficiency improvement, such as elimination of unnecessary QA items or steps and development of efficient software or hardware tools, were identified. A white paper to summarize our findings is being written. Conclusion: It is critical to improve efficiency by developing reliable proton beam lines, efficient software tools on treatment planning, optimization and evaluation, and dedicated proton QA device. Conscious efforts and collaborations from both industry leaders and proton therapy centers are needed to achieve this goal and further advance the technology of proton therapy.

Cost-Benefit of Improving the Efficiency of Room Air Conditioners (Inverter and Fixed Speed) in India

Energy Technology Data Exchange (ETDEWEB)

Shah, Nihar [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Energy Analysis and Environmental Impacts Division; Abhyankar, Nikit [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Energy Analysis and Environmental Impacts Division; Park, Won Young [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Energy Analysis and Environmental Impacts Division; Phadke, Amol [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Energy Analysis and Environmental Impacts Division; Diddi, Saurabh [Government of India, New Delhi (India). Bureau of Energy Efficiency; Ahuja, Deepanshu [Collaborative Labeling and Appliance Standards Program (CLASP), Washington, DC (United States); Mukherjee, P. K. [Collaborative Labeling and Appliance Standards Program (CLASP), Washington, DC (United States); Walia, Archana [Collaborative Labeling and Appliance Standards Program (CLASP), Washington, DC (United States)

2016-06-30

Improving efficiency of air conditioners (ACs) typically involves improving the efficiency of various components such as compressors, heat exchangers, expansion valves, refrigerant and fans. We estimate the incremental cost of improving the efficiency of room ACs based on the cost of improving the efficiency of its key components. Further, we estimate the retail price increase required to cover the cost of efficiency improvement, compare it with electricity bill savings, and calculate the payback period for consumers to recover the additional price of a more efficient AC. We assess several efficiency levels, two of which are summarized below in the report. The finding that significant efficiency improvement is cost effective from a consumer perspective is robust over a wide range of assumptions. If we assume a 50% higher incremental price compared to our baseline estimate, the payback period for the efficiency level of 3.5 ISEER is 1.1 years. Given the findings of this study, establishing more stringent minimum efficiency performance criteria (one star level) should be evaluated rigorously considering significant benefits to consumers, energy security and environment.

Energy efficiency improvement potentials for the cement industry in Ethiopia

International Nuclear Information System (INIS)

Tesema, Gudise; Worrell, Ernst

2015-01-01

The cement sector is one of the fast growing economic sectors in Ethiopia. In 2010, it consumed 7 PJ of primary energy. We evaluate the potential for energy savings and CO_2 emission reductions. We start by benchmarking the energy performance of 8 operating plants in 2010, and 12 plants under construction. The benchmarking shows that the energy intensity of local cement facilities is high, when compared to the international best practice, indicating a significant potential for energy efficiency improvement. The average electricity intensity and fuel intensity of the operating plants is 34% and 36% higher. For plants under construction, electricity use is 36% and fuel use 27% higher. We identified 26 energy efficiency measures. By constructing energy conservation supply curves, the energy-efficiency improvement potential is assessed. For the 8 operating plants in 2010, the cost-effective energy savings equal 11 GWh electricity and 1.2 PJ fuel, resulting in 0.1 Mt CO_2 emissions reduction. For the 20 cement plants expected to be in operation by 2020, the cost-effective energy saving potentials is 159 GWh for electricity and 7.2 PJ for fuel, reducing CO_2 emissions by about 0.6 Mt. We discuss key barriers and recommendations to realize energy savings. - Highlights: • The cement sector in Ethiopia is growing rapidly, using mainly imported fuels. • Benchmarking demonstrates a significant potential for energy efficiency improvement. • A large part of the energy efficiency potential can be achieved cost-effectively. • Ethiopia should ban the construction of obsolete vertical shaft kilns.

Efficiency improvement for vehicle powertrains using energy integration techniques

OpenAIRE

Dimitrova, Zlatina; Maréchal, François

2016-01-01

The main design criteria for the modern sustainable development of vehicle powertrains are the high energy efficiency of the conversion system, the competitive cost and the lowest possible environmental impacts. The need for efficiency improvement of the vehicle energy system induces the search for an innovative methodology during the design process. In this article the energy services for mobility and comfort are integrated. The energy integration of the mobility and the comfort service is a...

Efficiency improvements in pipeline transportation systems

Energy Technology Data Exchange (ETDEWEB)

Banks, W. F.; Horton, J. F.

1977-09-09

This report identifies potential energy-conservative pipeline innovations that are most energy- and cost-effective and formulates recommendations for the R, D, and D programs needed to exploit those opportunities. From a candidate field of over twenty classes of efficiency improvements, eight systems are recommended for pursuit. Most of these possess two highly important attributes: large potential energy savings and broad applicability outside the pipeline industry. The R, D, and D program for each improvement and the recommended immediate next step are described. The eight technologies recommended for R, D, and D are gas-fired combined cycle compressor station; internally cooled internal combustion engine; methanol-coal slurry pipeline; methanol-coal slurry-fired and coal-fired engines; indirect-fired coal-burning combined-cycle pump station; fuel-cell pump station; drag-reducing additives in liquid pipelines; and internal coatings in pipelines.

Policy modeling for energy efficiency improvement in US industry

International Nuclear Information System (INIS)

Worrell, Ernst; Price, Lynn; Ruth, Michael

2001-01-01

We are at the beginning of a process of evaluating and modeling the contribution of policies to improve energy efficiency. Three recent policy studies trying to assess the impact of energy efficiency policies in the United States are reviewed. The studies represent an important step in the analysis of climate change mitigation strategies. All studies model the estimated policy impact, rather than the policy itself. Often the policy impacts are based on assumptions, as the effects of a policy are not certain. Most models only incorporate economic (or price) tools, which recent studies have proven to be insufficient to estimate the impacts, costs and benefits of mitigation strategies. The reviewed studies are a first effort to capture the effects of non-price policies. The studies contribute to a better understanding of the role of policies in improving energy efficiency and mitigating climate change. All policy scenarios results in substantial energy savings compared to the baseline scenario used, as well as substantial net benefits to the U.S. economy

A systems approach to improving rural care in Ethiopia.

Directory of Open Access Journals (Sweden)

Elizabeth H Bradley

Full Text Available BACKGROUND: Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI, we identified PHCUs with consistently higher performance (n = 2, most improved performance (n = 3, or consistently lower performance (n = 2 in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51, we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1 managerial problem solving capacity, 2 relationship with the woreda (district health office, and 3 community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, and PHCU communities' leadership, particularly religious leadership, were strongly engaged with the health improvement effort. Distance from the nearest city, quality of roads and transportation, and cultural norms did not differ substantially among PHCUs. CONCLUSIONS/SIGNIFICANCE: Effective health strengthening efforts may require intensive

A systems approach to improving rural care in Ethiopia.

Science.gov (United States)

Bradley, Elizabeth H; Byam, Patrick; Alpern, Rachelle; Thompson, Jennifer W; Zerihun, Abraham; Abebe, Yigeremu; Abeb, Yigeremu; Curry, Leslie A

2012-01-01

Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units. We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs) in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI), we identified PHCUs with consistently higher performance (n = 2), most improved performance (n = 3), or consistently lower performance (n = 2) in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51), we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1) managerial problem solving capacity, 2) relationship with the woreda (district) health office, and 3) community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, and PHCU communities' leadership, particularly religious leadership, were strongly engaged with the health improvement effort. Distance from the nearest city, quality of roads and transportation, and cultural norms did not differ substantially among PHCUs. Effective health strengthening efforts may require intensive development of managerial problem solving skills, strong relationships with

Priorities for improving hospital-based trauma care in an African city.

Science.gov (United States)

London, J A; Mock, C N; Quansah, R E; Abantanga, F A; Jurkovich, G J

2001-10-01

This study sought to identify potential cost-effective methods to improve trauma care in hospitals in the developing world. Injured patients admitted to an urban hospital in Ghana over a 1-year period were analyzed prospectively for mechanism of injury, mode of transport to the hospital, injury severity, region of principal injury, operations performed, and mortality. In addition, time from injury until arrival at the hospital and time from arrival at the hospital until emergency surgery were evaluated. Mortality was 9.4%. Most deaths (65%) occurred within 24 hours of admission. Sixty percent of emergency operations were performed over 6 hours after arrival. Tube thoracostomy was performed on only 13 patients (0.6%). Only 58% of patients received intravenous crystalloid and only 3.6% received 1 or more units of blood. We identified several specific interventions as potential low-cost measures to improve hospital-based trauma care in this setting, including shorter times to emergency surgery and improvements in initial resuscitation. In addition to addressing each of these aspects of trauma care individually, quality improvement programs may represent a feasible and sustainable method to improve trauma care in hospitals in the developing world.

SUPPORTIVE SUPERVISION AS A TECHNOLOGY OF IMPROVING THE QUALITY OF HOSPITAL CARE DELIVERY

Directory of Open Access Journals (Sweden)

Svetlana A. Mukhortova

2017-01-01

Full Text Available Improving the quality of medical care is a priority in countries with developed and developing health care system. There are various approaches to improve the quality and safety of patient’s care, as well as various strategies to encourage hospitals to achieve this goal. The purpose of the presented literature review was to analyze existing experience of the implementation of technology of supportive supervision in health care facilities to improve the quality of hospital care delivery. The data sources for publication were obtained from the following medical databases: PubMed, Cochrane Library, Medscape, e-library, and books on the topic of the review written by experts. The article discusses the results of the research studies demonstrating the successes and failures of supportive supervision technology application. Implementation of supportive supervision in medical facilities based on generalized experience of different countries is a promising direction in improving the quality of medical care delivery. This technology opens up opportunities to improve skills and work quality of the staff at pediatric hospitals in the Russian Federation.

Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems.

Science.gov (United States)

Mueller, Keith J; Potter, Andrew J; MacKinney, A Clinton; Ward, Marcia M

2014-02-01

Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban "hub" emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest. We sent a user survey to all seventy-one hospitals that used the service and received 292 replies. We also conducted telephone interviews and site visits with ninety clinicians and administrators at twenty-nine of these hospitals. Participants reported that tele-emergency improves clinical quality, expands the care team, increases resources during critical events, shortens time to care, improves care coordination, promotes patient-centered care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base. However, inconsistent reimbursement policy, cross-state licensing barriers, and other regulations hinder tele-emergency implementation. New value-based payment systems have the potential to reduce these barriers and accelerate tele-emergency expansion.

76 FR 61365 - Bundled Payments for Care Improvement Initiative

Science.gov (United States)

2011-10-04

...] Bundled Payments for Care Improvement Initiative AGENCY: Centers for Medicare & Medicaid Services (CMS...: Letter of Intent Submission Deadline: For Model 1 of this initiative, interested organizations must...-improvement.html . Application Submission Deadline: For Model 1 of this initiative, applications must be...

Improving the global efficiency in small hydropower practice

Science.gov (United States)

Razurel, P.; Gorla, L.; Crouzy, B.; Perona, P.

2015-12-01

The global increase in energy production from renewable sources has seen river exploitation for small hydropower plants to also grow considerably in the last decade. River intakes used to divert water from the main course to the power plant are at the base of such practice. A key issue concern with finding innovative concepts to both design and manage such structures in order to improve classic operational rules. Among these, the Minimal Flow Release (MFR) concept has long been used in spite of its environmental inconsistency.In this work, we show that the economical and ecological efficiency of diverting water for energy production in small hydropower plants can be improved towards sustainability by engineering a novel class of flow-redistribution policies. We use the mathematical form of the Fermi-Dirac statistical distribution to define non-proportional dynamic flow-redistribution rules, which broadens the spectrum of dynamic flow releases based on proportional redistribution. The theoretical background as well as the economic interpretation is presented and applied to three case studies in order to systematically test the global performance of such policies. Out of numerical simulations, a Pareto frontier emerges in the economic vs environmental efficiency plot, which show that non-proportional distribution policies improve both efficiencies with respect to those obtained from some traditional MFR and proportional policies. This picture is shown also for long term climatic scenarios affecting water availability and the natural flow regime.In a time of intense and increasing exploitation close to resource saturation, preserving natural river reaches requires to abandon inappropriate static release policies in favor of non-proportional ones towards a sustainable use of the water resource.

Opinion: Medical Audit: A veritable tool for improving standards in ...

African Journals Online (AJOL)

accounting on the part of medical professionals or health care institutions to assess the effectiveness and efficiency of the services they render to the community. Its ultimate purpose is to improve standards in clinical care and encourage efficient ...

Efficiencies and improvement potential of building integrated photovoltaic thermal (BIPVT) system

International Nuclear Information System (INIS)

Ibrahim, Adnan; Fudholi, Ahmad; Sopian, Kamaruzzaman; Othman, Mohd Yusof; Ruslan, Mohd Hafidz

2014-01-01

Highlights: • Performances analysis of BIPVT solar collector based on energy and exergy analyses. • A new absorber design of BIPVT solar collector is presented. • BIPVT solar collector is produced primary-energy saving efficiency from about 73% to 81%. • PVT energy efficiency varies between 55% and 62% where as the variation in the PVT exergy efficiency is from 12% to 14%. • The improvement potential is between 98 and 404 W. - Abstract: Building integrated photovoltaic thermal (BIPVT) system has been designed to produce both electricity and hot water and later integrated to building. The hot water is produced at the useful temperatures for the applications in Malaysia such as building integrated heating system and domestic hot water system as well as many industrial including agricultural and commercial applications. The photovoltaic thermal (PVT) system comprises of a high efficiency multicrystal photovoltaic (PV) module and spiral flow absorber for BIPVT application, have been performed and investigated. In this study, it was assumed that the absorber was attached underneath the flat plate single glazing sheet of polycrystalline silicon PV module and water has been used as a heat transfer medium in absorber. Performances analysis of BIPVT system based on energy and exergy analyses. It was based on efficiencies including energy and exergy, and exergetic improvement potential (IP) based on the metrological condition of Malaysia has been carried out. Results show that the hourly variation for BIPVT system, the PVT energy efficiency of 55–62% is higher than the PVT exergy efficiency of 12–14%. The improvement potential increases with increasing solar radiation, it is between 98 and 404 W. On the other hand, BIPVT system was produced primary-energy saving efficiency from about 73% to 81%

Does improving surface cleaning and disinfection reduce health care-associated infections?

Science.gov (United States)

Donskey, Curtis J

2013-05-01

Contaminated environmental surfaces provide an important potential source for transmission of health care-associated pathogens. In recent years, a variety of interventions have been shown to be effective in improving cleaning and disinfection of surfaces. This review examines the evidence that improving environmental disinfection can reduce health care-associated infections. Published by Mosby, Inc.

Improving and ensuring best practice continence management in residential aged care.

Science.gov (United States)

Heckenberg, Gayle

2008-06-01

Background  Continence Management within residential aged care is an every day component of care that requires assessment, implementation of strategies, resource allocation and evaluation. At times the management of incontinence of aged residents can be challenging and unsuccessful. The project chosen through the Clinical Fellowship program was Continence Management with the aim of raising awareness of best practice to assist in improving and providing person-centred resident care. Aims/objectives •  Review the literature on best practice management of incontinence •  Evaluate current practice in continence management for elderly residents within residential aged care services •  Improve adherence to best practice strategies of care for incontinence •  Raise awareness within the nursing home of the best practice management of incontinence •  Promote appropriate and effective use of resources for continence management •  Deliver individualised person-centred care to residents. •  Ensure best practice in continence management Methods  The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System clinical audit tool was utilised to measure current practice against best practice. The results identify gaps that require improvement. The Getting Research into Practice process then allowed analysis of the level of compliance with each of the audit criteria, which would identify any barriers in implementing a selected course of action and aim to improve compliance. The project team was consulted with additional stakeholder consultation to form an action plan and implement strategies to improve practice. Results  Although 100% compliance with all audit criteria in audit 1 and 2 was not achieved, there was improvement in the criteria concerning the documented fluid intake for residents. Further strategies have been identified and implemented and this continues to be a 'work in progress'. Staff now have an acute awareness

Improving newborn care practices through home visits: lessons from Malawi, Nepal, Bangladesh, and Uganda

Directory of Open Access Journals (Sweden)

Deborah Sitrin

2015-03-01

Full Text Available Background: Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda. Objective: This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices. Design: Using data from cross-sectional surveys of women with live births at baseline and endline, the Pearson chi-squared test was used to assess changes over time. Generalised linear models were used to assess the relationship between the main independent variable – home visit from a community health worker (CHW during pregnancy (0, 1–2, 3+ – and use of selected practices while controlling for antenatal care, place of delivery, and maternal age and education. Results: There were statistically significant improvements in practices, except applying nothing to the cord in Malawi and early initiation of breastfeeding in Bangladesh. In Malawi, Nepal, and Bangladesh, women who were visited by a CHW three or more times during pregnancy were more likely to report use of selected practices. Women who delivered in a facility were also more likely to report use of selected practices in Malawi, Nepal, and Uganda; association with place of birth was not examined in Bangladesh because only women who delivered outside a facility were asked about these practices. Conclusion: Home visits can play a role in improving practices in different settings. Multiple interactions are needed, so programmes need to investigate the most appropriate and efficient ways to reach families and promote newborn care practices. Meanwhile, programmes must take advantage of

Improved entropy encoding for high efficient video coding standard

Directory of Open Access Journals (Sweden)

B.S. Sunil Kumar

2018-03-01

Full Text Available The High Efficiency Video Coding (HEVC has better coding efficiency, but the encoding performance has to be improved to meet the growing multimedia applications. This paper improves the standard entropy encoding by introducing the optimized weighing parameters, so that higher rate of compression can be accomplished over the standard entropy encoding. The optimization is performed using the recently introduced firefly algorithm. The experimentation is carried out using eight benchmark video sequences and the PSNR for varying rate of data transmission is investigated. Comparative analysis based on the performance statistics is made with the standard entropy encoding. From the obtained results, it is clear that the originality of the decoded video sequence is preserved far better than the proposed method, though the compression rate is increased. Keywords: Entropy, Encoding, HEVC, PSNR, Compression

Improving the identification and management of chronic kidney disease in primary care: lessons from a staged improvement collaborative.

Science.gov (United States)

Harvey, Gill; Oliver, Kathryn; Humphreys, John; Rothwell, Katy; Hegarty, Janet

2015-02-01

Undiagnosed chronic kidney disease (CKD) contributes to a high cost and care burden in secondary care. Uptake of evidence-based guidelines in primary care is inconsistent, resulting in variation in the detection and management of CKD. Routinely collected general practice data in one UK region suggested a CKD prevalence of 4.1%, compared with an estimated national prevalence of 8.5%. Of patients on CKD registers, ∼ 30% were estimated to have suboptimal management according to Public Health Observatory analyses. An evidence-based framework for implementation was developed. This informed the design of an improvement collaborative to work with a sample of 30 general practices. A two-phase collaborative was implemented between September 2009 and March 2012. Key elements of the intervention included learning events, improvement targets, Plan-Do-Study-Act cycles, benchmarking of audit data, facilitator support and staff time reimbursement. Outcomes were evaluated against two indicators: number of patients with CKD on practice registers; percentage of patients achieving evidence-based blood pressure (BP) targets, as a marker for CKD care. In Phase 1, recorded prevalence of CKD in collaborative practices increased ∼ 2-fold more than that in comparator local practices; in Phase 2, this increased to 4-fold, indicating improved case identification. Management of BP according to guideline recommendations also improved. An improvement collaborative with tailored facilitation support appears to promote the uptake of evidence-based guidance on the identification and management of CKD in primary care. A controlled evaluation study is needed to rigorously evaluate the impact of this promising improvement intervention. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care.

Improvements in dental care using a new mobile app with cloud services.

Science.gov (United States)

Lin, Chia-Yung; Peng, Kang-Lin; Chen, Ji; Tsai, Jui-Yuan; Tseng, Yu-Chee; Yang, Jhih-Ren; Chen, Min-Huey

2014-10-01

Traditional dental care, which includes long-term oral hygiene maintenance and scheduled dental appointments, requires effective communication between dentists and patients. In this study, a new system was designed to provide a platform for direct communication between dentists and patients. A new mobile app, Dental Calendar, combined with cloud services specific for dental care was created by a team constituted by dentists, computer scientists, and service scientists. This new system would remind patients about every scheduled appointment, and help them take pictures of their own oral cavity parts that require dental treatment and send them to dentists along with a symptom description. Dentists, by contrast, could confirm or change appointments easily and provide professional advice to their patients immediately. In this study, 26 dentists and 32 patients were evaluated by a questionnaire containing eight dental-service items before and after using this system. Paired sample t test was used for statistical analysis. After using the Dental Calendar combined with cloud services, dentists were able to improve appointment arrangements significantly, taking care of the patients with sudden worse prosthesis (p cloud services, provides efficient service to both dentists and patients, and helps establish a better relationship between them. It also helps dentists to arrange appointments for patients with sudden worsening of prosthesis function. Copyright © 2014. Published by Elsevier B.V.

Improving the Quality of Home Health Care for Children With Medical Complexity.

Science.gov (United States)

Nageswaran, Savithri; Golden, Shannon L

2017-08-01

The objectives of this study are to describe the quality of home health care services for children with medical complexity, identify barriers to delivering optimal home health care, and discuss potential solutions to improve home health care delivery. In this qualitative study, we conducted 20 semistructured in-depth interviews with primary caregivers of children with medical complexity, and 4 focus groups with 18 home health nurses. During an iterative analysis process, we identified themes related to quality of home health care. There is substantial variability between home health nurses in the delivery of home health care to children. Lack of skills in nurses is common and has serious negative health consequences for children with medical complexity, including hospitalizations, emergency room visits, and need for medical procedures. Inadequate home health care also contributes to caregiver burden. A major barrier to delivering optimal home health care is the lack of training of home health nurses in pediatric care and technology use. Potential solutions for improving care include home health agencies training nurses in the care of children with medical complexity, support for nurses in clinical problem solving, and reimbursement for training nurses in pediatric home care. Caregiver-level interventions includes preparation of caregivers about: providing medical care for their children at home and addressing problems with home health care services. There are problems in the quality of home health care delivered to children with medical complexity. Training nurses in the care of children with medical complexity and preparing caregivers about home care could improve home health care quality. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.